Sunday, August 21, 2005

The doctor is in the house

Yay post-test slackness. While I wish the Medicine posting could be a lot longer than it currently is, having got over the end-of-posting test and all its associated stress feels great. And surgery looks to be more relaxed than Medicine, so that should be good. Except I need to get to TTSH by 7.30 tomorrow, and I have no idea how I'll accomplish that, aside from waking at 5.30. Woe. I can only hope that normal days don't start so early.

Anyway, I won't say much about how my medicine clinical test went, except that the short cases were horrendous for me. While I can always examine pretty okay on my own or with other people in my CG looking on, being placed under the scrutiny of another doctor makes me get all flustered and panicky, and I start missing signs. And it was really embarrassing because when I get nervous I keep my GIT works funny and weird gassy sounds come from it. Bleh. Not to mention I was practically dripping sweat on my patients. I am so happy that my long case was far better. I love gastro cases.

This is going to make me look like I'm nuts or the most KS person in Med, but because I was of the strong opinion that 2 night duties for the Medicine posting is far too few, I decided to stay for one last night duty after the MCQ test on Friday. And just for the fun of it, I stayed all the way until the next morning. Not that there was anything keeping me awake after two, as I'll explain later.

The HO on call was Dr. ML, who is incidentally the HO under Prof Lee whom I follow for rounds all the time, so we know each other pretty okay. And she's super super nice! When I called her she was in a meeting and asked me if I could help her take blood from one patient, so I happily agreed, and went to work on it. She came before I had taken any blood, and because I picked a lousy vein I didn't get any, so she did it herself from the patient's other arm. Then we went for dinner, and it was pretty weird for me because we had it in the staff lounge, and all the doctors inside were looking at me like some offensive intrusion into their exclusive universe or something. It was alternately frightening and fascinating, because you hardly get to see so many consultants sitting around enjoying a free flow of alcohol and talking merrily. The alcohol part was pretty eye-popping, to be sure.

Dr. ML asked me, "Is this your second night call? I heard you all have to do 2." And my reply, "Err, yeah, it's my second one." Haha I suck at lying. Anyway the rest of the night call was pretty good for me, because we got to see quite a number of new cases. The thing about my previous night calls was that while I saw a lot of fascinating stuff, like ICU procedures and patient transfers, I didn't get to clerk any new patients. So this time was a lot better. In fact I took some history from 3 patients, one with pneumonia, one with dengue and the third with haematuria. Of course the haematuria patient was more fun, because there are more differentials to entertain. It so happened that he was from the naval diving unit, and had been having 5 days of intensive military exercise, so his haematuria was most likely due to the intense physical activity. The MO on duty, Dr. AW, is scary, because she knows so much and expects you to be the same, constantly firing questions at you. During my last night duty it was her that asked me to list the possible causes of bicytopaenia, and looked significantly disappointed when I couldn't get past the second cause.

Procedures-wise it was also a good night duty compared to my last two, during which I only did ECGs and one or two bloods. This time round I took bloods from two patients, unsupervised (yet again I think I do better when it's just me and the patient, because the presence of a trained professional makes me feel like an incompetent fool). That sort of fulfilled a little wish of mine, to actually be useful during night duties and help the HO do something without him or her needing to be around to look over my shoulder, or worse, mop up after me. And it was also a good thing that the two patients I took bloods from had nice veins, so everything was pretty smooth-sailing. And oh, I took an ABG too! It was a femoral artery ABG from a patient who was pretty knocked-out, so it went smoothly too, and it was pretty exciting to see that flashback of bright red blood in the syringe.

This was also my first night duty in which I visited the Kent Ridge Wing, because my previous ones somehow didn't bring me there. Of course I couldn't do any procedures there, because paying patients are more demanding patients, you think they'd allow a student to poke a needle into them? But I managed to do physical examination on an old man who had some neurological deficits. Nystagmus! First time I was seeing it too, so that was pretty eye-opening (pun not intended). After about two in the morning Dr. ML told me there was nothing more to see or do, so she asked me to go get some sleep, and that she'd call me if there were any new cases. So I retired to the student's lounge, and got some rest on the nice comfy armchairs they have in it (though some tiny voice in my head wonders how long they've been there, and whether they've ever been washed at all). I kept waking from time to time to see if Dr. ML had called me, but no call came, and I slept until about 6 in the morning. Apparently it was a good night with not many new cases. I don't think I could have stayed very much awake even if there were cases through the night, too, so thankfully there weren't any, haha, though it would have been fun.

I think I'll really miss NUH, and all the wonderful HOs who say Hi when they meet you along the corridor, and the profs, especially Prof Evan Lee (Dr. ML said he was asking where I had disappeared to during the last few days of the week, when we were all having our tests. Aww, I love Prof Lee.) But the HOs are having their new postings next month, so maybe I'll see some of them in TTSH.

Right now I'm going crazy with the downloading again. There's this great new series I'm following called House M.D., which is about this team of doctors headed by a misanthropic infectious diseases specialist, Dr. House. It has a lot of wicked humour, but of course is a really bad show of how to treat your patients. And it's a good revision of medical stuff too, thought sometimes I wonder how accurate their facts are, and whether they're getting real doctors to help them with the script. Because why do you test for funny viruses like Parvovirus B19 when you have a patient with rash, abdominal pain, low BP, low WCC and renal failure? But all in all it's a great show. Kind of like C.S.I. meets E.R.

Just now I was watching a little of the National Day Rally, and I got a little shock when he started talking about the "Malaena Bay area", before I realised he meant Marina Bay. And it's not just because I'm going mad, but he really pronounced it like malaena. Probably a slip of the tongue. The mental image of black tarry muck in Marina Bay is pretty gross.

I haven't even really started reading Traitor's Knot, but the first chapter looks great. I love Janny Wurts, like so so much.

Avaris / 8/21/2005 10:46:00 PM

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