Friday, November 17, 2006
Gas! GAS! Quick, boys! - An ecstasy of fumbling
Anaesthesia posting has come to an end. For some inexplicable reason I find it extremely comforting when I know I don't have to spend another day in the OT. Not that anaesthesia is at all frustrating or annoying or just plain detestable, like Psych was (no offense to people who actually liked Psych), but it just got really tedious and repetitive after a while. Change into scrubs, go OT, say hello to tutor and MO following tutor, help with bag-ventilating patient and maybe even intubate/insert LMA while MO induces and tutor supervises, then discuss a few "core topics" as the surgeons busy themselves with whatever things they busy themselves with. Over and over. Over and over. Anaesthestic technique varies from patient to patient, but essentially they all amount to the same thing, and it's kind of mindless after a while. Maybe because I'm just seeing the mundane everyday aspect of anaesthesia, that's why. After one week or so I started to really hate the process of changing up to go into OT.
If there was anything that kept me enthusiastic about the posting at all, it must be my tutor, Dr D (initial changed to protect her identity, and mine). She's got a spectacularly powerful personality, and every day I just look forward to cataloguing the things she says (she says a lot of fun things, as I shall demonstrate later). Of course she is also extremely knowlegdable, added to the fact that unlike most other senior doctors she is surprisingly enthusiastic and pro-active about teaching us things, and the result is that she can (in her rather solemn manner) expound on a certain topic at great length while we look on, slack-jawed, minds furiously churning to absorb the pearls of wisdom she offers and remember them for later noting down; after all, we can't really carry our notebooks around all the time in the OT. I think a side effect of remembering everything Dr D says in order to take them down later is that I've also remembered much of the stuff she says when she isn't talking about anaesthesia, thus I present them in great glory here for posterity. I totally idolise my tutor, she's one of those doctors who can be so cynical and yet, in an apparent paradoxical fashion, exhibit the greatest amount of care for their patients.
Please do not think that I am being dramatic and fanatical. It is all true. Seriously.
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"I always tell the new MOs who follow me: 'Welcome to Dr D's boot camp'... Do everything yourself. Your first case, I'll let you hold the mask, adjust the gas, the valve for you. Second case you do the gases yourself. Third case I let you draw the drugs, watch me give. Fourth case you give the drugs. By the fifth case, you can
fly. Or swim, whichever analogy you prefer."
"So. We are all prepared. The patient is here and ready. What are we waiting for? The imperial highnesses." -- one of her many digs at - who else? - surgeons
"Orthopaedic surgeons ... are power-mad. They are power-mad because they generate money. You want to make money, go into orthopaedic surgery. You know what's great about orthopaedics? Nothing is truly life-threatening. Can't operate on an OA knee? It's all right, send patient home with painkillers, TCU 2 months. Everything they do is a temporising measure."
More about orthopaedic surgeons -- "You know what kind of table they use for a total knee? A 5C table, which is the same grade as the table they use for liver transplantation. Can you imagine that? The most a good liver surgeon can do - and here I'm thinking of someone whom I personally think is one of the best liver surgeons - is 3 liver resections a day, while your average orthopaedic surgeon can do, what, 6 total knees?"
"Singaporean patients ... are ignorant. If they tell you they have a heart problem, and you ask them 'Can you tell me more about the nature of your heart condition?' they will tell you 'Dunno leh, my heart doctor he say that I have heart disease, cannot do PE'. Cannot do PE, that's all that matters to them. If you talk to an older patient, some guy who has done NS, he will say 'Oh I got heart problem, got downgraded, Pes D or E lor'. No point expecting them to tell you what kind of conditions they have. I'm very cynical about all this, but it's the truth."
"That's Singapore for you. Can you imagine, the most popular television show is Phua Chu Kang. Somehow everyone finds Singlish very funny. The sister-in-law (i.e. Margaret, played by Tan Kheng Hua), who speaks perfect English, does anyone bother to understand her? 'Eh, why this woman so ang-moh ah?', that's what they say."
"That's what life is like in Singapore. Everything is reduced to a bunch of abbreviations and acronyms." -- after we told her and the MO that we had to go for HPS (Human Patient Simulator) and subsequently had to explain what HPS stood for
"You smack the patient's hand one more time and
I'll smack you." -- when one of us did the customary hitting of the patient's hand to make veins more visible
"Chin
up! Chin up, chin up,
chin up,
chin up.
Chin up! Chiiiin up. Chin uuuup." -- when supervising us during mask-ventilation.
"Don't admire the patient's teeth. Just insert!" -- supervising a oropharyngeal airway insertion.
----
So quote-worthy. If only every doctor was as much fun to listen to, heh. The wording, of course, is not exactly as she said it, but the main gist of the statements are there, of course.
I sense a disturbing similarity in the postings I end up not quite enjoying. It remains to be seen whether that's just a coincidence or if p value is less than 0.05. I shall observe more closely, though now that I'm no longer blinded to the risk factor I cannot objectively assess if the posting is any less enjoyable when the risk factor is present. Oh, woe.
I should say, though, that for a two-week posting it certainly was extremely memorable. It tears me up that I might actually want to do anaesthesia just to be under Dr D again, but no, six months of anaesthesia will kill me.
Avaris / 11/17/2006 10:35:00 PM
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