Thursday, November 29, 2018

Home is where the hargow is

Just kidding, I actually prefer siumai.


I've been back in Malaysia for two weeks now, and it's been wonderful. The weather's been pretty good, I've been eating better (or worse, depending on how you look at it) than ever, and no work means having the time for far more regular exercise. Sleep comes easy, and I awake well-rested, revelling in the fact that I can get out of bed whenever I want. Mentally, I'm better than I've been in a very long time - I feel calm and happy and relaxed and rejuvenated. It's amazing what a holiday can do for you!


Spending time with family and friends this visit has been incredibly valuable. This year I've been a little bit 'out of sight, out of mind' - it can be hard to think of things other than what you're directly faced with when you're faced with so much. This resulted in minimal contact with anyone back home. Talking and reconnecting with people reminded me that there are so many here whom I love and who love me, and neither geographical location nor (in)frequency of contact will change that. It was quite heartening, to say the least, and I am very thankful.


The other special thing about this visit is the fact that I visited all four grandparents. My grandmother passed while I was away, and I didn't manage to go back for her funeral. I made it a point to visit her grave to pay my respects when I came back. She had been buried beside her husband, my grandfather, so I was able to visit them both at the same time. We hadn't been able to communicate much due to the language barrier, but Ah Neh always made sure we were well-fed and watered, and somehow (she had so many grandchildren!) always remembered to give me an extra birthday angpow every Chinese New Year as my birthday usually fell around the same time. I had a hard time equating the plot of land before me to my grandparents, so I looked around for a bit. The cemetery was a lovely place, well-kept and peaceful and green. A respectful sort of quiet covered the area - it gave no sense of creepiness or unease. I was glad that everyone there had such a beautiful final resting place. It was a nice place to be.


On perhaps a less morbid note, I've been doing a lot of eating. I've missed noodles a lot, I realised. Why do people like rice so much? Rice is just rice. When it comes to noodles, though, you've got dozens of different types, and they all taste different! There's bihun, mee, loh shi fun, mee pok, egg noodles, kuey tiao, laksa noodles, mee sua, ramen noodles, pan mee noodles/strips, tang hoon... There are just oodles of noodles, and I love them all so much. My favourite is probably chilli pan mee, and I managed to visit my go-to place, Super Kitchen in SS2, twice this trip. Also, I've decided that my go-to place for dim sum is Jin Xuan in DJ and my banana leaf rice go-to is probably Sri Paandi near Samad. The latter is where I had Indian apom for the first time, and it blew my mind how something so simple could be so delicious. Maybe it was the sweet, watery santan dipping sauce.


I've also had lots of local fruit! Twice now I've gorged myself on duku langsat, which I'd sorely missed. I've also had longan, jambu air, papaya, pineapple, and mango, all of which were delicious. It's true that I'm going back to Australia where a variety of fruits are in season, but I'm going to miss the fruit here. Few things compare to biting into a jambu air straight from the fridge on a hot day.


I leave on Thursday night, and will be starting night shifts the day after I land. (You can see why I find leaving to be incredibly unappealing.) Still, I can't complain - it's been a really great two weeks, and I'm probably as refreshed and recharged as I'm going to get. I am grateful for the time I've had here, and will try to focus on that rather than my reluctance to leave...which is quite great, to be honest, but I'll do my best to be positive. Hopefully.


Thanks for an excellent two weeks, Malaysia! I will miss you and your food quite dearly. See you again in 2019!

Sunday, October 7, 2018

Emergency!

Hello, blog! The time has come again for me to wax lyrical about how quickly the past three months have gone.


This time might be particularly interesting because I have been smitten with what is probably the worst case of pharyngitis in the world, so I am writing from within a weird fever dream-like fog. I have had several fever dreams in the past few days; they were very strange but also very real. I left several messages unanswered for a few hours as a result because it was hard to tell what was real and what wasn't, and I didn't want to be texting someone based on a strange dream I'd had that involved them. Text responsibly, friends!


Anyway, the past three months have not been an easy three months for a number of reasons, none of which I wish to write about. What I do wish to write about is my time on ED, which has actually been pretty great. It was a rotation that had received glowing feedback from most interns before me, so I was quite keen to start. Also, I was glad that we had a pretty good group of interns on the rotation, as it would make for easier shift-swapping and far more enjoyable shifts. It was looking to be a good rotation!


My aim on ED was to see as wide a variety of presentations as possible, as well as to get some procedural skills in. Looking back, I can pretty confidently say I managed to do both these things. I've seen Paeds, O&G, Psych, Gen Surg, all manner of Med, and even Ophthal cases! Trauma, both exciting and unexciting, was a common presentation; I even got to do some suturing, which I was super excited about. The bosses were wonderfully encouraging, talking a few of us through cardioversions and maintaining the airway during these, and letting us take over as they supervised. Towards the end of the rotation, I managed several Cat 2s (which I'd been terrified of doing at the start of the rotation), and was involved in a few resus cases. I think it's the resus cases that I really want to talk about.


It's a well-known fact that every doctor in the hospital sort of hates ED. They're an easy target, really. The jack-of-all-trades ED doctor wouldn't be the best at managing a complex patient before referring them on to the relevant specialty, which is often a cause of disdain from other doctors. There's also the fact that these referrals are being made in the first place, which means more work for the accepting team, and nobody likes being handed more work. People start to see ED as nothing more than a glorified triaging service, which is unfortunate, because they don't see what goes on apart from these referrals. And there is a lot that goes on apart from these referrals.


The most impressive thing has to be resus, or resuscitation. The first time I watched a cardiac arrest resus, I was awestruck, and the feeling has stayed with me since. Good resus cases are a sort of organised chaos, and things run like a well-oiled machine. People are assigned tasks, others stand back until something else needs to be done, and the team leader watches over everything and gives the orders. Airway. Breathing. Circulation. Disability. Exposure. Correct things that need to be corrected. Is the rhythm shockable or non-shockable? Then to rule out the 4Hs and 4Ts - the BSL's been done, so someone run a gas and someone else grab the ultrasound machine to check for tamponade. It's so quick and concise and systematic, and there's an electricity in the air like nothing else I've ever felt. Resus is amazing.


If you think about it, isn't that really what ED is for? Actual emergencies? And if ED handles these things and handles them well, I'd say they were doing a pretty good job. (I don't know. Maybe I'm young and naive and biased, and will change my mind once I become a jaded Med reg. We'll see.)


Of course, while resus is the bread and butter of ED, it is hardly the most common patient presentation. You would think that you'd see many emergent cases in the Emergency Department, but that was very often not the case. Ambulances get called for a variety of non-urgent things, which really gets my goat. One time I had to take deep breaths and calm myself before seeing a patient who had effectively called an ambulance for five hours of diarrhoea. They brought him in because he had a complex medical history which included some bowel problems. It came to light, however, that the reason he had been having diarrhoea was because he had been taking an unreasonable number of laxatives.


Never, ever assume patient intelligence. Ever.


The other thing I learned while on ED is that people like putting things up their butts. We had two such cases while I was there (both sex toys, I think), and the x-rays caused quite a bit of excitement on the floor. The unfortunate ED doctor who took the first case accidentally switched the toy on while attempting to manually remove it; they then gave up and rang the surgeons. It was hilarious, and can you imagine the documentation?! You won't get this anywhere other than ED!


It's been a really good rotation with a really good team, and I'm quite sad to leave. The only thing I didn't enjoy about it was the shift work, but then my next rotation consists of shift work too (boo). I will miss the complete lack of pretentiousness, not having to think about what to wear, the wide variety of patient presentations, the 2am food trolley, and the engaging bosses. Thanks for a great term, ED! Tomorrow, I begin shift work on a medical ward. After three months of scrubs, I can't seem to remember what work-appropriate clinical attire means anymore...but I'm sure I'll figure it out. Come at me, AMU. Last rotation, let's go!

Friday, July 13, 2018

No scrubs

I don't actually know what that line in the song means, but I thought it a fitting title for a post on finishing Surg.




Surgery has never been particularly appealing to me. I find anatomy tedious, have zero visual-spatial intelligence, and detest 30-seconds-per-patient ward rounds. Sure, Surg had been great as a student - I learned a lot and had no responsibilities. Also, I was only there for six weeks or something. The idea of living the #surglyfe for three whole months as an intern struck fear in my heart, to tell you the truth. I mentally prepared myself for long hours in a rotation that I cared little for, and bade the sun farewell (you're in the hospital well before the sun rises, and only head home after it's set).


There were some positives, though. I had been assigned to Breast and Endocrine, which meant I wouldn't have to be overly invested in patients' bowel habits/stool consistency (sorry, Colorectal). Breast and thyroid surgeries are generally pretty neat and quick, so no standing in theatre for hours on end assisting with complicated bowel resections or Roux-en-Ys. Also, thyroid and parathyroid surgeries meant at least some degree of medical learning, which this medically-inclined intern was grateful for. I'd been talking to a locum Psych reg (originally a Med reg) about starting Surg, and he said it wouldn't be so bad since interns dealt with patients' medical problems on the ward anyway. It had been a random, brief conversation with someone I might not ever meet again, but this was something I held on to throughout my time on Surg.


As the only non-surgically-inclined person on the team, I did my best to take care of the medical side of things. My biggest triumph was figuring out the cause of a pre-op patient's newly-diagnosed AKI after trawling through their drug chart, bloods, records, and taking a history. I would look through patients' histories and read up on the weird and wonderful diseases I encountered, just to get some medical learning in. Pre-op was great in terms of examination -- I learnt to listen for the prolonged expiratory phase in patients with known COPD, and got to examine Grave's patients with exophthalmos and good-going thyroid bruits. I also picked up a loud systolic murmur in a toddler, who went on to have a paediatric echo to look for structural abnormalities in their heart. And all that was just the non-surgical learning!


In terms of Surg itself, I also learnt heaps. A large part of being a Surg intern is managing electrolytes -- potassium and magnesium are the main concerns, but you're also worried about calcium when you're on Breast and Endocrine. Isaac was constantly writing up minibags, and I soon started calling him the electrolyte king. The other thing you get pretty good at is prescribing analgesia. Initially, whatever your boss says is gold and you just chart that, but then you occasionally overhear anaesthetics raging about charting (or not charting) a particular med, so you take that into account and slowly begin to formulate your own approach to analgesia. My two main takeaways: Long-acting analgesia should not be used for acute pain, and tramadol is the one thing that can definitely be used with a PCA. In addition to all that, I got to help out in theatre a bunch, and once did a close-to-perfect subcuticular stitch closure of a breast lump excision wound. It was beautiful and incredibly satisfying, and that was probably my proudest moment on Surg.


My favourite part of Surg, however, was the people. We had a great bunch of regs this term, and also a great bunch of interns. The doctors' office was always abuzz with activity -- paper rounds, general chatter, and everyone teasing/bullying Sarah. (Things got a bit confusing at times with two Sarahs and sometimes two Rachels, but we got over it.) The office was a narrow, stuffy, usually overcrowded room, but I already miss the good times we had in there. Like when an unnamed individual nearly gave himself a concussion. Or when the same unnamed individual somehow mysteriously ended up having his face plastered over the screen of every computer in the room. Or hilariously awkward Shoot Shag Marry sessions. Or 'superstitiously' planning but not planning basketball sessions. Or asking each other why they were still there and why they hadn't gone home yet. Or commiserating with each other because we were both still there and both hadn't gone home yet. Ah, the memories!


Of course, I'll miss my team as well. Isaac and I genuinely worked so well together -- it got to the point where if one of us was scribing and our phone rang, the other would silently reach for the phone to answer it, no prompting required. Jobs were completed quickly and efficiently, which meant we got to spend time in theatre. Our reg was an excellent leader, and I was constantly admiring his patient rapport. Also, thanks to him, we almost never had to come in before 7am, which is a huge blessing in the world of a Surg intern! The big bosses were an absolute pleasure to work for, and continuously showered us with surgical teaching and homemade food. It was such a fantastic team, and I will miss it very much. This is possibly the last Surg rotation I will ever do (woo!), and I'm thankful to have had such a great experience.


I've just started on ED, and found it to be a stark difference from Surg. Far less walking, for one, and also far more snacking in an attempt to stay awake (thanks, shift work). This does not bode well for my weight. However, I will theoretically have more time for gym, so hopefully this will help offset the extra food intake. My first day on the floor was kind of insane; so insane, in fact, that it actually made the news. I've just finished my second day, which went far better. All the bosses have been really lovely and supportive, and I've decided that ED nurses are my favourite nurses in the whole hospital. It's looking to be a good rotation, and I'm looking forward to the rest of it.


It's sort of ironic that I've titled this post 'No scrubs' as a farewell to Surg, but we actually wear scrubs in ED as well. But whatever. I thought it was clever, so I'm running with it.


NO, I DON'T WANT NO SCRUBS
(Bye, Surg!)

Tuesday, April 3, 2018

TGIH

In a whirlwind of work, work, friends, and more work, a quarter of the year has gone by, just like that. Whew. Thank God it's holidays, indeed.


Work is always eventful, but it started off particularly so -- a(n expected) patient death on day one, a code blue with full resus ten minutes into day two, dealing with an angry patient on day three, cannulating an uncooperative patient with dementia on day four... The list goes on. My first week as a Real Doctor was pretty overwhelming, to tell you the truth. It felt like I was attempting to navigate the stormiest of seas in a tiny boat, armed with a teaspoon instead of an oar. Thankfully, there were supports around that offered help right when I needed it, which was really what kept me going. I will always be grateful for friends, seniors, and the admin staff.


The other tricky thing was work-life balance. I lived with two interns last year, and it seemed to me that every spare moment they had was spent either sleeping or doing laundry (I exaggerate, but only slightly). This was me during my first month of work. Work was an all-consuming creature that grew to occupy every bit of time and brain space I had. It didn't help that I started the year on a notoriously busy ward, and I was determined to keep on top of things at any cost. At any cost. This included physical, mental, and spiritual health, which of course eventually took its toll on me. My diet was atrocious, I wasn't going to the gym, I spent the entirety of some days feeling like I was millimetres away from a panic attack, and I started skipping growth group because I was exhausted. I fell sick (surprise, surprise), and felt so awful and guilty and useless for not being at work that I completed all my mandatory modules instead of resting. Several people told me I was working too hard; I took pride in this, because I was on a crazy busy ward and working hard surely meant that I was seen to be on top of things. Flawed logic, but you can tell I wasn't in the best headspace at that point.


I'm glad to say that isn't really the case anymore. I started making it a point to do things outside of work, to do things for me because I enjoy doing them. Summer was great because the sun and warm weather were perfect for walks at the Gorge (this had the dual purpose of getting in some exercise as well as stocking up on Vitamin D). My housemate got a scoby from her classmate, so I started brewing my own kombucha. It's been fun experimenting with different tea combinations and flavourings! I muddled a bunch of strawberries and chucked them in for secondary fermentation, and that worked a treat. I also managed to finish a book! It was titled The Crazed, written by Ha Jin. I got it secondhand at Salamanca Market because I didn't think I'd ever read anything by an Asian author, so I thought I'd ought to broaden my scope a bit. The writing style was different from anything I've ever read, and reminded me a little of how my Grandad talks/writes.


Speaking of Salamanca Market, little getaways with/to see friends have also been highlights of my year thus far. There have been a few Hobart trips, which of course included Salamanca Market and the Sunday farmers market. I was pleasantly surprised to find some new stalls, and glad to see the old favourites were still there. In early March, a few of us from Launnie and Hobart flew to Melbourne to see Ed Sheeran! We crashed in the living room of a former Burnie Boy (now a Melbourne Man), who was also coming for the show. It was incredible. One man, a guitar, and a loop pedal were enough to draw in and entertain 50,000 people, for three (four?) nights in a row. Unbelievable. Though the hipster in me wants to say my favourite song was something that wasn't released as a single/playing on the radio, the best part of the night was definitely Perfect. It felt like the entire stadium was simultaneously holding their breath, and it was magical. I could fangirl about that night forever.


I've also just been to Brisbane! It turned out we had a five-day break for Easter, and I was only working on the first day, so I had a few days to spare. I worked a ten-hour shift and flew off to Brisbane that night, eager to make the most of the break. Brisbane was so great! The warmth was a welcome reprieve from chilly Tassie, and I adored walking along the wharf and marvelling at its infrastructure. I stayed with a friend with whom I'd been housemates for three years in Tassie, so it was very comfortable. It was great to catch up with her and another friend, as well as make a new one! Went along to a friend's church for Easter Sunday and ended up bumping into a UTAS med student and a lecturer from my college in Malaysia! Small, small world. Anyway, Brisbane was great, and I'd love to go back some day.


Tomorrow works starts again, and we only have three days left of our current rotation. I start surgery next, which I'm a little apprehensive about; I didn't mind so much being crazy busy this rotation, because I love Gen Med, but Surg is something I'm not overly keen for. On the bright side, it sounds like we have a good team, so we can bond through trauma or something, maybe. I kid, I kid. It'll be okay. I'm sure the next three months will go by as quickly as the past three have. It'll be an interesting year ahead!


Not sure when the next time I'll be posting anything will be. I'll have sleep to catch up on, and laundry to do. Not to mention kombucha to brew, and growth groups to attend, and exercise to do. Yay, work-life balance!

Sunday, December 31, 2017

Goodbye, 2017

And all too soon, the time has come for my usual year end post.


This post won't be like the other year end ones in the sense that I won't be doing my usual recap of events...well, I might, but I won't elaborate on them too much. The truth is, I feel like this year has been far more than a sum of its events. In preparation for these posts, I usually look through my Instagram and Facebook pics to get a feel of what to write about. That wasn't very inspiring this year, unfortunately - everything I came across seemed equally important. Also, the more unsavoury events don't get a fair representation on social media (which people tend to forget). Therefore, I'm just going to produce a sort of organised ramble and hope it serves as an adequate memento of the year.


2017 has been a big year for me, with really high highs and really low lows. It's been a year of learning, growth, and preparation for Life In the Real World. Graduation happened, and that was a big deal. Talking about everything graduation would be a blog post in itself - there was grad breakfast, the Declaration of Geneva, actual graduation, and grad ball. Before all that, there was the LCS grad dinner, the class grad trip to Goaty Hill Winery and later a smaller grad trip to Penang. We also had some post-OSCEs fun in Melbourne. Lots of fun times with great people, but also lots of goodbyes. Some friends are leaving Australia for good, and some are leaving for the mainland, so it's all been very bittersweet. Graduation always is, isn't it?


What made it even more bittersweet was news that hit the Kpop scene just days before (if this seems frivolous, it's not): Jonghyun of SHINee had committed suicide. This year has been marred with what feels like an unreasonable number of suicides. Jonghyun, Chester Bennington, two teens while I was on rural GP, another person I don't think I'm supposed to name. It's horrible. It's heartbreaking. I cannot imagine how their friends and family must feel, how they're ending their 2017. Sorry to be a downer, but this was part of my 2017, and I feel compelled to include it here. It's incredibly sad, but it's something we can hopefully learn from. We need to take care of ourselves (which isn't some wishy-washy, fluffy thing like I used to think it was), and look out for each other. Mental health is important, and I think we would all do well to remember that.


Moving on, here are some quick yays and nays of 2017!

Yay:
Spent Chinese New Year in Malaysia (for the first and last time in years)
Took part in a colour run
Hiked Cape Raoul
Had some really good rotations - Gen Med and GP in particular
Passed OSCEs + portfolio interview and graduated!
Volunteered at Teddy Mobile Clinic
Family holiday in Tassie and Melbourne

Nay:
Too Many Suicides
Job/AHPRA/visa applications
Mental health (or the lack thereof)
Not getting to see my best friend this year
Saying goodbye to friends who are leaving


2018 is looking scarily exciting, with it being my first year in the working world. I'm a real doctor now, and looking forward to actually being useful and doing some good! While there will be many new responsibilities and experiences, there are still some things that remain comfortingly the same: my house, the hospital I'm at, church, and always God. Hopefully these will ground me as I navigate the treacherous seas of intern life. They should be enough to ground me, in any case. Everything will be okay.


So long, 2017. Thanks for all the good times and the lessons.


Hello, 2018! Please be good to us all.