Muppets

There are good movies, then there are good movies.

Among the movies I've watched, I think "The Muppets" ranks pretty highly for its memorable songs and cheerful outlook. One of my favourite songs from the movie is much older than I am - my dad can hum it - but its a great song nonetheless.

"Rainbow Connection"

Why are there so many songs about rainbows
and what's on the other side?
Rainbows are visions, but only illusions,
and rainbows have nothing to hide.
So we've been told and some choose to believe it.
I know they're wrong, wait and see.
Someday we'll find it, the rainbow connection.
The lovers, the dreamers and me.

Who said that every wish would be heard
and answered when wished on the morning star?
Somebody thought of that and someone believed it.
Look what it's done so far.
What's so amazing that keeps us star gazing
and what do we think we might see?
Someday we'll find it, the rainbow connection.
The lovers, the dreamers and me.

All of us under its spell. We know that it's probably magic.

Have you been half asleep and have you heard voices?
I've heard them calling my name.
Is this the sweet sound that called the young sailors.
The voice might be one and the same.
I've heard it too many times to ignore it.
It's something that I'm supposed to be.
Someday we'll find it, the rainbow connection.
The lovers, the dreamers and me. 

Playhouse 2011

I headed down to ACJC with slight trepidation yesterday afternoon. With only 80 days to our final exams, just how would we fare at our last playhouse?

One part of me thought it didn't matter. True, it was our last playhouse, but given our hectic, stressful schedules, it didn't matter whether we won or not. It was understandable.

I liked the way the play turned out - a bit on the angsty side - but entertaining nonetheless.

My stomach lurched as the MRT sequence prodded my conscience for hogging the MRT seats for ages before noticing the ah-pek standing before me; The scene in which our protagonist examines "the best murmur in Singhealth, NUHS and some say NHG" made me feel even worse for all the times I saw a patient just to hear his murmur. I wouldn't say that the play was an altogether accurate description of medical school life - surely we don't all look that nerdy (though maybe I do) - it came pretty close.

I liked this photograph (courtesy of Michael):

and this one too (courtesy of RamenBar):

9 things to be happy about in M5

1. My clinical skills are better than an M3. Or so I hope.

2. I have gained valuable skills in charming aunties and uncles into letting me examine them.

3. I motivate myself to reach KTPH by 8am every morning and have managed to get my friends to do the same.

3. My sis can teach me radiology after spending 2 weeks in the radiology department.

4. My allergic rhinitis is better once I stop using the air-conditioning - hence I save medical bills and electric bills at the same time.

5. My working hours are shorter than that of a HO's.

6. I have 3 weeks of holidays to look forward to after my exams. And I might get to travel :)

7. Christmas is coming.

8. Internal Med EOPT is coming.

9. Playhouse is coming.

Updates from 24 Oct to 13 Nov

Non-specific viral illness

24 Oct: high fever 39.3

25: Sore throat - saw GP, given cefuroxime and fluimucil

26: developed macular rash - advised by GP to stop cefuroxime, dengue serology was -ve, FBC showed ?lymphocytosis

27: rash became itchy and confluent in areas

28: repeat FBC in polyclinic: normal. 1 atypical mononucleocyte. diagnosis by polyclinic doctor - infectious mononucleosis vs cefuroxime allergy.

Subsequently rash subsided, patient was febrile, vitals stable, no URTI symptoms.

7 Nov

First day of internal med posting. Time to try to start work ==(

10 Nov

Happy day.

13 Nov

Time to start worrying about case write up, tutorials next week and what not.

Sigh. ==(

At least I had delicious steamed jiaozi (dumplings) today. Today is a good day.

It was slightly cloudy today - but I skipped a thunderstorm in the afternoon.

But I would miss the hurried whirlwinds of the morning and the lazy afternoon sunshine - despite being initially unused to the climate.

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I need to sit down and smell the roses.

Time, where art thou?

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Learning skills in SIP

Some thoughts on practical skills I practised during SIP:

1) IV plug setting

- I practised this many times in A&E, anaesthesia, medicine SIP and now surgery SIP

- how I do it now:

- I get the IV plug set from the nursing counter - checking that the blue plug and all the necessities are intact

- I apply the tourniquet to the patient's hand, checking there are no contraindications to plug setting/ blood taking eg. mastectomy, AV fistulas

- I look and feel for veins at the usual sites eg. the houseman's vein

- I poke the patient (after cleaning the site of course)

Somehow I am not always successful, and I may end up poking a second or third time :(

2) Drain removal

- First time I did this is actually in medicine SIP (chest tube removal)

- I am somewhat new to this procedure, having performed it only 5 times to date

- Today I learnt a few lessons:

- One - use chlorhexidine for dirty wounds and normal saline for clean wounds

- Two - use normal saline after you have used chlorhexidine

- Three - watch out for those metal instruments! they are very expensive and are a headache if lost (thank god for nurses who count the instruments after I use them)

- Four - always clean up after yourself (the nurses will be very grateful). even better if you can assist them in cleaning up and applying a fresh layer of dressing

3) Time management

- Haven't really practised this much, because much of the stuff I do is delegated to me by HOs (and this is only a tiny fraction of what they do)

- See the sick patients first! Then do all the rest later.

- Try to finish all the changes on CPOE during the morning round, then do all the blue letters/ calls etc.

- AIC can be a headache.

- Try to get help if overwhelmed?

4) Knowing thy patients

- doing/ reading discharge summaries can be a good way to know the patient quickly

- but the best way to know thy patient is to clerk him/ spend one hour setting a difficult plug on him

- unfortunately sometimes there are a lot of patients, and it still takes time for me to put the face on the name....

5) Making referrals

- See above

6) Buying drinks after morning rounds

- get the money from whoever's treating

- take the orders

- buy the drinks

- try not to keep the change.

7) Having fun

- try not to think I will be a HO in 6 months time

- eat waffles and roti prata for breakfast every day.

- sleep every day if possible

- study for MBBS if possible

- go out during weekends while I still can - heh!

NB: Please note that the above is a concoction of fiction and half truths. Believe it at your own peril.

Why I like weekend calls

Meal	Normal	Weekend Call
Breakfast	Oats, wholemeal bread, fresh milk, hard-boiled egg	(If any) Waffle, Roti Prata
Lunch	Brown rice with 2 vegetables + 1 meat	(If any) White rice with 2 meat + 1 vegetable
Dinner	Home cooked goodness ie. Rice, soups, side dishes	(If any) Fried rice, da2bao1 (takeaway), KIV pastamania
Supper	None. Occasionally fresh milk + oatmeal cookies	(If any) Chocolate milk/ milo/ Yan Yan for kids/ Coke
Sleep	7 hours	Most unusual. Sometimes possible during SIP

The ABCs of Dermatology

A is for acute necrotizing fasciitis.
B is for bullous pemphigoid.
C is for chancroid.
D is for diabeticorum, necrobiosis lipoidica
E is for eczema
F is for folaceous, pemphigus
G is for gonorrhea
H is for histoplasmosis
I is for irritant contact dermatitis
J is for janeway lesions
K is for kawasaki disease
L is for lupus vulgaris
M is for madura foot
N is for nit (pedunculosis)
O is for osler's nodes
P is for pellegra
Q is for Queyret, erythroplasia of
R is for rheumatoid nodule
S is for scabies
T is for telangiectasia
U is for ulcer
V is for verrucous carcinoma
W is for wickham's striae
X is for xanthoma
Y is for yersiniae
Z is for zoonoses

Fortunately, none of these appeared in my derm test.

Mid Term Break

A breather in the year that will only get busier.

Trying my best.
As long as I tried my best, I don't have to feel bad about anything.
Or at least that's how the saying goes.
I wonder.

If anything would have been different if I did things a bit differently.
Went overseas for elective. (I liked it in Singapore)
Studied harder for pros. (I studied enough, thank you very much)
Played a little more sports. (Errr. where got time? Actually got lar..)
Made a little more friends. (I very friendly liao... Yeah right.)
And the list goes on.

I get this feeling at times.
That somehow if I do things a little differently, things would turn out different.
That's a happy thought.
If only it were true...

So far the year has been good to me.
I survived Internal Med SIP with some valuable learning experiences and (hopefully) contributed to the welfare of the patients placed under my care.
There is really no learning experience better than actually taking charge of patients and being thrown into the deep end with some well-thought out guidance.
I loved the SIP experience which prepares me better for the real world much better than exams and eopts would.
Which is why the new syllabus in which students in final year do 1 year of SIP (or so I hear) is the real deal in preparing medical students to be doctors.
Yay.

Nevertheless, there's still this you-know-what coming this March that seems really important. Looming. Not quite here yet, but almost.

Yikes.

YeeHa

I'm officially M5. It's the holiday week, but nevertheless I have a good feeling about this year.
It's an express train to the MBBS, according to some friends, but I do hope I can get a few things done along the way.
But everything has to be done with passing the MBBS as the top priority.
Urgh. Vomit.

Nightmare

I have this terrible vision of myself as a house officer, bungling up on the first day of work. I forget patient's names, stare for ages at the HIDs trying to make sense of the past history, and forget everything the patient said in his history.
This is a preventable situation.
I don't necessarily have to be perfect the first time I do things.
But I am well and truly stressed.
It's a big bad world out there.
I take a deep breath.
And pray. That I survive the deep end of the pool.

Blogger

I pray that all goes well.
Amen.

If electives were the best time of my life...

... it means that life won't get any better.

The NNI posting ended with 2 boxes of smarties and an honourable mention at last place in the inaugural NNI eopt quiz.
I will console myself with the thought that I helped my team gain a single point in the contest: by getting 2 questions wrong (-2 each) and getting one correct (+5).
But I failed to answer when it mattered most - the tie breaker.
(Why on earth was there a tie-breaker for last place? I do not know)

But certainly, excluding the very last day, I thoroughly enjoyed this posting.
Maybe because the posting revived my long-forgotten neuroscience knowledge and forced me to acquire more knowledge.
Maybe because the posting encouraged me to blog my longest post in a long time.

I wonder what posting I'm doing now?

End of Neuro Posting

I think I enjoyed my NNI elective the most so far because every elective seems to get better.
I will still be in Singapore in May, that may be a blessing because at least I'll get to vote.
As for my holidays in June, there are no plans for any electives or travelling yet.
I think procrastination will probably not get me very far, but perhaps I might be happier relaxing in Sunny Old Singapore as a compromise.
Anyway, home is where the heart resides.

NNI

I have gone slightly mad for my nni posting.
I never knew neurology was so interesting.
Jeez!

Last week in Rheumatogy

By this time I have spotted numerous photos of fellow medical students travelling the world on Facebook. I must say, somewhat reluctantly, that I envy them.

That is not to say that I have been idling in Rheumatology. I think the past 3 weeks, even though they had been spent in Singapore, has been strangely fulfilling and educational. Call me unadventurous or boring, but I'd rather think that my decision to stay in Singapore is one I haven't regretted yet.

Wait till the rest of the class goes overseas, Jia Yi...

Raving Rheumatology

Time flies when I'm having fun. That's perhaps why 2 weeks in rheumatology has flown past so quickly.

So far, these 2 weeks have been quite an eye opener. I can only say that I'm really glad I'm still a medical student.

There's 1 more year to go before I start work, I should make the best of it.

Break for the weekend

I had a great GS elective. Made especially fun with all the great ppl at ttsh surg!

I enjoyed the ward rounds with the surgeons and the many elective students in my team, the OT sessions watching all the -ectomies, the exceptionally educational and entertaining tutorials by all the tutors, and most of all, the exceptional company of friends, long-lost and new.

And to think this posting was the one I hastily shifted at the last minute due to clashes with other electives.

Thank you everyone who made my last month worth it! :)

Tmr, I start 1 month of SGH rheumatology.

This week...

• I continue my gen surg elective at ttsh. This posting has been surprisingly enjoyable with at least a quarter of the class at ttsh, and best of all, no eopt
• the desktop crashes. I am forced to blog using a laggy, small and cramped netbook, which, fortunately still works well enough to run internet explorer.
• to my horror, school fees are due and I have insufficient funds in my account.
  
• S begins her journey. Hope the arrival is nice and comfortable. Hopefully s/he adapts well
• I complete one blog post.
  

Green Hornet

The Green Hornet would just be another superhero movie if not for the presence of Jay Chou as the titular superhero's sidekick. I'm not saying this solely from the perspective of a Jay Chou fan. Rather, this was the general consensus by S and I after watching the movie.
We probably wouldn't have given it a second glance if not for the presence of this familiar star.
Although the movie probably isn't exactly going to win any awards for the plot and thinly sketched characters, the general premise is entertaining enough, and the chemistry between Jay and Seth is almost palpable.
Unfortunately, the other characters weren't given enough screen time for much character development.
Nevertheless, an awesome atypical superhero movie where I found quite a few chuckles laughing at Cohen, and pleasantly surprised that Jay Chou could actually kick some a** in Hollywood.
Way to go Chou!

In other news, I begin a general surgery elective at ttsh next week.

My favorite month is January

If I had status updates on facebook, they would probably run like this over the last month:

Early January:

Pathology exams were a blip on my calendar that I spend one month preparing for. No really, they were the highlight of the whole month.

Mid January:

Spent 5 days in Hong Kong mainly eating and shopping with random relatives. I ate like there was no tomorrow.

But I didn't gain much weight, surprisingly.

End January:

Rotting at home for the past few days. Really can't wait for electives to start. Still need to iron out some blips with the schedule. Argh.

Someone may be changing university given a surprise, extremely last minute but unconfirmed offer from Monash. Urgh.

And found out first hand from someone that bowel prep is not as simple as it looks - it's absolutely disgusting. Hopefully the actual procedure would be better - though I doubt it.

I prefer end January. Or rather, I'm rather looking forward to the end of January.