Tuesday, August 12, 2014

The difference

Two cardiac arrests in my entire year in Aberdeen.

Two cardiac arrests in my first week in Wick.

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So many patients have the same last name. It makes things extremely confusing. My friend came up with the conclusion that they're all inbred.



Sometimes I feel like I'm in the Great Scottish Redneck Central.

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I need a good soul wrenching heart vaccuuming anime or fandom with tons of my favourite themes and humour and darkside and bromance and fanfiction fodder.

If all fails, I rewatch those scathing Youtube reviews of The Last Airbender. Cracks me up every time.

(But noooo I'm here reading up on ischaemic penumbra and haemorrhagic transformation. People sitting for professional exams and who have to study consistently after work have no soul.)

Sunday, August 10, 2014

It doesn't rhyme


Started off in GI
Knocked out livers, bleeding varices
It's all the cheap alcohol I tell ya
Bilirubin Haemoglobin (don't forget the urea)
Hepatic flap, ascitic tap
IBD and steroids
Gastroscope colonoscope (I'm going down to Short Stay)
Patients yellow as the Simpsons
?functional I kept at bay
I stuck a drain in someone's belly
Then they went back to watching telly
Yay me!

Moving on to general surgery
Everyone was in a hurry
Receiving week, answer the bleep
Appendicities diverticulitis sometimes peritonitis
CRP, CT (we may need an MRCP)
You've got gallstones fatty!
KY jelly essential without a doubt
Triple therapy - gent monitoring is a pain!
No dalteparin post op please.
Although I didn't get to have a stab at an abscess
I slid a tube down someone's nose
They stopped vomiting so yay me!


Neurosurgery oh what the heck
EtOH XS knocking heads
Warfarinized oldies with SDH
Young ladies with GBM - I'm so sorry
(but I'll also need to examine your breasts)
CT head, MRI, are they obeying commands
GCS, pupils, always have a pen torch handy
ACDF, stealth CD, stereotactic biopsy
I stuck a needle in someone's back
But it wasn't a champagne tap
Anyway, yay me!

Oh how the year has flown
Being first point of call for scoring sewsing Mr Jones in bed 8
Who's tachycardic hypoxic pyrexial and likely septic
ABCDEs but don't forget the septic six
Speed typing IDLs
The family want to speak with a doctor now
Chasing bloods requesting imaging
Speak to dermatology he's got a rash
Speak to ENT she's got a nosebleed
Speak to the med reg it's not surgical
Sorry to bother you but I have to make a shitty referral
I'm at the bottom of the food chain you see
Please be kind to me.
Despite it all I survived the year
Yay me!


Brain surgeons

Despite the occasional (ok maybe half the time) chaos that was neurosurgery I strangely enjoyed it. Neurosurgeons have always had an unfortunately negative reputation of being aloof and pompous and 'never see that patient', and I must confess I initially had the same misgivings about the specialty (not entirely my fault - at the tender age of 15 on a hospital attachment I was rather emotionally scarred when the resident notorious neurosurgeon yelled at two other young un's and I for the grievous crime of being female and wanting to do medicine.)

It was chaotic, mainly due to understaffing and just plain lack of space. ARI Neurosurgery covered the whole of north east Scotland and we would see SDHs from Shetland and cauda equinas from Inverness all the time. I even have a NPH from Wick, and did the LP (twice because I botched it up). There were 5 consultants - 4 regulars and one locum. During my time there'd been two of these locums. There were 3 registrars for these 5 consultants and the whole of NE Scotland - and you can see where the problem is. We juniors would support the wards and oil the logistics of getting a patient in and out of theatre as best as we could, but that could only do so much.

Most ward review patients needed a reg opinion and there was nothing us juniors could do. The regs had haphazard ward work, theatre and oncall schedules and no one really knew where they were but were never around when you needed them (much to the chagrin or the receptionist who bore the brunt of many an unhappy patient in the waiting area). The consultants also had recently developed a habit of adding last minute elective patients on the list, which was a headache for juniors and secretaries. Honestly, the number of times I walk in in the morning and a reg asks has this patient been consented and the anaesthetist is looking for the big notes and I know nothing about this patient - because he was added on the list at 6pm last night after I left.

rageeeee

And the doctor's office, by gosh. It was the smallest space in all my three jobs, had 4 computers, two of which were constantly having issues. These were the jr dr computers of course, regs got the better ones. I must have spent hours on the phone trying to get to IT because it wouldn't open PDFs, or had a sticky mouse, or just wouldn't start. The office was in a state of constant mess with letters and bits of paper with referrals just existing no matter how hard we tried to keep it clean.

The two FY2s were constantly bogged down with extra work for MDTs which I honestly felt sorry for them for. It was a mind boggling, soul destroying amount of pure admin work that had been dumped on them...just because. Not the mention FY2s were on the reg rota meaning they carried the oncall bleep meaning they took registrar level referrals for heads and spines....which is probably a first. I mean cardiology FY2s don't take referrals that ask cath lab Y/N do they? But it was overall quite well supported by the regs and I'm sure my FY2s learnt a great deal. A band 3 (100%) pay grade didn't hurt either.

After the whirlwind of the first few weeks I settled in comfortably enough. I quickly learnt some tricks to increase efficiency - stuff like keeping a pen torch and measuring tape in your pocket, pre empting CDs for Stealth, and seeing pre op/post op patients the minute they arrive. Heads went to ITU mostly and spines went home comparatively quicker. I saw an EVD for the first time and more CT and MRI scans of brain tumours, subdurals, subarachs, and spinal stenoses than I'd ever seen. The consultants were generally approachable and very good at well, fiddling with peoples brains. They liked to do a separate ward round in the middle or close to the end of the day though, so we'd be on the phone at 6.15pm trying to discuss a relatively minor ailment to a usually equally disgruntled registrar.

We would share the spine oncall rota with orthopaedics although this arrangement was very arbitrary - what we were told would be 'one week us one week them' turned out to be 'three weeks us one week them' according to the whim of whoever did RotaWatch (who is probably sleeping with someone in ortho). Spine was the bane of the department, as it would easily double or triple the work load. I didn't mind the broken spines so much (usually fit young men falling off stunt motorbikes), but what grinded my gears were the query cauda equina compressions, who were more often then not, functional middle aged women with chronic pain issues. But of course, if they had some spinchter dysfunction we couldn't not accept them. Getting the needed MRI for these patients was a constant battle with our radiologists, and 9 times out of 10 there was no CES.

Chronic pain patients. Don't even get me started. They would have a PMH of IBS, depression, fibromyalgia, migraines etc with more than 5 documented drug allergies. Some are fine, and some are downright classical OSCE template 'difficult patients'. Malas nak layan.

Despite that it was all good fun in retrospect. We had great ward staff and allied health pros (the best pharmacist I'd ever had the good fortune of working with), I got to know all the regs and consultants and knew what each of them liked, and was actually starting to get really good at my job, until, like every one else, I had to move and start completely green in a new ward where I didn't even know where the cannulas were kept.

I'll miss you neurosurgery.

Friday, August 8, 2014

3

Day 3 in Wick.

Saw a  20 year old OD in A&E with a BAL of >500. Stayed back 2 hours to watch the show but that was on my own accord. Battled with an unconvinced radiologist in Inverness about a CT head but that's nothing new. What's different is probably the pissed of radiographer who may have come all the way for nothing.

At the moment the medical ward is full house with 3 FY2s and one CT who'd worked as an SHO before. That is definitely the reason I'm still able to feel light hearted about work.

I cycled to work today. Half  town probably knows me as the new doctor who cycles, but I don't mind that. What made me >.<'' somewhat was the bunch of kids who yelled 'hey chinese lady! ni hao!' and continued to ni hao until I was 400m down the road. The adult with them obviously felt there was nothing slightly awkward about this. I've been ni hao'ed by angmos since Nottingham and I'm sure they don't mean it in a rude way, but it's very >.<'' ok.

Oh and I got a gold star.

Wednesday, August 6, 2014

What rhymes with hick lick sick dick

Well. That was probably the most depressing induction I've had thus far.

I arrived road-weary in Wick after 10pm last night after a train and bus combination journey ( as the second leg train was cancelled) and I was lucky to get the day off - most of my colleagues had been working till evening and arrived close to midnight. We've been put in a B&B for the first two nights and the best thing that had happened so far is the fresh berries at the breakfast buffet. The first day was induction. We met with the usual managerial staff, pharmacists, some ward staff, consultant, lab people etc.

The general impression was that every department was understaffed and hence overworked, you could tell not only from the out of hours difficulty of getting anything done, or the fact they have trouble getting even locum consultants to stay, but you could see it in their faces as well. The charge nurse of the rehab ward had the demenour of Eeyore and the dead look of defeat and brokenness in his eyes, and I'm not even exaggerating. As we left the ward his parting words were, 'You've left this ward without being in tears, that's a first and will be the last.' The pharmacist was both patronizing and passive aggressively threatening at the same time, lacing the induction talk with the air of 'if you don't do this this this arrr, you better careful arr, I will kena you one. 没有骗你. There was also some 'gold star' chart thing for med rec prescribing, much to my colleagues' disgust at being treated like school children. And for a place as overstretched for medical staff as this, there is a surprising and stupid amount of extra (useless IMO) paperwork that is 'regularly audited', such as completing a form everytime you site a cannula, ticking that you've washed your hands before and after etc. And don't get me started on nights. Labs and radiology are weekdays 9-5 and outside that the radiographers and lab staff are 'oncall', so if a patient crashes at 3am I have the 'make a clinical decision' whether waking up the lab tech for a set of bloods will 'change my management'. As for out of hours CTs, it's ring Raigmore radiologist on call or no CT.

Every one just has this grim, sad look in their faces that you know, every one of their warnings and predictions are going to happen ( 'you will be pressured to your limit' 'you will be very very busy' 'you will be in tears'*shrug*) Not that I'd never anticipated this - I'd tracked down as many FY2 who'd done Wick and asked them how it was. Not many of them had much good to say about it.

I'm applying the same defence mechanism I used for General Surgery, a job I dreaded so badly. It wasn't too bad in the end, but no matter how busy we were there was always a reg around, CT scans, and I definitely did not have to wake a poor lab tech up for a full blood count in the middle of the night. I psyched myself into thinking it would be horrible, horrible, horrible, and came out thinking 'that wasn't so bad'. I am trying to do that again, but I have a feeling it may not be that effective this time, as all my expectations will be exceeded. My only comfort is knowing this is probably what my peer HOs in Malaysia are afflicted with, only with bullying seniors and lazy nurses, two things I hope are not (and should not) be a factor.

I will cry. Noisy, loud tears, probably in front of staff and patients alike, as I am stretched to my limit. Probably quite frequently. Once a week? Or one in two night shifts. I will snap at them, as I do when I am overstressed yet still bugged for needless paperwork. I will learn a lot, but will probably be glad to see the end of this place.

At the end of 4 months, let's see if I am right. I know I will be.

Saturday, August 2, 2014

People don't understand

I don't always blow my trumpet (if you can call it such in this case) or count my chickens before they're hatched. In fact I tend to do the opposite. But all this while while I've had my head and my future fixed on Australia, when asked about where I see my medical career going in future (the default smalltalk question), the answer that would roll smugly out of my mouth would be 'Australia'.

I'd always known it would be a long, drawn out and arduous  process but now that I've gotten my hands and feet dirty in the endless browser tabs and had my desktop littered with application forms and FAQ PDFs till I don't know what's what anymore, with barely any precedent saviour - then I realize this will probably be the hardest thing I've attempted so far.

But no. Now that I'm 'known' for being the one to go to Australia, when it's smalltalk time I get puzzled looks on why I've 'not gone to Australia yet', as though one simply hops on a plane and leaves just like that. 

Every fucking time

Sometimes it is scary, this thing called hope. I've been disappointed and let down by my own expectations far too many times in my short existence. From not getting an Australian PMS to not getting a foundation job first round like everyone else and not getting the deanery I wanted, each disappointment was like a slap in the face; a rejection. I'd learn to just shut it and not let others on on what I was truly hoping for - from past experiences it just made me look like a fool.

So I think I'd best shut up about Australia lest the universe/destiny/God/etc decide to just go lol nope. I'll send a postcard when I get there.

Sunday, July 13, 2014

Push and pull

I've come to realize I'm more of a balancing factor. How do I explain this. Ok for example if I'm in the company of a loud, boisterous group or companion, I tend to be more quiet and withdrawn. If I'm in the presence of a meek, shy group or person, I will tend to be the more outgoing, forward person. I strive to bring peace to group interactions and avoid conflict. I'm not the leader or the creative one or the perfectionist or the genius. When you know there's a bit of a spat or the slightest tinge of beh song-ness between friends or colleagues I try to be the indifferently neutral outside-POV person.

As for the break up of a nearly 6 year relationship, let's just say I wasn't ready. And I've never felt more at peace with a decision.

Brought to you by the Faye-discovering-herself series. (ha)

Saturday, July 12, 2014

.

So it's a nice-ish Saturday morning here and I actually managed to not wake up at 3am tossing and turning! I'm still a little tired but a few more nights good sleep and I should be back to being functional. I do think I have been sleep deprived over the past few months, more because of my body's inability to sleep early and sleep in when needed. The 4am sunrise doesn't really help.

I miss my family. I wonder what I'd be doing on a nice Saturday morning if I were in Kuching, or living in Perth, or Brisbane, or Melbourne, or Nottingham. Nottingham would be nice and warm now. I'd probably have a jog around the lake and then take the free shuttle to town for a walk. Or cycle to Beeston for cheap fruit an veg at the market. The Bruneians might even be having a barbeque.



That's the thing about me - I always tend to reminisce about the previous stage of my life with rose tinted lenses. When I was in Nottingham I would think back fondly of my IMU heydays. I just wonder what about Aberdeen I will miss. At the moment....I can' really think of anything.

Shut up Faye. Stop complaining about Aberdeen.


Thursday, July 10, 2014

hopes and dreams

Around (half) the world in 20 days

It's been a great holiday. Australia is still where I want to be, that's been well ascertained. Now to get there...

A slight worry of mine - all my trips to Australia have largely been that of leisure and holiday travel (the working holiday doesn't really count). Now we know holidaying and actually working, living, paying rent, buying groceries are completely different. I just hope the image of Australia I've painted in my head isn't too sunshine-and-rainbows, creating an artificial greener grass syndrome. I know it isn't perfect. I'd probably still moan about rent prices and how cheap peanut butter was in the UK.

Still.

I visited my brother in Brisbane and cousin in Melbourne. Also caught up with a few friends too, either in text or in person. Most of them were working out in the more semi rural areas. It just made me miss everyone.

Just recounting how many times I've been there...
1997 first trip as a family holiday. I was a shy 8 year old loli imouto.
2008 Another family holiday - driving one. Brissie to Melbie.
2009 Perth for a couple of weeks
2010 Working holiday in Perth for 3 months, then spent a week each in Brisbane and Melbourne visiting friends and family
2012 Perth again. Bro and cuz flew over to visit!
2014 Perth, mostly Brisbane, Melbourne

That's quite a few air miles and contributions to AirAsia. Apart from the family holidays I mostly funded the other trips with my own savings and earnings. Of course, that 3 month working holiday where I earned a ridiculous amount of money kinda helps.

Next up - research on how to get there.

Thursday, June 5, 2014

Stringsss

I joined the Aberdeen and North East Scotland Music Festival on a whim - a church friend's daughter was playing and she urged me to just sign up. It was a time when I was feeling very unmotivated in general about life, merely living out day to day at work with not much else to look forward to. I joined the Bach Solo Open but looking at the programme it was obviously going to be a kiddies thing - most classes were in the realms of 'recorder for under10s' that sort of thing.



The Bach Open was actually really good. There were 5 of us, 4 violins and 1 cello (6 on the programme but 5 showed up). All guys apart from me. Most of them looked a decade younger and were still in school. Everyone pretty much played like pros. I was first to play - did Bach's Partita in D minor Allemande and Gigue - made more slip ups in the Gigue than I'd liked. But then again I had pretty much been working 13 hour days since Friday and would get home at 10pm exhausted, play a couple rounds and a few bars of slow practice then crash, wake up at 7am the next day repeat. Althought I'm sure a tiger mum would say this was no excuse, lol.

This guy won btw. But I think he and the 14 year old were on par.

After I'd did my turn I was able to sit back and enjoy the rest of the show - they were truly spectacular performances. All wayyy ahead of me in technique - the smooth bowing! The position changes! The marvellous intonation! The reverb in the vibrato! All top notch. It was held in a traditional church (they kind with a massive pipe organ - there are quite a few of those in Aberdeen) with beautiful acoustics. If my room sounded like that I would practice all day.

Book cost a tenner - how now? 

After it was all done one of the judges actually gave constructive criticism to all of us - something I did not expect but was a nice touch. My main issues were technique, but I'd expected that. Somewhere between finishing Grade 8 in 2006 up till now my violin playing was sporadic at best, and I'd only play twice a year or something. I haven't done any technique studies in over a decade. I started learning the piece at around April but had virtually no technique practice for years. And no teacher to guide the music. I've got a good third finger vibrato but my bowing is crass and messy.



There were about 20 odd members of audience - it was a nice cosy set up on  Thursday evening. One of them was a violin teacher to at least two of the violin players who gave them hearty pats on the back after their performances. I spoke with him briefly. He congratulated me on a wonderful performance and felt I would suit viola as I played on the lower strings better. I do actually like the mellow sounds of the lower tones but I don't think I could stomach alto clef. All in all it was a lovely experience, despite my lack of practice and regressed technique.

How to practice without a music stand - that's actually Accolay's Concerto in A minor, something I've been learning half heartedly for a few years now

Part of me does want to get into music again - I want to be one of those Youtube anime cover pianists or one-man-bands, but realistically - Wick next, moving here and there, planning to live out of a suitcase etc - I'm planning to bring my violin back to Malaysia when I go home at the end of this month simply because I don't have the luxury of having non-essentials with the amount of moving I'll be doing. But that means my violin will probably gather dust for another year or so.

And so the dreary life continues.

Thursday, May 29, 2014

Of tigers and mothers

Some thoughts after reading Amy Chua's Battle Hymn of the Tiger Mother - a well known parenting autobiography that caused quite a furore a few years ago. Angmos were aghast at her methods and asian nodded knowingly, probably feeling proud and inferior at the same time. A lot of it was foused on the music.

I learnt piano and violin at a young age- though not as young as the average prodigy. My mother was a music teacher so naturally my brothers and I took up the instrument - but only I made it to the end, and only I still play today. I don't remember being 'initiated' into playing piano - all I know is I started playing a 5 and I really don' have much memory of anything that happened before the age of 7. I do remember however my older brother had a classmate who played both piano and violin, and somehow I thought that was very cool. When I was about 8 or 9 I mentioned wanting to learn violin, and that made my mum very happy. I remember basking in all the positive reinforcement.

Learning violin was much more difficult than piano though - as Amy Chua reiterates - with piano all you do is tap the key and the sound comes out. With violin there's so much more technicalities with holding the violin, holding the bow, intonation and how the slightest inaccuracy in finger placement on the finger board would result in a horrible noise. The violin is a beautiful instrument to listen to when you're good at it, but when you're just starting out, it's just a lot of scratchy mosquito sounds. Being left handed had its advantages - learning vibrato came much more easily, but on the flipside my bowing was crass and all over the place. I'm the complete opposite of ambidextrous. My left hand is strong but right hand useless.

I remember a few tiger-mum-ish practice sessions but by and large, it was mostly nagging rather than forcing. We'd drag our feet to the piano and tumble through the pieces for half and hour just to keep mum quiet. Stark contrast to Amy Chua's 5 hour drills with her daughters. No wonder they're child music prodigies and we weren't.  My mum didn't teach us piano - something a lot of people puzzled why - because we were related and the professional relationship wasn't there. We were sent to Ms Yeo, a friend of my mums who was also a devout Christian and single woman in her 30s/40s.

She was very strict with us when we were younger but mellowed out as we got older. Her piano/theory room was one moderate sized extension in the house she lived in with her extended family. Sometimes we'd do theory on the dining table in the main house. They had Astro though, so when we were done with theory and waiting for cars to pick us up we might catch a bit of Ceres or Slam Dunk on AXN and feel so wicked. My childhood and teenage years were basically being shuttled from one tuition or piano lesson to another.

Violin lessons were at home - my first teacher was a young lassie called Amelia Wong. She was probably the same age as I am now, if not younger. After she left Kuching to play the viola in west Malaysia her brother Anthony Wong took over. I was in my mid-late teens then, and very occupied with the school band - which was just as well, as he coached the 'rival' school band. Those were times or stress and times of fun.

I bet all my teachers are on Faebook now if I looked.

And like Lulu, I did go through a rebellious phase - at around Grade 6 piano or form 2 - I announced I wanted to quit. Like Lulu, I didn't hate the instrument - it was purely out of rebellion. I stayed on the finish all the grades though, which I suppose I'm glad I did. I know many friends who didn't though - and they mostly regretted it. Two things I find my peers regret - not finishing piano, and not learning/being able to speak Mandarin - the latter being something my parents did well - by sending us to chinese school.

Anyway back to the point (this is sounding more like my own autobiography rather than thoughts on the book) Chua made a point about kids not knowing what they want - it's up to the parent to decide. Kids will easily give up on something when it gets difficult it gets to hard ('the Western style') and the absence of dedication and commitment to honing the skill, is the death of attaining excellence - which in Chua's case is the only worthwhile thing in this world. If you're going to be mediocre, may as well not do it.

 I feel there is some debate to this. While Chua's daughters may not have possessed such wonderful skill at such a tender age, if not for her sometimes abusive practice regimes, one wonders what would have happened if left to their own devices. Likewise, if her daughters had no ear or innate attraction to classical music, perhaps no amount of pushing would have worked. It's the nature vs nurture debate in a nutshell.

My mum had far too many listless teenage-boy students who did an excellent job of looking like they'd much prefer to be somewhere else. There was also the baby-sitter-dumping parents who treated the hour lesson as a frivoulous after school activity, and the parents who thought their kids could 'learn piano' without practicing and not have a piano in the house.

So I guess if there were a scale of 'tiger mum-ness', most chinese (or asian, or migrant population, you get the gist) would be in the middle. Then you get the 夸张 end of the spectrum (Chua) and the chilled out parents who don't force their kids. But wherever you are on the scale, you would have a grudging understanding of what Chua was trying to achieve. Angmo readers cried foul and accused her of child abuse, but at the end of the day the results speak for themselves. Migrants would know and understand this. Anything worth attaining is going to be hard work.

Another thing I noted was the high level of intellect possessed by the two parents. Chua and her husband are a lawyer power couple from Ivy League Universities. They are professors of law at Ivy League Unis, they publish books on ecomonic and legal issues. When they visited Moscow, her husband was able to give the young girls a crash course on Russian History and the Cold War. I wonder if I will be able to do that next time. Chua said she did law because she didn't want to do med school, but if she did I have zero doubts she would have become a surgeon.


I'd also found the girls' Jewish upbringing rather strange - but then again I suppose it's because as a Malaysian we are very sheltered from Jewish culture of any kind. The pro-Palestine agenda of Malaysian politics makes anything Jewish a touchy subject, and we certainly didn't learn about Yom Kippur or Bar Mitzvah in the Christian church. As Chua mentioned - the notion of a Jewish-Asian couple might seem strange to some, but it was a fairly common occurrence in University Towns in the States (probably no coincidence either that it's these two races). My parents themselves had Jewish-Chinese couple friends. But the Jewish culture just seems so foreign to me. I remember watching the mafia movie Goodfellas - there was a scene where the guy goes to see his Jewish love interest at her house, and when she sees he's wearing a visible crucifix, she buttons up his collar and hisses 'don't let my parents see that!' I always wondered what that was about.

Sophia is now at Harvard (of course) studying what seems like Sanskrit philosophy, and Lulu will probably join her there. She blogs at http://tigersophia.blogspot.co.uk/ - incredibly well written stuff, but of course nothing less can be expected of a tiger daughter.

Saturday, May 17, 2014

Nothingness.

I think I'm stuck in a rut.

Every day that passes, as the end of FY1 inches closer, my lack of interest in any specialty at all just gets more and more depressing each time. My crap CV doesn't help. There are many medical students out there with much more padded CVs than mine. I never had much interest in anything research or academic related, which is going to be the death of my career in medicine. Audits are the dryest things in existence. I fear teaching because there's nothing I can impart that juniors/medical students don't know already and I'll just make a fool out of myself. And then I wonder if medicine was really the right thing for me.

I don't hate it - even though the job is stressful, but everything is. But not hating something is probably not going to be enough to sustain a career in the future. I'm just trucking along each day like a mindless drone, desperately trying to manage a ward and feeling more and more inadequate each passing day.

The curse of apathy.

Saturday, April 26, 2014

A theory

I think I know why I am so awkward with angmos.

Let's say there is a scale that ranges from 客气 ke qi and pai seh, to good old British style taking the piss. In short, the social norm here is to take the piss. I was raised much more on the 客气 and pai seh scale. I remember times when we were younger if we started talking more piss than 客气my mum would shush us and tell us we shouldn't speak that way.

I have since been unable to take the mickey out of anyone, especially people you are superficially close to, such as angmo colleagues and classmates. The right interaction with say, your favourite SHO is - you're the worst SHO ever, the ward's so much better without you. They will make an equally cutting jibe but both know you're joking. I would tell them they are such good seniors and it was joy working with them as I learnt so much. It's polite, respectful, and of course they appreciate it, but you apparently don't build the same kind of deepness in the relationship that you get with telling them the opposite.

When I do attempt to take the piss out of someone, it just feels awkward and there's silence rather than recognition and a retort. Think anime-style grasshopper sounds.

I went out for dinner with some colleagues. The difference between 'having dinner' between asians/Malaysians and angmos. Both sides will deliberate for an annoyingly long time before deciding on where to eat, equally long time ordering food and by the time you're actually eating it's 9.30pm. Only the angmos go to a bar for a few pints first.

We then wandered for a bit before settling for one of those posh Indian restaurants with 'Best Scottish Curry Award' certs hanging off the wall and waiters who serve hot plates wearing white gloves. And where average sized mains cost as much as my weekly grocery shop.

Another difference - Malaysians will split the bill to the penny, but in angmo custom it is apparently acceptable to subsidise the drinks of others. Including the post dinner coffee. (I never really understood that. Who tf drinks coffee after dinner?) The food was decent, but in the end the bill cost me double my weekly grocery shop. I nearly feel physical pain.

The 客气 upbringing, combined with my inability to spend money ungrudgingly, are the reasons I have no social life with the angmos. Every outing somehow results in more regret over spent money and awkward moments than treasured memories.

Friday, March 28, 2014

holy shit its 4 months already???

I've been virtually working 12 hour shifts only for the past 4 weeks, I've nearly forgotten what it's like to have regular meals and exercise. If you think about it, 10 hours of free, non-working time is actually sufficient to get a 7 hour sleep and still have 3 hours for things like cooking or cleaning or even exercising. I know I have it much better than my colleagues in Malaysia/Singapore/the older generation, but sometimes I still marvel at how I can work the equivalent amount of hours an average 9-5er does in a week in less than 3 days.

So my general surgery block is coming to a close, and surprise, surprise, I'm actually a little sad to leave. Just a little. Surgery has been ups and downs and one hell of a learning experience. It's pretty much the 'real world' of medicine and I've been pushed far more than I'd ever been. I'd feel indignant at the vascular SHOs goyang kaki-ing while I stammered referrals down the phone, but at least I can hold my own now when bleeping the cardio reg. I'd gone from never doing a night shift to ringing a consultant at 4am with a severely unwell patient. I've come from flicking through the BNF for dihydrocodeine doses to signing off all the needed PRN prescriptions to stop nurses from bleeping me every 15 minutes. And now that I've actually felt a properly peritonitic abdomen, I'm a little better at sorting  teenager RIF pains from functional bullshit to the real deal. (But only a little. The regs can pretty much look at a RIF pain and tell if it's going to be a watch and wait or a dx lap.)

I'd say I've come off as a little more confident in general, except when it comes to the consultants. Quite frankly, 3 out of 4 of the consultants terrify me and let's just say it doesn't do wonders for my self esteem. I just feel constantly belittled and unworthy everytime I attempt to speak to them, so I don't, unless it's absolutely necessary. The regs nearly make up for it though. Though some came off as bursque and stoic, sometimes it's just the way surgeons are (and sometimes it's just a case of resting bitchy face. It's real.) Some are more approachable than others, but they're generally ok.


There's one reg I like in particular. He smokes like a chimney, swears like a sailor and has the most scathing, crude sense of humour which cracks me up everytime - but he's also the most appreciative, straight talking guy ever. Communication has to be clear cut, black or white, no waffle please. It's made me realize how much ambiguity goes on in our daily communication that only serves to confuse people or lead to non-decisions or non-resolvement of questions. He speaks his mind and doesn't give a shit what other people think. And he'd always say 'thank you' sincerely to the FY1s - the nobodys, the bottom of the food chain - for simple things like chasing bloods. It's the little things.

There was an incident once where I did something and the consultant got really mad, not directly at me but at the fact it had been done and he wasn't told. The reg immediately apologized on my behalf and claimed responsibility even as I was on the verge of tears. In the end there was no harm done and there wasn't even the need for anyone to be held responsible for anything, but I'll never  forget the way he stood up for me.

No matter how bad things seem, there'll always be someone who can make it a little better. It's in the people.

Also one protip: if your SHO is a CST, you're gonna have a bad time. Quite simply because they'd be scuttling off to theatre at any instance and feel nothing about letting you deal with all the ward work and crap. In fact the best SHOs on general surgery are the medic/GP wannabes, because yknow, they're actually around. And care. And help you when you're out of your depth. And have pretty damn good medical knowledge. It is scary being an SHO sometimes though, especially when it comes to presenting patients on the round. I have no idea how they can remember everyone. All the hemicolectomies and lap appendixes blend into one after a few. And consultants do not take kindly to a blank 'ummm..' on a round, or a mix-up. Personal experience. Which is fair enough.

God help me I'm 4 months away from being an SHO. (Which probably won't apply as I'll be my own FY1, SHO and reg in godforsaken Wick. As my favourite demure SHO would say, fuck me in the arse.)

Things to suck less at/to do in the next 4 months:
-talking to family (the dreaded 'patient's family want to speak to a doc')
-talking to angry family members  (kill me please)
-doing the palliative conversation
-dealing with sickies (never forget the ABG!)
-remembering and presenting patients
-get a proper audit going

Two more work days and it's hellooo neurosurgery!