Tuesday, June 14, 2016

Open ended questions are bullshit, cause patients be cray

I can't help but to stare at her lipstick. It's a bright red, almost orange. I catch a whiff of her perfume.

'Doctor, I always wake up wanting to go to the toilet to pee. Sometimes at night I cannot go. I sit on the toilet for hours but cannot pee. You know doctor, sometimes I sit on the toilet so long at night I fall asleep on it. I almost fall on the floor.' She says in a single breath, in a slight European accent.

It is 2.10pm in general gastroenterology clinic. Not urology clinic.

I sigh inwardly for the 4th time. I'd read her chart. PMH IBS, fibromyalgia, depression/anxiety, chronic pain, multiple drug allergies. I suddenly understand why residents were meant to do this clinic.

The GP has written a one-sentence referral asking us to scope her. Something about a polyp years ago. Change in bowel habits. No reports, no histology. She used to shit everyday. Now she shits twice a week.

Tried any laxatives?

No.

Ok.

I sit as she monologues about her bladder issues, her complicated knee operation, her gynae cyst, her mother's arthritis, her pain control meds. And something or two about unquantifiable abdo symptoms.

I feel her tummy, listen to her chest, look into her mouth. I tell her I'll check with the boss but I don't think she needs a scope. Boss agrees. We spend twenty minutes trying to explain why. As she gets up to leave she seems genuinely grateful, but as I'm writing up my notes comes into the clinic room again and asks if she can take NSAIDs for her diverticulitis.

(I'm like GTFO)

*

The next patient is a 60 year old who lives with his 80 year old parents, who takes only a liquid diet of kombucha and 'herbal remedies' for his 'bunged up gut' due to a dental procedure gone awry in the 90s. He refuses to sit down. He says it's because of his ear infection.

I ask why he can't sit because of that. I ask what happens when he eats solid food. I ask why he thinks his teeth fillings caused his malabsorption. I try to pry out his GI symptoms. It's like squeezing water from a rock.

He answers my questions with a gruff, impatient air, almost reminiscent of my older brother when he goes on a tirade about 'why people shouldn't exist'. He literally facepalms 50% of the time in front of me.

He demands a capsule endoscopy. I wonder why doesn't he go to his herbalist and demand for stronger detox grass stems instead.

*

I finish clinic over 2 hours later and head back to the ward, where boss rounds are starting. Our 20-something jaundiced patient with ascites is reluctant to get inpatient alcohol rehab. Another young patient was just admitted with decompensated alcoholic liver disease. A lovely 86 year old lady waits for a repeat ERCP and hopefully stenting for Something Nasty In Her Biliary Tree. She looks young for her age, if not for the fact that she is the yellowest person in the whole hospital.

*

Sometimes gastro is quite literally and figuratively shit. Sometimes it isn't too bad.

We'll see.

Thursday, June 2, 2016

Monday, May 9, 2016

懐かしい

Is it possible to miss something so much it hurts?

The answer seems to be yes.

I miss my old life, my old self, the old days where we were just a simple Kuching family living under one roof.

Children can be despicable. You can love them unconditionally, raise them with care, spend a ton of money of them, yet they'll still turn around and hurt you where and when it hurts most. The traditional Asian retirement insurance plan is having kids, but it's really a terrible investment.

The hollow feeling I have in my heart now is my punishment.





Also, Tinder is a fucking waste of time. 

Tuesday, May 3, 2016

Lingual







One day, I shall be in possession of such wisdom. Alas! That day is not today. Thus I continue my befuddled existence; a firm believer in meritocracy, yet that being the source of my discontent, for I know I will never achieve what my consciousness desires.

Read more, create more.
Succumb less, consume less.

Thursday, April 14, 2016

An analysis of behaviour

I am afraid to make mistakes. I am afraid to fail.

I am afraid to show my ignorance.

These things bring shame. I need to avoid it.

I lack knowledge, and just that something that makes one tie theory with clinical reality. I'd know about some physiology or pathology fact, but just can't link it to the patient or case in front of me until someone points it out specifically.

I can rote learn (hence tend to pass exams) but just can't seem to remember things beyond the exam.

My young appearance and meek disposition and lack of confidence means I still, after graduating and working for over 3 years, get mistaken for the intern/medical student.

The thought of teaching junior colleague or students terrifies me. What if they already know everything? What if they ask something I don't know and look like a fool?

I have no interest in socializing with colleagues outside of work, believing that our interests are to dissimiliar for me to actually enjoy it.

Chinese primary school was a double edged sword after all. Memories of being absolutely terrified of forgetting to bring books or homework (you get canned), doing badly in a test (you get ridiculed in front of the class), attracting unwanted attention from the teacher (who was feared more than loved) shape my personality today.

When I was a kid, it was easy. All you had to do was be 乖 [guai], be good at memorizing, don't cause trouble. As a health professional in the western world, the value of 乖 is almost nothing. The problem is 乖 is the only real thing I'm good at (despite trying to be somewhat rebellious during some teen years).

My bosses don't want a 乖 doctor. They want someone who can think for themselves, reason and debate and justify, rather than just follow what the superior/senpai says. Being 乖 is a fast track to getting nowhere in this career.

There are good and bad with eastern and western culture. I just can't seem to shake off the perceived 'undesireble' aspects of eastern culture that have been somehow much more ingrained in me that other chinese ed people (despite my 'banana-ness' back home)

I've been told time and again since university in the UK, that I'm a bit conserved and shy and need to speak out more, be more confident etc. In Malaysia/IMU I was on club committees and organized things and designed posters and participated in sports and almost single handedly put our yearbook together. What happened to all that?

I just went from being big fish in small pond, to small fish in big pond. That somehow affected my confidence greatly.

Now what do I do?

Tuesday, February 16, 2016

spinnbarkeit

And so the love-hate affair with emergency medicine works. The hours suck, half your patients are crazy or frail, you play ball in specialty/referral centre tennis, and on top of that there's annoying paperwork and admin. I now need anti histamines to fall asleep because my body clock is completely wrecked from the 3 years of shift work I've been doing. For every sensible patient with proper pathology there are 10 rubbish cases waiting. Sometimes though, sometimes, the moment you diagnose the STEMI or stroke or meningitis or whatever - maybe makes it worth it.

I also have to thank ED experience for teaching me the ways of the real world. I was always in a sheltered bubble growing up in Kuching, surrounded by straight-A university-going peers from stable christian families and by default I tend to think the best of people until proven otherwise. ED doctors think the opposite and can smell bullshit from a million miles away. I'm slowly picking up that skill and I think it'll serve me well in life, if I don't get too jaded too soon.

(I also did a very clean looking spinal tap! Must remember to check if there were RBCs or I'm owed a bottle of champagne or something. )

However I do realize I'm way behind my peers in Malaysia. By my stage any decent doctor would have done a laparoscopic procedure, a Caesarian, an intubation, a chest drain and seen far more trauma than I do in safe little Australia.

(You also know you're getting Australianized when you call it ED instead of A&E)

Back to the title - I used to never think much of it, but now every month I think - whelp, that's another one gone. And then I contemplate my own mortality. Funny how aging changes your thinking.

Sunday, February 7, 2016

dong dong qiang


虽然已经说过了,【明年尽量要回乡拜年】 今年并尊重不了这希望。 还在拼命的在这红毛人国家打工。 可不可说有些后悔呀。 看着朋友们的 newsfeed  充满团圆饭,回乡,和亲人一起度过美好时间的照片,心里有点寂寞。自己父母亲呢都去外国旅行了, 兄弟们都也没特别计划。 就过着普通的一个星期日傍晚。

明年一定会,一定会计划好好来。

Since leaving home - I'd celebrated CNY at home when I was in KL/IMU because we had provisions for such festive seasons of course. When I went to the UK, as a student I barely came home but there was a close knit enough group of Malaysians of all races there and we would go out for dinner at a Chinese restaurant of something.

CNY2011 - first year in a white man's land. Dinner with the Malaysian Society then another one with the IMU seniors. Those were good times.





CNY 2012 - smaller scale dinner at a steamboat place - I remember harrying about finding a 'halal' steamboat place because we wanted to included our Malay friends.



CNY 2013 - was exam season but we put together a chap goh meh do with the juniors (because le gasp we were now the 'seniors'!) It was also a time of extreme relief as we were just past med school finals (pre results tho)





CNY 2014 - first CNY of my working life. I was a gen surg FY1 in Aberdeen Royal Infirmary. I'd also worked shitloads of nights before and after, and worked Christmas so I could get time off to come back to Kuching.








CNY 2015 - first year in Australia. I was working on the day the IMUians had planned a CNY dinner so had to make do with making my own, and had beg my brother to invite whatever friends he had over so I could have some semblance of atmosphere.





To be fair I did go to a CNY dinner last Sunday with some very new church friends, so yay I suppose. But it looks like I may have to go without a CNY folder this year.

Hmm I wonder if I have chap goh mei off.

Anyhows, happy chinese new year to you reader anons.



Friday, January 15, 2016

;_;

Been a while since I've had the snuffles. Called in sick. Don't think I've done that before.


Have some moe Snape enka. 

Good night sweet prince

Thursday, December 31, 2015

Again

I suppose of one of the foolish things I do every year is have an expectation that the moment a year turns over the to the next year will be something special, as though I'd feel some warm fuzzy feeling or sudden burst of joy and optimism. I don't have this expectation with birthdays though. New years are always anti climatic. Always.

So here I am, post seven 12-hour nights -over-Christmas, rather sleep deprived from he nature of the shift more than anything else, thinking of what to type and say. Truth is although I rarely post anymore, I always have a swirl of thoughts in my head that I'd like to pen down, for the unexpected reader to stumble upon one day. I've never been a diary-ist, if there were ever such a word, so these thoughts go unrecorded, to remain fleeting moments of my conciousness, perhaps one day to disappear altogether like the wisps of smoke dissipating from a birthday candle.

I feel bad about this, because somehow I have this feeling that it's maybe a teeny little bit important to record down the person I am today, so my future self can perhaps look back and reflect. Maybe I'll try harder this year.

It's been a year since I settled in Queensland. It's been alright I guess. Not mind-blowingly fantasic or awfully bad. Just alright. Work's work. I got all the sign offs I need for general registration except the last one due soon. After that it's career path bla bla bla.

The number of social media friends getting engaged/married has just exploded exponentially this year. It's as though someone turned on a switch. Everyone gets to that stage I suppose. Meanwhile I'm just doing what I do best - waiting.

To be honest I did kind of expect things to pick up after coming to Australia, which was my aim for so long. Now I'm here things haven't really moved at all, (though it's my own fault for being a homey stick in the mud) sometimes I think I'm sort of in a rut.

The New Year is supposed to be for resolutions but 所谓:江山易改,本性难移。If one could innately stick to their diets and budgets, one would do so at anytime, not just at the start of the year, which is just an excuse. Hence why I never really believed in new year resolutions.

Maybe my eyes just can't see the opportunities in front of me, but at the moment all I can see ahead of me is relatively short sighted. I'm still running away from the future because I don't know what I want and what I'll be and it scares me. If you ask me, I think I peaked about 10 years too early. Even at my heyday I never gave much thought to the future because someone I always took it for granted that by the time I reached the bridge I'd have a plan to cross it. Choices are only of value to those who know what they want to achieve.

Anyway, have a good year ahead, whoever you are.


Saturday, October 31, 2015

Kita!

Because all you 5 readers of this blog are still here, you get first peek.

http://tokyodeshou.blogspot.com/

Enjoy >:3

Saturday, September 19, 2015

Today was a rough day.



It was one of those days in A&E where there were nearly as many patients in the corridors as they were patients in cubicles, where the list of waiting to be seen patients was long and never ending, where worktops started to get really messy, where colleague fuses tend to run short.

I think I have a sort of love-hate opinion about A&E (not shaking off the UK terminology not sorry). I love the range and variety of presentations and how I get to do a bit of everything. I've done speculums and slit lamps and sutured and plastered and jabbed more kiddies throats with fake ice creams sticks than I've ever done before. It's great. I love the generalist-ness of it all.

The hate part comes not just from the crazies that come but from colleagues whose fuses are short probably in part when the workload gets harder. Then there's the colleagues whom I just barely manage to get along with at work. Me being the ok-with-anyone type personality can usually get along with most people. Perhaps that's what they can't stand about me. That I'm too wishy washy and don't stand for anything. In loud and proud Australia, being overly humble and meek and pandering is not a prized attribute. Nothing gets me down more than the disdain of a senior colleague and this can spiral badly.


A colleague snapped at me in front of some patients. I'd already had a less than stellar run with doing a backslab wrong and wasn't feeling too great. Another colleague comforted me in an amazing way by just letting me get off the floor for a few minutes to get some air and have a good cry. It's times like this when I wonder why can't I be this kind and compassionate to others.

Sometimes I wonder if I'm truly cut out to be a doctor, emotionally. I feel like I don't have empathy, especially with psych(o) patients. There are too many examples when I have thought dully to myself it would be better if they didn't exist. Everytime a registrar is caught up in resus with some repeat teenage overdose, or the multiple presentations alcoholic who uses his benefits money to buy more booze, the homeless druggies who end up intubated on a $4000 a night ICU bed-  I catch myself thinking why do we try so hard to save these people who are trying to kill themselves? Why can't we just let them be?

Is it wrong for me to think this way? Probably.

And then sometimes, someone just shows me so much compassion I wonder what I would have done without it. My heart overflowed with gratitude at his kindness but the only and best way I knew to repay it was to pay it forward.

But also, in times of stress and hardship, will I be like the colleague who snapped or the colleague who comforted? It is much easier to be nice when you are not under duress.

God grant me love and compassion in difficult times, towards people that are hard to love.






Friday, September 4, 2015

Flight of ideas, birthday edition

Hello everyone, from the newly-turned-26-me.

I remember my 25th birthday post where I was doing ALS in Stornaway on the other side of the world. I said that if I got my wish, which at the time was to move to Australia, that would be the best present.

And here I am.

I may have hit a dearth or aims in my life though. It'd been relatively easy to have an aim all this while. In school it was just passing one exam after another. Same thing in Uni. Then it was getting signed off for every job, passing FY1, getting GMC registration, looking for Aussie jobs and relocating myself there.

I guess my life was planned till young adulthood in Australia, and it seems I've more or less reached the end point. Where to go from here? That's all I seem to be lamenting these days. I know, I'm in that so-called dreaded comfort zone that should be abhorred. I suppose the next logical thing is to decide on which path my career is to head to, find a nice young man, get married, buy a house, procreate.

Of course, it's not that simple.

Career and life partner are just two unfathomably big decisions and not one I would take lightly. To a certain extent one has some degree of control over career, in that you can always get a glimpse into different specialties by talking to people or attending courses and maybe even working as a junior in the job. Life partner is a bit less...straightforward?

Basically, I'm a skeptic, not a romantic. What 'The One' means to me, is not the fluffy good times we will have or the initial butterflies and 'honeymoon stage' of dating, but rather the question of 'am I willing to put up with this person's shit for the rest of my life?' We all have shitty aspects of ourselves and our personalities. Usually we hide it from fresh relationships - it's only when you know someone for a while and had a few spats with them, will you know their true colours.

And that's what I'm talking about. It is no mean feat putting up with someone else's shit or expecting anyone to put up with my shit for the rest of our lives. 'Shit' can mean anything from annoying but benign habits like snuffling or not taking out the trash, to full blown differences on the big things, baggage, family dramas, anything that makes you wish you were single again.

It's fine and all fun and games when we're fit and employed 20-somethings with our lives ahead of us. But curveballs and shit happens, and I will be lying if I said I wholeheartedly vow to love you in sickness and in health, in the good times and in the bad. And this selfish part of me is what makes me believe I am not deserving of or ready for this life partner thing. I enjoy freedom and not having to put up with anyone's shit, far too much.


If you're asking what I want - well, here goes. Whilst I'm still young and single and prevocational I want to live in Japan, even if just temporarily. A 3 month language course, a 2 month au pair type thing, a few weeks trawling the islands with a JR pass and couchsurfing account, anything like that. Assuming I get an SHO job in Brisbane for 2016, I'd take it up just for the added years in experience, then maybe in 2017 I'd locum an SHO job for half a year and be an overpaid glorified secretary in some rural hole of a hospital, then take 6 months to hopefully get the JP novelty out of my system so I can resume life as a normal human being. There's nothing with being  30 year old first-year PHO or a 40 year old primip, ey?

It's just a thought. It may or may not happen. I've not made any inroads yet (well apart from signing up for N4 end of this year). But I think I will regret it if I never did this.

At the moment that's the only goal that actually gets me excited, instead of the possibility of ending up a med reg or living in RA2-5 areas for the next 10 years.


Elderly wisdom is best wisdom though, so if any oldie thinks I am wasting my life and talking a load of rubbish please feel free to give me a virtual clout on the head. At the moment I am just thankful I have my health, a job, family and friends, right of stay in a politically stable country, and am not wanting for anything at the bottom rung of Maslow's hierarchy of needs.

Happy birthday me.


Thursday, August 6, 2015

Speaking of camels

Just a few things I learnt in Gympie: 

Newborns can and will pee and poop on you as you are checking their groins
Bogans will be bogans and there's nothing you can do
GP anaesthetists are totally rad
There are camels native to Australia

So in Gympie one lives the country life. And you can be a hospital boss and live on a self sufficient 200 hectare land and care for camels and horses.





They were shy. All running away from me

The let-down for milk is like 90 seconds so yield is much lower to that of cows. You'll get 2 litres between 5 or 6 camels if you're lucky. 


Contraptions

Basically why hipsters in Melbourne will pay $50/Litre for the stuff (yes that's market price)
Camels headin home

Also, freakin horses.



 I was the horse mad kid. I also grew up reading Enid Blyton stories detailing life on farms/the country/the circus. Naturally this was the stuff of my dreams.


The first and only time I rode a horse was during a family holiday in New Zealand. I was 11.

Not pictured: the chicken coop, industrial size water tanks, wild kangaroos hopping in the 'garden'.


Don't get any more country than a real log fire. And trading cows and horses and camels amongst your hospital staff colleagues.




Absoluely brilliant.  


Unrelated - Noosa National Park on a day off, in the dead of winter. It was a nippy 26 degrees.




No regrets.


Oh you naive little human.....is what I'll think one day when I read through all these quarter life crisis blog posts

So it's that time of the year where the UK docs change jobs. Only with my peers, it's the Big Career Step forward. Some are CMT or CST or GPST. Some got into paeds or obgyn, a few in opthalmology, some genuis in neurosurgery run through and even one in anatomical pathology.

I'm somewhat envious and curious. Envious that I am nowhere close to knowing what to do for the rest of my life, unlike these peers of mine. Curious to know what's I'd be doing now if I'd stayed on in the UK. Probs something broad based and relatively uncompetitive, like CMT.

I know it's just Social Media Syndrome. It's the endless posts of new CT1 Trainee badges and moving to new cities on timelines. But I'll be lying if I said this didn't get to me at all. I knew I'd be taking a step back moving to Australia, career wise. I still don't regret making the move. I still am constantly finding out what I want and how I may get it.

One of my biggest flaws is I give too many fucks about what people think of me. I want to be universally liked, or at least not disliked, or have anyone have negative perceptions of me. This applies to my professional and social life. Superficially I get along with most people fine.

Maybe that's why I don't seem to have too many deep relationships.

Professionally I know I can't stay like this forever. No Consultant is ever 100% good with everyone. Even the best consultants I've worked with, there will always be some badmouthing here and there to varying degrees. This is universal, not just in the medical field. No top honcho regardless of profession, goes completely unscathed behind their backs.

People will disagree with my clinical opinion and I will just have to stand up for my actions or at least be able to justify them. And this comes with knowledge (post graduate exams) and experience (seniority). At the moment I am nothing. At the moment I can still hide behind 'I'll ask my boss', but time's already ticking and the higher up I go the more I'll be expected to make independant decisions. It's a tricky balance between maintaining some autonomy appropriate for my level and experience, and not being a completely useless fuckwit of a PGY2 doctor.

This year is my transition year. Next year, it will be expected of me that I start making decisions.  

Here's another thing I noticed. My peers are all raring to the top career wise, trying to get the edge over any little thing that will pad their CV a little. Every doctor gathering I go to, someone will always have a wittier, more interesting anecdote or more harrowing experience than I have, or the time they made the right diagnosis that baffled consultants or when they got the cannula when the anaesthetist couldn't. This leaves me feeling somewhat inadequate at times.

The more senior doctors I've encountered however, seem to think it's perfectly fine that I haven't made up my mind yet. Old wisdom seems to dictate that young people should not just focus on work and money but rather family, relationships, experiences etc, because what good are money and assets at the graveyard? (Apart from being able to choose the type of funeral and burial spot you wish for, of course) This is of some comfort to me. I trust oldie wisdom.

My 10 weeks in Gympie as a jack of some trades master of none resident is coming to a close. Despite the on-paper immense duties I have, it actually isn't that bad. Sure I do paeds and general surgery and all that jazz but the patient load is nothing compared to that of secondary hospitals and nothings been too overwhelming. I can undress babies and change diapers now and am at least of some use in general surgical clinics and closed a Caesarian beautifully (if I may say so myself) and seen a camel being milked and overall am better off for the Gympie experience.

I am twenty five, going on twenty six. I am also working night ED shifts on my birthday.

Life will eventually sort itself out. Right?