The Walls Are Coming Down
They swallowed it whole, they went for the gold, for the gold
We fall for the same lies we all have the same shoes to fit
The preachers and books of your empire will fight here alone
Some day the will be forgotten and die one by one
The walls the walls are coming down
The here and now is coming round
It will some day let you down
The ships the ships are coming in
The great ideas are wearing thin
There is nothing left to do
For atoms have gone as far as atoms will go
Your books write themselves
They line up in row after row
The walls the walls are coming down
The here and now is coming round
It will some day let you down
The ships the ships are coming in
The great ideas are wearing thin
There is nothing left to do
All in good time
Presenting complaint: 70 yr old, male. Claims that he had a fall in the toilet, due to OA (osteoarthritis) causing his knees to buckle forward under his weight as he was getting up from the toilet bowl. He lay on bathroom floor for a day and a half before using a spoon to reach the phone to call himself an ambulance.
I get this far in my history taking, then everything else the patient tells me starts to become a blur, his lips are moving but I am not listening. I am overcome with grief. My thoughts become fixated on a few things.
1) He lay on the bathroom floor for a day and a half!
2) I am immensely upset!
3) Ask about social support, that’s all that matters, ask about social support!
4) He lay on the bathroom floor for a day and a half!
I compose myself enough to resume listening, and shoot my partner a few apologetic looks.
This is one of my few stumbling blocks in medicine. I get very emotionally attached to patients so much so that I often become paralyzed with overwhelming grief, sometimes to the point where it renders me ineffective. Last week my demon came in the form of a 50 year old male who had been in hospital for 2 months receiving chemotherapy for mantle cell lymphoma. The prognosis was not good. He was terminal and coming to terms with his own mortality, very evidently depressed yet still rallying strength to fight, what he thought was a long battle ahead. I thumbed through his case file after the requisite history taking and examinations and saw that his doctor had made a note for a possibility of a referral to palliative care. That broke my heart. I went home very depressed and remained in that state for a few days. I thought about my demon and debated if I would ever be able to separate my emotions from the job, if in the preliminary phase I am already struggling against becoming a sobbing mess.
I don’t think how I reacted was necessarily a bad thing. Should the day come when I become so hardened and impartial to suffering, I think that would be a sign for me to leave this profession altogether. But, I have to be more in control of my natural instinct to want to do everything I can to make this person feel better, manifesting as debilitating overt empathy.
Having said that, we are constantly being reminded that we should treat all patients as a person with a condition, not a condition with a person. Very evidently, some of my peers, no doubt very brilliant, have trouble injecting emotion into the profession.
I know I will be able to compartmentalize my emotions a lot better as I progress through this course and will eventually be able to maintain composure and a clear train of thought, so that in the future, I can ask pertinent questions like,
“Can you tell me what were you doing with a spoon in the toilet?” 
Four eyed good…
I got a pair of reading glasses made when I last went back to Singapore. I was having problems reading for extended periods and found that I had to squint to see calibri font 11 (a favourite and oft used font) on my computer screen.
The diagnosis was astigmatism in left eye with mild long sightedness in both.
Crikey. Only geriatrics wear reading glasses, I thought. Oh well, just make and keep (in a secret hinding place) the pair and use only when absoutely necessary.
I have resisted wearing them, but with readings piling up and work to be done, it is talking a toll on my poor eyes again. I was wondering if the time it took (one day) for me to complete my 4 page summary on hypo and hypercalcaemia was as a result of pure procrastination or the slowing of my mental faculties, till I caught myself hunched over leaning forward trying to see what was on my computer screen.
Bollocks. Bollocks. Bollocks.
Guess I can’t fight it anymore.
Med school, you bastard, you took away my 6/6 vision.
Card
Did not get round to posting this excellent birthday card made by the very talented Sonny Liew
None of the gnomes in my life look quite so scary, but hey, there’s always space in the brood for a vampire gnome I think! Still, I’m getting the boys to start work on a garlic patch in the garden as a precautionary measure
Pulling our weight
In time we might walk the straight line
But with memories of a grapevine
A guitar, as we came close from far
Forgot about the war
We barely touched
As if being watched
And even in time
We’ll give in to crime
We’ll be on the line
Pulling our weight
Many miles from where I’m sleeping
You share laughter in the evening
As do I, in the great divine
Yours is mine
We’ll find love
The kind we’re dreaming of
And even in time
We’ll give in to crime
We’ll be on the line
Pulling our weight
Strange things will happen… today?
Today was a pretty day
No disappointments
No expectations on your whereabouts
And oh, did I let you go?
Did it finally show that strange things will happen if you let
them?
Today I didn’t even try to hide
I’ll stay here and never push things to the side
You can’t reach me cause I’m way beyond you today
Today was a pretty day
Autumn comes with
These slight surprises where your life might twist and turn
Hope to unlearn
Strange things will happen
If you let them come around and stick around
Today I didn’t even try to hide
I’ll stay here and never push things to the side
Today I didn’t even look to find
Something to put me in that peace of mind
You can’t touch me cause I’m way beyond you today
A Quickie
In the hospital library now using the internet (no internet at home for another week or so) so thought I’d just cough up a quick and dirty post before I get back to doing some actual work
I am still here, a little worse for wear, but still alive after having to up and move to a new rental property and having to deal with all the extra bits that come along with coping with the rigors of Med and with differences in personalities in a diplomatic fashion.
Milestones and other frivolous loose ends
1. Medicine: We get to go on wards once a week this year for our 1.5hr long clinical coaching session with our registrar. YES! Wards! Meeting actual patients! Listening to hearts, lungs, palpating for livers, spleens, kidneys, conducting neurological exams on actual patients, not each other
2. The new house: We have a garden. A lovely garden for, well, gardening. My room is 2.5x the size of my old one, its a little further into suburbia, but we love it nonetheless.
3. Iggy Pop: Our neighbour’s dog is the sweetest mutt. He came onto our porch one night, tail between his legs, extremely shy and placid. I found out that he was adopted by from the RSPCA. His hind legs are weak and unstable from what we presume to be, the abuse he used to receive.
4. I bought an iPhone
K. Back to the books!
