Quips
Our University adopts a ‘Problem Based Learning’ (PBL) approach, which means we learn through weekly cases generated by the School of Medicine, are assigned to a group of 10 and spend 5 hours a week locked up in the room with 9 other people discussing the case and generating learning objectives, focus questions and eventually a case summary from it.
There are 4 semesters in a year, and each semester, every group is assigned a PBL tutor to facilitate the session. We have been having a particularly bad run with tutors this year, starting with the Russian Post Doc fellow who did not believe in a democracy and chose to play dictator, the retired GP who spoke about not much else apart from her ski trips and ski lodge in colorado and the ex-dentist, turned homeopath whom the boys never took seriously.
This semester we have Kath, an Emergency Department Registrar, with razor sharp wit and the clinical smarts we all so desperately need during our case discussion.
Here are some of my favourite quips from Kath thus far:
“I am an emergency medicine doctor and I have no empathy for people, please take your sob story somewhere else.”
To a particularly self righteous PBL mate
Kath: “Tim, have you ever been wrong in your life?”
Tim, after a moment’s deliberation, “No Kath, I can’t say I have been.”
Kath: : “Ah. That’s what I thought.”
To a particularly obnoxious PBL mate who signs off the attendance roll by initialing his name in caps
Kath: “Tristan, at which point in life did you develop this signature, kindergarten?”
Tristian: “Yea that would be about right”
Kath: “One hopes you have achieved normal developmental milestones in other areas of your life.”
“I work in the ED. I have a very short attention span. I hate long pointless presentations, have a timer set to 8mins and am not afraid to use it.”
Sun minus the humdrum
Visitors, music, food and glorious days in the sun.
It has been a spectacular 3 months, but now it is time to knuckle down and live life as a proper diligent medical student should.
“But what is happiness except the simple harmony between a man and the life he leads?”
-Albert Camus
Take and leave
I have recently assumed a role to serve the Singaporean community of medical students in our region.
I agreed because I truly believe in speaking up for the forgotten, and we have been, for a while now.
I do this, from the heart, without expectation of thanks, recognition and praise, honestly, truly.
But I find it so disheartening when I see through people’s false enthusiasm and pretense, and I realise that all they really want is to reap the benefits of our organization, exploit all we have to offer and give us nothing in return.
It takes all kinds, but that does not mean I should loose faith in humanity, as I once did some moons ago.
Breathe.
Carry on.
Well Woman
Having come off a 7.45 hour flight and having the arse luck of sitting next to a toddler with the smelliest pair of feet, feet she exposed after kicking off her shoes the minute the plane was airborne, I was faced with the next challenge of the day, performing a well woman check.
A well woman check, which, in this session, consisted of:
1) Full History taking with an extra emphasis on Obs and Gynae history
2) Breast Examination
3) Pap Smear
4) Bimanual Examination aka Pelvic Examination
Not only did I have to perform it, I was going to be assessed as well. Nice.
Now let’s rewind a little to the plane ride itself, because, the well woman check drama started from there. I chose to fly emirates from Singapore to Brisbane, a flight which originated from the UAE, which meant that one would expect a large percentage of the journey’s passengers to be of Middle Eastern descent. When I reached my seat (aisle seat in the middle section), I was the last passenger of that row of 4 seats to be seated. Next to me was a middle eastern man, next to him, his daughter (yes, smelly feet) and on the other side of his daughter, the man’s wife, lovely looking lady in her hijab. As I put my hand carry into the overhead compartment, the man looked at me and asked “Oh! Are you sitting here?”, to which I gave an affirmative reply. He then turned to his wife, and a little discussion ensued, the discussion ended with the wife knitting her eyebrows and shaking her head in disapproval. Next, shuffling of seats took place. Man carried daughter and placed her next to me, and he sat, sandwiched between his wife and the daughter.
Ah.
He had probably asked his wife if she was comfortable that he was seated next to me, a female. Fair enough.
Now, prior to the well woman check, I had a stack of literature to read, literature which contained pictures of breasts, vaginas, the insertion of speculums into vaginas and pictures of cervices. Now, I figured based on what had transpired prior, my Middle Eastern neighbour was not going to take kindly to pictures of the female anatomy being so brazenly paraded by this female neighbour. Stereotyping, perhaps, but I was really not in the mood to (possibly) create a scene, hence, I spent the next 2 hours hunched over the readings, trying to digest the information while, devising ways to strategically cover certain pictures, a challenge in itself.
The examination proper was less confronting than I had expected it to be. I attribute it to the fact that I was fortunate enough to be able to witness a number of OBGYN procedures during our elective in India, so to put it very crudely, I was already vagina-ed out. Still, nothing can quite replace the lump in one’s throat when faced with a naked woman with her legs spread eagle on top of a gurney, lamp shining strategically.
The fear for me was always that I was going to hurt my ‘patient’ (magnanimous female volunteer, and one per student!) during the insertion of the graves speculum.
And, my patient requested for water as lubricant, as opposed to the traditional gel lubricant. Thankfully, she didn’t experience any discomfort. The bimanual examination was a little unnerving as it required us to insert our gloved, middle and index finger into the vaginal canal up to the cervix and gently apply pressure on the uterus from above. As with the pap smear, I was so afraid to cause pain, and was happy if she kicked me in the head for it.
All in all, it was a fantastic experience, and has made me extremely appreciative of the people who so magnanimously donate their bodies (dead or alive) to science, medical students all around the world are indebted to you all.
Interestingly, there have been NO volunteers for the Well Man Checks, which includes a testicular examination and the much feared (tho irrationally feared) Digital Rectal Examination, which, requires the insertion of the examiner’s index finger into the rectum.
I do wonder why 
Fuel
Two of the few things that make life worth the living during pre-exam hibernation.
1. Coffee and biscuits
Specifically the coffee at 1700hrs. Not any earlier or later.
Earlier and a headache usually ensues, presumably due to the compounded effects of the already present caffeine from the requisite cuppa joe in the morning. Later and I would still be bright eyed bushy tailed at 0200hrs.
2. Receiving parcels
Ridiculous online shopping usually takes place round about 3 weeks prior. Inexplicable because I am not much of a shopper on any given day. Perhaps it is a desire to have some sort of life beyond cramming.
That is all
Memories
In New Delhi, anyone that walks through the doors of the emergency department (ED) in a government hospital seeking treatment, will receive it for free. Sounds good in theory, yes? But like all things free in life, it is abused.
The ED of the large referral hospital I was in sees an annual turnover of 2.4 million patients seeking treatment.
2.4 million. That is almost half the population of Singapore.
From an inexperienced medical student’s point of view, a day in the ED is utter chaos. You’ve basically been thrown into the deep end and left for dead.
The triage is usually done by the guards stationed in front of the main doors leading to the ED.
How do they triage? You ask.
“If can say name, ok. See doctor later. If cannot, not ok.”
Patients are wheeled in on gurneys by their relatives. Gurneys are parked side by side like sardines. There is no queue system, relatives have to fight through the crowds to hopefully try and have an audience with a doctor, any doctor, in the shortest amount of time. They will then try to explain the situation amidst the cacophony of screams while handing over the patient’s case file/outpatient referral slip.
Good luck to those who come in on their own. They are wheeled in by the guards, and lie in wait among the sardine pile, till a doctor notices them.
Like a man from Chennai who had come in alone, severely dehydrated from acute gastroenteritis.
In his semi delirious state, he managed a, “Hello, my name is XXX. I am from Chennai. I am single.”
Eh?
“Oh. He’s telling us, he’s alone.”
A lost in translation moment.
But, chaos aside, all patients will eventually be seen, charts will be written up, they will be accessed, stabilized and either moved to the appropriate department for further investigation or treatment/kept in the holding area for overnight observation/sent home.
Night will come, the next team will take over and begins the cycle all over again.
“Can I have a feel?”
80 year old male, admitted to the cardiology ward for further investigation after a murmur was found when he presented to the ED with central chest pain, dyspnoea/SOB/shortness of breath , sense of impending doom (an actual symptom for someone having a myocardial infarction/MI/heart attack ).
Sweet old man we thought, as we take the requisite history before we move on to a cardio-respiratory examination. My partner S, gentle young thing with big beautiful eyes takes the lead in the examination. She stands on his right, as we are taught in the textbooks, and leans over to feel for his apex beat located slightly under his left nipple. Old man’s hands are raised up above his head at this point and before we know it, his right hand reaches out to S. S moves back and offers him her hand, thinking that he needed some sort of comfort.
“No, no, come here”, he says, letting go of her hand.
“Can I have a feel?”, he says, as he cups his right hand 2 inches beneath her left breast.
S’s eyes widen in shock and moves back, managing a “no, of course not!”.
S, mortified, composes herself quickly and continues the examination, still trying to feeling for his apex beat.
“Aww, I wish I could do the same to you” he says after she finally removes her hand from his L chest.
“Jo, can you confirm the location for me?” S pleads as she walks away from him.
I move in and lean forward holding my file firmly against my chest while I place my hand on his chest, terrified, but trying my best to give him my sternest look.
S decides to continue after I confirm the location and proceeds to auscultate the old man’s heart.
His heart sounds are extremely interesting, we momentarily forget what had just transpired and spend a good 3 minutes having a listening to the various heart valves. Old man behaves himself.
“Did he touch you?” I ask, the minute we walk out.
“No”, says S.
We both look at each other still reeling from the whole experience.
“Molester”, I manage to mutter after a while.
Reporting the incident to his doctor/the nurses would have served no purpose other than to prevent something like that from happening again. What did we expect, really, for them to call the cops and get old man in trouble for sexual harassment? We decide to leave the ward after looking at his case notes and move on to our next case.
I don’t think this is the last time something like this will happen, through the course of our career. We both decide we need to be firmer and more assertive with patients, instead of being overly apologetic for feeling like we are intruding in on them and as a result become overly accommodating allowing for patients to feel like they can take advantage of us.
Time to put on our stern, we mean business faces.
Hot, not
Found an excuse to talk to hot doctor in the nurses station today as we were looking for patients to do a long case (ie: full history taking and physical examination of all systems). He directed us to a patient, whom, he said “one look and it should be obvious to you what the diagnosis is, come back to me after you are done and we will discuss his case.”
SCORE! I thought, we get to talk to hot doctor and score a 1 on 2 tute after.
Said patient (severely jaundiced with obvious abdominal distention) was not in the mood to entertain medical students and promptly rolled on his side and closed his eyes as we approached his bed.
Oh well.
We bump into hot doctor as we try to slink away unnoticed from leave the patient’s bed, I flash him a smile and say “too tired, better luck next time.” Hot doctor proceeds to corner us along the corridor and pop quizzes us for the next 10 minutes on what we think the possible diagnoses might be based on observation, possible complications that might arise as a result of the condition and signs we would expect to find.
My partner breaks out in cold sweat as she tries to answer his firing squad style questioning. I rattle off best I can, with my mind drawing many blanks as I proceed to notice his crisp Versace shirt and leather shoes.
Mmm. So much for making an impression
No more accosting hot doctors, me thinks.
Away with ruts!
Best cure for academic misery/misery in general.
1. Purchase new album from itunes store, or if you are on a budget, revisit an old album, preferably something uplifting, really would not want to be listening to something wrist slitting inducing at this point. My choice was Fanfarlo’s Reservoir. Music sorted, now sync ipod or download music onto music device of choice.
2. Pull on favourite pair of ratty but extremely comfortable tracky dacks
3. Put on comfortable footwear, function over form.
4. Exit home/hole of filth/misery
5. Take a deep breath, pause, put track 1 on. Yes, the pause and the deep breath is imperative.
6. Begin, one foot in front of the other. Yes, you can do it.
7. Pick up pace now.
8. Flat ground for about 5 mins or so then start looking for some hilly terrain to begin some serious rut bashing.
9. Uphill for a good 10 mins, scroll through album to pace heart rate with music.
10. 5 mins of downhill
11. Back to walking on flat terrain.
12. Pause to pat and coo at neighbourhood cat
13. Smile at neighbours, the same neighbours who have been driving you up the walls with their thumping bass heavy music at midnight.
16. Return to what used to be hole of misery.
17. Walk around for a bit, and do a little heel click upon realization of inclusion of bonus track in new album.
18. Sit down for a bit and enjoy sweat rolling down face and back.
19. Hit the shower
20. Emerge and make yourself a nice up of tea, before getting back to the grind.
I prefer evenings, but I think mornings will work just as well too
