i am lying in bed with my macbookair, thinking of how much of my material assets i do not use. when i come home the only things i ever really touch are my toiletries, the bed and the computer. there's no need for all the soft toys, storybooks, posters of jaychou, and thousands of postcards/keychains/trinkets randomly collected over the years. they don't seem to add any value. i can't even remember when or how i came by half of them. feel like throwing out everything, pressing delete, and starting from scratch.
just me, the bed, a toothbrush and my macbookair.
i feel like i'm in limbo. can i really bring myself to just pack every object, that somehow used to be a part of my growing up, into black plastic bags and not give a hoot? what if my macbookair crashes and all the photographs i did not develop were to disappear forever and ever?
i also feel like i want to quit working and travel forever and ever. be a stranger in a strange land, although i like the familiarity of my bed, the smell of my kitchen and the warmth that spreads through my chest when i hear the heavy breathing of the rocky monster the moment i step into the house. i want to just float around, and not be committed to anything just for a few years or so. damn the bond. but is that just an excuse for not being brave enough to just go?
hai.
maybe lack of rest, proximity to exams, or simply the underexposure to sunshine is making me feel this way. or a retarded quarter century crisis kinda thing.
Saturday, August 27, 2011
Saturday, January 29, 2011
redefining hope
on normal night calls, just a glance to check if it's a real plastic IC rather than a photocopied version. but last night i had some time, and was (honestly) attracted to the blue tag to be attached to the body.
so i took a longer look at the photograph. a fine featured lady, with well groomed hair and a smile that radiated confidence and sheer happiness. out of curiosity i flipped open the big blue case file, its thickness an indication of her length of stay.
on the first page, in large clear letters, an order for no extraordinary measures to resuscitate her if she were to pass on. and her diagnosis - which happened to be the same as the cause of death, in as few words as possible (each letter on the death certificate costs money)
subsequent pages in the file were a summary of her condition till date. somehow it was not as medical-jargon-littered as i expected it to be. it started off with her social background - 49 and already widowed a few years ago, with 2 children under the age of 30. a beautician by training. it struck me that the man at her bedside was probably my age or thereabouts. the only difference is that i still felt like a kid while he was a grown person with a heavy load on his shoulders; it's never easy to watch your only living parent take her last gasp of breath. it's never easy to watch the process of deterioration, from fighting a cancer so bravely to stopping all therapy and just waiting and praying for It to be as painless and peaceful as possible. it's never easy to find your world spinning madly out of control and changing forever more.
he asked me if i was here to certify the death. it was the most awkward question because i was the one who was called yet i had no license to do so. all i could do was wait for a senior. he didn't know what i was saying, i don't think it mattered. his mind was overwhelmed with change, it did not matter that i was not the one to pronounce the death.
meanwhile, i went behind the curtains to check for any signs of life. not that i was expecting to find any as soon as i saw the flatline on the monitor. a moment of solitude without her family members who had throughout the night, one by one, streamed in and out. in that minute while i was there, i served no purpose. i could not bring her back, nor could i offer comfort or closure to the family who had their fair share of grief that night. they already knew, they already came to say their peace.
no one had bothered to switch off the wall oxygen, vigorously streaming air into her via nasal prongs, obviously to no avail. it seemed a tragic joke for a milisecond. i turned down the oxygen, and covered her exposed areas with a blanket; the ecg leads were hanging precariously from her unmoving chest as someone had moved the machine and dragged the leads with them. then i looked at her face and startled myself. this was not the woman in the photograph. her left eye was swollen shut, her right eye was fixed, half open, half staring ahead. her frozen face so haggard and sallow it was completely unrecognisable. the photograph did not capture the hours of misery she must have endured, from making the decision to stop her therapy, to telling her children, to accepting death. if at all. her left hand was puffy, and cold to touch - yes i still reached out to pat her hand to comfort her, out of reflex i guess.
i wondered, if she was a troublesome patient and seriously doubted it. their perspective must have been the complete polar opposite from the rest of the patients'. it was just a quiet few minutes of the night call that brought along such reflective thoughts i'm not eloquent enough to put down in words. if you knew your patient only had a limited time and there's nothing to do to stop It, would you still try your damndest to help them? how? by making things easier for them and their families, what with the circumstances, the managing team pulls out all stops and takes nothing lightly. so many people hope to be cured, but special patients these are. they hope to go... on their own terms. no wonder they call it redefining the meaning of hope.
so i took a longer look at the photograph. a fine featured lady, with well groomed hair and a smile that radiated confidence and sheer happiness. out of curiosity i flipped open the big blue case file, its thickness an indication of her length of stay.
on the first page, in large clear letters, an order for no extraordinary measures to resuscitate her if she were to pass on. and her diagnosis - which happened to be the same as the cause of death, in as few words as possible (each letter on the death certificate costs money)
subsequent pages in the file were a summary of her condition till date. somehow it was not as medical-jargon-littered as i expected it to be. it started off with her social background - 49 and already widowed a few years ago, with 2 children under the age of 30. a beautician by training. it struck me that the man at her bedside was probably my age or thereabouts. the only difference is that i still felt like a kid while he was a grown person with a heavy load on his shoulders; it's never easy to watch your only living parent take her last gasp of breath. it's never easy to watch the process of deterioration, from fighting a cancer so bravely to stopping all therapy and just waiting and praying for It to be as painless and peaceful as possible. it's never easy to find your world spinning madly out of control and changing forever more.
he asked me if i was here to certify the death. it was the most awkward question because i was the one who was called yet i had no license to do so. all i could do was wait for a senior. he didn't know what i was saying, i don't think it mattered. his mind was overwhelmed with change, it did not matter that i was not the one to pronounce the death.
meanwhile, i went behind the curtains to check for any signs of life. not that i was expecting to find any as soon as i saw the flatline on the monitor. a moment of solitude without her family members who had throughout the night, one by one, streamed in and out. in that minute while i was there, i served no purpose. i could not bring her back, nor could i offer comfort or closure to the family who had their fair share of grief that night. they already knew, they already came to say their peace.
no one had bothered to switch off the wall oxygen, vigorously streaming air into her via nasal prongs, obviously to no avail. it seemed a tragic joke for a milisecond. i turned down the oxygen, and covered her exposed areas with a blanket; the ecg leads were hanging precariously from her unmoving chest as someone had moved the machine and dragged the leads with them. then i looked at her face and startled myself. this was not the woman in the photograph. her left eye was swollen shut, her right eye was fixed, half open, half staring ahead. her frozen face so haggard and sallow it was completely unrecognisable. the photograph did not capture the hours of misery she must have endured, from making the decision to stop her therapy, to telling her children, to accepting death. if at all. her left hand was puffy, and cold to touch - yes i still reached out to pat her hand to comfort her, out of reflex i guess.
i wondered, if she was a troublesome patient and seriously doubted it. their perspective must have been the complete polar opposite from the rest of the patients'. it was just a quiet few minutes of the night call that brought along such reflective thoughts i'm not eloquent enough to put down in words. if you knew your patient only had a limited time and there's nothing to do to stop It, would you still try your damndest to help them? how? by making things easier for them and their families, what with the circumstances, the managing team pulls out all stops and takes nothing lightly. so many people hope to be cured, but special patients these are. they hope to go... on their own terms. no wonder they call it redefining the meaning of hope.
Friday, December 31, 2010
bye 2010!
it's been a while! 2010 passed by really quickly since work started and now blogging seems like such an ancient thing...
for tradition's sake, the 10 best things of 2010....
(an coincidentally, all these happened AFTER point number 1)
1. being over and done with mbbs
2. having a brand new niece
3. going to africa (now see points 4 and 5)
4. climbing a mountain till my legs were about to fall off
5. seeing the best sunsets Ever at the Serengeti
6. starting work (haha i might have to rethink this) and meeting a whole buncha cool people
7. having leave! :D
8. being thanked by grateful patients! :)
9. quitting my tv addiction (yeah right)
10. having really great company whenever Somebody isn't overseas
hai. such lacklustre blogging... time for a break.
for tradition's sake, the 10 best things of 2010....
(an coincidentally, all these happened AFTER point number 1)
1. being over and done with mbbs
2. having a brand new niece
3. going to africa (now see points 4 and 5)
4. climbing a mountain till my legs were about to fall off
5. seeing the best sunsets Ever at the Serengeti
6. starting work (haha i might have to rethink this) and meeting a whole buncha cool people
7. having leave! :D
8. being thanked by grateful patients! :)
9. quitting my tv addiction (yeah right)
10. having really great company whenever Somebody isn't overseas
hai. such lacklustre blogging... time for a break.
Sunday, May 02, 2010
maydaymayday
work is starting soon. going to go one day earlier to make sure things handover smoothly. how surreal is it that i get to say work instead of school.
grad trip to africa with 6 people i was not so close with turned out to be the best travelling experience ever, and now i have 6 good friends :)
here's my usual 10-things-i've-learnt-during-my-holiday shpeel:
1. corruption is abound, 20 bucks to bribe a police man to write us a lost items statement when wx lost his phone on the bus
2. sunsets, with no buildings to interrupt your line of vision, are heavenly. serengeti (meaning endless plains) lives up to its name, with clouds stretching as far as the eye can see, with all the shades of grey and silver possibly known to mankind.
3. animal sightings are fun, only for a maximum of 4 or 5 days. and that's if you're as lucky as i am; i got to see "the big 5" of african safari animals :) and lions mating - the stuff of natgeo documentaries!
4. if your mosquito net has holes in it, you might as well not use it. (i was going to take a photograph of it but i was too itchy to take out my camera so here are some elephants instead :)
5. falling asleep on a window seat in the bus/safari jeep will most often lead to a sunburn on that side of your body. in africa, sunblock up! btw fyi they buy 2nd hand cars from countries like singapore - check out the comfort cab we spied in zanzibar, where they didn't even bother to paint over the old adverts on the side (call 6552 1111!)
6. floating around in the indian ocean will most often lead to a sunburn on the backhalf of your body. that said, snorkelling in zanzibar is AMAZING. visibility of ~10-20m? AND DOLPHINS!!!! (okay, no photos because we were in the water for the visually stunning stuff and had no underwater cameras) oh, and zanzibar i will always remember for being the place we got our results, at 4am no less, and started a screaming/shouting fest in our bungalow by the sea :) hurray!
7. walking upslope to an elevation of 5000metres above sea level brings you closer to the sun, and will most often lead to a sunburn where you do not cover your face with sunblock/a ski mask. when summiting, ensure adequate protection!
8. please train before climbing a mountain, especially if it's the tallest peak in africa. mount kilimanjaro was physically demanding only because of our lack of fitness and the ever unpredictable altitude sickness. and also, retching is as miserable as puking.
9. sometimes it's the walking downhill that is more disastrous than walking uphill. for proof of that, i have bilateral subungal hematomas that turned from red to purple to blue to TOXIC GREEN.
10. appreciate, and use, clean toilets (especially those located above the level of the clouds with superb views albeit nasty smells!), drinkable water, and a roof over your head, as often as you can, whenever you can. just in case you don't get a chance to use them again for a long long time.
that's all for now, time to rest and enjoy my last few hours of freedom. glad to have had this chance to recharge and super happy to have such nice (for now) employers! :D
grad trip to africa with 6 people i was not so close with turned out to be the best travelling experience ever, and now i have 6 good friends :)
here's my usual 10-things-i've-learnt-during-my-holiday shpeel:
1. corruption is abound, 20 bucks to bribe a police man to write us a lost items statement when wx lost his phone on the bus
2. sunsets, with no buildings to interrupt your line of vision, are heavenly. serengeti (meaning endless plains) lives up to its name, with clouds stretching as far as the eye can see, with all the shades of grey and silver possibly known to mankind.
3. animal sightings are fun, only for a maximum of 4 or 5 days. and that's if you're as lucky as i am; i got to see "the big 5" of african safari animals :) and lions mating - the stuff of natgeo documentaries!
4. if your mosquito net has holes in it, you might as well not use it. (i was going to take a photograph of it but i was too itchy to take out my camera so here are some elephants instead :)
5. falling asleep on a window seat in the bus/safari jeep will most often lead to a sunburn on that side of your body. in africa, sunblock up! btw fyi they buy 2nd hand cars from countries like singapore - check out the comfort cab we spied in zanzibar, where they didn't even bother to paint over the old adverts on the side (call 6552 1111!)
6. floating around in the indian ocean will most often lead to a sunburn on the backhalf of your body. that said, snorkelling in zanzibar is AMAZING. visibility of ~10-20m? AND DOLPHINS!!!! (okay, no photos because we were in the water for the visually stunning stuff and had no underwater cameras) oh, and zanzibar i will always remember for being the place we got our results, at 4am no less, and started a screaming/shouting fest in our bungalow by the sea :) hurray!
7. walking upslope to an elevation of 5000metres above sea level brings you closer to the sun, and will most often lead to a sunburn where you do not cover your face with sunblock/a ski mask. when summiting, ensure adequate protection!
8. please train before climbing a mountain, especially if it's the tallest peak in africa. mount kilimanjaro was physically demanding only because of our lack of fitness and the ever unpredictable altitude sickness. and also, retching is as miserable as puking.
9. sometimes it's the walking downhill that is more disastrous than walking uphill. for proof of that, i have bilateral subungal hematomas that turned from red to purple to blue to TOXIC GREEN.
10. appreciate, and use, clean toilets (especially those located above the level of the clouds with superb views albeit nasty smells!), drinkable water, and a roof over your head, as often as you can, whenever you can. just in case you don't get a chance to use them again for a long long time.
that's all for now, time to rest and enjoy my last few hours of freedom. glad to have had this chance to recharge and super happy to have such nice (for now) employers! :D
Monday, March 29, 2010
24 hours later
IT'S OVERRRRR :D
time to play, travel, and stop facebooking! :)
aka, have a life! :)))
cyall when i return from the great continent of air-free-karrrr
time to play, travel, and stop facebooking! :)
aka, have a life! :)))
cyall when i return from the great continent of air-free-karrrr
Friday, March 26, 2010
last days as a medical student
sure feels uneasy. i pray. seriously, sincerely and wholeheartedly pray, that things go alright the next 2 days, the last 2 days of m5. and that monday marks a whole new chapter of our lives. hopefully will be employed by mid-april and have to come back to start that dreadful thing called work, which i'm looking forward to more than tmr's medicine long case exam.
it's just nervous rambling here. hai. maybe more when i come back from battle =p
addendum: may the medicine good luck carry through another 24 hours please please please. i am thankful for today's nice examiners and thoroughly helpful patients! :) good job, carry on! PLEASE!
it's just nervous rambling here. hai. maybe more when i come back from battle =p
addendum: may the medicine good luck carry through another 24 hours please please please. i am thankful for today's nice examiners and thoroughly helpful patients! :) good job, carry on! PLEASE!
Wednesday, March 24, 2010
surgery session 4 0730hrs
it has finally come, the day where we sit for our final mbbs clinical exams (or actually this is just for the surgical track) . all the late nights, or attempts at it, and all the facebook learning have come down to the next few hours. or rather, 30+20+16minutes.
the night before, insomnia and eventually a strange dream about barney stinson from himym bullying a little kid in the mirror.
the morning itself, palpitations. even more than the 4 days of serious palpitations every time i read the accounts from my classmates. here's my own account.
SYSTEM: ortho
ACCOUNT: not my birthday, didn't get the 2 prof lows for shorts or longs. but the 2 mentioned are rather cute, smiley and very encouraging. really helped when you get freaked out after reading 4 days worth of scary accounts.
Summary: Right OA knee X 3 years, secondary to right tibial fracture (fixed in a cast, no plates or screws, healed with malalignment 35 years ago) currently on glucosamine daily and paracet prn, on follow up at ttsh, not for any op in the near future, woohoo. Typical history of right mechanical knee pain, ruled out inflammatory causes, malignancy, septic arthritis, and screened for other joints. Function limited due to the pain, can't jog his normal 10km/day (this 71 year old uncle is fitter than all of us now) and sometimes difficulty kneeling to pray in the mosque. no DM, only htn and chol. 30 minutes passed really quickly, but in between i was talking rubbish with my patient. NO MO TO HELP WITH ANYTHING. but nvm, OA knees, damn happy already. Examine knee, remember to walk the patient. This man compensated with his other leg, which i suspect is also in pain but he refused to say cos he was scared i'd have to present more things.
They came in while i was examining his limb length which the patient pointed out to me in the beginning but i just got carried away after my initial knee exam, heart lungs abdo. can i just mention that i LOVE this man, he spoke english fluently, clarified every point for me, and even said "er i have back pain also but i can don't tell the examiners later, it's not that important" when i looked a bit shocked after taking an entire OA knee history. "no no, uncle, thank you but every pain is important to me, but if it's not bothering you, then we concentrate on the main knee problem la okay."
AT said, why don't you leave and consolidate, while we talk to him a while (is this what everyone got to do?? it's surg right, not med??) quickly summarised my points on a separate paper while i overheard the testers asking the patient for his main complaint. then the invisible MO came to tell me, eh not much time leh, just go back in. 71 year old malay man, retired protocol officer (CT interrupted and was like, wow what is a protocol officer, and started asking the patient which VIPs he escorted etc etc... WASTE TIME)
After i finished presenting, the typical qns ensued.
1. What are your differentials? "RA, gout, septic arthritis are not so likely"
AT: Huh? Girl, where's your main diagnosis, why did you say the rest first! Calm down! "oh yes, sorry i thought i made it clear in my history and summary that my main diagnosis is OA knee"
2. Oh, so in this case, we learn that there's more to OA than just primary OA right. what is the main cause of his right knee pain? - "the tibial fracture causing malalignment so development of genu varum and redistribution of weight causing increased wear and tear of medial compartment of the knee joint. "
3. Why did you tell me about no LOA LOW night sweats and night pain? to rule out TB/mets.
4. What other parts of the history are important.
5. Show me how you examine his knees, so i rolled up his trousers and started describing the genu varum, 8cm intercondylar distance. Name me the effusion tests, how to do.
6. Oh i see you marked his quads, very good. Oh i see you marked his asis and medial malleoli, very good. So is there limb length discrepancy? "sir i measured and found that there's NO discrepancy even after squaring the pelvis etc" (i really found no discrepancy but then when i looked down i saw there really was shortening, argh!) "however i would expect there to be in this case because of his genu varum as well as the tibial fracture causing shortening" OH okay, we believe you then, since you already marked everything nicely.
7. Okay, show me range of movements. What does he have? "Fixed flexion deformity." Prove it.
Tell me what it's called when on passive movement he CAN extend? BRAIN BLOCK. "er, flexion deformity, not fixed." AT laugh laugh laugh, yes you just described what i asked but is there a name for this, girl? "er, extensor lag!!!!!" YES, let's move on.
8. They brought me outside the cubicle and showed me an xray THEN asked for investigations. "As a HO and on admission, do typical bloods, and AP/lateral (weightbearing) + sky line xrays" Describe the xrays, which compartment is affected?
9. How to manage? Regurgitated everything in the last 20seconds after the bell rang.
Advice:
1. Clerk quickly, examine quickly, 30 minutes passed so quickly.
2. Give a good summary.
3. NO MO IN ___ TO HELP, except to tell you that there's 5minutes left. but if i pass and if i'm a HO in ___, and if i'm free, i'll come and help :)
4. If the tester wastes time, just use the time to think about what to say next
5. Just say simple things and don't shoot yourself in the foot esp if you have a nice straightforward case
6. Thank your patient! Build KARMA!
SURG: Short cases
HOSPITAL: ___TESTERS: CNL (nice nice!!) and some other nice old man (i love old men!! :)
1. AC joint subluxation
- didn't even notice the asymmetry or step deformity until palpation.
- wtf i thought i read shoulder (ant dislocation, frozen shoulder, rotator cuff tears) but i really didn't think i'd get this. don't even recall ever having known anything about it.
- the testers might as well have taken my hand, put it at the deformity and asked me qns. they were really nice to try and lead and get me to look more carefully. do not rattle off "no asymmetry, no squaring etc" MUST REALLY LOOK.
- what are the gradings (i really didn't know but mentioned, stable unstable, and he kinda just nodded and moved on knowing that i really didn't know)
- what's the difference between subluxation and dislocation
- how to manage
- will you manage differently if he is a professional badminton player
(I DUNNO but i just said yes/no/yes until someone nodded and pushed me off to the next case, who was actually just sitting in a chair 20cm away from the 1st man, and the 3rd case for that matter)
2. thyroglossal cyst
- first damn obvious one i've seen in my life!
- how to manage, describe the op (sistrunk procedure, removal of the cyst, its tract and the central portion of the hyoid bone)
3. dorsal ganglion cyst
- examine (soft, cystic, more prominent (not bigger) on wrist flexion)
- what is a dorsal ganglion cyst attached to
- management, draw on his wrist how to excise
(testers rocked, i just drew an elliptical thing, then he said really? i changed to a vertical incision, then he said really? i changed to a horizontal incision. then he said, VERY GOOD!)
- advice to patient after excision? may recur
4. direct hernia, irreducible
- examine his right groin
- went to examine scrotum instead, cos i thought the right scrotum looked abnormally low compared to the left "can't get over the scrotal mass, not separable from testis, soft in nature, no cough impulse"
- was later educated on how actually that's normal >.< damn sian. girls, pls go look at more balls haha. no wonder while i did running commentary there was absolute silence
- tester repeated, "examine his right GROIN, girl!!"
- looked upwards, saw a vague mild fullness in right groin, just imagined a cough impulse cos i heard some bells ringing, quickly described a direct hernia and got him to lie down to reduce. he tried and he said, okay can only reduce half. there was NO VISIBLE DIFFERENCE after he reduced half of it lor. the most unhernia-ish hernia in the world =/
- nvm carry on, what are the types of hernia (irreducible, incarcerated, strangulated) and how will a strangulated hernia present. THE END. argh.
the night before, insomnia and eventually a strange dream about barney stinson from himym bullying a little kid in the mirror.
the morning itself, palpitations. even more than the 4 days of serious palpitations every time i read the accounts from my classmates. here's my own account.
SYSTEM: ortho
LONG/SHORT: Long
HOSPITAL: ____
TESTERS: CT, AT (i have no idea who was active or passive because both talked to me, and after a while my brain got tired, and it became just a friendly voice and 2 eyes)HOSPITAL: ____
ACCOUNT: not my birthday, didn't get the 2 prof lows for shorts or longs. but the 2 mentioned are rather cute, smiley and very encouraging. really helped when you get freaked out after reading 4 days worth of scary accounts.
Summary: Right OA knee X 3 years, secondary to right tibial fracture (fixed in a cast, no plates or screws, healed with malalignment 35 years ago) currently on glucosamine daily and paracet prn, on follow up at ttsh, not for any op in the near future, woohoo. Typical history of right mechanical knee pain, ruled out inflammatory causes, malignancy, septic arthritis, and screened for other joints. Function limited due to the pain, can't jog his normal 10km/day (this 71 year old uncle is fitter than all of us now) and sometimes difficulty kneeling to pray in the mosque. no DM, only htn and chol. 30 minutes passed really quickly, but in between i was talking rubbish with my patient. NO MO TO HELP WITH ANYTHING. but nvm, OA knees, damn happy already. Examine knee, remember to walk the patient. This man compensated with his other leg, which i suspect is also in pain but he refused to say cos he was scared i'd have to present more things.
They came in while i was examining his limb length which the patient pointed out to me in the beginning but i just got carried away after my initial knee exam, heart lungs abdo. can i just mention that i LOVE this man, he spoke english fluently, clarified every point for me, and even said "er i have back pain also but i can don't tell the examiners later, it's not that important" when i looked a bit shocked after taking an entire OA knee history. "no no, uncle, thank you but every pain is important to me, but if it's not bothering you, then we concentrate on the main knee problem la okay."
AT said, why don't you leave and consolidate, while we talk to him a while (is this what everyone got to do?? it's surg right, not med??) quickly summarised my points on a separate paper while i overheard the testers asking the patient for his main complaint. then the invisible MO came to tell me, eh not much time leh, just go back in. 71 year old malay man, retired protocol officer (CT interrupted and was like, wow what is a protocol officer, and started asking the patient which VIPs he escorted etc etc... WASTE TIME)
After i finished presenting, the typical qns ensued.
1. What are your differentials? "RA, gout, septic arthritis are not so likely"
AT: Huh? Girl, where's your main diagnosis, why did you say the rest first! Calm down! "oh yes, sorry i thought i made it clear in my history and summary that my main diagnosis is OA knee"
2. Oh, so in this case, we learn that there's more to OA than just primary OA right. what is the main cause of his right knee pain? - "the tibial fracture causing malalignment so development of genu varum and redistribution of weight causing increased wear and tear of medial compartment of the knee joint. "
3. Why did you tell me about no LOA LOW night sweats and night pain? to rule out TB/mets.
4. What other parts of the history are important.
5. Show me how you examine his knees, so i rolled up his trousers and started describing the genu varum, 8cm intercondylar distance. Name me the effusion tests, how to do.
6. Oh i see you marked his quads, very good. Oh i see you marked his asis and medial malleoli, very good. So is there limb length discrepancy? "sir i measured and found that there's NO discrepancy even after squaring the pelvis etc" (i really found no discrepancy but then when i looked down i saw there really was shortening, argh!) "however i would expect there to be in this case because of his genu varum as well as the tibial fracture causing shortening" OH okay, we believe you then, since you already marked everything nicely.
7. Okay, show me range of movements. What does he have? "Fixed flexion deformity." Prove it.
Tell me what it's called when on passive movement he CAN extend? BRAIN BLOCK. "er, flexion deformity, not fixed." AT laugh laugh laugh, yes you just described what i asked but is there a name for this, girl? "er, extensor lag!!!!!" YES, let's move on.
8. They brought me outside the cubicle and showed me an xray THEN asked for investigations. "As a HO and on admission, do typical bloods, and AP/lateral (weightbearing) + sky line xrays" Describe the xrays, which compartment is affected?
9. How to manage? Regurgitated everything in the last 20seconds after the bell rang.
Advice:
1. Clerk quickly, examine quickly, 30 minutes passed so quickly.
2. Give a good summary.
3. NO MO IN ___ TO HELP, except to tell you that there's 5minutes left. but if i pass and if i'm a HO in ___, and if i'm free, i'll come and help :)
4. If the tester wastes time, just use the time to think about what to say next
5. Just say simple things and don't shoot yourself in the foot esp if you have a nice straightforward case
6. Thank your patient! Build KARMA!
SURG: Short cases
HOSPITAL: ___
1. AC joint subluxation
- didn't even notice the asymmetry or step deformity until palpation.
- wtf i thought i read shoulder (ant dislocation, frozen shoulder, rotator cuff tears) but i really didn't think i'd get this. don't even recall ever having known anything about it.
- the testers might as well have taken my hand, put it at the deformity and asked me qns. they were really nice to try and lead and get me to look more carefully. do not rattle off "no asymmetry, no squaring etc" MUST REALLY LOOK.
- what are the gradings (i really didn't know but mentioned, stable unstable, and he kinda just nodded and moved on knowing that i really didn't know)
- what's the difference between subluxation and dislocation
- how to manage
- will you manage differently if he is a professional badminton player
(I DUNNO but i just said yes/no/yes until someone nodded and pushed me off to the next case, who was actually just sitting in a chair 20cm away from the 1st man, and the 3rd case for that matter)
2. thyroglossal cyst
- first damn obvious one i've seen in my life!
- how to manage, describe the op (sistrunk procedure, removal of the cyst, its tract and the central portion of the hyoid bone)
3. dorsal ganglion cyst
- examine (soft, cystic, more prominent (not bigger) on wrist flexion)
- what is a dorsal ganglion cyst attached to
- management, draw on his wrist how to excise
(testers rocked, i just drew an elliptical thing, then he said really? i changed to a vertical incision, then he said really? i changed to a horizontal incision. then he said, VERY GOOD!)
- advice to patient after excision? may recur
4. direct hernia, irreducible
- examine his right groin
- went to examine scrotum instead, cos i thought the right scrotum looked abnormally low compared to the left "can't get over the scrotal mass, not separable from testis, soft in nature, no cough impulse"
- was later educated on how actually that's normal >.< damn sian. girls, pls go look at more balls haha. no wonder while i did running commentary there was absolute silence
- tester repeated, "examine his right GROIN, girl!!"
- looked upwards, saw a vague mild fullness in right groin, just imagined a cough impulse cos i heard some bells ringing, quickly described a direct hernia and got him to lie down to reduce. he tried and he said, okay can only reduce half. there was NO VISIBLE DIFFERENCE after he reduced half of it lor. the most unhernia-ish hernia in the world =/
- nvm carry on, what are the types of hernia (irreducible, incarcerated, strangulated) and how will a strangulated hernia present. THE END. argh.
Wednesday, March 17, 2010
you're the one thing that i'm missing here
i need to be bold
need to jump in the cold water
need to grow older with a girl/boy like you
finally see you are naturally
the one to make it so easy
when you show me the truth
yeah, i'd rather be with you
say you want the same thing too
say you feel the way i do
need to jump in the cold water
need to grow older with a girl/boy like you
finally see you are naturally
the one to make it so easy
when you show me the truth
yeah, i'd rather be with you
say you want the same thing too
say you feel the way i do
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