メリークリスマス！

Oh dear, it's that wonderful time of the year. Christmas has come and gone, families reunited, and the new year will soon be upon us!!

I'm adjusting fairly well to the orthopaedics department now, things have become slightly better since I first started. I know how to do things around the ward, and the most important thing is that I can be depended on!!

If i may be so bold...... I think I love my job!! ;) its hours are long, the work tedious, but I somehow like that I can do the job around the ward.

Worries of a house officer

I worry that I'm not a competent enough house officer.
I worry that I'm not safe to be a doctor.
I worry that the nation's fears of Russian medical graduates might have some basis after all.
I worry that I can't do do many things even after two months.

I have to do suturing soon. I need to perform a CBD too.

And the days goes on and on...

It's been a grueling experience, housemanship. I guess I've improved a lot since I first started when I didn't know what to do at all..now I kind of have an idea of what to do...
Here in Melaka hospital, housemen are expected to work at the clinics..about 2 housemen per ward. It's my least favorite part, going to the clinic. I always feel lost and don't know what to do.

Wow

Another week passed by!
Yay!

I've just gotten wind of my housemenship schedule...next up is....


SURGERY!!!

I'm having a headache just thinking about it. Hearing about the department from my friends, its absolutely terrible. But that's for later. For now, I have to concentrate on Orthopedics.

From what I realized, Russian grads (or possibly, just me) are quite horrid in Orthopedics. The main thing we have to do is clerk, get a concise and correct history of the patient's illness and examine them. But a lot of the physical examination skills we never learned in Nizhny, or at least I never did.

I have to read and read and read, so that I don't end up being the "target" again. Tomorrow I'm supposed to be Trauma 2 - the backup housemen for OT in case they decide to open 2 rooms for surgery. I'm hoping that they don't, but my luck kind of sucks so I'm prepared to be called in either way. :( I hate surgeries because they make me nervous. Being in the operation room with surgeons who expect a shit load from you is traumatizing. I sure hope its not Dr L or Dr A. Actually I hope its NONE of the Dr As (We have so many!). Ugh, I'm not sure who I'm rooting for. I just really really don't want to go in the OT!

On Saturday I'm S2 for OT, meaning that I'm going to be the person in the OT from 9am til 9pm for all emergency cases. I don't know who the MO will be. One of the Dr As? Dr S? Dr L?? No idea. I don't understand the MO's timetable.

Off tag

A week and a half has since passed since i'm off tag. As I probably mentioned in the previous posts, tagging is the 2 week period when you first enter a department and are required to work longer hours and " tag" along with your fellow houseman to get the flow of how things work.

This week has been hectic, and a bit disappointing. I'm still not getting better at cannulation. And the finer workings of the ortho department still eludes me. My presentation skills are also very lacking. It's very very frustrating for me. I always forget the patients cases and don't know the latest investigations and their results when the MOs ask for them.

I'm hoping I'll get better soon, but at the rate im going I really doubt it.

Yet another week breezes past...

Yet another week of housemanship breezed past me. I've been in Orthopaedics Department for a total of...3 weeks now? I'm still nowhere to being comfortable being in the wards. Whenever I think about going back to work the next day, I have palpitations and wish I was doing something else.

Medicine might not be for me.

Its taking me a long time to adjust to the working life, and I'm wondering how long is normal. Am I taking a longer time than usual? Than other people? Orthopaedics is supposedly the "easiest" department, why am I feeling like I'm such a blur case most of the time then? I'm making mistakes left and right, even in WRITING the damn cases back.

T_T

I need some guidance. I need time off. I need my other half. I need my friends. I need to bitch about stuff. Ugh, I need to get a grip on this...!!

My day off

Today is my day off. As taggers in the Orthopaedics Dept, we get one day break a week! :) It might not seem like much, but its much better than some of my friends who are unlucky enough to be working every single day. Tagging is the period when you first enter a department, so you're supposed to "tag" along with your seniors. I was so blur on my first day of work, but now I guess I'm coping a lot better than before.

As house officers, we are expected to do most/all of the ward work and plan the management of the patients (to be confirmed/changed by the medical officers or specialists during their rounds). So I arrive at 6.30 am daily to review the patients before the MOs make their rounds. This Monday, our "boss" Mr. Soh is expected to be back from his leave though, so things are going to get tougher! I'll have to know the patients very well because my seniors have said that he sometimes asks a lot of questions about the case.

After ward rounds, we do ward work. :D Ward work kind of sucks because everything is haywire. That's because other people will cross off the work even though it wasn't them who completed it, and then sometimes a mistake will be made and some blood was not taken or an ECG was missed, etc etc. I'd much prefer it if the person doing the work crosses it off the list herself, but this is the way things are done so....

Orthopaedics is very very new to me. In Russia, the only orthopaedics/trauma we learn are about the types of fractures and how to diagnose fracture from looking at the X-Ray. So now I'm having quite a bit of a problem trying to learn the proper and correct management for patients. Here in MGH (and possibly throughout Malaysia??), if patient has DFU or any other infection associated with DM, you start them on IV Unasyn 1.5g tds. If no DM, then IV Cloxa 1g qid. There's also Zinnat, Zinacef, Flagyl...those things I haven't figured out their indications yet. :D

Pain...for pain management...I'm really lost!! Usually the patients are on Cap Tramal 50mg tds. Some of the patients who complain of joint pain, they are started on T. Arcoxia 90mg or C. Celebrex 200mg. Some are started on Voltaren ( + Gelusil ). The finer points of pain management still eludes me, after one week. I need to learn more!!

the first week....

As luck would have it, I'm posted to Orthopaedics Dept of MGH..

The workload is so-so, but I'm still quite stressed because the absolute zero knowledge I have in this field. Diabetic foot ulcers are as common as they come in my ward, which makes it a little easier. But when it comes to fractures, I'm as blur as the patient!!

My MOs are really nice, I feel so bad for being a bad HO. I don't even know how to do certain basic things, but I'm learning. Orthopaedics might be considered relaxing to most, but there's still time for me to learn if I learn fast!!

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Hi, Its me again.

A week has gone by since I reported for duty at the hospital. And I still know shit.

:'(

Its not that I'm complaining that I have a lot of free time and holidays right now, but I hate being left out. Right now it seems that my colleagues are out taking blood, doing ABGs, putting in a central line (okay, maybe not this but STILL) and I'm still exactly where I was a week ago - feeling like a MEDICAL STUDENT.

I want to learn new things...

Its been a long time!

お久しぶり!　

Its been awhile since my last post, so long that I don't even remember when it was or what it was about! This post is going to be mainly about housemanship - HO, in short. In Malaysia, its compulsory to undergo these 2 years of Housemanship (HOship) where you will be placed in 6 different departments (4 months each - minimum). I'm currently posted in Orthopedics. The other departments available are Medical, Surgery, Obstetrics&Gynaecology, Paediatrics and Accident&Emergency. You will only be posted at A&E after your 4th posting... ^^

I'm quite lucky to be posted in Malacca, since the hospital staff are so kind to organize for us an orientation program. All in, we have to be given briefing about the Pathology Department, Infection Control, Imaging & Diagnostics, Pharmaceutical Department, Forensics and also Archiving Departments. So that effectively lets me start "working" on the 2nd of November. My colleagues were not so lucky, some of them are starting this Thursday! It'll be tough, going for orientation and then continuing on with the tagging!

There's a lot of things you'll need for your first day to lapor diri. A LOT. You'll need to fill in a shit load of forms - no kidding. Make sure you get pictures (6 at least). Photocopy your diploma, MMC letter and IC in multiples. I'm talking like 7-8 copies! Anyway the hospital will give you a checklist of what is necessary for you to photocopy and all. But the KWSP (EPF), go do your account earlier if you have the chance. Its annoying to leave and go do the account, come back, etc.

Okay, that's enough rambling for today. I"m so tired!!

Cardiac Arrhythmias (I)

Its no secret that Cardiology is my one-true-love. :)
I love it so much, I'm going to specialize in it, Insyaallah...

All of my favourite Internal Medicine teachers were great at teaching Cardiology, which I think definitely inspires me and a lot of my friends here to study well in this field. To name a few names, Elena Ivanovna Panova, Tatyana Anatolevna Nekrasova, Ilya Gregorevich Pachenko and my current teacher, the HOD of Cardiology, Svetlana Nikolaevna Botova. Dr. Nekrasova is an Endocrinologist by profession, but her knowledge of ECGs and Cardiology is extremely good. :)

Since yesterday was so cold, my group made a sad face and asked the HoD for a one-day break. If other groups want to call us "weak" and "lazy" so that they can appear as "hardworking" and "strong-willed", this is the chance for you to do so. The buses here were not heated AT ALL, and taking the bus for an hour is like sitting in the freezer. And upon reaching the bus stop, there was a 10-15 minute walk to the hospital in frigid cold weather of -27C. So yeah, I am weak. Lazy? Well, let's not go there. xD Let's call me....easygoing? Haha.

Anyway, today is officially my ECG day. Interpreting ECGs is not an easy job, for a medical student. For the cardiologists who picked up their first rhythm strip when I was in my diapers, of course its easy!! ^^

Here's a few pointers I learned from my attendings, esp. Ilya Gregorevich Pachenko, a.k.a. Bradley Cooper a.k.a McDreamy a.k.a. God of 4th Floor, 13th Hospital. Sometimes people refer to him as I.G.P or as the HoD~

Step 1 : Calculate rate

-          Count the R-waves in a 6-second rhythm strip and then multiply by 10

-          Find R waves that land on a bold line. Count the number of large boxes to the next R wave. If the 2^nd R is 1 large box away, the rate is 300, 2 box = 150, 3 box= 75, etc.

Step 2 : Determine regularity

-          Look at R-R distances

-          Regular (are they equidistant apart?), Occasionally irregular? Irregularly irregular?

Step 3 : Assess P waves

-          Is P wave present?

-          Do they look alike?

-          Are they regular?

-          Is there a P wave before each QRS?

Step 4 : PR interval

-          N: 0.12 – 0.2 seconds (3-5 boxes)

Step 5 : QRS duration

-          N: 0.04 – 0.12 seconds (But acc to Ilya, 0.04 – 0.10, not 0.12)

He He loves these 5 steps! :)) 

• Sinus Tachycardia is rate >100bpm (with sinus rhythm of course)
• P wave amplited often INCREASES and PR interval often DECREASES with increasing HR
•  RBBB, Complete has a QRS duration of >0.12 seconds
•  Secondary R (R') wave in lead V1 is usually taller than the intial R~
• ST segment depression and T inversion in leads V1-2
• QRS axis is usually normal!
• RBBB does NOT interfere with the ECG diagnosis of LVH or Q-wave MI (unlike its counterpart, LBBB)
•  Left Posterior Fascicular Block is diagnosed when
• RAD with mean axis between 100-180 degrees
• QRS duration between 0.08-0.1 seconds
• NO OTHER EXPLANATION for RAD is found (important~!)

• RAD explanations
• RVH
• Vertical Heart
• Emphysema
• PTE
• Lateral wall MI
• Dextrocardia
• Lead reversal
• WPW

 :) Are you having fun yet? Yes?? Hehe...Good, because Cardiology IS fun!! ^^ Most of the times anyway... ;)

You Bet Your Youth

10 years ago I hated science and wanted to become an accountant.

7 years ago, I thought Pharmacy would be better suited for me.

But 6 years ago, I enrolled in Medical School.

Why? 

To tell you the truth, I don’t have the answer for that. Not anymore. In the beginning, I was inspired by the late-night documentaries I watched about MSF volunteers and Chicago Hope re-runs (I wasn’t and still am not a fan of E.R.). I wanted to save lives.

It all sounds so cliché now!

With all my whining and complaints, I actually do still want to be a doctor. I just have no idea WHY. 

The first day of medical school seems like such a long time ago. And at that moment, I couldn't wait to be here. At this moment. Months away from graduating. The six-year wait have been fun and surprisingly, fast. As a 17-year-old, all I wanted to do was skip to the good stuff. Skip to the part where I learn how to take care of sick patients in the hospital. And now as a 23-year-old six years later, I find myself still wanting to learn that very same thing. 

In some months I'll be driving up to the hospital and reporting myself for duty. And I know it'll only be a few weeks or months from that point in time before I get burned out and exhausted and feeling like every new patient is my enemy. I'll be so tired from all the night calls and 36-hour shifts. And I'm so excited to start!

Finally I get to see what six years of hard work got me. I get to do what I signed up for - treat patients!

Of Surgery and Pancreatitis...

It has been a grueling rotation indeed.
Previously, if I was asked to describe my Surgery rotations knowledge, these words would come to mind

"Easy.."

"Boring.."

"Non-existent"

But after a hard-core month with Professor Yurii Markovich Zigmantovich, I changed my mind!
Damn, surgery is HARD!

To recap, our days with the dear Sir would start early. I don't mean 9am. I mean 8.30am. NOT 8.31am. And definitely NOT 8.45am like other (more fortunate) students. But 8.30 am sharp. And when you're late, you don't get a dirty look and snide remarks. What you get is a boot out the door. Yeah, go home and go back to sleep because he doesn't accept tardiness!

And if the early mornings are not bad enough, we have tests...not everyday (like he threatened) but at least once a week. Usually on the bigger topics like Dysphagia, Post-Gastrectomy syndrome, Pulmonary embolism, etc etc. But I don't mind it so much, because at least it forces me to study. :))


Pancreatitis
In the past 2 weeks, I have had 3 patients suffering from acute pancreatitis! :p That's one too many for me. I want to clerk something more challenging but instead...I'm pancreatitis girl!

Here are some fast facts for my benefit :

• Most common cause : Alcohol abuse and Gallstones
• Least common cause : Scorpion bite! xD
• C/o of acute epigastric pain, belt-like irradiation, nausea and vomiting
• adynamic ileus (sentinal loops on CXR) on auscultation
• Tender epigastric
• Fever
• Patient should be NPO! 
• Analgesic of choice? NOT morphine (it causes the Sphincter of Oddi spasm)
• Prognosis based on Ranson's criteria
• At presentation
• Age >55
• WBC > 16 000
• Glc > 200
• AST > 250
• LDH > 350
•  During first 48hours
• Base deficit > 4
• BUN increase > 5
• Serum Ca++ < 8
• Hct decrease > 10%
• P02 < 60mmHg
• Mortality rate is about 100% if Ranson criteria is > 6

First Day

Its a new year, its going to be a new (okay, old but with new improvements!) me!

SO...


its my last year in medical school

its all ending.

and soon too.

6 more months.

January is going to be Surgery month. I'm doing great so far, but I've got a lot of reading to do especially if i want to cover Traumatology and Paediatric Surgery before the new semester starts.

Will update tomorrow about Pancreatic Cancer. :)