Shifting Dullness

Moved to Tumblr

2010-05-07T23:59:00.001+08:00

See my new blog at jinn101.tumblr.com.

Catchya round.

Four years ago

2010-05-05T18:51:00.002+08:00

Four years ago, I started out as an intern at SCGH, naive and not knowing what the future was going to hold. Four years later and things have changed dramatically.

I completed my intern year.

I decided I wanted to do surgery. I did surgical rotations for entirety of 2008 and 2009.

I got married in 2008.

I travelled to Japan and Spain.

I applied for General Surgery in 2009, failed, and am trying again.

I spent a huge amount of money on polaroid cameras, a Diana F+ and film to boot. As well as got an iPhone (my most commonly used camera).

What will happen in the next four years?

Finally starting to settle in

2007-01-14T12:02:00.000+09:00

It's been a week now working on the wards, and I think I'm finally beginning to find my feet. I'm getting used to the responsibility of looking after patients, and I'm starting to find work a whole lot of fun.

When I signed up for med school, I always envisaged that I'd be on my feet at work, running around doing lots of little odd jobs - and this is exactly what being an intern has turned out to be. The stress of having to fix up your mistakes has been a little overwhelming at times, but overall it has been manageable.

Yesterday was my first on-call shift. I was covering the wards from 1pm until 10.30pm. Heaps of things happened - apart from the usual calls to see patients who needed med charts written up or fluids charted, I certified my first death, I attempted to put an IV cannula into a patient 7 times (I failed, and ended up getting screamed at by an anaesthetist, who I had to call to help me), a patient pulled his PEG tube out (it's a feeding tube that goes directly into the stomach through the skin), I saw and assessed a confused patient, and I finished all my leftover paperwork from the week. Again, it was a little bit stressful, but well within my capacity to sort things out. And if anything ever went wrong I always had a registrar (more senior doctor) available on the phone to call.

So it's one day off, and then back to work again tomorrow!

Watch out, new doctor coming through

2007-01-05T23:25:00.000+09:00

Today was the first day we hit the wards as fully-fledged doctors. We were supposed to be shadowing the intern who we're taking over from on Monday (the first 'official' day), however due to some staff shortages, some of us had to actually do a fair bit of work. My first job is Cardiology, which consists of three alternating weeks between the cardiology ward, the coronary care unit, and the day procedure unit. Because there are three of us interns covering the three different areas, it is meant to be a somewhat cruisy job.

Having said that, being a real doctor is f#cking scary. Charts get thrust in front of your face, medications need to be written and signed off, and every mistake you make is accountable to you - because you wrote your name on it and signed the stupid piece of paper. Life as a student seemed so much easer - there was no responsibility, you could do all the work yet not actually have any responsibility for any mistakes, and you could leave pretty much whenever you wanted to. Now, if I want to leave, I can't. If I mess up, it's my head on the chopping block. If I see a patient, I'm the real deal. I'm the doctor. It's been very nerve-racking so far. However, its still a massive adrenaline rush to be finally doing what I've trained for six years to be doing. I can't wait till I get used to the place and I can start properly enjoying the work. Here's hoping the fire never dies!

First day of work

2007-01-02T20:25:00.001+09:00

Happy New Year everyone!

Today was my first paid day as a doctor.

Well, not exactly - I didn't actually do any 'doctor-type' real work today, just sat through a day full of lectures and tried very hard not to fall asleep. It's our introductory week, a week full of lectures and 'revision seminars', or in other words, cramming our brains with stuff we have already learned but managed to forget since our final exams two months ago.

But we get paid for it! Which is a far cry from medical school, where we paid through the nose for similar teaching. Unfortunately, from looking at my roster, I'm not going to have very much time to enjoy using my money. Oh well. I'll just have to use ebay instead.

Most of the new interns at SCGH are fellow UWA graduates. But there were a few unfamiliar faces amongst the crowd - there are three graduates from interstate, coming back home to Perth to begin their new careers as doctors alongside the rest of us. It was a weird feeling talking to them - because unlike school or university, I will probably hardly ever see them again, and thus forming friendships is going to be unlikely. Hopefully we get to know them better through all the social events this year.

Work officially starts in earnest next Monday. My first term is going to be Cardiology. Having never worked a term there as a medical student, it will be interesting to see how I go - iin any case I'm quietly confident in my ability to handle being an intern. There are two other interns working the same job as me first up. Both of them are great girls and I'm really looking forward to working with them and having some fun. It should be a great year.

Back again!

2006-12-30T01:39:00.000+09:00

Wow, things sure have changed since I last wrote something here. The new Blogger has now been rolled out, complete with labels! I guess this means an end to my (lame) attempt to create labels with Technorati... heh. Anyways, I'll go back and make the changes to the old posts when I have more time.

Speaking of time, time is something I don't have much of these days. I just flew back from Kuala Lumpur on Wednesday and since then it's been go, go, go! I arrived back in Perth at about 4.30pm, and actually managed to find the energy to go post-Christmas shopping! (It was hard to find clothes in Malaysia that fit me or that I liked.) I managed to pick up a few bargains, I'm proud to say. Several pairs of pants and some shirts will complement my working wardrobe nicely.

My holiday in Malaysia was great! Spent a lot of time catching up with relatives I hadn't met in ages, being introduced to their children, whom I had never met, and eating heaps of really yummy food. Four meals each day is standard! Waking up late meant that breakfast was missed, but that was usually accounted for by having a brunch at 11am instead, followed by high tea at 3pm, followed by dinner at 7.30pm, followed by supper at midnight! And in between, we pounded the pavement of the shopping malls. It was a crazy way to live, and to be honest I much prefer the relaxing lifestyle of Perth. There's only so much yummy (but unhealthy) food you can eat.

Malaysia

2006-12-01T13:27:00.000+08:00

Next Tuesday I will be leaving Perth for a trip to Malaysia. I'll be away until the 27th of December, so that's pretty much the whole month of December taken up by this holiday. When I get back, I'll have a few days to get everything in order before I start my working life on the 2nd of January!

I'll probably spend most of my time in Malaysia in KL, shopping, eating and just relaxing. It will definitely be a different kind of holiday to the one I had a year ago, when I did a grand tour of Europe. It may not be any less busy however, if my relatives act anything like I remember!

My grandparents live in Seremban so I'll also make a trip over there at some point to check up on them and see how they are. I haven't seen them in almost 8 years, so I'm preparing myself for them to look a lot older than I remember. I guess I must have changed a lot in the last 8 years as well. The last time I saw them I hadn't even begun med school yet.

My mum tells me that my grandmother has some osteoarthritis of her hip which is causing her some trouble. The funny thing is, she is waiting for my 'expert' opinion before she decides whether to have a hip replacement. Haha! And we have two other doctors (my aunt and uncle) in the family as well. I don't want to step on toes so I have a feeling I'll just agree with whatever they have said to her.

Whilst I'm away I'll endeavour to blog about my adventures there and post some photos as well. But internet access may not be easily available don't be surprised if this page is not updated regularly.

Grad Week / Dedication Ceremony

2006-11-23T23:19:00.000+08:00

Friday was the end to a very busy week for us graduating med students after our last exam a week prior. One of the students in our year, Warren, had organised a week-long celebration to mark our last week of medical student-dom before our transition to fully-fledged doctors. He had arranged a massive house party, followed by karaoke, followed by a trip down south, followed by a river cruise, followed by the 6th Year Dinner, followed by a champagne breakfast, followed by the official Dedication Ceremony, where our transition to doctors would be officially complete once we had all sworn the Hippocratic oath.

It was a very strange feeling at the ceremony. Throughout the week, the celebrations had been muted somewhat as we had not known whether we had passed our exams until Thursday. On Thursday at the Dinner, our emotions were finally let out as we celebrated with a clear conscience. Yet celebrations were always slightly tempered, as we realised that six of us had not cleared the final hurdle along with the rest of us. On Friday at the ceremony, again, it was a strange feeling as we revelled in the fact that we had finally set out what we had achieved to do when we started this journey together six years ago. There was sadness for those of us who were leaving to either go back home, or start again in another city. There were the families of classmates who had to be introduced and talked to. There was another pang of regret for some, who had not received honours due to a past failure in an innocuous unit.

All in all, it was a very emotional day, an end to one chapter in our lives and the beginning of something bigger and hopefully much better. Pictures on the right and here.

Tags: Medical

Red Bull Air Race

2006-11-19T22:08:00.000+08:00

Along with 300,000 spectators, I decided to make the trek down to the banks of the Swan River to watch the Red Bull Air Race today. We decided to catch public transport there, as did most others, and after an hour of very slow trains and buses, we finally managed to get a vantage point on the South Perth foreshore.

The place had totally been transformed beyond recognition. A massive observation tower had been erected, there were viewing platforms for the more 'important' guests, and the Swan River had these massive inflatable gates floating on it.

The race is the self-dubbed 'Formula One' of the skies, in which planes time trial around a massive circuit specially created for the event. The pilots have to specially trained, needing to bank and turn very sharply as well as flipping their planes upside down and at times pulling up to 11Gs.

Our vantage point was great and we had an uninterruped view of the proceedings. In something that appeared to be almost like a computer game, there were speakers pumping out music that seemed to be more suited to a driving game as well as blaring out commentary of the race. It was a great spectacle!

Of course after that was the hellishly long public transport ride home. :(

Here's a video I found on Youtube of the qualifying on Friday.

The dreaded phone call

2006-11-16T12:52:00.000+08:00

Today was D-Day. The day that you would receive a scary phone call if you had not passed your final exams. The day that everybody had been dreading since we finished our exams last Friday. On a day such as this, my cunning strategy is to sleep in for as long as possible so that if I suddenly woke up at 3pm, and nothing had happened, all would be well - and I wouldn't have gotten stressed out at all.

But today I only slept in until 11am.

At 11.50am, the downstairs phone rang. I ran to pick it up, but I didn't get there in time and it diverted to the answering machine. The voice was scary. I said my name, and asked him to call him back. You can imagine my immediate thought: I HAVE FAILED MY EXAM.

FUCK!

Frantically, I attempted to call him back numerous times. In those ten minutes, visions of cancelling my holiday flashed through my head. I would have to re-sit the exam. I would not be able to be sworn as a doctor with the rest of my friends tomorrow at the ceremony. I would be pitied by everyone and be totally embarrassed for my family. It was the end of the world.

Finally I managed to get through.

"So sorry, there was a mistake. You're fine. You passed. Sorry to cause you any consternation."

Jeez! You think they could have been a bit more organised! They're messing with people's lives here!

On the flip side though, I'm a doctor. Congratulate me!

Tags: Medical

Exams are FINISHED

2006-11-14T11:45:00.000+08:00

My exams are finally over! What seemed like total hell has finally given way to rays of sunshine, and I can get back to enjoying life (excuse the hyperbole). :P

Friday was my last exam - the clinical OSCE, which surprisingly was not as difficult as it could have been. They asked us a lot of stock-standard questions and there was nothing overly tricky about the exam at all (which was a total surprise!). A lot of the questions were repeated from previous years' exams, which we all managed to get our hands on, so most of us should have been adequately prepared.

The written exam on earlier in the week on Monday was a little more difficult. Up until the exam I had been relatively calm about the whole thing, basing my confidence on my ability to do previous years' exams. Unfortunately my confidence was unfounded - and I really hope I passed. The bastards made it a lot harder than last year.

Thursday is the big day when we all get our results, and on Friday we are sworn in as fully-fledged doctors. There will be a lot of nervous medical students on Thursday, hoping that they don't receive the dreaded phone call of doom. I think I will be ok. But only just.

Tags: Medical, Announcements

Exam time

2006-10-25T10:25:00.000+08:00

Won't be seeing much on this site for while, or at least the next few weeks as I gear up for my final exams. I have two exams - a written paper on the 10th of November, and a clinical OSCE (clinical exam) on the 10th.

Wish me luck!

Tags: Medical, Announcements

That damned cancer

2006-10-07T20:22:00.000+08:00

Last week my family got the startling news that a close friend of ours was dying. It came as a big shock to all of us: he had always seemed to be too big and strong to suffer from the diseases and problems that the rest of us have to go through. This was despite having been treated for melanoma more than 18 years ago. I guess after all that time, we though he was invincible.

Melanoma is a horrible disease to get, and despite having been free of it for the best part of two decades, we were all surprised when we were told that it had come back in our friend. At it had come back with a vengeance as well - metastases to kidneys, liver, lymph nodes all over the place.

It's a totally different experience visiting somebody in a palliative care setting as a visitor rather than as a professional. Despite my experience in dealing with dying patients, when it happens to somebody you care about, it really hits you hard. I didn't know what to say. I couldn't talk ask him about symptoms or how it all started or whatever I normally ask patients. It is my friend. He is dying. That's all that matters. I'm there. That's all that matters. How did it start? That doesn't matter one bit.

As the end gets closer...

2006-09-26T18:26:00.000+08:00

As the end of the year inevitably gets closer and closer, I'm starting to feel a little suffocated by it all. We still have plenty of assessments that need to be done, as well as having to try and motivate myself one last time for the final exams. The problem is that I don't feel like studying when I still have assessments to do, and I don't feel like completing my assessments because they're boring.

So you can see my dilemma!

My main priority at the moment is finishing my Personal and Professional Development essay. The topic is:

Discuss the ethical issues involved in pre-test counselling

Eek. What a horrible topic!

It's all to do with the faculty and trying to create 'rounded' doctors. My main objective at the moment is to simply become a doctor! And that means passing my exams!

*sigh*

Back to my essay...
Tags: Medical

Flu / Man Utd

2006-09-17T00:27:00.000+08:00

I have been as sick as a dog for the last couple of days. What initially started as a bit of a niggle at the back of my throat and a bit of a cough rapidly progressed into a full-blown flu. I had a fever, muscle aches, a headache and this severe tiredness that wouldn't seem to go away. I spent most of Friday asleep, when I was actually planning on going into the hospital to see the patients I was going to write up for my assessment. Fat lot of good trying to see sick patients when I was in no shape to get out of the house myself!

In any case, I seem to be recovering - hopefully in time to catch the biggest game of the season yet: Man Utd vs Arsenal! With Thierry Henry out for the Arsenal, it will be difficult to predict what the outcome of the game will be. If Man Utd try to play football against us, they will find that we are exceptionally dangerous on the counter. On the other hand, if they sit back, the game might end in a draw - a result which we would be more than happy with.

Aspects of the game which I think will be important are:

Rooney/ Saha / Ronaldo vs Toure and Djourou: Whether the inexperienced Djourou will be able to keep a lid on Saha/ Rooney and Ronaldo is very important. If our defence holds firm, then it will give us every chance of snatching a goal at the other end.
The injury to Henry/Who will play instead? With Robin van Persie possibly out as well, whether Wenger chooses to use Adebayor as a lone striker up front, or in partnership with Baptista or Walcott will also be key. The latter two players have not played many minutes for Arsenal and it will be interesting to see if they are up for the challenge of playing Man Utd away from home.
Fabregas/Gilberto vs Scholes/Carrick: The midfield battle will be all important. Good service to the front players on either side will obviously have a huge bearing on the way the match will go. Gilberto will need to be on top of his game to close down the passing channels. Wenger has already talked up Carrick and his importance in picking out passes.

Tags: Arsenal, Medical

Surg Term: The Home Stretch

2006-09-12T00:14:00.000+08:00

I started my final ever term as a medical student today. It's a bit scary and definitely very daunting thinking about the path that lies ahead of me. In a few short weeks, I will have finished my final exams and officially will become a doctor. Yes that's right - a DOCTOR!

In a way, it's a huge relief to finally end this 6 years of madness, something I went into blindly after a previous 12 years of primary and secondary school. Looking back, I definitely would have put more thought into taking a year off and travelling. Having been on an awesome trip to Europe just this year, I would highly recommend taking some time off to see the world to anybody who is studying a very long course.

So my last term is Surgery at St John of God Subi. Again, this is a new experience for me. I've never ever done an attachment at a private hospital before. In fact, the only time I had ever been inside a private hospital before was when my father was admitted, ironically to SJoGS as well. So my experience as far as this type of healthcare is concerned is fairly limited.

On first impressions, they certainly put a lot of effort into their furnishings. The provate consulting rooms are sumptuous. The whole place reminds me of a hotel or an upmarket shopping centre. In a way it's almost like I'm in an episode of House or something. Beautiful glass doors here, magnificent prices of art there. Totally surreal.

But I'm definitely looking forward to finishing the term, the year, and my degree.

Tags: Medical

Med Dinner

2006-09-03T18:22:00.000+08:00

Last night was the 2006 West Australian Medical Students' Society Dinner. It was an awesome night, it was held at the Perth Convention Centre with close to 1000 people turning up to the event! Being in final year, it was tinged with a bit of sadness - it was my last Med Dinner ever. I had a great time, floating around, talking to people I hadn't seen in a while and meeting up with other non-med people I knew who were just there for the ride.

I've uploaded some pics to flickr, you can see them by clicking on the images on the right.

Tags: Medical

Charlie's it is

2006-08-11T22:30:00.000+08:00

Well, I kinda made the decision a while ago but never actually managed to sit down and write anything much about it. I will be working at Sir Charles Gairdner Hospital next year (provided I pass my exams!).

SCGH, aka 'Charlie's' is one of those hospitals that were built in the 70s and have areas that look like they haven't changed at all since then. Some parts of the hospital smell, some parts look really nice, and other bits look like they're falling apart, but generally it's a good place to be.

The other choices, Royal Perth and Fremantle Hospital, had too many cons that outweighed the pros of choosing either of them. RPH has an awesome location, right smack bang in the middle of the city, but it's future is very much in doubt. There are plans to demolish it and move the campus to a new super-hospital in the south, in Murdoch. Obviously this is going to be some time in the future, but it definitely affected my choice. Living north of the river, and with petrol the price it is at the moment - I didn't think it would have been a good choice for me. Added to that the fact that RPH are stoically sticking with only four terms next year, and it makes it difficult to mount a case for going there. The only thing is that some refurbished parts of the hospital are really nice.

Fremantle Hospital was just too far away again. It takes me an hour to get there by train, and about 45 minutes by car. It is also a very laid-back hospital, which is nice when you're a student, but I think I need a little bit more stimulation so I can learn more as an intern.

Charlie's is a nice balance between location, choice of terms (5) and also friends. Most of my mates are going with me to Charlie's so it will be fun hanging out on the ward next year with them.

Tags: Medical

Oncology and life

2006-07-31T17:39:00.000+08:00

I've moved on from Palliative Care into a different, albeit related, field - Oncology (otherwise known as Cancer Medicine). It's quite a sobering specialty, and in many respects, is even more depressing than Palliative Care. Most of the patients we saw in PCU knew that they didn't have much time left, and had accepted that fact. In Oncology, the diagnosis was generally a lot more recent, and the emotions were a lot more raw.

Being on the same ward as PCU, I was kind of able to keep up with some of the patients that I saw earlier. This meant I was around on the ward when one of the patients I had met earlier in PCU unfortunately passed away. This kind of experience really makes you realise how lucky we are (most of us) to be healthy and be able to go and do the things we like. For this patient in particular, they had cancer at a very young age and had to deal with the ramifications of the disease for their entire life. At the end of the day, when I leave the hospital, I can go and play soccer, or go out with friends and leave those problems behind. For my patients, they stay in hospital, with their cancer and chemotherapy and have to live with the realisation that their clock is counting down.

Tags: Medical

Palliative Care

2006-07-15T23:46:00.000+08:00

I was a bit nervous at the start of this week. This week was the devoted 'Palliative Care Week' - for the entire week, I was assigned to the Palliative Care team at SCGH. Now Palliative Care is (for those who don't know) the care of those patients who are getting towards the end of their lives. These patients are suffering from diseases that are incurable and are not being treated with a curative intent.

So I followed the team around, learnt about what they did, learnt about analgesia regimes etc. My head was full of doubts. How do I talk to someone who knows they are going to die in a matter of weeks? How do I bring up the subject of death? How can I provide reassurance to them when both of us know that there is NO HOPE for the future? What kind of doctor wants to deal with patients that never get better? Knowing next to nothing about Palliative Care (other than that it was for people who were going to die), you can imagine I was a little tentative about the whole thing.

All of my fears were unfulfilled as I discovered that Palliative Care is one of the most wonderful specialties that exists. The people who work in the area are, by nature, totally understanding and helpful to everyone (including students ;) ). The patients are wonderful - having accepted death, most of them are starting to get onto the important things in life - repairing old relationship rifts, sorting out their affairs, getting wills organised, spending quality time with loved ones. They are inspiring in the way they stare the abyss in the face and still are determined to make every minute on earth count. I learnt a lot about life from them.

Tags: Medical

Lily Allen

2006-07-02T01:58:00.000+08:00

I was listening to the radio the other day and heard this girl singing a song which mentioned 'Tesco', which she then rhymed with 'al fresco'. Brilliant, I thought! I need to download this track and have a proper listen.

But that wasn't it - the song sent on to describe London with all its characters, slappers, old ladies, pimps. I know this sounds sad, but having recently come back from the UK I felt a funny connection to the lyrics.

Anyway, she's my new favourite artist. Lily Allen (of Islington no less), hailed as the cover girl of the myspace generation and the new Mike Skinner. Listen to LDN on her website, it's a cracker of a song.

Tags: Music

Sunset in Bunbury

2006-06-30T22:46:00.000+08:00

On my last weekend in Bunbury, Sa came to visit for a bit and we went down to the beach to catch the sunset. As the above picture shows, it was spectacular. There was a bit of cloud cover above us, but as the sun slipped below the clouds and showed us its full face, we were very much impressed.

Tags: Design

Back in Perth

2006-06-26T19:14:00.000+08:00

I'm finally back in Perth after a good four weeks down south in Bunbury. The point of the attachment was to learn the differences between healthcare in urban centres and rural centres. Unfortunately with Bunbury being the second largest city in WA, the 'rural' aspect of it was also going to be difficult to find.

Anyway, I'm back in Perth now and it feels great. Actually, I secretly snuck back to Perth for two of the weekends I was supposed to be away... and I actually managed to catch Eskimo Joe launching their new album at 78 Records. Check out the pics down the right hand side there, underneath the Flickr heading. They played acoustic versions of several songs from the album, which sounded great. Me and Sa even managed to get pics with the band and also both got signed albums. Our first brush with showbiz!

Good luck to the Socceroos tonight as they face the might of Italia. Get in there!
Tags: Medical, Music

Rural GP

2006-05-30T23:00:00.000+08:00

As part of the sixth year course, we have to do a term of rural General Practice. The faculty makes us do this for two main reasons - to try and encourage some of us to do rural medicine again in future (perhaps as a career) and for our own education, ie allowing the medical students the opportunity to observe the differences between medicine practiced in the city and the country.

I am going to be posted in Australind, which these days is almost a suburb of WA's second largest city - Bunbury. It's not really going to be a very rural experience, not compared to some people who are travelling as far away as Kununurra or Kalgoorlie, but it should be a useful experience nonetheless.

Of course, this means updates to this site will be less frequent, depending on the availability of internet access and of course, how busy I am.

Hopefully I'll be able to get some nice pics!

Tags: Medical

Where am I working next year?

2006-05-29T22:53:00.000+08:00

The time has come to choose to the hospital I will be working at next year. I have from May 22 until June 22 to get my application in, complete with referees and about 3000 words of talking myself up. In Perth the choices are Royal Perth Hospital, Sir Charles Gairdener Hospital and Fremantle Hospital.

Due to a multitude of issues, the choice is not as simple as picking your favourite hospital. Broadly speaking there are issues to do with teaching, leave, travel, future changes to the health system in the state as well as trying choose the same hospital as your friends. At the moment, for the simple reason of travel, I'm tossing up between RPH and SCGH.

More on this when I make my final decision.

Tags: Medical

Arsenal shirt saves life

2006-05-24T21:09:00.000+08:00

What a lucky kid.

It shows I was right to support Arsenal. If I was wearing a normal T-shirt, I probably would be dead.

Tags: Arsenal

Complementary medicine furore

2006-05-24T20:53:00.000+08:00

Prince Charles has gotten himself into deep water by advocating the use of alternative therapies. Sure, the power of placebo is very strong, and if a medicine works, then by all means use it; but leading world figures should not be providing unqualified opinions about things they do not understand.

Why shouldn't alternative therapies be put under the same stringent regulations that govern the pharmaceutical industry? If patients are taking substances in the hope that they will help to treat a medical illness, don't they have the right to know if that therapy works? No nasty side effects? Perhaps there are no side effects because there are no active ingredients.

There was a classic case earlier this year, in Perth, of a whole family contracting measles because they had had homeopathic 'vaccinations' instead of traditional antigen-based vaccinations. Logically, homeopathic vaccinations do not even make sense. You cannot get immunised against a disease with, what is, effectively, water.

In my opinion, anybody who sells homeopathic/alternative medicine and advocates it over conventional therapies (which have evidence to prove their efficacy) should be liable for any adverse outcomes to the patient.

Tags: Medical

Are going to specialise? Part 1

2006-05-20T17:10:00.000+08:00

People are always asking me: "So you're a medical student. Are you going to specialise?"

It's the bane of my existence. I always say: "No I haven't decided yet. I think I can rule out a few things, like psychiatry and geriatrics though..."

Obviously you would want to chose a specialty that you enjoyed working in, but to be honest, I haven't really found one area of medicine that I'm truly passionate about. Nothing where I could be happy to say, "I could probably do this for the rest of my life".

But it got me thinking - what do I want to do? And what kind of criteria would I use to decide?

There are a few points I would use to decide, over the next few posts I'll go into them a little bit more.

Number 1: The People
I guess the terms I've enjoyed the most have never really been about the work aspect part of it. Generally the mre enjoyable terms have been the ones where the people working there have actually been friendly and approachable - I enjoyed those terms because I enjoyed working with the people there.

For example, last year in Paediatrics, we weren't really attached to a team. The workload was really heavy and we had to find patients to clerk by ourselves. This year by contrast, we've each been attached to different Paediatric teams and I've found myself enjoying the term a lot more than last year. The people on my team are really easy to talk to and good to get along with.

Orthopaedics is another example. You could enjoy doing the surgery, ie the actual work - but I could easily see myself getting really annoyed at the people who work in the field, ie the (sometimes) arrogant Orthopaedic Surgeons.

I guess it's made me realise that when you chose a specialty, you're also choosing the people (or type of people, eg surgeons) you're going to be working with for the rest of your life.

Tags: Medical

Random Links #2

2006-05-14T12:54:00.000+08:00

GUIdebook: Graphical User Interface gallery - A very well-made gallery of various operating system interfaces and a little bit about the history of each one. Great for you nostalgics out there.
Monet's Impression Sunrise- This is a little app which demonstrates how Monet used differences in contrast and hue to create his groundbreaking Impressionistic style.

Tags: Random Links

Eskimo Joe 6/5/06 Amplifier, Perth

2006-05-07T17:05:00.000+08:00

Eskimo Joe played at Amplifier last night, and they were f**kin awesome. They were rocking out the old tunes, belting out some brand new ones as well and generally giving the paying crowd a brilliant time. The opening acts, Faith in Plastics, and Red Jezebel were great value as well entertaining the growing crowd before the main act took the stage.

From memory, they debuted three (?) new songs: Black Fingernails, Red Wine, Forever Young (not a Youthgroup cover!), and another one, which they opened the set with (I didn't catch the name). Other songs played were (in no particular order): Liar, I'm So Tired, From the Sea, Planet Earth, Wake up, Come Down, Life is Better With You, Aint No Sunshine, This Room, Older Than You and Smoke. Let me know if I've missed one!

It was really good to see the lads back out on stage after an 8 month absence. Any fears I had for the new album are probably going to be unfounded - as the new material sounded great. Just like "A Song is a City" represented an evolution from "Girl", the "Black Fingernails, Red Wine" album seems like it will be another step in the evolution of sound from the Freo lads.

Tags: Music

Black Fingernails, Red Wine

2006-05-07T16:48:00.000+08:00

Download the video clip to Eskimo Joe's new single Black Fingernails, Red Wine here.
(right click, save as)

Tags: Music

Prescribing antibiotics

2006-05-05T16:28:00.000+08:00

The other day I woke up with a terrible pain in my mouth. I think it started with a small mouth ulcer, caused by this malaligned wisdom tooth continually bashing against the inside of my mouth. I think I then got a secondary infection - causing pain, redness and swelling. The pain was actually so bad I was taken regular paracetamol and even panadeine forte last night.

Anyway, I went to see the dentist today with high expectations of getting the tooth removed and/or getting some antibiotics to treat the infection.

Big shock! I was told that it was an infection, and that it would get better by itself! There was no need for antibiotics. All that was needed was to clean the area regularly, and it would heal up on its own accord. I wasn't very happy with this - I was in significant pain, and thought I needed antibiotics to treat (what I thought) was a significant infection.

Now this is a spiel which we (as med students) have been told to tell our patients all the time. If somebody came in with a middle ear infection, we would tell them that there was no need for antibiotics, that the risk of side effects from the medication were significant, and that it wouldn't change the natural progression of the disease. The risk of developing community resistance to bacteria is also an issue.

The thing is, when you're in the patient's seat, the situation feels a whole lot different.

Tags: Medical

ADHD - Overprescription of dexamphetamines?

2006-05-02T16:02:00.000+08:00

I've just started a new term this week - Women's and Children's Health. Pretty much it's just
the same stuff we did last year, with three weeks of Paediatrics followed by a single of week of O&G. Personally, I think it's a bit of a waste of time (although it's always good fun to play with the kids :D). I'm attached to a General Paeds/Resp team.

I spent this morning sitting in the outpatient clinic with the consultant, whilst we saw various cases. General paediatrics is pretty varied: we saw things like epilepsy, UTIs, asthma and Fanconi's anaemia, as well as things like ADHD (leading nicely into the point at hand).

At first, the consult started nicely enough with the patient's mother describing how her son was doing at school with respect to ADHD and his learning difficulties. Things were nice and civil, but then the mother asked the Paediatrician whether she could have a repeat prescription of dexamphetamines.

The Paediatrician had been writing in the notes, but suddenly stopped her writing and looked up, saying pointedly, "I've already given you a repeat prescription, last time you were here."

"Have you?"

"Yes, I'm pretty sure I have. Let me check." She checked.

"Yep, here it is. Two repeat prescriptions."

"Oh okay then. Must be my mistake."

"..."

"Um, when can we be seen by the GP? Can we not get the medication from the GP?"

At this point, the paediatrician lost it completely. This sudden look came over her and she started almost-shouting at the mother, telling her that she would not be allowed to be seen by the GP until it had been proven that the dexamphetamines were having an effect. And definitely not while the patient did not have a regular GP. And especially not when there are repeat prescritions outstanding. To be honest, it was a bit scary. I'd never seen anything like it before.

Seeing this ADHD patient brought up in my mind one of those controversial issues that seems to be plaguing Medicine, ie ADHD and the prescribing (or overprescribing) of stimulant medications. It's one of those things where everyone has an opinion, and depending on your training and area of expertise, you may have views one way or another.

It's a commonly held belief in the general community that ADHD is overdiagnosed, leading to overmedication of young children with stimulant medications. Unfortunately, there have been documented cases of young kids not taking their medications and instead selling them to their peers, or worse, drug dealers.

There are different schools of thoughts relating to this. One school of thought believes that ADHD is actually increasing in incidence, leading to an increased need for prescribing of medications. Another school of thought belives that the incident of ADHD has always remained steady, but we are starting to diagnose and treat it more. At the opposite end of the spectrum are people who believe that ADHD is a myth and that none of these medications are necessary. Between the extremes are people who believe that ADHD is overdiagnosed and that although there are patients who need medication, not all of them do.

The latter is probably the most likely of all the above scenarios, and various strategies have been implemented to counter this. Despite this, it doesn't look like the controversy is going to end, especially with the discovery of associated cardiovascular risk.

Tags: Medical

Nostalgia 77

2006-04-30T19:38:00.000+08:00

The other day I was listening to the radio on the way home and I heard this awesome, soul-jazz cover version of Seven Nation Army. It was by a group called Nostalgia 77 and I liked it so much, I bought the album, The Garden.

The rest of the tracks on the cd are pretty damn good as well. They're experimental jazz/sample based and are the kind of music you want to listen to when you're trying to study or have a hangover.

Quoted from the BBC Collective:

Nostalgia 77's debut full-length offered dark, synapse-tickling sampledelica to match anything by Four Tet or Manitoba. This time, Ben Lamdin has roped in some fellow musicians to help out. Springy double bass, lush clouds of electric piano and a heap of horns pick their way through edgy, psychedelic funkscapes. Most of it is achingly lovely, but while the cover of the White Stripes’ Seven Nation Army might liven up the odd DJ set, it seems out of place here.

I'd definitely recommend a listen. Another link.

Tags: Music

Random Links #1

2006-04-30T15:35:00.000+08:00

Every so often I'll post some random links to various sites I've been wasting my time at.

So Five Minutes Ago - If you appreciate vector art, this is the place for you. Such intricate, careful lines.
Mayang's Free Texture Library - A great resource for people who can't afford stock photos, or can't be bothered taking photos themselves. I actually used one of Mayang's texture's for the background of this site.

Tags: Random Links

Eskimo Joe tickets

2006-04-27T18:50:00.000+08:00

Went down to 78 Records today and got my Eskimo Joe ticket.

Tags: Music

Emergency Medicine

2006-04-27T01:30:00.000+08:00

Life as a 'senior' medical student is somewhat removed from life as an ordinary uni student. For starters, you're not on campus (to make use of campus amenities, but that's another story), you have few if any lectures, and you hardly see your classmates. The way 'we' as med students learn, is by being placed into various specialties in the community, be that in the hospital or elsewhere, and we learn by observing and doing. Kind of like an apprenticeship.

For the last four weeks, I have been doing ED at RPH - and I have to say, it has been one of the more enjoyable terms. There have been some real eye-opening moments, and a lot of good teaching provided by the kind staff there.

Allow me to go through some of the more interesting points about the term.

Working shifts
There were 8 of us at RPH ED, and each of us was rostered onto a different ED team. A team consists of four or five junior doctors (that's me next year!), and each of them work the same shift together. It was kind of cool hanging out with people only one year more advanced than me their careers - the still remember what it was like to be in my position!

Importantly, being attached to the team meant that we worked the same hours as they did! Thanks to the rota, I started the term with 9 days solid in a row working. That's 8am-4pm for the first five days, and then 12noon-10.30pm for the other four. It was not the easiest of experiences and really made me realise the physical drain that junior docs have to endure. I was pretty tired by the end of that.

Facing emergencies and death
We had all completed a day's worth of Immediate Life Support training, but we practiced on dummies, not the real thing! On one of my first shifts in ED, we got a call from the ambulance saying that they were bringing in a patient with a GCS of 3. Meaning he was as conscious and as responsive as a brick. I was charged with putting the intravenous line into him, whilst the other staff (docs and nurses) busied themselves with all the other things (ECG, undressing him, checking blood pressure etc). When I felt for his veins, I was shocked to feel a freezing cold, sweaty arm with no veins to feel at all. The patient's peripheral circulation was completely shut down. The consultant ended up putting the IV line into the patient's external jugular vein - but we couldn't do much for him. With a GCS of 3, his outcome wasn't good. We eventually stopped the resus and the patient died.

Dealing with death was one of the difficult aspects of being in ED. On the wards, you're not so intimately involved with patients' care to the point that you see people die. I saw someone die for the first time during my time in ED. It was a surreal experience to see someone deteriorate from being alive and aware at one instant to being dead within five minutes. Unfortunately for him, he had a ruptured aortic dissection. Definitely something I'll never forget.

Bed shortages
There is a worldwide phenomenon of decreasing numbers of beds in hospitals and more people wanting to get in. ED is no difference, in fact it is probably one of the places where that reality is most obvious. You rarely have a day in RPH ED where you don't see at least ten beds lined up in the corridor simply because there is no place else in the hospital to put them. It becomes a never-ending game of musical beds, wheeling patients in and out of cubicles, in an attempt to gain some provacy for when the doctor comes to see them.

Helping so many people
I saw more sub-acute stuff on my own than I ever did in GP. And as opposed to GP, most of these patients actually had medical problems! It was a good test of my training to be able to see a patient, and assess quickly whether they needed serious medical intervention, or if we could give them some medications, or suture their wound, or plaster cast their arm - and then send them on their way. And even if they needed serious intervention, they would always be turfed off to one of the other departments. The rapid turnover of patients and the fact that they did not need on going care from us was very appealing to me.

All in all, a useful term - and one that gave me a lot of confidence for next year, when I actually become a doctor. For the first time, I think I can do this!

Tags: Medical

Get in there!

2006-04-26T13:11:00.000+08:00

Arsenal have qualified for this season's Champions League final, and I'm still in a state of shock. I actually stayed up to 2.45am (Perth time) to watch the game - and therefore I'm still in a state of drowsy stupor. ;)

It was not the best Arsenal performance that you will ever see, but we did enough to keep Villarreal out - both with hard work and a lot of luck. Arsenal were completely smothered for most of the game, I think we only managed one shot on goal for the entire game!

It was a nerve-wracking experience, sitting there in the dark, willing your team on with the result still up for grabs as long it stayed goalless.

And then Arsenal conceded a penalty.

Up stepped Riquelme, the Villarreal superstar. To face him was Jens Lehmann, the crazy German Arsenal goalkeeper.

They eyed each other up.

Riquelme struck the ball to Lehmann's left...

And then Lehmann saved the penalty! And sent Arsenal to the Champions League final in Paris!

To quote Arsenal's left back Gael Clichy:

If you were to ask me who my favourite player in the world is right now, I would have to say Jens Lehmann.

Tags: Arsenal

New header

2006-04-24T23:15:00.000+08:00

I spent most of today and the evening designing a new header for the site. You can see the result just above this text.

I had been browsing around, looking for inspiration when I came across Cameron Moll's blog. I was inspired by his clean and neat designs as well as that fan-favourite 'worn' look. After checking out his excellent tutorial, I decided to give it a go myself.

I'll explain the meaning of the various objects (L-R):

On the left is the title header. Self-explanatory, and also a subtle hint as to my medical disposition.
Underneath the two bits of card is an old postcard showing the Scott Monument in Edinburgh. My trip to Edinburgh and Europe was profoundly memorable, and I learnt a lot about myself on the trip.
Coffee beans. I love coffee and probably drink too much - hence the coffee stains and coffee beans. My favourite drop is a caffè macchiato.
Australian stamp. I'm Australian.
Arsenal pin. I'm an Arsenal supporter.

I'm quite pleased with the outcome of my efforts! (Although I should be studying for my Emergency Medicine test tomorrow!)
Tags: Announcements, Design

What is shifting dullness?

2006-04-24T14:46:00.000+08:00

In the purely medical sense, shifting dullness refers to a sign elicited when a doctor examines a patient with ascites. It refers to the movement of fluid inside the patient's abdomen, which is detectable with percussion. GP notebook has a good summary.

Shifting dullness also refers to my ability to make everything I do, somehow, boring.
Tags: Announcements

Eskimo Joe

2006-04-23T22:59:00.000+08:00

According to Triple J, Eskimo Joe are releasing a new album in the next few weeks. I actually heard one of their new songs on the radio; it kinda sounded like old-school INXS (and I don't mean that new reality show crap).

It was an interesting sound, not quite what I was used to from Eskimo. The single was called 'Black Fingernails, Red Wine'. Kind of a bold move for the lads - although I'm going to reserve judgement on this new stuff until I hear the rest of the album.

They're playing two gigs at the Amplifier (where they'll presumably debut the new material) before heading on a national tour. It should be good.

You can read my review of their last gig here.

Eskimo Joe on myspace.

Tags: Music

Back again

2006-04-23T22:24:00.000+08:00

Brand new name for this thing - hopefully a brand new look and feel as well.

Watch out!

You can catch up on some of the shenanigans I was up to in the summer (or winter more accurately) by visiting Jinn and Sa in Edinburgh.

Tags: Announcements

Patrick Vieira leaves Arsenal

2005-07-15T00:56:00.000+08:00

I'm still in a slight state of shock. I mean, if he was going to leave at any time, I would have banked on it being last summer, when Madrid came calling. I never expected him to decide to go back to Serie A, where he was a failure with AC Milan and taunted with racist comments when playing against Lazio.

Still, what is done is done - and I have to say I hope Arsene knows what he is doing this time. Certainly previous transfers out of the club have been beneficial for the team and I really hope its the case again this time.

Now we need to find a replacement and the latest reports are that we are lining up Newcastle's Jermaine Jenas.

Jinn and Sa in Edinburgh

2005-07-12T11:35:00.000+08:00

For our Edinburgh travels.

Jinn and Sa in Edinburgh

London Bombings

2005-07-08T01:27:00.000+08:00

...

Today on my way back from uni I heard about the four bombs that went off in London, killing at least 33 people (at present).

These kinds of attacks make me feel sick and question the validity of humanity's existence - and whether we are actually worth anything as a worldwide society. That people can do these kinds of things to each other in what is essentially a search for meaning in death (ie religion) is beyond me.

I only wish I could go and do something tangible about it. It's helping people in these types of situation that actually made me want to become a doctor in the first place.
BBC

Stolen Bin

2005-06-30T19:05:00.000+08:00

On Monday, we had our rubbish bin go missing. It was there in the morning when all of us left the house, and it was missing when the first of us came back.

Of course, there was a bit of an investigation into all of this and my mum was especially wondering why the bin suddenly went missing just as the neighbours had some people come over to install a water bore.

So she decided to act on this instinct and told my dad to speak to the neighbours about what had happened, and feed them some story about some kids seeing the bore people taking the bin. Of course, our neighbour denied anything had happened and promised to have another talk to the bore people when they came back the next day.

The next day, my mum managed to catch up with our neighbour again, just before the bore people arrive. It turned out that he had talked to them on the phone, and they had said that they were annoyed we drove over their hose on our way out of our house. Which was somewhat surprising because they had left the hose on our driveway and hadn't even had the courtesy to tell us it was there.

Anyway. The bore people finally turned up and told my mum that they had seen "kids stealing the bin", which is a plausible story, only made unbelieveable by the post-script: "And by the way, did you know you drove over our $500 hose?"

Following this, my mum left to go wherever she needed to go, and happened to find the bin left in the bushes of our garden on her way back in. Our neighbour saw her and said that "the kids must have brought it back". .... Right.

The bore people were still around, but did not know about this exchange. When they saw my mum was inside, they secretively brought the bin out of the bushes and laid it on the grass outside. Unbeknownst to them, we were all home, watching as they confirmed their guilt.

Fun.

The big E

2005-06-25T14:26:00.000+08:00

I'm having some annoying issues between my consultant, Dr Ekla dious aka "the big E" and his perceptions of my abilities. For some reason, most likely based on a limited view of myself, he thinks that I am not good at this whole 'medical thing'.

Suffice it to say, the discrepancies between what I believe I am worth in terms of marks, what the students believe I am worth in terms of marks, what other doctors believe I am worth in terms of marks differs greatly from his perception of what I am worth in terms of marks.

Who the hell cares about BNP anyway.

Waiting for a phone call

2005-06-21T10:12:00.000+08:00

I think I might have mentioned PPD before. I think I can see the link now, even as I type this... PPD stands for Personal and Professional Development and its the faculty's way of making sure we all end up being 'rounded' doctors.

We all get assigned 'mentors' who we discuss issues with and submit essays to. The only thing is that my mentor went missing. Dropped off the face of the planet.

So I contacted the coordinator of PPD with an email telling her that my mentor's email address doesn't work. Her phone number doesn't work. And she's generally uncontactable.

Anyway, I got a reply with some new contact details. So I called her at work and her secretary is going to get her to call me back.

So I'm now waiting on the phone call.

My Idea

2005-06-21T01:26:00.000+08:00

I have an idea.

Hopefully this idea will help me make some money.

It involves Graphic design, photoshop, a new blog, and a newspaper advertisment. Hopefully someone will be bright enough to tie all of these things together into a money-making enterprise.

To the future!

Cold Weather

2005-06-20T18:19:00.000+08:00

I really have no idea about how I'm going to survive going to Scotland at the end of the year. I'm shivering my tits off at the moment, and it's "only" 15C. I mean, if I can't even handle 15C, how the heck am I going to handle subfreezing conditions?

I wonder what it does to your thermoregulation to be living in a place as cold as Edinburgh. People must be constantly hyperthyroid over there; to the point where it becomes physiological. I can imagine myself dying of hyperthermia, whilst travelling on the bus to the hospital.

I wonder what the locals would think.

Today's Music Link

Gen Med again

2005-06-17T16:57:00.000+08:00

This is where we're going at the end of the year.

So what have I been doing?

Not blogging evidently. You know, it would be easy to just blow this off and say "been too busy", but to be honest, I haven't felt like writing much in here. I guess I have been too tired.

I had my observed interview today. This is the piece of assessment where you have to go with a consultant and see a patient; take a history and examine them, and then present your findings. Whereupon he's supposed to rip you to shreds and you find out how much you don't actually know.

Happily, today's experience was not too bad.

I've been nervous as hell about this thing for the last week - I've been studying, reading up, trying to see a few cases and brush up my examination skills. That kind of preparation is meant to make you feel better and give you more confidence, you know.

But this morning I felt as nervous as anything, waiting in the coffeeshop, waiting for the clock to get to 9.00 am when the aforementioned caning would begin. I was literally paralysed with fear. Maybe I have some kind of anxiety problem, I don't know.

Anyway, after walking to his office, I see Dr Millar and he greets me. Nice guy. Scottish accent. Generally quite friendly.

He tells me we should go see Mr Scott. So we walk there and we meet the guy.

I've been studying all sorts of things, COPD, heart failure, AF, MI, asthma, palpitations, etc. Not much neuro, but I figured it wasn't much use cos I would suck at it no matter how much I studied.

And guess what? The guy had...

Not a neuro problem!

He had diabetes and associated renal disease. More things I didn't read up on much. But he didn't really ask me too many difficult questions - this was almost like a tute, but with a mark at the end of it. He would tell me all about spironolactone, ACE inhibitors and renal failure - and at the end of it he asked me about two questions. But he still gave me 7/10!

I ended up doing not too badly, although it could have been better. At least that's one thing off my chest.

My favourite link for today:
You Ain't No Picasso
I've also started a page at deviantart. I'm not sure whether I'll add much to it - I guess it will depend on how much I can be bothered and how much time I have.

Michael Jackson found NOT GUILTY

2005-06-14T18:40:00.000+08:00

Link

It's been a long and tiring term so far. I'll blog more when I have the time and/or energy.

Gen Med is very tiring

2005-05-31T19:39:00.000+08:00

I don't think I've been this tired at all this year. Which is kind of good in a way, but also bad - it means that the year is only going to get tougher, since I've already done the easy terms.

Had to stay back since our team was on take last night, and had 7 or so admissions. Today we were told that they're all going home soon.

FA Cup Final

2005-05-21T16:11:00.000+08:00

Henry out. Ljungberg in doubt. Sol to make way for Senderos.

It's FA Cup final day today, and I'm really looking forward to it. Arsenal winning today would cap off a really great week for me. (Which is why I'm afraid they might lose!) I applied for a job at the library a couple of weeks back, and they called me last week to ask me to come in for an interview on the Wednesday.

I couldn't even remember what I wrote in my application, but my bullshitting skills must be pretty good if they wanted to have a look. (See below for a sample of said bullshitting)

Anyway, I went for the interview on Wednesday which incorporated some "Apprentice" style talking myself up and shelving some books on a trolley, which was dead easy. Next thing I know I get a message on my answering machine asking me to call them back, which I did - and to my surprise I now am a librarian.

So next week I have to negotiate library training Monday to Thursday 5-7pm and then I'll start work. 8hrs a week, paying $18 an hour. Not bad for a slack job.

Anyway, back to the Fa Cup. Arsenal should win if its a clean match. At least that's the consensus of most Arsenal fans. I'm a bit worried about Wayne Rooney and van Nistelrooy though. Neither have had a very good season, but they are always capable of pulling something out in the big games. Hopefull Senderos/Sol and Toure can handle them. Cole should have Ronaldo in his pocket.

And then Cole should bugger off to Chelsea, the ungrateful bastard.

Bullshit PPD Essay

2005-05-14T16:04:00.000+08:00

At the end of our General Practice term, all the students had to sit an exam in which we practice consulting in the GP setting, with the help of an actor. On the day, for some reason, I was very nervous and wasn’t at all confident. It wasn’t a great surprise when I got a phone call later on that day saying I had to re-sit the exam in 8 weeks.

I guess, in my head, I knew that it wasn’t such a big deal. I knew that I was definitely good enough to pass the exam, and that it was just one of those things that happen on the day that you can’t predict. The thing that annoyed me the most however, was the fact that the re-sit of the exam was in 8 weeks. Which is a very long time! And a long time to be thinking that you’re not as good as everyone else in the group who passed it.

Subsequently, I was told that I didn’t miss passing by all that much. I missed out by 0.5 out of 20. This gave me some confidence because I knew that I had actually performed well below what I was able to on the day, so when the re-sit came, I knew that if I performed to my ability, that would be good enough.

So after I was told that I had to re-sit, I was pretty distraught for a bit, but I put it the back of my mind and starting getting ready for my option, and then Paediatrics. Paediatrics is actually quite a busy term with lots of written assessment, and I had to force myself to concentrate on the assessment and leave GP revision until closer to the date. That is what I did, and only began studying for it about a week in advance.

After putting in some productive study, I passed the exam easily. But then the difficult part was coping with paediatrics. My GP study had come at the expense of the paediatric study, and the assessment tasks were piling up with not much done!

To get through this, I decided I would think about each task one at a time and deal with them one by one. Once I finished everything, I promised myself I’d reward myself by buying something. In that way, I was able to get through the five assessment pieces that I had to do in the space of a week, as well as two nights in ED at PMH.

Bloody annoying crashing palm!

2005-05-06T16:15:00.000+08:00

My beloved T5 crashed yesterday and no amount of resetting will fix it. Now I'm trying to get my programs back onto it, with limited success and much growin annoyance.

Anybody heard of erythema multiforme? Or even Stevens-Johnson Syndrome?

Arsenal's kit for next season

2005-05-04T23:45:00.000+08:00

I think it looks classy.

Guess the Google Image!

2005-05-01T12:13:00.000+08:00

This is quite a fun little game. Pretty much it's like Jeopardy, except with Google images! Everyone knows about Google image searches, well this is in reverse. You are given an array of images and you have to try and come up with the search string used to find them.

Paeds ED

2005-04-29T23:55:00.000+08:00

Spent the night in ED tonight. It was actually a really good experience, even if I didn't manage to get the surg case I need for next week. Saw some good patients, and some 'interesting' ones. I guess it was a good mix.

There was one girl who came in with this vague right hip/RIF pain that at various points moved across her abdo, and radiated down her leg. She'd been seen by ED staff at another hospital, her GP, chiropractor and had had X-rays done. Nothing was conclusive. The mother was the worst historian, by virtue of being volume-overloaded. She just wouldn't shut up. Every minute detail and insignificant triviality she'd just talk about for ages. It took so damn long to talk to her, the whole ED was running behind schedule! (just kiddding)

Anyway, the docs went and saw her and they looked at her films, which seemed to show a slipepd disc at some level in her lumbar spine. It was still not a cause of her abdo pain and her inability to walk properly or stretch her knee out however. The docs ended up telling her to take some neurofen and that it would get better in a few days. Talk about Munchausen's by proxy!

Before that, we saw this little girl being resuscitated after being rushed to PMH in an ambo. She had been spiking temps for a while and was in the process of being seen by the GP when she lost consciousness and began fitting. Ater trying various methods of controlling the fits, she ended up having to be put under a GA and being transported to ICU. I'd never seen anything like it before in my life!

I'm back!

2005-04-28T17:48:00.000+08:00

After a long week, trying desperately to study for this GP exam, I've finally come back to this place. And as yet, there's been no phone call, so that's a good sign that I've passed it, finally. The stupid thing is that they used the same cases as we had last time - I got a lady with sinusitis and tiredness. Worried? I shouldn't have been. I nailed it.

Lomography.

It looks cool, doesn't it. It's some kind of special photography (that takes 4 pics) that I don't know about. But I want to know more!

Been busy

2005-04-20T08:19:00.000+08:00

I've been busy. Sarah's surprise birthday was a success! She had no idea what I had planned, which was good.

Anyway, the GP exam is next week and I have started studying. More confidence, less worry should see me through.

I'm taking some 3rd years on a respiratory examination tute today. It should be fun!

Stressful

2005-04-10T00:26:00.000+08:00

There's a bit of a stressful time coming up for me. Just finished writing those case reports on Friday, and handed them in just in time for the 5pm deadline.

It's really stupid how the cases we have to write up are so strict in their presentation. Like, one of them had to be an infant with a fever, and the other one had to be a adolescent with a chronic medical problem... the result is that students fight over patients. Its a hard time for all of us.

Not only that, but there's other stuff we have to do for paeds like the Community Paeds Assignment where we visit one paeds patient in the community. As well as write up another two case reports. And on top of that, I have to resit the GP exam. NOt going to be fun!

It's Sarah's birthday this week and I've also been under the kosh trying to organise that. I hope she enjoys it.

The inverse of busy

2005-04-05T21:56:00.000+08:00

A simple mathematical formula:

1/b = k.B

... where b is representative of how busy I am, and B denotes blog length.
k is a coefficient yet to be determined.

Of course, there are exceptions, but this is formula generally holds true.

Pretty much, it means that the length of my blog is inversely related to how busy I am. So when I have a short blog, I'm pretty busy.

Of course, the exception is when I'm very busy, but wasting time on this stupid thing. Such as now!

He might be onto something!

2005-04-03T14:40:00.000+08:00

Kenneth Yap might be onto something with this post.

Maybe that's what I've been lacking in my life: some effort on my part to get motivated.

In other news, Arsenal defeated Norwich 4-1! And Newcastle have three players sent off as they lose to Villa. Bowyer and Dyer sent off for fighting each other!

Crazy Paeds

2005-03-31T18:14:00.000+08:00

Paeds is totally crazy at the moment. There's people running up and down the wards, just everywhere. And that's just the students! The kids are another thing altogether...

We have to write up two case reports by next week - and so we're all going crazy trying to find patients to fit the cases. Which means there's a lot of angst with people poaching others' patients. It's really annoying - I went to see a patient today, only to find that they had already been poached by another student.

I have this idea that I'm going to get there really early tomorrow and find the new admissions, but I don't know how likely that is!

Busselton was good. It's nice to hang out with the family now and then.

Busselton

2005-03-24T22:43:00.000+08:00

On a spur of the moment decision, I've decided to go to Busselton over Easter. That means no updates whilst I'm gone! I'm going to miss some birthday parties too, so that will suck - but it'll be good to get away from it all.

I still haven't seen any paeds patients yet. There's a lot I need to read up on.

Sherlock

2005-03-23T22:42:00.000+08:00

Sherlock died today.

RIP.

He was the best dog I ever knew.

Something must be wrong

2005-03-23T02:40:00.000+08:00

I don't know. It's 2.40 am, and I still can't sleep. And I've only had 9 hours sleep in the last 72 hours.

Will I eventually eradicate the need to sleep? What a concept.

Paediatrics

2005-03-21T22:54:00.000+08:00

Started paeds today. I've got a bit of a funny feeling about this term - everyone we met today seemed to be angry. (?) Kind of weird in a childrens' hospital.

Anyway, one bad thing about this rotation is the starts. 8am every day - I think I'm going to have to pretend I live in a different time zone or something.

I'm thinking of calling Brigette to change my clinical option from gastro to something else. I enjoyed it all at Freo, but doing it again at RPH might be overkill. Especially if I end up getting a successful application for gastro again in Edinburgh.

Eskimo Joe: the aftermath

2005-03-21T00:55:00.000+08:00

I'm back from Eskimo Joe and I'm slightly deaf. We were very, very close to the stage, and some weird things happened, but it's best if I start at the top. (pics not from the actual gig)

Left home at 5.30, in an attempt to get to Dino's by 6. Got there at 6 and then got a lift with Lin into Freo, no dramas. Found parking at 6.45, concert starts at 7, it's all sweet.

Walk up to the door of Metros only to be greeted with a sign: "Due to liquor licensing laws, the concert advertised at 7 will now begin at 8."

*sigh*

So we had some time to kill, we walked to Fast Eddies and got some wedges and calimari rings. Which were actually quite tasty, and killed the time a bit more than we had liked as we got to the club at 7.50 with quite a line in front of us. We waited though and little by little we managed to get in.

8.05: We're in. And as expected everyone else there goes to the bar.

8.10: We decide to make the first move toward the stage. About twenty people join us at the very front, in the spitting zone of the singers.

8.45: We're getting restless. We know there's a support act first, and we're all getting tired. The others moreso after having ridden 30km in the morning on the freeway bike ride thing.

9.15: We're getting kind of pissed off. There's no sign of anybody starting although there's some roadie movement on stage.

9.45: Steve Parkin and the Foreign Films start playing. It's just loud, loud rock. Some acoustic moments but just really, really loud.

10.15: They still haven't finished their set and the crowd is getting bored. There's a big sheer when they announce their last song.

10.30: Still waiting for the Eskies.

10.45: BANG! And we're underway. The first song is Come Down.

Other songs they played included Older Than You, Smoke, I'm So Tired, Seven Veils, Life is Better With You, a superb rendition of Aint No Sunshine, Liar, and the last song From the Sea.

One very weird thing happned near the end of the set. This girl, kind of dirty looking, blonde, came up and barged past Dino and stood at the front of the stage. We all looked at each other, and shrugged. I thought to myself that we can't let this stand so I had a word to her, which she fobbed off with some weird reply. Anyway, I resigned myself to having this weirdo girl next to me.

But then it happened. I glanced over to my right and saw her taking off her panties.

Yes. Taking off her panties.

She then put them in her bag and mouthed something to the guy on keys, who couldn't hear her. When I looked again, she was dancing and moving her head around.

I took a pace back and mouthed something to the others, which they couldn't understand. The next thing I knew, she had thrown them on the stage.

They were bright pink, and huge! It was disgusting.

Anyway, she eventually walked off, having done the deed. I guess that's all she wanted to do.

Before the last song there was another intruder however. She came up and decided to dance right next to us, almost knocking Dino over in the process. She jumped about, and must have seen the weird look I gave her and asked me to join in.

"Come on, join in!"

"I don't think so."

"You're at the front, you have to!"

"No, I'm not."

After the song she walked off and wished me a good night, and apologised for being annoying. Well, maybe not for bing annoying but she did apologise regardless.

Eskimo Joe finished off with a song I had never heard before and Wake Up, my favourite song off the first album.

It was a great evening, although the lateness of everything was a bit annoying. The strange girls made the night a little more interesting than it would have been.

Eskimo Joe

2005-03-20T10:24:00.000+08:00

I have finished my report, and to reward myself, I'm going to watch Eskimo Joe tonight!

I remember when I first got into the Eskies back in 1999. They were a completely different sound, very raw, youthful, exuberant. I liked it a lot. I was going through some changes in my life, and their music really helped me to cope with the pressures coming with the teenage years.

However, as I've grown up, my taste has predictably changed. And funnily enough, so has the sound of Eskimo Joe. They've become a whole lot more melodic and reflective. When Their album Girl came out in 2001, I knew exactly what they were trying to achieve. They made the album cover look snazzy and modern, and the songs were more layered and intricate. Whilst it was good, it was probably a little too contrived for the alterative scene, and a little too surprising for the mainstream.

2004 - and the success of bands like Jet, the Vines and Coldplay have made it cool to have genuine melodies behind songs. Eskimo Joe has tapped into that and they've stripped back their songs, boosted the vocals and gone simple with the album look. Their second album A Song Is A City is great. It fits my muscial preference perfectly.

http://www.eskimojoe.net/

Medical Student Blogs

2005-03-19T19:29:00.000+08:00

Some interesting links about the supposed lack of medical student blogs.

Glorfindel of Gondolin - "Who blogs more, law students or medical students?"

The Lingual Nerve - "Med students on the net migrate to 'old-fashioned' web sites, mailing lists, and discussion boards. Questions (mostly technical or career-oriented) are answered faster, resources and helpful links are centrally located, and time doesn't get wasted addressing comments and updating the blogroll."

Lit Review part 2

2005-03-19T16:48:00.000+08:00

Don't you hate it when you're already over your word limit but are nowhere close to finishing?

I wish I could design like this guy.

Oesophageal dilation

2005-03-19T14:25:00.000+08:00

Yesterday was my last day with the gastros at Freo. A bit of a sad occasion, but it was time to move on. I had a great time, the people there were a really nice bunch and they taught me a lot without knowing it. Gastro seems to me to be a really good specialty to consider in future, as long as I can get over having to stick the finger up people's bums. >:O

There were again two interesting cases yesterday. Both were of guys with oesophageal strictures. The first guy had a narrowing that had been dilated before, so we did the same thing again. It's called a CRE dilator (controlled radial expansion) and it's pretty much just a balloon. The baloon is attached to a length of guidewire which is threaded down the oesophagus (you observe with the endoscope). And then once it's in the correct place you can inflate the ballon with a fixed amount of water. It was kind of cool, and the trauma to the oesophagus isn't that huge, although there were a few bleeding spots when we looked again. So pretty much you just blow it up bigger and bigger each time until you get to the size you want to get to. In this guy's case it was 15mm.

The second case was another guy with a similar problem, except that it was much more severe. This guy couldn't even talk. He had a trachesotomy tube and had been quite sick in the past. The oesophageal narrowing was so marked that we actually planned to use a paediatric scope. We ended up using the XP one, ie 'extra-paediatric', meaning really really small. John managed to just get into the stomach using the scope. With this guy, we planned to use the push dilating method, in which you just push a dilating probe down the oesophagus to open it up. There's lots of risks involved with these procedures, and this guy was in a lot of pain. It was my job to hold him down, and even with the heavy sedation we gave him (as usual fentanyl and midzolam) we struggled with a great deal of vigour.

The problem in this case was the fact that the stenosis was very high up. This meant that pushing the dilator down didn't work as the angle was wrong. We couldn't get the dilator in enough before we hit the stricture, so the force just created trauma instead of pushing down the lumen (hole) of the oesophagus. It was a failure, but it was a good learning experience for both me and John.

After that, there was the gastro grand round, where I got a free lunch. And that was it for the term!

On to paediatrics.

Beautiful

2005-03-18T01:21:00.000+08:00

Time lapse photography can be so beautiful.

Interesting Day

2005-03-17T18:27:00.000+08:00

Saw some interesting cases today. The morning was full of normal stuff, like colonoscopies and gastroscopies - with little more to find than polyps and ulcers. That stuff is kind of boring - its the same thing all the time. But in the afternoon, things picked up a little. There were two patients, both with alcoholic liver disease, both presenting with haematemesis and malaena.

The first guy was an IV drug user (he shot up on speed). He came in with a history of vomiting up blood for the last few days, and was rushed to the endoscopy suite from ED. Anyway, when we went in there was blood everywhere. It was difficult to see anything else really. We looked around the stomach and duodenum, ascertained that it was all normal, and then went back to the oesophagus to see where the blood was coming from. There were two longitudinal tears in the mucosa which were obviously the source of the bleeding. So we looked at them, and then the consultant suggested injecting them with adrenaline, which they did. And the bleeding gradually stopped: a) because of the mass effect of the adrenaline blebs, and b) because of the vasoconstrictive effect of the adrenaline. It turned out that they were both Mallory-Weiss tears. John told me about something else I hadn't heard before, Boerhaave's Syndrome, a complication of an oesophageal tear in which there is a pneumomediastinum. Diagnosis is by CT.

The second patient was pretty interesting. He was completely off his face, hepatic encephalopathy in full effect. He was totally disoriented, didn't know anything about his surroundings. On top of that, he was Hep C positive and had massive ascites. He had to be scoped on his back, with lots of us restraining him! Anyway, we went in and saw nothing much really - there were a few varices but they weren't bleeding (most likely due to the fact that his fluid had all shifted into his ascites). Then we saw a small tear in one of them. That was it! Out came the bands (variceal bands, duh) (which I hadn't seen before). Anyway, that was cool. They suck up the varices into a port which they attached to the end of the scope. There's a wire that runs from that port to the control trigger in the operator's left hand. So as they suck up the varix, the scoper releases the cord, and a little blue rubber band is released and gets stuck on the varix! Problem solvered. It was great!

Remember this?

2005-03-16T23:10:00.000+08:00

This website is full of pics of old operating systems, Linux, Windows, Mac OS. There's also screencaps of other apps too. It's a nostalgic walk down memory lane.

Potentially handy links

2005-03-16T20:13:00.000+08:00

Startup Control Panel is a nifty control panel applet that allows you to easily configure which programs run when your computer starts.
PowerToys are additional programs that Microsoft developers work on after a product has been released to manufacturing. They add fun and functionality to the Windows experience.

Altoid mp3 player / iPod Hacks

2005-03-15T21:48:00.000+08:00

Another article

They have other things too, like hacking iPods and putting Linux on it, with more games, apps, and better sounds recording. I wonder if I'm game enough to put Linux on my iPod.

Lit Review

2005-03-13T16:25:00.000+08:00

The assessment for this unit is to write a lit review. This is how I'm going.

Lit Review: Flexible Sigmoidoscopy as a screening test for CRC
Colorectal cancer (CRC) is the most common internal cancer in Australia. Close to 5% of Australians will develop the disease, and of those, about half will die from it. However, it is known that CRC develops in a stage-wise method, and that early detection of the disease can be life-saving. Furthermore, detection and removal of high-risk polyps can decrease the risk of CRC by up to 90% in those screened. Accordingly, there has been considerable research into the evaluation of potential tests that could be used to screen a population and detect CRC at an early and curable stage. Tests currently under consideration include faecal occult blood tests, flexible sigmoidoscopy, and colonoscopy.

Rivetting.

Fun

2005-03-11T18:02:00.000+08:00

I'm having fun at Freo. I really enjoy the hospitals much more than the GP surgery. It just seems to be a bit more interesting. More things to do. Different people to look at. You can just nick off if you want to. I like that.

Anyway. It's been a good experience so far. The consultants and nurses have been generally quite nice. You know, they talk about funny stuff. One of the nurses is a Geordie and likes Newcastle. It's kind of funny having a football conversation when there's a patient with a scope up their bum.

There's this nice reg called John, and he's from PNG. He's really good, and tries to get me involved all the time. Apparently his family are in a bit of strife over some immigration thing though. It's unfortunate cos he's a really good fella. Very competent and seems to know a lot, which he tries to teach me.

Today there were some interesting scopes. There was a Dieulafoy lesion that they blasted with the cauterising thing. On the monitor it looked like Star Wars, when the Emperor is electroshocking Luke Skywalker. I thought it was brilliant!

Another thing that was cool was watching the insertion of a PEG into a guy in ICU. This guy was in an unfortunate accident where he fell off a motorbike. In the impact of the accident, he completely transected his spinal cord at the level of the brainstem. Not a nice thing to have happen to you: his function has been reduced to blinking and a few facial expressions. Anyway, the PEG insertion was interesting because they actually did it in ICU, after carting all the equipment and nurses there. The ICU guys were freaked out by the food in his oesophagus. It kinda looked like old cheese.

Fun!

CRC/Endoscopy

2005-03-07T22:19:00.000+08:00

Time to put the disappointment of GP behind me and start afresh with this option. Hopefully it will be good. The people at Fremantle are generally quite friendly - that's got to be a plus.

I expect this week to be a whole lot of sticking my finger up people's bums. Literally.

Rectal examinations and colonoscopies are what I can expect with this option. Could be good, or very, very bad.

Failed the exam!

2005-03-04T16:27:00.000+08:00

Yep, failed the exam. I was too nervous, worried about it too much - ended up giving a bad account of myself. The dude was a guy with a migraine and a hidden agenda: he had unprotected sex two weeks ago. Unfortunately I brushed over that aspect of it (or so they tell me).

So I have to sit the damn thing again in 8 weeks.

No sense in crying over it.

Exam tomorrow

2005-03-03T01:37:00.000+08:00

I'm sitting that GP exam tomorrow. I hope I do ok.

Sheffield Utd 0-0 Arsenal (FAC)
Arsenal won 4-2 on penalties. Its the first time any team of mine has won a penalty shootout.

Morals

2005-03-01T17:23:00.000+08:00

Your Score

Your scored -0.5 on the Moral Order axis and 0.5 on the Moral Rules axis.

Matches

The following items best match your score:

1. System: Socialism
2. Variation: Moderate Socialism
3. Ideologies: Social Democratism
4. US Parties: Democratic Party
5. Presidents: Jimmy Carter (84.38%), Gerald Ford (84.38%)
6. 2004 Election Candidates: John Kerry (84.38%), Ralph Nader (75.59%), George W. Bush (65.62%)

Statistics

Of the 55069 people who took the test:

1. 2.3% had the same score as you.
2. 31% were above you on the chart.
3. 57.2% were below you on the chart.
4. 27.9% were to your right on the chart.
5. 60.3% were to your left on the chart.

Moral Politics

Strange happenings

2005-03-01T16:21:00.000+08:00

After finally handing in my logbook yesterday, I have just so happened to have come across patients I could have written in there. My logbook did not contain a single presentation of headache, but today, I got one.

Brief notes:

34 year old woman
Headaches seem to be related to menstruation/hormonal changes
Unilateral headaches can be either side
Cross the entire side of the head
Feels nauseous
Tablets are not good
Panadol has no effect
Nasal spray works

Feeling tired

2005-03-01T16:16:00.000+08:00

"Doctor, I'm feeling tired."

"Well have you been getting enough good sleep?"

"Well I only sleep three hours at night, but then I nap for another three in the afternoon."

"Well that's why you're tired."

"Oh."

Role-playing

2005-02-28T16:47:00.000+08:00

Had an interesting experience role-playing the GP today. Each Monday, we've (the med students) have taken it in turns role-playing the GP whilst an actor comes in and pretends to have a condition commonly seen. The idea is that we get experience in consulting and managing common problems in General Practice.

So I did mine today, and my patient was terrible. Stupid bloody somatisation woman and she never listened to a word I said. It's pretty annoying when you explain to someone that there is no possible way that stomach and leg pain are related, yet they keep insisting its true. And nothing can convince them otherwise.

It was a total nightmare!

Anyway, I need to get back to the books. I have no idea about how to treat someone with Meniere's disease. Also need to get good at taking a thorough history again, after losing all my skills in the GP surgery. Have to learn the dosing instructions for Stematil too.

Study and blog at the same time

2005-02-27T22:46:00.000+08:00

Zyban (buproprion)

Unknown mode of action. Presumably neurochemical.

Used in nicotine withdrawal in assoc w counselling

Contraindications
allergic
seizures
MAOI use (has a slight antidepressant property)

Adverse effects
insomnia, nightmares, dizziness, agitation, anxiety, fever, rash, itch, nausea, constipation etc
palpitations
can predispose to seizures

Come back if: you develop a rash, lips swelling, breathing probs
Don't drink alcohol much (seizures)
Can cause drowsiness (machinery/driving)

Dosage
Start at least 7 days before smoking cessation
150mg mane initially for 3 days, then 150 mg bd for 7-9 weeks
(Take in morning to avoid sleep disturbances)
Assess in 7 weeks. Discontinue if marked reduction in smoking has not been achieved.

Bored, amotivated

2005-02-27T17:42:00.000+08:00

You'd hardly think that the exam is on Thursday, for the amount of effort I seem to be putting in. I don't really know how much they expect us to cover. They reckon it could be anything we've seen in GP - but for me that isn't a great amount.

They won't have skin lesions. I know that, because they expect us to diagnose the problem mostly from history. And they won't have a common cold because that's too damn easy. I expect it would most likely be something like asthma, back pain, depression, STD... Not sure what else. And I still don't know whether I know enough. And I can't be bothered studying.

Gosh I sound like a whinger.

Tomorrow I have to hand in the long case and the portfolio. My preceptor must like me or something because he gave me a pretty good mark.

The long case is full of shit.

The most important lesson I have gained from this case is the patient-centred approach to management. Visiting the patient in their own home and asking them to explain what their understanding of the disease has given me a much better realisation of the weight a doctor’s words carry. As such, it is very important to remember that it is the patient (and not the disease they have!) that needs to be treated and kept at the forefront of our thoughts.

Haha!

Arsenal - what more would you expect?

2005-02-27T15:26:00.000+08:00

Longmire does Romance Novels

2005-02-26T14:21:00.000+08:00

How funny is this?

Results of boredom

2005-02-26T14:03:00.000+08:00

You are 'Latin'. Even among obsolete skills, the
tongue of the ancient Romans is a real
anachronism. With its profusion of different
cases and conjugations, Latin is more than a
language; it is a whole different way of
thinking about things.

You are very classy, meaning that you value the
classics. You value old things, good things
which have stood the test of time. You value
things which have been proven worthy and
valuable, even if no one else these days sees
them that way. Your life is touched by a
certain 'pietas', or piety; perhaps you are
even a Stoic. Nonetheless, you have a certain
fascination with the grotesque and the profane.
Also, the modern world rejects you like a bad
transplant. Your problem is that Latin has
been obsolete for a long time.

What obsolete skill are you?
brought to you by Quizilla

Nothing much today

2005-02-26T13:31:00.000+08:00

Just trying to do some study for the exam on Thursday, voted in the election and surviving on junk food.

Junk food and study don't really go together for me. I think study is losing.

General Practice

2005-02-24T20:11:00.000+08:00

So its been about a month since I last posted here. And what can I say about what's been happening?

Well, I've seen some stuff, chatted to some patients, and now I'm stressing about the exam next Thursday. Watching skin lesions being cut out of people is cool, and then suturing them up again is even cooler. Last week, I saw a guy with a basal cell carcinoma (bcc) on his nose, and one of the GPs had to cut it out. That was interesting - the way the cut was made (along the lines of Langer) meant that his nose had to be pulled up. Like Nicole Kidman, as the doc said.

But all in all, GP has been pretty boring.

I've been sitting there on my ass in the corner of the surgery and watched my dude consult, write out prescriptions, teach me the bloody wrong thing (MR is a pansystolic murmur, not a diastolic one, you dolt!) and then nick off at 3pm. 3pm. Yeah that's a good thing, finishing early means I can go home earlier - but for some reason when I get home, I am so exhausted. Even surg term last year wasn't that tiring - or maaybe it was but I wasn't so bored!!

Other things I've seen? A girl with Charcot Marie Tooth disease, coming in for assessment of her ability to work (which the GP couldn't do as he hadn't seen her before), plenty of UTIs, someone with chronic bronchitis, sinusitis, otitis media, 2 pap smears, depression, anxiety, viral URTIs.

Gotten some nice drug company lunches and morning teas, and went on a nursing home visit with my dude after one of his patients had a stroke. Turned out it was most likely a TIA as she was back to her usual (albeit not so good) self.

Then we have sessions at the Dept of Gp in Claremont. Each Monday and Thursday we meet there to discuss cases we need to learn, and different approaches to patient management. They suck too.

But what sucks the most is the exam next Thursday. 15 minute consult. Talk to the patient. Diagnose. Manage. Arrange follow-up.

It's a little daunting.

Let's see how we go.

Bloody tiring

2005-02-02T16:50:00.000+08:00

Who would have thought sitting in a GP's surgery would be so tiring. Saw a ganglion cyst and a kangaroo tick.

But when this happens, nothing really matters does it?

Fark.

GP is good

2005-02-01T01:11:00.000+08:00

General practice is pretty good. The people are generally quite friendly and I'm getting pretty good teaching with my doctor. He's been working at the same place for 22 years and is very good at what he does.

Interesting things I've done? Sutured a wound. Removed sutures. Urinalysis. Seen someone with Dupuytren's contracture. Looked into some ears. Seen a dodgy guy want some viagra.

There's a lot I need to learn and I hope I have enough time to learn it all thoroughly. It will be a very valuable term if I can manage to get everything that I'm supposed to into my head.

What else? Played tennis today. I can serve now. Hewitt lost the tennis to Safin. Iraq is having their elections. Kim Beazley is the new opposition leader. Arsenal take on Man Utd next. Chelsea have made a rocrd 88 million pound loss.

Starting 5th year

2005-01-23T20:30:00.000+08:00

Tomorrow I start the new year. 5th year. I am now 2/3 of a doctor! With very much less than 2/3 of a doctor's knowledge!

We're supposed to start at 9am at the University Department of GP tomorrow and I have a sneaking suspicion that the commitments there will take the whole day, dashing the hopes of those who thought we'd be able to watch a movie before the lecture at 5.

It's going to be a long and challenging year. Let's hope I pull through it in one piece. If all goes to plan, I should then be on my way to Edinburgh at the start of 2006.

Waking up early

2005-01-22T01:55:00.000+08:00

Waking up early is very difficult. Especially when it's sudden - you know, after days and days of getting up around noon, suddenly there's an urgent need to get up at 8am. It's got to be one of the hardest things about starting term again. It's not something I'm looking forward to.

I have just checked my allocation on the Med website (aka 'flying fish') and I have been allocated a GP in Balga. It's not too far away, but there seems to be a perception in Perth that Balga is full of poor people, delinquents, crack addicts etc. So it should be interesting!

All of us starting the year with GP have to meet at the university department of general practice in claremont. At 9am. Which means I actually need to get up at 7.30 in order to leave at 8am. Bloody hell!

And to top it off, Arsenal suck at the moment. In a terrible run of form, losing to Bolton last week and with injuries galore. Gilberto looks out for the season, Edu still has a broken toe and will most likely leave the club; Henry is off form, as is Vieira and Pires and Reyes. What is going to happen? Chelsea are 10 points ahead on 58 and Man Utd are closing in behind us on 47. It could be a disasterous season.

And next season, the last one at Highbury, Arsenal will wear a claret strip.
I'm still in shock.

Almost back into it

2005-01-18T03:15:00.000+08:00

Well its been a while since I last posted anything here, and any readership that I might have had (ha!) will most likely have all but vanished. So how's my holiday been?

It has been good. I've done lots of things I wanted to do. Soccer, movies, lost in translation, staying up late, in/out love, spirituality, having fun, what is life, death, romance, heartbreak, pain, gutwrenching, Arsenal, hope, relief, anger, sadness, wasting time, wasting life, shrewd choices, spoilt, hot, cold, concert, free stuff, 21st birthday, family, Christmas, gifts, sweat...

All the above has happened to me these holidays. And now time grows short as the academic year starts again on the 24th of January. Starting with GP term which is supposed to be rather slack. So it should be good, and enjoyable too.

Just had news that our elecive application to Scotland was unsuccessful. Hopefully this will be sorted out soon and we can make some definite plans.