How, How?

Where to?

2011-01-23T22:55:00.002+08:00

Just went for an ethics course over the weekend and they were asking us to fill up a survey form when i was once again stumped by the almighty question:"Given a choice, would you still choose medicine as a career?"

I took like 5 mins to think through but circled 'yes' in the end and that's because i was pressed for time. Actually i still don't know my true answer.

My past 2 years in hospital was kind of fun but demanding. Demanding because i was going here and there every 3 months, so for both admin and knowledge purposes, there's always a need to adapt and learn. It was fun as i did not feel any great stress to do well/impress at those postings since i was a 'by-passer' anyway. I was so looking forward to end up at the polyclinic ultimately during those 2 years.

So here i am, having spent 2 months + at OPS and guess what? Disgruntled sentiments settled in still. Many of us feel like it's a production line while seeing acute cases: at least 60 patients on a good day and up to 100 on a real bad day. You're basically aiming to clear the crowd while reducing the probability of yourself missing something and stepping on a land mine. Despite how some guidelines say subsidised government services are meant for those who really cannot afford private healthcare, we still see demanding, well to do patients who choose to come to the OPS, pay subsidised rates but yet want to see 'world class healthcare'. I'm sure every patient should deserve the best the doctor could give during the consult, but why expect a short waiting time or 'good medicine that private GPs always give' when they choose to crowd with others at OPS?? And when clinics close queue earlier as doctors cannot cope with the load? Complaints flood to forums when the whole idea of closing queue early and reducing patient load is to ensure patient's safety..

I've been to several inter clinic training sessions and could feel the angst among my colleagues, we can only hope the steps to bring the clinics to a fully appt based system will work out in the end..

I'm wondering if I'm a fickle person. Initially wanted to work in ED then found shift work too disruptive and ED work somewhat too stressful, went to ortho, found that i can't operate confidently, to OPS and feel that 80-90% of the time, i'm dishing out MCs/referring patients.
Did i choose OPS as it is something i could go on long term with less stress each day?
I'm still getting pre shift blues before ED shifts but the cases i've seen in ED really made me feel that my time spent there as a doctor is much more worthwhile..

I'm really fickle i guess.
Hmm, what if i spend my days just poring through financial reports and click the mouse button to invest??

Red packet

2010-06-24T21:37:00.001+08:00

A red packet, like a gift, is valued by not how much it costs but by who and when it's given.

Everyone knows that i'm sure, but today's incident made sure i don't forget it.

i didn't even think of opening it when i got itcos i know even if there is 1 cent or even nothing in it, it's still priceless.

Matsuri

2010-03-10T18:44:00.004+08:00

Long time no blog..
Quite many things went by, but somehow too lazy to blog them..
Anyway, was psychoed/coerced/dragged by dear... Er not so bad but anyway...
Was persuaded by her to go for Kitaro's concert although i've only recognised 1 of his songs: Matsuri...

Although it was a weekday event that got me quite sleepy the next day, it was well worth it.
I enjoy watching musicians that do music because of their love for it..
Kitaro certainly looked like he did.
He was like a wizard concocting a mix of tunes while his supporting musicians created the background.
He seems haphazard, natural and almost experimentative with his synthesizer.
Gives me a feeling that he is playing with his 'feel'... almost like 'hmm this should go well with the tune now.. ' and magically the sound came together to produce his great brand of music.

But he appeared real old under the spotlight, thought that he may just turn blue while blowing the flute or lie down in fatigue after hitting the drums.. but he managed to pull everything off well :) He also really impressed me by his humility when he speaks.

Anyway, real glad that he played Matsuri twice.. some of the other tunes were great too but not that spectacular. (Maybe i hadn't heard them before) And during the 2nd time he played Matsuri, he actually joined the ranks of the backup drummers and hit the drums with them... Could see their smiling faces when he did that.. Making it truly a 'festival'

Ho Gai Siao

2009-09-26T15:38:00.002+08:00

Attempted to fry something a while ago on a metallic ordinary looking but apparently very expensive German brand frying pan (Vxx brand) and ended up staining the pan big time cos the food will just stick to it the moment it hits the pan's surface.. Had to put real lots of oil to prevent the stick and needless to say, everytime you try to flip the foodstuff, you'll risk 'dismembering' it cos some parts will stick to the pan..
That's not all though, the washing was a real pain, cos the stains are so hard... i mean unremovable.

So having had enough of this sticky issue, Dear and me went in search of the infamous non stick pans..
Surprised to see NTUC hypermart selling Tefal in their store. (Thought Tefal very atas and expensive) and it cost about $30 per pan.
Really glad we bought it.. this brand really 'bo hao siao', really really non stick. With almost a non existent amount of oil, i can literally slide an omellete off the pan without using my spatula.
So if you're facing the same problems as us, feel free to try Tefal :)

Controversial

2009-09-12T21:23:00.003+08:00

Was at a teaching today and the topic of abortion was brought up.. The question goes: maid came for routine work permit renewal and was noted to be urine pregnancy test positive. Will you refer her for abortion if she request for it?
Well, most of us agree that she has the right to be referred.
However, 1 colleague said "For me, I'll definitely not refer.. Because of my religion.."
So it sparked a refute:"The maid is a human and should have the freedom to choose, so i feel the decision shouldn't be affected by the doctor's religion." I always thought conscious objectors to abortion will just not perform it, they could refer to somebody else if patient requests..

But anyway, my focus was his answer.. He said he didn't want it because his religion doesn't support/allow it. I guess if his answer was:"I don't support abortion because it's killing a life to me", I might see him in another light.

Religions are a good guide for the way we live, it makes us better persons, it gives us support whenever we need it as we'll always believe there's someone up there looking out for us when we're down. Most religions offer a desired end point when we follow the teachings: Nirvana in Buddhism, being a sage in Taoism etc. We however haven't seen someone reach the endpoint in recent years...

I wonder if it could be that we're now working backwards instead of understanding the essence in the religions/teachings We'll follow rules/commandments like not killing, not eating a particular food, not doing certain acts.. Most of the time, we do it because 'the religion says so'. Even if we manage to understand the rationale, are we able to internalise it?
That's why when he said:"My religion doesn't allow it" It seems he's following the teaching, probably not understanding it and more likely not internalising it. But who am i to judge?

I feel that the founder of the particular religion/teaching worked it out the reverse direction. i.e. there's a principle he has already understood in the beginning and has internalised it (The Tao/The way to enlightenment) and henceforth, he acts in ways in accordance to the basic principle. Over years, in a bid to get people to understand (Lao Zi said so: he can't describe this thing called Tao), these ways become like rules/methods that may lead to the ultimate destination. Maybe that's why so little people are successful in attaining the target? Cos now everyone will be working backwards

Well, i'm not a religious person, somehow just interested in them.. Will most probably be someone who can't see the light :)

Seeing the light?

Noob Kia

2009-09-06T21:03:00.003+08:00

Started playing DOTA some time ago.. I was wondering how people were so attracted to the game (that was quite some years ago) and now am beginning to understand why..
It's just like a team sport.. gather 10 people and it's 5v5. Team work is needed to score goals (pawn heads in this instance) The sensation of owning the game is undescribable and gives you great stress relieve when you are able to take it out on creeps and enemy heroes.
Inevitably, the beginning is difficult.. You dunno where the dangers are, you dunno which heroes are more dangerous and you often get ambush and pawned.. Then you'll be feeding the opposition with hoardes of gold and your team mate will curse you and shout "you noob la!!" or "stop feeding la you noob!!"
Alas, some time spent on playing will yield some experience and you know which hero you are more comfortable with and which one is more 'gay' i.e. able to stun the enemy and hit them while they are stuck in the position..

I sort of thought of the time when i started playing soccer in university with my classmates. I love soccer since primary school but was never good at it... But i still loved it... So because some one asked if i wanted to play, i agreed, thinking that it was like my secondary school days when everyone played for fun..
Little did i know that they used to be schoolteam players and you guessed it.. I was the noob kia again.
Kicking grounders when i should clear the ball far.. Missing tackles.. Rounded by strikers.. Ballooning the ball right in front of the goal line..

Fortunately, despite the screamings i got from the team mates, everyone was a friend after the games, they will tell me how to play better, that they dun mind me playing with them still..
Must say that without their patience and teachings.. I honestly wouldn't improve in the game.. will still be a kampong street soccer kid :)

Somehow, this leads me to think of job satisfaction.. I guess there are many things that makes a job satisfying.. My first thought is pay, but even if one is paid 10k and gets scolded at everyday, doesn't get any recognition etc.. is the job still satisfying?
Recently was in a ward with a consultant who gets agitated easily.. even a nurse knocking on the door to the MO room will get him into a fit (if he's doing some teaching). So naturally when there's one or two points about a patient you're not sure about, he'll show some agitation. So even though the ward has like less than 10 patients, and there's little to do, there wasn't satisfaction at the end of the day. You're just living in constant fear...

I'm now in a busier ward, but the consultants are nicer.. They appreciate what you know and what you do, instead of irking at what you don't know and what you didn't do.. So even if you're busy the whole day, ending the day later and having short lunches.. you'll still feel that the day has gone well and feel real satisfied at the end of it..
Can understand why dear's so lack of motivation to work with her BIG BOSS :P

Long time liao...

2009-08-23T21:58:00.006+08:00

So long no entry.. Even forgot how to log in..
Wonder if i'll ever be locked out of my own account in future when i cannot retrieve password or something...

Anyway, just came back from a trip to Cairns, dived in the Great Barrier Reef.. Name is Great, and probably the reason it is called Great Barrier is because the reef forms like a barrier over the north-eastern coast of Australia. The diving though... is not that Great, spend half the money to go to Southeast Asian sites like Sipadan and you may get to see almost the same or better stuff.

It was a liveaboard trip (5 days, 4 nights) and fortunately we managed to get some motion sickness pills before boarding. The ride was ROUGH. We went off all the way to Osprey reef from Cairns (Osprey is way up north on the map). Crossing the inner reefs to the outer ones will mean a real wild ride over the ocean waves and we were rocking left to right, up and down on our cabin bunks and we could hear the DVD player in the cabin sliding back and forth with the waves as well. Not our idea of some good rest before a hectic day of diving...

I always thought diving was like cycling.. You'll never forget how to do it.. Unfortunately, i somehow forgot that taking out your regulator underwater will mean water will get into your mouth...
I was a little sick (motion sickness) on the first dive and was about to puke. So i happily removed my regulator and attempted to puke but nothing came out and fortunately the nausea went down with the 'vomiting action'. So naturally after the attempt, i had to breathe. Happily i opened my mouth and inhaled and in went salty, cold, ocean water..
Had to cough several times under water, underwent a period of panic of not being able to breathe and needing to ascend.. then underwent a period of wondering if i would drown.. Somehow remembered that diving got oxygen tank and regulator one, so quickly replaced my regulator and purge whatever water is in the regulator before sucking in precious air.
Can't imagine doing an emergency ascend just 15mins into the first dive.
Water was also chilly though the gauges showed that it was 24 degrees, it felt like 16 everytime i dived in.. Was shivering in every single dive. Think next time must be more prepared with dry suits inside or something..

Well, reef life was abundant and it would have impressed us if we hadn't been to Sipadan.
Here, we had to dive like more than 10 times before seeing a single turtle and a ray. I almost couldn't believe my eyes and ears when a fellow diver jumped with joy after seeing 1 turtle... Maciam they are rare like manta rays..
But highlights of the dive were the potato cod feed and the shark feeds. They managed to organise some bait into the water and attract the more unique fishes to feast on them right infront of us.
However, besides these highlights.. have to admit that it is not that kind of MUST GO places to dive. Sites in our neighbouring countries would probably offer the same if not better sights.

Well at least it was a real good break from work and civilisation (100 miles from land, no other boats in sight... only water water everywhere)

Map of the Great Barrier Reef. Osprey reef was way up north on the map.

Interestingly, reefs occasionally 'pop' out right in the middle of the ocean like this..

Our dive group. From all over the world: China, Europe, US, Africa..
Spoke to some of them and they agree that GBR was probably not the best place they've dived in.

Potato cod feed.. These cods are huge compared to other fish.

Shark feed: In the initial moments, it was really a frenzy, the chain which hung the bin full of bait and tuna heads was shaking like crazy with all the feeding frenzy from the sharks and other fishes joining in the fun.

The Hike

2009-05-03T20:43:00.010+08:00

This was really the hike of our lives.
It starts from Scynige platte to First and it will take 6 hours. The hike starts from 2km above sea level, peaking at 2680m then coming back down to 2180m.
It's a great hike as it goes along a plateau that enables you to see both sides and enjoy the scenery on both sides of the mountain.
It was also a hike that we did twice (the second time was squeezed during our last day) as the first hike was blurred with a thick fog and we couldn't see much.

The start of the hike was already bustling with bells and 'moos'. We chanced upon a shepard herding his cows with a shepard dog. The cows have this habit of taking up the whole width of the path and we sometimes have to manoveure around them and at the same time avoid their dung.. Quite fun, but because this was out first time encountering cows without a barrier, we don't know whether they'll kick or ram us. But we managed to cross them safely :)

Keeping my safe distance

Like a scene from the movies. Peaceful shepard with his dog, just going about his daily life

The fog didn't quite set in at first and we managed to get some shots like these on the way up the peak.

Then the weather started getting colder as we gained altitude and we started to see ice form on the upper areas. We were so excited that we took shots of the ice.. Maciam never see before.. Actually really never see before this 'half-half' kind of look on the mountain.

Ice forming on the upper half

So we went on and somehow felt colder as we trudged on. Someone seem to say 'You want ice? I'll give it to you guys!!'
There you have it: Ice all around us and to make it better, the fog came to join in..

Ice all over with little visibility

Can only see the sign when you're near it. Otherwise will be lost in the fog. Dear was standing like only 10m away.. We could see no views on the plateau, only ice and the path which fortunately was not covered totally.

Cold was the main theme of the hike and it got to our hair.

We reached First after hours of walking in the ice and fog and wondering what's so good about this hike.. Atop First is a hotel cum restaurant which didn't have much business with this kind of weather. Fortunately they still served hot and good food. We took their Rosti (fried potato) and had some warm drinks to go along. Good for thawing our hair...

There's still something to smile about with this weather. (The owner is smiling at least)

We continued the hike after lunch and it was all descending after we came down from the restaurant. The walk was much easier as the ice eased away and fortunately we could still get snapshots like the one below when the fog lost some of its power.

But when it came back, all we could see was mist and we almost even ran into a moving truck (had it not been its engine noise that got to us first)
Being disappointed the first round. We decided to do it again the second time on our last day (went back here after visiting Lucern) View was much better and again we ate the same Rosti up on the peak. The owner there was so touched that we went there again she rewarded us with a First sticker. Well better than nothing...

Thinking back, it was a dangerous thing to do on the first run since there was actually no proper map. i.e. nothing with contours drawn or little tracks on the map to mark which direction we should follow. So if the tracks got covered with ice totally, we would have had it and been lost.. Dunno how to walk, dunno if got energy to move around to maintain heat. But fortunately the paths were really demarcated well after so long so the chance of them being totally buried is quite slim.

But that aside, the hikes here in Interlaken are really a class above the hike in Singapore. not only the views are spectacular, the weather there is also ideal since it is cool and less humid. You won't get sticky/sweaty/moody after walking 6 hours!

Jungfraujoch

2009-04-29T14:29:00.011+08:00

Touted as the "Top of Europe" at 3454m above sea level. Actually the title meant that it is the highest peak where people can have easy access to. Other mountains are definitely taller than this but you gotta hike/climb your way up.

Well in any case, it was something we haven't experienced before.. Whole mountain peak covered with glacier. Like a desert.
So because it was something we haven't experienced before, we didn't bring one of the essentials for going atop a glacier.... Sunglasses.
The glare was overwhelming. While we were walking on the peak (the trail just appeared to be about 1km long), we were both panting due to the low O2 level and also taking breaks to shut our eyes so that we could rest from the glare.
We thought about the shades but somehow didn't seriously went about buying it. So kind of suffered for a while.

But enduring through the whole ordeal of panting and straining our eyes was well worth it. View was astounding and the walk was really once in a lifetime..

Signboard at the visitor's center

1 cup of spicy Korean noodles before setting off to the ice. (Cheapest food at the cafe)

Vast plains of glacier. Abundance of ice.

Top of the world

Can't see the end of the trail from here, but it's supposedly quite short. But walking it is tough.. On the lungs and our eyes

'Ahh kena stuck!!' (Posed picture)

Huskies were for show. This Kor Lian Dai had to eat ice, most probably for rehydration.. Dunno how many days never feed/give him proper water. (Business too lousy?)

Thanks to this snow machine, they managed to compact ice to form paths that was walkable with normal shoes. Otherwise everyone will need snow boots. (Reminds me of the harvester from Dune)

Interlaken: Tummel falls/Lauterbrunnen

2009-04-28T08:39:00.016+08:00

On recommendation from Lili who's been to Switzerland during winter, we took a glass covered train (goldenpass line) from Montreux to Interlaken. It's a scenic route and the glass roof/windows etc were meant to enhance viewing pleasure. The cabin also had posh seats and well carpeted flooring.
The train's booking system appeared strange to me as they charge a booking fee when you choose seats online but if you hold a railpass, the trip is free (meaning only pay booking fee, don't need to pay for the trip itself). So we could just book seats at about 10 dollars each and show them the railpass when we board.
We booked this train twice unintentionally, due to some strange decision from the travel agency in Singapore who sold us the tickets... We are booking a scenic train ride and he had to put us on the aisle and not the window seat (when the train wasn't fully booked yet!!) So we had to do it ourselves online again but fortunately the booking fee they charged was not substantial.
So we happily went up the train to our window seats and realised that the aisle seats the 'friendly travel agent in Singapore' booked for us were marked 'reserved' as well.
As more people were streaming in (most without seat bookings) and had no seats, we nicely told the conductor that the aisle seats were reserved by us too but we'll forgo them. And the conductor had to reply 'Oh you've to sit at your reserved area!' Dunno had to spend how long explaining to her our whole story but she still didn't understand. Anyway, we still sat at our window seats and after some time, the passengers realised that the 'reserved' seats were empty and decided they could sit there. Really can't imagine what will happen if some prankster book the whole cabin then don't turn up..

Nice cabin, scenery. But book it yourself to avoid disappointment

We arrived at Interlaken and this started the best part of the trip :)

Our first stop was the Tummelfalls. A unique waterfall that transients within a cave. Engineers had skilfully crafted outlooks within the cave so that we can enjoy looking at this hidden waterfall which otherwise can only be seen when it exits.

This mine-cart like lift took us to the middle of the mountain from which we could continue ascend on foot to get to the lookout posts

Walk within the caves and you'll chance upon views like those below...

Honestly, the tummelfalls visit was shortlived (the walk was short) and wasn't that spectacular. It was just unique. So since we still had time, we decided to go for an easy trail in preparation for our planned 6-hour hike 2 days later. The trail goes from Murren to Lauterbrunnen. So the planned route is a cable car up to Murren which is about 2km above sea level and then going by foot downwards to Lauterbrunnen. Easy right? Walking downhilll for 1 hour...

The town of Murren was someplace i'll want to spend my retirement if given a chance. The village was quiet but well built up. Houses were lined with meticulously planted flowers and all the residents seem to have super green fingers here. Everybody's flowers were in full bloom.

Wonder how many crows it successfully managed to scare off...

From the town of Murren, we exited to a jungle path that kept going downhill for the whole hour of the trail. Halfway into the trail, we regretted choosing it as our 'suspension' (knees) began to falter with every step. We had to take breaks not because we were out of breath but because out legs were shaking from the repetitive impact.

Some sites along the jungle path. Good for admiring and resting the knees..

Finally seeing the endpoint.

We reached Lauterbrunnen at about 7pm and night was falling. We also just missed a train that goes back to Interlaken West and had to wait for about an hour. Fortunately, there was a small cafe near the station that provided cheap dinner. Forgot the price, but we were really thankful it was there to provide some warmth and economical but palatable pastas while we were waiting for the train.

Thank this cafe for its food and shelter amidst the darkening skies

Our first dinner in Interlaken

Switzerland: First stop Montruex

2009-04-27T09:44:00.012+08:00

Was honestly a little tired of the bustling in Italy. There's just people everywhere. Hence, was real glad we put Switzerland as our last stop. This was where I really felt 'honeymoony'

Our first stop in Switzerland was in Montreux. One of the town surrounding the peaceful, tranquil Lake Geneva.

A shot from a ferry that transits between the towns around the lake. (Hopefully i'm not wrong, but this mountain is Mont Blanc)

So, it was maciam a step into heaven from the busy/noisy/squeezy streets and water buses of Venice :)
We honestly didn't do much research for Montreux, as we intended to just spend a day here, just as a stopover to go Interlaken. Fortunately, the tourist information here is real friendly and they suggested we go to Roche de Naye mountain, as well as the Chateau de Chillion (Chillion castle) which we planned to go initially.

So we took an almost vertical train up the mountain, which supposedly is home to a mammal called the marmot.
The air at the summit was fresh and the view.... Breathtaking.

Those tiny trails actually offer avid mountain bikers an exhilarating downward trail. I find the thought of accidentally hitting a drink can and veering off track too exciting -- will reach the bottom of the mountain probably 10 times faster. So better to give it a miss.

The faraway peaks looked like they are floating on clouds

So since the main attraction is the marmots, of course we'll chance upon them on the mountain!

Cute right? But these creatures were locked up in cages. Don't see a single one scurrying around freely on the mountain. Had to poke my camera through the grill to get this shot actually...

We went on our castle hunt again after the mountain excursion. Chateau de Chillion

The castle was situated on the bank of the lake. Try magnifying the center of the photo then you can see it..
This castle was special because it was near the lake, it was very liberal: allowing photography and within the castle, there were courtyards with well placed flowers/fountains that gave the medieval feel.

'Aura'

Castle by the lake. Just wished it had the 'SOLD' sign and we were the buyers..

Played many games but none gave me such a big treasure chest to open.

Again reminds me of games.. Gotta search the shelves properly to find the hidden item/key card/ammo etc

To top these all, the hotel we booked in Montreux was the most expensive and classy (actually cannot find cheaper ones that's why..) So with a good hotel, they gave us a good view of the lake and also a special bed...

Can adjust head height, leg height.. Comfortable mattress with cosy blanket. But the adjustibility of the bed reminds me of the hospital beds... Only no drip stands, no temperature chart

Venice

2009-04-25T22:55:00.010+08:00

Whew.. more than half a year liao, but anyway, just put this up so that in years to come, probably can look back on this...

Venice: world famous for being the water city. Being world famous will inevitably cause an effect on it's citizens. Venice constitutes a group of islands and also a neighbouring area on mainland Italy. Due to the vast number of tourist swarming to the islands, most of the original citizens decided it was better to move to the mainland for livelihood.
We spent our stay in Venice on the 'island portion'. After touring almost most of the islands, we can't help but notice that the whole place is filled with repetitive souvenior shops, branded goods, restaurants, hotels.. The entire place gave us an impression that it was just made for tourists. And true enough, every street is filled with tourists, can hardly see any true blue locals around.

Image of Venice's Grand Canal

Image from a clock tower. Gotta pay 8Euro just to take a life to 6th floor for this!

Image from a clock tower

Accident and Emergency

Taxi

Police car.. Boat rather

Bus

Bus stop

Gates to the cemetery (It's a single island by itself) Don't ask why..

Stalled Engine

2009-04-25T22:23:00.002+08:00

Long time since any input.. Blogging engine not working for some time..

Slogging in mental health clinics not a very fun and ideal thing to do... Finally endured till a 1 week leave starting tomorrow :)

Sometimes, I don't know if I'm treating myself and the patient's family or the patient himself.
Of course, those with the mood disorders like anxiety or depression (excluding manics) will feel genuinely better with treatment. However, in patients with psychosis like schizophrenia, who in the first place may not have insight to their illness, i tend to wonder if they actually prefer living in their world of voices/hallucination than the real world.

The 2 types of schizophrenic patients i come across are: 1) the blunted (because of the medicine), obedient patient, who will follow anything/prescription offered. They'll say they are comfortable, getting well, not hearing voices etc. Then obediently accept any treatment we institute to them. Of course, these patients are our darlings since they make the sessions easy. Some of them also volunteered that they really felt uncomfortable when they had hallucinations and are happy that they are well now.
2) the no insight, not compliant, resistant to treatment patient. These are the patients i'll start thinking that the actual patients are the family members or the doctor. The patient usually says "i'm not sick, i don't need medicine!!" No matter how one will try, they'll persevere that nothing is wrong with them. So they'll not take their medicine or resist everything else one can offer like depot injections. They often behave strangely and disrupt the lives of their loved ones. Usually the patients require admission to the wards, only to return few months later with another relapse.
I'm wondering if they actually enjoy their world more, since if they become alert to the real world again, they'll need to worry about their livelihood/money/meals etc. And if being 'unwell' is that uncomfortable, why won't they want treatment? Admitting them will relieve their family of constant worry and caregiver stress. It'll also relieve the doctor of the paronoia: whether they'll commit a crime or suicide if they leave the clinic status quo. So? Are we treating the patient or the family/doctor?

Well anyway, most likely i'm not cut out to be a psychiatrist. Really admire them for handling the patients tirelessly for years. I would have suffered from burn out..

Guess i'll continue the trip blog for now :) still got more than half to cover...

Dr not = $

2008-12-19T00:22:00.002+08:00

Just went for a wedding dinner of a secondary school ECA mate. Haven't met him for like 12 years and not say we were very close during our secondary school days but still he invited me.

Was quite like deja vu when i saw many of my secondary school mates who didn't seem to have changed for 12 years. Same faces, same character, same way of talking. Many of them are real successful. Architech, bankers, engineers... etc..

Well, having known their bread winning methods, they'll naturally ask mine and the usual response of "Wa.. earn big bucks la!" or "Iron rice bowl!"

Ya i agree that my rice bowl a bit more metallic but don't say i earn big bucks and can buy the penthouse you're designing can?
Even more ironic when someone who 'envies' i can earn $ many many is buying some >$100k sports car when i need to think thrice (and now still thinking) about buying a car like Cherry QQ...

Also, the economic crisis you're suffering may also affect me even if patient load is the same. Cos you can't imagine hospitals giving us the same bonuses or pay rise at times like this even if our productivity is the same right? (Else we'll be thrown size 20 shoes by people everywhere we go!)

I'm enjoying what i'm doing and i feel i'm paid fine.. Buying/eating things that are of above average value are not unaffordable. I also need not think too much about whether i'll have enough $$ to spend for the month. Job security is also probably better than most fields.
But sometimes i just feel like letting everyone know that Dr does not = $$.

Florence/Pisa

2008-10-30T18:03:00.010+08:00

Hmmm, distracted off honeymoon blogging for sometime liao..

Anyway, here's Florence, the home of the Italian artists.
We went and we left, without entering a museum....

1st reason was the queues: can you imagine a queue at the science centre stretching to the center of its carpark? And the queue is waiting for people to exit so that you can enter, not just for buying tickets..

2nd reason was the price: guess we were too frugal. Minimum of 7E per person per entrance, we're not so arty farty, so we would rather spend the money on something else... (like paying 100 Swiss Franc 3 times in a bid to have an Alps hike on a clear day.. well, more on the unfortunate trips later)

So we just spent time walking the streets, looking at free art pieces on display.
I'll just splash on the pictures ba, nothing much fascinated me in Florence except for the humble looking Fiorentina stadium, SGD$4 fried rice, wonderful tuna sandwich (you don't see anything i fancy is artistic eh?)

Over a hill view of the whole of Florence. The prominent dome's called the Duomo, a large church

The famous David (the character in David vs Goliath) by Michalangelo. This was a reproduction on a Piazza. (Free to look) The original is in the Accademia museum.

Pisa is about 1hr's train ride from Florence. So what's there to see in Pisa?

Fiorentina! One of my favourite Championship Manager 2000 club! Haiz... but the stadium... Just need to imagine Jurong stadium with the Fiorentina logo pasted on the gate..

SGD$4 Fried rice! Cheapest staple food we found! Shop assistant from China but didn't dare speak to him in Mandarin at first (so was struggling using English with him) until he started Mandarin (when he overheard us use Mandarin)

Nice tuna sandwich, made by this '帥哥' (according to Dear).. Ok la, looks a wee bit like Brad Pitt. At least his tuna sandwich is nice.

Uffizi gallery: THE gallery to go if you're in Florence. But look at the queue man. (people lining up in the corridor) Can't even see the entrance from this shot.

Land Breeze, Sea Breeze

2008-10-23T23:04:00.004+08:00

Surprisingly saw my Sec 1 form-cum-geography teacher as a patient today.
Even more surprised he was a far cry from the person he was about 15 years ago

He used to call me 'botak' (cos of my previous hairstyle)
More importantly, he taught me a lesson i'll remember for life: Land breeze vs sea breeze:

1 fine day during a geography lesson: he taught - the land due to its heat conductivity heats up and cools faster than the sea. So when the land is warm in the day, air rises and sea air rushes to the land, creating sea breeze. The vice versa happens at night and there is land breeze, then he poped the question to me:

'Hey botak: so if one day you go sailing with your girlfriend, will you go in the day or in the night?'

At that point, I thought to myself: go sailing will need the wind in the sea ma, so need sea breeze lor..

'Sir, i'll choose the day because got sea breeze'

To this he said:'OK, so you'll scold your girlfriend - see la, because of you la, bad luck. The boat cannot go out to sea one'

Well the whole class laughed. The right answer was night cos there will be land breeze where the air rushes to the sea, so will push the boat out to sea..
So because of this lesson, i remembered land breeze and sea breeze for life (good teaching eh?) and i never needed to scold my girlfriend (now my wife).... cos we never went out to sea on a sailboat together.

When i saw him today, he was instead full of smiles, soft spoken, even close to meek. Can't imagine him calling me botak now.. given his current disposition. (anyway i also no more botak liao)
He didn't remember me and i didn't remind him. Cos i don't know if he will remember me or not and also i dunno if i will be able to sustain a conversation with him...

Sometimes i get this feeling... seeing someone i know but not that well and will rather avoid saying hi cos i'm afraid i cannot continue a conversation and it will end up an embarrassing silent 'conversation'. Maybe i'm 'dao' ba.. Wonder if anyone else has this same problem..

Close to ending of Heavenly Life

2008-10-21T23:05:00.003+08:00

Days in polyclinic ending soon...
Going back to hospital days...
Calls, wards, blood taking...
Arrgghh.. Too de conditioned liao
Siao liao la.. so used to office hours, how to do calls now?
now 11pm already feel like sleeping already, how to 'tong' whole night??

Must say i quite like the scope of the polyclinic, seeing many kinds of cases and more importantly, most of them very stable. If anything too hot to handle, then can send via ambulance to your friendly A and E colleague (who most probably curse you but you're not there to hear it..)
Old folks that come here are also generally nice, grateful. They are the ones who will really make your day when they keep thanking you/smiling at you/respecting your advise etc..

But of course, every job has its devil's tail...

1) MCs: 14 y/o girl, comes at 415pm to the polyclinic, well made up, well dressed up, complains of cough, runny nose in the morning, cannot wake up so come now. 'Can i have MC?'
'Wa lau, of course going somewhere to chiong la.. plan to cannot wake up one right?' But cannot say that, usually will give the benefit of doubt. Ok lor, so you so fit, recover in few hours, give lor. (else will argue for 5-10mins why i don't want to give MC, then next patient will walk in black faced...)

2) Referrals: working in ortho before really help me reflect ortho referrals better. At least can very confidently say to patients: if you don't want surgery now, refer to them now also will do same thing as here. Then can repeat a few times (cos confident liao) until they accept. Other disciplines a bit harder as really not sure if valid or not.
I usually try to satisfy patients, but some are really a bit ridiculous. What to do.. Either argue for 10mins to get them to understand that they dun need one, or just silently write the form..
Some patients opening statements really send chills down my spine: oh i come here for a referral (i.e. i actually dun want to see you one, you small lokun, but what to do? Dun see you the specialist price so expensive)

Some common remarks: wa!! see specialist must wait so long one ah??!!
(Ya lor.. cos before you already got like 10 persons ask for same referral although keep telling you all don't need to go one.. dun need to wait become need to wait liao)

(Don't get me wrong, if referral is justifiable, you don't even need to ask me to write, i'll offer..)

I didn't do any studies or statistical analysis, but i would dare say the crowd at the clinics can be much more manageable if it is an ideal world: i.e. only truly sick patients come to clinics. But like most of my colleagues say: you can't fight it man. So well... just have to enjoy the goods as much as possible and manage the bads as and when..
Anyway, will still prefer work in polyclinic anytime compared to hospitals....
Arrghhh calls!!

没话讲

2008-10-18T22:45:00.002+08:00

Lokun: 哇! Auntie ah! 你的血压 200/100 leh! 很危险啊! 你得吃血压药好吗?

Auntie: Hah?! 血压高啊? 这样我不是有高血压 lor?

Lokun: 对啊, 你有高血压. 你得吃药好吗?

Auntie: Hah? 不要啦! 不能吃太多药的啦!

Lokun: 可是你不吃药很危险啊! 很容易中风, 心胀病的 leh.

Auntie: 不要, 不要. 我不能吃太多药的啦. 我都不觉得有问题嘛.

Lokun: (Haiz... How to persuade her?? ........)

Auntie: Oh. 对 hor 医生. 我的脚每次痛的 leh. 为什么啊?

Lokun: Oh Auntie, 你有关节炎 leh.

Auntie: Hah?! Then 有没有药吃啊?

Lokun: 有啊. 你要吗?

Auntie: 要! 当然要啦! Oh 还有 hor.. 我觉得我骨头也每次痛 leh.. 可以给我盖资的药吃吗?

Lokun: Ok. 可以呀!

Auntie: 哇! 谢谢 leh.

Lokun: 怎么样 Auntie? 你要吃高血压药吗? 不吃危险喔...

Auntie: Hah?! 不要啦! 吃太多药不好啦 !!

Lokun: .............

Vatican City

2008-10-14T18:50:00.018+08:00

If someone wants me to use 1 word to describe the Vatican City, i would say 'ART'. It's staring at you everywhere you walk.
We went to Vatican Museum before visiting St Peter's basilica. The museum is wonderfully decorated by the glorious artists of the past: Michaelangelo, Raphael (and nope, no signs of Leonardo or Donatello).. It's really worth the 28E entrance fee. But somehow, after the visit to the Vatican museum, we developed a certain phobia to art museums and never entered a paying art gallery for the remaining of our trip :P

I was a little afraid the moment we entered the museum. Afraid of walking the wrong way/direction and ending up missing some sections, so i was debating whether to get the guidebook/map or even the audio guide to help us. Fortunately Dear reassured me and said 'just walk la'. OK, so 'just walk la' we did and it turned out that there was only 1 logical way around the whole museum.

Started off with this courtyard.. Nothing fascinating, but guess it offers some fresh air before you get 'drowned' by the arts.

Courtyard

The first section after the courtyard contains sculptures:

and more sculptures:

and even more sculptures (i gave up uploading the pics.)

Well of course art is not only 3D. They come in 2D pictures as well, just that they do so in different forms:

Woven Art:

Woven art..we picked this piece of Jesus ressurrecting without knowing (Was actually quite dark then)

and paintings:

The museum route was designed in such a way that the finale is at the Sistine Chapel. This is where the famous painting of Man and God by Michaelangelo is affixed on the roof of the Chapel. (You know the one which shows man lazily reaching out to God who is trying to stretch all he can to reach the idler?)

Thought they forbade phototaking but somehow this pic is on the net..

The whole of the Sistine chapel is a painting. Even the curtains on the walls were painted i.e. painting of curtains. From floor to roof and from end to end, it was a painting. Simply amazing. There were signs to forbid phototaking and 'lying on the floor' (most probably many are so awed by the ceiling art they were lying down for the most comfortable view), but it was so crowded inside that it's so difficult to stand still, let alone lie down lor..

After getting groggy from the ARTs, we made our way to the St Peter's basilica (St Peter's church). Apparently this was also the place St Peter's was crucified upside down. Dunno the whole story of him though. Just got a vague idea he was one of Jesus's disciples.
St Peter's square sits just outside the church and around the square lies the border between Rome (Italy) and the Vatican city. Well, you wouldn't feel you've crossed a country anyway. No custom officers, no causeway etc..

St Peter's square with the St Peter's church as the backdrop

Taken by a friendly tourist... Most probably he felt the Vatican border (those concrete stones on the ground) is more important then taking the church..

Walls of the church perimeter lined by numerous unidentical sculptures

The interior of the chapel was huge and it was hard to take a photo to give the impression of its size. Or rather, i still dun have the skill to take a photo to show the size of the chapel. But still, take my word for it, it's huge and impressive.

Throne of St Peter

Just 1 part of the interior of the massive church

After the walking, we finally came to the highlight of the day: climbing the dome of the church. It has supposedly 500+ steps to conquer without lift (have to pay 6E) or if you want to cut it down to about 300 steps: it will cost you another 5E for the life ride. Hmm, hope i got the prices correct.
But the climb was both vertiginous and claustrophobic.
Because it's winding (it's a dome ma..) and the stairway is pretty narrow. (1 man's width)

Narrow, narrow steps. Just like a bomb shelter stairway

Fortunately, the climb was rewarding as we get to see these scenic views from above.

Aerial view of St Peter's square

View of the rest of the Vatican city from the Dome. Is it a rich man's house or a whole country? (Boundary marked by trees)

And of course, what is a visit to the Vatican without seeing the legendary Swiss guards of the city? Apparently the only legion of Swiss guard left in the world (they used to work as mercenaries)

I yearned for a visit to the Vatican years before as i was so interested why the country was so small. But on reaching there, i just felt that it was part of Rome, cos there was nothing, nothing at all to remind me i'm visiting another country.
Nevertheless, i was glad we came here first before visiting Florence, cos we really saved a great deal of $$ by not visiting Florence's museums after seeing the Vatican's :)

Rome

2008-10-11T15:06:00.013+08:00

Our next stop was Rome. The overnight train from Zurich provided a comfortable and peaceful sleep with a 'rocking cradle' effect. I almost dozed off the moment i laid on the bunker.
Fortunately we managed to reserve a twin sharing cabin which appeared crampy enough. Can't imagine sharing this space with several others. (It's supposed to be able to sleep 3 per cabin) The carriage came with a sink, towels and breakfast. But of course it came with a price.... 140E to book per person, that's on top of the 100+ Euro we had to pay for the Europass per day. (Almost 400 singapore dollars per person just for the ride...But at least it provided the transport and overnight sleep.)

Small twin sharing cabin

Carriage comes complete with sink, mirror, towels. But please bring your own wife and toothbrush

We reached the Roma Termini (Rome train station) and along the walls were familiar graffiti, stuff we only see on TV. Wonder how many people will be caned and jailed if this was in Singapore..

Fine art along the railway walls

Our hotel was some distance away from the Termini and we therefore had to transfer to the metro to reach it. The metro is almost like the MRT, but the underground stations were not air conditioned (they don't need air-con anyway, given the climate) and neither were there doors at the platform.

Metro in Rome

The hotel or should i say apartment was on the fifth level and fortunately there was a lift in the building. (Looks like most European bread and breakfast accommodations are flat owners converting their homes into budget hotels.) The lift was more manual and automatic as you have to open 2 doors on your own to get in and open them again on your way out. Lift was tiny as well and we managed to fill up the whole lift with just us and our luggage..

2 X manual doors to open before getting into the tiny lift

Rome can be toured on foot. We visited several churches and museums but i guess there were only a few attractions that left a deeper impression in me. One of them is of course the colosseum. Where gladiators brawl to their deaths in front of excited (or sadistic) crowds.
The exterior of the colosseum appeared just like any stadium, just that it's built with stones and appeared older. Going into the colosseum itself did not really gave us a 'Waaa!!! So nice ah!!' kind of feeling either.
Well, guess it's special because of it's history ba..

Colosseum's exterior: Huge and well... 'stadium looking structure'

Interior: not the wide plain arena i expected like the show 'gladiator'. Maybe the fighters play hide and seek and ambush each other using the walls?

We went on from the Colosseum to the Palatine hill which supposedly is the origin for the word Palace. Cos it was the place the royals of Rome started to live in. The Palatine hill was one of the 'must see' in guidebooks, but after walking around for like 30mins and trying to find our way out, I got a little sick of seeing ruins. Really nothing fascinating but broken stone walls and sand. Maybe i just can't appreciate them. Fortunately the Roman Forum (sort of the city center in old Rome) provided good salvage. Also a 'must see' ruin, the forum brightened up our day somehow as the way it was preserved gave us a sensation that we were really walking along the streets of old Rome. It felt like a town which could have been bustling with activity and people. The columns were legendary and so were the arches and small churches nearby.

Roman Forum: Have to be there walking on the street itself to feel it: the sense that this was a bustling town full of activity and people.

Roman columns

Rome is also famous for its fountains. According to books: they managed to get a lot of water via their aqueducts and therefore can afford to built beautiful fountains for leisure. Just walk around Rome and you'll chance upon a fountain surrounded by sculptures of gods/heroes very easily. The Trevi fountain is still my favourite, given it's size and the beauty of the sculptures. There are even seats around it and people just love to sit around and stare at it for hours. Many will also toss coins into the fountain over their back... supposedly will help them return to their eternal life (whatever that means)

Trevi fountain: trickling water, splendid sculptures.. Really a hit with tourists

Fountains in Rome do not merely serve to beautify the area, they keep you alive as well!! We almost didn't believe the hotel owner when he told us we just need an empty bottle to walk around Rome as there are lots of drinking fountain around. But he's been living there for years, don't believe him also cannot.. Rome is cooler than Singapore but still one of the hottest town we've been to in this trip. The fountains were really energy boosters as they somehow found the right temperature for the drinking water and you'll feel thoroughly refreshed after a mouth full. And best of all? It's free!

Fountain fountain on the wall

Probably the only thing in Rome we should have done was to walk around at night as the city is
decorated with spotlights on their attractions and supposedly places like the Trevi fountain will be beautified like 2 folds by the lights. But somehow, we sleep at about 8-9pm while in Italy (maybe because it's already 2-3am in Singapore) cos we'll be super tired by then. Also the many advise from guidebooks to beware of pickpockets in Rome kept us away from the streets at night.

The Trevi at night (taken from someone's Flickr)

Castle Linderhof

2008-10-08T21:38:00.010+08:00

Day 2 of our honeymoon, we woke up to our first european breakfast from the hotel and we were simply amazed by how well kept the hotel's dining area was.

Wall attached seats and wonderful lighting

Breakfast was wonderful with sponge cake, bread, yogurt, ham and even scrambled eggs! We enjoyed the food thoroughly and fortunately we enjoyed it cos it was the best breakfast we were going to get for the rest of the trip :)

In memory of the best honeymoon breakfast

We went on to castle Linderhof after our departure from Schwangau. Well, it was another of King Ludwig's 2 castle and once again Richard Wagner influenced part of the design. The exterior of the castle was a huge garden, so it took like 10mins of walking the garden before we reached the entrance. And there to greet us was this pond with a golden sculpture in the middle (not sure if it is pure gold though)

Front view of castle

We were walking around the castle perimeter and snapping pictures, we came across this interesting looking statue that turned out quite sinister after we looked at the picture again.
The whole statue was corroded leaving the shiny, glittering dagger.. And god knew why we decided to have Dear posing under her.

Sinister statue... Hmmm why were we attracted to it.

We were happily snapping pictures when the sound of water splashes brought our attention back to the pond...

Strong fountain jet (technology in 1800s?)

The fountain will supposedly go off every hour. It could have reached the 4th-5th storey of a HDB flat. Pretty amazing given the innocent looking sculpture. Like the other castles, tour of the castle was guided and 'no photos allowed inside please'. And once again the whole place was build with grandeur, art and $$$. Oh didn't i say there should be an opera writer's association to the castle? Yup, this time, it was outside the castle and it is in the form of a man made cave:

The King will sit in the swan boat and move around the small river to look at the performance in the cave-themed stage.

The cave was constructed as this Richard guy wrote a play that had a scene in a cave, so the King just took the idea and built this. The cave was behind the castle (up this hill you see below) and to get to the stage, one has to walk about 2-3mins along the passageway of the cave, so it's pretty much hidden... Guess it adds to the King's pleasure

Hill behind the castle

Castles were one of our 'must go' in this Europe trip and i really have to thank Dear for suggesting to include Germany in this trip. The castles by Ludwig were really extraordinary and i enjoyed driving on the autobahn and the country roads.

We initially planned for a Munich tour on Day 2 after Linderhof but we arrived pretty late and met with Wansing for dinner in instead. Once again, i need to thank Dear for her foresight and persuasion as we decided to push off the Rhinefall visit in Switzerland and go for a city tour of Munich on Day 3 instead.

City tour of Munich was great as most attractions i.e. churches and town hall were free. Wurst (sausage) in Munich was splendid and cheap (1.90E - cannot find this price anywhere else liao). The city is bustling with modern shopping centers interspersed with buildings of historical values. I must say it was the city tour i most enjoyed.

Old town hall in Munich

Neuschwanstein

2008-10-06T23:04:00.008+08:00

We visited the Neuschwanstein castle next (New Swan Stone Castle). As said before, this was the brainstorm of the 'Fairy Tale King': Ludwig 2, who took great interest in opera and also loved the works of someone called Richard Wagner. So he actually built this castle in honour of the writer. i.e. many rooms/pictures of art were based on the writer's works.

King Ludwig 2

Well, construction of the castle began in 1869 and 17 years later, Ludwig was declared mad... somehow, then also somehow drowned in a pond with his doctor somewhere... And somehow, the castle was also never completed... even after 17 years. (although not unexpected given its size and Ludwig's ambition)

We arrived at the castle after taking a bus ride up a hill. We didn't know much about fogs till we came here. Visibility was less than 10m. We followed Rick Steve's guide up the Mary's Bridge which supposedly will give us a 'wunderbar' (wonderful) view of the castle and ended up with this:

See the castle? Does it remind you of some 'ghost in photo' shot? (Left of my head)

'What it should have been view' from Mary Bridge

We went into the castle following a guided tour and I was really awed by the amount of work that was put into the castle. For e.g. his bed's canopy alone took 4 carpenters 2 years to complete (if i didn't hear wrongly). The walls were augmented with golden carvings from floor to ceiling. Art was everywhere and rooms were enormous. This really felt like a castle and with the amount of effort required, it's no wonder it wasn't completed after 17 years.

Managed to find this online photo of the canopy, a little small though

I must say i quite enjoyed the castle visit as it looked Disney-like. Moreover, the grandeur of it all gave me the impact of a true castle. Unfortunately, the weather wasn't very clear. I guess the best shot of the castle we had was this entrance shot....
The rest were lost in the fog..

We didn't take the weather into account while planning our itenary and therefore had to make our way away from the castles the next day. (though the next day wasn't so clear anyway). Our next stop was Linderhof castle (an hour's drive from the castles we were seeing, but another one by King Ludwig 2..

Honeymoon!

2008-10-05T21:53:00.009+08:00

Finally got down to blog about the wonderful trip :) Had real fun and a wounderful time sightseeing, hiking, discovering and travelling with my Dear Wife :) Really enjoyed it and felt fully refreshed to start work again. Also got cold turkey from games. Hopefully won't start and get hooked on them again... Hopefully...

We touched down at Zurich and we subsequently drove to Fussen and went on to Schwangau to look at the castles there (Hohenschwangau and Neuschwanstein) Renting a car from Zurich was easy, got a Citreon C4 complete with GPS and steering wheel..... on the left..

香车配美女

Digital Speedometer, GPS on the windscreen, left hand drive and of course... the 美女

Driving around was certainly much easier with the GPS. First time using it and boy it's so intelligent. It gives specific instructions like "At the next roundabout, take the 2nd exit". "After 200 yards, turn left". If you go way off, it will program another route to take you back right on course, although sometimes, it will get lazy and say "turn back when possible".

Left hand drive was a little challenging at first, and it took us a couple of times to get used to going in the correct door. Fortunately, driving around the highway and country roads was easy with less cars and less turns. Car was also smooth and vibration was so well damped i didn't even know i stalled the engine when i did... many times (shows my skill eh). Makes me want to buy a citreon... The autobahn felt like any expressway, though it keeps reminding me of Einstein's theory of relativity. In Singapore, the trucks go 70kmh, normal cars go 90-100, the speedsters go 100-120. In Germany, the trucks go 90-100, normal cars like mine go 130-150, the speedsters go 200kmh at least. So you'll feel stationary at 70, like a snail at 90, like human at 130 and a devil at 200... (though i didn't go that fast). But what websites advised were true: the Porsche you see in a distance in your rearview mirror will appear beside you in seconds..

We arrived at our hotel near the castles (fortunately with car and us still intact without a scratch) and set out for our castle tour. We visited the Hohenschwangau and Neuschwanstein. Unfortunately, no phototaking was allowed in the castle (though we found out when we were in italy that it was easy to snap shots unnoticed..) The Hohenschwangau was where King Ludwig (known for his extravagance for building castles) lived when he was young. So since the Hohenschwanau is actually his 'lao beh's', it felt just like a rich residence with castle walls. Nevertheless, it served as good appetizer for the castle tour. We visited the Neuschwanstein (build by King Ludwig) next.. But guess i'll talk about it next time.. Need to koon liao..

Exterior of Hohenschwangau

Backdoor of the castle

Castle from a distance... (Inset:Little white riding hood)

Cancer

2008-08-16T07:38:00.003+08:00

Imagine you're 40 years old, smoking, living perfectly fine except for a chronic cough for few months..
You visit the doctor complaining of the cough and he decides to do a xray.
It showed a large tumor..
He refers you to the hospital for further investigations and you're told it's late stage..
Would you rather not know and continue living the almost perfectly normal life?

NB: picture taken off an educational website, no corelation to any local patients..

Fortune

2008-05-26T23:13:00.002+08:00

They worry when their homes can be rebuilt
They worry if they can have their next meal
They worry if the next body extracted is their loved ones
They can only think about the days ahead

I worry if I can wake up fresh the next morning
I worry if the patient queue is long tomorrow
I worry when it will happen again
I can think about the years ahead

They worry about their survival
I worry about my emotions

Ong Bak

2008-03-20T23:48:00.002+08:00

I always find the Thais a rather impressive group of people in Southeast Asia. Good soccer players (Kiatisuk, Surachai), good swimmers (Ratapong), good fighters (muay thai and Tony Jaa), not to mention the many encounters my colleagues and me had with stoic Thai workers who seem to have no pain sense.

My current posting is like an ASEAN congress, we have NTS MOs from Philipines, Thailand, fellow MOPEX from Malaysia.. Once again the Thais impressed me ++

I always feel so relieved i had finished the MBBS (something i thought as tortuous). Little did i know that for the Thais, the end of their exams is the beginning of their nightmare. They have to drawlots for their postings and people are known to faint if they drew the Southern provinces (you never know when you will be the next bomb victim). How to save lives? Can't even guarantee one will live the next day there..

But also don't expect too much if you draw another province, you will have to work 7 days a week (oh did i mention they are already working 7 day weeks since year 4 med school) from 6am to 9pm. morning round involves 6 wards of 300 patients. (i.e. 1 MO to 300 patients) Yup 300, the ED i'm working in now sees 400-500 a day (that's about 30 doctors seeing 400-500). So everyday is just seeing patients, doing changes from patient 1 to 300...

But of course not everyday is so sunny: just round and changes, patients collapse... So as a MO, one must resuscitate as well.. (not to mention they have no HO year), so a first day MO gotta resuscitate without the registrar and consultant. And that's not because the seniors are sleeping, it's because they are busy doing other stuff like operations or clerking, seeing, resuscitating other patients... My Thai colleague told me she actually had to flip a book right in front of anxious family members during a resus!!

I can't imagine myself working there... I'm already counting down to day offs everytime i start work.. How to survive 7 day work week for my whole life?? Singaporeans are pampered, true even for Singaporean doctors..

Jay's concert

2008-01-21T23:09:00.000+08:00

Haven't been to many concerts, but this was really the best.
Little wonder why the tickets were snapped up so fast
There wasn't a need for a crowd warmer to try to get the crowd aroused and warm (unlike JJ..)
The moment the music started and the star appeared, the payers of the most expensive seats were on their feet.
The concert went on and when it ended with Huoyuanjia and shuangjiegun, 99% of the indoor stadium's seats were redundant and everyone were shouting in unison to the song.
I guess no one's music can get the crowd hyped up so automatically except his.
He's the king of mandarin pop for now i guess
Pity though he didn't sing much of his older songs that were true classics.
Will be waiting for his next concert.. Hopefully i wouldn't feel too old in the crowd by then.
Must thank dear for pulling a colleague with an OCBC card to get the tics. Maybe have to get one such card before next year haha...

The soccer pitch

2008-01-01T19:56:00.000+08:00

A career in medicine seems like a career on the soccer pitch.
The high flyers (the specialist) fit the role of the strikers best. They get referrals (balls) from the other players and score the glamourous goals when they succeed. The crowd (patients) cheer and thank them for making their days brighter. Something that most other players in the field are unable to achieve

GPs can play both defence or midfield. With things they can handle, they would score the goals themselves. Else they will pass on to the specialists upfront for the finishing touch or if they think the ball or patient is too dangerous for them to hold on to.. They will do the ultimate necssesity: leave it to the goalkeeper

The goalkeeper plays the most important role in the medical field
They are the gatekeepers for patients. They get all the s*** ahem, balls from the defenders that do not feel confident enough to handle or at times, the balls just come flying at them at dangerous speeds.
The job of the goalkeeper is to keep the ball alive: (keep it out of goal). Who else is better at doing it than emergency doctors.
If the goalkeeper fails too many times, patients will drop like flies... the whole medical team will fail...

I'm most comfortable playing defender on the field... is that my career path too?

New year 2008

2008-01-01T19:50:00.000+08:00

Can't remember when was the last countdown i went to..
But this year was exceptionally good

Work ended at 11pm, quite on time fortunately.
Met Dear at about 1110pm and made our way to the merlion park
the train ride and the squeezing along the river bay brought us to 15mins before midnight
Quite a feat considering that it takes just 5mins to walk to the merlion park from the raffles place MRT station on a normal day
There were throngs of people gathering all the way from boat quay to the esplanade, almost no space to walk..

Fortunately, the fireworks were great.
watching together with dear was real special too.. Our first countdown alone together.. Haha
Hope the year ahead will be great for everyone.

Home

2007-12-25T21:37:00.000+08:00

Home sweet home :)

Total Defence

2007-09-26T21:07:00.000+08:00

I was initially so pleased with the plan.

Gown choosing this weekend, HDB first appointment the next weekend then the photo shoot on the third. It seems that our marriage plans are moving on after a pause. But why is Murphy always right?

My unit chose to be on standby this weekend. To make it more sian, i was made a detachment 2IC meaning i have to call all on my list to make sure they are still staying in their old homes, no shifts. And to be more sian, when i called the unit, the NSF on the other side of the line told me it's very almost sure they'll activate this time. How to choose gown with dear in peace?

Fortunately Dear who's quite pro Singapore is so understanding. Wouldn't mind choosing the gown on her own if the little green men choose to make their once a few months appearance on the top left corner of TV screens..

This morning scored a double for Murphy. The hospital decides to conduct a civil emergency exercise next saturday!! On my first HDB appointment i had been waiting for the past quarter of the year!! So since it's gonna be a "MRT explosion with chemical leak", fractures and blown limbs should be expected and of course any Lee(Tom), Tan(Dick) and Goh(Harry) in the ortho dept should be making their way back to hospital to boost civil defence. Again i was fortunate enough that the consultant allowed me to be back in hospital late that day..

Really wondered if leeway weren't there for both occasions. Would have been my disaster instead.

I was free on other weekends, i would have happily participated in these activities but yet the dates have to clash like this.. I feel my psychological defence breaking down..

Pride? Ego?

2007-08-28T21:46:00.000+08:00

I just knew i felt real angry and irritated during the encounter, but i couldn't tell why till i thought hard about it after my clinic ended

I have been seeing this lady with OA knees for the past 4 months, a total of 3 encounters. As usual, i started her on meds and physio, hoping she could get away without an operation. However, she came today and complained that the pain was not getting anyway ideal. I asked her if she would mind doing a knee replacement..... Then it happened.

Her daughter whipped out a piece of paper and said meekly:" one of my relatives told me to find this surgeon in another hospital.. Can you help me write a letter so that we can see him?"

It was quite common for patients to want to go elsewhere for operation, so i gave my usual warnings that they will be charged private rates etc. And we went on to compare a bit of the price if an operation were to take place there vs here. She persuaded me again and again for the referral saying that it will be an earlier appointment if i wrote the letter though i told her again and again it will be the same since she will be a private patient there. I gave in after my clinic assistant pushed me a little.

I carried on again to tell her we will stop the appointments here since she will already be going elsewhere. But the daughter went on to say:" oh can we keep the appt? because if we go there then if it will the same treatment but if too expensive then we can come back here right?"
I almost exploded (but i didn't know why then) to top it off my clinic assistant said:"they just want a second opinion la.. give them a date lor..)

I gave whatever she wanted and was glad that she was out of the clinic in what felt like eternity. Fortunately that was my second last patient.. i was in a super foul mood and i had real difficulty forcing smiles on my face when i saw the next patient.

I thought about my anger again an again after the day ended. I would usually just laugh off things that anger me during work.. like demanding patients or unreasonable nurses, but this time.. it was different, it hit me real deep.. I finally realised why.

1) I had to write a letter to another orthopaedic clinic for this patient who wanted a second opinion, meaning they are thinking my treatment was crap. And i even have to provide 'after service' for them to give them another appointment!!

2) So if this big name surgeon happily did a TKR and the patient happily walked without pain afterwhich. This daughter will happily say:"wa this surgeon so good! see him once then operate then good liao! not like this other doctor in this other clinic! See him so many months also no use!"

3) The daughter was obviously not listening to me when i tried to explain we were trying conservative first then operative if it was not successful

4) The clinic assistant was not helping me at all!!! Why wasn't she like most others who would feel the same way and played by ear with me?? Doesn't help that the hospital they want to go to was the one she was from previously and she had a good impression of it.

I don't know if it was my pride or ego that was hurt, making me feel this bad. But i will definitely feel injusticed if the op was done elsewhere and the daughter were to complain about bad treatment from me or the clinic i was working in..

Persuasion

2007-08-23T13:10:00.000+08:00

Completed Vampire Bloodlines not long ago and Guoping had been telling me all this while: Wa!! Eh you need to increase persuasion to almost max to win the game man...

Persuasion does not seem to only apply to Bloodlines.. A doctor needs a lot of it also.. Wonder what level i am now.. Enough to complete the game? haha

Ethics is hard to understand. "patients should be able to make choices for their own treatment" Yeah, but if i tell some one: hey you need this operation really.. Otherwise sure 99% cannot survive one.. How many patients still got a 'choice' to make?

i find that patient's decisions are usually swayed by their doctors. My head of department once admitted:"i haven't done much joint fusion before, so naturally i will paint a picture to a young patient who supposedly needs one according to textbooks' recommendation that he will benefit from a arthroplasty instead"

Persuasion: we always unknowingly use it so that patients tend to decide according to our point of view, but again isn't that the reason why people need to consult a doctor?
whenever an elderly with multiple comorbidities come into the hospital with a fracture, we will most of the time say "oh, she has very high risk for operation, unlikely to tolerate analgesia blah blah.. high chance of dying on table blah blah.. but of course if you still decide for op we will try our best" Er... which relative will take the risk and send the patient to what supposedly is hell's door as painted by us? So this patient will definitely decrease her chance of walking in future but supposedly increase her chance of living longer.

Then there are those who initially die die don't want operation/amputation, then we will stalk them every morning round, telling them all the scary things that will happen if the operation did not take place. Then try to downplay the operative risk or the possible chance that post operatively the situation will still be the same or even worse.

It sounds crudely like a game, but i'm glad some of the persuasion led to patient's becoming well and discharged. Though probably there are a few others the family will give you the "i thought you say can become well after op one??!!" kind of look. But what to do, we're not god but like it or not we have to play it. Who can deny this? Medicine is not 100%, unless we can look into the patient's future, we can only state probabilities and advise for the treatment that will most probably lead to the best outcome.

Felt.... Like Death

2007-08-23T12:45:00.000+08:00

I never felt this previously, despite the many encounters i had as a HO.
I stepped within the drawn curtains and then i felt it... Death... Total stillness.
She just became a matter just like the neighbouring bed/resus trolley..... Lifeless.
No nurses with me, no other colleagues around. Just me and the patient i had been seeing for the past 2 months. It was hard to describe, it wasn't the sight.. It was truly a feeling.
I haven't even looked at the ECG strip, haven't done the Doll's and pupils reflexes. What i had to do next was just routine.

I had been asked may times before: whether i felt sad when one of my patients passed away. I usually say "not really". This time, it was somehow different. First time i felt like crying, and also first time i had to certify a death.

I remembered how awake she was... how we first tried so hard to save her leg... and ended up trying hard to save her life... without avail. She wasn't the most motivated of patients, but she was one of those that appreciates you when you spend more time talking her into a treatment. She also had a super dedicated husband who comes everyday without fail to see her, buy her food, keep her company.

I guess i felt real sad that everything went in vain, and her husband despite his relentless efforts had to face the inevitable. This is probably the first case i had tried to fight for a patient's survival. Also the first time i had so much contact with the patient before she went into her pre-death coma.

I wonder if i would feel this again....

Who's the patient?

2007-07-05T18:55:00.000+08:00

It took me the entire encounter before i realised how i neglected her, the patient.. After i had to tackle the bombardment of questions her husband threw at me.
How much is the scan, what is her diagnosis, whether it can be covered by insurance.

The patient just sat there and listened..
I watched how she limped into the clinic.. she needed a scan/scope or physio at least.. but she got none of that..
She just got my answers to her husband's questions regarding claims. Whether anything will be done for her seems to need her husband's approval i.e. the insurance company's reimbursement before anything could be done..

Should i just take it that her husband's decision will be their shared one?
I hope so... Else that was a treatment failure.. the patient suffers but her husband's pocket is saved.

Great Bargain

2007-06-11T22:03:00.000+08:00

WHAT?!!! I PAID $300 FOR THE MRI AND YOU TELL ME IT'S NORMAL??!!!! HOW CAN LIKE THAT??!! THERE MUST BE SOMETHING WRONG WITH THE MACHINE!!!!

What can i say?
"Oh sir, i need to congratulate you on your great bargain! You have torn all ligaments possible in the joint! On top of that, the cartilage are all worn out. There's even hundreds of hairline cracks that only the MRI could detect!!! In fact because this is the first time you are supporting our product, we are throwing in a complimentary tumour in your bone! Though we cannot determine it's nature for now, we can offer a discount for the next MRI of your whole body to detect any more of them!!! Good deal for $300 eh? Game for more?"

If only the cause of pain is so straightforward...

Fighting against time

2007-06-09T15:46:00.000+08:00

Running clinics is always a fight.. against time.
There must always be a time limit to one's listening ear. And a time limit to one's explanation of the condition, else the patient's waiting outside may kick down your door, or the clinic assistant may suddenly become less helpful (cos she'll have less time for lunch or go home later..)

Fortunately there's somehow always a mix of patients and cases in the clinics. Talkative and problematic patients are often buffered by nicer ones who just listen and don't complain. It pains me everytime i have to spend only 1 minute on a nice patient just so that i have the time to handle a problematic patient who talks for 10mins without listening to me (but whose problem may be only half as serious as the nice patient)

The family medicine posting really threw light to a clinic encounter. It's better to find out the patient's wants early in the encounter so that the session will not go down the wrong track and end up real long.
We can throw the whole chapter's explanation for the condition the patient has but ultimately he will still be persistently sitting in his seat refusing to buldge if all he came for was actually an excuse IPPT memo..

After 1 month, I think i prefer standing the whole day in the OT pulling retractors than to sit in the air con clinic with shivers down my spine everytime i click the 'refresh' button and seeing expectantly how the number of waiting patients increase.

Orthopods

2007-05-29T22:02:00.000+08:00

It was triggered by an entry into a casenotes by a GS houseman.
"Orthopods please review and note the progress, many thanks"
My reg was a bit furious "how can write such remarks in case sheet one? Let's call them GSticons.."

Couldn't help laughing.
Transformers was one of my favourite cartoon during my primary school days. Now i've really forgotten why the 2 factions are fighting.. Feel like watching the upcoming movie :)

Orthobots! Transform and roll on!! (We used to comment that ortho surgeons tend to be a bit er... round..)

Familiar names of the GSticons.. i mean decepticons..

Lost Art of Zao-ing

2007-05-18T23:26:00.000+08:00

The medical student days are littered by occasional non curricular lectures that are termed "compulsary". But somehow the zao-ing syndrome never fails to hit everyone despite the multiple threats by the dean's office.

Now, post graduation, there's commencement, pledge taking.. all also compulsary and extra-curricular but everyone is present full force.. Maybe it's a milestone in our lives.. or maybe it's the only rare times we can meet our long lost friends. But the zao-ing syndrome seems to be cured.

I love these occasions as it really makes meeting up so much easier.. Catching up with many of my lost-touch CG mates was really great.

Most of our aims since medical student days have changed, though the hardcore ones like Jeremy could stick to his pursuit, relentless despite the setbacks and stresses. Where would each of us end up in years to come? Really interesting to find out..

Why go Diving?

2007-05-17T21:54:00.000+08:00

I used to think going to Sentosa's underwater world was expensive.. Not till I went with Dear the last weekend.. I realised I should have spent the money earlier instead of diving..

Why dive when you can confirm see stingrays, sharks, jacks and moray eels when you pay $20 at Sentosa..

Why pay to dive when $20 can bring you the natilus.. i dun even know where to dive to find these fossil creatures...

Not to say these giant japanese spider craps that can reach the height of my knees..

And where to get such a nice shot underwater without diving gear blocking Dear's face??

Was a wonderful trip.. It pays to visit some attactions after some time, the underwater world has really improved since the last time i went.. makes me think twice about diving next time :)
Oh and did i miss out the time taken to reach sentosa is like ten times less than the nearest good dive site in Malaysia?

Why go diving???

Toilet Advertisement

2007-05-14T20:39:00.000+08:00

Then if nothing wrong with your eyes can go level 4 for urology consult.... Then if nothing wrong with urinary tract can go level 5 orthopaedics to examine you for weak lower limbs... What good advertisement :)

Clinics

2007-05-13T14:23:00.000+08:00

First week of MO posting..

I know why so many doctors dread clinics.. This must be the reason why polyclinics postings are not that heavenly..

Even in the ortho clinics, there are usually bookings of up to 30 patients a session. This means 6mins a patient including all the paperwork.

I've been a patient before and i am always prepared to wait at least 2 hours to see the spine specialist taking care of me.. 1 hour is a blessing already. I can understand why. It just takes a more inquisitive or demanding patient and there goes the time allocation. Then one will have to rush through other cases or wish that the next case is just a post discharge review of a T and S or something similar

Some patients come in and have multiple other problems on top of their orthopaedic ones.. But how to tell them that they are in an ortho clinic so have to go elsewhere for their cough?
Then there are those who come with family members and both patient and relative complain of 2 different pathologies at the same time..

I guess there's no solution to this.. of course having more clinic rooms open is an option, but when colleagues go on leave.. how to do that?

Patient's relatives

2007-04-29T20:32:00.000+08:00

The most dreaded task to do in a night call is to "Update family members".
This sucks big time if the patient is not mine.. Then i'll have to flip the notes to see what the relatives might ask me.. whether i must be extra careful in answering.. A 临时抱佛脚 that's forced down my throat.

There are several kinds of relatives though..

1) The want-to-know-everything-want-everything-to-be-done-but-dun-want-to-do-anything-kind
This is an extreme case. They seldom visit the patient. They question you on every single issue they can think of and they complain about the slightest thing. They don't allow the patient the chance to speak for himself. But come the time they are told an operation is needed and consent needs to be signed, they will say "oh he can sign himself la..." Grrr...

2) The want-to-know-everything-want-everything-to-be-done-but-do-many-things-for-patient kind
This is the kind you'll prefer not to speak to because they are inquisitive but you'll willingly do everything you can for them because what they do for the patient is enough to make you go on your knees and bow to them out of respect. Example: an old couple with a bedridden and slightly irrational husband who needs constant care and will sometimes scold his wife out of his irrationality. Wife already out of work, dependent on pension. Cares full time for husband, enduring his insensible scolding. Has degenerative spine causing her pain when caring for her husband but she still goes on. How not to respect?

3) The angels
This is the other extreme where one will see the relatives around all the time, caring for the patient and ask minimal questions and accepts whatever you say. Just a 1-2 liner of update and they appreciate it.

Of course there are more variations. But i must say i have a lot to learn from many of the relatives that care for their sick ones..

Rest Days

2007-04-29T20:28:00.000+08:00

Free Weekends are hard to come by these days.
I used to be happy to have days of activities.. Soccer, hiking, rock climbing, singing.. etc..

Now i'm just too tired. Staying at home to slack is my favourite past time when the weekend is free. Extra hours of sleep, gaming and just plain staring.. At least i know it helps me recharge.

Perhentian

2007-03-30T13:24:00.000+08:00

Finally got my much awaited leave. How better to spend it than to have a dive trip with dear and some friends :)

Quite beautiful scenery on land and on the ship, though admittedly it can't beat Sipadan.

The dive center offers cheap dives and accom. Dives are good with huge stingrays, 1 turtle, couple of large puffer fish, reaching size of soccer balls (can play soccer with them when they blow up.. ) beautiful landscaping at tiger rocks.

Marine life is not as astonding as Sipadan but the landscapes are great, never dived between rocks before, till this trip. Many of the dives leave us happy:

But of course not everyday is sunday and there is one particular dive with crap visibility and we can't see a *beep*, NB(this is not me..)

Trip was relaxing, good way to get away from work. It felt too short..

I'll never forget the dive resort agent on mainland who is a bit of a 'money eater'. If you ask me if i will come back again to Perhentian, I'll say no for the next few years. At least i would try other dive sites first. This trip serves well for a getaway but it did not give me a feeling that i got a dive of my life.. (maybe i went to sipadan too early..)

When i'm not on call

2007-03-19T22:13:00.000+08:00

Spend about 12 hours in hospital
About 6-7 hours of sleep
About 1/1/2 hours of traveling
About 1/2 hour of bathing/brushing...
Left 3 hours..
To squeeze whatever i want to do for the day..

Fog of Care

2007-03-11T15:47:00.000+08:00

During ward round..
Consultant: So if you could turn back time 5 years, would you still choose medicine?

I found it quite hard to answer, seeing how my brother enjoys life as an engineer, how my many other friends could enjoy all their weekends and public holidays..
But still i said 'i guess so..' Because there are really times i find that it's a rewarding job.

It's too easy to hate what i am doing now.. but i might be hating being in other jobs that i haven't done before.

One particular trauma surgeon likes to use the phrase 'fog of war' in a resus. Meaning that while everything is ongoing, there will be items left out when everyone is busily involved in the resus and therefore there should be a 'bystander' looking at the resus and pointing out the gaps

Likewise, i seem to notice 'fog of care' when i am at work in the hospital. Most evident during night calls

'Fog of care' occurs because in times of need, it is nurses who call the docs rather than patients themselves. I will therefore tend to handle the nurses (the fog) instead of the patient's issues.
E.g. 'Doctor! Patient in pain now... How? Wants to see a doctor..' Reply: give him IM tramadol..
The exchange above will result in 2 scenarios:
1) Good nurse accepts and says:'OK if he got any more pain, I call you again ah?' (Yeah, 1 problem solved)
2) Very concerned nurse:'Huh? But patient anxious leh.. wants to see doctor ++' OR 'wa cannot order like that la. you come and see patient ok? slam..' (then how?.. what to do, must see patient lor)
So the same patient may have the same problem but because of the nurse, he may or may not get to see the doctor.

The head of my dept once said very rightly that made me feel real guilty (but the guilt only lasted till my next call) "Very often, we get irritated when nurses call us for patients' problems, forgetting that the patients need us. We always treat these problems as chores, forgetting why we want to become doctors"

I'm really not a compassionate doc.. I am one of those who will get irritated by nurses' calls at night. how do i get rid of this irritation? i have seen real cool colleagues who despite being super busy, are still real polite and patient with everyone. These are the true DOCTORS.

Back to the question.. will i still take medicine? I want to, but am i fit?

Death

2007-03-06T17:29:00.000+08:00

Attending another friend's wake tonight.

I've been to a secondary school's classmate's some years ago: sudden death while playing games. Now a suicide. It doesn't feel so close (death), until someone my own age passes away..
I wonder why she is not saved, why couldn't she like many others I've seen on night call come into hospital stable and I will go "just another DO.."

I've always wondered what death is like. How it feels. (or is there any sensation at all?) I'm looking forward to so much more things in life, but these friends my age have gone.
Is suicide stupid? Maybe? But is it possible that life's torture ends with death. Our ancestors may be laughing at us for not joining them earlier...
Suicide cowardly? But it takes so much courage to venture into the unknown territory of death when one hasn't experienced it..

Do we imagine that we have souls that will continue our lives after death because we cannot accept that we will be gone forever with death?
I can't imagine myself in a sleep forever, not waking up, not even dreaming, not seeing through my eyes again, losing all my senses, not even being able to call myself 'me' because I have already ceased existence but that's how it's supposed to be.. scientifically.

I'm sad to see them go at such an age. Where many happiness is still in stored for them, albeit the sadness of life. But hopefully there's solace in death.... that, i can only know when it's my turn.

3 weeks

2007-01-26T22:54:00.000+08:00

3 weeks of surgery in endocrine surgery and i really love the team!
Patient load is not that heavy, changes are not that many and most of the time i could follow the team to OTs/clinics
Best of all everyone in the team is nice from consultant to fellows to regs and MO

OTs are usually full of thyroid cases, if you wonder why they are so elusive from you in med school, it's because they do same day admissions.. come in straight to OT then back to ward... without the thyroid, so how to catch?
Still having difficulty stitching well and efficiently, still struggling with hand tie and also where to retract for my main surgeon's optimal vision.. Lots more to learn.

Clinics are fun cos the whole team is packed in 2 clinic rooms.. We look more like police officers interrogating suspects.. 3 persons at one end of the table and the patient on the other.. But it get things done much faster.. Everyone learns at the same time too..

Enjoying what is left of the endocrine team... Not really looking forward to next month though.

Some bizarre happenings:
1) Patient has impacted stools: solution? Manual evacuation in OT under GA!!! Post operatively put on PCA!!!
2) New private patient during night call: Reg calls for 1XMO, 2XHOs and 1Xreg (he himself) to gather to clerk patient.. In the end? Reg asks questions, 1XHO scribes, the other 2 persons wonder what they are there for..

New Life, more life

2007-01-07T21:11:00.000+08:00

End of medicine, on to surgery..
Been waiting for the past 4 months for this day to come..
Though i wasn't let off call on the last day of medicine and patients chose to 'dong' their illness until the end of the long holidays before coming in.. MO was complaining that she had the most number of admissions in her medicine career..

started off in the endocrine team in GS.. met my MO in the day surg OT and immediately assisted in a lipoma excision.. he told me not to worry about the patients in the ward because we don't have many..

finshed day OT and we went to review our patients. (2 of them!! i almost dun need to add an 's' behind patient!!)

anyway.. life might not be so good after this week.. more operations and patients coming next week, after the long holiday season.. hope my engine not rusty by then..
more awake in surgery than in medicine though i need to climb out of bed half an hour earlier each day.. hope this awake symptom stays long.

No..

2006-12-24T23:05:00.000+08:00

Were there occasions you didn't feel like doing something but feel obliged to do it and in the end you hate yourself for doing it?

Happened to me a lot of times but i always forget the lessons, just committed the same thing again today..

Didn't have the courage to say no..

From S to M (261106)

2006-11-27T21:59:00.000+08:00

The whole ceremony took only like 10 minutes, but bears a lifetime's significance.
Got another certificate in my life!!

I'm really thankful of my supportive family who made the above possible and also the below possible:

Home was transformed in a space of 4 hours.. And after doing all these, my phobia for balloons was sort of cured..
I'm really touched by everyone who came down to witness the event, want to say a big thank you to all of you!! :)
But it was not without hiccups though..
1) Our home's digicam decided to go on strike right on my big day.. Thankfully there were friends who brought theirs.. else i would have needed to rely no my Nokia..
2) Food was a bit of a disappointment..
3) We got a JP who looked more nervous than i was while carrying out the rites..
4) My chickenpox scarred face didn't help with my photos.. but i successfully brought dear dear more into the limelight by adding more contrast to her beauty (ok.. even if i didn't have those scars, it would have been equally successful.. i admit..)

Well but most importantly, the cert is signed and many of our friends were here to see us.
Thanks Weiqiang and Audrey for coming all the way from Sengkang.. and also for helping with photo taking, with your cool IXUS 800..
Also to Runzhou, Lili, Shaoxiong and Mengwei for the nice cake..
And of course to the gang that actually intended to do a pro outdoor photo shoot for us, but ended up only managing a few precious shots due to our fatigue.. thank you Jinquan, Christine, Weiling, MeiPing, Guoping and Enping..

Most importantly to Dear, thanks for accepting the ring :)

Hai.. 1 more day and i will need to survive a month more of medicine with 10 calls.. Arghh..

Water Beans

2006-11-14T12:44:00.000+08:00

I thought i was immune.. my brother had it but i didn't, my friends had it, i was close to them but still i didn't get it.. i thought i was vaccinated in the army and when i was a child..
Now after seeing 1 patient with varicella meningoencephalitis and 5-6 other old uncles and aunties with herpes zoster the previous month.. How can i escape?
It all began with fever, headache and a neck rash that looked like pimples.

Then clever dear was warning me that i could have chicken pox when the rash were more florid.
Didn't want to believe even my GP who whacked me with acyclovir cos the rash were still minimal. Not till i wake up this morning in a bid to work and fulfil my on call duty that i have to surrender to the virus. Classic vesicles on erythematous papules.. It just took one night's sleep and my face was full of them..

Fortunately i'm on leave next week.. at least my MC will not be affecting my colleagues much..

Dunno why the sugical dept has 17 housemans for 80+ patients while the medicine dept has 13 HOs for 200+ patients.. It's so hard to find cover when i'm on MC given that 2 persons are already on leave. someone will have to do EOD.. Jialat..

It sounds like a good break to further prepare for ROM.. Unforunately i'll be stuck at home.. How to prepare?

Well guess i could use some sleep that i lost over the past half a year..

Turning Point

2006-11-01T22:24:00.000+08:00

time to decide for clusters to work for during MO days.

I was quite full of enthusiasm as a student.. "I want to do A and E!!!!" But i guess i thought of it too early then. Working and studying is completely different. Just like ideals and reality.. Very different

Guess I'm not good enough as a full fledge doctor. Can't think fast/far enough. Missed a SAH, but fortunately my MO thought of it.. If not, wonder what will happen to the patient.. How many misses will i commit if i continue? Or have i missed many already but didn't know about it... Scary

When i was an ortho HO, i thought medicine will be better as people in medicine don't need to refer haemato to treat a DVT or don't have to refer to respi to treat a pneumonia or don't refer to ID to treat a necrotising faciitis... But when i started medicine, i feel the registrars/consultants are too 'cocky', not as nice as the ortho regs/cons. (i mean not all are like that though)

Now when i clerk cases i think of whether i will get a call from the con the next day for doing something stupid or not doing enough for the patient.. not whether i am doing things good enough for the patient... When i look at a patient's ECG i will hope that nothing is wrong so that i can just sign it and go off to do other stuff, i won't be thinking of the patient's well being when i look at it.. Call myself a doctor?

Too tired? Maybe.. No fighting spirit? Most probably.. But i still decided.. to join public health..

Office job.. why not? Family time.. WHY NOT?

I guess i lost it.. the fire... the passion... at least i can still console myself i'm doing something medicine related..

Long time never blog liao

2006-09-26T20:26:00.000+08:00

Almost a month of medicine posting and I realised that it was a rather bad decision to choose ortho first.. real de-conditioned liao.. Medicine calls are horrid too (and to think i am in NUH, what happens if i go SGH?) But quite fortunately medicine MOs are out in the open on call with us. Most are real nice to clerk cases for HOs. Ortho MOs are usually stuck in OT.. or call rooms...
With all those sleepless nights, Dear is commenting on my change in facial features towards:

Haiz.. What to do.. Not that i want to be big and dark eyed.

Fortunately not all is looking bleak.. My bro made me an uncle liao.. Here is our family's new addition.. the gorilla!!

Her name is Huanxin, but my bro always calls her xingxing.. and she also has a roar of a gorilla. enough to wake the neighbourhood. I didn't really need an alarm clock when she was staying with us.. Her stomach was our alarm..

Also looking foward to november:

Stepping into a new era in life.. Well, just hope I won't spoil dear's life, hope she don't regret :P
Must say it is real exciting.. All the preparations and planning (though not much at this stage).

But right now.. there's still many night calls to do.. Lao Tzi talked about water.. We should aim to be like water, occupying the lowest positions on land, nourishing anything that requires it and never tries to get anything in return. In the same note, I should psycho myself before every night call that i am the lowest life-form, that should meet every patient's/nurse's request without the desire for anything in return (i.e. sleep, food and thank yous..) I bet i can't do that...

Satisfaction

2006-08-13T09:35:00.000+08:00

As requested by Falconz long ago.. Sorry ah, has been trying to upload this picture but always tried doing this in the late nights when net traffic is so heavy, it never got to be uploaded.. But here it is :)

Got an advice from an MO:"We are whores.. We work to satisfy others. We must make everybody happy."

How true, I've been working to please consultants, registrars, nurses, patients... The only times i can please myself are instances like:
1) Prescribing analgesia to a painful patient then seeing him sleep soundly after that
2) Catheterising a patient with a bloated bladder and having him thank me profusely after that for reliefing his discomfort
3) Receiving my pay check..

Other times are "whore" times:
1) Patient complaining of reflux symptoms (i get this pain from the stomach that goes up my chest..) Vital signs stable, ECG normal, cardiac enzymes normal and consultant decides to refer PINK letter to cardio on a saturday afternoon for AMI/ischemia. and our dear cardio does not want to return page till 1 hour later... ended up going home late...

2) On call at 4am: "hi Dr ah.. this patient got fever 37.7, says got 1 nurse got flu then pass to him then not happy, already on panadol but wants panadol extra but we don't have. Can come and appease him or not ah?"

3) Just arrived at patient's bed side to clerk her and her son asked aggresively:"how is she ah? why you all don't tell us anything one? you all must tell us ma!"
"sorry sir, is it alright if i ask a few questions and examine her before i update you?"
"OK.."
finished history and going on to examination..
son pops in again and once again:"so her back alright? she said her spinal cord broke (!!??) just now"
again have to appease him and explain it is the vetebrae body and not cord that broke..
how important is communication..

4) Most times i could keep my cool, or should say i need to keep my cool. there was once when i was really at wits' end and chose to remain silent..
Patient had closed fracture, needed fixation, been fasted from morning for emergency op. parents really angry that till night OT was not available. refused drip offered by nurse
So along i came and explained at length Emergency OT needs to prioitise life threatening cases and therefore necessary to wait..
Patient's uncle and mother most aggresively demanded a fixed operation time which of course only god knows when it will be, said patient had been fasting for so long, was in pain.. explained again and again about emergency OT system and that someone's life will be at stake if OT given to non life threatening case first. Offered drip as patient had been nil by mouth..
they refused again..
what to do, they say patient haven't taken anything then offer them drip they don't want...
so asked them:"what would you like us to do?"
said wanted operation..
as we were going in circles. i chose to keep quiet and they also got nothing to say..
silence for 2 minutes and i chose to push my registrar into the limelight..

Realised i should learn some tricks from him, how he bravely put to them, though not in a direct way that their relative is not the only living being in the world that needs op.. and after that they still needed a 5 minute discussion before they made the almighty decision:"OK, put him on drip then.."

whole exchange took almost an hour.. setting the plug took at most 5mins.. though i was shaking at the thought i would miss the vein, bringing on more outbursts..

I guess what they told us the first day in med school counts, our aim is to:
1) cure sometims
2) relief often and
3) comfort always.. make sure patients and relatives are comfortable and these exchanges can be lesessened

Feelings

2006-07-17T21:02:00.001+08:00

It's quite wierd when my mom appeared at my workplace... in the same ward i was working... while i was working.. as a patient...
low back pain... one of the kind of cases an ortho HO on call would like for new cases cos it is simple.. but my mom came in the afternoon.. ended up she was clerked by my colleague taking care of the side of the ward
she improved andi typed her prescription, MC and memo to doctors.. really wierd.. but that's not all, nurses start telling me she look so young and they would have thought she was my gf.. wife... haiz.. i look so old meh?

I actually wanted to type this long ago.. but guess too lazy to do so..
really wanted to tell dear how i appreciate her coming to meet me at 11pm after my half call at the hospital's kopitiam.. nothing beats meeting a smiling loved one after a long day at work.. almost cried..

Convocation was over in a breeze.. for me it was a great chance to meet friends that are struggling at other hospitals.. sadly i couldn't get to take pictures with all other people in the cg.. as usual the elusive ones like weijie and wenlong gave us the slip..

actually wanted to upload more photos.. but blogger now is real slow.. some other time perhaps.. blogging frequency reduced to like once per month.. too busy? or too lazy? :p

Post B'day

2006-07-01T00:17:00.000+08:00

Found a cosy place for food and chit chat: Han's at great eastern building along south bridge road..
Food is so so but at average of $8.00 per set and cosy seating with no waiter/waitress or crowds bothering you at the seats, find it a good deal.
Had a great time catching up with gp, falconz and ep.. Especially with falconz who never failed to wake up a gang, who were initially sleepyheads, with his jokes.. Have to thank all of them and Dear for making such a wonderful birthday dinner..

2 months since the start of work.. Still find myself quite slow at times.. take about 30mins per new case.. wonder how i can survive med posting in future (if there's 20 plus admissions per night, not to mention the "salt and vinegar" passives of plugs, bloods, caths, collap....
Don't think i am advancing academically too. Really de-conditioned in ortho.
Low BP, chest pain - refer cardio
SOB - refer respi
Postive culture - refer ID
DVT - refer haemato.
Never seem to solve problems ourselves.

Post op: nearly everyone is diet of choice unless otherwise stated. Hopefully i won't pass the habit to surgery.. will get killed when i give someone with colectomy DOC immediately post op out of habit..
Must think think think..

Guess i will get more worried as days go by.. wondering how my brain will handle med and surg posting.. kind of regret starting a slack posting. but what to do.. chosen liao..

Will be meeting classmates soon on 3rd July. Boy it had been months.. hope they will look well, good and healthy.

Difference

2006-06-17T22:13:00.000+08:00

Had been enjoying the past month in a more busy ortho ward, but a more enjoyable one as i see more cases and more appreciative patients.
Half a month into wards containing private patients and i really feel i want this month to end real quick
Having an 'empress dowager' and a 'princess' at the same time doesn't help matters. Incidents that happen which we would normally tell nurses "observe patient" do not stand for these patients.
A registrar even had to 'ke blakang pusing' when he was reaching home to see the 'empress dowager' as the houseman me had to call the consultant on the request of one of her relatives (of course who do you think the consultant arrowed to go back to hospital on his behalf?)
Luckily was a nice reg. offered to hold the case notes and write for him and he said "it's ok la.. i only small lokun"
".... i even smaller than you...."

i must promise myself never to assume anymore. it would unintentionally hurt someone i treasure. some things obvious to me will not be so to others..
so sorry dear.. it was my mistake..

Empty

2006-06-08T20:23:00.000+08:00

It's only for 6 days...
But i can't forget the instant she walked through the counter...
Into the crowd of rushing passengers and trolleys...
She waved through the 10m we were apart and disappeared into the crowd...
I don't know how long i stood...
Waiting to see her appear again,
Through the crowd...
Through the same 10m she waved at me...
But it didn't happen...
Obviously, because she had a plane to catch...

Never felt this way before...
This emptiness when someone leaves...
This yearning that the parting didn't take place...
This sense of loneliness...
As i left the airport...
Alone...

Quite glad that work took up most of the time...
But unfortunately i am covering overflows this month...
Which means the long walks to kent ridge wing and back are occupied with thoughts of her...
Hmm.. will i feel the same way again donkey years later?

Well, glad she's coming back TOMORROW!!
Then most probably i will forget the way i felt the past few days as i get used to the togetherness...
Will forget how much longer than usual i look at the phone's wallpaper...
Forget how much more i think of her...
Amazing how the brain works...
That's plasticity at its best...

Hai. dunno why i writing so mushily...
But Dear's back TOMORROW!!!

Why like that?

2006-05-20T13:54:00.000+08:00

1) Consultant says 6 weeks light duty for guy with stress #. Kindly gave him 2 weeks MC with 6 weeks light duty.. Instead got threatened by guy's father that he will sue if patient falls down during light duty and shouted so that whole ward can hear him... Finally consultant consulted again and 6 weeks MC given to appease father.. Why like that?

2) Have to book High D bed.. HO cannot book, need anaesthetic registrar.. Informed anaes registrar then afterwhich called High D to confirm booking, got scolded for calling them and say should call anaes reg to check instead. Next day receive call from anaes.. "Have you checked if patient has high D bed???"

"!!!!!!!!!!!?????????"

Called high D to check, finally got bed.. called anaes to confirm bed. got told "ya we anaes book the beds but the team should check with high D if got bed.." Why like that?

3) Patients just went for DVT scan.. MO told me to review scan results. "Call me if there's anything.. but you know what's going to happen right? you tell me patient got DVT then i tell you to refer haemato then haemato will tell you to anticoagulate if no contraindications then you tell team what haemato tell you then team will tell you to start treatment.."
Ya.. even though everyone knows how to anticoagulate, backsides must be covered... Why like that?

But on the whole still like working more than studying... feel more satisfaction when patients are better and discharged. Also got to insert a steinman pin.. scary at first but real satisfying after the procedure.. Just hoping no pin track infection..

School Name

2006-04-25T17:21:00.000+08:00

I read with interest the article about NTU naming a school after former president Mr Wee.. Must say i was very envious of them, having the name of such a well loved president being tagged to the school. Not only can they proudly say Mr Wee was a great journalist, he was also a great and loving president for the nation.

I sour at the thought of the school where i come from.. Being named after somebody (i'm quite sure about 99.9999% of students don't know before the faculty's name change) because he had kindly donated millions of bucks to the school..

What if someone asks me... Did he found your school? Who is he? What did he do in his life? How did he look like? All i can say is "he donated money to us, then we changed name.."
Ya.. i know in all advocation for self learning that i should find out all these. But i really don't have the motivation to...

Quotes

2006-04-24T18:18:00.002+08:00

1) If you manage to diagnose a Torsade de Pointes at 230am as a HO.. you can win a nobel prize. It is as rare as faeces from a rocking horse.

2) A double blind study is 2 orthopaedics surgeons looking at an ECG.

3) Quick pulse and awake, give medicine and wait
Quick pulse and a nap, give him a zap
(hmm dun sound so smooth like what the lecturer said.. must have forgotten somethings..)

Great Sipadan

2006-04-20T15:55:00.000+08:00

Back from a great break at the great sipadan island..

Almost everything here is real beautiful.. beautiful creatures in the sea (unfortuntely these are not my pictures.. no underater camera):

Cuttlefish

Blue spotted ray (which looked like a vacuum cleaner sweeping on the bottom)

Magnificent leopard shark

Cool huge turtles

Beautiful scenery out of the sea...

And beatuy even in the comfort of the resort room:

Must admit I was more panicky during wall dives.. Being unable to see the bottom. And knowing that the whole wall goes on for kilometers of water.. It is more useful to look up than down.. Not only because there are more fishes on the shallower waters.. but looking down always gives me a thought that somehow i will get sucked into the depths of the ocean never to come up again.. Nevertheless, got used to it after some time..

Of course there were many more creatures that i came across.. Moray eels, pygmy seahorse, tiny clownfish (size of a fingernail), flying fishes, marlin jumping out of the water.. All in all it was a real great trip, but it also made me realise how amateur i am in diving.. Buoyancy control and current tacking showed as obvious flaws in my diving abilities as i was swept here and there, up and down while our beloved divemaster Tony was able to maintain his position as if he was waiting for a bus in a bus stop.. And he used half the amount of air we used!!!

Enjoyed the interaction with the marine life.. Almost touched nose with a turtle.. (A sign in the resort prohibits touching, hitting and riding turtles.) Had a good laugh when an italian complained a turtle rammed into his face while he was ascending.. And had a bad sore after unknowingly intruding into the territory of a trigger fish and ended up being bitten by it.. (sigh, saw so many sharks and none took interest in me.. but this picasso trigger fish...)

Well, great view, great creatures, great divemaster and of course great great Dear in the trip. Cannot ask for more..

GOAL!!!

2006-04-11T09:12:00.000+08:00

I sometimes wonder why soccer is the only sport where players run really wild after scoring a goal even though a goal does not mean they had won a game.. But i really felt like celebrating mad yesterday after getting my results.. A pass is all i want and i got it thankfully, a final stop to my weeks of worrying about having to repeat 6 months.. But i can't imagine myself celebrating by running around med fac twirling my shirt above my head, or spreading my arms out like a bird and run all round NUS (see picture)

Got to thank Pang Hung for helping me through an unnerving 5 minutes at the computer cluster.. The boot up was real slow and fortunately he was there to talk to, easing the tension in Weiqiang {who was exceptionally quiet :)} and me. I started off by asking PH about his knee and he started talking about karma, cos he had caused people to fracture their arms before etc, so now his knee is like that.. moved on to say "I really believe in karma.." At that point i wished i had helped more elderly cross the road or bought more tissue papers from the blind.. and of course that the computer will decide that its warm up is complete...

The boot up was finally complete, and there i was so excited that i was at a complete loss as to where to click for the results and it's PH to the rescue again, guiding me...
Finally heaved a sigh of relief at the result and few seconds later.. got to hug PH.. just like after scoring a goal.. haha he initiated it.. though i half suspect he wished i was from the opposite sex..

Going to NUH ortho with 3 other soccer guys.. can't blame me for the title of this entry right?

Time to enjoy the sun sand and sea this weekend :)

Murderous Medicine

2006-04-08T23:58:00.000+08:00

Chanced upon this book at JE library..
It talked about the Holocaust and interestingly some ethical issues about medicine surfaced just when i thought the Nazis killed the Jews without any need for excuses in the 2nd World War.. (Interesting that i also completed Call of Duty 2 recently.. what a coincidence..)

1) Eugenics had already evolved in the Nazi realm.. People of the Aryan race were favoured and all the handicapped, either intellectually or physically were disposed of literally by any means deemed legal then.. These done in the hope that future generations will be free of disabilities.

2) Then come the issue of communication with patients.. Typhus was endemic then in Germany and the Nazis were manipulative enough to make most believe that Typhus was spread by the Jews. Hordes of Jews were then "exiled" into Ghettos with conditions so bad that even bathing a hundred times a day will fail to rid the risk of being bitten by lice, the vector for Typhus..
So what do the Nazis do when a Jew is suspected of Typhus? They will line the 'patients' up into 'shower rooms' with a space to accommodate hundreds in the pretext of disinfecting them.. But instead of water coming from the showers, it was cyanide gas... No Nazi doctor told the patients of the real 'treatment'.

3) Last of which is patient's consent.. the many deaths caused by these executions yield thousands of samples for the German doctors either for research or for sale of skeletons/body parts.. Of course the doctors never asked patients if they were willing to donate their body for research.. The poor people don't even know they are being killed!!

One wonders how such hatred can surface that fellow human beings are no longer treated as equals. I can so easily say the Nazis were real cruel.. But i really wonder if i were born an Aryan, and told since birth all the bad things in the world about the Jews whether true or not.. Will i still see this episode in the same light as i would now?

Anyway, this book is quite good to read in the beginning.. Even tells of the origin of the name Rickettsia Prowazeckie but as the book goes on.. facts repeat themselves repeatedly.. (ya note: repeat repeatedly..) only to highlight the author's hatred of the Nazis. Well who could blame her? I ended up not being able to finish the book...

Good Break?

2006-04-05T10:04:00.000+08:00

Suffered from post-training insomnia on monday again.. Served to remind me that i underwent such episodes many months ago when training was regular.. Still a mystery why it happens.

Don't know what's wrong with me.. Had been doing things i liked to do but somehow i still feel that this holiday has not been fulfilling.. Maybe still worrying about the results. but by the time the results comes out... not much left of a holiday by then...

Came across a primary 4 science assessment book yesterday and was surprised by some questions they have inside that i thought i would only be able to answer as a secondary 3 student taking biology.

1) Which of the following blood vessels are the smallest?
2) You are in a state of ______ when your blood circulation is insufficient.

Kids are smart nowadays.. Maybe in a few years time a secondary school kid can prescribe painkillers according to the pain ladder...

5 more days to April 10th.. and about 1 week to Sipadan!! :)

Free like a Bird

2006-03-30T23:12:00.000+08:00

Post Exams!! Felt free like a bird living in a HDB pigeon hole..

It was ike 1 week away already but too busy doing other 'important' stuff like playing F.E.A.R than to blog.. haha

Finally could go out without any guilt, play soccer, swim without having to worry if i am taking too long a time off studying.. But it still bugs me there's a rumour that 1 person taking surg at AH had a direct failure.. Ya.. everyone is telling everybody else it cannot be the person they are talking to that is the one, but i'm sure nearly everyone is as worried as everyone else that it is him just like i am worried like everyone else it is me... Haiz.. still need to worry after exam...
Hopefully my days of mad enjoyment can get my mind off it till april 10th.

Tomorrow is my first return to:

since many months.. preparing to feel like an AS patient on saturday morning...

I'm still a Jap sports car fan...

2006-03-14T15:34:00.000+08:00

I'm a Mazda RX-8!

You're sporty, yet practical, and you have a style of your own. You like to have fun, and you like to bring friends along for the ride, but when it comes time for everyday chores, you're willing to do your part.

Take the Which Sports Car Are You? quiz.

Finish?

2006-02-24T13:15:00.000+08:00

Where is the finishing line in studying?

It's ever-moving....

Realised long ago that there's no such thing as 'finished studying'

But it still bugs me...

Arghhh!!!

Thanks WeiQiang....

2006-02-20T22:12:00.000+08:00

Lee KwangHow --

[noun]:

A hard-core grave robber

'How will you be defined in the dictionary?' at QuizGalaxy.com

Smelling The End..

2006-02-16T19:15:00.000+08:00

Tomorrow is Feb 17th

Will be the last day of medicine posting in SGH. Hopefully my last official day of posting as a medical student.
3 years of posting past just like that.. Felt like i wasted a lot of time.. Could have spent a lot of time back then drilling and mugging then will not feel so useless at this point of time..

Well, have to face it anyway.. Hope 2 weeks of study break can do wonders. Holding off things to do so that i can really enjoy them after exam..

Hmm.. how to be fearless?
1) no need to pay more school fees if fail MBBS, no need to wait 6 months, no need to etc etc
2) having the delusion that everything will surely be alright and there will not be any failures at all
I'm still in fear..

Want to get back to training and back to some shape at least..
Haiz.. i'm surely not his match now..

Not really holding off.. cos will not normally do it anyway..
hmm.. where can find such scenery anyway?

Last but the most....

Need to spend more quality time with Dear.. Too cranky this period..
Too many 'house-lock-ins' studying..
Thanks for putting up with me Dear.. Will be over soon, I hope..

Just Do It

2006-02-04T01:18:00.001+08:00

Seems like I can only know if I have done something right after I did it....

World Class

2006-01-27T22:17:00.000+08:00

While striving to be a world class university, the following should be practiced:

1) Send students to as far away postings as possible. After all we are already so advanced that transport should not pose a problem to the students.

2) Reporting times and venues for postings should be announced as late as possible. Well, what is a world class uni without the use of a "mouse over" personal time table system. Anyway, students need not worry or plan about their trips to the posting venues. (refer to 1)

3) In view of an ever-changing world, a world class uni should expose students to rapid fluxes. New obstacles to a degree should be imposed as and when deemed fit so that students can acquire adaptation skills. After all, which student will sacrifice the years of school fees and previous years of examinations and strongly oppose to any such changes and risk not getting the degree that is within months of grasp? They will therefore invariably accept all changes and hence aid the uni in attaining it's world class status.

4) Not only must the uni 'train' students to adapt to fluxes, the examiners have to demonstrate their "fluxing" abilities too. Decisions and announcements made about exam formats have to be changed within a week in order to demonstrate such abilities. This is also part of the students' training to adapt to changes since students will need to keep up to date with the changes frequently, like they would if they do played shares in the stock market. Over time, students should supposedly learn to keep up to date with medical advances too.

Haiz crapping..
5 weeks to go..
Head still feels empty..

New Year's Blog

2006-01-13T21:36:00.000+08:00

13 days past liao.. Wonder why i took so long into the year to put up the first 2006 blog.

Guess it's because i don't feel it is a new year.. Still a year 5, still the big MBBS to take..
The profs in charge of our education keep saying "we are making it easier to pass"
Ya right.. fail SIP cannot take exam..
fail OSCE cannot take exam..
not telling us exam format..
Easier to pass???

It somehow amazes me how amazing time exerts its presence and importance. Even a few seconds is sufficient to change moods and sometimes without knowing it... It makes me yearn so much for the period of time before the few seconds..

东亚大夫

2005-12-24T21:45:00.000+08:00

Western medicine: frozen shoulder
Treatment:
1) analgesics, physiotherapy
2) manipulation under GA

Chinese medicine
Treatment:
1)Manipulation under er.. no anasthesia (ouch ouch..)
2)Physiotherapy lesson (exercises to be done at home)

Time treated at western doctor: at most 30mins
Time treated at chinese sinseh: 1/1/2 hrs

Medical fees (western): $18 for consultation, more for physio... dunno cost of manipulation under GA because not done yet
Medical fees (chinese): Fees for both above stated treatment: $30

Western medicine: Plantar fasciitis
Treatment:
1) Analgesia, rest, soft support for soles
2) Injection of steroids and lignocaine

Chinese medicine
Treatment:
1) Acupuncture with electrical stimulation
2) 推拿 for sole of foot

Time taken in western medicine: at most 10mins
Time taken in chinese medicine: 1/1/2 hrs

Amount paid for western treatment: $10 for consultation, more for analgesia.. (about $20) no local injection done yet..
Amount paid for chinese treatment: $30 for both above stated treatment

What next to compare? Outcome.... have to wait few days for dad and mom's response to treatment..

Post SIP

2005-12-18T22:35:00.000+08:00

Hmm.. 4th posting in 4 weeks.. End of the SIP (med) liao

Really got to see what the houseman does.. Should not be feeling so lost in my first day.

It sometimes is real scary though, when i think of what was happening to the houseman i was following, especially under Dr (ahem)

Case1: Ya this type of things you dun have to tell me ok? you should do these by yourself.

Case2: Oh why do you do that? because the dietician/cardiologist/specch therapist tells you??!! you are not a waiter/waitress. you are a doctor.. you should decide for yourself. Now cancel this order... and put mine down...

Case3: What??! Why are you giving the patient this? Can't you see he's overloaded with the raised JVP? (It was obviously the carotids lor..) I find that you are doing things on your own and making your own decisions!! You got your MO and me to ask. Next time ask me first before doing anything!! Now stop the fluids for this patient!! (then case 1 how??)

Haiz.. end of the day whether life is good or not depends on the consultant one is following.. Why med school and working life in hospital like that one??

Anyway, got to thank Dr Lee SS for his fruitful tutorials and tests. Really forced me to read up and be better versed with hypocounts, breathlessness etc.. and also for his multiple tips on blood taking, IV plugs etc etc.. Really benefitted from him.
I think i will not forget his stern face and his pointing fingers that weijie so magnificently imitated. Also cannot forget the scene alvin told me:

After asking alvin about hypocount and fluids...

Dr Lee:"What is weijie's number?"
Alvin:"Oh er... blah blah blah"
Dr Lee calls weijie:"Hello weijie ah? you free now? If patient got hypocount of ... what do you do?"

Poor weijie got to think over the phone and answer him.. haha like a night call from a nurse..

To take or not to take..

2005-12-11T13:11:00.000+08:00

3rd week of "vampirism"

I feel it's ok if i was taking patients i'm seeing everyday in rounds. But for some strange reasons, there is a particular room where it is "no man's land" where there's only an MO seeing the patients without any HOs or SIPs but all the discharges and bloods are done by us..

So it's quite hard when approaching patients and some ask. "Wa again ah? How's the last result ah? This one is for what ah?" Then have to refer to forms, computer etc.. To satisfy them and make them more comfortable at giving their cubital veins for my perusal..

Worse scenarios include elderly patients that firstly think that 3 days of 2 tubes each will suck them dry.. Or those that feel that blood taking is a real torture. That doctors and nurses who have to hold their hands and poke them are cruel. Then have to convince them that they will not be dry with 20ml of blood gone in 3 days.. That we are doing this for their own good.. Will sometimes ask myself if i am doing the right thing by taking blood when they are so against it. Also dunno why i have this calling to try my utmost best to make a super reluctant patient agree to the blood taking when there's talks about patients' autonomy and also i will have 1 less blood to take with each refusal.. Hmm.. because i will feel uneasy if the blood taking tray still has empty tubes?

Worst Post-call

2005-12-11T13:04:00.000+08:00

Er.. though it's my first post call, may have worse ones to come...

Got last patient to clerk at 630am.. Altered mental status.. Cannot get any history from him so examined him and found nothing. Could be drugs.. Anyway, completed the clerking form and awaited MO to review. Who knows he's stuck with a talkative patient's son.. Fortunately he promised to review immediately after his patient and told us to go off.

Morning rounds as usual, then blood taking.. Unfortunately, supervisor was lurking around. Caught me and wanted to observe me take.. Wanted to prove i could do it.. quite confident of the vein then missed.. (Well done right?)
"I thought you could get 2 for blood taking in the first week.. Now.."

(Jialat.. why so sua?)

1230pm.. supervisor still lurking..
"Can meet you guys at 2pm today?"

"Oh.. we had night call last night.."

"Oh then never mind.." (Whew..)

1245pm... supervisor popped by again.
"I know you guys are post call but stay back at 130pm for a short session?"

"OK"

130pm... practical tutorial.. emergencies tutorial... on and on...

430pm
"OK that's it.. sorry for keeping you all... I'm afraid i have no time till the end of the posting to test you all again that's why.."

32hrs in hospital.

Pampered

2005-12-04T12:21:00.000+08:00

Was formally used to working on saturdays... Army, First few years of med school.. Until the 5 day week was implemented.
Then saturdays were heaven with 1 day to spare and not worrying about getting ready to work again the next day.

Things are different now.. Realised how valuable saturday mornings are... Now that i have to go the hospital on saturdays. Wake up the same early time as weekdays and by the time half day is up, the time taken to travel to whichever place i'm heading to after work takes away time again. Not to add the half day housework sessions on sundays.. my weekends are left with about 1 day's worth.. sigh.. pampered liao, wouldn't be complaining if there wasn't a taste of 5 day week.. (Will probably need to get ready for work on sundays soon..)

It's amazing how half days perk me up though. My stomach would be growling at about 12pm on normal weekdays and i'll be yearning for food. Yesterday's "half-day" took me to 2 plus without lunch and i wasn't complaining of hunger... Probably getting off from work was more important..

Newspaper man came to collect money today.. And amazingly asked us.. "没有出去啊?" Feel like telling him "有出去的话, 你收不到钱 lor"

Post SIP week 1 woes

2005-11-26T23:39:00.000+08:00

Lack of sleep? Too much to do? Made a great blunder today.
Was preparing for a blood culture, so in order to make sure that there is little chance of my sling bag, matric card and stethoscope banging into the sterile field while they are hanging precariously on my neck, i took them all off and set them aside on a chair.

Had to run in and out before the procedure cos many items not on the tray.. Hmm, guess have to check to make sure next time. The running in and outs invited nurse 1 to get me to draw blood from patient 1. Noted... So after culture taken over by HO proper, went straight to take blood without my valued items..

Blood taking: Struck vein 1st attempt, so happy, but flow was very slow.. (very is an understatement, then few seconds later.. stopped) taking PT/PTT somemore, blood flow like that clot in syringe liao, how to test clotting time?? Tried vein 2 with butterfly needle, cannot hit vein, family watching somemore.. haiz ... Sad enough... Need greater expertise..

Then nurse 2 called me to put IV into patient 2. Cleared blood taking tray and did IV. Patient i IVed was calling out in pain almost all the time.. Hmm.. when can i do a less painful IV? Cleared tray and cleanly forgotten stuffs.. 1245pm... No more jobs, finally can fly!!

So took off for home and realised i left the many things behind when i started clearing my bag at home.. Gotta go all the way back for them... Sigh... hours wasted just like that.

Was taking some naps today between pages of Talley.. Took a few seconds to get into slumber and all were REM sleeps.. Dreamt of what? Syringes, needles, blood and hospital... Haiz

Scares

2005-11-23T21:35:00.000+08:00

If you sustain a needle prick injury, you FAIL.
If you give the patient the wrong drug, you FAIL.
If you take blood from the wrong patient, you FAIL.

Why tourniquet all 4 limbs when you cannot find a good vein? Because you can find one in either limbs in 10 minutes. If you go one by one, you will take 40mins. Then if people ask you why you take 40mins, will you dare say you are incompetent?
But remember to remove any tourniquet left cos if not you will get limb ischemia, then people will ask you why you don't tourniquet one by one and be careful? You cannot say you want to save time because you are supposed to tourniquet one by one..

You cannot take too long to clerk one patient/ take blood from him. If you got 40 patients how? If one patient take 1 hour to settle everything then how? (40hrs...)

Tomorrow

2005-11-20T12:34:00.000+08:00

SIP begins tomorrow...

Uncle

2005-11-16T21:16:00.000+08:00

"Uncle, 你好吗? "

Uncle:"不好啦.. 给 gas 两次了.. 要死了啦!"

"huh? 不要这么讲啦.. 你还觉得不舒服啊?"

Uncle:"不是啦.. 给 gas 两次了就是要死了嘛.. 你做医生你不懂meh?"

(!!mana wu(有) ji(这) kuan(种) taiji (事情) e(的))

"不是啦 uncle.. 不是这样的.. 你作么会来医院?"

uncle:"肚子痛啦.. orr.. 你来访问我的啊? 以为你来看我的病的."

(........)

"要问你先才懂看哪里嘛..." (Haiz.. I lied... maciam i really doc..)

etc etc etc.... Couldn't get much history.. so asked him if can examine his abdomen...

Uncle:"看我可以啦.. 问我, 我很喘的.."

Abdomen: no findings, soft bruit over femorals??? (he said he had surgery over inguinal area before.. hernia? PVD?)

While examining...
Uncle:"Aiya.. 要死了还被做试验.."

(......)

Had some time before radiology this morning and was jio-ed by Desmond to see this new case whom we don't know the diagnosis. Also no known signs. End up with such a conversation..

Much as i want to deny the fact, i wasn't really helping him cure his illness. My main aim was to learn something out of him. And much as i want to deny the second fact, i was really making him a learning subject when he thought he was dying.
Tried to make up by trying to console him.. Asked him if he's alright.. asked him why he thinks he's dying.. asked him about his family.. then he turned quiet and just said.. "要死了..要死了."

Feel a little helpless. but have to go liao.. to see another case/go for tutorial. Then i forgot him for the rest of the day (because he has no good signs? because he will not be an exam case?) till i was on the way home with Dear.. Haiz, how can forget the patient like that.

Thanks to Weiqiang...

2005-11-14T20:32:00.000+08:00

Hmm.. dunno how they calculate one.. But don't mind selling my blog. Haha.. then keep opening new ones then can make $$$ :p

My blog is worth $1,693.62.
How much is your blog worth?

Ignorance

2005-11-12T00:58:00.000+08:00

What you don't know doesn't mean it didn't happen/exist

7 Hours

2005-11-06T22:31:00.000+08:00

Newspaper today: Less than 7 hours of sleep a day predisposes one to obesity (spot on!! looking at my tummy now), diabetes, cancer..

Wa.. if that's the case i should have slept 1/2 an hour ago. But there always seem to be something undone when night comes.. Must be my poor time management. Who wouldn't want 7 hours of sleep a day at least? Can only achieve this in the army (amazingly!!) Hope to cultivate the habit again. (must gain at least something from army right?)

Mass Comm

2005-11-04T18:24:00.000+08:00

Thought could study a lot yesterday but.. (hmm for me at least, maybe lack of discipline). Was planning a whole day of studying with Rei when eric called and jio-ed us for 'plane testing'. We ended up joining him late and had lunch with him and falconz instead. Thought it would be just an hour or 2 thingy and then can after that go back for books.

Who knows we were walking around JP when i saw a pair of muay thai shorts in the sports shop.
"Eh.. when are we going to watch Tom Yam Goong ah?"

"Oh today lor!" Falconz replied.

"Hmm.. should i have suggested?" (i kind of regretted) but decided to carry on anyway, cos will be watching the show anyway, so will anyhow spend the 2 hours. (luckily Dear didn't mind the change in plan too)

Well we then went on to" 怂恿" other friends to watch and amazingly gathered 10 people to watch within 4 hours to the show.. (Wa lau, dun know how come can like that one.. jio people for 5v5 street soccer so very kang kor.. must plan at least one day before one, watch movie few hours can liao.. hmm maybe SAF doing its job well)

Didn't regret the decision, show was stunt filled though too violent at times. And the supper that followed was filled with jokes and laughter. (Falconz at work most of the time..)

EOD week

2005-11-04T18:17:00.000+08:00

Never had such a week before... 1 day work, 1 day holiday. Really feels great cos every working day is met with energy and enthusiasm, expecting the holiday that follows it. But still i ran out of steam today.. Real sleepy.

Surgery is real great here in TTSH. Tutors are real enthusiastic in teaching and got the great Prof LCH.. Followed him in clinics one day and realised that many patients liked him just like many medical students do. But maybe it's because of his efficiency, he could afford some time to check out the weighing machine in his clinic.

"Eh.. this one accurate one or not?" He then weighed himself. "Hmm.. not very leh.. How come the needle dun start at zero one.. You come and weigh and tell me if it is correct."

Then one by one the 3 of us following his clinic had to take turns to weigh ourselves and assure him the weighing scale is accurate.. Finished the ritual and fortunately the next set of patients arrived. Haha.. wonder what he will test next if there's still no more patients.. The proctoscope??

Succusion Splash

2005-10-30T23:07:00.000+08:00

Patient is a 25 year old chinese student who had just eaten a big meal at marina south steamboat buffet 3 hours ago. He now presents with abdominal distention and the feeling of 'impending doom' about the possible growth of his abdomen.

On abdominal inspection, there was distention observed more on the left than the right. There were no visible masses felt. On palpation, the.... blah blah. On auscultation, bowel sounds were present and succusion splash was heard over the stomach when the patient is rocked side to side.

Hmm... luckily I did not have projectile vomitting..

Hippo

2005-10-23T13:45:00.000+08:00

Time taken to finish 613 pages of Dan Brown's Angels and Demons: 1 day...

Time taken to finish 100+ pages of a chapter in Kumar and Clarke: 2 days...

Amount of time and knowledge lost due to reading Dan Brown's story book instead of studying: Priceless

There are certain times when knowledge just refuses to get into the brain, for the other times, you will need a working hippocampus.

My encounter with hippos began in kindergarten when i keep seeing the hungry hungry hippo advertisements.. Quite bewildered and excited by the game.

But over time.. i realised that hippos are live and they have the big mouths.. (think i was in primary school then.. in a science lesson)

Then in second year med school.. i realised there's a hippo in the brain or rather a seahorse called hippocampus that aids in memory.. I need it to be alive and kicking now.. most of the time.. so that i can remember stuff all the time. Apparently i might not have trained it well.. It or rather the pair of them seems to be ailing now.. Hai.. how? feed them with essence of chicken? red bull? bird nest? or the plankton they used to eat in their natural habitat?

Happiness-Inducer Deficiency Syndrome

2005-10-20T23:19:00.000+08:00

Cure me...

Normal-life-sation...?

2005-10-17T17:11:00.000+08:00

Dad and Mom are back from China..

Was already quite used to being home alone.. totally, since they have been on trips many times liao.. This time fortunately, was not as lonely as the previous times. (Thanks Dear..)

Thought life would be normalising when they return, who knows some things became a little more abnormal..

1) Digicam suddenly went on strike. cannot focus, cannot take proper pictures, so had to send to repair.. dunno what is the etiology.

2) Mom was sunning the laundry from the trip this morning before breakfast when "CRASH!!!" the whole bracket holding the clothes line broke off the wall sending the whole infrastructure of the home's "clothes sunning system" to the ground. Will need some moderate operation to construct it again.. Luckily Dad has 2 more days of leave.. Hmm.. broke off the wall, first time in my life it happened..

3) Dad and mom also came back with a back full of medicine from China.. 熊胆 supposedly good for hypertension and 2 other medicines, 1 for liver and 1 for menopause.. I was real skeptical about the meds.. Most prob due to my western education.. but my parents seem pretty impressed by the profs and docs in the medical company they were brought to visit, so they bought the meds.. $1K of them.. What can i say? If they trust them and they will feel better, should be good for them i suppose.. i guess i will just have to look out for adverse effects... (Hmm, what made the chinese practitioners so trustworthy, compared to so many of us med students and docs?? Communication?)

Star Search 2005

2005-10-17T16:59:00.000+08:00

It was a new kind of test.. the introduction of an OSCE with 10 stations that we have to pass before we can take the MBBS.. Just took the mock test last saturday, to let us 'have a flavour of what it is like'

Turned out to be maciam 演员训练班 like that.

One of the stations was patient education about asthma inhalers and spacers for her child. I read the question then 'ACTION!'

'Hi Good morning.. Mrs Cecilia!" i began

'Oh.. er.. good morning' (the 'patient's mother' had to refer to her paper to confirm her name.. hmm... not my NG)

'I am KH, medical student..' i went on

'Huh medical student?!' she asked, glancing a little to the examiner

(Oops, the question said i was supposed to be a houseman... Hai.. used to it liao..) Well anyway, must act like nothing happened...

'So i see your daughter..blah blah blah... teach teach teach..'

After all the teaching, she offered to demonstrate to me to see if she got me correct.. (oops, forgot to tell her to do it.. think she saved me.)

Then surprisingly, after being 'taught' by 12 other people before me, she still could act blur then hesistantly shake the inhaler maciam she never did it before like that then place it to the spacer and pretend to spray.. she also kept confirming her steps till we finally reached the end. (She's really impressive.. she has another 3 more people to act blur with after me, i believe she can do it..)

'TING!' the bell went off = CUT!

Good take? have to wait for the review some time later..

Soccer final after the mock test. Last match in the last year.. We lost big time but i was glad i played my best game ever this last game. Most prob due to someone in the stands ;) Will miss the times with the soccer gang.. They really helped me improve over the 4 years.. We never failed to have jokes and laughter during our games too..

Need For Speed

2005-10-13T12:29:00.000+08:00

What is an acceptable pace for studying? Being able to go through the whole Neuro chapter in Kumar and Clarke in 1 day?

Really don't know what's ideal, but i seem to be trudging through the chapter like a 24km route march.. (not that i've done it though.. longest i marched was 10km) Well.. wonder how long i will take to finish it..

I like study breaks. Get to study more leisurely than during postings.. More energy to do so also.. Maybe it also gives me a false sense of security cause i won't know i don't know a lot of stuff.

Well, anyway.. think should grab the opportunity, next time might not have so much chances to stay at home the whole day.

Sick... Of the sick role

2005-10-04T18:15:00.000+08:00

Really hate this, the weak feeling with the desire to really do..... nothing but lie down

Glad this will be ending soon. All the worries for nothing with a negative for all results. Not even a raised total white or a differential shift in WBC to tell me what kind of an infection it was...

Anyway, found that my body only took a minor damage in this course of illness. So many more people are affected. Parents having to worry, whole family cannot enjoy a good dinner before my brother flies off, can't send my brother off, then whole family including dear Rei has to feed on fish porridge with me for a sunday dinner.. (how nice..) and all because of a rather atypical and prolonged illness.

And Dr Lim got to lose money by charging me peanuts for all the blood tests, consultation and medicine. (got to get him something..)

And i cannot do exercise though soccer final is nearing, cannot study properly, cannot do some housework (got to catch up this weekend), cannot attend outings, important birthday dinners etc

Hmm.. the sick role.. Can i decide not to adopt it by sheer mental determination? Looking back i think i had no choice.. or is it that my mind is weak?

Sick...

2005-10-02T12:21:00.000+08:00

Fever day 5...

Sore throat, occasional cough, no runny nose, temperature spikes in the evenings reaching 39.7, chills and rigours (first time i witness cyanosis of my own fingernails..) malaise at its ultimate.. 5 days liao.. what could it be??

Dr Lim ran dengue serology, blood film for malaria, UFEME, platelet count.. and gave me macrolides to cover strep pyo.. just in case. Well.. looks like all grounds covered liao. Wonder what i actually have. Doesn't help thinking i had been to CDC the past 2 weeks..

This should the best period of time to study: electives. must somehow psyche myself to do so..

The Fat Vampire Strikes Back

2005-09-25T12:57:00.000+08:00

I will know when i have been lazing too much on exercise and eating too much despite the lack of physical activity.. (When i wake up in the morning and stare into the face mirror while brushing my teeth.. a "fat vampire" polishing his teeth (fangs?) will stare back)

Pale, slight moon-like face, dark eye rings.. I'll only lack the long black cloak to pass off as 1

I always thought the human body is apt for homeostasis.. If i lack physical activity, shouldn't my appetite reduce accordingly? Or even if i had been using my brains more despite the lack of exercise (ya. right.. *cough* *cough*) Then the increased intake should only replenish the lost nutrients in the thinking process and not accumulate as body fat..

Well.. guess i have to resist temptations of good food and go for a lower caloric intake. Don't know how much more weight i will put on if i carry on eating before my body decides to find a balance. (already about 2 kg over the past 5 weeks liao..)

First impression

2005-09-17T22:17:00.000+08:00

First experience with Dr K was at an interactive session on cardio..

"Well this is supposed to be an interactive session, not a lecture.. so you all should ask questions." he said.

So well.. 'Pop' comes a question and he ended up asking the same question to the student. "What do you think?"

I didn't have a good impression of Dr K from then cos i thought:"You call us to ask question then you dun want to answer?" Well, anyway maybe it's his way of teaching.

Yesterday was a day of lousiness, weariness and "panicness". 4 plus after Prof I's tutorial and i was already dead beat. Somemore assigned to go cardiac clinic run by Dr K.

"Seow liao la.. Brain not working still go, if he grills me with questions i will end up telling him stuff like "the heart is located in the right hypochondrium and it moves up and down with respiration"" But i went anyway yearning to hear murmurs..

Ended up hearing none. But found that Dr K was not bad after all.. (错怪他了) He took the initiative to motion us to listen and also sometimes ask the parents' permission for us.. Also didn't blame us for not hearing what he calls a 2/6 ESM. "You all can't hear it la." He reassured us..

Guess it takes time to really know a person.

(Still wondering who is the 高人..)

100GB HDD?

2005-09-13T23:53:00.000+08:00

I guess it takes big and important postings to bring out this sense of inadequacy..

Paeds.. I wonder why it's always like that.. I can memorise a topic when i'm studying at home.. Write out the stuff that need to be memorised by heart and then happily tell myself:"Hor se la! I know about this condition liao!!"

Then the very next day when the tutor asks me a question on the topic i will be:"Er... Ah.." If the tutor's not very nice, he/she will probably give me a:"This one also don't know??!!" look
But most of them are nicer and will give the:"It's ok, you're stupid but it's alright.. i'll teach you or ask your more intelligent friends.." (Quote from Jere)

Then Lo and Behold when my friends are asked they will regurgitate the whole stuff, then i will go:"Oh Ya!!!" and feel like banging my head on the wall for forgetting.. And that's not all!! They can even go on to stuff i haven't heard about!!

I propose that there's a few degree of severity for forgetting:

Grade 4 --Learn and forget: The most severe of all.. everything that has entered the brain gets washed off after a night's sleep.

Grade 3 -- Remembering new things learnt but forgetting previous knowledge completely: Not as bad as 4.. At least can remember the newest thing learnt

Grade 2 -- Remembering new things well but vaguely know the older stuff: Hope i can at least reach this stage.. At least got something to say when asked..

Grade 1 -- Remembering everything but memory wears off over time (i.e over months): Lagi better.. Can at least cramp stuff in the last few months

Grade 0 -- Forgetting the ability to forget: What more can i say?

The higher the grade the worse is the prognosis for the 5 month survival rate for what is left of year 5.