enter Autumn (ie. March) and the start of freeze-ville! it’s still warm and the threat of bushfires remains imminent but it definitely is getting a little chillier, and i hope it stays that way… after that awful heatwave we had in January, i am officially siding with cool change. anyway i ended my neurosurgery rotation last friday and i was really sad!! i can’t believe how much i came to love it despite not being a ’surgical’ person and i have definitely learned heaps from being part of this awesome team. my new rotation, oncology, sounds a bit mehh after my glorious neurosurg days but i am definitely giving it a chance and hopefully the pace will pick up after a bit.. though i must say i was a little dismayed that the doctors don’t really read CT scans, they tend to click on the report and read it rather than view the scans…. and i was really dying to read the CT brains (because i learnt how to do so in neurosurg) but no one gave me a chance and this morning during grand rounds someone presented a case about brain lesions and i got the diagnosis right (because i actually could read the CT brain…..it is shocking how so few doctors can read a CTB decently) but anyway i was positively beaming!

so i was talking to a fellow fifth year whom i hadnt met before and she asked me what i was up to, and i said ‘Oncology’. to which she said ‘Oh. So you don’t diagnose… but you kind of make dying patients feel more comfortable…. right?’ can you believe how annoyed i felt upon hearing that? seriously. i can’t believe how people misconstrue what oncology is about. sometimes it may involve an element of palliative care but the fact is that most cancers are treatable and that is what oncology is about- curing cancer. i tend to get annoyed when all people think of when they hear the word ‘cancer’, is death. contrary to popular belief, not all cancer patients are dying patients. a sizable proportion of cancer patients make full recovery and actually go on to live to ripe old ages, and fyi more people die of heart attacks and strokes than cancer.

i guess i chose oncology as my specialty rotation because i wanted to gain a different perspective of medicine, and because i have an ambition to dispel the negative connotation of cancer among cancer patients and the general public. of course my other reason is because i owe it to oncologists that my father is still alive after 11 years of surviving cancer. my dad made it through cancer but he continues to suffer from the adverse effects of his radiotherapy…….. so my ever-inspiring aspiration is to help reduce morbidity after treatment and possibly make a positive contribution to every patient i see. another thing i wanted to comment about is that oncology is not ’sad’. for what it’s worth, i can say that a lot of the patients, even those with a bleak prognosis, have come to terms with their illness and don’t feel sad for themselves. i am constantly amazed at how ‘at peace’ they are with their situations and at the calmness at which they decisively refuse further treatment so that it gives them more quality time with family. i am even more amazed at how content they are with life and the fact that they are happy to have lived a full life….. if this is not inspiring… i dunno what is.

one of the best things that happened to me in my neurosurgery rotation was getting to watch an AWAKE CRANIOTOMY, today ie. brain surgery on a conscious patient. she had a tumor in her parietal lobe near Wernicke’s area, a strip of brain cortex that controls speech. if we removed too much of the tumor, she would lose her ability to talk. so Mr D opted to do the surgery while she was awake and we had to keep her talking throughout the surgery while we chipped away at the tumor.

we also used a cortical stimulator to determine the pre-frontal gyrus where the motor strip lay, by stimulating the brain with a small electric current and it was amazing to see her arms twitch whenever the current was applied. ok i will spare you the full details but IT WAS ABSOLUTELY MINDBLOWING. i mean, this is the stuff that i watch on Grey’s Anatomy and never ever thought i would get to see, but voila, my opportunity just came along! i think i hit the surgical jackpot- i am totally in awe and forever grateful. i will probably never see another surgery like this in my life but i’m sure i’ll remember it even if i’m 85 and demented heehee.

on a side note K and i both got ankle oedema from standing two hours at radiology meeting, so we took TED stockings from the ward to wear overnight. hahaha i hope it works

theatre today, for some strange reason, was absolutely hilarious. kr and i were laughing our guts out every 5 minutes, secretly hi-fiving (Mr D+us 1 theatre manger 0), stuffing ourselves with pastries from the drug-reps….. omg it was a riot! i probably haven’t laughed so much in theatre till now. then again, my OT experience before neurosurgery was probably all of 5 hours.

Mr D let me assist for an anterior cervical disc fusion today and it was amazinggg. it really makes me understand how stuff works. i always thought that invertebral discs were jelly-like and translucent (cos of those illustrations in the anatomy books) but now i know they look and feel like crabmeat. haha. i also finally understand how the stealth machine works. understand as in i would probably be able to perform stealth craniotomy right now if i had to. hahaha.

it’s funny how surgery never crossed my mind, because most people including myself think i fit the “physician” stereotype, but whaddya know…. neurosurgery is really pretty interesting. no actually it is intense, hardcore and mindblowingly insane but i kind of enjoy it. i really love hanging out with the team, they are such champs and every day just seems like a ride…. i mean we spend 12 hours on average at the hospital everyday, but it flies by so quickly and surprisingly i’m not counting down to the end of the day like i did in GP. tiring, yes, but boring, no. never a dull moment i would say, we have too much fun laughter and joy. ahhh i dont want this rotation to end!

AHHHHH tomorrow i start my first rotation. i’m more scared than excited really, my clinical skills are rustier than the sunken titanic and i havent been doing any reading that is even remotely related to medicine. i am not a fan of medical journals, truth be told. i would much rather flick through the glossy pages of Vogue than pore over the BMJ. don’t get me wrong, i do love med, for me its not about the reading, it’s about the doing. but of course you have to know before you can do (things correctly)… so it looks like i can’t escape the reading! ooh and speaking of fashion and medicine, i came across this interview in NYmag with Lanvin’s Alber Elbaz. he’s funny.

I wanted to go out of fashion, to study medicine. I thought, you know, who needs fashion? How important is it if you wear a red dress and an orange jacket? It’s not really. But it is important for that woman, she will find a nice fur coat and it will make her happy, she will have a better day. Our job is to give you comfort, to hug you with clothes. I always tell this story a woman told me, that every time she wears Lanvin, men fall in love with her.”

i love how he says “hug you with clothes”. i never thought of it that way, but i want to be hugged with clothes. engulfed in a giant wool scarf in the harshest of winters. i guess fashion has oft been regarded as ’superficial’ but i really do think it’s more than that. and i say that because dressing better inspires my confidence and makes me feel like i am better equipped to take on the challenges of the world…. and one day i would like to wear Lanvin (and Balmain and Valentino too. a girl can dream! teehee)

anyway tomorrow will be interesting! i’m so psyched that i’m in final year!!!! but that comes with the responsibility of doing things well and teaching the 3rd years… i remember this amazing 5th year louise who used to teach me how to examine patients properly, patiently correcting my technique and giving me useful critique that i still remember to this day. i really hope i’ll be useful to patients and to my juniors (and that means i have to start reading talley and kumar all over again.) i’m am going to have to get used to the wards again but i know i will love it- interacting with patients, seeing everyday miracles and just basking in the sheer privilege of being a part of other people’s lives. yes i know i love it.

ok i shall go do work now. i have watched the entire season 1 of samantha who?, and it is so funny. i love samantha! she is so endearingly cute.

annnnd. i leave you all with this SUPER HILARIOUS KARAOKE VIDEO called TUTS MY BARREH (go figure). watch it please?? please?

today i visited a patient in his home as part of a community palliative care visit. he was battling a terminal illness and was in a lot of pain. but he managed to smile at me and even offered me lemons from his lemon tree. he blew me away with his generosity, even in his difficult circumstances- so i accepted. we took a walk in his garden, towards his blooming lemon tree and he said i could pluck as many as i wanted. his wife gave me a plastic bag to put the lemons and so i gingerly tried to pluck 2 or 3 lemons but he stepped in to give me a hand. so we plucked lemons together and he made me take 11 lemons home. later he showed me his prized orchids, his empty aviary (he had to give his birds away), everything in his garden that was meaningful to him. he smiled at all these beautiful things and i genuinely believed that for that moment, he was happy and not in pain.

i saw 5 psych patients today. all of them had some form of schizophrenia, mostly the paranoid kind. all were nice and lovely. one taught me all i needed to know about clozapine. another left me with an original quotable quote: “people who write poetry only do so because they can’t write books.”

oh and i snowboarded over the weekend! it was lovely. the snow at falls creek was so white and pristine that i ate some. and snowboarding was EXTREMELY exhilarating and fun. we did the intermediate slopes and one of them was so steep i felt queasy just looking down. i spent the first day falling on my bum 378451 times while trying to master the sport. now my tail bone feels like it has been shattered into a million pieces and my knees are soooo sore i can’t squat. and ski-lift landings are my absolute nightmare! still. you know what they say- no pain, no gain. worth my every ache! now i can strike off ‘do some extreme sport(s)’ under my things-to-do-because-i-want-to list.

help! i am driving myself crazy trying to call shanghai to enquire about electives. for one, my mandarin is pretty much non-existent. i found myself saying ni hao, then i got stuck, and promptly switched to english. and the connection was so bad, i spent 5 minutes ni hao-ing and listening to the dialtone and then gave up. called again via my cellphone and this time i finally got a decent connection going, but the woman on the other end was the operator who did not quite understand my request. she redirected me to another number but no one answered. so after 3 attempts i threw in the towel… i shall try again tomorrow. perhaps i should make a draft in chinese beforehand. my level of mandarin is just …embarassing. can someone please tell me how i can contact the person-in-charge for international exchanges in Shanghai Second Medical University (SHSMU)? i’m getting a little desperate

anyway ive started my gp/psychiatry rotation and it looks to be a pretty peachy semester ahead *fingers crossed* we saw two patients with schizophrenia in psych early this week. one presented with attempted suicide, and the other presented with mania(?). it was really interesting, listening to them recount their thoughts and feelings and experiences….. i’m beginning to like the clinical part of psych but i’m not sure if i’ll enjoy the voluminous readings. haha. anyway i walked from my house to nottinghill for lectures today (must have been about 3 kilometres or so) and it took me 30 minutes. but it was a pretty nice scenic walk and i was dressed in 5 layers to keep myself warm and toasty. the weather forecast said it was going to hail but thank God, it only drizzled a little.

oh! and something amusing happened yesterday. for some reason i thought that class started at 2pm but in actual fact it ran from 1 to 2pm. so at 2pm i waltzed in feeling pretty breezy, while the entire class looked at me in utter shock. i was completely oblivious, until nesh told me that tute was at 1pm. oh my. i wanted to laugh out loud then, but i had to regain my composure so i could apologize to the tutor. and seriously this is not the first time i’ve pulled off something along these lines. i think i have a knack for doing silly things. haha!

exams in 4 days! i am officially in panic mode now. anyway i was reading through my paediatrics notes, and i can’t decide if medical people love or hate food. here’s why

• intussusception : red-currant jelly stools
• pyloric stenosis: olive tumour
• Maple syrup urine disease
• Sturge-Weber syndrome: portwine stain
• Transposition of the great arteries: ‘egg on its side’ chest x-ray finding
• Prune-belly syndrome

and these are just some of the references off the top of my head. of course there are references to animals (eg.spider naevus, stork mark), plants (eg. ash-leaf pigmentation in tuberous sclerosis), objects (eg. scissor legs in cerebral palsy, cogwheel rigidity in Parkinson’s), events (eg. cocktail party syndrome), weather (eg. thunderclap headache of subarachnoid haemorrhage), and of course people (the eponymous syndromes like Down’s, Tay-Sachs, Marfan’s. Turner’s, Edward’s etc)… as you can see i derive joy from making a list like this. anyway, going back to the food references, i have no idea why they are so rampant in the wonderful world of medicine. you would think i would be repulsed by now, but no actually i’m slightly hungry.

p.s. can anyone think of more food references? share, please!

since it’s approaching wintertime and i haven’t been able to go out for runs now nearly as much as i used to (or rather haven’t been able to exercise AT ALL), i’m slowly becoming a couch potato sooo…. i hatched a little experiment: i’m going to use the wii fit program (courtesy of housemate) in the comforts of my own living room (with toasty heater!) and see how much weight i can lose in a month! of course i’ll continue with my normal diet and all and make a very concerted effort to stop over-snacking. i’ve tried the yoga and it’s a pretty good back stretching session, which i like, and the only thing i don’t like is having to run on the spot for 5 minutes. otherwise it’s pretty excellent and fun, i love how the wii fit trainers tell me off (gently) if i’ve had a snack too many, and encourage me even when my posture is severely skewed to the left. so yes in one month’s time i shall be reporting back on the wii fit’s results! stay tuned!

in other news, gynae clinics have been very enjoyable. i get my very own room to see patients in (on my own!), and my registrar is such a sweetheart. what’s not to love?

i scrubbed into theatre today for a total abdominal hysterectomy that i wanted to watch. it was 2 hours long! i got a little bored halfway through because i couldn’t really see what was going on from where i was standing, just bits of bowel and fatty tissue here and there and of course the resected uterus, fallopian tubes and ovaries. we cut open the resected uterus to look at its cross-section, and there was a white mass growing into the uterine wall (this lady had endometrial cancer).

+ as you can it’s not really grey’s anatomy-esque… save for the green surgical drapes, and scrubs that we all have to don. there is no drama in a hysterectomy, at least. although at one point the anaesthetist instructed the nurse to take the patient’s temperature during surgery and the nurse said “there isn’t a reading”, to which the anaesthetist jokingly said “nothing? she must be dead then!” and i sort of laughed – not at the remark per se but at the way he said it so mockingly (which, in that situation, was extremely inappropriate of course- i need to stop laughing at the slightest things.)

also i went for ant3natal clinic this AM, and the doctor was absolutely beyond himself- i was not impressed. it’s a long story but if anyone is interested, here goes:

so we normally screen for D0wn’s syndrome (DS) at 12-14 weeks into the pregnancy in the form of an ultrasound test where the thickness of the baby’s neck (ie. nuchal translucency) can be measured… this helps us to give a risk estimate of the couple having a baby with DS. if the risk is found to be more than 1 in 300, a more invasive but definitive diagnostic test is offered- it is called amniocentesis and it carries a 1 in 200 risk of miscarriage or damage to the foetus

what really irked me was that this particular doctor not only spoke in riddles, but also tried to dissuade his patients from having the DS screening test. this is exactly what he said:

“would you have the test so that you will terminate the pregnancy in case of a bad outcome, or would you rather NOT have the test, so that you won’t have to terminate the pregnancy because you don’t know the outcome?”

i had to listen to that spiel 5 times over and it was not funny! if a woman insisted on having the test, he would retort with “so are you saying that if your baby was found to have D0wn’s, you would terminate the pregnancy? because it’s no good screening for DS if you’re not going to terminate it, you know.”

i was horrified that he seemed to keep harping on abortion, as though it was the sole option he could offer the parents…whatever happened to being objective and showing empathy? so what if the parents know that their child may have D0wn’s- it doesn’t mean that they will love it any less and it certainly doesn’t mean that foetuses who have D0wn’s should not be given a chance at life. i don’t think he was being fair to parents who have kids with D0wn’s…in fact he was being so rude and overbearing at one point in time that i felt like punching him at the back of his head (of course i couldn’t since i don’t reckon my indemnity insurance will cover me for that) .

having a baby IS and should be a lovely thing but he was totally killing the joyous mood and frightening patients unnecessarily with that cloud of DS and termination (emotional blackmail i might add). it is true that DS screening is contentious but i feel that couples should be given the choice and doctors need to be non-judgemental, irrespective of the parents’ wishes. my take is that all children are a gift from God and are precious and special, no matter what. well, thankfully clinic ended ridiculously early (he had to attend a meeting), and i desperately wanted to high-five someone out of sheer relief.

ps.sorry for the long medical discourse, i got carried away by frustration. usually i very much enjoy clinics, but this one was a nightmare! arGH

pps. kairui also wrote a post on Down’s Syndrome and one of the comments was from a mother with a kid who has Down’s, you might like to read it