Friday, December 03, 2010

On finishing medicine

Yes, that's right, all faithful followers of my blog (which I suspect there is none, considering I haven't been faithfully blogging...)

Sida is finally finished with medicine! Well, actually, as I'm typing this I'm still waiting for confirmation that I've passed my final exams. Due to be published by 5pm today.

On my first day, the Head of School said to us: "It will be a long, difficult year, followed by another long, difficult year, followed by two long, difficult clinical years... followed by a long difficult internship..."

If I had to summarise my 4 years in the shortest way possible, I think I would agree with what the Head said. There has been tears, there has been struggles...

I think back to the endless pages of pathology... endless warnings of "If you don't learn this or if you forget this then someone will die,"... endless lists of causes, diagnoses, investigations and management... drugs, doses, side effects, interactions... endless lists involving, it seemed, everything under the sun.

Then there was the human factor in it. I still have clear vivid images, in my mind, of various people I've encountered. The old dying man, sobbing by his bed. The placid (and flaccid) baby 4 hours before he died. The girl with schizoaffective disorder... the demons in her mind more debilitating than any physical illness. The parents of a young man in ICU after an overdose. The same young man, bleeding out of every orifice and vital signs plummeting before my eyes... then, the dead body, waiting to be 'pronounced'.

There was joys in it, too, don't get me wrong. But perhaps it's something in my character, or the character of the human condition overall... the joys are short lived, but the face of a dying baby haunts you forever. Suffice to say, it has been a long and difficult 4 years.

But now, I've come out of it... and I get the title of "Doctor". Perhaps I'm feeling a little tired and jaded, but that doesn't seem much of an incentive to me, and I'm not feeling particularly enthusiastic about using that title. I suppose it depends on who is using it and how you look at it, but there is something very humbling about that title. Doctor is someone who has seen your condition hundreds of times before, but is scared that she is starting to feel numb towards you and your condition. Doctor has been given front-row seats to human pain and suffering, and could do nothing about it. Doctor is someone whose every successful treatment is defined strictly within the bounds of protocols, guidelines, and meta-analyses of randomised controlled trials. Doctor is expected to be human in her compassion, empathy and care. And yet, she is not afforded the luxury that is given to every other human: she is not allowed to make mistakes. She is expected to "know best".

Is it any surprise that depression, divorce, and alcohol dependency is so high amongst doctors?

Anyway, I digress from the point. The point is, I'm finished, and I'm a doctor now... not really the end of the journey, but the beginning. Naturally, I would give thanks to those around me (you know who you are)... who put up with me the best way they could. And I would give thanks to my God. Only You and I know about the bitter complaints I uttered to you, during my darkest hours. Only You and I know about the times when I wanted to let go, the backsliding, the childishness, the pride, the tears. You didn't let me go. And, if the past 4 years is any indication, Lord, then I'm going to need more and more of You.

Friday, June 11, 2010

Why I can't be a paediatrician

There was a time, for a while, when I thought I was interested in paediatrics. Of course, this was before my actual term in paediatrics.

I thought paeds might be good for me, because as a radiographer I was good at working with children and always enjoyed the extra challenge. Plus, I wanted to keep my scope fairly general, I'm not really interested in specialising in something in a very small area. (I've since learnt, of course, that babies are very small, and specialising in something like neonatology essentially means specialising in an entire creature that weighs less than my lap-dog.)

My preconceived ideas of good with children was thrown out the window when I was asked to see a 2 year old child with sudden "inability to walk" - her mother suspects the child's legs are weak, but of course there is no way to get the child to tell you that. How do you do a neurological examination on a toddler? The child was in no mood to cooperate, was in no mood to allow me to test the power of her legs, and of course went into hysterics when she saw me approach with the tendon hammer to check her reflexes. My brave smile, my praises and coaxes, my flattering speech about the pretty butterflies on her dress, all fell on deaf ears. (Actually she was screaming so much I doubt she heard me.) In the end, I picked her up, watched her then run back to her mother, and then proceeded to report to the doctors that the child's lower limb power was "grossly normal" since she could run. Give me an irate adult that I can reason with, any day.

I think, though, the biggest problem with paeds is that I have a real soft spot for kids. I think they are all cute and beautiful and little balls of potential and hope and germs... and I really can't stand it when I see kids sick. I'm starting to get better about it now, but at the begining, even reading about paediatric diseases used to make me feel sad. I'd be reading a condition, like spina bifida, and I'd think... aww, poor baby, you poor thing. Then I'd have to tell myself to snap out of it. You can't be an objective doctor if you even feel emotionally sorry for the "hypothetical" kid with spina bifida.

The worst is the kids who are in hospital because of "social" issues - the ones who have been neglected and malnourished and abused. I don't particularly feel like writing a lot about them at this time... suffice to say, the thought of these children keep me awake at night. They deserve a blog post of their own. Perhaps, at the end of the rotation, when I have more time and when I've gotten a few glasses of red into me, I'll wax lyrical about them.

The paediatricians are all great. Lovely people, compassionate, and passionate about what they do. Of all the doctors that I have seen, I think the paediatricians have been the least cynical and the least tendency to be flippant or facetious. But, less than a month into the rotation, I already know paediatrics is not for me.

Oh yeah, my last rotation was obstetrics and gynaecology.

O&G is definately not for me, either. And the less said about it the better.

Friday, March 26, 2010

Sida's bucket list

A bucket list is a list of things you would like to do before you kick the bucket (ie - die). It comes from the movie The Bucket List, starring Morgan Freeman and Jack Nicholson. Love the movie, one of my all-time favourites.

My bucket list:
- Have a child/place/treatment/small country named after me.
- Try a wine that had been cellared for over 40 years
- Write a book, get published
- Compose a short symphony
- Lead a small group of people into some unchartered territory
- Proclaim my God before millions, in some way, shape or form
- Be someone's favourite doctor.
- Be someone's favourite person.
- Witness a miracle in someone else
- Give someone a gift they have never experienced before
- Save someone's life, twice.
- Fall in love.

Thursday, March 18, 2010

Applying the Reasonable Person Standard to Coffee

Imagine yourself, bleary-eyed, at about 7:30am, when, contrary to all reasonable human practices, you've already been up for about two hours, and somehow you find yourself standing at the entrance to the hospital, about to start your day. Or, perhaps, it is about 3:30 pm, lunch was a distant dream, and home seems even more distant.

You need that coffee.

You realise that coffee isn't the elixir-of-life, it is only the elixir-of-the-next-hour-or-so. But anything will do.

So, you trudge to the nearest coffee shop... or, if you have enough volition, you might search your brain to see which is the nearest cheapest coffee shop. Because, after all, you are a student, and by definition you are very poor.

"What would you like?" says the girl at the counter, in a painfully cheery tone.

You search your brain for the right words. What was it that I wanted? Um, the thing. Comes in a cup. Taste bitter-ish. Coffee. But that's not good enough! What do I usually say? Come on, she's starting to look at me funny...

"Regular-skinny-flat-white" you manage to mumble, the words blurring together. Flat white? Or latte? Oh well, too late now.

When the regular skinny flat white comes, of course, she charges you for much more than the price you expected, and you see why. It is huge. You look frantically around the counter, and you realise that "regular", to this coffee shop, actually meant "medium", and "medium" means very large. You should have told her you want the "small", if you want a "normal" size coffee... but it is all too late now. You take the coffee away, glad for anything. And you drink it all, because no poor medical student throws coffee away.

For the rest of the day, your hand shakes when you put needles into someone, you need to run to the toilet every few minutes, and your head feels distinctly antsy.

It is the opinion of the writer that "regular" ought to be regular. There should be a standardised sizing system for coffee. "Regular" means the small in some shops, but large in others... while still other shops name their smallest size coffee "grande"... it is very confusing, and I am usually already in a confused state when I call upon a coffee shop. All I want is a reasonable sized coffee to reasonably kick start my brain. If I had enough brain cells to figure out what "size" that corresponds to, then I wouldn't need to buy a coffee!

Thus, a law ought to be passed in parliament. The Reasonable Person standard already exists in law; it holds that: each person owes a duty to behave as a reasonable person would under the same or similar circumstances. It could be applied to coffee thus: the size of the regular sized coffee should be the size of what a reasonable person would order, under reasonable circumstances. If it doesn't make a lot of sense to you, don't worry, that's law for you.

Either way, something needs to be done!

Wednesday, March 17, 2010

New blog

I have started a new blog... the address is

I will still continue to write in this one, but there will be some distinctions between the sorts of things I publish here, and the sorts of things I publish in the other blog.

I just wrote an explanation of why I started a new blog in the other blog... so I won't repeat myself here. If you are reading this, I hope that you will check out the other one too, once in a while. But I realise that the other blog will not be to everyone's taste.

Not that this one is to everyone's taste, of course. But you know what I mean.

Friday, February 12, 2010

Ophthalmology and ENT

Well, I just finished my brief spell in the specialties of Ophthalmology (the study of the eye) and ENT (Ear Nose Throat, or Otolaryngology to the Americans). Two weeks in each. The word "Specialty" I suppose implies that it is special, and indeed it was.

Ophthalmology was interesting, in its own strange way. I spent the first week feeling like everyone was literally talking in a different language... The complexity of the subject can be appreciated simply by the fact that, in any textbook of ophthalmology aimed at primary carers and medical students, there are only a few conditions that does not carry the recommendation: "Refer to ophthalmologist urgently".

ENT, on the other hand... was... well, let's simply say, special. Let's look at it this way. When I looked up, in a textbook, a chapter called "ENT emergencies", the first one was "epistaxis", or nose bleed. Now, I am aware that very severe nose bleeds can be a big deal, but it really was a bit of an anticlimax. Considering ophthalmology had in its list of emergencies such impressive-sounding things as "sudden loss of vision", "sudden onset diplopia" and the like... a nose bleed really seems sort of humourous. And so it was for the rest of the specialty. ENT is indeed a complex subject (in its own simple sort of way), and interesting, in small-ish doses. But sitting in the ENT clinic listening to complaints of ear infections and runny noses just seems oddly humourous. It is no defect of the specialty or of the department that lead me to feel rather bored, I am entirely convinced it is due to my own ineptitude toward anything surgical. As the registrar kindly said: "You did a good job feigning interest for two weeks".

I do feel a bit apologetic for this, because a medical student could not have asked for better clinical teachers. As such, I have no taste for surgery, just as a person may have no business sense or no ear for music.

Anyway, without further ado, and continuing the tradition of previous terms, here are some "quotable quotes" of Ophthalmology and ENT.

By the way, if you are wondering why I am blogging so much this week... it's because I have finished my ENT assignment early, and have been "let off the hook" from attending a few clinics and surgeries... and thus with a reasonable amount of time on my hands. Next week I will be in Critical Care, and possibly not so care-free.


Ophthalmology Registrar: "Dr K is good with eyes." (I giggled at this... he's an ophthalmologist, of course he is good with eyes! On the other hand, I suppose it is the highest praise you can give to a doctor... to be simply good at what he is supposed to be doing.)

Ophthalmology Registrar: "Why go watch the cataract surgery? You could go to the library and watch a cataract surgery on Youtube, and you get a running commentary on it. Don't bother, it's boring."

Ophthalmology Registrar: "Do you know anything about the retinal changes in macula degeneration... no, let's simplify this. Do you know anything about macula degeneration? Who am I kidding, you're a med student. You wouldn't know anything. Let me explain."

Ophthalmology Registrar: "Have you considered specialising in Ophthalmology, Sida?"
Sida: "No."
Ophthalmology Registrar: "That was rather emphatic."
Sida: "Oh... sorry."

ENT registrar: "This patient presented with a severe case of runny nose."

ENT registrar: "Most salivary gland tumours arise from the parotid gland. Do you know where the opening of this salivary gland is?"
Sida: "It makes saliva... so in the mouth."

ENT consultant: "I'm a microsurgeon and I can't type."

ENT consultant: "Where does the rash in Ramsay-Hunt syndrome appear?"
Sida: "Um... we are in the Ear Nose Throat department... so I'm going to guess the ear, nose, and throat?"
ENT: "Amazingly you are right, except it doesn't appear in the nose."

Med student: "So why are you cutting little squares?"
ENT consultant: "Because little circles are too hard to cut."

Surgeon: "There appears to be quite a bit of bleeding."
Anaethetist: "Well that is because you keep poking it with your sharp instrument! I can promise you if you stop poking it it will stop bleeding."

Surgeon: "We will be finishing early today because our last patient cancelled the surgery."
Sida: "What a shame."
Passing nurse: "Your smile gives you away."
Sida: "I don't know what you are talking about..."

(And this following one doesn't really have much to do with either specialty...)
Med student: "Ooo, what's that book you are reading?"
Sida (shows her the cover): "The Confessions of St Augustine."
Med student: "Sounds interesting. Who wrote it?"

Tuesday, February 09, 2010

Sida is evil

Today, the registrar asked me to grab some pathology containers to put blood samples in. I didn't know which one to get, so I grabbed all of them...

He only needed two, so I was left with 4 empty pathology tubes.

I was too lazy to take them back to the storage room... so I just put them in my pocket.

They went from my pocket to my bag, from my bag to my table... and now, they are in my fridge.

"Sida, why are they in your fridge?" I hear my dear readers ask.

Well, you see... as I was standing there in theatre, feeling tired and dreadfully bored, it occurred to me that I could have a lot of fun with these containers. Imagine my dear mother's surprise and disgust when she opens the fridge and sees some pathology containers - all containing something yellow, purulent, and offensively mysterious. The thought was too sweet to dismiss, and I couldn't wait to get home.

Unfortunately my 11 year old brother was home when I got home too, so I had to let him in on the secret... but he promises to be a good sport.

In one tube (the EDTA tube), I put a mixture of Apple-Guava juice, cooking oil, and a drop of soy sauce. The oil separated nicely from the juice, which was again separated by the tube additive... I gave it a good shake... and, voila, I'm a genius. I created a purulent fluid resembling sputum.

In another, was a mixture of squid sauce and soy-sauce (giving it a lovely brown). In yet another, was the good old fashioned tomato sauce, mixed with some water.

I would have LOVED to take a picture of the containers for your entertainment, but unfortunately as soon as I'd done all this and put the items back, my mum's car drove in the driveway. I quickly put them all into a small plastic dish, and pushed it into the fridge, behind the capsicums. I will take a picture later, maybe, after mum goes to sleep.

I really hope she discovers it when I'm not at home - then, her imagination will run REALLY wild, she will be totally disgusted, but she won't be able to question me. Being a dutiful mother, she will assume that it is something work-related, so she won't throw it away. In fact her imagination will run so wild, she will imagine all sorts of disgusting things, and she won't be able to even TOUCH it. That is the evil dilemma I have placed my mother in - she will be disgusted to the core, but unable to do anything about it.

But now I have a problem. Say if she found it when I'm at home... what explanation should I offer? It should undoubtedly involve something to do with bacteria, or parasites. But why would the specimen be in MY fridge, rather than in the hospital? I need an explanation that is plausible, not too far-fetched, but never the less disgusting. And, if possible, I would like to convince her to keep it in the fridge for at least a month.

Any suggestions? Please help! Comments welcome.