The Silent Killer (not diabetes)

It’s been awhile, partly due to the burden of having to speed through Legal and Forensic medicine in a mere three weeks. It’s still too early to laugh about the events that transpired during the OSCE exam. Though there were one or two gems worthy of being mentioned, I’ll leave the rest till after I (hopefully) pass with flying colours.

The Silent Killer

Seery, the respiratory consultant, is known for his charming smile, politeness and kind words. The man is loved by all, except when it comes to OSCEs.

When I walked into his station, I shuddered at the sight of him. I knew had to bring my A-game or risk being docked marks for the smallest of mistakes. There was no room for carelessness.

I spent the first few seconds observing the patient, not forgetting to count the respiratory rate. I counted the amount of breaths for the first ten seconds and multiplied it by six.

I finished the examination and was prompted to report my findings.

“Mr X is a middle aged man, lying comfortable on the bed with no obvious signs of respiratory distress. His respiratory rate was determined to be 16 breaths per minute which of is normal.”

“How did you get the respiratory rate?” he asked.

“I measured it for the first ten seconds and multiplied it by six,”

Swear words started to form in my head

“Okay, so you multiplied by six. And you got 16?”

As I started to scramble for answers, the audible scratch marks of the silent killer’s pen filled the already silent room.

EXAM!

Reiters Syndrome. Felty’s syndrome. Keratojunctivitis sicca. Epidermal necrolysis. Guttate psoriasis. Pulsus parvus et tardus. Pyoderma gangrenosum. Erythema nodosum. Sjogren’s syndrome. Budd Chiari Syndrome. Dressler’s syndrome. Charcot’s Triad. Reynold’s pentad. Troussier’s sign. Grey Turner sign. Cullen sign. Murphy’s sign. Hashimoto’s thyroiditis. Anticardiolipin antibody. Amyloidosis. Pernicious anaemia. Infectious mononucleosis. Vitiligo. Fallot’s tetralogy. Dysdiadochokinesis. Telengectasia. Buboes. Clostridium difficile. Polymyositis. Helicobacter pylory. Systemic lupus erythematosus. Myasthenia gravis. Polycythaemia Rubra Vera. Cor Pulmonale. Torsade de pointes. Citrulinnated C-Peptide. Polymyalgia Rheumatica. Paroxysmal Nocturnal Dyspnoea. Henoch Schonlein Purpura. Non Hodgkin’s Lymphoma. Koilonychia. Onycholysis. Leuconychia. Leukoplakia. Heberden’s Nodes. Bouchard’s Nodes. Boutennier’s Deformity. Dupuytren’s Contracture. Marfan’s Syndrome. Steatorrhea. Malena. Haematochezia. Thyrotoxicosis. Mallory Weiss Tear. Meckel’s diverticulum. Virchow’s node. Oliguria. Erysipelas. Caput medusae. Hydrocoele. Pancreatic pseudocyst. Chvostek’s sign. Pseudomona Aeruginosa. Escharotomy. Cholelithiasis. Sialolithiasis. Cavernous Sinus Thrombosis.Wegener’s Granulomatosis. Ceeruloplasmin. Syringomyelia

I’m not making this up. Show this to your nephews and nieces who want to do medicine.

PS : it took me an hour to type this up

PPS : im proud that i can define at least 90% of the terms above.

Bite me

Tendon reflexes differentiate the men from the boys. It is often the cause of many sleepless nights amongst medical students and even the most senior doctors. The variability that exists among patients’ means that there isn’t really a formula one can stick to when trying to elicit a response.

In order to enhance the reflexes in a tense patient, a distraction test is done so that the muscles relax. The text books reckon that one should ask the patient to clench their teeth just before the tendon hammer hits the desired spot.

“Ms J****, could you clench your teeth on the count of three?” I asked the elderly patient, with the tendon hammer ready to swing at her elbows.

“Oh I’m sorry dear, I don’t have any teeth,” as she smiled a toothless grin.

So much for textbooks...

Stormy days

A hospital can be a very dark depressing place. Within its walls, people often go through horrific experiences that they never ever want to relive.

Today was just one of those days...

I saw a man diagnosed with cholangiocarcinoma (bile duct cancer) break down and cry.

I sat through a family meeting to inform them that their mum was dying

We later visited them in the ‘suite of death’ to make sure that she was comfortable and not in any pain

I heard an old lady crying out in sheer agony and frustration because of unbearable chronic pain;

We had to call security to neutralize our patient who was so desperate to get out that he attacked the nurses with his walking stick

A breast biopsy of our patient who was admitted due to a fall came back positive for metastatic cancer.

A disabled kid in a wheelchair got stuck in the toilet because he wasn’t used to wheeling himself around yet.

A mother not recognizing her own daughter after suffering from an ischemic stroke

And at the end of the ward round, my normally cool registrar asked for a timeout so that he could be alone and just calm himself down after today’s events...

Emergency Room

Back to Vinny's

I was really looking forward to the start of a new three week rotation with the gastroenterolgy team at St Vincent's University Hospital. Being at an elite hospital simply means more patients, ie more action. No disrespect to the peripheral hospitals we're sent to, they have some positives as well.

Danny, our spr aka 'the man who runs the show', is always well dressed and extremely courteous to the patients. Other members of the team include Katie, a gresh ucd graduate doing her internship, and Craig, the senior house officer with his unmistakeable orange(!) stethoscope. They're all generally pleasant people and make it a point to teach us whenever possible. So I am feeling good about the next three weeks.

Adrienne and I met up with our team for the first time in the A&E ward. It’s never as exciting as it seems on shows such as ER or Greys Anatomy. There might be one or two trauma cases, probably due to a bar fight or other alcohol related injuries.

We weren’t expecting any surprises (Obviously there was one)

As Danny was going through the patients charts, there was a loud thump. At first, nobody reacted.

I ran with Danny towards the patient. He had collapsed and was having a seizure.

I looked at Adrienne who was probably as excited as I was.

As the chaos subsided, Danny looked up to us and said, “That’s more action than you’ll ever get to see, unfortunately,”

Better than nothing, I suppose.

And within a minute, Danny was shouting at the top of his lungs,

“Cardiac arrest on bed 12, get me the crash cart NOW!”

Another patient had suddenly KO-ed right in front of us.

The whole ward suddenly burst into life. Everyone seemed to have a part to play in resuscitating the patient whose heart had stopped.

Everyone except us of course; as students, we’re generally told to try and not to get in the way. So yes, it was indeed very exciting.

"What else would you like to look for?" asked Vicky the red headed Scottish registar.

My nerves were having the time of their lives.

"I would like to look at his testicles, please,"

That didnt come out right.

She burst out laughing.

"Geez, would you now!" she said.

I meant to say external genitalia, not bloody freakin testicles.

Worth the pain

“Doc, I couldn’t sleep last night, it was agony. The pain was just...” she broke down.

Mrs AJ was diagnosed with breast cancer a couple of years ago. It had metastasized to her bones...

Pain is something that physicians deal with all the time. A simple analgaesic can sometimes do wonders for any miserable patient in dire pain.

The WHO pain ladder is a step-wise guide designed to aid doctors in describing pain meds.

The higher up one goes, the more side effects there are. Opiods such as oxycodone or oxycontin were very good opioid analgaesics. But their side effects are nausea, addiction and in some cases respiratory depression. Given the choice between the side effect versus pain, which would you choose?

My thoughts wandered...

It was a superb through ball which sent me past the keeper. The last defender was standing between me and the goal...

Judging by the trajectory of the ball, it was 60-40 favouring me to get to it first. I knew I was quicker. I also knew that he'd give it a shot anyway.
We both lunged for the ball.

I toe poked it home.

As the ball bounced into the net his trailing leg was still coming at me in full force.
The referee blew his whistle signalling a goal. As I limped off the field, I sometimes wonder if it's ever worth the pain for a moment's glory.

Rewind to about 9 years ago. I was 14. It was a martial arts sparring competition.

I had injured my right toe in the semifinals. My opponent in the final was a real cocky guy from the east coast. He had earlier whooped my good friend whom now had a crooked nose.

My coach took out a red spray can. He sprayed it all over my toe. I suddenly felt no pain.

A minute passed in the first round. We were evenly matched. Suddenly I felt a sharp pain all over my right foot. I signalled for a timeout.

The coach again sprayed the contents of the red can all over. I felt relieved but still tender.

As far I was concerned, I was destined to lose unless I used my right leg to counter his kicks. It was hard and predictable using just my left.

Round two

He had figured out from my numerous timeouts that my right foot was useless. He had the advantage.

A minute left on the clock...

At that time it felt like I was being heroic. I managed to whack his face twice with a roundhouse kick using my right leg. It probably hurt me more than him. But it was enough.

Two months later...

I stared at the gold medal hanging by my bedside. Then I stared down at my crooked right big toe, which was still tender at times...

Was it worth the pain?

Deja Vu

Another three weeks in St Micheal’s Hospital, a place very close to my heart due to the overall atmosphere of the hospital. The people are old; but they’re adorable and kind. The doctors aren’t too busy to tend to medical students; giving tutorials or bedside examinations.

I said hi to a few familiar faces.

Dr Mcsteamy (the girls actually call him that) was still looking as suave as ever in his one-size-too-small shirt and gelled up hair. He winked at me as we passed in the corridor.

Or maybe he was winking at my partner, a tall leggy blond wearing the shortest of skirts.

Little Carrots

In order to pass your final OSCE exams, you have to be street-smart. During your history presentation, throw a few little carrots to the examiner,” said Dr Carthage.

Little carrots are when you pretend to stammer or trail off on certain words, pretending that you don’t really know what you’re talking about. For example :

The patient, err, might be suffering from hypercalcaemia.

In theory, the examiner will pick up on your moment of hesitation and try to catch you off guard. When in fact, you’ve been reading up on hypercalcaemia and can totally hit it out of the ballpark.You’re basically setting the tone for the whole exam and talking about the things that YOU want to talk about, instead of leaving it to chance.

A useful tip, I hope.

A word of advice from our endocrine tutor,

“Only watch Grey’s Anatomy if you want to learn how to start a sex scandal in a hospital,”

Ending on a high

I had finally finished my surgical rotation. No more 5am starts. I felt invigorated. Starting class at nine gives me at least two extra hours of sleep, something I had been sorely lacking during the past six weeks.

Surgery was depressing. Not to mention tiring. On the last day of surgery, I just couldn’t find the strength to get out of bed. I loathed going to the hospital at such early hours in the morning.

I decided to stay home and do nothing.

I texted Adrienne and asked her to pass my attendance sheet to my consultant, Mr McDermott.

Oh, surgeons are addressed as “Mr” instead of “Dr”.

I got a reply from Adrienne.

“McDermott made me stay back after lectures and attend his clinic before he signed my sheet. He refused to sign yours. Sorry!”

Served me right to skip class.

I made my way out to St Vincent’s to meet McDermott. He seemed cheerful after performing a wide local excision of the right breast.

He put his arm around me.

“Now, where were you on Friday?”

I couldn’t decide whether to lie or not.

Somehow it just didn’t feel right to say, “I was depressed so I stayed in bed”

So a white lie it was.

“I wasn’t feeling too well”

He opened his mask and looked at me head on.

“Sounds like you were out drinking”

“Errr, no I wasn’t”

He didn’t seem convinced...

And no, I didn’t get my attendance sheet signed.

Dream of a dream

I stared at the exam questions for a long time. The Bimbo had surprised us by giving out test papers during one of her tutorials.

Classify and define Hyperparathyroidism.

My head started to feel heavy. I know this. I closed my eyes and tried visualize the diagram I once drew in my notes...

“YOU ARE NOT ALLOWED TO SLEEP DURING MY EXAM!” she shouted.

I was roused immediately. For a moment, I prayed that the nightmare would end. That I would wake up from this potential horror movie scene.

Then I realized that it was totally real.

She stood right in front of me, eyes wide open, breathing heavily.

“Was it THAT easy for ye?” she asked sarcastically.

“Err...I, I”

“You what? Have you finished?” as she grabbed the paper from my hand.

All eyes in the lecture theatre were fixed at the events that transpired. But I was alone in this. There was no get out of jail card...

My heart rate got faster and faster as she read through my answer sheet. I didn’t study and I knew most of my answers were crap...

And no, I didn’t wake up. It wasn’t a dream...

Feeling green

He was wearing scrubs. His stethoscope was hanging around his neck, his hair gelled to perfection. His subtle irish accent coupled with strikingly good looks has made him very popular in this small hospital. His name tag reads senior medical student. Oh, they call him Lee. Even his name is cool.

Just what I need. A teacher’s pet on my team. Thank god I have 3 days left.

I hate not being the centre of attention.

Let the stress begin

“Have you taken the patient’s history?” asked the registrar

I nodded.

“Well, I think you’re ready for the real thing,” as he passed me another patient’s chart

“I want you to clerk this patient in,” he added.

My heart was doing jumping jacks.

Another milestone.

She was in for a right temporal artery biopsy, a relatively simple and low risk procedure.

And she was my first.

Bad Dreams

The lecture was about breast cancer. I was sitting in my room, listening to the live streaming option. I was too lazy to thread out to Tullamore Hospital, about half an hour’s walk from the bed and breakfast I was currently living in.

The lecture was boring. My eyes started to feel heavy. I dozed off.

I heard a knock and a girl walked in. It was Hermione. I thought it was a dream.

What the heck was she doing in my room?

“Errr, hi there,” she said furtively.

My mouth was still half open.

I realized that I wasn’t dreaming.

“I thought this was my room,” she explained.

“I was given this room last night,” I said.

“Oh, there must have been a mixup, I’ll go check with Maria,” she said hurriedly leaving my room.

I went back to sleep.

That was almost a nightmare.

Kampung Tullamore

Tullamore Hospital-25 minutes from the BnB I'm situated in

Dinnis Cottage!

My room :)

Old-School

“Could you give me a hand, son?” asked the old lady who had just came out of the bathroom.

She was on crutches and was struggling to hold on to her change of clothes. I immediately helped carry her things and asked her to lead me to her bed.

The ward was full of elderly ladies. They seemed cheerful.

“I see you got yourself a nice boy toy over there,” said the lady in wearing a yellow dressing gown.

“Ooo, hello there son, I tip very generously,” said another, showing off her pronounced wrinkles as she winked at me. The rest of the gang sniggered in the background.

“Now you keep your hands off him! I found him and he’s mine,” said my patient.

I didn’t know where to hide my face. So I smiled at each of the ladies.

“Now you take good care of her. And no funny business!” said another one as I closed the curtains to my patient’s bed.

I helped seat her on to the bed.

“How can I help you there?” I asked her.

“Well, unless you have a thing for old ladies, I suggest you leave so that I can get dressed....”

Sheesh talk about mixed signals...

Home away from home

I was glancing through my files and realized I forgot to post this. It was written about three weeks ago, detailing my journey from Kuala Lumpur back to Dublin. Enjoy

..........................

So begins my long (very long) journey back to Dublin.

The two months spent back home seemed like a flash, though my stomach would beg to differ. Being away from home for the most part of the year leads to the assumption that one has to be fed till he cannot feed no more. Enough about my gastronomic exploits...

Hairy-zilla

I’ve always been fascinated with the concept of the unibrow, where one’s eyebrows meet in the middle and form a single eyebrow.

Never for the life of me could have imagined that hair could extend from the chin(beard), down to the neck(neck hair?), and ‘connect’ with chest hair. Now what would you call that?

I couldn’t keep my eyes of Hairy. He was wearing a polo shirt which was buttoned all the way to the top. And his chest hair was thicker than the hair on his head.

Oh I googled 'the world's hairiest man' and found this picture

It’s not polite to stare. It really isn’t.

DUBAI Airport

I’m a quarter way through my ten hour stopover in Dubai Airport. I felt extremely refreshed after taking advantage of the free shower rooms situated strategically beside the prayer room.

After spending half an hour browsing through duty free shops, I realized that 142.50 Dirhams doesn’t really give me a whole lot of purchasing power.

The free buffet was a disappointment. I couldn’t stomach anything but the macaroni and cheese. So, off to Burger King for dinner number two.

Burner King

No that wasn’t a typo. They burnt the meat in my double swiss mushroom, which cost a whopper 46 Dirhams! And it tasted like charcoal. Waste oh waste...

Displacement

India has a population of more than 1 billion. Ireland has a population of 5 million. Most countries in Europe have small populations. Hence the term ‘personal space’ is understood differently.

I am not a racist. This is just an observation.

A European couple were seated at a table for four. They weren’t really eating, just hanging out and having a conversation.

Along come two Indian ladies, who asked permission to occupy the two ‘empty’ seats in front of the couple.

What? Who does that?

The couple looked at each other uncomfortably without really saying no to the Indian ladies. That was the cue, the ladies sat down without batting an eyelid. It was awkward, even for me to watch. My table was right beside them.

Thirty seconds later, the rest of the Indian family arrived (in sorta like a scene from the Nutty Professor), carrying a whole bunch of whoppers and fries.

They just hung around the table, without really asking the couple to leave. They started to have animated conversations with each other, making a whole lot of noise in the process.

It was a psychological battle. I could almost feel the tension in the air. In the end, the couple left. The Indians won. They got the table without even having to ask. Classic.

It didn’t end there.

The table for four just wouldn’t fit the SIX of them. They weren’t exactly small. The two ladies inched closer and closer towards my table. The little ones had already arrived at my table, cautiously eyeing me as I hid behind my laptop. One of them finally sat down right beside me.

The invasion had begun.

Another glance at the clock. 7 hours to go.

Birmingham International Airport

I finally arrived in Birmingham. The immigration queue was ridiculously long. It took a little more than two hours to get my passport stamped. Just 5 hours left till my flight to lovely ol’ Dublin.

I found a cosy spot on one of the unoccupied massage chairs. Not that I wanted a massage. Nor did I want to hear groans of pleasure by the Arab beside me after he inserted a pound into the machine. Geez.

Bimbos & Bones

“What is the name of the gene that causes FAP?” asked the “bimbo”

“I can’t remember?” I gulped.

This would be the second time I failed to answer her question.

“What do you mean you CAN’T remember!? Did you ever know the answer?” she asked condescendingly.

For a moment I thought I saw a flash of red in her eyes.

“Errr, I did read about it, but I still can’t remember,” I was fumbling to find words.

“You read about it. And you can’t remember. What’s the point then? That means you didn’t LEARN it. You READ it. There’s a big difference!” she rattled on.

I vow never to forget the gene that causes FAP. The APC gene on chromosome 5.

I was still having palpitations as she left the room. The Bimbo wasn’t someone to mess around with. Not even Hermione escaped her wrath.

I’ve got to start studying!

......

Orthopaedics

The next two week’s will be spent in The National Orthopaedic Hospital, Cappagh, situated about an hour and a half from where I live.

I actually like orthopaedics. I don’t know why. It seems so simple and straight forward. And it involves a lot of anatomy which I excelled at during my pre-clinical years.

Even the ortho lecturers joke about how they’re regarded as thick and brutal

What's the difference between a rhinoceros and an orthopaedic surgeon?

One's thick-skinned, small-brained and charges a lot for no very good reason....the other's a rhinoceros.

This might just be the job for me.

Welcome Back You Drones

“You there, what’s your name?” asked the blond haired tutor, affectionately known as the ‘bimbo’ among med students.

“What can you tell me about the anatomy of the biliary tree?”

I froze. I honestly knew nothing.

“Well I’m waiting...”

I mumbled on about the gallbladder and bile. I really wasn’t sure

“Okay you’re at least you’re NOT a total idiot. So what produces bile young man?”

“Errr, the pancreas?” I answered.

My partner groaned. I knew I was in trouble.

She got up to explain the whole anatomy of the biliary tree.

“I’m gonna ask yous again next week. If anyone of yous do NOT know the answer, I’m gonna ask yous to leave my tutorial, is that alright?”

Welcome to Medicine II

Cervix Wars

“A D&C, or dilatation and curettage is a diagnostic test, where a dilator is inserted up the vagina to ensure the walls are patent. Then a currete is used to obtain samples from the endometrial wall which are then processed in the lab to obtain a histological diagnosis,” explained Aisling, the enthusiastic gynae intern.

“If you’re lucky you might be able to see one in theatre today”

I was one of the “lucky” ones...

...................

The women was quite obese. She laid in the lithotomy position. It wasn’t a pleasant sight

They inserted a metal rod right into her vagina, which I assumed functioned as the dilator. I cringed. It looked painful.

Suddenly, she started moving.

“ The patient is waking up!” cried the scrub nurse. Everyone froze for a second.

The anaesthetist was furiously turning knobs and injecting more white stuff. He was in trouble.

The patient started excreting urine and faeces. She was writhing in pain.

THE ROD WAS STILL IN HER!

Thank god for the surgical mask. My mouth was wide open. I was terrified.

The consultant anaesthetist came over to assist. It was all over in 10 minutes.

I glanced at the anaesthetist. It was Tom...

Stoma-phile

In medicine, a stoma (Greek - pl. stomata) is an opening (a direct translation of the Koine Greek would be "mouth"), either natural or surgically created (artificial), which connects a portion of the body cavity to the outside environment.

One well-known form of an artificial stoma is a colostomy, which is a surgically-created opening in the large intestine that allows the removal of feces out of the body, bypassing the rectum, to drain into a pouch or other collection device.

Wikipedia

Case of the week

A middle aged female, presented for stoma bag replacement due to contamination of its contents. When asked further about the reasons why her bag would be contaminated she finally gave an honest reply,

“My husband ejaculated in my stoma”

Sick!

Bottoms Up

“Hi, my name is *****, I’m a medical student and today is my final exam....” as I shook his hand, praying for the life of me that he didn’t suffer from one of them rare and complicated syndromes.

And so it began.

I had 40 minutes to figure out what he had, before being grilled by a couple of consultants. The curtains were drawn....

40 minutes later...

“Mr JN is a 62 year old gentleman from Dublin, presenting with a painful and swollen left elbow on a background of Rheumatoid Arthritis for the past two years...”

“Go on,” said Dermott, my examiner for the day.

40 minutes ago...

“Do you have any allergies?”

“I have a rash on my elbows after taking Humira,” replied JN

Things were going smoothly.

“I also have a rash near my bottom,” he continued.

“Your bottom?”

Within a “flash” (literally), he pulled his pants down.

So there I was, sitting in a chair, with a naked man’s buttocks held up to my face.

“Can you see it doctor?” he said, peering in between his legs.

As if the day couldn’t get any better...

Exams and all that jazz

No one enjoys exams. Period.

At this point in time, all I can think of is home.

Homesickness is exacerbated by exams.

Sounds like one of them lines from the untouched clinical textbook just lying on my desk, almost teasing me to pick it up.

.....................................................................

“I just want to pass, that’s all that matters,”

I don’t even need a reference for that quote. All of yous have said it before. Especially medics.

In truth, a pass is never enough. It’s a consolation, yes. But deep down inside all of us high-achievers can’t stand to see anything but an ‘A+’ on our result sheet. Sad, but true.

However, admitting that you want an ‘A’ could potentially ostracise you from your friends. Or even blow up in your face when you fail to get it. Therefore most of us settle for “..as long as it’s a pass”.

And this isn’t a shoutout asking any of you to stop pretending. In fact, I do it, and will continue doing it. It’s much more comforting when you have low expectations. You just can never get disappointed.

Aim for the stars. If you miss, the fall will hurt like hell.

While it’s nice to dream about getting a perfect report card, it sucks to wake up and realize that you chose medicine as a career.

So, a pass will do...

A Bloody Mess Called Surgery

It was a pretty routine surgery. It was me, my partner, and Prof Gorey who scrubbed in on the case. The first incision was made. 4cm across the crease of the neck. My eyes were fixed on the patient. I have recurring nightmares where the patient jumps out screaming in pain. Thankfully the anaesthetist was in top form.

I have a fear of blood. Correction. I have a fear of squirting blood.

The patient's thyroid was enlarged and overly vascular. Prof Gorey wasn't too happy. It wasn't going to be as routine as expected. Blood vessels were enlarged, and in places where it shouldn't be.

A quarter of an hour into the surgery, my partner looked quesy. I knew what was coming next.

“Professor, I think I'm going to faint,”

Immediately she was taken off the case. It was only me and the Professor.

An hour into surgery, the first bleeder 'erupted'. As the Prof was exposing the platysma, he hit a bood vessel. The vessel squirted out blood which sprayed all over my gown.

Then he hit another one. This time I had to hold the suction to clear the area so he could cauterize the bleed.

Blood was squirting all over the place.

“Not as elegant as I hoped it would be,” said Prof Gorey.

Surprisingly, I did not even remember that I had a fear of blood. Maybe it was the adrenaline.

The C-section

Dermott had just finished giving us a tutorial on the gastrointestinal system.

“Which one of yous would be disappointed if yous got a C grade?” he asked.

Few familiar faces raised their hands. Hermione included.

I resisted the tempation and looked to see what the point to this was.

“This isn't secondary school. Most of of yous are used to being on top in class,”

At this point my eyes were on Hermione.

“Well wake up. The days of getting straight A's are over,”

“A person who can answer all the questions without making a single mistake would qualify for a B,”

“A 'C' grade is what most of you will get. And that would qualify you for an honours grade in your final degree. So suck it up and accept that you are no longer in your small town competing with a bunch of duds. You're in the big leagues now,”

He was right. As of now, the elusive 'A' seems like a far cry from the days of high school back home. Clinical years have a totally different assesment system in where a passing is already a huge achievement.

“The most important thing is to GET THROUGH your exams, and become a doctor!”

He was brutally honest wasn't he?

Scrubs

Scrubbing in for surgery was indeed exciting.

Inscribed on one of the walls up in the MATER :

You put your right hand in

You put your right hand out

Touch another patient

And you spread the bugs about

I don’t even need to get into the hoo-haa involved in infection control in hospitals. It’s absurd at times. I spent 5 minutes scrubbing up only to be asked to scrub all over again because I touched (more like brushed my hand against) an unsterile surface. Nice. All for the greater good I guess.

Burn Baby Burn.

I was positioned in front of the Registrar, with the patient on my right totally unconscious (I hope!).

The first cut was made underneath the areolar crease, approximately 2-3cm wide. The diathermy was then used for the rest of the procedure to both cauterize and coagulate ‘bleeders’. The smell was awful.

You know the feeling one gets when a putrid smell is basically implanted in your brain? The smell of rotting burnt flesh has probably permanently manifested itself in my olfactory bulbs. Yeap. Burning flesh.

....

Surgery isn’t all bad.

No other profession involves people actually begging you to stick a knife in ‘em. Then they pay you loads for it.

Another good reason to become a surgeon :

CROCS!!!

I snapped a photo of my bright green crocs

Cest la vie

I’ve always been biased toward medicine rather than surgery. Then again the door isn’t closed shut. I might just give surgery a chance. At least for the next two weeks.

Maggot of a Man

“I’ll kidnap you, drag you up to Killarney Hill, gag you up and leave you there,”

The dressing nurse remained calm. She seemed unabated by the threats of the horrid man.

Maggot man, as I call him, has leg ulcers which have necrotized deep into his tissues. A curative approached would have been amputation of both his legs. He obviously didn’t want that.

If he was cured, Maggot Man would be liable to a court date for selling heroine. In other words, he was jail-bound barring definitive treatment of his leg ulcers.

Dr Swear-a-lot (remember him) decided to try a relatively ‘alternative’ treatment by ordering MAGGOTS imported from Wales in order to remove the necrotic tissue surrounding the borders of the ulcer.

Yup. Maggots eating away at dead tissue. And I had the wonderful opportunity of holding ‘em baby maggots as they positioned the sachets as to cover every inch of the foot ulcer. I’m not being sarcastic. It was exciting!

Sad Goodbyes

After three weeks in St Micheal’s, it was finally time to leave. What started out as a pretty mundane setting turned into one of the most educational experiences for me, and I’m sure, the rest of my group mates. The laid-back atmosphere of the whole set-up allowed more time for the doctors to hang around and actually teach us a thing or two. So adios and on to the MATER for my final rotation. Enter SURGERY.

Bowels in Motion

I looked over the new time sheet that was given out.

Gastroenterology Rotation

Reg : Dr JLC

SHO : DR CG

I went up to meet the team. My partner, blondie (her car sticker reads : Danger-Blond driver) was absent.

McDreamy...

“He’s gorgeous,”

“Such a peach,”

"Love the hair,"

It’s unfortunate that in real life, not all doctors look as hot as the ones in Grey's Anatomy or even House. He was the exception. He was in fact of movie star quality. And they(the girls) do love him up in the wards.

With my manhood being challenged by such a good-looking SHO, I was determined to see what the deal with the guy was. To my inherent surprise, I do actually like him. He is a very pleasant and charming young fellow, who isn’t at all snobbish or stuck up. In fact, he goes out of his way to teach us baby-doctors everything he knows. Thumbs up to my very own version of Dr Mcdreamy.

Small freaking world

On to the Registrar, who was Chinese by the looks of it.

“Where are you from?” he asked. His pronunciation was pristine.

“Muh layh shia” I answered in the most legible way possible. Malaysia isn’t the most well known country amongst the Irish.

“Ah, me too. Whereabouts in Malaysia,” he answered to my surprise.

This was going well.

“Err, somewhere near KL, have you heard of Subang Jaya?” again trying not to be overly specific.

“Really? I’m from Subang as well. I used to go to Seafield. I assume you’re from SMSJ or SMSU?"

“SMSJ,” I answered, trying to contain my excitement.

“We’ll get on very well then,” Dr JLC smiled.

Small world it is.

Up yours!

The Gastro team does weekly endoscopies involving the GI tract. Patients are usually sent for either a colonoscopy or a gastroscopy to check for any underlying pathology that might’ve caused their symptoms.

A colonoscopy involves sticking a camera up the patient’s ass anus all the way into up the large bowels leading to the caecum. Suffice to say, it isn’t a pleasant procedure for the patient.

Far-t-ales

The room where they perform the procedure is pretty small. There’d basically be a consultant, the registrar, one or two nurses, and a maximum of two students. Anything more than that would make it very difficult to manoeuvre.

I’ve recently altered my eating habits to a healthier diet (I’ll explain more as we go along). I’ve also developed a liking for ‘prawn salad’ that costs only 2 quid in the Tesco opposite the hospital. The increased amounts of fruit and vegetables have caused, for the time being, hyper-flatulence. To put it simply, I’ve been farting a whole lot.

It had to happen in the endoscopy room. Of all the small, cramped, poorly ventilated places....

I felt the bowels move and immediately knew what was coming. I couldn’t get out as I was stuck in the corner beside the patient. I looked around. The window was closed.

It felt warm as I clenched my ‘cheeks’ to prevent it from being released. My brain was racing, trying to devise a way out of the mess I was in.

Then it hit me.

“The anal patency is reduced when the patient is in a sedated state,” explained the consultant.

Perfect.

As they inserted the camera up the patient’s anus, I knew that this was the moment.

It did smell like prawns.

Not even a bat of the eyelid. Everyone was too polite and assumed it came from the patient.

“The anal patency is reduced when the patient in a sedated state”

I had picked the perfect moment. Good save, huh?

Moral of the story:

Smile, and the world smiles with you.

Fart, and you’ll be the only one smiling.

Bus-capades

It was a bad start to an already crappy morning. I had woken up late. And it was RAINING!

I decided to go “Irish” and skip my daily shower. Deodorant and Brylcream would suffice.

I wasn’t sure if my bus card was still valid. I didn’t want to risk it. So I made my way to the nearest shop to get a new card. As I was threading through the rain, I saw a yellow flash.

The bus had arrived. I made a u-turn and ran across to the bus stop. I made it just in time.

Thankfully, my bus card had one day left in it. Close one!

Each day, I take two buses in order to arrive in Dun Laghoire. The first bus stops in Stillorgan, which is the last station. I then have to hop on the 46a which goes directly to St Micheal’s.

I make it a habit to revise a bit on the bus.

“We have to be proactive!” Hermione’s voice echoed in my head while I was turning the pages of my beloved clinical handbook.

The bus had slowed down. I looked left and right and realized I wasn’t in familiar territory. And I was the only one left on the bus.

“Where are you heading?” She asked

“Stillorgan, I thought it was the last stop?”

“Well it is, and we’ve gone past it,”

I tried not to swear. I got off and made my way back to the Stillorgan stop. It wasn’t that far. But it was RAINING.

About 50 metres from the stop, the 46a had arrived. “Not again,” I muttered as I made another hopeful dash towards it

I arrived (out of breath) and hopped on.

“I’m sorry, the bus is full,” said the driver.

My mouth was half open. “Wh-whhat?”

Then I looked around. It was half empty.

The driver was chuckling now. He got me.

Well, at least I put a smile on someone’s face today. The look on my face must’ve been priceless. He smiled all the way to Dun Laghoire.

Hunger Pains

Please observe protected mealtimes from 12pm-1pm.

I didn’t really understand the meaning of the sign until today. As the german giant (my consultant) was doing rounds, the clock struck twelve. Immediately from left to right, carts carrying food suddenly appeared from the doors leading to the alleyway in the corridors to be flooded. The smell was mouth watering. I thought I smelt steak.

The german giant was still in Mrs GH’s room. And he took his time. A lady carrying a tray of food barged in.

“LUNCH TIME!” she cried.

The giant was taken aback. He ignored the lady and continued to examine the patient.

When he left the room, he was confronted with whom I presume to be the “manager”. She was small. But she still stood tall in facing the giant.

“We have a clear policy about mealtimes, doctor. Patients are NOT allowed to be disturbed during lunch hour. It has always been that way. They need to have their meals” she said without flinching.

“Well I understand and am all for that. BUT,”

I realized how intimidating the german giant can be.

“When I am in the middle of examining a patient, I would at least expect SOME degree of RESPECT. What your lady did back there was plain RUDE. She SHOULD have just let me finish with the patient,” he argued.

The heated argument continued for the next quarter of an hour. Neither gave in.

The moral of the story : DON’T mess with meal times. Patients need to eat.