My Twisted Mind

Memorable conversations

2009-07-03T01:02:00.002+01:00

"You want career advice? Listen up then. You don't want to do acute medicine. Otherwise you'll end up like me. Fat and unhappy."
-consultant, acute medicine

"The MRCP PACES is a good exam to pass, but a very bad exam to fail."
-staff grade, acute medicine

"You're a bright young thing aren't you? Go type something into Google and come up with a diagnosis."
"It doesn't work that way..."
"It doesn't?"
"No."
"Well, do something."
-consultant, respiratory medicine

"When you get to my stage, you'll find out that everything causes everything else."
"Really?"
"Well.... eventually."
-registrar, cardiology

"You know, in life, many, many people will tell keep telling you about all the things that you're doing wrong, they'll keep harping on all the crappy things that you've done, and you can be sure that they'll belittle you at every opportunity. My job right now, is to tell you that you're a brilliant doctor for your age, and you're doing just fine. We all screw up. Your job, is to make sure that you screw up as few times as possible."
-consultant, anaesthesia

"What's that you're reading?"
"Renal physiology."
"Ah, you know, I never really understood renal physiology until just before my fellowship exams. I had this one amazing lecture during a course and everything clicked and suddenly made sense. I don't remember much of it now, but I can remember feeling really proud of myself back then."
-consultant, anaesthesia

"What are you doing down here?"
"I work here!"
"Oh."
-consultant, gastroenterology

"The idea is that if you can maintain a reasonable frame rate... did I just say frame rate?"
"You play pc games?"
"Looks like you do too."
-registrar, anaesthesia

"Damn it, I'm damned if I do and damned if I don't. I think I'll go have a fag and think about it."
-staff grade, acute medicine

Parting Shot

2009-05-19T21:00:00.004+01:00

I was on-call the weekend, covering the medical wards. Of course, as soon as I sit down with my cup of coffee the bloody pager goes off. I pick up the phone and call, sigh, another venflon to put in, 'We need it now if you could, her meds are overdue'. I sip at my coffee. It's still too hot to drink. No doubt by the time I get back, it will be cold or some over enthusisatic neat-freak would have poured it down the sink.

So I head over to the ward to find out who the lucky person is. 'You'll have a right job with her doc, we can't get anything into her,' the disgustingly cheerful nurse says to me while nibbling a cookie. I see a steaming cup of tea on the desk in front of her. Sigh.

I walk into the supplies room and gather my things. Tourniquet-check; alcohol swab-check; syringe-check; saline flush-check; micropore tape-check; gauze swabs-check; dressing-check; venflons, venflon, venflons, venflon.... hmmm, we only have these new closed-system venflons here. C'mon, c'mon, where are the good old-fashioned venflons? Darn. None.

So I grab my tray of stuff, a pair of gloves and a sharps bin and head over to the patient. Elderly lady, overweight, oedematous. I shall refrain from using other, more descriptive adjectives. Liver failure, alcohol abuse, self-inflicted. About a million people in the UK fit the description. But this lady, I'll remember her for life.

Now, these closed-system venflons are a new thing. They minimize the chances of you getting a needle stick injury from your own carelessness, but I find them more clumsy to use. Sure, I won't prick myself with the needle, but I may have to poke a patient several more times simply because these things are just a little bit fiddly and harder to maneouvere, especially when the veins are almost thread-like, like in this lady.

So I go through the usual routine and get my stuff out. Tourniquet on the forearm, looking for a vein, looking, looking, looking, looking, and rudely interrupted. "You're rather young for a doctor, have you put many of these in before?" Yes ma'am, although I sure haven't put in as many venflons as you've had tots of whisky, I am pretty good at this. I didn't say this of course. My 'professional-courteous-kind' mask is on. 'Well, I hope you put it in the first time, the last doctor was really experienced but she couldn't get any into me until the third go. I was really hoping she'd be the one to do it today". Yes, well, you're stuck with me unfortunately, and me with you. Looking, looking, looking, found one! Yes!

Swab, wait for it to dry, venflon out, sharp scratch ma'am, "Owwwwww, what ARE you doing, feels like a blade going in," that's because a venflon needle is really a tiny blade with a hole in it, "it didn't hurt this much the last time, Owwwwww...," whatever, flash-back in the venflon, needle out 3 millimetres, advance the cannula, slide needle out and 'click' as the locking mechanism snaps into place and the whole thing should just detach and... WTF? I pull at it a little harder, but the bloody thing refuses to budge. Most unusual. There was definitely a click. I tug at the needle again, keeping a firm hold on the cannula. It still won't budge. C'mon, c'mon. I release the tourniquet with my other hand and keep a firm hold on the cannula while I try to remove the needle and the locking mechanism, won't work, no, this can't be happening, no, no...

"What ARE you doing there young man? Have you got it in or not? If it's in stop fiddling with it! The last doctor didn't fiddle with it! NURSE! NURSE! Come and give this doctor a hand, he's not doing much good!" You fat overweight turd, wtf do you think you're doing shouting your head off like that someone with your vitality shouldn't be in a hospital bed damn venflon why won't you work stupid stupid thing detach I say and let me get away from this...

"Doctor are you ok? Is something wrong? Oh, it's one of those new things isn't it, I hate those, can never get them to work properly. Is it in though? Ah yes you've got it in but what, sorry, you say it won't detach? Let me try, hmm, it seems to be stuck fast, I think you might have to put a new one in, let me try again, hmmm, your call doc," no don't go away, no, help me dammit, sigh. She disappears out of the bay.

No, I refuse to put a new one in. I may not be able to find another vein as good as this one. Point-blank NO. I tug again as hard as I can at the bloody thing and it still won't budge. WTF is wrong with the bloody thing? "WELL? Have you got it or not? If you haven't stop fiddling around down there and get someone who knows what they're doing. My arm's getting stiff." Well fuck your arm and fuck your stiffness and, brainwave hits me, the device is held in place by what appears to be a screw mechanism, I get a good firm hold on the locking mechanism and give it a good twist, and joys, the bastard device finally decides to let go. Note though, that you're not supposed to twist it, the whole thing is supposed to pop off when the needle is locked in the device, i.e. when you hear the 'click'.

Bungs on the venflon ports before they bleed, no such luck, blood flows freely and onto the pillowcase, compress the vein dammit, why won't it stop bleeding, no matter, bungs in place, dressing out, and on the venflon, flush out, and into the cannula, and yes, finally, hurray, hurra-"You've made a right mess haven't you? The last doctor was much better, no fiddling about and certainly no mess like the one you've made, you've gotten blood everywhere, you're certainly, CERTAINLY, not as good as the last doctor."

'Ma'am, I may not have been as neat as the last doctor, I may not be as experienced as the last doctor, but I CERTAINLY, CERTAINLY, ONLY, needed ONE attempt to get the cannula in. As you said, the last doctor, despite her skill and experience, needed three goes before she got one in.'

"Well, you're MUCH ruder than the last doctor as well, she didn't speak to me like that. She was much gentler and nicer, and it didn't hurt as much as when YOU tried...", well go and boil your head you old geezer I didn't have to try, I did it right the first time. I pick up my tray and sharps bin and the assorted pieces of refuse and walk out of the bay as quickly as I can...

"I CERTAINLY HOPE YOU KNOW WHAT TO DO NOW THAT YOU'VE PRACTICED ON ME!"

Stupid, ignorant, illegitimate-daughter-of-a-dece-, nurse walks into the bay to change the pillowcase with blood on it and I hear, "Does that DOCTOR know what he's doing? He seems RATHER young for a doctor, he was fiddling about for a AWFUL long time, and my arm's all sore now..."

And my coffee was cold by the time I got back to the doctors' room on the acute admissions ward.

An observation

2009-03-15T12:41:00.001+01:00

I have to now state VERY clearly:

The previous post is an OBSERVATION I made. I was not judgemental and I did not condemn in any way. If you find it offensive go report this to google.

A day in town

2009-03-15T01:51:00.003+01:00

Got my lazy ass out of bed this morning to go to the bank. After that, I walked over to one of the two local shopping complexes. This one in particular simply because it has a bookstore. Bookshops are in short supply in Rochdale.

So I take the escalator up to the first floor, walk into the bookstore, and spend a good half-an-hour looking at books before I pick out 3 that I like, spot a copy of Gray's Anatomy on a shelf and impulsively add it to the 3 book stack I already have, head to the counter, pay and walk out with one arm cradling a stack of books and both hands organizing my wallet.

So I walk towards the escalator, and just before I put my full weight on the first step, I glance over the side and see below me...

A fat, I mean really fat, the kind of fat where the person is wider than she is tall kind of fat, woman stuffing her mouth with a cream cake. I see the remains of a froth moustache from her cappuccino above her upper lip. I see a half-eaten jam filled doughnut with sugar icing on the plate in front of her.

Around the escalators in the atrium is a cafe of sorts, and practically every table is occupied. And from my height I have a pretty good view.

Of all the people sitting in the cafe.

And at least half of them are grossly overweight. Obese. At least 30 really fat people sitting in chairs sipping coffee, eating pastries and dying.

Heck, we're all dying, but these people sure are dying a lot faster than I am.

Oh, and look at that woman's ankles, swollen beyond belief, nearly the size of her calfs, attacking a scone and winning. And look at that one, she's taking her tablets before she tucks into her steak pie. (I know its a steak pie because by this time I'm sitting 2 tables away from her with a steak pie in front of me and pretending to read)

And look at the one opposite the lady with the cappuccino-froth moustache, so fat that he can hardly bend over his overly large belly to pick up his paper napkin from the floor. And look at that kid, he can't be more than 11 or 12 and his ass is so big that it is spilling over the sides of his chair and of course, he has to be eating, in his case a chocolate sundae with the candied cherry on the table beside the dish.

And lo and behold, there's one of the security guards, so fat that I wonder if his bulletproof vest and walkie-talkie belt had to be custom-made. So soggy around the midsection that it bounces up and down with very step. I doubt he can walk very far before getting out of breath let alone chase me down should I decide to give his fat ass a kick before bolting out the main entrance.

Sigh. I know there's this fat virus going around. Go google "AD-36" if you don't know what I'm talking about. But this, this is ridiculous. The virus can only account for so many fat people. So, what accounts for the rest of them? Behaviour? Genetics? Bad luck? Some would say that it isn't a sin to be fat, and I'm certainly not saying that it is. One cannot deny however, that obesity is an epidemic, one that may soon be beyond our control. If we are all standing on a line, would you prefer to be on the leaner side or the heftier side? And don't get me wrong. I fully believe that you can be both fat and healthy. It's just that I don't think that most fat people are healthy.

I certainly hope the 15 minute uphill walk from town to my apartment got rid of most of that steak pie.

Overworked

2009-02-28T01:04:00.005+01:00

Because some bastard colleague decides that the best time to take a few days off is when his frakking team is on-take. And therefore, the two other doctors, who do happen to be around, and have been looking forward to a nice, not-so-busy week, end up doing his frakking job simply because he was a sneaky bastard who figured that he could get away with it.

And end up overworked. Sigh.

Nurse not happy

2008-12-19T00:01:00.004+01:00

'Her venflon's tissued doctor, we need a new one.'

'I know, and I've spoken to the registrar. She's really difficult to get a cannula into. We think she should get as much fluid as possible through the cannula before it stops working.'

'But it's TISSUED, doctor.'

'We know. But it took us 45 minutes to get that one in. It's tissued but it still works fine. And her condition is picking up now. I'd hate to stop her IV fluids right now. Her kidney function is still impaired at the moment. what if she goes back into renal failure? We don't want that.'

'Doctor, I don't know how much they teach you about the scoring system for venflons. That venflon IS tissued. And it has been in for 3 days. It should come out today.'

'The registrar and I have taken a look at it. We think it's fine. It'll last another day we hope. And then we can take it out.'

'Doctor, I'm NOT happy to run any more fluids through that venflon. It's tissued and it should come out.'

'Right. Okay. It's 1740 now and I should have been home 35 minutes ago. I believe Mr Zalaf does a ward round at about 1830. Why don't you let him know what you think. I'll see you tomorrow.'

Needless to say

2008-11-26T01:01:00.001+01:00

...the wifi in Dubai was crap.

Flying home!

2008-10-30T19:36:00.003+01:00

Today was a good day. Simply because I'm going home!!!

No ward rounds, no taking bloods, no venflons, and...

No on-calls with frustrated nurses saying "Why haven't you clerked my patient in yet?"

And no need to reply "I'll do it as soon as I can", while thinking: because I have 4 other patients that need clerking, dumbass.

It feels great, being able to do all the jobs on the ward and at the same time being able to think: I won't have to chase up these results tomorrow because I might as well be a million-billion-willion miles away.

I'll blog more from Dubai. Right now, I have to pack.

And thanks for all the comments for the previous post!

Please leave a note doctor

2008-09-12T21:58:00.005+01:00

Just another day at work.

There I was writing in the notes of a patient I had just reviewed, when out of the corner of my eye I spot the gentleman in Bed 6 (let's call him John) sit up, pull his covers off him, and proceed to get out of his bed. He walks towards me and my notes-trolley, stands directly across me with the trolley between us, looks sternly at my face, and says:

"You aren't welcome here."

Wha... I'm sorry? What did you say?

*louder* "You aren't welcome here."

But I'm a doctor!

"You still aren't welcome in other people's houses."

But this is a hospital!

"This is a hospital?"

Yes, and I'm a doctor. I work here.

"Why am I in hospital?"

Because you've been very ill.

"Oh, that's alright then."

John then slowly turns around, walks back to his bed, gets rid of his slippers, lies down and pulls the covers over himself again and goes back to sleep.

15 minutes later, it's John's turn to be reviewed. He's sleeping, so I walk over to his bed, and turn on the reading lamp. He doesn't wake up, so I touch his arm gently. His eyes open immediately and he turns to look at me.

"I remember you."

*how nice...* Uh-huh, and who am I?

"You're that doctor."

Yes I am. And how are you today?

"Very well, until you woke me up."

But if I didn't wake you up, I wouldn't be able to speak to you to find out how you are?

"Yes, I understand that. But next time, when you want to speak to someone and they're asleep, you should leave a note saying, 'I've been here to speak to you but you were asleep, I'll be back to speak to you later.' It's only polite you know?

Alright, next time I'm here to see you and you're asleep, I'll leave a note saying that I was here to see you but you were asleep and I'll be back later. Is that agreeable?

"Yes, very agreeable."

Good, so how are you today?

"Very well thank you, at least until you woke me up."

Good. I'm glad to hear that you were feeling well until I woke you up. Is there anything else bothering you?

"No, I was perfectly well, until you woke me up."

Very good then. Have a nice day John. I'll see you later tomorrow.

"No, I can't have a nice day. Now that you've woken me up, I shall have to get out of bed and get dressed and then do what I have to do."

But you can always go back to sleep.

"No I can't. Because you've woken me up."

Right. John, I'm very sorry I woke you up, but there's nothing to stop you from going back to sleep. I'm going to turn off the light and write in your notes and you can go back to sleep. So I'll leave you be for now, and have a nice day. Alright?

"No, I'll never get back to sleep now that you've woken me up."

Goodbye John.

I turn off the light, walk back to the notes-trolley and grab his obs chart on the way. When writing in the notes:

Obs stable. Apyrexial. Sats 97% oA. HR 78. RR 14. Dementia worsening.

The rest is confidential. Strictly, strictly confidential.

Prescription

2008-08-28T01:06:00.002+01:00

On the acute admissions ward:

Staff Nurse: Hey doc, could you write this discharge prescription for me?

Me: Huh? Ok, sure.

*takes drug kardex and starts to write*

Registrar: *sitting in front of me, looks over my shoulder, looks at what I'm writing, and looks over my shoulder again*

Me: *stops writing and looks over my shoulder, sees SN now with her glasses on leaning forward and squinting at the prescription pad, trying very hard to read my writing*

SN: Sorry doc, I don't normally look over shoulders but it's because you're still a baby doctor, you know?

Reg: *bursts out laughing*

Me: *WTF???*

A lady is dead

2008-08-21T22:33:00.005+01:00

And, in another universe, she wouldn't be.

She had walked into the hospital for an ERCP, but she didn't walk out 2 days later.

Her serum amylase levels were over 5k and no one did a thing.

Acute pancreatitis.

Because no one knew.

Which is not exactly true.

The lab had phoned the clinical investigation unit (CIU) nurses to tell them about the blood results. The CIU nurse had phoned up my ward to relay what the lab people had just said. And the nurse on my ward had told...

A doctor

One of the doctors.

But who?

Which doctor?

Because none of us, the three doctors who were on the ward, can recall ever being told about this lady's amylase levels.

Could one of us have been told, a passing remark carelessly forgotten and set aside by a brain already flustered and overworked, a cursory sentence, that could have been:

'We've got this new lady coming in from the CIU doctor. Her amylase levels are 5k by the way.'

'Hmm? Uh, ok.'

And the doctor resumes what he or she was doing, not even looking up at the nurse to acknowledge that the message had gone home, too focused at the task at hand, which could have been as simple as trying to decide what antibiotic to prescribe, or whether or not Mr X should go home with some zopiclone to help him sleep.

And the lady feels perfectly fine, eating and chatting, not at all unwell, until 1900 when all the ward doctors are away, the last one having left a mere 30 minutes before, when her blood pressure drops and she loses consciousness. Yeah, she was feeling a bit of discomfort some time before she loses consciousness, but who doesn't feel a bit uncomfortable after a procedure.

And never regains it.

The on-call doctor is paged. He arrives and assesses the situation. He's a busy man. He still has 4 new admissions to the acute medicine ward to see. He takes a look at her observations chart. He asks the nurses about her. He writes her up for some fluids. Lady doesn't even have a cannula in her. Did he take a look at her blood results and conclude that she had acute pancreatitis?

I don't know.

Lady goes into cardiac arrest. Arrest team called. Lady dies. Despite their best efforts.

It's the weekend. Ward doctors find out about her death 2 days later.

And we ask ourselves the same question over and over again.

"Was I the one who was told about this lady's amylase levels?"

I don't know. It wasn't me. I don't think so. Can't remember ever being told that.

Malpractice? Mis-management? Negligence?

Who is to be blamed?

A lady is dead.

She should still be alive.

Shadowing, again

2008-06-30T01:56:00.003+01:00

I'm getting an introduction to what I'll be doing this August, and I can't say that I'm enjoying myself very much at the moment. Starting work doesn't seem as fun as it was half a year ago. I sometimes wish I was back in 1st year, with no worries, no stress, and no responsibilities. For now, work seems boring. Boring and stressful. Yeah, I know. Weird combination. Probably the only form of excitement I get will be during consultant ward rounds, assuming they will ask me difficult, hard to answer questions about what I should have done (or shouldn't have done), and whether or not I've found a patient for next week's education meeting case presentation.

It's 0200 at the moment, my mobile broadband download limit is running out, and I should have finished reading those 'safe prescribing' notes that have been lying on the table since 0030. I'm tired, and I'm so looking forward to my 2-and-a-half weeks back in M'sia after the graduation ceremony in July. Yeah, 2-and-a-half-weeks. Sigh.

Conversation

2008-06-12T21:52:00.003+01:00

Registrar: It's such a hassle buying a house these days.
Me: Oh, I wouldn't know. Is the house in Rochdale?
Registrar: God, no! You're new here aren't you?
Me: >.<

DotA conversations

2008-05-30T20:08:00.004+01:00

I've been playing a lot of DotA the past week. Since the portfolio submission anyway. And we got Raf to start playing too.

Raf: Hey, what's "-ms"
Me: That shows you your movement speed.
Raf: Shows in what? Miles per hour?
Us: *ROLF*

Raf: WHYLAR I KEEP DYING???!!!

Raf: How much is 'eaglehorn'? 3000 pounds ar?
Us: What???

Raf: I got 5 kills 'kay...
Us: Yeah, yeah... K-S K-S...
Raf: What is K-S?!
Us: Aiyah, K-S is K-S lar...
Raf: *googles "KS"* Killing spree ar?
Us: Wtf??? ROFL!

Raf: Hey, where's the secret garden again?
Us: What?!
Raf: The place in the forest where you buy 'perseverance'
Us: Ah...

Raf: MAH-CI-BAI enchantress killed me again!!!

It's great that the exams are over. It seriously is. Back to DotAing!

Portfolio exam

2008-05-23T11:05:00.002+01:00

I passed.

But some of us didn't. I wish them all the best in the resit.

Onco Ward

2008-04-25T21:43:00.010+01:00

*edited*
*edited again*

So far...

Venflons put in: >38
Bloods taken: >70
Chest drains: 2
Ascitic drains: 1
Discharge scripts: 19
Rectal exams: 5
Clerk-ins: 14
Gloves used: >250
Distended abdomens palpated: 9
Drug rep lunches: 5
Friendly junior doctors: 6
Friendly registrars: 4
Friendly consultants: 2
Helpful pharmacists: 1
Annoying Professors: 1
Screwed-up unfair assessments: 1

Incompetent?

2008-04-15T01:20:00.006+01:00

There are times when I lie awake in bed at night wondering if I'm going to be a competent doctor when I graduate. I was supposed to have acquired 'self-study' and 'lifelong learning' skills in IMU, and here in Dundee, I have been thought to reflect on what I've learnt.

A couple of months ago, several of us, all 5th year students, were discussing the 5th year UniofDd curriculum. We arrived at the conclusion that current 5th year curriculum can in fact be shortened from approximately 30 weeks (including holidays), to a mere 12 weeks. And that's being generous.

Current 5th year curriculum:

2 theme special study modules (ssm), 4 weeks each, total of 8 weeks
2 clinical ssms, 4 weeks each, total of 8 weeks
2 house officer shadowing blocks, 4 weeks each, total of 8 weeks
1 rural GP block, total of 4 weeks.
Grand total of 28 weeks.

My curriculum:

1 GP block. 4 weeks.
2 shadowing blocks. 8 weeks.
Grand total: 12 weeks.

As you may have noticed, I have completely eliminated all special study modules. All the ssms I've attended, barring the current one, have been interesting, but ultimately, that's all they are, interesting. My current ssm is just crap.

The current uniod curriculum emphasizes reflection. Therefore, I propose that 4 weeks which would otherwise have been wasted on ssms be used for reflection. Preferably somewhere warm and sunny. Maybe even tropical. Somewhere where we can reflect on all our deficiencies and incompetencies and somehow be inspired to rectify these defects. And the remaining 12 weeks of 5th year would then be spent doing something useful.

Or, why not have us graduate right after the above grand total of 12 weeks. The rest of the year could then be spent doing clinical attachments, gaining actual work experience, learning more about medicine and surgery than we're actually expected to know, adding to our knowledge, to the ultimate effect that we'll be slightly more competent doctors.

The current UniofDd policy of producing doctors competent enough to work as house officers is just wrong. A consultant I was speaking to claims that during his 5 years of medical school, he was performing appendectomies and actively assisting in major surgery. He used to play an active role in the management of patients in the hospital, not just stand and stare like us. Where have those days gone? To be able to scrub in just to stand closer to the operating table here in the UniofDd has become a privilege, and is no longer part of the curriculum. In fact, 'scrubbing and gowning' is just another box to be signed in our books (more on these books later, not today).

In 5th year, we have to write glorified essays known as case discussion on a variety of topics, and we are provided with guidelines to help up write these essays. One such guideline, when discussing appropriate references for our essays, states, "The USA is not always right", referring to the quality of journal articles and other resources.

It is my opinion that they aren't always wrong. And, and, the UK is not always right either. The UniofDd medical curriculum would benefit if the brilliant, smart, and wonderful individuals in the medical education department would observe how things are done in other countries and incorporate the better elements of their medical programmes into the UniofDd curriculum. And then they should get rid of 90% of all this reflection bullshit. As it is, I am thoroughly disgusted by the quality of education I'm receiving, and the sooner I'm out and far away, the better.

Improving my clinical skills

2008-04-14T01:16:00.005+01:00

Dear Prof Ingkran,

Your special study module, 'Make Your Clinical Skills Better', is, in my honest opinion, the most useless special study module (ssm) a 5th year medical student at the University of Dundee can choose.

This is supposed to be a CLINICAL ssm, not a theme ssm, and therefore, I see no reason as to why I have to present to you a reflective essay on the 12 Dundee medical school outcomes upon which you are going to base my assessment.

Oh wait, hang on. The reason I have to write this essay is because there is really no other way you can assess my clinical skills, is that right? If my clinical skills are crap and there's no one to give me ADVICE or TEACH me new techniques or maybe just OBSERVE me examining patients on the ward and then give me FEEDBACK on how I can actually improve my clinical skills, what's the point of this silly SSM.

If you are going to base my assessment on an essay, I might as well stay at home REFLECTING on the most worthless 5 days I've ever had in medical school and work on the essay instead of showing my face at 0900 till 1700 on the wards. To be honest, I'd rather spend the next 3 weeks watching the grass in the backyard grow instead of wasting my time with this silly ssm.

Yup, the key word is REFLECTING. It's a compulsory word in the vocabulary of any Dundee medical student. In fact, REFLECTING is more important than LEARNING or KNOWLEDGE. I think it's pure rubbish. The only thing that I've ever learnt from reflecting is that I shouldn't waste so much time doing it and instead spend the time writing fictional essays on how reflecting has helped me because these are really important and my grades depend on them.

5th year medical students in Dundee are supposed to spend their final year REFLECTING on their core competencies. What core competencies? Half the 5th years don't even know how to palpate an abdomen properly. Reflecting on core INcompetencies is good, isn't it? If more time was spent instilling the core competencies into medical students, instead of teaching us how to reflect on them, we wouldn't need to reflect on our core competencies to improve them, would we? Reflection is an aid to learning, not a SUBSTITUTE. Please get that into your head Prof Ingkran.

In addition, I would like to suggest that the medical education department carry out a survey amongst the final year students to poll their opinion on all this reflection bullshit. This survey should be completely anonymous and sent out online. But wait, our opinion doesn't matter, does it? That's because we're medical students and we don't really know the best way medical education should be done. You folk ought to know best. And after all, the decisions that really matter aren't made by people with REAL medical degrees.

Yours in good faith,

Casey.

Random Fact Tag

2008-04-06T16:45:00.002+01:00

Tagged by Yuen. Right, let's not drag this out too long, shall we?

The Rules
1. Link to your tagger and post these rules.
2. List eight (8) random facts about yourself.
3. Tag eight people at the end of this post and list their names.
4. Let them know they've been tagged by leaving them a comment on their blogs.

RF1:
I'll probably never get abs, ever. It's not from lack of trying though. I suppose I'll just have to be content with one large pack and not six.

RF2:
I have this amazing ability to stay up the entire night and morning doing work and still remain perfectly functional the next day. I am usually a little crabbier after these sessions, and my best friend for the rest of the day is the 1st person who offers me a cup of coffee.

RF3:
A friend here in Dundee calls me a junkie. I apparently get a rush doing last minute work, which is perhaps why I keep doing it. And I have to admit, not doing any last minute work for a while tends to make me feel a little down.

RF4:
I have the amazing ability to consume vast amounts of chocolate and not put on any weight. In fact, I know one other person who can do it, and he eats twice the amount of chocolate I do. And no, I'll not give any figures. Chocolate makes me happy, that's all that's important.

RF5:
I get bored very very easily. There're only a few things that can hold my interest for more than 10 minutes at a time, and sitting down with a textbook for more than 5 minutes is pretty much impossible. I sometimes think that I actually have a mild form of ADHD. But then again, I suppose anyone who's been through medical school is liable to self-diagnose. Just like a neighbour who thinks he may have a mild form of Asperger's.

RF6:
I have a weird ability to befriend the weirdest people I meet, people who don't really have cliques of their own or fit in anywhere else, and who generally behave weird. No examples. Not that I really fit in either, but I'm always thankful that I never ate many (if any) lunches alone back in college or IMU. And of course, I'm always glad to have another friend, however weird you may be.

RF7:
Waking up early in the morning is not usually a problem for me. My subconscious alarm clock seems to know whether or not it's worth waking me up in the morning. If I have to wake up for something important, I will, and I don't even have to try.

RF8:
I'm not a religious person. I like to believe that my moral compass is sound and that it's all I need. Besides, any extra time I have is better spent sleeping.

And that brings us to the end of this post. I'm too lazy to tag anyone, and someone has to end this eventually.

Paracetamol in liver disease

2008-03-30T00:13:00.002+01:00

I came across this article when I was researching painkillers for a recent case discussion.

For all those who're interested, please follow the link below.

Paracetamol in liver disease

Not shpeakin da same ran-guage!

2008-03-21T23:08:00.005+01:00

I sometimes wonder if I have a big, invisible (to me) sign above my head that proclaims:

"I DO NOT SPEAK MANDARIN, NOR DO I UNDERSTAND THE LANGUAGE."

No, seriously.

When people start talking to each other in Mandarin in a country, i.e. Scotland, where nearly everyone speaks English, one can't help but wonder if what they're talking about is not meant for you to hear.

I sometimes get the impression that these people are in fact, speaking about me. Saying things they don't want me to hear in a language I might not understand.

That I can, in fact, understand every word of Mandarin they're speaking is besides the point. I think it's just plain rude to talk about me when you're literally behind my back. At least have the courtesy to perhaps, move a little further away, or wait till I'm not around. I know I would do that.

This happened quite some time ago, but it still galls me for some reason. And now that it's off my chest, I feel so much better.

And now, to do some backstabbing (+2d6 damage!) of my own.

I should, but find it very hard to, pity these individuals I'm writing about. I have no idea how good their written English is, but the way they speak is horrendous. Harsh and crude, so uncouth and hard on the ears. It is said that the English massacre their own language. The individuals I speak of have diced it and deep-fried the remains in lard. When in Scotland, do as the Scottish do. Adopt their expressions and phrases and learn the local accent. Not only is it important that you understand them, it is very much in your favour if they can understand you as well. The fact that I cringe whenever I hear you speak goes unnoticed, but surely you feel the stares of the people who can only look on in horrified silence whenever you attempt to converse in their national language.

And you're way uglier than me too. That you won't understand half of what I've written here without your digital talking dictionary is a bonus.

I feel SO much better now.

Keeping in touch

2008-02-27T01:24:00.004+01:00

I've just had a long conversation, via w*ndows live messenger, with a friend that I haven't spoken to for 5 years. And it wasn't as if we'd parted on bad terms or anything like that. We've always been good friends, since I was 7 or 8, I think. The last time we spoke was when we were in college, back in 2003, before medical school. I somehow never realised that he was always there, on my messenger list, just another blip on the radar, another person I'd forgotten about, an anonymous name in my address book. Sigh.

And I must admit, if there's a fault with me, it's that I never take the trouble to keep in touch with very many people at all. Other 'faults' include laziness and arrogance, but that's for another time.

Indelible Ink

2008-02-22T18:17:00.003+01:00

I've just read an article on the Agence France-Presse website regarding the use of indelible ink. Yes, indelible ink.

Ballot workers in Malaysia wil apparently be applying indelible ink onto the index fingers of voters, during the upcoming elections in Malaysia on the 8th of March.

I certainly hope the ink is truly indelible. And I would define indelible as: Anything that's likely to take the ink off will most likely take the finger off as well. In other words, there should be no convenient means of removing the ink, and that voters will have to let cell turnover on their fingers eventually shed the skin cells stained by the ink.

Why do I say this? Well, read this article.

Or just type the words "indelible ink" and "pineapple juice" into any search engine.

Yes, apparently the 'indelible ink' used in Sri Lanka was easily removed with the use of pineapple juice.

Interesting. Most interesting. The acid maybe?

May the Force be with you.

Nurses

2008-02-18T18:23:00.003+01:00

A 'joke' I heard on the ward:

House Officer 1: How many nurses does it take to change a light bulb?

House Officer 2: Errrr.... One?

HO1: Nah, try again.

HO2: Ten?

HO1: Nah. Give up?

HO2: Yeah yeah, give up.

HO1: 3.

HO2: Huh?

HO1: Yep. One nurse to take the 1st break. One nurse to take the 2nd break. And one more nurse to bleep the House Officer on-call to change the bulb.

My apologies if you don't understand the joke. But then again, you've probably never experienced the frustration of trying to find a nurse when they're taking their breaks, which seem to last nearly forever; or tearing your hair out when a patient was supposed to get his blood transfusion the night before but didn't get it because the nurse-in-charge 'forgot'; or getting bleeped by a nurse and having to phone him/her back, only to have the phone answered by a different nurse who doesn't know what's going on, and when you finally decide to walk to the ward the call came from in the first place, you find out that the nurse who bleeped you needed something really trivial done, like a discharge script that could have waited till the next morning, or even better, bleeped the wrong house officer about a patient not under his/her care that the house officer knows nothing about. And then, when something goes wrong, it's the doctor's fault, not the nurse's, because doctors don't get any breaks until the ward rounds and jobs are done.

And the first person to comment about how badly nurses get it and how much less they're paid will be struck by a light bulb that an overworked house officer didn't screw in tightly enough.

Sigh. But we do need nurses to do all the things doctors don't, or won't, do.

Paris update, not

2008-02-02T14:44:00.000+01:00

Right.

I been trying for the past 30 or so minutes to unsuccessfully upload the photographs I took of Paris.

I give up, for now.