My Twisted Mind

Fourth-order Rainbow?

2011-10-08T18:56:00.006+01:00

I read the articles here and here with great interest.

The photograph below was taken on the 6th of May 2010 at 1900 in Rochdale, Greater Manchester, UK. I believe that I may have captured the first ever photograph of a fourth order rainbow with my Nikon D90 over a year ago.

This is a low resolution image of the original photograph. As you can see, even without enhancement, the fourth order rainbow is clearly visible. This is a crop of the centre of the image above to better show the fourth-order rainbow.

This image has been edited to increase contrast and colour saturation.

9 hours

2011-10-06T15:39:00.004+01:00

... up and down and this is perhaps the only half-decent picture I got from Ben Nevis. Loch Eil in the background.

Psychiatry, so far

2011-05-21T00:05:00.006+01:00

And I'm halfway through my stint in psychiatry already. Barely 2 months to go before I (hopefully) rejoin a proper medical ward. And it's not that psychiatry isn't enjoyable, seeing 4 patients a day and being able to go home on time (or early!) is most definitely a welcome change from running around the ER trying to persuade doctors from other specialties that my patients really are theirs, and trying to persuade my registrars that I'm not a total idiot. I usually succeed, on both counts.

There is a learning curve to psychiatry, no doubt about that. However, after 2 months of seeing patients on my own and only running to my consultant for help when I really need to, I've sort of settled in.

And I don't like it.

The only physical contact you'll ever have with a patient is the initial handshake before the consultation. Sometimes, there's a handshake after. Occasionally (last week), you have to stab a guy in the ass with a needle to administer some medication that he doesn't really want to stop him from clawing the eyes out of every patient and staff member on the ward. At least I'm not the one trying to pin him down and shouting 'Any time now doc!'.

And the there's all this talk about the 'mental state exam'. Important words are thrown about: appearance, behaviour, mood, affect, risks, harm, perceptions, thoughts, insight, cognition etc. I was told quite early on that someone else reading your notes should be able to go into the waiting room and pick out your patient from the crowd. Seriously? Don't take it seriously. As another doctor told me: 'Just cover your ass'.

I've taken numerous psychiatric histories. I've talked to patients about their childhood, hobbies, likes and dislikes, aspirations, feelings, partners, parents, children, finances, associated physical health issues, sleep patterns, dreams; well, almost everything in their lives up to the point when I see them. And somehow, I feel further away from the person who is the patient than I've ever been in my entire medical career (which hasn't been that long). Somehow, by knowing everything about the patient, there is no connection anymore. Sounds paradoxical, but most certainly feels real.

And then we come to weekly small group discussions, otherwise known as Balint groups. A group of doctors, mainly psychiatry trainees (which I'm not) come together and someone talks about a patient they've seen and the rest of the group with the aid of a facilitator is supposed explore the patient-doctor relationship and emotions involved. Somehow though, it's become more of a speculation exercise about how the patient got into into his current situation and not so much about how the doctor has (or has not been able to) connect with the patient. Maybe I'm just too insensitive to realise how this should be helping me 'connect', or as a colleague helpfully put it (still not sure if I understand it), 'it's like a controlled mind-fuck'.

Maybe it's because I have to keep telling patients things like 'It's going take a few weeks (sometimes 6 to 8) for the medication to kick in and maybe you'll start feeling better. 'Maybe'. I've come to loathe this word that I've most definitely overused. It's almost a lie a lot of the time. And then you say something like, 'If that doesn't work, we'll increase the dose. If it still doesn't work, we'll need to find something else that hopefully does. But it will be a few weeks before we can try something else. Why do they take so long to work? Well, for those who are interested, there's an excellent paper on the subject (http://bjp.rcpsych.org/cgi/content/abstract/195/2/102). Which is so not frustrating, regardless.

Am I actually helping anyone in this specialty? I don't know. Some patients thank me. Some thank me regardless of how the consultation went. Some even shake my hand again. Some break down and cry. Some get angry. Some don't tell me anything. Some tell me they want to kill themselves. And there was this one chap who wanted to kill someone else. That was slightly disturbing. Most were on medication, some on more than one. Does medication help, I don't know. I haven't been here long enough to find out on my own. I suppose with psychiatry being such a large specialty medication HAS to help, right? Please tell me it does, I've been prescribing all week.

I'll be so glad to get back into MEDICINE. Only 2 months to go. The Force is with me.

Kinder Scout, Peak District

2011-05-14T14:37:00.008+01:00

First it was misty and cold.
At least it wasn't snowing.
The ridge of Kinder, mist included. Compulsory, if anything.

Rocks. And the prospect of a nasty fall.
And then the sun came out. We headed down this way, enjoying the sunshine.

And realised that we had to head back up, and it was now unbearably warm.

But it did give us the opportunity to have a look at the ridge again, with less mist and more sun. I'm told that there is supposed to be a waterfall where the sheep is.

The 'river' bed which supposedly leads to the afore-mentioned 'waterfall'.

The trek back, in the blissful sunshine.

Prayers

2011-03-24T23:46:00.003+01:00

One tsunami and some freaks think it's a sign from god. Some even think they indirectly caused it and are happy that god answered their prayers. I wonder how many monotheists were among the victims. Obviously their god didn't love them enough.

Thank who?

2011-02-24T10:31:00.005+01:00

So this dude is brought into the ER almost moribund. Not really responding, tachypnoiec, looking quite dry.

Really unwell. So...

Oxygen on, blood pressure cuff on, chest leads on, pulse oximetry, cannula in, some blood for the lab, fluids in, arterial stab, slightly acidotic, oxygen levels ok, low CO2, high anion gap, blood glucose 29, second cannula in, more fluid in, chest radiograph shows consolidation in the right base, insulin sliding scale up, some IV benpen and levo, patient gets better, starts talking, refer medics. Well done team.

A textbook case of DKA.

Patient's relative starts thanking god for saving this chap's life. 3 relatives join hands with the patient and proceed to give thanks to the lord.

Reviewing a patient in the next bay, separated by a shelf and a curtain, I'm obliged to hear everything they're saying.

God is thanked for saving a life. God is thanked for being benevolent and merciful. God is thanked for his kindness and infinite wisdom.

Yep. No thanks to the paramedics, nurses, or doctor. Seriously. If god really wanted to save a life, he should have done it at the patient's house and not in the ER at 0200.

I'd like to see a 'faith' healer work on a DKA patient. If you can make 'crippled' people walk, treating DKA without insulin should be child's play.

And whenever something bad happens to a patient, it's never god who gets the blame.

You want to know why? Try going to your attorney and ask him to sue god for 'killing' someone. He'll tell you it's much easier to sue the hospital, the staff, and the potted plant in the waiting room.

And don't even bother telling me that god works through doctors, nurses and paramedics. I have considered the premise and I find it offensive. Very. I work through me.

God didn't send me to medical school.

God didn't buy me medical books.

God didn't bless me with good senior doctors who continue to educate me.

If you're offended, go pray.

May the Force be with you. Because if there is a god, he isn't. His masterplan is all worked out and he isn't supposed to interfere.

And why is god a he? Why is he never a she? Oh I'm sorry, is that offensive? Next time you want a doctor, go put on a lab coat and see if he'll work through you.

Fabese

2011-01-10T23:43:00.003+01:00

Yes, fabese, defined by the urban dictionary as fatally-Jabba-the-Hutt-obese.

I'm not talking about 250 pound people here; I'm talking about people who weigh about as much as the average bear, about 250 kilos.

Sometimes, people who weigh that much can be a little hard to treat in the ER. Difficulties that may arise include:

1. Finding suitable bed for such individuals. Normal hospital beds start to sulk at the prospect and usually die when faced with such a burden.

2. Moving said patient, who may be unconscious, onto the bed, from err, the floor? or another bed? or from a bariatric chair? It took more than a dozen of us the last time.

3. Finding a suitable vein to insert a cannula or to draw blood from. Adipose tissue, while being an excellent insulator, makes it difficult for us to identify suitable veins. And um, if we miss, it's not because we aren't good at it, it's because you're, um, 'fat'.

4. It is almost impossible to check for abdominal tenderness, masses, shifting dullness, or a pulsatile abdominal mass. The last means you're totally fucked if we can't find a vein, or two. Also means a couple of extremely tired junior doctors should they manage to open you up in time.

5. Because you can't see your own feet, you can't tell us if the unpleasant looking ulcers there are getting worse. Hell, you can't even tell us if the horrible, fungal rash in between the layers of your abdomen is getting better.

6. You smell. Although I have to agree that it's not your fault that a cat crawled into a crevice after a rat and couldn't find it's way back out again; it's the rat's.

7. The toilet cries after you visit. The cleaners cry too, but they're being paid, at least. If you've done your number two in bed because you're unconscious, then the nurses and the health care assistants cry. The doctors just look smug and pretend to be busy. The junior doctors are sometimes forced to get involved though; it takes more than one to roll you on your side.

8. They don't seem to realise that it won't hurt for them to live off their 'reserves' for a while. And on that matter, they ask for TWO packs of sandwiches, not one, TWO!

No, seriously. Some are plump, and that's fine. Some are fat, and that's okay. Some are obese, but they can't help it. The fatally obese though, are a different matter. Surely you realised something was wrong when you couldn't get through a door without great difficulty. Or that you needed crutches to get to the kitchen because your knees are arthritic and give way when you try to walk even though you're only 30. Or that you haven't left the house in years. Or that you can't wash between your butt-cheeks because, um, it's a little out of reach? Or that you can only wear XXXXL sweat pants and even that's stretching it.

And the list goes on.

So, I guess what i'm trying to say is, well, help yourself. If you can't, at least realise that you need help and talk to someone. Also, bariatric surgery is free in this country if you meet the criteria. Bah.

May the Force be with you.

(note: I may be wrong about how much the average bear weighs)

Christmas announcement

2010-12-23T12:57:00.006+01:00

This article is meant as a JOKE. Please do not take it seriously, and refer to guidance number 7 for advice on how to proceed with your complaint.

Dear all,
If you plan to get shit drunk on Christmas eve/day, the following guide will keep all the ERs in your region happy (or happier):

1. Please collapse in some dark alley or in the nearest, deepest ditch so that no one will find you and you won't be brought into the ER.

2. Please fight as enthusiastically as possible and knock each other out, and if possible use sharp objects and/or firearms so that by the time you're brought into the ER you're dead.

3. Please have a seizure, but do it in some out of the way place so that when your seizure self-terminates, no one will phone the ambulance to bring you in and you can continue drinking.

4. To all the 'good' samaritans who phone ambulances for other people, please make sure that the other party actually wants to come into hospital. Alot of people are brought into hospital against their will and that makes 2 pissed off parties, the 'patients', and the already overworked ER staff.

5. Please google the safety profiles of illegally (or legally) obtained drugs before you take any. If you do plan recreational/suicidal drug use, please take a massive, massive overdose. The results are more impressive.

6. If you are brought in and decide you want to leave, please just walk/run/fly out of the department, taking care not to: a) collapse at the hospital doors. b) collapse in view of any good samaritans. c) tell any of the staff that you're leaving.

7. If you're brought in and wish to complain about the treatment you received from the people who saved your sorry ass, please send the letter to your MP/congressman/PM/DoH saying that you think that ALL medical staff who actually do clinical work and have to deal with your intoxicated asses are grossly underpaid for what they have to do and that's why the service was unsatisfactory and deep down inside you think that all of us are kind, amazing, marvellous people. Medical staff includes paramedics, receptionists, lab techs, radiographers, porters, and the kind ladies who clean up cubicles full of vomit, blood, and shit. Anyone not on the shop floor getting their hands dirty (yes, management staff, I mean you, you're ALREADY overpaid) need not apply.

8. If you slip on the ice BECAUSE you're intoxicated, and break a bone, please make it a mid shaft fracture of a long bone to maximize complications. Best results occur if you can actually see the shards poking through your skin. Bigger shards = better results. Fat emboli are absolutely necessary! If you survive and still plan to get drunk in the future, please refer to number 9.

9. If the festivities are getting you down, and you decide you want to kill yourself, paracetamol is a bad idea, because you'll eventually come in to us dying and we still have to treat you to try and save you. Don't jump in front of fast-moving vehicles, the result are messy and give the other involved parties a shitload of grief, AND paperwork. Heroin is good, especially in large doses, but don't take my word for it, please refer to number 5 for further guidance. Bridges are good, high ones are better, and hard landings are best. Go for it!

10. Numbers 1 to 9 apply for New Year's as well.

Merry Christmas and a Happy New Year! May the Force be with you. (because god hates ER staff)

Yr Wyddfa (Snowdon)

2010-10-27T22:37:00.004+01:00

Highest peak in Wales, bla bla bla. Go look it up if you're really interested. Took the South ridge up and descended via the Rhyd-Ddu path. And don't ask me how these Welsh names are pronounced. I have no idea.

The South ridge path starts off nice and flat.

As you can see, after an hour of walking, you look back, and... you realize that you haven't really climbed very much

Dragon's tooth. This is Wales after all. You know, King Arthur and stuff.

2 hours into the walk, and I find myself out of breath. So I used my camera as an excuse to take a breather.

Pretty near the top now. That's the sea in the background.

And as always, the view from the top.....

...is anything but spectacular, no thanks to Murphy's Law and cloud cover

The trek down was anything but boring, amazing views all the way down

And the day comes to an end....

...well, excluding the gruelling 2.5 hour drive home

Ingleton Falls

2010-05-23T16:40:00.004+01:00

About 1.5 hours drive from Rochdale, and the trail took about 3.5 hours to finish (including numerous stops for photos). Not at all strenuous despite the warnings unless your arthritis is bad or if you're missing a limb or two. It was a little too warm for it to be a relaxing stroll, but enjoyable nonetheless.

Pecca Falls

Pecca Twin Falls?

Can't remember what this one's called

Thornton Force. Sun-deprived people making the most of it. A kid walking past me points at a 'swimmer' and asks his mum, 'Is that another nut-job?'

River Twiss. Accidentally left the camera on shutter priority for this one.

Bluebells. And trees. Some grass too. And sunlight. Um.

PSed slightly for better colour saturation.

I've got a new blog

2010-05-02T21:34:00.001+01:00

Though that doesn't mean this one won't be updated periodically, when I feel like it.

12 hours to the deadline

2009-12-18T01:38:00.003+01:00

As above. To the deadline for the submission of specialty training applications that is.

I still have absolutely no idea what specialty I should apply to.

I have no interest.

I have no reason.

And I'm bored.

What I really want to do is to go for a walk. Someplace scenic. And take nice photographs.

I wish I could do that forever.

No more COPD, or ACS, or Acute on CRF, or GI bleeders, or overdosers, or social referrals, ever.

Maybe in another universe. Certainly not this one.

May the Force be with you.

Pics

2009-11-19T23:51:00.006+01:00

First few pics are from Healey Dell

The next two are from the park behind Hollingworth Lake

May the Force be with you

Excerpts, from case notes

2009-10-14T13:38:00.002+01:00

"Impression: af-attack" FY1, gen med

"On examination, abdomen distended due to fat, soft and non-tender, mainly fat." SHO, gen med

"Patient proceeded to assault fellow colleague with half-a-cup of calogen." FY2, gastro

"ATSP - SOB. Patient has gone out for a smoke; I will review her later when she is really SOB." Med SHO on nights

"If the nurses want another cannula they can put it in themselves." FY1, gen surg

"Dx: ???, refer to medics." ST1, A&E

"Systemic review: c/o pain eveywhere. Pain radiates everywhere else. Morphine helps." FY1, gen med

"GCS 15/15. Patient obviously confused. Not orientated to time, place, or person" SHO, A&E

"Dx: Patient fell on his kness after going to the bathroom and couldn't get up. Wife does not want him to go home as this may happen again. Plan: Refer to medics." SHO, A&E.
*Comment from fellow colleague: Maybe he saw God? And maybe his wife is afraid he'll see "Him", again tonight.

"PmH: Osteopenis." FY2, acute med

"Nurses think she's malingering. I think so too." SpR, acute med

"Symptoms have fully resolved. ? Stroke." ST2, A&E

"Please rule out TIA." GP

"ATSP - Has severe leg pain. Patient asleep. Not easily rousable." Med SHO on nights

"I have been asked to request a 'Head x-ray' for this patient who has apparently fallen. I do not plan to do so." Med SHO on nights

Congenital Defect

2009-09-04T23:26:00.004+01:00

Sometimes, I think, I try too hard.
Perhaps I cannot comprehend,
Where I stand in all this,
Always asking, if this is my part?
Do I sit and stare, silently,
From the stiff back of this chair?
Or do wallow into the struggle,
For it's not my way, to fight, or grapple.

And then later on, I wonder,
Why did I even bother?
I should let someone else care,
But it nags me, this feeling,
Like someone, tugging at my hair.
It distracts me, drags me,
Maybe from where, I really ought to be.
It annoys me, confounds me,
Like a (bastard) bee that can't be bothered,
To go after nectar, or make some honey.

And when I try to take a breather, I wonder,
Why (the hell) go through all the trouble,
When I can just look away,
And under my breath, mumble.
When I can turn around,
And pretend to take a tumble.
When I can feign deafness, or stupidity,
And if needs be, perhaps, even insanity.
For you may have been told, as I have,
That one, most unfortunately,
Cannot force, serendipity.

Later on, I discover,
That all that time spent, in 'wonder',
Is now well and truly, lost, forever,
'slike an artist who regrets,
That final, unnecessary stroke.
Or the pianist who misses,
That one, crucial, note.
And the thoughts of these, will always linger,
For sometimes, in life, when you falter,
There's no option to, 'try again later'.

And yet I cannot help, but wonder,
Why I put myself, through all this torture.
Is this what they call, 'cause and effect'?
No, I believe it's due,
To a congenital defect.

Attempted Suicides

2009-08-22T19:01:00.004+01:00

If there's one thing I hate about medical on-calls, it's the number of attempted suicides I see. Every single time I've been on-call I see at least one attempted suicide, almost always with pills. Except for that one person who drank a pint of anti-freeze. And that one person who gulped down a shitload of bleach. Both died. It's sad really. There are far too many people who are depressed, or think they are depressed. There are far too many idiots who think that taking an overdose of whatever tablets they have at hand is a quick and painless way to die. For those of you who don't know, an overdose is slow, painful, and stupid way to die.

A chappie I clerked who had overdosed on venlafaxine asked me what pills were best for suicide by overdose. Continue reading:

Chappie: What kind of tablets should I have taken doc?

Me: None.

Chappie: I knew you were going to say that.

Me: Then why did you ask?

Chappie: Well, I was hoping that one of you doctors would be helpful for once.

Me: Let's just say I'm not the best person to ask about suicide. Wrong profession. Also, if I told you how to kill yourself and someone overheard, do you have any idea at all how much paperwork I'd have to do? As it is, I already have to clerk in every single person who comes in with an overdose.

Chappie: I'm sorry for causing you all this trouble doc.

Me: It's quite alright. Do you have any other questions?

Chappie: Do you think jumping off a bridge is a good idea?

Me: No. Unless it was a very high one, and one where you'd be assured of a very hard landing. Otherwise, you'd just give my surgical colleagues a shitload of work trying to put you back together.

Chappie: Oh. *nervous laughter* Sounds painful.

Me: What would be even more painful would be seeing your four children and wife around your bed when you did wake up. And maybe finding some body parts missing. Yours that is.

Chappie: *laughs* I really appreciate you trying to make me laugh.

Me: I didn't try. I did. You want to hear something else that's funny?

Chappie: Yeah?

Me: You're way to old to take an overdose. Please don't do it again. It's almost embarrassing.

Chappie: *chuckles* Thanks doc.

Me: The nurse will come to do a tracing of your heart in a bit. Don't go anywhere.

Later on, at the nurses station, with a cup of coffee.

Nurse: I overheard you talking to him just now. *points* Did he ask you what the best way of killing himself was? If I was you I'd have told him to hang himself. These people waste all our time.

Me: Like I said, wrong profession. 'sides, the rope would have broken anyway, he weighs more than a hundred kilos.

*laughter*

Greying

2009-08-16T21:42:00.003+01:00

So there I was minding my own business and checking blood results. Nurse sits down beside me and starts chatting to the ward clerk when suddenly...

Nurse 1: My Gods, you're greying, doc!

Me: Huh?

Nurse 1: There and there and there! *points at my head repeatedly*

Ward clerk: *leans over for a look* She's right, you've got lots of grey hairs.

Me: Em... I've had grey hairs since I was 14.

Nurse 1: Really? How come?

Me: Dunno. *resumes checking blood results*

Ward clerk: How old are you doc?

Me: 23, plus a few months.

Nurse 1: Really? And you have all those grey hairs? I'm almost 50 and not a single grey hair on my head.

Me: Uh huh. *logs on to the PACS system to look at radiographs*

Nurse 1: Maybe you should dye your hair?

Ward clerk: If you cut your hair short enough they won't show so badly I suppose.

Me: Yeah.... but I like my grey hairs.

Nurse 1: Why?

Me: Well, grey hairs are a sign of wisdom.

Ward clerk starts laughing and Nurse 1 just looks confused.

Ward Sister: Chris, what he's trying to say is that you're not wise.

Me: What?!!!

Ward clerk: He's got a point Chris, you ARE pretty immature.

Nurse 1: I didn't catch what you were saying, something about wis...

Me: No no no no no. Let me clear this up. *speaking very quickly* I didn't say you aren't wise. I was merely implying that you're most likely not as wise as I am. *simultaneously grabbing my stethoscope and getting off the chair as quickly as I can* Goodbye, see you tomorrow. *runs away before nurse can make a reply*

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.

Unfortunate but true

2008-01-22T01:22:00.000+01:00

Yes, unfortunate but true.

To the great displeasure of the many people who hate me.

I'm not dead.

Although those who used to frequent my blog may think otherwise.

well, I'm very much alive.

And I promise another post very soon.

One with photos.

Of Paris.

As soon as I can get them uploaded properly.

May the Force be with you.

The Impossible is just very very difficult, and exhausting

2007-12-14T03:23:00.001+01:00

Once again I've left myself a 'little' too much work for too late. But I always maintain that these all night typing marathons every 6 weeks are so are what keep me going. But this time, I may have pushed it a little bit too far. Just a little. I might just, just, just, meet the submission deadline. Because unlike last year's case discussions, this year's case discussions are *curses* checked for plagiarism by some fancy software against the millions of journal articles and god-knows what else online, in addition to every piece of work ever submitted to the program. Which means that one has to be really careful when referencing and citing journal articles. Hopefully textbooks aren't on their list. Hopefully. Oh well, back to work. yawn.....

p.s. anyone who wants to know why we went to the Nottingham games is welcome to ask me on windowslivemessenger. I'm just too lazy to post anything regarding it.

Nottingham Malaysian Games

2007-12-09T03:32:00.000+01:00

Right. Above we have a not-very-good picture of 14 extremely unwise individuals who drove down to Nottingham and back to Dundee last weekend. We started off at about 2300 on Friday night, got to Nottingham at around 0800 on Saturday, spent the day there, started driving again at about 1900, and got back to Dundee at 0400 on Sunday.

No, we did not get very much sleep.

And now for several comments...

A convoy is only as fast as the slowest car. And the person driving the slowest car normally has a pretty good reason for driving slowly. Perhaps it's the dark, narrow, single-laned, winding road through the hills that we're on? Or maybe, just maybe, there REALLY is a speed camera a little distance away from the sign that says "50 MPH, SPEED CAMERA". Who knows? One more tip. Please please please DO NOT call the driver on his cell phone to tell him to speed up. The driver is responsible for the safety of his passengers, and does not care if we reach Nottingham late.

Maps are vital. Maps are important. Maps tell us where to go. Correction. The RIGHT kind of maps tell us where we should go. When planning a long driving trip, for example, oh, from Dundee to Nottingham perhaps, it is essential that appropriate maps are used. Road maps of the towns you plan to stop by may be necessary as well. After all, who doesn't know that British road signs are just as bad as the ones in Malaysia? Spending an hour driving around a small town trying to find a route to the highway is not usually recommended. Also note that a good navigator, someone who actually KNOWS how to read a map, is present.

Petrol is important. Without petrol, we wouldn't get anywhere would we? Which is probably why there are petrol stations every 25 miles or so on the major highways. Why pump petrol in the city, where a convoy of 3 cars is nearly bound to be separated due to unpredictable traffic conditions and unfamiliar territory? Much time will be lost trying to regroup. Therefore, my advice would be to hit the highway asap, spend that extra 2 pennies per lite of petrol and pump petrol at a rest station instead of wasting time in the city.

Try not to leave a car behind. Although the drivers are responsible, most passengers have at least one functional eye. Looking-out for each other is good policy. Driving as a convoy in an unfamiliar city is NOT recommended. Traffic lights, roundabouts, and asshole drivers tend to get in the way. If the 'leader' is separated from the rest, he should stop and wait at the first opportunity, not drive off and relay inaccurate directions via cell phone. "Why didn't you follow my car?" is NOT the best thing to say to a lost driver. We all know that he intentionally took a wrong turning because he couldn't see car in front anymore.

Staying alive is generally a VERY good idea. One should not speed up when: a) the roads get darker. b) the roads get narrower. c) when it starts raining. d) when you see a sign saying "CAUTION, WINDING ROAD". I'm not sure about the rest of you, but I'm pretty sure I'd be pretty unhappy if I found out that there's really an afterlife prematurely. Heck, if possible, I'll even make sure that someone finds out if there's an after-afterlife.

Yawn. Bedtime.

May the Force be with you.

JHO shadowing

2007-11-29T00:17:00.000+01:00

I hate clerking patients.
I hate taking bloods.
I hate putting in venflons.
I hate requesting X-rays.
I hate it when radiologists say that they can't give 'my' patient a head CT.
I hate looking for misplaced case notes.
I hate walking behind everyone else during ward rounds.
I hate walking to the hospital on cold, rainy mornings.
I hate pharmacists who speak to me as if it's MY fault that the patient is on cefuroxime instead of ceftriaxone.
I hate 'bed managers' who bug nurses who in turn bug me about expected patient discharge dates.
I hate the smell of shit on the ward.
And I hate hate hate carrying a pager.
Especially when it's NOT even mine!!!

But everything else is great. Especially...
The junior doctors who ask me to help interpret ECGs.
The nurses who offer me chocolates whenever they see me.
The ward assistants who run after my 'missing' patients.
Phlebotomists who need help taking bloods.
Pretending I'm an expert at reading MRI films.
The coffee runs at every opportunity we get.
Playing table-tennis in the doctors mess.
Knowing the right answer to a consultant's question about some obscure disease.
Making the right diagnosis after clerking with no X-ray, no blood results, no ultrasound, and no biopsy.
Patients who thank me after I poke 'em more than once trying to get a venflon in.

Yep. It's certainly more good than bad.

But I hate that god-damned pager. I hate hate hate it.

Yellow!

2007-11-10T20:40:00.000+01:00

Malaysian? Click Here

22 most awful...

2007-10-06T14:24:00.000+01:00

...moments in science fiction.

I don't agree with everything the article says, but it's a pretty good read when the alternative is a book on O&G.

O&G.

SO not my favorite specialty.

Sinusitis and...

2007-10-05T16:15:00.000+01:00

Yep, I had a bout of sinusitis. It wasn't very nice too. And the first symptom I got was pain in my upper left molars and pre-molar, eventually progressing to an excruciating left frontal headache, worse when leaning or bending forward and relieved by... 500 mgs of mefenamic acid. Brilliant stuff it is. But it wasn't the headache that annoyed me. It was the pain in my teeth. It wasn't very painful, but everytime I moved my head, or walked down the stairs it hurt. Just so bloody annoying.

What really worried me was the thought that it might have been a malignant growth in my sinuses. But since I'm all better, it probably isn't.

On to the next topic:

I was at the 'juniors' house the other day for a mooncake festival sort of celebration. But this isn't really about the celebration. It's about the juniors. By 'juniors' I mean the latest batch of IMUians who have come to Dundee.

It so happened that on the very same evening, our landlord was throwing a party for his tenants at the place he put us up in before we moved to our current accommodations.

There was free booze at our landlord's party, and a few of the juniors wanted directions to to the place. This is how the conversation went (heavily edited):

Juniors: Can you give us directions to the place ar?

Senior: Sure, we can draw you a map.

Senior 2: Or even better, if you bring your laptop down, I can show you exactly where it is with googlemaps.

Juniors: No need lar, its okay. Just give us directions.

Senior 1 and 2: Okay. what you do is you take the bus and... bla bla bla bla bla...

Juniors: Errr, where exactly is that ar? Right after the police station and then?

Senior 2: Look, if you bring your laptop out, everything will be SO much easier.

Juniors: No need lar, just tell us clearly can d. We are going to walk there btw.

Seniors: You sure? Ok fine, just give us a pen and paper and we'll draw you a map.

Junior: Takes out his PDA. Here, draw on this.

Seniors: *wtf*. Fine. *draws rough sketch on PDA screen*

Junior: Errr, you sure ar?

Senior: *sigh* If you get us a pen and piece of paper, we'll draw you a map. A BETTER map.

Junior: *looks around the kitchen for a piece of paper, and grabs a serviette i.e. TISSUE PAPER, that has fallen onto the floor and hands it to us. proceeds to look around for a pen, finally finds a marker and passes that to us*

Senior: *cough* Ahem, the marker doesn't work.

'Smarter' junior (who wasn't going to the party): *to other juniors* Look, my room is just round the corner if you guys want to use my laptop...

Junior: No need no need...

Seniors: *sigh sigh sigh*

They didn't go to the party in the end.

But like c'mon. They've got a wireless router which means that there's wifi in the entire house. And they refused to bring a laptop down. But the most pathetic part was when they couldn't even bring us a proper piece of A4 size paper or a ballpoint pen.

Pathetic.

Nap time. Till the next post.

Aceritis indeed

2007-09-17T00:31:00.000+01:00

First documented by by Starghazzer. Usually (mostly) involves Acer laptops.

The following are the symptoms my laptop is manifesting:

1. Weird beeping noise at odd intervals. Usually at night. As many as 3 beeps and hour or 1 beep a week. No apparent causative factors.

2. Webcam does not run unless connected to my USB hub. It ran perfectly well before I bought the USB hub. WTF is going on?

3. Stuck pixel on screen. May get unstuck on its own, always reverts back to being stuck. Very very annoying.

4. It won't detect my external hardisk unless I restart my com with the hardisk connected. It worked fine until about 2 days ago.

5. My 3 USB ports are starting to get a little temperamental. They may or may not detect my various USB devices at random times.

Sigh Sigh Sigh.

I'm reformatting this fella the next chance I get. Probably during the 1 week break before my GP block. Hopefully the various problems will settle down after that.

Still Alive

2007-08-18T20:58:00.000+01:00

And halfway through my elective at Klang GH.

The last couple of weeks was spent in the A&E and I'm gonna be in the medical wards next.

And the most significant difference between Ninewells hospital and Klang GH is:

You don't get toilet paper in the gents in Klang GH.

And don't ask me about the ladies, because I haven't been in there.

Not good

2007-07-11T14:23:00.000+01:00

There are things that you can't help noticing when you live in the same house with 3 other blokes for a year.

You'll know what they like, what they don't, when to laugh at their jokes, when to listen and when to shut up.

I hate to say this, but just so you know,

I know when you're fucking lying.

Especially you.

Butterflies

2007-07-09T23:42:00.000+01:00

In approximately 8 hours, I'll be sitting at a desk in a cold and unfriendly hall with about a hundred-and-sixty other 4th yrs, all ready to start on the first 3 hour written paper.

Yes, the first.

'Coz there's a second 3 hour paper after lunch.

You know how people always talk about "butterflies in the stomach"? That queasy feeling you get?

My stomach feels funny right now.

But it's probabaly 'coz I'm hungry.

Midnight snack here I come.

"The Force fights with me!" - Bastilla Shan

Better

2007-06-29T01:02:00.000+01:00

There's only one thing that surpasses the 16th edition of Harrison's Principles of Internal Medicine.

The fully 'searchable' .pdf file with color pictures and the ability to magnify the tiny words that plague my hard copy of it.

But, I have to admit that I'm rather attached to my hard copy. The feeling that nothing in the world of medicine can baffle you so long as you hold the book in your hands and thumb the pages in your quest for knowledge is wonderful indeed (note: exaggeration; Limiting factor - my brain.)

Plus, plus, the fact that you can brain THAT fannoying person with the hard-cover-and-1300-page-combo is a bonus.

Unfortunately, it's far too lenghty to read this close to the exams.

Work, work, back too work.

Week 5/5 - I hate...

2007-06-26T16:27:00.000+01:00

...HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE HATE...

... being woken up from an afternoon nap.

Especially when afternoon naps are what keep me going through the night.

If I'm being crabby, there's a VERY good reason. YOU caused it.

So fuck off. Or go study. Or go jump into the river or something. I don't fucking care. I don't fucking care how stressed you are or how much you've revised or whatever. 'Coz right now, I'm pissed. Pissed that the slightest sound wakes me up from my slumber thanks to my heightened sympathetic nervous system responses, partly me, and partly the cortisol and adrenaline. If you make any sudden moves in my presence, don't be surprised if you find yourself waking up in a hospital bed 48 hours later with a folding chair attached to your skull and half your brain in a jar by your bed.

Feh. A week left to go.

TaiChiMASTERS!!!

2007-06-18T23:45:00.000+01:00

First of all, I would like to say that I practise Tai-Chi Chuan regularly. I hope fellow practitioners of the art don't find this offensive, because I think it's hilarious. Or maybe I just have bad taste. Well, it's MY blog after all. Enjoy!

Week 3/5 - Fear

2007-06-17T14:09:00.000+01:00

I must not fear.

Fear is the mind-killer.

Fear is the little-death that brings total obliteration.

I will face my fear.

I will permit it to pass over me and through me.

And when it has gone past I will turn the inner eye to see its path.

Where the fear has gone there will be nothing.

Only I will remain.

-Dune, the Bene Gesserit Littany against Fear.

To say that I'm not under any sort of stress would be, for the most part, untrue. Yet, I'm strangely relaxed. Right, enought chit-chat. Back to work.

Week 1/5 - Denial

2007-06-03T22:41:00.000+01:00

It's unreal. I can't have been here for nearly a year. What's more unreal is that my 4th year finals are a mere 5 weeks away and I still have a shitload of work to complete, on top of revision.

What's even more unreal is that I still have time to blog when I should be reading up on thrombolysis and atrial fibrillation.

But not too worry. I still have 4 good weeks left. That's about the same amount of time I had when I started revising for my Semester 5 finals in IMU. There is one snag however.

This isn't Sem 5 in IMU.

Because I still have to go for ward rounds and tutorials in addition to my case reports as well as revision. But I'm sure it'll be ok. I still have 4 weeks left. Plenty of time.

*nervous laughter*

My subconscious knows the truth. Oh well, the truth has a week to sink in.

That's all for this time. May the Force be with me.

p.s. Milo tastes really weird with Tesco milk. Really really weird. I need the super sweet condensed-milk milo you get at mamak stalls.

Unsuccessful

2007-05-27T20:47:00.000+01:00

I've been unsuccessfully trying to write a decent article to post up here since I was rudely awoken by the harsh whir of the vacuum cleaner on Saturday morning.

I hate my mask.

But I can't take it off. Not this mask. At least not yet. For the simple reason that even I can't predict what I'll do or say when it comes off.

I'll have to craft a new one soon. Hopefully my subconscious will do most of it for me.

Finally!

2007-05-19T11:47:00.000+01:00

STARCRAFT 2!!!

Countdown!

2007-05-18T13:06:00.000+01:00

The clock is ticking.

The moment of truth.

Even the sands of time, in their eternal ballet, will pause.

For, in less than 24 hours,

We shall be answered!

But wait! What is the question, you ask?

The question is...

WHAT NEW GAME WILL BLIZZARD ENTERTAINMENT BE ANNOUNCING IN KOREA ON THE 19TH OF MAY 2007?

Screw the ward round

2007-05-16T09:05:00.000+01:00

I'm not going in today.

It's my half-day anyway.

I can self-certify 5 'sick' days anyway.

I have 4 days left anyhow.

I don't think anyone actually keeps count, unless you report it to the medical school office. They keep track of everything.

Besides, what can they do? Break my legs?

*evil laughter*

Tired

2007-05-15T22:27:00.000+01:00

I'm tired. In fact, I'm so tired that I'm considering skipping the bloody ward round tomorrow morning.

The ward round is pointless. For me at least. When there are 4 3rd year medical students, 3 junior house officers, 2 senior house officers, 2 registrars, 1 consultant, at least one nurse, and myself on the ward round, there just isn't much breathing space.

Especially when the consultant decides to check a patient's colostomy bag.

I doubt that my absence will be noticed.

Actually I think it will be.

Someone has to answer the questions directed at the medical students. Especially since the 3rd year students on the ward seem to know nothing.

Perhaps that's a little harsh.

They could probably find their own assholes with both hands and a pen-torch.

But for crying out loud, not knowing what 'Q-waves' are in an electrocardiogram (ECG) is just plain pathetic for 3rd year students. And they've just had their 3rd year exams.

And for emphasis: PATHETIC

I hope I haven't offended any 3rd year medical students to happen to be reading this.

I'm in a foul mood. Forgive me. Only if you want to that is. I don't really mind.

The Force is so not with me at the moment.

Bloody Sunday

2007-05-13T13:14:00.000+01:00

No, not literally.

But it's bloody fricking Sunday and it's a bleeding cold day.

So why the F*** do I have to show up at Ward 12, Ninewells Hospital and Medical School, on a bloody bleeding cold Sunday?

Sigh. I'd better get ready.

Bye.

General Surgery

2007-05-08T23:07:00.000+01:00

It's pretty ironic that I don't get to see much surgery at all during my general surgery block. Instead, most of my time is spent on the ward doing stuff that I'm not currently paid to do, but will be paid to do in a couple of years time. Hopefully.

So anyway, this morning, after the 0800 ward round, I had to take blood from a patient with a really really really bad case of the hiccups. Hiccups so bad that he had to be prescribed Chlorpromazine for 'em.

And the Chlorpromazine didn't work.

Everytime I tried to prick him with the bloody needle, he'd hiccup at exactly the wrong time. He'd jerk his arm (his whole body jerked at every hiccup) and even though I did my best trying to hold his arm steady, I couldn't prick him because I'd risk giving myself a needle stick injury. It's not his fault that he's hiccuping, true. But boy did I feel like giving him a swift kick in the butt, when, between hiccups, he proudly told me that he's had blood taken 'loads of times before', and 'they dinnae take longer than 2 seconds'.

After the third unsuccessful prick, I went and got the house officer.

If he'd made me prick myself, I would've given him a poke in the pancreas. (yes, he has pancreatitis)

And guess what? I had to hold onto this fellow's arm with both hands and pin his arm to the bed so that the house officer could get her needle into the vein.

So we did get the blood, eventually.

Work work... Back to work.

p.s. When I left the ward at 1630 he was still hiccuping. I know. I heard him.

Dying

2007-05-04T21:38:00.000+01:00

Not me. The daffodils. Actually, they're wilting, but you get the idea.

Well, 4th year project's over, and I'm finally done with paediatrics. It's been, by far, the longest, most tedious, and most hellish block I've been through. Well, partly because I had to tweak (rewrite, more like it) my 4th yr project write-up at the same time.

Yawn, I should get some sleep tonight. All these stay-awake-throughout-the-night sessions doing write-ups can't be good for me.

The Force is with me, I hope.

Spring!

2007-04-29T21:43:00.000+01:00

Yes, I know it's late spring, which means that summer will be here soon! The sun has been setting well past 2000 and the longer daylight hours are just GREAT. Soon, it won't even be full dark at 2330, like it was when I first arrived last year!

These are a few recent pictures. If you're wondering why some of 'em look fuzzy, it's because it was slightly misty when I took 'em. Yes, it was sunny and misty. Sigh, I just love scottish weather, don't you?

Magnolia trees, I believe. Not sure though.
Daffodils, daffodils, pretty pretty daffodils!

Thats all for this time. May the Force be with you.

Some photos

2007-04-22T21:55:00.000+01:00

Just a few pictures from last month.

The 2 above are pics of the Perth railway station. Really really creepy. The place is almost totally deserted whenever I'm there. The atmosphere is very "Half-Life 2"...
A photo Tim took when we were at the Dundee Law.
From left, Ben Rafiq, Tim, me. I think it was Ven Gee who took this pic.
Another pic of the Perth railway station. You have to be there to hear the wind howling through the place.

Right. That's it for this time.

Shanidar

2007-04-19T22:49:00.000+01:00

A must read!

This might rub some of you the wrong way...

2007-04-15T22:27:00.000+01:00

My response to 2 blog posts, by 2 different people, I read today today.

This is about me, it's my opinion, repeat - MINE. Not something I read about, heard about, or had put into my head telepathically. It's something I thought about and it's something I thought about when I was between 15 and 16.

Some of you who were in Methodist High School Klang when I was in Form 4 may recall a little talk I gave about our "conscience", but that's another story for another time, if that time ever comes.

My opinion?

Praying helps no one. Prayers but offer a small measure of comfort and security to the one praying.

Look, do you really believe that some greater force will change the way things are just because you asked it to? Do you really believe that praying for someone's good fortune, praying for someone's health, or just praying, is ever going to make a difference to the world.

Yes, and no. More on this another time.

Prayers do nothing but comfort the one praying. Praying that one will pass an exam is not going to work unless one studies for it, or has a particularly high IQ and a good memory.

I was introduced to a religion at a pretty young age. It was a form of Buddhism with Japanese teachings. Some of you may know of it as the Soka Gakkai. I went for meetings, I kneeled and chanted, I went for various talks, I joined various youth activities, and I even helped clean the floors of the building where most of these activities were held.

What a big fat waste of MY time. The smartest thing I probably did was to NOT memorize the prayers in that little book I got from them.

The speakers at the talks used to say, "If you chant, what you chant for will come true". "If you chant for good results, you will get good results". He even went so far as to say this, "You must be specific, if you want 10 As you must chant for 10 As. You cannot chant for 'good results' because 9 As is also a good result. You must be specific."

(On a related note, this would be a good time to mention that most of them spoke English really really badly.)

Wow. Really? If that were true, I'd chant for the sky to fall on your head. Not hard enough to kill you of course, but hard enough to give you an epidural hematoma. For the simple reason that I would like to make a hole in your skull to save your life, but I wouldn't give you any anaesthetic for it.

Fact is, I can only think of 2 possible ways, through which something you chant for will come true:

1. Something will come true if you want it to come true and work hard for it, to make it come true.
2. Chance. Coincidence. Fate. Luck. Call it whatever you want.

Therefore, if I have to work to get what I want, why bother praying at all? I know that praying that my luck will change is never going to change my luck. So why bother praying at all. Instead, if you get cracking and start working for whatever you want, you get it sooner. By cutting all the praying out of the picture, I could get more sleep instead.

What do most religions preach? All the mumbo jumbo, in my humble opinion (IMHO) basically boils down to 3 words:

DO NO EVIL.

And without fail, we shall have to question the nature of evil itself, or some people won't be very satisfied. Here we go again.

Imagine a straight line, not curvy or wavy of whatever, perfectly straight and 20 miles long. Now imagine, at one end of the line we have 10 mile high capital letters spelling out the word "GOOD", and at the other end we have 9.99999 mile high capital letters spelling out the word "EVIL". (measurements are approximate and exchangeable, the letters spelling 'evil' could be 10 miles high instead, and vice versa)

1. Would you be able to tell that the letters spelling out 'evil' are 0.00001 miles shorter than the the letters spelling out 'good'?
2. Would you know exactly where you stand on this line?
3. Would you know which direction you're facing?

My answer, to all 3 questions, is 'No'.

Go figure.

Before I continue, I would like to say that I have many whom I consider friends who are Christians and I bear no ill will towards you or your beliefs, just questions and uncertainties.

A friend once told me that I wouldn't be allowed through the pearly gates into paradise/heaven/whatever you want to call it, because I wasn't a Christian. Define 'paradise'. If you believe that a such a place exists, and you truly believe that you deserve to go there because you are a Christian, you're either misguided, stupid, or both.

You believe that your God (I'm using capitals so as not to offend) is all powerful, kind, benevolent, loving, and willing to cleanse and forgive anyone of all their sins so long as they believe in him. Yet, you don't believe that he'll allow me into heaven. If that's the case, can you still consider him kind, loving and benevolent?

Another friend spoke these words,"My belief is that only those who are Christians will be saved when the end of the world comes, all the rest will go to hell. That is what I was taught". Let's say that you're a Christian and you believe this with all your heart and soul. Let's say that your 22 year old daughter whom you love so much that you'd die for her, decides that she wants to be a Muslim? Would you still believe in the words above, or would you pray feverishly day and night that He will still accept her into His arms on account of her having been a Christian once, or would you offer to trade your soul for hers, that you go to hell in her place?

Another friend, who was going around campus talking to people about Christianity (he was a Christian of course) told me without hesitation, when I asked him about the 2 people above,"I do not believe that the God I love is so cruel. The God I love loves all and He will save all who deserve to be saved. He will see and judge. What happens then I don't know." And he left me with a bookmark. One of the few that I've kept to this day, just to remind myself that that not all are blind and without a shred of independent thought.

Easter wasn't too long ago. A friend mentioned that it should be us on the cross having nails driven through our hands and not Jesus. Jesus sacrificed himself so that we might live etc etc etc...

Well, if we're all on the cross, who'd be the one driving in the nails?

Damage Control

2007-04-11T22:07:00.000+01:00

"Damage Control"

One of our favorite pre-exam phrases back when I was still in IMU. I'll leave the uninitiated to puzzle out what it means.

Anyway, my finals are in early July. Yes, finals. 'coz for some reason, we have our finals at the end of 4th year instead of 5th year. And on top of that, my 4th year project is due on the 27th of this month, which means that things are pretty hectic at the moment.

Reminds me of when I was in college and typed out my 2000+ word literature review in under 8 hours. I didn't get any sleep that night. Probably won't get any sleep this weekend either, as I'm trying to tweak my 4th year project write-up before next Monday.

And on the plus side, my hair is a little longer. Which is good, because the fact that it's uneven isn't so obvious anymore.

Work work.

May the Force be with you.

Cap

2007-04-02T16:00:00.000+01:00

Of all the miscellaneous items I brought with me to Dundee, the most useful, by far, is my cap.

Why? Well, here in Dundee, it never pours, it just drizzles, for a really long time. A cap is best thing I've found that keeps the rain off my head and unlike a hood, it doesn't obscure my sight or hearing.

However, after today's haircut, my cap is going to be a permanent part of my wardrobe till my hair is long enough to properly comb again.

I've not getting another haircut in Dundee, ever. Today's haircut was probably the worst one I've ever got. Henceforth, that motherfucking-idiot-daughter-of-a-deceased-barber-whore shall be refered to as that "motherfucking-idiot-daughter-of-a-deceased-barber-whore".

I swear I gave her explicit instructions. I said: Cut the back short, take away the sideburns, but only trim half-an-inch from the rest.

Motherfucking-idiot-daughter-of-a-deceased-barber-whore said: Right, short back, and only half-an-inch off the rest.

Motherfucking-idiot-daughter-of-a-deceased-barber-whore got out her motherfucking-idiot-daughter-of-a-deceased-barber-whore-electric-shears and did the exact opposite.

First she cut the back short, and that was fine. But before I could say anything, she got to the side of my head with her motherfucking-idiot-daughter-of-a-deceased-barber-whore-electric-shears and took off half the hair from the side of my head.

Bitch.

So she had to do the other side as well.

Then she got out her motherfucking-idiot-daughter-of-a-deceased-barber-whore-scissors and tried to patch up the damage.

Fuck you bitch.

If she had gone slow, and cut of a little at a time, she could have saved what was left of my hair. instead, she started cutting off half-an-inch at a time. Unevenly, from both sides. First she'd cut the left side, then go to the right, and then the left again.

And in the end, she finally decided that she couldn't get it even. So she got out her motherfucking-idiot-daughter-of-a-deceased-barber-whore-electric-shears and kept trimming bits and pieces off either side of my head, until she realised that I'd end up bald if she didn't stop soon.

And it still isn't even. Bitch.

I've no idea why I was so patient with that motherfucking-idiot-daughter-of-a-deceased-barber-whore. Any other person would have got up, called her a motherfucking-idiot-daughter-of-a-deceased-barber-whore and slapped the motherfucking-idiot-daughter-of-a-deceased-barber-whore twice on the same side of her face.

I'll give you a description of what this motherfucking-idiot-daughter-of-a-deceased-barber-whore looks like so that those of you who read my blog won't ever suffer the same fate I did if you ever decide to get your hair trimmed in Dundee.

She's about 5 feet 4, with long brown hair, slightly overweight, a pear shaped face, and oval glasses.

And the address is:

Huir & Co
7,Bunk St,Dundee, Dundee, DD1 1RL
Tel: 01382 205003.

Replace the first 2 letter "U"s in the address above for the real address.

The other hairdresser, with black hair, did a pretty good job for me the previous time I was there.

Fuck you, you motherfucking-idiot-daughter-of-a-deceased-barber-whore.

This post does not affect my statutory rights.

Tired

2007-03-19T00:32:00.000+01:00

As I type this, the time is 2332, and for no reason at all, I feel like going to bed.

Back in Malaysia, my average bedtime was around 0230. In addition, it wasn't unusual for me to get 3 hours of sleep but still be able to function normally for the rest of the day.

It's got to be something about this damned weather that gets to you. It's the cold. Whenever the temperature drops, you won't want to do anything but cover yourself with a blanket and go to sleep.

The weather's getting colder now, when it's supposed to be Spring.

I suddenly feel like getting under my blanket.

May the Force be with you.

Laser Printer

2007-03-04T17:52:00.000+01:00

I got my printer cable for 2.50 pounds from the friendly neighbourhood computer shop. Yes, it's still overpriced, but it's better than getting a ridiculously-overpriced 'Belkin' usb cable from Pc WORLD.

And speaking of overpriced, I got my printer from a shop next to Pc WORLD.

For 30 pounds less.

Pc WORLD ripoff-bastards.

I'm never going to Pc WORLD again. Ever.

Rant alert

2007-03-02T17:53:00.000+01:00

I've been trying to buy a laser printer, without much luck.

I don't care if the printer costs a bit more than it does back home.

But when they try to sell you a printer-to-computer usb cable for the absolutely ridiculous price of 9.99 pounds,

Tell them to shove the printer and the usb cable up their ass.

And in case you didn't know, the cable actually costs 19.99 pounds. But when you buy the printer, the cable is half-price.

What a half-assed way of doing things.

Back in Malaysia, everything comes in the same box. Printer, toner, cables, and EXTRA cables for which I've never found a use for.

What the fuck is going on here man?

CNY photo

2007-03-01T23:06:00.000+01:00

Only 1 more write-up to go. One more agonizing case study about ankylosing spondylitis. Did I spell that correctly? And I'm obviously not making very much progress if I'm blogging. Anyway...

We had a little CNY celebration. Plenty of food. That's why we all look so happy. Keeps us going. We are Malaysians after all. Well, at least most of us in the pic are Malaysians.

My keyboard. Keeps the blues away. Jee Ken needs one too. Poor dude's depressed. I'm not surprised. Anyone who can remember the names of those fricking Teletubbies should be depressed.

Work work. Ankylosing spondylitis here I come!

Is it just me...

2007-03-01T17:36:00.000+01:00

...or do most officials/politicians/reps/police-chiefs/ministers sound like total retards whenever they make statements the newspapers?

Hell, even Bush sounds like a retard, but what's new there?

Anyway, I was just browsing through thestar-online, a Malaysian newspaper, when the above thought hit me. Well, maybe it isn't totally their fault, as the journalists involved could have paraphrased what they said. Still, I'm apt to believe that most journalists are more intelligent than most politicians, that's why they're journalists. But that's my humble opinion.

Gah, I'm in a foul mood. I've got 2 more write-ups to finish before noon tomorrow. Back to work. Oh, how I hate the various arthrides. Rheumatology. Gah. It's so not my field.

Random Photo

2007-02-26T01:34:00.000+01:00

Was trying to sort out my photos and came across this one. It's at approximately 1.2 megapixels (unlike most of the pics on my blog, which have been resized to 1024 x 768 at most) in case any of you peeps want it. Yawn. Bed time.

At the moment

2007-02-25T21:17:00.000+01:00

I'm pretty full, having just had dinner and waiting for the heater to do its work before I take a shower. And I'm bored, obviously. So I shall just mention a few things that I've been thinking about.

Have any of you watched 'Neon Genesis Evangelion' (NGE)? I watched it quite some time ago, but I recently got the 'remastered' edition which comprises 26 remastered episodes of NGE and the 'End of Evangelion' (EOE) OVAs. I shall take the liberty of saying that the anime is masterfully executed, and brilliant in the sense that no two people who watch it will interpret it the same. But, I am most definitely disappointed at the 'alternate' ending of EOE. In fact, though many say that the original ending of the NGE series was bad, I say that it was by far better than the ending in EOE. I only hope that the 'Rebuild of Evangelion' takes a more sensible approach and remains true to the first 24 episodes of NGE.

Death Note. Heard of it? Another brilliant manga, with wonderful art and a complex maze of mind games and intrigue. My only regret is that I can't read Japanese and I'm forced to rely on the proficiency of the translators who I hope have done a good job. I haven't watched any of the anime or movies yet, and I hope they don't spoil the manga's presentation or storyline in any way.

I was recently at the Perth Royal Infirmary on an orthopedics attachment. I enjoyed it thoroughly, and thanks to a colleague who picked me up every morning, I didn't have to spend a single night in Perth. However, there is one thing in PRI that bothers me. Wait for it. Ready?

Teletubbies.

There are fricking posters of fricking Teletubbies all over the orthopedics outpatient clinic. Well, maybe I'm exaggerating just a little bit. I suppose the posters are for the kids. Still, Teletubbies, are, in my opinion, among the most ungainly and disgusting things to have ever been created. No offense to whoever designed them, but if I ever saw them as a kid, I'd probably be scarred for life. Even the 'Alien' movies I saw as a kid wouldn't have scared me as much. And, the aliens from the Alien movies look far more appealing when placed alongside the Teletubbies. 'Alien' aliens have those uber-cool claws and spiked tail and who could forget that jawed-and-fanged-green-tongue. Teletubbies are just fricking weird. Fricking ugly and fricking weird with fricking weird names. Jeez. Why Teletubbies posters of all things? Why didn't they put up Sesame Street posters or maybe Winnie the Pooh. Anything is better than Teletubbies. Seriously.

And yeah, I've always been a Stargate fan. I saw the original movie a long long time ago (thanks to an aunt who loves sci-fi almost as much as me) when I just thought that the lewt Anubis and Horus costumes were uber-cool, not to mention those laser-staffs that the characters in the above costumes carried. Of course, it helped that my parents took me on that memorable trip to Egypt when I was still a kid, not to mention the fact that I knew more about the Egyptian gods and afterlife than all the other adults on the tour, save my parents (who read up all kinds of stuff before they embark on a trip) and the tour-guides, thanks to the history books my mum bought. And I've been a keen follower of the SG-1 tv series, until they stopped broadcasting it in Malaysia. I've just watched the director's-cut version of the movie, and it's still pretty watchable and very enjoyable, for such an old movie. That's my biased opinion of it, at least. Most of the reviews on the Internet don't speak very highly of it. Well, whatever rocks your boat.

This is probably my most random post to date. Death to Teletubbies.

May the Force be with you.

p.s. For a more expressive version of this post, replace 'fricking' with everyone's favorite 'F' word. No, not 'fishing'. Not 'farming' either. I don't have to spell it out, do I? And yeah, was tagged by Ken but haven't found the time to post on that. Well, maybe next time.

Success!

2007-02-14T22:01:00.000+01:00

My brain's working properly again, sleep wise at least. Although that little experiment did make me look pretty bleary-eyed in the OT the next day. I got through the rest of the day fine though, but I nearly gave myself a shock with the defibrillator during the acute life support course. Good think I hadn't turned up the dial yet. You're meant to turn up the dial before grabbing the paddles. I grabbed the paddles first! What a mistake to make. On the upside, I managed to intubate the mannequin in less than 15 seconds. Heh. That pretty much made up for my mistake with the defibrillator I suppose. Oh well, time to get a shower.

May the Force be with you.

I need stage 4 sleep

2007-02-12T00:10:00.000+01:00

I've been having lots of trouble with my sleep ever since my first night in Livingston, and though I've been back in Dundee for a week, they're yet to resolve. I get to sleep OK but tend to wake up every couple of hours and I don't seem to be able to get more than 6 hours of sleep at night. Really really odd. I'm guessing that it's my subconscious telling me that I've got work to do.

Therefore, tonight, I'm going to try a little experiment. I'm going to work through the night and morning and the rest of tomorrow without any sleep to see if I can reset my sleeping schedule. As long as I've got plenty of snacks and work to keep me going I don't forsee any trouble.

Not to mention that it would be an excellent opportunity to catch up on my reports.

Off to work.

Back in Dundee

2007-02-04T19:05:00.000+01:00

Just a few pictures of assorted stuff since it's been a while since I posted any pictures.

The cathedral in the center of town. The name eludes me at the moment.
The path we take to the hospital every morning.
23 Kinloch Park. Where I stay. Duh.
Bleak. Yup, the highlands are bleak. And cold. And very windy. But beautiful nonetheless.

Another pic from the highlands tour. Can't remember where though.

Guy Fawkes day fireworks. I'm only putting up one pic 'coz most of the others turned out crappy. Notice the fine wavy paths of the individual streamers. My hands were shivering and I didn't have a tripod.

Malaysian Society gathering.

The view from my front door. The white stuff is ice. Not snow. ICE.More ice. And fog. It was pretty cold during the Christmas season. No snow though. The pic below just shows more ice and fog.

Spiderwebs. The pics didn't turn out as nice as they looked that day. Couldn't find a frozen spider to take a picture of though.

Gammon - Before

Gammon - After. It was good. Ben ate most of it. Monster!

One of the few times when it actually snowed. 'Twas snowing when I took the pic. This was in Livingston. The red buildings are the medical staff residences where I stayed. No complaints, just wish they'd put in microwaves.

That's all for this time. May the Force be with you.

Wireless... need... wireless internet...

2007-01-30T13:01:00.000+01:00

I was hoping to get Friday off so that I could get back to Dundee by Thursday night, and miss the super super crazy crowd rush at the Edinburgh-Haymarket train station on Friday evening when all the folks who work in Edinburgh decide to head home for the weekend.

No such luck.

Because of a very important meeting, my assessment has been postponed from Wednesday afternoon to Friday afternoon.

I hope I have enough food to last me till then.

Oh well, at leastI'll get to put my Tai-Chi Chuan skills to good use when I rush to board the train this Friday.

And it's time to go revise for my assessment.

May the Force be with you.

Curzves Disease

2007-01-24T12:33:00.001+01:00

I came across this whilst reading through a patient's case notes this morning.

>HPC: chronic renal failure (lithium nephropathy), previous Curzves disease.

Wow, I thought, I've never heard of that before! And I'm the kind of guy who prides himself on knowing abut quite a few, uh, unusual eponymous syndromes.

So I looked it up in my clinical specialties handbook... Hmmm, it's not there.

Oh well, let's try Googling it then. Google's reply: "Did you mean: curves disease?"

Hmmm, maybe I did. Let's try 'curves disease' then.

Needless to say, it was a fruitless attempt. I now know that there is probably no such thing as Curzves disease. Nevermind, let's try asking one of the nurses.

So I take the case notes along to the nearest staff nurse in the ward and ask her if she's ever seen those words before.

Her reply: Em, c-u-r-z-v-e-s... ker-zves disease? I've never heard of it dear, you're better off asking one of the doctors.

The duty Senior House Officer's reply: Jeez, what the hell has she got? Did you google it?

Sigh, I give up. I'll just read through the rest of her notes. And after 3 pages of extensive notes documenting her psychiatric history, I see this:

>current meds: olanzapine, thyroxine, haloperidol...

Wait a sec! Thyroxine?

My conclusion: This guy's handwriting really really sucks. It was GRAVE'S disease dammit. Radioactive iodide treatment renders the patient hypothyroid, which is why she's on thyroxine.

May the Force be with you.

Only 2 weeks to go!

2007-01-23T16:22:00.000+01:00

Right, it's my 3rd week of psych here in Livingston and I've got enough groceries to last me till the Friday of my last week before I head back to Dundee; back to my double bed, my double wardrobe, wireless internet connection, a proper shower, my Yamaha keyboard, and a tablelamp! Yes, a tablelamp. I have to study in the kitchen of my Livingston flat simple because it's the only room in the flat that's adequately lighted. And yes, I don't have a tablelamp in my room here, in case you haven't figured that out.

One thing I'm gonna miss is the heating. The heating in my flat here makes my room in Dundee seem like a portal to the North Pole. Ah, the joys of being able to turn the heating on for as long as you want without worrying of having to pay for it! Bliss, I tell you. It might be a little creepy being the only one in the flat, but then again, the flat wasn't really furnished for more than one person. It's definitely built for four people, but it only has one small miserable fridge that's just enough for me but certainly not enough for 2 people even. Especially if they're 2 strangers who cook and eat individually.

Sigh, the only thing I need at the moment is a laser printer. I've been meaning to get one ever since I got here but I haven't gotten down to it yet. Maybe it's because I don't really want my housemates to come into my room to use the printer all the time. Dilemma dilemma. Anyway, I'll worry about that once I get my ethics application form for my 4th yr project sorted out. It's starting to be a real pain.

May the Force be with you.

One week of Psychiatry down.

2007-01-15T18:01:00.000+01:00

Things I learnt last week.

1. There are some VERY ill people out there. Very very ill. Mentally.

2. In psychiatry, the history is EVERYTHING.

3. Keen observation skills count for a lot during a psychiatry history session.

4. Asking 'how do you feel about that?' is generally a good follow-up question to any reply.

5. I'm never gonna be a psychiatrist.

6. Pasta sauce from LIDL is good.

7. Yogosan's yogurt with chocolate chips is worth every penny of the £1.25 per kilo price tag.

8. There is no such thing as 'bad' weather in Scotland. Putting on 'wrong' clothes for the occasion is the socially accepted phrase.

9. Having no internet connection in my apartment sucks.

10. The bacon, chicken, and avocado sandwich from Marks and Spencers is good.

*referring to point 10: Drug reps are really nice people. They bring tons of good food and loads of freebies, and all they ask in return is 5 minutes of your time to hear their spiel. Pretty good deal I say.

Psychiatry block

2007-01-10T17:44:00.000+01:00

So here I am in the Napier University library at the St John's hospital at Howden, Livingston and I'm sitting down at a computer terminal downloading anime and blogging. Psychiatry here is fun. Seriously. And all the JHOs seem to know one another, 'coz they all graduated from Edinburgh uni at the same time. Anyway, I need to get to a place with wifi by this weekend or else I'm going to suffer some serious withdrawal symptoms. Maybe I'll post up some pics then.

May the Force be with you.

Too lazy to update but will try soon

2007-01-04T12:58:00.000+01:00

Well, the past 2 weeks have been pretty enjoyable, i.e. no classes, no ward rounds, no department meetings and no walking to the hospital in the rain. Come to think of it, the weather has been pretty nice and warm for the past week or so. Nice and warm over here means that the temperature hasn't dropped below zero, not even at night. No snow yet, but I've got a couple of pics showing the whole place frosted over, will put them up as soon as I get the photographs sorted out. Yawn.

May the Force be with you.

The Rings of Saturn

2006-12-19T22:29:00.000+01:00

Image from pds.jpl.nasa.gov

Saturn, the sixth planet from our Sun and named after... Saturn of course, or the Greek God Kronos, father of Zeus.

Saturn is a Jovian, or gas giant, and has the most prominent system of rings of the planets in our solar system. The rings, as most of you might know, are the most distinctive feature of this gas giant, and are not solid, as they would appear at first glance, but composed of a million billion willion... well, alot anyway, chunks of ice and rock, which sizes range from specks of dust to several metres across.

The rings were first obeserved by Galileo Galilei, and he was confounded by their appearance at the time, and went on to describe the planet as having 'ears'. Later astronomers, armed with better telescopes, identified the rings correctly, and James Clerk Maxwell, better known for 'Maxwell's demon', theoretically proved that the rings weren't solid, but composed of multiple objects.

Though the rings extend from 6600 km to 121000 km above Saturn's equator, they are, on average, about a kilometre thick. (I would go into the finer details of the rings here, but they're just too many of them. Go wiki them of something...)

And why am I suddenly blogging about the rings of Saturn, you may ask. Well then, Adrian, who lives in the house opposite mine, kindly lent me his collection of Robotech DVDs. In episode 6: Blitzkreig, the Robotech defenders and the Zentraedi (who the heck came up with these names?) battle in... the rings of Saturn.

I'll probably never get a chance to visit the rings of Saturn. The closest I ever got to the rings was in the space-flight sim 'Starlancer', where you fly against the biggest, baddest (but not yet operational) coalition (the bad guys) carrier, the Czar, and the whole scene is set with Saturn and its rings in the backdrop. It was a truly epic moment in the game, and the graphics were (and still are, IMHO) pretty impressive.

If there's one place I could visit before I die, it would be the rings of Saturn.

May the Force be with you.

I get 3 weeks off...

2006-12-15T16:46:00.000+01:00

Just before I have to go to another far-off place for and outblock... Psychiatry, of all things. Gah, I'll probably need to be warded in the same place as the psych patients I'm going to be seeing after the attachment.

Anyway, Boon Hui came up to Dundee on the 12th, and his parents kindly took the whole lot of us, well, 3 of us, me, tim and ben, for dinner at an indian restaurant, with the MOST expensive naan I will probably ever eat. But it was good. Really really good.

With some luck, our landlord will come with our wireless router sometime this weekend and then we'll finally have an excuse to get our internet connection set up, and then I can stop hacking my neighbours... err, never mind.

I'm too much in the holiday mood to write anymore.

May the Force be with you.

Killing time

2006-12-12T15:37:00.000+01:00

So here I am sitting in the computer suite online waiting to go for clinics that start in an hour's time.

Hopefully I'll be seeing a friend who has come all the way from M'sia, because he can afford it and because his uni screwed-up, in a few hours.

Then hopefully, we'll have a really good dinner and chat about the good old days... that were, less than 6 months ago. Back in IMU, where the lecture theatre seats were really good for sleeping in and where food costs a third of what it costs me now.

And it's getting pretty cold here.

May the Force be with me, and all the rest of you.
Especially one particular friend who happens to need a lot of it right now.

Oxygen

2006-12-08T21:49:00.000+01:00

People don't die from hypercapnia (usually...)

People die from hypoxia.

Enough said.

The Mystery of the Missing Sock

2006-11-27T18:20:00.000+01:00

It's time for me to bitch... again.

Wait for it.

I woke up at 0800 this morning feeling pretty good. I had my breakfast at 0845 still feeling pretty good. I put on my jacket, shouldered my backpack, and walked to where we keep our shoes (just inside the front door). I bend and reach for my socks and pull one on over my left foot. I reach for the other sock and...

Hey, where did my sock go?

I'm pretty sure it was right here, yesterday, that is.

Yeah, it was right over my shoe, that's where I put my socks.

Hmm, could I have taken it upstairs? (runs upstairs and searches frantically in my room)

Shit, it's not here. Where the F*** could it be? (runs back downstairs and looks around)

Ok... I'm looking for a sock. It's grey, and patterned in black. It's been with me ever since I got to Dundee.

I like my sock. Alot.

Ah, what the F***, screw it, I'll look for it later, after I get back from the hospital. (runs back upstairs, grabs a new pair of socks and pull them on)

Alright: backpack - check; gloves - check; stethoscope - check; brain - check; cap - check. (opens the front door)

OMGWTF is my sock doing in the MIDDLE OF THE ROAD!!!

Fuck.

(runs and grabs sock, that is dripping wet and pretty much dirt covered from middle of road, picks it up and looks at it)

NOOOOOOO.....

Fuck.

OMGWTF was my sock doing in the MIDDLE OF THE ROAD!!!

*runs random probability program*

Probability: of me sleepwalking and throwing my sock onto the middle of the road = very very low.

Probability: of housemate(s) throwing out my sock onto the middle of the road to piss me off = very low.

Probability: of sock falling into a spontaneously generated wormhole that opened up onto the middle of the road = very very very very low.

Probability: of sock walking to front door, unlocking it, opening the door, walking out, and locking the door without the key, before running to the middle of the road, getting confused, and suffering a massive myocardial infarction (heart attack) = very very very very very very very very very very very very very low.

Probability: of housemate(s) 'unintentionally' picking up my sock and throwing it onto the middle of the road = low.

Probability: of a freak wind entering the house when the door was opened, and my sock was caught in the gust and landed in the middle of the road = very very very low.

Probability: of me being able to cast a teleport spell on a sock = very very very very very low.

*deduction program running*

Based on results of the probability program, a housemate must have somehow been involved.

Here's how I think it happened:

A housemate had to leave to catch a bus, and he was in a great hurry, as usual, and was dragging a trolley-bag along with his clothes and what-not. You know, the kind of bag with wheels on them. He probably dragged his trolley-bag over my socks after displacing from my shoes in his hurry to put on his own shoes.

I'm guessing that he dragged his trolley-bag over my socks and one of them got stuck in the wheels of the trolley bag. He then proceeded to drag my sock to the middle of the road, where my sock finally decided that it had had enough and escaped, albeit onto the middle of the road.

I'm guessing this because the last time he left the house, he dragged his trolley bag over my best pair of formal shoes, Timberland shoes, no less. And he dragged his bag over my shoes not once, but twice, because he forgot something, came back into the house, and dragged his bag over my shoes again on the way out. In front of me, before my very eyes.

Fuck.

But, with insufficient evidence, the culprit may not be apprehended.

With insufficient evidence, who am I to accuse anyone.

Maybe, just maybe, my sock did run to the middle of the road and suffer a massive myocardial infarct.

The Mystery of the Missing Sock may never be solved.

You know...

2006-11-17T13:22:00.000+01:00

You know, winter is fast approaching, if not already here.

You know, it's cold enough that your breath fogs up at 12 noon when you're outside.

You know, it's has to be pretty cold when your landlord is wearing more layers than you.

You know, there's only so many layers that one can wear before looking like a jacket covered chinese yeti.

You know, it's pretty ridiculous for me to have to wear gloves in the house to keep my hands warm.

You know, I think it's pretty cold INSIDE THE HOUSE when your breath fogs up INSIDE THE HOUSE.

You know, it's pretty stupid to suffer in the cold, AT HOME, IN THE HOUSE, wearing several layers, just because some of my housemates are trying to save a few pounds.

You know, for the record, our seniors down the road turned on their heating weeks ago.

You know, just to make it clear, this is a not very subtle message to my housemates.

You know, I think I've said enough for the time being.

Different

2006-11-08T20:35:00.000+01:00

There I was, sitting on a pretty comfortable chair in a hematology clinic and the consultant is examining a patient on the bed. I'm watching him without paying much attention when he suddently turns around and beckons.

Consultant: (to patient) Would you mind if my colleague here had a feel of your tummy?

Patient: Oh sure. No problem there. He has to learn someday.

Cons: Palpate his abdomen and tell me what you find...

Me: Are my hands warm enough? Alright... (starts with light palpation, hmm, whats that in the left hypochondrium, is it a mass? might be the spleen, let's see...) could you take a deep breath for me please...
(hmm... doesn't move with respiration, alright, lets see, starts percussing, hmm, seems pretty large, but the right iliac fossa sounds resonant, hmm, continues percussing, alright, the area around the umbilicus is definitely dull, the mass extends till there, what could it be, percusses some more, alright, it definitely extends to where the spleen should be... palpates some more, hmm... this part of the abdomen seems strange, tough like, but its doesn't feel like he's guarding, hmm, odd)

Me: (what's that crease running across his tummy? well, he's fairly plump, it's probably caused by a fold in the fat, but odd, it's tough like, all along the fold) What happened over here?

Patient: Over there? Aye, my aorta ruptured like, an aneurysm the doctor said then, ruptured it did. They opened me up over there to fix it.

Me: (okaaayyy... scar tissue from the operation, that's why it feels tough, but that mass, is it the spleen?)

Cons: Alright, go on, report.

Me: Okay... No discolorations or obvious masses seen, no visible bowel movements, there appears to be large scar running laterally across the abdomen from an operation in the past...

Cons: Yes, yes. Good. But tell me what you felt.

Me: Well, there's a mass extending from the umbilical area to the left upper quadrant. The upper border is not palpable and is below the costal margin. It doesn't move with respiration, and feels smooth and firm. It's also non-tender.

Cons: So... what do you think it is?

Me: Errr... I'm not sure. My first impression is that it is an enlarged spleen but it didn't move with respiration so I'm inclined to think otherwise.

Cons: How does the spleen normally enlarge?

Me: In what direction? From the left hypochondrium to the right iliac fossa.

Cons: Did it enlarge to the right iliac fossa?

Me: No.

Cons: And you said that it didn't move with respiration. So, what do you think it is?

Me: No idea...

Cons: Alright, I'll give you an idea then. You found out about the scar right?

Me: Yes...

Cons: And how does scar tissue form?

Me: Err.... fibrosis?

Cons: And if there's fibrosis there?

Me: (Bangs head on wall. How the hell did I miss that?) The spleen wouldn't be able to enlarge to the right iliac fossa, and the fibrosis would stop it from moving with respiration as well.

Cons: Excellent. Now, moving on. Can you tell me what disorders might give you splenomegaly?

Me: CML, myelofibrosis, hairy cell leukemia, malaria, thalassemia, polycythemia...

Cons: Good. Now this man presented with... bla bla bla...

How things have changed compared to my days in IMU. Just a reminder to my friends who haven't started their clinical phase yet: What we learnt in IMU is important. When you are examining a patient, always always always start with inspection. The inspection is one of the most important aspects of a clinical examination.

Man, I so miss the times in IMU when we would be practising for OSCE by examining our friends. I don't know if anyone ever noticed, but I was never the one being examined...

Dammit, I miss all the people I used to hang out with back in IMU. Sigh.

May the Force be with you.

Ball Cartoon!!! and others...

2006-10-26T18:15:00.000+01:00

1. The *ahem* now famous, BALL CARTOON!!!

2. A video that was taken when we were in Edinburgh

3. Kat telling us a lame joke before we went out for dinner...

Broughty Ferry... with company!

2006-10-10T15:36:00.000+01:00

A few friends came down from Edinburgh to visit us last weekend. And we took them to Broughty Ferry, 'nuff said.

Jakuns who've never seen a cannon before, sigh, take a trip to Malacca or something.
Just a random pic to demonstrate why it took us 20 minutes to walk 150 metres.
And we couldn't have chosen a better day to visit Broughty Castle, lovely lovely sunshine.
Lopsided photo... and a little blur as well. The wind was so strong that the camera was wobbling about when I put it on my bag to take the photo.
Back row from left: me, Rafiqu, Darren, Ven Gee, Tim, Ben

Front row from left: Victoria, Ai Ling, Kath, Zul, Wei Lun

That's all for this time.

p.s. You really know you should be doing more Taiji when you have dreams telling you that you should do more Taiji...

Broughty Ferry

2006-09-28T13:25:00.000+01:00

And in response to Eve's question, Broughty Ferry is a place...

Yes I know we are damn jakun but couldn't help it...

If u look really hard, u can see the two bridges leading to Dundee in the background. Anyway, this is part of the Tay river.
From left: Rafiqu, Irene, Tim, me. As for the others... Iftida couldn't make it, and the others had already been here, without us. Ben was supposedly hard at work at home.

Hungry hungry swans... a whole lot of them. We were hungry too. And yes, we were tempted to take one home for dinner.

This, my friends, is a katar, all the way from India. It's a thrusting, one handed weapon of Indian origin. I have no idea what it's doing sitting in the Broughty Castle museum.

You don't want to know how much this costs. I will, however, tell you that it tastes pretty good. Here's to the best ice cream on the coast.

Broughty Castle. We chose a really bad day to go. It was raining and really cloudy most of the time. Typical Scottish weather.

That's all for this time.

Labor ward

2006-09-25T10:18:00.000+01:00

I spent my last week in the labor ward, and I have to say that it was very interesting.

Things aren't, however, very interesting when it involves waiting. A whole lot of it.

For example:
0900: arriveed at labor ward
1000: met the patient, asked for consent
1100: been sitting in the labor room for 45 minutes, chatting to the midwife, patient, and patient's husband.
1200: ran out of things to talk about half and hour ago. sitting on a stool reading my clinical specialties handbook. nothing remotely interesting happening at the moment.
1300: went for lunch at 1230. attending a tutorial on eclampsia and pre-eclampsia.
1400: tutorial over, heading back to labor ward.
1500: sitting in the room with patient, patient's husband and midwife. different midwife, the first one went for a tea break.
1600: getting hungry, nothing happening yet.
1700: went to the staff lounge to get a cup of coffee. nothing happening yet.
1800: contractions starting... finally, the patient has been in the room since 0830. well, its only been 9.5 hours, plenty more on the clock. got another cup of coffee.
1900: no new developments. legs cramping up, but it would look really weird if i started practising tai chi there. decided that the coffee in the staff lounge sucks, got some tea instead.
2000: contractions a little stronger, but the patient seems able to bear the pain. Entonox is nearby though. went for a tea refill.
2100: patient has to use entonox now... finally, the action begins.
2200: err... no action yet. decided that the tea and coffee were both below standard. got some water instead.
2300: went home. too hungry, and suffering from caffeine overdose.
2321: got home, prepared dinner, ate, crapped, showered, chatted with housemates, slept.
0132: Zzzzzzz.... rghmztgsmm.... rolls over..... zzzzzzz
0735: wakes up.
0900: arrives at labor ward.
0915: midwife says: oh the patient you were sitting up with, she delivered at 0328.

You get the idea.

I have to say now though, that I really admire the midwives. I have no idea how they cope with all the waiting and the small talk, how they patiently wait around, tending to the patient, trying to keep the medical student from dying of boredom, making sure the patient's husband is there to hold the patient's hand instead of watching Skysports, and all the other little things... which I shall leave my fellow colleague to find out when they are in the labor ward.

Yawn.

May the Force be with you.

My life, at the moment

2006-09-13T11:05:00.000+01:00

Hey there people

I know I haven't updated for a while and it's not because I've been busy, I've just been lazy.

In fact, i'm so lazy that i'm not even going to put up more pictures from our trip to Broughty Ferry.

Just a quick update to let you people know that I'm still very much alive.

May the Force be with you.