I know we are already 3 weeks into the new year, but I guess it’s a good time for me to reflect on the past year now that internship has officially ended. It seems quite surreal that I’ve been a doctor for a year already. I can’t imagine having interns coming to me for advice/help. I still feel like such a noob. I can’t see my future. Perhaps it’s the ‘setback’ of not getting the ideal job that I want for this year that’s making me unsure about what I want to specialise in. Perhaps it’s because I’ve found something else that I enjoy doing. I don’t know. But at least I’ve got a few of the rotations that I asked for this year, so it’s a good time for me to figure out where my interests really lie.

Rotation 1 was an ideal rotation to begin the year as a doctor. The workload was manageable and the patients weren’t that sick. Learnt how to manage the bread & butter stuff such as CCF, pneumonia and COPD. However, the downside was the lack of exposure to emergency situations. MET calls were few, and there were usually more than enough people to deal with the situation, so most of the time I just observed. Except on one of the cover shifts where I was the first doctor to arrive at the MET call. Thankfully DRABC sufficed whilst awaiting more senior help. I still remember that I used to make a point to see every single patient I got paged about when on cover, even if it was a page about a BP of 180 or a BSL of 18. Gradually I learnt to ask a few important questions to determine whether the patient needed a review or not, and I was able to give phone orders with more confidence.

Rotation 2 was surgery, which wasn’t my cup of tea to begin with. Early starts & late finishes, intimidating bosses, and a NUM who picked on us didn’t make things any better. But someone up there was kind enough to give me the best colleagues to make up for the job that I didn’t like doing :) People used to call us “The Three Musketeers”, haha. Yes I’ve met many new people throughout the year, but the ones that I still keep in touch with and see outside of work are those that I met in this rotation. It was 1 of the 2 rotations that the team went out – interns, registrars, consultants – and got to know each other better in a social setting. You guys have been a blessing, you know who you are :) I hope we still get to catch up this year despite us going on different paths.

Rotation 3 was a different world altogether. Every patient had their own story, and I still have very vivid memories of some of them. I went on quite an emotional ride but emerged knowing myself a bit better than before. It was nice to be working directly under a consultant, who acknowledged my efforts and talked me through things, good and bad. I’ve said this before, and I will say this again: I have the utmost respect for mental health nurses. They have so much patience, and they have selflessly put themselves in potentially dangerous situations. It was a fantastic learning experience, but I don’t think I can do this for the rest of my life.

Rotation 4 was a bit difficult initially, being 7 hours away from home and having to live by myself again. Luckily everyone got along pretty well, and there were frequent dinners, be it a cook-out in someone’s apartment or going into town to try one of the many restaurants. In the last few weeks we even had weekly drinks in the courtyard and a BBQ as well. This was the other rotation where we interns hung out frequently with the registrars. After all, there were only that many of us around, haha. Only that we stopped hanging out when the rotation ended, ah well :( Anyway, making referrals was stress-free because everyone knew each other and were generally nice. The patient load was heavier than in Rotation 1, but I learnt to manage quick enough. Didn’t mind finishing work late because I got paid for OT, and accommodation was only 1 minute away, so I got home with plenty of time for the evening/night anyway. Had 3 locum registrars in 3 weeks, which was horrible because I had to orientate them and introduce patients to them at the start of the week. But it gave me some autonomy with regards to patient management, so something good still came out of it. This rotation was also where I had my first CPR experience. I still remember it like it happened yesterday, I hope Mr L is resting in peace.

Rotation 5 was a good way to consolidate what I’ve learnt throughout the year. I saw a variety of cases, and I liked the fact that I turned up to work each shift not knowing what I would see. Makes life less mundane, hehe. Shift work didn’t bother me as much as it did some of my other friends, but I have to admit that a few night shifts here & there did make my sleep cycle go haywire and sometimes on my days off I felt so exhausted that I just wanted to chill at home. Worked with a few really awesome consultants, it’s certainly nice to know that people have been saying good things about me :)

In terms of the social aspect of life, like I’ve said, I’ve met many new people at the workplace and have a group whom I meet outside of work once in a while. Still keeping in touch with the old friends, catching up over meals about once per rotation. And still going strong with the bf of 5.5 years :) I also have meals with the bf’s friends sometimes, whether he is around or not. So on the whole, I think I have a decent social life although I have to admit that things are not the same without some of the other meddies I used to hang out with. (Met them recently back in Singapore and we had sooooooooo much to catch up on!)

I still call home via skype once a week like I’ve done over the past 5 years. It sucks to be away from home, but I’m happy & satisfied with my life in Melbourne. I’m glad my family has been very supportive of me all these years and I’m thankful that they are all healthy and doing well.

2011 had been a good year of experiencing, learning and growing. May 2012 be even better :)

Third stop: Hobart
# Day 1
Arrived pretty early in the morning, and I must say that I was quite surprised at the size of the airport; I thought it’d be bigger! We were meant to take an airport shuttle to town, but I got an SMS (that was sent 1h before our arrival time) to say that there were operational issues and they couldn’t take us. WTH?! Luckily we managed to pick up our rental car though we were meant to pick it up in the city later during the day.

Found Tassie Backpackers without too much difficulty after navigating around the one-way streets of the city centre. We paid $28/person/night for the first night in a 3-bed dorm, and then $30/person/night for the next 2 nights in a triple ensuite. With only $2 difference, I don’t see why anyone wouldn’t book the en suite (unless it was already booked out, like it was on our first night). It’s a relatively old place, and the toilets/bathrooms look like they were haphazardly placed in the building. There was a big bathroom with showers, bathtubs and toilet cubicles, there were toilet cubicles alone, there was a toilet cubicle with just the toilet bowel and no sink – you get the drift. It was still clean and comfortable, but I guess we were just a lil spoilt after staying in YHAs, haha.

Anyway, we left our bags and had lunch at Underground 53. The shopfront wasn’t really eye-catching, you could easily walk past it without noticing it. But the place was really cosy and the waitress was so thoughtful. She realised Pek wasn’t there when she served his hot choc (he stepped out to go look for his sunglasses strap after we had ordered), and she said we should have told her so that they could have made it later and it’d still be warm when he returned :) They serve an awesome vanilla chai latte btw! I think Fi liked the spiced chai latte too.

Headed to Mount Wellington after that and drove all the way up to The Pinnacle. It was cloudy initially, but thankfully the clouds cleared up so we enjoyed the breathtaking views!

Jumping again. People must have thought that we were crazy.

And even more crazy, we went to plank on the rocks (I’m sure planking must be outdated by now…)

Doesn’t this look like a Hyundai Getz advertisement? Hehe :)

Drove down and stopped somewhere to take a short walk to O’Gradys Falls. And then drove further down to Fern Tree where we went on the Fern Glade track to Silver Falls and back.

Had dinner at Annapurna, I guess we all missed rice by then, haha. Had the Masala dosa, Butter chicken, Mushroom cheese pakora, Dal & lassi. Felt that they toned down on the spices, perhaps to suit the local tastes. Still good nonetheless!

# Day 2
White water rafting on the Picton River! :) We almost missed out on this because there had to be a minimum of 4. Eventually we were prepared to pay for the 4th person so that we could go ahead. But we got lucky and there was another group for the day, so glad it worked out! Plus we still had a raft to ourselves, which was awesome. Photos credit to guides/other rafters.

We stopped on the way back at a town called Franklin. Had a bite at a random Western/Vietnamese fusion cafe that served an awesome seafood chowder! Pek said he would come back to Tassie and drive all the way out here just for this ;)

# Day 3
Headed down to Port Arthur for the Tasman Island Cruise. It was gloomy but at least it wasn’t raining. To prepare us for the rough conditions of the sea, we were clad in these orange wind/waterproof jumpsuits which look like spacesuits, haha.

Took a short bus ride to Eaglehawk Neck where the boat was waiting. To be honest I was a lil nervous given my previous seasick experience. Thankfully I survived, and even managed to sit right in front of the boat! Either 1) the dimenhydrinate that Pek gave me worked, or 2) the ginger tablets the staff gave us worked, or 3) the seas weren’t too choppy, or 4) all of the above.

The tour ended about 1ish. After asking for recommendations, we headed back to Eaglehawk Neck for fish & chips out of a caravan. Follow the signs to “The Blowhole” and you’ll find it in the car park. Awesome scallops :D

We explored The Blowhole, then drove a short distance to Tasman Arch and Devils Kitchen. Interesting rock formations/sea caves made by nature.

Visited the Tasmanian Devil Conservation Park after that. Not only were there the devils, there were also quolls, kangaroos, birds & eagles.

Ended our day by going to the Remarkable Caves, which weren’t quite remarkable after all. At least there was a beautiful coastline!

Had dinner at Fox & Hounds Inn, which was probably the worst meal of the trip. Maybe Fi & I ordered the wrong dishes; Pek seemed quite happy with his lamb cutlets. When night finally fell, we went on the Ghost Tour at Port Arthur Historic Site. I must admit that I was a lil freaked out :( Unfortunately we didn’t have enough time (given that we went for the half-day Tasman Island Cruise), I would have liked to explore the Isle of the Dead & Point Puer Boys’ Prison, maybe next time.

# Day 4
Spent the last day exploring the city itself. Had brekkie at Machine Laundry Cafe at Salamanca Place, then walked up & down random streets. Too bad our visit didn’t include a Saturday, so we missed the Salamanca market.

Bought ourselves a souvenir each :)

The adventure ended back in Melbourne where we spent the last day along the Great Ocean Road. It’s my 5th time in 6 years, but I guess it’s on the tourists’ checklist so I had to bring Fi there haha. It’s my first time in summer though!

We stopped at Torquay for brunch and window-shopping, where I found a pair of Oakley aviators that actually fit my face (miracle!). Was thinking about buying it for myself for Christmas, given that the coating on the lenses of my current pair is peeling off and I’ve been too lazy to get it fixed. But I still like my current frame a lot, so I was going to go home and think about it. Besides, I don’t usually buy things on impulse, especially something that costs $260. You should have seen my hesitation before I finally bought my first pair of Oakleys. Anyway, I had a pleasant surprise when I got home, the boyfriend had bought it for me! Thank you dear :)

Stopped at Bells Beach, Kennett River (walked down Grey River Road to spot koalas in the wild), Apollo Bay (for the famous ice cream), 12 Apostles, and Loch Ard Gorge. They found it quite repetitive after what we saw on the Tasman Island Cruise. I probably didn’t give Melbourne/Victoria enough justice, but then again, they planned it such that we only had about 2.5 days here (maybe because I live here and Pek’s been here before) so there were limited places I could bring them to.

Anyway, it was a good break from work and I thoroughly enjoyed myself with these 2 buddies :) Ending off my travelogue with more jump shots!

Second stop: Sydney
# Day 3
After 2 gloomy days, the weather was finally kind to us. We took a ferry from Circular Quay to Milsons Point, so as to walk back via the Harbour Bridge. We didn’t do the bridge climb due to the cost, but you could get pretty good views just being on the pavement. We did, however, go up Pylon Lookout to get a better view.

It was 11ish by the time we got back to The Rocks, and we were famished! Got some yummy gourmet wraps & freshly squeezed juice at the Foodies Market and then sat by the harbour to eat.

After filling up our tum tums, we roamed the streets of Surry Hills, visiting antique and boutique shops. There were some interesting finds but unfortunately not everything was affordable. Good to look at still! We discovered Butt Street:

Had our afternoon snack at El Loco – nachos, burritos, margaritas! So glad they had salsa that was actually spicy :D

Then we walked back into town and had a lie-down on the grass at Hyde Park, joining in on Aussies’ favourite activity, haha. The walking continued afterwards, as we wandered to Darlinghurst and Kings Cross, before finally taking a bus back to Central. How’s that for a day of walking? ;) We had 羊肉串 and BBQ squid at the Chinatown food market, and Chinese desserts at a shop which I can’t remember the name of. Though I remember we sat beside a window and saw the super long queue of the prata shop next door. Walked to Darling Harbour (again) and took the ferry back (again).

# Day 4
Time to escape the city and enjoy Mother Nature! We took a morning train to Katoomba, Blue Mountains. Our accommodation, No. 14, was just a stone’s throw away from the station, though we had to navigate up a steep slope, haha. It was only 10ish, but the kind lady boss cleaned up the room swiftly and allowed us to check-in. It was a cosy little house, kinda wish we had a few more nights there!

Checked out a couple of antique shops in town before taking a bus to Echo Point to see The Three Sisters.

We began our hike – down the Giant Staircase into Jamison Valley, along Federal Pass, and arriving at Scenic World where we took the Scenic Railway back up.

Had some trouble finding the bus (don’t know whether we fail or person who gave us instructions fail) so we walked back to town. It wasn’t too long a walk and the weather was pleasant, so it wasn’t too bad. Passed by some pretty houses along the way, including one that was engulfed by an overgrown tree! Dinner was at Gustissimo, where we had the bread with garlic butter, duck ravioli, triple bypass pizza, and dessert trio. The tiramisu was to die for! :D

# Day 5
Canyoning at Sheep Dip & Rocky Creek! Probably my favourite day of the trip :) I had never done this before, and it was certainly heaps of fun sliding down natural water slides, jumping off waterfalls, swimming in 14-degree cold water, and scrambling all over rocks! Wasn’t at my fittest so was quite exhausted towards the end; imagine my horror when I realised we had to trek uphill back to the car :( Thankfully I had my buddies to cheer me on! Photos credit to Pek.

We were meant to have a ‘snack’ whilst waiting for the train back to Sydney, but ended up with a massive meal of pumpkin soup, wedges (sooooo good!), scones and coffee/hot choc at some random cafe. Spent the next 2 nights in Sydney at YHA Central instead, just for a change. It was $54/person/night for a twin + extra roller bed + en suite. Slightly more expensive and older than the one at Sydney Harbour, but still clean and more convenient; it was just across the road from Central Station and there were more food places/bars within walking distance.

# Day 6
It was yet another gloomy day :( Started the day by having a feast at the Fish Market. The sashimi was really fresh, but unfortunately the person who prepared it was no sushi chef so they weren’t properly sliced. Oysters were big and juicy, and the flatfish/whiting/calamari were awesome too :D

We then headed to Bondi Junction where we did a bit of window-shopping, given that it wasn’t beach weather at all. Fi took a while to decide but settled on a plain red Country Road bag in the end. Strolled towards the beach but missed our turn and walked all the way up to North Bondi/Rose Bay haha. FYI if you’re walking down Old South Head Road you need to turn at Curlewis Street!

The weather didn’t pick up, but at least it wasn’t raining. What do you do when it’s windy and chilly and you can’t surf? You attempt at jump shots to keep warm :)

Had our usual arvo coffee, browsed through a few shops in the area, then turned up at our dinner appointment an hour early because there wasn’t anything else to do. Thankfully they managed to accommodate us. Finally got to try the much raved about ribs at Hurricane’s! They were soft and melting off the bone, but you’ve got to eat them quick because they aren’t as nice when they turn cold. 2 full racks + Caesar salad + side dish of garlic mushrooms was certainly enough for the 3 of us. I think the general consensus was pork > lamb ribs.

So that concludes our Sydney leg of the trip, onward to Hobart! :)

I’ve been dying to travel to somewhere I’ve never been, but I didn’t really have a travel buddy and 2 weeks seemed a bit short for Europe/US/Africa. Was thinking about traveling NZ alone, but then Fi told me she was planning on coming to Australia for a holiday, so we made plans for an Aussie adventure :)

First stop: Melbourne.
# Day 1
Picked them up from the airport, had lunch at Mr Burch, then off to Philip Island we went. Visited the Koala Conservation Centre, where we almost got peed on by a koala up in the trees. Hung out on the beach at Cowe, where we fended off seagulls as we had our fish & chips. Then ended the evening at the Penguin Parade, where we braved the massive winds and the cold to catch those cute little happy feet in action.

# Day 2
The next day, we roamed the streets of the city. Walked along the Yarra, had baguettes & waffles at Waffle On, took the city tram up to Queen Victoria Market, had Bratwurst sausages, admired the graffiti along Union Lane, and stopped for a drink at Brunetti. Brought them to Springvale to have Pho for dinner.

Second stop: Sydney.
# Day 1
We headed straight to our accommodation (YHA Sydney Harbour) after landing at the airport. The place was new, clean, and had a roof terrace where you could enjoy a view like this:

Paid $47/night/person for a 4-bed dorm with private bathroom. On the first night there were only the 3 of us in the room, but there was someone else on the other 2 nights. Didn’t really bother us much given that we got back at 10-11pm and all we did was shower/sleep. Only bad points I can think of are that it’s a little inconvenient as it’s not right in the city centre, and it’s a 5-10min walk from the train station with a couple of stairs to climb. Still, I would highly recommend this place!

Anyway, we checked-in and went to get lunch. Picked at random The Rocks Cafe. Liked the ambience, and the food was good too :D

Started drizzling/pouring after that, which kinda dampened our mood :( But we still headed to the Opera House as planned.

Afterwards Pek went for capoeira, while Fi and I walked around Darling Harbour having our girls’ night out. We took the ferry back to Circular Quay and attempted some night shots along the way. By the way, we bought the MyMulti3 ticket, which costs $57 for a week of unlimited trains/bus/ferries/tram – gives you heaps of options/freedom regarding public transport!

# Day 2
Skydive the beach at Wollongong. Jumped out of a plane at 14,000 feet! Need I say more :)

Had lunch at Diggies Cafe. We were absolutely famished after the jump!

Hang-gliding was the next activity on our list but unfortunately the winds did not permit. Headed back to the city and had ramen at Gumshara, which was highly recommended by a few friends. We felt the soup was a bit too thick and salty :( But the egg was awesome, it’s a must-add!

Walked around Darling Harbour again, thankfully this time it wasn’t raining!

Got some yummy desserts from Adriano Zumbo at The Star, and we sat at the ferry pier in Pyrmont Bay eating whilst waiting for our ferry. Yes, the ferry had become our means of transport and not just a touristy thing, haha.

To be continued!

Sorry I’ve been MIA. Since the last post I’ve had 2 weeks of annual leave, which I spent exploring Melbourne/Sydney/Hobart with 2 awesome mates (will endeavour to blog about it at some point). Then I had a difficult time getting back to work after leave. Ah well.

And before I know it, it’s the last day of the year now. Oh how quickly this year has gone by. Not quite in the mood to do a ‘reflection’ post, because I’m absolutely exhausted from my shifts and I have one more tomorrow before a day off. Realised that I have this draft post saved but not published, so I shall just leave my readers (if any) with this for the time being.

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Acted like a dental nurse when I assisted my reg in temporarily fixing back a tooth that had fallen out post-seizure (with blu-tac and aluminium foil!). And then another day I saw this old lady post-fall who was spewing blood from her mouth. My consultant moved her to resus because she wanted to have a better look at her mouth, and good thing she did because the patient suddenly became bradycardic/unresponsive. It was likely a vasovagal, but got us all panicking a bit because we were having trouble getting IV access. Eventually we managed to stop the bleeding, and the dentist came to suture up whatever that needed to be sutured. They were reminders of why I was never, and am still not, keen on dentistry.

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Was going to see a 36yo man with a new Dx of glioblastoma multiforme but the neurosurg team was already here. Didn’t get to speak to him, but saw his CT pictures. So young, so sad.

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One night I saw this lady who was transferred from one of the country hospitals. She was pregnant, and had hydronephrosis/pyelonephritis. The U/S she had didn’t say explicitly whether there was obstruction. I was speaking to the urology reg and he was teaching me a thing or two, telling me that stenting is not ideal for pregnant women (cos as the uterus enlarges, the stent can become blocked again) so they usually do nephrostomies. Interestingly enough, 2 weeks later I saw another pregnant lady with a nephrostomy tube in situ because she had a 1.5cm calculi in her right VUJ.

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Dissecting thoracic aneurysm! Not my patient, but I was being a busybody and had a look at the images. They took him to OT and I was glad to hear that he survived. Unfortunately I heard he had an intracranial haemorrhage a few days post-op, I’m not sure what happened after that.

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Renal cases. Someone came in with a blocked AV fistula (I managed to cannulate him with 1 go, happy!). Someone else came in with acute-on-chronic renal failure with hyperkalaemia of 7.2 and peaked T waves. The renal team came very promptly, and he had a Vas Cath in for immediate haemodialysis.

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Bony injuries post-mechanical falls. One lady had a fractured rib. The other had a fractured mandible + full-thickness chin laceration. Poor lil old ladies. I hope that doesn’t happen to be when I’m old :X

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Had a 22yo lady who just returned from Thailand with diarrhoea and ? ascending weakness. Thought she might have Guillain-Barre, but on examination she was neurologically intact and reflexes were present. She had this odd tic-like movements (consultant called it truncal ataxia, patient says she feels “wobbly”), which seems to be anxiety-related. It was just quite bizarre.

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Had to refer to ortho one evening and the reg was really nice! I guess I should stop stereotyping, haha.

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Lady at switch: So you want U for the drains and not N for the brains?

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Had my first “acopia” patient this rotation. It was 11pm and Bed Brokers was closed, so we couldn’t get him a private bed even though he’s got a DVA Gold Card. Had no choice but to refer to the med reg. Thankfully he was really nice. I know it’s a crappy admission, but like my consultant said, we can’t send him home. What to do? :(

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Asked to request for abdo U/S for a 46yo lady with epigastric pain, 3rd presentation in a week, ex-ETOH abuse, normal WCC/LFTs/lipase.

Radiology reg: So what if you could only order 1 test, abdo U/S or gastroscopy, and if you don’t pick one the world will end.

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From a patient who came in with dizziness/chest pain/back pain (and a million other complaints), with absolutely normal examination & investigations: ‘Your air con here is so good. If you send me home I’ll just ring the ambulance again.’ OMG, KILL ME PLEASE.

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Happy new year folks! I hope you’ve had a great 2011, and may 2012 bring more joy and love :)

Looking back on my recent posts, they’ve all been wordy, work-related stuff. So I’ve decided to create a post of selected photos that I’ve taken randomly with my iPhone this year. After all, we’ve arrived in December now.

A tier of yummy cupcakes, lovingly made by a student’s sister.

Moby has grown.

A thank you gift.

Managed some volunteer work despite my busy schedule.

My first T&Co piece, thanks to daddy.

Pretty packaging that I almost couldn’t bear to open up.

For our favourite surgical registrar :)

Go bangs!

Best page of the year :)

My first conference, which made me seriously consider taking some time off to work/volunteer in a developing country.

One of my favourite photos of the year :)

Me typing up notes for the SSU patients that we’ve seen so far that morning.
Consultant: Stop what you’re doing. Notes can wait. I’ve got a more important job for you.
Me: ?? (thinking he wanted me to make a referral or something along those lines)
Consultant hands me a list of coffee orders.

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Picked up a random phone that was ringing even though I hate doing it because it’s the right thing to do. On the phone was this agro lady who said she was in ED the day before with lumps in her neck. The lumps were not resolving and she’s feeling worse today. She said she wanted to speak to the doctor who looked after her yesterday. I had to wait for a bit before I could pull up her records because the nearest computer was in use. She started saying stuff like, do you want me to just die here. Patience, my dear! Anyway, I looked at the notes and told her the doctor who saw her wasn’t working today. Apparently she was for admission yesterday but she refused. I advised her to see her GP but she didn’t want to and started threatening to turn up to ED to kick up a fuss. I told her she could most certainly come to ED again if she wanted to, but she didn’t have to kick up a fuss. Well, at that point I felt I wasn’t going anywhere with her so I handed the phone to my AO for help. After he hung up the phone, he told me there’s a nutcase coming my way haha. Thankfully I finished my shift before she turned up :S

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Palpated a pulsatile liver! This was a patient with severe TR & right heart failure. So thankful my reg shared the case with me :)

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Had a 29yo lady with ruptured Achilles tendon from playing badminton, ouch!

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One of the senior regs told me I was doing a good job and that I was better than most of the other interns she’s worked with :)

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Consultant: Wow, you’ve got 100% on your diagnoses today.

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Had a good chat with one of the registrars who is a dual trainee in RACP/ACEM. She’s passed her RACP and will be taking her ACEM soon. It’s been 10 years since she graduated. Respect +++. Don’t think I’ve mentioned this in my previous blog posts, but I didn’t make it to the kids this year and will be doing a general HMO2 year. I would be lying if I said I wasn’t disappointed at all, but I’ve been trying to look on the bright side – having more experience in other fields, having more time to decide what I actually want to specialise in. Talking to her helped reinforce these positive points, and she gave me a better idea regarding training through the paeds route VS the ED route. No rush Jas, no rush.

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Successfully DCR-ed a patient, whee! :)

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One of the consultants was so nice, he made sure to come look for me when he had something interesting. There was a patient with a tick stuck on her calf, and he let me pull it out. It was kinda cool but gross at the same time, haha.

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Someone called me the “subdural magnet” cos I had 2 such presentations in 2 nights.

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Positive Pemberton’s sign! :)

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Remember that “nutcase” I mentioned previously? She rocked up again and I picked her up unknowingly! Thankfully she wasn’t mean/aggressive when I saw her. She’s got cervical & inguinal lymphadenopathy, hepatosplenomegaly. After chasing up all the results of the tests she had on her previous presentation, the final Dx was Hep C!

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Reg: There is only 1 indication for an AXR, and it’s not to check for constipation.

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Found out that homemade cookies go a long way; simple to bake, and makes everyone happy. The consultant wrote a note saying ‘D’s cookies, eat them and you shall die’ and stuck it on top of the box. Haha. The things that happen in ED past midnight :)

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3 weeks to annual leave, can’t wait!

Can’t believe the year’s drawing to an end, 2 more months to 2012, and I’m wondering if I actually achieved anything this year.

Finished my first week in ED and I have to say that I’ve enjoyed myself so far. The first day wasn’t too exciting as I spent the morning doing a few jobs for the SSU patients, had 2+ hours of orientation, and then had an hour left which was spent seeing a patient with a perianal abscess. Had 3 days off afterwards, which was a much welcomed break.

Following that I was scheduled on for 3 nights. I had never done a night shift before, but the sleep thing didn’t end up to be too difficult to manage. So on the first night, I introduced myself to the consultant when I got there, and picked up my first patient. Mid-way through, one of the regs interrupted me to introduce himself, and to let me know that he was i/c that night.

T: So, essentially it’s your first shift tonight. Are you scared?
Me: Kind of, I don’t really know what to expect.
T: You don’t have to be. I’m here. ED is the best time for you to do what you want to do, you have the autonomy, you think, you try to work out what’s wrong. And if anything happens, it’s my responsibility.

Aww. I guess that made me feel slightly less nervous :) He’s so easygoing, which made work a breeze. Eg I was checking electrolytes for a young patient with gastro and he said that wasn’t necessary. I’ve noticed he tends to not over-investigate, and he’s got a relatively low threshold for discharge. Last night a different reg was i/c and she was much more conservative. Apparently it depends on where you’ve been training / who you’ve been training under. Well, I guess it just gives some food for thought regarding how to strike the best balance. It seems like everyone’s afraid of litigation these days.

Anyway, haven’t had any major dramas; most cases I’ve seen were straightforward. In fact, I was on such a roll that I saw 7, 8, 5 patients respectively over the last 3 nights (and the reason why I saw only 5 last night was because it was scarily quiet). Procedures wise I’ve done a IV bung, IDC and backslab. The nurses are so good that patients usually have bungs/bloods taken by the time we get to see them.

I’ve been made to realise that we might not necessarily work out the Dx itself in ED. I was told that our job in ED is to provide immediate Rx, and then to decide whether the patient is well enough to go home or unwell enough to be admitted, in which case we make the referral and the admitting team can take their time to do a full work-up.

I can see why a lot of people I’ve spoken to hate ED. But 1) I don’t mind the shift work, 2) I like being the first person to assess the patient to decide on the next best step to take, 3) most of the time it doesn’t really bother me not knowing what eventually happened to the patient, and 4) I come home not having to think of my patients (on other rotations sometimes I worry about my patients overnight/over the weekend etc).

Going well so far, but it’s only been a week. We’ll see how things go. I was asking T about studying for primary exams, and he’s like, can you please just enjoy being a doctor for now. Haha. He told me not to rush into things (he dropped ortho for ED), which is fair enough. I’m just thinking ahead and asking/sussing things out early! He put a huge smile on my face this morning when he said: thank you, I’ve enjoyed working with you, you’ve done well, and I’m sure you’ll continue to do well :)

Off till Thurs, and then I have 4 days + 4 nights in a row. Need to recuperate!