Random memories of the past 2 months:

What a twist: 23yo female triaged as anxiety/hyperventilation, turned out to be non-compliant T1DM with DKA (pH 6.9, pCO2 14, HCO3 4, BSL 28 & ketones 5.6), and was admitted to ICU eventually.

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Because we all need to feel appreciated sometimes. This was at the end of a mad busy shift with a shoulder dislocation & 3 GAMPs so I was essentially running fast track by myself whilst my consultant was fixing those with the ortho team.

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Whirlwind trip back to Singapore for Mel’s wedding. And managed to spend some quality time with the family :)

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Inherited Rick’s old iPad for $150 for studying purposes (so I don’t have to lug my MacBook Pro back to SG & then to Europe), I must say it’s been really handy at teaching sessions so far. Study has been going alright. I need to stay focussed and hopefully not burn out, only 4 months to go!

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Intern: Are you on the morning or afternoon shift?
Me: Afternoon.
Intern: Oh, so you just started like, an hour ago. No wonder you look so happy. *slight pause* Well, actually you are happy all the time.

Evidently I do enjoy my work :)

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Med reg to me (after the 4th referral of the day): You’re doing a good job, keep it up.

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It’s kinda awkward when your intern is a maxillofacial surgeon-to-be and you could have possibly referred patients to him in the last 2 years.

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Joy is when you go collect your new pairs of glasses and find out that your health fund covers more than expected thus giving you a refund on your initial deposit. 2 pairs for only $30 out-of-pocket! :) Finally time to retire my 6-year-old pair.

I wanted to start off by apologising for neglecting this space, but really, I don’t know who actually reads my blog, haha.

So the work year started 2 weeks ago and I’m enjoying being back in ED. To be honest, I still feel awkward introducing myself as a registrar. I think I’m worried about the associated expectation that others will have, I’m worried that I’m still not good enough (of course, when are we ever good enough?). However, I must say that I have gotten more prompt/positive responses from specialty registrars, haha.

I was actually quite nervous on the first day, because the consultant who was on was someone I hadn’t worked with before. Of course, my fears were unfounded as she was really nice and gave me heaps of encouragement. You would never guess what happened to me when I saw my first patient of the day – I got punched in the jaw! He was psychotic, and I was trying to examine his hand wounds as he had punched his hands into windows. I think I am too naive and trusting, haha. I honestly didn’t find him threatening and I was more surprised than anything else. Luckily I wasn’t hurt. I need to learn to be more careful next time!

On the second day I got asked to help a HMO with a paed IV bung. It’s nice to be able to help and teach the juniors! Fast track shifts have been good learning in terms of orthopaedic and plastics stuff; did my first femoral nerve block as well (although the patient didn’t seem to get much relief from it, oops). Being the rover and helping with the Cat 2s gave me the opportunity to think on my feet, and to learn how to multi-task and prioritise.

Looking back on my HMO2 year, the first part probably didn’t benefit my learning by much. On one hand, it was great that I had some medical specialty exposure; but on the other hand, having not received much feedback meant that I had no idea whether I was doing things right or not. The 2 weeks of ED in the country were good in the sense that I saw a wide variety of cases and had more hands-on, and it helped point me towards the direction of my future career. The 5 weeks of nights were essentially a holiday; it was so quiet we slept 6h on most nights. Well, on hindsight it was probably an easy progression from an intern to a HMO.

Then came an awesome 10-week ED rotation. Loved every bit of it, and like I’ve said multiple times, I was really lucky to be there during the time of job applications. So thankful to have been offered the job for this year. O&G wasn’t exactly my cup of tea, but at least now I’m more familiar with common conditions in pregnancy (eg pre-eclampsia), I’m more comfortable doing speculum examinations, and if I really have to I can probably help deliver a baby in an emergency. I was a little disappointed that I didn’t enjoy my paeds rotation as much as I thought I would, but better to know now than later. It was a steep learning curve, but I’m glad it has given me the confidence to deal with children and also the chance to practise some IV cannulation and basic neonatal resuscitation.

On the personal front, the bf of 79 months has popped the question and I said yes :) Thank you for all your love and patience, I look forward to spending the rest of my life with you!

2013 has been great so far. I’m so so so happy that I got off to an awesome start in both work and personal life. Can’t wait to see what the rest of the year brings! :)

Happy 2013!

For the first post of the new year, I thought I’d share some articles that I came across recently that I found really insightful.

Dr Roberts, chairman of emergency medicine and director of division of toxicology at Mercy Catholic Medical Centre, writes an open letter on How to be a Real Emergency Physician. Plenty of wise words of advice which I will most certainly bear in mind, of which my favourite was ‘above all, always, always, always be nice’.

Dr Riner, a retired emergency physician, gives a list of 10 things that you could incorporate to your daily practice. I have already done some of them, and will certainly try to keep them up + try out some of the other ones when I return to ED in 3 weeks’ time.

Yes, only 3 weeks to go before I become a registrar – I’m excited but nervous at the same time!

A collection of Instagram photos over this festive period.

Countdown-board on the ward.

Our very first humble little xmas tree.

One of the many presents that the bf received from his students. Awesome drawing!

Attended the bf’s school’s Christmas function, where he performed with another colleague on stage.

My self-created e-card ;p

Thought about this for months before I finally made the plunge; I decided that it would be a reward for getting the job I wanted for next year, and it should satisfy my lust for a Bal bag for now, lol :) Thankfully I found a forwarding company that had reasonable shipping prices, so I paid only about $20 on top of the actual price of the item.

Working on Christmas day = 30% doing actual work + 50% eating chocolates + 20% going around the ward taking photos/having random chats/noticing random stuff (I’m sure people who write ‘pussy tonsils’ do not realise how bad it looks when written).

Boxing day lunch party at the Montgomery house. Kudos to John for organising & preparing this vintage suitcase for our Kris Kringle gifts!

I hope everyone’s had a good year. May 2013 be an even better one! :)

4 weeks into my much-anticipated Paediatrics rotation and I ask myself what drew me to it in the first place.

I don’t know if it’s because of the way this particular unit runs. Different consultants are on call each day, who are responsible for the day’s intake, which means multiple consultant ward rounds a day that can occur as and when the consultant rocks up. The registrar roster is all over the place, with the same reg on for a maximum of 2-3 days at a time. Don’t get me wrong, the consultants & regs have all been very patient and helpful. But because of the lack of continuity, there’s just no real feeling of a ‘team’.

Or maybe it’s because I didn’t like paeds for the ‘general’ stuff. Or perhaps working as a resident is completely different from being a student.

The Special Care Nursery job got boring after a while. Most of the time, it is either potential sepsis admitted for IV ABx, or jaundice admitted for phototherapy, or NAS admitted for morphine, or premature/low birth weight babies admitted for feeding establishment. Every day it’s ‘how is baby feeding?’, ‘is baby gaining weight?’. Yawns. Also, probably because of the demographics of the population surrounding the hospital, we deal with a fair bit of social issues, eg drug use, homelessness, domestic violence. In some cases, these mums need to be hassled to come to the nursery to visit and bond with their babies. Yet there are people out there who want babies but cannot conceive. Ironic, isn’t it. The nurses there can be quite pushy, sometimes insisting on doing things their way, overriding the decisions of the regs or consultants. Yes I respect the fact that you have plenty more experience than I do, but you don’t need to come across as condescending, and you don’t have to put me down in front of my seniors.

The Children’s Ward job isn’t that much more exciting either. Recently it has mostly been asthma, bronchiolitis and gastroenteritis. Most of them get admitted for overnight observation and by the time I see them the next morning I’m doing their discharge paperwork. We’ve got a couple of kids with FTT at the moment, which honestly doesn’t interest me. I think all these growth and development stuff is not my cup of tea. One of them is a 5 month old child who has put on < 2kg since birth (normal is about 1kg gain a month). He’s got good growth in length and head circumference, and all investigations so far have come back normal. We’ve decided that it’s likely due to insufficient caloric intake rather than any organic cause. Mum is adamant about not giving formula because ‘it is not natural’. Like seriously woman, would you rather your child starve?!

Attending elective Caesars is part of our job as well, and sometimes if the reg informs me I’ll go with them to the emergency ones, just to get experience. Went to 10 in total last week, which is more than what I assisted in when I did O&G! (Un)fortunately, all the babies have come out well and healthy, and I haven’t had to do anything more than give one baby some free-flow oxygen.

What drives me insane are the referrals from the postnatal ward. Gosh. I thought I was done with a certain group of people when I finished O&G, but I am still haunted by them every day. I was told that they have to refer anything that is not normal because it is outside their scope of practice. Surely some education on what’s acceptable as normal variants (eg pale red eye reflexes, small fontanelles) can help reduce the number of referrals we get a day? On top of the 3-4 that we have on our list to review daily (eg low birth weight, premature babies, potential sepsis awaiting blood test results, babies on BSL monitoring), we usually get an additional 3-4. Sometimes I feel that we’re practically seeing all the babies on the ward! Seriously, they might as well set aside an hour every day where the babies are lined up for us to review.

We always get hassled to see these ‘abnormalities’ found on discharge checks asap because they are waiting to go home, but please understand there is only one of me (and one registrar), and we have our own patients to see and our own discharges to do as well. Most of the time these aren’t even abnormal anyway. That’s where prioritising comes in, and there is no point telling me ‘not till tomorrow’ when I say ‘this can wait’. It will wait until I have done everything that has a higher priority, and then I will decide whether I can see the baby today or it will have to wait till tomorrow. I’ve also gotten useless pages such as ‘please review new referral on postnatal ward’ with no name/patient details/phone number, and I would have absolutely no idea whether it’s urgent or not.

I don’t know if I’m feeling this way because I’ve had a bad week, but I haven’t really enjoyed myself so far. 8 more weeks to go, I hope things improve. The good news? Now that I’ve tried paeds, I’m fairly certain ED is the right choice for me.

# Day 3
More lectures/symposiums, including the interesting one on Women in ED.

It was also poster presentation day! :)

Headed to Namdaemun market in the late arvo/evening. This is an outdoor market, selling mainly food, socks, T-shirts, bags & souvenirs.

As night fell, it was time to take the cable car up to Mount Namsan to have a view of the city from the top. It wasn’t easy finding our way to the cable car station; there were no signs at all. Thankfully Daryl had sharp eyes! From Myeongdong station exit 4, walk along the main road towards Shinsegae department store and turn left at the traffic junction towards Namsan tunnel #3. You should see the entrance of the tunnel, and you’ll find the glass elevator that brings you up to the cable car station.

Dinner was at Myeongdong again, and this time we headed to Dongdaemun for night shopping. Actually I had already been browsing at the malls over the first 2 nights (like I’ve said, the hostel’s location is perfect!). But there were so many malls anyway so we just went to a one that I hadn’t been, haha.

# Day 4
OOTD: Waterfall Top in White from Agneselle, Tea Party Madness Skirt in Black from The Tinsel Rack.

Skipped the last day of the conference because there weren’t any lectures that caught my interest (it was a half day only anyway). Visited Gyeongbok Palace. The weather was perfect, and there was so much greenery surrounding the palace that made it another pretty place to visit.

Favourite picture of the trip :)

Met Daryl’s friends for lunch at Insadong and then explored the area. There were plenty of shops selling handmade goods & souvenirs, as well as many traditional teahouses & restaurants. No wonder it’s termed the cultural area of Seoul.

Scuba diver tea infuser, how cute!

After which everyone went their separate ways and I wandered over to Samcheongdong, an area with numerous small art galleries, shops and cafes. Where old meets new, restored traditional-style houses and modern buildings sit side by side. I thought I got lost, but that’s the beauty of traveling isn’t it? Found my bearings just as the sun was setting and hopped on the train back to the hostel.

Met Clara & her mum for our last dinner in Seoul, and another round of night shopping at Dongdaemun. Bought bottles of nail polishes at only $1 each!

# Day 5
Plans for my last day got ruined by rain :( Headed to the City Air Terminal at Coex to check in, which then left me luggage-free to roam around during the day. Also cleared immigration, which meant that I didn’t need to go to the airport that early as I could go straight to the boarding gate. Very handy! Wanted to go explore the Ewha Womens University & Hongik University areas (and potentially get a Korean haircut), but unfortunately it was pouring and I was forced to stay indoors.

Shopped around Coex mall but there was nothing that caught my interest. Searched for a place for lunch, and I just chose a random shop where there was a kind-looking auntie behind the counter. Had to have my favourite Korean dish again! :D

The rain did not stop so I decided to head to Gangnam underground shopping mall. Just so you know, it’s located beneath Express Bus Terminal subway station and not Gangnam station. I assumed that it was at Gangnam but luckily I googled the place before I left Coex, phew! The arcade consists of 2 parallel rows of side-by-side shops stretching about 1km or so, selling clothes, accessories, skin care products, and even household products and kitchenware! I don’t think I saw any men’s stuff though. Bought 2 tops & 4 pairs of earrings for $25 :) Also popped into the food hall at Shinsegae which has a massive variety of food stalls (like Takashimaya), but it was way too crowded so I didn’t get anything.

Since it was on the train line on the way to the airport and the rain had stopped, I got off the train at Hongik University and wandered around the area for about an hour. The place was gradually becoming crowded as the day drew to an end, with bars/pubs opening their doors to business. Came across an interesting flight of stairs.

Got caught in the rain walking back to the station but a kind soul offered to share his umbrella with me. Bless him. An uneventful train ride to the airport marked the end of my short trip. Arrived back in Singapore at around 1am, went home and had some durian, slept for a couple of hours, then had wanton mee & chwee kueh for breakfast before my final flight back to Melbourne. Till the next conference! :)

Revisiting Seoul 8 years later, and to be honest, I barely have any recollections of being there before. I’m glad we had time to explore the city on top of attending the conference :)

# Day 1
Arrived at 0730 in the morning & took the train into the city. It wasn’t too difficult to navigate as everything was well-signed. The subway app is pretty handy too. There is an express train & a regular one, but the time difference to get to central Seoul is only 10 minutes and the cost difference is almost $10. I had plenty of time to spare so 10 minutes didn’t bother me. They also have airport buses that bring you to various hotels, so if you have heavy luggages or prefer to travel in comfort, that’s an option too.

I stayed at Dongdaemun Hostel, which is 20m from one of the exits of Dongdaemun History & Cultural Park station. It was extremely convenient as there are 3 lines that pass through this station, which take you to the main tourist places. Also, the malls around the area open till 4-5am, so you can shop till the wee hours and then walk back! The streets were brightly lit and bustling with activity so I felt relatively safe even though I was alone. There is free wifi at the hostel, and a well-stocked kitchenette where you can help yourself to breakfast. The only downside is that the room is really tiny – after taking into account the bed, small wardrobe, bar fridge, table, and toilet (where you had to stand next to the toilet bowl for a shower), what’s left of the floor is just enough to fit a sleeping bag. It didn’t bother me too much as it was just a place for me to shower and sleep. It was clean, and there was warm water, so that was good enough for me. Besides, it cost me <$40 a night, can’t complain.

OOTD: Blazer from Zara, Bliss Flutter Top in Raspberry Pink from Swivelle, Jeans from Giordano.

So anyway, I left my backpack there and headed out. First thing I did was to buy some spicy rice cake from a roadside stall and eat by the stream :D

Walked around the Dongdaemun markets but not many shops were open at 10-11am. Shops selling similar items were clustered together, so you’d walk down one lane and all you see are shoes, shoes, and more shoes. In fact, every shop sold pretty much the same things.

Met up with Daryl and we explored the Bukchon Hanok Village area.

Our next sightseeing destination was Changdeokgung Palace, which housed the beautiful Secret Garden. I reckon we were there at the right season as the leaves were just starting to turn red, giving us picturesque views. For $10, you can get the integrated tickets which will grant you entry into all 4 palaces & the shrine. Do note that some of them are closed on certain days, and English tours run at certain timings, so you might want to plan ahead.

Daryl had dinner plans with his friends, so I went to back to the hostel for a shower before heading out to dinner. The hostel owner gave me directions to a nearby street with plenty of food options, but when I saw ‘chicken & beer’, my mind was set!

# Day 2
OOTD: Blazer from Zara, Must Be Love Scoop Back Dress in Forest Green from The Tinsel Rack.

Spent most of the day at the conference. Got to say hi to Dr Judith Tintinalli (someone called her the ‘Goddess of ED’) & also Dr Scott Weingart behind emcrit.org.

Dinner & night shopping at Myeongdong. Spent $100 at Uniqlo but didn’t buy anything else. Window shopping was fun regardless :)

Yummy potato snack! :D

To be continued…

The short trip to Seoul was a much-welcomed breather away from the craziness & frustrations of O&G. Heard from some great speakers at the conference, and also got massively inspired by the successful women leaders in the field. Did a reasonable amount of sightseeing, shopping and eating too :) And of course, the transit in Singapore allowed me to spend some precious time with the family.

Just some random thoughts about Seoul in general for now. Photos/travelogue to come.

• People have no sense of spatial awareness. I’ve been bumped into so many times that I’ve lost count. And I mean people walking straight into me, which could have resulted in a head-on collision if I didn’t step aside in time. I never once had someone say sorry.
• If you use an iPhone, you are most likely a foreigner. All the locals use Samsung.
• To illustrate how much emphasis they place on skincare: at every major train station there is at least one The Face Shop / Nature Republic / Skin Food / Tony Moly / Missha / Innisfree store.
• I didn’t think there’d be a big coffee culture, but there are plenty of cafes around, as well as coffee booths at most train stations. Average prices are $3-4, which are similar to that in Aussie. The cheapest latte I’ve had cost me $2 and it was decent. Starbucks is everywhere!
• Their variety of knitwear is amazing! The only reason why I didn’t buy anything is because we are moving out of winter (and hence I’ll have to wait 6 months to wear them). Also the fact that I’ll be wearing scrubs most of the time for the rest of my life. Sad fact: I bought a basic long-sleeved top with the intention of wearing it under my scrub top. *The secret fashionista in me is crying*
• Sometimes there are salesmen on the train selling household products. One time we saw the police chasing one down the train carriage!
• Before every train announcement there is a jingle, which has only 2 variations. They’re kinda stuck in my head now.