Tuesday, October 6, 2015

Stage: Consciously incompetent.

I will not be surprised if a patient decides to shout at me or hurl a filled vomit bowl at my direction one day. I mean, if I am feeling sick as hell, confused, half deaf, half blind, half naked, hungry and old, the last thing I want to experience is having an utterly dumb medical student, who has no idea what she is doing, to repeatedly stab my arm with a needle, while 'attempting' to take my blood but ended up with nothing so the nurse has to stab me again.

It's my second week in the ward now. I am still very happy to be part of the 'student doctor' team! Unlike the pre-clinical years, I am experiencing completely new, unique things every day and I am meeting new people every single day! When I wake up in the morning, I have no idea who I will meet and what I will see in the hospital, but I am excited to be there and to learn.

The thing is, I am also slightly frustrated at the moment. If you know the 'conscious competency' learning model, I am currently at the consciously incompetent mode.  (When I was told pre-clinical students are unconsciously incompetent, I didn't believe it. But it's probably true.) 

For instance, when I listen to a heart, I know it's abnormal, but I can't tell what's wrong with it. Then I learned that any heart sound that you hear aside from the 'lub-dub' is a murmur. So I spent ages trying to figure out what kind of murmur that is, but I still have no idea where on earth does it come from or whether it's a stenosis or a regurgitation. I feel even worse when my patient starts quizzing me what murmurs does he has when he knew his diagnosis. What a joke. (If I manage to make the patients feel better this way, good then. At least, I am somewhat useful. :/ ) 

Even frustrating is the fact that I can't remember much from my pre-clinical years. All the anatomy, all the pharmacology, all out of the window. There are instances that I recognise a drug name, but have no idea what does it do; there are instances when I don't even remember seeing that word before! Eg. I don't remember reading about 'brachiocephalic veins' until I re-read my notes from first year this morning. (Apparently, they are pretty damn huge and important veins, which obviously everyone knows) So much for doing the most expensive anatomy course in the world...

It's almost like I have complete amnesia sometime during the past 3 years that I almost have no recollection whatsoever that I learnt those stuffs before! Or probs, due to the concussion i had on my head a month ago...hmmm

I have to learn the millions of new stuffs out there while trying to remember the millions of facts from the past. Not that I don't want to learn them. The fact is, I really hope I know all of those things now. I really hope that I will be as capable and as smart as the qualified doctors now. I really hope I am that bit more competent now so I can be useful on the ward and actually help my patients, instead of doing practice examinations on them when they should be resting. No wonder many of them wants to charge us students for each examination we do on them (I can assure you they are joking). 

I really don't mind spending that bit more time to learn, if that's what it takes to get me there.
Oh brain, work please. 

Monday, September 28, 2015

Musings of an amateur 4th year

So..this is it...year 4, my first clinical year. I was looking back at my first post on this blog when I have not even step foot on this amazing British ground just 3 years ago and now, look at me! I'm entering my 4th year here. This is an exciting year for me because

1. it's my first year in the hospital, doing real medicine and touching real patients (instead of body parts..) 
2. I'm in clinical school with my amazing friends and my <3! 
3. No more essays! 

I have to be quite wary on what I put up here due to patient confidentiality and I really do not want to get referred to the GMC. I hope I won't. Anyway, most of the time, I talk non-medical stuff, instead of work. To make this post less boring, I'm going into this schizo mode of asking myself a series of question and answering it on my own, just to stimulate my own thinking and reflect on it. So if you think I'm going bonkers, don't mind me. (btw, that's my essay writing style for the past 3 years - yeap, schizo style.) 

So how has medical school been so far? 
It has been tremendously amazing. Term time for clinical school in Cambridge is wildly different from the normal university terms. Actually, everything is different. We started our first term in early September, so I have just finished my 2-weeks intense, introductory course. We learned how to do basic clinical examinations (CVS, respi, abdo, neurology, MSK etc), how to take blood/phlebotomy (more like how to stab each other without bleeding each other too much) and how to navigate around the clinical realm, physically and on that ever-so-confusing online portal. I really enjoy my first 2 weeks because we are no longer confined to the lecture theaters and libraries, and we are actually supposed to go onto the wards and talk to as many patients as possible. I just finished my first day on the ward, and with my very productive/intense/helpful partner on the ward, I had a really interesting and productive first day, learning how to take histories and do examination, without supervision! (wow, much freedom!) Don't worry, we are not doing anything mildly harmful at all, we just talked and examined them with their consent, so even if this medical student species is completely stupid and incompetent, we are not harmful at this stage. Well, at least, not yet.  

Which part of medical school do you enjoy most?
I love talking to patients! I love listening to their stories, their experience, their life or simply, how has their day been. They can go on for hours and I love it, though I still find it a bit hard to understand some of them sometimes because of the accent and some of the slang. I am absolutely useless in abbreviations, so when ppl start using it, I'm lost. Besides, everyone in the ward is SO FRIENDLY, it's unbelievable. It's so different from the hospitals I've been to in Malaysia. They are so helpful and lovely that it's totally no problem fitting in. I just need a bit more guts to talk to everyone. Also, I hope that my examination skills will be much better sooner so I can find out what's wrong with them and make myself useful on the wards sooner. 

I am also enjoying the freedom. As long as we attend the compulsory teachings, we are free to roam for the rest of the time, or we can just go home. In fact, I'd like to experience how it's like on the ward overnight one day. Just to see if there is any horror interesting stories to tell the next day. We are basically responsible for our own learning and are treated like proper professionals now, instead of confused/wild undergrads. .  We are 'suppose' to act like a doctor because people don't know the difference between a junior doctor (who is a qualified doctor) and a student doctor (essentially, medical students). So we are seen as part of the profession and expected to dress and behave like one, regardless of our empty cranium atm. -_-" (we've been taught to fake our confidence even though we have no idea what we are doing. It's a trick, GUYS!)

I love Sherwood Room. It's a room equipped with we students get to chill and eat

Also, since we don't have essay crises on weekends like in undergrad years (muahahahahah.....), we get our weekends off! like really off! It's too good to be true, for Cambridge standard. So I went to church, learned how to play badminton with Mr. K, went to BBQ and play croquet, cooked good meals, read half of a random book (k fine, not exactly random, it's an ECG book) and spend quality time with Mr K. It's like...a perfect weekend.

Which part do you fear most?

Which part do you think is the most awkward part? 
I haven't done any intimate examination so I am not sure if I will be awkward for that. I only did examination that requires me to touch the breast but as a girl, I really don't feel awkward at all and the patients, both female and male, are generally at ease with me touching them. It's a different story for my male colleagues. So I feel female doctors have a huge advantage in building rapport and doing examination in this sense.

But atm, the hurdle I have to get through is to understand the MANY accents GB has and try to put up a proper one, speak in a concise manner and speak up in a louder voice, so people can understand me. Malaysian accent is a NO-NO. 

So...so far so good. Life has been pretty amazing. I will try to update more often and share with you how's like being a real medical student :) 

Wednesday, July 22, 2015

Rules? What rules?

It has been 2 weeks since I was back and I have been waking up at 7 am almost everyday since then, except during the long weekend of Raya. . The morning sun was beaming, a tad too bright, directly into my eyes. I could somewhat see the Petronas Twin Tower and KL Tower in the distance, but the rest of the city scape was just a blur because of the haze. I've not seen a clear city scape since I came back. I wonder if haze is a norm now, because I remember the last I came back, I still hear the radio reporting every time there's a haze, but I don't hear anything like that now.

I was driving at about...100 km/h (please don't report me) and I saw a police sitting by the highway. I shrugged my shoulders and continued speeding. I used to slow down to the speed limit whenever I see him last week, I was anticipating for a police barrier in front to catch whoever's disobeying the traffic rules. But this morning, I thought 'he's sitting there every single morning anyway and he doesn't do anything, why should I bother slowing down?' Really, he's there every morning. But he's always looking down, probably at his phone... I wonder why isn't he more eager to fine those who break the rules, after all, he will get more 'pocket money'. Pocket money? You may ask. Yes, why not? Just turn on the radio and television and go online to read the news, I think our people's ability to perform advanced bribery and corruption, top to bottom, is worth to be our next national pride. 

After dodging several 'professional' drivers who think signal lights are only for decorative purposes (no wonder so many Malaysians have high blood pressure), I reached office parking lot at 8.29 am safely. I am rather proud of my fast reaction on the road. I locked my car and pulled the door handles a few more times just to make sure they are really locked, just in case, people try to break in. Even though this is the territory of our country's federal government, it doesn't harm to be cautious. After all, the security guard only guard those big black cars in front of the buildings. Who cares about my humble (but cute) MyVi? 

I thought I'd be late for clocking-in so I ran up to the machine at 13th floor. To my delight, the clock on the machine showed 8.27 am. Someone must be rewarding me for being late, I earned an extra 3 minutes in my life. 

So I strolled into the office (since I am 'early') only to realise, there's no one's here yet, not even the supervisors! I couldn't believe this. Isn't 8.30 am the latest we should be at work? I went back to the clock-in machine to check if everyone's really late. To my surprise, most people have already clocked in at 7.30 am. But why isn't there anyone?!

Molly the admin secretary arrived. 
'Where's everyone?' I am allowed to ask stupid questions because I am an intern, and interns are 'meant to be dumb'. 
'Oh, downstairs for breakfast. They will be back before 10 am.' 
Damn, they made me feel stupid for rushing my breakfast at home when I can have it leisurely in the office cafeteria after I clocked-in. Then my record will show that I am always on time and I can have my breakfast properly. What a win-win solution, why didn't I thought of that? 

It has only been 2 weeks since I came back from the UK, where rules are not mean to be broken. Otherwise, you will, not only, get fined (and you can't bribe your way out, damnit) but you can really cause accidents if you don't obey the rules (maybe because everyone's not trained have 'fast reaction'). That life on the other side of the world seems so distant in the past now when it has only been 2 weeks. 

This routine. This daily dose of rule-breaking act is perhaps what makes this mundane, mind-numbing routine that bit more exciting. Love it or hate it, this is home. We are told to 'fit in', to be complacent about it, you know, just for the sake of maintaining 'national stability'. 

There is nothing so pitiful as a young cynic because he has gone from knowing nothing to believing nothing. - Maya Angelou

Monday, June 1, 2015

Lucky fool

I thought: That was it. I can never possibly get up anymore. I can never trust any single soul in the world anymore. But I was wrong...

There is actually someone
so strong yet gentle and caring,
so outstanding yet humble,
and most of all,
so God-loving.

I am a freaking lucky fool. Thank you, Lord.

Sunday, May 3, 2015

Exam craziness

"Hey, how are you?"
"Too good for Easter. I'm practically laughing like a mad woman everyday," I said.
"This is normal. What happened for the past 2 years, isn't normal."

Perhaps. What have exams done to us? When we are stressed, we complain; when we are not stressed, we complain. Oh dear... But I guess it's better to be in the latter group. :)

23 more days to finals! 33 days to freedom! :D

Saturday, May 2, 2015

What is Good?

And here comes a point in my life when I am confused about 'good' and 'bad'. No, I am not the slightest bit depressed; in fact, I am a bit too happy for Easter term because I have been blessed with so many good friends around and opportunities to grow. But recently, I had a conversation with a friend and we talked about how some people we call 'good' or generally perceived as 'good', were actually very mean to us. And we were like, 'how are those people good?' And there were just times when unjust things happen to good people (like the flood of political stupidity happening in my country now), when bad things happened to innocent people (the recent earthquake in Nepal) or things which I think were not fair happened to me (I have been holding grudge against generally well-perceived mean people). These moments really made me go, 'God, you are a good, loving God. I am sure you have your plans, but why all these unjust sufferings? If this is good, I don't know what is good anymore."

There are times when I thought something is good for me but when it turns out to be really bad; and there are times when I thought I've been through hell, but on hindsight, those hellish days are the ones which pruned me most. I don't even know how to judge what is good anymore? I mean, I know what loving is and how a loving act should be like, but what is 'good'? How do you define someone/something as 'good' or 'bad'?

Thank God for Psalms 73. 

We can never judge each other when we are on the same plane as them. Who are you to be more superior to judge over a fellow human being? What gives you the right to be the moral police and label someone as 'good' or 'bad'? There are times when you, yourself is so mean that you hate yourself too, remember? 

Indeed "When I tried to understand this, it toubled me deeply, till I entered the sanctuary of God, then I understood their final destiny". It is not to say, "you, non-believer go to hell, burn!" Really, no. But rather, it teaches me not to judge others, because since we are all of the same level, how can we ensure we can judge rightly/justly? The only One who can judge is God, who is on a higher level and can see clearly all that is happening.  Only He can judge justly. Things that may seem unjust, bad for us on plain sight, may not be completely bad. I never ever mean to say earthquake/other natural disaster that took away thousands of live is a good thing, I empathise with the lost of those precious souls. I don't know what God's plans is through all these devastating disasters that should not happen to good and innocent people, but it is not up to us to judge God. The fact that Jesus died to remove our sins from us, the fact that we are still here and the fact that we still know what 'love' is - those are enough for me to come to a conclusion for my faith in God.

So let's not judge others then have selective treatment, because no good will come out of that and we don't know the full picture. (Unless you're a judge, then you judge according to the law because you have the full knowledge of this human construct.) Rather, let's just keep our hearts pure and be loving towards everyone, because it will not be in vain when the day comes. 

(I need to work on the habit of constantly passing judgement onto people) 

Friday, April 24, 2015

New found motivation

To be honest, I was never that interested in 'medicine' medicine. Shocking, I know. Whenever I tell my colleagues or people around about it, they would be so shocked. "WHY?! It's such a noble job? You will save lives!" "But you're so good at it..." (not true.) The thing is you can be an expert in things you really don't give a damn about, especially in the academia. Just put in the hours, read, you'll get to the top. Maybe you weren't interested at first, but given the right guidance, you'll get to there. I don't hate, medicine. I was good in chemistry, biology and maths, and I am remotely interested in human biology, so when I was offered such rare, precious opportunity to do an interesting course in a prestigious, interesting place (+ an immensely quality lifestyle), I took it. Let's just say, I did it for the sake of, first, because my parents wanted me to; second, I had somewhat an ability to do so(?); thirdly, for the sake of proving social mobility is still possible in our society.

And satisfying those 3 points has got me quite 'happy' life for the past 2.5 years in Cambridge. No really, there were moments when I was truly happy to be here. 

But you know, people grow up and meet people, see the world. I saw there are actually so many others things which I am interested in the world. There are so many things that I want to do in the life! Life isn't that long you know. 2.5 years of this is fine. But I can't continue wasting time, doing what I am barely interested in any longer. I can't bear the thought of doing something I am not really passionate about for the rest of my life. I can't bear the thought of wasting my life just like that...So I started exploring what really resonates with me. It's a bit late, I know, to only do this when I am half way through a course and people have already invested so much money, time and energy in developing a hopeful-medic. But how can you expect every 17-years-old to know exactly what he/she wanted to do with his/her life when we don't even have sufficient life exposure, experience to know what we really like?! Gap year is a way to do it, so I had a gap year before but I still didn't know what to do by the end of it. 

"I am truly grateful that I have the opportunity to be in Cambridge. Not because it's one of the top university in the world, but because of the way we are taught."

I said similar thing while filling in the SAQ form during my university application without being consciously aware of what I was really talking about. I was just trying to please the interviewer. Halfway through my 6 years here, I became conscious of what that sentence really mean. I love the collegiate system. Because of how Caius forced us to dine in the hall almost every day during term time, we get to meet people from other courses. I also love how we can be involved in a society like CUMaS, where you meet all sorts of 'interesting' people from our country. People from different courses really do have different mindsets and opinions. And having the opportunity to talk to them on a daily basis opens up my mind to the world beyond medicine. I know you get to do that in other universities too, but over here, you essentially live, eat and breathe with experts from all sorts of fields. I see medics during lectures, I hang-out with engineers, economists and lawyers and my tutor is a linguist. I believe (or i like to believe) that these people have impacted the way I think in a very significant measure. 

Then I became interested in economics and sociology. The humanities used to be painted in very bad light in secondary school. Everyone was trying to get into the science stream in Malaysia's secondary school because that's where smart people go; because art stream classes are for less capable students.How far from the truth can that get!?I love how these disciplines touch on almost every aspect of life in so many different ways. The things they do are really meaningful and impactful on a larger scale, and not just on an individual basis in clinics. I started to doubt whether I am in the right course. I went "omg being a doctor is such an ineffective waysof solving problems. Omg I am in the wrong course, I hate my life, how do I get out?!" (Please don't get me wrong, I respect all doctors in every way. I just don't like the idea of doing the same thing for 40-50 years for the rest of my life.).I was reading the journal of a doctor who went to Sierra Leone under Doctors without Borders (MSF). After reading those horrifying accounts, I twitted back to MSF, "omg these doctors are so noble, sacrificing themselves and putting their own lives at risk to save those poor souls! But they are just putting bandages on a bigger, deeper problem! There's must be a better way to make lives of more people better, more effectively." I think designing and implementing good policies is the way to go. Don't get me wrong, we definitely NEED doctors to be at the front-line, otherwise those marginalised would not have any care NOW. I really salute the doctors in MSF and I look forward to be part of it one day. But I can't picture myself being that noble for long, and I really, want to do something more impactful in a larger scale with the short amount of time I have in my life on Earth. Then I realised I can't get out. I was in dismay. I started to explore again.

In our third year in Cambridge, we can choose to do any course we like. I, for some unknown reason, chose Pathology in Immunology and Microbiology and Parasitology. I had no idea what is coming up. I was taught about the molecular mechanisms of microbes, parasites and our immune systems. I was shown pictures of Ascaris lumbricoides (those icky spaghetti-like worms in the intestines) and hepatosplenomegaly while my family was enjoying Chinese New Year Eve's dinner in the far east. I was quite...frustrated.

Then we were taught epidemiology and public health. We were taught how to do simple math models and how to it has been used to affect health policies on a global scale; we were showed how our lecturer has helped WHO in planning vaccination programmes in Latin America, in Africa and in my very own home country, Malaysia. His math models have helped save billions in various cost- and time-effective ways. What the lecturer did really resonates with my interest. I went on to investigate the background of those working in WHO. I went on to check Margaret Chan's profile. Then I realised, they were all practising doctors for many years before they went on public health.

Today, I am able to see how a doctor/clinician scientist too, can impact billions of life, in very specialised, extremely demanded and significant ways, be it in research or policy-making. I see how we need to be trained this way: to know the science behind and to gain actual medical experience in the field, to really make a difference in the world. There is really a place for every personality in Medicine.

I often wonder why God opened these doors to put me here. 
 I can only pray that He reveals more and more of His will every day.