Tuesday, November 17, 2015

Constant change of ambition

This is my 9th week in the clinical school and I am currently on placement in a tiny town on the south-east coast of the UK - King's Lynn's Queen Elizabeth Hospital. Unlike the massive Addenbrooke's back in Cambridge, QEH is considerably puny, calm and quiet. The people seems to be friendlier and the consultants actually teach and entertain medical students like me, the lowest of the low in the medical hierarchy. I can't blame the doctors in Addenbrooke's. They are very skillful in their profession and are extremely caring for the patients, but considering the workload that they have over there, where on earth can they actually find time to give us a glance, what more to teach or talk to us? So while in QEH, I am enjoying all the attention a medical student can get and grabbing all the possible teaching opportunities one can get, no matter how irrelevant it seems for now. :p

Just months ago, in April, I was quite determined to pursue my career in Public Health. I thought I'd enjoy it because given my utilitarian/outcome-based work ethic, to work on patients one-at-a-time would be too inefficient. By the time I retire, how many patients will I see? Not that many...There must be a more efficient way to change more number of lives with efficient use of money. So I went on an internship with the Minister of Health and observed how the Ministry of Health in Malaysia works. I saw Public Health in action...but disappointingly, there was not much in action. In a perfect world, you'd plan, strategize, execute the plan and achieve the outcome. But in the real world, there's simply too much red tapes and restriction to carry out a plan that will save money and benefit everyone! For example, the MoH would be able to do much better than it does now if the ministry is allocated more money in the annual budget, instead of spending the money in preparing for warfare or on lavish banquets that will only benefit certain groups of people. I can see how our Minister himself is working hard every day trying to reform our health system, but there's only so much he can do. To truly execute your policy in Malaysia, you have to first change deeply rooted the 'anything also can lah' culture to cultivate the spirit of excellence. When your whole organisation and community are on the same page of reform as you do, only will your reform be carried out. When your subordinates go for 'breakfast' during work hours from 8am to 10am, then have 4 hours long lunch break, you will never get anywhere. 

There is so much talk in the world of Public Health. So many policies and ideals. But how many of them actually make it to the real world? I am sure many of them do, and many of them are actually changing lives in this world, but I am not sure about my own country. What I witnessed over my internship just made me so cynical about being about to make any difference in healthcare at all. 

Being in the hospital has made me love the clinical work so much. Instead of enduring the frustrations of not being able to implement your policies maybe for your whole life, these doctors are actually make changes to people's lives. Doctors, nurses and the staffs on the ground are the ones that actually do the work, make the changes that will have direct impacts on people around. There's something so fulfilling about this that I began to forgo my aspirations in Public Health, and focus on the clinical works. 

I am, at the end of the day, a utilitarian. 

'What specialty do you want to go into?' That's the question I am being asked daily. At the beginning, I was quite inclined towards surgery. I like doing things, and sitting in the clinic and talk to people the whole day seems a bit dull to me. However, I had no ideas/knowledge to base my decision on. I have been on the hospital for 7 weeks. It's terribly short, I know, but I realized the more surgeries I observe, the more bored I become. Clinics seem so cool. Doctors can just sit there and talk to people, and even before touching the patients (and without the need to cut 'em up), they can reach the diagnosis and treat the patients accurately. Isn't it cool?

I also find myself to be elated when I get to talk to patients and take their histories. Many of them are actually quite funny and lovely people, even thought they are quite sick. Just the other day, I was performing a cranial nerve examination on an old chap with stroke. 'Now, I am going to test your hearing,?' I said. He immediately replied, 'Pardon?' *gigglitis attack* 

But then again, what do I know? Watching a surgery is different from doing one. Till the day I actually get to scrub in and do something dramatically life-changing, don't take my decisions seriously. 

There are so many decisions to make. Before I pre-maturely dive myself in something, perhaps the best thing to do now is to keep an open-mind, to be curious and interested in everything around me. I do realise the change in my attitude towards learning. For my whole life, I have been learning to score in exams. My ultimate objective in any part of my learning to get that distinction in my results. It seems pretty retarded, but that's how it was. Recently, I find myself to not care so much about exams anymore. Rather, I am working very hard because I want to be competent as soon as possible so I can do something to help the patients while learning on the wards. I want to be as skillful as possible so as to minimise the mistakes I will make and to give people the best care they deserve. And if I am ever good enough to help my fellow peers, I am glad that I may be able to play a part in their journey of becoming good doctors, who will eventually help many more people in the future. 

I am, at the end of the day, a utilitarian. One which is constantly swayed by the outcomes I desire to achieve. 

Till then.

Whatever you do, work at it with all your heart, as working for the Lord, not for human masters. 
- Colossians 3:23

Whatever you do, do well. 
- Ecclesiastes 9:10

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)