Thursday, May 19, 2016

Worst regional posting you can get?

I have been posted to the worst regional hospital I can get in Cambridge they said. Seniors warned us with all sorts of stuffs before we arrive in the first term.
'Remember to bring your duvet. They have plastic blankets there'
'Remember to bring all the food you can, there's no shops around.'
'Remember to bring...etc'
'Oh ya, there's no wifi in your room.'

Queen Elizabeth's Hospital, King's Lynn

Now that I am on the last day of my posting, I can testify, what they warn us about...are all sadly, very true.

I remember on the first night we arrived in November last year, it was super cold and foggy, and there weren't any soul outside the train station. Everything's dark and quiet in this coastal town. We took a taxi to the hospital and lugged our luggages and duvets around the hospital to get keys to our accommodation, which is right beside the hospital.

When I first entered my room, I thought it was quite good. I mean, it's basic - a bed with a pillow and a plastic duvet, a desk, a desk lamp, a sink and a cupboard. That's it. It's clean at least, I thought. We don't pay for this accommodation because it's covered under our tuition fee. But for the amount of tuition fee, international students pay, I am not sure this is worth the money. But since I am on scholarship and am not paying for this, I guess I have no right to complain. BUT THERE WASNT A CONSISTENT WIFI OMG. The wifi keeps cutting off every 5 minutes and my phone's 3G was burning through very quickly.

Life in this hospital is pretty boring. It's like you're on a camp for 1 month. There's no proper wifi, there's no shop nearby (the closest is Tesco, which is 30 minutes walk away) and you have a very small group of friends from your year. Unlike that in other regional hospitals where you get big group of friends, we only have 6 students from our year, at any point. In summary, you're pretty much isolated. All you can do (if you dont have 3G) read a book/clerk a patient/pester the docs to let you do something.

Library where I spent most my time when there's no wifi in my room
At one point, because of a blunder in the administration, I was not given accommodation for a night, and I had to return to Cambridge with all my luggages. I remember lugging the luggages around town until I had calluses on my hands. I was so furious and boiling that I ranted non-stop for an hour to K (poor man) and I even said, 'Is my tuition fee any less than others that I deserve such placement...'

Found around hospital. I simply can't understand/empathise with smokers.
Fast forward to I happy that it is finally over? Boy, you bet I am. I am counting down the days to get back to civilisation, to my own room, my coffee machine and high-speed internet in my dearest Cambridge. I took one last stroll around the hospital this evening and reflected on the time I had actually was not that bad at all.
The accomodations
A random, one and only turbine in town, right beside the hospital

The art of asking for what you need/want
There were bad times, especially in the beginning, when there was no wifi and I could not understand any medicine or the art of persuading someone to teach you/let you do something. But actually, as the year went on, we got pretty top-notch teaching around here. Yes, we did not have much supervision throughout the year, apart from the last 2 weeks, but we had pretty good teaching sessions. They rarely get cancelled. And when they went on, they are usually very helpful for us. The consultants are usually the ones we will later on shadow in their clinics. They are usually very kind and are very willing to teach if you ask them questions. (If you dont, obviously they will concentrate on their job and ignore your existence.) Although I must say, some may think you are absolutely brainless, especially when I was trying to help them clerk patients during the Junior Doctors' strike days. I remember one consultant being completely appalled at the way I prescribed on the drug chart...'But I was never taught about this before, at all! and I have never seen it done before! Can you teach me how to do it?' Only then he realised I am not a finalist. From that day onwards, he started being kind to me and taught me a lot of things. Slowly, I started to realise that many of the consultants thought we are final years and thus, expected us to be very independent in our learning and to know what to do on the wards. Then only I know the importance of letting the docs know what level am I in whenever I shadow them. The easiest way being acting honestly dumb.
'What is this...?'
'Uh...uh....maybe it's...I don't know.'
'What do you mean you don't know?! Which year are you in?'
'This is my first ever medical rotation. I am in Year 4.'
'Very well...'
Since learning that, I have learned to make my time on the wards more productive. And if I am continuously being ignored for 15 minutes, I learned to just quietly slip away, and Yay, free time!!!, and go back to do some reading, instead of stupidly standing there for no reason.  It's not their fault. They are really super busy, not rude.

I have also learned how to pester the staff nurses to let me do practical skills so I can get them to sign me off. Some of them are super friendly, some of them just can't be bother with another medical student. But as long as you supervise my work and sign me off at the end, I am eternally grateful to you, nurse. :p 

Oh, and I love Wednesdays! It's the day we learn practical skills, with just 3 of us and our very 'fun-loving', enthusiastic trainer will let us do simulations on management of acutely ill patients on SimMan. Apart from that, she also entertains us with a weekly dose of rant about her ex-husband and life on the farm. It's really quite entertaining I must say.

Familiar faces
I guess this is the perk of being in a small hospital. You know every one after you've rotated through all medicine, surgery, pharmacy and A&E. It's nice to walk around the hospital and have doctors and nurses greet each other in the morning. And obviously, you know people from your own year very well. There are only 3 of us, to stare at each other, for a month. We depend on each other to survive, stay sane and eat fish and chips together.

So, honestly, it may be bad, but probably not all bad. Regardless, may all my postings for the rest of my career be an uphill journey from now onwards. Bye bye, King's Lynn!

Thursday, April 28, 2016

Empathy, or the lack thereof.

 In my final term of the year, I am finally in my first ever Medical Rotation. And I started this when the Junior Doctors are on strike. Great. Honestly, it's great, because I get to do most things the juniors do, under the supervision of consultants, who usually don't even acknowledge our existence in the wards. So, it's so great for our education!


I was in Neurology clinic this morning. My first ever encounter with clinical neuro. It was really strange yet very interesting at the same time. The patients came in with epilepsy, migraine, headaches etc, just like how I read in the textbooks before. However, the strangest part of the whole morning was this consultation...

The patient had been experiencing difficulty walking and blurry vision, twice in 3 years time. Before she came in with her family, the consultant and I had a look at the MRI scan of her brain. 

'Look at those plaques.' It wasn't great.
'Does she has a diagnosis yet?' I asked, 
'No.' Then she walked out to get the patient in. 
I thought, No...this is bad.

The patient came in with her young family, all cheery and happy and agreed for me to be present while the consultation went on. She smiled. I forced myself to smile back. I thought, this is really bad. Does she knows? Is she suspecting? Will she walk out of this room the way she walked in?

The consultant smiled and carried on doing examinations, as if she does not know anything. Everything went on smoothly until the examination ended and everyone was back at the desk. I felt very strange throughout the whole time. I kept asking myself, how would I feel if I were in her shoes? Young family, strange symptoms happening to myself, confused, probably desperate for an answer, nah, I hope it's just something trivial. 

'Remember you had an MRI scan?' the consultant said. 
'Yes, how was it?' she replied. 
'From your history, your examination and your scans...It seems very likely that you have Multiple Sclerosis.' 
The air was cold, dead silent then. Even the baby was not making a sound. 

She started tearing. I grabbed some tissue for her immediately, having observed how the nurse reacted the last time I saw a consultant broke bad news to another patient with breast cancer. The consultation went on with her prognosis and treatment options. The patient went out slightly more composed, but I could see she was very fearful at the end. 

I was not quite sure what to feel. I was constantly battling between 2 different point of view within myself, throughout the consultation:
From the medical point of view, the consultant knew from the beginning what was happening and what will happen. She will get the diagnosis, then she will treat it the best she could and the MS should be under control, given she had RRMS. Job done. At one point, I almost could not understand why is she crying. I thought, don't have to cry, you are not going to die, at least, not that soon. There's a cure, MS is super common, I just saw several patients with MS before you. You will be fine. 
Then I put myself into her shoes: Omg, I am freaking scared, with all the news and things happening to people with MS! Will I shrivel up, stop breathing and die? Will I be wheelchair-bound? What will happen to my baby?! I want to watch him grow! 

I realised how my perspective and state of mind change as I learn more about Medicine. We see so many very very ill people coming in day in and day out, it's just seems normal to be very ill. The same for death - a dead body was pushed pass us on a trolley the other day and we continued to talk about the patient we were about to see as if nothing happened. A life just passed away, for goodness sake....

But...we don't live with those diseases and we have never experienced most of those diseases before, it is very hard to imagine how does it feel like. 

During our Clinical Communication Skills session, we were told to empathise with our patients, whom we have never met before and many with diseases which we never even heard before. I really don't know how medical students like us, 20-something years old, who barely have enough life experience or children of our own, can truly empathise with our patients. We can offer our utmost sympathy, but to empathise?

As for now, to expect us to offer empathy, as it is defined, will take more time, more experience and more deliberate effort to put ourselves in others' shoes in our every day life. 

Wednesday, January 13, 2016

Buying opportunities.

So for the past 1.5 weeks, I have been chatting with the FYs here and there. They are from all over the country but none from Cambridge, so no one really knows what we experienced back there. One of them worked in Addies before tho, and she said it was nice because there were many very fancy technology like the Da Vinci machine (3D console + laproscopic robot that allows surgeons to perform key-hole surgery over long distance). Many were in awe of those technologies. I was actually quite surprised tho. I mean, I saw those machines during the 1st week of my first ever placement when I was back there in a urology theatre. I didn’t know it was something that fancy, advanced and sought after? As I eavesdropped around more, only then I realised how advanced and equipped Addenbrooke’s really is, compared to other regional hospitals. And guess what, I had been loathing over my time in Addies because we weren’t taught properly and there wasn’t much teaching sessions…everyone was simply busy and we medical students are just obstructions. I guess, it’s true, when you are the major, top-notch hospital in the country, the doctors there are really the top-dogs and whatever they do are thousand years away from where we are, so it will take another million years before we eventually reach their state, why bother teaching so much about it now? (Tho it really wouldn’t hurt to tell me what you are doing…a bit of teaching wouldn’t hurt right? As long as it doesn’t hurt the patient..)

As I reflect upon these first few months in medical, I realised I really shouldn’t complain about the teaching opportunities. We are 20+ years old adults, had 3 years of pre-clinical teaching and mature enough to ask for help if we need any, do we really need spoon-feeding? The answer is, no, not really. And I do find that I learned much more reading from textbooks and interacting from patients, than sitting in the lecture theatres. Most of the time, I don’t understand like 70-80% of what the lecturer is rambling about and I ended up reading up everything on my own, at my own pace to finally understand it. So, it really is independent learning for us now.

Then, you may ask, why are we pay so much?! It’s freaking 40,000+ pounds per year that we are paying. If no one’s teaching us, why do we bother paying? I might as well sit at home and read on my own. True, but…how much do lecturers get paid? Not much at all. Most of our tuition fee goes to creating our learning opportunities, in a sense, buying a conducive environment for us to learn. This includes, stocking up the medical library (which is really really good, honestly, I can find all the books I need there and more..), giving us access to the hospitals anytime we want and also the practical skills laboratories. And along with these, easy access to the extreme experts… It’s not so much about formal teaching and spoon-feeding now, but more about proactive learning. The opportunities are right in your face, you just have to grab it.

SO yea… I guess I have to stop being so timid and soft-spoken when asking for help or opportunities to learn in the wards, and stop feeling like an obstruction which causes abdominal distension, vomiting, absolute constipation and pain...

Tuesday, January 5, 2016

First day of surgical posting

Happy New Year! And…I am back in King’s Lynn. Today is the first day of my first surgical posting here in Queen Elizabeth’s Hospital, King’s Lynn. I was not sure what to feel. When I first started clinical school, I wanted to be a surgeon, but after watching several surgeries, I am not that sure anymore. In some way, I think Medicine is very ‘sexy’. I mean, most of the time, without touching the patient, you will know tonnes about the patient, and probably can come up with a pretty accurate diagnosis. The examination and investigations are, as if, just to support and confirm your diagnosis. It’s like solving a puzzle!
Surgery is, well, straightforward.
For this week, I am attached to the colorectal surgical team. They care for the patients mainly in Denver and Elm wards (Surgical assessment units). Since there was no teaching scheduled for the day, I was expecting my day to be quite dull and same old, as in core clinical method, with no one to entertain me, and no consultant to acknowledge my existence.
Upon arriving at the ward, I was introduced to the team. To my surprise, they were all very warm and welcoming! I met 3 consultants, 2 FY2s and 2 FY1s, who were all very keen to teach! During the ward round, the consultant explained about the conditions and even invited me to his theatre tomorrow. The FYs were kind enough to let me tag along and got me involved in whatever they were doing – from doing ward rounds, writing TTOs, issuing a proper sick notes, filling in drug charts, to clerking patients properly in the A&E. I was even supervised to do a PR in the A&E, which I only did it on mannequins before. They kept mentioning, ‘you must be bored to death watching us do this.’ But, hey, I have never seen all these before, what more got taught to fill in one of these on my own. It was all very fun and interesting, all because these were all new to me and I was actively involved!

I stayed there till 5.30pm, but the day didn’t seem long at all. For the first time, I actually get to experience the life of an FY. And for the first time, my presence was acknowledge by the firm I am attached to. Maybe, surgical posting isn’t that bad at all. 

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. 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 :)