Day 5 of 20
Ah, what shall I say about today. Longest day ever, 8am to 7pm+, some of my groupmates will probably be staying till 11pm so they went home after a tutorial at 8.30am. Gotta meet Aaron later on though, so left earlier.
Today was interesting - went to OT to assist the plastic surgeon! This really sad case, a young woman had an RTA (or MVC or whatever they call it - it's ALL THE SAME DAMMIT. Why nitpick on the small details when people are dying in the A&E?) in a taxi and wasn't wearing a seatbelt, and sustained a really bad laceration on her left cheek and left eyelid. And it's not the lacerations we usually see when people accidentally cut themselves - this one cut right through the dermal layer and even muscle, and in the OT the plastic surgeon put his hand under the flap of flesh just to check if the laceration cut through the buccal mucosa on the other side. I'm not usually frightened of blood, but there was this pool of blood oozing on the face that made it really scary.
In the OT I had my ass fried by surgeon, who insisted on calling me Dr. Tan. He's very pleasant, but stresses me in a way - he won't accept "i don't know" for an answer. So, a typical conversation would be, "Dr. Tan, what is the difference between using a monofilament suture and a braided suture?" Obviously, I wouldn't really know unless I was shooting for a distinction in surgery right? So ... after 1 minute of uncomfortable silence and "erms" and "ahs" on my part, he'd press on, "Yessir, carry on Dr. Tan."
"I don't really know .... (inserts a guessed answer)"
"How can you not know? Your patient is asking you what sort of suture you're using - try again?"
Goodness ... and he's the kind who likes to make you dig a grave for yourself. For example,
"Dr. Tan, what is L.A.?"
"Local Anaesthetic"
"Good! What L.A. am I using now?"
"Lidocaine"
"Yes - so, what's the mechanism of action of L.A.s?"
"(insert 5-minute conversation on year 2 pharmacology)"
"So what other L.A.s do you know of?"
"Erm ... Prilocaine? and erm ... erm ... (insert mental block)"
"OK, don't need to know too many, just (insert 5 or 6 different ones which we never bothered learning since it almost never comes out for the MBBS written)."
*grave-digging starting*
"OK, Dr. Tan, you mentioned Prilocaine. What can you tell me about prilocaine?"
OMG. You get the idea eh? Wow, I felt SO stupid. It's like most of the stuff I DID know at one point or another, but it's been stuffed into a little draw-string purse and stashed somewhere in limbo. Stuff we went through were:
Common maxillofacial fractures, LeFort classification, tripod fractures
Layers of the scalp
Layers of the dura, different types of intracranial haemorrhages, their origins (like the middle meningeal artery in extradural haemorrhage) and CT scan features.
Glasgow Coma Scale (made me go through the whole damn thing from E1 all the way to M6)
Raised intracranial pressure, mechanism of secondary injury in haemorrhagic stroke, management of raised ICP with and without the neurosurgeon, danger of coning when using a spinal tap on patient with raised ICP.
And hell lot more. At the end, a very battered, bruised and multiply-traumatised medical student emerged from the OT (was helping snip the sutures) and gave him a resounding mental applause, and a heartfelt thank-you for the excellent tutorial. Would love to meet Mr. Plastic Surgeon again one day, but damn, I do hope I'd be much better-prepared next time round.
Other cases seen today:
Another peptic ulcer disease
2 cases of possible stroke and neurological deficit
A possible headache (have to read up on all the different headaches ... gross)
Pneumothorax (saw the needle aspiration! Gosh it's so different from what I thought it'd be - the patient was twitching in pain all the time)
Sepsis
Spent more than an hour with the old lady with sepsis, trying to comfort her. For some reason my heart melted when I saw her lying in the P2 area (she's actually a P1 case), alone, sobbing into a piece of tissue paper silently. In retrospect, she actually made my day - there's nothing so much as gratifying as being able to help a patient in these small ways. It probably helped that I spoke Teochew as well, so at the end of it she started calming down and chatting. Would have stayed for longer, but had to meet Aaron. She was a red-herring case - crying due to the pain in her right femur (intertrochanteric fracture 2 months ago, managed conservatively with analgeisa and skin traction) but admitted from AMK hospital for low-grade fever for 2 days. Abdomen soft, generalised tenderness and generalised rebound tenderness with slight pallor. They wheeled the poor dear into the resuscitation area, where I went again to talk to her - imagine her bewilderment, getting pushed on a trolley into this scary single cubicle with ECGs, machines and whatnot - just for a fever, from her viewpoint. Really hope she'll be ok.
Some of the docs in the ER are really fantastic people - for once, we med students are being treated nicely, and not as pesky little blow-flies hovering around. Like Dr. Mark Leong, who's quite a big shot but really doesn't behave like one (*cough* general surgeons *cough*) I was following the old lady but thought it would be appropriate to ask Dr. L if I could observe him managing this patient. He was like, "Of course! You're very welcome! You can observe anyone here you like!" and later, while I was writing from the case notes and he needed it, he didn't snatch it away like some docs from other departments. The beautiful man apologised (omg) for interrupting and promised he'll have it back in 5 minutes.
I love this posting already, although there aren't any poisoning/venom cases so far. People are busy but very, very pleasant, including the nurses. Ah .. that OT nurse who bustled around me making a big motherly fuss of making sure I'm not lost in the OT when it came to scrubbing up - MOST UNLIKE G.S. where the nurses don't give a SHIT about you, and obviously you'll be so fricking lost in there and then they snap at you for obstructing their way. HELLO .. I don't even know where the scrub suits are, what do you expect me to do? That nurse was soooo motherly! =D
Let's leave out the part where I told this to the 2 evil women in my group and they accused me of being the "Auntie Killer".
Today was interesting - went to OT to assist the plastic surgeon! This really sad case, a young woman had an RTA (or MVC or whatever they call it - it's ALL THE SAME DAMMIT. Why nitpick on the small details when people are dying in the A&E?) in a taxi and wasn't wearing a seatbelt, and sustained a really bad laceration on her left cheek and left eyelid. And it's not the lacerations we usually see when people accidentally cut themselves - this one cut right through the dermal layer and even muscle, and in the OT the plastic surgeon put his hand under the flap of flesh just to check if the laceration cut through the buccal mucosa on the other side. I'm not usually frightened of blood, but there was this pool of blood oozing on the face that made it really scary.
In the OT I had my ass fried by surgeon, who insisted on calling me Dr. Tan. He's very pleasant, but stresses me in a way - he won't accept "i don't know" for an answer. So, a typical conversation would be, "Dr. Tan, what is the difference between using a monofilament suture and a braided suture?" Obviously, I wouldn't really know unless I was shooting for a distinction in surgery right? So ... after 1 minute of uncomfortable silence and "erms" and "ahs" on my part, he'd press on, "Yessir, carry on Dr. Tan."
"I don't really know .... (inserts a guessed answer)"
"How can you not know? Your patient is asking you what sort of suture you're using - try again?"
Goodness ... and he's the kind who likes to make you dig a grave for yourself. For example,
"Dr. Tan, what is L.A.?"
"Local Anaesthetic"
"Good! What L.A. am I using now?"
"Lidocaine"
"Yes - so, what's the mechanism of action of L.A.s?"
"(insert 5-minute conversation on year 2 pharmacology)"
"So what other L.A.s do you know of?"
"Erm ... Prilocaine? and erm ... erm ... (insert mental block)"
"OK, don't need to know too many, just (insert 5 or 6 different ones which we never bothered learning since it almost never comes out for the MBBS written)."
*grave-digging starting*
"OK, Dr. Tan, you mentioned Prilocaine. What can you tell me about prilocaine?"
OMG. You get the idea eh? Wow, I felt SO stupid. It's like most of the stuff I DID know at one point or another, but it's been stuffed into a little draw-string purse and stashed somewhere in limbo. Stuff we went through were:
Common maxillofacial fractures, LeFort classification, tripod fractures
Layers of the scalp
Layers of the dura, different types of intracranial haemorrhages, their origins (like the middle meningeal artery in extradural haemorrhage) and CT scan features.
Glasgow Coma Scale (made me go through the whole damn thing from E1 all the way to M6)
Raised intracranial pressure, mechanism of secondary injury in haemorrhagic stroke, management of raised ICP with and without the neurosurgeon, danger of coning when using a spinal tap on patient with raised ICP.
And hell lot more. At the end, a very battered, bruised and multiply-traumatised medical student emerged from the OT (was helping snip the sutures) and gave him a resounding mental applause, and a heartfelt thank-you for the excellent tutorial. Would love to meet Mr. Plastic Surgeon again one day, but damn, I do hope I'd be much better-prepared next time round.
Other cases seen today:
Another peptic ulcer disease
2 cases of possible stroke and neurological deficit
A possible headache (have to read up on all the different headaches ... gross)
Pneumothorax (saw the needle aspiration! Gosh it's so different from what I thought it'd be - the patient was twitching in pain all the time)
Sepsis
Spent more than an hour with the old lady with sepsis, trying to comfort her. For some reason my heart melted when I saw her lying in the P2 area (she's actually a P1 case), alone, sobbing into a piece of tissue paper silently. In retrospect, she actually made my day - there's nothing so much as gratifying as being able to help a patient in these small ways. It probably helped that I spoke Teochew as well, so at the end of it she started calming down and chatting. Would have stayed for longer, but had to meet Aaron. She was a red-herring case - crying due to the pain in her right femur (intertrochanteric fracture 2 months ago, managed conservatively with analgeisa and skin traction) but admitted from AMK hospital for low-grade fever for 2 days. Abdomen soft, generalised tenderness and generalised rebound tenderness with slight pallor. They wheeled the poor dear into the resuscitation area, where I went again to talk to her - imagine her bewilderment, getting pushed on a trolley into this scary single cubicle with ECGs, machines and whatnot - just for a fever, from her viewpoint. Really hope she'll be ok.
Some of the docs in the ER are really fantastic people - for once, we med students are being treated nicely, and not as pesky little blow-flies hovering around. Like Dr. Mark Leong, who's quite a big shot but really doesn't behave like one (*cough* general surgeons *cough*) I was following the old lady but thought it would be appropriate to ask Dr. L if I could observe him managing this patient. He was like, "Of course! You're very welcome! You can observe anyone here you like!" and later, while I was writing from the case notes and he needed it, he didn't snatch it away like some docs from other departments. The beautiful man apologised (omg) for interrupting and promised he'll have it back in 5 minutes.
I love this posting already, although there aren't any poisoning/venom cases so far. People are busy but very, very pleasant, including the nurses. Ah .. that OT nurse who bustled around me making a big motherly fuss of making sure I'm not lost in the OT when it came to scrubbing up - MOST UNLIKE G.S. where the nurses don't give a SHIT about you, and obviously you'll be so fricking lost in there and then they snap at you for obstructing their way. HELLO .. I don't even know where the scrub suits are, what do you expect me to do? That nurse was soooo motherly! =D
Let's leave out the part where I told this to the 2 evil women in my group and they accused me of being the "Auntie Killer".
posted by R. at 4:19 PM
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