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dark side of medicine
8:51 p.m.
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medicine has always been about life and death. as people look at me, a medical student, sometimes they ask me how do i cope with seeing life and death so often. they are so emotionally affected by stories of how some cancer patients are on terminal care etc. i will give them a blank confused look, and tell them that i don't actually see dying patients everyday.

come to think about it, it's more like I tend to ignore the fact i see dying patients everyday sometimes.
for me, (it'll sound horribly unempathetic and unkind) I'll be so focus on the task at hand-
take a history
draw bloods
do this examination
examine this joint
examine the nerves

and because these task are no simple task and because i lack the clinical competence to do it on the fly, a million and one things will run through my brain
(example: taking a history. i tend to speak in monologue to myself. it'll be things like "remember to ask about her cough she just mentioned. remember to ask if it was productive. and if was bloody. oya, don't forget about appetite, sleep and weight. wait, she just mentioned chest pains. make sure to write that down. ask about radiation. make sure to do a systemic review. this patient seems complicated. she said morphine helps the pain. what dose was it?? check her drug chart later. remember family history sook cheng. i keep forgetting that. wait, what did she say?"
imagine this all condense into a 30 second banter in my brain.
a typical history would take about 5-10 minutes.
no wonder they say doctors don't listen. i have to admit i don't listen sometimes because i'm so busy thinking about the next question to ask! otherwise i'll get the dreaded awkward silence while i try and sift through the information and ask about the next relevant question)

with all these, (examinations are far worse) we really do lose sight of the patient as a person.
times where i feel really sad is when patient's own expectation doesn't match up with reality. worse if the patient's family has greater expectations than the patient or the doctor.
i met a patient who had COPD, and i was just meant to sit him through the whole clinic. his wife and him were really chatty and i found out he came to the clinic to have a "flight test" as he wanted to visit his relatives in Spain (flight test- patients with poor lung function have to do this to make sure they can cope with reduced oxygen pressure in the aeroplane). he was really keen on going to Spain and told me he has been trying to get more exercise done on his stationary bike to improve his lung function (since he had to stop a few months back due to "winter flu").
in the doctor's office, the doctor told him to keep up the good work and continue exercising. when it came to the flight test, the doctor just became really vague about it and told him it might not be a good idea to think about flying now since he just recovered from an infection.
when the patient left and i said my goodbyes, the doctor signalled me to come into the office. we discussed a bit about COPD then he asked me what I thought about my patient. I didn't really know what to say but I knew his COPD was pretty bad since he was on oxygen and was pretty breathless just chatting. The doctor told, "to be honest, he probably has months to live since his O2 sats are dropping and he is becoming cachetic (aka super thin... like cancer patients)"

i left the clinic feeling a bit empty and sad as i don't believe he or his wife knows this.

is ignorance bliss?



pass exams
10:22 p.m.
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i can pass my exams
i can pass my exams
i can pass my exams
i can pass my exams
i can pass my exams
i can pass my exams
i can pass my exams
i can pass my exams
i can pass my exams
i can pass my exams

participating in a pseudoscience called law of attraction. where if one thinks positive things, positive things shall happen to one.

And we're meant to think about something we really want feverishly and assume we already have it, and somehow the universe will allow us to have it.

so i'm assuming i've passed my exams in order for me to pass my exams. make sense?

so yes, on the last day of exams (which is meant to be osce hell day 2), i shall be out celebrating with friends. we shall moan and groan about the exams but we shall feel happy with a burden off our shoulders. then the next day, i shall wake up late in the afternoon, walk to uni and get boxes to pack my stuff up (i know there are hidden boxes on level 10... some skulking skills would be required). then i shall spend the day doing my laundry and packing my books and winter clothes and shoes. then i shall have to pack for malaysia as well.
the next day, my passport will arrive, then i shall keep it away in a safe place, and resume packing up the rest of my room, the bathroom and kitchen.
i shall then leave to leo's place in newcastle for the weekend, enjoy myself and be back to start moving. i'll take a final look at eldon and finally return the keys to the owners after clearing it out. then i'll chuck all my stuff at laily's place, sort out banking stuff, change addresses, sort out accommodation and flights in sarawak and tie up loose ends.
then i'll hang out at my brother's place for a few days, have a bbq, chill in the sun, play games, watch movies, bunk with audrey and the rest when i'm homeless, go to york and plan india trip till july 4th.

july 4th shall be a bucket of sweats and palpitations but i'll be confident and at 3pm, the results will be uploaded to VLE. i'll see my student number with really good grades on the online sheet. everyone will pass, hugs for everyone and then we'll have a fantastic dinner somewhere (tong's again? hahaha) we'll resume frantic packing, say bye bye to laily, apply for visa to india, print out the forms, check in to our flight and print our boarding passes. then we'll scan laily's living room (which would be in a big mess) one last time, call the taxi, grab our luggages and documents at 4am and load the taxi and be on our way to the train station. there, we'll probably hv our morning breakfast at McDs, laughing about how stressed out we were this past year. at 5am we'll be on the train to manchester airport and we'll be waiting around to board the gates. i'll send a txt to my friends, thanking them and wishing them a safe trip back home too. me and geetha will board the gates at 6.45am and board the flight. we'll then make a quick dash to the gates in heathrow and board MAS back home. Quick scan of the flight for laily and we'll all get to sit together, ready for our 14 hour trip back. laily will tease geetha and vice versa while i'll just cuddle up in my blanket and watch a movie.

7am, we'll touch down on m'sian soil. then i've to make a mad dash to KL with laily to sort out india visas. and finally at 11am, i'll get to sleep on my bed and hv a great time in subang.
i'll meet with kaye and the rest, and collect my visa on monday then get on the airasia flight to chennai with geetha and her sister. we'll meet laily at night and we'll hv a good time there :)

now to go make it happen 
bloody cannulas and bloods
1:29 a.m.
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if anything is going to put me off medicine it'll be the cannulas.

this whole placement is going into the dumps cause i just can't place a cannula right.
everyone started out at the same foot, being really crap at cannulas.
but others have moved on and have successfully mastered the skill of inserting plastic tubing into veins whereas I still struggle and more than often have given patients a large hematoma.
heh.. do no harm.

worse shit is that i know i just have to practice more which makes me sad as I have to give more people internal bleeding -> lose confidence -> cannot get cannulas inserted -> feel like a failure ->sad -> (repeat)

the dreaded vicious cycle of life.

sigh.

immigration... why can't you go away
11:51 p.m.
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stupid robber. why can't he send me back my passport.
i hate him.

now ukba is being asses. i'm being an ass.
this is so much headache.. my head is about to explode.

sounds like a poem

anyway, i'm stuck. i'm totally stuck in this situation which seems to be getting stupider by the day.
i need my passport to go back to malaysia but it's with the uk visa ppl who has yet to start processing my application. i've paid 220 pounds which i stand to lose if i request for the return of my documents. on top of that, i still have to get my visa sorted out when i go back to malaysia and pay another 290 pounds.
bloody immigration

if i just leave it with them, i'll burn my 500 pounds ticket back to malaysia and i won't be doing my electives. such awesome options. i can't even change my flight dates since it's like a domino effect; changing my flight back to m'sia means i have to change my flight to india which would compromise my electives.

so i should request back for my documents right?
burn 510 pounds instead of losing 680 pounds worth of flight tickets and fees and lose out on my elective experience. but then again, people are saying there MIGHT be time for my passport to be returned to me on time.

can someone just tell me what to do?