this is it. 6 months into doctoring.

and i don't think i've come a very long way

I'm still pretty naive, pretty lazy, pretty stupid.

But the past months have brought out all sorts of emotions and have forced me to mature in some ways.
Now, I'm a bit more certain with my career choice.
It made me think a lot about career progression and with the current visa climate, where I would eventually like to end up.
Lucky for me, the doctoring degree has made the choice of immigrating elsewhere easier than if I had a degree in business or law.
But it's not to say exactly high in demand too. Each country has its own pros and cons. Staying in the UK would be the best but it comes with the promise of lonely winter nights.

Going to Aus is not so easy now and its unlikely I'll get to progress as fast as I like to.

Singapore is just manic and there's no promise of career progression as well with horror stories about their working hours and kiasu workaholics as colleagues.
Malaysia is similar and with the added fear of horrible bosses who can't give a rats ass about you or patients in general.

Let's just see where the wind takes me

On more current things, I would hopefully be sitting for MRCS in April. Never would I expect to be studying for an exam so soon. It's like I never left medical school :( 

Take a deep breath, and remember, there's sunshine, rainbows and happier things in life somewhere out there. It's not all just doom and gloom. Things will get better

Sweating palms, check; palpitations, check; dry mouth, check

I did my best to prepare for my first night. Slept right through the afternoon (thank you blackout curtains!), ate as much as I could and packed as much food as I could.
Even read a bit about common emergencies just in case I get called to a crash.

The moment I stepped into the room where handover happened, I never really stopped working.
Jobs was already accumulating when I took over. It was the run-of-the-mill jobs: prescribing fluids, putting in venflons, taking blood, writing discharge letters. My first patient to review was this old lady who was palliative.

"Doctor, her urine output has dropped"

A quick look at the obs chart showed that she always had low urine output. But it was complicated by the fact that she had kidney injury and palliative care was still not discussed with the family. Thank god the registrar was still there so she gave me solid advice to just leave the lady alone. Right after that...

"Doctor, this patient has low BP"

Shit! Another quick look at the chart showed that her BP is hovering just at the cut-off point. Everything else was normal. I looked at the notes but nothing really was clicking. I went to her cubicle and she asked me to draw the curtains around. Then she started sobbing about how the nurses were not paying attention to her and how she was in pain (she had an epidural in!). I had no clue what to do. Basic common sense escaped me. The nurse rescued me by suggesting I call the anaesthetist to check the epidural. Duh!

It's amazing how 5 years of medical school is non existent in my mind. Application skill= 0
The 12 hours went so quick. By the time I was done, I was back in my bed ready to sleep.

And I realise how much uncertainties there are. I came back home just wondering if I actually did the right thing. Was the lady with tachycardia really just dehydrated? Was the lady with the epidural in being a drama queen (apparently her block was still fine) or was she really in pain? Was it right not to push for the transfusion for the lady who dropped her haemoglobin? Is the lady with hypocalcemia alright? Was that really the endocrinologist's instructions?

I really should check up on these patients.
I just followed the nurses' instructions mostly since I'm still not comfortable making clinical decisions for patients.

2nd night and I wasn't bleeped at all to see any sick patients. Maybe the nurses realise I'm such a useless person they might as well just do what they think is necessary or call the registrar directly.
argh

hopefully things will be better

finally, graduated!

this blog has followed me through secondary school, college and now medical school.
hopefully it'll continue on for as long as I need a place of catharsis.

I start next Thursday so everyday feels precious. It's like I'm trying to grab hold of whatever freedom I have left. Yet, I spend it wasting away in my room. I guess eventhough I may just be hanging out in my room, not spending it exploring places or trying new things, it's good to have the feeling that you have time to waste.
This will not happen so often in the future now.

Anyway, I won't be able to concentrate in whatever I do. I have a mix of emotions when I think about it. The feeling of responsibility, doubt, nervousness, excitement and fear. It's exactly how I felt, coming to the UK 3 years ago. The dread of having to make new friends, push my boundaries, trying the unknown, the knowledge that I will make a mistake... times like this, I wish I can rewind time and go back to being a student.

I can get all my student discount perks as well.

Onwards I guess
Wish me all the best and hopefully the first week will be smooth sailing.


No idea if I'll be able to hold true to my oath...

stress vs time graph.

we start of with the slow incline of stress when we start the year. stress levels are already slightly elevated even at time 0 due to the type of personality that enters med school- type As.
First episode of panic attack is a mild one when school administrators starts briefing us about our impending exams.
then the first major attack is when you notice your batchmates all getting stressed out about it.

The incline gets steeper when revision starts and you realise how much you have no clue about. panic attacks are more frequent now.

major "OH SH!T" moment is when you start counting down DAYS (not months or weeks) and realise the amount of crap you have to go through. i start posting "i am so stressed; i am doomed; i am stupid" entries on my blog. pace of studying steps up significantly.

then stress goes down when you realise, "hey actually, i do know something now" and the belief is validated when you start having group study sessions. unfortunately, pace of studying slows down significantly (scrubs has taken over my life yet again).

the last major panic moment is on exam day, outside the hall. that episode of panic is of sheer terror- the one that plagues every medical student when they are stood outside the OSCE stations literally feeling like they are going to pee themselves. we all have signs of an adrenaline storm- dry throat, cold clammy hands, blood pressure and heart rate through the roof and blood rushes to our amygdala instead of our cortexes, where all our hard earned knowledge is stored. instead of muttering the answer that we know, in our heads we are trying our best to suppress the natural urge to scream and run away. or maybe for some people, punch the examiner's face. it's not called fight or flight response for nothing.

finally, when the final station is done and over, the stress levels finally swoop down to 0. seriously, it's like someone finally opening the windows in a very very musty room. the relief that comes..... best feeling ever.


wish me the best of luck guys. finals in 3 days :) can't wait for this to be done and over