I finally found a chance to sit down and doing some blogging. It's almost 2 wks since i last blogged and SO much has happened, let me do some recalling. Hope this is a good time to sit down quietly to reflect. Reflection is something i feel i lack, something that i so dread that i didnt grab the opportunity to do during the hols. In day to day life, I always find this lame excuse of lack of time but well i've got to make more effort la i guess.

So what exactly happened aft 30may tues?
i know it was the very last week of CSFC, when the tension was rising, everyone was extremely stressed, well including myself.
Studying, mugging, practicing.. trying to brush up skills of clerking/physical examination i guess..

Then the tests came along.
I was suppose to have my surg test on monday, we met doc wong and each clerked a patient, mine was Mdm F with a gangrenous toe, needing an amputation. But to our dismay, doc wong had to run off to do some scopes so we had to reschedule our tests on thursday. Well we got new patients in the end cause Mdm F that i talked to already had her toe amputation on wed i think.

It was during both my surg test 1 & 2 that i so strongly felt that language barrier is crippling. Mdm F spoke malay which i had no clue, but luckily i had 2 very friendly nurses around to help translate, when i asked. Her husband helped too.

The 2nd surg patient i talked to was Mr F who spoked Cantonese and once again i had no clue and needed her daughter to help out in the translation.

But coming to that, I'm now taking malay classes and it proved to b fun :) altho the pace of the class is rather fast and i've got q a bit of revision to catch up but i tink malay's q an interesting language.. the pronunciation of the vowels are the same as jap so good for me i guess. I enjoy the classes with Encik and it reminded me how language classes were always one of my favourites in school. Hope it opens up opportunity for me to better communicate with the patients i meet next time.

surg test was more like a tutorial i guess. Dr wong is a very very nice doc. I enjoyed his tutorials tremendously and I like the way he gives people such good vibes, how he's always so good-spirited even post call and how his MO and HOs get along so well with him.
We examined a few patients with abdominal probs and pt's with arterial and venous diseases. My short case was to examine a patient with venous insufficency resulting in varicose veins and venous ulcers.. which i did it q clumsily, haha but it was fun learning so much even during a test. The patient was a very nice man, who let us examined his varicose veins with the trendelenburg test 4x, with him lying down and standing up and lying down and.. feeling the veins refilling when i let go of the digital pressure is an interesting feeling which i wont forget, so thankyou.

And well after the test was the end of surg for us.. we gave doc wong our card with my green-bean joke that he laughed at (so yay!) and took pix with him and elton before we said bye.
Thanx doc wong, you made this CSFC posting a good start to general surg posting which i now look forward to.

then there was the Medicine test.
I think i'm a kan-chiong spider. Haiz i hate to admit it but it's true. Weikiong keeps hearing mi whine about being stressed as we waited together for doc widjaya.

I'm thankful to get dr widjaya as my examiner because she actually spent time sitting down with us to evaluate our performance during the test and point out our mistakes so that we can improve.
And like i told wk, i admire his steadiness, the way he examines patients in a this confident way which i want to learn from him. He has steady air around him when he does his venepuncture/examination which i tink is great.

So coming back to my kan-chiong spider story. I was abit taken aback when i saw my patient with this big bold "ENDOCRINOLOGY" word beneath her name on the wall. She is this young lady who complaines of swollen eyelids and legs. I had no clue what happened in those bits of presenting complaint so I was even more worried. Until she came to her past medical history of a thyroid problem, before i saw that relatively big goitre (swelling) on her neck.
Haiz, which says so much about my poor skills of observation, after talking to her for a good 10min, then i saw her neck swelling, just doesnt make alot of sense. I really must open my eyes and look carefully before i do anything i guess. This was something doc low thought us the very very first day of CSFC, and i forgot all about it. He showed us how he could give differentials of meliodosis and tells us so much about that patient before we even talk to the patient.

So well with this lady i kinda gave up spending too much time on the history bit and went on to examine her and asked her more qn during my examination, i was abit flustered but luckily my examiner wasnt really around, otherwise she would definitely frown, so another bit to improve on i guess, but in the end it felt more like a surg approach of examination of a lump, with a quick cvs, resp and abd exam.

My presentation of history was no good, i was q disorganised and didnt sound pro enough i guess, but i was just very nervous but well i did manage to come to the diagnosis of a relapse of thyrotoxicosis due to her stopping of her medication last sept. My presentation of examination described much about the lump but i didnt say it out loud that "therefore it's a thyroid!" and so that flaw was pointed out to me too..

whew, i was so much more calm in the surg case but i didnt get all 4 bits of the diagnosis. My patient was a malay gentleman with a prosthetic aortic valve replacement with a background of coronary artery bypass graft, complicated with congestive heart failure and suspected of infective endocarditis.
I heard the prosthetic aortic valve but i dint hear the murmur btw S1 and S2, even on the second try. sigh.. i miss the soft murmur in the lady earlier on too. To think i spent so much time listening to all the heart sounds on the cd, i'm still not good enough to pick up soft murmurs.. so need practice practice practice! I thanked doc wong for showing us so many vascular patients with their long sapheous vein harvested so i could pick up the scar immediately, altho my general inspection failed to expose the patients leg properly and my examiner actually did it for mi. I heard the creps, and said it suggested R heart failure possibly but my examiner was looking out for mi presenting the link to a possible complication of CCF, and i didnt mention IE even though she told mi he was febrile and had +1 urine dipstick tests, so haiz not good enough la.
but well i enjoyed the tests now looking back and it was a great learning experience. Thanx to doc widjaya and ling for letting my subgp crash their tutorials.

we said goodbye to doc low on thursday too aft taking pix w doc wong. and haa yes being abit chiong-hay he got us standing along the corridor in an ICU for more than an hour telling us many many stories and important things we needed to hear at this very beginning of our training.

Doc low is someone i respect alot actually. He's

(.. actualli i fell asleep last nite @ this pt, let mi continue)

Dr low is someone who i always feel abit stess before our tutorial because he asks us mani mani qn and when we cant ans or get it wrong he'll shake his head and tell us to go back and READ READ READ!! haha and he's so particular with finesse that u feel that he's expectations are extremely high
but i'll never forget he bought us drinks when we joined him for clinics, just like doc wong who bought us drinks also. he likes to tell us about 2 most impt characteristics doctors should have namely "integrity" & "responsibility" it's so impt for the right people to inculcate us with the right values during the course of our training.. he says he hopes to tell the few of his students he meet each time these key values and i'm grateful we met him at the very beginning of our training, he say if we get the first starting few steps in the correct direction, we wont go wrong that easily next time, and it would be good for us. I rem how he said he was so angry with 2 irresponsible HOs tt he almost cried and as he was telling us that his eyes actually reddened. He ended his hr-long goodbye talk with us, saying in short he wants us to be "有用的人" Hope we wont disappoint him la.

So that was the end of our clinical posting. I had fun, and learnt alot of new things, met alot of people... so general med in AH will be next stop on 26/6.

Then there was OSCE which was q disatrous. I remember suturing but even aft my stitch, the wound dint close haaaa. -.-
I rem the venepuncture section which i told the lady i wud recap the needle and she almost wan2 kill mi, while i knew it was dangerous but i was tinking abt the one handed technique tt some pple taught us.. haha but oh well, i still manage to get blood in the end la so not so bad. and i dint really know the ans at some stations. the communication station was stressful too, w the examiner and the mock patient, it's over la it's over..

with cheaper by the dozen 2 movie.. which was q nice, but we didnt get to finish it..
so this is the end of my CSFC.