Job!

So internship offers came out today.

Congratulations to those who got a first preference offer!

Good luck to those that haven"t got an offer as of yet :(

I got my first preference offer of Mt Gambier & Districts for internship next year! Hooray!

Hand Surgery

So day 2 of hand surgery is down.
It seems that I will need to start at 7:30am everyday and generally finish after 5pm.
So far, I"ve spent a day in clinic and a day in the operating theatre.

The day in clinic consists of me measuring grip strength, joint angles and pinch (apposition?) strength while the consultant drills me with questions.

The day in the operating theatre consisted of me standing around.
Well, until the last case which was a radial nerve repair. Seems that the orthopods that put a plate in for the fractured humerus got the radial nerve caught under a screw, so it had to be repaired with a graft.
I got to stand around but also take photos using the consultants flash camera (Olympus E-1 I think it was). That was fun. Sort of.

I"m tired of it already...

Anaesthesia,: Epilogue.

So I"ve now finished my 2 weeks on anaesthesiology.

Twas a short trip, but I learnt a lot.

My introduction to anaesthetics was gentle. Starting with the basics, I was advised on what to learn and read up about, the basics of the risks involved, and the indications and contraindications.
My learning was encouraged by questions and revision of the basics. Practical skills were encouraged and with repetition, I slowly understood what needed to be done, and what to watch for.
It challenged me in my knowledge. It stimulated interest.
I definitely  feel  like I have learnt a lot and in particular, feel more confident with achieving and maintaining a patent airway.

I also got two intubations down (from two), which is a good start!

As a farewell, my mentor signed me up for a presentation and dinner.

At the Grand Hyatt Singapore Hotel, speech on Multi-modal strategies in the management of post-op pain given by Professor Schug of the University of WA and Royal Perth Hospital. It was a very interesting speech, concentrating on the benefits of COX-2 inhibitors in conjunction with opioids, as well as the use of pregabalin/gabapentin.

And the food.

Oh my the food.

Tuna and Avocado Tartar, with Lavoche and Remoulade Sauce

Previously a Cream of Mushroom soup

Pan-fried Fillet of Cod, Puy Lentils, Gratin Potatoes, Glazed Asparagus, with Dijon Mustard Sauce

Crispy Chocolate Praline Cake, with Raspberries and Vanilla Cream

 Oh my.

*hugs*

That is all.

One Week

So one week down in Singapore!
Well, one work week anyway, but that pretty much counts!

Anaesthesia is vaguely what I"ve imagined it to be.
You check you"ve got the right patient, you inject some stuff, you make sure the patient continues to breath, you check your email and surf a bit, you inject more stuff, keep browsing, the surgeons tell you they"re done and you send the patient off.

Well I finally intubated a patient today!
First time, first go! Hooray!

Otherwise it has really been quite uneventful.

Singapore, Day 4

This was so exciting that I needed to blog about it:

I got free lunch!

Ok, that"s part of what I"m going to blog about, but definitely the most exciting (for me). The food was significantly better than FMC, sort of on par with those "all you can eat for $8" places in Central Market. Which is acceptable, but not the greatest.

Of course, if I wasn"t such a cheapass, I could have paid a whopping SGD$1 for a plate of noodles or SGD$5 for just about anything (as mentioned in the last blog post...).
Note: SGD$1 = AUD$0.75
SGD$5 = AUD$3.80 i.e CHEAP.

What else I"m impressed with is the internet I"m using at the moment at a family friends house: 100Mbit connection. That is a theoretical maximum speed of 4x the best of what Australia has to offer (at least, until the NBN comes through... Someday...)

So I was having a conversation with one of the MOs which waiting for a thumb PVNS excision to finish up, and it seems that there are lots of pros and cons to living in Singapore.

Pros:
Minimal income tax - Even for earning $300,000 you pay about 13% tax. Above that rises to about 20%.
Food - The food here is spectacular, cheap and available all hours of the day!
Travel - The Singapore MRT is bloody awesome, reliable, fast and pretty cheap.
Internet - As mentioned, super fast!

Cons:
Pollution - Air quality ain"t the greatest here.
Rent - From what I can figure, quite expensive.
Cars - I also discovered something crazy about this:
Singapore have freakin' expensive cars.
Now, I don"t mean like, Ferrari"s and all that, but even just regular cars!
From what I can work out, in order to own a car, you must first be able to afford to pay a "certificate of entitlement". This is a sort of registering of the car with the government. I think they do this to put a limit/quota on the number of cars in Singapore (due to increasing pollution, population etc), which is a decent idea, as those that can"t afford, use the MRT which reduces carbon emissions etc.


So yeah, how much would cars be?

Lets see, I am contemplating getting a Ford Fiesta. You can get it on sale in Australia for a scratch under $20,000.
Second hand Ford Fiesta here? $70,000.

Seriously. What.

3 days down

Hey there, didn"t expect a blog post so soon did you?

Well, I sent an email to friends and thought I"d edit it down a bit and put it here.

Yes, very lazy I know.

I don"t really have much of anything that is quite as exciting as other elective destinations, so you guys will have to do with a quick summary/diary entry of whats happened so far...

After disembarking the plane, I went with priorities first. I found myself some internet to let the masses on Facebook know I was still alive.
After that I managed to work my way through customs (impossible to find a working pen to fill out those immigration cards!) and snuck my 16kg of uncooked beef and fish through the "nothing to declare" line. Yes, thats right, my parents priorities on packing were to get fish and beef to family friends. Luckily, I was allowed to bring 2x23kg of bags, which is actually a ridiculously large amount. Packing everything I could think of amounted to about 20kg.

Stepping outside, I discovered one thing:
Singapore is hot.
I"ll say right now that going from 12 degrees or so to 30 degrees or so is killer. I have no idea how the Canadians do it.
Apart from that, what strikes you is the humidity, with sweat dripping off you as there is no way it can evaporate into the already water filled air.

Oh, the pollution and population ain"t great either.
There were about the population of Adelaide trying to get onto each train I wanted to get on. Luckily, I had 40ish kg worth of frozen goods to use to clear some space. It worked surprisingly well.
Arriving at my destination (family friend's apartment), it seemed like everyone smoked. The lower level is a shopping complex type thing (which I think is the same with every building in Singapore...) and all the shopkeepers would be chainsmoking their hearts out. The only places that weren"t smoke filled were the food places. Everything looked so appealing, especially after airplane food (fake scrambled eggs and baked beans? Really Singapore Airlines?).

Have to admit, the view from the 14th floor is quite good. The layer of smog you can see silhouetting the city not so much.
My cough has gotten worse, and seeing a doctor at the hospital (they have a staff clinic), cost $10 and the bastard barely examine me. Wanted to send me for X-ray until I argued that he was a fscking moron and to try, I dunno, doing a respiratory examination? He ended up prescribing some cough syrup (which I"ve discovered is one of the ingredients of what I believe the cool kids call "purple drank") which hasn"t helped spectacularly, and I"ve taken the first two days off.

Had a brief stint in the anaesthetic setting with a breast tumour removal. Got to experience the "Time Out" thing that they had in our Patient Safety Workshop, they found incorrect consent! The system works!
Surgeon still went ahead with it following the consent they got and chased down extra consent. Not sure how that worked considering the patient was under a general.
Had an infection control lecture with N95 mask fitting. Not exactly very exciting.
Then there was a 5 hour ENT (LaFort I) operation. That was hell boring.
The consultants and regs love to drill you here... Luckily, my "mentor" is really nice and is happy to explain things to me when reply with "I don't know..." Which happens quite regularly.

But yeah.

Food is great here though!
The hospital cafeteria is like a super food court! You can get so much asian food for so cheap! A plate of noodles for $1. Almost everything is under $5. Crazy stuff!

Anyway, I think thats all I have for now.


Ciao!

To Infinity and Beyond!

So I managed to pack all my stuff and move out of the Village.
Much thanks go to my friends for helping move things and for my housemates for helping me clean, else I would probably have missed my flight home to the Gold Coast.


Its kind of strange coming home. I haven"t lived here for nearly 9 years now, and most of my own things have been packed away in some dark recess of the house. Actually, I think most of my stuff was packed up even before I left. My mother is quite efficient.
So without a lot of the little things I have, the emotional ties they each represent, this house feels more like I"m visiting a relatives house. Its a very strange feeling. I know I will always be welcome here, and my parents encourage it, but despite that, I just don"t feel like I belong here.

So now with everything stored away (mostly at a friends place), I am in limbo, with no real place that I can call mine.

I look forward to finding out where I am placed for my intern year so I can find a place and move my things in. Its always nice to come home to a place you feel truly linked to.

In the meantime, I will be off to Singapore in about 15 hours. I have a bit to pack and then I have to get some sleep since I have to leave at 5am in order to make it to the airport. It still hasn"t really clicked that I"m leaving the country. I suppose when I step out into 33 degree, 98% humidity, something will click then.
So yes, Singapore for 6 weeks! Yay!
My beautiful girlfriend will be meeting me in 5 weeks! YAY!

I cannot wait :)

One Week

Only one week left before I leave the country.

I have so much packing left to do despite all my efforts.

Raaaaaaaawr.


That is all.

I"ve been told to blog more.

As always, I slacked off with my blogging.

Bumping into our wonderfully assertive, yet surprisingly gentle giant PTR, I have been told to blog more.

I shall try, for great justice.

Or just us.


So anyway, ED has been remarkably fun, with suturing galore!
Glass, metal, chain saw, circular saw, fence post... If it has a vague point, someone will cut themselves on it!

The traumas have been interesting:

Any guesses on what happened here? (click for larger image)

I guess its sort of expected that I get to treat acute things, but some of the things I"ve seen so far are shockingly silly.

Headache? Sure, there have been nice ones with red flags (such as the man with a giant AVM) but there are those that present purely as "headache for 2 hours, panadol has helped, no neuro, currently nil pain".

Abdo pain? Serious ones from MVA and such or alternatively "abdo pain since 4am, ate ?dodgy chicken last night".

There have also been some good classical signs seen with the yellow (not asian or scared) lady with a liver that fills half her abdomen, scarred, pulsatile, solid with ascites.
Or the man yesterday with a 16cm spleen.

Some also quite unclassical signs:

Diagnosis anyone? (click for larger image)

Fun times.

Music Night

So the DJ Village (where I currently reside) had a music night on Wednesday.

It was a lot of fun with great performers.

A friend and I decided to perform a bit ourselves. I think we did alright, you can judge for yourself though:
My Favourite Diseases - http://www.youtube.com/watch?v=RQT-Q1sftiU
Colours of the Wind - http://www.youtube.com/watch?v=iB_X4R5Z0r0
Rip Rip Woodchip - http://www.youtube.com/watch?v=RWUFy2eg0ZU
Four Chords (Part 1) - http://www.youtube.com/watch?v=dMk4cCSQk1o
Four Chords (Part 2) - http://www.youtube.com/watch?v=TSujWprTXBk

 It was definitely a lot of fun, though nerveracking!

Another term.

So I tried to post this ages ago, but it wouldn"t work, so its not my fault I haven"t blogged in a while...


Ok, I tried yesterday. Its still my fault for being really late. But blog issues is a much better excuse...


I"ve had to go through and re-edit to change my tenses and some dates. How irritating...


So anyway, I"ve been slac- err... busy.

ICCU has come and gone, and though I said it was ok with little hands on, it definitely picked up in the last couple of weeks.

1. Saw an Extracorporeal Membrane Oxygenation (ECMO) being setup on a patient. Basically a heart AND lung bypass, where the blood is taken out from the venous system, oxygenated in a machine then pumped back into the arterial system. It only happens once or twice a year, so we were definitely lucky to see it.

2. Also tried out a night shift. I figured that at some point in my career, I would probably need to do one, so I might as well try it out to see what all the hype was about. Of course, I probably should have slept a bit more during the day...
Summary: Saw a patient with a complete whiteout of the right lung due to a tension haemothorax. 1.6L of blood/clots were drained and then I accompanied that patient to theatre. Was invited to scrub in with the cardiothoracics team and stood at the patients hip while the surgeons pulled out handfuls of blood clots and suctioned what seemed like an endless flow of blood. Total blood/clots removed in theatre: approximately 4.5-5L. Patient improved dramatically and went to the ward a few days later.

Yesterday I started on ED.

That is to say, I would have started had the ED consultant bothered to come in.. Instead, we waited for 40 minutes then I finally found someone to give him a call. He said he wasn"t coming in, and asked for another consultant to give us a tour. Considering the ED is pretty much mostly still under construction, it wasn"t a very long tour. Then we got to see a little baby"s laceration of her brow being glued. I then went home.

I then went to the airport to see off my girlfriend. A sad day indeed, the bad news that my girlfriend has left the country, not to return for 18 weeks. Four and a half months! The good news is that luckily, I will be meeting her in Singapore in around 11 weeks, spending 7 weeks with her, then not seeing her again for about 5 weeks. Everyone else will have to survive without her for 18 weeks.

So she"ll have 7 weeks in Zambia, doing some mixed discipline hospital stuff and some safari stuff, then she flies to Europe to meet up with her sister and tour around for 4 weeks, then to Singapore to meet me and hang around for a week before the both of us go to Cambodia for 6 weeks of paediatrics.
So yes, exciting times ahead, just have to survive this term...

2 months?!?!

2 months since last post? Really?

Damn I"m slack.


Summary:
GP land is awesome. Lots to do, lots of hands on, lots of fun.
ICCU is ok. Not much to do, not much hands on, not too exciting. Did CPR and saved a life though. So I guess that counts for something.

Better late than even later but worse than not late at all.

Its funny how memory works.

I forget where I was going with that line.

Anyway, its been weeks since my last post. Because of that, I"ve decided to ramble for a bit. Bear with me (or not, none of this would be particularly interesting...)



So since my last post, quite a lot has happened.
The New Year for the world ticked over at the usual time.
The New Year for Asians  (because we always need our own reason to eat more dumplings...) ticked over at the not quite so usual and often very random time.

5 weeks are down for the first term of hopefully my final year in university.
Hopefully.

In the last 5 weeks, I have learnt that the TA pub gets very cold, Adelaide gets very hot, and that eating a large pack of chips for breakfast may make you feel ill.

With the last 3 years, we were often encouraged to go to the wards, to practice our clinical skills and learn what we could. Of course, the main educational point was the lectures, PBLs and tutorials that we got, so ward work was always a little bit of a bonus thing, whenever we could find the time.
The funny thing about fourth year is that all our learning is meant to really be from the wards. Despite the whole purpose of fourth year being for us to actually be on the ward doing things in hospital, learning on the ward itself, I"ve found that I"m busier with things outside the ward.

This is probably made worse by the fact that the school hasn"t given us very much guidance or assistance at all with necessary things.

Of course, that could come down to trying to make us more independent and that sort of thing...

But anyway, exciting year 2011, if only I can get everything organised...