The Finer Points of Learning

I attended my team's clinic yesterday. As our team specialise in colorectal surgery, a majority of our cases seen were bum cases.

I arrived early and managed to clerk a new case which had to be presented to my specialist later on. A colleague of mine was already tagging the specialist in his clinic when I arrived. They were seeing this patient with haemorrhoids, and was already examining the patient behind the screen. I joined them after obtaining permission, and the scene that greeted me was really quite hilarious.

The patient was on the examination couch, lying on his left, legs bent to allow optimum exposure of his rear end.
My specialist had already inserted the proctoscope, but very strangely, he was looking away from the patient and looked as if he just licked bile.
My colleague was standing at the foot of the couch, giggling silently.
There was a strange smell within the cubicle.

I think my specialist took a blow in his face. (LOLOLOL)

I took a peek into the proctoscope, and saw some faecal material within the proctoscope. Looked like the patient did not answer nature's call that morning.

To cut a long story short, the patient underwent a rubber banding for his haemorrhoids.

I learned that we cannot be too enthusiastic when doing a proctoscopy... Do not stand so close when removing the probe, and be careful of noxious gases.

To all those who will not be peeking into other's bums in future, remember to empty your bowels before seeing a bum doctor.

Learning the ropes

Surgery is not my favourite division of medicine. In fact, it is probably my least liked subject. And it is not because I am haemophobic.

There is just something about surgery that gives me the chills. Personally I find surgery relatively messy, dealing with abscesses, intestines, infected wounds, hernias, cancers... The list goes on.

When I was in my 3rd year of studies, I did a 10-week rotation in surgery. Needless to say, I wasn't the most enthusiastic student and only spent enough time to learn the basics, whatever was necessary to pass the exams.

Now that I am in my final year, and in my final months of studies, I find myself going through this rotation again, this time for a much shorter period, only 4 weeks.

I am taking more interest in surgery now that I am almost completing my training, voluntarily doing or assisting in procedures.

After a whole morning in the clinic yesterday, I realized that there is more to examining a patient than what medical school can teach.

I've already been reminded of the importance of wearing gloves in a previous post.

Yesterday I remembered to wear the latex fingers before performing a rectal examination... But I only wore it on my right hand. I thought that since I was only going to use my right index finger, what's the point of wasting another glove for my left hand?

I only saw the point after applying KY jelly on my finger. I needed my left hand to part the err... you know what I mean. So there, bitten by my stupidity again.

That was for the rectal examination. I was observing the house officer inspect another case, this time a fistula in ano. I could never forget how bad the smell was... It reminded me of smelly salted-fish with belacan. Ughh....

So lessons from clinic :
Always wear gloves on both hands. You never know when you might need your hands or what you will touch.
Always wear a mask when examining a fistula in ano.

I am wiser now.

Kitty Meal

Tuesday night and I'm bored out of my wits! I was going through some of the photos I took with my phone and found some pretty interesting pictures.

It was New Year’s Day 2008 and I was on my way to the ward (yeah, talk about no life!). As I was walking down the walkway, I came across some odd looking pieces (and a cat) lying on the floor.

On close-up...

(Tail)

(Jaw)

(Sleeping cat)

Feline post-prandial narcolepsy.

Was it a rat, squirrel or another cat? I'll leave the guessing to you.

How's that for a New Year meal? LOL.

Growing pains

I went out for lunch with a coursemate of mine today. I haven’t seen him in almost a month, as he had been regularly missing our classes. By chance, we met in the library today and decided to go out makan.

He told me he was going to quit med school, and that was the reason he was back at the faculty.

I was not stunned by his statement, as he had been saying this throughout our academic year. Still, I was very surprised at his decision to quit now when we only have less than 3 more months to go.

I asked him why not complete this degree as an insurance. After all, we had gone through almost 5 grueling years of studies. Just 3 more months to make the whole 5 years worthwhile.

He told me that he could not bear to go through this kind of life anymore, and since he will never walk down this path again, what good will the degree do anyway.

His statement made me think of another friend of mine who quit college to run his own business, and after some hits and misses, he is doing well now. He told me that he was not gaining much from college, that the qualification was just a piece of paper anyway.

My encounter with the 2 of them made me question my personal objectives in life. I was raised with the mentality that academic qualification is the most important acquisition of our lives. I grew up believing that a degree is my passport to success. Almost all my friends are graduates, and my sister even obtained her Masters degree from Cambridge.

“Middle class mentality”

Those were the words of my lecturer 4 years ago. He once said that a majority of our society is stuck in the middle class mentality, where we were raised to study hard as children, get a degree, get a steady job, find a spouse, and raise a good family.

In other words, “Play it safe.”

I am a safe person. Maybe it is because I have been protected by my parents all my life. They had kept me safe, and I am very comfortably snuggled in my cozy cocoon.

At this juncture, just months before I attempt to spread my wings, I do not know how successful I will be as a doctor, a daughter, a wife, or a mother in future.

And qualification might not be the most important thing in life after all, but I still would not dare to venture out into the world without my MD.

I admire the courage and determination of my 2 friends, and my second friend is an example of making life work come what may.

After all that had been said, I have come to realize that the wisdom of growing up is something of ours forever.

And that is what I will hang on to.

My Hands

I did something quite dumb today. I examined an inguinal hernia without wearing gloves!

No, it's not a deadly sin, but would have been better had I donned the gloves. The purpose of the gloves is mainly for hygiene sake, protection for my own good against body fluids of a patient.

I only thought of those darn latex after I started my palpation, when I felt that something was not quite right. Everything felt so....distinct! Only then was my mind flooded with the same message,

"Bare hands! Bare hands! Bare hands! Bare hands!"

The joke is on me, really. Moral lesson of the day : Don't forget your rubber.

I won't, hopefully :P
Thankfully there were no secretions or discharge. Phew!

My Way

The Road Not Taken

Two roads diverged in a yellow wood,

And sorry I could not travel both

And be one traveler, long I stood

And looked down one as far as I could

To where it bent in the undergrowth.

Then took the other, as just as fair,

And having perhaps the better claim,

Because it was grassy and wanted wear;

Though as for that the passing there

Had worn them really about the same.

And both that morning equally lay

In leaves no step had trodden black.

Oh, I kept the first for another day!

Yet knowing how way leads on to way,

I doubted if I should ever come back.

I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and I--

I took the one less traveled by,

And that has made all the difference.

-Robert Frost-

At this point in time, I imagine that I am Robert Frost when he was standing in the woods where the road diverged into 2, and while deciding which road to take he wrote a poem.

The latest issue in my life is deciding on the hospitals to apply for my housemanship. Everybody asks the same question,
"Do you want to go to Sabah or Sarawak?"

I had decided some time ago to apply some place near home, but personally I have no objections going to Borneo. It will be a challenge, to start a new life away from home, away from my parents.

I do not know if there is a difference staying in KL. Work exposure and workload should be the same. I am still going to be a houseman for 2 years. I still want to be a paediatrician at the end of the day.

So now I am standing at the diverging road, wondering if I should stay or go. If I decide to go, all I have to do is to tell the authorities during my interview, and I'll be on my way.

Do I follow Frost in taking the road less traveled by? Knowing how way leads to way, if I go, will I ever come back?