About Me

Thursday, May 29, 2014

wow

chanced upon joanne's reflections on her nni elective. just beautiful

"... we are now Christ's hands and feet"
"having just gone through 4 weeks of neurology, a specialty that obsesses about eliciting physical signs, i am certain that this sign is the most ... definitive and convincing sign of all - the sign of the cross"

wow. cant even begin to describe the enormity and the awesomeness of this statement

as a student, and even nowadays in our flash ward rounds, we hunt for signs and symptoms
as a house officer, we hunt for a minute to sit down and rest, for a place to rest our heads at night on call and catch a few snatches of sleep. we hunt for signs of what God wants us to do with our lives

the way to become better, faster and more efficient
is not to keep on doing our jobs day after day like monkeys trying to type out the completed works of shakespeare

but the answer lies solely in God

the end and the beginning is that we are called to be Christ's hands and feet
whereever and however we are called

to hug and cuddle babies when they look terrifiedly on as the nurse suctions them, or worse, we put plugs in
to sucessfully get the plugs in so they can go home and play and learn how to flip over

ps: the baby today whom i helped the nurse hold as she was suctioning the baby on my way out was super super cute. she was worth cabbing down for ty meeting for. totally worth it. 

"until God opens a door, praise him in the hallway"

so i'm coming to an end of this first month of working life. i realise now how slow we were at first!! and why people's jaws dropped nearly to the floor that first week! even now i keep discovering new things i should have known. hahaha. oh well. one lives and learns. 

started out in what i now know is the nearly, if not the BUSIEST WARD in the whole hospital, at least i know that if i can handle what is known as the busiest with the highest turnover and largest no of patients the con needs to see (ie rounds take longer), then whatever is thrown at me from now on can only get better

calls although painful, do make me much better in terms of clerking speed and efficiency. it's purely out of necessity cos if you dont speed up it's just really multiplying the pain. calls are just such a funny thing. honestly speaking as a pre-med kid/ student, i really used to think calls were so cool and anticipate them. even before my first call, i was pretty excited. the truth is that calls are a massive to do list that are really difficult to complete.

each task by itself is not really very difficult (for paeds at least), and not hard to do well (eg called to see patient for rash, or spiking fevers, or puff review, or new case). but to do all fast, and well, and prioritize, is a whole different ball game altogether. and you get called all the time for random things, ambushed for changing paracet orders, for first dose abx, stuff like that. and all the wards are pretty far apart and you have to walk briskly without outright running to prevent alarming pple 

so in summary, this month has taught me that the next 11 months will be good character training and medical training. in terms of efficiency, in terms of how to work the system, how to win the game :)

2 more months, lets go!

i will praise him in the hallway until i find out which door he wants to open

ps: thank you to all the various pple who have encouraged me in one way or another regarding my future aspirations. although i truly am still trying to figure out God's will, sort of please help me to change what i can and accept what i cant aka the serenity prayer, i think all the helpful tips are really indispensable and i am really grateful for them!! thank you for helping me get even one step closer to self improvement if not perhaps even fulfilling God's will if so this be it. 

Monday, May 26, 2014

second call!

i'm getting much better at this call thing!! :) just keep on running.

at the end of all this, i'm going to be a superefficient human being. and on the bright side, at least im of some use to humanity being the only girl in the ward and hence the only one who can do ecgs and headss assessments on girls. it sure beats feeling useless as a medical student

anyway 2nd call was much better. no matter how much systems based practice they try to let you get as a student you really really just have to hit the ground running. anyway knowing my baseline levels of awkwardness, i think whatever 'this way' means is an awesome way coz there is like this built-in group of people i already know which makes it so much easier.

to the ward that first taught me how to be a doctor (the cons/ regs/ mos/ fellow hos/ nurses) and the mo on my first two calls, thank you so much for all the things you guys have taught me. we are now SO efficient we can do our changes even before reverse rounds hahaha. things got much better once vivek connected my laptop to the ward printer HAHA. and i whipped through lots of new cases yesterday, being both efficient and thorough, and cleared all my passives and escalated appropriately and quickly as needed! and i even slept >1 hour on call!! and survived the morning round!! and took at least 3 bloods overnight! yayness

happy songs




Saturday, May 24, 2014

without you now

this song is inexplicably catchy & ironically boppy haha


should have known better what you put me through
should have known better than to fall for you



on circuses

first call of my life. 

wow what can i say. a) i was incredibly lucky b) i was also incredibly slow and stupid

my mo really did so much for me - clerked 2 cases and ALL THE BLOODS. its not that i didnt want to do the bloods its just that i could hardly get thru clerking one case without the phone ringing a zillion times so hence i never got round to the bloods. or the million passive changes. and also why is one ward so far away from the rest?? oh yeah my mo also cleared aforementioned tons of passive changes for me. and then she bought me breakfast and coffee. and answered all the difficult qns during handover [ive heard that this depends greatly on the niceness of ur mo]

plus only 8 admissions in a night cos the hospital was super full. plus two sleep studies plus one in the private ward plus one in the haem ward. so that's 12. but only needed to present 8 at handover thank goodness.

HANDOVER. scariest thing alive. thankfully i was so high on adrenaline and numbed and humbled at my inefficiency that i had no space in my brain to think of what would happen if it didnt go well - just typed out two patients and photocopied the rest and WENT FOR IT. we rehearsed 2 patients and after the rehearsal i think my mo must have really felt like running far, far away into the mountains. but again thankfully for my debate training that somehow kicked in. if only that could kick in during ward rounds as well, i wonder why it doesn't. so we survived handover. except for the fact that there were a million qns about management which my mo tackled and sometimes we literally didnt know why the reg did that.

how to improve for the next call:
1. buy a huge bag to stuff all my things and sustenance thruout the night [oh but then wkend call sometimes the reg buys dinner. hm well see how. coffee never ever hurts]. put my bag of sustenance IN THE WARD not in the call room. i didnt even sit down for one minute on the bed in my call room.

2. haem onc patients tend to be sicker. so when faced with a haem onc pt who is spiking a temp and a gen ward patient with one day of urti, i think i know where to go. [in my defense on call the other day once the nurse called about the pt and i realised i didnt know what to do coz the primary team had said hold off abx - i just escalated right away to my mo. good choice, and SO LUCKY she didnt scold me. sometimes when u escalate too fast pple get annoyed. she actually told me that was a good move coz even if i walked all the way there to see it would delay and i wouldnt know what to do and wld have to call her anyway. BUT it would have been a good idea to open up the flowsheets to look at the T spikes. yup].

anyway this call im gonna try and prioritize the haem onc pts. i feel more confident abt the gen ward clerking thingy after trying it once and also i know i dont have to be SO THOROUGH and clerk for like 1 hr per case, just make sure pt stable and ok. the rest morning team can do. and no need to chitchat with the parents for too long when on call, can do that in the daytime...

3. clerk new cases faster!!! just whip through it. i'm gonna time myself, 30 mins for each case esp easy cases. honestly the reg is gonna see soon anyway. and they are pretty detailed. u just need to not miss anything big.

4. go back and check the cases for changes after reg rounds. i resolve to do at least 3 bloods. my mo cannot keep doing alll the bloods for me! and anyway, most mos wouldnt.

5. do small changes (like paracet) fast coz if not, they KEEP CALLING and it really disrupts anything u are doing. not least clerking new cases.

6. pre-sleep

7. highlight URGENT changes.

8. bring chocolates to the nurses in the wards im covering on sunday. and tell them its only my 2nd call and please take care of me. haha the nurses in my own home ward are so awesome. when they call me they'll be like "elizabeth, this is su su, you have a puff review in bed 2, come soon ok?"

ending off with a quote from a navy seal dude on my fav topic: HOW TO CHANGE THE WORLD. well i dunno about you but medical training (HO yr included) sounds pretty much like this.
But an interesting thing happened to those who were constantly on the list. Overtime those students—who did two hours of extra calisthenics—got stronger and stronger.The pain of the circuses built inner strength-built physical resiliency.Life is filled with circuses.You will fail. You will likely fail often. It will be painful. It will be discouraging. At times it will test you to your very core.But if you want to change the world, don’t be afraid of the circuses.
i also like this:
Every SEAL knows that under the keel, at the darkest moment of the mission—is the time when you must be calm, composed—when all your tactical skills, your physical power and all your inner strength must be brought to bear.If you want to change the world, you must be your very best in the darkest moment. 
let's go! :)

Sunday, May 18, 2014

sunday thoughts

first time going to the gym in 2 weeks of working life!!

for the first time, i'm actually not going for the purpose of weight loss (running around in circles like a headless chicken is surprisingly good for that, it just doesnt release the same kinda feel-good endorphins a real workout does). more of de-stressing, building up physical and mental musclez for call/ the week ahead haha

so epiphany for today is that: miracles do happen, but i need to be fast and efficient anyway and there's no two ways about it. no matter what happens, i have. to. level. up. HOWEVER. i am blessed with determination and great self-motivating skillz (if unfortunately not innate efficiency). so. I CAN DO IT!!

cowherd

today i woke up feeling as if i ran a marathon yesterday. i was really perplexed until i remembered that everyday we have to push cows and trolleys around. i'm beginning to feel a bit like a cowherd.

there's a poem somewhere in there about electric cows and all those virtual hoops we keep having to jump through. percolating in the coffee maker of my mind

there was a reading the other day, about the road to emmaus. i really loved the reflection in one of the bulletins. something about two people, confused like anything about the events of reccent days, meeting Jesus on the road to emmaus. but they didn't know who he was, even though he was with them. he walked with them the whole way and ate bread with them. then suddenly their eyes were opened and they saw. 

so many beautiful beats in that. firstly, their belief even in the middle of confusion. their hospitability to a stranger even in the middle of their own problems. that Jesus accompanied them the whole way, listening to them reccounting and discussing their problems. and that finally they saw the light. 

i'm not really too worried about my future these days to be honest. i'm more concerned with climbing the everest learning curve and being a good doctor & colleague. 

but i was just thinking that... sometimes we think that God wants us to do something but maybe he wants us to do something else. looking back the first time i seriously wanted this was one winter's day walking through a tree-lined path. and before that winter's day, i had wanted to be a neurosurgeon. that's how it all started, then the fireworks, blah blah. although thinking about first anythings is clearly not very reliable cos i came into med sch wanting to be a surgeon. and obviously i dont have the temperament or capability for that haha. 

and that God had never really told me (before good friday that is) explicitly which part of medicine he wants me to do. not that we should always expect him to pass us direct messages but i did try really hard to discern which of the two hospitals i should apply to and i never got a direct answer... i just ended up swinging between the two and never really knowing. maybe the lack of an answer was an answer. 

just a thought. who knows. my life does have a way of doing funny things that turn out for good. strange how it does that. anyway, i'm really glad i have this training ground on which to cut my teeth. it's probably the best choice i could ever have chosen to make myself the most efficient version of me ever. i guess i'm not ready to stake everything on a new choice in a way cos having staked everything on this belief once, it's a bit daunting to re-stack my stakes, if yknow what i mean. but then again, if it's literally the one message i got from God, and it IS the third time... who knows... 

i guess just keep an open mind, try not to over-emotionalize things (ITS A SIGN FROM GOD! OK GO GO GO) because yknow we are all human and feelings and things can confuse one sometimes. but also not to close one's heart and mind to God; maybe he DID plant some desires in your heart & mind at certain points for certain reasons. to be revealed in ... in the sequel haha

to do list
- email mohh to change bank accounts
- finish online learning things
- log duty hrs/ procedures [being the only female ho in the ward means i have done ecgs for like everyone. i am now the go to ecg person whom the nurses call when they cant get the machine to work. HAHA the thought of tt really amused me.]
- prepare for call on wed *kungfu warmup*
- church & gym tmr! my one perfectly free day to spend on usual activities that human beings usually do on weekends
- presentation 

Saturday, May 17, 2014

it's okay, it's love

second week reflections:

this week started out AWESOME with the public holiday and whatnot, and ended AWESOMELY with the mos and regs finally telling us good job and us finishing at 430pm!! the mos were sitting in the room playing music on youtube waiting for 530 to come and the on call to take over, no nurses were calling us for anything, everything was settled, and there was like only 1 hids left to do. i left the ward at 6pm after hids-ing, it was BRIGHT OUTSIDE and there was actually traffic because it's the time normal people leave work. jh left to prepare for call at like 4pm (!!) with all the mos shooing him off. 4 of us actually left to ward to go down for lunch at kopitiam (!!)

wow speechless.

thank you God!!

although there are many circumstances that led to this e.g most of the days we had full manpower in the ward (4 hos) thanks to suemei helping us to hids and me expressing to her how badly we had died last week (a blessing in disguise that we had so many hids people had to come and help out), junheng becoming superman (sadly unlike me who is still a snail), the con being more conservative and not asking for so many bloods, only ONE discharge and ONE new case today....

i am still amazed and grateful.

also i did bloods today!! although, erm, i think the nurses' help was indispensable. literally. i think we would die without the resident nurse. no question about it. best. nurses. ever.

hoping third week will be survivable too!!

Tuesday, May 13, 2014

sunlight follows me

grateful for this small oasis in the middle of madness

goals for next week/ ways to be faster
1. finish ward round by 11am (HAHAHA so ambitious. fyi, we've been finishing at 12 on a good day. fyi, mos are supposed to start subspec rounds at 1030.)
2. know all my patients inside out. ie, relentlessly probe them about every single day of fever, look in ALL of their throats and noses and ears. if i have to go even ridiculouslier earlier than i've alr been going, SO BE IT. its really not fair to my mos if they cant go for subspec rounds on time coz of us. also if someone had a symptom for a long time, must ask more in detail (yea yea i know, it's so DUH)
3. go and see who needs a memo written and pre-write the memo (cos its so painful to write the memo at the point of discharge... you wouldnt believe.). also summarize all those pple our mos keep asking us to summarize. if not when we're running around like headless chickens the mos will ask "so have u summarized the pts yet?"
4. be the person doing bloods at least one of the days. maybe tmr? procedures log yo
5. finetune my system for writing down to do lists for the day.
6. pm round faster. nuff said. just write: continue management, unless something changed drastically from the morning. no need to rewrite all the issues cos the am round alr has all the details. more impt to flag up any sicker cases to the mos!!
7. sit inside the mo room to do stuffs so i wont get asked to change random things like paracet timings halfway through doing something

because inspiration is always good:
He promises to keep us safe and to bring us to our true home to be with him forever. The opportunity we have this week is to accept this offer of deepening our relationship with our Lord.  We do this by beginning each day in a simple recognition that we are not alone: “Thank you for this day, Lord. I know you want to stay close to me, to guide me and support me today. I need some real strength and courage to face some of the challenges of this day. Help me to remember your presence and love.” This 20 second prayer will open our day to a Lord who invites us to surrender our troubles to him.
If we find ourselves sidetracked and distracted all day, or for several days, it is easy to get right back on track by pausing, while doing almost anything, and asking our Lord to remind us of his constant presence. We will quickly return to a sense that Jesus knows us, understands us, and wants to be with us in whatever troubles our hearts. And, each night, when we give thanks to our Lord for his fidelity to us throughout the day, we will be given the grace to know, again, that we are never alone.
on the bright side, i may have been slow, but i (generally) havent done anything majorly wrong. so that's a good thing!

halftime

note: alot to get out of my system and pep myself up so apologies for probable repetition. a suggestion: go eat gula melaka pancakes at revolution coffee and dont read the below ramblings. hahaha
~
two unexpected days off work due to public hols and whatnot is so luxurious!! unfortunately manpower is a bit shorter tmr so it's back to being fried. was a bit freaked out at covering 16 patients over the weekend (and then passives for 2 wards...) but it was the best rounds ever!! nicest con ever. a breath of inspiration & encouragement. couldn't believe my ears that someone actually still believed in me.

its also scarier when the consultant is one of your heros cos you want to make sure everything is perfect. there was one interesting event, which ended with me proposing to call the con to ask him something and the mo actually had to cover her face with the mask cos she was laughing so hard. -_- anyway everyone was very nice about it.

only survived half call thanks to the nurses. maybe the nurses here are used to looking after little children anyway haha but they are AWESOME. in 66 the nurses actually prepared a list of all the things to do and gave it to me. and half the time when they're asking me to order things i've never ordered before they'll just show me how to order them. (no worries it's usually minor stuff like calamine lotion). and they never scolded me or rushed me even though i was abit slow with the discharges cos i was settling something in another ward. and also thanks to SY, who was helping me though he was on FULL call. by the end of the day i was whizzing thru my puff reviews and resolving not to be so super conservative with cutting down the frequency of the puffs haha. and also JH, my ward partner, for making work life so hilarious even though we're so stressed all the time, and my mos for bearing with us and always giving us pep talks. i promise to be faster!!

today's daily dose of inspiration comes from  http://onlineministries.creighton.edu/CollaborativeMinistry/051414.html 

“It was not you who chose me, but I who chose you and appointed you to go and bear fruit that will remain” … JohnToday we read that the Lord of the Universe has chosen even us playground losers for his team. WOW!            And what do we have to do to be worthy of this honor? “Go and bear fruit that will remain.”            I’ve been pondering what this means since we former team rejects will never cure cancer, compose a hymn that competes with  “Ode to Joy” or work in Calcutta’s slums. 
So if you are overwhelmed with the idea of God actually choosing you for his team (even if you always struck out), don’t be intimidated. .... remember that there are about a zillion small things you can do in your ordinary life to “bear fruit that will remain” and justify your place on God’s team.
~
well i wasn't really a playground loser HAHA, i was chosen not first but not last either, somewhere in the middle ;p and since i started cross country and gymming, i did become significantly more athletic ;p like the time i was the fastest runner amongst the girls during 2.4! (literally the last will become first, as i'd also just been the last straggler during cross country training a few weeks before that...).

but something that really struck me is the idea that God has chosen us for his team, no matter whether we are winners or losers. i may be an okay runner but in terms of daily work right now i dont actually think any mo in their right mind will choose me for their team (yesterday i took mc and received a triumphant whatsapp from jh "liz i'm on the bus home at 630! record! and finished 11 hids!"). man whoda think i was the rate limiting step. darn.

despite this all, i DO have the ability to cure/ heal/ comfort in some way or another. isn't that amazing?! it doesnt always feel amazing when i'm running from one tower to another with a whole list of mundane things to do that i'm late to do, but big-picture wise, it is. God HAS chosen me for his team, all i have to do is find out what i can do in my daily life to justify my place on his team :)

back to work tmr, will be a paragon of efficiency yes! come on world we can do this!! i specifically signed up for this SI because i knew that there is high volume which would train me well both clinically in and efficiency. and oh yes indeed. by the time i finish HO year (if i manage to jump thru all the electronic hoops and documentation) i would probably be like a h2g2 robot on speed. go go go

Saturday, May 10, 2014

to think about

sometimes, if you dont get on the right bus, there may be a good reason for it

times in your life where you know something great and awesome is coming your way; some epiphany, some explosion of goodness. where everything will make sense when you look back over the puzzle pieces

... this is it

~
meanwhile, i am currently lusting for sticky date pudding with gula melaka at revolution coffee!! but no free weekends to go. why am i on call every weekend...?? what good can i do on call anyway sigh. on the bright side, all this hids-ing is giving me a good idea of impt qns to ask in histories and management HAHA. there was a super interesting case last night. one of those neurometabolic conditions. altho the way i'm going i am not going to be a paeds neurometabolic doctor anytime in this life until pigs fly, it was def interesting. and thankful for all the nurses who pretty much treat us as their kids (the ward sister can often be found exclaiming "children!!!") and who keep telling me how good and hardworking i am for coming back on a weekend when i technically dont have to. good to know one is appreciated somehow lol. 

first week of work

i've survived one week of working life! it's true when they say, nothing prepares you for it. NOTHING

well, when i say "survived" i mean

a) i'm still alive
b) my patients are all still alive
c) i havent made any major errors (actually to be exact i havent made any errors at all! just super slow. haha)

actual quote from ward sister "there are three new cases, who's going to see?? chidren!!!" *children referring to us the hos not the patients*

i think i more than slightly underestimated the case load having only worked in a private ward during SIP, nothing could have prepared me for the daily craziness and withdrawal symptoms when the TWO OLD HOS BOTH WENT ON LEAVE AT THE SAME TIME. we kinda knew they were doing more than half the heavy lifting and we knew we were going to get fried when they left but... it was still painful anyways. haha.

NEVERTHELESS, i can confidently say that i have helped countless small kids over the past week. yay for meaning in life. the reason i know there are so many kids i have helped is i have also been staying back to do their discharge summaries until 9-9.30pm everyday.

a few mixed feelings:
- relief at having survived a week, particularly the last few days, even though we were glacially slow and mos, reges etc keep giving us pep talks, at least we managed to finish everything and nothing got left out
- gratitude at actually being a doctor and knowing how to do this doctor thing (kinda)
- wondering how i could possibly be more efficient next week and not being very sure how to. awkward moments when you get scolded for things sometimes not your fault and just accepting that you need to bite ur lip and apologise for things, and sometimes that you ARE lacking and there is no use making excuses just apologise anyway.
- happiness & inspiration every time i see the neuroteam
- joy at having my abstract accepted for the upcoming conference.
- feeling really grateful to the covering hos, mos, nurses and pharmacists who regularly save me/us & who never scold us for being lacking but keep telling us that its ok cos we're new, even tho we finish so late everyday they hardly have time to go for subspec rounds. and esp the mos who keep pulling us aside to tell us it's ok (HAHA the fact that they do it means it's not ok, but oh well. like they said, at least we dont make any medical errors, the only thing is everyone goes home super late everyday and are constantly hopping up and down on tenterhooks and rushing us. yep)

ANYWAY. half call tmr and first real call next sun. (why do i have so many sunday calls). off to do all those interminable online modules and try to shore up my knowledge. if anyone has iv efficiency, please pass me some.


Friday, May 2, 2014

happy days :)

dear God,

thank you for finally helping me find my easter joy, and especially on the first day of starting work, after a long day that started with feeling so blur the m4 medical student actually helped me and jh print our lists and see one entire cubicle (LOL), of very looong talks, of endless "one more hint"s from the guy teaching us how to use the computer (the tips are really appreciated tho!!), and ended with taking super long just to do one discharge summary cos jh and i kept chatting in the mo room hahaha. also so lucky that the first dr i saw when entering the ward was dr riza who was one of the mos during my SIP! or we could never have figured out the pw to the mo room. haha.

after the very long and dark tea-time of the soul, finally, a glimmer of light, and on such a day as the first day of work in my life. it was really really nice :)

it just feels like once i finally turned everything over to God, all my desires and wants, and decided that whatever He wants me to do, I would do, whether i originally liked that area or not, the way starts to smoothen out before me. it kinda feels like a test, which well... i never really pass these tests with flying colors. the last time, i kinda just gave up in a stairwell and waited for God to send someone to save me. but yknow, in this world, the only one we can ever, ever count on to save us, is God. and He always will :)

He can open doors I am not strong enough to open and close doors I am not strong enough to close. He can turn rejections into acceptance; He can move mountains.

the future is still far ahead, and i have a long way more to go (my first call, my first actual round where we dont go off halfway for orientation, my first blood taking from a kid...). i have so much more to learn.

but if God is for us, who can be against us? 

now just to survive sunday rounds. haha. I AM SO SLOW only saw 5 patients this morning!! we have 16 each on sun. good luck to us.

Thursday, May 1, 2014

there are many things i don't know.

but this i know, that this year of my life will only be turned to good. that God will be with me through my ho year. that i will look back on this time period & see God's hand in my life. that He wants me to pick myself up, stop wondering about the what-ifs, and get into the superman mode of savin the world. (haha. as if we can save the world. well one starfish at a time...)

if it is the right road, then i'm well on the way. 
if it's the wrong bus, my holiday showed me that even if you take the wrong bus and it's dark and scary, you can still get to the right destination in the end. 
(especially if you see a rainbow before starting off... then you are reminded of God's promise to never send the flood again) 

whatever this is, this will make me a better doctor and person.