Our first week at surgery passed so fast! I was so tired I slept for 10 hours at the start of the weekend. It's a stark contrast from family medicine; be at the hospital by 7.30am every morning, show face at ward rounds where everyone is rushing everywhere, chock full of tutorials by busy tutors, learning how to clerk and examine patients all over again. Yesterday I did an abdominal examination on a patient who had an inguinal hernia, but didn't end off with an examination of the groin. Nearly got chased out of the clinic because I missed the hernia eeeeps!

It's been extremely tiring, but I've realized as challenging as it is, how much I've missed being in the wards. Being so busy that you have to find time to eat, being overwhelmed by how much there is to learn that you feel extremely inadequate all the time, clerking patients and stopping by for chats before they discharge.

We've met a few tutors who're great mentors, like our oldest prof who only works part time. And how I'm glad he still works in the hospital, and cares to take the time to take students like us.
It's amazing how he can be so impressionable, just shortly after meeting us for a few hours. I love his sense of humour, and the sharing of values that he interjects in between his teaching of medical knowledge.
Like how learning should be self directed, and we should leave the hospital everyday only when we've learnt something new.
Like how we should count our blessings daily, for however tough it is, we are privileged to be studying medicine and there are so many people who would give so much just to be where we are.
Like how we should treat every patient as though he/she is our last, be a little kinder, more compassionate and caring because all these qualities make so much of a better doctor.

SYTYCD inspires me.

Some routines speak so much that I could watch them over and over again and get goosebumps every time. It amazes me how much can be portrayed through dancing; friendship, love, happiness, fear, anger, redemption, hope.

It's the most beautiful language in the world (:

Palliation.

These are issues that I hold close to my heart. I believe most of us fear death in one way or another, and seeing how families have to go through such loss makes you think a lot. About life and death. About fulfillment. About how illness and disease impacts the patient and his/her family in a way more than we could imagine.

One of our tutors shared with us something that I found rather inspiring; patients may forget what you say to them, but they hardly forget how you make them feel. Observing history taking in palliative medicine is very special. The doctors don't rush through the consultation, but spend time exploring not only the medical needs of the patient, but the psychosocial aspects as well. I sat through a 1.5 hour consultation on Monday, and was truly amazed at Dr Goh's patience and understanding. The relationship built is not transient or fleeting, and I think that there are so many admirable things about a such a doctor-patient relationship. May we be able to learn much from these qualities, and apply them to every aspect of medicine that we will face in future.

When I was younger, I used to dread the long 3 hour car rides back to Malacca because of the inconvenience. During my awkward adolescent years, I gradually distanced myself from my cousins because I hardly saw them and there seemed to be no common topics to start a conversation (of course my lack of mastery of Hokkien was also a deterring factor). Over the years I learnt to become more social, and we started to talk more and share about our lives. They would bring me around Malacca to hunt for good Satay Celup, we would go crazy at the playground near to our grandma's house, we would sit and watch my younger cousins chase each other around the compound on bicycles to compare whose skills are the best.

It made me come to realize how much I treasure such kinship. My dad's family has 6 children who are scattered all over Malaysia (and in our case, Singapore) in view of better job opportunities. We only get together once a year over CNY. It's such a happy, warm feeling, to see such a big family getting together to lou hei, to watch the younger kids running around and mingling with each other, and to talk to people whom I've known all my life yet hardly meet. We would reminisce about the earlier days when ah ma's courtyard had many many chickens and we would compete to feed them with corn, the days when the kampong nearby was still a kampong and our dads would bring us on a tour of the neighborhood, when we used to pretend play and jump on the beds and play hide&seek even though there was nowhere to hide. It's something that I used to take for granted. But I realize that as we grow older, and become more entangled in the woes of our adult lives, these opportunities will be harder to come by.

Someone told me that these get-togethers will eventually cease once our grandparents are no longer around. I don't believe that family relationships are so fragile, that the ties that bind would be so easily cleaved. Because as one ages, I think that companionship and kinship will be all the more precious.

So, this Lunar New Year is over. We're back in Singapore, ready to prepare for yet another busy year.
May we have many more happy and lively Chinese New Years to come (:

Christmas is over, Chinese New Year is coming, halfway through Family Medicine.
Time is passing so fast I feel like I'm letting it slip past my fingers.

Fam Med has been a welcome breather. I really appreciate the regular hours from 8-4.30 everyday, the time to go home when the sky is still bright, the time to spend with family and friends, the time to rethink my priorities. Really ought to be starting revision for Pros but I'm so reluctant to give up this time.

Primary care is very different from the hospital. They're part of the same healthcare system, and work synergistically to provide holistic healthcare. But juxtaposed together, the working lifestyle, profiles of patients and diseases that are seen in each setting are so different. There are many elderly patients with chronic diseases who are regularly reviewed in primary care, and the emphasis on the social circumstances of the patient is very great because it affects how the patient copes with his/her disease. There are so many financially estranged patients who are non-compliant to their follow-ups and their medications because they simply can't afford it. It's an eye-opening experience to see how different patients in different social settings are managed and counseled. There are a different set of skills to master.
Communication skills are something that we'll take a long time yet to learn. Technically it's something that can't be taught verbally, but picked up through learning from seniors, and from experience. During my case clerking, I encountered an elderly lady who could only speak Malay, and the best I could manage was asking her "ada kenching manis, dara tinggi?". I really regret not taking up Malay classes in secondary school haha.
I guess it's the soft touch that makes healthcare so challenging.

Excited to start our palliative care attachment, I think it'll bring a very different perspective to life and death. I'm rather sensitive when it comes to these issues, but it's a part of medicine that we all have to deal with.

Happy New Year friends!
The rumours that the world is ending in 2012 only serve to remind us that life is short and transient.
In this new year, I hope to re-explore my relationship with God, and become a better person.

I'm physically and emotionally drained from barely 6 months in the wards. With each passing day, I feel my heart harden a little more, and I see myself building up that invisible wall between myself and patients. This is what I fear the most, stepping into the shoes of a person that I told myself never to become.

We're halfway through medical school, you know. In 2.5 years time, we'll no longer have our white coats as a shield to hide all our flaws and inadequacies. It scares me. And it scares me to think of how much we have to immerse ourselves in our work, and how much more jaded I may become.

I need a break. I need to stop and breathe, and remember what has inspired me before.

The minute you feel like giving up, think of the reason why you've held on for so long. This is, so apt.

After more than half a year of planning, we've concluded PHS with a final debrief. We would have done many things differently with the benefit of hindsight, and even though there were so many issues that surfaced along the course of the event, it was really enjoyable. We had a common goal in mind, and it was something I strongly believe in and found very rewarding (:

There have been many debates about such large scale public health screenings, about the efficacy and accuracy of our screening methods in picking up abnormalities and disease. It may not be diagnostic, but I believe that we have definitely helped to raise more awareness about public health. And well, everyone has to start off somewhere. For the poorer income groups who are unable to afford regular health screenings, PHS was a good way to sieve through these people and pick up those with chronic diseases and cardiovascular risk factors. Ultimately, awareness is very beneficial because prevention is better than cure.

In manpower, alot of the work was about getting frustrated at irresponsible people who withdrew at the last minute, and we practically met up everyday during the last week to grimace at the allocations. It was fun nonetheless, our meetings would last until 11+pm and we would start getting tired and ditzy and laughed at everything even though it wasn't funny. Going through those volunteer and supervisor trainings, feeling my blood pressure escalate when I opened the manpower gmail with 10 new emails to attend to, and surviving the epic shirts' crisis were all so memorable haha. I'd like to think we managed it as best as we could. PHS taught me alot about crisis management and interacting with people.

There was this gentleman we met during the second day of PHS who started shouting at Lynette and I because an usher directed him to a seat which was unfortunately taken up by another participant before he got to it, and he claimed that he was not being treated like a human being throughout the entire screening. It was a very unpleasant encounter because he made unreasonable demands and refused to listen to our explanations. He even wrote in to Lynette after the entire event demanding for the email address of a "higher authority". Seriously -.-
But there are the other participants who are so friendly and appreciative of what we're doing. Interacting with them, dispensing small advice about healthy living and hearing them express simple gratitude was very gratifying.

I really enjoyed planning and executing PHS, it's something that made these few months very busy but yet very fun. We managed to screen more than 2000 participants, and I believe that we have helped to benefit these participants in one way or another. It's a meaningful way to contribute in our capacity as medical students.

8 weeks of Internal Medicine just flew by in a flash. We start Paediatrics tomorrow, albeit with a note of apprehension. I believe my foundation in general medicine is not strong enough from the past 8 weeks of learning to be able to confidently start on medicine for little people. It has definitely been an eye-opening experience. I haven't seen enough to conclude that this will be the kind of work that I want to do in future, but I prefer it to surgery nonetheless; the lifestyle and the culture differ significantly. I have met so many patients and doctors who have left a lasting impression, and it has impacted my learning in a way that books and lecture notes would not.

Over the past 8 weeks there were a few points in time when I felt so tired of listening, tired of having to carry so many people's burdens even though they didn't expect me to. It's so dangerous when that happens, because I realized I started to distance myself away from patients, and started viewing them as entities, as bed numbers and pathologies, rather than as individuals. When times like these happen, I have to remind myself to take a break and revisit my priorities again. No one likes to be a nameless, faceless, statistic. I know this for myself as a medical student, because being ignored during ward rounds is such a despairing feeling.

I've talked to many patients over our medical posting, have seen many people cry and have heard many people who are frustrated and angry and frightened. I've witnessed a few deaths, a few malignant diagnoses being revealed, and it all just comes to sum up the fact that the hospital is a very scary place where patients are at their most vulnerable. It reminded me of what a privileged profession this is; to be able to help, heal and listen. Medicine is as much of an art as it is a science. There's alot more for us to learn (:

Just when you start to think about how the life of a medical student sucks, there's always someone in the wards who reminds you of how privileged you are, and how you should never, ever, take things for granted.

I spoke to someone with a metastatic cancer today. She was so sick and in so much pain. I really didn't know what I could say, and so I just listened. She told me about her life, her family, and how all that had changed when she found out about her diagnosis. She told me, in Chinese, how she wished she could live a few more years just to see her children grow up. My heart just broke. It's so hard to say something to someone who has been so brave, who has been through so much more than anyone of us could ever imagine.

She reminded me to cherish every moment.

We're already at the end of our first posting, and a few days away from EOPT. It's rather unnerving, because I still feel that I don't know as much about Orthopaedics as I ought to. I think it's partly due to the fact that we spend alot of time in the hospital attending clinics and clerking patients, but not as much time reading up on our content knowledge. It's like building a house; the fancy details of the house can be there, but if the foundation of the house is not strong, it's not sustainable.

We had our OSCE examination on Saturday, which was in retrospect quite alright. There were 2 stations which were rather unexpected but the rest could have been manageable if I didn't let my nerves get the better of me. I was super lucky to start off with a knee examination, and Dr Leslie, who was just so nice and encouraging that he really helped to start the rotation off on a good note. All was not too bad until I reached a post-operative management discussion station that hardly anyone anticipated, and that was just a mess. I think the examiner was trying very hard to prompt but somehow I misunderstood many of his leading questions. It's almost hilarious to think of it.

Well, I don't think Ortho is a very slack posting. It's a very specialized field, and your anatomical knowledge has to be very strong to understand most of the pathologies (which sadly, is not the case for me). It's not too bad a start to year 3 though. I think I've also learnt alot more soft skills from clinics. I guess every day is an experience if you're willing for it to be.

I saw a patient whom I clerked during my first day in SGH in follow up clinic yesterday. His physical and emotional state have been deteriorating, and I felt so helpless when I saw him sitting there waiting for a wound inspection. The nurse shared with me that some of these patients come all the way down to hospital, waiting for hours even though they're so sick, only to find out from the doctor that nothing more can be done for their condition because it is terminal. It is only the truth, but the truth is so cruel to hear.

I've realized that every encounter with a patient, no matter how transient, matters. No one likes to be sick and vulnerable, and they come to the hospital looking for someone to address their concerns and provide some answers. So much of it depends on one's reassurance and standard of care. A simple smile or gesture to help the patient up from the examining couch can make that much of a difference. There's so much to learn and so much to be inspired by, and it takes alot to keep these goals in mind.

Being in the hospital made me realize how human I am. It is so easy to be tired, so easy to forget that patients wait for hours to get their concerns addressed, so easy to lose patience after a long day. We enter medical school with lofty ambitions of wanting to be good and caring doctors, but how easy it is to get jaded along the way.

We're barely even 2 weeks into year 3 and I'm impossibly tired. Year 3 is hard to get used to because everything is own time own target. You know there's a set of skills you have to learn, a list of conditions that you must see and a few procedures that would be good to observe, but there's no one to guide you through it. I feel a bit like a lost sheep at times.

Orthopaedics is one of the supposedly slacker postings, and I'm glad for it because it gives us time to adapt and find our way around the system. It's tough though, and I can't begin to imagine how much tougher Paeds or Internal Med might be. There's so much to see and so much to learn. I've been through my first night call, clerked my first ortho patient and done a (no doubt haphazard) knee examination. Can't believe we're already year 3 and doing all of that. It's all an experience (:

Back from a week-long marathon of events - possibly the most exhausting week I've ever experienced. It was a fun and fulfilling kind of tiring though, and I'm really glad I went through all of it.

Camp Simba
I was the guardian of 2 adorable 9 year old girls who are so sweet, and who are typical girls getting squirmy at dirt and sand and insects. I really felt like a mummy during the camp, ensuring the girls had enough food and water, making sure they didn't run off or injure themselves. There were points in time where I had to remind myself to be patient and understanding, because after all they were just kids and they can't help feeling tired easily and sometimes they can't understand what is reasonable and what is not. I can't imagine how hard it must have been for the other facils who were taking care of much more boisterous boys, and I really respect them for it!
Having said that, I really miss the kids, it felt weird not having to hold 2 hands all the time, calling out the names of kids when they ran too far away, tucking them in when they went to bed and leaving the lights on because they were scared of the dark.
I really enjoyed my time with the kids and I think they've taught me a lot as well. I learnt a great deal of patience, how to look out for others, appreciation for my own parents, and how to be a kid all over again (not that it was very difficult haha). Their innocence and lovely smiles really warmed my heart (:

Bintan
After many adjustments and an amusing grocery shopping trip for instant noodles and snacks, my CG made a super last minute trip to Bintan. In all honesty, there is nothing to do there because you're practically isolated within the resort and there are very limited activities. But the company made it fun all the same! I'm glad we got to know each other slightly better over the kayaking and banana boating, the cooking, the instant noodle dinners and the lepak nights playing monopoly deal haha :)

21st
I headed down to a planned family chalet after a 4 hour long PHS meeting to a surprise birthday party complete with party hats and balloons.
It was a hilarious one, with cake smashing, silly talk and a lot of fun, and I'ld like to thank everyone for making my 21st so special :) Thanks guys, I really appreciate all of it and I'm so so thankful for all of you in my life <3

MDAS Camp
It was a short 2D1N camp, but it was really inspiring and fulfilling. I've never had any encounters with muscular dystrophy children before, and this camp showed me that they need alot of care and encouragement, especially because most of them are rather introverted and take a long time to open up to others.
There was this hyperactive young boy whom you literally have to chase around to ensure he doesn't crash into anything or get lost somewhere. He made many demands which might sound unreasonable, but after hearing his family situation, I understood alot more about why he was behaving that way.
Many of these kids have Duchenne's. They grow up not being able to walk, spending their lives on a motorized wheelchair, and some of them are too weak to even lift their arms to feed themselves. They're entirely dependent on their caretakers and I can only imagine the impact that this condition has on their lives and that of their families.
Despite all of that, they're ever so cheerful and optimistic towards life, and they're appreciative of every thing that you do for them. Such big hearts.
Our considerations are so parochial next to all these children, and I think that their determination and positivity is so admirable.

I was talking to Ms Oon and Hon Sum today about JC life and scholarship applications, and we got to the topic of how experiences shape a person. Even the worst ones do. I distinctly remember the panic, the chaos and the frustration we faced during YFC and ExCo, but I'ld like to believe that we've all come out stronger and better leaders. Similarly, I'm very thankful for the experiences I've had this week because I've learnt so much from them (:

So, year 3 starts tomorrow. Knowingly or unknowingly, we're almost reaching the halfway mark of medical school. I'm preparing myself for the onslaught of crazy hours in the words, and lots of hard work. Even so, I start year 3 with the hope that everyday, I will be inspired. And convinced that this profession is worth the hard work and sacrifices (:

Each day in the wards/cath lab is so busy that I hardly register how fast time is passing. It's been a really short period, but such an insightful experience. I've been inspired in many ways.

By patients. Those who have so much courage, cheerful optimism, and a heart of gold. We met a patient with a history of rheumatic heart disease presenting with features of congestive cardiac failure. I was really moved by her strength and courage to come to terms with her current condition, her cheerful disposition and her willingness to help clueless medical students like us by allowing us to take a history and perform a physical examination despite her weak frame and easily fatiguability. Her words of encouragement were really heartening.

By doctors. Dr Chong's schedule was packed to the minute, but yet he managed to squeeze pockets of time in between procedures, clinics and appointments just to talk us through cases and concepts. It was also very inspiring to sit in for clinics and observe how he interacted with his patients and managed them, listening to their concerns however trivial without interrupting, greeting them with a smile and ensuring that they were important in the decision making process. I think we all hope to be a doctor like that, whom despite the busy schedules and the heavy responsibilities, remembers the importance of listening and the human touch.

Yesterday when we left the hospital we went back to say goodbye to all the patients whom we've met over the course of the 4 days. It made me realize how much you can help someone just by being there and lending a listening ear. It was so nice to chit chat with the patients and their families, and I was especially heartened by an old lady whom opened up to us a bit more every time we went back to say hi after being convinced that we weren't going back to ask more questions haha!

Over the course of medical school, there are always periods where I feel incredibly inadequate both in terms of medical knowledge and patient communication. But someone shared with me that it's not so much the person that you were that is important, but the person that you will become. I guess it's all part of the learning process (:

It's the first day of our cardiology attachment and I'm completely zonked out, a reminder that we need abit more time to adjust to ward life again. It's been quite an experience though; we observed a few procedures, learnt alot about arrhythmia management, and got to talk to a few patients. It's really nice to learn for the sake of learning, and not memorizing/cramming for the sake of an examination. There's so much to learn and so much to see, and though it's really tiring, I'm enjoying it alot (:

We talked to a patient who presented with pericardial and bilateral pleural effusions today, attributed to her hypothyroid status. It was affecting her so severely that she couldn't even lie down 20 degrees because she wouldn't be able to breathe. The doctors did a pericardial and pleural tap to drain the fluid, and it was really painful to watch the procedure because it caused so much discomfort. But her faith was stronger than steel, and she even told the doctor "May Jesus give you the wisdom to do it right". I was really moved by that simple gesture.

May God grant us the wisdom and faith to do what is right, and to do it right.

Just returned from a trip to Taiwan with Shun and Zhiying. It was plenty of fun, notwithstanding the fact that we spent the entire holiday just eating and shopping. There wasn't a point that I felt hungry during the trip! And bubble tea was like hypertensive medication; a necessary daily dosage. The streets of Taiwan bear a striking resemblance to those of Hong Kong, but the roads were alot messier. The night markets were a super exciting experience though, full of food and crazy adorable things (you catch a glimpse of spongebob/elmo/pooh etc. everywhere you turn). We also went into one of the Taipei hospitals in Ximending wanting to buy medications for Shun, but we realized that medicine in Taipei is very centred on TCM. The hospital was very old and rather like those 古代 hospitals you see in 1960s drama serials, it gave me a sort of 亲切感 though.

Returned to Singapore just in time to tune in to the results of the General Elections, and I was really sad to hear that the PAP Aljunied team had lost. After attending the WP rally with Laine some time back, I wasn't convinced that WP had a concrete plan in place because most of the rally was spent talking about the flaws of the PAP. I'm full of admiration for minister George Yeo though; his graciousness and humility were displayed during his concession speech and recent media conference. It's sad that we have to lose such an outstanding foreign minister to pave way for a stronger opposition voice in parliament.

Made a trip back to NJ yesterday evening to spy on the Aristal technical rehearsal haha. Even though we only managed to catch a glimpse of the WD JH item, I'm heartened that the standards of NJWD are so high (: Also met many of my former students who are already SH1 omg, and I'm really glad that they're doing well. The former chem class rep of JH305 actually topped the cohort in 3 subjects! Actually the news is not very surprising because she is intelligent and extremely hardworking. She once shared with me that she had wanted to do Medicine since she was 6, and I have faith that she will be able to achieve that dream (:

为了病人一切
一切为了病人
为了一切病人

This phrase was on the wall of one of the corridors in SGH. Even though it's in Chinese, I think it very aptly encompasses the medical practice. Clinicals have been such an inspiring experience, and I'm rather looking forward to year 3 even though it'll be crazy tiring.

CSFC concluded the second year of medical school. It was an unnerving examination; you're alone in the consultation room with a simulated patient and an examiner who is eyeing your every move. The momentary waves of panic severely impaired my cognitive function enough to forget some of my steps and completely forgot the glaring diagnosis that was TB. I guess we have to get used to this kind of examinations soon enough. Hope I manage to pass decently enough though ):

In the meantime, so thankful for the holidays and the time to do crazy things like stayover at the airport and scaring the guts out of ourselves by watching horror movies dead in the night.

Phuket was all kinds of awesome (: I didn't expect to have so much fun initially, and I'm really glad that it happened (: It was my first time trying all those crazy sports like rafting, snorkeling, ATV riding, motorcycle riding and my favorite was rolling around on the beach :D Really glad to have made new friendships on the trip too, and I really wish I were back in Phuket smelly and wet on bumpy boat rides and long bus trips.

Today was the first day of CSFC, and I think we were all pretty unprepared for what was thrown at us. I feel rather overwhelmed because all of a sudden, barely a week after Pros, we have so much to study and so much to do again. Despite all that, it was truly eye opening and somewhat inspiring, because we got to experience medicine beyond the lectures and tutorials. It's not just about mugging the causes of obstructive jaundice or the presentations of end stage renal failure, but about talking to patients and learning from them. Getting to see the signs and presentations of a certain disease and their social implications was something that I felt enhanced my learning greatly. The fact that some patients were feeling sick and uncomfortable, but yet were so patient and willing to talk to us and help us in our learning was something that really touched me.

So we got scolded first thing in the morning for not being spontaneous enough to take a proper history/physical examination, got bombarded by questions we had problems answering, and got half of our CG belongings locked up by the time we went back to the lounge. It's almost hilarious to think of all the unfortunate events that happened today, but I believe it will get better (: