Cooking and Living

The good thing about living alone is getting to decide what I want to eat for each meal. Even if it is a weird combination of omelette and watermelon.

This week has been trying again. My dad has just come out from a second operation to drain out a new bleed in his brain. While the CT scan 3 days after his first surgery showed nearly no more accumulation of blood, the MRI done yesterday showed marked increase in bleeding on the left side, compressing his brain and giving him terrible headaches worse on lying down.

How I wish we could have a holiday this semester so I could go home to see my family. What makes all this worse is that I’m too far away from everything, getting all the information delayed and spending all my time worrying. It really sucks. Not to mention everything that’s happening now is seriously draining me and stressing me out to no end.

Just looking forward to the end of it all.

Finally got to have a good night’s sleep last evening, only waking up at noon today in time for my catheterization assessment. I’ve been epically tired this past week, taking naps during the day and still feeling very tired towards the end of the day. The Girlfriend thinks I’m depressed. Though I wouldn’t put it past my brain to be depressed.

I made some french toast this morning following a recipe by The Girlfriend. It was pretty awesome and I managed to finish an entire small loaf of bread topped with a drizzle of honey.

Epically yum. Going to have to do it again soon. Often, my meals are dictated by the weather. A typical example being this evening’s beef stew made from a cobbled together concoction of two different recipes. It actually turned out really nicely. Amazing what a good 45 minutes of simmering can do for flavor.

I’ve been told when I was scrubbing in that my glasses were not “occ health glasses” and thus I had to put on an additional shield around my face which continuously fogged up as I breathed. While I wonder about what “occ health glasses” are, I also contemplate that I’m going to need to look for a new pair of specs soon, seeing how mine have gone all out of shape and make it look like I have a very immensely wide head. Though that being said, when others wear my spectacles, it really does show how wide my glasses (and ipso facto my face) are.

We end off with a picture from the interwebs. Sometimes, clothes really do make people look fat.

Define: Calories

Sometimes, facebook is funny too.

Also, if there happen to any Singaporean students coming into Monash Gippsland Medical School in 2012, please drop me an email! We’re all doing a big get-together soon and it would be great to get in touch with everyone.

Scrub In Day

Surgical rounds today was terribly interesting. For the first time ever, I got to scrub in an assist. This morning’s big operation was a laparoscopic right hemicolectomy for a rather nasty looking bowel cancer taking up residence in the caecum and beginning its ascent up the ascending colon.

The idea of laparoscopic hemicolectomy was intriguing to me, seeing how most ports I’ve seen so far have been tiny little incisions. So today’s procedure really opened up my eyes to the myriad of possibilities laparoscopic surgery can provide. The surgery begins laparoscopically, with the surgeon separating the previously marked bowel from any adhesions, as well as sorting out the blood supply to the area.

Following this, a larger incision is made along the midline, through the rectus sheath and the loop of bowel was pulled out and excised. An anastomose was then formed and the patient sutured back up.

Fascinating. Especially when I got to feel the bit of bowel with the cancer in it. VERY STRANGE.

Scrubbing in for the first time can be quite daunting really, trying not to touch anything. But at the same time, the entire experience was very awesome. Will try to get into another surgery again sometime soon while I’m still here.

The Royal Melbourne Show weekend 2011

So, this weekend we went to the Royal Melbourne Show 2011 It was different from the last time I went (rain, non-stop eating… Then again, not that different after all). But this time we made an effort to try to see everything in the show on the day. Starting with taking photos with these cutouts at the entrance.

We also saw some alpacas with no legs! Look at that grumpy, frumpy looking one at the back!

The livestock enclosure had a bunch of free-roaming animals like sheep, goats and calves which visitors could freely pet and take photos with. Assuming they’d stay still long enough anywho.

I discovered that lambs are pretty nice to touch.

And pigs are not. In fact, they feel like the wrong end of a toilet brush.

Lambs are still much nicer.

I also bought some chocolate biscuits from the Australian Girl Guides. I was a guide back in secondary school and we were just reminiscing about those tins of mint chocolate cookies. The volunteer at the stall told us that Australia just has the chocolate ones.

She also asked if I was interested in joining the Australian guides activities. Never thought I would be able to form another network here in Melbourne outside of medicine, but it might be something to consider.

The main event though seemed to be the woodchopping competition! It was pretty epic with the wood chips flying in every direction (including towards the audience), and the ever present fear of the axe hurtling our way.

And here’s me, for once being too tall to go on a ride.

On Sunday, I went to my first Vic ALMA outing! It was pretty fantastic, getting to see the people I haven’t seen in so long, and meeting new friends. Several couples brought their kids and it’s astounding how much they’ve grown in a year! Kids are simply amazing. It was really great getting to meet up with everyone again. Hope we can do it again sometime in the future.

But for now, this last weekend will have to do.

I got a showbag from Men’s Health at the show- a khaki duffle bag filled with Men’s Health magazines, a bottle of isotonic drink, some anti-perspirant, moisturizer, and whitening toothpaste. I’ve discovered that Men’s Health magazines are infinitely more interesting reads than women’s magazines. =\ All that gossip and chattering about what celebrities are wearing doesn’t really pique my interest. Articles on how to maintain your engine, quick and easy dishes, 30 minute workouts for every age bracket on the other hand, definitely more interesting.

Righto. Time for work.

Non je ne regrette rien

A song made famous again in recent times by the film Inception (2010). Non je ne regrette rien (I don’t regret anything. I think anyway. My French is rusty.) was recorded by Edith Piaf in 1960. Came across it again today while taking a QI study break and this was one of the buzzers for the panel guest. It’s one of those times when you hear something and you swear you can picture in your mind an exact scene where it is playing but you can’t place it for the life if you. Thanks to modern wizardry (aka SoundHound on my iPhone), the 10 second clip was identified as the song Non je ne regrette rien and that followed on to a whole series of searches, culminating in me watching the entire Inception all over again. Good study break. Oddly enough, this is now my study song. One that I play on repeat while I try to shove impossible amounts of information into my brain.

In other news, I’ve only got 3 things to get signed off now. And next week I’m on general surgery. Hooray!

This weekend is going to be an exciting one. The Royal Melbourne Show tomorrow followed by sichuan crab dinner and mooncakes (plus lanterns). And brunch with the Vic ALMAs for the first time on Sunday! I’ve been rather shamefully missing all the previous meetups since I’m never in the city whenever they are held. Figured this would be the best time to go. Especially since I can’t make it to this year’s conference. =\

Well, time to study then! Got to set off bright and early tomorrow (good lord where did my weekend sleep-ins go?)

Last PBL!

Today was our last PBL! Sadly our tutor wasn’t around and one of our group mates had to go on the grand rounds, so our group photo will have to happen next week at the revision sessions. But that didn’t stop us from having a food party in class.

And I got drunk on my one glass of champagne in class, needing to stop midway through my presentation to announce that I felt “a little drunk and sleepy”. Much to the amusement of my group mates who kept bursting into laughter at my drunken grin.

Of bigotry in medicine

This morning I read an article on Medscape about including LGBTQ education in medical schools to promote tolerance of others. While this was all fine and good by itself, the very first comment on the post was by a one “Ironjustice” who was registered as a medical student on the website. His comment is in quotes below:

Quote: In rebuttal, I’d like to ask, would it be ethical for a physician to refuse to treat a patient based on their sexual orientation?
Answer: It is well known a LGBT person is prone to carrying a communicable disease. WHY would a doctor possibly expose all of his patients to these diseases by having a person ‘hanging around’ in his waiting room coughing and spitting up phlegm ? NOW with the newer laws which do not restrict public nudity the exposure potential would be even higher due to the reservoir in the anus ?
“Sweat may be another way to pass on hepatitis B infection”
“Reduced Hygiene, Illicit Drug Use Linked to CA-MRSA in Men Who Have Sex With Men”

Ignoring the many fallacies in his post (Hep B isn’t really transmittable by sweat =\ Also, (aside from his strange assumption that all LGBTQ persons have a predilection to spreading diseases) would we refuse treatment to anyone with a communicable disease? Or anyone who would be at a higher risk to having one? Like refusing treatment to someone who comes from a TB-endemic country (like myself), or refusing to treat people from certain ethnic groups because statistically, they have a higher risk of contracting a certain disease? If we were to turn away all these people, and all these patients with communicable diseases, our waiting rooms would be empty, and so would our Hippocratic oath. His accusations extended beyond that, later further claiming that, based on a newspaper report of a (probably drunk) homosexual man who was found nude on a park bench one night, all LGBTQ persons like to walk around nude and would likely show up in a waiting room naked and placing “his naked anus placed upon the vinyl seat spreading feces and therefore allowing the kid running around the waiting room placing said feces in his mouth or eyes.” (yes that was a quote)

It is truly disheartening when you know someone like him would one day become a doctor. And he might have a homosexual patient come into his waiting room. And that homosexual patient, honestly seeking medical treatment, will be denied any help and thrown out of the office.

Thankfully, someone pointed out that Ironjustice might actually be a very notorious internet troll, going around on various websites, perpetuating nonsense like this and stirring up unpleasant sentiments.

Misunderstanding and ignorance are enormous factors leading to misplaced fear and intolerance of people different from yourself. Perhaps proper education on these issues (not limited to just LGBTQ, but also education on practices of other cultures) would help with alot of this and give doctors a better understanding of what their patients are going through. After all, medicine is more than just seeing a patient as “that kidney in bed 25″.

While we can talk all we want about treating all patients as equals, we have to also understand how our LGBTQ patients themselves feel about it all. Doctors who shove homosexual patients out of their clinics are thankfully extremely rare, but we should also understand that there are many LGBTQ patients who hesitate to tell their doctors about their sexuality, in fear of being treated differently or refused treatment. This can sometimes then lead to them withholding information or just making stuff up to fit whatever they think the doctor thinks is “normal”. Maybe we should look at why this fear exists and work towards earning our patients’ trust.

I myself have been guilty of this for most of my life, deciding not to tell my doctor about my sexuality till much later. I thought I even had to lie about not having any partners at all, which could have put me at risk if anything had gone horribly wrong. My GP and gynae were absolutely amazing when I told them I was gay. As the words left my mouth, I grimaced and waited for the outcry of disgust which never came. Their eyes bore no anger or disgust or negativity at all. Just understanding and acceptance. When I did come out to my doctors, I felt an overwhelming sense of relief. Like this massive weight had been lifted off my shoulders. And I no longer had to pretend to be someone I wasn’t.

There is no room for intolerance in medicine. Or bigotry. Or racism or sexism or any other form of discrimination. I for one know that the day a homophobic, chinese-hating, chauvinistic person comes into my clinic, I will not hesitate to treat them just as I would anyone else.

Subcutaneous Emphysema

Let’s start off with some science!

But really, some real science now.

Ever heard of surgical emphysema? neither did I right up till this morning when we got to palpate a very strange bubbling crepitation below the left costal margin. It’s more commonly called subcutaneous emphysema which presents as air which has permeated the subcutaneous layer of the skin. This feels alot like a weird buzzing fizzy drink under your hand. It’s absolutely wicked.

The nurse at the ICU called it surgical emphysema since it’s quite common post surgery, especially laparoscopic procedures. During laparoscopic operations, the abdomen is inflated with gas. This gas is then later removed before closing up, though sometimes the air gets sequestered somewhere within the body cavity and doesn’t get removed. While this feels very very odd, the treatment for this is simply to wait. The body would eventually rid itself of this air anomaly.

Other more worrying causes of subcutaneous crepitations would be gas gangrene, or necrotizing fasciitis. Gas producing organisms such as clostridium or some anaerobic strep species can get under the skin and start up like a gas factory. This leads to necrosis of the area. Treatment recommended by the intensivist was clindamycin. Or a fasciotomy if it’s really bad.

Such crackles felt at the neck or upper lobes of the lungs is a bad sign for asthmatics as it is one of the signs of a pneumothorax. CXR would be a good first move to confirm this. This image on the left shows a case of a right pneumothorax with subcutaneous emphysema.

The nurse described to us a case she had a while back with a fellow with subcutaneous emphysema of the face so severe that they had to squish the air out of her eyelids so she could see. =\ Strange, but true.

And end off with a pretty long but awesome 2D animation on Mario vs Pacman

The Last MCR

So today was my last MCR of the year, hopefully of my 3B year of med school. As one can probably surmise, my confidence about passing this year dwindles every day, and getting the rather unexpected renal examination for my MCR today didn’t help much.

The case came from left field really, and it was a patient who was sitting in the middle of the gastro storm now washing over the entire gen med ward. So I went about as per normal, running through all the steps till it was time to ballot the kidneys. Then I noticed something that was very odd. 2 stoma bag-like pouches on his back.

It was only at the clinical reasoning half of the MCR that I realized they were nephrostomy bags, a catheter which is inserted directly into the kidney and channels urine out into the bags taped onto his back.

He could still produce urine via the urethra though and had an IDC which somehow led out to two separate collecting bags on either side of the bed. So in total, he had 4 bags collecting urine and still had a rather distended bladder that was very easily palpable.

On the topic of patients, being in the hospital everyday now makes us sometimes forget how traumatizing it is to be on the receiving end of it all. Patients are always telling us about how difficult it is to sleep at night with all the noise on the wards, nurses coming in once in a while, being surrounded by strangers with conditions unknown to you. I was interviewing a patient today who was very distracted from his story. Last night, the patient in the bed next to him had passed away and it was a very traumatizing experience for my interviewee who had to lie there, listening to doctors busying about, family members crying and arguing with the doctors, and the patient coughing violently till his last breath.

It must have been a truly terrifying experience, and one we might become desensitized to the longer we work in healthcare. If this has taught me anything, it’s to always remember what it’s like to be a patient, not knowing what we know.

So anyway.

Look, a cute cat on the internet.

An Unusual Case of Vaginal Tumor