My first week

I survive my first week as a doctor! It's unbelievable!

As I am not working this weekend, I decided to spend some quiet time to reflect on my first week of internship, hoping to share it with my friends, many who are in the same boat as me.

My first attachment is with two different units: general medical & rheumatological. Although I don't have much active involvement with the latter, it can be a challenge to handle both units at a time. On the whole, I have a good and gentle start. With about 12 patients on average in the general medical unit, many who are waiting for rehab or placement, it is managable although I am still quite slow with carrying out my tasks. I just need more time to familiarise myself with my new role.

I am rostered to start at 8am. Nevertheless, my day usually starts at 7.15am so that I can catch up with my work, for instance ensuring as many discharge summaries are kept up to date and that all pathology tests are requested before the path nurses arrive. Some days, when I feel too tired to get up early, I arrive just before 8am for handover, when interns and registrars from each medical unit gather to get an update of admissions/issues encountered during the night.

Ward round begins immediately after the meeting. As my consultant or registrar reviews the patient, I attempt to catch what they say and scribble my notes in the patient's file and at the same time, looking at the many different charts (e.g. observation, fluid balance etc) recorded. I try to stay focus but it's not always possible especially when my beeper goes off and I have to return the call to find out what's happening and if it's urgent, thankfully often not.

Ward round is followed by paper round, when I clarify with my registrar the jobs that needed to be done, putting them into a list and ticking the ones completed. Making referrals is my greatest weakness/fear and biggest enemy. I dread doing them, either because I'm asked lots of difficult questions over the phone or the referrals are refused or that my calls are not returned. Yet, it is a task which I face everyday, if not almost. With more practice, I hope it will be conquered soon.

There is no "full-stop" in my job. Just as I am about to finish ticking all the boxes in my job list, my beeper goes off again: often for IV resites and patient review on pain control and blood sugar level. When these are done, it is only then I realise that it is already 3pm and that I haven't had my lunch yet or hydrated myself or even gone to the toilet. It amazes me that I can be quite fixated to my job and not aware of the basic requirements of life.

When I have time, I will find a computer to do discharge summaries, hoping that my beeper doesn't go off. It may sound like an easy task, but half of my patients have been in the hospital for more than a month and their cases are quite complex. Imagine going through all the voluminous notes written since a month ago - it takes a while to decipher the illegible writing and extract the correct information, as some notes written by different units are contradictory to each other. Soon, it is 5pm - yes! - no more pages. My registrar happily says goodbye and urges me to leave too. But I stay back for a while, sometimes up to 7pm to do my paperwork. If not of my inefficiency, I could have gone home earlier to have life out of med. Often, I'm just so tired when I reach home that the only thing I do is continue my 'Mousehunt' on FB.

Twice a week, there is an allied health meeting which I am expected to attend. And once a week, there is a compulsory intern education session. So, it is not just about work. But also education for continuing professional development and working with other members of the healthcare system.

Help is always available around the hospital and hence I shouldn't be too worried (although I did). It was my registrar's half day on my very first day of work and an incident had already happened! A patient of mine was accidentally given an increased dose (5x) of methadone! He was alright but a bit drowsy. I was just dead worried that he might have a respiratory depression and that I could not handle the situation appropriately. Thankfully, the cover registrar came to my rescue immediately and all was fine thereafter.

My first evening cover happened to be on my second day and I had to work for 14 hours till 10pm. I thought I had the time to do more paperwork and unfortunately, it turned out to be a little busier. My beeper went berserk that evening with loads of calls for IV resites and patient review for various issues. I felt HALT (hungry, angry, lonely, tired). I tried to remain calm and keep cool, which I fortunately did. After all, everything went fine. Dinner was at 10.30pm and I arrived home at 11pm, dead tired.

Overall, my first week of internship has been an overwhelming yet an exciting experience. As a medical student, I can choose to avoid doing things that I hate/fear. I can come and go at anytime I like. Now, I am responsible for each patient under my care. I can't run away should problems arise. Instead I have to manage it and/or refer to other senior doctors if I feel it's beyond my level of expertise. I expect that it will be a tough and stressful job, but I must always remind myself to keep strong and not to take any criticisms too personally. I may not be the hero in my patients' recovery; however I feel glad that I can contribute to the care of my patients. It gives me great satisfaction that my patients improve during their hospital stay and that they are discharged in optimal conditions.

I love my job! =D

Happy New Year!

First of all...to all my blog followers, Happy New Year!!! I know that it's already past mid-January, but better late than never, right? May 2010 be a great year for you all!

Just a brief update - I haven't kept in touch with my blog for more than a month as I was quite "busy" since graduation. A day after my graduation, I attended the medical registration ceremony at Monash University (it was only then that I'm officially called a doctor!). And the next day, I was already on my to Malaysia to enjoy my well-deserved 4 week holiday, before I embark on my medical career - internship. It was indeed one of the best times I had, with loads of memorable moments especially with my dear family. Mainly relaxed at home and also did a bit of travelling as well as catching up with friends. Will elaborate further if I have the time.

Time flies...Right now, I'm already back in Melbourne, for almost a week to attend orientation which began on Tuesday and concluded on Friday. It was quite an exciting exercise though I felt a bit overwhelmed as there were lots to learn within a short time.
And in less than 12 hours, I will officially begin my internship! I'm thrilled but at the same time, feel extremely nervous. I'm dead worried that I can't perform my job well and do not meet my reg's and consultants' expectations. Although an intern is just a step above a final year medical student, it is a HUGE gap and I don't know if I have managed to take such a big leap. I am now accountable for each of my patient and can't "run-away and hide" if problems arise. RESPONSIBILITY - that's the big word which I must learn and hope to adhere to throughout my internship and beyond.
Well, let's see if I survive my first day (i.e. tomorrow)!

Graduation

A short speech which I dedicated to my beloved parents on the night of my Graduation Day......

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My dearest Mummy and Daddy,

Today, 10th December 2009 at approximately 4.50 in the evening, dressed in academic regalia, I received my MBBS (Hons) degree from the Chancellor of Monash University (Dr Alan Finkel) and hence, it officially marked the end of a chapter in my life – education.

After 12 years of schooling and 5 years of pursuing a medical course, I have finally graduated!

I know you have waited for a long time to celebrate this joyous moment. You have toiled very hard; you have given up the many pleasures in life which you could have otherwise enjoyed; you have always poured in your unconditional love and support to me. Yes, there are difficult times...yet, you have never complained. But you persevere.

You have sacrificed so much to see who I am today. And I hope this is one of your proudest moments in your parenting life. I must convey my most sincere gratitude for everything you have (and still) done for me – your greatest gifts to me...love and education.

And so another chapter of my life will soon begin. Yes, I must admit that I’m afraid and nervous but I will boldly face the challenges that lie ahead of me; and hopefully achieve more successes for us to cherish.

I don’t know what else to say, but...“THANK YOU. I LOVE YOU BOTH VERY MUCH”

Love,
Andrew
*unashamedly written with tears in my eyes*

A "collection"

Presenting my 5 years worth of collection...

This is the voluminous amount of study material which I have gathered over the last 5 years of my undergraduate course. Plus the many textbooks which I bought from Kamal bookstore in KL.

And more notes and presentations which remain in my laptop. So much resources used for my studies and yet, I wonder how much information is retained in the little organ sitting in my cranium...not much I guess - perhaps 1% at most?

Now, I'm not sure what I should do with the study materials in my folders - to keep or not to keep??? I have thought of recycling them to reduce the utilised space in my room. Also, most of them haven't been referred to for a long long time, especially the 1st and 2nd year stuff. Perhaps I'm superstitious, but doesn't that mean I'm 'throwing' knowledge away? What if I need them one day, only to realise that they are gone?

Another decision to make......argh!!!

A new interest???

I am currently reading...

" The House of God", by Samuel Shem, a book that I was recommended to read since I started medical school 5 long years ago, but for whatever reason, haven't got a chance to read, until I found it in a bookshop in Union Station, Washington DC.

Disclaimer: This is NOT a book review
This medical novel portrays the life of Roy Basch, an intern in a distinguished American hospital called "The House of God". It is a satirical story about him being a junior doctor and its impact on his life - relationship; psychological well-being etc. It also tells how his initial "innocent" approach to medicine, the one he learnt whilst in medical school, is greatly influenced by the Fatman (a resident he was earlier attached to)...

From my three years experience as a clinical student, I find Shem quite accurately (though not entirely) depicts the life of junior doctors - the challenges and stresses they encounter at work. Not very much in a depressing way, but hilarious and outrageous. It is kind of a great relevance to me, being a soon-to-be intern, which is just a month's away! Still halfway thru the book and I'm loving it. Highly recommended - A great book for those about to enter the medical workforce.

I am not someone who really read books, well apart from The Lord of the Rings and Harry Potter series along with a few selected academic books, the latter only to help me pass exams - yes, I'm not that nerdish as you may think.

So, how am I suddenly engaged with this interest?
It all started when I began my elective placement in India about 3 months ago. I bought Jodi Picoult's "My Sister's Keeper" from Big-W and brought it to the sub-continent to read - well, an accompaniment along with my brother's iPod for my long, often boring journey to different places. I was very immersed with the story and thoroughly enjoyed it...that's how the interest started to grow.

Also, many of my fellow elective mates read too and we sometimes came about to discussing books. I was recommended Khaled Hosseini's "The Kite Runner" - brilliant! Also read his 2nd book: "A Thousand Splendid Sun" - extraordinary!

Books can be dirt cheap in India (e.g. Rs80 or AUD2) if you find the right shops.
As soon as I finished reading a book, I started to hunt for a bookshop to buy another one. And that includes Dan Brown's "Angels and Demons", another book I bought in the US, the story which always puts the readers on the edge of their seats.

Books that I'd read during my travel

Now thinking of the next book I should read IF I have the time once internship starts. Not a bookworm......yet =P

USA 2009 - Washington DC

Although my uncle lives in St Louis, he works in Washington DC. So, he travels there every Monday morning and flies back on Thursday evenings. Great!!! It means I had the opportunity to follow him to the nation’s capital, which is about 2 hour’s flight from St Louis. So, while he was busy at work during day time, I travelled around the city, which was very close from his apartment.

Most of the “must see” places are located within the National Mall, which stretches about 2 miles from the US Capitol in the eastern end to the Lincoln Memorial & Potomac River, in the western end. The White House, the Washington Monument, the Library of Congress and the US Supreme Court are other iconic features of the city/country situated within this national park. A visit to these places is another memorable moment of my US trip – it reinforces the feeling that I had been to this wealthy and powerful nation.

The White House - the Obamas were not there to greet me =(

Lincoln Memorial

During my 4 day stay, I joined a short tour in the US Capitol, where I watched a short historical video before taken around to different sections of the building including the dazzling Rotunda where lying-in-state and lying-in-honor funerals were previously held for notable Americans, such as Ronald Reagan.

The US Capitol

The Rotunda

Somewhere in the centre of the mall is the Washington Monument, a 555+ feet tall obelisk structure built to commemorate the first US President – George Washington. I went up the monument and from there I was able to enjoy the panoramic view of the city.

The Washington Monument
Facing east from the Monument - the National Mall with the US Capitol on its eastern end and the many museums along the national park

The park is also home to the Smithsonian Institution, where many of its museums are located – my favourites include the National Air & Space Museum, National Museum of American History, National Museum of Natural History, and Holocaust Memorial Museum. There are at least a dozen more and each has a huge displayed collections. Too many things to see and one needs to spend quite some time there to appreciate all of its collections. A great learning place especially for school students and those who want to know more about America.

The Smithsonian Castle

Inside the National Air and Space Museum

Best of all, the entrance fee for everything in the National Mall is zero (i.e. free)!!!

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And this concludes my USA 2009 entries. I certainly had a great time during my 4 week trip, travelling to places which I have never dared to dream of.
I will definitely want to return, but this time to travel in other places and hopefully, someone to accompany with =D

USA 2009 - St Louis

St Louis, a city in the mid-west, is probably famed for its Gateway Arch, which is part of the Jefferson National Expansion Memorial. At a height of 630 feet, it is the tallest monument in the US and signifies St Louis as a gateway between the eastern and western sides of the great country.

The Gateway Arch

Cathedral Basilica of St Louis

Well, my main reason of being here is not to see the St Louis’ iconic structure, but to visit Uncle Daniel (Mummy’s cousin) and Yee Po (i.e. grandaunt), who had always urged me to go over, either for a holiday or for good. I had an unforgettable time during my stay – they were just so wonderful...took me around to visit different places; shopping (prices here are very reasonable) and good food (I put on a few pounds).

St Louis pork ribs - yum!!!

Eagles Nest Onion served with Chiptole Sauce

This is Salt Lake City (Utah), viewed from the air, during my stopover en-route to St Louis. It was only fall and there was already lots of snow in the city - love the view of the great mountains and lake in the background.

USA 2009 - Oregon Road Trip

I didn’t know anything about Oregon until Kenneth planned a 4-day road trip around the southern part of the state, which is situated just north of California. And I must commend him for the excellent itinerary he had organised for us.

Oregon is truly blessed with nature’s gifts – it offers various landscapes with breath-taking views, especially during the fall season as the foliage can be quite intense.

Mt Shasta - a snow-capped mountain seen on our way to Oregon

For this trip, I’ll split it up into 2 main parts:
1st part –inland Oregon...We drove through the dense forests of a few of Oregon’s national parks, mainly along the Rogue-Umpqua Scenic Byway, which were lined with conifers on its sides.

The highlight of this leg of the trip was to visit the Crater Lake, a caldera lake. Unfortunately, it was too foggy on the day we arrived and hence, we couldn’t appreciate its grandeur. =(

Click here to see its true beauty......

2nd part – Pacific coast...For this part of the trip, we headed south towards California, along the Pacific coastline, which is abundant with rock formations, almost all which are created by the great ocean’s constant erosions – just like the Twelve Apostles along Victoria’s famous Great Ocean Road.


Also during our way back in northern California, we drove along the Avenue of the Giants, another scenic highway running through Humboldt Redwoods State Park. This was where I saw the towering giant sequoias, the world’s largest tree species...many of them are thousands of years of age, almost 300ft tall and 20ft in diameter – impressive!

Drive-thru tree! Age: 5000 years; Height: 275ft; Diameter: 21ft; Cir: 64ft - what a giant!

USA 2009 - One week tour trip

My itinerary appeared packed – only 10 days left to visit many different places in and near California before going off to somewhere else, which had already been planned prior to my arrival. Although not my preferred method of travelling, I decided to join a one-week tour with a group of Chinese visitors, which covered all the places I wanted to visit. Great! It saved me from the hassle of planning these trips within a short time.

Yosemite National Park
A UNESCO’s World Heritage site since 1984, this national park features stunning views of granite cliffs, waterfalls and clear streams as well as a diverse range of wildlife. Unfortunately, it was raining and foggy the entire day; hence the view wasn’t as clear as I hoped it would be...

Las Vegas
Dubbed as the “Entertainment Capital of the World”, this popular city of lights and casinos lies within the Mojave Desert in the state of Nevada. The city was particularly beautiful and lively as night arrived. Everyone expected that I did the obvious thing (i.e. gambling), but surprise surprise, I didn’t! Maybe I tried to be good =P
In fact, I spent a lot of my time sleeping as I didn’t feel too well, which might be due to motion sickness from the long travel on the bus.


Grand Canyon
It is the highlight of my USA 2009 trip! About 2 hours away from Las Vegas, passing through the Hoover Dam, the Grand Canyon offers a magnifient view, especially with a clear blue sky backdrop. I paid for a $179 helicopter ride, which included a short boat ride along the Colorado River. Expensive - but the experience gained was just incredible! Love it, love it, love it!!!


Los Angeles
The “City of Angels”, the 2nd largest city in the US after New York, it is very busy with lots of traffic almost everywhere almost everytime - not a city I like to live in. The main itinerary here was to visit Hollywood and the 2 well-known theme parks - Universal Studios and Disneyland.
My childhood dream of visiting Disneyland had finally come true! I really enjoyed the experience , though there were so many people on that day - I even had to queue for 2 hours to ride the latest thrill ride! I spent 12 hours there and it was still not enough. Next stop - Disney World in Florida =D

USA 2009 - San Francisco

My long-time desire to step my foot in the United States has finally come true with my recent trip to the country in October during my Year 5 vacation rotation. Many of the trip photos can be found on my Facebook; but as promised, here is a brief summary of my trip along with some of my favourite photos.
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My first stop was San Francisco, where I spent about 8 days and stayed in the East Bay area with Kenneth, an ex-schoolmate from ACS. Thanks to him and his younger brother for their hospitality and taking me around during my stay. One does not visit San Francisco until he/she stops at the Golden Gate Bridge, the city’s most iconic structure. I was quite mesmerised by the view of the famous suspension bridge, which connects the northern tip of the San Francisco peninsula to Marin County.

Other sites visited included......
The infamous Alcatraz, a federal penitentiary located on an island in the San Francisco bay, which housed prisoners from 1934 till its closure in 1963

The popular Pier 39 on the Embarcadero in Fisherman’s wharf, which boasts a wide range of restaurants, shops and attractions

The Palace of Fine Arts, a splendid Greco-Romanesque structure originally built for the 1915 Panama Pacific International Exposition

Golden Gate Park, apparently the largest man-made park in the world

Coit Tower on Telegraph Hill, built to fulfil the bequest of Lillie Hitchcock Coit,
who left funds to be used to beautify the city she loved

Lombard’s “crookedest” street with eight hairpin turns on a 40-degree slope, with beautiful (and expensive) homes and gardens lines its sides

Well, these are the highlights of my San Francisco trip!

Overall, I find it a city very similar to Melbourne – vibrant with a diverse ethnicity; though there are a lot of homeless people, probably due to the cost of housing, which is very expensive and to make matter worse, with the country’s current economic recession.

Med school...the finale!

After 5 long gruelling years with much blood, sweat and tears poured out, med school has finally come to an end. And that completes the first phase of my life - schooling years.

B2B week has been very informative and educational to me as I have not attended any placements for a long time, and hence forgotten quite a lot. It was a time to revise important things which I should know that will (hopefully) prepare me well for my internship next year. Great lectures were delivered by dedicated staff members, including Prof John Murtagh who will retire soon and gave his final lecture to us - what a great privilege for us to listen to his awesome stories about being a country practitioner. Also, it was a time to catch up with friends who I have not seen for ages. What's more...free lunch everyday from different sponsors and a cocktail evening organised by the faculty!

I must admit that I'm a little sad that my schooling years have finished. I have been very attached to it for it has been a major part of my life for at least the past 17 years. Now it's over and I'll soon be thrown into a working world, which I'm not so ready for despite attending clinical placements for the last 3 years.

In the meantime, will enjoy my holiday (or rather my transition poeriod) as much as I can before the harsh reality sets in next January.

A thought...to continue or not

I had been very lazy and not motivated to update my blog, even to the point of deleting the whole thing (blog).

Firstly, I wonder again why I started this blog...I could not think of the exact reasons. Maybe because I felt a bit lonely all these years, not having regular close contacts with friends here. So, by creating this blog, I hope my thoughts, experiences and life events can be shared and be heard. Not that I yearn for popularity and ask for sympathy; but just a means of communication, in a different way.

Perhaps...it's just a diary, mainly for personal keepings and reflection, which I 'stupidly' share with everyone - anyone around the world has access to it. Hence by doing this, I sometimes feel a sense of insecurity and humiliation.

But right now, I think I'll continue what I had started almost a year ago and reconsider my current decision at a later time.

Any opinions from friends are greatly appreciated...

1 final week...

My blog has not been attended to for quite some time as I was busy travelling in the US. I had a fantastic time although I must admit I was a bit home-sick by the end of my 2nd week there.

I am now back in Melbourne since yesterday morning, after a long 33 hour journey from the mid-west, St Louis. Glad to be home again together with my loved ones. Surprisingly, I didn't feel much jetlag - what a relief.

Well, after having a long break, it's time to attend med school again (yay!!!)- one very final week of my 5 year undergraduate medical course --> back-2-base week!

United States of America!

I'm currently in the United States of America! Woohoo!!! I just can't believe that I am here...

Being the cheapest option, I took Air New Zealand, which to my great satiafaction, provided an excellent service! I had initially thought of flying with Qantas so that I could sit in the jumbo-jet Airbus A-380, but as a poor student, the price put me off. Nevertheless, I had a glimpse of it in Melbourne Airport...

"One day, I'm gonna make sure I'm in it - just for the experience!"

The journey to USA was relatively a long one - first, a 3h30m flight to Auckland, where I transited for 2 hours before boarding the next flight to San Francisco which took almost 12 hours. I have not taken a half-full flight for a long time and was glad that I could have a whole empty row to lie down and sleep...wasn't too comfortable though.

My first glimpse of the land of the USA from the sky

The plane touched down at San Francisco International Airport at around 1130 on 9th October (when it was already 0530 on 10th October in Melbourne)

Upon arrival, I was delayed at the Customs and Border Protection for almost an hour - was being asked lots of questions. Anyway, I had already anticipated that this would happen, probably because it was my first visit to the US and that I'm a Malaysian citizen. By the time I went to the carousel to collect my baggage, they were already placed on a trolley, ready for me to push through the customs and then exit, where I was greeted by Kenneth, a friend who I have not seen for almost 7 years.

Will be writing more about my US experience later - not too soon as my itinerary at the moment looks packed!

"Stop-over" in Melbourne

I have just arrived Melbourne after a long journey from KLIA – the plane was delayed for almost 2 hours due to technical problems + an hour transit in Jakarta, where I had to remain in the aircraft. I was surprised that I slept quite a bit during the flight...perhaps I was too tired due to lack of sleep for the past few days.

My stay in Malaysia was simply too short – I had a great time there. Nevertheless, it’s great to be home in Melbourne seeing Mummy and my brother and sister, who I have not seen for almost 8 weeks!

Will be here for only less than 48 hours before I resume my vacation...this time in the United States of America for 4 weeks – a country which I really really want to visit since I was a little boy many many years ago! Yes, I’m quite excited although I’m starting to feel a bit weary from my recent travel.

Well, gonna continue unpacking my luggage before repacking it...again.