Mumblings


Catching Up

so it’s been a while since mumbler posted. left a post uncompleted the day after her first MICU call. the reason? it says it all in the title of the intended post: “monster call”. apparently it was the worst MICU call anyone had seen in recent memory, with 4 admissions and 2 collapses, because the registrar that day was some kinda tornado and her calls in that month were all…campfire worthy. she’s known for her “bad” call luck, and she described my call as the “worst” – that’s how bad it was. so bad that within a week, people in surgery, dermatology, geriatrics and cardiology had heard of it, and thought i was scarred for life.

well, i survived it. survived the two resuscitations which lasted from 8pm to 5am the next day, which resulted in TWO coroner’s cases, which resulted in an overflow to the surgical ICU. this SICU case was a nightmare, because not only was it a public relations problem (poor premorbids but decision for ICU admission made because of an iatrogenic issue) but her lines were also horrendously difficult to set. we initially gave up setting them, but i had no choice and forced in a central line as her BP began to dip in the wee hours of the morning. she survived the night (and the next day at least) so that was victory enough for my reg and me.

fortunately i haven’t been scarred. i think. the rest of my ICU calls were pretty good, and i even had zero admissions for one. the sad thing about this is that i’ve got to repeat my ICU posting for my residency – at the grand ol’ dame, in half a year’s time, which is really sad because if given a choice i would have chosen to go back to chalet hospital, where my ICU posting was arguably the best times of my working life. my six months of medical ended on a high note – apparently i did well enough that the department was wondering why i hadn’t chosen it as a career, and i received a vote of confidence from a consultant whom i greatly admire. would’ve nice coming from any senior really, but from this particular person, i am most astonished and humbled. really favoured. heh.

right now mumbler is rotating through anaesthesia, which is an eye opener, an experience, but something she’s glad isn’t going to be permanent. there was a time as a student that she thought she would be one, but now that she’s doing it as a job she’s realised that it isn’t for her at all. what’s up with leaving my trash in one corner while i set the plug? why does the plug have to be set with LA? and why does it matter if i cap my syringes with a drawing needle, and so what if i don’t?? this bizarre ocd-ness is really getting to me – after three days. and putting patients to sleep just as soon as you’ve gotten to know them just isn’t my cup of tea. but oh well, they’ve got intubation down to an artform, so i’ll just have to learn as much as i can from the masters. heh.

today is polling day, and in a few hours’ time we’ll know how singapore voted. it’s amazing how five years can rewrite everything we’ve known about singapore politics. when it was easy to put gag orders on critical voices, it’s now twice as easy to upload opposition videos onto youtube and facebook. the ruling PAP has been really slow to note this change in our lives, and they’re really paying for it. from apologising to the people, to promising reforms, they have shown sudden humility and have even declared themselves as the “underdogs” in some areas. LKY hasn’t really helped his son by telling people that they can “repent” on their choice on May 7th.

it’s actually very sad to see how things have turned out. LKY is old and frail, and to be fair, he has done a great deal (together with his team of stalwarts of course) to turn this country into the nation that it is today. but when times change, people change. the people of today are tired of being told of what the PAP has done -before-, because they are not seeing the results -today-. what’s the point of saying that the PAP has made the country rich and on the world map, when people can’t afford housing, can’t afford medical care etc? and you know, it’s one thing that the citizens can’t afford, and another when the government doesn’t think it should -help- them afford it or is so deluded that it feels that it’s affordable. i’ll always remember how a certain minister declared a few years ago, that $290 a month was “sufficient” for a person’s “daily nutritional needs”. if you do the math, it makes out to be less than 3 bucks a meal. hands up if you’ve managed to get a full meal on less than 3 bucks? needless to say, mumbler wasn’t impressed.

i could list many examples, but the above example is a great illustration of how far the PAP has come since independence. they have forgotten to stay rooted, and they have taken their role as the absolute government for granted. they are still living in the past, and talking about the future while ignoring the present. like i said, it’s very sad, and i wonder, should the PAP end up losing many seats to the opposition, what would LKY be thinking? he’s dedicated his whole life to this country, and if his party loses considerably, he’ll probably leave this world disappointed and bitter.

that said, the opposition has a long way to go to be as good as the PAP. while they might have stand outs like nicole seah who is fresh faced, down to earth, and startlingly eloquent to counter ms kate spade aka the story teller aka ms tin pei ling, their policies and strategies for singapore’s future frighten me. what they’ve got is populist politics, and woe the day that singapore ends up that path, because that would be the end of us.

so, mumbler voted PAP this time round, but she wonders if it’ll be the same five years time?

before i end this post,


The Blues

in a blink of an eye, mumbler’s hols have come and gone.

’twas the last day of the hols today, and i was honoured and glad to perform at and celebrate the wedding of one of my junior college friends. it’s just a wonderful feeling to see two people coming together to start a new life. a joyous occasion it was indeed.

so mumbler started out the hols with a list of things to do, but only some have been achieved. i got my much needed hair cut (and added highlights too!) as well got a few pieces of new clothes, while discovering a shop at a nearby mega-mall that i’ll likely patronise many times in the future. i also got my new phone, a HTC Incredible S, which is absolutely gorgeous! it’s slim, light, fast and it’s running on Android 2.2!! yesh, mumbler is a pseudo-techie when it comes to phones, and no she does not intend to get an iPhone anytime soon because 1) EVERYONE has an iphone so it ain’t cool to own one nowadays and 2) you can’t customise your home screen. so not only does everyone have an iPhone but everyone’s iPhone looks the same. on my HTC phone, i can change the clock widget, play around with the background, decide which apps i want to put on my home screen and on the rest of the screens. very functional, yet allows for creative “expression”, if you would.

talking about iPhones, i must recount how one patient’s daughter told me how she could not afford to pay for her mother’s dialysis, and in the next moment, whipped out an iPhone 4 from her handbag. i mean, c’mon, it’s a bit hard to be sympathetic when you know how much that thing costs, and how much you have to pay every month for the data bundle right? and she made it even harder for me, because after looking up from her phone, she sarcastically said,”i thought the government says no singaporean will be left behind in terms of healthcare? are you saying that if i can’t pay for my mother’s dialysis that she will die?”

the awful truth of the matter is, she would and the details of the matter would need an entire blog post to delineate. but my point being that this woman was the perfect caricature of the typically selfish singaporean, who expects the government to help in all ways possible while she views her material needs greater than her mother’s life. my consultant once told me how his ward received a complaint letter about getting a son to rush down to sign the consent for an important procedure for his incapacitated father – because the son had lost out on a million deal to do that. apparently the son felt the hospital was unreasonable to expect him to participate so closely in the care of his father at the expense of his millions.

i have no good reply to that, and pity the person who had to answer that complaint letter. but relatives like these will always exist, and our job would be to soldier on and treat the patients as best as we can.

guess that’s the end-of-leave blues talking. while i did enjoy my hols, i can’t accept that fact that i’m going back to work tomorrow, on a SUNDAY no less.

have a good weekend. i shall hang in there till my next block of leave in april. ganbatte!


Hols

not just yet, but since mumbler will have a week long break in less than a fortnight’s time, she should start planning her holidays no?

so here goes nothing:

1) get a new phone. the hero has served me well for the past one year, through the last half of my intern year then as an MO. it has also been with me to shanghai, to vietnam and a whole lot of places in singapore. it’s time to get something with a faster processing speed – the htc desire. if only it was installed with android 2.2.

2) get a new camera. less important than point 1) but just as significant. currently have a canon ixus, but have been itching to get something more…complex. had previously toyed with the idea of getting a dslr, because the resultant photos are awesome, but after reading the reviews and the technical specs, i think i’m not the kind of person that would enjoy it. too many knobbly knobs, too many buttons. stumbled upon the canon powershot series, so i’m doing some research to see if that would be better. exciting!

3) get a new ‘do. mumbler last cut her hair…i can’t remember when i last cut it, but it has now grown very long, so much so that people think i have rebonded my hair. this sounds really bimbotic, but i’ve been trying to find a new hairstyle. problem is i want my hair short to medium length, i don’t really spend much time pampering my hair (i often give my hair just one comb through right before stepping out of the house), and my hair isn’t voluminous. all that googling for japanese/korean hairstyle don’t help much either. guess i’ll just have to entrust my unruly mane to my hairdresser.

4) new clothes and shoes. especially the shoes. work shoes – because i only have one pair and i want shoes with heels that are minimal because i CANNOT wear high heels. have twisted both ankles before so i think the lot of ligaments that are supposed to “strengthen” the ankle joint (please don’t ask me to name them) are all weak now. and clothes, just because.

5) major room spring cleaning. this will need some planning because i will really need to rearrange how my room is right now. my room has been a mess ever since i moved into this flat more than six years ago. at first glance a visitor might think that my stuff are all nicely stacked up, but you’ll soon find one or two CDs stuffed into my books, and my bag stashed in some random corner.

6) meet up with friends. might be a little hard, but will certainly try.

7) and of course, sleep. sleep. sleep. watch tv, then sleep. after my two days of lying in bed nursing that horrid URTI in early feb, i realised how much sleep i truly have been lacking.

i wonder how much of the above will i achieve in that one week? heh.


V Day

v as in valentine’s day, not victory over some random thingy day. a very happy valentine’s day to one and all. i’m not sure why i’m wishing everyone this, since mumbler has got nothing to celebrate (yeah, no more BFG for me), but possibly because the friendly customer service lady at my phone company wished me “happy valentine’s day” after i had inquired about recontracting my mobile phone plan. (weird huh, i know.) so yes, a happy v day peeps.

valentine’s day marks one week since the first time i’ve ever taken sick leave after starting work. caught a random URTI bug which then developed into a raging fever for three whole days which did not abate with panadol, and completely messed up my nasal plumbing. it was one hand holding up the cold compress, the other for blowing my nose, while i sat in front of the telly and watched everything from silly kids shows to the sleaze on MTV.

all that has since resolved, so mumbler went to catch black swan last night. for more details about the movie, look here. i’ll just state for a fact here that it’s a very good movie, but a very scary one at that too. like inception, it really messes with your mind. the movie lets you follow the lead character around – too closely in fact, as the tight angles and close ups provide (loved that photography!), and you end up getting into her head. at the end of it, you have to rearrange your mind and emotions before exiting the theatre. it has made me somewhat fearful of all things ballet, which is bad, since i’ve been trying to resume classes. but it’s also a reminder of how dark the true soul of art is. i mean, how many of the famous artists ever had pure souls? there is usually something deep and dark that drives them to their greatness, if you dig hard enough.

that’s all for now, this valentine’s day. oh wait, there’s more – would you believe it that a neighbouring country has decided enough is enough, so they’ve laid the blame for all the thousands of babies born out of the wedlock on the existence of valentine’s day, hence their people are prohibited from celebrating it. apparently there are “immoral acts” linked to this festival which has “elements of christianity”. i can’t think of a better example of religious intolerance – instead of trying to help their community and tackling the issue head on, they use it to attack another religion. like, seriously. i get the whole Bible belt vs Pharisee belt thing, but to make this link between a completely secular and commercialised occasion (regardless of it’s tragic origins) with a religion is a bit too much, by my standards anyway. oh well, it’s not the first time and it won’t be the last that such things will happen. shall just be grateful that singapore is as multireligious and mutlicultural as any place could possibly be.

man, there’s so much more to blog about, for instance my (ultra) short stint in micu, preparations for my friend’s wedding, my (hopeful) run up to being an emergency medicine resident…

when there’s time, and when the time comes.


And It Just Goes Round And Round

mumbler is back home, post call from her second call of the year, and after the first day she’s spent in the MICU. there’s a million and one things that mumbler wants to blog about but she just hasn’t got the time (and energy) to do it. she’s been wanting to blog about that first call of the year, what with three admissions to the acute stroke unit which were NOT strokes (one turned out to be a fulminant APO) and unreasonable relatives asking where the consultant of the ward is (in the night). then there was her first taste of clinics just two weeks ago, where the cases can be really interesting (young woman presenting with persistent vomiting eventually diagnosed to be hyperthyroid) to the really boring (string of people with diabetes who refuse to help themselves in the control of the disease).

which brings to mind one of the patients in her ward, this thirty-something lady with a sky high BMI (she -broke- two hospital beds, go figure) who came to the general ward after being intubated for decompensated respiratory failure. she’s so huge she needed like five people to move her from the bed to the trolley so that she could be discharged. but all these while, she has not been motivated to lose weight. a few of us have seen her, sitting (of course) on her hospital bed, eating out of TWO huge bags of chips, one of each side of her and one hand in each bag. at the same time she was admitted, we had a middle aged deaf-mute being worked up for constipation and a suspicious chest xray. turns out she had gastric cancer (the scopes apparently showed that it involved nearly the entire stomach, almost like the textbook linitis plastica) with mets to spleen, pancreas, liver and multiple lymph nodes.

our deaf-mute patient is married to another deaf-mute, and their kids also have the same condition. both parents have jobs, but i can imagine it barely gets them by. it hurt to see her on the day of her discharge, with her smiling serenely at us and mouthing the words “thank you”, when all i could think of was the death sentence we had just handed her, and of that other patient in a ward a few floors above who quite obviously did not care about how long she had to live. i know that i am in no position to judge another mortal, but how could one think otherwise?

and, speaking of judging, this latest batch of house officers who have joined us are giving us quite a headache. one is uber slow and leaves the MO to clerk and sometimes even take the bloods for the new cases, another does not tell the MO when there’s a collapse, and yet another leaves things undocumented and once even did not turn up for work. mumbler really hopes that this state of affairs will not last for long because it is really trying the patience of the seniors, especially the MOs because it is us who bear the brunt of it on call, and have a lot of explaining to do to our registrars and consultants for changes not completed. the posting may well turn into a nightmare if some things stay the same.

on a much happier note, mumbler has started rehearsals for her friend’s wedding. it’s so nice to be singing again, and to, literally, rediscover her voice. it’s a bit rusty but i’m sure it’ll be all warmed up by march! there’s also her ONE precious week in the MICU to gain some experience (note to self: will need to beg for a full month to accredit it).

and oh, oh! sara bareilles is coming to singapore! on May 11th, at the esplanade. woohoo! haven’t been so excited about a concert in a long while.

as a treat, here’s one of her coolest songs ever:


Bonuses

i say bonuses because just a few days ago mumbler thought that the only bonus she would be getting would be the thirteen month bonus that was dumped into her bank account last year. (which wasn’t really that great because they apparently pro-rated it since i have “only” worked as a medical officer for eight out of twelve months so i don’t deserve to get the full medical officer pay.)

then today mumbler attended the MOPEX briefing at her hospital and discovered that there -will- be another pay out. and she also discovered that if, by some fluke shot, she scored an A* (yes it’s like back to primary school and PSLE grades) she would be entitled to a bonus of more than TEN GRAND. like, wow. she never knew that her grades would amount to much. (kidding) but to be fair, as with all big organisations, the number of people who actually score such grades are few and far between, so most of us will be getting much, much less.

as the sole breadwinner for her family the past few months, it’s good news enough for mumbler. then again, i shouldn’t complain. it’s a stable job with almost no possibility of retrenchment, plus it’s a noble profession (for now at least). i’ll keep my job for now. heh.

new HOs came in today. which made me think, i’m getting old. at the chorale concert last month, my junior college friends and i realised that we were already a whopping J9 – and we are J10 this year. (though this is a uniquely Rafflesian way of couting, i think it’s rather self-explanatory no?) in may this year i’ll start my second year as an MO, and my third as a doctor. time -really- flies.

which is why mumbler is sending emails to some dance schools to ask if they would take her as a student. before my knee joints decrease in space and before the juices of my nucleus pulposus evaporate.


New Year

a very happy new year to one and all. how did everyone spend their countdown?

mumbler spent it trying to catch up on sleep. she was post call, but still went out for dinner with a good friend (and a fellow ED hopeful) in town. then it was back home to watch the local countdown show (hosted yet again by gurmit singh, i wished i could just pay this guy to retire, it’s getting more painful with every year) before she hit the sack and slept for the next ten hours.

i guess i needn’t elaborate, but that call wasn’t one of my good ones. yes there were only six admissions, but with so many sickies, i was kept awake watching over them. then again, they weren’t -that- sick, it was just me…being worried that they could turn sicker. oh well, i suppose i should learn to worry less in the new year, so that i can get more sleep on call!!

anyhow, that was so last decade. it’s a new year, and a new decade. the last decade took me from bumbling high school student through medical school to becoming a doctor. i got to travel to china and europe and the us of a. along the way, a heck lot of stuff happened, both good and bad, but i dare to say, mostly good.

Jeremiah 29:11 “For I know the thoughts that I think toward you, says the LORD, thoughts of peace and not of evil, to give you a future and a hope.” (NKJV)

what will the next decade bring?


Pazzed

so mumbler has passed her MCEM part A. after all that preparation and anticipation, it just means that i’m one more step to even more exams. and the need for research papers. for more postings, and hence more calls. and i still am awaiting confirmation of a traineeship.

but i shall celebrate for now, since it’s christmas. heh.


Mugged

it’s, like, less than a week to the exam and mumbler is already exhausted. after a while, all the MCQs merge into one huge giant monstrous question that becomes impossible to answer. i’m not sure what sort of questions will come out, but it’s rather annoying (to me at least ) that we have to know that it’s THREE percent of patients on amiodarone (up to 9% apparently) that develop lung toxicity, and not TWO, and like, the epididymis is exactly SIX metres in length etc. even though mumbler scored an A in maths in high school, her brain is not wired to think and memorise things in numbers. and there is so much information that i’m cramming into my head now that i really feel like my brain is about is burst out of my cranium. i wonder how having a raised ICP feels like?

this self imposed isolation, or study leave as it is officially known, reminds me of MBBS, where i would stay up till late to revise as much as possible. it does not help that it pours every afternoon which prevents me from swimming.

but there are things that make me happy:

1) will be going to watch two performances over the next two weekends – which means entertainment, catching up with friends and nice food. will supporting my JC schoolmate who’s acting in a musical . the following week would be sleeping beauty, yet another of SDT’s year end offerings.

2) mumbler also discovered this interesting program called dailybooth, which allows you to post up a picture a day in a kind of photo journal. not that mumbler is an avid photographer but i must say it’s quite interesting to have to think of what image or scene would best capture my day.

that’s all for now. mumbler will try to blog more frequently from now on, because, well, that’s the purpose of having a blog isn’t it?

till next time.


Rambles

mumbler is post one heck of a fantastic call. SEVEN hours of sleep. of course it helps that she’s now an MO, and no longer needs to answer calls about hypocounts and low BPs and NPUs. she only needs to use her brain, well, most of the time. many thanks to the ED, which did not admit a single patient to her floor after midnight, and admitted only one patient each to the other floors – and the last came in at about one if i’m not wrong. must be the call power of her two registrars, who are just the sweetest bunch of people in the department. heh.

mumbler went for her residency interview the day before. it was short and brief, and she was ushered in much earlier than expected as the person before her was late. can’t really gauge how well – or badly, it went, so am crossing my fingers. besides there’s still the part A to clear in two weeks.

work wise, it’s been less trying, but i’m going to switch out of renal so am feeling a bit sad. the people are funny in the geeky sort of way (ever seen someone’s eyes light up at the words “acid-base”?) and it’s been fun helping to answer blue letters instead of being the one to write them.

a couple of not so pleasant things occurred in the past few weeks. one of mumbler’s patients died early last week. we all expected it, and even the patient himself knew his end was near, but everyone on the renal team were sad, including the nurses. what was even more tragic was finding out that his family did not want to come and see him after being told he was dying. of course we do not know the person he was before he fell sick, and it is possible that he might have done something so hurtful to his family that made them react that way.

the week before, mumbler found out that someone she knows got his/her name published in a local tabloid, because a patient made a complaint. mumbler does not know the facts behind the complaint, but it’s very sad that the local press seem to have taken upon themselves to name as many “errant” doctors as possible.

perhaps it was something to do with all these not-so-happy things that mumbler suddenly recalled a (very) short story shared by jeffrey archer in one of his books. it’s origins are debatable and it’s apparently translated, but it’s the most marvelous piece of writing i’ve ever come across.

Death Speaks:

There was a merchant in Bagdad who sent his servant to market to buy provisions and in a little while the servant came back, white and trembling, and said, Master, just now when I was in the market-place I was jostled by a woman in the crowd and when I turned I saw it was death that jostled me. She looked at me and made a threatening gesture; now, lend me your horse, and I will ride away from this city and avoid my fate. I will go to Samarra and there death will not find me. The merchant lent him his horse, and the servant mounted it, and he dug his spurs in its flanks and as fast as the horse could gallop he went. Then the merchant went down to the market-place and he saw me standing in the crowd and he came to me and said, Why did you make a threatening gesture to my servant when you saw him this morning? That was not a threatening gesture, I said, it was only a start of surprise. I was astonished to see him in Bagdad for I had an appointment with him tonight in Samarra.

have a good sunday everyone.


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