My prayer

Dear God,

Today was such a lovely day (Playhouse day). Spent with so many of my favourite people :D
As tomorrow shall be as well. Thank you for the wonderful weekend.

New favourite cake: NYDC's Mochamisu
Told stupid Q gleefully that I got a huge slice and he announced it to everyone haha. Thank you for lovely friends that make me happy, that I sit here typing this when I'm so sleepy. Thank you for each of them who make me smile as I think of them now.

Medicine EOPT is over, thank you God for letting me pass. Thank you that it is time for a break, cuz I really could not go on much longer. As you know, on the very first day of Gen Med posting I was already tired. Lord, please let the patients whom You took home be united with You in heaven, especially the two from my ward. Lord, you give, and you take away, in Your time. And we were caught off guard, because Your time is not predictable. When I stood in the crowded space within the drawn curtains watching my first resus case, all I could do was stare. At the patient, at the doctor doing the resus, at the other doctors, at the nurse, at the vitals monitor........ I can't really describe what I felt then, in fact I think I don't really know.

Thank you for Winter, I know she has been trying to tell me that I should spend more time with her and not keep telling her that I'm going to bathe, and then that I'm going out. Please help me to make time for her cuz I love her and actions speak louder than words.

Lord, you know everything there is to know about me. Even the answer to the question I asked myself tonight while on the way home: Why am I always like this? Why do I always react like this and feel like this? When I feel afraid, think I've lost my way, still You're here right beside me. I don't know why it always comes back to me feeling this way, Lord help me to grow, help me to change, teach me Your ways and guide my words and my steps. Most importantly, may You guide my words and deeds that I may not hurt anyone dear to me.

And as always, thank you for never leaving me and for being the best listener ever whom I can pour out my heart to anytime and all the time. Truly You are the love of my life and may You give me the grace to be more faithful.

Love,
me

Sand behind my eyes

H & J miss you guys, need some love and need to talk.

My heart stops
When you look at me
Just one touch
Now baby I believe
This is real
So take a chance
And don't ever look back
Don't ever look back

Love

There is an Ahma in my ward who lays in her hospital bed by morning light and by night. She doesn't open her eyes unless we open them for her first but she is fair with a chubby face and I can imagine that she must have been great company, a wonderful mother, wife, grandmother. For she is so very much loved. Day after day, at all times of the day, there is family, perhaps one, perhaps all together, sitting on foldable chairs that they bring from home keeping vigil by her bedside. Sponging her face, massaging her calfs, stroking her arms, wiping away the bubbles that she blows in her sleep. Every day during rounds they wear a common protective worried look that may come across as demanding to one seeing them for the first time. Their chairs may intrude on the neighbour patient's space, they may have stolen the opposite patient's "granny chair" for Ahgong to rest more comfortably, and be labelled as "difficult family who deprives other patient of granny chair".

Their care is so observant that they were able to tell the doctors what time it was on an unfortunate day that they noticed the change in Ahma's responsiveness, sharper than our around-the-clock care, alerting us that the change in her mental state may not be due to just sepsis. Also, what is remarkable is how well-informed they are about Ahma's past medical history. This is not surprising as they request for updates during daily morning rounds.

Today it was just before 11 am as I listened to the update given to Ahma's family. They were informed that Ahma had suffered another stroke the day before, so during the exchange they were concerned primarily about her prognosis (not likely to be able to understand and speak again), causes of the new stroke, rehab...... Ahma's daughter asked all the questions that I would have asked in her position, one question leading to another and another, trying to get an understanding (really, of what we learn everyday- diagnosis, severity, aetiology, complications) and her despair and the family's deep sadness and loss were evident. Just then, Ahma's grandson, who is around my age came into the ward to visit his grandma. As he walked in I could almost see his thoughts through his eyes..... first the reality of it all hits him anew, then he greets his grandma, bends over to hug her, talks to her, gently pries open her eyes and tells her that he has come to see her. The doctor is still telling Ahma's daughter and son about the abovementioned issues and I am close to tears.

When I was about 11 an ambulance came to my house to bring my grandma to the hospital and the paramedics carried her onto an orange stretcher. My mom told my grandma that we would pack some stuff and come to visit her slightly later at night. I stood at my door watching them take her way and I was so scared and overwhelmed and had so many questions but I didn't ask them cuz I was trying my very best not to cry (thought I had to be strong or something). I remember asking God over and over to let her be okay.

They are older yes but is it any less scary now for them? And unlike the young me who didn't know anything except that grandma is sick enough to need to go to the hospital, they understand their Ahma's condition.... which is worse?

SAVE MEEEEEEEEEEEEEEEE!!!!!!!!!!!!!!!!!!!!!!!!!!!! (Im failing to thrive)

10/10/10

It's not okay. Honestly, it's not okay, and I am a little angry and it is just not a good enough excuse. But you obviously can't tell my disappointment even though I could not mask the flat tone of my voice. I'm done trying.

Now that I've got that piece of unhappiness off my chest. Ortho posting has ended (oh joy) with rather dreadful OSCEs and an otherwise really satisfying day of eating really satisfying meals, shopping and watching Eat Pray Love with good company. (:

Two episodes Grey's Anatomy marathon begins NOW :D

You made me feel better (:

Super Sian ++

May the coming week be better, because the weekend was totally unhappifying. =(

D':

H says "Things will get better in the morning"

Okay.

GREY'S ANATOMY IS BACK!!!!!!!!

Watching the first episode now (With you I'm born again). :D

There's not a thing that I would change

11.50 pm. I'm enjoying the solitude in my room. It's easy to imagine that the whole world is asleep and there's only the music and me now (:

Happy birthday my dear

I'm So tireddddddd (in a good way). From a lovely day out with lovely friends to celebrate Winter's 6th birthday. A bit belated, but still a very happy one.

Also, a very nice break from the days at the Tropical Garden Resort hospital, and thinking about starting the lit review for the project, and fractures, and chondrosarcoma, and traction, and classifications..........

Canton pop

Spent my post-call Hari Raya morning and afternoon in bed with food poisoning. Oh the agony. Had to eat my lovely Mcgriddles Macs breakfast at 4pm. I have to admit that I still drank milk with my coffee, just couldn't resist it....

My last day of Ortho at SGH was fun. Scrubbed in for a 30cm (!!) liposarcoma resection in the morning then attended a busy MO clinic before lunch. My role in the surgery was to keep 'Baby Ashley' (the liposarcoma) warm and alive in the towel and to staple the wound. After that I went to a prof's clinic where I got to examine almost every patient. Learnt a lot there as he sees a wide variety of cases with fresh signs and he is a great teacher. But the Ortho tests are hard to do.. it would be useful to have bigger hands and much more strength, i.e. be a guy. Couldn't have tea with CGmate call partner like we usually do before calls as clinic was too useful to leave. So we ended up looking at each other pitifully all night cuz we were starving haha. This was the first call where we didn't want to stay the night as today is a public holiday, and ironically so many cases kept streaming in. Anyhow it was a good night that ended with me doing my first blood culture and at the same time my first success at doing plug-blood. Got blood on my jeans as I was too elated and grinning at my HO, and forgot to put the swab on the patient's hand. Well it was worth it, I was beginning to wonder when I would succeed with plugs but now I think I have got it (:

Conversation with a view

(:

After this frenzy of activies is over, I wanna go on a shopping spree to buy clinical clothes (esp bottoms) and shorts, and hunt down my hairdresser who has moved to cut my hair and do my eyebrows, and write a post titled "The joys of GS at TTSH".

Two weeks into Ortho

Did an I&D (almost) all by myself during call last night!!! :D

And am home so early today- a first in the last 3 months

What should I do?

or rather, what can I do?

??????????

??????????????????

<:(

I can't stand to fly
I'm not that naive
I'm just out to find
The better part of me

I'm more than a bird; I'm more than a plane
More than some pretty face beside a train

M3

I can't sleep!!! Probably too excited (or nervous) about tomorrow.

Today was the most fun school day ever. :D

1. Got to catheterize male and female and get jelly lubricant and 'pee' all over my hands. Success on first try with the doctor pouring huge amounts of 'pee' into the bladder

2. Got to wear the pulse oximeter and BP cuff. My oxygen saturation is 100%!

3. Got to charge the paddles to 150 (not 300 like in tv shows) and shout 'All clear!' and shock the (fake) patient

4. Managed to intubate the patient on my first try

5. Got to put in a NG tube and open the patient's chest and watch it go into his stomach. Also put in one into the lungs oops- but got to feel the high resistance

6. Volunteered to set up the bag mask ventilator and ventilate at 20 breaths per minute

7. Got praised by the surgeon for my continuous suture (beams)

8. Love knot tying- except I just realised he didn't teach us the one-handed one! Have to watch the video tonight.

9. Learnt the subcutaneous suture (start from deep)

10. Ayam penyet

Jesus is fairer, Jesus is purer

Who of us is good at all
without Your love
to heal our brokenness?

Thank you God for blessing me with the loveliest of friends

You guys are really the best kind of friends. Yall did more than I could ever ask, and I am so grateful and thankful, and touched beyond words.

I'm having chocolate withdrawal symptoms.

There's no guarantee that this life's easy

There's really only two weeks left of the holidays!! And this hols has been really FAB

Camp Simba was a wonderful experience. I loved it when one of my three angels sang When I look at you. Her voice was so sweet but it also broke my heart, cuz she said the song meant a lot to her. Lord, please hug the little ones when they have to face such big things now, and in the future.

CSFC in point form

Watched two surgeries:
- One laparoscopic colorectomy- got such a high during 'tumour time!' when I stood on a stool and the surgeon pulled out the bowel and
- one extremely bloody rectal fistula turned sinus repair

Patients that caused me to look at them a bit harder (discreetly) and think, 'Hmmmm something looks not quite right, but what is it??' and then 'OHHH' when the tutor points it out:
- Man with flushed and swollen face --> SVC obstruction
- Man who looked like a sumo wrestler, but no abdominal striae --> Cushing's
- Man whose skin looked very smooth and relatively hairless --> Jaundice
- Man who just looked a little odd --> Cushingnoid facies
- Woman who just looked a little odd and tremors --> Parkinsonism with mask-like facies

Other cool cases:
- Charcot-Marie-Tooth patient
- Pneumonectomy patient who knew more about his various conditions than we did
- Plus many many more

Some moments:
- We were heading to Kopitiam for lunch and we were in the lift when a patient whom we previously met, examined and took a history from was wheeled into the lift on her wheelcar. My first time feeling an irregularly irregular pulse and heartbeat (This moment was wondrous too.) Also, she had two murmurs and was scheduled for a MVR. She was always very friendly and so nice but in the lift that day, she looked very much weaker and so very tired and she struggled to answer us when we asked her how she was. She looked like she had just got a stroke actually, and I didn't dare to say that, and then my friend said it. The few moments of discussion with them after that were awful. Then I left them and went to Mr Bean to get a drink, and said a prayer and gathered myself and she stayed on my mind the whole day.

- TZ and I were taking a history from a woman who was admitted for abdominal pain and other problems. When we asked about the onset of the pain she said "Da ge si le" (Big brother died) and started crying. I'm sure the look of alarm that flashed on TZ's face was a reflection of my own. We will do better the next time. And I've learnt that we should try our best not to cry cuz that makes the patient cry more

- When a patient's daughter took us aside and told us that actually her dad had stage 2 ca and they were not going to tell him about it. Somehow I think he knew too, but both sides were trying to protect each other.

Embarrassing-please-let-me-disappear moments:
- When I finished a respi exam and got the correct signs that lead to a very obvious diagnosis but I said another diagnosis (Had just gone over it the previous week don't know what came over me), and to quote one of my CG mates, "Did you see the prof jump?" Haha :S Then she said "I would have given you full marks if you didn't say that"

Awesome tutors:
- Above-mentioned prof- An elderly lady who runs 15k every morning before rounds. Inspiring. A very very good prof whom the seniors asked us to squeeze as many tutorials as we could get from her.
- Colorectal surgeon who let us eat during his tutorials and told us his love story and grabbed my other hand and put it on an inguinal hernia (my first) when I gingerly felt it with one hand. He said I'd never forget this case and when I read up all about inguinal hernias that night the info would stay with me for life.
- Urologist who owns a chocolate company
- Neurologist who made a quiz specially for us

Lunchtime (food that I liked and quite miss eating):
- Chicken rice and Meekia
- Mr Bean!


***


Went running today and Winter ran away from another (small friendly) dog. She yanked so hard that the leash came off. And her hind legs and bum fell into a drain and she looked at me in fright. SO cute :D

Holidays

I'm sitting in the dark and typing this, having woken out of sleep and not able to fall asleep again. Guess I'm not used to getting so many hours. It is very quiet, and I can hear my thoughts. Should I go for a run, or back to bed?

I'm yours

Well you done done me and you bet I felt it
I tried to be chill but you're so hot that I melted
I fell right through the cracks, now I'm trying to get back

Before the cool done run out I'll be giving it my bestest
And nothing's going to stop me but divine intervention
I reckon it's again my turn to win some or learn some

But I won't hesitate no more, no more
It cannot wait, I'm yours

Well open up your mind and see like me
Open up your plans and then you're free
Look into your heart and you'll find love love love love

Listen to the music of the moment people, dance and sing
We're just one big family
And it's our God-forsaken right to be loved loved loved loved loved

So I won't hesitate no more, no more
It cannot wait, I'm sure
There's no need to complicate, our time is short
This is our fate, I'm yours

Day 1

Pretty awesome.

WE HAVE CONQUERED PROS!! :D (with crossed fingers)

The Countdown: 11 days

I've been spoilt with homecooked food this weekend.

Sat:
Lunch- Mom cooked chicken rice!! Dinner- Laksa from Toastbox (which I've been craving)+ 2 cups of yuanyang + cake

Sun:
Lunch- Mom cooked nasi lemak (This was not entirely a success as the ricecooker broke down halfway and the rice only almost done, simmering in coconut milk and pandan leaves, had to be microwaved. :S) Tea- mushroom cheese eggtart + coffee. Dinner (will be)- Ginseng chicken soup + curry leaves cereal prawns

Yummmmm (:

In need of benzodiazepine/ evening melatonin/ sunshine

And now we pass and just like glass I see through you, you see through me like I'm not there

I am feeling awful. Just awful ):
Bloated, nauseous, headache and hard to breathe.

This reminds me of
x,
and i feel. even. more. awful.

Dementia

I just cried while webcasting sheeeeeeesh. (Luckily I didn't go to school haha.) The lecturer showed a video of a cute old lady with dementia who got lost after buying a packet of chicken rice for her granddaughter. She reminds me of my own grandma, because she went out specially to buy lunch for her granddaughter, and was so worried that her granddaughter would starve while she was lost.

His yoke is easy

Recently, I've developed a liking for orange foods, orange chocolates in particular- Marks and Spencer's orange truffle chocolate, orange chocolate thins from a relative, Honey orange mocha from Starbucks...... But also orange drinks, particularly Ichiban's Moonbeam drink/ variations with orange cubes. Yum.

Today I grieved for a boy whom I did not know but followed his case for six weeks from his parents' pretty detailed updates about his condition. He was the boy I wanted to donate my platelets to, but chickened out, though the need for them never arose. He presented with an unremitting high fever and was diagnosed with a very rare type of lymphoma that required foreign doctors expert in this area to fly to Singapore to take a look at him. He then underwent a bone marrow transplant from an unnamed donor which was successful but subsequently he acquired an EBV infection and spent many days in the PICU where he was sedated on and off. His organs started to fail, causing large amounts of blood to be passed in his urine and gut, affecting his BP and thus he needed multiple daily blood transfusions. He also had lung infection, clotting problems, and finally his consciousness was affected and he succumbed to septicaemia. He was a really cute boy (from the picture that his parents posted) with beautiful large almond-shaped eyes and a lovely face shape. His parents wrote, 'We love him, but we know Jesus loves him more.' Throughout this impossible journey, their faith in God's goodness was unceasing. From their entries it is clear that their strength these six weeks has come from having an total trust in His love.

It makes me wonder how I will cope when such a patient is in my care in the future, and if I will be able to cope with such loss.

Jesus take the wheel

Jesus, take the wheel
Take it from my hands
Cause I can't do this on my own

I'm letting go
So give me one more chance
Save me from this road I'm on
Jesus, take the wheel

Delayed Sleep Phase Disorder

Symptoms: Stable sleep schedule that is substantially later than the conventional or desired time. Patients with DSPD have sleep onset insomnia and extreme difficulty arising when they attempt to conform to a conventional daytime schedule

Etiology and affected groups: May arise from longer-than-average circadian period, reduced exposure to light during morning hours. DSPD is most common during adolescence and may be self-reinforced

People with this disorder are called "Night owls". I am one :S

There's a fine, fine line

There's a fine, fine line between a lover and a friend;
There's a fine, fine line between reality and pretend;
And you never know 'til you reach the top if it was worth the uphill climb.

There's a fine, fine line between love
And a waste of time.

There's a fine, fine line between a fairy tale and a lie;
And there's a fine, fine line between "You're wonderful" and "Goodbye."
I guess if someone doesn't love you back it isn't such a crime,
But there's a fine, fine line between love
And a waste of your time.

And I don't have the time to waste on you anymore.
I don't think that you even know what you're looking for.
For my own sanity, I've got to close the door
And walk away...
Oh...

There's a fine, fine line between together and not
And there's a fine, fine line between what you wanted and what you got.
You gotta go after the things you want while you're still in your prime...

There's a fine, fine line between love
And a waste of time.

I don't want to live on the moon

Alpia fruties

Alpia fruties (chocolate-covered raisins) are my latest thing. During study breaks or when I cannot fall asleep (like every night) or when I need some endorphins, they are therapeutic.

I discovered them in Primary 6 when J and I went to watch a movie and she brought a long a packet which her dad bought for her and I couldn't stop eating them cuz they were so addictive!

I've put my trust in you, pushed as far as I can go

I'm trying to webcast the lecture on how we see while my aunt (some times removed) with flaming red hair is having a really loud chat in the kitchen, which is unfortunately closest to my room, and so I just cannot move past the cornea to get started on glaucoma, which I am very interested in as my grandmother has the condition, although I will probably never be an opthalmologist as I fail to see anything more than some yellow, some black and some vessels when I peer in despair through an opthalmoscope.

I take a deep breath that I need. Haha

On the bright side, I got to see otitis externa in my friend's ear.

NHS which happened last Sunday was a good experience. Armed with case files, stets, syphomanometers, alcohol swabs, clorhexidine hand rub, CBG sets etc and my M4's willingness to teach, the three of us set of down a row of 1-room rental flats and were lucky to be welcomed into four of these. It was a real eye-opener, seeing how the residents live in this sector. Most of them are poor, but the residents we saw are not that removed from the healthcare sector. They were on treatment for the common chronic diseases, cancer, and bone and joint problems. Some of them had problem lists numbering up to ten and corresponding drug prescriptions!

When I look at you,

my heart fills.

((((((:

Joys of reading Robbins

"Cigarette smoke condensate is a witches' brew of tumorigenic delicacies such as polycyclic hydrocarbons and other potent mutagens and carcinogens."

Joys of mugging

Funny lecturer:

"Heparin inhibits the activity of coagulation factors 2a, 7a, 9a and 10a. 2 plus 7 equals to 9, and 10! So it's a lot easier for you to remember, isn't it?"

"Warfarin stands for Wisconsin Academic Research Fund coumARIN. This is a blockbuster drug for University of Wisconsin. Anyone who wants to go to Uni of Wisconsin to study, be rest assured that they have a lot of money to support you, because there is only one oral anticoagulant in the world, so every year they enjoy a lot of royalty. So we are trying to develop drugs as well. So if we develop one, we'd call it NUSarin."

Duo

It's late, I'm tired and my mind is full of sick kidneys and prostates, but I don't wanna go to sleeeeeeep. I have been sitting here, cheek in hand, staring at the screen in a sedated state for the past ten minutes.

It is time to sleep.

You make me feel:

Sad. Disappointed. All these non-productive and even counter-productive emotions at a time when I would like to feel supported, encouraged. So upset that I need to intentionally go online (when I'm originally not signed in to msn) to talk to my friends and rant and let them warm me up, and let their love seep into me. Like I need to type out stupid details, so that I can get another opinion on you, and on why. Weighed down. Like you don't care, and can't be bothered to do the little things that matter. That I'm prolonging the inevitable. Like I'm not good enough. Like you are not good enough. In fact, like you suck. Like I have poor judgement, and also am judgemental. Confused. Like already, you've forgotten what you said. Like I'm at the bottom of your list of priorities, because who cannot make plans just a week in advance? Like I may be wrong and may be partly at fault. Like I need to go to bed now because I've wasted enough of my energies on this nonsense.

Culinary attempt Two

Butter vegetarian fried rice. My accomplishment of the day! Okay, la

First culinary attempt

I made a mushroom and buffalo cheese omelette for lunch today and it was pretty awesome although I was rather apprehensive about taking the first bite. :D

2010 life

Had to do a grocery run after school today lugging my two lovely new textbooks (I especially like Epstein whom I will be spending tonight with) along, and that really tired me out. Homecooked lunches, good for the soul and good for the body, have become a thing of the past since grandma's cataract surgery. The bright side of it is that there are delicious things available in the supermarket (Frozen shrimp wanton soup noodles, excellent with sesame oil) and delicious-sounding things too (XO seafood and Roasted beef nissin noodles).

I did stop to ponder at the row of pasta sauces and Leggins has come up with interesting new wine-infused sauces eg sundried tomato infused with chardonnay. However I think I'm not ready to move on to the league of pastas, having overcooked my instant noodles yesterday. The two fantastically awesome cooking expeditions that I have participated in are 1. Blueberry chocolate chip muffin (melt-in-your-mouth goodness, alas, it may be cuz my friend is a baking goddess) and 2. Creamed chicken with carrots and wild mushrooms (much of the credit for this dish must go to me ;))

Fresh Infarct

It feels like an area of my myocardium is now nucleus-less, and replaced by fibrin and RBCs.