Almost 3/4 into GS

I was pretty inspired by one senior who did weekly post about her journey through HO-ship and wanted to do the same. But I guess it didn’t happened – I was too busy, too lazy, and too unmotivated. Since I have some free time now, I figured why not?

Almost 2 months have passed since I last blogged, went through 2 different teams as well. I am definitely very honored to be in teams with good seniors and amazing co-HOs.

My 2nd team was HPB (hepatopancreaticobiliary) and there’s two HPB teams. I was in the not-so-shag team. Tbh, when I first found out I was posted to HPB, I was quite excited actually. Since M3-M5, I haven’t been to HPB or CLR (colorectal) team and these are really the bulk content of GS we should know as medical students.

I remembered feeling so incompetent in my first team despite the reassurances from my seniors and other colleagues. And when I transited over to the 2nd team, I felt like I was able to cope much better and managed things much better. Like knowing a little bit more about my patients, knowing how to handle the administrative work well. My bosses from HPB team were amazing as well. I often hear stories from them from their past, their present and also, about the career pathway in surgery. No doubt the 2 of them inspired me to want to pursue a career in surgery.

Which was why I have applied for the MRCS part A examinations this coming September. Honestly, I think I have learned a lot from both my 1st team and HPB team with regards to knowledge and application of what I learned from medical school. I was able to correlate the management of acute pancreatitis, cholecystitis/cholelithiasis, malignancies of the pancreas and liver. I’ve even managed to see 2 patients with intrahepatic cholangiocarcinoma who have underwent stent insertion, with very different outcomes.

Of course, starting a new team isn’t always easy. I remember my first day in HPB, this patient died right in front of me. I have completely zero clue on what to do. I just stood there and texted my seniors and sent a priority message to the palliative team taking care of this patient.

(Off topic, in healthcare here, we have this messaging application called tigertext, and essentially, as long as you have the name of the person, you can drop them a message. There is this feature of “priority message” whereby the person who received it will get an annoying and loud beeping on the phone to let them know this is an emergency. Sometimes people abuse it for the wrong reasons, but ya, people from many many meters away can hear.)

That was my first time sending a priority text over, and I am so glad the palliative medicine doctor didn’t slaughter me for sending the priority text during their rounds. But wow, what a way to start HPB.

Regardless, the team was really amazing and I even gotten the chance to go to lumps and bumps OT, where the MOs will excise out the lump (can be abscess or sebaceous cyst), and we get to close the skin too. This whole experience really affirmed my decision to pursue surgery as a potential career in the future.

But then, as I transited into my new team, CLR, I realised most patients come in for colorectal cancers who have undergo some sort of colectomy with stoma. Most patients would be on total parenteral nutrition (TPN), and what we (HOs) are really doing is mainly coordinating care and settling the administrative work. I understand that this is the job of a HO, but I don’t feel like I am learning a lot either. Most times, we are trying to settle discharge issues, or when a new acute event happen, we will need to attend to them.

Generally, I really don’t enjoy this posting as much as I wanted to. This also spurred me to reconsider my decision to pursue GS in the future. GS can never escape from malignancies and I really have not enjoyed dealing/studying with cancers since medical school. Maybe I do not see myself in this path. Then again, there’s still other surgical specialities like cardiothoracic, neurosurgery, eye, ENT, etc… which are still up for grab. This would depend on my MO posting. Hopefully I can get the relevant postings I want, and get to truly experience life in the subspecialty before applying for anything.

Somehow, I realised specialty training is quite important because there’s always a motivation for you to be a better doctor. You have to advance your knowledge and skills, sit for examinations and show competency as well. Majority of which, would’ve ended by the time medical school ends. Who would want to use their free time to study? I doubt not a lot of people would want that. Especially when free time is so hard to come by. Feels sad that I’m not spending a lot of time meeting and catching up with my old friends, or trying out new things, or doing things I want in general. Feels like I’m just trying to catch up on sleep.

Shag Not sure if this will ever get better, but I just hope that things will be slightly better in the next few months. Anyway, 12 more days before I transit to a different team, and another 1 more month before the end of GS posting.

Hopefully the learning opportunities will continue to present itself, and that I can find a posting I truly enjoy +++

Consecutive mistakes

2nd week has been shag and nerve wrecking.

Honestly my bosses are nice and my workload is more or less manageable.
But despite all these, I seriously can’t help but to feel so trash about myself.
Many mistakes have been made, I am still taking the same 2 hours on 5 patients vs 15 patients.
I’m still unsure about things and feeling the need to ask for help.
Sometimes, I still hesitate to call seniors for help for fear of disturbing them, getting scolded.

I cannot say I have it very badly because there are people out there with worse bosses, with higher patient load, but I really can’t help but to feel that I am not progressing at the pace I want.

I really don’t think it’s a good idea to write about the mistakes made here. But if I every read this many many months or years later, I hope I can still remember these events with just a few words: getting accused/system error INR/SN TT boss. Honestly, the number of mistakes I made over the few consecutive days is really urgh… I feel so embarrassed making such mistakes and I really dreaded heading back to work because I need to face my bosses. If I can’t get such basics right, then how can I aim for bigger things…

Idk, maybe I’m just too hard on myself. But oh well.

My boss once told me, “a good HO will make an MO useless”, “a good MO will make a reg useless” etc.. This was similar to what someone told me in M5. A good M5 SIP will have to think like a HO, yadah yadah… But tbh, I think it’s quite tough because we usually don’t have a good grasp of what HO life is like until we are doing it. Maybe not for YLL students since SIPs + studying for exams are lumped together in a posting, unlike LKC/Duke students were their SIPs are after their graduating exams. The LKC/Duke medical students really just follow the HO and do their work as tho they’re the HO, and I guess life is a lot easier once they start working as a HO. Sometimes I wonder if NUS would ever consider this system. Hmmm…

On the slightly brighter side:
– I’m so glad my 2 duke SIPs were there to help me manage like so much of my workload, really gonna miss them after this week. They have made my life much happier in the team.
– Medicine is a calling. Like literally. I have gotten better at calling for scans and arranging them asap so my patient’s can get evaluated for confirming the diagnosis and further management. I truly remember the first day trying to call for scan and getting asked: “so what this pt come in for”, “why you need the scan now”, “what are the vitals/labs” and then fumbling around the system while the radiologist is waiting for me to get the answer. Don’t ever do that man, cause it waste their time too. But I’m damn glad that those I’ve called were very patient with me. Nowadays I guess I already have most things prepped and ready to call.
– The best thing that happened this week was when I managed to arrange scans for all my new admits during the call, such that I didn’t have to call anyone to arrange for the scans the next morning. Tbh, I really hate calling people. lol. Families included. Esp families, Idk why it sounds so awkward to end the conversation LOL.
– I think my documentation for my patients are definitely improving and hopefully it’ll get better as more time passes
– also, many seniors/friends have reached out sharing their experiences as a HO and the mistakes they’ve made, how it helped them to be better. It is really very encouraging and touching to know that you’re not alone in this and that everyone is suffering together. Hopefully all these will make us better and stronger doctors in the future.

This upcoming week is going to be damn shag. On-call on Monday, team is taking new admits on Wednesday. On call on Friday again. Then the following week on the 31st, I’ll be joining a new team with completely new co-HO and new bosses. I hope I can survive through next week’s hellhole.

^{featured image from happycat318 on instagram}

1st call

As we embark into the journey of becoming doctors, we have to go for calls. Calls are like you taking care of the patients, just that it happens during days in which manpower is severely limited. Like during the night time or over the public holidays. And you will cover for a huge number of patients, majority of which you have not seen before.

Unfortunately (or fortunately), I was on call on my 1st official day of work. And it was the worst (so far, lmao, 1/1 experience).

4pm is the start of the call, and generally speaking, the ideal process of a call should be
– monitoring the status of the ED and see if there are new admits to your department
– if there are, pre-clerk (means look through why patient came in to ED, why were they admitted to your department, what has been done so far, what is their past medical history and medications, formulate your top diagnoses, consider adding on new tests to do and add on other interventions)
– once you’re done pre-clerking, depending on your bosses, you’ll either go to ED and see them now, or wait til a few more has been consolidated before you go see them
– once you’re by the bedside, you’ll open up the notes, document the important stuff, add on new investigations and management plan before you move on and see the other patients
– this will repeat until the sun rises at 8am, when you’ll handover to your own team (at least that is what we do in General Surgery Trauma team)

This part may vary from hospital to hospital, team to team, but just sharing from the one team I am with

– then you go for rounds to see both the new patients admitted overnight, and your old patients
– needless to say, the number of patients under our team’s care blew up
(my call luck was so bad, I didn’t have sleep and there were 30 patients by the end of the call)
– and then make all the changes for them before I go home
– well, I guess technically I can go home straight and sleep after that, but having 2 people to settle changes for 30 people is crazy
– so I decided to join the rest and help them out as much as possible
– I only went back home by 2pm, and I really wanted to die lol
– and the changes weren’t even 100% done when I left
– and ya, it was just a shit ton of work to clear
– given how slow and bad I am with things, you can imagine by 2pm, I haven’t really contributed much

Anyway, during the call was hectic
– Just before 4pm, my team had a trauma activation and we were all caught up with that
– subsequent, my morning team had a few more ED patients to see
– by the time we were settled with them, I am almost 2 hours “late” into my night call
– wanted to let my team know to go off first, but they were very busy and would probably need my help (which I might just end up adding extra work for them LOL)
– anyway, by the time my morning team finished their stuff, I was lagging behind by 3 patients
– one of them had my senior concerned about acute limb ischemia presenting as leg pain, so she had to rush me to quickly pre-clerk before she sees them
– I didn’t finish my 3 patients and we were by the patient’s bedside
– as I am still damn noob with the system, I took pretty long to settle the stuff for my patient
– even my MO had to help me even though he was damn busy
– worst of all, I had the super senior helping me out lmao
– they were damn nice and encouraging, didn’t really scold me, and one of them even chased me to eat dinner (at 2am LOL) but I know I was damn burdensome
– I cannot imagine what will happen if I had a super bad senior that keep scolding me for not knowing my stuff well enough

People always say “the sun will rise” – i.e. the call will end and you can go home and sleep and all. I mean, ya it does, but what happens in between really matters man. My incompetency is really affecting me so badly… I can only complain about it, but like… I can’t seem to do anything about it. Everyone has got their own system, tried to adopt some but it didn’t work. I have thought of a new system awhile ago to try and keep things on par, and I’ll test it this coming Sunday (2 days from now)… Hopefully it’ll prove useful and I’ll be able to see the bigger picture and focus on things better.

Shag man… I honestly have no idea how people truly cope with such a steep learning curve.

Sometimes I just want to cry, but it’s really a waste of time and I rather use that time to clear some work lol. By the time I am done, I am just too tired to cry. Ded.

patient prob pulled out some lines that was inserted (context)

Shock

I’m typing like all these posts in one go, however much my sleep-deprived and stress-filled body can take it. Otherwise, I won’t be able to remember these 2 weeks worth of event to share LOL.

Anyway, this is going to end up in a multipart series so there’s some posts here and there to keep you guys entertained/enlightened and also for me to reflect on things.

During the orientation week, it’s really mainly for us to pick up skills and learn how the team works before we get thrown into oblivion. For my team, I had like 1 house officer (HO), 2 medical officer (MO), 1 associate consultant (AC), 1 consultant (con). This team has been like that for almost a month, and I joined them when the 1 HO + 2 MO are on their last week. With that said, ofc I needed to learn as much as possible before the 3 of them left me and 3 new people joining the team.

I am honestly so glad that my HO is super teachy and guides me through almost everything. He shares many tips and tricks I needed to know, and I guess at some point in time, he realized that he hand held me too much and so, he decide to throw me into situations to make me become a bit more independent LOL. I guess that kind of worked because (1) I become less reliant on him, (2) I get a bit more confidence when facing patients/talking to other people, (3) I get to attempt to problem solve on my own first before asking for help (though it takes 5ever). He has no idea how much I appreciated it, especially after hearing from my friends that the HO/MOs don’t even bother teaching them.

I remembered the nurse from a ward texted my HO, and he was caught up with an angry patient. The nurse told my HO that the patient blood pressure is 190, so he told me to go see first.

Approach to hypertension, not too difficult right? Just make sure not hypertensive emergency (i.e. with end-organ invovlement like heart attack, stroke, renal failure etc)… So I was there by myself, trying to make sure patient is ok and is not in some life threatening condition. Tried to get the nurse to check the vitals (BP, heart rate, respiratory rate, oxygen saturation) while I try to figure things out. I find of figured that the BP spike was due to the abdominal pain he was having and the nurse asked if I could give him something. I wasn’t very sure, and wasn’t confident so I didn’t agree and said I’ll wait for my HO to come over before anything. Throughout my 15 minutes there, I was just stoning and observing my patient.

Slowly, but surely, the patient deterrioriate right in front of me. BP went from 190 > 170 > 130, while the heart rate climbed up from 100 > 110 > 130. Temp also started climbing from 36.8 > 37.1 >37.3 and patient starting shivering damn bad. This is definitiely concerning for shock. Quoting from UptoDate: “Shock is a life-threatening condition of circulatory failure, causing inadequate oxygen delivery to meet cellular metabolic needs and oxygen consumption requirements, producing cellular and tissue hypoxia”… Eventually his temperature went up to 38.9… This whole entire chunk took place in like minutes and I was so shocked how patient can deteriorate so quickly.

Not that patient is having hemorrhagic shock, but this is just to show the physiology and severity – usually when the BP drops, the heart rate goes up to compensate since BP = HR x cardiac output, and BP is maintained by increasing HR. However, after a certain point, increases in the HR is unable to support the BP, and therefore, the BP dips.

Yeap, so anyway, I was quite stumbled and I wasn’t exactly sure what to do. I mean theoretically, I will “call for senior, stabilize ABCs, start O2 supplementation if needed, set 2 large bore IVs, run bolus IV fluids, draw bloods and start medications”. This is what we usually say during exams.

But irl, everything is different. Trying to call for senior takes damn long – if you have the phone number of your senior, great, can call. If you don’t, that’s another 5 mins of trying to search for the number. Then again, the seniors may be busy getting caught with something else, so must find another senior. Just before the senior picks up, you also need to know what you’re going to say, otherwise it is a waste of everyone’s time. All these things will take way more than the time you need to say “I will like to escalate this to a senior” during exams.

Thankfully, when the patient deteriorated, I was able to get hold of my HO, who then came over and called my seniors. None of them picked up but I was so freaking thankful the APN (Advanced Practice Nurse) came over to help too. Eventually things kind of settled and we managed to help the patient before he deteriorates further.

That whole CTSP (call to see patient) really gave me a lot of confidence to see patients whenever they have problems, like (1) hypotension, (2) desaturation, (3) abdominal/chest pain, etc… At least today, I have seen a few CTSP and manage to handle them ok. Could’ve been better but I guess it wasn’t too bad.

The problem about CTSP is that, I am broken away from the changes I needed to do after rounds, and then having absolutely 0 clue on what the rest of the team has done. And eventually, me falling way behind everyone. This is a really shitty feeling man… I’ve been trying to work out some system so I can be efficient and see the bigger picture, but nothing is truly working. Fml. I really hope to figure this out soon man. I don’t want to be a burden or go back home at 8-9pm because I am freaking slow and am not up to speed and up to date with things.

Sigh,

I guess that’s all for this post.

1001 things

Nobody talks about how transition from med school to working life is like.

I’ve not seen it before on any blogs, neither do I hear them actively. Or even if seniors do share, it’s usually very vague like “shag la”, “worse time of your life”, etc…

Figured if I stopped procrastinating, maybe I can get my thoughts in place, and also share this journey to whoever is reading. 2 weeks have lapsed since I first started – one week was orientation/shadowing week, the other is the official week.

If I were to describe med school, it’ll be like a fish tank. You’re the little gold fish in the fish tank, learning all the theoretical stuff, and trying to apply them into clinical context. In M1 you’ll learn about biochemistry. Example, the pathway of ketones formation. In M2 where abnormalities of the body happens, you’ll find out why the body is producing ketones, say in patients with insulin deficiency. In M3-5, you’ll see them playing out in real life about patients presenting with diabetic ketoacidosis. From here, you’ll learn about how they present (usually young patients with severe abdominal pain), the differentials to the approach (e.g. abdominal pain has 1001 causes), how to investigate them (with blood test, imaging etc), and how to manage them.

You’ll slowly, but surely, thrive in that fish tank as the gold fish – getting bigger and fatter each day until the day you ended your MBBS. Then bam, the fish tank has been dropped into the river and shattered. You’re now a small gold fish in the huge river with so many things you’ve not seen or experienced before – let alone know how to cope.

That was how my orientation felt like. I have no clue on how to use the system, or how the team works, or what are the expectations or general task you’re supposed to do. You’re kind of supposed to know. And when you don’t know and start to seek clarification or help, it seems like you’re incompetent and not learning to problem solve your own.

I mean sure, many seniors have been through it, and yes, it was hell. No matter what happens, you still won’t be prepared for this. Anyway…

The first few days were hell. Had to learn how to navigate the system, order medications, admit patients, track new admits and pre-clerk them. So many things, and then you need to learn how to quickly take down plans that the bosses want as you move from patient to patient.

When seeing patient A for example, a good HO would’ve opened up the notes, document the conversation, physical examination findings, and ordered the relevant investigations and medications the patient needs. Once that has been done, it would be time for the next patient.

What I am doing now (during rounds – i.e. seeing all the patients in the morning and deciding on plans):
– team walks to patient A
– struggles to open up the document
– struggles to quickly type them into the document
– intermittent system lags that slows everything down
– forced to write things down on notepad in hopes of transferring later
– team is done with patient A and moves to patient B (say 4 mins walk away)
– still struggling to finish up the notes
– unable to because the connection disappears during certain area and the app just freezes
– bam, you’re at patient B and the best thing you did was typing things into the notepad

Then comes the horror… (after rounds)
– I thought I can transfer the notes from the notepad into the program notes directly
– but nope, some adjustments still needs to be done
– then need to ensure all entries for all patients are put up and correct
– usually that requires checking with seniors, who have other stuff to worry about
– then comes the “doing the most urgent thing”
– honestly, this is the part I usually just become v v v lost
– I am unable to remember or consolidate all the things for all my patients, and as such, I have no idea what is needed to do, unless I scroll through the patient’s notes (which takes 5ever)
– and then everyone else seems to know exactly what to do, which honestly isn’t helping for my confidence
– sometimes, they’ll tell you what to do: “order scans for this”, “order this meds” and what not
– then again, I am just doing things I am told and not really making a good contribution to the team
– the worse thing is when I am told to “order scans” (for example), I would just jump on it and call without giving much understanding on why patient needs the scan (and all in hopes that I can get things settled fast, which then ended up me sounding stupid over the phone for not knowing my patient, and then getting whacked for wasting time)
– by the time everyone is done with like 1001 task, I just did like 4 tasks

It is really horrible man… I know this is just the start, but I am running out of the opportunity to use “this is my 1st week here” as an excuse (lmao) for my shitty performance. Most people I have encountered has been damn nice to me (though some are more intimidating than the others), but I always feel like a huge burden whenever I got questions to ask or to clarify.

I guess other than trying to settle all the (1) notes for the patients, (2) ordering investigations and medications, (3) calling people to refer patients or expedite scans, (4) reviewing them after operation, there’s the (5) trying to answer questions/review patients from everyone else that text you (be it doctor, nurses, pharmacist, etc) and that is a huge struggle.
– like I’m trying to settle some important work, then “ding ding”, some texted me
– it can be about ordering medications for this patient, or reviewing them post-operation, or asking if patient can eat or not
– it is damn disruptive, but sometimes the text just keeps haunting you

I honestly can’t multitask well and I cannot remember things well. People always say that in retrospect, I shouldn’t worry because everyone will make it through. What if I cannot and become the shittest doctor…

This is really a nightmare to think about…

Off topic, I saw this goldfish meme and thought the goldfish analogy was apt HAHAH

Part 2 of M B B S

Now that exams are officially over, its time to post about the Medicine part of the exams.

Medicine exam papers have been notoriously known to be very difficult. Most seniors whom I spoke to would’ve mentioned that majority of the batch will think they fail after finishing up the paper.

For Medicine component – there’s both MCQ, Modified essay question (MEQ), OSCE stations (6x OSCE stations – meaning they can be on communications/focused task (FT)/call to see patients (CTSP) (will elaborate them later on), short case stations (x4) and long case station.

MCQ
This was honestly one of the most challenging papers I sat for. They gave you like very long stems (with patient’s presenting complains, past medical history, long list of drugs) and then ask you questions on it. The depth of questions can be very detailed too. For instance (not an exam question) – Mdm Tan 65YO Chinese lady with background of poorly controlled diabetes, hypertension, hyperlipidemia, asthma, on simvastatin, propanolol, enalapril with salbutamol inhaler now presents with 1 week of bilateral lower limb swelling. Physical examination showed bibasal crepitations, pitting edema up to midshin, with no raised JVP. Initial tests showed urine dipstick protein 3+, eGFR 35ml/min/1.73m2, HbA1c 10.3%. Which of the following drugs would have the most benefit to her? Options A-E.

In order to answer this question, you need to know what is this lower limb swelling due to (in this case, her kidneys gg), what is the most likely cause of this kidney problem (based on the history, it’s likely her diabetes), conclude the physical examination findings, and then understand the lab test interpretation (patient also has poor kidney function, with poor control of diabetes), know your various options A-E (which drugs are used for what, and is the patient compatible with this drug, and if there’s mortality and morbidity benefits). All for that 1 mark out of like 100++ questions. Most questions are of similar style, but there’s quite a few of them with shorter stems and more obvious answers.

I thought my anaesthesia posting exams in M4 were bad enough (actually they were cause like I was completely clueless), but this was the next worst paper I did. So many questions were uncertain.

MEQ
For the modified essay questions, we had a stem similar to the top. However, each time we moved along to the next question, the case unfolds itself and we are unable to go backwards to answer them.

For instance (again, not exam question) – Mr Tan 45YO Chinese gentleman presents with 3 weeks history of cough. Past medical conditions includes heart failure (previous EF35%), Chronic obstructive pulmonary lung disease (COPD) – GOLD4C, previous ischemic heart disease with coronary angiography bypass (CABG) on these medications _____.

Q1) What additional history you want to ask

Once I moved forward from here, the stem would have the additional part to the previous question. So if what I wanted to ask in the history was wrong, the stem would’ve already shown me what the correct answer was

“Mr Tan last follow-up was 3 months ago, recent lab test were ___”
Q2) What would you like to examine for in Mr Tan

This paper was challenging because a lot of rare conditions were tested, and honestly, if you never study them, it’ll be a tragic lmao.. Or you’ll realise by the end of the question that they were testing another condition and all your original answers were wrong. Ded.

OSCE stations
So essentially, we were given 10 mins per station, and once we are done, we will proceed to the next station and start. There’s 2 mins reading time so we could slightly prepare for it.

There were a few communications station where it test on your ability for both speaking to the fake patient (SP) and partly test on your content too. Generally speaking, there’s a few themes – including but not limited to apologising for mistakes made either by you or from the team, or breaking bad news, or dealing with angry patients, or explaining diagnosis and plans etc…

There’s also this CTSP where you’re the house officer in the ward, then sometime happens to your patient, and you have to “rush to see the patient” and then walk the examiner through what you will do to help the patient. Example, patient post operative day 3 for laparoscopic appendectomy now having a fever (I’m using a surgical case as an example). Please speak to the nurse who is calling you on what to do next, go to patient’s bedside and evaluate, escalate to senior/start the appropriate management. Something similar.

Lastly, there’s this station called FT – where you’re in the clinic setting, meeting this new patient for the first time and they have a new complain. So in the short 10 minutes, you are supposed to take a history, examine the patient and explain to the patient what you going to do for them (including any form of testing). This is quite intense cause time is usually not enough.

I mean, I can’t reveal much of what has happened for my exam but among the 6 stations, I really wasn’t very certain about like 1-2 stations lol.

Short case
Short case exams are not communication-based. These station test your ability to pick up signs from the patient and synthesize them into what the patient has, why the patient has this, and any complications. I am just going to cut and paste this portion of the senior’s notes here so you roughly get the gist of it.

Credits to Jansen Koh PACES notes

Essentially, these are real patients with real findings and we need to examine them in 8 mins to look for all the above features, present them as per this way, and then have a short discussion.

For my batch, we had our final year 3 postings cancelled from the start of COVID-19, and quite a lot of our major postings becoming home-based because of COVID-19. As such, we didn’t have a lot of contact time with patients, and this is honestly our 1st time examining patient’s with real signs for examinations. It was really quite upsetting (but then again, it’s ok) to have our final graduating exams with real patients. Doesn’t matter cause we all survived.

I remembered among the 3 adult short cases I had – I already knew what one patient had when I was sitting outside the circuit for my rest station. Partly because the admin halfway said, “eh, faster, get more tissue paper and plastic bag. Patient a lot of phlegm”. This cued me in that patient has bronchiectasis LOL. True enough, this patient did XD (I mean there’s only like 5 kinds of respiratory short cases that can come out for exam – asthma/COPD/ILD/Bronchiectasis/lung removal) and only bronchiectasis patients usually have phlegm LOL.

My other adult short case was 10/10, but the last adult short case was a neuro case and I was pretty uncertain about what it could be. I mean, as I was examining the patient, he had 0 signs, until the last part of my examination. By the time I realised what this was, my original script for this disease was already in the trash bin LOL. I was able to identify what disease this was nonetheless, but could’ve been a lot better XD

Then the paediatric short case was the 4th station. Not a true short case but the school modified that. Can’t reveal much but i totally bombed that station lol.

Also, since real patients were invited, what kind of patients you get really depends on your luck. You can get the easy patients, or the super challenging ones. And I’m glad I had the 3 patients whom I know what was happening.

Long case
37 min long station (15 mins history, 10 min examine, 2 mins consolidate, 10 min discussion).
When I first went in and heard the presenting complain. I was damn fking relieved. Mostly because I didn’t study this until when we were in the waiting room LOL. I would’ve been fk-ed all over if I didn’t read through it man. After taking the history for the presenting complain, patient dropped a second bomb on me – another new symptom. When I heard that symptom, I knew what this whole case was about already. But the downside is that, this disease has many many symptoms that I would need to ask. I was so thankful I decided to revise this disease condition the day before. At least things weren’t so crazy after.

I think I managed to get a grip on myself on the first 25 mins with the patient (and 2 examiners watching me LOL) and doing the relevant examination. However, I guess I got a bit more flustered at the end cause the 2nd examiner was staring at me – and he didn’t even blinked his eyes once while quizzing me – and I forgot what other problems patient had. So I kind of forgotten my other important management. (Didn’t realised it until the end when I spoke to my classmates and they told me other stuff that I’ve forgotten – ded)

But overall, I think I passed my long case. I was really damn happy that the examinations have concluded. The 1 entire month of study break was really damn long and I have no idea how I made it through. (Ok, no complains cause seniors have 2 weeks to study for the exams, while we had slightly more).

Honestly, this is really one of the toughest and longest exams I’ve sat for in my entire life and things are gonna start climbing uphill from now on. I guess I’ll enjoy my holidays first before I get slaughtered.

AND HOPEFULLY WHEN RESULTS COME OUT, I WILL PASS!! Heard many horror stories that most people who failed are the ones who are totally unexpected ones (e.g. the super smart ones). I just want to pass and start working.

Part 1 of M B B S

Edit: sorry guys, I had to take this down until the actual exams are over… to avoid trouble just in case…

Figured that since I’m lazy to study now, and that the surgical exams are over, I shall blog about my experience.

MBBS – as the degree goes, has two parts, Medicine and Surgery. And the graduating exams would definitely compass both aspects of it. The whole exams is spread across an entire month, with both theory and clinical exams for both.

The surgery track exams had a few components, including MCQ, essay questions, OSCE type questions, extended matching questions and clinical exams.

Most of them were pretty tragic.

We had like almost 60 mins for 80 questions in OSCE, where we would be shown one photo, and a few follow up questions regarding the photo.

For instance (insert photo of X-ray showing some surgical conditions), there’ll be like 4-6 questions on it not limited to (1) interpretation of results, (2) other testing you would like to do, (3) how to manage it, (4) some trivial about the condition. These definitely needs a lot of time to think about and to vomit out your answers. But then, given you have less than a minute per question, it’s really about first impression. I really felt like I didn’t know a lot about anything, and then just quickly vomit what I think may be right. LOL. It was quite tragic.

Example of question for OSCE, taken from Charles Tan OSSE book

EMQ was equally bad. Basically, you’re given 6 scenarios on a symptom – e.g. blood in urine. Then you are also given probably like 10 options (e.g. conditions/investigations) and you’re supposed to match them up together. I remembered I didn’t knew half of what the given options were lmao. I dieded again.

EMQ questions, taken from https://med-mu.com/wp-content/uploads/2018/07/MCQs-and-EMQs-in-Surgery.pdf

The other two papers were ok, but equally tragic.

Next came the clinical exams. Possible stations included figuring out what the diagnosis is in the patient, procedures, communications/counselling for procedures. There’s 2 minutes of time outside the station with a given stem, and then 8 mins to do what you needed to. I remember I stared out with the orthopedic station and it was terrible.

Usually, the task is to take short history and examine so you can present your findings and possible diagnosis to the examiner. I usually spend around 2 mins for history (during practice with friends) and 6 mins for physical examination (PE) and presentation. My first station was so bad because the examiner made me take a lot more history than expected, and then the fake patient didn’t want to take out his shirt… And he should’ve just taken it off because it was important. He eventually took it out, but a lot of time was wasted. Instead of doing the entire physical examination steps I needed, I told the examiner if it’s ok that I just do the steps to confirm my diagnosis. I literally spent like 1 minute to show like 4 positive signs and neglected the rest of the examination. He asked me for diagnosis, and I gave him 2. He wanted like more, and my 10 mins in that station was up already… So I just anyhow whack (lol), and I knew I gave the wrong answers but in that moment of panic, I couldn’t think of anything.

Because the 2 mins for the next station had started, and I was still in the 1st station trying to clear as much as possible, I only have like 1 min 30 seconds to read and prepare for my 2nd station. 2nd station was also ortho, and the fake patient was damn nice. She vomited everything out I needed to ask for my history, and she was damn fast too. During the PE, she GAVE ME THE WRONG FINDING omg. That threw me off completely and I legit blanked out. That station was damn bad because I honestly have no clue what the problem was and I have no idea how to move on. It was fucking tragic.

I swear all my ortho stations were damn badly done.

The ortho doctor (2nd station) asked for my diagnosis, and I gave him all the wrong diagnosis. Sian, I hope he pass me because I was able to take the history and do some of the steps well.

General surgery cases were amazing. I think I totally winged them XD And I enjoyed them as well hahaha.

Anyhow, those are like the 10 min cases that took place over 2 days. Sat through a total of like 8 of those 10 min stations, and also, 1x 20 min station on ortho long case where we have to take a complete history, examine patient, talk about diagnosis, investigations and management. I think I slayed the long case cause my friends and I kind of predicted it.

Last part of the surgical track exam was the surgery long case.

Generally, how it goes is that:
1. 15 mins to take history, and also to write out the template on what you going to ask
2. Examiner 1 (who sat with you to listen and grade your history taking) will leave the room, and you will take 2 mins to consolidate everything you clerked
3. Examiner 1 and 2 (who hasn’t heard you take your history, and will know your history taking skills from what you summarize) will come back into the room.
4. You will proceed to summarize the case and examine the patient in the next 8 mins
5. Then the last 15 mins will be grilling session.

So typically, when we go in at the start of 15 mins, we have no idea what case this would be until the examiner tell us the stem. For instance, examiner would tell you “this lady came in for weakness (obviously not surgical case, but I cant say what was tested anyhow), please take a history”

Obviously, there’s a lot of things you need to ask about the weakness (e.g. is it true weakness, is it neurological, is it upper motor or lower motor, where is the level of lesion, what is the lesion, etc) and in order to do that, we will just write our approach on the paper and all other relevant past medical history, drug use, surgeries, scopes/vaccinations, social and functional history (etc etc). An example of how an approach looks like is below, but this is like only 25% of what we would write on the paper.

This is important because, not only do you have to talk to the fake patient, but also vomit everything out so you ask everything you need to ask, generate diagnosis, differential diagnosis, possible etiologies, complications, risk factors, etc and present them in the summary.

So imagine to my horrror, when I went in and the examiner drops the stem on me and it was something I have absolutely not prepared for at all. It was a topic I didn’t touch because I thought it was more Medical than Surgical and would just study after my Surgical exams are over.

Lmao. I have absolutely zero clue what to write on my paper. I had no approach. My mind fucking blanked out. Time was ticking and the fake patient was looking at me, waiting for me to ask questions.

Honestly, I felt like Zenitsu from Demon Slayer (LOL, he damn panicky and annoying when he awake, but when he unconscious, his other half will take over his body and this other half is more calm and stronger). I guess subconsciously I kind of just zoned out, and then just went with the flow.

Zenitsu when he is awake

Zenitsu when the other part of him awakens

There was 2 main problems that was presented to me in the stem. I kind of knew the main problem was problem 2, but I have no approach for it. So instead, I decided to tackle problem 1 from the start and then work my way there. I think I spend a lot of time asking, while trying to save my sorry ass for problem 2. There was just so many things goes on.

By the time I clarified enough history for problem 1, I had to face my fears. I just whacked what I could remember about problem 2’s approach. Honestly, it wasn’t much.

When the bell rang 15 mins later, the examiners stepped out. My mind was fucking blank and I stared at my paper. How the fuck I present sia… My mind was still in a state of major panik. My notes was all over the place on the single sheet of paper. I was still trying to generate enough differentials and diagnosis. Especially for problem 2.

Before I know it, 2 mins rang and both examiners came in.

I was like “fuck it”, just present from problem 1 to 2 and try my best as I can to salvage it.

Tbh, in retrospect, it feels like my mind just took over and do whatever it wanted. Maybe it was from the practices I had, maybe not. But somehow, I think I managed to present it cohesively.

Before I moved on to my PE, examiner asked me about my diagnosis and differentials to problem 2. I just whacked (it was obvious that my brain was empty), but as he probed me further, more and more stuff came back into my mind so I kind of am able to answer him. I guess I fucked up my history portion. Damn… Maybe bulk of the marking points is on problem 2. Sian.

Anyway, proceeded to do PE on the fake patient, and then had discussion on investigations and management. Which honestly, I am damn thankful that my examiners were nice enough because I kept saying the wrong thing but am talking about the right thing (like 2 similar sounding words with completely different meaning but the examiners knew what I was talking about). Lmao, one of them “tortured” me a bit and make me said it a few times to get it right (lol, I still got it wrong and he said nvm, dont torture you haha)

Anyway, I think this was damn unexpected case. And when time was up, I left the room and saw a few of my classmates looking damn worried. This was indeed a super tough and super surprising case and it definitely killed everyone.

Where did the breast and thyroid cases go to T_T ?? I was more prepared for these 2 sia…

Just before we were dismissed, the 3rd doctor who was there throughout my entire session (not marking me but just watching) came out and told me I did well.

I guess that was good enough consolation for me. I really hope I pass my surgical exams tho. It’s so painful to sit through everything again.

Now that the 1st part of MBBS exams are done for me, I should spend the next 7 days to study for my Medicine exams because it’s been so neglected and it’s one of the toughest exams.

Please let me pass this.

Tonsillectomy KIV adenoidectcomy

While I still have some small pockets of time, I should post this XD
If not by the time MBBS strikes in March 4th?, sure no time to blog and I don’t want y’all to think this blog is dead either.

Anyway, recently in July, I had my first episode of tonsillitis… It was terrible.
It started out with high grade fever (>38C), followed up super bad lethargy and sore throat. I knew it wasn’t COVID or other URTI (upper respiratory tract infections) because no cough, sneezing or other relevant symptoms you’ll expect in those 2 conditions. Besides, I have painful lymphadenopathy in my neck as well, so tonsillitis really fit the clinical picture.

I still remember having to go to the GP to get the swabs done and make sure it wasn’t COVID, and then the 7-day course of Augmentin did wonders and I recovered. Thankfully, I only missed 2 days of my Geriatric posting so not much damage was done.

In Oct, my 2nd tonsillitis hit me again…

Same procedure this time round, go to GP > get swabbed > take 7 day course of Augmentin again. This time, the doctor gave me a STAT (i.e. immediate) dose of ciprofloxacin too.

I got better after 4 days. But on day 10, my tonsillitis hit me again. This time it hit me worse.
Then again, I went back to the GP (I think he must be like “woah, why he keep getting tonsillitis LOL”. Did the same thing, but this time, he gave me 14 days of ciprofloxacin.

Thank god for ciprofloxacin man (sorry not Christian)… I had such bad antibiotic-related diarrhea from Augmentin I wanted to die (not literally, but it was bad). I thought things would get better, but nope.

Ever since the 3rd tonsillitis happened, I noticed this sensation at the back of my nasopharynx – like it’s obstructed. Occasionally, I can feel some mucus trickling down, but it doesn’t cause me to cough so not post-nasal drip (lol). The worse part was, ever since that day, I started having symptoms of OSA (obstructive sleep apnea). I started choking in the middle of the night during sleep, waking up grasping for air, with observed periods of snoring (which I didn’t have), excessive daytime sleepiness from the lack of sleep (it’s damn bad, I thought I was depressed or hypothyroid lol).

I couldn’t take it anymore, and wanted to end this for good. So I headed to polyclinic and got my referral for the tonsillectomy and also, to do something about the new OSA symptoms. Part of me wanted to go for the surgery is to avoid me having fever and sore throat during or half-way through MBBS next year. I don’t want to be barred from exams and then having to sit the exams 6 months later, paying like $65k++ or something for the half semester… (no more MOE tuition grant since I was a transfer student :< )

Throwback to when I was with the specialist, he did the scope for me and said that there was nasal congestion +++ at the back of my throat, but otherwise nothing significant structurally. I asked if I could have nasal spray to try to relieve the symptoms, but he said the congestion might be due to the numbing nasal spray they use before the scope went it.

I left the room after all the consent taking and what not.

Thought about it for damn long.

Went back and asked him for nasodex.

It worked! My symptoms improved significantly, but it didn’t go away completely.

Fast forward to today, I went for the tonsillectomy. Pre-operatively, they double checked my consent, settled administrative and financial stuff, and then re-evaluate me again prior the operation. I was the 1st op for the day, but by the time I was home, it was 3pm already.

The whole surgery took 20-30 minutes btw, just that observation was damn long.

When I was outside the OT (operating theatre), they re-checked my consent again, and the surgeon was there. Because the operation was KIV (keep in view) adenoidectomy, I was wondering if I could have it removed in the same setting (partly because I believe my adenoids was inflamed and causing my unrelenting OSA symptoms). She told me that they’ll check intra-operatively and if they find it, they’ll burn it off for me.

I went to the table where all the various monitoring machines were placed on me. The anaesthesia MO started setting plug. Interestingly, she gave me a sub-dermal LA (local anesthesia) injection (it’s fucking pain, like tuberculin skin test) before she insert the cannula. I wanted to tell her just cannulate me directly but I didn’t and wow, I didn’t feel a single thing when the needle went in. She then pumped another LA before infusion of the GA (general anesthesia – one that makes you sleep).

While I was lying on the table and getting cannulated, I was also oxygenated with a face mask. Quite funny cause my non-existent anesthesia knowledge from M4 started coming back. Halfway through, I tasted something sweet and powdery – then I kind of guessed that the anaesthetic gas was also given. I tried fighting the effects of anesthesia (obviously not gonna happen), and I toh eventually.

After the operation, the anesthesia was reversed and it didn’t down upon me that extubation (removal of ETT tube – tube that is put into your throat to help breathing and prevent stomach contents from going into the throat when you on GA) was done after the anesthesia was reversed. So during this whole period, I honestly thought I vomitted damn badly and I just turn to the left lateral position to protect my airway (lmao…).

I guess I was still down for like 1 hour after extubation because my mind was kind of gone and I cant open my eyes. But my GCS (Glasgow coma scale) was a 14 because I could hear them talk and reply them (and I moved to left lateral position hahah)..

Anyway, the first thing that hit me was the coldness… I shivered like mad that I hope it didn’t look like I have seizure. My temp they took was like 34.8C and they started using Bair hugger :,) and flow the warm air into the space between me and my blankets. I swear I shivered for damn long.

Eventually as my temperature climbed by to 36.5, I started thanking everyone whom I could roughly see LOL. Idk why I did that, but they took great care of my in PACU :,) I also asked for the time and apparently it was 10am already. I know I asked a lot of funny stuff but those are what I remembered. Ded.

So back to the day surgery area, I was still GCS 14. Can’t open eyes, but I was feeling not great either. So I toh-ed awhile more… And that was when so many realisations hitting me at once:
1. Now can feel 2 huge holes at the back of my throat where the tonsils were
2. I cannot control my swallowing (now I know how does oropharyngeal dysphagia feels like… I didn’t even do shit, and the water in my mouth just went straight down… And I can’t cough either cause I’ll traumatize the surgical site… I think I’ll end up having aspiration pneumonia eventually [touch wood])
3. My OSA symptoms are back, this time with a vengence

So long story short, I had my lunch in the hospital (honestly, feels like I’m in the airplane… The food is good tho, contrary to what many patients told me about hospital food XD maybe I was hungry)

My swallowing wasn’t painful because they loaded me with so many pain meds and I am so glad I didn’t have to experience the pain first. I was surprised how I could still eat my grilled fish pasta (though I didn’t finish). I was told to eat cold stuff so the staff nurses brought me 2 cups of ice cream.

Honestly, that was the time I truly appreciate why consistency of food is so important is patients with dysphagia (swallowing problems). Even though my ice cream was melted, I could easily control my swallowing and bring the melted ice cream into my stomach. But when I attempted to drink water, the water just doesn’t want to stay in my mouth and went straight down. It’s really damn scary. Now I feel like I have to relearn how to swallow.

Also, I can’t even breathe when swallowing, so I really had to try coordinate my breathing and swallowing so I don’t feel like I’m choking on food and struggling to breathe.

Here’s a post-op image of my throat (sorry no NSFW or gory tag)

Anyway, those charred areas on the back were where the tonsils once chilled and getting infected
Not sure if the 3D part of it is showing, but the holes are fricking big
Also, this was me trying to suck in air from the mouth to open up so you can see what’s happening. In reality, everything is swollen that it’s obstructing my airway

Which brings us to the OSA problems. I headed back home after almost 4-5 hours of observation. I was damn tired so I decided to sleep. Then I realised I had a lot of problems trying to sleep. I keep waking up cause of the snoring, so I decided to record myself snore as I sleep. Just a short 3 minutes, I already had like 4 loud snoring and 8-10 other small snorings. Ded, I really hope all the swellings will come down soon and this + my OSA will get better.

I guess before I end off this lengthy and idk-what’s-the-point-of-this-post, here’s a photo of all the meds I was given XD intense but I hope this will really get better.

ok, I cant rotate this for nuts on the blog, but look at the number of meds

I am damn tired now, probably also hypoglycemic… I hope that, I’ll get better in time for my clinicals and also, be more motivated to study and push through my final MBBS preparation in March 4th 2022.

Stay safe y’all!

Edit: immediately after this post, I went to brush teeth.. midway through I realized there’s no way for me to gurgle my mouth without having water going into my throat.. i’m fked… and yea, i swallowed one whole gulp of toothpaste water…. lifetime of regret.. and also, i coughed like mad cause some of it may have went down the trachea…

and then when I re-examined my wound site, there’s bleeding on the posterior wall of the oropharynx.. I have no clue what triggered it – was it the cough, the nose wash, or has it been there just that this is my first time noticing it… fml…

Short postings

Okay, now I’m just procrastinating and not studying for my EOPT for OBGYN lol.

Since I’m lazy to do that, I shall just talk about posting 4: Eye, ENT, pathology.

Essentially, this is a 6 week posting comprising of 2 weeks in eye, 2 weeks in ENT (ear, nose, throat) and 2 weeks of pathology.

When I started out with my eye posting (1st posting), I felt so much love and joy that I’ve not felt before in other posting. Like this really felt like the right posting for me. I know it’s too early to really decide on any specialty now, but this feeling was really hard to ignore.

I’m not sure why, but maybe after being trapped in psych posting for 6 weeks made me feel that any medical/surgical posting was interesting. And eye had components of both which I really enjoyed. Then again, this was also the posting which I got “scolded” lmao.

Essentially, we have 1 week home-based learning (HBL) followed by 1 week in clinics. I remembered my first clinic session, the prof was late and then before anything could happen, she started quizzing me. She asked me “what are the eye drops we use to dilate the pupils”, “tell me what class does phenylephrine and tropicamide belongs to”, “I give you 10 minutes to go find out”, “why you still get it wrong after 10 minutes” (lol, I dieded at this point), “you should’ve known your stuff first before coming to the clinic”. I mean, despite that, I was quite thankful that she engaged me and made me examine all her patients who came in. So, I’ll take the scoldings XD

That’s really way better than sitting there and not feeling engaged at all.

But other than the visual field exam, fundoscopy, and the pupil examination, there was really nothing else I could do. The clinic doesn’t have the extra binoculars for the slit lamp so I can’t watch and observe what they are doing, and I’m not sure what findings were there either. So I’ quite dumbfounded by why I felt eye was the one special posting.

Of course there were other scoldings as well. During my 5th day of the posting, I joined this surgeon and watched 2 cataract surgery. The first one was done by his training resident and then he started quizzing me: “tell me about the complications of cataracts surgery”. I listed a few and he said: “have you done any surgical postings before? From the way you answer, I can tell you don’t know your stuff.” I dieded, my soul was crashed and I felt like disappearing into the wall lmao. But it’s okay, because after that, he told me to answer this way: “complications can be intraop and postop – intraop complications can be due to GA (general anesthesia, and list them) and specific to cataracts itself, and postop complications including …). Yeah, I don’t think I’mma ever gonna forget that because that was thought to me back in GS (almost 2 years ago already…).

I think I also accidentally stepped on his toes when he asked me to join his cataract op and sit by the head of the patient, and I started adjusting my side of the microscope lol. I didn’t knew it affected his microscope and he told me off. Damn, so soul crashing (and this happened again in OBGYN posting.. fml)…

Anyway, there were also good things out there that happened. Like how the other doctors from the other clinics pulled me in to examine patients with signs (like there was one with bitemporal hemianopia, and his CT showed some pituitary mass that was massive). Or this other random senior consultant who passed me this piece of glass and asked me what I saw, and then engaged me a bit more. I think I had a lot of teaching and engagement with the doctors there despite the many scoldings lol.

Basically this is to test 3D depth perception. You’re supposed to see the moon, star, elephant and car but on this 2D image, it’s not possible to see them.

Anyway, that was eye. The next posting was ENT.

Given the COVID-19 limitations, we weren’t allowed to observe any nasoendoscopy (damn sian) cause there’s a risk of aerosolizing, so most of my ENT experience was just the ear. Then again, most ENT doctors are quite nice. There was this tutor, whom I decided to join for clinic, came in late 2 hours lol. Despite that, he was damn nice and teachy. He made me clerked/present and examine the patient. I even helped him out with the excision of a tongue biopsy (which was the closest OT experience I could get haha).

I think my ENT experience would’ve been better if I was allowed to observe this uncle who came in for epistaxis. The nasoendoscopy revealed a large vascular nipple and there was a lot of bleeding going on that needed to be stopped. If it wasn’t for the limitations, I would’ve seen the case and assisted. But I guess oh well D: It was a huge pity.

Other than that, it’s really a lot of different types of hearing loss problems, and neck swellings.

The last posting – pathology – is more home-based. Could’ve joined in an watched an autopsy done in real life if it wasn’t for COVID-19 limitations. Then again, a lot of good things came up from COVID-19 too – like more time to consolidate theoretical knowledge, shorter psych posting, etc…

Ultimately, this is really one of the more chilled posting before my last and current posting. (and also, before M4 finals).

I guess I will stop here and start studying for real. Otherwise, I think I’mma get scolding again zzz. M4 is really a year of scolding. But I think M5, HO year is gonna be worse. Guess, I’ll have to embrace that.

3: Psych posting

It has been awhile, and it’s such a weird time for me to start blogging now, especially when EOPTs are in 3 weeks time and M4 Finals are 2 weeks after EOPTs. There’s so much to do but so little time. And I’m serious hooked up to Grey’s Anatomy.. Been binging 12 seasons worth of episodes at 2x speed over the past month and I’ve 5 seasons to go. I seriously should stop getting myself into watching dramas lol.

Anyway, I’m back so I’ll be sharing my interesting M4 experiences. And hello to you new readers.

Psychiatry posting was the next one after ED posting. And it was like a whole new world.

No matter how much I see, I felt like psychiatry was quite a foreign world. We were so used to learning signs and symptoms of specific organ systems with a standardized list of investigations to do to evaluate and workup the cause of patients with organic disease that psychiatry felt like a completely different world.

I remembered struggling to understand multiple concepts in psychiatry, and it wasn’t until I met this prof that I started having a better grasp. He told me that I can view psychiatry similarly to how we approach our other medical/surgical postings. Rather than to view someone with abdominal pain as pain coming from the GI tract, HPB system, urogenital tract and asking specific symptoms (e.g. diarrhea, constipation, jaundice, dysuria), we can view our approach to psychiatry issues as dysfunction of the mind.

The next question he told me was: “So, can you tell me what are the functions of the mind?”. I was stumbled. It felt like I was entering some philosophical conversation that I would be deeply lost in. Thankfully it was and, under his guidance, I was able to work out those functions.

Those function includes: cognition, emotions, memory, perception, orientation, thinking, insights. With that, we can approach psychiatry as disorder of these function. For instance, any derangement in the emotions can lead to depression, dysthymia (such a cool term right? I was so amazed by this word lol) to the other end of the spectrum like hypomania and mania. Another example would be the thinking – are the thoughts coming in too fast (e.g. flight of ideas) or too slow (e.g. retardation of thinking), are they obsessive and intrusive thoughts, or are these delusions? I was quite mind blown with his teaching, it made learning psychiatry better.

Taken from reddit: https://i.redd.it/503mrg7czia61.png showing the various types of psych conditions for those who are curious and this is a pretty nice map

Psychiatry posting was definitely quite interesting as I saw patients with a range of conditions ranging from personality disorders, to the common mood disorders and even child psychiatry. I think I have a lot of affinity with pediatrics related stuff even outside of pediatrics (e.g. 50% of my time in hospital psychiatry was dealing with pediatrics, I had pediatric eye clinic too). Maybe I’m delusional haha.

Anyway, halfway through my posting, I realized I was super sian and bored from psychiatry. There was this time I was in clinic with this Doctor, and this patient came in. He was here for some follow-up for some previously treated condition, and this follow up was 1 year later. The first thing the doctor said was “wow, you look skinnier”, and he said he had lost some weight (I’m surprised he still remembered his patient). As I was observing that conversation, I noticed he was a bit jaundiced and putting 2+2 together, I was like, “damn, I would like to examine and find out why he has jaundice and weight loss. Is it some cancer?”. This was also the time I realized how much I miss examining my patients. Psychiatry has a lot of talking and for someone who loves to talk, I think this is really way too much talking for me. What an irony.

Personally, if I have to share one memorable experience, it would be this primary school girl who was admitted for Anorexia Nervosa. Prior the start of the tutorial, we were told to clerk and find out about this patient so someone could present the case and have a discussion around this topic. There were me and 2 other students clerking this girl. We took about 30-45 minutes talking to her and I really appreciated her opening up because there’s 3 medical students starring at her trying to take history regarding a very sensitive topic. She did and I’m happy that she shared them with us. We left after that and had our tutorial.

A few days later, the few of us were heading back to the clinics when my friends noticed this person, who was walking towards us, kept starring into our direction. It took me awhile to noticed, and I starred back (lol). 10 seconds later (or what felt like it, and after almost walking past each other), I suddenly recognized her and had a quick small conversation with her. Turns out she was discharged and was going home and I was happy for her. But wow, can you believe it? I’m not sure what I did, but somehow this girl remembered me. I honestly have no idea how she is doing now, but I hope she is getting better.

I think such experiences definitely made my clinical journey a lot better (and also don’t feel like I’m dumb and can’t do anything haha).

At the end of the day, I still think this is an important posting because through this, I realized how common and rampant psych conditions are and I must applaud those who went to seek help/managed to seek help. Even though psych is an important posting, I really don’t see myself doing in this the future. I prefer medical/surgical postings more.

With that said, for those who are going through tough times, and if you need help, please feel free to reach out to the various government organizations (https://www.gov.sg/article/call-these-helplines-if-you-need-emotional-or-psychological-support).