The Pensieve

Sianz, I’m on call today. :(

HAPPY NEW YEAR to everyone! And hope you guys enjoy yourself at our last HO posting! (Chilling isn’t it? I just found out that I’d forgotten how to mx COPD exacerbation!)

Wonder how today’s call will be like… I can imagine…

1. Scaling the highest point of the hospital to catch a glimpse of fireworks around midnight.

2. Singing auld lang syne with the nurses.

3. Telling patients who’re requesting sleeping pills that they should join our countdown at the TV room.

4. Having a good new yr’s eve dinner (wonder who’s the MO ordering food today?)

5. Sleeping a lot tonight. Pls let everyone be healthy and the hospital be empty tonight!

6. Being very jealous of the active HO cuz he’s definitely going to be sleeping more than me!

7. Receiving lots of smses from well-wishers from 31st to 1st… while I’m frazzled and trying to takebloodsetpluginsertcatheterupEOTchitinkupmedsoffdrip at the same time.

If you’re reading this and having fun now, sms me sth to cheer me up!

The Line, Shangri-La

With the new found delight that our fund still had so much money left (because the team was living such an ascetic lifestyle for the past yr), big boss proceeded to schedule elaborate lunches in order to spend our money… First we had the horrible duck & char siew rice, then nasi padang TWICE, in between the Straits Kitchen but the best of all was….. The Line! (and yesterday, they had chicken rice from that place in River Valley, but I was feeling too sick to eat then)

The Line is one of the new restaurants fashioned after the concept of an open-kitchen ie. food’s cooked right in front of you and replenished in small batches, so u get really ‘fresh’ food despite it being a buffet. (and you get to ogle the good looking chefs, if any). Gotta give credit to the US-based Adam Tihany for transforming this place into such a hip eatery. Plus it’s open 24h and seats up to 400 people!

The Food:
The Line did not earn the name of ‘mother of all buffets’ for nothing, it’s a whole gamut of cuisines here! Your first stop is usually the appetiser / cold foods bar featuring endless rows of oysters, clams, mussels, crabs, lobsters, pretty little servings of appetisers in shot glasses; sushi & sashimi and all kinds of greens.
Next up, you’ve got a choice of Italian (B recommends the pasta which they cook on the spot for u, even if you’d only wanted two spoonfuls of it; pizza), Chinese (dim sum and other Chinese dishes), Western (the salmon fritter in oats and cornflakes are absolutely yummy! the beef slices with mushroom is super tender…), Indian (prata, murtabak, various veggies and curries… the chicken is really succulent, unlike the dry stuff u get at most other places), and this noodle shop (din try the noodles but Boss said it was not bad… they had wanton too).
Finally we’ve got the desserts… There’s a crepe station, a chocolate fondue and rows upon rows of tiramisu, poached pears, cakes, tarts, meringues and puddings in cute little trays/cups. Boss drowned himself in the fondue.

The Service:
Very good, if not a tad over-enthusiastic. They clear off empty plates and cutlery really quickly, once, I was just having my second last mouthful when my plate was whisked off, leaving an absolutely bewildered expression on my face. Then B, who’d left a crayfish on her plate intending to attack if after she’d sampled other stuff, found it gone by the time she got back… I think they clear off plates a little too quickly, such a waste of food. On the other hand, your napkins are always folded nicely by the time you return back with more food, you don’t have to wave your guts out to get them to refill the glasses, and they are absolutely enthusiastic and knowledgeable when questioned about some queer concoction on their dessert bar.

All in all, it was a great experience, both the food and of course, the company!

Hello, is this Dr… … … … (what follows is my horribly mangled surname, not that I blame the nurses, since a significant portion aren’t locals, and even those who were locals have problems pronouncing such a distasteful stringing together of vowels that I really blame the midwife who registered my grandfather’s/father’s name with her own version of hanyupinyin that had such a long-lasting result)

Hello, yes, this is the passive. (ah the wonderful generic name for the job that is nothing but passive!)

Can you come and see this patient who complains of:

1. Burping, and burping, since admission 5 days ago

2. Pain on the lip (but no rash/ulcers/trauma/new foods/drugs)

3. Being unable to sleep (at 8pm)

4. Shortness of breath, blocked nose for 1 month

5. Hungry (but he is NBM in preparation for scope)

6. I don’t know but he says it’s private and he wants to speak to the doctor (turned out, he was unable to erm ‘get it up’ in hospital)

7. Unable to pass motion for last 3 days (and it’s 3am at night now)

However, despite the seemingly ridiculous complaints and the obvious solution we have to many of those ‘passives’ above, I’d like to share an incident detailing how we should not just brush aside these complaints at times…

One night, I was called for: pt unable to pass urine but is already on urinary catheter.
I asked if pt’s cath was newly inserted or whether he was delirious accounting for not knowing that a tube had already been placed to relieve his urge, and asked if the cath was draining. The nurse said yes. So I just left it at that.
About an hour later, she called again, saying the pt really seemed uncomfortable and the bladder felt distended. So I went to take a look, and lo and behold guess what I found?
The patient had a distended bladder because….. someone had clamped it down!

Ok, I finally gave in to curiosity and signed up at Facebook. Find out what all the hype’s about. It’s a lot like friendster, except it’s more convenient to use, and there’re a helluva applications…

But apart from the usual putting up photos/videos, sending pple messages… it’s really hmmm dunno why everyone’s so excited about it.

It’s probably a fashion thingy…

Well, Merry Christmas to everyone!!!

Introducing a very entertaining and well-written blog by:

“an Anesthesiology resident in New York City trying to get used to the idea of calling herself “Doctor” without using those finger air quotes”, introduced to me by a fellow HO while in the HO room one fine day. Heh heh.

The site

Click here to view her comics (which had me rolling around in tears…) Enjoy!

This is a really belated blog entry. This is how long I take to recover from assisting in OTs on certain days. Haha… I’m definitely not into surgery. By and by I do get the RUSH from all that cutting and fixing stuff together, but I don’t see myself doing this for the long term.

Anyway, was sent to OT to help out with a case… I thought it’d be a fast in fast out case… but… I was sorely wrong…. It turned out to be one of the longest cases I’ve assisted on during this month but it was also the most interesting of all the ops I’ve been present at.

It was a skin sparing SMAC with reconstruction with TRAM flap ie. Take out the breast but sparing the skin, and all the armpit lymph nodes and do a tummy tuck and use the fat from there to make the new breast.

To put it simply, and so that non medical people won’t be put off by all that jargon (if they haven’t already sworn off my blog)…
1. Core out the breast with the cancer like how you remove the fruit from the pumpkin from the top and leave only the skin.
2. Make a small cut at the armpit area and take out all the nodes you can find.
Simultaneously, the plastics:
3. Make an elliptical incision across the tummy in the area encompassing the belly button.
4. Make cuts around the belly button so that it’s separate from the rest of the tummy fat.
5. Find the vertically arranged rectus muscle on the side of the breast you cored out, and cut off the end that connects it to the lowest part of your tummy. (of cuz there’s all that ligation of arteries and division of the Scarpa and sheath)
6. Undermine the edges of elliptical incision (ie. Separate the fat from the muscle wall both above and below the elliptical cut area you made)
7. On the elliptical flap, draw a circle approximately the size of the missing area on the top of the breast.
8. De-epithelialise the area around the circle (ie. Skin the flap), make sure no remnant skin left behind or the recon will result in cysts.
9. Then tunnel this L shaped pathway from the breast to the mediastinum (centre of chest) and vertically down to the flap.
10. Push the TRAM flap, together with it’s stump of muscle up through the L tunnel into the cored out breast.
11. De-epitheliase more of the skin such that any skin under the edges of the opening (where the nipple used to be) would be dermis.
12. Sew yp the edges using yr vicryl 4 and ethilon 5.
13. Break table. Flex the pt’s hips and then pull together and secure the Scarpa’s fascia, then the outer layers…

END RESULT: Breast reconstructed and a TUMMY TUCK at the same time! TADAAA!!!

Realised I’ve been talking a lot about food these days, indeed, we people from the ER-HEM team seem to do nothing much but eat and walk around, do some changes, trace case notes, eat somemore… and then one or two will go sleep. Imagine that! There really is an unfair distribution of workload amongst the teams. Yet despite all our feedback this arrangement will stay in order to prevent bruised egos. Sigh… In the end who suffers? The patients!

Anyway, back to food… Last Monday, our con craved for ‘nasi padang from zion road’ only. Teehee and we were sent out to dabao mucho packets for the team at the OT (who was really sick of OT food). Alas, the store’s closed on Monday, so we took a chance and thinking that the next door stall should be of certain standard to have made it to the recommended foods in U Channel, bought 31 packets of char siew and duck rice…

It was the most terrible char siew rice I’ve ever tasted! EEEEK! The rice was sooooo hard…. I don’t know how it made the chart! GROSS!

The team of course, we rather disappointed at the poor quality of food after a tiring morning in the OT. Sob sob, and perhaps our evaluation dropped a bit. (haha, just kidding, relax…) On Wednesday, we ventured out to get the elusive nasi padang at 55 Zion Road. I tell ya, it’s really GOOOD! Yummy yummy! Still tasted just a nice even at the second try (My ex ex boss took us out there for lunch once.)

My ex-team had lunch here just last week, a buffet as well. (I’ve never had buffets so many times a year until I started working, somehow, GS people love buffets, I think it’s cuz they starve for hours on end while operating and then when they are finally let loose from the theatre, they stock up on food – a bit like camels)

Anyway, this place wasn’t that good but it was still worth a taste. It mainly serves Penang style cum Peranakan cuisine. They’ve got stuff like spice rice, curry of all kinds, quay tiao, mian xian, prawn noodles (I think), all kinds o kueh for dessert, and the most awful otah I’ve ever had the misfortune to try! EWWW… It was all soggy and tasteless, someone actually wondered if we were actually eating the RAW form!

All in all, though I found the place so-so, I think the seniors in my team loved it, and it’s supposedly Prof’s favourite place too!

Lunch Buffet
My team decided that it was finally time to use the team fund to go for some much needed entertainment - ie. gorge ourselves to near death at any sinfully expensive buffet in the area. Top choices were the Line Restaurant and Mezza 9. However, due to the fact that our big bosses often only can decide rather last minute, we were tragically unable to get places. *sob* So in the end, we ate sinfully branded hawker food at this place. It was such a big group, close to 20 people! Actually I thought this was part of the welfare fund, but my con revealed that actually every month, each consultant forks out a certain amount of money, making it 300 SGD per month for the team’s fund, and it’s this money that we spend so lavishly and sometimes, rather freely. hehe…

The food there was a variety of local favourites, ranging from your Indian prata/murtabak/curries of every shade and flavour; otah, satay, rojak, chicken rice, char quay tiao, carrot cake (their’s was especially yummy)… … … Not too bad a variety, but just far too heavy on the palate. Lots of stuff’s spicy/curried and can be rather harsh on the tummy. They also had a dessert bar with kuehs, ice cream, malay desserts, and to quote my reg, ‘free flow fruit juice, that’s the best thing’.

We were so full! And some people can really EAT! And I dunno how they remain SO THIN! Life’s so unfair. Boss ate a lot too! WAAAA so much carbo! Predictably, the conversation turned to less palatable things like PEG-ing ourselves, doing gastric lavage and trying out to see if we had the succussion splash, at which point the con went: I doubt it’ll be a splish-splash, more like a plop-plop cuz there’s just too much food in your stomach!

We were all like sloths after we got back, someone took an afternoon nap in the HO room! I was falling asleep while updating the list, unfortunately ending up besmirching the good name of my fellow HO. Haha… At evening rounds, everyone looked so tired, I think all the blood got diverted to the gut already…

When we signed on the dotted line right before we started medical school, we knew that amongst our duties as HOs in the future, we were chiefly:

CLERKS

But we didn’t know that the fine print included responsibilities such as these:
1. Portering (sending pts from place to place)
2. Tracer (tracing everything including old notes from Medical Records Centre, scan appointments, histology samples, once I even traced a pt to his dialysis centre!)
3. Writer of memos for everything (fit to travel, excuse relative from work, excuse from IPPT, allow to cancel trip, VISA application, maid employment…)
4. Mediator (between warring factions of family)
5. Financial advisor (preparing quotations for nursing homes, for example)
6. Scribe (official scribe of conferences, discussions between snrs and pt+family)
7. Part time physiotherapists, nurses, porters, ah-mas (cleaning aunties), buyers (help pts to buy equipment), and often, full-time MSWs. (medical social workers)
8. Part time photographer and retractor in the OT.
9. Finding places for team lunches and dinners.