medicine

stormtouched earthquake

Well, it’s been some six months-ish since I last poked my head in here, said hello and spent a half hour or so following my stream of consciousness. It might have gone for a bit longer if I didn’t have a free afternoon in a foreign city to fill, or at least take up some time with, so here goes. 🙂

It’s now September and I’m currently sitting in a small room in John Harrison House, Whitechapel, London. I’m over here for an elective term at the Royal London Hospital with a Professor of Neurology, and have spent the past couple of days settling in, finding a supermarket, discovering three bad, one okay and zero good nearby coffee shops, you know – that kind of stuff.

In terms of what’s been going on… hey, well. I passed medical school back in June. That’s a big deal right? My final exams were at the end of June and I sailed through the written, and dare I say, smashed the living shit out of the clinical. I’ve just spent six weeks on the renal ward at the Wollongong Hospital doing a PRINT (pre-internship) term, learning what I need to know for next year (so doing some bloods, cannulas and a lot of paperwork) – that was fun, I had a great team with awesome interns and regs, so that was good fun.

I followed that up by flying overseas (for the first time since I was what, fifteen) solo to London via Dubai. Great fun and a lovely experience, even for someone who’s six feet tall. Airline was great fun, especially the A380 from Dubai to London (wireless internet at 38000 feet!) with surprisingly decent food.

I’ve since found my way to Whitechapel, have learned how (more or less) to use the Tube, and enrolled in my elective today at the medical school – and don’t really start until tomorrow, as my supervisor is off today. So I’m thinking I might go exploring again – I visited Westminster yesterday but the Abbey was closed, so I want to go back and do that properly. It’s also sunny and such in London, so it’s a shame to let the day go to waste.

In other news, I have a job for next year – I’m moving to Tamworth for 2 (probably 3) years to do my internship: one of my top two choices so that’s pretty damn nitty, and otherwise well, I’m well. Miss Butterfly is still well (and still together with self), and the family is well.

Ho hum.

At any rate, I’m going to try to blog more frequently now that I’m overseas – I want to talk about MedRevue this year, amongst other things. Talk soon darlings.

 

-Benjamin Andiyar

Geriatricageddon: Day Three

I intended to post earlier, on the first day of my geriatrics rotation at TWH (Wollongong Hospital) but honestly, it’s been that hot that I’ve been lucky to even sit in my room for more than ten minutes at a time without feeling like a lobster in boiling water. If that’s too hyperbolic for you, well, tough. It’s hot. 😛

I don’t know, as yet, that the title of this blog post is necessarily accurate, but I’ve had a relatively bad day – relatively. The week started off well, with Andre and I sitting down together after our orientation and agreeing on what we both wanted to do with the rotation, and both coming up with the same goals, which is nice. We then wandered down to B7 (The WAGU, Wollongong Acute Geriatrics Unit) to meet our team. The consultant, Dr. Pearson, is quite nice though he’s not around much. The other members of our team are Jude the Reg and Daniel the Intern, both of whom are very welcoming and pretty damn awesome. On our round outside the ward for outliers, Jude asked what we both want to do in the rotation, and has been involving and engaging us very well, and Daniel’s been really great too so that’s nice. That afternoon, well… the GSM, in its wisdom, has scheduled 4-5pm sessions this week as ‘wake up’ sessions, more to scare us about exams than anything else as by that point I’m less than awake. The 4pm on Monday was ‘Intro to O&G’, which may have been useful to the ten people in the room who haven’t had O&G yet. I snuck out after half an hour, as I had a doctor’s appointment – which was thirty minutes late anyway – at which I got a surgical referral to our Prof of surgery.

I suppose the worst point of the day was trying to sleep in thirty-odd degree heat and failing miserably, scoring up around 4 hours in total. So that was a nice way to start Day two… though that day got better, with me ducking over to the Prof’s rooms over lunch and telling his secretary that yes I was a student but I was there to book in an appointment, and then her slotting me in a non-free space next week, being the next clinic he has. That’s the fastest I’ve ever had a specialist appointment made. I’m happy about that. The rest of the day was fine, although the tutorial in the afternoon was useful in that it gave me a kick up the arse to start the Study Plan 2011 Extravaganza… which then stalled but is aimed to be completed this week. So yes. Another less than ideal night, but I managed some more sleep – around 5/5.5 hours, so that’s functional.

Today was less so. The past few days have been medication (excepting Senna) free, which was reversed at around midnight when I took paracetamol and bitched on facebook about pain. This morning was busy on the ward, with us learning how to do a PACE call as an intern by tagging along (not as scary as we thought), and Andre cannulated the patient while I did the relevant exam/Hx with our team. That was about when we started our round, and I started to feel less than positively happy with my pain management – two hours into a double panadol dose. Anyway, we managed to finish the round and grab a coffee, then lunch and came back to play Blooddsucker on a pair of patients – one each – that Daniel had given us. I was up first, and sadly I failed. Well, first try missed the vein, second try got the vein with the butterfly but then either a) the vein collapsed, b) I moved the butterfly to far (though I held it fairly still) or c) something else (probably me) went wrong and the blood ceased flowing at around two mls. Considering I needed two tubes and around 15mls, this was irritating. Admittedly, the patient (a dear old lady) had several bruises on each arm from bloodsuckers, and had very very mobile veins, so she wasn’t easy; additionally my butterfly skills aren’t great but still… not feeling well with pain + failing at a (relatively) simple task do not a happy Ben make. Andre’s patient also proved difficult mostly due to cannula-in-situ and a crap other arm, so we both left the ward irate at that point and chatted for a bit, before I skived off home instead of attending the afternoon lecture at 4.30 – this was around 3.30. Shocking, I know.

The afternoon has been taken up in doing some study planning and a little bit of reading, Stephen Colbert, and feeling generally unwell. I’m hating this sickness crap, and it’s not fair. I am, however, really really enjoying this rotation so far. All I need is to feel a bit better and then have a successful procedure or two (cannulation would be nice) to get my spirits up there, and I’ll feel better about it. At least tomorrow is teaching-and-free-lunch day… so I can sit down most of the day and let my abdomen feel less horrific. And tonight is cloudy and there may be storms, so sleep due to coolness may even occur.

It can get better. It will.

 

-Andiyar

Two Thousand and Ten

I’ve never really been one of those people who sits back at the end of the year and casts a discerning eye on what has gone before, what can be learned, and what shall be taken into the next year – at least, not in public. Granted, I learn from a previous year’s activity, I may even follow the customs of making a few top ten lists or resolutions, but they generally don’t propagate further than a partner or a friend or a family member in person – or perhaps, in the past two years of blatant anti-privacy, on facebook. I think I’ll shake that custom up a bit this year though – I now have a blog hosted on andiyar.com, after once swearing it would never happen (as I maintained my livejournal, naturally), and I’ve been moving the majority of my presence on the ‘net to a less anonymous but more private form… that said, I think a Year in Review isn’t necessarily a bad thing. Let’s do it, shall we?

2010 has been a year of change for me. This can of course be said of all years for all people, I imagine, if only for cellular processes, but I have to say that with the possible exception of 2007, 2010 has been the year of greatest change in my life thus far. For those playing at home, I am twenty-seven, so no doubt there are a few more changes coming; we’ll have to rank and compare.

I entered into 2010 in a serious relationship, albeit one that two days prior had been rocked to its foundations. I leave 2010 single, with said relationship not surviving the foundation-rocking due to matters completely outside of my control, which left me depressed and emotionally non-functional for a good two or three months following. During that time I resumed my study of medicine, which was what triggered me to seek help, resolve the emotional funk, and become both more certain of why I am studying medicine and of where I am going with it all. I learned to study effectively, to become less destructively perfectionist, to cope with emotional stressors in a more healthy way, and to move forward to Espresso Finishes.

The most significant singular event in 2010, therefore, was the breakdown of my relationship with my then-partner. That relationship lasted some two and a half years and, upon reflection, changed me more than I was aware during it. Oddly (to me), I think I changed most of all in the aftermath of the relationship and the time that followed it, or at least the change was most rapid. I matured a great deal, I loved, and as the cliché goes, I lost. Loss shapes and defines, and I think I am now a better person because of the loss, but I cannot say. I don’t wish to devalue the relationship or my then partner for what I felt and did – but the breakdown was definitely the prime mover for me in the first half of the year. Some effects:

• I began writing again, and have since written one complete short story (flawless, 4000 words), began a ‘fanfiction’ work (The Infection, 5000 words), made a very serious start at a novel project (elohim, 30000 words), began preliminary work on a second novel project (Gospel, 8000 words), started writing poetry again (published letters to Jessica, and wrote Medical Verses), and began not only blogging semi-frequently here, but began a side-project blog at the lonely empath. Creatively, that’s an astounding year, with almost fifty thousand words of prose fiction, two dozen poems and some interesting thought patterns.

• As mentioned before, I learned an effective study technique (with incredible thanks to Kylie Mansfield) which resulted in me writing Phase One: the systems review, a personal summary/textbook of some 70,000 words alongside Pathology Maps, another 20,000 words of diseases in notes and mindmap form.

• Worked through some emotional issues regarding perfectionism and drive and emerged in a better place mentally

• Lost ~10kg at the most, for an overall loss of around 6-7kg, resulting in not only a new feel of ‘health’ but a lot of new clothes… which isn’t necessarily a positive

• Reconnected far more regularly with some close friends that I had not seen as often, resulting in Sorbocles, regular golf, the Coffee Safari and too many other fun times to count.

Those are, of course, the positives. Several times during the year, particularly in the second half, I found myself feeling slightly downhearted. Even now I can feel it – I miss being in love, to be truthful. I miss my former best friend (as she then was), I miss the in jokes, I miss the perfect companionship, I miss the sex (let’s be honest), I miss just talking about nothing, I miss feeling like half of something. I noted during the actual breakup period (although I suspect the entries are no longer visible) that I really understood what it meant to ‘lose half of yourself’. It did feel like that, and I miss feeling like I was a part of something. Those feelings have, however, become more and more background. The majority of the time as the year moved on to the present, they have faded to the occasional wistful regret. Time heals.

Other significant events in the year included the passing of my Phase One medical component after failing to do so in 2009, resulting in me moving onto clinical term. I have now spent six months in the hospital, having rotations in obstetrics, paedatrics, oncology and general surgery, and have arranged a personal elective in palliative care. I have found myself several times during the past six months nodding to myself and thinking (if you’ll pardon the french), “this is fucking it.”. Clinical placement in the hospital has taught me that medicine is, for me, the right choice. Hopefully when I return to this entry in a year or two this isn’t prophetically wrong, but I must say I have only felt this ‘complete’ in myself in terms of direction when I was studying creative arts and learning about poetry, feeling that this is something that feels right for me.

Hopefully the next six months will continue to do so. I will then, barrier exams pending, pass through to a twelve-month longitudinal clinical term and will soon after that graduate and earn money. Financially I’ve been a shot duck for quite some time – I resigned my job at Woolworths as a customer service supervisor in July – and it would be nice to be able to feel financially stable, even secure.

Otherwise? Well, friendships continue and endure. Life moves onwards. I have an iPad as my Tech Toy of Twenty Ten – five stars – and I find myself thinking, now and again, that life is pretty good, all things considered.

Let’s keep it that way. On 2011.

 

-A

Nowra General Surgery, Day 25 – more or less.

It’s Friday night, and I’m all alone in Nowra. None of the nice physio friends are around, none of the other med kids are around, there’re sirens playing in the distance and I’m out of TV episodes to watch. Also, I have a memorial service in the morning, have been sick for two days, and am feeling so goddamned exhausted that I could just curl up and not get out of bed for a week.

I miss caffeine. I haven’t let myself have much for the past few days, due to GI troubles, and I think my minor headache has been due to withdrawal… which is sad. I don’t just miss caffeine though – there’s a massive list of people I miss as well. Here, I’ll mention some.

I miss Erin, Ben, Ben, Miles, Lance, Sam, Brendan. I miss Kate, Jess, Kate, Ash, Matt, Kimmy, JC, Steve, Cate, Vindi, Jess, Beth (god, I miss Beth), Rach, Max, Mark, Jonno. I miss Zoe, Shaun, Pier, Shona, Sheridan, Mel(issa), Sandra. I miss Greg. I miss Andrew & Gracie and the rest of the family. I miss Lilla, Beth, Kim, Matt. I miss ‘M’. I miss Damo, Lids, Chris, Jen. I miss ‘C’. My god, I miss so many more.

I miss myself, too. I look at myself from time to time and wonder, where the fuck did I manage to lose myself along the way? And what the hell am I doing right now? The answer to that is, of course, learning to be what I find fits me like a tailored glove, but it’s hard, damn it’s hard. It’d be nice if there was some kind of immediate payoff… which makes me into a whiny little person of course, considering the sheer enjoyment and satisfaction I glean from my ‘job’ but hey. This is my bitch session. I imagine it has a great deal to do with being at the end of the year, a single week out, and just wanting to switch off, even for a little while.

I just fear that I’ll never switch off again. Never fully. My last week of holidays I spent clerking patients and hanging at the GSM to volunteer with the New Kids. The holiday before that I took maybe four consecutive days off without work – and that was between phases of the degree. Over summer, I took time off but that, well… that ended badly for me personal-wise. Right now it ended ‘well’, but it was not pleasant.

Being a doctor is kinda all I have at the moment, for myself. I have two novels in progress which I want to work on over summer, and I will, but I didn’t get to NaNoWriMo this year (two years in a row now, thanks-a-fucking-lot) which is an experience I treasure. I haven’t managed to write a poem for about two months now – literally, haven’t been capable – thanks to mental death of lyrical expression (excepting maybe the lonely empath). I wanted to start playing the piano again this phase, but haven’t been home… that’s a summer thing now. I want to read fiction and not feel guilty. I want… want, isn’t it.

It feels like medicine has required a great deal of sacrifice of my life. Financial sacrifice, friendship sacrifice, relationship sacrifice, even family sacrifice. Life turns into a minefield of shattered dreams and fragments, and you’re walking on it barefooted and trying not to cut yourself open and bleed.

Morbid I sound, hrm. Yoda speaks thusly, yes. Anyway, for the people (heh) who got to this point, don’t stress about me. I’m feeling slightly moody and lonely and missing some people, but it will get better. Maybe tomorrow has gotten me down – mortality’s a fun thought isn’t it – and made me consider my own life a bit.

At least mine can get better.

 

-A

Nowra General Surgery, Day 14ish.

Hello there world. It’s me. Yep.

I find myself in a slight pickle this evening – for the first time in living memory (being mine) I am approaching a clinical skills assessment tomorrow without a clear understanding of what I shall be doing. It is apparently a “psychiatric history and risk assessment”, which is well and good except for the fact that I, as well as some half of the grade, have not *done* a psychiatric rotation yet, and as such will be relying on one twenty-minute clinical skills session to draw out a full history and RA.

Which is of course perfectly reasonable, why did you ask?

Life in NowTown continues apace. I have been plagued by sleeplessness and headaches, which are not migraines – the failure of my domperidone attests to that. Rather, I believe it to be the heat, and two (okay, four now) paracetamol this evening have brought down both the pain and my core body temperature, making me far more comfortable, so we’re going to go with that regimen for the nonce. Otherwise, I scrubbed into surgery today and monday, though did not really do much other than retract openings, and trim sutures. Ah well.

I have yet to revisit my new coffee shop haunt, and have been suffering the lack of caffeination that implies. My coke consumption has sadly compensated, which sucks quite frankly, but we must make these sacrifices sometimes in order to grow. Yeah.

Otherwise, I have been socialising with the physio kids staying here – last night Kate & I decided we wanted custard after watching QI, so we walked and obtained it. Otherwise, I need to learn a lot about bipolar disorder, schizophrenia and depression in the next twelve hours or so. I have the data, I just need to read it I suppose.

Bid me good fortune, dear digital diary-like representation. I still love you, even if I do write for your bastard stepsister at times.

Yours ever,

 

-A

Nowra General Surgery, Day… Eleven?

I’m sorry about the lack of updating for a while, dear audience. I had initially intended to make this a three-times-a-week endeavour, by it was hijacked by a number of things, including mood swings, fruit-mince pies, and exhaustion-aided surgical irritation.

Not to say that irritation is all there is, but let’s go with that. 🙂

For the past week now I’ve been continuing on my merry trip through the surgical rotation. I sat in on a day of surgery a week or so ago, and scrubbed in as an extra pair of hands a couple of times. Otherwise I’ve been confined to the ward(s) – partially because on my second scheduled surgical day, I had a delicious visit from my old friend Captain Migrainé, who insisted I take some domperidone and sleep for six hours in a medicated stupor.

Regardless, I have Accomplished Things™ this rotation, including finally being a bloodsucker, or a vampire, or a blood fairy if I was in pink. Drew blood from four people, three of which… well, worked! – and almost managed an ABG (blood gas for those playing at home), which would have worked too if it wasn’t for that meddling radial artery being almost midline dammit. Also that patient crashed with a major internal bleed (two/three units of blood in her stomach on scope) and so I got to witness a PACE rush with the ICU team (Patient with Acute Condition for Escalation… I think).

Otherwise Lisa & I have been examining and chatting with people, going to tutes, doing a little study (she’s doing more :/) and drinking coffee. I started eating yoghurt again for the first time in… what, fifteen years? but other than that I have been living on a best fat burner for women diet of Lean Cuisine and takeaway pizza. And Indian food. I plan to cook tonight, now I have located a communal-ish frypan, so there should be a teriyaki pork + vegetables + rice in my future, but since I bought the ingredients at Aldi (being poor right now) my expectations are low, although it would be nice to have some vegetables, let us be fair Garcinia Cambogia is the best product out there right now .

I have managed to find a coffee shop in Nowra that I quite like – the River Deli – which makes a nice latte, and a nice croissant. I visited yesterday and did some sketching of chapter superstructure for Project Cana, and came up with some ideas for my PPD essay (due in three weeks, now half done woo!) so the weekend down here has not been wasted really.

Well. Essay words written: 848. Phase 3 Proposals finished: 1. Fiction pages read: ~500. Oxford Handbook pages read: ~20. Fiction words written: ~500. Facebook status updates: 4.

So… not a tota waste no. The new week plans to be fun with me intending to do surgery tomorrow & thursday, rounds tuesday & wednesday… and Lisa and I really need to plan out our two presentations that need to be given. At least I have my two CEX-S forms already done for this rotation, so as long as I keep turning up and make a good enough impression for a nice performance review, my assessable material is moving right along. 🙂

Good afternoon, dear readers. Enjoy your Sunday evening.

 

-A

Nowra General Surgery, Day Three

I was going to start this entry with a term of endearment directed at an old-fashioned paper appointment book, but I elected not to. That said:

It’s now day three of my surgical rotation ‘back home’ and so far, so fun, so good. I left the hospital at half past three this afternoon, and spent a brief moment feeling guilty about leaving early – until I recalled that I had started at seven am so I was in fact, not early at all. Better than yesterday, where I was there from seven in the morning until half-past five. Bleh.

Apart from the hours, the actual rotation is so far interesting enough. Today was mostly taken up with ward rounds – three different ward rounds – and then Lisa & I examined a few patients and took a few histories, as well as did some independent study. Little ‘hands on’ surgical/procedural stuff yet, though that m ay well change – tomorrow is our first full day in theatre, and I imagine we’ll have opportunities to get our hands dirty in there. Or at least if not dirty, involved. Our list tomorrow includes a biopsy lymph node, a couple of hernias, a laparoscopic cholecystectomy. So, hopefully, that will be fun.

Also it doesn’t start at 7am, which is nice. Though I’ll still get up fairly early, in order to stay in the habit. Bah.

In other news, I drove into Nowra to find a post office and send off my broken penlight today, which I did, and then decided to wander, so I had a stroll of a couple of klicks around the town. Impressions are that there isn’t much variety, really… I found one chinese place, one thai place, no italian places, and maybe four cafés. I actually sampled two of the cafés – I had a chai latte at the Tea House (and was disappointed as it was a chai tea latté, but hey) and a mocha from a place called the Cocoa Café – which I’ll be honest about and say I chose because the name made me chortle slightly. The mocha wasn’t bad, easily the best coffee I’ve had in Nowra (excepting maybe one time at River Deli), but I’d only rate it a 3/5.

For the interested, a 5/5 is a coffee from Swell in Wollongong, Elephant Boy or Gastronome in Bowral, and… I can’t remember the name of the place in Melbourne. Sad. A 4/5, well, Lee & Me in the ‘Gong is about there. 🙂

Right now, having consumed a microwaved indian meal, I’m planning on a small rest and maybe 20 minutes of reading about pancreatitis, as per the idea by Dr. Jones. Otherwise I imagine there will be Internetting, some iPadding, and perhaps some writing, though maybe not tonight as my muse isn’t here and quite frankly, she’s probably sleeping, poor thing. It’s hard working for me in a creative sense, and she’s had at least three poems written about her recently, so she needs her break.

I’ll write again soon, legion of adoring fans. I promise.

-A

Nowra General Surgery, Day One

Well, I’ve survived coming ‘home’, as it were, to Nowra Hospital. Or, let’s be fair – the Shoalhaven District Memorial Hospital. Sounds to me that it should be built after the Shoalhaven is destroyed, or flooded by global warming, but hey.

Orientation at the hospital, followed by visiting the surgical ward and meeting the reg, resident and intern, then we were at a loose end – so we visited a couple of patients, taking histories and chatting, then had an early lunch/coffee break. After that, we found that our theatre orientation (scheduled for 2pm) was cancelled… so we went to theatre anyway, met Dr Sithi and the reg again, and sat in on a cholecystectomy (via lap), and a combined gastro/coloscopy.

Knocked off around 3.30, which isn’t bad. I managed to unpack most of the stuff from my car before the rain caught me inside, whereupon I changed, prettied up my (tiny tiny) room, and then as the rain ceased I decided it was shopping time.

Staying in the quarters here isn’t so bad so far, other than the lack of really good cooking facilities excepting a microwave and a hot water machine – there is an oooold stovetop, but that’s about it – so I decided something microwavey would be the key. Before I wandered off, I met a nice physio person staying in the quarters, and chatted for a bit, then I ventured out into the wilderness that is Now-Town, and went to Woolworths.

There I acquired:
2 x microwave pasta
1 x microwave butter chicken
1 x box cracker barrel cheese slices
1 x box arnotts cheese crackers
1 x litre dairy farmers full cream milk
1 x box instant mocha mixers (nescafe)
4 x premium tuna tins
1 x double pack of herb rolls/foccacia thingies.
1 x packet fruit mince pies
1 x 1.25l bottle of Agrum

So I’m set for dinner today and tomorrow, breakfast & lunch for the week, snacks for the week (hopefully)… apart from maybe some bread rolls on thursday/friday.

Other thasn that, and the fact that it’s almost time to eat, there isn’t anything to say. Tonight’s plans include some OCHM, some Drawn Together, and maybe a little fiction. Ah, the joy of it all.

Alcata’riel.

 

-A

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