The Road through my Fucked Up Life.

Road paved on 11:02 PM |

The Illness of the Mind

A good friend of mine decided to blog a blogathon, blogging in remembrance of a dear friend and to raise awareness of the state of mental health in Malaysia and this is done in support of Malaysia Mental Health Association.

Elena: Do you know Malaysia has a Mental Health Association?
Richard: Well, it is common sense for each country to have such an association.
Elena: But do you know Malaysia has a Mental Health Association?
Richard: Well, no, I did not know. Are they in charge of Hospital Bahagia and Tanjung Rambutan?

SEEEE!!! I am not the only ignorant brat in the Malaysian healthcare system that did not know the existence of the Malaysian Mental Health Association.

And this I blame IMU and the education system of the hospitals. And myself for my ignorance.

But they said ignorance is bliss. And truly it was.

I always thought that mentally ill patients are those with psychosis and are mentally retarded, who sit in chairs the whole day drooling with no memory of who they are. They are the one who grinned and laughed for no apparent reason, they have hallucinations and are often delirious.

But that is not the case. Mental illness covers an enormous spectrum, and schizophrenia and mania is only a minuscule part of this illness. I never knew depression and anxiety was regarded as a mental illness, I always thought people who 'act out' are people who had nothing better to do or LOA (lack of attention).

This may be because of the Asian upbringing which does not believe that mood disorders and eating disorders is a disease.

"It is all in the mind..." - Zen saying

Admitting that you are depressed is like giving up, it shows that you are useless, a pessimist who has no hope left. If you suffer from panic attacks, you are just melebeh-ing. You have anxiety, you are just 'kan chiong'. You attempted suicide, people think you are crazy, or you lost big in the stock market, or you owe the loansharks a lot of money. You starve yourself, people think you are just stupid. You have horrible mood swings, people think you got problem.

I do not think this is stigmatisation. I think it is just pure ignorance.

But then I came to Australia and found out that actually this is actually a diagnostic illness certified by the DSM. In Malaysia, we were never taught that depression was because of chemical imbalances in the brain, we were never taught that suicidal thoughts and self-harming are symptoms of certain mental health illness. It is considered sad when I, a medical student, learnt a little about mental health from DEBATING!!! And I still lack a lot in the knowledge department.

And I still have trouble acknowledging these illnesses because unlike a heart attack or a stroke, diagnosing these illnesses is difficult and vague and so fucking subjective. And unlike diabetes and asthma which can be treated with just medication, treating depression and anxiety is again so vague and the patient must be cooperative, and you do not get results... It can be so fucking frustrating at times.


So what am I trying to say again?

The bottom line is, our family members and friends could be suffering from such mental illness for all we know. And we do not know, because we are not aware of it. So for just one day, in remembrance of a friend that we could not help because we were not AWARE... let's just join hands with Yee Pei to pay tribute to that friend and together create awareness of the state of the mental health system of our country.

This is to WALK ON BY, in support of the Malaysia Mental Health Association. Blogathon starts at 9pm (GMT+8) on the 28th of July. Come online and support the blog.

And to the blogging team, I dedicate this little poem:

bold = patient
italics = doctor

CONVERSATION

Hello, you came again,

How are you today?

I am great, eating bait,
Fate and number eight.
You look good in the rain.

Did your wife send you that bouquet?

Yes, beautiful flowers,
From the king’s towers,
In the state of Maine -
What did you ask again?

Do you still having grandiose delusions?

Nope, I am still god.

How about exaggerated self-esteem?

I am still greater than god.

Any hallucinations or illusions?

Nope, but the voice in my head,
Is telling me you are to be dead.

What about yesterday’s dream?

You know the men in white?
They give me a fright,
They are going to kill me,
So dream is no good, save me.

Are you feeling any better?

I never felt as good,
Ever since I met that dude.

Which dude? What’s the matter?

The voice of love says kill you,
She says that you are a frengetu.
Hotdogly you may be a friend,
But we have to kill you in the end.

Now, please put that pen down,
Calm down, stop fooling around.

Baby… natural… inches… heart…
Test… relief… easy… smart…
Stay away, leave me alone,
Over this cuckoo nest I’ve flown.

Nurse, hurry, he is psychotic!

He is psychotic, you miserable cur!
We will triumph, bathed in myrrh!
Let me go, the aliens are here,
Let me go, you have lots to fear!

Pump it up, those hypnotics.

No… I don’t want to go back,
Not to those king, queen and jack.
No… I am… not… in..sa..ne…
Will…you…come…see me…a…gain?

Take him back to his room, nurse,
Talking to him is a curse.

The… world… is…no…good… no more…
I am…not…crazy…I … snore…………………

The patient is clearly schizophrenic with thought disorders. For explanation of thought disorders, click HERE

We passed by on 11:02 PM |

Road paved on 6:44 PM |

Harry Potter and the Deathly Hallows

It all started with the picture of this cute plush owl of Hedwig that I saw at the poster, and I thought to myself, might as well just buy the book together. It is afterall only AUD29.95 (x3 = RM90) which is lesser than the price offered by MPH Malaysia. And I get a cute Owl as well.


Major bookshops in Malaysia ain't selling The Deathly Hallows due to a price war initiated by Carrefour and Tesco. Wikipedia had news about it (surprisingly).


And so there I was, waiting in line that went round the block just to get a book. And boy, the first thing I said to the person behind the counter: This is sure the ugliest cover in the series.


I waited till after lunch to finally sit down to read.

And as how I had done with my review of Harry Potter and the Half-Blood Prince, I started reading with a few questions on my mind.
1. So is Dumbledore really dead?
2. So what's up with the Deathly Hallows? (WTF is it anyway?)
3. So is Snape bad or good?
4. Who died?
5. So did Harry died?
And more importantly:
Is the ending going to live up to expectations?

And 5 hours later (I fell asleep halfway)...

MAJOR SPOILER!!!
Highlight at your own risk!

Harry Potter and the Deathly Hallows by J.K. Rowling
First published in Great Britain in 2007
Bloomsbury Publishing Plc, 38 Soho Square, London W1V 5DF
607 pages 36 chapters

Short forms used:
Harry Potter: HP
The Philosopher Stone: PS
The Chamber of Secrets: CoS
The Prisoner of Azkaban: PoA
The Goblet of Fire: GoF
The Order of the Phoenix: OotP
The Half-Blood Prince: HBP
The Deathly Hallows: TDH

At 607 pages, TDH equals HBP in thickness and length. And after the filler and anticipation built up of HBP, TDH has better be good or I will personally fly to UK and assassinate Rowling. Ok, maybe I would not go to that extend, but I think even if this isn't the best book in the series, it was still one of the better books.

We are introduced to the 17-year-old Harry Potter who can finally perform magic outside of school. And to my relieve, there are more spells being thrown about, and after all it is the final duel between the two wizards, there are some high tech stuff being unleashed. There are not few spells that I have not heard before, and it is pretty cool to finally see these advance spells being put to proper use.

The book started out at a very fast pace. Battles are fought in midair, and once that was over, it slowed down to a pace that I actually fell asleep. This slow pacing could be attributed to the fact this book frequently back track to the past of almost all its characters and Harry having visions as well. For several chapters, the three main characters barely moved from their physical spot in the book at all and the plot remained stagnant for a while, while the flashback plays and more info overload which explains very little of things, but in some other things, made things a little clearer.

And the search for the Horcrux... the book is supposed to be about finding for the Horcruxes, but the search only started in earnest in Chpt26, pg419. And what's up with the Horcrux and Hallows? The introduction of the Hallows was a little tad confusing for me. Somehow I do not really see its significance. And how could the Dark Lord be so stupid? But the reasoning Rowling gave was pretty convincing.

And be prepared to have all the other 6 books laid our around you while you read, because TDH refers to so many red herrings and little little details that you would have normally ignored in the last 6 books. I am still cracking my head thinking about one of the things stated - pg498, 3rd last paragraph (when and where did that happen?)

It was around Chpt26 that the pace started to build up again. Find the Horcrux, search for the Dark Lord, the battle, the kill!!!!

In the end, I would say that the closure to this series is pretty good. It follows the standard old-fashion Tolkien formula of journey, discovery, WAR and triumph. It tied up almost all loose ends, settled some rivalry, it delivers some emotional punches (I had one punch that left me going, "WTF? WHYY!!!"), killed the people it needed to kill, and in the end, it did deliver what it had promised.

I would definitely say, 'Good book'. Not the best in the world, but "That will do, Potter, that will do." (Said like how in Babe, the farmer told the pig).


I would not go into details of the book as what I have done in my review of HBP. But I will talk about the main question everyone is asking:

Who died?

People, people... there is a war going on in the book, a lot of people are dying. You want the entire list, wikipedia has a nice list to see.

Deaths that impacted me most:


Actually there are so many things else that I wanted to blog about this book. Like the stupidity and naivety of Voldermort, and how Ginny could have played a bigger role, and Snape and Draco should have more book time...

But I just could not say anything about it at the moment. Or I am just too lazy, and I am having that weird sensation I always have every time I finish reading a series of book.

It is this bittersweet feeling that wells up inside. You feel like you are saying goodbye to a very close friends, and indeed it is. It has been a 7-year long friendship, and you know that you'll never see that friend again. You feel like you want the story to continue forever, but sometimes, it is best to let it end where it ends.

So in remembrance and respect of these books that had somehow got the world reading again, I will not comment further on the books. Let its memories and opinions lie where it should: in the heart and the mind of its readers.

So long, Harry Potter. It has been an up and down journey of good books and bad books, and I am glad it ended where it ended, and therefore we parted good friends.

Yes, the man's last great accomplishments I fear.
And so it comes to me to put an end to this thing.
- Balthier, Final Fantasy XII

We passed by on 6:44 PM |

Road paved on 3:45 PM |

I Fucked Up Again

Or I think did.

Yup, exams over. And this is one of the few exams I actually studied for, so why is this exam the only one that made me so nervous?

Reason #1:
Stressing out over the fact that Dr. Wittmann may be my examiner.
Reality: No worries, I did not get him. But bad news: I shall remain the idiot that does not how to do a proper PE in his eyes.

And instead I had another male doctor who played the Good Cop and a female doctor who played the Bad Cop. And it was a little funny to see her playing Bad Cop because she is so slim and neat and fragile and when she tried to look angry, it was just hilarious. Not that I laughed out loud or anything.


Reason #2:
Stressing out over not being to get a good history for long case because we have a lot of demented and old patients.
Reality: I actually had a very, very nice lady who gave me her ECG results, troponin levels and echo results when I asked her about her condition. So it was pretty ok. I just mixed her age and her marriage up a little.

The lady was born on 1937.
Me doing my presentation: Mrs So-so is a 80 year old -
The doctors looked up in surprise and I went rattling along, a little confused on why they looked so surprise. It was only after that and I went to talk to the patient again that I realise that I calculated her age wrong.

I forgot to ask about her husband and because she seemed reluctant a little to talk about it, I thought he died and I happily reported that she was a widow. In actual fact, they had a divorce and I was like WTF?!!!



Reason #3:
Stressing out of not being able to hear murmurs or crackles during short cases.
Reality: The murmur I heard was pretty audible. But it was heard loudest over the aortic region and instead of radiating to the carotids, it radiated to the axilla. I was like, what the freaking shit? And I could not hear a fucking single thing over the mitral area. Screwed?

Until my colleague who had the same question heard the murmur over the aortic region, radiating to the carotids but not to the axilla. Strange patient. And she had an awesome high arch palate. It was like the ceiling of a cathedral! And the uvula was like the bell hanging from it.


Reason #4:
I fuck up on presentation.
Reality: Other than the minor setbacks, my presentation was pretty okay.

Dr: So what did you think of the enlarged liver? The surface?
Me: Erm... when I palpated over the liver, I felt craggy surface.
Dr: Craggy?
Me: *remembering that the patient came in for alcoholic disease* But it may be the dilated veins. On palpation for the liver, the lower border was smooth.


Reason #5:
It is the hardest exam in our entire career as a medical student.
Reality: It is the hardest exam in our entire career as a medical student.

So now it is finally over. Another 2 months gone, and 1 week holiday to be enjoyed.


During my Medicine rotation, I was attached to a Mater Hospital in South Brisbane. Unfortunately, a large part of the hospital was under renovation during that 2 months, so it could be pretty frustrating and funny at times.

Imagine trying to here a murmur with drills going off at the background. There was one time when I was listening for crackles and there were bloody saws sawing something somewhere. I actually thought it was crackles.

And it is uncanny how the hammers coincides with the heart sounds.
Me: S1 is louder than S2.
Dr: No, I think it is the construction workers.
Me: Really?

But the good thing about Mater is, it has very very few patients. And almost all of our patients have either stroke, cardiac failure/infarction, pleural effusion/pneumonia/pneumothorax and diabetes. So we are pretty certain what cases are coming out for our exam.

And I actually talked to the patient that became a colleague's long case patient. And we even went through his case together. And I even did a short case with my short case patient before the exams. That is how lucky Mater students how.

"It is so unfair, you guys get the same short case patients, you have seen all your patients for the exam!" - Richard, about me, Raj and Daniel.

Looking back, Mater Adult Hospital (the hospital I was attached to) is going to hold many fond memories.

Johannes Wittmann, Dr. J Wittmann, Dr. JW, Dr. W...

Shut up, brain! There are many other things other than a cute doctor.

We have a cynical doctor.

Patient presents with muscle dystrophy.
Dr: There is nothing we can do about it. (Said with a BIG smile)
When the patient walked out:
Me: So what is her prognosis?
Dr: Not more than 2 years.

Patient presents with idiopathic weakness of right hand.
Dr: We will send you for an EMG. (Said with an encouraging smile, and even taught the patient what EMG is all about).
After the patient left:
Me: So you do the EMG because you think that the weakness is due to radiculopathy?
Dr: Nope, to stop her whining.

But overall, Dr. CS is a pretty cool doctor. For one patient he pretends to care for, there are three that he really do care for (or so I think). And in that aspect of pretending to care for patients, I totallyhim.

And we have our ward doctor, who is tall and has hands that can never stay still. The patient would be telling him stories and he will be bending and unbending paper clips. During ward rounds, he would be fiddling with his stethoscope and fidgeting with the patient's drip. And he is the doctor who likes to send people home.

Patient in bed, looking really ill and on oxygen.
MK: What the hell is she still doing here?

And from the next medical team is a doctor who talks really cryptically and somehow he sounds really good when he presented it to the patients, but after when you try to write in the charts about his plans, you have no freaking idea what he is going to do.

We also have a nephrologist who does not have anything to do in Mater because all our renal cases are sent to another hospital.

The last doctor I met the day before my exam is Dr. David Serisier. You may remember him as the doctor with all the blings blings. Well, I found him flirting with the Year 2s, and decided to join them for their tutorial.
And after following him for 3 patients, he turned to me.
DS: So what year are you?
Me: Three.
DS: Ah, so when is your exam?
Me: Tomorrow.
DS: Ah... then I don't think it is a good idea for you to follow us anymore.
Me: Damn.

I would have posted Dr. Wittmann here as well, but I guess you guys would have been bored to death about him, so I'll move on.

And not only the consultants are brilliant, their registrars are superb as well. Richard was telling us how he never had a chance to perform procedures on patients, his registrars never wanted to help him with short cases, they are always 'busy'. Well, that is not the case in Mater. We need countless cannulas, ABG is kinda our forte now, and hell, Raj and I even assisted in an endoscopy courtesy of Dr. Wittmann and an ICC insertion courtesy of the Respi reg.


The funny thing I find about Mater is that about 80% of their doctors are not Australian Australian per se. There was once we were doing ward rounds, and we had only one Australian who was an intern. The consultants and registrars were all non-Australian.

Dr. Malcolm King is South African. One of our endocrinologist reg is Danish. We have about 4-5 registrars who are either Indians or Sri Lankans. There are at least 2 senior registrars who are Taiwanese/HongKee/Chinese. The GI team led by Dr. Johannes Wittmann is entirely non-Australian: Dr. Wittmann is German, the registrar is an Indian, and the intern is a Filipino.

So who said non-Australian getting work in Australia is tough?


When all is said and done, I am really looking forward to getting Mater for my Medicine rotation and I am so going to beg the lady in charge to give me Gastrointestinal and put me under Dr. J Wittmann. YAY!!!

***************
News update:
The lady in charge of the exams just emailed me that I can ENJOY my holidays. Hmm... I wonder what that meant.

I just want my journey to be full of laughter.
- Yuna, Final Fantasy X

We passed by on 3:45 PM |

Road paved on 9:23 PM |

I Fucked Up!

I need to rant to someone, and there is no way I'm going to go to Richard to rant about another guy, hence this post. So bear with me.


When it comes to short cases examination (ie 6 minutes to examine a patient, 2 minutes to present, 2 minutes for questioning), I can always hold my own grounds. I know what to do, and I am confident of doing it. I have had practices, and I KNOW I am quite good at it.

But then why of all fucking days, I have to just screw it up. It is just another practice, I have been taught well, and the only difference is that HE is present.

I mean, COME ON, he is just another doctor who is here to just check on our techniques, and techniques is what I do have. If that is so, why does my heart give a little jump when I hear him speak, and I get all flustered and confused when he asked me questions?

I am not a girl who does anything to please anyone, especially not some higher ups. Then why is there this urge to show him that I am one of the better students? I practiced through the night before to just polish my skills and presentation. I am confident when I went to the patient to start the CVS examination. I was doing fine until the neck.

Can you show me the JVP?

And I gave a little hic when I heard his voice and coupled that with my lack of skills for finding the fucking JVP, I knew then I was screwed. But I persevered on, trying to keep on exuding that confidence. And then I listened to the heart and everything went downhill then.

We students all know that each patients we are asked to examine always have a sign, and at that one day, I could not hear a single fucking thing on that fucking heart!

Will you do anything else?
He was standing right beside me, looking at me and I could not remember a single thing. My mind was freaking blank and Daniel had to jostle me along.

Then let's go wash your hands. We will share a sink.

And my mind was going in overdrive in trying to rearrange my thoughts which were flying everywhere. But I really still thought that I could still salvage it. But when he stood there, leaning casually against the wall, his long legs crossed, the boyish grin on his face, and asked me to present my findings, I began to fumble.

I wanted to impress him, I really do, but I guess my plans backfired on me. My urge to make a good impression began to have a toll on me. And when I reported no murmurs heard, the look that he gave me was of surprised amusement.

No murmurs? Hmm... no murmurs.

It was then I knew I was screwed. I could not complete my presentation, my confidence level was subzero and I floundered all the way through. Hell, the next few seconds was a blur because I could not even remember what happened until the doctor started talking.

So presumably this patient has a mitral regurgitation, what would you have heard?

Shit, this is like the easiest question in the world. I knew the answer, I really do know it. But looking at him, no words could come out of my mouth. I was praying for the floor to open up and just swallow me whole, or just let me have a stroke and fall unconscious, or go into an epileptic seizure. Anything is better than making a complete fucking fool or myself.

Then he went on to illustrate how I should have done my presentation and he told me I lack maturity and sophistication.

And then Raj did his short case examination and reported, and HE looked at me.
"This patient's murmur is harder to hear compared to your patient's murmur, Elena."

Oh God, just let me die.

"Elena, I think you better not get Dr. Wittmann for your exam." - Daniel

It is just HIM!! I cannot concentrate around that man. If I get him for my exam, I have a fucking gut feeling that I am so going to fail. But if I do not get him for my exam, I will never have a chance to show him how good I can be! He will always remember me as the immature fool that should never step into medical school.

Ohhh... I just feel so much like dying. It has been a day since that eventful stupid practice, but here I am still feeling depressed about it. I mean, what the fuck?! What is with this fucking obsession about screwing up a practice? If it was back home in IMU, and the examiner was Tin Ong, Achike or Tim Song, I won't even give a fucking damn. So why now?

ARGH!!!! *runs around the room screaming* I need to get him out of my head so I can just fucking study.

He is a teacher, an adult who is an authoritarian. I don't do authoritarian, I don't do teachers. So why am I doing him? (That sounds wrong). Why do I catch myself staring at him whenever he walks into my sight? Why do I listen to his voice instead of his words? Why do I find myself repeating his name to myself whenever I hear his name? Why is 'Did you see HIM in the wards today?' the first question I ask Raj when he comes back from the hospital? Why is there this urge to impress him? Why am I (in Sheena's words) gushing over him?

Argh!!! I hate my life.

And Richard is being so nice and understanding by not saying anything while I wallow in my depression.

We passed by on 9:23 PM |

Road paved on 9:31 PM |

Deciding my Road

When I was a kid, I always dreamed of winning the Nobel Prize by finding the cure for AIDS. I wanted to do research, indulge myself in the world of viruses and finding this elusive cure for a disease that was an endemic before I was even born. I wanted to be like Gertrude Elion who won the Nobel Prize for Medicine by finding the first anti-retroviral drug Acyclovir.

Then I did ONE year of research and HATED it! Oh my !@#$%$^%^&(*!! Who can stay still in a bloody lab, hunched over ELISA plates for the rest of their lives?! Oh, not me. I am so not going to waste my time in labs.

But I still want to win the Nobel Prize or at least leave my name in the future medical books, and what better way to do it than to discover some new surgical techniques or new signs.

My new idol is Dr. Augusta Marie Dejerine-Klumpke. Yup, she found the Klumpke's Palsy. Now who is Augusta Marie Klumpke? She was an American who was brought up in Germany, educated in Switzerland, before going to Paris to study medicine. In her third year as a medical student, she described a paralysis of all the intrinsic muscles of the arms and true claw hand paralysis and this is due to radiculopathy of C8 and T1. For that thesis, she won several medical science award in the field of anatomy.

This is the exact picture found in Dr. JPJ's brachial plexus notes.

She became the first female intern in a Paris hospital and married her professor, Jules Dejerine. Both of them became famed neurologist and neuroanatomist, and Augusta Klumpke became the anonymous collaborator and illustrator for most of her husband's writings and books.

The reason she is my current idol is because like her, I am in my 3rd year of medical school and she inspires me by the fact that even a student can achieve great things. And even better is the fact that she was into neurology as well.

A MBBS degree means I can either choose to be a physician or a surgeon. So for the life of me, I will never ever choose physician. I work better with my hands than my head, so I have always wanted to be a surgeon. I always tell myself, if I want to do something, might as well aim for the most challenging one and reach the top, that way I really stand tall and say I did it. So I have always opted for what I thought is the most difficult field of medicine: neurosurgery. Yes, playing with nerves of the brain and the spinal cord, joining broken nerves together.

And the sound of a high speed cranial pneumatic drill... salivate.

But what about orthopaedics? This field of surgery gives me a bigger margin for error, after all, bones are bigger than nerves. And have you seen the chainsaws!! Walking into a ortho OT is like walking into a hardware store. Bbbbrrrzzzzz... eeeehhhhhhggg (chainsaw sound).


I always prefered open surgery, where the chest is flung open, the ribs sawn and spread apart; or the skull taken off to reveal the entire brain; or a huge gaping hole in the abdomen where you can see the yellow fat and juicy organs glistening with blood. To be able to twirl a scapel stylishly and cut right into the body, like how a butcher twirls his chopper before butchering a pig, and to feel the blood splatter, that is what I call a surgery.

But things are turning away from those huge ass surgeries now. Doctors are opting for surgeries that do not have so much scarring or trauma. And this is done by making small incisions and having cameras within the body and long long instruments to do the job inside the body while we control from outside.

This is where we come to the topic of endoscopy. People usually thinks that endoscopes are just that tube that you insert the mouth to look into at the patient's oesophagus, stomach and duodenum. But endoscopes are scopes to look into the human body, and endoscopy includes:

The gastrointestinal tract (GI tract):
* esophagogastroduodenoscopy - commonly called endoscopy because this is the most endoscopy done.
* small intestine
* colonoscopy
* proctosigmoidoscopy
* Endoscopic retrograde cholangiopancreatography (ERCP)
* Duodenoscope-assisted cholangiopancreatoscopy
* Intraoperative cholangioscopy

The respiratory tract
* Rhinoscopy
* Bronchoscopy

The urinary tract
* Cystoscopy

The female reproductive system
* Colposcopy
* Hysteroscopy
* Falloscopy

Through a small incision:
* Laparoscopy
* Arthroscopy
* Thoracoscopy
* Mediastinoscopy

And of course with the endoscopes, we have the endoscopic surgeries, something that I am looking for. The most common endoscopic surgeries done would be the laparoscopic surgeries. And the one I was interested in was the endoscopic brain surgeries. I am an avid video-gamer, I prize the manual dexterity of my hands. I have not touched a endoscopic surgical instrument before, but I believe that it is going to be one tool I can easily master (let's not talk so fast first).

And then I saw the endoscope, not the surgical instruments but the plain old scope, used by physicians and not surgeons.



This piece of equipment is simple, consisting of a tube linked to the controller which is so super cool. You hold the controller in your left hand and the shaft in your right, meaning you must be very ambidextrous. Both hands got to think separately. Ok, I play PS2, I'm used to have two hands doing two different things, I play the piano, again both hands play different notes all the time.

I have seen an endoscopy before, and I was never attracted to it until I saw Dr. Johannes Wittmann (Gastrointestinial Consultant) uses it. He made using an endoscope looked like a dance, his right hand worked in perfect coordination with his left. Never mind that he is left handed, it doesn't really help that he is cute and nice as well.

Dr. Johannes Wittmann graduated from UQ and then served in the public system for 7 years before going to London (University College Hospital) for his specialty. He is a physician with a Fellow in Pancreatobiliary Medicine and he is like me, he slants towards the procedural side of medicine. He has special interest in ERCP and is the only public doctor in the hospital that can perform an interventional ERCP.

I think I need to rein in my obsession with untouchable guys, but it really does not help with him being cuter than the other consultants I have in the hospital. Granted that I have some consultants who are extremely young (29 years old being the youngest I have met), and the Respi Consultant is pretty hype with all his bling bling, no one comes close to being as adorable as Dr. Wittmann. His cheeks are always red and his ears are so cute and small, like a chipmunk. And his startling grey blue eyes made me realise that it is very difficult to perform a consensual and accomodation reflex on Asians brown eyes. And that casual nonchalant stance he has as he leans against the wall or counter, and that wide smile.
vs
Guess how old is the good doctor?

And I think I have fallen in love with the name 'Johannes'. Seems so sophiscated and mature.

"As a doctor, you need to have maturity and sophistication to grab your time back from the examiners." - Dr. J. Wittmann, on answering viva questions.

So coming back to endoscopy.

I first observed Dr. Wittmann perform a simple esophagogastroduodenoscopy when I popped into his consultation room and he happened to be carting a patient away for the procedure. So I and Rajinder decided to go along. And then I saw him used the endoscope with such dexterity that I could only stare at his big hands as he manipulated the tool. I have seen other doctors perform an endoscopy, they fumbled with the controllers with both their hands, and yet Dr. Wittmann just inserted the shaft with his right, his left thumb twirling the knobs, his other remaining fingers pressing the buttons for water, suction, air and image shot.

I know I was supposed to pay attention on the screen but his hands were just fascinating and his voice just so soothing...

Then there was the time the nurses and registrars were talking about him doing a colonoscopy on this young patient who was having Crohn's disease and was in pain and distress. Dr. Wittmann performed the colonoscopy with minimal sedation, and he was talking all the while with the patient, and he even reached the terminal ileum. And he did it in a record time.

"When I do the procedure, it is just too stimulating." - Dr. Johannes Wittmann, commenting on his colonoscopy technique when a registrar commented that her patient was still sound asleep.

And his next procedure was the one that sealed the deal - the ERCP.

JW: Ward round's over, you can go off with your colleagues for lunch.
Me: No, I want to watch the ERCP.
JW: Oh, then go get changed.

There I was, the rude medical student who was already dismissed but insistent in joining the ride. He was nice enough to take me to the changing room to get my scrubs, he patiently taught me the route to the OT and even instructed old stupid me on how to wear the lead vest and skirt because I put it on upside down.

So I lingered around, a useless medical student being a nuisance in the tightly packed operating theater. And then he started.

ERCP is a procedure of inserted an endoscope into the duodenum and from the opening of the common pancreatic duct, insert a catheter into the ampulla and up into the biliary duct to observe the biliary tracts by injecting a dye and Xray-ing the area. And Dr. Wittmann did it which such flair and elegance that I was enchanted. He placed the shaft into the mouth of the patient. I looked away for a moment to get his phone out of his pocket and when I looked up, the camera was already in the duodenum.

I mean, what the hell? So freaking fast!

On a side note, girls should always wear something over their underwear before putting on the scrubs pants. If Dr. Wittmann had done that, I would not have known that he is an underwear guy, black underwear in fact. Haha.

Then the scope was in the duodenum and he pointed to the screen. "So what do you see, Elena?"

And I went... "Huh? Are you in the duodenum?" (Wow, Elena, smart...)

There was this tiny flower thingy on the wall of the duodenum that seemed to shrink and open like an anemone. And that is the opening to the pancreatobiliary tract.

And now comes the difficult part, blind cannulation of the ducts. Because the scope is too big to enter the ampulla, a cannula is inserted into the ducts, and this is done blindly with some occassional help from the X-Ray.

JW: Screen!
And the Xray will be on for less than 20 seconds.
JW: Oops, wrong duct.
And then the Xray goes off and he will work a while before calling Screen again to show that he is in the right duct and ready to proceed.

He now has to handle three things: the controller, the shaft, and the catheter, and he made it look so freaking easy. He even had the time to tell me what was going on, calling for extra screens to show some stuff that I could not understand.

JW: Screen. Elena, can you see that I am just before the cystic duct?
Me: Huh? (Words going through my mind: What the fuck is the cystic duct)
Xray turns off.
Me: So why can't you go into the cystic duct? (Trying to assume that I know what is the cystic duct)
JW: I'm inserting the dye now. Screen. See, you can see that it is tortuous and blocked.
Me: Ahh... (Only understand abit).

And then he backtracks towards the hepatic ducts without any help of the Xray. The rest of the procedure involves ballooning and removing gallstones. There was also a bit of burning (sphinterectomy) and the smoke caused the sleeping patient to fart.

But most of my attention was on Dr. Wittmann. His left hand never left the controller, it twitches the dials to direct the flow of the catheter, his arm flexes back and forth to adjust the scope.

Throughout this whole process, there was a new nurse who was just learning how to assist in an endoscopy. She was fumbling with everything, and Dr. Wittmann just turned and give her this oh-so-boyish smile and said, "Calm down, I will not bite." And he taught her how to be a nurse. I have seen other surgeons who would have snapped at the nurse.

After the whole thing, he sat me down as he prepared the report and talked me through what he had done and what he would have done if not for risk factors, bla bla bla. Most things just flew over my head because it is a subspecialty knowledge and the headiness of being there just listening to him talk, haha. Have I told you he has a very soothing voice?

Watching this procedure made me realise, if using endoscopic surgical instruments is like playing PS2, using the endoscope is like playing Wii.

vs

vs

So now there are two 'gaming instruments' out there waiting for me to play. And with NOTES coming up, life is gonna be good for a gamer eh? And do not forget the Lindbergh Operation where the surgeon operates a robotic arm, and when the first micro robot enters the body to perform a microsurgery, I will be the first to be behind those controllers.

I just can't wait to start neurosurgery and start playing with all these tools. But the problem is I don't think OZ have endoscopic brain surgeries or brain endoscopy. Well, we will just have to wait till I start my surgical rotation. Can't wait!!!

But being with Dr. Wittmann had opened my eyes to the world of procedures done in the Gastroenterology Unit. The endoscopes, the laparoscopes, you get to play with much more 'gaming instruments' than in the brain.


And remember what I was saying about aiming for the best?

The surgery claimed to be the toughest by John Hopkin's Chief of Surgery is the Whipple's procedure also known as pancreaticoduodenectomy. Reasons for it being tough:
1. The pancreas is behind the stomach, duodenum, bile duct and gallbladder.
2. There are lots of large blood vessels in the area.
3. The pancreas is friable and damn tough to stitch.
4. Pancreatic enzymes destroys flesh like nobody's business.
5. You have to reconstruct the pancreas and the gastrointestinal tract.

Before and after Whipple's.

The Ivor-Lewis procedure (oesophagectomy) has a mortality rate that equals heart PLUS lung transplant.
1. You split open the rib cage.
2. You deflate the left lung.
3. You go around the heart and pull out the oesophagus.
4. You resect the part of oesophagus.
5. You pull part of the stomach through the diaphragm.
6. You sew the two ends together.
7. Inflate the lung and you are done.

But then again it is very difficult to say such things as each field has its own medals of honour and their own equivalent of the Whipple's or Ivor-lewis.

The nerve-sparing radical prostatectomy is done by urologist and involves resecting the entire prostate without damaging the nerves and sewing the bladder back to the urethra.

The staples (bone in the ear) replacement of the ENT team is also as difficult because you are working in such a small area.

The cardiac surgeons have the Batista procedure (left heart reduction) and the Paed cardiac surgeons have to squeeze their huge hands into that tiny walnut size heart.

So what about my favourite field, NEUROSURGERY? John Hopkin's Chief of Paediatric Neurosurgery was 33 when he became Chief and he majors in hemispherectomy (removal of one half of the brain) in children and he was famous for separating a pair of siamese twins joined at the head! And imagine trying to untie some baby's spinal cord which is so tiny.

So until I have done my surgical rotation, this is going to be tough to decide. But I kinda have it planned out. I have two choices each for my Surgical and Medical Specialties, so I'll most probably be doing:
Medical Specialty: Neurology, Gastroenterology
Surgical Specialty: Neurosurgery, Orthopaedics

"Pass Medicine rotation first only talk." - Richard Lee.

But let's see what my aptitude test says:

1 radiology
2 urology
3 nuclear med
4 neurosurgery
5 gastroenterology
6 allergy & immunology
7 pulmonology
8 pathology
9 plastic surgery
10 aerospace med
11 neurology
12 anesthesiology
13 emergency med
14 dermatology
15 endocrinology
16 cardiology
17 ophthalmology
18 otolaryngology
19 thoracic surgery
20 infectious disease
21 colon & rectal surgery
22 preventive med
23 orthopaedic surgery
24 pediatrics
25 general surgery
26 radiation oncology
27 nephrology
28 occupational med
29 psychiatry
30 obstetrics/gynecology
31 general internal med
32 rheumatology
33 hematology
34 physical med & rehabilitation
35 med oncology
36 family practice

Hmmm... the first three is wrong, but 4 and 5 reflects my vision. Maybe this is a sign. haha. And as you can see with the last few ranks, I hate taking care of people, so maybe radiology suits me in the way that I do not have to deal with any patients at all! But I would be nothing but a technician... OMG, downgraded! (No offense to the techies. Without you guys, the hospitals will never be able to function, but I just don't see myself doing technical stuff.)

And if I do take the Gastroenterology Specialty, let it be at my current hospital and my consultant be Dr. Johannes Wittmann. I am so going to learn all my endoscopic skills from him. Not only he is a great doctor, he is a great teacher as well. I just hope I don't get on his bad side - he was seen reprimanding a group of 2nd years and they all looked like whipped puppies with tails between their legs.

But I just find him so very fascinating. And oh ya, I barely reach up to his chest. And I realised that my one hand can not even reach the dials of the controller. They really do need to make a smaller version controller.

Cyrus! My life regaineth its meaning!
- Frog, Chrono Trigger

We passed by on 9:31 PM |