3.31.2006

oodles of warm fuzzies

*beams*

that's about all i'm able to do at this point. as usual, i'll be posting a recount of my long case below for those interested to sift thru the medical waffle.

exuberant. deliriously happy shocked. that's me right here and now!

"shit." was the first thing out of my mouth about 20mins ago as i stepped out from my long case and saw the door close. decisions were going to be made in that room. my fate laid in the hands of the 2 examiners. a curtain of absolute dread crashed down.. i felt claustrophobic, like when my mosquito net fell down on me when i was little and how the more i struggled, the more i entangled myself. sorta like a straightjacket i suppose.

at that point in time, everything was drowned out. i vaguely remember mel telling me i'll be fine, how she liked my top and how her voice kinda trailed off. i vaguely remember noticing the other exam coordinator looking taken aback at my swearing but didn't really care about the impression i was making

i had enough time to process all this, to turn my back to that forbidding door of gaudy mint green when i catch mel's gaze drift past me. what could've happened in there?! there was only about a half minute difference in time between when the door closed behind me and opened again! "shit" went my brain, realizing that the examiners had already finished discussing me. thoughts of those judges on the iron chef whizzed past, dissecting each dish except in this case, i was the dish.

i ready to be devoured alive, excruciatingly torn apart bit by bit as i slowly made my way back into the room. bring it on! tell me i was disjointed. tell me i need to work on my knowledge. ask me if i've even seen a patient before this. is that the best you can do?? i had a full-fledged wwf round happening in that parallel universe my mind escape to and was frankly quite flabbergasted to be interrupted halfway as doc bisits' voice cut in. "we were very happy with you. *smile* you obviously have the knowledge, you must've studied really hard for this.. and the only thing we felt that you lacked comes with clinical experience. you passed. *doc shah smiles as i look over at him in utter confusion, grappling with that last bit* any questions?"

i was dumb enough to say no when he asked if i had studied hard for this. "you mean yes, right?" he interjected. urm. yah, that. i paused after being given the chance to ask questions and was yet again saved by "no questions right? you're scared we might change our mind?"

man, were they in a good mood this morning. thank goodness! so all in all, i guess things went swimmingly well this morning =)

people in cars next to me must've thought i was a loony with a smile 2 sizes too large plastered across my face. i can't help feeling oodles of warm appreciative fuzzies. thank you guys for all the shouts of good luck and all the best, all the msgs of concern and encouragement from friends new and old alike. this... this. for all you out there who say they can't live without a significant other... try to understand that for some of us, we're completely content with this version of cloud 9. we're happy with oodles of fuzziness from friends from moments like this. stop trying to set us up!

hi amy, i'm doc bisits...

this is doc shah. take a seat. youi will be presenting your case to me today. fire away whenever you're ready. right. inside, i was very unsightly mess of jittery tangles. lucky for me, neither examiner had xray vision.

*takes a deep breath and gets ready to start*

*my pen drops*

*minor dilemma of ignoring or retrieving*

*picks up pen, takes another deep breath. jacket tumbles across crossed legs in a heap*

"screw it" i thought, exasperated. i took a deep breath and started...

i saw mr. m, a 50yo rock band manager who presented 24 hours ago with a 2-week history of abdominal distention and later, abdominal pain and diarrhea.

he first noticed his abdomen gradually swelling up 2 weeks ago, up to the point where he felt he had fat flanks. there was associated vomitting, 1x/day for the first 3 days of abdo distention that ceased by the 4th day. no blood was in the vomitus, no associated nausea but he lost his appetite.

about 5 days to a week later, he experienced pain and diarrhea. the pain was described as a band across his umbilicus, going across his abdomen. it was constant, dull with periods of exacerbations ranging from 2 to 7 on a pain scale of 10. no radiation of pain reported. lying/standing was more comfortable than being in a sitting position. the onset of diarrhea coincided with his abdominal pain. there was no blood or mucus in his stool, no pain on passage. he found it hard to quantify daily frequency but reported that he'd go 3 - 4x/day on his best days and every half hour on his worst, such as this tuesday post-CT. he has opened his bowels everyday although this morning was the first time he's passed formed stools. they were still semi-solid yesterday. his urine has been dark since tues, post-CT and has otherwise been normal in color and appearance. no pain on voiding.

he has been afebrile throughout the course of his complaints.
although he was unable to quantify his weight loss, he reported that friends have commented on him losing weight in the past few weeks. (i forgot to mention that until later on when they started asking for differentials. they got confused when i mentioned cancer mets. oops. i also forgot to mention: he hasn't done any recent travel to foreign countries and is unable to determine if he's come in contact with anyone suffering from diarrheal disease due to the vast number of people he meets as part of his job.)

mr m has been a smoker of 20 - 25/day for the past 35 years. he drinks 7 - 8 standard drinks of wine/day, reporting that he's increased intake to this amount over the past 8 years after his 2nd wife left him. his etoh withdrawal scale score was 13 upon admission yesterday morning but he scored 5 this morning.

he reports no history of liver disease, bowel disease, diabetes, cancer.

past surgical history includes an appendicectomy when he was 7 and a left forearm bone graft more than 30 years ago due to a mva.

relevant family history include, on his paternal side: lung cancer. his grandfather passed away from it at age 97, his father at age 83. on his maternal side, the only family history present was his mother dying instantaneously from a cva at age 54.

other medical history of mr m: he's been suffering from depression for the past 8 years but was only diagnosed 2 years ago.

he's on paxtine for his depression at home. in the hospital, he's on esomeprazole, timentin, morphine, maxalon, clexans + teds as dvt prophylaxis

when i saw him. mr m was alert, comfortably lying in bed watching tv. he had fluid drained from his abdomen yesterday afternoon and reports the fluid being "like urine" and becoming bright orange at the end of the tap. he's also had a CT on tuesday as suggested by his gp. he currently rates his pain as being 1/10.

on examination, mr m was a thin looking man, slightly jaundiced and was hooked up to IV saline + glucose. his obs were mostly stable... BP was 116/86, he was slightly tachycardic with a pulse of 105. oxyge- ...

"tell me about his abdomen" doc bisits interrupts.

*amy stares back blankly and prepares herself to wing it* you see, i ran out of time to write everything up so i had to go by my very rough scribbles and concoct a plausible tale.

<-- that. that was all i had to go by in terms of reporting about physical exam. i babbled about peripheral stigmata of liver disease and got cut off again! that was it.. i was getting a tad annoyed now. where is this going?? i'm wondering...

and then the viva portion started. tell me about signs of liver disease. what do you think is wrong with him. how do you explain his diarrhea. do you think he has cancer? what kind? how would you manage this guy as your patient if you knew that he's got ascites, bowel cancer and liver mets? what's his prognosis. and on and on it went for the next 20 minutes.

seniors and interns tell us to start with the basics if one's in doubt. when asked how i'd manage the guy, i started with the basics. said i'd get him to lay off the alcohol and the ciggies. that greatly amused my examiners, eliciting huge guffaws. urm... yay?

can't remember the rest of the viva.. it was pretty much all over the place. as disorganized as my initial presentation anyway. bottom line is that it's over =)

3.28.2006

dredging up the past




what does it take to make one forget

what does it take for memories to fade
when does one cross the line of regret
when does one realize the mistakes one's made

how long will you stubbornly wait
why do you insist on defying fate
friendship and soulmates, they don't equate
so hurry up you, please find another date

3.25.2006

jittery words and blurry nerves

i wished for a study break and whaddya know?!
is this truly a case of you reap what you sow?
the timetable's out, i squint for my name
turns out that i'll be the very last dame

friday arvo at one pee-em
that's my time to test the mem
hope the patient will be nice
a complex case will suffice

no straightfoward simple ailments, that i don't want
for evil horrid questions will the examiners taunt
if they don't know what is going on
i too, won't be expected to search for babylon!

five days and counting, exam day's looming
staring at books til the words seem to be moving!
cadbury chocs of the hazelnut kind
are the only things that are on my mind =(

there's plenty of time for some last minute cramming
there's even some space for intermittent snacking =D
beware of an aemii at the end of the week
with junk food & facts, she may turn into a freak

steer clear til friday's past
by two pm, i'll be free at last!
til then, well all you will see
is exactly this portrait of grumpy ol' me =)

3.22.2006

bloody karma wheel

ever heard of the theory on reincarnation? the one where you're supposed to do good in this life so you can accumulate lotsa good karma and be reincarnated into a life of bliss as you bask in attention while other ppl repay their debts to you?

you cause ppl pain and suffering this life, they'll come back the next to cause you pain and suffering. that's how the karma wheel spins, no? so if one grins and bears all the suffering that's been hurled in one's direction over a lifetime, does this mean that the next life will be blissful? does this mean that in theory, one can sit back and inflict suffering on everyone else without nary a care?

as a mozzie, one can flit around as carefree as one wishes looking for the next hot-bodied human to feast on. a lifetime of gorging, albeit a tad short, inflicting wanton pain and itchy agony upon complete strangers with nary a care! welcome to the land of criminal bliss... do you see where i'm going, do you see the parallels?

bloody mozzies, biting me in the most unconventional of places. IN BETWEEN MY FRICKIN TOES would be an example. another bite smack on a joint, 2 toes away. and another where i'd take my dorsalis pedis pulse. and another 2 cm lateral to that. my bloody foot's the perfect textbook example of inflammation - red, swollen, damn painful, hot to touch and i don't know if it'll fit in a shoe tomorrow morning so i guess that justifies as loss of function.

moral of the story, for those of you who believe in karma: stop being such a nice guy, grinning and bearing all the crap or you'll end up as a mosquito in your next life!!

bloody mozzies.

3.20.2006

classic amy moment #2

haven't had one of these in a while, but hey... that's a sure sign that one's long overdue.
other classics included the mooncake festival and moment #1

blame my blabbermouth again, complete with lack of pre-speech processing this time around as a bonus. i had wanted to ask what i was to do with my supervisor's report due next friday if my supervisor's going to be away til the monday after that. was hoping for an extention.. after all, this was one of those things that could cause one to fail the subject if it wasn't handed in on time. yesh, my course can be a tad inane at times.

i started with...
"one more question, well problem actually. i've just found out that my supervisor'll be away for the next two weeks and i've got this supervisor's report he still needs to fill out...."

what the prof heard was "one more question, well problem actually. i've just found out that my supervisor'll be away for the next two weeks and i've got this supervisor's report he still needs to fill out...." as he developed a look of utmost concern halfway through my sentence.

"oh, we must deal with this straight away!" he said. "follow me!" he urged as he continued to mutter about dealing with this straight away.

alarm bells were jiggling by this time. surely, my supervisor's absence wasn't tantamount to the end of the world as it currently seemed. here comes the moment we've all been waiting for.... embarrassment soon ensued as i began to grasp what's happening.

before i could root myself to the musty carpeted corridor, docs wills and chen came into view. they were obviously enjoying a well earned break away from irritating patients, registrars, interns and students alike. the prof did the intros.

"t h i s . i s . a a a m y" the prof explained in his characteristic slow drawl.
i was inwardly squirming, desperately trying to use my eyes to enlighten them that this wasn't my idea. i saw an eyebrow or two twitch, curious stares. i felt like something the cat dragged in, some bedraggled tattered raggedy doll that might've belonged to some savage child that the prof is asking these two elite surgeons to babysit.

"she's one of our 4th year med students and her supervisor's on leave this week. this is her last week and at this crucial time, it would be very important for her to still be attached to a clinician so she won't lose her confidence this last week before exams. would it be possible for her to attach herself to either of you for this week, on top of your current students?"

*faints*

noooooooooooooo... ohh.. ohh.. oh... i was inwardly screaming, complete with the reverbs. i was looking forward to having this week off so i could study! last thing i want is to be hanging around the wards from 8am - 5pm the week before my long case.

*grumbles* what have i done... what have i done... =(

3.18.2006

weeks and weeks

pitter patter clickity clack
backspace. backspace.

patter pitter clackity click
backspace. backspace.

thus goes my stubby fingers bouncing off the keyboard. obedient things they are, despite suffering from the occassional fat finger syndrome. apologies for misunderstandings ~ i was getting a tad exasperated last week with the amount of distraction that stemmed from msn and the like. i didn't mean i'd stop blogging til april as many have asked ~ ooo, this is my outlet, my personal playground of sorts. my own padded cell in chic spanking white. i need this retreat, it saves everyone else in the real world from the majority of aemii-monsters =)

not much of a week really. nothing jaw-droppingly exciting. nothing smoke-inducing exasperating. everything's settling into a certain calm... a swirl of the calm induced by dreams, mixed with a sprinkle of unsettling nerves like the calm before a storm. just enough to tip the meter over to "exciting" rather than "mundane" ~ mmmMMm good!

two weeks ago, i was looking around for Confidence. took it out for a walk and the leash snapped. all i had left was a tuft of hair caught at the end of the leash clasp.

one week ago, i was knocking on every door in my search for Confidence. mood foul as the stinkiest sulphur geyser, temper black as midnight on the far side of the moon.

this week, a ragged-eared sorry sight crawled back through the doggy door. oh nono, Confidence didn't just come back all by itself. lotsa baited treats were dropped as a breadcrumb trail in the form of presentations over coffee with my registrar and intern, plus that extra session with the prof.

in another week, aemii will present to the hospital 5 days pre-exam. obs will be stable, heart rate may be a tad high. no signs of anemia or jaundice will be apparent, but peculiar darkened crescent-shaped areas under the eyes may be seen. she will have no drips or catheters attached. instead, abernathy's surgical secrets is attached to the right palmar surface and she will be clutching numerous chunks of cadbury's hazelnut chocolate. her pupils will be fixed and dilated, staring at stacks of past papers and scribbled notes. despite some worrying signs, prognosis is expected to be good. she will be deemed fit to travel to perth when the first week of april arrives.

*beams*

3.14.2006

my bluefaerii obsession

it's unnerving, when stressed, what one will do
obsession is not what i usually woo!
although i adore munching on scrumptious itty blueberries,
i hope they didn't induce this recent spate of blue fairies.

a new project, i would like to embark
hopefully it'll let me make my mark.
it's currently just a fuzzy vision
realizing it will be my newest mission.

Procrastination and Panic have sought older friends,
they decided to leave me so i could make amends.
'twas a rough little parting, 'twas feeling a tad empty
this promptly resulted in some retail therapy o.0

an uncluttered desk, some brand new toys
thanks to some of my eshopping joys =)
lotsa changes are in store
to attitude, outlook and lots more.

my supervisor was worried, what a sweetie
he didn't want me to be another repeatee.
despite the stigma attached to the concern
extra long case sessions are exactly what i yearn!

an unfortunate planning of everyone's schedule
made help as scarce as unflammable fuel!
i needed to explain my little predicament,
just to enlighten the prof's acumen.

apologies to friends, i'd love to chat
wait for me come april, i can't before that. =(
there's still plenty to cover, in terms of books
facts and figures still hide in crannies and nooks...

but i know things will be fine
for my dear, don't you see..
i've got the blue faerii & little lübblii
they're constantly watching over me!

i hope things are well
for friends near and far
if things could be better,
you can borrow my wishing star =)



3.09.2006

plodding along

2 weeks til long cases and what am I doing?

Besides having long chats with my friend Procrastination, who sometimes brings Panic along, i've been embarking on yet another revamp of my webby, this time with nucleus. the amount of work spent figuring it out is directly proportional to the level of stress i'm feeling. it's always inversely proportional to the time i've left. besides that, i also point the finger at prison break, medium and smallville although it usually helps if i don't switch on the googlebox as mood lighting the moment i get home. oh, and i've been enlightened in a .pdf manner regarding a certain office mystery.

Yes, I've been bugging the hell out of seeing patients and chasing down my registrar for presentations, managing to string a semi-coherant babble sprinkled with waffle. things become ten times worse when I do the same thing in front of my consultant but as a result, i managed to score a few more extra presentation sessions, so a silver lining does exist! some arr and arr (not of the fishie version tho! that would be stealing fishie and his shel's moment) would be gladly welcomed tho, but that won't materialize for another 2-odd weeks. in the spirit of a pirate... *dons on an eye patch & bursts into song*

Yo ho, yo ho, an intern's life for me.
I stutter and stammer in front of the doctors,
Chin up, me 'earties, yo ho.
I desperately need a very stern proctor,
Chin up me 'earties, yo ho!

Yo ho, yo ho, a woeful life for me.

3.07.2006

unexpectedness

In the instant messaging system, friendship-based actions are considered especially delightful. In New South Wales, Australia, the dedicated detectives who investigate these amicable affairs are members of an elite squad known as the Special Recipients Unit. These are their stories.

The Thank You

another wave of dejavu swept over me as a brown paper package not tied up with string arrived. this time, no felt cutie arrived. this one was a tad more three-dimensional.

*strikes up a drumroll*

say hi to itty bitty shy snowy sent by shu from singapore! (now say that 10 times as fast as you can *grins*)

he's testament to friendship, how a simple comment over msn sparked a chain of events leading to his epic voyage across a few seas and islands to arrive in one unbruised piece at my doorstep. i had seen snowy's clone in blue as shu's msn avatar, squealed at how cute it was and before i knew it, i was being promised his clone! i'm still speechlessly touched at the kind gesture and i just wanted to say thank you shu, thank you for brightening up many an otherwise dreary day! don't worry, snowy will be well taken care of =)

The Ooops
in other realms of unexpectedness came a sudden msn msg from L beginning with:

amy u dolt brain

that's the great thing about friends... a freeflow of insults can fly at all hours, wrapped in the security of smug knowledge that a soft landing will be had. bemused, i waited in anticipation at what she'd tell me i did wrong.

L says: u uploaded your photos onto the wrong folder in my livecargo
L says: & that folder called 'signed agreements' is the one i share w the CEO, COO
L says: directors, etc

big big oops... but friends are very forgiving and make the world seem safe, even when they know it really isn't.

L says: moving them now......

that's my L for you, being both my devil's horns and angel wings all at once. i don't think i ever really spelt it out, but i'm glad you're in my life =)


The Congrats

yet again on msn, i get my first wedding invite from another one of my galpals. not that she'd have a second wedding.

L said: amy! please keep ** nov 06 blocked out k? wedding date's confirmed

it was so unexpected that the message took a few minutes to sink in. especially after her vehement protest when i told her it was the day before my exams and i'd be in a different country. *wails*

L said: no no no!!! u MUST make it *pout*

gawd help us! whether i make her wedding or not, by the end of next year, there will be a very real prospect of mini Ls running around calling me auntie. *gasp* despite being mortified at the fact that i'm comfortably in the age group where most people are of marriageable age, i'm at the same time jumping for joy on L's behalf. girl, if i was there in singapore right now, you'd be suffocating from my hugs! a very very happy congratulations dearie, from both me and snowy =)

3.05.2006

big sister is watching

my old friend, procrastination, knocked on my door for a late night chat. we ended up wandering over to my webby, replete with cobwebs and furballs and started the spring cleaning. in the midst of all the dust, we stumbled upon a visitor at the "ask aemii" section, one who piqued both our interests.

the following footprints were left and it was only common courtesy to reply when one has been spoken to, so here were my two replies. thought the first one was too longwinded on a short span of hindsight ~

curious to uncover the faceless, nameless entity behind the question and armed only with a lone IP address much akin to homer's buttprint on his sofa, i rummaged around my statcounter logs to unearth this treasure. so my visitor's a local eh? *taken aback* i was expecting a complete stranger with nothing better to do, but the question now carried a bit more weight coming from an hunter ISP... namely one by soul pattinson telecommunication.


a few moments of introspection flitted by, followed by a few fingers of insecurity creeping up at the back. i don't think i'm self centered. having a blog doesn't equate to self centered. my johari window tells me i aint.. are my friends just being nice then? *bashes thoughts into the ground with a hammer* that's when angry amy woke up seething. "who are you to judge me for being self-centered? you haven't even visited my blog yet - u spend 58 seconds on my main site, bypassed all other pages but the main and have the gall to label me as being self-centered?! would've given you more credit had u stumbled across this blog before coming to that conclusion." she spluttered and hissed.

little kids grow up with happily ever after endings where the prince always slays the dragon and the princess always gets rescued.f even as adults, some of us (well, me actually) still hang onto that glimmer of hope that the world's not as big and scary as everyone says it is, that cynicism is overrated and there remains a grain of good in everyone despite how things may seem. "well kiddo, i'm sorry to burst your bubble." my old friend, procrastination told me. it was still hanging around.

i've always prided myself at being able to handle criticism well but i suppose one tends to harbor slightly distorted perceptions seeing things from this angle. obviously, i wasn't as good as i thought. this not-so-distant stranger struck enough raw nerves to warrant a rant from me (go you!!) but i'm not rattled enough to break down in tears (please slap me if i ever become that insecure, anyone..)

anyway, the storm has passed and the winds have died down. all that's left is the quiet rustling of the leaves outside as the first rays of sun play hide-and-seek between the dark scary shadows of the night as aemii tucks herself in between mr snuffles and sleepyhead. reassured that big sister is always watching, she drifts away with a smile on her fluffy chariot of rainbows seeking happier horizons.