my much anticipated sigh of relief and jubilation at the close of 4th year for the semester didn't arrive after finishing my long cases yesterday...
not that the long case itself was hard. i had no qualms about that part. aside from spending about 20 mins finding my patient (he conviniently decided he needed a walk - and justifiably so with his DVT/PE!) and then spending another 5 listening to him gabber in Romansh i think waiting for him to get off his cell. (A ~ this is as much for you as it is for me: Acoording to the Swiss Embassy, there are four national languages in Switzerland: German, French, Italian and Romansh. In principle, all four languages have equal rights. It didn't sound like the first 3, so it probably's the 4th..), the history taking and examination went fine.
:: oops, got sidetracked. i went on to talk about the patient.. that's in another post for those who're interested ::
anyway, it was the presentation bit that i was squeamish about. i don't know if i passed or not. me... being the chicken that i am, didn't ask them either. i mean really... what do i do? ask the examiners.. "so, did i pass?" and have them flatly say "no."... and then what? say thank you to them for examining me? or have my heart sink and walk out in a daze? not that i'm in a better state by not knowing, mind you! but relatively speaking, this is a better state to be in where there's a glimmer of hope that i might've passed. i went around canvassing for opinions...it's not exactly a randomized controlled trial but outta the people i've asked, 6 said don't be stupid..you passed. 2 were like uhh...that's weird.. i dunno. 1 was like why didn't you ask?! technically, it doesn't matter. it all depends on the writtens in june. they only look at how you did over the semester if you're a borderline case for the writtens and with my track record, they're gonna look lol. i hope not, i hope i break the trend but there's still a very possible possibility.. anyway, there's the 48hour task to do. i'm slogging away at that now.. gawd it's a pain!! i can't quite get rid of an awful phrase M used in first year to describe all domain 2 assignments...about how doing one was worse than being constipated. it's slow and painful and a friggin pain in the butt.
after i hand it in on friday, 4th year will officially be over for the semester, sans writtens ~
i celebrated early without the post-exam euphoria last nite by going out to dinner with nuls, abs and the rest. haven't seen them in forever cuz they've been doing pediatrics so it was good to catch up. forgot what that was like.. the last time i went out out for anything was dinner close to 2 months ago. sad eh... spent the rest of the nite watching episodes of scrubs i got off the network lol.
back to the constipa...oops, 48hr task i mean. 
for those of who who're interested, he's a swiss immigrant who had a PE.. presented a week ago with sudden worsening dyspnea causing him to collapse despite rest while cutting grass on his farm on a history of an acute sharp pain at his left calf radiating up his inner thigh made worse with movement/restricted walking (? Homan's sign +) 6 weeks ago.
his GP told him it was prolly mm cramps, prescribed panadol and also scheduled him for excision of his melanoma on anterior left chest. Pain self-resolved 5 days later without him taking panadol. had urinary incontinence with collapse. no headaches, vertigo, fevers, rigors, associated chest pain. described his SOB as "couldn't get air in" ~ no cough, sputum, history of respiratory disease. no asthma, pneumonia, TB, blahblahblah. also had severe flank pain radiating to lower back with gross abdo distention at time of presentation last week. had abdo CT done, showed enlarged kidneys. told it was just fatty deposits. had a vein stripped 30 yrs ago in switzerland for similar type of pain. no other risk factors for DVT ~ no recent surgery requiring immobilization, no recent long distance travel, no family history, no history of stroke/MI, definitely not on the pill or HRT... exercise tolerance normal - spends time working on farm, walks dogs at least once a day for a few kms. No orthopnea, sleeps well, flat on 1 pillow. no personal history of heart disease. GI system ok other than colonoscopy and treatment of hemarroids 5 years ago that were causing bleeding. other systems unremarkable. no other previous medical history or known medical problems ~ no HT, diabetes, hyperlipidemia, prostate cancer etc.
the dude's a chronic alchoholic (ohhhh... i have about half a liter of red wine and a few schooners of beer. about 3 or 4 of those. yes, i have that every day.. i mix the wine with iced tea you know..) and ex-cigar smoker of 10 years who averaged 1 cigar a week. (how do u estimate pack years for cigars...) not on any regular medication, no ADR/allergies.
Family history: mother had CABG, diabetes. died in 2000 at 83, father is 90, alive and well.. brother is 63, no known med probs for latter 2.. he's 57, lives on farm with wife, both immigrated here in '78, no kids. was a chef in swizterland, owned hotelier. worked as caterer, driver at building sites transporting steel/concrete, turned farmer 10 years ago.
P/E: vitals normal.regularly irregular pulse pattern tho. ruddy complexion, very ambulant (searched the friggin hospital for him!), hooked up to heparin drip. vesicular breath sounds, even/normal chest expansion, hyperresonant @ right lung apex, dull to percuss @ left lower base with decreased breath sounds and vocal resonance (???). could also be that vocal resonance was increased at right lower base tho.. anyway, HSDNM, normal JVP. abdo distended, numerous petechiae, couldn't elicit shifting dullness, umbilicus pointing slightly inferiorly. hyperresonant @ right flanks. tender in lower 2 quadrants with light palpation. couldn't palpate liver... or anything else really. kidneys not ballotable. palmar erythema, no clubbing, small mm wasting, asterixis, peripheral cyanosis, couldn't find pedal pulses, cold white toes, edema up to mid-calf on left leg. no central cyanosis, xanthelasma, horner's, scleral icterus, anemia.
he's most likely had a DVT 6 weeks ago that got dislodged and gave him the PE last week on top of hepatic disease prolly due to his chronic alcoholism. already on panadol and heparin. started on warfarin yesterday. one would assume he's already had a CXR and/or CT, ABG, FBC, glucose, lipid levels, UEC, LFT, INR, D-dimers, V/Q scan or pulmonary angiography done. might do an ECG as a just-in case.. might show arrythmias. *shrug* stick some TEDS on the guy, encourage early ambulation (he's got that down pat..). stop heparin in ~5 days' time, measure INR and maintain between 2.0 - 3.0. as for the gastro problems.. refer to gastroenterologist! *grin* hey, that's the beauty of being able to say "sorry, my subspecialty this term was respiratory.. i don't know enough about gastro and being a lowly 4th year med student who doesn't even qualify as the bottom-most layer of scum in the hospital hierarchy, i'd seek a more expert opinion."
for those of you not on my msn, my current screen name reads:
æmii » i found a brain cell ~ not sure if it's mine
after a whole day's reading up on respiratory stuff, my brain's full and i'm doing nutty things. like going out to buy www.aemii.com *runs and hides now* now that i have it, i'm not quite sure what to do with it. i think i need to find some sort of web hosting... *sigh* out of the frying pan and straight into the fire...
stupid me also managed to cancel my subscription to my moonfruit site.. i thought i'd be smart to cancel and then re-subscribe to the "lite" plan rather than the standard. those grrr-ingly shrewd people at moonfruit only give you the option to upgrade, not downgrade plans.. grr. now, i'm losing the site in 6 days' time so all the pages are gonna be visible and i'm going to be off taking screenies after this. *bangs head against the wall*
and i know that i said i wouldn't be blogging til my exams but i'm so steeped with respiratory stuff to the point where i'd tell you that one should just give broad-spectrum antibiotics for every patient coming in with a productive cough and send them off for an xray...
hernia!! 
eew, no. couldn't resist. kinda sucks that associations are now a tad skewed, thanks to medicine.
friends complain of a headache and i find myself automatically asking them how long for, how severe is it, can they describe the pain, what were they doing when the pain came on... *piak head* or what about when i was puking last year from food poisoning @ gosford. instead of being sprawled in bed feeling sick and miserable as one might expect from someone with an unhappy stomach, my brain made me go thru the mechanism of vomitting..i was tracing the diagram from physiology lectures back in first year thru my head as i went through the different steps (sharp deep inspiration, increased intra-abdo pressure, contraction of abdo mm, blahblahblah) that ultimately had me running down the corridor to the nearest bathroom. made it to the sink but not the toilet bowl. eew.. too much info.
anywaaaay.. the point of posting was to say that everything's put on hold til april fools' day. means no more posts. blame my long case. it's at 9.30am this coming wednesday.. it's now officially less than a week to them and yet, i'm still off with the fairies. been downloading songs, learning the chinese lyrics with a live translator hehe (hey, i can sing lin yi chen's "gu dan bei ban chio" off by heart now...but i still can't coherently tell you all about asthma *sigh*), cooking up spaghetti & ma puo dou fu rice, devouring boxes of cookies.. anything but look at the opened books in front of me.
Compy's back! *smoochies* ^.^
despite the ...
- non-stop rain that's been pouring down since last nite
- the @#!* that opened the dryer halfway through my drying cycle so that when i went down 40 mins later.. my clothes were still very much damp and the dryer door was open
- fact that i wasted much of today in terms of study-time
- reality that i may need to do a case presentation on someone i've yet to see tomorrow afternoon
- sinking feeling that long cases are effectively 1 week away
... i'm unnervingly calm and contented *sigh*
*bangs head against wall*
first of all, for those who're wondering why i'm not on msn 24/7 anymore.. no, it's not because i've curbed my online time and finally got down to do some studying. something went *kapish* with my computer saturday nite and by sunday morning, it was barely rebooting. windows was on my c: drive. my documents were on my e: drive, other program files were on f: drive. my cd-rom drive was d: drive... by sunday morning, my documents were now found on c: and program files found on d: ....windows was nowhere to be found. apparently, the partition was still there but only 1mb of it was used up. somehow, i don't think windows takes up 1mb. my comp's been dropped off at the local doctor's (aka tri benedict's @ the junction) for a short stint where they'll hopefully be able to extract whatever files are left on my hard drive, run diagnostics and reformat the thing. now i think twice about telling smokers to quit.. i can so emphatize with their pain now that i've gone cold turkey with no computer for all of the past two days...so here i am at the JHH library blogging... and then there's school. that's a pain in general. not because we've paid our school fees to be overworked.. it's the fact that they expect us to show up and do nothing. it's somehow much more tiring to stand around listening to people talk to us (and sometimes, at us) rather than be involved. when there is a chance to get involved and talk to patients, half of them are too ill, too breathless, too irritated, too aggressive, suffer from short term memory loss, confabulate or have people visiting them. it's friggin annoying to ask someone "so, have you been in the hospital before this time for anything at all? any past surgeries? any other illnesses that you have? anything that runs in the family?" and they answer "no, i'm as good as gold, love... " and then you go read their notes and they've had so many co-morbidities you're surprised they're still alive. kinda nullifies all that talking you did with them for the past hour. so much for that empathy we all professed to embody during our initial medical interviews to get into med school...other than that, there are long cases coming up in less than 2 weeks. arghhhhhhh.. i'm so not ready. the only thing i have down pat with regards to the long case would be probably finishing it within the 1 hour time limit. somehow, i don't think the examiners will be impressed by the feat.and then there's the continuous daily flow of geriatric patients to see because sadly, these patients are not being seen because i want to. rather, it's because i have to. i have to come up with cases to present every week either for psych tutorials or the official case presentation/talk sessions we have twice a week. or just for ward rounds when dr. p*chooks asks for updates on her patients this week.oh and don't forget my 3rd year classes. haven't been to a 3rd year lecture in 2 weeks just because it's physically impossible to get from the JHH to MSB in less than 1 min. that is, assuming i wanted to go in the first place.. but that's beside the point!*sigh* i just need a break *wails*can't wait til april starts.. it's when the madness ends, sometime near when the clocks get turned and i gain an extra hour.. of SLEEP ^.^got a mini break by cookin up a vat of green bean soup and another of egg flower soup over the weekend tho.. *slurp*and *waves hi to Shoooo* lol, i had the mental picture of a closetful of papers falling on top of you as you dug out my last email just so you could reply ^.^
*sigh*
eBay's evil..
i was browsing around and *bam* .. there it was. at first, it seemed kooky. the more i stared, the more i liked it for the kookiness..
it's ebay item 4362292867
sad isn't it..
msn's acting up, i can't send msgs to anyone on my contact list cuz it keeps bouncing back. what do i do? instead of plowing through my stack of ecgs i meant to read tonite, i'm sitting here blogging in the hopes that someone will be online to validate my unnecessary want for that light box that could double as my night lite.. argh!
A and N would be smacking their foreheads right now if they're reading this... and mine too i guess. i know, i need to curb my online window shopping :(
my pet elephant.. well i guess i shouldnt keep calling her that. she does have a name. R came down to apologize for stomping around upstairs... awwwwwww! i couldnt stand the stomping and finally called up to tell her as well as i could w/o sounding nasty. she was so nice about it and apologized, so she got me apologizing for making her apologize... and i thought that would be the end of that. turns out she paid me a visit @ my room.. im assuming the knocking on the door this arvo that i didn't answer cuz i was on the phone would be her. she was all like she felt guilty so she wanted to apologize in person and gave me full permission to tell her to shut up if she ever did it again. turns out she was making her bed this morning, hence the ruckus.
that being said, it didn't mean that my ceiling has stopped vibrating, nor has the boom boom boom-ing (think of the drums/bass in any pop song..) ceased. at least she's aware of it and she means well to be more aware of her footfalls... guess it's the thought that counts. the kimochi. awwww... *cranks up the airconditioner to drown out the booming*
i felt so bad about her feeling so bad.. luckily i had whatever's left of my 2nd year past papers/notes lying around. resp and endo were the only 2 i got back. (yes i bear grudges... long ones at that. i may forget the nerve that innervates the pinky but i don't forget insults.. man, i hate living up to predictions. it's such a taurian thing..) anywayyy.. i passed them onto R. hope it helps her ^.^
3 happy days in a row..
like i said, they scare me. without sadness, there's no happiness. like what the angel of death told piper on charmed today.. you need death so people have something worth living for, so that they'll value life. (omg, to think that i'm quoting charmed to back up my theories.. *sigh* just because i like it doesn't mean i base my values on it!) it's all about balance. yin and yang (whatever that may entail), day and night. right and wrong. ups and downs. each exists as a reference point, a benchmark of sorts, for the other. sooooo... in the cycle of emotions.. if i'm going thru the happy ones, i guess there'll be mediocre and icky days in store soon. on the other hand tho, i did just get out a rut of sorts so mebbe this is just the happiness that was meant to follow. *shrug* i'd like to think so yet i'm a wuss when it comes to pain, so i'd rather let myself prepare for the worst. c'mon storm clouds, i'm waiting for your thunder and lightning ~ meanwhile, i'll just continue dancing with the faeries 
http://www.cafepress.com/aemii
my cafepress store *beams*
...
...
well.. why are you still here?
get your butt over to the store!!
set it up on a whim.. thought mebbe i could get the s03e brain cells back into press if anyone was interested...
for all the s03e peeps, lemme know what kinda stuff you want your brain cells on and i'll put it up. alternatively, i could start up a cafepress store for s03e peeps and email around the login info and password so we can all order what we want, when we want..
AWWwwwwwww! i can't stop gushing.. it's so cute!! ka·wa·ii des ga!
no, it's not melon bun and the boy. it's another J & J couple and even tho it's got nothing to do with me, i've been gushing for the past few hours since i found out they're together hee ~ 
i think it's the maternal instincts kicking in a tad too early. i feel like some proud parent at their son's wedding... *sigh*
He is an old colleague of mine dating back to first year med and She is our junior in 2nd year med who also turns out to my my direct junior both @ RGS and RJC. AWwww...!! They're sucha cute couple and like T said, it's really .. (sigh i wish i had a bigger vocab so i don't have to keep saying AWwwwwww!) AWwwwww!-ish to see J have someone by his side after all these years ^.^
i kinda picked up that there was somethin' more to the friendship when we were sittin there talking tonite.. J was pickin off the flower from J's hair. and then there were the elbow nudging and the other little signs *grin* AWWWWwwwww! i feel like some mad idiot sitting here in my room just grinning to myself.. but they're so sweeeet! it's the perfect picker-upper to end a very tiring day. these things never fail to do that for me ^.^ now i'll be starting the weekend with all smiles 
i didn't know what to expect going to the housewarming but all in all, i'd hafta say i enjoyed myself ~
in the short while i was there, i managed to meet J and a few other med juniors, some of their friends, some of YH's friends, run into M, organize tomorrow's study group with L, point out my bara neighbor, make a fool of myself for thinking that one of the girls from Iowa had a German/Euro accent and telling her that.. and forgetting her name 5 secs after she told me and i repeated it, catch up with J, YH and with T all the way back to bara...i'd say that wasn't bad eh? thank you to YH for the invite.. and for making me turn red lol 
