like a ton of bricks

here's my summary of events regarding the appeal for those interested. i love the way things work around here ~ told to enroll in Obs/Gyn because i've already been timetabled for the next rotation and withdraw from the rest of the Yr 5 courses. you heard right. i've been timetabled for a course i haven't enrolled in. considering that i've officially only emailed the appeal outcome to the Prof yesterday, asking for a meeting sometime this week or the next... and considering that i haven't gotten a reply about meeting times until the University Complaints Manager called up a member of the faculty who called up the Prof this afternoon.

suddenly, i'm meeting him at 9.30am tomorrow. suddenly, i come home 10 mins later to find his reply in my inbox - he was happy to discuss arrangements for next term but can't help me with appeal itself cuz he wasn't involved in the process, contact faculty if any questions. Somewhere in the list of duties befitting the role of Course Coordinator is the line stating that he should oversee or co-operate in the remarking or moderation of students' marks. hmmmmmm...

plenty more inconsistencies where that came from that i shan't bore you with.

as for my long case.. first time i got a borderline and was happy. i seriously thought i was going to fail it. in my current state, i would've came outta that room laughing whether i passed or fail. it was comforting to get encouraging "congrats" from both sympathetic profs. one even smsed me from sydney asking "any news amy?" awwwww! he told me "chin up, that was a case for the fellowhip exams, not for a medical student. you did well considering the stress you've been under" awwwwwwwww... that made my day =)

for those of you who're interested, here's my traditional write-up of my long case:

19 year old girl presented with a diagnostic problem of 1/12 Hx SOB + generalized chest pain on background of similar episode 6/12 ago. She has the current working diagnosis of myocarditis after initial investigations. Other possible diagnoses could be PE, chest infections/pneumonia, other cardiac causes/pericarditis.

SOB - increasing severity over past 1/12 with assoc. dry cough. not relieved by antibiotic therapy/ventolin commenced by GP. orthopnea, sleeps on 2 pillows. PND. no assoc fever, nausea/vomitting, chills, rigors, cyanosis, LOC.

Chest Pain - pt driving car at onset of generalized constant pain similar in quality to heartburn. radiated to L shoulder, neck and both ears. 8/10 in severity, lasting few hours. no relieving/aggravating factors. previous similar episode 6/12 ago - abnormal ECG suggestive of "infection" and d/c on panadol with no further f/u

HxPC -
· Symptoms first thought to be chest infxn, commenced on antibiotics w/o CXR with no resolution.
· GP thought she may have had exacerbation of asthma, commenced on steroids, ventolin w/o lung function tests with no resolution.
· Presented to hospital 2/52 ago to CCU.
· Since being here, she has had a DVT @ R upper arm on Day 2 that progressed to a pulmonary embolus.
· Also had a UTI that has since resolved with antibiotics (?trimethoprim)
· Is now at Day 15 of hospitalization - doing much better. no c/o pain, SOB, appetite well, bladder/bowels normal.

Background -
· unable to recall childhood Hx of illnesses (like rheumatic fever, chromic infections, etc).
· no recent illnesses, travel, surgery, trauma. vaccinations all up to date, no fluvax/pneumovax ever.
· non-smoker. binge drinker averaging once/month. (forgot to ask about IVDU)
childhood asthma - last attack 10 years ago, has not used ventolin/puffers for that long.
· no Hx of diabetes, HT, hyperlipidemia, previous cardiac problems. not obese.
· no other significant Hx on systems review.


Family Hx - significant cardiac Hx on both sides of family.
· Mother's side: mother - "blocked artery" (? coronary artery stenosis)
uncle 1 - PDA, died as baby
uncle 2 - MI @ 50yo a few months ago
aunt - MI @ ? age
· Father's side: father - MI @ 32, died. diabetic.

Meds -
@ home: OCP (levolin)
@ hospital:
warfarin 3mg daily
lasix (frusemide) 20mg mane
aldactone 25mg daily
digoxin 125mcg daily
astrix (aspirin) 100mg daily
prednisone 40mg daily
ramipril 2.5mg nocte
clexane 50mg bd
dilantrand 12.5mg bd

NKDA

SHx - lives at home with mother and brother. works as hospitality trainee, will graduate in Feb '07

O/E - well looking girl of stated age sitting comfortably in bed.
Obs - HR: 56 BP: 95/61 RR: 16 T: 35C Sats: 100% RA
No cyanosis noted. Did not appear to be in distress.
CVS - JVP not seen, apex unable to be felt (tho she states she's got cardiomegaly - would expect a laterally displaced apex beat), extra heart sound heard tho unable to tell if it was S3 or S4. i thought it was a S3 gallop. no ankle/sacral edema.
Resp - no acc mm use. chest clear.
Abdo - soft, non-tender with bruises from heparin injection sites
Peripheries - hands: no clubbing, no splinter hemorrhages @ nails, several small transverse white bands on each nail w/o hx of recent trauma. no signs of anemia. good capillary refill. feet: TEDS worn.

Impression - heart failure due to unknown cause, most likely due to myocarditis/pericarditis. endocarditis less likely given no supporting history. PE/DVT of unknown cause (should've said ? coagulopathies)

Plan - Admit. Pain relief + O2. Routine bloods, coags, ECG, CXR, echo (TTE/TOE), cardio consult. appropriate meds as commenced for heart failure (diuretics, b-blockers, ACE-I). later on, heparin/aspirin/clexane --> warfarin for DVT. trimethoprim for UTI.

there ya go.. *sigh* poor girl. yes, both of us =P

so this is it?

is that a hint of a smile, or a wan expression of tired defeat? after the past 8 weeks of harrowing angst and other unwanted emotions, i peek into my mailbox one last time to check for that letter and there it was. innocuously in the corner that little envelope sat, innocent whiteness masking the string of crisp emotionless words inked by a machine.

i picked it up and opened it in the solitude of my car with the steady pitter patter of rain in the background. no amount of water could wash away that sense of dread, that heavy knot at the bottom of the heart. at least it's confirmed, at least it's tangible, at least i can chase away those little rays of hope in the corners of my mind with finality.

tomorrow will be my long case. the one i wasn't timetabled for. the one i found out i'd be sitting for just 36 hours ago. the one that will count. the one i still need to study for. headed over to see the prof for a practice session today - nice enough of him to offer the extra session, i must agree. it could've gone worse but being told that i'd scrape through with a pass with today's session was encouraging. considering the state of mind i've been wandering these past few weeks with, i'm pretty relieved that i managed something coherent at all.

they say bad luck comes in threes. well, things generally happen in threes anyway. i got caught in a huge downpour yesterday walking to my car. one would've thought i had fallen in a pool if they had seen me walk through the foyer doors. damn headache that came with it. *note to self: listen to mr v next time.* today, i lost my room keys. of all days for such folly, it had to be the night before my long case. bravo. i eventually found them after backtracking back to the hospital after my practice session today and almost got locked in a stairwell to boot. damn autolocking one-way doors. thank goodness for those fire escape doors that had false threats of being alarmed plastered all over it. what will tomorrow bring? please make it inconsequential. i don't think i can take much more.

liar liar pants on fire

fastest way to piss amy off? lie. in any color, shape or form... lie and you'll encounter the blackest face and a death stare.

well actually, i don't know if it's the lie that gets to me or the fact that the person thinks they can get away with bamboozling me. like the time at the dentist.. i scared off 3 other adult patients in his waiting room at the tender age of 8. if i saw him again, i would still tell him "serves you right."

my two front milk teeth needed to be extracted.. the new ones were too cramped and wouldn't descend properly otherwise. mr dentist thought he was oh-so-smart to suddenly talk to me in a singsong voice as he inched towards me, half-hunched with his hands behind his back. i was wary already. a glint of metal from somewhere behind his white coat confirmed my suspicions but i didn't let on. i let him come towards me. he was trying to distract me and keep me talking so he could opportunistically whip out my teeth. i played his game. he said he wanted to see my teeth again and that's when i turned my head away from him. he got desperate, tried to wrench my clenched jaws open... big boo boo, buddy. in order to do so, he needed both his hands and thus exposed the metal pliers he was hiding behind his back. that was the last straw... i yelled bloody murder pretty much, kicking and screaming in that dentist chair of his until he staggered out the room covering his ears to find my parents.

i heard them conspire in whispered voices just outside the door. braced myself for the next wave of attack and the man had the gall to tell me i was mistaken, that he didn't want to extract my teeth just now. being 8 years old, i just reacted and screamed more bloody murder. this time, i called him a liar too. i still remember his face scrunched up in anger and frustration. ultimately, my parents did the distracting and each pulled out a tooth. betrayed by my own family.. sigh. i wasn't expecting that but it ended the ordeal. i later got lightly rebuked for scaring away the next 3 patients in the waiting room with all that screaming but my mom understood why i got so mad and found me a new dentist.

heh, sorry for getting carried away with nostalgia. i was harping on lies because i met up with another prof today who was helping me sort out my issue. i'm dealing with one screwed up faculty, i tell ya. man, would i like to find out who told the year manager "amy has been informed. someone called her last week and she already knows her appeal didn't get through" you are one naive bastard, whoever you are. that statement is so wrong in so many ways...

1. i never received a phone call. i was the one who called up one of them (namely the program convener) and he told me that as far as he knows, my appeal was rejected but this is unofficial information because i needed to receive something in writing
2. both persons i've talked to regarding appeal results have emphasized that what they're telling me was unofficial
3. even if someone from the faculty DID call me to tell me that my appeal was rejected... it wouldn't count for shite when done over the phone.

the prof made a note of that, scribbling that i have not met with any faculty member save the obs/gyn prof who was just as clueless as me... or likes to make the impression that he's clueless. i have my doubts. mr dean of medicine, i hope your head is screwed on properly to your shoulders. i hope that you'll be able to see how ridiculous this whole situation is and that you have some very irresponsible staff. i don't want compensation for whatever policies you guys breach. just do me justice by following your own course outline and pass me.

foot-in-mouth!

They've done it!

It's day 42, their deadline to reply. there is no email in my inbox from the faculty.

my year 5 course coordinator now knows and states "it's not on. you have a case. they broke their own policies" so that's a relief. off to a group meeting. couldn't help but share.. they've kicked themselves in the shin and choked on their own shoe this time....

not quite here or there

today's doomsday.. my self-proclaimed one. i expected to come home to the dreaded email revealing what the outcome of my appeal would be. i went through the day with a heavy heart and my face dragged 4 feet behind me. was too scared to come home and face the email, yet i didn't want to check my mail in the wards so i ended up gathering supplies to bake mini apple strudles and picked up two half cakes at the cheesecake shop in case the apple studles flopped. i decided that if it was gonna be a horrible night full of tears and angst with no power to resolve it til the next morning, i might as well have something to keep me busy with. after all, tomorrow's my last day of this rotation and i had wanted to bring in some baked goodies as a thank you gesture for the staff.

kudos to a certain patient down in ED today for making me laugh til my tummy hurt tho. my registrar got such a kick from seeing me nearly piss myself laughing. actually, we had a lot of funny patients. funny in the sense that it it was so sad it became funny.

this patient in ED was ruddy, obese and would qualify for gynocomastia on inspection. he came with a thick accent that wasn't helped with his oxygen mask whooshing 8L of O2 at him per minute. taking the history was a hoot - he spent 5 mins telling us about this man in a wheelchair whom he helped 3 weeks ago. very important to save him, you know. if he fall in elevator shaft, he die, you know. we nodded with perplexed smiles - after 10 mins, we still couldn't get a presenting complaint out of him. by that time, he had told us his GP diagnosed a hernia in his chest (he meant pneumonia) and he had his balls removed (he had said bowels but his accent said otherwise). best i've heard so far. beats the usual patient complaining about his prostrate even when your next questions include the word prostate in it. he also announced that he'd like to pee, could we take out his catheter because it feels like it's fishing him down there and nipping. "we'll take it out. we wouldn't want it to nip you there" my reg told him. don't worry, i've been nipped before. 0.0 oh dear, i don't wanna know. he failed to mention all his 18 wives but he had told us of his Maori wife he married as a silent protest against aparthied. the stories continue =)

another patient of ours.. decompensated alcoholic liver disease. the one we drained 14L of ascitic fluid over 3 hours from yesterday. that had me worried all of last night. he didn't crash in the horrible sense, phew. in my registrar's words, he looks 52 months pregnant again today. he also got aggressive and tried to run after his 85 year old mother for money "to get home" despite being told free hospital transport had been arranged. we all knew he wanted the money for when he makes a pit stop on the way home for more booze. i guess he remembered he had legs to walk with after that incident. a few hours later, he had the patient next to him in tears. he was up walking for some reason, tripped over her drip stand and fell smack on top of the poor little old lady. she cried for the next half hour out of pure shock. i would too if i awoke to a strange man reeking of alcohol flopped on top of me.

and then there's dear ol' mrs m who has dementia but somehow covers it up so well you wouldn't have expected a mini-mental score of 15/30 on cursory conversation. "can you tell me what you get if u take 7 away from 100?" you ask her.. she scrunches up her face and concentrates real hard in silence for the next minute before she suddenly lights up and says 100 and 7? 100, 99, 98, 97, 96, 95, 94, 93, 92, 91, 90! is that right? *faints* i can only muster a smile and ask her the next question.. what can you do for her? nothing but to keep her happy =( like i said, sometimes all i want to do is to hug a patient or their family members and tell them it'll be all ok. i need to find some faeriedust =(

thank you for the reality check

i feel a mental breakdown in the making, or at least another rant. the only difference this time around would be that i'm too tired. i'm tired. you hear me? that's what you wanted anyway, no? to wear me down enough so i won't fight back.

y'know what? you win. i'm beaten. congrats for cornering me, for leaving me with options that i cannot realistically pursue. thank you for turning me just that little bit more cynical, for teaching me to stop trusting people and when the day comes, thank you for tipping me over the edge.

i just logged on and saw my long case timetable. a very neat timetable consisting of columns telling you exactly when you should arrive, when you should be seeing your patient and when your viva will begin. neat little rows filled with names matched with their exam times. lotsa neat little rows. one glaring row jumped right out at me tho. the one that was missing a name next to the exam times. the one that was missing MY name.

...thanks.

like i said, thank you for the student support. thank you. you say you value your students, especially international ones. that would explain why your webpages for international students don't work after a year. that would explain why the staff info for faculty support staff for international students has been out of date since 2003.

as for my appeal.. i dug through old records and realized that they normally use up their allocated 42-day response window period before sending out an email to let you know of their decision. i guess it's frustrating only because i fear for the worst. living the past 2 months in this constant state of not knowing, of preparing for the worst but never quite managing is bad enough. compound those worries with worries of fulfilling my student visa requirements and things get a tad worse. now add all that to trying to concentrate on my current rotation/exams, all the while knowing the work and effort i spend may be for nought is just plain depressing.

we shall see. they have 2 more days to get back to me. i'm hedging bets that i'll get a reply tomorrow at 5.38pm. that's when they replied last year regarding an error in marking and i had to lodge an appeal too. fingers crossed. i don't know what else i can do.

my five steps of grieving

I.
onslaught of water
from bad news breaking the dam.
puffy painful eyes.

II.
tired but not beat.
will not let them bully me.
determination.

III.
chorus of voices
bring new perspectives and hope.
pillars of support.

IV.
let them coerce
i am but the better one
proving they are fools.

V.
what will be, will be
conspiracies or the truth?
unchartered future.

.

left for dead

count backwards from ten.. count backwards slowly. deep breaths. deeeep breaths.

screw it.

***

dear idiots,

what the hell is wrong with you people?!?!
first, you email me in the middle of the fricking day to tell me i failed a subject, feel free to contact you if i have any questions or worries.

my life goes on, you morons. don't you understand that i have commitments to fulfill and classes to attend to?

you leave me hanging for more than a month after pointless meetings that are a waste of everyone's time. you call me today on my cell phone and leave a message. thank you for having the brains to do that. i'm sorry you didn't have the brains to figure out that continuing my year 5 rotation means i have ward rounds to attend to, things to learn and presumably have 9 - 5 days.

oh excuse me, i'm sorry i forgot you have no concept of what a student's life entails. after all, all you do is plan our timetables. i'm truly sorry you have no concept of what most other people consider a day job.. one that runs from nine to five at least. i forgot your hours only run from eleven to twelve. and i'm sorry i forgot you were blonde. spending a whole 8 weeks in the same building as you must've affected me more than it should've.

you call to tell me there's something urgent, please call back. since you're already on the phone talking to my answering machine, why couldn't you have told me what it was about? you said you'd leave a message on my home phone just in case i didn't get the msg you left on my cell. i saw blinking lights on my home answering machine so i delete your cell msg. were one of the 5 msgs on my machine from you? sadly not. now we probably have some baffled soul somewhere out there wondering "who the hell is this airhead" when they check their answering machine tonight.

fricking idiots. yes, you. i'm talking to you. thank you for leaving me hanging, thank you for screwing the rest of my night. there's no point worrying about it, i know. when you leave me a half-baked message telling me it's urgent and leave me no means of finding out the answer until at least 12 hours have passed, do you truly believe anyone in my shoes wouldn't be at least a tad ruffled? i'm only human. oh, my apologies. you wouldn't understand.

i should so sue u all for emotional trauma but that would be a waste of resources. if anything, you guys are completely responsible for turning me into a bitter ranting bitch who will eventually be responsible for other human lives. now do you really want someone mentally unstable treating you when you fall sick? should you encounter one in the near future, you only have yourselves to blame.

in the meantime, i will be watching out for your nominations for the darwinian awards. good luck. with your track record, i'm sure you'll make it into the top 10 any time now.

from the bottom of my heart, and i mean bottom bottom. like 6 feet under..
amy.

just wishin' and hopin' and thinkin' and prayin'

you know i'm in a good mood when i start humming or bathroom singing =) what brought about the crooning? besides watching the australian idol auditions and nearly pissin' myself laughing with some of the loonies that showed up, there was also some good news of finishing our team's grand round powerpoint presentation for tomorrow.

loading individual CT slices, one slice per ppt slide for three different CT sessions was definitely not fun. at least the end result was kinda worth it - it was like watching one of those flipbooks going thru all the CT slices back to back.

i also came across something right up my alley, something that's on par in my books with the likes of coolhunting *beams*

if i had a wishlist, it'd look like coxi's life fever. one more reason why i can't wait to move out and start house hunting and decorating. now if they'd just approve my appeal so i can get on with my life... seriously, They'd be so liable for inflicting emotional trauma. i'm sure i could come up with a valid arguement and get a psychiatrist to back me up.

in the meantime, here's something sappy. found it as a fowarded email from my cousin angie.. forwards usually never make it into my inbox, let alone have the glory of taking up the full area of my monitor. this one did, and aside from the usual pishposh about having bad luck for the next umpteenth years if you break the chain... this one's actually kinda sweet.

family. 'twas described as father and mother i love you. now say it with me... awwwwwwww!

but i'm only human

[braindump alert] - be warned of random ramblings. it's hard to concentrate on anything nowadays when my academic future is still hanging in a limbo. that would also explain the anti-social and pms-like behavior of late.

jj used to tease me about starting up a daycare center with all the little 'uns i pick up, esp through tibs. nowadays, i have yh teasing me about my geri-club with all the cute old 'uns i pick up in the wards. *sigh*

it's hard drawing personal boundaries sometimes. it's a good thing i'm more headstrong than heartstrong in a way in this respect i guess. a few weeks back, i was telling my mom how hard it was to restrain myself from giving a patient hugs sometimes just because it would be inappropriate. complete strangers, they are.. crossing paths only because of unfortunate circumstances, yet i'm always amazed at how much impact the ripples of collision make.

***

how do you tell the person whom you've been having daily chats with, the one you wave hi to every time you pass their bed. how do you tell him he's got bowel cancer that's spread to his lungs and liver when all he knew just a second ago was that he came in with diarrhea? damn heartbreaking to wave hi to him a few hours after he found out, only to receive a wholehearted attempt to smile and put on a brave front before catching his face fall out of the corner of my eye as i turned to put in a cannula on another patient.

i wish i could've given him a hug and tell him it'll be ok, everything will be fine.

***
how do you make the dear little widowed german immigrant in the corner bed by the window feel better when he's down with a nasty bout of pneumonia and tells you he's been sleep deprieved for the past 3 days? he's in with 5 other ppl in the same room and half of them are "pleasantly demented" - they rave and ramble at all hours in perfect bliss. he's got emphysema and his lungs aren't doing too well. temazepam won't do. we never got around to trying out the efficacy of antihistamines on him. he passed away with his family by his side, frail and exhausted from battling the infection. exhausted from struggling to breathe. exhausted.

i wish i had the power to give him a single room so he could get his much needed sleep. then he might have recovered well enough to flash me his little smile as his way of saying hi. after all, the overweight man huffing and puffing across from him at the time was in a worse state than him but managed to recover in a matter of days and leave the hospital alive. i wish my little german immigrant could have done the same.

***
how do you not feel sorry for the little old lady who is so insecure and desperate to belong that she starts crying when we tell her she's well enough to go home, the paperwork's all ready. "but my daughter will only be here at 4pm doctor" she whimpers. "someone else must need my bed, i understand you're all very busy. will i get to sit in a chair somewhere to wait for her? " she beseeches. the poor dear thought she was getting kicked out of the hospital and hence the ensuing display of waterworks.

i wish there was a way to make her feel secure all the time, to make her realize that her family does indeed value her very much contrary to her beliefs.

***

it's hard not to start treating the patients like one's children when you see them on a daily basis. it's hard not to feel some sort of attachment when you've seen them go through some of the worst times and then see them recover. it's hard not to feel like a proud parent after knowing their personal life stories and see them go home knowing they've fought bravely and won the round this time.

it's been 5 weeks into this general medicine rotation and i've absorbed many lessons and moments that can never be taught. it seems not so long ago that i had the fiasco regarding my results. that still hasn't been resolved - no news from the appeals committee yet but it's slowly fading into distant memories. i'm more than ready to bury the emotional roller coaster from those weeks under 18ft of dirt but i'm scared of letting go. letting go means that should the news be bad, the emotional roller coaster will rise thru all that dirt with greater force and speed than before. i'm not quite sure if i can handle that.

one of the GPs i saw in year 1 was an alumni from this university, from this very same course. she had asked how i was coping and if i had wanted antidepressants. it's normal.. a lot of students, especially 4th adn 5th years were on them, she explained. i still remember thinking "what the hell would i need those for? crazy lady, i think she's the one that needs random meds" five years later, i understand. i totally understand although it seems that antipressants may not be enough. i think a drug cocktail would be more apt.

i wish someone had warned me of what i was getting myself into five years ago on orientation day. i love the clinical work and some aspects of the course, but man... i am so ready to get outta the system! (but i heard it's a case of "out of the frying pan and into the fire")