Wrap-up

Time for a quick post before the end of 2009.

I guess, overall, this was a better year than 2008, though I didn't love 2009 either. I didn't fail any exams, but I certainly came close and was constantly stressed about it. I had too many things on the go, with studying, work, and the yearbook - I feel like I'm only now getting back on track. I remained single, I put on weight, I hardly did anything photography-wise, and yet again I didn't pick up my violin. And I remain in debt, living week to week. Hmmmmm, not such a great year after all.

Tying up some loose ends:

• I really enjoyed my O&G rotation - enough to briefly consider it as a career. However, I wasn't so keen after talking to the registrars. The training program and the specialty itself have a massive impact on your life, and that's a big turn-off for me. I enjoyed the gynae part the most - it's essentially a surgical sub-specialty. Obstetrics was also better than I expected. I assisted with several deliveries, and nearly got the chance to deliver a baby myself (rare for med students at my uni - unfortunately the labour didn't progress before the end of my night shift). I made it through the exams, though again tried very hard to fail (especially the OSCE).


• The yearbook is now onsale, and I've had some great feedback on it. I'm really happy with it, but disappointed about some printing errors. Most people won't notice, but after I gave up so much of my free time to get it right, I was devastated to see the errors.


• At the beginning of December, I returned to South Australia for my final John Flynn placement. I was even less motivated than last year! It went fairly quickly though, and I took the opportunity to catch up on lots of TV shows and DVDs in the evenings. Medically I got to do the usual suturing and vaccinations, etc., and this time I also dealt with several mental health patients, which was rewarding. The best part was going to McLaren Vale, Hahndorf, and the Barossa Valley with a friend from Sydney after the placement was over. We tasted some beautiful wine (Torbreck was my favourite), cheese, and chocolate.

So now it's New Year's Eve, and for the first time, I'm spending it alone. Several of my close friends are away on holidays, and although I could've made the effort to find a party somewhere, I eventually decided to park myself at my friend's place (I'm housesitting), and have a BBQ by myself. I'm looking forward to it! I'm going to have a bath, and some wine and cheese, and a special icecream dessert that I purchased from Glacé this afternoon. At midnight I'll have some champers, and then have a lovely long sleep without being woken by my housemate, his dog, or my neighbour's dogs. Bliss!

Happy New Year! And thanks for reading.

Scary age

My two best friends and I were all single in our mid-to-late twenties, and would often get together for nights out and many bottles of cheap wine in inner west pubs. Inevitably we'd end up lamenting the states of our respective love lives (or lack thereof). It was around this time we discussed the concept of 'scary age' - the age at which being single would change from being a mere annoyance to something more serious. Vaguely aware that one's fertility is said to decline from around age 35, we fixated on 35 as 'scary age'.

It was my birthday in late September. No prizes for guessing how old I turned. And yes, I'm still single. (Those two friends are no longer single - one got married last December, and the other gets married in two weeks.)

It's a tough age to be single. I'm very independent and like things to be just-so, and the thought of introducing a partner into my very busy life at this stage seems daunting. And it's harder to meet someone - that's why I've tried the speed dating, the online dating, the getting-drunk-and-picking-up-dodgy-men, etc. And if I meet someone, they will be all too aware of the whole declining fertility thing too, which is a lot of pressure to put on a new relationship. Even if I met someone today, it'd take a while to build up to being ready to have a child with that person, during which time my fertility would continue to decline. Gah!

I've been single for about 18 months now, which sucks. But I really only have myself to blame - I've been so busy this year that I haven't wanted to be proactive about dating. That'll change soon, hopefully. (I'm also unhappy with the way I look, which is daft, and will also change soon.) Happily, I still have several single female friends, so we can arrange to go out together when the couples are coupling. (Hmmm that sounds dirty - didn't mean it that way! Also, who else loves Coupling [original UK version of course]? I have the DVD box set. /tangent)

I'm currently doing my Obstetrics & Gynaecology rotation. Almost every lecturer and tutor has mentioned the declining fertility from age 35 thing. By the end of a full week of lectures, I was ready to punch the next person who brought it up! Admittedly, most of the lecturers delivered the message with sensitivity, but some were complete wankers about it - the worst thing they can say is, "Don't leave it too late, don't delay having babies so you can have a career", etc. You can't accuse someone of leaving it too late if they're single!! I can't have a baby by myself!

Or can I? Reaching scary age has got me thinking about the other options. There was a great guest post on Mamamia a few weeks ago from this blogger, about using a sperm donor. I think it's something I should consider, or at least have in the back of my mind. On a few drunken occasions this has come up with one of my gay friends, but it's never been seriously discussed, and probably should be at some point. The other thing to consider is freezing my eggs while I'm still fecund (love that word), although my understanding is that that isn't a particularly successful way of conceiving - but I guess the technology continues to develop.

Of course, it would help if I didn't want to have kids. But I do. I don't care about the marriage part so much (life partner = yes; marriage = if they really want to), but kids are important to me. My career is important too, but I'm willing to put it on hold for the sake of having kids.

We finished the yearbook last night (OH HELL YES WE DID), so my life will slowly return to 'normal', if there's such a thing. O&G study takes centre stage for the next month, but so do exercise and social life and everything else. It's time to turn my life around!

Identity theft

I've just remembered some things that particularly struck me during my Paeds rotation.

On ward rounds, the doctors would always say hi to the parent/s (usually mother, but sometimes father) - but instead of greeting them by name, they'd say, "Hi Mum, how's little Johnny going today?" I saw this time and time again - in fact, I never once saw a parent referred to by their name. I felt bad for the parents. Sure, the child is the one who's sick and needs attention, but it's damn hard for parents to give up work, or caring for their other children, to spend time in the hospital. And on top of all that, they lose their identity and are reduced to the generic "Mum" or "Dad".

I also felt bad because the parents often have no idea how long they'll be staying in hospital - that's par for the course, as it really depends on how quickly the child recovers. But for a parent who's never experienced this before, it must be so frustrating and daunting. Each day they wait for a visit from the doctors - sometimes first thing in the morning, often not before midday - to discover their fate, and often they're disappointed to find that they're stuck in the hospital for another day, or a weekend if it's Friday.

A couple of patient encounters particularly bugged me:

• One 3-year-old child had been in hospital for weeks, and his poor Mum looked frazzled. I ended up taking a detailed history from her, and found out that she also had a 4-month-old child, had recently split from the father of the second child, and was going through a bitter legal dispute with him (he had assumed custody of the child). She had to sit there and entertain her sick, bored and cranky child each day, while also trying to deal with these legal and relationship stresses. I don't know how she did it. In the child's notes I was pleased to see that these issues had been identified, and that the social worker was involved.



• During my farcical week of surgery, we went on a lightning quick ward round. One mother was confused because two groups of doctors had been to see her. Who was in charge? Who should she believe? It was clear that she had questions, but the doctors blew her off and she was left floundering. Another student and I trailed out of the room behind the team, and he said to me, "How would you evaluate that patient encounter?" I said, "Possibly one of the worst I've ever seen." He agreed. It was tempting to go back into the room and have a chat with the mother, but who were we to do that? We didn't have the information she needed. I wish I'd spoken up, but I'd only just met the doctors on my team - in fact, they hadn't bothered to give us their names, and never asked for our names. (That's a pet hate, by the way - it happens all the time.)

So endeth my random observations.

Kids! I don't know what's wrong with these kids today...

I've finished my Paediatrics rotation. It kinda sucked. I loved the kids and could easily see myself working with kids, but my weekly placements within the rotation sucked, and that ruined it for me.

My first week was spent with the Renal team, and I was looking forward to solidifying my renal knowledge, and learning about kid-specific things too. But it was dull - with only one or two inpatients, there wasn't much for me to do. Clinics were the main part of the week, but it really gets dull sitting there, not interacting, hour after hour, day after day.

My second week was General Medicine. Two or three students are attached to each team, and we basically spent the whole time walking around on ward rounds that lasted several hours. Sometimes, if we were lucky, we got to write in the notes. Mostly we were ignored.

My third week was in the Child Development Unit. I'd already heard that it was pretty cruisy (finishing at lunchtime each day), and that was fine with me. But the time I spent there was pretty useless. One day I had to sit behind a one-way mirror to observe a session with an autistic kid, but they hadn't bothered to check whether the audio equipment was working, so I sat in silence and ended up playing with my iPhone for an hour. Then I was told that the doctors would be on a conference later in the week, so I really only experienced three half-days of questionable value.

My fourth week was Anaesthetics. I specifically requested it, and I'm glad I did. Everyone was friendly and they let me do lots of stuff, including cannulation and intubation. And during the operations I chatted to the anaesthetists about the pros and cons of their chosen career. Finally, a good placement!

My fifth week was General Surgery. It was SO frustrating. We had to be there at 7am for ward rounds. But the rounds never started before 8am - one day we waited until 8:30am! Not happy after getting up early to drive a considerable distance to be there on time. Also, on the first morning the registrars on our team told us that there was only one day of theatre that week because all the doctors would be at a conference. That also meant they wouldn't be admitting any patients, so there was absolutely nothing for us to do. They had three or four neonatal inpatients, so the ward round was over really quickly - and then later in the week, the NICU was closed because of a pertussis outbreak! While it was good to have spare time so close to exams, it was ultimately disappointing.

The other weeks were made up of lectures and exams. I passed the exams, but gave myself a bit of a scare. I had a brain freeze during the written, and ended up passing by one mark. I was convinced I'd failed. Similarly, I stuffed up one of the stations in the OSCE - I knew I'd failed that station, but had to pass the other three stations to pass the OSCE. Luckily I scraped through, but only just. I spent three days sick to my stomach with worry, constantly in tears - not the best when I was supposed to be studying! The annoying thing was that all of the exam questions (written and OSCE) were from past papers, so it should have been a breeze. I really need to get over this exam anxiety already.

Apart from Paeds, I've been continuing with the yearbook. We've collected profiles from most students now, though some are being particularly difficult about it. We've even got some "conscientious objectors" who don't want profiles in the yearbook. WTF? We'll be editing all the content over the next couple of weeks. It's slowly coming together...

And in my massive amount of spare time (yeah right), I'm helping to organise a Vietnam fundraising dinner and my friend's hen's night. I am mental.

Acceptance

In case you don't already know via other social networking sources, I got my 7th preference (out of 14) for internship. It's Wollongong.

Pros:

• I have lots of relos down that way
• It's near the beach
• I went to Wollongong Uni for four years (in the mid-90s), so I'm familiar with the area
• It's not too far from friends and family in The Shire.

Cons:

• It's too far from friends and inner-city lifestyle in the inner west
• It's not in Sydney
• I have to move house, and a considerable distance.

I've been whinging about it, but the pros outweigh the cons - I need to just shut up and get over it. I tried to swap, but no-one wants to swap into Wollongong - only out of there! So today I bit the bullet and accepted the place.

It seems like people either got their first choice or their 7th/8th/9th choice. I've heard of a few in-between, but they're the minority. So much for IMET telling us that everyone gets within their top 4 or 5! On average, maybe.

In other news, I've just finished my week of holidays. I had grand plans for the holidays - especially working on my photography. Unfortunately I got the (most likely, swine) flu last weekend, so that ruined it. I had no energy and was very unwell, especially earlier in the week. I seem to have come good now, but my throat's still not 100%.

So it's back to uni tomorrow, and I feel like I've hardly had a break at all. I'm doing Paediatrics, and I really wish I had more energy before starting this block.

Also, I recently agreed to take on the role of Yearbook Editor for our class. This may prove to be a very unwise move - I always over-commit and end up stressed out. Although it certainly is a good role for me - project management, editing, proofreading. It'll really test my powers of delegation! (And I'm very happy to have Liz helping me out...)

Bedtime!

Triple J Hottest 100 Volume 16

All this talk of the Hottest 100 of All Time reminds me that I haven't reviewed the most recent Hottest 100 CD.

I really love this collection. Here are my picks...

Hottest 100 16 (2008)

• Favourite: "Burn Bridges" - The Grates
• Hidden treasure: "Dawn of the Dead" - Does It Offend You, Yeah?
• Shit: "Jungle Drum" - Emiliana Torrini
• Best grammar reference: "Oxford Comma" - Vampire Weekend

Ponderous

Does anyone remember this song? I loved it back in the day:



So the Hottest 100 of All Time has come and gone. No surprises about #1 (Nirvana, "Smells Like Teen Spirit"), though I was very pleased with #2 (Rage Against The Machine, "Killing In The Name Of"). Thought there would've been more women in the list - the only lead vocals were Massive Attack's "Unfinished Sympathy" (LOVE that song, and the video) and "Teardrop" (not a fan, can't believe it charted so highly). Surprised that Björk didn't make an appearance, let alone Tori Amos and PJ Harvey. (I know I didn't vote for them, but they're JJJ favourites.) Only one of my top 10 songs made it into the list - Jeff Buckley's "Lover, You Should've Come Over" at #56. No R.E.M.! Devastating.

In other news, I've pretty much finished my GP rotation. Just one presentation and one quiz left on Wednesday. The second part of my rural placement in Menindee was, as predicted, very dull. Many days with no doctors and very few patients. As planned, we got our assignments done, and I also worked a lot (gotta keep earning the big bucks).

We were in Menindee for a weekend without a car, and it was very painful. We asked to borrow one of the Health Service cars, but we were declined in no uncertain terms. In fact, the whole time we were there no-one took us for a drive around town. And seeing as Menindee is all about the lakes outside of town, we were not impressed. The sunrises and sunsets were lovely though. And we frequented the pub, playing pool (badly) against the locals. Aaaand of course there were some good photo opportunities.


Foggy sunrise in Menindee


Alongside the Darling River in Menindee (I really like this one for some reason)


Pro Hart sculpture in Broken Hill

Back in Sydney (finally), I started my three-week urban placement at a bulk-billing GP practice in the city. I expected a lot of transient patients, but was pleasantly surprised to find that a lot of people use the GPs there as their regular GPs, because they don't have time to visit their local doctors outside of work hours. Unfortunately, being a bulk-billing place we had SO MANY people with colds, wanting medical certificates. If they'd had to pay, there's no way they'd have bothered coming to the doctor. I caught two colds during the rotation. Plenty of 'flu cases around too, including swine 'flu.

My GP supervisor was very friendly. He was happy for me to see patients, so I was relieved that I didn't have to sit there and watch him all day. (Watching him type notes onto the computer was especially painful, but he soon realised that and let me do the typing.) We alternated with each patient who came in (unless it was a WorkCover matter, which I let him deal with). I did heaps of vaccinations and am very confident with those now. Far too many patients needed their ears syringed - gross! I'd be happy to never do that again! Lots of STIs, a bit of this, a bit of that. It wasn't too bad.

My supervisor gave me some nice feedback. He said that I'm a good listener and can quickly establish rapport with patients (which I knew already, but it was nice to hear anyway). On my evaluation form he wrote, "Will make a great doctor". Awwwww.

So why am I ponderous? Well of course doing this rotation makes me think about my career path again. My main areas of interest so far have been Psychiatry and Anaesthetics. GP is also a possibility, because I could do a lot of Psychiatry as a GP. I'm good at establishing rapport and talking to patients - considering that, perhaps Anaesthetics isn't for me? Perhaps I wouldn't be playing to my strengths. Hmmm much to think about, but no rush...

Spinning on that dizzy edge

Triple J are running the Hottest 100 of All Time in July. They last did it back in 1989, when this song was number 1 (I suspect it'll be up there this year too):



I voted this week, and it was difficult! First you creat a shortlist, and then you select up to 10 favourites from that list. You can also nominate your number 1 song, which enters you in a prize draw.

I browsed my iTunes collection (over 10,000 songs) to create my shortlist of 55 songs. From that, I had the torturous task of selecting just 10 songs. Here they are (in no particular order, apart from number 1), with my reasoning behind each choice...

1. 'Just Like Heaven' The Cure

Click here (YouTube embedding disabled).

This song just makes me happy - the melody, the lyrics, and the association it has with happy moments in my life. Also, I love to dance to it. In my loungeroom.

(The Cure's 'In Between Days' could've easily made it into the top 10. I love to dance to it too.)

2. 'Find The River' R.E.M.



That's the acoustic version - you can find the original music video on page 2 at this site.

R.E.M. are my favourite band, in case you hadn't already figured that out. 'Find The River' and 'You Are The Everything' are my two favourite songs, but 'Find The River' wins for the sheer joy I feel listening to it. The instruments, the harmonies, the lyrics - perfect.

3. 'Disarm' Smashing Pumpkins



This song reminds me of uni in the early 90s. I have a specific memory of a summer holiday down the south coast of NSW, listening to this song over and over. We especially loved the line, "To wither in denial".

Oh yes, and I should mention - as a (bad) violinist, I love string arrangements in pop/rock songs. *swoon*

4. 'Light & Day' The Polyphonic Spree



This one should also come as no surprise. A beautiful, joyful song. Great to sing along to in the car. It's a good motivational song too.

5. 'I've Got A Plan' My Friend The Chocolate Cake



One of my favourite Australian bands. I first discovered them in the early 90s with my first boyfriend (he's now gay, and one of my best friends, and isn't that a whole other story?), and I've lost count of the number of times we've seen them live. This song in particular resonates for me, but there are so many to choose from.

6. 'Lover, You Should've Come Over' Jeff Buckley



The 'Grace' album is amazing of course, and many people love the more well-known songs like 'Last Goodbye', 'Grace', and 'Hallelujah', but I adore this one. My favourite line is, "She's the tear that hangs inside my soul forever". I was lucky enough to see Jeff in concert in 1995 - amazing.

7. 'At First Sight' The Stems



My favourite Aussie love song. "Just say the word and I would die for you."

8. 'The Rainbow Connection' Kermit the Frog



What's not to love? I saw The Muppet Movie at a drive-in in 1979 or 1980. We owned the LP soundtrack too. Hmmm, I wonder if my Mum still has it somewhere...

9. 'Even When I'm Sleeping' Leonardo's Bride



Another wonderful Australian love song. I saw Abby Dobson perform this at The Famous Spiegeltent in December last year, backed by her old bandmate Dean Manning. It brought a tear to my eye.

10. 'Crash Into Me' Dave Matthews Band

Click here (YouTube embedding disabled).

I was a late convert to the Dave Matthews Band - they're not hugely popular in Australia (at least not on the radio), and I first heard this song on an American workmate's computer back in about 2005. I quickly amassed all their albums, and saw them live in 2007. They've just released a new album, which I need to buy. I love many of their songs, but this one is my fave.

**************************************************************

So - what's your top 10?

Country feedback

It's the beginning of week 3 of my GP term and, as predicted, I'm bored.

I'm on my rural placement in far western NSW with another student from my uni. We thought we were going to Broken Hill, but we've actually done one week in Wilcannia, and just started a two-week placement in Menindee. They're both very small towns.

Wilcannia was an eye-opener. It's a really depressing place. It used to be a thriving riverside town - the beautiful old sandstone buildings are a reminder of that time. But now it has one shop (a supermarket where, for example, broccoli costs $13 a kilo), one pub, and one club - and a raft of social, cultural, and health problems. There is a large indigenous population.

The hospital is very nice (another gorgeous sandstone building), and our accommodation was better than expected. But we couldn't go out at night, and felt very isolated. Even walking to the supermarket at 4pm on a Wednesday meant encountering groups of drunk men walking the streets.

It's a frustrating place. I have a lot of respect for the people who are trying to make it better, but I don't know how they can handle it. Small steps, I suppose. Health has improved in recent years with the implementation of a chronic disease monitoring program, and an early childhood program. Change is coming - slowly. But there's just so much that needs to be done - not just in healthcare. It's a place that many people have tried to fix over the years, but the list of failures is long.

One night we put our names down for ambulance/ED callout, and were woken at 1am. There was a brawl - one man had been glassed and he was in the ED, very aggressive and not allowing anyone to examine him. It was obvious that he hadn't just been drinking. Drugs are having more and more of an impact on the community. The perpetrator was there too - he'd broken his arm.

I was given the task of examining a woman who'd come in after having the crap beaten out of her by her drunk partner. I'd never examined an assault victim before (I'm sure it'll be all-too-common next year though), and I was pleased that I stayed calm and got a good history and did a good examination. In the ED we have to phone the on-call doctor at the RFDS base in Broken Hill, and she was happy with my assessment. Thankfully, the woman was not too seriously injured (no broken bones).

We found it hard to learn much about general practice because the doctors weren't there every day. One day, the RFDS doctor couldn't land due to fog, so we ran his clinic and called him to sign off on what we were doing. Sounds interesting, but it wasn't too challenging and we weren't getting feedback on our performance, so it didn't feel worthwhile. The clinic staff were very grateful for our help though. The worst thing we saw was a child's infected scalp still crawling with lice. (I just typed that and then scratched my head - happens every time I think about lice.)

We arrived in Menindee this morning, and the healthcare setup is more of the same - except there are even fewer doctors here, and fewer patients coming to the ED. Today dragged like you wouldn't believe - and I'm here for 11 days. Thankfully this town is more functional than Wilcannia (two shops, two pubs!), and we feel safe walking around. But it's cold and windy and rainy, and we've already had enough.

The aim for the next two weeks is to knock over all of my uni assignments so that I can relax when I get back to Sydney. It'll be good to do my urban placement with one GP who I can build a relationship with over the three weeks, and hopefully learn from.

PS. We were quite amused to see that Wilcannia Hospital made the news while we were there! Thanks to Yay for letting me know...

That shrinking feeling...

I've been absent for a while - a couple of months I guess. I thought about posting during that time, but Twitter seemed to suffice.

I wanted to talk about how much I was enjoying my Psychiatry rotation, but as I got closer to exams, I started to worry about failing again, so I decided not to tempt fate and only post if/when I passed.

Well, I'm posting, so that means I passed! Yay!

It'd be ironic if I ended up as a Psychiatrist. My first degree was in Psychology, and by the end of it I was pretty sure I didn't want to be a Psychologist. I distinctly remember saying, "I'm not interested in listening to people talk about their problems all day". Such a load of crap - obviously there's a lot more to Psychology than counselling, and if I'd gone on with it I imagine I would've ended up doing some sort of HR role. But at the time, the thought of doing a year of supervised training (with a small salary) turned me off the idea of Psychology as a career, and I never went back to it.

With Psychiatry, you can end up listening to people's problems all day, but that'd be more common in private practice I think. That's where the money is of course, but I know I'd get bored with it. Public psychiatry definitely has some appeal.

My first placement was with the drug and alcohol team. I mostly saw patients affected by alchohol dependence, though I did encounter some IV drug users too. It's a frustrating area, because relapses are so common, and recommendations so often fall on deaf ears. To work in that area, you'd need to redefine "success" - it's not curing someone, or even getting them off the substance they're using. Small victories are important - avoiding complications of their addiction, getting them into a rehab program (even if they don't complete it), and so on. I had a long chat with a 40-year-old man with longstanding alcohol dependence. He'd tried all the rehab programs, various pharmacotherapies, and so on. He had advanced liver disease and brain damage. He was due to be discharged the day after I spoke to him. I asked him the likelihood of him drinking again after discharge - that day, or that week, or that month? He said he would be drinking again by the end of the week: "I know I'm an idiot, I know it's making me sick, but I'm going to keep drinking."

My second placement was in the community. It was quite interesting, but I don't have any exciting stories to tell. The placement was interrupted by the Easter break, and also the registrar I was with had holidays in the second week, so I had a lot of spare time!

My final placement was in the acute unit at the hospital. I really enjoyed it. All the registrars were friendly and helpful, and I was lucky to be allocated to a good team with a friendly consultant too. I interviewed a lot of patients, mostly with psychosis. I practised my interview skills for the long case, which I did last week. My registrar also saw patients in the eating disorders clinic, so I attended that a couple of times. Those patients made me want to tear my hair out - so self-obsessed, so painful. Not an area I'm interested in. The consultant was really encouraging. One day she invited me to coffee with her and the registrar. All three of us were in our 30s, and had plenty in common, so it was great to just relax in the sunshine with our coffees and have a good old chat. We ended up being there for over an hour!

My long case went well. My patient didn't have many overt signs of psychosis, as she'd been in for a while and was medicated. I asked her whether she'd ever heard voices, received instructions from the TV, etc. and she denied it. However when I read her notes afterwards, she'd come in with all sorts of delusions and auditory hallucinations! After the long case, the examiner gave me some excellent feedback. He said that the questions I asked the patient were at the expected (medical student) level, but my interviewing style was more advanced. He said I'd fit in very well in Psychiatry. It was really nice to hear and I was a happy camper for the rest of the day!

The exam was a couple of days ago - 60 multiple choice questions. Some of the questions were easy, some ridiculous, many tricky. A lot of the questions had several reasonable options to choose from - for example: Naked man on a farm, talking to himself - what's your first step? Options included establishing rapport, asking if he has weapons, giving him some clothes, etc. We also got the pavlova and Vegemite question that Liz mentioned last year. Anyway, I felt OK about the exam, but I made the mistake of chatting to people afterwards and talking about the questions. I started to get nervous when I realised there were a few I'd stuffed up.

But I passed, and all is good in the world. I'm excited to have a week off! Holiday plans include exercising a lot, learning how to use Photoshop, playing with my camera, getting my recipe collection sorted and trying out some new recipes, working (my clients have saved up a lot of work for me because I've been unavailable while studying for exams), giving blood, watching lots of TV (the list includes Arrested Development seasons 2 and 3, Mad Men seasons 1 and 2, Scrubs season 7, Dollhouse, Brothers and Sisters season 3...), and playing my poor neglected violin.

GP rotation is next. I suspect I will be bored. Hopefully I'll get a chance to do things (e.g. procedures, examinations), instead of just sitting there watching the GP at work. I still don't know where I'm going for my rural or urban placements - apparently we'll hear about the rural placement this week.

Also - I submitted my preferences for internship. They're due on 1 June, so I've got time to change my mind, but I'm happy with them for now. Exciting! We find out on 20 July.

Holidaying and tweeting

So much for my resolution to post more on my blog!

I finished my elective back in Hanoi with O&G. It was certainly eye-opening (and eye-watering - brutal episiotomies!) but I found it quite frustrating and dull. Only one of the doctors spoke decent English, and he wasn't particularly interested in teaching or showing me around, so I often found myself at a loose end. And while I felt privileged to experience the miracle of childbirth (not first-hand, thank goodness), it got very boring with no-one explaining the finer points of the procedures.


A baby born via Caesarean

I witnessed an abortion that affected me more than I thought it would. The patient had rheumatic heart disease and was not expected to carry the baby to term, so the decision was made to abort the 15-week foetus. The patient had been given some sort of local or spinal anaesthetic before we arrived, but it was clear that she could feel the instruments and was in pain. She was not sedated. A 15-week foetus is about 10 cm long, so the doctors used the instruments to break it into pieces for easier extraction. At one point, a perfectly-formed foot was removed, about 8 mm long. That really got to me. It also bothered me that the doctors pointed out each part of the foetus as it was removed - in Vietnamese and English. The English was good for us because it helped us to learn, but I don't think the patient needed to hear the details. I wish she'd been sedated.

So with my elective finally complete, I made my way to Thailand for a long-awaited holiday! I spent a couple of days in Bangkok and crammed in some shopping and sightseeing, then headed south to Railay Beach, near Krabi. It was perfect - a sleepy resort peninsula only accessible by long-tail boat. It wasn't too packed with tourists, the beach was gorgeous, the sunsets were divine, and the food was delicious. I must admit I was feeling a bit of trepidation about spending a whole week at a beach resort by myself. It worked out well though, and I had a great time doing very little. I didn't realise how tightly wound I was until I started to unwind...


Transparent sea at Phra Nang Beach, on the same peninsula as Railay Beach


Sunset at Railay West Beach

Now I'm back in Sydney, with one more week off before I go back to uni. I start with Psychiatry, which I'll hopefully enjoy, considering I have a Psychology background.

Now to the blog. I'll continue to write here when I have something substantial to say (longer than 140 characters!) or photos to share. Otherwise, cast your eyes to the right and you'll see my Twitter feed. You're welcome to follow my tweets: @pathologic_kt

Cacophony

I like silence. I find it difficult to sleep unless it's very quiet. I wear earplugs to sleep back home in Sydney (I live under the flight path, on a busy street). And if I'm sleeping beside a snorer, well, that means I get no sleep.

So you can imagine that I'm struggling a bit with the noise in Vietnam. I feel like I haven't had a decent sleep since, I don't know, December? I also get migraines - I've had a few since being here, and let me tell you, they're not much fun. Thank God for triptans.

Having been here before, I knew that I would constantly hear horns - motorcycles, cars, buses. After a while you get used to them, because they rarely stop. And I'm staying in hotels, so of course there'll be noise from other guests and their TVs, and clueless hotel staff.

In Hanoi there are always renovations happening somewhere, and the workers start early and finish late. They're currently restoring the "footpaths"* in the Old Quarter, so that's additional noise.

My hotel backs onto Tin Street (Hàng Thiếc), where various tin products are constructed and sold. So from first thing in the morning until the evening, I hear hammering on metal and angle grinders.


Tin Street

In an earlier post I mentioned that I was woken on Tết (New Year's Day) by the sound of ABBA singing "Happy New Year". I waited for it to end so that I could go back to sleep, but it was not to be - I had to listen to the whole "Best of ABBA" CD. (It sucks you in though - I was singing along to "Super Trouper" in the shower.)

With music and TVs, there are only two possible settings here - off, and VERY FUCKING LOUD. Everything goes up to eleven.

In Hanoi, the other thing that gets you first thing in the morning is the loudspeakers that suddenly burst to life with either a woman speaking very loudly in Vietnamese (apparently, she's announcing the lotto numbers), or very loud music (a muzak version of Bryan Adams' "(Everything I Do) I Do It For You" was especially memorable).

And in the evening, there's a distinctive clanging noise that goes on for about half an hour. It's the garbage collector making the rounds of the Old Quarter on foot. Granted, it doesn't wake you up (unless you're trying to nap, WHY BOTHER?), but it's just another sound competing for your attention.

The garbage collectors in Hanoi's Old Quarter have nothing on the collectors in Hoi An though. One Sunday morning I woke at 6 am after hearing some repetitive music in the distance. I thought to myself, "Don't wake up KT, just roll over and ignore it." That worked for a few seconds, but then I realised that the music was getting louder. Before long, it was blaring in my ears. I stumbled out of bed and looked out the window. On the street below, a garbage truck was parked. The music was their way of letting people know to bring out their garbage for collection. Aaaaagh! After the truck left, there was no getting back to sleep - everyone in the hotel was awake and making noise. Very frustrating.

The worst sleep interruption I've experienced was in Danang. We stayed at a bible-recommended hotel that wasn't far from the Catholic cathedral. In fact, I could see it from the window in my room. However, on the first night, I was woken at 4:20am by the church bells ringing! It wasn't even a tune - just "dong, dong, dong, dong...". It lasted for about five minutes, after which I was well and truly awake. We soon discovered that this happened at exactly the same time every single night. Incredible. Luckily I found a different hotel for my second week, nowhere near the bloody cathedral.


View of the cathedral from my Danang hotel room

I do have some solutions for a better night's sleep. Earplugs are obvious. White noise is a good idea - one of the other students over here suggested turning up the air conditioner fan, and that's worked quite well for me. I've tried using my iPod, but I'm yet to find the perfect music that's loud enough to block out external noise, but calming enough to let me fall asleep (suggestions are welcome).

And then there are drugs. I came over here with a Stilnox prescription. I've used it several times and it's worked well. I wouldn't recommend using it if you have to get up at a specific time the next day - it's better if you can just wake when you're ready. One day at the hospital I was out of it all morning. Another student is using temazepam. When that ran out, she went to a local pharmacy and they gave her diazepam over the counter! She's reluctant to use that though, and has tried Valerian root, which they also sell at the pharmacy. So far, it's been successful.

Maybe I'll get the chance for a decent sleep on my beach holiday in Thailand...

* Actually, there's rarely room for people to walk because of all the motorcycles and bicycles parked there, and the families eating their lunch and dinner on plastic stools. It's much simpler to walk on the road and dodge the oncoming traffic.

Leave me alone, I'm lonely

I'm very comfortable with my own company. I lived alone for many years, and loved it (I have a housemate now, but I may as well be living alone). Despite this, I wish the situation was different. I'm so tired of not having a significant other to share my life with.

I've been particularly affected by this while in Vietnam. I'm spending a lot of time with two other med students from my uni (one male, one female). Both have partners at home, who they talk to every day. I don't really have regular contact with anyone from home. I've Skyped with my Mum a couple of times, and with my sister (and nephew), but that's it. Whenever the other students talk about their partners, it depresses me - I wish I had someone special to miss, or someone special who missed me. (Yes, I know my family and friends miss me, and I miss them, but it's not the same.)

I had a mini-meltdown in relation to this on (lunar) New Year's Eve. We'd been drinking for about seven hours, and I was also a bit hormonal, so it's hardly surprising that it all caught up with me. We'd just watched the NYE fireworks around the lake in Hanoi, and were taking silly photos with the locals. One of the other students said something to me about how he wished his girlfriend was there to experience it. It was weird - I was immediately struck by a feeling of overwhelming loneliness and despair, and walked away so that no-one would see me crying.

One of the female students from a different university spotted me, and tried to comfort me with a hug. Bad move - I'm not a hugger (unless it's a big bear hug). I shrugged her off quite rudely and walked away. All I wanted was to go back to the hotel and cry myself to sleep. Eventually the others talked me into staying out, and I had an OK time - we went to a smoky pub, and had street food at 4am (better than a dodgy kebab!). But I was putting on a brave face - I really felt like complete crap. When I eventually made it home, I did cry myself to sleep. Sometimes it feels good to do that (I know how strange that sounds).

Anyway, this situation isn't going to change while I'm on holidays, so there's no point dwelling on it. Sorry about the 'woe is me' post - I'm alone in Hoi An for the weekend, and I guess I'm feeling reflective.

More on the Vietnam trip soon, with photos...

Happy New Year, Happy New Year...

If I never hear this song again, I'll be a very happy KT:



I've heard it several times a day since arriving in Vietnam a few weeks ago, and was woken by it far too early this morning (Tết - New Year's Day). It's insane!

Sorry for the dearth of posts - I've actually had plenty of time to post while here, but have lacked motivation. So my first resolution of the lunar new year is to post more regularly on my blog. Most of the hotels here have free broadband in the rooms, so really, I have no excuse.

Hanoi is just as I remembered it - busy, confusing, and LOUD. There are motorbikes everywhere - as well as cars, buses, and cyclos - and they all honk their horns incessantly. Crossing the road is scary! You need a lot of confidence to do it. Some people say you should just walk at a steady pace, without checking for and dodging vehicles, but I think that's crazy. My best method of crossing the road involves a bit of a shuffle, and making sure I'm on my toes in case I need to dodge a speeding motorbike. I've seen the surgical hospital - I DO NOT want to end up there.


Motorcycles everywhere

I'm comfortable getting around the Old Quarter of Hanoi without a map now, which is fantastic. I've done a few touristy things, like visiting Uncle Ho, riding swans (paddle boats) on West Lake, and visiting Tam Cốc (things that I didn't do when I was here two years ago), but it's been fun just settling into life as a resident of this crazy city. The New Hanoian has been very handy, as has the trusty travel bible. We've discovered some really wonderful places to eat, we've been to the opera (La Bohème), and last night (New Year's Eve) we even cooked spag bol for a big group of med students and hotel staff at one of my fellow students' hotels. We bought all the ingredients (except the pasta) from a street market - it was so fresh. The beef was fantastic. And it was so great to be cooking - I love to cook, and was already missing it.


Swans on West Lake

I've gotta say, I'm not loving the local food in Hanoi. I find it a bit bland and greasy, especially when compared with food from southern Vietnam. And I know this is blasphemy, but I don't really like phở bò. There, I said it! I'm just not a noodle gal. That said, I have eaten it and haven't minded it, but I certainly won't go out searching for it (and would never eat it for breakfast like everyone else does). I'm heading south tomorrow (Danang and Hoi An), and I'm really looking forward to eating some of the local specialities, such as white roses (shrimp dumplings) and fried wontons.

I did a good cooking course though. We prepared Hanoi street food - BBQ pork strips and meatballs, noodle and herb salad, spring rolls, and dipping sauce. Unfortunately, I'd woken that morning with a stomach bug, and spent most of the class in the (thankfully clean) bathroom. It was only a 24-hour bug, and I've been otherwise really well.


Spring rolls - deep fried for half an hour!

I'm here with four other students from my uni, and four students from an interstate uni. We all get on well, and have had plenty of fun out and about in Hanoi. Some of the students have been very keen, whereas I've been more inclined to take it easy and have a half-holiday, half-elective experience. On each weekday, I tend to be at the hospital until about lunchtime (sometimes finishing earlier), with afternoons free for sleeping, sightseeing, shopping, etc. Perfect! I do plan to step it up a bit in Danang next week, because there won't be as much to see and do in our spare time there. We've been told to take this week off because of Tết - quel domage!

There are three major hospitals in Hanoi - Viet Duc surgical hospital, Bach Mai medical hospital, and the Paediatrics hospital. I've spent most of my time at Viet Duc. I did a week of neurosurgery, a week of orthopaedic surgery, and a few days of Emergency before heading to Halong Bay last week. I also visited the Paeds hospital one day - my koala bear toys were a big hit with the sick kids (and I still have plenty more to give away, probably in Danang).

Viet Duc hospital has been an eye opener. The thing that's really struck me is the lack of pain relief. I think it's a cultural thing - the Vietnamese people appear to be very stoic, and they don't complain when they're obviously in a lot of pain. The strongest painkiller I've seen on the wards is IV paracetamol. I haven't spotted morphine anywhere yet. Even amputees only get IV paracetamol.


IV paracetamol

The main mechanism of injury at Viet Duc is motorcycle accidents. Vietnam brought in a compulsory helmet law at the beginning of last year, but the poor quality of the helmets and the fact that they're rarely fastened properly mean that serious head injuries are far too common. Limb injuries tend to be catastrophic. Other reasons for visiting the Emergency department are machinery accidents (I've seen many mangled hands) and falls from building sites.

Communication is a big problem for us at the hospital. Some doctors speak English (some better than others), and only a few of the medical students speak English. None of the patients (so far) speak English, which makes it hard for us to perform examinations, and obviously impossible for us to take histories. So unfortunately that means we're reduced to standing around, observing. It doesn't take long for that to get boring. We have been learning some Vietnamese language, but certainly not enough to allow us to converse. (A lot of people at the hospital speak French, so I've been trying to access some HSC French in the deep recesses of my mind, with limited success.)

The operating theatres aren't as sterile as we're used to in Australia. I watched brain surgery while the window to the outside world was open! And I wore open-toed shoes! Although there's a sterile field for operations, the surrounding environment feels decidedly less sterile. We got the sense that people were going through the motions of maintaining a sterile field, without a clear understanding of the theory behind it. We saw some surgical instruments being rinsed after one brain operation and re-used in the next operation. We're trying to remain open-minded - who's to say that Australia and other Western cultures don't go overboard with sterility? We really want to know what the post-surgery infection rates are like, but we don't want to sound arrogant - and we doubt that the statistics will be available.


Open-toed shoes - we have to change into these before going to theatre

The surgeons are excellent, though. Most of them have done some training overseas. For example, one neurosurgeon trained with Charlie Teo in Sydney. They've been friendly, and the surgeons who can speak good English are keen to explain the operations they're doing. However, I'm not interested in being a surgeon, so I'm kind of over the standing around and watching. I'm hoping to get some more hands-on experience in Danang.

The triage area of the Emergency Department is run by medical students. It's been frustrating to watch them faff about with seriously injured patients. For example, we've seen patients with major limb injuries, but no pressure on wounds, no fluids, no pain relief. The students seem to be very good at checking pedal pulses, though - each patient has their pulses checked by at least five students! And they tend not to use supraorbital pressure or sternal rub to test pain response - they do massive nipple cripples instead! We saw one severely comatose patient nipple crippled by several successive students and doctors, until his chest was bright red.

There are a few security guards dotted around the hospital, with megaphones and batons - both of which they love to use to control 'unruly' family members. One patient came into the ED with a severe head injury (actually I think it was the nipple cripple patient), and his daughter came into the room, sobbing while standing by his side with other family members. The security guard came in and stood next to her, then yelled at her through his megaphone, telling her to get out. Guess they don't like public displays of emotion.

I visited the neurosurgery and orthopaedics wards. Both were overcrowded, with beds in the corridors and in spare spaces in each room. I counted at least 15 white coats on the rounds, so there was very little room to move in the crowded rooms. There are also people in yellow coats on the wards - they're family members, who stay in the hospital to help care for their relatives, because there aren't enough nurses to go around.

Wow, this is a long post. That'll teach me to post more often. Congratulations if you've made it this far! Not long to go...

As I mentioned, tomorrow I'm heading to Danang and Hoi An. I haven't booked a return ticket, because I'm going to suss out what it's like down there before deciding how long to stay. Ultimately I have to fly out of Hanoi at the beginning of March.

I just finished listening to the Hottest 100 streaming online (predictable but fab number one) - gotta love the free internet! We were planning to find an Aussie pub for some Australia Day beers, but after a massive NYE we all need afternoon naps and an early night.

Chúc mừng năm mới!* I'll try to stick to my new year's resolution.

* Happy New Year!

Catching my breath

Since the exams ended, I feel like I haven't stopped. My mind is constantly racing, and I have several to-do lists. I really need a holiday...

The first week of December was taken up with visiting my gorgeous new nephew, and preparing for a close friend's wedding. The wedding was fantastic! I was in charge of the music, and I also did a reading - both went well. The reading was unusual. I was the narrator for this story:



I adore Edward Monkton.

Two days after the wedding, I flew to South Australia to begin my John Flynn placement - a rural placement that takes place over two weeks each year, for the four years of my medical degree. This was my third placement. Unfortunately, I was BORED. I got the chance to do some anaesthetics, which was good. I assisted on two Caesareans (and stapled up one patient's abdomen), and I spent an afternoon at the Pap smear clinic (a tad confronting, as you can probably imagine - but great experience). I spent most of my time seeing patients in the drop-in medical centre (part of the GP practice I'm allocated to). But overall it was medically and socially dull. My attitude didn't help - all I wanted was to be on holidays, not using my brain for medicine - especially after such a crappy year. Thankfully one of the doctors saved me from complete boredom - he lent me his car for the whole weekend. I drove to the Clare Valley, a place I'd always wanted to visit. I bought quite a lot of wine and had a divine lunch at Skillogalee:







I arrived back in Sydney just before Christmas. Luckily I'd completed my shopping before I left, because I had to launch straight into Christmas Eve lunch with Dad, then Christmas Eve drinks (too many) with friends, then Christmas Day at Mum's place (too much food and wine consumed), then Boxing Day at my uncle's place down the coast (again, overindulgence).

Then it was back home again to make a dent in my to-do lists. Why so many to-do lists? I'm leaving for Vietnam tomorrow - my two-month elective. Following that I've got 12 days in Thailand (finally - a holiday!), so I had a lot of fiddly bits and pieces to get done before leaving.

Oh yes - and I had to hit the sales! I bought several tops, one pair of pants, two skirts, and lots of books. I didn't want to buy too much because I'm going to get clothes and shoes made in Vietnam. (And also because I need to lose weight.)

So I'm on the plane in less than 12 hours - eek! I've been to Vietnam before, so it won't be a complete culture shock. And there are several of us going, so it will be loads of fun. Can't wait!

Stay tuned for tales from South-East Asia...