9 more sleeps to the big day

So it's gonna be an interesting birthday for me. Job interview in Hobart in the morning, flying off to Melbourne in the evening.

Now that I am almost a quarter century old, I find that I don't enjoy birthdays that much any more. It's just an unpleasant reminder that after multiple relocations around the world, how very few friends you have left by your side who would be free to spend your birthday with you, or how few would even remember your birthday. And how this could be about the 5th birthday you are spending away from your family who are thousands of miles away. Oh and of course, how you are getting another year older, and still without a stable job, a home, a family of your own. At times I feel like I am no much different from that fresh-faced 17 year old girl who left home in pursue of greater things (deep down knowing that the best life would probably always be the one she was leaving behind); I can still taste that fear of the uncertainty, that helplessness in the hands of faith, that loneliness ...

At least I have you with me. And that is enough to make me feel so so blessed. You're my window in the dark.

Now if only dear God would please grant me a successful interview, and a job in Hobart, where I intend to be. That would be the best birthday gift ever.

*praying hard*

To the one who was never meant to be:

I kinda miss you tonight.
Not the I-badly-want-to-see-you-now kind, just a subtle regret that you aren't present in my life any more and I somewhat wish you were.

I find that I can no longer recall your face in the details like I used to. For in those days I used to memorize every line on your face, your slightly lopsided smile with the perfect white teeth, the soft brown roots of your hair, and those eyes which colour I could never really tell. Your scent, strawberry cheesecake. How you reminded me of sunshine. The sound of your name rolling off my tongue. Five-thirty waiting for you in the foyer wishing you would walk by. How you could always take my breath away and leave me tongue-tied.

Despite all that, looking back I don't think I had truly loved you. I thought it was love back then, but somehow it wasn't. Or maybe it was, but I had gotten over it now and could no longer comprehend how I felt before.

You see, as unbelievable as it might sound now, there was this one time three lifetimes ago when "loving" you was my world. And despite the pain and the tears and the shoulda-coulda-woulda, I kinda miss the sentiments of that. There is a kind of bittersweetness that sounded almost romantic; destructive but beautiful.

Things change over time; I bet I did, and so do you. But just so you know, I still like your previous last name better. For that was the you that I knew and loved.

Wherever you are, I wish you are happy, just like I am happy. It took me a while, and many regretful choices in the interim, but I had once again found happiness in the form of love.

I miss you.
Not in an I-love-you way, just... in an I-miss-you way.

But as always, you'll never know. 

Knick knacks

The mystery had finally been solved. Our deductions were pridefully accurate, and when interrogated, the 'culprit' (surgeon...orthopod...duh) confessed right on the spot. Case closed, one point for Detective Stephen and Detective Christine! =)

I would've loved to tell you that my life had been happening but it sadly isn't. The power trip in the psych unit medical officers' room has been the highlight of the week. Pathetic much? Heh. Still, I'm not complaining, somehow I am getting used to this mundane, slow-paced rural lifestyle. I am still undecided whether it is a good thing or not.

Fortunately, the fortnightly drive down to Hobart and back is starting to be increasingly enjoyable. Especially when singing along to Taylor Swift records. (Don't judge me! =P)

Interview calls seem to be gradually coming in from the mainland and all, I am both anticipating and dreading the one from Hobart. I NEED to get a job there next year. Burnie is no doubt a very beautiful place, but it gets tiring, all these 'long-distance thing' with my beloved boy. It gets lonely too.

30 weeks down, 22 more to go.

At times, I'm jealous of those people who get to see you everyday... 

 

Of purple fingers, unequal pupils and sore bottoms

You might wonder what rotation could offer me such great opportunities to review these mighty presentations. And some of them were even "urgent"! Of course, purple fingers turned out to be Raynaud's phenomenon and not ischemic fingers; unequal pupils was just due to an old eye injury, and sore bottoms were usually due to prolonged sitting/lying (common in catatonic/schizophrenic patients who assume a statue-like posture, not moving for hours at a time!)  

I am currently in week 3 of psychiatry relief and I am kinda enjoying myself. I had always loved mental health and truly enough there was never a dull moment in the ward! Head-banging, dismantling doors, shouting and wailing were common occurrences. However as the psych RMO, my job seems to be nowhere mental health related. Rather, I was much like the over-exploited pseudo med reg/ward slave/walking encyclopaedia/dental consultant/receptionist/IT support/patient's boredom reliever. Sometimes I wonder, where is the psychiatry?

Anyway, I am not gonna complain because compared to ward cover or surgical rotations, the workload in psych was a breeze. It could easily be as few as 5 jobs per day, including writing up investigation forms. No discharge summaries too, what a treat! I could hang out with my friends in the med/surg ward or sneak out for an hour-long lunch break. Other times, I could work on my languages. Yes I'm proud to announce that I am finally back to working on my Spanish again, after a year-long hiatus! And I am starting to pick up some French too (since the Boy learnt it in high school, maybe it could be our secret language. Heh).  

Also, Stephen (my partner in crime) and I had currently became part-time detectives, whereby our newest case is to investigate the ownership of a certain black Porsche 911 Carrera in our hospital staff parking lot. Whoever it is, what a lucky bastard!

Hmm...or maybe not. =P 

Think twice before you marry a doctor!

This will be the engagement story I'll tell my friends and future children:

He didn't propose to me. I wasn't even sure if we were ever engaged, really. We just sort of came to a consensus that we are getting married, vaguely "in about a year's time for that would be a suitable time". About the same way doctors and patients discuss treatment plans: 

There was no sky-writing, heart shape balloons or candles, fireworks, riding in on a white horse or 999 roses. Not even the typical feat of man getting on one knee asking "Will you marry me?". The only thing I recall was that we had a great meal in a mall in a third world country. We were walking around window-shopping when I suggested "Let's look at rings here, they might be cheaper. We could buy one, you know, get it over and done with."

Now which little girl still dreams about marrying a doctor? =P

Will you call me tonight?

Hello, Christine here, ward cover/night intern!

Sorry for the long hiatus. These days, my biological clock's a mess.

Ten things I learnt about working nights:
1. The term SHIT MAGNET.
2. You'll be amazed at the magnitude of the 'flight or flight' response that the beeping of your pager could generate.
3. You'll almost always PUT ON WEIGHT! (Imma blame it on midnight snacking!)
4. You'll love the peace and quiet of the wards (most times) but dread the social isolation.
5. Getting used to walking down long, dark hospital corridors and not thinking of scenes from a horror movie.
6. You will be constantly praying that there will be no MET calls/Code Blues, and obsessively counting down to handover time. (Yawn yawn yawn)
7. 0400 is the most difficult point of the shift to stay awake.
8. 0600-0730 is when it gets busy. (and when you're most crankly)
9. Add "home team to review mane" in almost every plan you make. You can never go wrong. =)
10. Your main aim is to keep em' hangin' on till 0800.

So catch me if you could.

Beyond - Circa

I was back for the long weekend.

It felt as if I never left. 

The circus is in town. The splendid Spigeltent, and all the wonders it holds within. 

The Boy got us tickets to the opening of Circa (half price for Battery Point residents - SCORE!).  

It was a night filled with out-of-the-world experiences. Trapeze, aerial hoops and straps, silks, and of course, the almost-two-storey-high pole.

Once again, I wish I could run away with the circus.
Yet I'm just that awe-struck girl watching them soar.

Isn't it bliss?

Don't you approve?

Me here at last on the ground,

You in mid-air.

Where are the clowns?

Send in the clowns.

Don't bother, they're here.

Ain't Nobody Got Time For That

I never liked Chinese New Year. It is the time of the year that reminds you that there are people in your life that you need to get rid of.

Toxic people. People who tries to make you feel small because they are insecure in themselves; people who curse you because they are jealous of you and people who are so fucking selfish they would take advantage of the elderly or disabled.

Oh yes there ARE people like that. Not just anyone, but relatives.

Well the truth is, I don't care one bit. Because even if allegedly you people have some vague blood ties with me in some way or other just because we are related, I AM NOTHING LIKE ALL OF YOU. I would give a gazillion bucks to bet that my set of DNAs are nothing like yours too. As far as I am concerned, you are NOT family to me.

But I do care if you hurt MY FAMILY.

So back off. Go hide behind your pompous shells and mind your own goddamn business. Oh, and do us all a favor, don't ever come over to 'visit'. Because we all know, that those visit are just to borrow more money or to steal someone's fridge magnet or your elderly mother's coffee powder. For God's sake, how low can you people get to?!!

Well then, hope you get rich one day just by saving up on paying your part of grandma's monthly medical bills of approximately....... 30 dollars.

IDIOTS. 

Valentine's Day

It's basically just like any other day. Albeit over-commercialized.

At least the Boy's here with me. And I'm not working that dreaded 15-hour weekend shift.
That's good enough for me.

I thank God today for having him (and all his leftover reports from work) here with me on our very first Valentine's Day together as a couple.
I thank God he knows me well enough to have the sense not to spend unnecessary money on flowers that will wither or chocolates that will exacerbate the ache in my sensitive gum near my left premolar.

Instead he brought me a whole box of (healthy and not-so-healthy) snacks that I can have in bed while reading my ALS course preparation handbook. (Think pine nuts and pork crackling) Also, Indian takeaway for dinner. Pea pulao and garlic naan's the best.

I pray for the many more Valentine's Day to come. That the Boy will be here by my side, regardless of whether we celebrate it or not. I  don't need any expensive gifts, fancy fine-dining or fireworks. Just us, together. Spending quality time, sharing workplace gossips.

To me, that's the best kind of Valentine's Day.

Burkholderia Pseudomallei

Doesn't that sound lovely?

I have been learning a lot about infectious disease these days. (Who says orthopedics is only about the bones?) One would think that in a little hospital like this, you do not come across many types of bugs. Mainly just the Staph Aureus, at times some C.Diffs, and occasionally some gram negs (proteus mirabilis). 

How wrong were we. 

For on this faithful week, we were visited by not one, but two rare infections amongst our inpatients. I am not going into much details as it will be a boring read (I don't have many viewers to start with and this would definitely send the last of them fleeing - microbiology seems to be everyone's least favourite subject).

Hence, quick succinct case summaries as below, with plans as per ID consultant from Hobart:

Case 1

65yo F, presented with septic L knee. 

Joint fluid culture grew Burkholderia Pseudomallei.

B/G - Recent visit to Darwin during wet season. Had pneumonia 4 weeks prior to this admission - now resolved. No past medical history. 

Dx - Clinical picture consistent with melioidosis.

Mx - Extensive investigations warranted as occult sources of melioid might be present and can be asymptomatic (ECHO, CT, bloods etc). IV meropenem cover for at least 4 weeks, and then at least 6 months of oral antibiotics as prolonged eradication therapy.  Weekly bloods + inflammatory markers. Repeat investigations down the line as well.    

Sounds like a big deal? IT IS A BIG DEAL. Not a bug you ever want to get, as it has a high recurrence rate, as well as being associated with high mortality and morbidity. Technically, it behaves kinda like TB. Both being tropical diseases, endemic in Northern Territory of Australia, and South East Asia. Usually spread via contact with contaminated soil or water, at times even via inhaling dust particles. Increased susceptibility among the immuno-compromised, diabetes or cystic fibrosis patients. 

Main cause for melioidosis. Melioidosis is an infection caused by Burkholderia. Signs and symptoms may include pain in chest, bones, or joints; cough; skin infections, lung nodules and pneumonia. Might even cause liver abscess - typically with a "honeycomb" characteristic. Lung nodules and liver abscesses might at times be asymptomatic, hence the need to perform extensive investigations. The strange thing is, melioidosis is said to be able to affect any organs except for the heart valves (endocarditis). (*We are not sure how far this is true, so we did an ECHO just in case.)

Case 2

48yo F, presented with infected R index finger.  

Wound washout m/c/s grew Roseomonas Gilardii. 

B/G - Previous similar infection in thumb. Both infections requiring repeated surgical washouts and debridement. Both infections arise from simple cuts from household work. Works at a milk processing factory in the packaging department. 

Dx - Infected R index finger

Mx - x2 surgical washouts and debridement. For IV Tazocin + oral Ciprofloxacin until wound-healing is satisfactory. Then stepdown therapy with oral Ciprofloxacin + oral Augmentin DF for another 2 weeks then cease. For investigations of why she suffered recurrent similar infections (likely linked to her workplace). Occupational health physician to review with regards to workplace safety and prevention/precautions to be taken.

As compared to Case 1, this is a less menancing bug. However, it is very rarely known to cause human infections, and we were unsure how did the patient actually pick it up. Transmission is via contact with contaminated soil or reservoir water. The most likely explanation was that the source of infection was from her workplace, possibly from the pumped creek water they use for general cleaning purposes. 

Roseomonas infections tend to occur in the immunocompromised or debilitated host. Most patients recover completely from their infections. Bacteremia is the most common clinical presentation reported in the literature. The patients generally present with fever. Other rare presentations reported in the literature have been peritonitis, septic arthritis, ventriculitis, left ventricular assist device (LVAD) infection, vertebral osteomyelitis and keratitis.

Once again, kudos if you survived my boring blog post up to this point. You may call me a nerd, but I actually found these cases pretty interesting, so I thought imma share with you this time. Even the ID consultant was like:" these are not infections that you will normally see. You might not even get to see another case of Burkolderia infection ever again, especially if you are working in this part of the country (the very much non-tropical Tasmania)!" 

Once again, behold the beauty of a Burholderia colony on blood agar. And culturing these is apparently a biohazard to the lab and special isolation is needed! (sounds cool! Made me think of  my fav zombie movies i.e. Resident Evil) 

*all patients are fully de-identified and no patient details contained in these case summaries* 

Typical Day of an Orthopaedic Intern

I find working strangely calming. Being constantly on-the-go, with missions to complete and new issues popping up every now and then to add to your list is actually kinda exhilarating. And I just love how time flies without you even noticing it. These days it seems like time is no longer defined by the numbers, but rather, the jobs left to be done before 5pm.

If you are ever curious about how a typical day goes for an orthopaedic intern, let me enlighten you with a timeline (say for today). Hold your breath, here goes.

6.30am - Arrive at the surgical ward. Update patients' list. Add on new admissions, check progress of all patients overnight, chase bloods and imaging results. Do your own pre-rounds (before the reg's pre-rounds, and wayyy before the actual ward rounds) if time permits.

7.00am - Registrar arrives at ward. Print patients' list to hand out to the team. Paper round with registrar to update him/her/them about all patients. Registrar does his pre-rounds. Carry out new jobs (eg: order repeat bloods/XRays for post-op patients)

7.15-7.30am - The rest of the team (consultants, allied health members and occasionally nurses) arrives. Official paper round of the morning - team will discuss patients' issues, and coming up with plans. Intern to note down plans and carry most of them out later in the day.

7.30-7.45am - Commence ward rounds. Interns leading the way and showing the team to the rooms and patients. Also looking for patients' obs chart. More jobs might be added to list as we go.

8.00-9.00am (depending on patient load and complexity) - End of ward rounds. Consultants and registrars off for coffee/clinic/operation theatre. Interns return to doctor's office to write progress notes in retrospect for the ward rounds in each patient's folder. Liaise with nurse unit manger about plans for each patient under our care. Also liaise with nurses looking after each patient if there are any specific jobs to be done (catheter to come out/new medication charted or ceased/obtain urine sample/stitches or staples to come out etc).

9.00am to 12.30pm - Completing jobs and chasing up results. For today, we had to chase an ID consult, chase an ECHO, chase x2 blood cultures, chase x2 urine mcs, discharge x3 patients, and also prepare discharge scripts and paperwork for another x2 patients for discharge to nursing home tomorrow. Also x1 palliative care referral and x1 opthalmology referral. While we are going about completing jobs, nurses might approach us about new issues about patients under their care, and we will need to review or manage accordingly. For today, we had a post-op young guy who failed to void and requiring a catheter. There was also a cannula to be resited. Multiple medications to be recharted. A lady with low blood pressure and query to withold frusemide for today. Meeting family member of a paediatric patient to discuss ongoing management and compliance issue. Providing

12.30-1.30pm - JMO education sessions every Tuesday for an hour. Today we learnt about how to assess journals from the hospital library.

1.30pm to 5.00pm - Continuing where we left off, completing the rest of the jobs leftover from the morning. I attended the palliative care consult for one of our patients, and discussed the plan with the consultant. Received phone call liaison by the ID team at the Royal Hobart Hospital (gosh I miss that place!) and confirmation of antimicrobial therapy for patient with septic knee. Then I received a call from pre-admission clinic to see a man who is due for elective L total knee replacement - completed assessment, pre-admission and paperwork. Chase up post-op bloods and XRays to see if all were well. Then I returned to discuss ID consult results with registrar and carry out plans as per discussion. Went to talk to patient and explain her condition and tentative management plan. Printed patient information for her.        

5.00pm to 6.00pm - Was just about leaving for the day when registrar called up to admit a patient from ED with a L neck of femur fracture. Did admission and bloods and ordered CT. Waited for registrar to arrive to take over admission and discuss plan. Finally got to leave when all paperwork was settled and handed over to evening ward cover intern to chase up CT for the new patient.

Kudos if you have endured to read up to this point.

And to think that I once aspired to be an orthopaedic surgeon! Thank God that was a brief phase I have long since gotten over. Oh, but I guess that was mainly about the money anyway. =P

Have I told you how much I hate waking up early in the morning? ARGH. 

There must be a reason

At this very moment, I am sitting in a bus en route to Hobart. The first of many future trips, I would presume.

Ahh Hobart, the place I have lived in for the past 3 years. I used to think of it as a boring little town, until I came to Burnie. Now Hobart feels like paradise.

What is my calling, dear Lord? Why is it that you have sent me here? There isn't much for me in this place. Burnie is beautiful, breathtaking even. But there is no dance, there is no pole. There is no one, and nothing I love. Just long, lonely nights and endless phone calls that will never be the same.

Who am I then, without all those that sustain me?

My workplace was pretty great, but ortho is physically and emotionally draining. We have half the workforce but the similar patient load as Hobart. Go figure.

Three weeks down, Forty nine more to go.

There must be a reason. Even if I couldn't see it just yet. This I believe.  

Beginner's luck?

So the past week has been a blur of events. Orientation week for new interns. It was overwhelming; with zillions of forms to fill in, wrapping our heads around the system, organizing salary packaging and ID cards etc. Upside is we get paid though. So am not complaining. Heh.

Today marks my first day working as a doctor. An orthopedic intern, to be exact. Gosh, I am still getting used to having the title Dr in front of my name. Signing patients' charts, ordering bloods and scans... For one, it felt so strange that suddenly my signature became of so much value. Everything I write becomes an order that people would actually care to follow.
To think of the responsibilities!

I have to say, it was exhilarating.

Waking up at 5.30am to turn up at work before 7am wasn't much fun though. Dear me, I am never a morning person! Strangely enough, I wasn't dozing off at work. (much.) Guess it's the adrenaline rush that sustained me.

At the end of the day, all I hope is that I made the right call for my patients. That Cephalexin I started; that Tramadol I ceased...

So I survived the day. And hopefully that'll be the case for the many more days to come. Tomorrow is yet another new day; with new challenges, new unknowns, new opportunities to make or to break.

Till then, I pray with all my might that I won't kill anyone.