the Crazy 88

This past week has been one of purely survival. Survival and checklists. Survival, checklists and drowning in paperwork. But I guess the fact that I am alive to tell the tale speaks for itself.

Unexpectedly, however, an incredible end to the week, because what better way to spend your Friday morning than assisting in a bilateral mastectomy. And when I say "assisting" this was one of those rare times when I was actually assisting! Just me and the surgeon -- no registra, no other students -- and it was beyond amazing. And the icing on the cake? The spritzing of arterial blood, Quentin Tarantino style (albeit on a much, much smaller scale)! My fourth year surgical experience is now complete. :)

insanity

"Though this be madness, yet there is method in't." --William Shakespeare's Hamlet


[50-page ethics application + sleep deprivation + looming deadlines = INSANITY]

my uber sexy weekend: the adventures of applying for ethical approval

I cannot believe just how productive I've been this weekend, making major progress with both my Surgical case write-up AND my summer research project ethics application -- a real achievement; utter satisfaction.

A lot of supervisors do the ethics applications themselves (or it has already been done!) for summer research students, but right from the get-go my supervisor has been focusing on my learning as much as possible regarding setting up and carrying out a clinical research study, which has been awesome for me.

Just with this kazillion page ethics application alone I've learnt heaps already! LoL Most important of which is not to be intimidated by a kazillion page application "form" cos most of the questions probably aren't applicable.

While I fully acknowledge and appreciate the need and the importance of an ethics committee (having a sideline interest in bioethics and the like), the whole concept of a group of people deeming a project as "ethical" verses "unethical" remains not laughable per se, but "chuckle-able." What I mean is, as per the argument of many of my classmates who adamantly voice their opinion of against the need for such a process, you'd think most of it was common sense. LoL


From the Guidelines for the National Ethical Application Form:

" In the context of research, the ethical issue of payment (in money or kind) or reward for carrying out the project – including any payment (in money or kind) or reward for recruiting participants – is generally reviewed under three main categories:
i) payment (in money or kind) or reward received by research investigators, host departments, or host institutions;
ii) payment (in money or kind) or reward received by participants recruited into studies; or
iii) payment (in money or kind) or reward received by individuals/organisations who recruit participants into studies but who are not involved in the research as research investigators.

Note:
- that (i) raises ethical concerns that require closer scrutiny by an accredited ethics committee;
- that (ii) raises issues requiring review by an accredited ethics committee into whether or not any payment (in money or kind) or reward, or benefit of any sort, offered to any participant constitutes undue inducement; and
- that (iii) raises concerns that are generally considered unethical."


But like I said, the process remains undeniably important. Just look back at the history of medical experimentation! Plus, those classmates highlighted above probably (a.) will never do research, ever, and/or (b.) are more likely to potentially make the headlines, if you get what I mean.

The Scrambler (aka Life?)

I remember as a kid I went on a carnival ride which I utterly hated but loved at the same time. These carriages would spin and fly around erratically, each on a seemingly different axis, creating the illusion that you were about to crash into another carriage at very high speeds. Yet at the last possible minute you're flung into another completely different path. I loved how it was so erratic, unpredictable, and yet, in the end, we were all connected.

I often think back to that ride and as strange as it might sound, it reminds me of... life. How surprising, erratic, unpredictable it can be. How we're constantly flung into one path or another, into the lives of this person and that person, and then we're off again! Into another completely direction... You can never predict where you'll go next or where you'll end up or with who, but ultimately, we're all connected.

We're all connected, and there's a certain kind of rhythm to it all, a certain kind of rhythm we're all intuitively dancing along to.

I spent two hours this morning volunteering to act as a patient for the surgical registras (=residents) sitting their Part 1 clinical examination, and for five minutes I entered the life of that person sitting their exam, this future surgeon. I was flung into their path, then five minutes later flung right back out. S/he and I spoke, interacted, touched... and then they headed back in one direction and I headed back in another. Our lives intersected for those few minutes. And probably never will again.

It's funny how that happens -- and constantly happening, every day. The ride may slow down more as you approach some carriages compared to others -- your lives may intersect for longer -- but in the end, you're off again.

Is there really more to it than that? Will two carriages ever meet, crash, and subsequently continue on together? Would it ever... stop? Will it ever slow down, and not eventually fling you back out in another direction? Is it worth holding your breath in anticipation? Or should you just not bother, assuming it will sooner or later, and so acting accordingly? Is there really more to it than that? Is there relaly more to it than The Scrambler?

I'm not sure what my point is to all this... Just thinking, I guess. Procrastinating from my essay, I guess.

But then again, it doesn't really matter. LoL.

... Or does it?

oh, zac, I love thee for thy...

I was yet again flicking through a magazine whilst spinning at the gym and was reading about the dressed men of '08, one of whom was Zac Efron... and as I looked at his picture I couldn't help but fantasize about... his huge-o veins, and the overwhelming desire, nay, this deep-seated, gut-wrenching NEED to attempt cannulating him.

Either I'm maturing as a person on the whole, or it really is true what they say: med students all start off as different kinds of pasta but we all come out as ravioli in the end.

Well, true, sans the inherent cynicism. :)

I would change the name of my blog if I could

Six weeks into my surgical run, and if I could add another item to my 10 Things I Love (the most) About Surgery it would be this: I love how you can never predict what your day will be like when you wake up in the morning. You never know what will happen, how it's gonna go, what you might see, what you might end up doing. The only thing you do know is that it'll be fast-paced (well, it is for me, but not all my classmates), and I LOVE it.

I really should re-name this blog, SURGERY ROCKS MY WORLD/LET ME WRITE YET ANOTHER BLOG ENTRY ABOUT HOW MUCH I LOVE SURGERY... etc. LoL.

Today was yet another one of those awesome unpredictable nonstop days.

Theoretical Schedule for the day:
8:00 - 9:00 --> Surgical Clinical Meeting (case presentation/etc.)
9:15 --> Team Ward Round
2:00 - 3:00 --> Tut with Mr X (one of my consultant= attending surgeons)

Didn't seem like a heck of a lot, almost ambiguous. So when I was heading to the hospital this morning I thought it'd be a good day to work on my surgical essay due Friday.

But like I said, you never know what your day will be like (if you make the most of it that is).

I was the only student on the Team Ward Round cos the other three in my group had various other things scheduled, and it ended within the hour, which was nice. Mr Y (my other consultant surgeon) then took us out for coffee, his shout! (Yuss!) He's such a lovely person, so sweet, so grandpa like! :) Then, at said coffee I found out that my house surgeon (=surgical intern/junior resident) was assigned to preadmit the paediatric surgical cases scheduled for this very afternoon. You see, our hospital doesn't have any paediatric surgeons so they fly one down every so often to do some/most of them. So I followed my house surgeon around, helped her preadmit a 20month old boy with an undescended testicle, and then, THEN --> wait for it, wait for it, WAIT FOR IT... I GOT TO SCRUB IN FOR THE SURGERY! And what's *EVEN* cooler, because this surgeon (Prof Z) wasn't from our hospital he didn't have any registras (=residents) assigned to him, so it was just ME, a fourth year medical student, assisting!!!!!

Holy crap, it was AWWWWWWWWWWWWWESOME. Like Whoa. Like indescribably so. Paediatric surgery, as heartwrenching as it may be sometimes, is amazing to watch because, quite like Plastics/Reconstructive Surgery it entails a lot of finesse. Delicate, precise, almost... beautiful work. Elegant.

After that case, Prof Z said I should stick around for the next two cases, but I knew the Trainee Intern/6th year med student would be coming to scrub in, so I left the OR. But on my way out I ran into said Trainee Intern who asked me to stop by Mr X's OR and let him know she couldn't make it to his surgery because she'd be scrubbing into this paed's case on at the same time. So I went to Mr X's OR, and surprise, surprise, his registra wasn't there, and no other students! Just a whole bunch of nurses and the anaesthetist. AND --> wait for it, WAIT FOR IT... IT WAS AN ABSCESS DRAINAGE! (Refer: The abscess that got away) And not just any ol' abscess, a HUGE BREAST ABSCESS! So I asked if I could scrub in, and he said, of course, and so I assisted! And have I mentioned it was an absolutely HUUUUUGGGGEEEE abscess? In the BREAST!? AND --> while we were draining the abscess the patient started moving around!!! Like moving her legs as if she was changing positions -- while under GENERAL ANAESTHETIC. It was pretty freaky to see, but the seasoned anaesthetist took care of it; what was even more interesting was that apparently this patient has a history of being "aware" while under General.

After the breast abscess surgery, I hopped back to see the end of the second paeds surgery, and then that was my day.

Another incredible, unpredictable, FUN, indescribably cool day in surgery. Is it just me that DOESN'T want summer vacation to come in three short weeks??!?

... okay, enough high speed rambling like the hypomanic person my classmates are trying to convince me I’ve become! …and on to this surgical essay I didn’t get a chance to work on at all today.

Wow

There was most definitely a feeling of "Wow, this year is really very nearly over" yesterday. We had our 4th year Practice OSCEs Saturday morning, which weren't a big deal at all because you pass the examination if you show up and just do it regardless of how good/bad you may be. Then later that night we had our end-of-year Class Dinner (with just three weeks of school left), which was great fun and at the same time left me with a twang of... wonderment. Is that the right word?

It seems as yet another year of med school slowly comes to an end I find myself having the (almost exact) same conversation with my med school friends yet again. An expected sense of deja vu, without so much the mysticism I guess.

I can't believe another year has come and gone. We're not just fourth years now... fourth year is over. After summer we'll be fifth years, studying for MEDICAL SCHOOL FINALS. Then we'll be Trainee Interns, and what an absolute adventure that'll be -- getting PAID, like actual money; being *somewhat* useful on the wards (hopefully); going overseas for three months for my elective.

Wonderment. I think it is the right word. Awe.

What's even more surprising is that even though so much has changed these four years, a part of me still feels like that second year med student standing outside the lecture theatre on Day 1, "99% excited 1% scared, or was it the other way around?" LoL Well, maybe that's a little too overkill, but I do think it's pretty freakin' amazing when I think of how far I've come in just four years, all that I've learnt (and continue to learn everyday), and how much not just me but my whole class has achieved in so short a time.

Wonderment... Definitely.

the abscess that got away

At nine o'clock this morning I found out there was a young lady in hospital for urgent incision and drainage of a significant abscess on her anterior chest wall.

During these four years of medical school, my relationship-interaction with abscesses have been largely a theoretical one. The all-elusive abscess, I often think to myself: talked about a lot, apparently very important (the age-old adage, "never let the sun go down on undrained pus," etc), but do they really exist (like, really, really?)? Much like, yes, I know man has walked on the moon, but has man really walked on the moon? Like, really, really?

So when I found out my surgical reg would be operating in an hour or so, I left my pager number with the Main Operating Theatre receptionist and eagerly waited.

But, alas, as is almost always the case, a couple hours turned into two, which turned into three. By the time I was paged it was half twelve.

ANY OTHER DAY I would have said, screw everything else, I'm adamant on seeing this abscess! And the surgical reg (really cool guy) probably would have thrown me a bone and let me do something, anything! Put in the local? Make the incision, maybe? And the ultimate dream of all fourth year med students on their surgical run?? SUTURE.

A lot of possibilities. A lot to look forward to.

Any other day... The thing is, I was speaking at Med Christian Fellowship today... at one. And I was excited to, as I always am. And I was hoping I could do both -- rush up to Theatre; see as much as possible; leave the operation at the last possible minute, even if that meant being a few minutes late to the meeting.

But... as is almost always the case, even once the patient was in the theatre waiting bay and ready, there was such a process to go through before the operation even started. By quarter to one the anaesthesiologist hadn't even seen the patient.

So I left.

Which was fine. But let me tell you, it was a hard moment. I know it shouldn't have been, and more than that, I know it should be a joy and a privilege getting a chance to talk to and encourage the preclinical med students (and it was! definitely!), but I'd be lying if I said it was an easy moment. Actually, in ALLLLL honesty, it was much tougher than it really should have been, which may have been a reflection of my gradually drifting from the 'narrow path' these past several days, if you get my gist. With on-call and being sick, etc., I haven't really been spending a lot of alone time with God lately, which is probably why the letting go of the abscess was just *that* much harder.

I just REALLY wanted to drain an abscess. Like, REALLY, REALLY. *sigh*