Vampy's Weblog - Life of a Medical Officer

I started my term of Obsterics and Gynaecology or Obs & Gyn for short today. We were taught to do a pelvic exam and Pap smear today. WE were told to practice on plastic models at first which was easy enough. The plastic models needed a bit of extra push and pull to insert and extract the speculum but at least you know there's a cervix in there. Then, we were asked to practice on real people. I have to say that these women who volunteer to allow medical students to exam their nether regions are very brave. I mean, it's a uncomfortable examination (ask any women) and having 6 medical students to probe and poke in that region does not make it any better. So a huge thank you to those brave women who volunteer to allow us to practice. For guys who don't know what a speculum looks like, a picture below will illustrate why the examination is rather uncomfortable.

A photo of what a speculum looks like.

However, it would have been better if the instructors who arrange this exercise to get women who have intact anatomy in that region. The women I got had a total hysterectomy. It's good for me to be able to insert the speculum in but I really would appreciate the practice to see an actual real life cervix. I mean I need to know if my technique will allow me to visualise a normal cervix. But as the woman had a complete hysterectomy, there's no cervix to visualise except for a horizontal scar at where the cervix was. Also, as part of the pelvic exam, I have to feel for the uterus, ovaries. But again, as the woman had no ovaries and uterus, I can't be sure if I'm doing it right and what it feels like in a normal woman.

Yes! I shocked my first living breathing patient yesterday! Essentially, the patient's heart was beating too rapidly and as a result the heart was not pumping blood efficiently. So we had to shock the heart to bring it back to normal. It was like on TV - I called for everyone to clear and then shocked the patient. Luckily for the patient, one shock was enough to bring the heart back to a somewhat normal beat.

There's this taboo in ED - never say that things are quiet... because Murphy's law dictates that once you said that, all hell will break loose... Well, that's essentially what happen today... In the first hour that I was there, all was Q-U-I-E-T... beds were empty... and then all hell broke loose. 4 trauma cases came in through the BAT phone (as in the cartoon "Batman" - when the police chief wants to summon Batman for help) within the span of 15 minutes. All of them were motor-vehicle accidents or MVA for short. (Don't read further if you are squirmish.)The most serious case belongs to a patient who literally had a side of the lower leg sliced off like a ham... I can see the leg bone quite nicely with parts of muscles still hanging, not to mention blood...

My elective term is drawing to an end... Next week, I'm starting Obsterics and gynaecology - babies here I come...

Talk about imbicile! I was doing some grocery shopping today and was coming down the escalator when bunch of punks decided that it was funny to press the stop button on the escalator. Seriously, how is that funny or fun?! Really, why the hell do God give them brains so that they can press stop buttons on escalators.. they should just be born with a bird's brain and that's being kind to them... If only brain transplant was possible I'd gladly transplant their brain to someone else who needs it...

Anyway, to more important stuff... Yesterday I decided to stay overnight in ED cos i have not had the opportunity to do an overnight shift... I went in at 10am yesterday and only ended at 8am today... What did I realise from this experience? My brain cannot function properly after 20 hours of no sleep... By 5am, my brain was grinding to a halt... So there's another good reason why I can't go back to Singapore for intern... 36 hours shift is going to kill me...

I had a couple of interesting days in the ED the past couple of days. I saw 2 major trauma cases within one night. Both of them are self-harm cases. The patient had slashed her major blood vessels on her arm and stab her abdomen and had taken some unknown tablets. She was only found several hours later and had unpalpable blood pressure. The other involved using a sharp object or razor and essentially stuck it into his throat - essentially giving himself a cricothyrotomy. He was found in a pool of blood though conscious. Because he had lost so much blood, he was shivering as the body could not maintain his body temperature.

I was allowed to do my first suture! I was asked to suture this patient who basically had cut his toes from glass. He had to have 6 stitches all in all. I have to admit that even after watching several other doctors suture wounds, it feels different when you have to do it. I was shaking initially. I could see my hands trembling when I gave the local anaesthetic and my first couple of stitches. But as time went on, I began to relax. When I first started, essentially I was concentrating so much on the wound that it's as if only the patient's disembodied foot was there. I took quite a bit of time to suture those 6 stitches which I'm sure other doctors would have been much quicker. The patient's father came in just as I cut the last stitch, thankfully. On the whole, I really enjoyed suturing and hope that I will get the chance to do it again in the next couple of weeks.

Alrighty, time for me to go and experience human civilization - I'm going to the city!

Finally, it happened. I was given the opportunity to cut open a person... (Okay, the cut was only about an inch and it wasn't deep.) Basically, I was asked to cut across an abscess just under the umbilicus (belly-button) so that we can expose more pus and assess the depth of the abscess and the clean it out. But hey, it was nonetheless, my first cut. I know everyone will think that I'm , but as a medical student you kinda get excited over the smallest thing you are allowed to do. I was also hoping that I could suture the wound up after we clean the wound out but as luck goes, the doctor said that she would rather leave the wound open so that it can drain and heal by itself.

These 2 weeks in ED has been great. I finally feel that I'm not just a wallflower on display and being trusted to do some stuff. I'm still waiting for my chance to assist in a resuscitation case. Hopefully, one of the days when my supervisor is on and she is heading the resus, I'll be ask to assist. *fingers cross*

I also submitted my intern application yesterday but I still have to gather some documents and get them sign by Justice of Peace before sending them off. Well, hopefully I will get my first choice. But I guess second choice would not be that bad either. The results of the intern allocation will be known at the end of July which will be when I'm starting my last rotation. I was talking to this overseas elective student who was doing ED as well and she's at the end of the life of a medical students in less than 5 days! I was saying how great that feeling would be and she agreed but she added that it's kinda scary as well. Well I'm glad that I'm not the only one who feels ecstatic but at the same time a tinge of apprehension.