In this past year, internship has changed me - some for the better and some for the worse.  I'm no longer the naive medical student who believes everything he's told by patients, colleagues or superiors. However, I believe tat I have survive internship with my principles intact. My passion for medicine or my patients have not diminished.

For now, I'm enjoying a bit of R&R while waiting for all the paperwork to be approved by Sungapor Medical Council and hopefully I will be able to start work in early March. I'm excited about work as I am told I can most probably do at least 6mths of paediatrics and possibly a full year. At the same time, I'm petrified as paediatrics is a whole new field of medicine (children are NOT little adults) and in a way it will be like internship all over again as I try to find my wings. I'm also hoping to do my paediatrics exams in middle of this year and if I can pass it, hopefully I will stand a better chance in getting a trainingship position at the end of the year in paediatrics. Wish me luck!

Others are even worse. They want free medicines even after discharge. One claim that he can't work because of the injury which is fair enough, but the partner can work but is not. The partner has use of all 4 limbs and they have the cheek to say they have no money to pay for medicine after discharge and want us to supply him with free medicine. Hello! Get your partner to get off her fat arse and work and maybe that way you have money. I mean that's how majority of us have money. There are more deserving ppl who genuinely can't work and still they try. God gave you arms and legs so you can work. If you don't make use of them then give them to some others who appreciate them and make use of them. I'm sorry if I don't sound caring or sympathetic as a doctor would but I have no patience with ppl who demands free stuff like it's their goddamn right! Just as I said in my previous tweet - how about a stretch limo or private jet to send you home from hospital or a butler who will bring your pills on a silver platter? These are the ppl that is part of the reason why the healthcare budget keeps ballooning year after year.

Was in a mood for seafood and thus this review. Wild Harvest is a restaurant/ bistro that serves dinner on weekdays and weekends, lunch on weekends and breakfast on sundays. While the repertoire of the menu is quite limited, I have to say they serve one of the best fish and chips in NSW I had so far. One of the selling point of the place is that it is literally next the the sea. During winter the lower deck of the restaurant is closed but the upper deck is opened and it is quite a view to behold. Imagine having your lunch/ coffee out on the upper deck and hearing the waves crash against the breakers and sea gulls flying overhead (beware of them pinching food off your plate though).

One of the main reason why I love the fish and chips is the light batter used. It's light, crispy and not thick. It's not overly salted either so you can enjoy the freshness of the fish. The fish is fresh, no fishy smell or after taste and it's juicy and melts in your mouth. It's serve with a generous portion of chips which is just about the right thickness and but crisp on the outside. As usual there is a green salad by the side. The one complain I have about the fish is that it's a tad too oily. Perhaps kitchen paper towels may solve the issue easily.

I also ordered a thick chocolate milkshake which is good and thick. I have had experiences with other cafes/ bistros where thick shakes are not thick at all.I'm a chocolate lover and thus I find the chocolate is too mild for me. It's more like a after taste. Service is nothing to boot about but prompt. Overall, I would go back for their fish and chips or maybe try something different the next time.

I'm starting a new section in my blog i - reviews of restaurants in Sydney/NSW. Note I'm not a professional food critic but who doesn't. So here's my inaugural review.

First of all, from the exterior of the restaurant you wouldn't think it was a thai restaurant because the building looks more european than thai. The same goes for the decor. We have a very european (think Louis VIII) huge mirror, phoenix wallpaper that looks like it has seen better days and tulip-shaped lampshades. The only decor reminiscene of thailand are the 2 buddha statues. The placemats are of a disgusting dark green color which sticks out like a sore thumb on white tablecloths.

The atmosphere was more of a western style than thai. While the restaurant tries to set a atmopshere of a 4 star restaurant, it failed to carry it through. The food I ordered were not remarkable. My entree was a mixed entress plate. When the service staff first put it on the table, it looked like the waitress had taken a tumble with the plate. While the entrees were arranged properly but the presentation was just a mess. It looked like the chef while trying to decorate the plate with bean sprouts did not quite know how to go about it and decide to just throw them around the plate. There is a serious lack of asthetics. The way I see it is if you can't decorate a plate well, then don't.

The mixed entree plate consist of a serve of thai fish cake, fried dumpling, beef puff and fried vegetable spring roll. The only entree I enjoyed was the thai fish cake. Rather than to use commercially ready thai fish cakes, the chef have made his own. Hence it is not the perfectly round fish cakes some restaurant serves. The beef puff is oily. Every bite oozes a fair bit of oil that I have to wipe my mouth after each bite. The spring roll was unremarkable. My grandaunt makes much better ones. The fried dumpling was again unremarkable.

The 2 mains I ordered were Changmai noodles and one of their specials - Fish Panang curry. The noodles were literally swimming in a pool of oil. After a few mouthfuls, I had enough and this is with the pineapple juice I ordered. When you order the noodles, you can specify how spicy you want it to be. So I ordered it to be hot. For a restaurant that appears to cater for majority of western clients, they did make it rather spicy. Another thing about the noodles, it was severely overcooked. It's just a plate of starch.

The fish curry was good but not fantastic. You can tatse the creamy coconut texture without it being overpoweringly sweet. Fish itself wasn't the freshest but not stale.

Serivce was average. The one thing I found disconcerting was probably my own experience with one particular service staff. She leans too close when she talks and in a rather loud voice - not rudely loud but just a few decibals above what I expected.

Overall, food is passable but if I have a choice I would not go back for seconds.

I have just completed my second term - Emergency medicine. It was a lot of fun with adrenaline pumping moments as well. My first cardiac patient unfortunately died on me despite attempts at resus. I guess what made a lasting impression was how rapidly the patient deterioriated in front of me. One moment he was talking to me and the next, he had a massive heart attack. Frankly, there were moments during the resus that I wondered if I had done something wrong or my inactions that resulted in his death. But the consultant who took over the case said to me after that there wasn't anything anyone could have done. I went with the consultant to talk to the family and it was then when the emotions started to build up as we told the family the news. Once again, I had to try my darnest to maintain my professionalism and not break down in front of the family.

Working in the ED made me realise how unreal medical dramas are. All the cardiac arrest that came through were non-revivable. Despite everything we throw at the patient who arrested, they just did not survive. So people, don't believe those heroic efforts portrayed on TV! In most cardiac arrest, patients don't make it.

Having finish my ED term, I have just started on my 3rd term - Rehabilitation. This term I'm actually sent to what is considered rural - a beautiful coastal (think of beaches) area called Coffs Harbour. It's about 6 hours drive from sydney. I stopped over one night in Port Macquarie which is another beautiful coastal area. the problem is that I have no internet access at the apartment they provide. So I'm actually submitting this post via my mobile internet. Sigh! A photo of Port Macquarie above at twilight.

Second milestone - I got my car, finally! My first car! I'm very happy with it. It's amazing how mobile you become when you have a car. Not to mention that grocery shopping is no longer a pain - both literally and figuratively. I got my car on Thursday and have since clocked over 100km according to the odometer. I got a GPS as well and thank god for it! Even with the GPS I still make the wrong turns - usually because I wasn't quick enough to response to turn left/ right in 100m. Seriously, with so many cars how does it expect you to change 3 lanes in that amount of distance?!

Third milestone - I have applied for my first credit card. Crossing my fingers that it gets approved. I have been a good customer of the bank for the past 4 years and have always paid my bills and rent on time and well I have no credit history.

I'm also counting down to the time my mum will be coming over...In 3 weeks! I'll be able to have dinner with someone other than myself. I can see why some of my seniors have said that once you start working as a doctor, it can get lonely at times. I have not been able to catch up that often with my fellow former classmates since we started work. Not because we are working extended hours but just simply because on the weeks that they work weekends I am not and vice versa. So coordinating a time suitable for everyone is proving to be an issue.

During the end of last week, the patient started bleeding through the stomach while stop-gap measures were put in place to stop the bleeding, all the doctors and nurses looking after the patient knew the end was nearing. I spent quite a bit of time explaining to the patient and the family after the bleeding occurred but I believe that there were questions and answers best left unanswered.

When I informed the rest of the team that the patient died, no one was surprised and while we agreed that it is probably better for the patient to pass on - at least the patient will no longer suffer, we can't help but wished but a happy ending.

After working for the past 3 weeks, I have come to realise something. The amount of knowledge that an average intern require in terms of medical stuff is actually very little. It's not because people expect very little from you (which may be true to a certain extent) but it's simply because most of the time (I would say 99%) what an intern does can be easily accomplish by a clerk/ secretary. Let me iterate what a typical day is for me:

6.30am: Rush onto the wards and print a list of patient under my team's care. At the same time, scroll through all the results of all the patients and write them down. If the results is red in color that means something is wrong and something needs to be done.
7.00am: Ward round begin. Me and other interns scramble around looking for patients' charts. When we find them, we write what is being said by the more senior doctor and the patient. The we write down the plan for what needs to be done for the patient kindly supplied by the senior doctor.
8.00am-exhaustion: Ward round finishes and we the scatter to do the jobs. What are some jobs that we do? Call other doctors to come and review and suggest treatment for the patients. Call the GP to find out information about the patient. Call the patient's family. Call an interpreter. Call the social worker and so on. So most of the time we are on the phone. Occasionally we may be asked to review a patient who became unwell. You may think well that is something a doctor does but guess what?! After the review it's more calling and writing forms and notes. In my first 2 weeks of work I actually ran out of ink on a brand new pen. That is how much I write.

Having said that, the moments when I have to act as a doctor scares the shit out of me... For example, just into my second week a patient literally died in front of me. I was asked to insert a tube into a patient and I was unsuccessful. I hence pulled the tube out and was just clearing up the area with my back facing the patient when the nurse who was assisting me whispered,
Nurse: "Um...I think the patient is not breathing anymore...".
I was momentarily stunned.
Me: "Urrr... Are you sure?".
Nurse: "His chest is not raising."
Me: "Oh right...Um...Mr Poor.. can you hear me?"
I shook him gently first and then more vigorously...I then performed what we call a "sternal rub" which is essentially kneading your knuckles onto the center of the chest. It is as painful as it sounds but that is the idea. If someone does not even respond to the pain... the person is pretty much pushing daisies.
Of course Mr. Poor did not respond. I then went through the whole drill of certifying the death. Of course there are stacks of paperwork that needs to be filled out and lots of crying as well.

On a happier note, I bought first car and I got a new TV... I'm looking forward to getting them next week...Plus the fact that next week is pay day again! Yoohoo!

Then we need to fill in the death certificates if we think thet the death is not a coroner's case. This is where the book of death comes in. There's a set of criteria that would determine if the death should be reported to the coroner. If not a coroner's case, then we have to fill in the death certificate and cremation certificate. Filling in the death certs more complex than just putting in the person's demographics. You actually have to think about what really caused the death of the patient and it has to be specific. You can't write "Cause of Death: cardiac arrest".

Although formally, I do not start work on the wards till Monday, I have to go for a handover today. For this term, I will have to wake up at 5.45am for most days! 5.45am! The last time I had to do that was when I was back in the army! I really could see myself being chronically sleep-deprived this term. After the handover/ orientation of the wards me and 2 other interns would be in charge of this term which ended at 6.30pm, I'm exhausted and I wasn't even doing much. This is not a good indication. The scary bit of this term is that there is only the 3 of us - fresh interns looking after the wards most of the time. The registrars and consultants would be in operating rooms most of the time so in essence it's up to us fresh interns. It's scary to think about that. It did not help when I asked the outgoing team whether if patient in our wards crashes often and her replied is "Often enough." Yes, I'm suppose to call for a code when it happens so that the crash team comes but while waiting for the calvary to arrive I'm suppose to stablise the patient. How scary is that?!

After this one week of Orientation, next Monday would be the real McCoy. Now I know why some of my seniors who were doing their intern year said "I wish I could introduce myself as a medical student again."