Day 11
As a result of not sleeping on Sunday, I came home the previous night exhausted, and retiring early in bed, forgetting to set the alarm clock for the next day.. As a result, instead of waking up at 4.30pm, I was horrified to see my clock showing 6.05am, and the sun already rising in the far distance. No time for breakfast, so I grabbed the 1st pair of clothes I see as I opened my wardrobe, and off I ran to the bus loop. This is not to be a good day, as I had to sms the registrar that I'm arriving late.
Rounds already started, and later had the opportunity to follow one of the residents who was a Monash graduate and went through the same posting I did. Great, he would know what I need to do in the wards, and I do get more work to do (eg writing referrals, examining patients and reporting findings to him, calling up GPs for patients' results and medications etc)..
Neurosurgery is a competitive unit, or so I found out, where residents compete against each other to earn a good references from their consultants to move on to a higher level (registrar, specialist).. not a very nice thing to do, when a resident jumps on the opportunity to go to the operating theatre / clinic where consultants can see them working, and leaving the other poor guy to settle things in the ward.
2 3rd year medical students joined us for rounds, and after that I followed them to the clinic, where we tagged along with a consultant. He was plain rude, a quick talker and won't hesitate to scold people (I misunderstood his question, and he scolded me "No, don't give me that s**t!") But the way he grilled us and a fellow resident on the neuroanatomy of the spine and lower limb dermatomes was AWESOME, I walked away from that session remembering more than I actually ever read up before this!
Was asked by some 3rd year juniors to supervise them revising their neurological examination, so took them around the ward looking for patients. Ok, let's see how well I do if I were to apply to Monash next time as a lecturer.. I hope it didn't turn out like the blind leading the blind, but I think it wasn't too bad, only that they ended up giving me homework to look up some stuff which I didn't know that time.
Afternoon was spent in OT where I actually planned to observe a microvascular decompression for trigeminal neuralgia, but instead ended up bumping into the Professor and Head of Neurosurgery. Freaked me out a bit when he actually invited me to scrub in, coz a friend of mine once mentioned that he's a very strict person, though he likes to teach. Was actually praying very hard that he will not ask me any neurosurgery or neuroanatomy questions coz if cannot answer then embarrasing leh - got 3rd years watching along (luckily he didn't).. I felt privileged that he asked me to assist him with the registrars in doing the lumbar peritoneal shunt revision, a 2-hour operation up close beside the patient.. Wow, experience of a lifetime!
Day 12
Afternoon was super boring, that I actually wanted to sleep. Clinic finished late, and my modular tutorial with the registrar was postponed again. I do hope we can make it up, coz I hope to get everything done by this Friday..
Morning was different though, as we saw a 90-year old man post-fall with a subdural haemorrhage (ie bleeding in the brain) and was unable to go into OT for operation coz suddenly deteriorated in the ward with a very bad pneumonia. Anaesthetic team decided he was too risky for surgery, while medical team was considering withdrawing his antibiotics. After the counselling session with the wife and daughter, I felt prompted to go and sit down and have a chat with his wife.
She was pretty responsive, and we talked a while - about Greece and Malaysia (they are Greeks by the way), about people, about family, about life..She shared how she had been married to the husband for over 50 years, and they moved to Australia from Greece 45 years ago. She is an Orthodox, and though I may not understand their custom for having a priest come over and sprinkle a drop of wine onto his lip for some kind of ceremony, I do see how closely-knitted the family can be, everybody from grandchildren to uncles will come by to visit.
"It's unfortunate that though we talk to him, he did not seem to recognise us anymore... The other day, he woke up in the emergency department and immediately asked for his shoes. I told him why you wanted your shoes for as you need to stay in hospital. He never liked being bed-ridden, even at home he wouldn't let anybody into his room upstairs, as he claimed he got work to do.. now memories of those times just seem so distant away.."
"I suppose like the doctor explained just now, probably he hears you all, it's just he could not respond coz of his condition." I did try to offer some assurance..
"Well, look at him now.." *points at the cachectic patient lying in bed, gasping desperately for air on the ventilator*
*silence for a minute or 2*
"Are you married?", she asked.
Wow, now where in the world did that come from..
She added, "Marriage is not easy, you see everything as beautiful before you get married as a couple, but once you get together officially.. phew, troubles aplenty.."
We had a good laugh. As I was leaving, though I felt a bit nervous not knowing how she would respond, I shared that I'm a Christian and offered to pray for her family and husband - that if it's God's will then heal him, otherwise pray for peace and His comforting presence as they go through these tough times.. What I lack in clinical acumen, I try to make up by caring for my patients. She was actually touched and so grateful, that she said, "Last time when I was admitted to hospital, there was a couple, Malaysian also, in the same ward.. they too offered to pray for me. I think it is good, as it never hurts to do so. Thank you very very much" she said in a choking voice, tears starting to well up in her eyes. Then it caught me by surprise when she offered me a box of expensive chocolates. "Have 1." I was a little reluctant, but relented when she insisted. "Sorry, it's just that I'm a shy person.." She responded by saying something which I will never forget for a long time, "You are still a baby.. but you are going to become a doctor... and many times you are going to see things which are difficult, which are not easy to handle.. so you cannot be weak, you have to be STRONG. Look at me, I'm almost 80 years of age and I had breast cancer inside of me despite the surgery, but I tell myself I'm still going to fight on. So should you."
Her husband was projected by the consultant not to survive beyond 48 hours as we try to make a palliative care referral. Despite our efforts, we end up confirming time of death as he never made it past that afternoon.
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