Never ending work

Day 6

I suppose when you are sleeping an average of 5 hours from Monday to Friday (waking up 4.30am), you will have to learn the art of sleeping and studying anywhere, anytime - on the bus, on the train - even when it is not that conducive.

Communication is a headache.. try clerking someone who speaks Russian as her mother tongue and needed a friend to translate for her.

Clerked a guy who came in for nothing apart from homonymous hemianopia.. Scan showed he had a brain tumour. By the time we ended, he just had to ask me, "Can you help me ask the registrar whether I can have a copy of my operation video?" "What for?" I asked him. "It's a once in a lifetime life-saving procedure. I just got to invite all my friends to watch it together with me in my living room so that they know what I went through!" *I was seriously trying very very hard not to laugh..*

Day 7

I learnt never to bargain with a registrar's instructions - got scolded coz I wanted to follow up a patient on the 7th floor whereas she asked me to go with another registrar to levels 3 and 4.

Anyway, this registrar whom I followed - although he looked rather intimidating from afar (never smiles), but he's actually quite nice, gave me a few tips for the presentation to my consultant supervisor. He even paid for my Latte during the break (apparently he's British and it's a common custom for registrars in the UK to occasionally treat their interns for coffee.

Scrubbed into the operating theatre (OT) for a cranioplasty, and as I did, my consultant supervisor walked by. "Enjoying neurosurgery? I'm sure you do. (before I even had a chance to answer) Eh *gestures to the registrar*, watch the medical student closely ok? If this procedure becomes infected, I swear I will rip your testicles out!!!" Before the surgery even started, was asked to put on the sterile handle for the overhead lights.. duno why suddenly the light flipped upside down, hit my hands, and now the scrub nurses look at me one kind as I have to change gloves. *swt*

Never mind, it was a fun surgery.. saw the scalp being opened and they put a titanium plate to cover the previous site of a cerebral abscess, where the skull was malformed.
Registrar: Would you like to drill in the screw into the skull for the plate?
Me: Can I?
Registrar: Do you want to? You know, one of these screws cost $50 you know, so the more you put in, the happier the department handling them will be. How does it feel to be saving a person's life with that? Still wanna do neurosurgery?
Me *telling the nurse*: You know, he's been asking me that question since Day 1.
Nurse: What did you tell him?
Me: Well, I told him I'm considering internal medicine. Then, when I saw his facial expression change, I put a disclaimer at the back "But I would take it into consideration."
Registrar: See, hilarious or not this guy? Do you like what you see?
*at that moment, 1 of the screws I was screwing slipped and fell into onto the scalp.. temporary moment of silence from everyone. nvm, I manage to get a few other screws in*

Another registrar asked me to read up about wound management and tell him the A-Z of it tomorrow.

I was fortunate that in the wards, when the consultant asked whether I have been behaving, the registrars said yes with some compliments (but in actual fact, got grilled like crazy). Consultant reminded me of my presentation and long case this Monday, which I will probably spend the weekend doing. Back pain or neck pain, suppose to cover anatomy, epidemiology, clinical presentation, management.. Long case? Oh yes, I should go and follow up on my patient who is to undergo surgery for a biopsy tomorrow. Found out that, unfortunately coz of a problem with the BrainLab machine, surgery got postponed. Fine, I got another patient whom I clerked who might be suitable - the guy I mentioned above with a temporal lobe tumour.. scheduled to have a scan done today and operated tomorrow. Found out that - his surgery got postponed to next Wednesday. Great, how do you find a patient to follow up then?

I was done in the wards by 3.30pm, and the residents asked me to go home, nothing else to do, but I was about to get my MCR on Fluids and Electrolytes graded by 1 of the registrars. In the meantime, got asked to write a patient's discharge summary. Then, by the time rounds ended, it's already 6pm, and the registrars are getting cranky. My brain already shut down that I could not remember what I studied last night.
Registrar: What is the conclusion of the SAFE study on crystalloids and colloids? (yes, they expect me to read a journal article).
Me: No difference between usage of crystalloids and colloids in ICU patients..
Registrar: What? Hey, you got read the whole thing or not? Or just the abstract. Faster go and Google on the PC its relevance to neurosurgery and come back let me know! (Answer: Colloids result in higher mortality. Results of study does not apply to neurosurgery coz of small sample size representing that group)
Registrar: Good, you are well-versed in your fluid compositions. How you manage a patient with head injury? What fluids you give? (am I suppose to know this? I thought only surgery in general) (Answer: instead of 3L of fluid, you only give 2L coz of risk of cerebral oedema)..

Acid base balance was something I was not that well-versed in, so when I got asked:
Registrar: What is the normal value of PCO2, PO2, HCO3 etc (ok lar, I admit I've been relying too much on given referenced figures on the lab form)? What I want you to do, go back.. read up on respiratory and metabolic acidosis and alkalosis, what causes it, how do you manage it. Come back and present to me on Friday, THEN only I sign your assessment sheet? Fare enough? I was an intern before, so these are important things you will need to know, otherwise.. next year doctor already right? Ok?

Getting home later and later.. reach at 8.30pm..