Post CSFC

Well sort of. I'm not sure if the exam is counted as part of CSFC...

That being said, exams start in 30 hours time and I have totally no idea how stressed I'm supposed to be. I came out with this theory that, based on the marking scheme, the minimum mark I need to get in order to pass is 25% of the maximum possible mark.

Sounds really easy, but I suppose human nature gets the better of us: we tend to think of the worst case scenario, how we would have to take a re if we fail, and how if we fail the re, we re the whole year and how if we fail the re-year we get kicked out. Yes it just seems to happen all the time for some reason. But practically speaking, that aside, I suppose I STILL want to do well for the exam, not so much because it's a judge of how well I've been studying, but rather because it serves as a marker as to how well I'm getting the hang of my future career ahead.

Anyway, exams aside (they tend to be depressing all the time... somehow...), it's only been a month in the wards and I've seen.. just so much. There are many extremes of the kinds of patients I've seen. There are patients who are cheerful regardless of their (severe) condition; patients who tend to think the worst of their (insignificant) condition; patients who are depressed; patients who bring joy to others; patients who are paralysed; patients who are healthy at the age of 80+ years; the list goes on and on and on...

I've come to realise that, one day, however good I become at taking a history or doing a physical examination, it takes so much more skill and experience to learn and know how to communicate effectively with the various kinds of patients, those with different outlooks of life, those with entirely different personalities. How do you educate a person who thinks smoking is beneficial for him? How do you solve problems within a family, beyond a patient's medical problem? How do you encourage a person who is terminally depressed? How do you continue asking for details from a person who knows he has cancer which gives him only a few more months to live? How do you communicate with a patient who has had a stroke affecting his speech, but is evidently gesturing for... something? How do you deal with.. death?

At first glance, while all these may seem so melancholic, it still brings so much anticipation of the future at the same time. We weren't (at least I wasn't) born knowing how to deal with all these situations but, God being my Guide, I'll pick these skills up slowly. Of course, in life there's always this thing that sets you back no matter how hard you try. For me... well, I guess Chinese always gets the better of me. But THAT aside, I pray that God will continue to enlighten me and nurture me into the person He has called me to be.

~Over every thought, Over every word, May my life reflect the beauty of my LORD~

Mid CSFC

I realise it's only 10 days to my CSFC exam and I haven't read even 10% of what I'm supposed to have to. Ok but that's besides the point for this post...

Since my last post, I haven't really had any new conclusion, it's still: hospitals are fun, but seriously physically draining. Somehow I feel that my current Med posting is more tiring than the Surg posting even though it's less packed to some extent.. It's more structured too but that also means more tutorials, and poorer quality time spent with patients.

Today I experienced part of what the seniors were talking about: medical students tend to "pounce" on patients the moment they have "good signs". I saw a patient today, led by the doctor in charge of my group, who had pretty severe ascites. Reluctant as she seemed to be, she was sort of oblidged to allow us to examine her as she was once treated by the doctor before. Didn't have much choice then since the doctor told us to proceed... Then there another patient with a goitre - rather rare sight in Singapore nowadays. She was really nice, being perfectly fine with random (and many) medical students examining her neck one after another. That being said, I can imagine how many "visitors" she'll have if this news spreads.

It seems like in the wards, it's always two sides of the same coin when it comes to medical students and patients. From the "practical" viewpoint, spending time with patients benefits them more as they get to express their heartfelt thoughts, while for the student, it'll mean that he gets to see less cases. "Good signs" are definitely good for the learning of a medical student, but on the extreme opposite, that probably means that the patient has a rather severe condition, so much so that he now exhibits the "good signs" that we are expected to pick up.

The list goes on. A chop-chop attitude is considered efficient for students but leave patients feeling they've been "used". Talking to patients whom we clerked in the past makes them happy, but on the contrary it's considered "a waste of time" on the students' side. NOT "spreading the news" of a patient with "good signs" would be considered selfish to students, but a great favour for the particular patient - they sure don't need the exponential growth in "visitors"

Notice the extensive use of apostrophes so far. It's not to say that these words within the apostrophes aren't meant literally. They are. It's just that, there is so much more meaning that is left out in those words. Wasting time isn't the smartest thing to do when your exams are coming, neither is not approaching patients with good signs very wise if learning is to be possible. But is talking to patients really a waste of time? Is it right to bother a patient just because he has good signs (considering group after group of medical students have approached them already)?

The balance has to be made, between learning and patient welfare. But as of now, I believe that patient welfare is top priority. God won't fault me for not learning everything; the world of medicine is endless anyway. But I believe it isn't right to learn at the expense of the patient's wishes.

Just another random reflection from CSFC~~

Reflections from CSFC week 1

It's been a really tiring week, mostly self-inflicted I would say. But I suppose at the end of this week, I've seen much more than I have over the past 2 years, and learnt much more than I would have over the course of 10 PBP sessions. Practical really puts more perspective and more purpose than dry text. I gave some thought about the past week though... and so I've reached the conclusion that...

Awesome as it has been, it has also been a tad depressing... somewhat. I'll use three patients that I clerked as examples...

I clerked Mr A. on Tuesday. One of the standard cases - obstructive jaundice. Went back to see him on Weds, his pain and cough was gone, he was feeling better. Then I went back today to see him again, found out he had diarrhea, with the case notes suggesting sepsis and hepatic encephalopathy

I saw Mr B. for the first time on Thursday. An elderly man, with children who wouldn't support him. Monthly income of <$1000; government rejected his multiple applications for a HDB flat.

Ms C. had SLE. She was really cheerful, really helpful. I was probably the countless medical student who approached her to ask for a history. One question and the entire history came out, filled with medical terms and information that taught us much. On that day, she was awaiting results - which came out the following day. Her previously controlled condition had progressed to cerebral lupus. A very poor prognosis indeed

I think about such cases and then I think back on my goal of striving to be a doctor. Much as medical science can do, it cannot solve chronic conditions, it cannot solve end stage diseases and all the more, it cannot solve social problems.

People talk about how great doctors are, how they have the 'ability' to heal and how they are able to change lives. But really, what can doctors do for these things? Nothing I would say. Simply nothing. While all these glorious talk is going on, what people don't talk about is how helpless the healthcare profession is when faced with these problems. Paliative care doesn't heal, it relieves. Financial aid has its flaws, as evident from the elderly man's case. Medical science right now tells you that you have a chronic/end-stage disease and it leaves you there - no cure.

So what really is the purpose of health care workers? With much thought, the best answer I can find is that, we treat those that we can. For those whom we can't, we'll have to support them emotionally, if possible, financially. Thing is, there's always a limit. How much time can you actually spend with one patient when there are hundreds and thousands more out there who need someone to speak to, but don't? How much aid can we give to one person, how much do we help each one of them?

I think back to the story of a boy and the beach of starfishes...

~~~
Once upon a time, there was a wise man who used to go to the ocean to do his writing. He had a habit of walking on the beach before he began his work.

One day, as he was walking along the shore, he looked down the beach and saw a human figure moving like a dancer. He smiled to himself at the thought of someone who would dance to the day, and so, he walked faster to catch up.

As he got closer, he noticed that the figure was that of a young man, and that what he was doing was not dancing at all. The young man was reaching down to the shore, picking up small objects, and throwing them into the ocean.

He came closer still and called out "Good morning! May I ask what it is that you are doing?"

The young man paused, looked up, and replied "Throwing starfish into the ocean."

"I must ask, then, why are you throwing starfish into the ocean?" asked the somewhat startled wise man.

To this, the young man replied, "The sun is up and the tide is going out. If I don't throw them in, they'll die."

Upon hearing this, the wise man commented, "But, young man, do you not realize that there are miles and miles of beach and there are starfish all along every mile? You can't possibly make a difference!"

At this, the young man bent down, picked up yet another starfish, and threw it into
the ocean. As it met the water, he said, "It made a difference for that one."
~~~

I suppose, that'll be a good way to end this post. It's a long journey ahead. And it'll a journey guided by God. LORD, may You guide my steps, my speech and my heart.