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Tuesday, January 24, 2012

Orthopaedic Posting

Honestly, i don't really like orthopaedic stuffs. The feeling is like when i was studying physic in secondary school. (i don't like physic either).

Well, orthopedic was a totally different posting compared to surgery posting. I meant the the way how it was organized. Unlike surgery, everything has been arranged & scheduled nicely. Just that you got to wake up early to sign to your attendance before the clerk take away the attendance sheet. Next, you go for ward rounds, clinics, seminars and clinical teachings as scheduled, and also depending on which team you are in. After around 5pm, you will be allowed to go back and study at your room. I was in the spine team. The doctors were damn nice. They spoon-fed everything to us. The only drawback was i had to stick with spine things for 6 weeks, where i could hardly study stuffs from other teams. And i really hoped that my CT could be better. Almost every time doctor would be kept commenting on our history and after that, time was already spent up and he couldn't teach us much about PE. Till now, my PE still sucks!

Moreover, you may have to go for on-call occasionally if your team is in charged on that night. Luckily, i didn't have much on-calls, where i could have more free time for my study (or more time to waste?). Anyway, you can still learn a lot through on-call. you can see "fresh" cases like those mva cases in emergency ward, do dressing on those "fresh" wounds and learn the way how doctor manage the casualties there.

Hmm, not much 'great' procedures i have done in this posting. One STO, some dressings and assisted in some POPs. That's all. I knew that i should be more aggressive and asking more questions but honestly, i was quite tired with the log book requirements already and i chose not to chase blindly after signatures in log book. It was stupid attitude. And my reading was clearly not enough, most of the time i didn't really know what to ask and didn't even know what the doctors were talking about. Haiz. What a bad attitude!

My supervisor? Dr Halim, head of department! Omg! Till now, i am still scared of him. He scolded me few times during ward rounds as i couldn't cover my cases well. If i am smart enough to cover all cases fully and yet, manage to study well, i will definitely do it. But obviously i couldn't make it. I am so sorry to my doctors, and also my teammates, especially Prof Chong. My examiner? Dr Mohammad! Another scary doctor! Thanks god he was free finally after delaying for 3 times. I managed to answer those questions asked by him, even though i knew that my performance was just mediocre. Hopefully i was good enough to pass the posting.

Eventually, my turn to go home! My mood was so badly affected in the last week of orthopedic. I didn't really have the 'mood' to study for exam already. I missed my home sooooo much because i has been away from home for almost 5 months already. I felt so guilty for not studying well enough even though it was already the final week but i just couldn't control my mind. I needed a getaway and a nice rest after a long run in 4th year.


Therefore, as usual, i still couldn't manage to finish studying what i planned initially. Haiz. I knew i was quite lazy throughout this posting. Aargh! Got to be more hard-working next time!

Happy Chinese New Year and Happy Holiday to everyone! :D

Thursday, January 05, 2012

BKA


BKA aka below knee amputation, is a surgery which cut off your leg at a measured level below knee.

This is the operation I saw during my second orthopaedic oncall during last Monday night. The patient was the one I clerked before for case report last month. He was actually admitted once last month due to diabetic foot. Ray’s amputation was done before he was discharged. And I thought that he would be okay after that. However, after another 10 days , he revisited our ward again due to the spreading of gangrene again in his left foot.

He said when he was in clinic, the doctor cut through his foot and found a lot of pus inside his foot. It’s a sad thing when you thought that you are already recovered after removing part of your foot, and now the doctor tells you that you have to remove another bigger piece of your leg. His wife once told me before that they were actually having some financial restraints. Even with the help from government’s welfare, it was just enough to drive through their routines. All his children but the eldest one are still schooling. He can no longer work as he feel tired most of the time. ( fatigue is one of presentation for diabetic patients, not that they are lazy. ) His wife can only earn a few hundred bucks by working in a school canteen.

During morning round, our doctor told him that BKA needed to be done on him as the foot was already not viable and also to prevent the colonization of microorganism there. He agreed without thinking too much. He understood. Just that I could not understand why he could be so calm when someone told him that his foot needed to be removed? I guess if I am him, I am gonna cry a whole day long.

Sometimes, it might be just an ordinary operation for us as medical students or doctors, but it plays a huge part for patient’s life. It might be vital for survival but it does affect a lot on patient. I just feel like the psychosocial part is a important part also in managing patient. They are human being, their hearts are still pumping, they still have their feelings which we can never ignore it. Don’t blame them if they are reluctant to accept your decision of management, especially the more invasive one, but try to understand why they feel that way. It does not always appear to be the good choice. It might treat the disease but not necessarily the patient himself.

Appreciate your patients as they are helping you in becoming a doctor. Without them, you can never be a doctor. That’s what I feel and learn from him.