Med School Diaries #2: Pigeons, Pain, and Surgery Posting

I'm about a month into my 3rd year, and its safe to say that Surgery was the luckiest first posting I could possibly have gotten. Not as relaxed as Psych, but not as intense as Peads or Internal Med - this nice, even, middle ground where I can learn basic history taking and how to do a general examination without the pressure of remembering all the definitions and growth charts and dermatomes just yet.

It does come with its own challenges, though.

One of my friends lovingly referred to this semester as our "Touching Grass Arc"

Starting off with the leg pain - but hear me out. I can walk. Back in Melaka I was hitting 40 minutes on the treadmill daily (an hour on weekends) WITH INCLINE. Leg day was my best day in the gym because I did those goblet squats with a 7kg dumbbell like a champ. So yeah! I can totally walk. But the standing? Standing should be considered in extreme sport. Standing in those corridors, our lab coats stuffed with at least 1kg in equipment and notebooks, our backs sweating from the sun, our calves shrieking in pain because we just. Can’t. Sit. Down. Of all the things my seniors warned would be difficult, standing was the unexpected underdog taking first place in terms of strength needed to overcome, both physically and mentally.

Surgery lecturers love to talk. A good thing! You can ask questions and get detailed explanations. A bad thing when you need to clerk another patient or do a case presentation and your lecturer has lost the concept of time somewhere along the way of his explanation of a colonoscopy. Of the 4 hours I spend every morning at the hospital, at least 2 are dedicated to simply listening as a lecturer rips your case presentation to shreds. In the moment, talking to your patient, you tend to forget to ask important questions like how often were you vomiting? Does the pain radiate to anywhere else? How many children do you have? And somehow, no matter how quickly you try to brush by it, your lecturer will always know exactly what information you forgot to ask. It's almost like a sixth sense.

Look, I want my lecturers to think I'm a good student. Studious, curious, self-improving, intelligent, well spoken; but I’m not going to reach there overnight. I’ve realized pretty quickly that the skills they’re trying to teach us right now – history taking, empathy, connecting to a patient – are things that aren’t taught in a classroom. So I’m giving myself some grace to be a little bit awkward at first.

(I called mom on the first day of hospital visits and complained to her that I felt pretty dumb. She scolded me for 15 minutes because I was being too hard on myself.)

Pretty sure I make this exact face during case discussions 

Bags are another funny (ish) issue. I'm not allowed to bring my bag around when I do ward work - and so far there's no rooms available for me to leave them safely in. Two issues with this: one, despite everything being able to fit in my white coat pocket, my water bottle and wallet disagree entirely with it. Thus I am at risk of dehydration, or worse, not having money to get a cafeteria snack on mornings when I miss breakfast. Second, some days I come back from the hospital for lectures at the classrooms. Bringing my laptop, prize possession, keeper of my 101 unfinished story drafts and 30 textbooks worth of notes accumulated over the past 2 years, to a hospital and leaving it in a corridor is not exactly ideal. Not to mention, my lunch box, which I am equally as protective of considering its literally saving my wallet. (Never get between me and my lunch by the way. The closest I’ve been to landing in jail has always been when I’m hangry). 

I'm not the only person who disagrees with the bag policy - nearly all of the students in surgery are just quietly bringing their bags and hoping they can get away with it. Thankfully, the security guards outside the wards are nice enough to assure us that they’ll keep an eye on our bags while we’re inside.

Having a good day at the hospital depends on a variety of factors; the patients that are admitted and how willing they are to comply to our rounds of endless questions, for one. Some patients love telling stories and others just uncomfortably shrug and look away. I’ve witnessed a patient whip out his phone and start scrolling on Facebook while my groupmate questioned him.

Another factor is our lecturer for the day and how foul of a mood they are in. If you know anything about university, you know that there’s an underground network of students who spread information about our lecturers and their temperaments. Someone heard that Prof X likes coffee. By the next day at least 5 students will have offered to buy them a cup. Prof Y made a student cry with their questioning? By the same afternoon people will be shooting that professor dirty looks. It’s a quiet sign of student solidarity – no matter if we don’t or do like each other, we all know to protect each other from the judging eyes of our teachers.

 The amount of cases we get to present (note: cases need to be presented for us to get marks to complete our posting) is entirely dependent on how long our lecturer wants to take on one. A good day will have us presenting three or more cases. A bad day is the entire 3 hours spent discussing a singular case. Some days we get to practise our examination skills on patient – however most of us are terrified of pressing down to hard somewhere and causing a patient pain, that we tend to be too gentle to feel anything. I swear, the way the lecturers do it makes it look like they’re pressing down with enough force to squeeze a lemon dry. 

Trying to see from afar if the patient is in the mood to answer my questions be like

I have to talk about the pigeons. See, HTAA is an old school open-air hospital- save for a few rooms, there's no air conditioning in the wards. There's large open doors at the sides to let in lots of fresh air, and apparently, the resident pigeons. One of the nurses told us they like to call them their 'local specialists'. They've got next to no fear of humans - they fly around regardless of how many people are crowding the entrance and walk around under beds, inspecting for cleanliness. I even saw one particularly hungry bird perch on a sleeping patient's side table and munch on his breakfast leftovers until a nurse shooed him away. Sometimes the pigeons stare at us while we are history taking- almost as if they know when we are making mistakes. I swear they know more about appendicitis than I do.

On Wednesdays and Thursdays we have lectures in the flipped classroom. It's a pretty boring part of the week compared to the daily hospital trips – but there’s a sweet treat in it for me. From my table I have a little peek of the ocean and the beach outside the window, not too far off. Sometimes I feel like Moana with how the ocean calls me. If I only had a car and money for fuel! I'd live by the beach and eat at the beach and, yes, even sleep at the beach. Beach is love, beach is life. It’s monsoon season, however, so it’s no longer safe to be near that location. The head of our Kuantan campus has taken to signing off his emails with a warning to students to not go swimming. Thou shalt not stop me, professor, from dreaming of it anyway.

Me every time I think about how I could have been chilling at the beach rn

One of the best things about living in Malaysia as an extrovert is the multicultural friend groups. I find it immensely fascinating to just sit and discuss the differences in the places where we grew up, the languages our parents speak, the history we brought with us as children of people who moved entire countries to support our futures. I especially love hearing international students talk about their time in Malaysia – it’s fascinating to see what are normal things to me look so special in their eyes. It may seem like we're just passing time, but these conversations are endlessly educational. It's funny to think of how different our lives were - and yet somehow, we all ended up in the same place, at the same time, suffering for the same degree.

On to extra curriculars. We had our first Christian fellowship meeting this month and I was the one speaking - I volunteered myself and then regretted it a week later when I was practising in my room near midnight knowing I had to wake up and go to the hospital tomorrow. Most things went a little bit haywire during that first CF meeting, as is standard from my experience last year. We had an extensive one and a half hours post-mortem meeting a few days later, where doubts were cleared and roles were more clearly defined. I'm hopeful for the future of CF. A bit crazy to think that a few months ago I was sitting on my bed worrying that it was going to die out because we couldn't get more juniors to join us.

I’ve been very disciplined about cooking for the past month. In order to make things easier for me I’ve taken to peeling my onions and garlic and storing them in ziplock bags, as well as doing the same with chopping my veggies right after I buy them. I have discovered, however, that I need to make sure they are completely dry before I try to store them – I’ve so far lost an entire bag of cabbage when they spoiled overnight. I have also dropped an egg in my early-morning haze as tried to crack it into a pot. For new recipes – I tried cooking soft tofu for the first time, served with minced meat – and was pleasantly surprised that I could make something that delicious.  I also have continued my obsession with kimchi with two entire jars in my fridge – one of which I finished the day before writing this.

Before signing off, I’d like to take this opportunity to say that I’m genuinely enjoying myself a lot more than I was in pre-clinicals. I think that’s part of the reason why I’m only actually staring these med school diaries in Year 3, because before this I think my med school diaries would have been rather depressing to read XD. I’m looking forward to what the other departments bring, and I’m especially grateful that I’ve got some amazing people to share this experience with. To batch 53, and our slow but sure takeover of Kuantan!

Me and my groupmates telling each other how smart we are for answering Prof's questions (there was no wrong answer)

Talk to you later, World!

Joy (ﾉ◕ヮ◕)ﾉ*:･ﾟ✧