Med School Diaries #3: Five Postings Later...

You know those episodes of TV shows where it’s clear they stitched together three different episodes because they didn’t have any other ideas on how to fill the time? That’s what this blog post is going to sound like.

Psychiatry: Self Diagnosis Speedrun Any%

Though she was iconic I'm afraid I cannot endorse Lucy Van Pelt as a valid medical professional

Psychiatry was funny. It was funny because, during lectures, we’d take turns pointing to a symptom and telling each other, that’s just like me fr. Self-diagnosis is, of course, discouraged in the medical community. You’d understand why if you’ve ever googled why your cough won’t go away and had google tell you that you have tuberculosis. Still, as medical students learning about diseases all the time, some days we need to make a light-hearted joke about how expecting to pass the exams without studying was enough to diagnose someone with Delusions of Grandeur.

Psychiatry is a science of words. While other diseases can be measured by blood tests and microscopy and radio imaging, psychiatric disorders are diagnosed based on the patient’s experience with the disease. Things like changes in mood or dissociation are not exactly numbers you can tally on a chart. I would like to express my deepest gratitude to my little green textbook that made this whole experience significantly easier to comprehend.

It was also the posting where I had to start asking patients rather… uncomfortable questions. Ones that, if not gently put, would probably earn me at least a hard stare and at most a slap on the face. There’s no easy way to ask a random stranger if they have any strange sexual preferences. I think I was blushing even more than my patient! Thankfully, after four weeks I was able to ask a simulated patient about sexual attraction with a straight face – the power of repetition alongside the subtle art of embodying the ‘I-need-to-pass-this-exam’ mindset.

I admired the patients in this posting a lot. They were open and honest. They shared the worst moments of their lives alongside the best. They talked about things that scared them, things that made them cry, the aspects of their disease that made them feel lonely. Eternally, I am grateful for their bravery and generosity in sharing their experiences with us.

Obstetrics and Gynaecology: The Womb Where It Happens

Shoutout Osono for running that bakery like the navy at 30+ weeks pregnant

Let’s face it – hospitals are depressing. Everybody’s not feeling their best, people are worried for their loved ones, hospital staff is running on caffeine and prayers alone… And yet, there’s those shining pearls of happy moments here. In fact, a lot of people’s happiest moments take place in a hospital. The miracle of birth – in my mind it’s just like the movies, with the dad almost fainting in anticipation, mom’s face scrunched up in effort but her hair effortlessly styled, a small army of doctors and nurses all in a luxuriously large room with beige furniture. And finally, moments after birth, cradling the newest addition to the family, whose cries herald new beginnings.

So uh. Who’s going to tell them about the blood?

I’ll be honest. I knew what I was in for when I started this posting. I was morbidly curious about what my mother’s pregnancies for me and my brother were like, and my mom was always kind enough to indulge my very invasive questioning. OBG might be the happiest department in the hospital – but it’s still a hospital, after all. Delivering bundles of joy are a decidedly bloody affair. I saw two live births – both thankfully uncomplicated, with experienced mothers. Surprisingly doctors don’t actually do a lot during normal deliveries – we just have to monitor its progression and keep an eye on baby’s and mom’s vitals. The female human body is hardcore.

This posting, I was also given the opportunity to attend a c-section surgery – which was my first time ever in the surgery room. We were dressed and gowned like proper surgeons and stood around the table like a huddle of penguins peering wide-eyed at the surgeon’s precise movements. For the most part everyone in the room ignored us – which is a better outcome than being grilled by the anaesthesiologist, as one unfortunate group recounted to me. A surprisingly fast procedure, though. We were in and out within an hour.

The best part of this posting was undoubtedly the patients. I was blessed with a myriad of women from different backgrounds and at different stages of life, all willing to answer my incessant questioning and even let me examine their stomachs. I won’t ever forget the joy I saw in an expectant mother’s face when her baby decided to kick exactly where my stethoscope lied over her belly. Nor will I forget the experience of coming into the ward and seeing a patient from the previous day smile and show me her new baby, who’s heartbeat I heard yesterday.

On an academic note, this posting nearly burnt me out. I have atrocious handwriting during my clinicals – I write fast trying to keep up with what my teachers are saying, then two days later I open my notebook to find gibberish. So I decided to force myself to rewrite / re-type my notes every. single. day. Sometimes it took 20 minutes. Other times it took 2 hours, multiple open tabs, and two textbooks open on my already small desk. I made up for the lost sleep on the weekends (mostly) and was severely disappointed when all my efforts translated to a rather lacklustre score in my long case presentation at the end of the posting.

Internal Medicine: I would like to be External of Medicine pls

That 5pm-6pm Monday nap hits different

The internal medicine department, humorously explained to us by a specialist doctor at the hospital, is the department that specialises in tai chi. See, IM is where everyone who has a disease that doesn’t require surgery ends up – this includes people with heart problems, lung problems, kidney problems, liver problems, metabolic problems, nervous system problems, endocrine problems… the list is seemingly endless. To relieve themselves of the nightmarish workload, IM specialists must train in the art of figuring out how to ‘get rid’ of patients by giving them to other departments.

IM sucked. I cannot lie about this. I was not enjoying myself in the slightest. Far from the joy-filled wards of OBG, or the silent clean wards of Surgery, IM wards are utterly depressing to be in at 8am on a Tuesday morning. It is upsetting seeing so many people on nebulizers and oxygen, gasping for breath. At the back you can see people who have been intubated, the consistent beeps of their heart monitors forming white noise. When we go in the wards half the people are still sleeping from how tired they are – and this is very good for the patients and not at all good for me when I have only three weeks and 6 case summaries to complete.

Yes. I only had three weeks in this posting due to public holidays overlapping. Yes, this definitely was a major contributor to my stress.

Honestly, the posting was a blur. I’d go to the hospital, absorb an exorbitant amount of information from my lecturers, go back to campus, absorb more information from classroom lectures, go back to my room, cry, rewrite my notes for the day, stare at a textbook for 30 minutes, forget to eat dinner, cry again, then sleep.

This is such an interesting department, don’t get me wrong. I feel like if I just had more time, and if my lecturers were a little more forgiving, and I could just somehow catch up with my workload, I would have done better. But that’s a lot of ‘if’s, and the reality is none of these things occurred. I jumped for joy when this was over/

Somehow, during my end of semester exams, I got the highest marks in internal medicine compared to all my other departments. Don’t even ask me how. Reading an ECG is now only slightly easier than translating ancient Egyptian hieroglyphics.

Paediatrics: They Can Smell Fear

Average peads student's reaction to being sneezed on

Small children make for interesting patients. No matter what complaint a child’s guardian brings them into the hospital for, as paediatricians you’re expected to do a complete and thorough assessment of their overall growth and development for other issues. As a patient, that sounds really nice that doctors are looking out for our kids. As a doctor, aw man, not another 3000 questions I need to ask this already tired out parent!

Kids are scared of us. We’re not allowed to wear our white coats because small children will start crying if they see us coming towards them. I swear, some of them have this sixth sense for figuring out we are doctors, because once we pull out the stethoscope they’ll run into their mother’s arms and start scream-crying that we’re going to stab them with a needle. Not exactly great for morale. Or our marks – lecturers minus marks if, at any point during our examination, the child we are examining starts to cry.

On the advice of one of my friends, I bought a few packs of stickers as gifts / bribery material. I am pleased to report that the kids still do think fish and fire trucks are cool. I’ve even met one or two who were very talkative and eager to tell me all about what they were learning in school. The most interesting case I saw was of twins who were coming in for a regular blood transfusion. Their mother laughed as she told me how they insisted on doing everything the same – the same clothes, same shoes, same pencils, even the same videos on their ipads. It was a little uncanny how they both acted like mirrors of each other – they were lying in bed, their backs turned to each other, but in the exact same position.

I had a unique experience this posting of seeing a mother I clerked during my OBG posting be in the ward with her baby. She was the one who recognized me first; it surprised me that the barely 30 minutes I had spent with her nearly two months ago had made such a strong impression on her. She introduced me to her baby and caught me up on the remainder of her pregnancy. For just that one hour, I didn’t feel like a medical student trying to get information from a patient – I felt like a human being making a genuine connection with another human being. I am grateful that she trusted me enough to share her worries for her child, and I can only hope my broken malay conveyed that.

Community medicine: Beach Episode

FREE AT LAST (until end of semester exams)

Field trips! I love field trips. Students should go on field trips more often. Ever since COVID and the experience of my miniscule high school graduation where everyone had to mask up, I am always down to leave the classroom and have fun in the sun. That’s what Com Med was this semester – a fun respite after the headaches that were Paediatrics and Internal Medicine.

I finally actually got to read a non-medical related book this posting – Days At the Morisaki Bookshop. I finished most of it on a day when we had the opportunity to spend our lunch by the beach – reading a good book by the beach, in the shade, eating ice cream, is genuinely an experience everyone on earth should have. The book itself was surprisingly very deep despite its short number of pages. The protagonist’s journey to find herself was something I related to a lot as someone close to her age. One qualm I have is that the language is rather simplistic (however it’s translated from Japanese, so I assume some of the nuance of the language did not translate properly into English), however, I find the author has a knack for writing lovable yet complicated characters. The most compelling parts of the story emerge from these character’s relationships and how they interact with each other.

Back to the actual posting, we visited three different KK (Klink Kesihatan) around Kuantan, each equipped with different activities for us to try. I got to get my hearing tested in both ears (both working very well despite my love for heavy metal), as well as got to deliver a public health talk in the waiting room of a clinic. Funny how, once I have an audience, my vocal cords suddenly decide to stop working properly. We also got to visit a school and host the quiz session at the end of a educational session on Dengue and Aedes mosquitoes. Afterwards the kids came over to us and asked for our signatures, which made me laugh because I remembered practising my own signature all the time when I was their age.

This posting honestly was just us having fun and being really tired of all the travel time. I am thankful I had the foresight to force myself to start studying for my end of semester exams so I wouldn’t dissolve into a sludge of laziness.

Thus concludes my fifth semester of medical school :) It’s unfortunate that all these postings had to be combined into one post, but your girl was REALLY busy. Unrelated to academics, in the last few months I’ve done some cool new things, including:

• Making Aglio e Olio pasta for a group picnic
• Volunteering for a CNY celebration at an orphanage home
• Making chicken noodle soup every other week
• Attended my first surgical society event and learned to suture
• Had acne-free skin for the first time since I was 12 years old. It did not last.
• Painted a dinosaur after watching a new dinosaur documentary (The Dinosaurs on Netflix)
• Joined the SMMAMS in my university as a member of the public relations team
• Listened to opera live!

When I say I got that dawg in me, I very specifically mean Snoopy

That’s all from me. Talk to you later, world!

Joy (>’-‘<)