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Forecast: Hazy today. My brain, that is. Subsisted on 3 1/2 hours of sleep for the whole of Friday and the earlier part of Saturday, before finally hitting the sack at midnight and getting up before 7 this morning to do a bit more unpacking. I'm tired, but immensely relieved. And I just love my new room. :P

Not too happy with my department secretary for ignoring my request to have at least one day off this week. She's usually quite sharp, but didn't give me what I asked for, for some strange reason. Oh well. Tomorrow's my first day at KKH, and none of us even knows our shifts yet. Not good.

So now I'm stuck here from 8-4, fighting off the constant urge to yawn, or to give yet another NS boy a piece of my mind. But why bother? I may be losing steam, but things will only get better once I move on to the next ER. No more 50-patient calls, or 40-patient shifts. Crying babies aren't my cup of tea, but it's a welcome change nevertheless. 6 months of it -- tolerable. :)

After a full year in emergency medicine, I'm inadvertently forced to (re-)evaluate my opinion of this field. It's a natural process regardless of which specialty you're in. What I feel isn't different from my past experiences in other departments -- the highs and lows, the usual difficulties that come with each job, adapting to new colleagues / environments, facing the occasional FON cases and getting stabbed in the back with a belated bloody complaint letter.

Why emergency medicine? Reading someone's blog entry about The One (pertaining to mate-choosing), I guess a lot of it can be extrapolated to specialty selection as well. You know when you know . I didn't aim for a life in the ER from the word go. I'm a big fan of the TV show, but considered it little more than simple entertainment. There isn't a particular moment which I can pinpoint, when I said, "Eureka! THIS is what I want to do for the rest of my life!" It was more of a gradual realization, though technically over a relatively short period ( 3 weeks at most, which equals the length of my 4th year A&E posting ). True, I had novelty on my side at the time -- wet-behind-the-ears med student dipping her toes into the ocean of ACLS / ATLS / breech deliveries in the ER -- but now, many years down the road, there's a new kind of novelty. I may have seen almost every common condition in the book, but it's the sleuth work that always gets me going. Pinpointing the patient's problem(s) ( sometimes through history alone ), knowing what to do based on your best clinical guess ( e.g. man presented with postural giddiness, not particularly pale, but I PR-ed anyway and found a fungating rectal tumour; young lady complaining of "generalized numbness", who looked just a tad edgy -- I pulled down her turtle-neck collar and found a goitre; guy who couldn't stop walking x1 episode and almost knocked into a wall, neurologically normal -- CT head revealed an acute subdural bleed, but had zero history of trauma ).

Patients don't understand what's involved in making such diagnoses, so don't expect any gratitude. In fact, in the field of emergency medicine, I don't expect thanks at all. Short consultation, no follow-up, high stress situtations with tense psyches all around -- ideal recipe for complaints, I guarantee you. Busy shifts, manpower shortage, getting rapped for incidents that are beyond your control... why did I choose this again? :)

At the end of the day, though, I know I wouldn't be happier anywhere else. And that is what matters most. For every idiotic patient who gives me a hard time, there's another nice one who appreciates my efforts. For every complaint about "missing a diagnosis", there's one that I managed to make based on clinical acumen alone. The ER is where you hone your skills and practise "minimalist medicine". If I had a choice, I'd like to work in a rural field hospital in a developing country for a short stint, in order to experience medicine in its most primitive form. But that's an issue my parents and I have to resolve. :)

A few fellow trainees have expressed feelings of disillusion, with a number of them dropping out along the way. It's expected, of course. But again, not restricted to this particular specialty. I gripe and rant, yet am certain that this is where I want to be. Besides, I have my ways of coping with the stress, as you readers are well aware of. :P

Adios, CGH A&E. Hello, KKH Paeds. I'm not too optimistic about seeing fretful kids and hyper parents. But life's unpredictable. Who knows, I may actually end up liking it. ;)

And how could I possibly forget...

Movie quote: from "Four Weddings and a Funeral", which introduced foppy-haired Hugh Grant to the world.

( oh heck, there're so many good ones, let's have a few all at once )


Gareth: I've got a new theory about marriage. Two people are in love, they live together, and then suddenly one day, they run out of conversation.
Charles ( Grant's character ): Uh-huh.
Gareth: Totally. I mean they can't think of a single thing to say to each other. That's it: panic! Then suddenly it-it occurs to the chap that there is a way out of the deadlock.
Charles: Which is?
Gareth: He'll ask her to marry him.
Charles: Brilliant! Brilliant!
Gareth: Suddenly they've got something to talk about for the rest of their lives.
Charles: Basically you're saying marriage is just a way of getting out of an embarrassing pause in conversation.
Gareth: The definitive icebreaker.


[at Gareth's funeral]

Matthew: Gareth used to prefer funerals to weddings; he said it was easier to get enthusiastic about a ceremony one had an outside chance of eventually being involved in. In order to prepare this speech I rang a few people to get a general picture of how Gareth was regarded by those who met him. "Fat" seems to have been a word people most connected with him. "Terribly rude" also rang a lot of bells. So "very fat" and "very rude" seems to have been the stranger's viewpoint. On the other hand, some of you have been kind enough to ring me and let me know that you loved him, which I know he would have been thrilled to hear. You remember his fabulous hospitality and his strange experimental cooking. The recipe for "Duck a la Banana" fortunately goes with him to his grave. Most of all, you tell me of his enormous capacity for joy, and when joyful... when joyful, for highly vocal drunkenness; but I hope "joyful" is how you will remember him. Not stuck in a box in a church! Pick your favorite of his waistcoats and remember him that way! The most splendid, replete, big-hearted... weak-hearted, as it turned out... and jolly bugger most of us ever met! As for me, you may ask how I will remember him; what I thought of him. Unfortunately, there I run out of words.


Charles: Why am I always at, uh, weddings, and never actually getting married, now?
Matthew: It's probably 'cause you're a bit scruffy. Or it could also be 'cause you haven't met the right girl.
Charles: Ah, but you see, is that it? Maybe I have met the right girls. Maybe I meet the right girls all the time. Maybe it's me.


[Charles comes running after Carrie]
Charles: Ehm, look. Sorry, sorry. I just, ehm, well, this is a very stupid question and... , particularly in view of our recent shopping excursion, but I just wondered, by any chance, ehm, eh, I mean obviously not because I guess I've only slept with 9 people, but-but I-I just wondered... ehh. I really feel, ehh, in short, to recap it slightly in a clearer version, eh, the words of David Cassidy in fact, eh, while he was still with the Partridge family, eh, "I think I love you," and eh, I-I just wondered by any chance you wouldn't like to... Eh... Eh... No, no, no of course not... I'm an idiot, he's not... Excellent, excellent, fantastic, eh, I was gonna say lovely to see you, sorry to disturb... Better get on...
Carrie: That was very romantic.
Charles: Well, I thought it over a lot, you know, I wanted to get it just right.


Enjoy the rest of your weekend.