Wednesday, July 25, 2007

Another Blog Link

I like the name of this one. :)

Update -- Course Day 3

Didn't realize attending lectures and tutorials the whole day can be so tiring.

Or maybe it's because I'm feeling very relaxed. Zero adrenaline equals major lethargy. Plus the air-conditioning and regular food inputs. Extremely conducive to dozing.

Not complaining! Anything's better than seeing patients, haha. :)

Interestingly enough, this stats and epidemiology stuff is essentially a rehash of our med school COFM lectures, which I'm sure all of us have completely forgotten by now.

Good way for the department to earn money. $1000 for 5 days, MINUS lunch, MINUS parking concession.

Make sure you attend it before you turn Associate Consultant. Or else getting sponsorship will be hell.

Brothers & Sisters

There's a new drama series on Channel 5 every Monday night at 11pm.

It's got Oscar winner Sally Field and Ally McBeal star Calista Flockhart, playing mother and daughter in a dysfunctional family of -- let's see -- 3 brothers and 2 sisters.

Lots happens in the first 2 episodes alone -- major arguments and tear-shedding, dad dies of a heart attack, the family business is in jeopardy from embezzling of pension funds, an adulterous affair revealed.

What saves this series from melodrama purgatory is the acting, which is damn solid.

The latest episode, for example, featured a gut-wrenching scene where Sally Field's character screams at her youngest son, Justin, for being such a disappointment despite being so privileged. He, in turn, says extremely hurtful things which reduce her to bitter tears.

At one point, her voice breaks as she tells him, "You spoiled, ungrateful child!", which actually brought tears to my eyes.

Maybe it's because I'm very familiar with the concept of familial conflict and have learned to appreciate my relatives much more as I grow older.

Anyway, it's a GREAT piece of work, and highly recommended.

I can blog from the COFM lab computer. Yay! :)

Sunday, July 22, 2007

Review of the Royal Shakespeare Company's King Lear - Esplanade Theatre 21st July 2007


I just need to say this: being a big fan of the LOTR movies ( I haven't read the book - yet ), I still vividly recall a trip to Wellington, NZ, back in December 2003, during which I joined an LOTR film locations tour.

One of the places we visited was Harcourt Park, which doubled as Isengard Gardens, and was featured in a scene where Gandalf strolled with Saruman.

I remember feeling profoundly awed as we stood on the very spot Sir Ian McKellan and Christopher Lee set their feet.

And when the LOTR exhibition tour called the Singapore Science Centre its home soon after, I was equally blown away by the fact that I was in the same room as all the great costumes and props ( I also couldn't resist poking Aragorn's attire by reaching over the plexiglass barrier -- no alarm, yes! :)).

Of course, nothing could possibly beat seeing Peter Jackson's Wellington home up close as we cruised by in a bus ( if you know which tour to join, and if the guide likes you enough to point the place out to you, which ours did :)).

Hence, it has come full circle, as last night, I sat within 10 feet of the great Gandalf The Grey / White ( aka Magneto of the X-Men franchise -- a double bonus! ).

Review Proper

I'm a Shakespeare fan, having been part of a generation when early secondary school syllabuses made it compulsory study material -- not anymore, I'm told; what a pity.

However, we followed the usual trends of covering the Bard's more popular works, like The Taming Of The Shrew, Julius Caesar, Macbeth, Twelfth Night and Romeo & Juliet ( the latter was my 'O' Levels text ).

Therefore, I was initially completely ignorant about King Lear, though I did my homework earlier this week, borrowing The Complete Works of William Shakespeare from the Tanglin Club library ( old and yellow with migraine-inducing small print ) and renting a beautifully written companion guide from Sunny Bookshop to make some sense of the play.

The effort cost me a post-call day, but it was worth it! King Lear is as complex as they come, following in the great Shakespearan traditions of gleeful scheming, mistaken identities / disguises, double-talk and strange coincidences.

Reading beforehand also helped highlight a few favourite scenes to watch out for, raising the enjoyment factor significantly.

As most in attendance will agree, the RSC is the foremost authority on staging Shakespeare, and I'm glad I spent the money to catch its cast in action.

I'm no play connoisseur -- the last production I caught was eons ago, ie. the local version of The Blue Room, which wasn't too bad.

Previous exposure to the Bard 'live' occurred during my schooldays, thanks to a small American troupe's retelling of Romeo & Juliet ( at some polytechnic, I think ), and a disastrous Raffles Institution version starring Lynn Kuok ( which I walked out of after the first act -- it was TERRIBLE! ).

Last night's experience was a far cry from that nightmare. Though sparing where props are concerned, the actors breathed fiery life into their characters and lines, displaying great comic timing ( in a tragedy, no less! ) and holding the audience captive for close to 3 hours.

Sir McKellan, as the lead, did not disappoint. It's easy to see why he's highly sought after for a wide variety of film roles and deeply respected as a thespian. The range he displays as Lear is formidable, beginning as a fierce, bellowing monarch, then gradually degenerating into madness and despair as his humanity and mortality consume him.

He commands the stage with ease -- whether this can be attributed to his Hollywood celebrity status, one can only speculate -- and is actually rather tall in person ( doesn't he look tiny as Magneto though? ). His sprightliness contradicts the snowy white hair and beard, and he even manages to carry the actress who plays Cordelia in the final scene without throwing out his back.

Hearing his voice proved the best part, for me at least. Not particularly low in pitch, but somewhere between a kindly grandpa and authoritative professor ( I still think he should've succeeded Richard Harris as Albus Dumbledore -- Michael Gambon kinda sucks ), with a smoky texture that proved its versatility in conveying a rich palette of emotions, be it paternal affection, volcanic rage or quivering sorrow.

My favourite bits always involve his angry outbursts as he berates his unfilial elder daughters. I remember thinking ( multiple times ) about Gandalf's famous demon-deflecting line: YOU...SHALL NOT...PASS!!!

One word: WOW.

The supporting cast is equally excellent, of course. His conniving daughters, Goneril and Regan, are effectively hateful, with Goneril exuding a Julie-Andrews'-evil-twin-sister vibe, while Regan opts for a booze-swigging Cockney-accented caricature.

Sylvester McCoy received raucous cheers and applause for his buoyant role as Lear's Fool, an easily overlooked character if improperly handled.

The parallel plot involving the Earl of Gloucester and his 2 sons, Edmund and Edgar, proved equally absorbing as Lear's troubles, thanks in large part to exceptional acting.

Aside from Sir McKellan, my other favourite is Philip Winchester, who almost stole the show as the bastard scoundrel Edmund. Easily the best-looking of the lot ( tall, lean and blonde with killer cheekbones ), he clearly relishes his juicy role, which gets embroiled in everything from adultery to sibling rivalry to treason.

Did I mention the final swordfight between Edmund and Edgar is superb? The choreography matches what we see in Hollywood blockbusters, complete with hurled furniture, high leaps and graceful sword-whipping ( whatever the technical term is ).

My favourite lines came during Act I, Scene IV, where Lear curses his ungrateful eldest child, whose true colours have just emerged, exclaiming:

"Into her womb convey sterility!
Dry up in her the organs of increase;
And from her derogate body never spring
A babe to honor her! If she must teem,
Create her child of spleen; that it may live,
And be a thwart disnatured torment to her!
Let it stamp wrinkles in her brow of youth;
With cadent tears fret channels in her cheeks;
Turn all her mother's pains and benefits
To laughter and contempt; that she may feel
How sharper than a serpent's tooth it is
To have a thankless child!"

All bow before The Master and declare yourselves unworthy! :)


I just have one complaint: that the parking arrangements were horrendous. Not the parking, mind you, but the arrangements.

I left the house at 6:30pm, hoping to arrive before 7:30pm, only to find myself circling the area 3 times as all the Esplanade carpark entrances were blocked by the police, who stood below electronic signboards flashing the words "CARPARK FULL".

Detouring to nearby commercial buildings proved futile, as the Fullerton's carparks were similarly blocked, resulting in a short anxious spell cruising along South Bridge Road without a map, before I miraculously returned to Collyer Quay by making a series of random turns. In retrospect, I guess it's pretty funny. :)

After a last-ditch attempt to park at the Ritz-Carlton ( the ROAD was closed, &*^%$#@! ), I almost gave up 15 minutes before 8pm, but decided to return to the Esplanade and try to beg my way in.

Lo and behold, the man at the entrance revealed that the "CARPARK FULL" message was a red herring, designed to ward off those without any tickets to King Lear! He then told us to go right in, after which my mom and I literally made a mad dash to the ladies' and got to our seats 5 minutes before the play began.

Wah lau eh. Never mind, I didn't forfeit anything, so lesson learnt.

Harry Potter 7

**spoiler alert**

**spoiler alert**

**spoiler alert**

I'm one of those who thought Harry should've died.

And he doesn't! ARGH!

Not being mean here, but there's something called copping out, and JK Rowling did just that.

Sad lah.

Anyway, I flipped to the last chapter so that's how I know.

Will be reading the rest of it soon, with a review to follow.

**end of spoilers**

**end of spoilers**

**end of spoilers**

Harry Potter 5

The only 2 Harry Potter films to date which do justice to the novels are The Sorcerer's Stone and The Chamber Of Secrets.

The Order Of The Phoenix is a poor interpretation of what I consider a fine book. Unwieldy, yes, but it also boasts one of the richest collection of characters, and lots of intriguing subplots which are grossly overlooked in the interest of time and crowd-pleasing.

Harry and Cho Chang's tenuous relationship is skimmed over ( there's just so much more to it in the novels, beginning from Book 2 or 3, I believe ); Dumbledore's Army is whittled down in terms of on-screen time, and the flashback sequences where Harry reads Severus Snape's schoolday memories about the former's parents are only granted 10 seconds of coverage -- it was an entire spellbinding chapter in the book, for pete's sake!

Helena Bonham Carter is reduced to a cameo as Bellatrix LeStrange, and Sirius Black's demise is horrendously inadequate, considering the importance of his role.

Even Harry isn't spared the one-dimensional characterization. Director David Yates opted for more visual effects and action sequences, compromising severely on plot and emotional depth.

As a result, I consider this by far the weakest of the Harry Potter movies. How tragic.

Numb3rs Returns!

Last but not least, tune in every Tuesday at 9pm for season 3 of this terrific series.

The Epps men are back, with brothers Don and Charlie doing battle with nefarious criminals, while their wise father offers pearls of wisdom and a gentle, guiding hand.

David Krumholtz is cuter than ever, and Rob Morrow's gotten more buff.

A great way to spend a Tuesday evening, if you ask me. :)

Enjoy your week ahead. I've got 5 days off to attend a course. No patients, heh heh!

Sunday, July 15, 2007

New Link

Check out Jerwin's ER.

I think s/he's an MO at Alexandra Hospital's ER. The wonders of Google. :)

Always been a supporter of local medical blogs, so I've added the address to my list of links. The site's pretty young, so hopefully readers can get things rolling by posting a few comments.

More Controversy?

I'm suffering from a bit of writer's block re: the Black Sheep entry, so will leave that alone for the moment.

Contemplated a discussion on ER bed block and sentinel events, but decided against having my throat slit from ear to ear.

( But it's been happening more often lately, so think about it. )


Will be catching Harry Potter and the Order of the Phoenix tomorrow, after a 7-month hiatus from the cinema. I have high hopes for this film, since I consider it the 2nd best in the series after The Prisoner of Azkaban ( though the movie version disappointed ).

Then there's the Royal Shakespeare Company's staging of King Lear next weekend. Sir Ian McKellan aka Gandalf aka Magneto in the flesh! I can't wait!

Am indulging my long-time fascination with serial killers and American true crime yet again. Got a bit tired of all the medical tomes I've been ploughing through, and am now buried in a book sleazily titled "Sex Sadists", which features loads ( and I mean LOADS ) of brutal sex crimes in the US. Some of the stories are horrifying, while others saddened me immensely. There's just so much senseless killing going on, with many of these cases never gaining worldwide attention ( unlike high-profile murders involving JonBenet Ramsey and Polly Klaas ).

Sex Sadists compiles articles previously featured in the True Detective magazine series in America, and boasts some really good writing. The research is meticulous, the criminal profiles insightful, the crime scene descriptions ( and photos ) blood-curdling to say the least. There're psychos walking among us, even in Singapore.

In case you didn't know, I started delving into the world of serial killers way back in junior college, when I stumbled upon pioneer FBI profiler John Douglas' excellent non-fiction novels and began hunting down articles on Jeffrey Dahmer and a Russian madman ( the name of which I can't recall ) -- both guys were cannibals, by the way.
Used to frustrate my GP tutor with my endless essays about crazy murderers. Even wrote on the same subject for my A Level exam, haha.

I highly recommend John Douglas' The Cases That Haunt Us if you're interested in a good intro. It attempts to profile the killers of JonBenet Ramsey and Charles Lindbergh's infant son, and also analyzes Jack The Ripper and Lizzie Borden. Bloody fantastic stuff!

DVD update: Rented a number of movies, but didn't like any of them very much. Babel was tolerable, but a tad melodramatic. The Illusionist was better than The Prestige, IMHO -- Paul Giamatti is unrecognizable with his European accent and gruff voice ( his normal tone is much more high-pitched and nasal ), and Edward Norton carries himself well as a dapper magician and romantic lead. Love the costumes!

Pan's Labyrinth, however, deserves special mention. If you haven't watched Guillermo del Toro's films before, go rent The Devil's Backbone and Hellboy stat. Labyrinth is another feat of achievement in everything from great storytelling to wonderful directing to eye-popping makeup and cinematography. del Toro excels at children-in-peril situations ( Devil's Backbone is a good example ), and the way he weaves all the different subplots into one seamless, dreamy product is just amazing. You end up with a terrific mixture of horror, fantasy, childhood whimsy, poignant drama and even some tense action sequences.

But my fave del Toro film is still Hellboy. Can't wait to see the sequel!

French fare is pretty cool too. Arts Central recently screened an Audrey Tatou psychological thriller titled He Loves Me, He Loves Me Not, which features a young woman harbouring delusions of love about a dashing cardiologist, resulting in tragic consequences. It's obviously low-budget arthouse stuff, but once in a while, it's a nice change from the usual Hollywood blockbusters, which often lack a coherent storyline and rely on gimmicks to rake in the $$.

Music update: Russell Watson's latest release, a jazz album titled That's Life, took quite a number of listens before growing on me. His odd pronunciations and over-the-top operatic delivery initially irritated, but after the 10th spin in the CD player ( am I patient or what, haha ), his rendition of Frank Sinatra's It Was A Very Good Year proved the tipping point, converting me completely ( to my surprise ).

I now consider it one of the best jazz releases I own. Favourite tracks include Strangers In The Night ( my mom absolutely loves this one ), You Make Me Feel So Young, It Was A Very Good Year ( much slower but also much more moving than other covers I've heard ) and Born Free.

Watson's style definitely isn't jazzy by conventional standards. I would characterize it more as "Operazz" ( a combo of opera and jazz ) or "Broadwazz" ( Broadway jazz ), but I like it because it's so uniquely Watson and actually works.

My sole complaint? He could try a little tenderness now and then, especially on songs like Smile and You Don't Know Me, which were splendidly covered by Michael Buble and Peter Cincotti. Those two crooned and whispered the lyrics so beautifully, but Watson tends to shout the words, so he should break this bad habit.

Maroon 5's It Won't Be Soon Before Long is still blasting away in my car ( took a short break during my Watson switch, but it's back in there now ). An MTV Asia interview revealed that the band's style changed after they got a new drummer ( the previous fellow suffered a shoulder injury and had to drop out ). Frontman Adam Levine ( my mom calls him a "hottie", heh heh! ) said the new guy's an "all-out rock drummer", compared to his "more laid-back" predecessor, which explains their sophomore album's edgier sound.

Never mind the sexually explicit lyrics -- I don't really listen to them anyway. :)

More updates at a later date.

Sunday, July 01, 2007

Baa Baa Black Sheep

Right, I'm going to stick my neck out once again and write something risque.

So as promised, here's a watered down version of my experiences thus far.

Bear in mind, of course, that the definition of Black Sheep In Medicine doesn't just pertain to practical errors. On the contrary, it alludes more to the doctor's attitude and moral character. After all, I doubt any of us can claim to be 100% mishap-free ( myself included ).

I encourage readers to add to the following list via the comments box.

Gender terms are used at random so don't jump to any conclusions.

How To Spot Black Sheep In Medicine - Part I

1. It usually starts during housemanship.

If this person had a bad rep as a HO, chances are she'll continue to have one later in her career.

Whether it's a case of performing disappearing acts ( especially during night calls ), slacking off on changes, or backstabbing her colleagues ( even those who outrank her ), if the stories are widespread and disturbingly similar, they're most likely true.

If the seniors who appraise her are sharp enough to notice and give her the grade she deserves, then that's a fortunate thing, because I've worked in departments where the hardest workers get screwed with B's and C's, while the lazy buggers who know how to sweet-talk the consultants and supervisors get away with A's.

As such, I usually prefer to talk to my juniors whenever I encounter problematic HOs / MOs. It's the most accurate and objective feedback you'll get, and I trust it wholeheartedly.

2. They almost never admit guilt.

Because those who do are the ones who will change for the better.

Black Sheep, on the other hand, will argue till their faces turn purple, or just stand there and keep quiet, without showing any contrition or humility.

Or at most, they'll modify their behaviour temporarily to avoid incurring your wrath any further, before reverting to their old ways once they're out of your line of sight.

A willingness to change reflects some degree of insight, a quality I search hard for in everyone I work with. Even now, I sometimes overlook things which are then picked up by fellow colleagues. But it's important to show appreciation rather than stubborn pride, and I never consider it beneath anyone to apologize.

2 cases in point:

In my current batch of MOs, there're 2 who stand out -- one for positive reasons, the other for negative ones.

Some time ago, you may remember an angry rant on my blog about a junior doctor with really bad work ethics who got blasted by me. The MO accused me of having some personal vendetta behind my complaint, but thank goodness it was taken seriously by both the MO's supervisor as well as the HOD, and my fellow seniors backed me up, so this person ended up with the worst appraisal grade in the entire cohort.

Granted, we've noticed a few changes since that episode, but earlier this month, the bad habits returned yet again, when the MO went missing at midnight, as nurses and patients' relatives hunted high and low throughout the department. Even the handphone was switched off. Who knows when the MO finally returned, since I'd just finished my shift at the time and was too tired to hang around to find out. But the MO's supervisor was on call that night and made fully aware of what happened.

In contrast, the other MO has shown immense improvement in just 2 short months. He initially irked me with his bo chap attitude -- running to me for everything, even resus cases who were just wheeled in and needed oxygen and an IV line, or expecting me to read x-rays and make diagnoses for him because he just couldn't be bothered to think for himself.

I tried to point these out to him on a number of occasions -- sometimes snapping at him in the process when I was already busy attending to my own resus while he loitered beside me -- but the turning point came when he glaringly missed a DKA and didn't even bother to start antibiotics for a raging infection, which was then picked up by a ward MO who happens to be my friend.

I spoke to him very sternly following that incident, stating clearly that what he did ( or rather, didn't do ) was indefensible. He looked absolutely horrified and immediately apologized for the error. Since then, he's shown much more diligence in his work, and actually appears to be thinking before approaching any of the seniors for their advice.

No more complaints from upstairs -- always a good sign. :)

3. Beware of those who curry favour.

A surgical trainee I worked with during my MO days -- let's call him A -- related a story of a classmate of his -- let's call him B -- during their HO posting in Internal Medicine.

A and B belonged to different wards and thus worked under different consultants.

A's consultant ordered a knee aspiration for a patient, but specified that she wanted it done a certain way. However, A didn't think the method she described was correct, and informed her accordingly. She, on the other hand, insisted she was right, after which A refused to perform the procedure, fearing that it would cause massive bleeding.

B came to hear about the conflict, and went behind his friend's back to offer his services to A's consultant. After obtaining the latter's blessing, B carried out the aspiration according to her ( incorrect ) specifications, only to cause ( as A predicted ) significant bleeding.

A went on to become an orthopaedic registrar, while B is now in a medical specialty.

Am I the only one who sees the irony in this?

As for patient feedback, err, I choose not to rely on it. I'm sure some of the praise is warranted, but there's a legendary chap in my department who was often overheard soliciting for compliments, saying things like, "Wah! See how skilful I am? I got the plug into your vein on the very first try! Make sure to put this in your feedback form ok?"

So the clueless patients did as they were told and got this MO lots of service quality stars. Never mind how obnoxious and lazy he was. His resume sure looked good.

Most seniors don't really care, of course, especially if the kissing ass works in their favour. But an SGH gastroenterology professor's words about one such MO resonate to this day: "Spacefan, you're very quiet, but I know you work extremely hard. Unlike 'someone' who talks a lot and tries to impress us but doesn't back it up with his actions. Rest assured that I know who's the better doctor."

Wise words to live by, my friends. I will always consider this professor one of the nicest, most upstanding people I know.

4. An unwillingness to help is a red flag.

This is an excellent indicator of any doctor's work ethics ( and overall character ), and I can tell you straight off that a doctor who actively helps her colleagues is someone you should admire and respect.

Having gone through the entire spectrum of rotations from general / orthopaedic surgery, to eye and ENT, to cardiology, internal medicine and A&E ( including hell-on-earth KKH children's emergency ), I know that the most hardworking and helpful HOs/MOs are the ones with the best team spirit and greatest integrity.

I read somewhere that Integrity = doing the right thing... when nobody's watching.

These doctors go way beyond their designated duties to assist others in finishing changes, clerking cases and clearing clogged queues, often without the knowledge of the seniors ( and therefore without earning any brownie points for appraisal time ).

CGH General Surgery used to have a peer appraisal system, during which lazy MOs who tried to cover up their bad habits were exposed and hung out to dry by their disgruntled colleagues. Do they still have that now? If not, then all departments should implement it.

This is just for starters. More will follow at a later date. It's time for my lunch now. :)