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Pez's Journal

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Dec 31, 2007 - 08:29 AM
Final thoughts for 07.
If I never get this stuff down, I never will.

Graduation week consisted of a string of events. And what a string…
Activities included a Cocktails night, Hippocratic oath ceremony, family breakfast and Graduation Ball (the last two in the same day). One of the highlights of the graduation ball was seeing my photos, all taken over the last few years, making up the bulk of the ones in the slide show that was screened during the night. One of the girls compiled a Graduation CD of photos, and interestingly enough, most of those were ones I’d taken too. On review of the disc, there’s some personal satisfaction knowing that people had kept them, heck, people had thought enough of them to actually label them (eg. Me and Michelle), use them on sites like Facebook and even send them in. Finally, there was the Convocation ceremony. Aside from a couple of uncomfortable moments (bumping into an ex’s father, and the combination of woolen graduation gown and a hot Australian summer afternoon), the week was good. Amazingly good. Or maybe just good that it was finally over. Three of those events were sponsored by different medical indemnity insurance companies eager for our business, with some free gifts thrown in for good measure. Free shit is always welcome, although the Emergency medicine handbook would probably have been more useful a couple of years ago before exams.

Anyway, this was followed the next day by actually having to register with the state medical board, and a mad rush to rustle up $100, some passport sized photos and photocopies of 100 points worth of identification. Speaking about photos, I took a couple of hundred of them from the events: I want to make a DVD slide show of it using Memories on TV, and while I say this now (actually a week ago), I suspect it will take me so long to choose appropriate music to accompany the slideshow it will have lost any meaning by the time it’s complete. My father’s already making one which I’m sure will be brilliant, but the music selection will be doubtful in its relevance. Mine will definitely have Lovage, and something classy like Eva Cassidy. Also Emily Bindiger’s long version of Adieu from Cowboy Bebop will be a certainty as it’s a lot more meaningful than most of the ‘proper’ graduation songs out there.

Somewhere along the way, we found time to do a lot of home restoration. That involved digging up 800 pavers with a crowbar, pick and innumerable ant bite, paving a pathway with said pavers, rerouting some drainage pipes over two days of unexpected monsoonal like deluge (that was on my pre planned ‘rest’ day), mixing up concrete and organizing a swimming pool to be filled in (that was the day after registering). Diverging again, that was also Battle for Wesnoth day, being stuck in an empty house with only a laptop. I don’t think I’ve ever enjoyed a turn based strategy game so much… actually, that’s not true, I did beat a translated copy of Der Langrisser earlier in the year which this title is indebted to. How enjoyable? Everything else I was currently playing (Metroid Prime 3, Xenogears, FF7) got put on hold, shit, it even took me away from Facebook… anyways, it’s at http://www.wesnoth.org/. The campaigns are highly addictive and it deserves undivided attention although I’d break it up once in a while with something less cerebral, like Marvel vs Capcom 2. Dreamcast emulation is just… incredible. It does crash from time to time, but otherwise it runs fairly smoothly. Soul Calibur also works, although the menu system is glitchy. At some stage I think I’ll try one of those other 3D fighters next (either the Tekken or Dead or Alive series) because for me that was the generation of gaming that I missed out on/ignored at the time (hence the playing of FF7, Xenogears etc). Emulation wise, I’m still chasing my tail -who knows, I might even end up playing FF8 in the next 5 years.

Further unscheduled activities (mainly food related) included a poorly organized barbeque, spontaneously arranged meals at the drop of a hat, dinner at a seafood restaurant followed by the consumption of gourmet Gelati in the dark. Those last two were part of a farewell dinner, and my unexpected meal selection of the octopus salad (more adventurous opposed to generic deep fried fish and chips which I can get anywhere else for half the cost) proved to be a delightful experience after a week of overeating.

Christmas was like any other year, a selection of barbequed meats for lunch. I never get anything, which probably stems from never asking for everything, or give anything to anyone… I bet that helps. Then again, there’s widespread acceptance that none of us want to be given crap or useless things, no matter how well intentioned. The closest thing to a gift was a DVD trade with a friend squeezed in between the graduation events and Christmas. He was over an hour late and guilted himself into buying me lunch. Actually, trade probably isn’t the right word, as it was a pretty one sided, with me receiving a set of GTO live action dvds, Hotaru no Hikari and 2 other Korean series. I suppose I did have to listen to him gushing over his latest find, a half Persian, half Norwegian pornstar -just the concept sounds hot. Also got the entire series of Saiyuki. D is adamant that I give it another chance, although I remember finding the banter intolerable and the plot itself falling into typical monster of the week territory. Right now I’m halfway through watching it.

I’d agreed to housesit do for my sister for a few days over Christmas. She and her husband plan a vacation (or pretend to) in order to get out of all the family events (his side), I collect the mail, feed the tortoise, fish and birds, tend to the garden (easy in these times of water restriction) and make ‘best’ use of their broadband quota. Unfortunately, they didn’t leave me a lot to play with this year, so aside from adding Power Stone 2 to the Dreamcast collection, time was spent perusing the bookshelves and enjoying the peace and quiet of an empty house with the company of a few Terry Pratchett novels (The Wee Free Men, Thief of Time, The Truth, Hogfather). In all honesty, reading has to be the most self absorbing activity on the planet, and there’s something particular about these books in that you can read through them, enjoy them thoroughly for what they are, and then wonder just what the hell it was all about.

So at the end of day, end of the year in fact, I have Dr in front of my name (along with a $36,000 debt). Of course, this has additional social perks. And not just the instant respect won from strangers which I’ve done nothing to earn either, the other night at a goodbye bash I had some young thing rubbing me up for ‘luck.’ She’s naturally attached to some other deadbeat, but looking to trade up. But that’s young as in, Go directly to Jail/Do not Pass Go/Do not collect $200; that kind of young.

Speaking of unusual women, then there’s the impossibly thin lass who’s been dubbed my first facebook stalker, I think she was impressed by the paving photos, because regular Asian kids don’t do stuff like that. What’s this outdoor work? And what’s this using a crowbar outside of a videogame? And her parents have decided I’d make a good son-in-law. It’s always nice to be consulted about things like that. Finally, there is OMG Girl who quite possibly provided me the strangest moment of the year (aside from the good Doctor from Whyalla -see previous posts). This is a chick who’d say, OMG, not on an SMS or email, but in actual conversation. It took me a while to catch on. What’s this MG she keeps going on about? She’s lovely, but who the hell says things like this? She’s going to be a doctor next year. Oh em gee.

There’s probably more I can comment on, like finding out I have a cousin in Malaysia who proudly announces in every email he is MBA (Married But Attached) but that will have to wait. Anyway, it was a stinking hot 42.2C (something what 108F?) today. What a way to end the year.

Currently Playing: Delta Goodrem -The Guardian

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Nov 13, 2007 - 11:06 PM
It feels like a long time because it is.
A week ago I finished my last clinical rotation, so from about now it’s only a short one month break before graduation. The last days of university, but in reality it is only the beginning. Then it’s on to real work with another new group of people. While there’s an air of doubt and unfamiliarity, there’s also a sense of purpose and excitement. Working at a less prestigious hospital was a personal choice and will mark a change in many ways: from people I went through the course with, many of which I never really bothered to form strong relationships with and I consider more associate than friends. But I don’t feel particular introspective today so I’ll leave those thoughts hanging.

When I think about it that means I’ve been a member of GFF for over six years. I wonder what I’ll write in another 6 years after achieving the next academic milestone.


Currently Playing: Emily Bindiger -Fiction

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Aug 26, 2007 - 08:36 AM
Stupid facebook.
It’s one thing being able to satisfy my curiosity and find people I haven’t seen in years, although I don’t really want to know them, rather just find out whether they’re still alive and what they’re up to. Still, it’s interesting to note how people respond to you after all this time apart.

(And Y. demanded I sign up so she can set me up with her hot, desperate friends. Fine by me, although I wonder how much interest I would get if I didn’t have medicine in my education/work profile.)

Anyway, it was enough of a distraction to interrupt my normal routine of downloading manga chapters and the latest Naruto episode. Which for a change didn’t lag!

In the previous entry I forgot to note that Doc also did acupuncture. And sometimes with electrode therapy (battery pack connected to acupuncture needles). I’m not sure what else to add, but one patient said, “Once he forgot about me and I was well cooked after 3 hours.”

Currently Playing: Electric Light Orchestra -Moment in Paradise

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Aug 19, 2007 - 08:23 AM
Rural Placement (Part 2)
Continuing on from the previous entry, I spent the remaining 3 weeks of the placement with an rather eccentric rural GP. It was a very busy solo practice situated in a less well off area, usually running 1-2 hours behind. A typical day for him was a swim at 6.30, hospital ward round 7.30-8.30, private clinic 8.30-6pm (usually finishing around 8-9pm). The hospital round often went longer and up to 9.30, so we’d start the day on the back foot and be running a couple of hours late. I’d usually skip the round and do more reasonable hours of 8.30-5.30-6pm.

Next door to the surgery was a takeaway place, with descriptions and prices all up in texta on white paper. No pictures. It’s run by a tough, no nonsense Spanish lady who’s known to get into fights with druggies/dealers loitering outside, with them all being getting carted away by the police. I think it happened once while I was there. Compared with the previous clinic there was a noticeable difference in the clientele. Of course there were your typical cold and flu types (with these mainly presenting as whole families), scripts, immunizations, investigation reviews, driving assessments and sick certificates. Throw in a few baby checks and antenatal consults every now and then, and every once so often a stable teaching case (Girl with a VSD/hole in her heart, the guy with cyanotic heart disease, various skin lesion/spot diagnosis) and it’s a fairly interesting day. Occasionally there were instances of serious, we’re not stuffy around medicine. One lady who I’d worked up for chest pain and sent to hospital arrested on at home after being sent home by the visiting cardiologist after an equivocal stress test.

On average, I was seeing 20-30 odd patients a day unsupervised, and when I’d done as much I could (paperwork, scripts etc) I’d walk into his room where he’d be inevitably cracking some joke with his patients (more on this later) or musing on how he’s just “fiddling around”. Call it adult learning or slack supervision, but it sure beat sitting in a corner and just observing. I’d known people who gone on rotations where they’d only been able to do independent consulting for the last week and had found things most uninteresting.

But aside from all that relatively ‘normal’ stuff, there were the noticeable standouts. One of the first patients I saw on the Monday was explaining how he’d just spent $5000 on a fake ID because he wanted out of Workcover, out of Centrelink, and most importantly f*** over his ex and get out of paying child maintenance etc. Then there was the lady who came in demanding all the investigations under the sun because she’d just failed a random drug test at work and wanted to know when she’d be clean so she could get back in. She only smoked her own private stash of dope on the weekends. Of course. Or the young Aboriginal child who’d stabbed his foot as part of a dreamtime ceremony in a case of don’t ask, just treat.

Another patient girl came in for a review of her wound. She hadn’t had the money to buy antibiotics, so it was all looking foul. Her 25 year old boyfriend claimed she’d spent it all on cigarettes and alcohol. On the other hand, he was an interesting case as he’d gone and cut himself and needed sutures on his hand too. “What happened?” I asked. “Playing ninja in the bathroom.”

Come again?

But that was just the patients. The doctor was another entity in himself. Before I’d even left I was been informed that he was the doctor with 8 children. The uni coordinator took us around on the first day and confirmed this. Apparently they’re all runners, and each year you’d be able to see the whole family do the town fun run, complete with goat in tow. “You’ll definitely have an interesting time,” she said. All this before I’d even met him.

“I’ve been away for a week, so let’s just fiddle around and see how we go.”

That was the first thing he said. He walked in carrying a faded school bag containing 3-4 loaves of jumbo multigrain bread, cartons of milk and juice and cans of tuna, all bought from the nearby supermarket. Noticeable were the glasses with African print frames, complete with “new glasses” sticker in the corner that most patients commented on, some more politely than others. Then he put on this magnifying glass headgear thing which complemented the mad look. My immediate was he looked like, Doc Brown from “Back to the Future.” I wasn’t the only one who thought he looked like something from TV. “Look kids, it’s Doctor Who!” said one mother. “Where are you hiding the Daleks?”

His practice nurse was also an interesting person. Being ex army and having done such things like fall out a helicopter and deal with more extreme injuries, she prefers practical procedures and hands on work in favour of the paperwork. Once she heard from the doc I knew what I was doing, she was eager to let me inject her and take her blood. In addition works as a part time property developer and marriage celebrant.


Apparently there’s a subject called Communicology which the current first year medical students have to do. As it wasn’t around in my time, I have no idea what’s involved. However, but I would bet that this guy would fail. But it would be spectacular.

One patient came in with a sight problem, “Doc, I’m having trouble seeing.” He just said, “Really?” gave me a ridiculous grin before giving her first the finger, then the 2 finger salute just inches from her face.

You had to be there.

At other times, I’d be in the process of taking blood on a patient and he’d burst in and say something ridiculous like, “Sucked in! He’s practiced once before on an orange.”

A sample of the conversations…

“Doc, my back hurts.”
“Who cares.”
“What?”
“I said WE CARE! Your hearing must be going too.”

“Can you help me doc?”
“Sure, we’ll hurt you.”
“What?”
“We’ll HELP you!”

For long term patients, they’d expect it and instead of ‘what?’ they’d just respond, “I know you don’t care,” or “I know you’ll hurt me” without skipping a beat.

Aside from the orange comment, taking blood and administering injections were made more interesting by comments like the following.

“That was good, I didn’t feel a thing.”

“What flavour do you want?” (giving an injection in the backside)

“Think of mother England.” (giving an injection in the backside)

At points during a consult he’d appear to stop listening, and start rummaging through their shopping and wallets, saying things like: “Can I have 10 dollars?” or “You shouldn’t eat that. It’s shit.”

As he runs a bulk billing clinic, his patients they need to sign which results in comments like…

“Sign here…
-so we can send you to the old folks home.”
-so we can send you to the looney bin.”
-so you can get some Viagra.”

Then he’d send them out saying, “go home and make babies.” Did I mention he has 8 children? There were a few families that had more.

Or it would be something totally unrelated to medicine. Fridays was his half day, meaning we’d finish around 4pm (last patient booked before 2pm, but 2 hours behind).

“It’s Poet’s day. Do you know what that means?”
“No.”
“Piss Off Early Tomorrow’s Saturday.”

Then there was the incident where he hid someone’s car keys. “Watch what happens, it’ll be good.” It was for us, but I don’t think they appreciated it as much as we did.

Watching him deal with the drug reps was also hilarious.
“I’m here to tell you about <drug>”
“I like your watch.”
“Uh…”
“I like your watch… Can I have it?”
“Uh, it was from my girlfriend.”
“Oooh!

“I use a lot of that one. But I don’t use that drug.”
“And why don’t you use …”
“Because it’s crap.”
“Hang on, there’s evidence to show that…”
“Who cares?”
“Don’t you want the best for your patients?”
“Nup!”
“Come on, don’t you think they deserve the best?”
“What they need is a bullet”

He’d also recommend that last treatment quite often to patients.

I’m sure there’s was a lot more stupid stuff that was said. The best part of it all was leaving at the end of each day after having seen 20-30 patients, having laughed a lot and not feeling exhausted. If there was one thing I noticed, it was that no matter how long they had to wait, all the patients left laughing or with a smile on their face. I think it’ll probably be one of those experiences that doesn’t fade quickly.

Currently Playing: Sarah McLachlan -Full of Grace

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Aug 11, 2007 - 01:02 AM
Back from the country.
I’ve just come back home after spending 4 weeks on placement in Whyalla, population ~20,000 and some 380 km from the state capital.

We left Adelaide at 8am, switching drivers every hour. It was an uneventful trip, although I was glad my father accompanied me. I haven’t done a lot of country driving, and slowing down from 100kmph is something that takes some getting used to. When they came to Australia, my parents worked at Port Pirie (a town along the way) in the 70s, so this was a bit of a memory trip for him. Then, it was only a single lane highway in those days and he did a lot of overtaking on the ‘wrong side of the road.’ It’s since been expanded to a double lane, but only for some of the way up. A few stories came out too, like how the first time they ordered pizza, they’d never done it before so they ended up ordering a large one each.

We arrived just after 1pm, picked up the keys and got a quick tour of the city in the afternoon. Our guide, pointed out all the nightspots (mainly hotels, pubs etc) took us up to the point, and showed us the clinics where we’d be working. We happened to get there on the same day as the doctor’s conference, and as students we were invited to go along for the dinner (soup/entree/main/desert) and talk. All I can remember from that night was it was a massive feed, and I was pretty much stuffed at the end. Soup and entrée were rich and filling, and the mains were generous portions. Those who chose the fish were greeted with 4 large pieces (grilled or battered) and the girl who selected the chicken pastry was surprised at the size (size of a couple of toilet rolls). Thankfully the steak was a more manageable size.

Early next morning I dropped my father off at the bus station, and wandered over to the first clinic. As my official preceptor was away for the first week, he had arranged for me to sit in with another doctor from Wednesday-Friday. This chap had been in the area for almost 30 years, and his clientele consisted of mainly elderly, stable patients. He seems like a laid back person, talked a lot about his 100 acre hobby farm in the Adelaide Hills and discussed various aspects of agriculture, gardening and farming with patients. And I learnt loads of random stuff, like how you could make fish traps by dumping things in the sea, although you had to be careful with what you decided to dump. Told a story of a couple of guys dumped fridges to make fish traps, but they floated up because of the insulation. Or he’d ramble on about global warming, how this town won’t last longer than 40 years (only 40 years supply of petrol); how you shouldn’t let yourself be shouted at (walk away) –it’s people who’ve lost control who shout. About how he’s lived through the best time (and messed it up for future generations), and things like how to head hunt stuff and the qualities of a good receptionist. Or that the last game he played was the original Command & Conquer (with his son) -we had a couple of patients who were into gaming. One had a social phobia, although I couldn’t help but wonder if it was just a case of being in the wrong environment.

Then there’s the jokes. He tells them, and so do the patients. Most of them are fairly crude and rudimentary, but this one’s probably the best.

There’s an eagle who’s flying around and looking for some company. He meets a hawk
“Hawk, I’m lonely.”
The Hawk says, “Hawk’s don’t talk.”
The eagle flies on and spies a dove.
“Dove, I’m lonely.”
Dove says, “Doves don’t love.”
The eagle flies further on and spots a duck in a pond.
“Duck, I’m lonely.”
The duck says, “You’ve made a mistake, I’m a drake.

I think that was after reading the Whyalla Newspaper front page headline. “Duck bludgeoned to death,” accompanied by an out of focus photo of a wire fence and duck. We weren’t sure what it was supposed to be, but we had a good laugh about it all the same. It was fairly relaxed and laid back atmosphere, and he generally takes the time to talk to patients, and he knows all of them. After all, he’s been there for 28 years.

Another of his patients summed it up best, when she said disapprovingly: “You’re not a doctor, you’re more like the guy at the pub.” We had a laugh about that, too.

Around Friday, it was already starting to get weird. There were 3 occupational therapist students staying in the house with us, and as it was their last week, there supervisor was coming up. Apparently they’d never given him much respect, so they’d decided to get a medal for him. That’d be taking the piss, in my view. The other medical student complained that the three had done things like wake up at 6am to see the sunrise, and caused a general ruckus in doing so.

So that was basically the first week. The next three weeks would be a totally different experience. TBC.


Currently Playing: Phil Collins -Separate Lives

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Jul 15, 2007 - 02:31 AM
Shattered.
Here I was planning to write about how I’m hyped about going away for the next month, and then I get the news that one of my best friends at medical school died last week.

I knew he was sick and that’s why he was allowed to transfer home to complete the course, but damn, he was going to graduate this year. With the rest of us.

I can’t believe it, it’s just like 2003 again.



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Jun 20, 2007 - 07:00 AM
Choosing work.
I haven’t written anything for ages, which is explained by being getting flogged at the “best hospital in the state” over the last month. Stuck in the dumping ground of medicine, the patient list is seemingly endless and it’s been hampered by bureaucratic bungling. In a couple of days it will be over, and I’ll be able to enjoy my last holiday period ever.

At the same time, the application dates for next year draws to a close. Training at certain hospitals is widely considered to be “career suicide,” and the one that I’ve put as my first preference just happens to be one of those. It’s unpopular, so I’ll be sure to get it. It’s unpopular, which equally excludes a subpopulation of the cohort who are prepared to step on anyone to get what they want. I think I’m pretty happy about that too.

It’s been interesting to note the subtle peer group pressure to “go where your friends go,” although in my case our career aspirations are widely divergent: theirs are more reliant on getting the specific experience and making the right connections. That crawling attitude doesn’t particularly suit me, so we go our separate ways. I’m also not afraid of meeting new people and making new friends, content to leave behind some of the baggage I’ve accumulated in medical school. I also like the fact that it won’t be as busy, so even though I’ll have students I’ll actually have time to teach.

While I’m certain I know where I’m going, I also know exactly which rotations I will be getting. While their isn’t the scope of the bigger hospitals, the certainty is again an appealing factor. The lack of a hardcore orthopaedics rotation is also no disincentive, although one drawback is that I won’t get an initial psychiatric term, although I have been informed that if I decide to go down that pathway I won’t be disadvantaged because it’s apparently still so unpopular. And if this trend does change, the prospect of me not specializing and forgoing financial reward for lifestyle is also not entirely out of the question.

About 5 years, MF mentioned the lack of politics as a reason why he chose the hospital where I’m going. Part of my link to the hospital is emotional (because I was the one who took over his role at the club when he passed away), although that doesn’t take away from the fact that I’m genuinely enthusiastic about starting their next year. He also lived quite a distance away, so it wasn’t a claim that had been made lightly. During my time, having worked at all the state hospitals, I’ve now become aware to the fact that the most prestigious hospital is crippled by dysfunctional politics. The system is already bursting at the seams, and the announcement of a new hospital development (contingent on closures, resource shifts and downgrading of peripheral hospitals) adds more fuel to the flames. It’s a messy situation which comes at the wrong time for us.

What else sucks? The lifts are in disrepair and there are only 2 express blood chutes in the whole hospital. In it’s defense, the “best hospital” has a Wii in the doctor’s lounge. Which is pretty cool, but still not enough to change my mind.


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Apr 16, 2007 - 05:03 AM
Saved a life today.
Clinically diagnosed an ectopic pregnancy in a lady in the waiting room today. A bed block was in place (lots patients in emergency waiting to be admitted to the wards can’t go because there are no free beds, meaning those in the waiting room can’t get seen), so she could’ve died while waiting. I think it was even more satisfying because one of the senior doctors had made the call of non surgical abdomen after he’d had a feel of her stomach. Pregnancy confirmed with on urine and blood tests, and pelvis ultrasound established it was actually ruptured. She was shipped of to theatre ASAP. Lots of internal bleeding, apparently.

This has certainly been the most rewarding day of my emergency medicine term.

Currently Playing: Jeff Buckley -Hallelujah

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Mar 4, 2007 - 06:45 AM
Finger up the bum.
Not really much in the way of interesting stories. However...

Last week one of our patients had 4 straight days of bowel prep. How much is that? One day of the stuff should have you shitting water. We need this so we can scope him and exclude a cancer down there. After a previous unsuccessful try and consults with the gastro team, our supervising intern decides that a per-rectal examination needs to be done, and suggests that my medical student colleague should do it because she has the smallest hands (and would be more likely to get anything out if it’s blocked up). She’s also been really keen to do “hands on” stuff, so it was natural that they offered it to her instead of me.

However, on the very day she was stuck in outpatients, and left to break a diagnosis of breast cancer to a new patient unsupervised. Not a good position to be in. I’m left to examine the poor bastard, and after gloving (double) and gowning up with mask and goggles (there’s a high risk of a ‘brown’ explosion), I stick a finger in.

Nothing to remove.

Really great that I didn’t get splattered in crap, but we’re still at a loss over what to do with this poor gentleman.

Currently Playing: Oasis -Don't Look Back in Anger

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Feb 26, 2007 - 08:15 AM
Well, I’ve started again.
Surgery ward, same place as two years ago. Then there was much to do (or so it seemed), but it was fairly reasonable. Now it’s a different story shadowing the interns instead of the surgeons. It’s a different experience, but it’s not really as demanding even though the hours are longer. It’s actually just a lot of paperwork and the occasional jelco/needle, both of which I need to get more used to. I’m not sure if we’re expected to show up to theatre or outpatients as much as before, but I’ll probably take a look-see on the days which are less busy. The other student with me is keen (if not also a little anxious about it all), so that should prevent me from slacking off too much.



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