The post that should have appeared 3 weeks ago..

Ok, I realise that I should have typed this post like 2-3 weeks ago.. But procastinated constantly since there were nice photos to put up with exciting weekend haunts and getaways.. The other reason why I put this post back, was so that I would more or less know what would be my normal schedule like..

So yes, I am in JHMI for a 4.5weeks attachment to the General Surgery Dept.. (and am into my 2nd last week here already). So I spent my first 2.5 weeks in the GI department of my team, before just switching over to the Endocrine/Breast/Melanoma department of my team this week for the last 2 weeks.

Schedule's pretty much the same for both teams..

5.30am-6.30am
Morning rounds - can be early as 5.30am if there are conferences /M&Ms in the morning, or can be as late as 7am if there is nothing going on and a small patient load, or even no morning rounds if all the patients got discharged over the weekend cos the breast patients generally go home same day, while the rest go home within 1 or 2 days. O_O Thankfully i dun haf to pre-round my patients before the rounds..

But basically we read the vital signs of the patients, call up lab reports (usually done by the Residents), follow the team to see the patient, and write in the notes if there's not enuff manpower.. Oh, there's not much clerking done here, cos basically the patients come in with very detailed history examination and referral letters from outside doctors/clinics/ER..

6.30am-7.30am
Conferences / teachings - these usually start at 6.30 or 7am, and last about an hour or so.. There's the standard M&M rounds, the GI conference, the Endocrine conference, Grand Ward Rounds (which are actually lectures on non-academic stuff like research...),... depends on which team you're on, the conferences vary slightly..

7.30am-?
OT - generally start at 7.30am, and end variably throughout the day depending on type of operation, and number of operations that I have to scrub in to observe / lend a 3rd pair of helping hands.

Anyway, some things don't change - the OTs here are still equally cold.. =P

OR

8am-?
Clinic - Clinics start either at 8am for morning session, and end by 12noon, or 1pm for afternoon sessions.. Clinics are potentially more enjoyable than back home. Depending on the consultant, he lets you go in and see the patient first, before presenting the case to him. As mention above, the patients usually come with a list of problems / referral letters,... so the job is significantly much easier (ok, so it doesn't exactly tie in with Singapore syllabus aims to teach you diagnosis), but it certainly makes you feel so much more of a team, being more involved.

3-6pm
Closing rounds are generally variable.. Sometimes I don't even do afternoon rounds cos i'm in the OT, and the other Residents generally round for us.. Yes, so a lot of buzz generally stops around 5pm here as the people are given time to head home before it gets dark (and dangerous) - i mean, the OTs try to finish before 5pm.. (of cos, if cases go on, then staff stay of course, and there are always other General OTs open for emergencies..)

So yes, that's my basic schedule for the day. Generally its 3 days of OT per week, with 2 days of clinics.. GI was a bit more relaxed since there were only 2 consultants, and days tend to end a bit earlier, slanting closer to 2pm sometimes.. But of course, when operations run late, it can finish up to 8pm..

However, since i swopped over to the Endocrine/Breast/Melanoma team, the schedule's a bit more hectic since there are 7 consultants on the team, and with so many permutations and combinations, it doesn't take a genious to figure out that there's always some clinic / OT that's going on every day in the morning and afternoon. And since there's only 3 Residents and 4 students including me, (horrors, the 3 other students start rotate away this week, so there's only me left) - the 7 of us need so split ourselves into the OT/clinic sessions to lend a hand.

And with 7 consultants, there are so many ops, my days are starting to end later at 5-6pms.. luckily there might be a slight lull on thurs and fri cos of clinic days? =P

Well, basically students lend a hand in OT = holding retractor / suction / scissors / all assortment of retractors hemostats or some other holding device / occasional suturing, tying / catheterization.. just to name a few.

Doesn't seem too much different from Singapore GS right?

Not really, but what's different are the spectrum of cases, and hence the spectrum of operations being performed. And not to mention that the consultants and residents here are generally so much more friendly - you can ask them questions, and they won't mind answering them. They willingly let you scrub into an operation - not like in Singapore, where many nurses (sorry lah, but its true) give you the evil eye when you say you want to scrub, cos it seems to them that we are wasting 1)gowns 2)gloves 3)resources 4)space 5)their time. Yah, if you dun scrub here, the consultants give you a questioning look instead.. haha.. a nice reversal.. =P

When you've scrubbed up, you can stand at the bed (not like back home where you're still relegated to a seat with a poor view); the consultants give you stuff here to do (even if its menial holding of retractors - cos you get scolded here if you slacken.. haha) not like back home where you're still treated as part of the wallpaper.. You can ask questions, chit chat.. and just basically have a more positive learning environment.

Now, if only such a culture can be nurtured back in Singapore.