30th

Today I am 30.

Without getting all sentimental I just want to say thank you to anyone and everyone who have ever played a part in, my life.

I'm content. What follows can only be splendid.

across the Ditch

Nice to know that we're paying similar price for gas as people across the ditch..

A full week ahead with lousy weather outside, just as well really.

Failure

When speaking on failure, people are often reminded of the life story of President Lincoln, and the famous quote from Thomas Edison.

The following two I haven't come across before, refreshing.

"My reputation grows with every failure" - George Bernard Shaw

"My imperfections and failures are as much a blessing from God as my successes and my talents and I lay them both at his feet" - Mahatma Gandhi

To add my take on things, if one has tried as hard as any athlete preparing for the Olympics, then even if one fails, one would be quite content.

From that perspective, I'm not content.

headache

Mrs M is one of those "heart-sink" patient. One that you try to avoid to see in your morning ward rounds.

I assume, for one reason or another, she hasn't been looking after her health for years. She has poorly controlled diabetes, on inuslin, had her leg amputated a few years ago and she still smokes. At a young age of 53, she was put on warfarin for her PAF some years ago. Strangely, her INR hasn't been all that bad.

She came in 4 days ago, with 1 week history of vomiting and diarrhoea. BSL was 30. The admitting registrar's impression was: "mild HONK, gastroenteristis, dehydrated".

On the ward round the next day, we tried to control her blood sugars better by adjusting this and that. Requested a diabetes nurse review... etc, hoping she'll be well enough for discharge within the next 24 hours. Why should we kept patient in hospital when they don't stay in the ward and keep wondering off smoking?

Day 1, dry retching somewhat settled. Day 2, a little better, but she still looked miserable. Day 3, she told us that she has a headache.. "how long has it been there?" I asked, as I was about to walk out of the door.. "3 weeks", she said quietly.

Well, that prompted me to do a full neurological exam, for there was a Fourth year medical student with me on the round, I can't really dismiss a complaint like that. Fundi looked normal, no focal neurological defect, no neck stiffness, no history of head trauma recently.. well, no red flags to her headache really.

A CT was ordered anyway, as she just didn't look right.

The CT showed acute on chronic subdural haematoma, with midline shift that even a fourth year student can see. She was transfered for neurosurgery within hours after the CT scan.

I wonder what's the moral of the story.

Headache from the Annals

Etiquette-Based Medicine

An article from the NEJM stated the obvious - a bit of manner goes a long way

Tears

I, along with a few in my team cried today. At work. Towards the end of a family meeting.

My role was to explained to Mr T, a non-resident who's been here for many years, and his family, that his immediate short term prognosis is grave. That there is no immediate cure to his cancer. Because he is not a resident, we're limited in how we can treat, and support him.

I, along with the rest of the team, all managed to "keep our cool", until Mr T, a Tongan man who, still have all his mental facilities intact, graciously thanked us for what we have done.

We were moved, genuinely moved by his generosity. For we have done so little. Our tears may also be an indictment to the care our dying patient receives.

a nation .. finds its better self

The cover of the Europe, Asia, and South Pacific edition of Time.

Hong Kong

A place we visited 3 times for buns...Dani loves these..



These aren't bad either..



HK$14 and I was a very happy man.

Sorry for not catching up with some of you. We only had a few days to get stuff sorted.



Thank you Dani, for putting up with ..

such a tight schedule..
being woken up at 0615hrs..
all my grumpiness.. and
everything really.. the list goes on and on.. ^_^

Dunedin

It was a pretty cold morning in Dunedin.

The last seven days have been fantastic. It was also a week of having cup noodles everynight then going to bed rather early.

Thank you to all the good people in Dunedin.

day light saving

Day light saving ended last Sunday. This was glimpse of the sunrise from the backyard at home.

After working for 12 days in a row, I've lost track of time. Needed to look up the diary to see whether I worked the last weekend!