Trauma

Once upon a time during the good old days of being attached to ITU, I came across a scene in the A&E where a rather mangled individual was brought into the resuscitation room. And this guy was seriously mangled; limbs were at odd angles and he quite literally had bits of brains on the floor. After the initial ‘Fucking hell…’ the next thought on my mind was ‘What the hell do I do next?’. As it happened, I was only there to observe, so I just stood back and in one of the rarer moments of being fantastically impressed with the A&E staff, watched the team swing into action.

I went away from the experience with a promise to myself that I will learn more about trauma situations and the exact manner in which appropriate management should be put in place. That, in turn, led me to enrol myself onto an ATLS course.

The ATLS (Advanced Trauma Life Support) is a training programmed for the management of acute trauma that was developed by an American orthopaedic surgeon by the name of Mr Styner who had crashed his light plane in a field back in the 1970s. His wife was killed instantly and his children suffered critical injuries which he had to sort out himself on the field. However, things didn’t get much better when they arrived into the hospital, and he had to get himself out of the bed and organise an adequate and appropriate response to the injuries that his children received.

Swearing revenge (ok, he didn’t actually), he set out to improve things and it is from his perseverance that a standard system for the management of trauma was established and has subsequently been adopted worldwide.

The nature of the course attracts applicants who’re keen on surgery, A&E and anaesthetics so many of the instructors were surprised to see an F2 in O&G with aspirations of being a physician in the course. And I think that that is one of the downsides of the current mismanagement of medical training in the UK – you don’t get the opportunity to spend a little time in areas of interest or spend attachments to gain new skills if it is not deemed necessary for the career of your choice. If you wanna be an ENT surgeon, don’t bother learning about ECGs. And so on and so forth.

Personally, I think all doctors should at the very least :

1. know the basics of medicine and surgery
2. what to do if someone falls down in front of you
3. what to do if someone suffered a traumatic injury e.g. hit by a car or whacked on the face with a baseball bat
4. recognising if a pregnant lady needs medical attention
5. likewise with a kid
6. have decent handwriting and other nitty-gritty things that I won’t get into.

So having been told by various people that spending £500 on a course that will have no relevance whatsoever in General Medicine application is a waste of time, I went ahead and had a rather enjoyable 3 days of training.

The course was well-organised, with friendly but stern instructors who didn’t suffer fools. And although it was mentally and physically draining, time just flew by ‘cause various new bits of information was seeping into our brains (I've learnt more in the past 3 days than in the past 3 weeks of O&G, that's for sure!) and we had lots of skills and scenario stations including bits where we were able to practice our surgical airway skills on little dead sheep.

MBek.

I felt a little nervous but didn’t feel as stressed or nervous as my subconscious probably did - I somehow managed to develop a zit and a mouth ulcer over the past couple of days. Thankfully, the tests didn’t go pear-shaped and I performed well enough that I would’ve been invited to be an instructor if it wasn’t for the fact that I was too young (all instructors are at least of specialist registrar level). And this translates to a middle-finger salute to the folks that kept on harping about how a ‘medicky-person’ won’t be able to change his mindset in a trauma setting.

Unfortunately, this medicky-person has to now study for the MRCP Part 1 exam in 16 days which he has ‘cleverly’ signed up for. I am not too fussed though – I’ll either prove that hardcore mugging of 2 weeks’ duration is sufficient for the exam or I’ll just resit it a little later.

I quite look forward to the latter bit of spring and then summer actually, as I’ll probably spend a bit of time not studying and I should be able to indulge myself in a few novels (yes, I’m also waiting for the last Potter book), movies (starting with Spiderman 3 next weekend. And there’s also Shrek, Pirates, Transformers, Ocean’s 13, Fantastic Four, The Simpsons & The Bourne Ultimatum to look forward to) and maybe even a short holiday, with Prague being on top of the list.

More importantly, I should be able to spend more time just chilling out with my friends (which I did to great satisfaction last weekend) and with Sweetie. But all that’s for later. For the moment, it’s the beginning of night shift and hoping that not too many babies get delivered over the next week!

Tembak

‘A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringe’.

Thus states the 2nd Amendment of the Constitution of the United States. Some say it is outdated, a relic of the war between the British and the colony. Some say it is guarantee that all individuals have the right to bear arms. And be damned with the consequences, of course.

The single deadliest shooting in the Unites States (nothing compared to the daily quagmire that the US has reduced Iraq down to) occurred in a university in Virginia, which happens to be the headquarters of the National Rifle Association (one of the biggest lobbyist in Capitol Hill and regular donor to both Republican and Democrat campaigns). It would appear that when Bush said that he would 'make no distinction between terrorists and those who harbor them', the definition of a terrorist was rather loosely made up.

In the United States, one can easily purchase a gun. For example, one can just walk into Walmart (recently proclaimed by Fortune 500 as the biggest company in the world) with an I.D., a bank check and a phone bill and voila! You’re ready for the next killing spree. In the United Kingdom however, handguns have been banned since 1997.

The difference between the two countries? Less than 200 firearm-related deaths a year in the UK, compared to the approx 30 000 of the United States (which has roughly 5x the population of the UK).

Some think that this was just bad luck, with the university students being in the wrong place at the wrong time. Which means that we probably should start avoiding any institutions of tertiary education. And some say that things would’ve been better if other students had guns to protect themselves (err...). The Republicans are not saying anything as they’ve persistently voted against more gun control and the Democrats aren’t saying anything either ‘cause the last time someone (Al Gore) spoke out against the widespread availability of guns, he lost the rural American vote.

Funny thing is, the US isn’t the only country which has widespread availability of guns. But the gun-related deaths are higher than most developed countries. And when you look at the gung-ho attitude of the administration, the shoot-first, ask-questions-later, we-can’t-do-no-wrong attitude; you have to then start looking deeper into the mindset of a niche population that is alienated and fed on a diet of super-sized media hyperbole.

The way I see it, one of two things need to happen – you either lock up the psychos and would-be-evildoers (which is kinda difficult since telepathy isn’t an exact science) or you restrict access to dangerous materials. If they believe it works with drugs, then why shouldn’t it work with guns? But will it happen? Nah…

And they keep on wondering why these things happen to them.

Time destroys everything

The last time I cringed whilst watching a movie was sometime last year when Oh Dae-Su swallowed a live octopus in Park Chan-Wook’s Oldboy. And I don’t think I’ve ever consciously everted my gaze from the screen (excluding the first time I watched The Exorcist ) until yesterday, when I finally caught up with a DVD that I bought a couple of months back of the movie Irreversible.

The movie was originally released in 2002, and was infamous for its uber-violent scenes. It is unfortunate that the violence in the movie has garnered so much negative publicity; as the movie itself is (in my opinion) a cinematic masterpiece. Yes, it’s sadistic and pretentious, but if one can get through the initial stomach-churning bits, there will be a more cerebral reward at hand.

Violence in movies has almost been vouched for by the usual suspects as a factor in adolescent misbehaviour and social degradation as a whole. Of course, there is no real tangible evidence to stand up for this case but as it seems to make sense at an intellectual level, movies have had to endure criticisms as a harbinger of social decay. As opposed to other factors like socioeconomic depravity and lack of parental control. But that’s a topic for another day.

Personally, I don’t applaud violence in movies for violence’ sake. Scenes of gore in a movie like Saw II for example, is just wasteful wherelse the scene of Edward Norton’s character (in American History X) smashing his foot into the occiput of an African-American as he bit the pavement for the crime of having darker pigmentation has left an indelible memory for the potential of cruelty and bigotry that can be seen in the world today; from the genocide of Bosnia to the daily reports of Shiah and Sunni slaughters coming in from Iraq.

And that is the power of movies – its ability to not only entertain, but provide a platform for art and foundation for realism that might be hitherto unknown to the viewer. Saving Private Ryan was critically acclaimed for its accurate portrayal of WW2, not for its admittedly impressive special effects. And likewise, I believe that Irreversible is a portrayal into the darker recesses of the human psyche and our ability to cope with it.




The technical accomplishment and acting prowess of the folks in the movie is not to be underestimated. The film is divided into 12 parts, each shot continuously with improvisation by the actors/actresses (who all put on a sterling performance, and should be applauded for playing their difficult roles). And the movie is played out in a chronologically-backward manner, ala Memento, so that you are first confronted with the effects of previous events.

The soundtrack resonates with the tone of events, from a disturbing bass rumbling in the initial scenes of violence to Beethoven’s Symphony No.7 in a scene later during the movie that involved the more lukewarm activity of sunbathing. We are taken from scene to scene by quirky camera movements, reminiscent of the chaotic but ultimately goal-oriented flickering of a butterfly, moving not from here to there, but from now to then. A bit headache-inducing at times, but once again in keeping with the theme of the movie.

Of course, the main talking points have inevitably centred on two highly controversial scenes – the graphic, unflinching recording of fire extinguisher versus face and the 10-minute, lengthy rape of Monica Belucci’s character. It is in the final part of the film that we move to more familiar topics of friendship and love, and the light-hearted and tender portrayal of the protagonist brings a sad smile to your face as the memory of the previous/future violence is still fresh in your mind and you are brutally aware of how fragile the beauty of everyday life really is. And you are then faced with an almost ironic happy ‘ending’.

The movie does not attempt to explain the rationale behind human behaviour, not does it attempt to investigate the nature of violence and its effect on us. Rather, judgement is left to the viewer. It does not condone the brutality but we are given, almost forced to endure the scenes of grotesque inhumanity and you end up wondering if anyone can actually behave in that manner and more importantly, HOW can anyone behave in that manner in the first place?

Yes, you might criticize the level of violence in the movie, but it is no different than what individuals have to endure in daily life. Women get raped, men get beaten up (and vice versa). As morbid as I am, I can’t even begin to imagine hurting a human being to the point of death, but such instances do happen all too often. And how will you behave if someone you loved and cared dearly for was hurt in the most unimaginably violent way possible (this being the central thesis of the first part of the movie)? What are the consequences of being reduced to your primal instinct and embarking on an emotionally-charged mission without paying heed to rationale, which is what you can see occurring in everyday life? Me – In terms of the final response, I’m probably more Pierre than Marcus, and you’ll understand what I’m talking about if you catch the movie.

Would I recommend this film? I can only think of a few people I know who might even consider watching it but yes, I’d recommend it with a few ‘ifs’. If you think that Kill Bill was violent and you couldn’t stand to watch it, then don’t bother. Kill Bill is like the Teletubbies compared to this movie. If you’re into movies because they give you a warm feeling in your heart and help escape the dreariness of everyday life, then don’t bother either. But if you are an adult and you’d like to challenge yourself and open your mind into the inherent cruelty of human nature, then go for it. Watch it once, and then keep the DVD in a box that you won’t be opening for a while.

Elseworld

I've started life as an F2 in the world of O&G, and I was 'cleverly' placed on nights for my first couple of days and on-call today (my 3rd day). Apparently this was due to some swapping that was going on prior to my arrival, and this has resulted in me being on-call for 7 of the first 10 days that I am here. Clever, no? And so very unselfish of some people. Somehow, I don't think sarcasm cuts through the internet as well as in real life.

But hey, on-call here is a piece of cake compared to the madness of acute medicine. I would never have had time to write in my blog or bitch about people if I wasn't on-call for O&G. No emergencies have occured yet, but that is bound to change. It'll be interesting to note how things progress here, as nobody who works here has had a good thing to say about the place yet.

Over the weekend, I downloaded and registered myself in Second Life. It's basically a virtual reality platform that's been in the news lately and was recommended by Omar, so I was curious to find out more about it. The graphics were pretty impressive with the new laptop, and I came away with the impression that the whole thing is an amalgamation of RPGs with IM programmes. Interesting, with lots of potential - as evidenced by the increasing presence of corporate and political figures in the new world.

Naturally, there's a seedier side to it as well and it wasn't too long before my avatar (the virtual incarnation of yourself) was approached by some guy who was wanting to sell me a penis. Turns out that just because your online character is male or female, it doesn't mean that one is anatomically complete. Below is the first, rough image of my ugly self in Second Life. It can be addictive, I'm sure, but I'll probably keep away for the moment.

A change will do you good

One of the biggest (and more common) challenges that we come across during our brief stay on this planet is our ability to cope with change. After all, nothing lasts forever; whether it’s something simple like that last piece of chocolate or something more profound, like your country being blown to pieces by the instigators of ‘democracy’.

With that in mind, I find it quite amusing and surprising that some people actively resist change, especially if it’s for the better. I for one can’t bear the thought of a mundane, predictable life (hence me discounting GP as a career at this stage). And as JFK said, ‘Change is the law of life. And those who look only to the past or present are certain to miss the future’.

Sweetie and I are going through career changes at present – she’s just started a new job at a new place, and I’ve just been thrown into the O&G night shift during my first couple of days on the job. And from a long-term point of view, the upheaval of sorting out the specialist training application is still far from over. The term ‘damage control’ would come to mind, if it wasn’t for the fact that I think it’s more of a vicious circle.

I go through cycles of despair and rage to periods of calmness and acceptance. And at the end of the day, I know I’ve done my best and I know that I am looked upon favourably by those that matter and that brings a certain sense of pride and achievement in my day-to-day work. Nothing beats the feeling of knowing that you’re doing a good job and making a difference to someone’s life. Except that warm feeling I get with regards to Sweetie, but that’s a totally different matter.

The whole issue of change came to mind after my chat with Jessie, the other day. She’s the high-school sweetheart of one of my best mates from SGI, Taiping, and chatting with her about events from my teenage years to the present day just brought a smile to my face. It’s amazing looking back and realising how much has changed (and how much has remained the same) in little over a decade. I will probably laugh at my current self when I’m 35 the way I’m currently laughing at my antics back in school.

The one thing that remains the same though is the friends you make and the ones that you keep. I can easily slip into a comfortable conversation with a close friend that I only meet up with once a year, and it’s amazing how little the chemistry changes over that period of time. And all the keepsakes from yesteryear have no hold over your past when compared to a session of teh tarik or wantan mee with your friend/s.

I am probably reminiscing for the simple reason that nights in O&G is amazingly quiet. I don’t intend to jinx it, but it’s heaven compared to the nights in medicine – not only do I have a room with a comfortably soft bed and fluffy duvet cover, I can actually sleep for a lot longer than the usual 15 mins. I do miss ITU at present, ‘cause I think it was probably the rotation that I’ve enjoyed the most in my working career so far but it’s too early to give my take on being an F2 in O&G.

And by the time I decide if I love it or hate it, it’ll be time to move on again. Where to? It’s too early to say but I look forward to changes in both my professional and personal life. And on that note, here’s wishing Yew Wai & Jessie my heartiest congratulations.

Feathers

Ku Li and Tun Dr M sharing a platform? Most intriguing, and promising one might add. But then, a week's a long time in politics. And I've lost count of the number of weeks left 'till the perceived date of the next general election. Or rather, I haven't bothered to count.

As you can probably tell, I've been browsing the net and generally putting my time to not-very-good use. Which is what happens when you force yourself to read about the complement system and other immunological nonsense that is bound to come up for exams. Instead, I've been reminiscing of the rather exciting and memorable time Sweetie and I got ourselves involved in the sport/art of falconry.

Falconry has traditionally been the sport of royalty and aristocracy - having had its origins in both medieval Europe and Japan. Obviously, there aren't such limitations in this day and age. Traditionally, it's described as the art of using trained raptors in the capture of game, and this ranges from little wabbits to largers targets like foxes.

We had started our session by receiving a 'pet' each - a falcon for me and an owl for Sweetie. The falcon's head was continuously kept under a hood, as it'll go into 'hunting mode' the moment it's released wherelse the owl had no such protective gear, enabling it to hoot and screech to its heart's content.

We were taken on a tour of various raptors - both longwings and broadwings, ranging from the more docile Harris hawks to the large Golden eagles (which apparently are used to hunt wolves). Whilst most of them were locked up, we did manage to 'play' with some of them and by play, I mean feeding them and getting them to land on our arms.

One of the nicer birds was the rather pretty Secretary Bird, a friendly and elegant terrestrial raptor that hunts snakes. It's smallish size does not mean it's weak though - strong legs allowed it to demonstrate its ability to leap vertically to perch on our hands, and apparently it can easily stomp on your hand and destroy the bones and tendons within. So much for being cute.




The Harris hawk was quite fun to play with too - we exchanged the birds between ourselves, watching it glide and smoothly and extremely quietly as it nipped food off us. At one point, the mischievous little devils even stole food that we were offering a vulture. Speaking of which, I have a newfound respect for vultures now. They're rather intelligent and clean birds, and their heads feel like the fur you get off a soft little teddy.




The highlight for Sweetie was her meeting with the Snowy owl though, her professed favourite bird. Unfortunately, we couldn't play with it for a prolonged period of time, as the poor little thing was so obviously not in Arctic conditions. It was the end of a memorable experience though, one that I wouldn't mind repeating in the future.