The paediatric consultant

I had my assessment with Dr. Graves yesterday.
He asked me a couple of questions about the rotation,
thanked me for choosing their specialty as an elective,
and thanked me for doing some of their jobs.

So he wrote on my report.
While he was doing so, I tried to formulate in my head my final/ ultimate question.
"I am trying to get a job here..." hmm...that doesn't sound quite right,
"I am in the process of applying for a job here and I need a reference, can you be my refree?" That...sounds like a proposal...
"I am in the process of applying for a job here, can you give me a reference?" This sounds better and direct. I practiced the sentence in my head.

"Ok, done."
When I was about to say THAT sentence,
he continued,
"If there is anything that I could help, it will be giving you a reference. Just make sure you establish direct contact, i.e. call me, because I don't always respond to email. In future, if you need something more than the online reference, I am happy to do it. You know my contact."

First thing that came to my mind,
"Wow! Where got consultant like that one?"
Second thing that came to my mind,
"Thank you...really really do..."

Gosh...I miss paediatric developmental disability!
I met lots of wonderful people there. The paediatricians (Dr. Graves, Sabine, Dr. Fullerton)and the registrars who are keen to have students (Czarina, Jasuina, Svatslana, Julia and Talia...haha they rhyme), the psychologists who are always smiling and warm(Crystal, Nicola and Jane), the speech pathologists whom I never really spoke to but they are very good with kids, and the ward clerks in the clinic.

Daniel said, "You girls are always like this, miss every rotation that you have gone through!"
I said, "Nope, only if the people of the team are nice."

The colorectal team is asking to go out for Peking Duck gathering again...haha!

身不由己

终于看到一个有Prader Willi Syndrome的病人。
身为医学生我感到兴奋，
身为一个人，我为他感到难过。

他现在的体重是119kg，曾经一度190kg。
每天必须要克制食量，做运动。
但这并不容易。
因为这个病，他会不停吃但不会感觉到饱。
因为肥胖，走动也很难，更别说运动。
也因为肥胖，任何跟肥胖有关的疾病也尾随而来，
所幸的是他还没有患上糖尿病，高血压，不过这是指日可待的事。

有时侯看见各种不同的病人，
会启发很多想法与感想。
像这个病人就让我觉得，
很多时候事情不是表面那么简单，
很多时候别人也是身不由己。
就像肥胖不一定是因为贪吃不运动，也可以是因为生病。

命运。运命

命已在掌心，无法改变。
怎么去运命，仍然操纵在你手里。

我接受唔到咯！

想像一下，
一个五十岁育有二子一女的女人，
孩子已经二十几三十岁，
她离婚了，
然后遇到一个好男人决定要一起生活。

没问题，我觉得这是可以接受的。

妙的是，
她想要再生一个孩子，
科技发达，试管婴儿可以让她梦想成真。

虽然我觉得以她的年龄会有一定风险，但这并不是无法接受的。

更妙的是，
她用的精子是现任老公的，卵子是她女儿的。

我接受唔到咯！
说我思想老土也是酱的啦！

你家有过动儿吗？

他没有办法静静坐下，
他就是会不断地走动，跑，爬高爬低，不断地说话。
他没有耐心等待，
还没轮到他他就已经抢先做，
还没问完问题他已经回答，
他会很常打扰或闯进别人正在进行的活动。
他很粗心，
他记忆不好，
常弄不见东西，
没有专注力，
跟他说话是他好像没有张开耳朵，
他没有办法完成指令，
他讨厌，不想做需要用很多精神的事情，所以他不做功课。
他很容易被周围的琐碎小事吸引。

他有
用不完
永远不会完
没完没了
的精力！
但这些精力都用在不恰当的地方，而且他在学校的学习能力也因此严重地受影响。
除了改变环境和态度，
他需要药物的协助。

酷！

A Helpful Website for Paeds

I came across this website when I was google-ing for some pictures of dysmorphic features.
The photo gallery is quite helpful, especially for describing findings for newborn exams.

Disability at a glance

Sitting in the clinic for a day, I came to a conclusion.

First class disability:
physical disability or severe mental retardation (eg blindness, congenital diseases that cause physical disability and mental retardation)
You earn sympathy. Your parents earn respect for taking care of you. People will try to help you and try not to discriminate you. People forgive you for whatever you can't do or did wrong.

Second class disability:
moderate mental retardation, no apparent physical disability
You still earn some sympathy. Your parents still earn some respect for taking care of you. People may try to help you but may tell you off when they are having a bad day when you did something wrong.

Third class disability:
No mental retardation, no physical disability, but you have Asperger syndrome (especially if you have high IQ)or ADHD.
You dont earn sympathy. Your parents get blamed for not teaching/educating you. You get nothing except for a world that doesn't quite accept you and your diagnosis.

Is life fair or unfair?
Well...it depends how you look at disability.

I was in the consultation session of a girl with Asperger + attention deficit disorder. She has an IQ of 120 and is on a private school scholarship. She cried in the consultation.
Mum said: The teachers only see the final results. They don't see how hard she struggles to get there.
(Mum cried, daughter cried and both hold hands)
The story was that she couldn't focus on planning and writing her schoolworks. For example, she spent a whole day to write an essay and she got really tired. She got excellent marks for her essay though. Mum was complaining to the teachers that she struggled to get the results but teachers don't see the problem.

Right...I don't see the problem also.
To me she doesnt have a disability lo.
I tried very very hard to sympathise...
Maybe this is because of our chinese upbringing or unfamiliarity with the diagnosis.

Demotivated

My runny+stuffy nose makes my breathing difficult.
My facial movements ie smiling, talking, eating make my mouth ulcer painful.
And DD is not really very stimulating.
Every person that I bumped into, asked me why did I choose DD...
I just couldnt lie and say "Oh, because I am interested..."
I would give a simple answer "It's not that I like, I just don't mind doing it..."
So ya...that is the extent of my enthusiasm.

I miss real clinical, ward-type of thing :[
And I will have to wait for 11 more weeks.

热忱，信仰，坚持

才在Developmental Disability几天，
我所看到的不多但感受到的，很多。

第一，这是一份需要很多热忱的工作。
我的supervisor已经年过古稀，
领着一群年轻的儿科医生，为这群特别的孩子服务。
头发已经全白，架着一副眼镜，
左手还不时地颤抖。

他宣布他已经决定要关闭他的私人诊所，
理由是他的私人助理兼太太觉得她已经负荷不来工作量，
是时候退出休息了。
而他依然决定留在医院里工作，说直到医院不要他为止。

他每天的工作，除了诊断这些孩子，
就是得准备一份又一份的报告，资料，
好让父母可以把这些资料带给学校作为沟通的管道。
可是很多时候，学校没有办法接受这些特别的孩子，
原因包括学校没有受过训练的教职员，没有办法教育他们。
有些孩子太顽皮，没办法控制脾气，总在学校捣乱，引起学校的不满。
他的工作就是去学校见一群教职员，跟他们解说孩子的病况，改变学校对孩子的期望指标，并希望达成共识。

我常想：这不是等于丢盐进大海？学校和社会真的有可能被你游说吗？尤其是自闭症的孩童，难道你解释说他们的顽皮和怪异是因为他们的脑子的问题，学校就会接受吗？
所以，除了热忱，第二：这份工作需要坚持和信仰。
还是有学校愿意配合，或许只是少数。
他相信，这些孩子只要能够留在主流学校，就能过将近常人的生活，
在特殊学校，他们就永远是被社会排斥的特殊孩子，因为在那里他们不会过像一般孩子那样的生活。
而我又想：真的吗？一般的孩童会愿意跟他们做朋友？或许我太悲观了，不尝试又怎么知道答案？

这个问题就像种族歧视吧，
无论我们假装我们不是其中的一分子，或是觉得根本不关我的事，
或是某部分的人多么努力地提倡反种族歧视，
多数的人心中还是觉得：肤色不一样，就是不一样，我没有歧视，但不代表我得无条件接受。

这是一条很漫长的路...
它不像一个骨折或一个细菌感染的伤口，时间或药物没有让它痊愈的能力。

我很感恩接触到了这一块领域。

又是新开始：Developmental Disability

Developmental Disability(DD)掀开了我final year的新的一页。

从忙碌的colorectal ward work 到只有outpatient的DD，是一个很大的转变。
这六个星期，我将会见到的病人包括了ADHD(注意力不足过动)，autism(自闭症)，intellectual disability (智障)，spina bifida(脊柱裂)，cerebral palsy (大脑性瘫痪)，Down syndrome （唐氏儿）等等...不幸的孩子。

今天我跟着我的registrar去上一个autism的课程，很不错，很充实，学了很多。