A Small Act That Won A Nurse's Heart

I was on my cover shift last weekend. A renal patient needed an IV cannula resite thus I went. The patient is old and crumbly and looks like he has had a stroke in the past because he couldn't move his left arm well.
I put a new cannula in and then wrapped it up with a bandage to give it extra protection.
Later I bumped into the nurse that looked after the patient. She was so surprised when she went back to the patient to find that the cannula has been wrapped up. I guess she hasn't seen many doctors doing that themselves. Doctors normally leave that to nurses.
She asked me, "When are you coming to renal? We would love to have you!"
Well...not this year.

A kind act no matter how small, will leave a good impression I think.
When you make someone happy, the happiness will come back to you :)

急诊室

快刀斩乱麻又不可以遗漏任何一点，
急诊室的工作不适合我。
可是，学习是不错的经验啦 =）

First Suturing

On ED rotation now...finally got to do suturing on a real person!!! As usual, I felt bad for the patient, but thanks for the sacrifice...god will bless you :P

6 weeks away from being an intern, I will have to admit that it is a bit late...ah well...Really grateful to the registrar, who waited for me to come out from another patient's cubicle and offered to let me do the suturing. Before we went in, he got a suture set and a tissue box for me to briefly practice the knots.

I was thinking if I should get consent from the patient...and my answer was hell no (dont lecture me on ethics...)...unless the patient really screamed refusing me doing it...

It was a 23 year old guy who accidentally lacerated his middle finger while fixing his mountain bike. There was a flap of flesh over the PIP joint, bleeding profusely. The registrar supervised me doing a ring block and then suturing.

I decided that it wasn't a good idea to tell the patient that "Hey, you are the first patient that I suture...but don't you worry coz I have good skills in sewing!" So I just did whatever I needed to. 3 stitches done, bleeding stopped. Amazing!!!

The patient took a photo of his wound and the stitches with his iPhone. I bet you it is on FB somewhere...haha!

A consultant...

A consultant is someone who only has to come to the ward once in a while to take the bradmas of private patients and then 顺便 does a brief wardround by saying hi to patients.

A consultant is someone who sits at the corner throughout the endoscopy list, playing Angry Birds on his iPhone/window shopping on eBay whilst the registrar is busy scoping. He then 拍拍屁股leaves at 4pm, whilst the registrar is still scoping the last patient.

A consultant is someone who accepts essentially any patients referred to him on phone, wrapped up nicely with a "gastro" story, without thinking much...whilst the registrar is frustrated, "Who said this patient comes under gastro? No one told me about it!"

我看我学我做

遇到很好的医生，
学习他的态度，
记得然后付诸于行。
geriatric有很多这样的医生。

名字

我的名字很少人会记得，尤其是洋人。因为那个发音是完全无法和任何东西联想起来。我没有怪他们。但也坚持不要取一个可以让人琅琅上口的洋名。
我曾经把名字切成一半，让他们叫我"Yeu"，但也闹出很多好笑的事。
比如说：“Hey,Yeu!”（Hey you!)听起来很没礼貌。
或者A told B that I was going to do something.
A,"Yeu was going to do that."
B,"Me? I didn't..."
A,"No, not you. I meant Yeu."
后来我决定了，还是全名好了。

曾经有个病人，我帮她放一个打点滴的针，然后跟她解释一些她的状况。她很善意地记起了我的名字，甚至隔天都还记得。我感动极了...

我的respiratory registrar，geriatric nurse，花了最少两个星期来记得我的名字。刚认识他们的第一个星期，他们每天都给我叫不一样的名字。有一天终于叫对了！

有件奇妙的事，友望告诉我，在DD 的registrar，竟然屡次把她的名字叫成我的名字。这真是破天荒啊！她问我说我究竟在DD做了什么惊天动地的事。

但我还是常觉得我的名字好酷...哈哈！

温馨的爱情故事

老婆婆大小便失禁，神志有点不清，说话含糊。
老公公在她身边，
笑说：“我听不懂你说什么！”
老婆婆嘟起嘴，然后笑笑。
老公公也笑了。

老婆婆两年前中风了两次，原本已在康复中，
有天突然情况急速恶化，
原本说话只有小问题，突然听不懂她要表达什么，
原本只有小便失禁，突然大便也失禁。

老婆婆要被送去做脑部扫描时，
他们还嘴对嘴亲了一下。

好幸福的画面。

在aged care，很少看见那么老还有个健康的老伴，
还依然那么幸福。

Geriatric Rotation

Just entered a whole new world of geriatric. Interacting with elderly doesn't require much skills but just patience. They are generally nice. Once you sit down and have a chat, they can tell you what happened to them 50 years ago. Not very helpful in terms of history taking but no harm listening to their stories since my rotation is quite relaxing. I talk to one patient each day, so at the end of my rotation, I will have gathered about 30 life stories. Unfortunately, most of them will be sad or unfortunate stories...about terminal illnesses, lacking family support, loneliness, neglect...Most of them always smile and get very excited when they talk about their children and grandchildren. I guess the memories are what keeping them going, especially when they are sick.

一个特别的际遇

上星期接触一个很特别的病人。他是一位聋哑人士。所以拿病历都是通过纸与笔。我写一句，他写一句。
五十五岁的他，是我在这短短六个星期内，第六或第七个肺癌病人。他满脸胡子，胡子上和手指都有明显的尼古丁痕迹。他也是我的第一个pleural tap的病人。我的registrar当时还开玩笑说，给我找了一个“好病人”，又聋又哑。他今天出院了，将由肿瘤科接手。
不幸的事，发生在幸运的人身上叫不幸。不幸的事发生在不幸的人身上，那叫什么？

医院里，病人来来去去。
有时会很好奇他们后来怎样了。
希望他接下来的治疗会让他好起来。

五个病人的完结篇

第一个：老老的公公，右肺积水，抽取组织化验是肺癌。在医院只呆了两个星期就去世了。
第二个：不算很老的公公，pulmonary fibrosis，一次肺部感染就被击垮了，每况愈下。从每天可以对我招手打招呼到呼吸困难，连话也没办法说。上个星期也走了。
第三个：老老的公公，COPD 进来时情况已经很糟，respiratory failure，进院隔天就去世。
第四个：不算很老的公公，没有朋友，没有家人。进院因为呼吸困难，切片扫描看见有不妥需要抽取组织化验。在还没来得及进一步去检验，突然不省人事，送入深切治疗部，过了一个星期，没有好转，上个星期也走了。
第五个：老老的婆婆，没有家人，最终我们找到了她的一位老老的朋友来看她。COPD 病入膏肓，只能够palliate她。今早走了。

短短的几天走了五个病人，
虽然死亡并不是好事，但对这些病人而言，是很大的解脱。
呼吸不了但也断不了气，是一个很痛苦的死亡过程。
如果你看过这些病人怎么痛苦，你不会想拿起一根烟。

肺科病人的故事

病房里有个二十八岁的华裔病人，肺积水入院，原本怀疑是肺结核，但组织化验结果竟是小细胞肺癌。
病人一向身体无恙，也不抽烟。这对他来说一定是晴天霹雳。
作为旁人的我，目睹主治医生告诉他真相的当儿，我屏着呼吸，心跳加速，深怕多吸一口气都会让他觉得更难过。
我们比较容易接受老人生病，人到了一定年纪体内的机械一定会当机，那是正常的。
我们比较容易接受吸烟的人得肺癌，认为那是迟早的事，不需要惊讶。
相比之下，健康的年轻人生病，我们会觉得特别难过。
我最不能接受的就是看见无知的小孩生病。我宁可远离他们，当作我没看见，当作我不知道小孩会生病。

每个在肺科病房的病人，每口呼吸都在挣扎，
真的重复又重复地提醒我：可以正常的呼吸真的是很幸福。
很可惜，人总是会为了物质或精神上的烦恼而忘了这些提示，
甚至会觉得，若我得不到我所追求的，能够顺畅的呼吸那又怎样？
我可以担保，病房里的那些病人，会宁可放弃所追求的一切来换取正常的呼吸。

有个医生这样说

For Future Doctors: General Misconception of being a doctor PART 1
November 11, 2010 by Pagalavan Letchumanan

1) Guaranteed Job and Good salary/can make money

Many parents still believe that being a doctor guarantee their children’s future. Well, it may be so before but not in another 5-10 years time. You can read about these issues in my MMA articles column. 20 years ago we only had 3 medical schools producing about 400 doctors a year but now we have almost 30 medical schools in the country (the highest per capita population in the world). Last year alone, almost 4000 new doctors started housemanship in Ministry of Health (MOH). The number will further increase in coming years when all the medical schools start to produce their graduates. I believe it will reach a figure of 6000/year by 2015.

This is where issues arise. Even now, the MOH is struggling to place these doctors in various hospitals in the country. We have almost 30-40 houseofficers in each department now not knowing what to do every day. Their training is compromised and they are being released after that without proper training with license to kill! I may sound negative but this is the reality. Even district hospitals are being used to train houseofficers now, starting 2010. As you would have read in the papers recently of parents complaining that their child has been transferred to East Malaysia after completing housemanship, it is a known fact that the shortage of doctors at this point of time is in East Malaysia. As our MOH Director General had said, most doctors will be sent to Sabah and Sarawak from this year on wards.

What’s going to happen in the next few years? Again, my prediction is, there will be surplus of doctors by 2015. There will more bodies than post in MOH by 2015. Doctors most likely will need to queue up to be posted in government service. You will be sent to rural and East Malaysia to serve. Any appeal will not be entertained. If you think this would not happen, please look at the nurses! 5 years ago, the government began to approve numerous nursing colleges due to shortage of nurses. Now, we have surplus of nurses without any jobs. I know of nurses who are currently working in petrol stations! BTW, the MOH is currently considering introducing common entry exams for all medical graduates. Only those who pass this exam will be given housemanship post. This will happen soon.

Furthermore there may be a pay cut for doctors when all the post are filled. One of the allowance known as critical allowance of RM 750 will be removed once all the posts are filled. Critical allowance is never a fixed allowance and is usually reviewed every 3 years. As you know, the pharmacist’s critical allowance is going to be removed if not already.

I had one budding doctor who said that the reason she wanted to do medicine is because it is the only field where you have a guaranteed job and a starting salary of RM 6000. Well, I have talked about guaranteed job issue above but she is definitely wrong in stating that the starting salary. The starting salary of HO has gone up over the last 5 years; no doubt about it (please read my MMA article). However, the starting salary of HO currently is about RM 3500 to about RM4000 after including the on-call allowance. Remember, your salary only increases about RM 70/year. You will only reach a salary of RM 6000 after 7 years of service as a medical officer, when you are promoted to U48 according to current promotional prospect in civil service introduced end of last year! BTW, other than the difference of critical allowance, a doctor’s salary is only RM 200 more than a pharmacist in civil service!

2) Medical degree recognition

If I can’t work in Malaysia, I can go to Singapore or Australia to work, right?

Again, another misconception. Many do not know that medicine is a very peculiar field and cannot be compared to any other profession. In order for you to work in another country, your degree needs to be recognised by the Medical Council of the other country. If it is not recognised, you would not be able to work there. For your information, only UKM and UM degrees are recognised in Singapore.

Almost all medical degrees from Malaysia are NOT recognised elsewhere.Malaysia Boleh mah! Only Monash University Malaysia’s medical degree is recognised by Australian Medical Council and thus you would be able to work in Australia/New Zealand. Some of the private medical colleges do twinning programmes with external universities from Ireland/UK/India etc. These may be recognised depending on which degree and where you graduate from.

3) Housemanship & Compulsory service

I have mentioned a little about housemanship above. As you know the housemanship has been extended to 2 years since 2008. Even though it is good for your own training but it does prolong your future postgraduate training. After Housemanship you have to undergo another 2 years of compulsory service before you decide to resign for private practise or pursue your postgraduate degree. It is during this compulsory service that you will be posted to anywhere in the country.

Furthermore, housemanship is not an easy posting. Even though the numbers of HOs have increased tremendously over the last 2 years, it is still a very exhausting job. Many have had a mental breakdown during housemanship. I just heard of a houseman who is on psychiatric MC for the last 2 months! It seems she thought that being a doctor is just like sitting in a clinic and seeing cold cases (probably she thought she can become a GP immediately!)

4) Hard work and post graduate training

20-30 years ago, being an MBBS holder itself is good enough. You can easily open a clinic and become a GP and well respected by the community. But things are changing. Even GP practise is a speciality by itself in many countries (Master in Family Medicine/FRACGP etc). Malaysia is also moving towards that. Many patients are demanding and would prefer to see a specialist directly nowadays.

Thus it is important that when you join medicine undergraduate degree, please be prepared to continue your education for another 10 years after graduation! In order for you to complete your postgraduate education, it will easily take another 10 years, assuming you pass all your exams in one try! So, don’t assume your education is only 5 years! MBBS do not mean anything now, in fact it is only considered as a diploma!

Getting into postgraduate training is also becoming increasing difficult. The number of places for Master’s programme is very much limited in local universities. The demand is greater than supply and of course don’ forget the quota system as well! Other than MRCP (UK) – internal medicine, MRCPCH (UK) – paediatric and MRCOG - Obstetric, you have to depend on local master’s programme for your speciality. Thus, you have a very limited option. With such a big number of doctors coming into the market now, I can assure you that getting a place for post graduate education is going to be a major problem in 2-3 years time! Be prepared.

For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 2)

In this Part 2, I will write more about what to expect after finishing your 2 years Housemanship posting in Ministry of Health.

1) Compulsory Service

I am sure everyone knows about the compulsory service for doctors in government service. According to Medical Act 1970, a medical graduate has to undergo compulsory service with the government for at least 4 years. This includes the Housemanship which is now 2 years. This means that you need to serve the government for another 2 years before you decide to leave the service.

2) District/Rural postings

As I have said in my first part, after completion of your housemanship, you will likely be transferred to rural clinics or district hospitals. With the recent influx of large number of doctors, almost everyone will be transferred to rural areas, mainly Sabah and Sarawak. You can see this from various letters posted in almost every newspaper recently, embarrassingly by parents of “so-called” grown up doctors!

From my experience, district posting is a wonderful experience. Working alone without anyone to consult immediately, gives you a lot of experience. Remember, other than X-rays and some simple blood test, you don’t have anything else in these hospitals. Usually there will be about 3-5 Medical Officers (MO) in each district hospitals. When you are “on-call”, you are all alone and need to manage the A&E department as well as all the wards including obstetrics cases. It is really scary at times, especially if you are working in district hospitals which are far away from the nearest General Hospital. If you are preparing to sit for any exams then this is the time to do your revision as the workload is generally lower than in general hospitals.

The same goes for those who are posted to health clinics (Klinik Kesihatan). These clinics are usually situated in rural and semirural areas. Most of the time there will be 1-2 MOs in each clinic. The major bulk of patients that you see in these clinics are antenatal and outpatient cases. There will also be a lot of administrative work to do in these clinics including school visits, running various health campaigns and public health talks. In cases of any outbreaks, you will be called to assist in containing the outbreak. Basically you are the primary healthcare providers. Many doctors do not like the administrative work that they are supposed to do, and the meetings that you need to attend!

Even though it is a good experience to do rural/district postings, please do not stay long in these clinics/hospitals if you intend to do postgraduate studies. A maximum of 1 year should be adequate. The reason I say so is because you will lose the momentum to further your studies after some time of good life in these centres. Since the workload is lower, you will get carried away with relax life compared to your housemanship training.

This rural/district postings are usually given extra points when you apply for your Master’s programme even though it does not guarantee a place. At the same time you can use your free time to prepare for your exams like MRCP Part 1, MRCOG Part 1 etc etc. After passing your Part 1, you can request to be transferred to the General Hospital for continuation of your training. Again, this may become a problem in the future as the number of post may be limited and it may be increasingly difficult to get a place in bigger hospitals.

I think people who grumble about going to rural and district postings should just give-up medicine. If you choose medicine to help and treat sick people, then these postings is where you really see the real life of people. You will learn a lot about their social life and the struggle they go through daily which you do not see when you work in general hospitals. You will also realise that people here appreciate you better than urban people. I would advise each and every doctor to do rural/semirural and district postings for at least a year after completing your housemanship.

Next: Postgraduate training…………………

For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 3)

Let’s look at the postgraduate training in Malaysia. I have written about housemanship, district/rural postings and problems of oversupply of doctors in the near future. The issue of oversupply of doctors by 2015 will lead to another very big issue: postgraduate training. Many of the budding doctors and medical students are not aware that the postgraduate training in Malaysia has many limitations and problems. At this point of time, most postgraduate trainings are dependent on Master’s programme conducted by the local universities. Once upon a time, we were totally dependent on UK-based exams and training but unfortunately we lost it along the way. Currently, only MRCP (UK) – Internal Medicine, MRCPCH (UK) – Paediatric and MRCOG (UK) can be done in Malaysia. FRCS (for surgeons) used to be available to Malaysians but not anymore. None of our hospitals are recognised as a training centre for FRCS, which is now known as MRCS. Thus, for any surgical field in Malaysia, you will need to do Master’s programme!

MRCP (UK) – Internal Medicine

Membership of the Royal College of Physicians (UK) is a well-known exam all over the whole. It has a very strong reputation as an entry exam for speciality training in UK as well as in other parts of the world. It is conducted regularly, usually 3 times a year in various countries. Malaysia is one of the centres for the MRCP exams, all 3 parts.

MRCP Part 1 can be taken about a year after your graduation. It is a theory paper. After passing your Part 1, you need to clear your Part 2 (written paper) and Part 3 (clinical) within 7 years. It is usually coordinated by University of Malaya, where the exams are usually held. Just for your info, the passing rate for MRCP (UK) is always around 45-50% worldwide! You need to have a proposer to sit for these exams, who can verify that you have undergone sufficient training to sit for the exam. If you fail miserably, your proposer will be notified.

Since MRCP (UK) is not a specialist exam in the UK, the Ministry of Health, Malaysia only recognises and gazette’s you as a specialist after undergoing further training of 18 months post MRCP (UK). You will need to submit a log book and recommendation by your HOD before being gazetted. This rule applies for all other overseas degrees which include MRCPCH and MRCOG. You need to undergo this gazettement process in order for you to be recognised as a Physician by the National Specialist Register (NSR).

MRCPCH (UK)

MRCPCH is similar to MRCP (UK) but meant for those who wants to become a Paediatrician. It‘s examination structure is similar to MRCP (UK).

MRCOG (UK)

MRCOG has 2 parts but the second part has both written and clinical component. However, you need to undergo training in O&G department for at least 4 years before being allowed to sit for Part 2 exams. One of the major issues in sitting for MRCOG is the fact that there are not many MRCOG holders in MOH to sign as a proposer for you!

Master’s programme

Now, this is where a big problem is going to appear soon. For all other fields, you are totally dependent on Master’s programme. This includes all surgical fields. Master’s programme is a fixed 4 year programme.

In order for you to be eligible to apply for the Master’s programme, you should have completed at least 3 years of service with good SKT marks of at least 85% and above, recommendation from Head of Department and confirmed in service. You also need to attend an exam or an interview before being selected for certain disciplines.

The major problem that I foresee in the future will be the number of places that are being offered. As of this year, the total number of places available is only 600, all disciplines included. Imagine, with 6000 new doctors coming into the market every year from now onwards, only 10% is going to get into the Master’s programme annually. Furthermore, you must understand that the selection process is never transparent, the typical Malaysian scenario as well as the quota system! Most of it is done by the Universities.

The government is planning to increase the number to 800 next year but the situation is rather critical in the Universities as there are not many Senior Professors to supervise the programme. I must say that the standard of Master’s graduates have dropped significantly over the last 5-10 years. We have Master’s graduates who can’t do surgery but have passed the exams! I just hope that the Master’s programme do not become another “specialists mill” like our undergraduate medical schools!

There are 2 types of Master’s programme, the open and closed system. In the closed system, you will do the entire 4 years within the university, like in UKM Hospital, UH and USM Hospital. The open system may have various programmes, like 2 years in MOH hospitals and another 2 years in the Universities etc. You may even do the entire 4 years in MOH hospitals for some of the fields.

After completing your Master’s programme, you need to undergo another 6 months of gazettement process before being recognised as a specialist. Furthermore, you will be bonded for 5-7 years for receiving scholarship during the programme, which is compulsory!

Subspecialty training

With the advancement in medical field, every discipline now has subspecialty training. As such, everyone will try to do certain subspecialty after gazettment as a specialist by MOH. Generally, the subspecialist training is about 3 years except for certain field like Cardiothoracic and Urology which may take 4 years. Again, whether you get a place or not depends on availability of post and demand for that particular field. For example, the waiting time for Gastroenterology training can even go as far as 1-2 years.

Recently, to overcome this major problem, MOH has taken another step backwards. You can only apply for subspecialty training 1 year after you have been gazetted as a specialist. For MRCP holders, this means 2 and half years after passing MRCP (UK)!

Usually, the subspecialty training is divided into 2 parts, the first part (the first 2 years) will be done locally and the 2nd part (remaining 1 year) will be done overseas. The MOH will provide a fully paid scholarship for overseas training of 1 year but you will be bonded for 3 years. If you have received undergraduate scholarship and Master’s scholarship, you will be bonded a total of 20 years in service!!

Singapore

One good advantage that we have is Singapore. Unfortunately, only UKM and UM undergraduate degrees are recognised in Singapore. Our Master’s degrees are NOT recognised elsewhere. Thus, we would not be able to work in Singapore with any other medical degrees or even with our Master’s degree.

However, Singapore does recognise MRCP, MRCPCH, MRCOG and MRCS. Thus, if you have any of these degrees, it supersedes the undergraduate degree and you should be able to get a job in Singapore. Singapore is also a recognised centre for MRCS Part 3 training, which you can’t do in Malaysia. So, if you have MRCS Part 1 & 2, you can go to Singapore to finish your MRCS training and sit for the Part 3.

I must say that Singapore’s postgraduate training is more structured and organised with their BST (Basic Specialist Training) and AST (Advanced Specialist Training) programmes. I have written about this in my MMA article “Back from the Future: From 1st world to 3rd world”.

For all of you out there; budding doctors, medical students, houseofficers and medical officers; the future is very bleak for the medical field in Malaysia. The oversupply of doctors will get to you sooner or later. My advice to those who insist on doing medicine for passion is to choose an undergraduate course that is recognised internationally. Then, pursue a postgraduate degree that is also recognised internationally. If not, you will end up with a lot of frustration in the future. Jobless doctors in the future will be a reality!

读后感言：
由于本人现在不是一个很有大志的人，所以他所说的我都觉得还好啦。每个人都会有自己的故事，我们不需要一定要跟着别人设定的道路走。可是人会变，万一有一天我突然有大志却无法得志，我会怨吗？
哈，幸亏Monash是受别国承认的=)应该感到幸运。

出卖

此出卖非彼出卖，
此出卖是要把自己卖掉，
把自己当一个商品介绍然后推销给医院。

该怎么卖？

我对着电脑发呆...写不出来。

The end of 4th year

That means:
We are 4/5 a doctor (provided that we pass the end of year exams, which are just around the corner)
We are now expected to be able to manage most diseases commonly known to mankind.(Which is a bit worrying (Lau 2010))
ranging from
common cold to influenza,
TB to emphysema,
AMI to arrhythmia,
constipation to diarrhoea,
acne to melanoma,
vaginal atrophy to prostatic hyperplasia,
delirium to schizophrenia,
obesity to anorexia...

Haha...I also started to have grandiose delusions that I will be a good teacher to the 3rd year students...just because I know that it is the way it should be ^^
3rd year in Dandenong colorectal surgery, respiratory medicine in MMC next year etc...你们有福啦！

mentor

躲在mentor背后的感觉很好。
好的mentor的好处：
感觉有她在帮我撑腰，theatre里的老臣子不敢欺负我 =P
mentor对theatre里的人说：
she will do the VE (vaginal examination)
she will do the pap smear
she will scrub in

有mentor在，不再像是个孤儿。
好感动...

A dispute

Today I witnessed a dispute between the anaesthetist and the surgeon.
The anaesthetist disagreed to position the patient's arms into the position that the surgeon wanted because it can cause ulnar nerve palsy. The surgeon insisted. The anaesthetist left the theatre.
Everything froze.
The charge nurse called in another anaethetist who was willing to comply with the surgeon.
I was standing at a corner, holding the speculum,thinking "please don't spoil my only pap smear of the day..."
To be honest, that was my only concern =P

Coffee

First day of mentor week - in the theatre.
" Do you mind to go downstairs and buy us some coffee? Here's the money. You can have one too," The surgeon said.
" Sure," I said.
Thinking that, "Do I have a choice?"
So that's my first task on mentor week.

手术室的感想

在O&G四个星期，有些杂想。

1）那天被叫去当中文翻译，对方是一对来自中国的夫妻。发现我无法正确发翘舌音“手术室”变成“擞素四”。后来想起有点好笑，有些惭愧。还好，他们听得懂我多数的翻译。
2）我从来不喜欢进手术室，因为医院的手术室护士，永远都是匆匆忙忙，多数很不友善，不喜欢有多余的人在他们的地盘（他们说是为了控制病菌传播给病人）。然后如果成功侵略了他们的地盘，通常他们会限制你站在某一个角落，那样你才无法入侵他们的核心（sterile area)。感觉很渺小很渺小的我告诉自己：那是他们的职责所在。如果不舒服就不要去好了。在小家一点的医院，他们做的都是风险较低的手术，相对的，护士姐姐们的防卫也降得比较低，而且奇怪的是很多都脸带笑容。我第一次感觉冰冷的手术室是有温暖的=）
3）一个很好很友善的surgeon，会让你觉得在手术室里你不是隐形的。而且，还会学到一些有用的知识。会让你觉得苦等至少也有回报。
4）记得别人的名字很重要，打招呼时如果你叫得出那个人的名字，我相信那个人会觉得很开心，然后也愿意帮助你更多。（问题是，病房里有太多的ｍｉｄｗｉｖｅｓ，轮班制，我的脑容量不胜负荷）

我不要变成你

在医院里学习，机会有很多时候是可遇不可求的。
Medical student friendly的医生，他会愿意停下来，让你问问题，然后为你解答，会让你有机会接触很多学习机会，以建立你的技巧和信心。那种态度，是值得学习的榜样。这种医生的名声会在学生群里传开来，因为我们见面聊八卦时就会提到哪个部门的哪位医生很好人。

有些医生，或许有什么苦衷，总会让学生觉得有一段距离，总是挂着一副很忙很忙你不要来吵我的嘴脸。问他什么他都指你去找别人。那种医生，会让我告诉自己：我将来不要成为你。

接生婆

就是多了那么一点点的dedication

接生婆-Midwife，
在产房里势力强大，
力量单薄的我们，
对抗是
以卵击石。

（对学生很好的midwife还是有的，只是可遇不可求）