“Hope is definitely not the same thing as optimism. It is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out.” 

Vaclav Havel

Day 3 atas panggilan (on-call)

Hmmmm......still feel fairly incompetent. Not cryingly incompetent, but a quiet desperate hum in the background that's a buzzing that indicates im not exactky sure what is going on.

That just sounds like me everyday of my life.

So, the moral of the day:

1. GP patient summaries are useless. Try calling NOK if any doubt, but it's hard. Hard hard. Confused little ladies are tough.

2. Look up: criteria to CT head.

3. Risk factors for PE and well's score. Virchow's triad: hypercoagubility, stasis and vessel injury. + PMH of DVT or PE
   Well's score (thanks wiki)

• clinically suspected DVT - 3.0 points
• alternative diagnosis is less likely than PE - 3.0 points
• tachycardia - 1.5 points
• immobilization/surgery in previous four weeks - 1.5 points
• history of DVT or PE - 1.5 points
• hemoptysis - 1.0 points
• malignancy (treatment for within 6 months, palliative) - 1.0 points

Traditional interpretation^[5][6][11]

• Score >6.0 - High (probability 59% based on pooled data^[12])
• Score 2.0 to 6.0 - Moderate (probability 29% based on pooled data^[12])
• Score <2.0 - Low (probability 15% based on pooled data^[12])

Alternate interpretation^[5][8]

• Score > 4 - PE likely. Consider diagnostic imaging.
• Score 4 or less - PE unlikely. Consider D-dimer to rule out PE.

Scoring system for DVT

1. Active cancer (treatment within last 6 months or palliative) -- 1 point
2. Calf swelling >3 cm compared to other calf (measured 10 cm below tibial tuberosity) -- 1 point
3. Collateral superficial veins (non-varicose) -- 1 point
4. Pitting edema (confined to symptomatic leg) -- 1 point
5. Swelling of entire leg - 1 point
6. Localized pain along distribution of deep venous system—1 point
7. Paralysis, paresis, or recent cast immobilization of lower extremities—1 point
8. Recently bedridden > 3 days, or major surgery requiring regional or general anesthetic in past 4 weeks—1 point
9. Previous documented DVT-1 point.
10. Alternative diagnosis at least as likely—Subtract 2 points

4. Heart failure- diagnosis and treament.

5. Cellulitis- criteria for IV abx.

6. Must carry spare pens on person. Had emergency of no pens with a consultant. Im so blond.

7. Must make a point to drink water and have a biccie after each long clerking. If i didn't wish i was dead so much i'd wish i was a robot. Being human is tres difficile.

Someday, i will be intelligent and self-assured and then, everything will be better. Day 2 oncall

Ward cover was awful. I wanted to cry. I actually had a proper mope when i got home. And then had a mini emotional/mental breakdown in my kitchen, binged on undercooked pies and brussel sprouts. Slept on my sofa and pissed of my housemates.

Lessons from today:

1. Be faster and more through.

2. Start planning work early.

3. Do not get distracted. Nurses must be handled. Use the DR power. Do not pander to anyone. No one.

4. The 6 Ps of ischaemis: pallor, pulselessness, perishing cold, parathesia, pain and paralysis. Ischaemic foot on my watch, yo. At least i spotted it. Remember risk factors: AF, coagulopathy.

5. If an ABG is venous, say it. Or else ITU will scream down the phone at you.

6. Follow your gut instincts. If you think someone is a CO2 retainer, he probably is. Don't wait for repeat ABG. Just watch out for a flap.

7. Use your brain. And more chocolate bars for oncalls. Especially weekends. And water bottles.

8. Work on ECG skills.

9. THINK, THINK, THINK!!!

"A trainee Dr is like a light bulb - not measured by how bright they are but by how much they can illuminate everyone that surrounds them."

If only, if only.

A smile at work today!

It doesn't follow the theme, but this might be seem familiar to those who know me well. Down to the facial expression and posturing. Im such a squidward.

I dont want to believe it!

I hate when astrology readings tell me things i don't like. Tell me lies, tell me sweet little lies.

I hate it when i hear things like:

Ruler of 6th house in 4th:

You feel secure when you are working, for it fills your emotional need to serve and be needed.  Your most fulfilling task is to stay "home". Mundanely, you love to be involved in domestic projects, and put your greatest energy into your home and family.

Mundanely......mundanely! Me, mundanely domestic goddess?! Wah, must get someone to pray and change my fate.....

Day one oncall

I think i get to caught up in my own misery to be a doctor. Too introspective, to self-involved.

I hate saying that i'm a doctor. Because i feel like a faker- i dont actually know what im doing.

Need to stop wallowing in my own my misery and expending neurons of being depressed and instead, use my brain THINK.

I just need to apply myself.

Lessons from today:

1. Better systems review!!

2. Bring pen torch- and do proper cranial nerves!!! Dont forget visual fields, sensory inattention and cranial nerve 12. Really liez!

3. Chloprodiaproxide 10 mg PO QDS +PRN for DTs! And pabrinex is I +II OD (IV!!)

4. Headaches- types and sorts!!

5. Symptoms of salicylate and paracetamol OD.

6. Happiness is something i need to find in myself.

Quote

From an earlier blog entry:

"I wonder when you're gonna get tired of it. I wonder how bad it's gonna feel when you do. "

I've not seen my flirt buddy in weeks. It's like there's no fate, no red strings. Coincidence or chance not being kind to me or God just telling me, 'patience, child'.

Bukan sedih, tetapi bosan. A more bereft sort of bosan, like a little bit of my daily joy is missing. It doesn't feel as bad as it makes my life dull. I also kinda miss glowing.

*switch to gossip mode*

apparently said boyo was seen making his way outta the nearby woods with a girl. I know her, and this is entirely possible to be valid gossip. She also wanders the hospital with him. Hmmmmmm....

Can i make a quick mention of Dr Barbie? All intelligent blonde blue eyed girls would wanna be her. Hell, i can't compete. I raised my arms in defeat to long blonde hair, perfect legs and mile long lashes. She be bangin' but not my type. I think i definately look for personality in my women.

Delusions of grandeur / self importance

I am starting to see think my patients (who would be doing fairly ok) tend to die the day after i go out drinking.

My God is not a vengeful God.

that was my first thought after the initial statement crossed my mind. and the fact i think God would sacrifice another human being to warn me of the errors of my ways is very delusional. i must be so full of myself to think God would pay me that much attention.

God is merciful and kind.

Really. there is always much to be thankful for.

i start on calls tomorrow. im so scared that God won't be on my side that i won't even have a cigarette.

God is merciful and kind.

Hmmm... these are some sweet melons

The art of buying melons:

1. Smell them- they've gotta smell sweet.

2. Percuss: it's B-flat.

3. It's gotta feel dense- nice and heavy like.


My friend's mom once told us, "all young people are beautiful".

As i was putting on my warpaint this morning i realized i am one of those girls who wear make-up everyday.

Thanks to certain things said and my hair sorting itself out im beginning to believe that i could be beautiful (with a little bit of help).

Nov 18 is......Have sex with a guy with a moustache day.

You don't say

From urban dictionary

Muppet

1.  A person who defies explanation with regard to common sense and logic, exhubing an air of confidence that is mutually exclusive to that of their accomplishments or ability

2.  General name given to a large cast of bizarre comedy puppets created by the late Jim Henson. While many performed on "The Muppet Show" (and numerous movies and spin-offs) others appeared on the children's television series "Sesame Street."

3.Noun: See entry- Idiot.
"I don't care who you use, as long as they aren't complete muppets." Harry the Hatchet in Lock, Stock, and Two Smoking Barrels, 1998

I had my dresses and my Kocani Orkestar CD sent to my old house. 
I'm having a Bruce Banner moment.


OK, it's over. Now i just have to go pick up stuff.

Caroline you're angry cos you sleep like a spinster and you're 28

You've been thinking late, you couldn't catch a cold

-raincoat song, decemberists-

I hope i dont catch a cold. Just wanna catch a man to keep the bed warm.

Im tired and i have hip pain and i should quit jogging and stop taking pills that give me the runs and tummy cramps but this girl is kinda dedicated.

I like my routines, but i like it just a wee bit more than i like not being in pain and having a happy tummy.

My dresses aren't here yet, im still so fat and ugly and it's fucking cold outside.

If i sleep i should sleep forever.

Dream

I dreamt i was accepted to an exclusive scholarship program with a dozen people i know.

On the second day of the program, the coordinator comes up to me and says, 'your application for this program is contested and is in the process of being rejected'

I took that decision well, in my dream.

I fell asleep after my run in the fog and cold last night. I was hungry but sleep won- my snack was left on the table. I have recurring visions when i go on these jogs of big iron nails being hammered into the back of my neck, my temples and shoulders. Like how you kill a pontianak.

That and a slightly scary demi-wish that i get hit by a car and get killed instantly. But i still look before i cross.

I wake scared this morning of the coming day.

I will embrace happiness.

Tomorrow.

Now i'll go jog.

"Zeus did not want man to throw his life away, no matter how much the other evils might torment him, but rather to go on letting himself be tormented anew. To that end, he gives man hope. In truth, it is the most evil of evils because it prolongs man's torment."

Human, All Too Human;  Friedrich Nietzsche

This is my escapism

My love for Interpol has grown slowly- an initial curiousity pushed by friends, a missed concert and lots of listens later i can say im a bit if a fan.

I listen to Interpol to cheer up- a friend said this is ironic seeing the content/lyrics of their songs. I've now got Narc on loop. I loved the sound of it, didn't realize it was about sex. Im not sure exactly what the story is; but the opening chords are magic. The ending lines- 'You should be in my space, you should be in my life, you could be in my space' sung in Paul Bank's perfect hopeful/desperate/pleading manner is just what i want say (but will never be able to. Im giving up on hoping)

But this post is about sharing. And how i dont care for it when it comes to the people i love. I use love loosely here- as clearly Romance has left me out of her list for another quater.

Im possesive, slightly obsessive and prone to crazy jealousy (i might not make it apparent, but i am). Im better now, but maybe it's because no one has been mine in a long-long time. I've taken to being a bleeding heart, thinking if i just keep loving, giving they'll love me back just as much, or more. It doesn't work and i just keep going because i want to be a matyr. And this is why i self-destruct and rebuild everytime just to start all over again.

It was nice; sitting in your car parked outside my house, listening to songs i knew but couldn't remember.

This is from postsecret this week. It reminded me about what your friend said.

For she was not as ordered as people thought, but she did have her own desperate method for appearing to do so; she hid the disorder.

-Love in the Time of Cholera, Gabriel Garcia Marquez-

Because if i dont laugh, i'll just cry.

This is for my medics.

I have a presentation to the consultants in hours and i am looking forward to a sleepless night of bronchiectasis.
The Decemberist's Sleepless plays on the computer:

Hand it over (hand it over)
Hand it over (oh)
You're weary, lay him down
You did your time so thank you very much
Hand it over (hand it over)
Hand it over (oh)
So now your hopes are all laid
But you hand it all away

It's funny cos that's what they tell me to do all the time at work- hand patients over and go home. I still only go home at 7. Im slow, that's why. The others complain cos they don't have work. 

I want my flirt buddy back. Work's no fun with no flirt.


Oh and did i tell you my keys fell into the gutter during my run today? Of all the places my keys had to jump out of my pocket, at just that spot on the road and had to fall between the bars.....

Im still shit scared of living. I jumped at my own shadow today. 

Here’s the truth

I have no clue what I’m doing in my life.
Im so scared of tomorrow, of deadlines, of bosses, of angry patients, of everyone I’ve failed.

I don’t want to face my failures.

Im don’t know how to deal with loss. I just block it off into a part of me I don’t look into often. I’m a robot- I don’t feel, I don’t think- I just do. My uncle just passed away Monday- I went out shopping. I should’ve sat and prayed. I haven’t prayed properly in awhile. I haven’t even truly accepted that Dadi is gone.

Im still expecting to see her when I go home next week. I want her to tell me again to always pray, give money to charity and comb my hair. It struck me today that there are only 2 people left in the world who still call me “Gebot”.

I still hurts that I am no use to my family. I don’t know what exactly I’ll do to make things better if I was there, but I assume there is some merit in being physically there- even if it is just to get in the way.

Im continually sad, ever-angry at myself for failing to be good enough.

I’m losing my friends, im losing my intelligence, any ability for coherent thought.

There’s this quote by Marianne Williamson:

“Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that frightens us most. We ask ourselves, 'Who am I to be brilliant, gorgeous, talented, and famous?' Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that people won't feel insecure around you. We were born to make manifest the glory of God that is within us. It's not just in some of us; it's in all of us. And when we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.”

I try, and try, and fail. I’m so scared to try. Im so scared to disappoint more people, to make trouble for others. I feel my existence is an imposition to the happiness/functioning of those around me.

I want to be good, I wanna be great. I want so much. But I know I cannot have it. So why even try?

I hate that I continually whinge about my own misery- Im so self-absorbed it’s boring.

I continually apologize for everything: for being boring, for being whiny, for being alive. I even apologize for wanting to be great- who am i to even dream of greatness?