Losing the will (II)

So, my scrubs are covered in vomit - fine. I can just about cope with that.

1 hour later, I am walking down the corridor holding my mid-shift snack. There's a cleaner doing some mopping and she accidentally slips her mop across my path and I trip over it and land on my knees...

...in a puddle of urine.

Hooray.

Sick down my scrub top.

Urine trickling down my trouser leg.

And to top it all off, I've dropped my Kit-Kat on the floor.

This makes me very, very unhappy.

Losing the will

It's 5:30am.

I was doing very well - feeling very energetic, very keen, there was one more patient left to see and none waiting.

It was all going so well, until I managed to lean into a puddle of vomit that had collected on the rails of my patient's bed. So now my scrubs are covered in somebody's sick. And there aren't any spare scrubs so I'm going to have to walk about with vomit stained scrubs for another 4 hours.

This makes me very unhappy.

Better through daisy

betterthroughdaisy, originally uploaded by Sunshine follows me.

So it's a quiet night in the department, and I while away the hours surfing the internet. Stumbled across this site with some really cool nature-inspired jewellery!

I really love the way that Colleen (the designer) makes fantastic pieces of 'wearable art' from shards of porcelain. The whole idea of creating something new and beautiful out of something broken really appeals to me.

Training my patients (II)

Another trying encounter with the SSP.

It's 3:30am. I've sewn up a forehead and an elbow, given a wheezy baby some steroids and bound up a broken leg. Mrs C walks in. This is a clue - anyone who can walk into the A&E department really isn't terribly sick.

TSCD: So, what brings you here today?
Mrs C: My throat has been really sore for 2 days. I have a fever.
TSCD: (Is this an emergency?) Did you try any painkillers for that?
Mrs C: No.
TSCD: I see. Why not?
Mrs C: I was saving them.
TSCD: Saving them?
Mrs C: Yes. I was saving the painkillers for when I really need them.
TSCD: And you didn't feel you needed them now?
Mrs C: No.
TSCD: But you decided to come into hospital because of the pain.
Mrs C: Yes.

(long pause for effect, as TSCD realises she is dealing with the SSP.)

TSCD: I see. Now, I need to look at your throat, so open your mouth and say 'Ah'.
SSP: (parts lips) Oooo.
TSCD: Say 'Ah' please. AHHHH...
SSP: (teeth clenched) Ooooo.
TSCD: I can't see down your throat unless you open your mouth. Open your mouth please. Open it, please. (taps tongue depressor on SSP's teeth) OPEN!!! That's right, now say AH. AHHH.
SSP: (Opens teeth slightly) Ooooeerrrr.

(TSCD realises that drastic measures are required and shoves tongue depressor right into the mouth so that patient sticks tongue out and gags.)

SSP:AAARGHH!! (flails arms wildly)
TSCD: (ignoring protests) Good good, well done. No pus down there, tonsils not swollen, just a little inflamed. Take some soluble paracetamol, gargle it and swallow. It'll help with the pain and bring down your temperature.
SSP: No.
TSCD: No?
SSP: I don't know how to gargle.
TSCD: Okay. You can just drink it - sip it and swallow.
SSP: Can't I rinse my mouth with it and spit it out?
TSCD: No. It's not your mouth that is sore, it's your throat. You need to drink it to make it work.
SSP: But I can't gargle. I don't know how.
TSCD: That's okay, just sip it slowly and swallow. (realises maybe SSP doesn't know how to sip, either) Err...you know sipping, right?
SSP: Yeah, drink it slowly. Why can't I spit it out?
TSCD: Well, it would be better for you if you swallowed it.
SSP: Why?
TSCD: Because it would take away the pain and you wouldn't have a sore throat.

(a long pause whilst the SSP processes the information)

SSP: This is a waste of time. I could have done this at home.
TSCD: (smiles at SSP) Yes. You are absolutely right.

The importance of being earnest...

...with the nursing staff.

There is a longstanding rift between doctors and nurses. The hierachy of medicine is such that doctors and nurses work together, with the nurses ever the subordinates, carrying out the doctors orders and subject to the menial (and oftentimes unpleasant) task of care-giving.

I often find that the nurses are more experienced than myself, and I value their opinions and observations. After all, some nurses have been working at their job longer than I've been alive - and even the younger, more inexperienced ones would have had more contact with the patient than I.

Never underestimate the observations of a nurse. They really get to know their patients in very great detail - after all, they are involved in much of the intimate details of a patient's life (it's hard not to get to know somebody if you have to bathe and dress them everyday). I try always to take their opinions into account - and when they do raise false alarms (eg. "Doctor, the patient is lethargic!" because the patient is sleeping), I take them with me to see the patient so that we can both agree that there is nothing to be worried about.

Occasionally, there can be the senior nurse who tries to throw her weight around, testing the boundaries of her control over junior doctors such as myself. When this happens, I have to remind myself that a poor doctor-nurse relationship can only make things bad for the patient - so I have to be firm yet sensitive. It doesn't always work, and I do get yelled at by irate nurses when I refuse to do their bidding, but I am proud to report that I have never lost my temper...and sometimes I have even been able to win over their respect.

It is really hard sometimes to maintain professional courtesy and not yell. Especially if something has been done incorrectly or missed out by a nurse, which has led to substandard patient care.

Sadly enough, I have seen some doctors being excruciatingly rude to the nurses. I cringe when I see it happen. Nurses have the power to make a doctor's working life very, very miserable. They talk to each other during their breaks and gossip about doctors and share stories. A doctor who has been needlessly mean to a nurse can develop a poor reputation throughout the hospital in no time...and suddenly, all the hospital staff become very unhelpful.

I like being nice to my nurses. It's rewarding. I like it when they actually go out of their way to help - it makes my job so much easier, more pleasant and I can be more efficient.

Plus, it's nice to hear them say 'Oh, doctor, you look tired. Why don't you sit down? Can I make you a cup of tea? Would you like a biscuit?'.

The morning (afternoon? evening?) after

So it's 7pm and I have managed to grab about 6 hours sleep today. It wasn't a bad night, but I had to come in early because one of the other doctors was so ill that she was forced to go home halfway through her shift.

I was doing perfectly okay until I looked at the clock at around 1 am and realised that I would have another 8 hours more to go. You would think that only really really ill people would be unwell enough to come into hospital during the wee hours of the morning, but I still had to deal with my share of patients with constipation, tension headache and muscle sprains.

But we did have a few really serious cases come in.

Last night, I had to watch helplessly as an 80 year old man had a stroke in front of me. There wasn't alot I could do to stop it from happening - when patients start to go bad, they go bad very quickly.

One minute he was talking to me, and the next minute he was mute and looking at his wife with terrified eyes, trying desperately to keep a hold of her hands in his ever-weakening grip...then he was slipping away, away and I was screaming into his ear and pinching his fingernails to get him to respond to pain.

It was all I could do to keep calm, get one nurse to call the senior team members and put out a 'code blue' call, another one to grab oxygen masks and ECG machines and get him transferred to the Resuscitation area (for serious cases - not always for CPR). All the time, I'm telling his wife and son to talk to him, talk to him, try to get him to hear you. It's weird, but I could hear at least 3 voices all talking at once, and all the voices seemed to be coming from myself but from a great distance.

He was dying, and I watched. I watched and I remembered once again that, in the end, the length of a life is not determined by my skill as a physician, but by God.

"See now that I myself am He! There is no god besides me. I put to death and I bring to life, I have wounded and I will heal, and no-one can deliver out of my hand." Deuteronomy 32:39

An hour later, I watched as they wheeled him up to the ward so that he could die quietly and in the company of his family.

The rest of the night passed by uneventfully, but when I got into bed in the morning, I still went over and over all the details of that case in my mind trying to see if there was anything more I could have done...which is probably why I slept fitfully, and why I'm now crouching in front of my computer - bleary eyed and clutching a glass of paracetamol dissolved in orange juice.

I go back to work in 4 hours.

Staying up

Evenings in, originally uploaded by Sunshine follows me.

I'm starting a week of overnight shifts, and the first thing I want to do is start to adjust my body clock by staying up late.

So...last night, MDH and I made up some uber-foot-long-sandwiches, and then we settled in front of the TV to enjoy our latest purchase.

Hooray for the Lord of the Rings Extended Version DVDs with hours and hours of extra behind-the-scenes documentries!

We've been wanting to get the films for ages but decided to wait until the set was going really cheap before buying...I think we must have saved about £40 so it is definitely worth waiting for.

MDH and I are going to watch the films in one hour instalments over the next few days (weeks?). We'll have to pace ourselves otherwise we might suffer from a surfeit of Tolkein and then go into Obsessive Fan Mode (very bad thing because then we'll fight over who gets to reread the books first).

MDH is not so interested in the commentaries and learning about how the film was created, so I ended up watching that by myself into the wee hours of the morning (MDH had to be up early today anyway).

So now it's noontime and I'm sleepy - which is good because now I can have a long enough nap this afternoon to keep my resources up throughout the night.

Hopefully.

Initiated!

I was standing at the nursing station, coding my notes and chatting to one of the senior nurses.

Senior nurses in A&E are almost always the ones wearing the most number of decorative pins on their uniforms. The one I was talking to was no exception - she had 4 intricately patterned nursing qualification pins, 2 colourful name badges, and 4 or 5 cartoony pins 'for the kids'.

She must have noticed me admiring her shiny collection, because she took one of the badges off and pinned it to my scrubs. "Keep it," she said, "I've been looking for someone to give it to for ages."

A&E badge
Originally uploaded by Sunshine follows me.

It's a rather tacky looking thing, nothing which I would have chosen myself - a dishevelled looking rabbit wearing a green singlet with 'A/E' emblazoned on it. But I feel as though she's given me a medal.

You see, this means that the nurses and I actually share a good working relationship, and I'm now considered a part of the team.

Excellent.

Summer rain

I start a week of night shifts soon, so the Boss Lady has given me two days off to 'prepare' myself for the long haul.

It has been Raining all day.

Raining!

Now, I love rain and I love thunderstorms. I love the heavy rain thats fall thickly like from the sky, drenching the trees, flowing down my windowpane in rivulets and turning the roads into glittering black streams. Sometimes, I would put down my umbrella for a few seconds, and lift my face to the sky, so that I could watch the raindrops as they fly towards the earth, like so many glittering pearls, landing in great splashes on my forehead and cheeks. And afterwards, there is a wonderful smell in the air - a sharp, clean, crisply green, sparkling blue smell.

Drizzling, however, is something I cannot abide. Especially the pathetic London Drizzle - not strong enough to warrant an umbrella, but penetrating enough to chill. Worst of all, when the drizzle dries off, it leaves a faintly greasy, sticky film on the skin. It does nothing to clear away the city grime - in fact, it makes it look all the more worse for wear; clumps of mud bubbling on the pavement, being spread all around the city by yuppie footwear.

In my entire time in the UK, I haven't ever experienced the type of Rain that we get in Singapore, where the stormclouds roar across the sky and the trees flail their branches wildly in protest.

But it's Raining today.

And there that wonderful green and blue smell in the air.

Why me?!

3 patients come in - one elderly lady with a broken hip, one young child with appendicitis, and one young man who has cut himself 20 times with a broken piece of glass 'for fun'.

I get to see the young man. He glares at me as I clean and suture his cuts. I want to refer him to the psychiatry team for assessment but he runs out of the department after I close his last cut. I have to call the police to ask them to find him.

3 more patients come in - a middle aged gentleman with chest pain, an old man with urinary retention and an elderly lady dragged in by the policemen who was drunk in the park.

I get to see the elderly lady. She is offended by the policemen's presence and as I turn around to check the readings of her ECG (heart tracing) on the monitors, she leaps to the floor and proceeds to bang her head repeatedly on the floor, knocking herself unconscious.

2 more patients come in. Teenage boy with a collapsed lung and middle aged man with severe abdominal pain.

I get to see the middle aged man. He is rigid and pale and terribly sick with his abdominal pain. I put an intravenous cannula into him and take some bloods off, prescribe him some morphine for his pain. I go off to get hold of the surgical team. When I return, my patient has disappeared. He gets brought back in 6 hours later. He used the IV access that I put into his arm as a line through which he gave himself an overdose of heroin.

As the last few patients trickle in, (and I finished dealing with Mr 'I have Pain All Over', Miss 'I fell over 5 years ago and now I have a pain in my foot' and Mrs 'I have had diarrhoea for 50 years') I go to the chief nurse who has been divvying out the patients to the doctors.

'Why are you giving me all the toughies?', I demand, 'It's driving me crazy!'

'Because I saw the way you dealt with the young lad with the cuts and thought you were really patient,' she says, smiling sweetly at me.

Ooh, I was this close to wringing her neck.

I am a doctor...

Not a...

1.Waitress. You will address me as 'Doctor'. My name is not 'You There' or 'Girl'. You do not attract my attention by snapping your fingers and shouting 'Can we get some service around here?'.

2.Chauffeur. I will not give you a lift home in my car, especially not whilst I am still at work. The ambulance service is not a taxi service either; please call a cab.

3.Washerwoman. If you vomit on your own clothes, I will help you remove them, but I will not help you launder them. I don't care if it's Versace, go and pay for your own drycleaning. Meanwhile, stop trying to puke on my scrubs.

4.Cabaret girl. Get off me, man, can't you see I'm trying to work? Go do the cha-cha in the corner with your dripstand instead. No, I will not join you in a rousing rendition of 'There was a young lady from Burma', stop that now, you keep your hands to yourself, mister and quit trying to grab Staff Nurse Gina's bum.

5.Mechanic. Mr Motorcyclist, I'm here to fix you, not your 'speedy wheelie chick magnet'. Stop asking me if your Harley will be as good as new. Yes, I'm sure your machine was 'da bomb'. It has definitely blown you to pieces.

Filtered light

New leaves
Originally uploaded by Sunshine follows me.

Trees are good. They keep the air purified, dampen out the sounds of traffic, cast a cool shade. I think they even somehow filter the light to make it clearer, fresher.

There are trees everywhere in Singapore, which is an excellent piece of urban planning. Those trees probably why Singapore doesn't smell as sickly stale or look as dusty as London.

I took this photo of new maple leaves in the early spring at my old place. The trees there were slim saplings still, shivering in the cool spring breeze.

There's a staid oak tree standing in front of our new apartment, and that makes me glad. Trees are a sign of home.

I couldn't live in a place without my woody friends.

When you say nothing

Another problem with working the twilight shift is that MDH and I don't get to see each other much.

I get home at 2:30am and MDH is already tucked up in bed. When I wake up in the morning, he's already left for work. When he gets home at night, I've already left for work. Ships passing in the night and all that.

I've actually gone 7 days without talking to him this week.

I guess this is when we learn to communicate without speaking.

Before I leave for work, I make his dinner and leave it on the stove so he can heat it up when he gets home, exhausted from a day's worth of tedium. This actually means 'I love you'.

When I wake up in the morning, still groggy from lack of sleep, I find that he's done all the washing up and taken out the trash. This also means 'I love you'.

He puts away his ties and refills the waterjug with filtered water. I file away our correspondance and vacuum the carpets.

A plateful of chocolate chip cookies, a freshly laundered shirt, a pine-scented kitchen, a fluffed up pillow...this is how we talk. And I am learning how to listen.

Give me a break

I finally get a break after a week's worth of twilight shifts. My annual leave are fixed by my rota (weekends not on shift count as annual leave too) - I d0n't get to choose when I get time off. The Powers That Be have built in days off into the shift rota so that we get enough rest in between shifts.

I've had rather a hard week - the twilight shift is usually one of the busiest (everyone comes into A&E after work), so I've been really looking forward to this day off.

I was really planning to do quite alot today - go grocery shopping, sort out some of the household utilities, reorganise the 2nd bedroom, update my CV...but I just woke up feeling so exhausted. I've hardly managed to accomplish anything on my to do list.

So let's see...I've been working the 6pm to 2am shift this week. That's 8 hours work, and I take a 10-15 minute break after 4 hours so I can get something to eat. I finally get to bed at around 3am. I try to sleep until 8am, and then take a catnap at about 4pm before work. So for the last 4 days I've been getting roughly 6 hours sleep.

Now a body needs a minimum of 5 hours sleep a day in order to maintain optimum function, and then it will make up the rest of the requirements by 'microsleeping' (that's when you doze off for a few seconds - I do that alot when I'm sitting in lectures). In my profession, I'm on my feet all the time so I can't actually microsleep - 15 minutes is not long enough for my body to become relaxed/bored enough.

I know that I normally need about 8 hours sleep in order to feel completely refreshed.

So I'm missing out 2 hours a day...that means I'm now 8 hours behind.

No wonder I feel so rough. I'm a day's worth of sleep short. And I'm working this weekend, so I need to catch up on my lost hours or I won't be able to concentrate when my patient talks to me.

I don't think sleeping time should be considered 'Time Off'!!

Baby, you can turn me on

BROADBAND!!!!!!!

WOOHOOOOOO!!!!!!

*prances around*

Feeling disconnected

I finally get my Broadband switched on tomorrow. Hooray!

I can hardly wait. I feel so out-of-touch.

Internet is my one connection with the rest of the world. MDH and I own a TV but we only use it for Playstation 2 and DVDs - we're not home long enough to justify paying for satellite/terrestrial television.

Besides, there is never anything good on the telly nowadays - it's full of skanky talkshows and soft porn reality programmes. It's pointless for us to pay for the TV connection in order to watch the 10pm news and catch the odd decent movie or sitcom.

We don't do newspapers either - everything we want to read in the news can be read on the BBC websites. Or Channel News Asia website. Or Tomorrow.Sg.

A couple more hours and I can be back to surfing the net.

Is this an emergency?

Please, people.
Before coming to the Accident and Emergency department, first ask yourself if your problem is:

(a) an Accident? (ie. happened in the last hour, day or week)

or

(b) an Emergency? (ie. you will die or be maimed if nothing is done now now now NOW)

Take these patients for example.

Patient 1:

19 year old girl. Ate nothing all day. Drank 8 cups of expresso. Felt immediately dizzy and had palpitations. Came to A&E and lay down for a while. Felt better. Went home.

Patient 2:

28 year old gentleman. With knee pain. For 9 years. Can still play run, climb and play football. Did not use any painkillers. Gave him paracetamol. Pain went away. Went home. Next time try some pain killers before you come ino hospital complaining of pain, Sparky!!

Patient 3:

48 year old lady. With diarrhoea. 4 days ago. No diarrhoea now. Wants to know why diarrhoea has stopped. Diarrhoea has stopped because now you are better. Went home.

Are any of these cases accidents or emergencies?! NO!!! So...why come to hospital? Hospitals are not nice places to be, trust me, I work here. Stay at home! You will feel alot happier that way, the food is better plus you can watch as much TV as you want!!!

*grumblemumble*

I'm just grumpy because it's 1:30am and I'm hungry.

Out, damned spot!

Melon!
Originally uploaded by Sunshine follows me.

MDH and I were sitting down enjoying this sweet rock melon yesterday, when I noticed that the skin on our hands looked really sore and chapped.

One of the mainstays of infection control is the prevention of spread of germs from patient to patient. We bleach and clean the floors and beds and cupboards, practically boil all the bedclothes in the laundry, and still it is common to find that one patient's bacteria still spreads to the rest of the ward.

The main culprits who are responsible for this heinous crime of spreading infection around are actually doctors and nurses. We handle and examine one patient and then wander around the rest of the ward touching things (and other people). Disgusting, isn't it?

Hence, handwashing is the number one method of limited the spread of infection. After any physical contact with a patient, I wash my hands thoroughly with soap and warm water.

In fact, I wash my hands so many times during the day, that occasionally after shaking hands with my friends outside work, I sometimes feel the urge to go and wash my hands. I have to stop myself from doing that, otherwise I could turn into Lady Macbeth.

The supervising doc (who is reading this over my shoulder - it's a quiet day in A&E okay?) tells me that the A&E is the only place where the men wash their hands before going to the toilet.

The problem with washing our hands with this generic handwash (no moisturising Lux soap here, girls) is that our skin gets really dry and cracked. And the open cracks in our skins are prime places for bacteria to settle.

So it's very important that MDH and I indulge ourselves with good handcream.

I've just discovered this wonderful handcream from LUSH, called 'Helping Hands'. I want to say that I purchased it for it's wonderful smell of soothing chamomile and lavender, nourishing linseed oil and honey, softening almond oil and shea butter...but really, I bought it because I liked the name (packaging is everything!!).

The product really is fantastic, and every bit worth the price I paid for it. I used it overnight and this morning, my hands weren't as sore and chapped as they normally are. They are all smooth and soft - and one of the nurses commented today how soft my hands felt (she was trying to drag me away from my patient to go and eat some lunch).

I can't wait to go home today and put some more handcream on!

Sup-sup-suppertime

Shepherd's pie
Originally uploaded by Sunshine follows me.

Sometimes, after a hard day at work, I like to work off my frustrations in the kitchen.

Cooking is so satisfying. I get to wield sharp implements and hack things into tiny little pieces. I pound on slabs of meat with a minature sledgehammer, I slice and dice onions, I mash potatoes with maniacal glee. And at the end of all the hard work, I get to sit down and enjoy the results.

This method of kitchen therapy originated from my 'A' Level Biology Teacher. She used to listen to our pathetic attempts at describing the physiology of kidneys, glare at us and say, "I will think of you all when I'm carving tonight's chicken with a meat cleaver. Chop! Chop! Chop!"

Today, I made this lovely Shepherd's pie - juicy lamb mince slowly stewed in a tomato based gravy with carrots and onions, topped with mashed potatoes and melted cheese, green peas on the side. I decided to use red leicester cheese for the topping - thought it would give it a nicer colour and flavour.

It looked beautiful when I pulled it out of the oven, bubbling gently, filling the kitchen with a lovely meaty fragrance. As MDH and I sat down and ate it together, I felt warm and happy - and at home.

You know it's going to be a long day when...

...your first patient greets you with "Get out of my house!".

It's amazing how the body becomes less tolerant to infection as one gets older. A perfectly well elderly person can become completely loony with a simple chest infection or urinary tract infection. They won't be able to walk steadily, they'll suddenly become incredibly confused or incontinent. Sometimes, they can even become violent.

I have a staff nurse sitting in the corner quietly applying ice to a huge swelling on her forearm - our elderly lady clamped onto her with her toothless gums for about 5 minutes becfore we could pull her off.

Sometimes their personality changes so much that they can't recognise their own family members (which can be more distressing to the family than to the patient).

It's all temporary, however. Once the underlying infection is treated, the patient returns to normal, and it's amazing how quickly they recover after that.

Meanwhile, the elderly ill patients are highly distressed - people seem to be invading their home, stabbing them with needles, asking them questions. They scream and scream to get the strangers to leave, but instead the strangers come and yell in their ear, telling them to relax. How can they relax when thieves are in the house, hurting them?

Their bed has grown bars and become a jail; they cannot seem to escape from it to get to the toilet (where has the toilet gone, anyway?); they wet their beds with great embarassment. Someone comes along and pushes their bed from one end of the room to another, into a cold room where they have pictures taken of their nakedness. The walls of their house have taken on garishly bright colours, and appear to be moving, sliding back and forth on rails.

It's no wonder elderly patients become violent. It's self-defence.

Hip-Hip-Hooray, It's our National Day

National Day has always been a big deal for me. Every year, we'd watch the National Day Parade, singing along with the songs and waving the little plastic flag. I never missed a single National Day Parade until I left Singapore for university. I'd watch the parade with my mates, laughing at the propaganda.

Even then, us overseas students tried to celebrate it in my own way.

The Singaporeans in my university would get together, throw a barbeque or steamboat party, and then huddle together in the autumnal cold, laughing and talking about the things we had in common - school assemblies and flag raising ceremonies, favourite hawker foods, moral education classes. The boys, of course, would tell army stories until the girls complained. And then maybe we would have a little sing-along of all the National Day songs that we could remember - all learnt by heart during our formative years in primary school.

When I moved out of the dormitories and into Real Rented Property, I'd throw a party on the 9th of August and use it as an excuse to introduce my British chums to Singaporean Culture. I'd wear red and white and insist that everyone else try to follow suit to 'get into the spirit of things'. I'd pin up a plastic flag onto the door of my room, walk around humming patriotic tunes. I even got hold of a CD of National Day songs ('Muneru Valiba', 'Chan Mali Chan', 'We are Singapore' and other old favourites) and played it in the background. I'd tell all my friends about National Day propaganda and laugh.

The afternoon would be spent happily making Hainanese chicken rice, 'proper' fried noodles, pork dumplings and then torturing all my guests by making them eat using chopsticks. I taught them all to sing 'Stand Up For Singapore'. And I'd invite some of the Singaporean boys over so they could tell army stories to their hearts content.

Today, I'm working the evening shift, so there will be no National Day dinner. I wear green scrubs to work, and my plastic flag is far too battered and faded to hang up.

But I have spent the entire week singing patriotic tunes to my heart's content (and much to MSH's amusement). I still make fun of our National Day propaganda, but I sing our songs with gusto, nevertheless.

Happy 40th Birthday, Singapore. I miss you.

Long days

Today, the M-OL and I did some unpacking and cleaning of the new apartment. The place looks a bit more homely at the moment, now that I've got some pictures put up and scattered cushions and stuffed penguins around the place.

I discovered that the shower leaks and the washing machine leaks and that one of the pipes draining from the kitchen sink is clogged. Jobs for the MDH!

In the afternoon, M-OL and I wandered around the neighbourhood, found the local Sainsbury's (yay!) and the post office, enjoying the sunshine.

Had a nice hour long nap before nipping off to work (boo...). I'll be here until 2am.

It's quiet in the department tonight with a steady trickle of patients with minor complaints. I've seen about 5 sprained knees and ankles already (Rest, Ice, Painkillers and Elevation, people! Of course it's not going to get better if you carry on doing gymnastics!). I'm glad it's not completely deserted, otherwise I would get bored and sleepy...there's enough going on to keep me occupied.

Someone is announcing the arrival of a 'Code Blue'.

Time to run.

Worldly Wisdom

It's a bright and sunny Sunday afternoon.

People are walking in pairs outside, sitting on the stone steps and enjoying the breeze. Children are licking icecreams and dribbling it down their tee-shirts. Dogs are frolicking on the ends of leashes.

And I'm stuck indoors. Working. I've just seen 10 patients in 2 hours, which means that it is busy but not crazy.

On the bright side, I have learned much about common sense and worldly wisdom during my first two shifts in the Emegency Department...

1. Never try to adjust the blades of a lawn mower whilst it is still running. You will have to get your finger glued back together by a trembling ED doctor.

2. Never poke a German Shepherd in the eye with a pointy stick. You will get your eyebrow glued together by a trembling ED doctor.

3. Never try and break a china teacup with your bare feet. You will get pieces of precious heirloom removed from your heel by a trembling ED doctor holding a sharp pair of tweezers.

4. Never try and jump over a small brick wall whilst wearing stiletto heels. You will get your ankle wrapped up by a trembling ED doctor.

5. Never use a rubber band to maintain an erection. The trembling ED doctor will laugh at you. And you will be very, very, very embarrassed.

Young Upstarts

So, new town, new job.

I'm now sitting at the hospital computer in the education centre. We've been having 'Induction to Emergency Medicine', which I am very grateful for, because there's nothing worse than being thrown in the centre of the shop floor (as we like to call it) and being torn apart by the rabid patients.

The stress of the move has taken it's toll on my skin - a brand new crop of Emotional Pimples. A great start, I must say, turning up on my second day of work with a raspberry for a head.

At home, MDH and I are living out of a suitcase (the rest of our stuff will be moved over this coming weekend) and our fridge currently stocks milk, apples, ham, eggs and butter. We also have got some bread, potatoes, cereal and most importantly, chocolate chip cookies. Enough rations to last us until we figure out where all the supermarkets are.

I spent 1 hour yesterday trying to get our phone line connected and it's going to take 10 days before British Telecoms can connect up my broadband (wail of despair). I don't know how I'm going to survive.

It's in times like these that I really appreciate Singaporean efficiency.

There with my love

So moving day is finally here.

The house looks all empty and forlorn. Or maybe I'm just feeling that way.

The movers are transporting 6 years of my life out in brown boxes marked 'fragile'. I'm standing outside watching them and remembering again that I'm still a foreigner in this country that is not yet my home. There's a cold wind which smells like rain, and I can feel the stray drops on my cheek. The moisture collects, trickles by the side of my mouth and I stick my tongue out to catch it. It tastes salty and I'm suddenly glad that MDH is inside the house supervising because it would make him sad to see my face all wet.

There's no permanance in where I live at the moment, and I would dearly love to be able to throw all my empty boxes away when I finally unpack the last one. Instead, they will lie flattened and tucked into a cupboard, quietly reminding me that I am still drifting with all my flotsam and jetsam.

Then MDH comes out of the house and puts his arms around me, and I am once again reminded that 'there with my love, I'm home'.

PS. Broadband won't be turned on at the new place for a couple of days at least, so it will be a while before I can get online again (the horror!). I really hope my new workplace will allow me to get on the internet. I'm convinced I will suffer withdrawal symptoms. I feel shaky already.

PPS.It's time to go.