Caption: A popular medication in the Emergency Department at the moment.

Blacktown ED (Emergency Department) is a Level 2 Trauma Centre with 28 beds (18 acute, 10 sub-acute/suture/plaster rooms).

It is supposed to be a good rotation for interns, but this is negated by the current swine flu epidemic on top of the regular winter flu season. It seems that every second person in the department is coughing their lungs out, whether you're a patient, doctor, nurse, paramedic or the cleaner.

The wait time to be seen by a doctor is currently averaging about 5 hours if you're a category 3 patient (category 1 being the most critical and 5 being non-urgent), but at times it has exceeded 8 hours, during a day when there were more than 30+ waiting room patients still to be seen.

Thankfully some of the non-acute patients choose to leave rather than wait, but I am sometimes amazed by how many of them simply tough it out until their names are finally called.

My job as an intern involves picking up patients off the board, taking the history, doing an exam, sending off bloods/requesting imaging, and then discussing the patient's case with a senior member of the staff regarding their management.


Caption: A 23 year old trainee electrician who sustained a superficial laceration at work became my first ever patient I sutured outside the operating theatre.


Caption: 5 interrupted sutures with 4-0 nylon. The patient got sent home with some antibiotics and a Workcover certificate.

Many of my patients have been those with respiratory symptoms, but I've also had my fair share of abdominal pains, headaches, dizziness, nausea/vomiting which makes up the bulk of ED presentations. I even picked up my fist ever laceration last shift (see photos above).

The nature of the presentations in ED means that you're doing lots of GP-type work, but the difference is that you get your test results back quickly and make a diagnosis before sending the patient home or getting them admitted in hospital. Plus you're ready to provide life-saving resuscitation if your patient crashes.

Shifts are rostered so that one usually works 3 days in a row (10-hour shifts which may be day, evening or night shifts) followed by 2 days off. The lifestyle in ED is quite attractive, with no overtime or being on call. I'll have to see if I enjoy it enough at the end of the term to consider it as a career.

So that brings to an end my Westmead upper GI surgery rotation.

It was a term I got because I made sure of it, but I'd be lying if I said I didn't regret my choice.

The long hours and the subsequent fatigue and lack of sleep aside, it was feeling unappreciated and accountable for things beyond my control that made it hard.

However knowing all that I'd do this term again without hesitation.

I was involved in the pre- and post-operative management of patients undergoing all kinds of major abdominal surgery, and scrubbed in on several operations which I had only read about.

Working for and assisting operations for influential surgeons who I knew about from their interviews with the media was an exciting experience, but less so than seeing patients progressing from intubated and sedated in intensive care to well enough to walk out of hospital in a matter of weeks.

My next rotation is an ED (emergency department) term at Blacktown Hospital. I absolutely loved my emergency rotation as a med student, so I have high expectations of the next 10 weeks of my intern year.

At any given point in time, about half the patients admitted in upper GI surgery are cancer patients.

Of these less than half of them are operated on with curative intent, the rest receiving palliative surgery so that they can get a few more years of life.

Pancreatic cancers are most commonly seen in our unit, with the occasional oesophageal, liver, stomach, and small bowel cancers.

Most patients are in their 60s or older, but last week a young father was operated on. He is recovering well, but despite everyone hoping he lives to see his children grow up, his pre-op staging returned a prognosis which was far from encouraging.

A few years ago, a general surgical trainee told me that his preference was for colorectal rather than upper GI surgery, since you can't offer a cure to most upper GI cancer patients, compared to many patients with large bowel cancer living for decades after receiving curative resection.

Back then I didn't think much of it, but it's much more rewarding when I know I am treating a patient who will make it. But someone has to be there to treat patients who are not expected to do well, and I guess that's us at the moment.

My registrar told a patient who has had a bowel resection that his 'gut feeling' was that the patient would be ready for discharge early next week.

That made my day.


It's good to be simple sometimes.

Every now and then we send blood specimens to the lab and mark it as 'urgent' to prioritise them over other patients from other teams (and hence less important).

This is usually in the context of hypo/hyperkalaemia (too low/high serum potassium levels which can cause potentially serious changes in heart rhythm), because after correcting the abnormality we want to know that it has returned to normal.

Previously the laboratory staff would kindly page us and then tell us the potassium level within 1/2 hour, but lately it seemed that 'urgent' just doesn't cut it anymore, with long delays in processing specimens.

So my registrar has been asking me to write 'life-threatening - has ECG changes' on the forms instead.

This worked for a while, until today when it took more than 90 minutes and several phone calls to know that a patient's potassium had risen from 2.6 to 3.1mEq/L following replacement.

So that got us thinking what the logical step up from 'life-threatening with ECG changes' would be. We toyed with the idea of writing, 'patient currently in cardiac arrest'.

If that fails to work, then we'd be forced to write 'patient has now passed away, and his/her last wish was to have a potassium level done ASAP and the result phoned to the surgical intern'.

Caption: The stunning coastlines at The Royal National Park.


Caption: Taking in the harbour views with our drinks

Our family rarely get the opportunity to be at one place together, so when Dad touched down in Sydney for my graduation, we were determined to make the most of it.

It started with my graduation and then dinner at the Hilton on Friday night, and on Saturday our family walked 16km through the Royal National Park, NSW. Usually the Coastal Track is a 2-day hike from Bundeena to Otford, but we squeezed it into a day by walking about half-way and then walking back.

Today we drove to the city and visited Kirribili, Milson's Point, The Rocks and then Darling Harbour. Me and my sister bought Dad a belated birthday gift, and we enjoyed good food and drinks.

It all went by so quickly, as it always does when you're having a great time.

Dad flies back on Tuesday and my sis was able to take tomorrow off, so I hope they enjoy another great day together. For me it's back to reality, with another busy week on the surgical wards starting in about 8 hours from now.

I graduated today from the University of Sydney for a second time, this time being awarded a degree that actually got me a job.

Sydney Uni has a tradition of holding graduation ceremonies around mid-year. This sucks somewhat because rather than graduating when we're excited about finishing med school and ready to take on the world, we graduate when we've worked for several months as an intern and wondering why the heck we didn't do dentistry instead.

However the positives are getting a day off work to attend the graduation ceremony (which wasn't a guarantee in my surgical rotation but thankfully the team agreed that I should be allowed to go to my graduation), and being able to catch up with friends, who are doing internship in various hospitals around Sydney and NSW.

Both my parents flew in from Korea for the occasion, my mum having arrived a week ago and my dad this morning. We went out for a nice dinner, and have made plans for the weekend, starting with a hike through the Royal National Park tomorrow.

Many thanks to all of you who've supported me over the years. I've been truly blessed, and in return I will strive to be a great doctor to the best of my ability.

This morning I picked up this 3D-reconstructed CT angiogram for a patient who is under one of my bosses who happens to be a general/vascular surgeon.

So I think to myself wow.. how awesome is this - maybe I should consider a career in radiology if I don't 'cut it' in surgery.



And then I see this mountain of x-rays and CTs to be reported, apparently by one radiologist.

Okay, so that was an easy way to rule out a specialty for me.