Jesus, I my cross have taken

After 2 months of an unplanned hiatus from the church worship band, I was finally able to lead Sunday service singing again last week. I thoroughly enjoyed all the songs we sang, and sneakily recorded this gorgeous music that we ended the morning service with.

Jesus I my cross have taken

All to leave and follow you

Son of man despised forsaken

Lord of all I am or do

Perish every fond ambition

All I sought or hoped or known

Yet how rich is my condition

God and heaven are still my own

 

Let the world despise and leave me

They have left my saviour too

Human hearts and looks deceive me

You are not like them untrue

Then while you shall smile upon me

God of wisdom love and might

Foes may hate and friends disown me

Show your face and all is bright

 

Those who trouble and distress me

Drive me to your presence best

Life with bitter trials they press me

And will bring me sweeter rest

How can grief or sorrow harm me

While my heart still feels so loved

How can this world’s pleasures charm me

When you are my joy above

 

Go then earthly fame and treasure

Come disaster scorn and pain

In your service better pleasures

In your favour loss is gain

I have called you Abba father

I have stayed my heart on you

Storms may howl and clouds may gather

All has worked for good to me

 

Take my soul its full salvation

Conquer every sin and care

Find in every situation

Joy and peace and service there

Think what spirit dwells within you

What a father loves you yet

What a saviour died to win you

Child of heaven why should you fret

 

Onward then from grace to glory

Armed by faith and stirred by prayer

Heaven’s eternal days before me

God’s own hand shall guide us there

Soon shall close our earthly mission

Swiftly pass my pilgrim days

Hopes shall change to glad fruition

Faith to sight and prayer to praise

Jesus, help me pick up my cross daily to follow you. Lord, let me lose my life for your sake so that I may find life eternal in your presence. God, you are worthy. I love you.
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When hard work doesn’t pay off

I kissed my social life goodbye in the middle of August when I decided to sit the primary FRCA OSCE/Viva examination in October. I know I have only recently sat the MCQ examination and the knowledge should still be fresh in my mind, but the OSCE/Viva is a whole different ball game. Whilst I can identify if a given statement is true or false, and am able to pick out the best answer out of a choice of 5, I really struggle to articulate and explain my knowledge in succinct sentences for the oral examination. “Define and classify, or DIE!” is the anaesthetist’s motto, but I find that really hard. I knew that there was a lot of work to do and redo, and I had to put in my best effort for the best chance at passing these notoriously difficult exams.

Once I got myself into the rhythm of revision, it kind of took over my life for the last 2 months. I would start the day at work, making use of any break time between cases to revise. After I knock off, I would get home for a quick dinner and shower before settling down in my study to do another couple of hours of work before going to bed. The same cycle would be repeated the next day. Work-Study-Sleep-Work-Study-Sleep. After moving into the new flat, I did not have time to unpack everything properly before throwing myself into intense examination preparation. Some of my belongings are still in boxes, and aside from the study and the bedroom, I have hardly spent anytime anywhere else in the house at all. I did not go out for nice dinners or drinks with friends either. I never went out to the cinema. And come to think of it, I hardly did any shopping too, unless grocery shopping counts for anything at all. Upon waking up in the morning, my first thought was not “what shall I have for breakfast today?” or “what time is it?” Instead, I found myself trying to answer the question “What is the saturated vapour pressure of halothane?” in my sleepy, semi-conscious state.

My life in the last 8 months has been quite a blur to be honest. I do not have any recollection of many events that happened in the last half a year since I started preparing for my MCQ exam in March, sat the exam in June, and then started revision again in August. I know that this contradicts one of my previous posts about not letting work take over your life, but this was precisely one of the reasons that I was inspired to write that blog– I wrote it as a reminder to myself! Also, I wanted to pass in October, so that I can then spend the rest of the year free from exams and revision. I was willing to endure short-lived suffering if it means that I can enjoy the freedom that accompanies sweet success- freedom to just enjoy giving anaesthetics at work, freedom to come home and watch TV without restraint, freedom to just do whatever I want.

11 October 2012. The day of my OSCE/viva examination. It was a really long and extremely exhausting day. With butterflies in my stomach, shortness of breath, palpitations, and an anxiety-driven nausea, I went and sat the dreaded exams. I wished I had more time to do more revision before going to the “execution grounds,” but I also knew that I had gotten to a point in my revision when my little brain was so saturated and my body so exhausted that any more studying would have yielded little benefit. I just needed to get out there and show them what I’ve got. I prayed to God that the day would be a wonderful celebration of my knowledge.

So, my examination started out with the physiology and pharmacology vivas. I got asked about local anaesthetics (easy!), interpatient variability in response to drugs, and antianginal medications (!). I have to say that cardiovascular drugs are truly not my forte, but I calmly just told them everything that I knew. I spoke about nitrates, beta-blockers, and calcium channel blockers. The examiner then asked me about nicorandil (which I knew nothing about and was hoping to avoid), and so I told him the only thing I could remember about nicorandil– “it is a potassium channel activator.” And with that, I was saved by the bell and we moved on to physiology. The physiology questions started with me drawing the left ventricular pressure-time curve, an aortic pressure-time curve, and finally a superimposed ECG. These were not too bad. The examiner then asked a question that made my heart sink “tell me about the stress response to surgery”– it was a topic that I vividly remember going through whilst sat in Starbucks last year, but I had not had a chance to revise it again for this exam. I told him whatever I could remember, and the examiner then took my thoughts in all directions as I fumbled through my answers. The questions went on to fluid compartments, most of which was fine until he asked me to compare fluid distribution in a child vs adult, and what the mechanism was by which osmoreceptors in the hypothalamus detected a change in osmolality. My clinical viva was another heartsink topic: paediatrics. I have had such little exposure to paediatric anaesthesia thus far, and all that I could tell the examiner was what I have read from the books. He kept pushing me to tell him more, more, more, and I found it difficult to speak from my (lack of) experience when he kept asking me “what would you do in your daily practice?” The physics viva started with another tricky one “describe the anatomy of the different laryngoscopes.” We then went on to talk about cardiac output monitoring and had an in-depth discussion on decontamination (seriously, can you get a more obscure physics topic than that?!) I finished the day off with my OSCE. This was the exam that I had prepared the least for and was most prepared to fail. The 5 minute stations were just too short to accomplish the stipulated tasks and the questions asked were seriously hard. The examiner who was asking me questions about intraosseous infusions gave me the dirtiest “you are such an idiot” look that I have seen in a while. Frustratingly, my mind also kept freezing whenever I got to the resuscitation stations (which should really be a breeze as all I had to do was to regurgitate the ALS guidelines). What did I do? I gave stupid and random answers/responses, only to realise my mistake later and attempt to save myself by saying that “actually, I will do this, this and this…” By the fifth station, I was convinced I had failed the exam and had started making plans on how I would revise for my re-sit OSCE. It was THAT painful. I thought in my heart that I would not even have passed myself if I had examined the candidate I was that day. The only saving grace came from an examiner from my deanery (I knew him but he didn’t know me), and he examined a station for which I had all the answers for. Whatever the case, I was really relieved to finally finish when the final bell rang.

I got my results the next day (at work, as I was on call). Initially, I had planned to check my results only after I had reached home at 8pm. However, the tension throughout the day was too much to bear. The pressure was even more intense given that the other 2 guys from my hospital (whom I had been revising with) had both passed both parts of their exams. I really did not want to be the “odd one out” who had failed. At 2pm, when the results were made available online, I found a quiet spot with a computer to access my results. To my disappointment, I had failed the vivas (though I miraculously managed to pass my OSCE). Dammit, I’ll have to go through all the pain and anguish again. Freedom is not yet mine to enjoy. And worse, I now have to go and tell all my other concerned colleagues that I was the only one who did not clear the exam. And so, I put on a brave face, entered the anaesthetic office, and declared my failure. The other anaesthetists were very nice about it; some of them even congratulated me! “Congratulations on passing your OSCE, at least you have one less thing to worry about now and can just concentrate on the vivas.” I know that they meant well, but somehow it still feels strange to be congratulated on your half-success, or half-failure, however way you choose to look at the situation. I went on to break the news to my educational supervisor, who then gave me an “awww” look and tried to hug me. I lost my cool then, and tears just flooded my eyes as the wave of defeat crushed over me. I felt like I have let so many people down.

I now feel surprisingly peaceful about my failure. So peaceful that this can only come from God. God knew from the beginning of time that I would fail this examination. It has always been part of His plan for my life. I do not resent anybody, and just put it all down to “bad luck” (not that I really believe in luck anyway). You get yourself ready for an exam, and hope and pray for good questions. I guess I just had a run of bad questions. With having to re-sit the exam, I will have to go through all the work again, and hopefully all the knowledge will now finally stick in my head permanently with such repetition. Hopefully, with my failure this time, I will learn to be a lot more sympathetic towards people who struggle to clear these exams. I now know how crushing this sense of discouragement can be, and how frustrating it is to fail despite all the hard work. Hopefully, this failure will also put any arrogance I have about myself and my knowledge in check.

I AM going to pass this exam when I re-sit it in January! But for now, I am just going to have a little break.

p.s. I got my exam breakdown 2 days ago- I failed by 1 miserable mark. 1 mark!!!! *sigh

Crash section

I had been on a set of night shifts this past week.

Tuesday night was particularly stressful.

That evening, I arrived at work as the 2nd on call anaesthetist, half expecting to have a quiet 12 hours covering for any gynaecology emergencies that needed to go to theatre overnight. However, there was a haemodynamically unstable patient with a massive post partum haemorrhage in obstetric theatres. And so, I attended to give the 1st on call a hand in resuscitating this patient whilst the surgeons proceeded to perform a life-saving, haemorrhage-halting hysterectomy.

As I was busying myself checking blood products for this bleeding patient, one of the obstetric registrars burst in from the scrub room, completely gowned, gloved and masked up, shouting out “Who’s gassing my patient next door?!” Apparently there was a patient with placental abruption and a severely compromised fetus needing a category 1 crash caesarean section as well. A second emergency theatre had to be opened up, but they managed to inform everybody but the anaesthetists.

By the time I dashed next door, the woman was already on the table holding her own face mask and preoxygenating herself. The scrub nurse had already laid out all her instruments and the midwife was catheterising the patient. The surgeons were all scrubbed up and waiting expectantly with their scalpels. And me? I had NOTHING ready to anaesthetise the patient at all. The emergency drugs that are normally on stand-by had obviously all been used on the lady with the massive bleed. I didn’t even know this patient’s name or had a chance to do a pre-op assessment at all! What made things worse was the fact that the lady on the table was obese and pregnant- making her the perfect nightmare for difficult intubation and rapid hypoxia. And the worst bit? I was on my own- the only other anaesthetist in the hospital was the one next door, and she would most certainly not be leaving her unstable patient unattended on the table to bail me out if I run into any trouble.

My adrenals were working overtime then, and I had a heck of an adrenaline surge. I got my drugs ready (trembling hands all inclusive), performed a brief assessment lasting all of 20 seconds, got the patient to take a few vital capacity breaths, ran through the difficult intubation algorithm in my mind, muttered a quick prayer, and then performed my rapid sequence induction. Before I could even attempt to intubate the patient, the obstetricians had started painting the patient with skin prep and begun applying their drapes. They had their scalpels ready, waiting for me to give the go ahead to start. I had a look with my laryngoscope, and initially struggled to get the patient’s tongue out of the way to get a good view of the vocal cords. And then, I saw epiglottis. And with an upward lift of my laryngoscope, I saw the black hole into which I knew my endotracheal tube needed to go. You would not believe the relief I felt when the airway was secured, and when the surgeons pulled a live baby out in the next minute.

The tension in theatre certainly eased up after that, and I composed myself to administer all the other drugs she needed intraoperatively, watch the anaesthetic and catch up on my record keeping. Thankfully, everything went on without a glitch thereafter and the patient was safely extubated at the end, and returned to the recovery area feeling quite comfortable.

Due to the fact that most women coming for caesarean sections usually have a spinal anaesthetic, I have only ever given a GA for emergency caesarean section one other time (and I had a registrar giving me a hand then). And so, this particular episode of “flying solo” was particularly stressful. But I knew what I had to do, and I did what I needed to do, and more importantly, my patient was safe and the baby was alive.

I feel like I’ve taken a small little step forward in my journey as an anaesthetist.

Hopefully, the next step I take won’t be half as nerve wrecking as this one.