波士頓所見系列 (1)

Tuesday, January 31, 2006

First day at Harvard (在哈佛醫學院的第一天)


Early morning I catch the public transport to the Hospital. Its simply amazing (isn't everything??) how efficient everything is. The morning was chaotic as paperwork had to be filled in and I got my own little ID (which is a real difference from Kenya). Security is equally tight at the hospital. I also got my timetable which involved me swinging through 4 different fields of orthopaedics over the ensuing month (Hands, Trauma, Spine, General Joints). It looked comprehensive and surgery was often spread over 3 hospitals. I also met Dr Simmons (on the left) today who is the Hand Surgeon and we began immediately on to Outpatient clinics. It was interesting and reminded me of the clinics at RNSH. Eventually around early afternoon and a hearty lunch later I was handed several journals and a chapter from the book Dr Simmons had written and instructed to familiarise myself with the anatomy and examination of the hand. Tomorrow was going to be a 7am start.. I headed home and realised I left the papers in the suites and will have to pick them up tomorrow. Groceries arrived in the evening and I felt more at home in Boston. Anthony (who i did vietnam with) will be travelling up this way on the weekend and it should be great having someone who knows Boston inside out. (# posted by Phil Huang @ 1:51 PM)


一早醒來 [註: 應是當地 30/Jan], 我就搭乘公共運輸工具到哈佛醫學院裡去. 院裡的每個人做起事來都是超有效率的 (每件事難道不都應該是要這樣子的嗎?), 這實在是讓我覺得非常驚奇. 整個早上我都是在院裡各個不同的行政部門之間跑上跑下的; 因為我要填很多的文件表格. 我也拿到了我個人的小 ID身份通行卡 (這真的是和在肯亞的希阿亞區域醫院有很大的差別). 醫院裡的安檢設施同樣地也是很嚴密. 我還拿到我的課程時間表, 它包括在接下來的一個月當中, 我所必須要上的骨科 4 大類課程 (Hands 手, Trauma 外傷, Spine 脊椎, 和 General Joints 一般骨關節). 課程時間表看起來是簡單易懂, 而外科手術則是經常散佈在 3 間不同的醫院裡上課. 我也和 Dr. Simmons 碰過面了. 他是 Hand Surgeon手的外科手術醫生. 我馬上就跟著他學習看 Outpatient Clinics 非住院病人的門診.

他的門診方式很有趣, 也讓我想起在 RNSH [註: Royal North Shore Hospital 雪梨皇家北岸醫院, 這是 Philip 的固定實習醫院] 上門診課時的情形. 我吃完一頓很豐富的午餐後, 在下午過後沒多久, 有好幾篇 Dr. Simmons 所寫的醫學報告文章和他著作書本中的一整篇章節文件, 就被交到了我的手中. 他要我要熟讀這些有關 Anatomy 解剖學和手的 examination 檢查等相關內容. 明天一早, 將會是從 7:00 開始上課. 我在回家的路上突然想到, 我居然把這些相關的文件留在門診室裡, 忘記拿了. 我可得明天一早趕快去取回.

我上網選購的日常生活食品和雜貨, 在晚上也送到我的住處裡來了. 我覺得在波士頓生活過日子, 和我在雪梨的家中, 並沒有兩樣. Anthony (和我一起拿獎學金, 在 2004 年年底去越南實習的那位同班同學) 這個週末將會旅行到這個方向來. 我能向一位深悉波士頓的人, 多請教有關這個城市的一些事情, 總是好的一件事. (Posted by Phil Huang @ 1:51 PM)



Saturday, February 04, 2006

Hands (手)


So ended my first week at Brigham. Besides being exhausted and being reminiscent of my 3rd year ICA's there was also the fact the weather was terrible (Snow, hail, sleet etc). Most people at the hospital tell me the weather is actually fantastic! And that is usually gets down to 0 degrees Fahrenheit...

The rest of this week was spent with Dr Blazar and Dr Koris (moustache). Both were excellent teachers. They were always keen to talk to me and teach me various things but would only do so when I showed interest.

They made me work for it basically. The residents (registrars) were equally brilliant. All were patient and eager to teach and allowed me to close and do suturing. Katie was the main resident I was on with this week and she showed me the ropes. She is PGY2 and they choose what they want to do the time they graduate. She will be a consultant in orthopedics 5 years after graduation. I was extremely jealous.

Brendan (flexing) was a PGY4 and was a typical orthopod and alot of fun. Neal was a resident in joints who i will work with and i assisted him this week on a car crash patient who had multiple fractures in her hand and wrist. It was an excellent week. The Clinics were filled with exceptionally interesting patients and although I wasn't passionate about the hands it was still great experience to see the cases. There was a lady who had an infected elbow prostheses and had to have it removed. A custom replacement was built for her but she had no elbow joint for over a year. It was surreal and a little creepy to see her in theatres with her dangly arm but no joint.

We saw a total of 38 patients today in clinic and I was exhausted by the end. Besides Monday, I have had a 7am start every day. Next week I commence trauma and supposedly they start at 4:30am which will be a real treat. I am also heading in tomorrow (Saturday) at 7am as Katie is on call this weekend in Emergency and there should be fantastic cases. Pharmaceutical advertising is an ever presence inside the hospital and Brigham is outfitted like a giant shopping centre. It’s amazing how large the hospital is. The posters in the clinics are deceptive. They are all "AMAZING" pictures of the joints but on the bottom there is a clear sale for tramadol+acetaminophen. Just one of the many adverts one can see around the hospital.

Another thing you notice immediately is the efficiency to which everything is done. Although the residents whinge and complain, it can't be denied that things are done efficiently in the operating theatre. People in Boston tend to be so much ruder than the rest of America but at least things get done. Patients are infinitely more neurotic and demanding and most are on zoloft, effexor and the like.
I got to catch up with James Sparks (had Stephen Hawking as a supervisor back in Cambridge) this week as well and we had a great meal at my place. It was great to catch up and see him. He has not changed one bit. It was good to catch up on old times and just sit around like we use to back in the college days at Selwyn.

Anthony Barker (who i did Vietnam with) is currently on a bus from new york and hopefully I'll see him tonight and hear about his adventures also... Trauma here I come (# posted by Phil Huang @ 10:07 AM )


在 Brigham 醫院實習的第一個禮拜, 就這樣結束了. 除了我是累慘了之外, 這個禮拜, 也讓我回想起去年當我還是第 3 年學生時, 在雪梨的醫院裡我整年都在做的 ICA [註: Integrated clinical attachment 的簡稱, 意指不在大學課堂裡上課, 而是直接到醫院裡實體見習教課]. 同時, 氣候也很糟 (下雪, 下冰雹, 下雨又下雪等等) [註: 3/Feb 室外氣溫是 3° C], 可是醫院裡大部份的人卻告訴我說, 像這樣的天氣是算很棒; 如果是華氏 0° [註: 攝氏零下 18°], 那才叫做很糟.

這個禮拜的後半段, 我都是跟著 Dr. Blazar 和 Dr. Koris (有留鬍子的那一位). 他們兩位都是很棒的教授醫生. 他們總是很熱心的和我談話, 也教了我很多各種不同的事; 但前題是我必須先讓他們知道我有興趣學, 他們才肯教我. 基本上, 他們兩人就是用這種我要肯學他們才肯教的方式, 來引導
著我.

那些駐院醫生們 (總醫師級) 也都是非常聰明的一群人. 他們全都對我非常有耐心, 而且也很熱心的教導我, 甚至於還讓我動手做傷口的縫合 (close and do suturing) 工作. Katie 是我這個禮拜跟的主要駐院醫生, 她也總是很樂意的教我事情應該要怎麼做, 或告訴我東西是放在那裡, 或什麼時間應該要到那裡去之類的 “線索 (rope) “ 事.

她是一位醫學院畢業生第二年工作的醫生 (PGY2). 在美國這裡是, 醫學院學生畢業後, 馬上就可以選擇要走那一科. 她畢業5 年以後, 就可以升為一位骨科的主治醫生 (consultant). 我簡直是妒忌死了 [註: 在澳洲, 一般是平均要 10~12 年才可以]. Brendan (雙手交叉抱胸的那位) 是一位醫學院畢業生第四年工作的醫生 (PGY4), 也是一位為人很好玩的典型骨科醫生. Neal 是骨關節的駐院醫生, 我將來到一般骨關節去的時候會跟著他. 但是這個禮拜, 我已經先協助他處理過一個女病人因撞車車禍, 以致她的手和手腕有多處骨折的病例.

這個禮拜, 我過得很棒. 門診的部份, 每天都是充滿著很有趣病例的病人. 雖然我對手並不是很有興趣, 但是, 能夠看到這些病例, 對我來說, 還是一種很有幫助的經驗. 譬如說: 有一位婦人的人工手肘因細菌感染 (an infected elbow prostheses) 以致必須將之取下, 另外換上一個特別為她訂做的替代品給她, 她已經將近一年的時間沒有肘關節了. 在手術房內, 我看到她那吊在那兒晃來晃去的胳臂卻沒有骨關節, 還真有點不真實感, 也有點兒毛骨悚然的.

今天 [註: 應是當地 3/Feb] 我們門診總共看了 38 位病人. 看到最後, 我都已經是精疲力盡了. 這個禮拜, 除了禮拜一以外, 我每天都是早上 7 點鐘就在醫院裡開始工作. 下個禮拜, 我將會在外傷 (Trauma), 他們是要早上 4:30 就開始. 所以這個禮拜的累根本就不算什麼, 我看下個禮拜才算是精彩. 同時, 我明天 [註: 應是當地 4/Feb] (禮拜六) 一早 7 點鐘時也要到醫院裡面去; 因為 Katie 這個週末在急診室 on call, 屆時應該會有一些很不錯的病例可以讓我看得到.

在 Brigham 醫院裡, 藥商的廣告是到處都可以看得到的, 而醫院本身看起來, 就像是一家很大的購物中心 (shopping centre) 一樣. 能夠看到一家醫院的規模可以達到這麼大, 實在是讓我感到很驚奇. 門診室裡牆上貼的海報其實是名不符實的. 骨關節解剖圖的最上面, 都貫上斗大的 “神奇 (Amazing)” 字樣, 可是在海報的下方卻都很清楚地印有 “Tramadol + Acetaminophen” [註: 這 2 種都是治療關節痛的止痛藥] 等字樣. 類似這樣子的免費替藥商打廣告的海報, 在這家醫院裡, 到處都可以看得到.

另外一件你馬上就會注意到的事, 那就是: 每一件事都會被很有效率的執行. 雖然那些駐院醫生們和其它醫院裡的醫生一樣, 總是會抱怨東抱怨西的; 但是不可否認的, 在手術房裡, 任何被交待應該要做的事, 他們還是會把它們做得好好的, 也都很少會出錯. 住在波士頓這個城市裡的人, 一般來說, 我總覺得他們是比在美國其它城市裡的居民, 來得更沒有禮貌 [註: 我是覺得波士頓人比較高傲]. 可是, 至少波士頓人會把事情做好, 也很有效率. 來這家醫院的波士頓人病患, 通常總是非常地神經質, 而且是喜歡要求醫生能夠為他們多做東又做西的. 大部份的病人都有在服用 Zoloft, Effexor [註: 這兩種都是治療憂鬱症的藥物], 或是其它類似的藥物.

這個禮拜, 我也和 James Sparks (在劍橋大學時, 由 Stephen Hawking [註: 世界有名的宇宙天文物理學家, Philip 自高中時代就非常崇拜他] 來做他指導教授的那位) 在我的住處用了一頓很不錯的餐, 我們兩人也好好地敘了一下舊. 能夠和他見到面又彼此交換近況, 實在是很棒的一件事. 他一點兒都沒變, 還是老樣子. 我們也像當年一起在劍橋大學的 Selwyn 學院唸書時一樣的隨意坐在地上, 彼此聊著過去那些歡樂的老日子; 這感覺真好! .

同班同學 Anthony Barker (和我一起去越南實習的那位) 此刻正坐在巴士上, 打算從紐約來看我. 希望今晚我就可以和他見到面, 我很想聽聽他過去這幾個禮拜以來, 到底是有什麼樣的經歷 …… 哇! 外傷, 我來了! (Posted by Phil Huang @ 10:07 AM )



[後記]

當 Philip 還留在肯亞實習時, 他爸爸經常和朋友開玩笑說, 聖誕節和過年期間, 在非洲, 他兒子是 “看到人, 就拿刀宰”. 在非洲大陸的第三世界國家裡的醫療資源嚴重匱乏, 人命也比較不值錢; 所以他一個醫學院最後一年的學生, 被當作是很有經驗的全能駐院醫生來用. 這種情形, 在醫療資源充沛人命關天的美國, 當然是不可能會重演. 看他在前一篇文章中, 是那麼的捨不得離開肯亞; 我本來是有點擔心, 他突然間由 “雞首”變成 “牛尾” (哈佛大學的醫學院, 平均每個月都會從全世界收到 1 萬多封醫學院最後一年學生的申請函, 但是他們每個月只收 100 位實習醫生), 一時之間可能心情會調適不過來. 但是, 照現在這篇文章的內容看起來, 他並沒有被打倒; 甚至於, 他的鬥志比起以前來, 是更為高昂了. 我很欣慰, 我的一對子女, 都沒有忘記我以前經常告訴他們的話, 那就是: 做人, 就要面對現實, 迎接挑戰, 享受事情已經被解決了的成就感! 事情有沒有做得好, 那是另外一件事, 但是, 如果要做一件事, 那就要盡全力地去做. 也就是說, 成不成在天, 做不做在自己; 不要怕事多, 只怕沒事做; 記得永遠都要抬頭挺胸, 向前走!



[Feedback: 回響]

1) Just read your Chinese blog.. and the summary at the end.

It’s true you know.. I have never forgotten what you have told me. Life is all about challenges and we have to constantly push ourselves on all fronts.

I just hope you remember that yourself and know that life is an ever continuing process and it doesn't end at 40.

Love you, Phil.