Disclaimer: All chapters to this story is purely fictitious. Any resemblance to actual person or event is purely coincidence. 

“Posteriorly to the stomach, lies the pancreas which plays an important role in both endocrine and digestive functions.” Dr. Manson went rattling on about the various cells in the pancreas that has an endocrinological role in the body.

I was about to doze off when Lucas nudged me by the shoulder, “Hey Dan, looks like you will be Dr. Manson’s next target.” Irritated by Lucas’s voice, I pushed him away and leaned my head against Daphne’s shoulder, who was sitting on the other side.

“Dan, would you like to educate the class on how does the inactive form of insulin secreted by the beta cells gets activated?” Dr. Manson raised his eyebrows, hands crossed together, clearly not amazed that one of his top students was sleeping.

“Yes, Dr. Manson, it would be my honor.”

“Let us hear from you then, Dan.”

“Pro-insulin secreted by the beta cells will be cleaved by the proteases to remove 4 amino acids, producing an active form of insulin in its C-peptide structure.”

“Very well Dan, I’m impressed that your brain is still constantly on the run despite your circadian rhythm overlapping into my class time.”

Embarrassed by Dr. Manson’s indirect fume of fire, I quickly took a seat and look at Lucas. “See, I told you to stay awake. But, what does Dr. Manson last statement meant?”

“Oh, he is just surprised that my sleep-wake cycle has taken such a toll that I have transmogrified into an owl.” I quipped.

“Stop kidding around” and he slapped my back.

Before I go on telling you a story that changed my life, I would like to introduce myself. My name is Dan and I am a first-year medical student at the National University of Singapore (NUS). Previously, I was from Nanyang Polytechnic and graduated as one of the top students in my cohort.

Like most Singaporean sons, we have to serve the mandatory 2 years’ worth of military service and I must admit, military service for me was fun! Bearing the rank of a Lieutenant in the military intelligence section for my Battalion, I was constantly involved in planning missions and experiencing the planning first hand! One of the funniest experience (or rather, shocking) took place during one of our exercises, where we were hiking through the forest shrouded in darkness that was apparently a pretty steep hill. Moving along the slopes with a heavy field pack on my shoulders, I was amazed by the number of people who collapsed as I was making my way towards the objective. Every five meters or so, I would see a soldier lying flat on the floor, with a medic infusing I.V. fluids into their basilic veins. Usually, I would have issues spotting casualties for most of our missions, and this was the first.

Besides my pretty fruitful experience in the army, I am the adventurous guy who likes to explore various places and try out something fun. Also, being an avid fan of writing, I have dedicated time to invest into a blog where I share plenty of experiences.

On top of that, who does not like cheese and desserts?!

I am certainly a huge fan of that which I can promote myself to become an air conditioner (pun intended). Can you imagine the stringiness of the cheese when you pull a slice of pizza from its main body? What about the sweetness of the chocolate lava cake that your metal spoon cuts into and the thick heavenly scented chocolate just oozes out from its chocolatey core? I have never understood why people dislike chocolates though sweet treats are an anathema to Daphne.

 Back to the main story, the reason for my sleep deprivation was not due to overnight cramping of medical information from my textbooks. Rather, it was one of the encounters the night before at the National University Hospital (NUH) during my internship that was incorporated into our medical syllabus that crept the living daylights out of me.

As part of early patient exposure initiative by the medical school, we were attached to various hospitals to understand the basic workings of the healthcare sector in Singapore. Fortunately for me, I was given my first choice of hospital when they released our schedules. A 10-minute bus ride away from home, NUH was one of the closest hospitals from my domicile and they have an emergency department which I was very fascinated by.

On our first day in the hospital, I met Lucas and Daphne, at the Kent ridge monorail station (MRT) before we set off to look for our clinical supervisor. Our supervisor, Dr. Amy Lee, is the head of Cardiology department for NUH, with at least 30 years of experience in the field of hearts. Of course, with all those educational certifications ranging from “M.B.B.S to FRCP to FESC to FSCAI”, I am certain that I would be able to pick up more applicable clinical information from her. Sometimes, I wondered if she could resolve my heart aches with medication or complex surgery. Surely, I would not want to die from Broken Heart Syndrome ever since I was rejected by my eye candy. Maybe Citalopram or Wellbutrin can comfort my depression from that heartache a little.

When we first stepped into the office, we were greeted by a relatively large room with whitewashed walls circumferencing the huge dark mustard brown table located centrally of the room. Surrounding the table, were 4 soft maroon office chairs parked neatly into the crevices of the table. The first wall that was towards my left had many accolades and awards hang up. “National Healthcare Excellence Award 2014”, “International recognized cardiologist award”, just to name a few, were beautifully hung up, in a chronological order starting from the top left corner of the achievement board. What surprised me was the tidiness of the awards floating up in mid-air, grabbing on to a small iron pin of hope for their dear life. As far as my obsessive compulsive disordered eyes could discern, all of the awards were extremely straight. I meant, like 90 degrees straight, not a degree tilted to either side. Also, the spacing between each medal, each paper, each plate, resembled the 5-centimeter gap between the forceps I used during dissection.

Opposite the wall of recognition, were anatomical charts we have seen in our anatomy lab sessions and photos of the interior aspects of the human heart which we had observe in the cadavers. Aside from the standardized anatomical aspects of a functioning heart, there were multiple photos which displayed certain pathologies of the heart which Dr. Amy saw during her 30 years in the cardiology field.

Before I can cascade a conversation about an aortic aneurysm I saw in an echogram framed up nicely on the wall, I heard footsteps from behind and spun around.

Standing in front of us, was Dr. Amy. She had thick lustrous black hair that bounced whenever she walked, like how most models in shampoo advertisements would have looked. Despite her slightly old age, she had the features of a 20-year-old lady! In her dark royal blue hospital scrubs and a bright baby pink stethoscope hanging from her neck, she ambled towards a chair and gestured for us to have a seat.

After the 30 minutes of opening by Dr. Amy, she allocated us to our individual wards and assigned us to a senior medical officer who we will be shadowing for the next month. Despite having requested to be posted to the Accident and Emergency (A&E) department, I was placed in the neurological department. Imagine all that disappointment that course through my blood when I discovered quickly that Dr. Yap, my attending physician, is a specialized neurosurgeon. As much as I love medicine and contained insane volumes of passion for the medical field, neurology is my least favorite of my subjects as neurology is more of an ambiguous uncharted field, unlike the other fields that have foundations solidified. That is my own view about neurology which I have told my friends about. Most of them would disagree with me, and I have not seen any with similar mindset. Regardless, I was hoping to be able to make the best out of the whole session here in the neurological department. Honestly, I am kind of jealous of both Lucas and Daphne since they were posted to their first preference – cardiology – unlike me, who have to be attached to a field which I showed the least interest in.

I remembered the first few days, I followed Dr. Yap along for his rounds, examining the patients and see how they progress through the different stages of neurological impairment. Due to patient confidentiality, all names have been changed and any details that might potentially reveal my patient’s identity has been adjusted as well. Besides seeing Mr. Yip who had suffered an ischemic stroke that left him in a state of hemiplegia on the rounds every morning, Mdm. Tan was one of those patients who was suffering from a strange neurological phenomenon which, the residents and Dr. Yap are trying to investigate. The majority of the patients here suffer from functional disability due to stroke or a non-apoptotic tumor that presses on the cerebrum, but we have a few special cases like Mdm. Tan.

About 2 weeks or so into my attachment, a patient was brought into the hospital with complaints of a drastic personality change and appeared to be in delirium. Usually, these are the people diagnosed with a psychotic disorder and would end up in the psychiatric wards. However, the psychiatrist believed the problem to stem from a neurological basis of the brain and decided to ward him here. He’s name is Julius. He is one of the youngest patients I have seen throughout my time here and at the age of 24, where most of us still struggle with coming terms to our own identity and future, he was tangled up in a mess of unexplained psychosis and hallucinations.

There was something strangely familiar about him when I first set my eyes on. But in the large ocean of medical information swimming around the neurons of my brain, searching for that piece of information associated with Julius was akin to looking for a needle in a haystack - impossible. 

Julius seemed pretty normal when I first saw him. Sometimes he would greet all the doctors and nurses he sees whenever they waddled past his room. On the other times, he would act up all insane, tossing whatever his hands could reach towards our team of nurses and doctors and caused chaos the more experienced staffs have never seen. Whenever he gets into fits, the other nurses and doctors would hold him down and I would administer 1mg of Midazolam intravenously and wait for a minute or two for the drug to kick in. If we are unlucky, higher doses of Midazolam will be administered. Occasionally, when things do not work out, Dr. Yap would come into the scene with a larger dose of Midazolam or other benzodiazepines.

Fast forward to my last day of attachment in the neurological wards, I must admit, the neurological department has its fair share of unique cases I never thought I would have seen before. In addition, the team has built a strong sense of camaraderie which helps interns like us to fit in easier and learn more information. The morning of my last day was pretty hectic with a sudden influx of patients who needed to have their conditions reviewed before we could discharge them. Afternoon was slightly better and my colleagues managed to pull out a farewell celebration for me. Before I left the hospital to meet up with Lucas and Daphne for dinner at the nearby coffee shop, news about a coroner dropping by the mortuary struck my ears.

Having been fascinated by the workings of the human body and taking every opportunity I have to explore the innards, I was hoping to have a chance to see how an autopsy is being conducted. Determined, I rushed into Dr. Yap’s office and pulled a 15-minute long presentation on why I should be granted this opportunity to be exposed to another side of medicine. After pulling strings and a few phone calls to the various department, Dr. Yap said yes!

Imagine all the excitement that came buzzing around my body! This was going to be the best time of my life! Just when I was about to leave Dr. Yap’s office, he said: “Dr. Sims will only be here at 9 p.m. at the mortuary and he sure sounds excited to have students!”

I winked at Dr. Yap and flashed him the biggest smile and a thumbs up and hurried my way to Lucas and Daphne.

“You guys can never believe what just happened!” I shouted in excitement, which attracted several stares from the patients strolling by the aisle of the hospital.

“I will be joining Dr. Sims, the coroner tonight in his death adventure!”

Lucas and Daphne grasped.

“What I meant to say was, I have been granted permission to watch and learn from Dr. Sims how an autopsy would be done and we need to get going for dinner before I end up late for this mind blowing session!”

“Wow, you are so lucky Dan! Don’t forget to teach us a tip or two tomorrow when classes resume!” Lucas smirked.

 

Read part II here.

Read part III here.

Published by Lucius