In LKCMedicine (NTU Medicine), we are privileged to have the opportunity to gain invaluable experience through early patient contact starting from Year 1. Our week in the polyclinic was followed by a week in a public hospital.
I must first make a disclaimer that the week was far more happening than can be gleaned from the recounts that follow. We aren’t allowed to reveal any details of actual patients’ cases and interactions, and therefore the bulk of our experience cannot be captured in this post. I have left out some deeper reflections as well, since they are interweaved with patients’ stories. I can only say that there’s so much more to it. This is but a glimpse into the actual experience, which was nothing short of eye-opening, enjoyable, and inspiring.
Monday: Auditorium Day
The first day was more of a welcome-cum-introduction (i.e. a series of briefings). The upside was that unlike Polyclinic Week, we were allowed to go down physically to the facility, albeit with everyone sitting two seats apart. We thus spent most of the day seated in the auditorium. Most briefings were sleep-inducing, while there were those humorous and inspiring talks that kept me going.
In the afternoon, we went off in our teams to our allocated department. My team was assigned General Medicine. (While I was slightly envious of teams who’d landed General Surgery, I knew it would be an amazing experience no matter which department we were in.)
Before the day ended, we were brought on a hospital tour. Our team visited the Tuberculosis Control Unit (TBCU), General Medicine wards, and subacute wards in the community hospital.
Tuesday: An Unplanned Day Off
We were so ready to step into the wards. But alas, it was not to be. An MOH audit was taking place over Monday and Tuesday, meaning that students (us) were not to be seen roaming the hospital grounds. We thus had a “day off” and were barred from entering the building.
We had to put up a presentation on Friday—a mime to be performed without speaking. So our team decided to meet at CSB (LKCMedicine’s Novena campus) to prepare our presentation. This was a vastly unproductive day where we spent the entire day rewriting our “script” three times (since we hadn’t actually seen anything in the wards yet), eating Fish & Co., singing and playing music, and doing anything but read or study. Still, it was great fun.
Wednesday: Physiotherapy & Speech Therapy Day
For our first day in the wards (only half day), we shadowed a physiotherapist. This was a lot of using walking sticks and walking frames, climbing stairs, doing leg exercises, and so on. Mainly the day-to-day job of the physiotherapist entailed going to different patients in the ward to conduct physiotherapy sessions with them, while documenting in the patients records and screening new cases in between.
One session with an elderly lady was conducted entirely in Hokkien. I watched with deep respect as the young physiotherapist fluently chatted away with the older lady, throwing strings of words into the air that I could not understand. This encounter reminded me, once again, of how important it was to pick up the common dialects in our country, as well as the other official languages. I resolved to try self-learning Hokkien, Cantonese, and Malay.
The Abandoned Walking Stick
We walked out of the cubicle and noticed an abandoned walking stick leaning against the wall at the side of the corridor. The physiotherapist picked it up, wondering if it belonged to any of the patients. As she held up the walking stick to read the label, it must have dawned on her that no patients currently in that ward bore the name printed there. She must have thought it odd. Bemused, she went to check with the nurse at the computer. Her brows creased when no results surfaced upon a search for the patient’s name. Had the patient been discharged and left his walking stick behind by accident? Murmuring to themselves, the nurse and physiotherapist keyed in the patient’s NRIC into the overall registry. A matching result came up. The nurse clicked into the patient’s records. A small red tag hovered on the left side of the screen. I had to squint to decipher the small print: “Deceased”.
It hit me then how frangible our lives were. While we, standing in the brightly lit hospital ward with our bodies intact and our breaths full, could whisper a soft “oh no” and move on, there were people—somewhere—who must have felt acutely this loss. And there was someone who had braved a battle against debilitating illness, and ultimately, lost.
Next, we had a session with the speech therapist, though this was, unfortunately, conducted over Zoom. Due to the nature of the coronavirus, we were not allowed to engage in the actual work. We huddled in a spare room in the hospital and listened to yet another presentation. The focus was on dysphagia, the most common condition tackled by speech therapists.
The “interactive” part came when we mixed different amounts of thickener with water, and tried for ourselves what the patients had to endure. (Fluids consistencies have to be adjusted for patients with dysphagia to ease their swallowing. You might think that this would mean making the liquids as thin as possible. That is not the case. In fact, for some patients, thicker consistencies are required to give them better control when swallowing.) All in all, the mixtures were tasteless and felt like phlegm half-stuck in our throats.
Thursday: Occupational Therapy & Case Scenario Day
Back to the wards. The morning was spent with the occupational therapist. She began the day by screening cases and determining which patients she had to see. (My friend and I peered over her shoulder at the computer screen, trying to decode the different medical acronyms and abbreviations. Most of the time she scrolled past way too fast for us to catch anything much.)
It was interesting that while the physiotherapist (PT) and occupational therapist (OT) had clearly delineated roles, in the hospital they did “trans-disciplinary management” of patients, meaning that the PT and OT were trained to manage both aspects. FYI, to put it simply, PT focuses more on improving body movements (think standing and walking), while OT focuses on enhancing the ability to perform daily functional tasks (think putting on clothes and buttoning a shirt).
At 10am, the OT had a scheduled caregiver’s training (CGT). I gladly assumed the role of the proxy patient, allowing the OT to lift me around as she demonstrated to the patient’s caregivers the complex process of moving the patient from supine to sitting, from bed to chair and vice versa. After they’d had their hand practising on me in the gym (a small activity area in the ward with a bed, bars, walking frames etc), we went with the caregivers to try it on the patient.
A lot more happened—all of which have been omitted from this recount. Overall, it was a most meaningful experience, and the OT was unbelievably patient and compassionate.
After lunch, we had the opportunity to try the nasogastric tube (the feeding tube that goes in through your nose). Done as a blind insertion with no anaesthetic, it’s a lot more painful than it looks. Having heard how uncomfortable it can be, I desperately wanted to experience it for myself. However, we only had two tubes to our team of six, and my name didn’t get chosen by the online random generator.
Before the experience, I had told myself that if I had the chance to do it, I would grit my teeth (figuratively) through the pain and get the tube all the way down. After watching the ordeal my first teammate went through, I was less certain I could have done it myself.
One of my teammates who tried it told me that there was pain from the start when the tube was pushed to the back of her nose, but it was still bearable. When the tube reached the throat, it felt like a hard stick jabbing forcefully at every part of her throat. Even after the tube had been removed, she could still feel it there. The insides of her nose and throat felt raw. I shuddered, thinking of the fear and discomfort that patients must go through.
The last programme on the agenda was a case scenario activity. The doctor came down to discuss issues with us that are pertinent to the General Medicine specialty. While this was in the form of a PowerPoint presentation, she asked us all questions throughout and engaged our thinking. (We had to do some pre-readings and watch some videos prior to the session as well.)
She touched on health inequities across the globe (as evidenced by the differences in the leading causes of death), Singapore’s healthcare through the ages, a case study on tuberculosis, and lastly, several “medical ethics” scenarios.
Friday: Nursing & Presentation Day
This was the day of our shift with the nurses. We each followed a nurse on the ward for the whole morning. For me, this was the most “happening” session. It was definitely a lot more fast-paced than PT and OT sessions, which consisted of longer sessions spent with each patient and could not be rushed. On the contrary, the nurse had so much to do that she was constantly hurrying from one place to another, and always had a task on hand.
We started the morning as breakfast was being served. The nurse did her morning rounds and dispensed medications. I felt useless tagging along behind her and offered to do any task that I could help with. I was promptly dispatched to a bed in a separate room to serve breakfast to the patient. I felt wholly inexperienced as I stared twice at the controls to make sure I was pressing the right buttons to adjust the incline and leg angle of the bed.
My movements were slow—probably snail-like compared to the swift efficiency every trained nurse exuded. As I manoeuvred the table towards the bed (why did the wheels feel stuck?), trying to make sure it was comfortably positioned at just the right distance in front of the patient, I imagined the nurse doing it in one clean gliding motion.
Shadowing the nurse turned out to be one of the best experiences of the week, as I could actually see stuff and do stuff, and was on my feet the whole time. After spreading butter and pouring water for the patient, I reported back to the nurse and occupied myself with other menial tasks. All the while, I tried to observe and take in as much as I could.
The afternoon was dedicated to our presentations (mimes). Due to Covid, the teams were split by half. After the first half, we had to vacate the auditorium along with the first seven teams. So the rest of the time was spent playing Secret Hitler (very good team bonding), while we tuned in to the other presentations via Zoom.
Some Personal Reflections
While patient encounters must be kept strictly confidential, I have published a few select parts of my reflections, with all patients’ stories omitted. It’s definitely not complete, and perhaps not as compelling or well-articulated without the accompanying experience. Nevertheless, they are my imperfectly expressed thoughts on what I have seen.
Note: The names of the hospital staff have been omitted. No patient details or identifiers have been disclosed out of respect for patient confidentiality.
This page is where I share everything related to life in medical school. The posts here may take on a slightly more casual tone and journal-like writing style. Ultimately, they’re just honest accounts of a medical student’s experiences – which will hopefully give you a glimpse of what med school is really like. 😊