Christmas holidays

I have been fortunate enough during this internship rotation to be able to choose when I could have my designated leave. Since my last long leave was in mid-September, I decided to keep my leave for the end of my current rotation, around Christmas time. It was also very fortunate my leave coincided with my brother's return to Hong Kong, so I would be able to spend some time with him. It has been almost three years since I last saw my younger brother Jeremy and he has not changed one bit. He's still the slacker I remember him as.

It's great to have my brother back home. At least my mum can bother him now instead of what she normal does and bothers me whenever I'm home. Jeremy has also bought me some presents from old Blighty - Cadbury Roses & Quality Street chocolate, DVDs of British TV series and an nice Arsenal mug.

Currently I'm in the second day of my leave and haven't been doing much. On my last leave I went to Kuala Lumpur and I decided to spend this leave at home, since I didn't want to organise another holiday and I need to start saving money (thanks to those wanker bankers in America). Most of the day is spent surfing the Internet, watch downloads on my laptop or DVDs on the plasma screen TV plus playing darts. My dad bought a dart board not so long ago and I've been chucking those spears since. It's more difficult than it looks but hopefully I'll be good enough to be playing in pubs soon.

Hectic calls and designated leave

Not much happening in my life now. Still very sexually frustrated. I had the most hectic call on Sunday. Usually we admit about six children each day at PYNEH. On Sunday it was about sixteen children. On Monday all our wards were full - the first time it has happened in my three months here. It has calmed down a bit over the past two days. I'm sure children will continue to be admitted to our wards, it being the season of rotavirus gastroenteritis, asthma exacerbations and parental anxiety about the cold. I'm sure anybody reading this who works at Queen Elizabeth Hospital think that is their usual day, to admit sixteen kids per day but I hope for their sake it isn't.

Thankfully I'm not on call ever again on the weekends, at least not until my next rotation. I'm on call on Boxing Day but apart from that, it is just weekday night calls. I'm looking forward to the next few days. I've got my first ever full free weekend - from Friday night till Monday morning. That is a rarity in my profession. Next week is my designated leave, so I'm looking forward to some rest, relaxation and internet pornography. What I actually need is a full body massage but I need to go somewhere relatively inexpensive and not very seedy (i.e. not Shenzhen).

I'm nearing the end of my time at PYNEH paediatrics. I have learnt a lot but the most important thing I have picked up from my time here is that I won't be doing paediatrics. These three months has just reaffirmed I don't like kids that much to be subjected to their crying and whinging for the rest of my life. I have the utmost respect for my current paediatric medical officers who can go through all that but not me. I don't know if I could go through another three months of paediatrics, which I have to do if I decide to pick family medicine as my specialty.

Intern nervous breakdown - Episode 2

I thought I could get through my internship without having a nervous breakdown but it was too good to be true. The previous nervous breakdown was caused by my inability to take blood from an elderly patient. This time the cause was the grief I got from the medical officer on-call.

I would like to state most of the medical officers in my current hospital are very nice. They don't scold me much if I do things wrong and when it is possible try to teach me when I do go wrong. Yet there is always one bad apple which spoils the crop. This person has a Jekyll and Hyde personality about him/her. Sometimes this person is OK but all of a sudden can turn on you. This medical officer always bitches about everything I do when I admit a patient. If it is not a poor management order, it is my clinical skills. If it is not my clinical skills, then it is my attitude.

I don't mind being told off and I do admit I'm not totally enthusiastic about paediatrics. Yet there is way of telling people instead of screaming and pointing at the management order, saying "This is not good enough!" There is a tactful and considerate way of telling interns what they have done wrong and maybe they will learn if you don't scream at them so much.

Why is it so many senior doctors forget what it is like to be a medical student or an intern? Have they risen to such lofty heights in their white towers? I never have been in favour of the Gordon Ramsay method of teaching people, that is to scream at them and humiliate them. I always been in favour of making them feel part of the team. If a junior team member does something wrong, tell them off but make sure they learn what they did wrong.

I often wonder if I will continue in this job. I'm seriously thinking about not joining any training after my internship has finished.

"Do not lie with a man as one lies with a woman; it is an abomination."

Note: I don't have many things to write about daily life right now. Work right now is pretty mundane and with my fellow intern on holiday for the next week, I predicting it will be more mundane and hectic. Nothing is going on with my love life because I don't have a love life. I'm still whinging about having no sex or girlfriend (in that order). I've been meaning to write about the topic of homosexuality for a long time, so here goes...


I have always been irked by how Christians interpret and use this quote from the Bible in daily life. This is the leading problem I have, not with my faith or Christianity, but with other Christians. There are some people who say we should believe everything in the Bible but tend to ignore other more atrocious or ridiculous parts, for example the acceptability of selling your daughter into slavery and not being able to eat pork and seafood. And wasn't the whole point of Jesus dying was that even if we sinned (for example having gay sex) we would still go to Heaven? And that quote says nothing about lesbian sex

I will agree with Christians there should be no same-sex marriages. Marriage is a religious concept. However there should be equal rights for same-sex couples as there are for opposite-sex couples, so civil unions should be allowed. I'm glad there are some countries such as United Kingdom and the Netherlands who endorse but I'm disappointed with the failure of Proposition 8 in California. I'm in favour of same-sex couples being allowed to adopt children or being allowed access to in-vitro fertilisation. Maybe they will be better parents than those fathers who leave their kid behind or the mother who tends to have sex with anything straight and those heroin.

And why does it matter which way somebody's sexual compass points? As long as you're not doing anything to hurt other people and isn't morally wrong, I don't care what you are doing in your private life. I should state I'm not gay but I'm into bisexual women.

I'm actually very surprised at how many famous people are homosexual. I came across the Pink List by the Independent, a list of the top 100 most influential homosexual people in UK. Reading down the list, it does make for interesting read. I had my suspicions about Russell T Davies, the man behind "Queer Folk" and the recent revival of "Doctor Who", but it is very difficult to confirm unless somebody actually says in an interview "I'm homosexual" which they shouldn't do since it is nothing to do with the general public. I'm also glad there hasn't been such a reaction by the British public, especially parents, towards having a homosexual behind a family classic such as "Doctor Who" or that there have been many homosexual elements in the new "Doctor Who" such as same-sex kisses or homosexual actors (e.g. John Barrowman, Mark Gatiss, etc.)

Some people you obviously know are homosexual, such as Sir Ian McKellen, Sir Elton John, Alan Carr, Graham Norton and Stephen Fry. I'm a surprised about Sandi Toksvig, who I listen to religiously on "The News Quiz" being a lesbian. I also like to see homosexuals not being stereotypical - Matt Lucas of "Little Britain" fame is an avid Arsenal supporter. Yet sport and male homosexuality is still one barrier to be overcome. Just look what happened to Justin Fashanu and John Amaechi when they came out of the closet - one took his whole life and one caused Tim Hardaway to say "I hate gay people." You don't hear about prominent male athletes being homosexual. Some keep it secret all their lives or only come out after their playing career is over. Obviously the view from sportsmen is as neanderthal as from Christian society.

Obviously we need to educate people more about homosexuality. I don't mind you don't like gay or lesbian people but don't let this affect your daily life.

"Ambitious but rubbish"

I miss top quality TV. Here in Hong Kong the local channels and programs are not my cup of tea. There is this constant stream of TV soaps which bore me to death. It is usually the same formula with the same bad jokes and undramatic storylines.

I'm more partial to the UK comedy panel show, such as "Have I Got News For You", "Mock the Week", "QI" and "Never Mind the Buzzcocks". I don't really like sitcoms, especially the ones from USA where they have to insert audience laughter into the program. If a joke is funny, people will automatically laugh. We do not need to have cues to when and when not to laugh.

That is not to say I don't like USA shows. I know sometimes I come across as condescending towards the way of life in USA but I do like some aspects about America. I do like "The Daily Show", "Frasier" and "The West Wing". I do like cheerleaders, not just for their beauty but their ability to dance well and hold careers at the same time. I'll write about that in another blog entry. Since Barack Obama has been elected presidenta of USA, I think more people (like me) will be a little bit warmer towards the USA.

With that said I do enjoy the return of "Top Gear" on the screens. I can't wait for the programme to turn up on local screens. I will have to wait for a year before ATV World does it. I also cringe at the subtitles they put up on the screen. Most of you know I cannot read Chinese and it wouldn't matter to me but the person who does the subtitles must be the most stupidest, laziest person ever and I tell you why. Even though most of the subtitles are in Chinese, the name of the cars are in English. Yet they can't even get those names right. I think I saw the name "Camaro" spelt differently six times in the same programme. Even if you can spell it right, you can at least check the spelling on the internet or something.

My mother has commented the Chinese subtitles are not that good either. Sometimes the subtitles are a literal translation of what is being said. If I said "spanking the monkey", they will literally write "spanking the monkey" in Chinese in the subtitles instead of "masturbating".

Now I know why people download programs from the internet - the quality of their local TV must be appalling to resort to this measure.

"Three men walk into a pub..."

Over the past few years I have been drifting away from movies and more into comedy. I remember watching "Whose Line Is It Anyway?" when I was kid in England and loved the mix of American, Canadian and British humour on offer. Whilst at boarding school I remember watching the repeat of "Have I Got News For You" and loved the show for the wit and political satire.

My love for comedy was rekindled thanks to Youtube. I find old episodes of "Have I Got News For You" online and it is great to watch classic episodes such as the Angus Deayton scandal or recently the Brian Blessed episode. Through Youtube I have also gotten to like "QI" and "Mock the Week", which are probably my two favourite shows.

I am partial to British humour, for its wit and sarcasm, the cynicism and the political satire. That is not to say I don't like American humour. The USA are best at stand-up comedy (which I love) and sitcoms (which are not my cup of tea). Everybody in school loved "Frasier" for its wit and there is no better political satire on TV right now than "The Daily Show", with Jon Stewart being the best at his job.

So why am I writing all this? Last Friday I went to my first comedy gig. I like to say it was unusual place to hold a comedy gig - a curry house - but the Punchline Comedy Club have been doing this gig for years. They have comedians I have seen or heard of, such as Paul Sinha (who shows that doctors can be funny) and Mark Watson. This time around I only really heard of one of the comedians - Andy Parsons from "Mock the Week". I like his kind of humour; it is more along the lines of wit. He was very funny on the night but a lot of the jokes I have heard before as I download all the episodes of "Mock the Week" and watch them again and again and again.

That is not to say the other two comedians - Mark Walker and Russell Kane - weren't bad. They were bloody hilarious. I haven't laughed that hard for ages. In fact I laughed so hard, I was coughing too much at the end and the lady in front of me was probably scared I had tuberculosis.

As an obsessive compulsive, I tend to categorize comedians into what kind of comedy they do. Obvious categories include the impressionists, which include Darrell Hammond from "Saturday Night Live", Jon Culshaw from "Dead Ringers", Rory Bremner from "Bremner, Bird and Fortune" and Hugh Dennis from "The Now Show" and "Mock the Week". There are comedians who use bad taste and political incorrectness as their main weapons, such as Jimmy Carr from "8 Out of 10 Cats" and Frankie Boyle from "Mock the Week". Comedians such as Jeremy Hardy, Mark Steel, Ian Hislop and Jon Stewart use political satire in their work. Sean Lock, Russell Howard and Johnny Vegas are the ones who think of ridiculous ideas and just make them funny. So there is fun for everybody.

Next time I will probably like to see a comedy gig where I do not know the comedians, so I don't have any preconceptions.

I also have advice for anybody wishing to attend a comedy gig. I thought this piece of knowledge would be obvious but apparently, after attending the comedy gig last week, it is not. If you don't want to be picked on or you have an obvious trait which can be picked on such as having a manic laugh, being old or being American, don't sit in the front where the comedian can see you.

"The best argument against democracy is a five-minute conversation with the average voter."

Sir Winston Churchill was right about democracy. Not many people actually go out of their way to listen to all the policies of the candidates running in an election and on voting day make an informed decision on which candidate they are choosing. Most of the voting population have made up their minds months beforehand, or even years as they are most likely to stick to the party they have been voting all their lives. I'm probably guilty of the latter fact. I would vote for Liberal Democrats in UK or Democratic Party in Hong Kong. In all fairness these political parties are on my wavelength. We need better human rights for minorities, such as homosexuals, ethnic minorities and the poor. We need to tax the rich more to help the poor. We need to do more for the environment.

I say this on the weekend before the US presidential election, which will have repercussions on the world and not just on USA. Yet there are 10% of the US population who think Barack Obama is either a Muslim, an Arab or a terrorist and they think all of those kind of people are the same thing. I often think democracy was designed by stupid people for clever people and communism was designed by clever people for stupid people. Democracy is a simple idea of one person - one vote where you need clever people to make informed decision to elect who is the leader. Communism needs stupid people to believe the state is important and ensure all decisions are made by the leaders.

I want Barack Obama to win the presidential election. Yet I cannot show favourtism, especially to an election I cannot vote in. I just want people to read all the facts and on Tuesday tick the right box based on what they have processed and not leave their decision based on the charisma of the politicians concerned or believing the media/advertisements all the time.

Bawling and wailing

It is the second aspect of paediatrics I dislike, behind the irrational thinking of parents. I hate when children crying. I should correct myself; I don't like the continuous crying of children. Of course it is natural to cry when you unexpectedly get hurt. I don't mind this type of crying if it doesn't occur for too long.

The type of crying I cannot stand is when I am examining a child and when I place the hearing component of the stethoscope on the chest, the child starts bawling like I just stabbed him/her in the chest. I know children associate a medical examination with the consequences of having a needle stuck in you and blood being taken. Yet it is useless to cry at this stage. There is no pain (at this stage) when you are being examined and the child's parents are already there if they need help. If crying is supposed to deter the doctor from examining you, it is not going to stop us from examining children.

It is the same with blood taking. I know sticking in a needle will hurt and you will cry when the needle goes in. Yet at some point children will have to learn when one is admitted into a hospital, it is inevitable blood will have to be taken and it will hurt. It is useless crying out for your parents to help you since your parents are outside and not running into save you.

If there is something I am impressed about the situation, is the capability of children crying. The intensity, duration and frequency of their crying have made my eardrums totally damaged.

Next time I'm going to work I'm bringing earplugs or might as well just listen to my mp3 player.

A new flavour of Ben & Jerry's Ice Cream... the Credit Crunch

Whatever you like to call the current situation - the economic depression, the global downturn, the dreaded 'R' word - it is here to stay for us for a while and it will affect us all. For the first time in my life I have to be interested in economics and finance.

I hate having to focus on anything remotely linked to money. When I first heard bankers, estate agents and insurance agents losing their jobs due to the poor financial climate, the first thought which crossed my mind is: "Good". I don't really have much sympathy for people who chase money and have no morals to living their lives. I say this even though my brother works for a large bank. They have enough money in their own accounts to get by without having to claim unemployment benefits. What peeves me off is how the governments of the world are reacting. They are bailing out these banks and businesses by giving them money. This money is probably gained through the taxes of hard-working people. I know I'm a socialist but I hate this idea. You don't have to nationalize financial institutions - just let them die. People have to accept once in a while there will be a downturn in the economic climate. Shares will have to go down as well as up.

I don't think many people grasp these concepts about shares, bonds and funds. They think these magical objects will earn them loads of money if they chuck enough money at it. Many people don't just take a serious interest to go and research what they are investing in. This was the situation when the Lehman Brothers bank collapsed, with many Hong Kong people wanting to claim back compensation regarding the stock they bought in the bank. I'm pretty sure the banks who sold them these stock properly informed them about the nature of shares but common sense tells you the price of shares will go down as well as up.

There was once upon a time when all you had to do with your money is put it in the bank. Nowadays you have to invest in shares, bonds and funds. Yet you do need a little knowledge before you decide which companies to invest in. There are people who use too much time in doing this, becoming too obsessed with the stock market, and there are people who use too little time, leading to bad investments.

Also you have to consider not just saving more but spending less - don't go out dining so much, use your car less and so on. Why don't people do that instead?

Heart-breaking moments

At times it can be rather depressing working in paediatrics. You see all these kids become ill and it breaks your heart sometimes. It just not the medical problems you have to deal with - there are the social and psychological matters that arise when a little boy or girl gets admitted into hospital.

I like to state I'm a huge campaigner of human rights and I respect everybody right to have a child. Yet I feel this right is constantly abused when I see many children with bad parents. I honestly wish there was an examination prospective parents had to take to show they are competent enough to take care of kids. Doctors have to undergo medical training to acquire a license to practise and so lawyers. You need a license to drive a car or have a firearm. So why don't we have a license to take care of our most prized treasures - our children.

During my short time in paediatrics I have observed three types of bad parents:

1. The abusive parent

The abuse can come in a variety of ways: physical, sexual, spoken. I think every hospital with a paediatric department have children who are admitted for child abuse. The children can come in a variety of ages. I honestly don't know how adults can abuse unprotected children, especially their own flesh and blood.

2. The neglectful parent

These are the parents who couldn't care less whether their kid lives or dies. They occasionally take their child to a doctor but they don't care about the long-term management. They just leave their children to the TV or video games and don't really care about their academic achievements. These include parents who use their domestic helper as full time nannies and leave all the upbringing to these domestic helpers.

3. The overprotective parent

You might think being overprotective is not a form of bad parenting but I still think it is. These are the parents who don't let their kids go outside to play in case they get a cut or use the child's free time to engage in extra-curricular activities they don't like. These are the parents who constantly admit their kid into hospital just because they have a low-grade fever for a few hours, despite the accident & emergency medical officer tell them the risks of exposing the child to even more dangerous organisms in hospital.

I know parenting is difficult and not many people are taught what to do and where to go when things go wrong. I admit that I have no idea what being a parent is like. Yet there are people who want a child but have no idea what is entailed.

In the past two weeks I have seen two children whose predicament breaks my heart. For privacy reasons, I'm not allowed to mention their names or go into details about their condition. The first kid was a young boy who had been ill for two weeks with very vague symptoms - fatigue, vomiting. The boy was genuinely frightened about what was wrong with him. Turn out he had leukaemia. This is not what your kid have to go through - thinking about dying, which was probably what this young boy was thinking about.

The other kid was a young girl, a cute, adorable shy kid. She was admitted for recurrent headaches. I noticed in her medical records she was living in a hostel for youths. I asked her where her parents were and she came out directly with, "They both drug addicts." That was a shocking indictment to hear. You don't want any kid thinking their parents are bad, let alone come straight out with that statement.

Kids should never have to think about serious matters such as drug addiction and cancer. Children should be thinking about fun and jokes, not these matters. This is probably why I don't want to go into paediatrics full time. Like oncology it probably be too heart-breaking.

Lift etiquette

I know I whinge a great deal on this blog. I’m eternally sorry about this but this is the whole purpose of this blog – to get things off my chest and not to make everybody happy. Occasionally I write about good things such as television programmes I like. For this entry normal service will resume by me writing about how to use the lift (or elevator if you have bought up with American English) in an appropriate way.

It may seem such a minor point in life on how to use the lift but it just one of those things which annoys me. It is more prominent in Hong Kong, since everybody has to use a life in this metropolis of sky-rise buildings and the total lack of manners prevalent in this population. If everybody can use the lift properly, society will run much smoother.

- If the lift button has already been pressed, you don’t have to press it again. Why press it again? The lift won’t go faster to reach its destination. You only have to press the button again if you are uncertain if the button was pressed in the first place (such as the presence of a bad indicator light).
- Let people get out the lift first. This goes not just for lifts but for buses and trains. Letting people out will make more room for you to get into the lift/bus/train. You don’t have to worry – the lift won’t depart without you as most people think it will and if the door closes you can always shove you hand in or press the open button again.
- If you are getting out at the final floor (either the top or the bottom floor, depending if you are going up or down respectively), please make room for everybody else by moving to the back of the lift. It only makes sense since you will be the last person to get out of the lift and you shouldn’t be blocking the lift door like some big fat lemon.
- If you are at the lift buttons inside the lift, do the courteous thing and hold the lift doors if somebody is rushing into the lift and not close the lift doors just so you can get to your destination faster. How would you like it if somebody closed the lift doors on you?
- If you are at the lift buttons inside the lift, press the close button if everybody is inside instead of waiting for the lift to do it automatically, which can sometimes take ages.
- Be courteous and offer to press for somebody’s floor if that somebody cannot do it themselves such as the elderly who cannot see the buttons that well or people carrying heavy objects in their arms.
- If somebody at the back of the lift wants to get out and you are in the way, sometimes you do have to get out of the lift yourself so that person can pass. Don’t worry again – the lift won’t leave without you.
- Try using the stairs if you have to climb up one floor or down one to two floors. You will probably get to your destination faster if you use the stairs instead of waiting for the lift to come. I’ve seen too many health care assistants waste hospital time just by waiting for a lift when they only have to go down one floor. You only have to use the lift if you are going up several flights of stairs, you can’t walk that well (in the case of the elderly or physically disabled), you are carrying heavy objects or if you are pushing trolleys/hospital beds. You probably get some well deserved exercise as well.

All that I have written is basic common sense but nobody uses it. What I have written is based on ‘the good of society’ principle but most people operate on the ‘me first’ principle. So the next time you use the lift, keep these pointers in mind.

"We're experiencing technical difficulties at the moment..."

I won't be update this blog as often as I like over the next three months. Internet access at my hospital is difficult to come by. So forgive me if I don't answer your Facebook messages or emails as regularly as I can.

Also I won't be reading my SMS/text messages as often as I will. For some inexplicable reason, my hospital provides everybody with a Nokia 3G phone. I don't know why they don't get cheaper phones but they are pretty handy, coming with a MP3 player and camera. Basically I dverted my own phone number to my work number but it doesn't seem to divert SMS messages.

F*cking terrified for no reason

I'm currently settling into my new post as an intern for the paediatrics department . I don't know why but I'm so sh*t scared of paediatrics. My heart was racing a thousand miles per hour and I was having chest discomfort when I was on-call on Friday for no apparent reason.

I don't know why I should be afraid. All the nurses and medical officers are nice to me. The medical officers don't scold me if I keep calling them when I can't take blood or I can't insert a drip. The admissions haven't been too taxing either.

Probably I'm just traumatised by the paediatrics department of my teaching hospital, having gone through the specialty clerkship about four times.

Coming to an end...

Currently I'm finishing off my surgery rotation by being on-call. Guess I got the short straw for tonight. Thankfully I don't have to be at work tomorrow at my new place in paediatrics.

So what have I learnt from my past three months in surgery? Let's start off with the good stuff. The nurses have been very nice to me. Most of the nurses at my previous hospital were very nice to me with only a few bad apples. I'm not saying who or which ward but after I got the hang of things they were very nice to me. The nurses at D5 at the main hospital were very nice to me. You would think that being in a high-tempo situation like an admission ward would make them hormonal cows but the head of ward plus all their nurses were very good to myself and the other intern. They were so nice I treated them to my chocolate brownies!

I'm glad that I got to see many subdivisions such as colorectal, vascular, general, endocrine & breast surgery. I got to admit such varied cases such as cholangitis, acute retention of urinary and appendicitis in the admissions ward. Even though many people don't like to work in admissions since there is no continuing care and the turnover rate is quite high, with few patients lasting twenty four hours before being changed to another subdivision ward, at least I get to see a variety of cases instead of just seeing colorectal patients or neurosurgical patients.

With that said, I won't be doing surgery as my specialty. I don't see myself working those long hours and standing doing surgery all day long. The most surgery I probably will do in the future will be in orthopaedics or during family medicine. Also I'm just not compatible with the surgeon personality. Surgeons are usually headstrong and overconfident which borders on arrogance. Also it is mostly a male-predominant, jock environment with little room for emotions. Most of the surgeons I have met are nice but there are others who could use a little tact and consideration when talking to people.

I don't think I will be doing radiology either. I have ruined my chances already and I think my reputation will spread to other hospitals as well. Also I do want to have more patient contact and I don't think I will get that with radiology.

I'm not trying to offend people by saying I don't like this specialty or I don't like that specialty. It's just a personal opinion. I know a lot of people who want to go into surgery or radiology, but it is not for me. I know a lot of people don't like psychiatry but I really like it.

Well I got three months of screaming kids to handle... wish me luck (lots of it).

Expressing one's own opinion

DISCLAIMER

The views expressed on this blog are the opinion of solely the writer and does not represent the views of anybody else. What is written in this blog is not meant to offend anybody and if this is the case, the author of this blog apologizes in advance.

---------------------------------------------------------------------------------------

I feel I had to write the above disclaimer after an incident with one of my blog entries. It was a nasty surprise when I got back from my holiday in Kuala Lumpur. I knew it would be tough getting back to work after a holiday, especially since the other intern in my ward was taking his scheduled leave, but I wasn't prepared for what was in store.

I'm not going to blog much about my trip to Kuala Lumpur. All I did was see some sights and shopping. That was the intention of the holiday and it was fulfilled. I didn't take many photos either since I'm that kind of tourist. Most of the time was spent in shopping malls remarking how Hong Kong is so expensive, especially with the same foreign food like Waitrose's orange marmalade or fennel. Kuala Lumpur and Bangkok are still way ahead of Hong Kong in being termed 'a world-class city'.

When I got back to work, I was asked to see the head of our department. I didn't know what it was about but I knew it was something bad. Every time you see the headmaster is not for a good incident. Maybe a patient complained about my attitude or I did something wrong in the management of a patient.

Eventually I got to meet the head of department. It was regarding a complaint. Yet it was not from whom I thought it was. One person who I don't know and who's identity was not revealed to me complained about my blog entry 'A match made in hell'. They commented the blog entry was sexual discrimination against female radiologists.

Let me just re-iterate what I said to my head of department and to the public relations officer (who I spoke to today). The views expressed in my blog are a personal private opinion and do not represent the views of other interns, surgeons or anybody else for that matter. Even if I don't like a particular person or if I work for a friend, I will give 100% in my work and will maintain a professional relationship with my colleagues whom I work with. The comments in the blog are suppose to be sarcastic in nature - I truly don't think female radiologists' ovaries have been affected by radiation. That is just the way I write and who I am in real life - ask the people who know me best. I'm not sorry for expressing my views of what I think of female radiologists through the brief interaction I have when booking urgent investigations. I am sorry for offending anybody with my blog - this is not my intentions.

I do have some opinions of this incident (which are the opinions of this writer and not meant to offend anybody):

1. I am disappointed that one of my 'friends' passed this along to other people without confronting/facing me about the comments I made.
2. I am disappointed by the person who made the complaint for not confronting/facing me about the comments I made.
3. I am disappointed with the accusation of 'sexual discrimination'. Obviously the person who read the comment about female radiologists neglected to read the paragraph before regarding my view of male surgeons. I don't have any male surgeons making any complaints.

Please if you do have comments on my blog, please don't hesitate in contacting me. But please state who you are. I honestly find it cowardly if you don't reveal yourself.

A match made in hell...

Having been back at the main hospital for nearly three weeks, I have observed many things. From all the paperwork to cover your own arse medicine, it's been an eye opener.

One thing that hasn't surprised me is how stereotypical doctors' personalities can be. Take for example the typical male surgeon. This is a person who usually is condescending, heartless and emotionless. "Constructive criticism" and "tact" are not in their vocabulary. I have met many male residents in surgery who just look down on your and scold you for not doing something write. They can put it a bit more tactfully but I don't think that is in their nature. These are the jocks you had in high school or secondary school, who's self confidence borders on arrogance.

Another typical stereotype is the female radiologist. I have to book urgent CT & ultrasound scans all the time. Most of the male radiologists are constructive and considerate at rejecting my requests. Yet when I get a rejection from a female radiologist it's like going to the Antarctic - cold & frightening. What does radiology do to women to make them not smile? Does all that radiation fry their ovaries into secreting abnormal hormones which make them into cold cucumbers? Or does all that power of rejecting men (& women) goes to their head?

Either way I now know I'm not going into surgery and radiology.

Paperwork, signatures & ink stamps

I've just finished my second week as the house officer of the Surgical Admissions ward. Already I'm starting to feel a bit despondent about being a doctor.

I don't mind working the long hours associated with being a doctor. In fact I rather crave working, since there is nothing for me to do when I return to my room in the intern quarters. My laptop cannot play DVDs for some reason despite having the capability to do so, there's no internet connection so I cannot surf for porn and I can only take so much reading of "Pride and Prejudice" each night. Most of the time I'm just too tired to do anything active and I just fall asleep at ten o'clock at night after having a shower and brushing my teeth.

I don't mind being at the whim of the nurses either. There are a lot of tasks nurses can perform but legally cannot since they are not qualified to do so. They cannot write prescriptions or order CT scans despite knowing what it is entailed. That is where my signature and my ink stamp comes in. I accept there is much I can learn from experienced nurses about the running of a ward and what protocols and procedures need to be followed.

I don't mind my superior either. Most of the consultants & senior medical officers are nice. It's some of the residents I cannot stand. There are two resident surgeons who are obnoxious, condescending twats but I'll leave that to another blog entry, just like how I like to comment how female radiologists are such bitches.

What really gets me is the amount of hospital bureaucracy and CYOA (cover your own arse) medicine that is being practised. There are a few examples I like to share with any readers out there:

1. Whenever somebody is admitted to the Surgical Admissions ward, the interns have to fill out a sheet pertaining to which specialty the patient has to be under. If the patient has probably peeing, he/she goes under the urology team. Unfortunately these forms are really constrictive with little space to elaborate on the patient's condition. Also we still have to fill out these forms even if the medical officer has taken a history already. It's a stupid practise that seems only to happen in surgery to the best of my knowledge. Sometimes I can't be bothered to ask the patient a second time how's his poo is and just fill out the form based on the medical officer's notes.
2. Whenever a patient has a condition, there are some investigations we have to order despite the chances of them occurring are non-existent. For every person who comes in with chest pain, we have to order cardiac enzymes & CK-MB to rule out a heart attack. Anybody who comes in with tummy pain has to have his/her amylase checked to exclude acute pancreatitis. Even if the person banged his head a few days ago and comes in complaining of just dizziness the interns have to go down to the CT room and order a brain CT just to exclude any bleeding, despite having examined the person thoroughly. When did we rely so much on tests and not on our clinical judgement having asked a complete history and performed a thorough clinical examination?
3. Medical officers send us to order urgent CT scans despite knowing the chances of succeeding are remote. Why? Because they are scared of their seniors asking why they didn't TRY to book those urgent CT scans if they don't. Nobody wants to take responsibility for the patient. When nurses inform house officers of a change in the patient's condition, they don't really care about the patient's condition. They just want the responsiblity of the change in the patient's condition off their hands and into the doctors. They just want you to say the phrase, "I will check on him/her."
4. Everything has to be documented. Whenever you see the patient, look at his/her investgation results or do anything to the patient, you have to write it down, put your signature next to it and then put your ink stamp next to it just to make sure. Even if the patient has a perfectly normal chest X-ray which for no apparent reason was order, I still have to write down, "CXR: NAD" in the patient's progress notes.

All this paperwork gives me no time to practise real medicine, the one that you aspire to be and what they teach in medical school. I just wish this bureaucracy will stop.

Stupid patients

I'm rather glad the Olympics are over. It has been a very good Olympic Games, with Michael Phelps & Usain Bolt being the top stars. I just hope the changes that have been made for the Beijing Games will keep - the sporting venues are used instead of being left abandoned to disuse & the pollution levels are kept low. I also hope the local channels beef up their coverage next time, with presenters who actually know what they are talking about instead of pretty faces who have only two brain cells.

********

Even during my first week in the Surgical Admission ward, you get to see the most absurd of admissions coming in. When the Typhoon Nuri hit Hong Kong on Friday, there was this elderly lady who was blown over and suffer multiple abrasions including a knock to the head. The police didn't know who she was since she didn't have any identification on her and she was so confused she couldn't say her name. Eventually when her condition had settled she could say her name and her husband could be bought over to properly identify her. When I was setting her drip, all she was saying was, "I got hit on the head... how did that happen?" to which I replied, "There's a typhoon out there and you were blown over." I couldn't actually say what I was really thinking which was "You silly cow! Why did you go out in a typhoon?" Thankfully her condition was stable and she was mentioned in the news.

Even more absurd is the elderly man who scratches his butthole with a toothpick and then is surprised to find his bleeding out of his arse. Or what about the woman who dislocates her jaw for the second time but waits twelve hours to go to hospital despite being in considerable pain?

Really I think there is evidence for creationists to prove that evolution doesn't exist.

Working through the storm.

I'm currently at work today as intern in the Surgical Admissions Ward, even though I'm not supposed to be. Since there is a typhoon heading straight towards Hong Kong, only on-call doctors are required to be on duty. This means the on-call doctors have a lot more work to do, since there will be people admitted today despite the weather. This is a ridiculous rule that applies to house officers, since us interns are living right next to the hospital, barely 50 metres away. There might be a slight threat of us being blown over but I still think it is negligible.

I came into work because I know somebody will be swamped with work and I'm too nice a guy to allow that to happen. I know it is a huge character flaw in Hong Kong that will be exploited. My admissions ward partner didn't come in today, despite living next to me in the quarters. He has an exam in October, so he needs to study and he was on-call the last time a typhoon nearly hit Hong Kong. So I can forgive him for not coming in today. However the intern who is supposed to be on-call for the Admissions ward today says he's not coming in until 18:00. That means the on-call medical officer for admissions is being swamped.

Also many of the nurses were surprised that I was in. Most of them were grateful I was in but there were a few who said I shouldn't be there since I'm not covered by the hospital. That is really the attitude of most hospital staff - to not hold responsiblity for any actions. Everybody doesn't want to work on the day of a typhoon. Nobody wants to hold responsibilty so nurses tell house officers when a patient's condition changed. I really don't like that attitude and in the era of litigation & claims & insurance, it really prevents good medicine from being practised.

Even more Olympic criticism

So far this Olympics hasn't been marred by too much controversy. The Chinese government has effectively suppressed any demonstrations or protests by limiting them to certain areas and putting up so much bureaucracy in the way that it is virtually impossible to successful apply for a permit to protest.

There haven't been many doping offences either. Only one major doping offence that concerned a medal has appeared. So far it has been a relatively clean Olympics and I hope it stays that way. Let's hope we don't get another Marion Jones or Ben Johnson incident.

I'm still hating my local TV station's biased towards the Chinese during the Olympics. As I said before the media should be unbiased and impartial during coverage of any news, whether it is news, sports, business or entertainment they cannot put their opinions in. I say this after Liu Xiang pulled out of the 110 metres hurdles. The channel treated it like somebody important has died.

Another thing I don't like about the Olympics is how some participants swap countries just to compete in the Olympics. I just think it is wrong. You should be proud to represent your country at the Olympics. Even though I think patriotism is blind and irrational, there are times when it is warranted. Lots of Chinese athletes who couldn't get into their national team go to your countries to compete for them, including Hong Kong. There should be a rule, just like in football, that you can only represent one country during your lifetime (apart from when countries break apart like the former Yugoslavia and USSR) and you should have lived in your adopted country for at least seven years.

I'm just glad the Olympics are coming to end soon - I don't think I can stand any more Chinese propaganda at the moment.

The off-season: West Bromwich Albion

I finally made it to the last team and I was only on day over my limit. Assisting in my analysis of the last team West Bromwich Albion is the fact I haven't seen them play, not even yesterday against my team Arsenal.

Out of the three promoted teams, WBA are the most likely to stay up. They have the attacking power to score enough goals whilst they have consolidated their defence during the summer. Hopefully Tony Mowbray can do the job.

GK: Dean Kiely, Scott Carson, Michael Danek

Getting Carson was a real coup for WBA. An England international with Premiership experience under his belt and still relatively young, West Brom can have two good goalkeepers hopefully keeping the goals out.

RB: Carl Hoefkens, Gianni Zuiverloon

Really I have no idea about these two players. At least Mowbray has two players for this area.

LB: Paul Robinson, Marek Cech

Probably a better area for West Brom. Robinson has Premiership experience and was courted by other Premier League clubs during the summer. In the first game against Arsenal, Cech was pushed into left midfield, maybe indicating he may be there for the rest of the season.

CB: Leon Barnett, Neil Clement, Shelton Martis, Abdoulaye Méïté, Pele

Recruiting Meite was vital - none of the other players bar Clement has played in the top flight. This is where Mowbray may have to recruit more players than he needs and fast.

WG: Chris Brunt, Graham Dorrans

A lack of wingers could lead West Brom to play a defence style of 4-5-1. Chris Brunt is the most likely to shine in this area.

CM: Robert Koren, Jonathan Greening, Kim Do-Heon, Filipe Teixeira, James Morrison

With Greening, Koren and Morrison in the centre, the middle of the park is a solid area for Mowbray. We still have to look out for Kim whilst Teixeira might leave.

FW: Roman Bednar, Ishmael Miller, Craig Beattie, Sherjill MacDonald, Luke Moore, Bartosz Ślusarski

Probably the most crowded area for West Brown. Only Bednar, Miller and Moore could take on the Premiership whilst the rest are just too bad or unknown to me. Most like they will play 4-5-1 or 4-4-2 with Bednar partner the other young striker.

Summary

In: Winger x 2, Forward x 2
Out: Martis, Beattie, MacDonald, Ślusarski

Olympic burnout & overexposure

Unless you have been living on Mars for the past few years, the Olympics are being held in Beijing for the next two weeks. Already I'm sick and tired of the Games.

I'm not usually a great fan of the Olympics. There are a number of things wrong with the whole Olympic movement. I hate that the Olympics have to sell themselves out to companies like Coca Cola and McDonalds just to make themselves viable. The whole Olympic ideal is to be "stronger, faster, higher" and I don't think you will be doing that consuming soft drinks and burgers.

I also don't like the way the Olympics are treat by viewers. Everybody uses the Olympics for blatant country bashing; to say one country is better than another. Let's face it, you can't watch an event if there isn't anybody from your country competing. We all great when our country wins but try to make excuses when our country loses - we can never applaud the fact that our country's athletes were beaten by better athletes. In the modern age when war has been phased out (almost), the Olympics is our substitute for war.

Taking this idea that "our country is great" is the host nation itself, China. Politics and sports are not supposed to mix but China are just doing that with the Olympic Games. They are using the who event to show the world just how great they are, just glossing over the act that they have a poor human rights record, they only could just manage to hold the Games by shutting down all the factories & taking away half the vehicles off the road and they don't do much in the world politics such as matters dealing with Sudan, Burma and Zimbabwe. Why am I not surprised that they used a little girl in their little propaganda? Just read this article from BBC News and you know what I'm write about. I just hope Great Britain don't go down the same road with London 2012.

What is much worse than China using the Olympics Games as a propaganda tool is the local media coverage of the Olympic Games. Most of the Olympic Games is being broadcasted on TVB Jade, a local Chinese TV channel. Unfortunately the word "unbiased" is not what I would describe their coverage to be. I understand you will broadcast all the events China and Hong Kong are taking part. However to hear in the commentary "this just shows how great China is" or "Come on China!" is not what I want to hear. The media is supposed to be impartial, non-partisan and professional, not some crazed sports fan who has the microphone. They are not supposed to impose their own views on the event. I have heard BBC commentary on sports when England are playing. I was in USA when the Atlanta Games were on. I have never heard any of the commentators going throughout the whole coverage saying how great the nation is.

I remember eight years ago in the Sydney Olympics when one Hong Kong female TV 'reporter' (I use the word 'reporter' lightly when in essence she is a TV 'personality') when one Chinese athlete won (I think it was in the swimming events). I could hear was her screaming in delight that a Chinese swimmer one and I don't think she got a question in because she was so excited. That's when I started hating TVB's coverage of the Olympics and wished for more professionalism. If I was in Britain, at least I would be listening to seasoned sports commentators or ex-professionals who can string a sentence together. Unfortunately I'm in Hong Kong and I get TV 'personalities' and actors commentating on the Olympics. I'm sure they could find some former athletes who could commentate on the events instead of getting Dodo Cheng or Hakken Lee (yes, those are their real names).

I was going to go on about how competitors would rather compete in the Olympics than represent their own country but we still got two weeks left of the Olympics. I can rant and rave later about that.

The off-season: Stoke City

Like Hull City, Stoke will be struggling to stay up this coming season. They were hard to beat in the Championship with the impregnable defence but in the Premier League they will need more than that to stay up. I really don’t think they will be able to stay up if they continue with the squad they currently have.

GK: Steve Simonsen, Thomas Sorensen

Getting Sorensen will help bring some solidarity in between the posts. This is a goalkeeper who has experience with Aston Villa, Sunderland and Denmark. Simonsen may have been given a chance but I think Sorensen will start in goal at the beginning of the campaign.

RB: Andy Griffin, Lewis Buxton

Griffin might be an experienced right-back with Newcastle United, Portsmouth and Derby but I don’t think he has the capability to be a Premier League right-back. Clearly Tony Pulis will need recruiting in the upcoming weeks.

LB: Carl Dickinson

I have never heard of Dickinson which doesn’t say much about his playing ability. Even if Dickinson is an unfound treasure playing in the lower leagues, Stoke will still require a back-up left defender in Dickinson falls foul to any injuries.

CB: Leon Cort, Ryan Shawcross, Andy Wilkinson

In Cort and Shawcross, Stoke have two up and coming centre backs. They maybe have fantastic ability but experience is still wanting. Tony Pulls will need to bring in another centre-back, preferably somebody with experience.

WG: Liam Lawrence, Danny Pugh

Not a great line-up - a Manchester United reject and somebody who couldn’t make the grade with Sunderland. I actually think Lawrence is underrated and shouldn’t have been booted out of the Stadium of Light by Roy Keane. I still think Pulis needs to recruit a natural winger.

CM: Glenn Whelan, Salif Diao, Rory Delap, Seyi Olofinjana

Probably Stoke’s strongest area with Premier League experience with Diao & Delap plus natural flair in Olofinjana and Whelan. I don’t think Stoke will require buying players in this area.

FW: Richard Cresswell, Ricardo Fuller, Dave Kitson, Vincent Pericard, Jon Parkin

Probably not the most impressive line-up in the Premier League. None of the players actually lit up the Premier League or are twenty goals per season strikers. Fuller is chronically injured whilst Kitson was not prolific in the two seasons when he was playing in the Premier League. It will require more goals to keep Stoke City up. Even Pericard, who has played for Juventus and Portsmouth, is not in the frame.

Summary

In: 1 x Right-back, 1 x Left-back, 2 x Centre-back, 2 x Wingers, 1 x Forward
Out: Buxton, Phillips, Parkin, Pericard

The off-season: Hull City

Hull City will be in the top flight for the first time in its history, which stretches back more than a hundred years. So forgive me if I state I know nothing about how the team play or what kind of players they have. Phil Brown, who used to be Sam Allardyce's number two at Bolton before going off to Derby and failing there, will have a hard time keeping them up. In the back of his mind he knows the team won't stay up. He will have to wait out this season, pick up the parachute payments and try again the season afterwards to consolidate themselves in the Premier League.

With that said, he does seem to be attempting to stay in the Premier League from some of his summer signings...

GK: Boaz Myhill, Tony Warner, Matt Duke

Bringing in Warner gives Hull City some Premier League experience between the sticks. Although Myhill is a keeper with international experience with Wales, he's still relatively inexperienced and will be facing top strikers every week. Don't be surprised if Warner starts to be in the goal during the middle of the campaign.

RB: Nathan Doyle, Bernard Mendy, Sam Ricketts

It will be a straight fight between Ricketts & Mendy for the number two position. Doyle may move on but he's still young.

LB: Andy Dawson

Dawson still is the only left back on the squad, so it won't be a surprise if Brown recruits a more experienced left-sided defender to back-up or even displace Dawson.

CB: Michael Turner, Anthony Gardner, Wayne Brown

Hull needed to bring in a defender with Premier League experience, so bringing in Gardner on loan was a good find. They still need to bring in another central defender.

WG: Ryan France, Richard Garcia, Nick Barmby, Craig Fagan, Peter Halmosi

This is where Hull have an abundance of wealth. With Nick Barmby being the experience they need, it will alow the likes of Garcia, Fagan & Halmosi to attack without fear. France is most likely to leave though.

CM: Ian Ashbee, Geovanni, Bryan Hughes, John Welsh, George Boateng

Brown has got the best idea of bringing two veterans in the likes of Geovanni & Boateng to be the centre of midfield. It looks like club veteran Ashbee will have to take a back seat whilst Welsh needs to rediscover the form he had at Liverpool.

FW: Caleb Folan, Dean Windass

If Brown doesn't recruit now, he won't be in the job come Christmas. Goals keep you up and he doesn't have any strikers of worth. It's difficult seeing where the goals will come from for Hull City at the moment. Folan didn't exactly light the Premier League up with his previous club Wigan Athletic whilst Windass will be used sparingly due to his age. Phil Brown will have to invest in a striker with Frazier Campbell, last season's top striker for the Tigers, staying at Manchester United for the immediate future.

Summary

In: 1 x Left-back, 1 x Centre-back, 2 x Forwards
Out: Doyle, France, Welsh

Running around like Mike the Headless Chicken

I'm really thank I have been posted to my current convalescence hospital. Compared to other hospitals, the workload is lighter. I don't have to admit many emergency patients which would require asking a proper history and performing a thorough clinical examination. Most of the patients I admit are transferred from the main hospital for convalescent care or are having elective surgery. Therefore most of their details are already on our electronic database and only requires a cut & paste approach. Of course for each patient I do ask how they are doing and assess their condition but it is much easier.

Most of the blood taking is performed by the nurses but I am proficient in taking blood, since I need to do it if the nurses can't, for example if they can't find a peripheral vein, for cross matching blood and when a blood culture is required. Most of the other stuff the nurses can do but usually require the house officers' signature. Interns do get ridiculous calls from nurses just to say what the blood results were and they require the interns to do nothing, just so that they are informed. Basically the nurses are covering their arses and shelving responsibility to the interns, in case something goes wrong.

Since I'm based around four floors in the current hospital, most of the time I'm running around like a headless chicken try to do all my tasks. One manages to sort out which is necessary and what can be left to a later time but I do manage to get off work at a reasonable hour, if you call six o'clock a reasonable hour. If fact I don't mind working to late. I don't have nothing much to do in the evenings. I'm just thankful I don't HAVE to revise or study when I get back in the evenings. Eventually I will have to study, since I can't remember how to read an ECG or what to do in particular situations but that will come later. Most of the evenings I'm bored to death now. Initially I had videos to watch on my notebook. Now I've run out of videos to watch and can't download any on the hospital internet networks. So I'll have to wait until I get back home to retrieve my videos. I can't be bothered to go out since that requires money and I can't watch a movie every day. So far I have resorted to buying some books and now am engaged in the fierce rivalry between Mr. Darcy and Elizabeth Bennett (prize to the first person who knows which novel that comes from).

At times I'm grateful I am busy and at other times I wish I had something to do... like now.

In need of a booty call

I had a good call night last night, with nobody calling me between 01:00 and 08:30. It's a bit of a coincidence that the calls I have without being called in the middle of the night, I'm attached to the same doctor. With that said, my day was busy with me having to certify the death of three patients and taking massive amounts of blood for microbiological work-up. I thought I can take blood well but I've still a long way to go.

********

As a constant horndog, I'm always seem to be looking out for a girlfriend. Unfortunately my options are very limited. I'll start with my largest group - patients. If I liked very old woman this wouldn't be a problem but I still want to stay with my age group. The only lady who came close was somebody who came in for thyroid surgery - she looked like an actress I keep seeing on Hong Kong TV.

There are a couple of cute nurses in my current hospital but most of them are too old for me or too Hongkie for me. I've been teased constantly how my hospital ID photo, which was taken about seven years ago when I was thinner, does not correlate with my present appearance. Probably for this reason I'm ruling out nurses.

So what about doctors? I've always maintained in the long term I don't want to be married to a doctor. I do want to talk about something other than medicine. I have a lot of doctor friends but when they gather, I'm usually bored stiff out of my mind when they start talking about exams, patients or anything else medically related. I know I cannot date somebody who's a medical officer now even though I may be older than her - I don't want to upset the social balance of this conservative society. I don't have many options within the intern pool since everybody seems to be paired up.

What I really need is a f*ck buddy. Somebody I can pay a booty call just for sex and have no intimate relationship or attachment to. Unfortunately the idea of a f*ck buddy in Hong Kong is a farfetched as free elections, so I have to give that up.

The off-season: Wigan Athletic

If Wigan had been relegated last season, I don't think anybody would have missed them. Like Middlesborough, Bolton and Fulham, they have pitiful attendance records and other bigger teams such as Nottingham Forest or Leeds United or areas where they are no Premier League team like the West Country or Yorkshire would pull in more fans. As it is they managed to stay in the Premier League by getting rid of a bad manager (why did anybody think Chris Hutchings would do a good job?) and getting a dire manager who was struggling with his own team, Steve Bruce.

Regarding Birmingham City who were relegated, Bruce has raided his former club for players but hasn't done really much that would satisfy Wigan fans, if there are any. He still needs a major recruitment drive soon, otherwise it will be another tough season for the Latics.

GK: Chris Kirkland, Mike Politt, Carlo Nash

With Politt recently signing an extension, it will look like Nash going as he has been on loan other a few Championship clubs already and will no doubt interest many.

RB: Mario Melchiot, Ryan Taylor

With Emmerson Boyce more likely to shift to centre-back, Bruce will allow Taylor to revert back to his usual role as right-back but to be second choice to Melchiot's experience.

LB: Erik Edman, Martin Figueroa

If Bruce can tie down FIgueroa to a permanent deal, he won't have any issues in this position.

CB: Emmerson Boyce, Paul Scharner, Titus Bramble

Everybody knows what will happen here - Bramble has to leave. He's the worst player to grace the Premier League. He's the reason why we have so many foreign players in the Premiership. After Bruce has finally got rid of Bramble, his main priority is getting a couple of decent centre-backs.

WG: Luis Antonio Valencia, David Cotterill, Daniel de Ridder, Kevin Kilbane, Jason Koumas, Rachid Bouaouzan

With Bruce bringin in de Ridder, Cotterill's days are numbered at the JJB Stadium. Also Bouaouzan will be looking for a new club after doing sod all. There have been rumours of Kilbane and Koumas leaving but that would be suicide by Bruce. They are two exceptional footballers who can keep Wigan in the Premier League.

CM: Wilson Palacios, Michael Brown, Oliver Kapo

After recruiting more players from his old club, I think Bruce will stop here. He may recruit another central midfielder but he has priorities elsewhere.

FW: Antoine Sibierski, Henri Camara, Emile Heskey, Marlon King, Amr Zaki

Only Heskey and new recruit Zaki are guaranteed to at Wigan come August. King has been shopped around despite being recruited in January whilst Camara and Sibierski have fallen out of favour with Bruce. Expect at least anothe forward coming to Bruce's squad in the next few months.

Summary

In: 2 x Centre-backs, 1 x Centre-midfielder, 1 x Forward
Out: Nash, Bramble, Cotterill, Bouaouzan, Sibierski, Camara

Movie Review - The Dark Knight

I used to write for a movie site called "The Trades". The writers were a group of amateur enthusiasts covering the world of entertainment, covering box office grossings to TV shows. Whenever I had the chance I would write movie reviews for the site, especially if the film was opening in Hong Kong before it opened in USA, where the website is based. I stopped writing a few years ago - mainly because I didn't have time to go to the cinema to catch the first screening of a movie and then immediately write about the quality of the acting but mostly because I started to become more dispassionate about the quality of films. I would constantly hype myself up about a film only to be disappointed. I should stop watching too many Hollywood films and turn my attention to other world areas but it is difficult to find these films.

On Wednesday I finally found a film that lived up to its hype - "The Dark Knight". You may have heard it broke all box-office records but it doesn't say anything about the quality of the film. It is one of those films I would go back to see in the cinema again. Christopher Nolan has broken all the rules - he's made an action film with intelligence, a sequel far superior than its predecessors and a summer blockbuster which could vie for best movie of the year. Forget about Oscar nominations for Heath Ledger, you could start dishing out nominations for the film itself as Best Picture and Christopher Nolan as Best Director.

Much has been lauded about Heather Ledger's performance as the Joker. A very deep psychotic performance compared to the wacky, insane approach by Jack Nicholson, Heath Ledger totally dominates the movie. Forget Best Supporting Actor, Warner Bros. could seriously push him for Best Actor. It's a good thing they didn't try to explain the Joker's origins, which helps with the mystery.

That's not to say the other actors performances were poor. In any other film, Aaron Eckhart would be lauded as Harvey Dent whilst Maggie Gyllenhaal was radiant as Rachel Dawes. Christian Bale continues to represent Bruce Wayne/Batman well whilst you cannot fault Morgan Freeman and Michael Caine when they were on screen.

With "The Dark Knight", Christopher Nolan has truly flexed his muscles and shown he can direct and write well. The plot and storyline are intelligent down to the finest details whilst the dialogue and directing are spot on, with nothing too cliched.

See this movie, because it is the only good movie out there.

The off-season: West Ham United

Last season West Ham United were the most average team in the Premier League and probably in the world. Too good to go down but too crap to vie for European places, there season petered out by February. With the recent takeover Hammer fans should be expect to challenge for Europe. Yet the money has been tighten and Alan Curbishley needs to sell before he can, which has lead him to shed some excess weight already.

GK: Robert Green, James Walker

After Richard Wright was sold back to old club Ipswich Town, it will be just two keepers battling it out. I don't know why Green has been ignored by McClaren and now Capello in the England reckoning. He clearly is better than most English keepers around.

RB: Lucas Neill

Now with Pantsil having gone to Fulham, Curbishley will probably need another right-back but he still has the option of playing Spector here.

LB: George McCartney

West Ham United seems to be lacking full backs, with only McCartney being the only left-back. And he's not that good either. There has been rumours of Nicky Shorey at six million pounds but with purse strings being tighten, Curbishley has to look elsewhere.

CB: Danny Gabbidon, Anton Ferdinand, Matthew Upson, Jonathan Spector, James Collins, Calum Davenport

Probably a well packed area but with too many inferior players. Gabbidon, Collins & Davenport are surplus to requirements whilst Ferdinand has been shopped around since his off-the-field behaviour has been overshadowing his performances. It only leaves Upson & Spector as the real centre-backs likely to keep their places.

WG: Fredrik Ljungberg, Julien Faubert, Kieron Dyer, Matthew Etherington, Luis Boa Morte

At one point Curbishley had too many right-wingers but after getting rid of Norberto Solano and most likely to payout Ljunberg to go somewhere else the number and quality of wingers is just right.

CM: Scott Parker, Mark Noble, Hayden Mullins, Lee Bowyer, Nigel Quashie

After hopefully getting his worst buy in the form of Quashie, it is most likely Curbishley will just consolidate in this area.

FW: Dean Ashton, Craig Bellamy, Carlton Cole

After selling Zamora (which I think is a bad idea) and not keep Henri Camara, there is a need for a striker, especially with the injury problems of Bellamy and Cole's uncertain future. There haven't been any names flouted around, since it will require a considerable amount to pay for somebody decent.

Summary

In: 1 x Right-back, 1 x Left-back, 1 x Forward
Out: Collins, Davenport, Ljungberg, Quashie

Post-call + taking it on the chin

I'm currently post-call. I don't know why doctors have to differentiate between pre-call, call & post-call but they just do. My call last night was relatively good. Only had to be waken in the middle of the night once at 03:00 for fever which I should have dealt with early at midnight. That's all part of the learning process.

********

I had a relatively long weekend. When I write 'relatively' it means that - doctors don't have long weekends like other professions. My long weekend was from Saturday afternoon to Sunday night, meaning I could go home and sleep overnight. I do what I normally do at home - eat, drink & sleep plus bake. Since my dad is away on business, I can get to cook dinner which I'm not normally entrusted with, despite being quite good at. I enjoy the cooking process - creating something that other people get pleasure out of. Whether it is baking carrot muffins or baking fish in lemongrass & curry leaves, I enjoy the end result. Also it was nice seeing my dogs around and playing with them.

********

I was in the lift the other day with my supervising MO, a doctor friend of mine, when this obnoxious couple started commenting about her appearance. To give you a background I live in the most conservative society in the world where burns patients have more skin exposed than girls/ladies. This ignorant couple started commenting on my friend's dyed hair, dress sense, stockings & high heels. They regarded it as "inappropriate" for a doctor

Let me just say she was not provocatively dressed at all. My friend was not wearing a see-through low-cut top or a short skirt. She was not wearing red, three-inch, f*ck-me heels. She wears her make-up beautifully (unlike most Hong Kong ladies) and she has dyed her hair. She was dressed smartly But does this has nothing to do with her performance, her attitude or her professionalism as a doctor.

We could talk back since we don't a dreaded visit from the public relations officer, so she had to take it on the chin and just stand there whilst this couple continued their inappropriate barrage on her, just half metre away. There is always this phrase that the customer is always rights but it is wrong. Most of the time the customer is ignorant and doesn't know what he truly wants, whereas the business/service has a much better understanding of the customer needs. The customer is blinded by hearsay, rumours and dodgy advertising, so his/her view of perspective is clearly distorted.

We don't doctors in flip-flops, shorts and a tank top. But calling somebody inappropriately dressed when she clearly isn't may say something more about the caller than the target.

A good on-call day/night

I had a nice call day yesterday, what is described in my profession as "complete bed rest". You need to be a doctor to understand that type of humour.

The day didn't start off that well. I was admitted patients when I heard one of the health care assistants shouting one of the patients had collapsed. Since I was the only doctor around, I raced over to check what was going on. The patient became unconscious whilst walking to the toilet and fell forwards, banging her head & cutting her lip. I checked to see if she was responsive (no) but if she was still breathing & had a pulse (yes to both). I didn't know the patient that well since she's not on my team but had to do a quick assessment. It felt unnecessary since one of the medical officers was going to document her condition anyway but I felt as the first doctor there that I at least should write something.

In the end it didn't really matter. Three hours later the patient passed away. Her condition deteriorated very rapidly. I'm just surprised at how patients can go from being good & walking around to being comatose and near death.

********

The medical officer that I was on-call with last night was a good friend of mine. Whatever people say about her, she's a nice girl. It is slightly awkward having a friend as your senior. In the presence of other people I would call her "Dr. Chow" but if nobody is around I would call her by her first name. I know it aggravates a lot of people but in this situation she's not my pal but my superior. She's the one who tells me to do things, whether to write up discharge summaries or consultations. I just have to remind myself she's doing her job and so am I.

The off-season: Tottenham Hotspurs

We knew Ramos will do a clearout of some of the players in his squad. It is surprising that only a few players have left so far, with Cerny only the one that springs to mind. By August most of the peripheral players and even some stars will have left White Hart Lane with new players joining in.

GK: Paul Robinson, Ben Alnwick, Heurelho Gomes

With Robinson culpable of many mistakes last season, Ramos needed a more reliable goalkeeper. In stepped Gomes Gomez from PSV but will he be enough to propel Spurs to a top four finish?

RB: Alan Hutton, Pascal Chimbonda, Paul Stalteri, Chris Gunter

We all know Chimbonda is an arse and wants to leave to greener (i.e. richer) pastures. With Stalteri also likely to go, it will lave Hutton and Gunter fighting out for the number two shirt.

LB: Gareth Bale, Gilberto, Lee Young-Pyo, Benoit Assou-Ekotto

With far too many inadequate left backs, surely a few must leave during this summer. Players from the former regime such as Lee & Assou-Ekotto are set to depart White Hart Lane whilst Gilberto may stick around for another season. Ramos will want to use Bale more in his most ideal position of left-back

CB: Ledley King, Jonathan Woodgate, Michael Dawson, Ricardo Rocha, Younes Kaboul, Anthony Gardner

There have been rumours of King leaving Spurs this summer due to his constant injury plights but it will be difficult to replace his quality. More likely to go are Rocha, Kaboul (who maybe going to Portsmouth) and Gardner. That leaves a slot free to fill.

WG: Aaron Lennon, Steed Malbranque, Teemo Tainio

This is where Ramos might consider investing a lot of time and money in. He really doesn't have many natural wingers. Malbranque and Tainio are wide attacking midfielders, leaving only Lennon as the only out and out winger. He may consider playing Modric or dos Santos in the wide areas though.

CM: Didier Zokora, Jermaine Jenas, Kevin-Prince Boateng, Adel Taarabt, Tom Huddlestone, Jamie O'Hara, Luka Modric, Hossam Ghaly

We all know Ghaly was expected to leave and maybe followed by Boateng but I'm surprised that O'Hara and Taarabt might be on their way. They are both technically gifted playmakers who will do well in any Premier League team. That said there are far too many midfielders at Tottenham and to make room some have to go.

FW: Dimitar Berbatov, Robbie Keane, Darren Bent, Giovani dos Santos

Even though Bent was worthless last year, it will be difficult for Spurs to shift him to any other team if they want to recoup any of the 16 million pounds they paid for him last summer. But they did get a good bargain on dos Santos, For just 5 million pounds, he has got to be bargain of the season already.

Summary:

In: 1 x Right-back, 1 x Centre-back, 1 x Winger
Out: Robinson, Chimbonda, Stalteri, Lee, Assou-Ekotto, Rocha, Kaboul, Gardner, Tainio, Boateng, Taarabt, O'Hara, Ghaly

Settling in...

I'm finally settling into my job as a lowly intern. 90% of my job involves paperwork - filling up the drug chart or writing a discharge prescription; writing up admission management orders; booking follow-ups; writing admission notes or discharge summaries. The only thing that differentiates me from a nurse is my signature. Most nurses I know are experienced enough to know the bureaucracy of our health care system and how to navigate through it but require my signature for the authorization to do anything. I get through 90% of my paperwork without any mistakes but it is nice there is somebody like a nurse to correct me. Unfortunately none of the nurses at my current hospital are sexy.

All this mind-numbing copying of previous notes and orders has left my brain dull. Most of my clinical sense has gone out the window and I'm afraid without it I might kill a patient. I nearly did on Sunday. A patient developed a fever at 6 am. I diagnosed it as pneumonia and did what I normally would do - take blood for culture and laboratory tests plus gave her oral antibiotics. At 9 am she developed a low blood pressure. I ordered IV fluids & antibiotics for her and basically was about to leave before somebody reminded me what her blood pressure actually was. After looking at her blood pressure and nearly freaking out, I eventually called the medical officer on call. Before long the patient was sent to the Special Care Unit because of septic shock. I just hope I develop back my clinical sense so I don't kill another patient.

Doing procedures is starting to become much easier for me now. I almost proficient in venous blood sampling but my arterial blood sampling is still in need of practise. I had to take an arterial blood sample from a patient today. I'm fortunate the patient was in a state of stupor, since I had to poke her a few times before I could take enough to perform an arterial blood gas. I'm also relieved I could catheterise a patient's bladder without any major hitches, even though the last time I performed an urinary catheterisation was a year ago... on a dummy.

What surprises me most is the number of deaths I had to certify. In a convalescent hospital , we don't get many emergency cases. However we do get a number of terminal patients with "Do Not Resuscitate" orders. Yet it seems my luck that I had to certify three deaths in a four day spell, all of them when I was on call. Compare this to the other interns in the hospital, who haven't had any, and you start to think you have a black cloud following you.

I'm not looking forward to my next call on Friday if this keeps happening.

********

Yesterday I had afternoon tea with two of my best friends at the Peninsula. I was quite surprised that we had to queue for something like this. The food was actually very good. I loved the scones with clotted cream and strawberry jam. How I miss English food! And the tea was very good - it didn't need milk to be enjoyed. I was disappointed they didn't have any cup cakes or french fancies but you can't have everything.

Of course I'm going to whine that I could all that at home - serve tea with scones and everything else. But I have to realize not everybody could do that and sometimes the experience is more important than the food itself.

The off-season: Sunderland

I'm in the middle of my lunch break right now, so excuse me if this entry seems a little truncated.

I reckon Sunderland were fortunate to survive last season. Roy Keane is a good motivator and coach but his prowess in the transfer market is a little less desired than most. He needs to make more astute signings over the next two months to consolidate the Black Cats' position in the Premier League.

GK: Craig Gordon, Darren Ward, Martin Fulop

Even though Gordon had a slippery patch last season, he's still considered the No. 1 at the Stadium of Light and most likely Ward will back him up. Fulop has been courted by many Championship clubs so he is most likely to leave.

RB: Phil Bardsley, Greg Halford

Roy Keane should cut his loss on Halford and just sell him instead of loaning him out. He doesn't need a back-up since he has many players who can also play in the right back role such as Whitehead & Nosworthy.

LB: Danny Collins

After letting Ian Harte go and playing a centre back in this position, Keano will need to get a left-back as one of his priorities.

CB: Nyron Nosworthy, Paul McShane, Danny Higginbotham, Russell Anderson

With Anderson most likely to go, I think Roy Keane should go an experienced centre-back to balance the back line.

WG: Carlos Edwards, Roy O'Donovan, Kieran Richardson, Ross Wallace

Keane has already stated Wallace can go, despite the fact he's not bad and versatile. With Richardson and Edwards spending most of last season in the treatment room, this is another area Keane needs more numbers in.

CM: Dickson Etuhu, Dean Whitehead, Liam Miller, Greg Leadbitter, Dwight Yorke, Andy Reid, Graham Kavanagh, Arnau Riera

Everybody knows Riera, Kavanagh and Miller have fallen out of favour with Keane. So you won't be expecting them to be at Sunderland in August.

FW: Anthony Stokes, Daryl Murphy, Michael Chopra, Kenwyne Jones, David Connolly, Martin Waghorn, Rade Prica

This is where Roy Keane has the most trouble with. He seems to buy hopeless strikers and even his best striker Jones has trouble scoring. I'm sure he will keep everybody apart from Connolly but I still think he needs another striker.

Summary

In: 1 x Centre-back, 1 x Left-back, 1 x Forward
Out: Fulop, Halford, Anderson, Wallace, Miller, Kavanagh, Riera, Connolly

Many firsts

Everybody seems to remember their first time for everything. The first time they kissed a girl or boy for example. It is suppose to litter your life with memorable events that you look back on when you're older. In my short lifespan as a slave to the Hospital Authority, I've experience quite a number of firsts. Not all of them were great but some where.

I had to deal with my first difficult patient in the General Clinic, who insisted having a colonoscopy despite there was really nothing wrong with him. Yeah, he was a bit constipated and was reliant on medication to take a dump but the guy was in his late fifties and most people are starting to depend on lactulose or senna to prevent constipation at that age. Thankfully the medical officer in charge stepped in to save me from the hassle of dealing with this patient. I was eternally thankful, having been arguing with the patient for more than ten minutes. I'm just grateful these people are a minority.

I've been approached by my first drup rep during my shift in the Breast Centre. I don't know why they put a guy in the Breast Centre but they did. Probably more disappointing was the gender of the drug rep - it was a guy. I know most the drug reps in the industry are women, just to entice the male doctors into buying drugs they don't need to prescribe. Thankfully he was courteous enough to explain the drug trial I knew nothing about, about a drug I knew nothing about and gave me a free gift - a placemat for your car to prevent items like your keys and mobile phone sliding all over the place. I know it must sound daft to some people to think this is your highlight for the day but it just reminds you that you're a doctor and these people are giving you a bit of respect for what you are.

The last 'first' I'm going to write about is one 'first' I didn't expect to be doing. I was on call last night and after having done the night round, I was settling in for an episode of 'Bones' before I got a call from the nurse. I had to certify the death of a patient. My mind thought, "Jesus Christ! Isn't this suppose to be a job of a medical officer!" I was going to ask the nurse to phone the medical officer instead to certify the death. Yet I thought I will eventually have to do this. So after getting changed quicker than an adulterer who hears the partner coming into the house, I whizzed to the ward and at the same time brushed up on my knowledge on how to certify the death of a person. I had seen it done before but I had to make sure since this was somebody's life (or death as it was).

After reaching the ward and asking the patient's sisters to wait outside the room while I conducted the examination. It just dawned at me at that point this was no longer a person but just a body. I know it sounds harsh and cold but it is true. I just had to get this over with, with respect, dignity and professionalism. After making sure I had all the signs to confirm death and double checking just to make sure, I told the relatives that their brother had passed away and I was sorry. I had to get down to the business of writing all my findings and documenting everything. I had to call the medical officer on-call just to inform her what I did.

Probably what scares me most is that I don't know the patient's name - even now after 18 hours post-mortem. I think it is easier for me to not know, to actually detach myself from the event and not to personalize it. The patient (whoever he was) was from a different team which I'm normally attached to during the day. I just so happened to be the house officer on call who had to perform the necessary duties. It just is a fact of life.

I just hope that I don't encounter too many of these incidents in my career.

Week 1 out of 52

I'm one week into my intern life and I'm learning quite a lot. I'm not learning much medicine as it is. The life of a house officer is basically to learn the mundane bureaucracy and protocols that come with daily life in a hospital structure or within a health care system. You learn to know which drugs to prescribe, when you can book a follow-up clinic, how to write up discharge summaries and which people to consult for particular patients.

Perhaps I'm being too harsh since I'm based at a convalescent & rehabilitation hospital. Most of the patients I admit into the hospital have already been assessed a number of times by more senior doctors. So when they come into have surgery there is really no point asking them a history or performing a physical examination since it does really help his/her management and more important it wastes my time. Most of the time I feel I'm treating a laboratory result or a finding, which I know I've got to stop. Every time a patient has low potassium levels, I should be stopping myself prescribing potassium chloride syrup and actually go to the patient, assess his/her status and then think about some management. I hate to say it but I think my mind is being numbed. The pay off is that the work is not that taxing and my calls are not that harsh. I will probably miss having a good night's sleep when I'm on call in the admission ward but I think my mental thinking will benefit a lot more.

After this week I know which doctors and nurses are nice and who is a real bastard or bitch. Fortunately those are a minority but it does make your life hell. Thank goodness I've only got five more weeks of this. The doctors and nurses who I don't like expect you to know everything and when you don't they give you a really hard time about it. They don't know about insight or putting themselves into other people's shoes.

For once I'm really glad I have my evening free. I'm glad that I'm not revising my exams and being under pressure. I'm glad that I'm just reading for my benefit and not for the benefit of somebody else. I'm glad I have the evenings to sleep and watch episodes of "House" and "Bones" that I have (illegally) downloaded off the internet before my internship.

The off-season: Portsmouth

It's been a long time since I did an analysis on a Premier League team. Since the last time there have been many changes and a lot more transfers. I won't be going back to revisit my past analysis despite the movement.

After winning the FA Cup, Portsmouth will be needing to maintain this form otherwise they will be going backwards. This will be dependent on who Redknapp brings in.

GK: David James, Jamie Ashdown

Having the best English goalkeeper, Portsmouth doesn't need to bring in an extra goalkeeper and Ashdown is adequate enough as back-up.

RB: Glen Johnson, Lauren

With Johnson rediscovering his form, there is no need to reinforce in this area.

LB: Hermann Hreidarsson, Djimi Traore

With Traore seeming to go, hopefully Redknapp can keep Aubey to keep two left-backs.

CB: Linvoy Primus, Sylvain Distin, Noe Pamarot, Martin Cranie, Sol Campbell

Distin & Campbell are great and tough to budge, so Redknapp might want to consider getting some young back-ups since Primus and Pamarot are ageing whilst Redknapp doesn't seem to have faith in Cranie. However he won't be doing it this summer.

WG: John Utaka, Glen Little, Franck Songo'o, Sulley Muntari, Niko Krancjar

With Songo'o effectively out of the picture, I still think Redknapp will like to bring another winger. Muntari's best position is in left central midfield rather than an out-right winger. Bringing in Little reinforces the right side.

CM: Lassana Diarra, Papa Bouba Diop, Richard Hughes, Sean Davis, Pedro Mendes, Antonio Mvuemba

The best area for Portsmouth, so much so that many of the players will leave. Only Diarra and Bouba Diop are certain to stay. I think Hughes is the most likely to leave and Davis won't be far behind.

FW: Nwankwo Kanu, David Nugent, Jermaine Defoe, Ben Sahar

By bringing in Sahar, I think Nugent can effectively say goodbye to his career at Portsmouth. I don't know why Redknapp bought him in the first place. I think the leap was too far for the one-cap wonder but he's still young enough to recover.

Summary:

In: 1 x Left-back, 1 x Winger, 1 x Forward
Out: Traore, Songo'o, Hughes, Davis, Nugent