Saturday, February 2, 2008
Thursday, January 24, 2008
NVS
It's been close to a month since I've started seeing pts at NV. The school is housed in the middle of housing flats in Yishun, and the building is 19 years old and counting. The architecture and layout reminds me of the old RJ compound, small, but cosy, a rather homely feel.
The students that I've seen by far are the worst behaved amongst the 3 schools that I've been to. However, the encounters I've had were much more interesting as compared to the other two schools. Population wise, this school has the smallest enrolment. There are only 3 express classes, and 5 other Normal classes.
On some days, I can really be driven crazy by the din that is created by the rowdy students. They usually come in their cliques, and usually it's a all-or-none strategy employed by such students. You either see none of them, or take in the whole jing bang, rowdiness and all. They would refuse to go back to class after you're done with one of them, and they would only leave together when the clique has completed treatment. On some occasions, the clique would refuse to leave, choosing instead to stay in the mobile to enjoy the aircon, expressing their fascination at our 'microwave'(autoclave) oven, playing with the extra chair or simply, being a nuisance. My nurse was worried that the staff may be unhappy with the students staying unnecesarily, but I'm thinking, the teachers should be grateful to us for taking all these students in, who would otherwise disrupt their lessons in class, judging from their behaviour in our mobile.
Some of the students are clearcut disciplinary cases. Most of them come with tongue studs, lip piercings and what have you. Interestingly, they are often the ones who complain that scaling is painful. To me, that tongue piercing of 3mm in diameter looked much more daunting than my scaler tip. Some come in with nicotine stainings and equally potent breaths to match, and are currently under counselling for smoking cessation. They represent the modern Hokkien Shakespeare, and exhibit proficiency in dishing out vulgarities in 3 out of the 4 national languages.
There were even three students organising a group confrontation in my mobile when one of them was recieving dental treatment. One of the them(from sec1) had been 'diaoed' by a sec 2 boy, and the sec 3 students were planning to call in reinforcements to support their confrontation. Apparently, they operate by neighbourhoods. Members at Admiralty are too far to render any support. Yishun members had to be rounded up for the 'big' event.
Of course, there are the perennial jokers. One guy who required root canal treatment for a decayed tooth insisted that I 'knock his head, make him sleep' and give the injection. I duly rejected. There was no need to sacrifice his continued cognitive development for an infiltration.
In general, it has been a culture shock, as well as an eyeopener. Previously, the most rebellious act I've done in school was to turn up late for school. My school life really paled in comparison. However, it is disheartening when you think of them as kids who had just left primary school 3 years ago, but changing from innocent young kids to such rebellious teens. But well, in my short encounters with them, I do advise some of them to work hard for their future. Hopefully, some of my advice had had some effect. Meanwhile, I shall pray that my sanity will be preserved in the midst of the ruckus that the cliques create during my screening sessions.
The students that I've seen by far are the worst behaved amongst the 3 schools that I've been to. However, the encounters I've had were much more interesting as compared to the other two schools. Population wise, this school has the smallest enrolment. There are only 3 express classes, and 5 other Normal classes.
On some days, I can really be driven crazy by the din that is created by the rowdy students. They usually come in their cliques, and usually it's a all-or-none strategy employed by such students. You either see none of them, or take in the whole jing bang, rowdiness and all. They would refuse to go back to class after you're done with one of them, and they would only leave together when the clique has completed treatment. On some occasions, the clique would refuse to leave, choosing instead to stay in the mobile to enjoy the aircon, expressing their fascination at our 'microwave'(autoclave) oven, playing with the extra chair or simply, being a nuisance. My nurse was worried that the staff may be unhappy with the students staying unnecesarily, but I'm thinking, the teachers should be grateful to us for taking all these students in, who would otherwise disrupt their lessons in class, judging from their behaviour in our mobile.
Some of the students are clearcut disciplinary cases. Most of them come with tongue studs, lip piercings and what have you. Interestingly, they are often the ones who complain that scaling is painful. To me, that tongue piercing of 3mm in diameter looked much more daunting than my scaler tip. Some come in with nicotine stainings and equally potent breaths to match, and are currently under counselling for smoking cessation. They represent the modern Hokkien Shakespeare, and exhibit proficiency in dishing out vulgarities in 3 out of the 4 national languages.
There were even three students organising a group confrontation in my mobile when one of them was recieving dental treatment. One of the them(from sec1) had been 'diaoed' by a sec 2 boy, and the sec 3 students were planning to call in reinforcements to support their confrontation. Apparently, they operate by neighbourhoods. Members at Admiralty are too far to render any support. Yishun members had to be rounded up for the 'big' event.
Of course, there are the perennial jokers. One guy who required root canal treatment for a decayed tooth insisted that I 'knock his head, make him sleep' and give the injection. I duly rejected. There was no need to sacrifice his continued cognitive development for an infiltration.
In general, it has been a culture shock, as well as an eyeopener. Previously, the most rebellious act I've done in school was to turn up late for school. My school life really paled in comparison. However, it is disheartening when you think of them as kids who had just left primary school 3 years ago, but changing from innocent young kids to such rebellious teens. But well, in my short encounters with them, I do advise some of them to work hard for their future. Hopefully, some of my advice had had some effect. Meanwhile, I shall pray that my sanity will be preserved in the midst of the ruckus that the cliques create during my screening sessions.
Saturday, January 12, 2008
Yesterday, the mobile DOs made our way back to HPB to attend the briefing on the workplan for HPB for this year. Figures and numbers had been bandied about, and we were told to improve on the targets set last year. Sometimes I wonder,statistics is used by the administrators to rate performances and determine the employees' efficiency and work quality. However, in clinical situations, numbers simply do no justice to the complexity of clinical practice. Grey areas do exist. Sometimes, compromises are made in the pursuit of fulfilling the numerical targets. Well.. but I guess there's not better way to go about evaluating the performance of an institution.
Anyway the briefing ended early, and we managed to sneak out to Clarke Quay, bidding a silent farewell to koffAahemBkoffT. Had lunch at Azabu Sabo(is it spelt like this?), tried the Hokkaido hotball. It tasted like fried potato or sweet potato, topped with vanilla ice cream, red bean and Japanese sweet potato. DS tried a dessert similar to an expensive chocolate ice kachang, minus the jelly beans. The food there looked rather promising, will go back one day to try their main courses.
Attended the NUS symposium today, saw many familiar faces, seniors, Profs and other clinical instructors. The lecturers were rather engaging, especially Prof Stanley Malamed. Americans seem to have a way in lecturing, they're always more engaging, more interesting than the rest, and the way they weave anecdotes into their script is amazing. The other Italian speaker spoke on usage of MTA, and some of his philosophies are rather radical, from my personal point of view, well... take the stuff with a pinch of salt I guess.
Tomorrow will be a packed day of lectures again. Time to zzz..
Anyway the briefing ended early, and we managed to sneak out to Clarke Quay, bidding a silent farewell to koffAahemBkoffT. Had lunch at Azabu Sabo(is it spelt like this?), tried the Hokkaido hotball. It tasted like fried potato or sweet potato, topped with vanilla ice cream, red bean and Japanese sweet potato. DS tried a dessert similar to an expensive chocolate ice kachang, minus the jelly beans. The food there looked rather promising, will go back one day to try their main courses.
Attended the NUS symposium today, saw many familiar faces, seniors, Profs and other clinical instructors. The lecturers were rather engaging, especially Prof Stanley Malamed. Americans seem to have a way in lecturing, they're always more engaging, more interesting than the rest, and the way they weave anecdotes into their script is amazing. The other Italian speaker spoke on usage of MTA, and some of his philosophies are rather radical, from my personal point of view, well... take the stuff with a pinch of salt I guess.
Tomorrow will be a packed day of lectures again. Time to zzz..
Wednesday, January 2, 2008
Thursday, November 29, 2007
I've got a sticker!
Another patient made my day again.
Let's call this guy A. A is a 4 yr old boy, came in, sullen sulky, recipe for a crying,screaming kid.
He was a walk-in case, and had complained of pain, which disturbed his sleep for a night, and was painful when he bit down on food. The mother was worried, and had taken leave to bring the patient back for a consultation.
The previous visit was a relatively smooth one with acclimatization and 2 small fillings done, but the mother mentioned that he was reluctant and resistant towards coming back after that visit. Wow I thought, damn, how should I convince this kid to work with me, when he was already resistant towards treatment, and had severe pain the night before.
Starting from the entrance of the cubicle, the patient had refused to come in. Mother brought the kid around the other cubicles and showed him how the rest were responding well to treatment. Thankfully, no crying wailing kids were present at that time. If not, it would be a tough case of persuasion.
Next, he made the entry successfully,but refused to sit on the chair.He was totally unresponsive, didn't speak a word, didn't left an arm or leg to get onto the chair, his mother had to carry him onto it.
Coming on, opening his mouth. He pursed his lips tighter everytime his mother asked him to open for me. After using the big fat uncle threat and the 'going home with me,since you don't want to open for me' threat, he finally opened. Sticking my finger in, I refused to budge, lest he shuts his mouth when I remove it.
Taking an xray for him, I realised that the area that he pointed to was not giving him the problem, but the back tooth. Unable to give anaesthetic solution, I could only manage to scoop out decay with my insturments and used a little of my handpiece, amidst a crying, moving head. I was so certain that I'd mutiliate his cheek, but thankfully, I didnt. Stuffed a medicated cotton pellet in, and tampahed a temporary dressing. All this while, the mother helped by convincing the kid not to shut his mouth on my rotating handpiece.
The mother then egged me on to do the second filling for him, as she was convinced that the child would not return for a second time. I agreed and made the kid hook fingers with me, saying that he must promise me to behave, if not I'll be very sad. Upon lowering the chair, the kid shut his mouth tight again. Damn.. urgh, spent the next few minutes coaxing the kid and the mother was asked to leave. Miraculously, this time round, the child opened, and we were able to place in a permanent filling.
The kid was a completely changed person after getting off the chair. He was bubbly, smiling at his mother, and he even gave me and my nurse two stickers from his collection. He promised me to behave better the next time round. Well hopefully he keeps to his promise. I'm feeling rather happy that I am able to alleviate his pain for him, and you can see the transformation in his behaviour, from a sullen kid to a smiling one. This is the satisfying part of the job that keeps us going I guess, to be able to help others solve their problems and enjoy their food and playtime better.
Ok, back to work again! Let's hope this day will be as good a day as yesterday. Going to extract a tooth for my appointment kid later, let's hope it'll be a smooth one.
Let's call this guy A. A is a 4 yr old boy, came in, sullen sulky, recipe for a crying,screaming kid.
He was a walk-in case, and had complained of pain, which disturbed his sleep for a night, and was painful when he bit down on food. The mother was worried, and had taken leave to bring the patient back for a consultation.
The previous visit was a relatively smooth one with acclimatization and 2 small fillings done, but the mother mentioned that he was reluctant and resistant towards coming back after that visit. Wow I thought, damn, how should I convince this kid to work with me, when he was already resistant towards treatment, and had severe pain the night before.
Starting from the entrance of the cubicle, the patient had refused to come in. Mother brought the kid around the other cubicles and showed him how the rest were responding well to treatment. Thankfully, no crying wailing kids were present at that time. If not, it would be a tough case of persuasion.
Next, he made the entry successfully,but refused to sit on the chair.He was totally unresponsive, didn't speak a word, didn't left an arm or leg to get onto the chair, his mother had to carry him onto it.
Coming on, opening his mouth. He pursed his lips tighter everytime his mother asked him to open for me. After using the big fat uncle threat and the 'going home with me,since you don't want to open for me' threat, he finally opened. Sticking my finger in, I refused to budge, lest he shuts his mouth when I remove it.
Taking an xray for him, I realised that the area that he pointed to was not giving him the problem, but the back tooth. Unable to give anaesthetic solution, I could only manage to scoop out decay with my insturments and used a little of my handpiece, amidst a crying, moving head. I was so certain that I'd mutiliate his cheek, but thankfully, I didnt. Stuffed a medicated cotton pellet in, and tampahed a temporary dressing. All this while, the mother helped by convincing the kid not to shut his mouth on my rotating handpiece.
The mother then egged me on to do the second filling for him, as she was convinced that the child would not return for a second time. I agreed and made the kid hook fingers with me, saying that he must promise me to behave, if not I'll be very sad. Upon lowering the chair, the kid shut his mouth tight again. Damn.. urgh, spent the next few minutes coaxing the kid and the mother was asked to leave. Miraculously, this time round, the child opened, and we were able to place in a permanent filling.
The kid was a completely changed person after getting off the chair. He was bubbly, smiling at his mother, and he even gave me and my nurse two stickers from his collection. He promised me to behave better the next time round. Well hopefully he keeps to his promise. I'm feeling rather happy that I am able to alleviate his pain for him, and you can see the transformation in his behaviour, from a sullen kid to a smiling one. This is the satisfying part of the job that keeps us going I guess, to be able to help others solve their problems and enjoy their food and playtime better.
Ok, back to work again! Let's hope this day will be as good a day as yesterday. Going to extract a tooth for my appointment kid later, let's hope it'll be a smooth one.
Happy Day
Much fewer files stacked up today, fewer crying kids( for me at least), and that really made my day. At least I didn't make anyone cry, and I was able to help my colleague finish up treatment who was being difficult.
However, I shall blog about this patient who made this day special, in a way.
Let's call her S, she's 12 and was referred for a filling on a baby tooth. When I saw her, she looked like any 12 year old, dressed in ill fitting jeans too long for her legs. S was accompanied by her grandmother who was more conversant in Malay. I noticed that S hardly spoke a word, and most of the talking was done by her grandmother. I took it as a sign that she was really scared and didn't take too much notice of it.. I mean, who wouldnt be scared of a visit to a dentist for a large filling, which may involve needles and all.
Upon examination, the decay was so severe, so I decided to take an xray to check whether adult teeth were present underneath, to decide on the next course of treatment. In the xray room, I asked S to stand straight to take the large Xray, since she was unable to tolerate the small film, threatening to throw up on me a few times. She started crying and was being difficult. In my mind, I just wanted her to listen to me and get it over and done with.. it was just an xray, I thought and more treatment may need to be done after that and it was close to the end of the day. After coaxing and adjusting her final position and asking her not to move for the umpteenth time, we managed to coax a xray out of her.
While waiting for the film to be developed, I chatted with S, with me doing most of the talking, I lifted the salivary ejector to remove some saliva and she did a little jump, which shocked me cos tears started rolling down her eyes. When I tried comforting her, I realised that her body was very tense, and her hands were cold.
The film came, and her grandmother was asked in to discuss the treatment plan A Malay nurse had taken over as interpreter. Plan was to chabok(take out) the 'rosak'(bad/spoilt) gigi(tooth), I explained in halting Malay, since the adult tooth is erupting soon anyway. S did what any other kid would have done, she cried and shut her mouth. Since she was 12, I didn't want to force treatment on her, and tried rationalising. She opened reluctantly, and the tooth was removed successfully, after my story about swallowing the worm into the stomach and giving her very painful stomach aches, not moving when I'm injecting (I'm blowing a magic balloon into your mouth, so you better not move, if not, the balloon will burst).
After which, unexpectedly, the grandmother shared with S's story. S is studying in a special school. Her dad had passed on, mum is working 12 hr shifts and she has two brothers and one sister. The 2 brothers are being taken care of by her grandmother, while S and her sister stay in an orphanage, as her mother has no time to take care of them, rushing to make ends meet. S would probably have been through a lot during this while, and I wonder if I could have been more understanding towards her behaviour.
Many a times, kids in our clinic come and go, some are really difficult on the surface, but there could be other underlying reasons that we don't know about, that have caused them to behave that way. They may be crying, wailing their lungs out, but that could be their way of seeking attention from their parents who may be too busy to interact with them during other times. I must admit, that it is hard to be understanding towards the kid's needs, when you get a hysterical kid screaming into your ears, threatening to burst your ear drums. However, the lesson behind this incident is that people behave in a certain way for a particular reason, and you may only truly understand when you interact more with your patients. I'm honoured that the grandmother had decided to confide S's background with my nurse and I, and I'm also thankful that the system in the clinic allows me to spend time to interact and understand more about my patient. In other clinics, due to manpower constraints and the large number of patients who are waiting to seek treatment, dental treatment is a drill,fill,bill job and it's hard to inject a personal element into a dentist-patient relationship, when you're just getting your job done and waiting to send off this patient and see the next. That's a common trait in most public healthcare systems in many countries, and I guess it'll be hard to change this deeply entrenched trait locally.
Ok, enough of rambling, countdown to Leave Day! 5 more days!
However, I shall blog about this patient who made this day special, in a way.
Let's call her S, she's 12 and was referred for a filling on a baby tooth. When I saw her, she looked like any 12 year old, dressed in ill fitting jeans too long for her legs. S was accompanied by her grandmother who was more conversant in Malay. I noticed that S hardly spoke a word, and most of the talking was done by her grandmother. I took it as a sign that she was really scared and didn't take too much notice of it.. I mean, who wouldnt be scared of a visit to a dentist for a large filling, which may involve needles and all.
Upon examination, the decay was so severe, so I decided to take an xray to check whether adult teeth were present underneath, to decide on the next course of treatment. In the xray room, I asked S to stand straight to take the large Xray, since she was unable to tolerate the small film, threatening to throw up on me a few times. She started crying and was being difficult. In my mind, I just wanted her to listen to me and get it over and done with.. it was just an xray, I thought and more treatment may need to be done after that and it was close to the end of the day. After coaxing and adjusting her final position and asking her not to move for the umpteenth time, we managed to coax a xray out of her.
While waiting for the film to be developed, I chatted with S, with me doing most of the talking, I lifted the salivary ejector to remove some saliva and she did a little jump, which shocked me cos tears started rolling down her eyes. When I tried comforting her, I realised that her body was very tense, and her hands were cold.
The film came, and her grandmother was asked in to discuss the treatment plan A Malay nurse had taken over as interpreter. Plan was to chabok(take out) the 'rosak'(bad/spoilt) gigi(tooth), I explained in halting Malay, since the adult tooth is erupting soon anyway. S did what any other kid would have done, she cried and shut her mouth. Since she was 12, I didn't want to force treatment on her, and tried rationalising. She opened reluctantly, and the tooth was removed successfully, after my story about swallowing the worm into the stomach and giving her very painful stomach aches, not moving when I'm injecting (I'm blowing a magic balloon into your mouth, so you better not move, if not, the balloon will burst).
After which, unexpectedly, the grandmother shared with S's story. S is studying in a special school. Her dad had passed on, mum is working 12 hr shifts and she has two brothers and one sister. The 2 brothers are being taken care of by her grandmother, while S and her sister stay in an orphanage, as her mother has no time to take care of them, rushing to make ends meet. S would probably have been through a lot during this while, and I wonder if I could have been more understanding towards her behaviour.
Many a times, kids in our clinic come and go, some are really difficult on the surface, but there could be other underlying reasons that we don't know about, that have caused them to behave that way. They may be crying, wailing their lungs out, but that could be their way of seeking attention from their parents who may be too busy to interact with them during other times. I must admit, that it is hard to be understanding towards the kid's needs, when you get a hysterical kid screaming into your ears, threatening to burst your ear drums. However, the lesson behind this incident is that people behave in a certain way for a particular reason, and you may only truly understand when you interact more with your patients. I'm honoured that the grandmother had decided to confide S's background with my nurse and I, and I'm also thankful that the system in the clinic allows me to spend time to interact and understand more about my patient. In other clinics, due to manpower constraints and the large number of patients who are waiting to seek treatment, dental treatment is a drill,fill,bill job and it's hard to inject a personal element into a dentist-patient relationship, when you're just getting your job done and waiting to send off this patient and see the next. That's a common trait in most public healthcare systems in many countries, and I guess it'll be hard to change this deeply entrenched trait locally.
Ok, enough of rambling, countdown to Leave Day! 5 more days!
Monday, November 5, 2007
Pottery 101
Venue: AMK CC, next to a old town centre, where the newly renovated hawker centre appeared as the most modern piece of architecture. Surroundings appeared stuck somewhere in the 80s, which I like.
Time: 7 to 10pm
Instructor: Mr L@#, someone who appears to be of Prof Yao's era, the sort who would throw your piece into the bin if it's not satisfactory to his taste. Emphasised on teaching and mastering the basics. Condemned use of machinery and use of ANY shortcuts. Spent a considerable length of time lecturing on harmful side effects of disposable wooden chopsticks, 'chicken' glass bowl (the ones found in old hawker stalls) and any glassware with patterns found on them.
What we did: kneading the clay to get rid of air bubbles, rolling them into cylindrical shapes. Drawing perfect circles on clay. We will probably end up with rather nice arm muscles towards the end of the course.
Next lesson: We'll make a cylinder, and some animal of our preference. I want to do a chicken.
Any good recommendations for a digicam? I'm deciding between a sleek, point and shoot camera, and a camera with more manual controls but thicker, less sleek. Hmm...
Time: 7 to 10pm
Instructor: Mr L@#, someone who appears to be of Prof Yao's era, the sort who would throw your piece into the bin if it's not satisfactory to his taste. Emphasised on teaching and mastering the basics. Condemned use of machinery and use of ANY shortcuts. Spent a considerable length of time lecturing on harmful side effects of disposable wooden chopsticks, 'chicken' glass bowl (the ones found in old hawker stalls) and any glassware with patterns found on them.
What we did: kneading the clay to get rid of air bubbles, rolling them into cylindrical shapes. Drawing perfect circles on clay. We will probably end up with rather nice arm muscles towards the end of the course.
Next lesson: We'll make a cylinder, and some animal of our preference. I want to do a chicken.
Any good recommendations for a digicam? I'm deciding between a sleek, point and shoot camera, and a camera with more manual controls but thicker, less sleek. Hmm...
Subscribe to:
Posts (Atom)
