And to the delight of all who are visually stimulated, here are pictures

Yes, this is what I look like when I think of all the exams I have to take in the near future and how they can trust someone like me to take care of sick people.....

And sorry, Eve, but your butt is being broad-casted on the WWW.
And this is what I want to do with myself as a consequence.

Shakespeare's Globe Theater, which is a re-make of the original in case anyone didn't know. It's not even in the same location as the original Globe, which was rebuilt several times and was once destroyed in a fire because during one of the plays, they fired a canon ball into the air from the top of the stage (the barn window looking thing at the top of the inverted V-shaped roof) and it landed on the thatched roof and caught on fire. You would be please to know that no one was killed in the folly.

More of the same...
The pillars look like marble but actually are wood painted to look like marble.

And were it not for this guy, Sam Wanamaker, the Globe theater would be a thing of history. The Brits laughed at him when he first proposed this idea in 1965. They were an incredulous mob; for how dare an American come into their country and tell them that they should preserve a little of their cultural and literary history?

I'm way too young to remember this actor.

See the balcony with the fake gold banisters?
This is where the Royalty sat. They didn't really watch the play but played cards, smoked, ate etc. because the purpose of their visit is to be seen.

This is 221B Baker Street. If you ever visit London and are a Sherlock fan, this place is a joke and not worth my 12 pounds but all the same, it was interesting. Did you know that Sherlock Holmes was sited in Stolkholm?

See Sherlock lighting the candles?

Britishisms

Intern = House Officer
Resident = Registra
Attending = Consultant
Nurse = Sister
Medicaid/care = National Health Service (NHS)
Pompous Prick = Pompous Prick


EGD as in EsophagoGastroDuodenoscopy. I kept hearing them Brits make a blurp every now and again about OGD this and OGD that and here I was thinking that OGD must represent Oral-gastro-something when it meant EGD because they spell Esophagus as OEsophagus! Killed me.

During surgery, no one wears a mask except the surgeons and the scrub nurses. Needless to say that they laughed at me when I asked for a mask and all I did was stand at the sidelines and cheered.

How are you doing? = Hello (because they aren't really asking how you are doing; they're just exchanging polite
pleasantries so if your day is horrible, don't overload the British sensibilities by saying
how bad your day was, unless you're a very good friend).

Hello = Yes, I'm here.
Here's an example to illustrate the above.
Surgeon is performing surgery.
Enter nurse who is confirming the cancellation of a case. The nurse walks away into the foyer outside the surgery suite.
Surgeon yells: "Sister!" because he has forgotten to ask her something else.
"Hello?" she replies.

You gown and glove yourself in sterile fashion.
There are no foot operated faucets so when a surgeon finishes washing his hands, he shuts off the faucets with the back of his hands......?

Wards = Floor
Ground Floor = We don't have one. Our elevators stop on the 1st floor
Lift = Elevator
Dinner = Lunch
Supper = Dinner


Britian's version of a Golf Cart on steroids with top speeds of 80 miles/hour

"You should come over for tea" usually means "It was nice to have met you, have a good life, goodbye".
I guess it is similar to our "we should do this again sometime" where the "sometime" is some indefinite date in the distant future.

Playing Hookey Act III

One Saturday, we did the mandatory tourist thing and went to Buckingham Palace. I'm sure it's like visiting the Grand Canyon like fifty times, one for everytime someone visits Arizona.

Playing Hookie Act III CLICK ME (You need Quicktime for this)


The flag is up!


Fighting out of pure boredom.


Check out Armando's face...."Ohmigod, what am I doing here?"


Queen Victoris's back side. The angels above her statue are made out of pure gold. Should I climb it and chip off some of the wing? I'm sure Victoria's not going to miss it.

Hookey Lesson 102

My Hookey sessions continue....

I love this picture of Big Ben but the ugly CCTV post is in the way



Lincoln's statue in the middle of a square where they have all the past Prime Ministers of England! Strange.

St. Margaret's Church or better know as Westminister Abbey.

The National Gallery which used to be the Royal Stables, where they kept the Royal horses, who ate Royal hay, who had Royal shit....

Nel mezzo del cammin di nostra vita

I find out from several sources that when a student in the UK does their electives during the last years of their formal education, they do it in far away places like Fiji, Australia and Penang and go into hospital and do clinical work like 2 days a week, spending the rest of the week sightseeing, or sun tanning on the beach. So they really weren't prepared for someone like me who wakes up at 6:30 in the morning so I can be there by 8 o'clock for morning rounds, am present at all the teaching events, and make it to O.R. and stay until the cases end at 4:30. By the way, there is no such thing as "pre-rounding" and since the health system is nationalized, work starts at 8 and ends at 4:30 on the dot. Everyone in the same vocation gets paid the same and hence, are only required to do the required amount of jobs and since work above and beyond is not really recognized, healthcare being socialist in nature, no one really goes above and beyond. Welcome to the NHS, where healthcare is accessible to all, including non-citizens from far away places like Lagos and Tunisia.

Hence, it was interesting for me to find out that proof of health insurance was required of me before the start of this elective. How does that make sense when people from Lagos bring their infant sons for open heart surgery due to a congenital defect and don't have to pay a cent, and I, a foreign student, am mandated to carry health insurance in case I fall ill with the flu?

Open heart surgery....flu. Go figure.

Like I said, welcome to the NHS. I hesitate to think that the US is heading in this direction since we are already providing healthcare for a million or so foreign immigrants by the mere fact that they are in the US where they (and to be fair, as well as citizens who carry no health insurance, like Mitch and myself) overtax the E.R. and use it as a primary care provider.

In that light, I think to myself: why the heck am I working that hard anyway when they aren't expecting me to? Afterall, I'm a mere student, with no responsibilities whatsoever.
So slowly, day by day, I leave a little early. I started out leaving at 3 instead of 4:30.
Then, one day, I took half the day off.
Then the other day, I just took the entire day off and visited Portobello market where it is reputed to be like NY's Tribeca.

This is the famous picture of the bridge in London when one thinks of the London Bridge except that this is the Tower Bridge and London Bridge (of the "London Bridge is falling down" fame) is on the other side, some several meters away.

This is at the bottom of Tower Bridge where, in the days past, they used to fish up dead bodies.


This is the famous Tower of London, where ghosts like Anne Bolyn still linger. I thought it was particularly lovely set against the dark gloomy sky, all lit up from within. Gives it a spooky sort of feel.

This is Her Majesty's mounted guards. I was about to stuff a feather up the horse's nose just to see what will happen.

Although you can't really see it, this is Downing Street. Hello Mr Blair, friend of the U.S.!

More adventures to come. Stay tuned as I play hookey.

How Many Roads Lead to Rome?

Initially, I thought I was in love with the British. When I arrived in the wards, I was greeted with an enthusiastic welcome. The nurses smiled and invited me to ask them for help should I have any problems on the wards. The interns (they call them House Officers here) were so warm and all of them asked me if I wanted some tea, including the nurses!

I had to pinch myself to remind me that I was in a real hospital with real nurses.

The senior resident (they call them Registras here) took an actual interest in me and my goals and what I would like to gain out of the elective. He made sure I was introduced to everyone on the team, including the patient and he didn't patronize.

Man, I am doing medicine in the wrong place. This is what I thought as a young sapling, googling at the wonders of a new green house, thinking: that's really nice that they do things like that here.

Fast forward seven days. I am presently introduced to another Registra, who only just recently obtained a position at Guy's. The British medical system is socialist in nature and currently, there is a surplus of doctors in the country since Britain is required to accept medical graduates from all over the EU. A new graduate can find himself stuck in an internship (house officer) position for several years, sometimes like 10 years, before Registra jobs open up.

I guess I am immediately stunned by his cockiness. This is something not foreign to me as we too have our cocky bastard equivalents in the American system such that I have learnt to ignore people like them who are too keen on letting you know how smart they are and how gloriously stupid you are. He's just recently read a research paper for his interview and for the life of me, I cannot remember what his snotty speach was about because I was so immediately put off by his arrogance that I had mentally shut him up. I think it was something about risk factors for mesothelioma, a rather prevalent cancer in this population, or some googoo gaga shit like that.

And because I have been introduced as "the medical student from America," he is giving out quotes from the New England Journal of Medicine, citing this randomized controlled trial and that randomized controlled trial.

It all sounds very intellectual and everything and he has a table of four just mum because we are polite, I by default because I am with polite people, just listening to him over coffee and croissants. I doubt anyone was drooling at his wealth of information but we were, nevertheless, paying apt attention, as opposed to rapt.

After his speech, Mr I'mawhitemanandIknowitall redirects his attention at me and asks:" So where in America do you go to school?"

So begins this question that has a complicated answer, which I relay.
"It's rather complicated," I begin and tell the story.
"In the Caribbean, eh," says Mr I'mapompousassandidon'tknowit.
Yes, I say and start to explain when Mr Ilovetohearthesoundofmyownvoice turns away and looks at his nails, sighs, stretches his arms across the back of the booth where we were sitting in the corner and yawns.

And I think to myself: I guess this is politeness, some sort of 1000-year history of etiquette where one asks a question and makes an attempt at genuineness but is not really interested in listening to the answer.

Fast forward three days. I am with Mr Pompous Prick getting ready to watch another marvelous day of surgery in the back drops. The Attendings here (they call them Consultants) don't want the medical students to scrub in and since this particular consultant likes to make a 4-inch thoracotomy versus a 6-inch thoracotomy, one can really see shit even if one is scrubbed in. He asks me these series of questions:

"What is the percentage of people who survive a pnuemonectomy?"
Er, do I give a fuck? Is this a question a medical student would genuinely know?
"I don't know but I will make an educated guess; 15%"
"No too high, try 2%."
"What is the percentage of people IN THE UK who survive a pneumonectomy versus a lobectomy."

I laugh. And since he likes to hear himself talk and pat himself on the back due to his absolute smartness because he can rattle off percentages like he is rattling off latin conjugations, I let him rattle. Can I recall what they were? Can I even barely recall the questions to these ridiculous answers he's asking of me like I give a damn what the percentages in the UK are?

And to add insult to injury he says to me in the middle of his rattling: "Are you chewing gum?"
"Why does it bother you?"
"Yes, you really shouldn't chew gum. You should NEVER chew gum while talking to your patient."
So his British ass spends about five minutes chastising me on the bad values of gum chewing and in my head, because I am so polite, I am thinking: well Buttfuck, I would rather chew gum and have nice breath talking to my patients than not chew gum because some 1000-year etiquette says it is bad form to chew gum and gum chewing is akin to hooliganism and have bad breath like yours and kill my patient.

This starts me thinking about the utmost importance the British (and to a certain sense, a part of the medical profession in the US) place on the value of appearance. They dress up in their suits and cuff links in the wards and look absolutely, spectacularly professional, but have bad breath because all they've drunk in 10 hours is a cup of coffee. Everything in the appearance and for the sake of it; I quote the New England Journal of Medicine and I can rattle percentages off the top of my head and I can quote you this randomized controlled trial and that randomized controlled trial. Watch me, I'm a British thoracic surgeon and I'm so fucking smart.

Sounds so much like the Singapore I left behind and much like the greater establishment I have spent the best part of my youth fighting against.

So I chew my gum a little harder and make small popping noises with it becuase God strike me dead if I become like Pompous Prick and start to quote jibberish as if intelligence can be measured by that yardstick. Empty pinata.

At this point, I am thanking my lucky stars that I am doing medicine in the US where one is allowed to be himself and nobody cares. No one is trying to conform you to the amalgamation of goo and even if they were, no one faults you for resisting. Albeit there is a price but by this time, you are fully aware and fully prepared to reap the consequences because there are many avenues to take to Rome.

I realize the British are nice, not because they like you, but because they are merely polite, which may be the worse of the two.