3 Stages of Burnout

Stage 1. Stress Arousal
(includes any two of the following symptoms)

1. Persistent irritability
2. Persistent anxiety
3. Periods of high blood pressure
4. Bruxism (grinding your teeth at night)
5. Insomnia
6. Forgetfulness
7. Heart palpitations
8. Inability to concentrate
9. Headaches
10. Gastrointestinal problems

The stress arousal stage includes persistent irritability, persistent anxiety, periods of high blood pressure, bruxism (the grinding of teeth during sleep), insomnia, and forgetfulness.

Additionally, you may have heart palpitations, unusual heart arrythymia, concentration problems, and headaches/stomach problems.

With the presence of any two of these, you may be experiencing stage 1 stress arousal.

Stage 2. Energy Conservation
(includes any two of the following symptoms)

1. Tardiness
2. Procrastination
3. Decreased sexual desire
4. Persistent fatigue
5. Turning work in late
6. Social withdrawal (from friends and/or family)
7. Cynical attitudes
8. Resentfulness
9. Increased stimulant consumption (caffeine, nicotine, ephedrine, etc.)
10. Increased alcohol consumption
11. Misuse of prescription and non-prescription drugs
12. Apathy
13. Loss or lack of spirituality

The energy conservation stage might include excessive lateness, procrastination, excessive time off, decreased desire for sex, persistent tiredness, turning work in late, social withdrawal from friends and family, increased cynicism, resentment, increased stimulant consumption, increased alcohol consumption, misuse of prescription and non-prescription drugs, apathy, and loss or lack of spirituality.

Again, any two of these symptoms may signal you’re in stage 2 of the burnout cycle.

Stage 3. Exhaustion
(includes any two of the following symptoms)

1. Chronic sadness or depression
2. Chronic stomach or bowel problems
3. Chronic mental fatigue
4. Chronic physical fatigue
5. Chronic headaches
6. The desire to “escape” from friends, family and perhaps even school
7. Perhaps the desire to commit suicide

The exhaustion stage is where most people finally get a sense that something may be wrong. The symptoms include: chronic sadness or depression, chronic stomach or bowel problems, chronic mental fatigue, chronic physical fatigue, chronic headaches or migraines, the desire to “drop out” or “escape” from society. Like the previous stages any two of these symptoms can indicate stage 3 burnout.

Remember, burnout is a process that usually occurs sequentially, it progresses through stages, thus giving you the opportunity to recognize symptoms and take the necessary steps to prevent it. If you see yourself in stage 3, it is time to get help. Meeting the criteria for stage 3 is your signal and you need to seek assistance: your stress level is beyond your control.

Currently I'm having 5 of Stage 1 symptoms, 10 of Stage 2 symptoms, and 5 of Stage 3 symptoms. What to do, what to do...

Whinges from the Underground

It's sad when you really feel like updating your blog when it suddenly dawned on you that you have nothing interesting to write about regarding your life for the past couple of months. My life outside Medicine just ceased to exist. That would have been fascinating if it's not so depressing.

Then again, that's not quite true. Finally got to read a novel from beginning to end within a week, which is mostly due to the fact that I have a long 4-days Easter break. The book was The Kite Runner, by Khaled Hosseini. While the novel wasn't spectacular, it was quite a memorable read, with themes of betrayal, courage and redemption. As I've recently developed an interest in foreign culture that I'm totally ignorant about, I find viewing the world through an Afghan character intriguing. That said, I still find the author too optimistic about the States, probably because he is now an American I guess.

It's until I've finished reading The Kite Runner that I realize that I've forgotten the joys of reading. While I can't exactly say that I don't have the time to read novels since clinical phase started, I just find it hard to continuously reading a novel without long periods of interruptions. Studying Medicine is just too distracting for you to actually focusing in anything else. So far I've neglected my exercises, meals, sleep and hobbies. Whenever I find myself overwhelmed with boredom or disinterest in Medicine, I lose myself in hours of computer games, which makes hours disappear like seconds (damn you Oblivion!).

I seriously need to end this disengagement to my own life. I need to feel in control again. While I feel that I'm coping better this year, I'm still not completely there yet. I need to get my priorities right. I need to manage my time more wisely. I need to fuel my passion in life again.

But this is doubly hard as I could hardly find any other like-minded people around me. I constantly feel like I'm suffocated by the endless herd of buffoons, drunkards & sluts all around me. Are there really no kindred with a soul here? Or am I just too uptight?

Godfather in 1 Minute

An amazingly amusing and appropriate summary of the Godfather, all in 1 minute! Ok, maybe 2. XD

I hate thinking of a title

When encountering a culture shock, many of us tend to recoil from our surroundings and built a cocoon of familiarity and comfort among our fellow expats. We build up walls, and threw rocks at others from our comfort zone, calling people racist or anti-Malaysian and such. A normal, acceptable reaction, I guess.

But I didn't. The more I experience this cultural alienation, the more I reflect on how I myself have been practicing this very form of discrimination towards the Others subconsciously. Although I didn't go as far as to purposely persecute or scoff at people who doesn't share a similar cultural background as mine, I do identify a gross deficit in my empathy towards these people. It's sad how you never realize you have mistreated others until you find yourself slighted.

While I was never the subject of racial discrimination, I have felt the perception as the Other often during my runs from my superiors. But I've accepted it as a perfectly reasonable human behaviour now, for I can't deny that I am the Other in relative to the local kiwis. I just hope my knowledge and proficiency is enough to sustain me thru med school without me having to constantly prove my worth thru excessive vocalization of my 'enthusiasm'.

Malaysia's former leader calls on prime minister to step down after election fiasco

(International Herald Tribune (Asia-Pacific) March 9, 2008)

KUALA LUMPUR, Malaysia: Malaysia's former leader Mahathir Mohamad on Sunday urged his successor to resign in the wake of stunning election losses, and apologized for hand-picking him in 2003 to lead the country.

Prime Minister Abdullah Ahmad Badawi's National Front lost its two-thirds majority in Parliament and five of 13 states to the opposition in Saturday's general elections — the coalition's worst setback in its 51-year rule since independence.

"I think he should accept responsibility for ... this massive defeat," Mahathir told reporters. "He needs to consider stepping down."

Mahathir, who resigned in 2003 after 22 years in power, choose Abdullah as his successor but turned against him Abdullah two years ago and has frequently accused him of corruption and nepotism. He has said in the past that Abdullah's deputy, Najib Razak, would have made a better prime minister.

"I'm sorry that I apparently made the wrong choice," he said. "My greatest concern is that the leader doesn't understand the situation." He said Abdullah and others in the coalition "have become so arrogant."

Earlier Sunday, Abdullah dismissed suggestions that he would now face pressure from party members to step down.

"I don't know who would pressure me. There is nothing at this time," he said.

Mahathir cited voters' frustrations over price hikes and alleged nepotism as the main reason for the poor election showing, which gave the National Front 139 parliamentary seats and the opposition alliance 82 seats with one still to be decided. Previously, the opposition held only 19 seats.

He said successive high economic growth has not trickled down to ordinary Malaysians, who were now suffering from the rising cost of living.

"And then, of course, they've observed that this government is run by one family," he said, accusing Abdullah of favoring his son-in-law, Khairy Jamaluddin, a National Front member.

Malaysians also were upset over the rise in crime and seething ethnic and religious tensions. Some 60 percent of the country's 27 million people are Muslim Malays, while a quarter are ethnic Chinese and 8 percent ethnic Indians.

Discontent over policies that favor Malays in education, business and job opportunities led some 20,000 Indians to protest last November in a rare show of anger. They also complained their Hindu temples were unjustly demolished.

But critics say many of the problems facing the country, including racial tensions, inflation and judicial corruption, have their roots in Mahathir's rule

"Twenty-two years of Mahathir's maladministration and dismantling of democracy and weakening of institutions came to fruition in the last four years," said Malik Imtiaz Sarwar, a political commentator.

Winds of Change

Barisan Nasional suffered its greatest defeat in history. Many people cheered over that fact. I find it quite silly and naive really. True I would like to see the opposition gaining more positions in the new government, but I am truly concerned about the opposition's burden to fulfill their pledge now that they have won so many seats all of a sudden. There's much to learn, and little time to get things done to prove their worth.

This may be the winds of change in Malaysian history... or it may be a minor setback for BN until the next election if the opposition can't hold things together. Only time will tell. I'll definitely have a close watch over the Malaysian political scene for the coming months.

He's out of my hands.

You bastards better make sure you take good care of him, or I will never forgive you all.

Alienated

You would have thought that by sharing a common language, one wouldn't have too much problem with communications and having the "human connection" in a foreign country...

But I'm wrong at that.

Eventhough I've arrive in NZ for a year, I still often feel like the protagonist in Sofia Coppola's Lost in Translation. Feeling alienated, lonely, longed for companionship, yet unable to attain it. It's not like I don't know the easy solution to this dilemma. I could choose to either embrace this foreign culture, or hide myself with my expatriate friends. But I chose to reject both alternatives and accept alienation, for reasons I can't comprehend.

Why is authenticity worth such unhappiness?

First, Do No Harm

Valentine's Day 2008. The day that I will hereafter remember as the day I've failed to uphold the first principle in medicine: primum non nocere. To those unfamiliar with the term, it's a Latin phrase meaning "First, do no harm".

While examining a patient's ear with the otoscope (in a rather awkward position), I accidentally turned the handle much too quickly, causing the patient to exclaim in pain and jerked her head to the side. I was as shocked as she was then, as I was very certain that I have not introduced the otoscope too deep into her ear as to hit her eardrum. The doctor, slightly alarmed, proceed to take over the examination from me. I apologized profusely to the patient, and she told me it's alright and all.

After the patient left the clinic, the doctor told me that I've caused 2 small lacerations on her ear canal, one probably from turning the handle too much, while the other was probably caused by her sudden jerking movement. He later corrected me (gently and sternly) about the mistakes I should learn from this. I was burning with guilt and shame then for the rest of the day, hoping that the wounds will recover well, and wondering what permanent effect have I caused from this accident... The patient will probably don't want any med students to examine her for the rest of her life...

My pride is bruised from this incident, and I still feel the burden of guilt and shame as I'm typing this. This will be a day I'll never forget. Valentine's Day 2008.

Primum non nocere.

GP

Still feels a bit weary of life, but at least I'm coping now. When I saw the juniors so full of life and joy, I can't help but feel pity for them. Things gonna change real soon. Really hope they enjoy these last moments of blissfulness, before the whole world starts collapsing on them.

Starting off with 2 weeks of General Practice is OK so far, although the leisurely pace is really testing my patience. Most patients visit the clinic to get their 3-monthly prescription repeats, and I have yet to seen any acute cases after being in the clinic for 3 full days. But it's great to finally get my first observation of a cervical smear, and it's surprising how similar the procedure is to the models we practice on, and yet more difficult in a way (esp when you're trying to locate the cervix).

Quite happy that I'm finally familiar with the opthalmoscope, though I have yet to practice on a dilated pupil. At least I get to learn something. Let's hope things will get more productive next week.