Last Day of Rotations

I knew this day would come fast, but I still can't believe I've made it to this point already.  I've lived in Singapore for 5 weeks now and I still feel like there's a lot I haven't seen or eaten.  I started reflecting on the rotation by revisiting the path I walk to the hospital every day and the things I pass by:

My neighborhood, Tiong Bahru

The bridge I walk across the highway to get to the hospital

Hospital Entrance

The hospital is so large it has its own 7-eleven

There's one in every restroom, it is a cancer center after all

First, an update on my MTX toxicity patient.  After 2 weeks, he's finally cleared his MTX and his kidney has returned to normal.  It's been a long ordeal and we're just glad he didn't really catch any nosocomial infections so he can go home now.

Of course since it was my last day, I needed to do a final patient presentation.  This was an interesting patient of mine because she developed Ewing sarcoma which is normally only seen in pediatrics, more often seen in males, and is rarely seen in Asians.  Her prognosis isn't good and she's developed post surgical complications that is delaying her chemotherapy, but since it is my last day I won't know how it turns out.  Learn more here:

 

I do feel like I accomplished what I wanted to learn on the rotation.  I was able to learn a bit about the healthcare system which was a major academic goal for this block for me.  I learned a lot about supportive care measures for chemotherapy including antiemetics, management of neutropenic fevers, and appropriate antimicrobial prophylaxis for different chemo regimens.  I learned how to manage methotrexate toxicities and calculate its kinetics.  Because the physicians had weekly teaching sessions, I also learned quite a bit about pathophysiology of some cancers.  Conversely I was able to teach physicians about a few things like my presentation on CMV treatments and the pharmacology of some drugs like Januvia and methotrexate.  I was even able to help out with a portion of the write up for my preceptor's phase II study of a specific chemotherapy regimen for B cell lymphomas that will be conducted soon, so I feel like I contributed a good amount.  Essentially, because everyone here follows US guidelines, the practice is not too different but the subtle nuances like how payments work and the different drugs available did present some challenges during the hospital stay and when getting ready to discharge the patient.  Still I enjoyed working here a lot.  It was definitely a worthwhile rotation and something I will remember fondly.