Right off the bat, I would like to give thanks and say how grateful I am to Prof Anthony McLean, Dr Sam Orde, Iris Ting and the ALL the wonderful staff of Nepean Intensive Care Cardiovascular Laboratory for giving me the once in a lifetime opportunity to learn Echocardiography at such a hallowed institution.
I am an Emergency physician from Singapore who has been dabbling in ultrasound. Been wading in the shallow waters of FAST scan and always dreamed about swimming with the sharks in Echoland, so when the opportunity to train in Australia came up, I jumped and soldiered through the 1.5 year process to get my paper work in order.
With the arrival in Echoland, my emotional roller coaster ride began. There were good days when I would be able to get every window only to be quickly followed by many bad days where slim patients whom I thought were easy-peasy would not yield me their cardiac secrets. I also found out how “weak” a six footer I was, when the constant gentle exhortation by my 5 foot goddess of echo, Iris Ting, was “a little bit more pressure” on the probe.
That said, I think there are 2 components to my Echo journey. First off was the kinaesthetic-visuo-spatial skill of acquiring the image, and a second, acquisition of a cognitive framework to make sense of what I was seeing.
My initial mistake was to try to take the two together. It was only when I reflected on my daughter’s experience of learning to ride a bicycle that I progressed a bit better. I learnt how to ride a bicycle by jumping onto a bicycle, pedalling away furiously and trying not to kill myself in the ever obliging lamp post. My daughter had the benefit of a push bike, where she first picked up her sense of balance and only later did she graduate to pedaling on a full bicycle. She learned much faster and less painfully.
For the kinaesthetic-visuo-spatial, I found that the best way forward was to quickly memorise the scanning image protocol, then break it down and focus on improving each individual section (parasternal long, parasternal short etc. views). For image optimisation, it helped to have a mnemonic for depth, width, frequency and gain. Patient position and probe pressure was more important than more gel though that didn’t stop me from emptying the lab’s stock. Swimming in gel in awkward directions did, however, help me acquire a sense of what probe manipulations produced the needed image orientations. TOE threw all of that out of the window. The only saving grace was to turn the images of a TTE upside down in my head. The ultimate end point is to have a 3 dimensional mental representation of the heart as it sits in the patient’s chest. Now if only I could transplant Iris’ brain into my cranium. Skin as thick as my favourite fruit, the durian, helped me to weather the shame and self flagellation of the roller coaster ride.
For the cognitive, the 3 hour daily commute helped to block out reading time. The threat of flagellation that penetrated the durian’s skin by my supervisor helped me to stick to the revision time table (just joking Sam!). Working the fields was where I learnt a lot, but sitting at the feet of gods who reported echo was where I learnt most. The overhanging guillotine of the DDU Exams served to provide the needed motivation.
All told, it was a wonderful year of learning, friendship, exploring limits and persevering. Did I get to swim with the sharks in Australia? Nope, no time, but at least I dare to venture out to deeper waters now echo-wise and, hopefully, I will get to come back someday…
Thank you very much!