COAMS #42 - Family Medicine

I noticed I left out a blog entry during my family medicine posting… i should acknowledge it here because it has indeed been a fairly important 2 months of my life… I mean, I had a non-hospital setting rotations for 8 weeks! Half day work, afternoon naps on weekdays, even off on Wednesdays!! Wow! How cool is that! Not to forget, I also had one of the worse days of my life- down with Dengue Fever, but I’ll come to that later…

I learnt a couple of important things during family medicine… I finally got to witness the long queues, long waiting hours, insufficient number of medical staffs.. There’s like a doctor to 60+ patients per day… and they were seeing each patient for an average of 5 minutes at the health clinic (klinik kesihatan).. despite the whole holistic lectures.. p/s: 5mins is a very short time…

The fun part of family medicine, you get to participate more in clinic activities.. You get to see patients, clerk them, examine them and even manage them… Yes, you get to prescribe medications!! Under the supervision of an attending doctor or medical attendant, of course, who counter checks the medications, but still, it’s pretty cool,… though most patients complains of simple problems like URTI, conjunctivitis, muscle sprains, allergic eczema, etc…

The crammy place at PPP, the nasi ayam at KK Batu 9, sunflowers at KK Batu 14… who would ever forget? ^^

p/sss: after rereading the above post, i realized it sounded like the writings of a primary school kid... i guess we can't fake enthusiasm, can we?

(Written on May 08, 2008 at 10:03 PM)

COAMS #41 - i met a bitch today

A patient spoilt my mood today. Correction: she was not even a patient; she was just the friend of the patient.

For the first time, I was called a liar. Which was bad, really bad. And I didn’t lie, obviously.

The patient’s queue was long today, as usual. Which government clinic is not anyway? So, I was in the mood to clerk a new case this morning, so ya, I saw this uncle, and was introducing myself to him. Well, don’t get me wrong, the uncle was really, really nice, and very co-operative. It’s just the bitch who brought him here whom I really wish to curse like mad.

I don’t usually label people as bitch, in fact, I had never labeled anyone this way all my life, but she, the women, she was really bitchy, that lady.

So, ya, after the introduction, before the uncle can respond to me, the bitch said to him in hokkien, “she is just a student, you do not have to talk to her’, and shooed me away with her glances. Well, forgivable. I mean, I respect patient’s rights, patients do not have to be co-operative.

But, the uncle was very nice. Sure, sure, he said excitedly. And we had a great chat. I clerked the him, and he even told me bout this church and his family. Later, I took his file in, and yeah, he waited for his turn patiently.

Not long later, the bitch came knocking impatiently about why is it taking so long. I don’t know why I took the trouble to explain to her and reassure her that his turn will be soon.

Then later, she knocked again. I reassure her that his turn will be next.

After that, she knocked again, and called me a liar in front of like 30 over patients, and was making a hell of a noise. ‘how can a doctor lie? You said he was the next patient, and how come the other patient get to go in first?’ I tried to explain to her that

1. I did not lie. There were 2 doctors running the clinic but sharing a room, and he was indeed the next patient on the list. Anyway, the patient who when into the room was like 2 numbers before him, anyway.
2. I am not a doctor
3. I was just being nice. I do not have to be here, talking to you, explaining to you.
4. The patient was not even complaining, who the hell are you?
5. And if you can’t wait, go to the private sector!!!
(Wait, they actually came from the private sector to the government sector, because of some recommendation from a friend.)

But, well, I didn’t get a chance to explain as she just shouted out ‘I don’t want to hear anything anymore’. Which was very embarrassing. I wanted so much to say it in her face, give her a piece of my mind, but somehow, I couldn’t. And so, i swallowed everything down, tell myself, ‘you do not have to lower yourself down to her level’, ignore her and when back into the room.

Later, other patients started knocking at the door, complaining bout the slow speed. And I found out that the bitch was postulating about how medical student slowed the clinic, that we were having ‘teaching sessions’ in the clinic. Which made me really mad, because the fact was:

1. we were actually speeding up the clinic as we were helping the doctors to take history
2. we were speeding up the clinic by being translators
3. we were speeding up the clinic by helping the doctor check the vital signs, doing physical examinations, writing MCs, running clinic errands, etc
4. and no, we were not paid to do this, and it is not compulsory for us to do this. All this is sort of like volunteer job. In fact, we pay to get into medical school. And hey, we are not complaining, are we?
5. and even IF the doctor was giving teaching sessions, we deserve it because THIS IS A TEACHING CLINIC. HUKM is a teaching hospital. It suppose to be this way. And we student weren’t even demanding or complaining.
6. HUKM was build for UKM students. Without students, you think there’ll even be this place? Pleasseeee.....

So ya, I was really mad at the bitch. On top of that, I was bearing my menstrual pain, and yet she was really torturing me mentally, emotionally. ‘patience, shinyin’, I told myself, and explained to the other patients that there were shortage of doctor, and apologized for the delay.

So when finally, it was uncle’s turn, I went out, called his name, and waited. The bitch said that he was in toilet. It’s okay, we’ll wait, I said. (God knows why was I still being polite and nice) She added, ‘It’s all your fault! He wait until he had to go to the toilet!!’ I just stared back in disbelief, thinking: since when people going to the toilet becomes my fault. Superbly Insane!!

Finally, he’s back. And so, the doctor asked a few more questions, which I’ve missed. I was asking him for urgency symptoms and frequency (thinking BPH). And this bitch just have to stop us and comment, ‘where got people urine without urge one? What kind of medical student are you?’. I wanted to clarify to her that these questions are important, but Nat us nodded her head. I could read her eye language. True, there’s no point arguing with a bitch.

The uncle had left ventricular failure. So, Nat and I took some time to explain the condition to him gently. Dr Harvin asked us to transalate a few more information, telling the patient he needs to run some test. I took a while to explain, and the bitch stopped me, and criticized my Chinese language. ‘Your Chinese is terrible! My English is poor but I understand the doctor and I can explain better than you!’ she declared. She repeat that like twice. I have to admit, my Chinese language sucks. But this time, I really could not take it anymore! This is the first time in my entire medical life that my Chinese language has been criticized so badly.

Even the other patient who was sharing the clinic looked back in puzzlement. I couldn’t take it anymore.

I gave up, shut up, back away and took my seat by the couch. I DON’T CARE ANYMORE. So, I let her explain. Well, her Chinese was ordinary. I have to admit, comparatively, my Chinese language sucked a lot. Maybe I talk in really broken Chinese but at least I do not translate facts wrongly. Yes, she translations was indeed incomplete and some even wrong, but hell, I DON’T CARE ANYMORE!

Later, God knows why, she told me, ‘Don’t think I don’t know anything. My son is a doctor’. I replied sarcastically, ‘I do not wish to meet your son’. Then I told Natalie, ‘Thank God she’s not my mum’, loud enough for the bitch to hear.

Later on, I met the uncle again. He apologized for the bitch’s behavior. I told him it is okay, although really, I did not feel anywhere near okay at all. So, I then managed to explain his condition to him, although with some difficulty. I have to admit, my Chinese is really bad, but given time, i could do it. It's a limitation, not being Chinese Educated. But if you give me a second chance, i would still choose to be English Educated, to enter a national school, rather than a chinese school. I enjoyed my childhood very much.

Later when she left the room, the other patient commented, she was a difficult lady. I am glad that I wasn’t the only one feeling that way.

I am back in my hostel room, still upset. Moral of the story:

1. Nice people are easily bullied. You do not have to be nice.
2. Sometimes, we should just ignore bitches.
3. If I ever see this bitch again, I’ll overdose her with Haloperidol and Xanax. (Let her get EPS and get fat!)
4. Don’t attempt to speak Chinese, just pretend I’m ABC, or MBC (Malaysian Born Chinese)
5. I need to learn to handle difficult patients and their friends. (Oh God, I bet there will be many more difficult patients to come.)
6. To improve my Chinese? Haha! Try me...

Hoping to feel better...

(Written on January 31, 2008 at 01:04 AM)

COAMS #40 - Semenyih blues.........

Dear all,

I am typing from my hostel room, in Semenyih… I haven’t figure out who to address this letter to, I am, well, just typing… 3 weeks here, I have lived such a boring meaningless life. Meaningless, perhaps because I do not really enjoy what I am doing, research. And perhaps, I do not like this place either. And maybe because I have to share my room with 10 other people, being stripped off the luxury of having a single room which I had since 10 years old.

Perhaps I should elaborate more on what I do here. And why I hate what I am doing here. For the first week, I had the room lights waking me up as early as 5am, with my friends performing their prayers, while I tried to steal extra sleep under my covers. Not to forget people chattering at the background, when I decide to sleep early. Eventually, I got used to sleeping with the lights on, sharing a common bathroom, and sharing the same speed of fan.

I am allergic to the kampong.

And I mean it quite literally.

You see, our research area is in Kampong Kuala Pajam, which is at the border of Selangor and Negeri Sembilan. My home is just a 40minutes drive away. Many times, I have the urge to just drive myself home and forget everything. Anyway, back to the kampong. Like I have said, I am allergic to the kampong. I would end up with red rashes at my limbs. I am not sure whether it is the grass, the sand, or just the air. Allergens seemed to be everywhere. Avoiding grassy areas did not help much.

And guess what? The villages in Kampung Kuala Pajam does not have the luxury of the Town Council (Majlis Perbandaran) workers coming to empty their rubbish bins. In fact, they had to burn all their rubbish! And I seriously mean ALL, yes, the smoky-open-burning thingy…. Which I hate it, a lot! My lungs practically rejected it by giving me an asthmatic attack! Oh well..

Anyway, I am still recovering from the sun-burn from the beach 2 weeks back and the sun in semenyih which somehow seemed to be much hotter than other parts of Malaysia. Perhaps also recovering from even more things. The scorching sun cut through my skin, dehydrating it as I resist from scratching my skin. I did as many as 3 face masks that week, my friends thought I was obsessed.

I guess what made me hate this place most is because I believe this place made me sick. Well, it could all be a co-incident, the upper respiratory tract infection, my wisdom teeth growing and the intense menstrual pain, all hitting me at a go. It’s like the whole world is going on a strike against me. I have been abusing antibiotics and pain killers for the past week.

I am back to the hospital. And I realise how much I missed the hospital. Not so much of the clerking and educational part, I simply missed the smell of HUKM, the clean walls, the people… oh well….

p/s: My posting mates turned out to be pretty fun people,... but semenyih, the place is just not for me............

(Written on December 14, 2007 at 06:29 AM)

LINK: i found another old post of mine, on another Kampong experience in Kedah, back in 2006... surprisingly, my opinions of the kampong was totally different from this!! perhaps, it's the shorter duration, or perhaps it was 1st time syndrome... click to read it here..

COAMS #39 - The first delivery conducted

OS FULLY!!! Dr Yuli shouted while I stared at my index and middle fingers, still trying to figure out whether they were 10 cm apart.

The mother had been suffering over 8 hours of intense labour pain, with contractions pain as often as 5 in every 10 minutes. Imagine having terrible menstrual pain, once every 2 minutes, and multiply the intensity 10 times. Or perhaps a toothache or an awful stomach ache, intensity multiplied 20 times. Labour pain has long been agreed upon to be the worst pain on Earth. Women admired for the strength to endure it.

Bringing water, readjusting the bed, offering the extra pillow, holding the mother’s hand and reassuring her- these had been the medical student’s role here at the labour room in HUKM. Ermmm.., I would not want to leave you with the impression that we have limited ‘function’. I mean, apart from that, students also set the IV line, apply the CTG monitors, run the pitocin, fill up partographs, catheterize patients, etc… but patients often remembers the former.

The calm labour room quickly evolved to a battlefield, as if getting ready for a war. The mother shouting in pain, and everyone else moving swiftly, taking their positions. I grabbed the apron and put on the sterile gloves. People around me were dressed, prepared, and readied. The delivery set opened, sterile drape spread out. She was in lithotomy position, hips and knees bend, both hands grabbing her respective legs. The suction device heard at the background, readied to welcome the baby. I tried to calm the patient, tried harder to calm myself.

The baby’s head appeared at the vaginal opening, as the mother pushed with all her might. ‘TERAN!!’ we shouted in unison, the doctor, the midwives, the students, all very supportive, like a cheerleading team at a ball game. The mother working very hard, doing a very good job, probably she had learnt very much from her previous experiences.

I held the baby’s head while Dr Yuli said, ‘It’s exactly what I taught you in class, stay calm, you can do it’. I was numbed. My hands moved automatically, very obedient to her verbal instructions. The baby squeezed through the passage faster than I expected. A series of pictures flashed through my head. The tension eased, the baby slid out. I clamped the umbilical cord and cut it. The baby cried. I let out a sigh of relief. I was stunned.

The world is a beautiful world.

‘Show it to the mother’ a voice instructed, breaking my thoughts.
Right. I held the baby in front of the mother.
‘Lelaki atau perempuan?’ Dr Yuli asked the mother on my behalf.
‘Perempuan’ she answered, almost breathless.
‘Congratulations!’ I said excitedly.
‘Thank you everyone’, she replied with a smile.

The midwife cleaned the baby and wrapped her in warm sheets.

‘Your first time?’ the Doctor asked.
Yes, I replied. I wondered when she started realizing it.
Congratulations, she said. Thanks Doctor, I replied.

Blood was taken. Lower abdomen massaged, placental delivered and checked. My heart sang happily, as I cleaned up the mess, helped the mother to change and tried to make her as comfortable as possible.

It was a full term 2.54kg baby girl delivered via spontaneous vertex delivery after 12 minutes in second stage. Baby’s Apgar scores were 9/10. Placental and membranes were completely delivered and they weight 600mg. Cord pH was 7.306. Estimated blood loss was 200cc.

I conducted my first delivery that day.

Her name was Aifa Amira.I brought life to Earth.

Correction: God created life. The parents bought life to Earth. The team and I merely facilitate. But it felt so good. Delivery of a child is a magical experience. And I was glad Dr Yuli was so nice, and even more glad that it was a successful delivery.

I called my mum that day and shared with her my experience. I never felt so thankful and appreciative of the pain she went through. She agreed with the rest of the world that labour pain was the worst pain on Earth. She added that I was a very stubborn baby, (still very stubborn now). They had to forcep me out. Okay, let’s not imagine how I might have looked during the first few days of my life.

And if you are wondering whether I will ever put myself through that extreme labour pain,…. Considering my low threshold for pain – N-E-V-E-R!! Well,…….. there’s always epidural… many thanks to the genius who created such great pain relief drugs!!

Footnotes:
CTG = cardiotocograph, a electronic device to monitor fetal well being by measuring the fetal’s heart rate and maternal’s uterine contractions, plotted against time.
Pitocin= a drug used to stimulate the contraction of smooth muscle of the uterus during labour
Apgar score = A scoring scheme to assess the general physical condition of a newborn infant based on a rating of 0, 1, or 2 for five criteria: heart rate, respiration, muscle tone, skin color, and response to stimuli.
Lelaki = Boy (in Malay Language)
Perempuan= Girl (in Malay Language)
(Written on December 09, 2007 at 02:12 PM)

COAMS #38 - My first post-mortem forensic experience...

The Professor made us went down, One by one, we stood in a line, ‘warm’ he said, smiling at me, as if reading the fear written all over my face, as he took my hand and held it longer against it. I guess pretending to touch it didn’t work, and I totally lacked the enthusiasm my coursemates had, and the fear, I wasn’t faking it. I was so obsessed and compulsive, I washed my hands over 10 times that day…

The Professor took a knife and made an incision across the scalp. Then, he pulled the skin outwards and downwards, until the skin of the forehead touches the nose, like peeling a coconut husk. The mini electronic saw made an eerie ‘eeeeee…’ sound as it cut through the skull. The skull pulled apart, the brain removed. ‘No hemorrhages’ my friend whispered, but I was so shocked to actually rationalize anything, anything…

My friend, reading my fear, warned me, this part is even worse, she said, ‘the chest would open like a pod, and every internal organ removed’…The Professor, ignoring my fear, continue his carpentry work through the ribcage. I appreciated the emotional preparation, but somehow, I was still stunned.

Come on, you have seen numerous of cadavers(corpse) before at anatomy dissection, my inner voice tried to rationalize,.. ‘but this is fresh, it’s less than 4 hours!’ another voice argued.. and I wondered whether they were just thoughts or hallucinations…

‘Pop’, the chest cracked open and the mini saw stopped. In silence, he went through the intestines, as if searching for something. He tied one end of the gut, and later extract the whole gastrointestinal tract, from the tongue all the way to the colon, the lungs, the heart, the liver as well.

Then, they moved to another table. The brain was inspected and weight. Then the cerebellum divorced from the cerebrum. He sliced through the cerebellum. ‘Ouch!’ I shouted inside me… Although I understood well that the central nervous system has no nocicepters (pain receptors), and on top of that, it is already dead, I just couldn’t help feeling the pain… Then he sliced the cerebrum(forebrain), 1.5-2.0cm apart, sharply, skillfully and steadily,… spreading each out for signs of stroke, hemorrhages or infections. ‘Clean’, he said. At this point, I have a sense of déjà vu, as if this was a scene from a horror movie,.. I was already peeping through the narrow slits of my eyes.

Later, he started weighting the other organs, one by one, slicing them, analyzing them, like as if it’s the most interesting thing to do in the world – The tongue, the lung, the heart, the liver, etc..

He commented, ‘You should get used to the smell, no covering your nose and mouth with your hands’. He looked up at me, followed by another 30 pairs of eyes (of which belonged to my coursemates). I swallowed a gulp, it regurgitated back. It wasn’t just the smell, this, this was entirely gross… yet, I could tell no one… I cannot imagine me being on the table, and I vowed never to let it happen, and was already making plans to clearly state it in my will… I guess I was shallow, despite my profession background. But hey, I bet you would have thought the same back then if you were in my shoes.

Then, they sew up the body, halfway up the chest, shoved everything back into the body, including the brain and sew it tight. The head was filled with cotton and sutured.

And I, I could not eat any meat that day.

--------------------------------------------------------------------------------

I stared down from above. A group of curious students looked at me, with cruel glances and disapproving expressions. I was not sure whether this should be done, I am not capable of stopping them anyway; I just had to get through with it.

The doctor recorded the bruise marks on my body, the cigarette marks and the multiple old scars from the slashing of my father’s belt.

I was hurt before. And so, I fled to Malaysia for employment, or rather, for new hopes, for a better future. My new employee was very nice to me. Despite not having any blood relationship, they treated me like a relative. I taught their children to read, played, and raised them as if they were my siblings… Here, I found home.

Then one day, my chest hurt so much, I could not breathe… and that was the last thing I could remember.

I feel guilty having my employees now being suspected for abusing me, for my death. How can I tell them, they were kinder to me than my very own flesh and blood? Would anyone believe it?

The doctor sliced through me. Funny, I felt no pain at all. Yet, I felt like I have lost something. That is me, or rather, that was me… Seeing this only restrengthen the fact that I can never return to it. So, that’s it, that’s the end.

As he sliced through the heart, he nods affirmatively, as if he found eureka. ‘Fibrosis- the scar tissue’, he explained to the students, ‘Look, the left ventricular wall is much thicker than the right, left ventricular hypertrophy’. The students nodded in unison while I understood nothing at all. ‘Here, another strip of fibrose tissue’ he continued speaking Latin and pointed to some grayish-white section of my heart. ‘The cardiac enzyme stain confirmed it. She had a heart attack’

I had a heart attack.

Finally, that answered everything. I died from a heart attack, like my mother, which left me to my cruel abusive father. My employees were free of charges.

And I, I was free too…



(Note: all identities are confidential)

Written on September 02, 2007 at 12:51 PM

COAMS #37- so sick of being sick

it's been a week already,.. i suspect that i am resistant to the antibiotic prescribed... or perhaps there's just too much allergens... i suppose i am allergic to classes altogether... and i mean it quite literally... every morning, i have to attend ENT classes in this air-conditioned room with thick curtains infested with God knows how many zillions of dust mites and dirt... not to forget the tick carpets... the dark environment... my condition never recovers... having nasal congestion can be very torturing... BELIEVE me... especially when it start blocking your nose bilaterally, and you have to breathe through your mouth, your throut gets dry.. you get sore throut... URTI(upper respiratory tract infection) only worsen the condition... the the mucus start moving into your airway... the allergic reaction worsen.. the next thing you know, YOU CANNOT BREATHE!! terrible, terrible,terrible... cocaine spray and ventolin nebuliser only gives temporary relief... (just in case you were wondering, no, that does not make me a cocaine addict) Mr Megat adviced exercise to stimulate adrenalines,... is there any easier way? siGh.......... maybe when i get better...

i am so sick of being sick... the world keeps on spinning without sympathy... i feel terrible,.. physically and emotionally... and i start suspecting i might have Munchausen syndrome (falling sick to gain attention).. then again, this may not be the kind of attention one would like to seek... you have your coursemates subconsciously taking a 'FULL HISTORY' of you... impressive nodding their heads when you happen to be a VERY TYPICAL HYPERSENSITIVE TYPE 1... siGh...

sometimes, i just wished to escape... it's hard even to fish the 3 magic words [GET-WELL-SOON...]... really, instead, i have people around me 'taking history' and asking what medications i am taking... i suspect the 3 magic words doesn't exist in the chinese and malay dictionary... hmm... [semoga cepat sembuh]... sounds weird isn't it? xi wang ni hau yi dian? haha, yup, my chinese sucks...

oh well.. got to continue eating porridge.... why being sick have to eat porridge? i wonder whether who create the condept, whether it really works... all i know is i can't risk it cause i'm losing my voice, (correction: i lost my voice) and i am having shortcase (oral clinical) exams soon... i don't think my examiner will postpone the exam for me or excuse me for being sick... and hey, i don't know sign language, neither does he... siGh...


(Written on June 28, 2007 at 06:10 AM)

p/s: Later on, in Family Medicine Posting in 4th year(8th Sem), i learnt that:
1. URTI, in my case, is viral in origin,... so it's only normal that it last over a week
2. Viral URTI is self-limiting and does not requires antibiotic... it only needs adequate rest and symptomatic relief
3. i was abusing antibiotics
4. No wonder my body is more and more resistant to antibiotics!!

COAMS #36 - falling SICK... feeling SICK....

i hate falling sick, terrible running nose with post-nasal-drip, blocked nose with the ENT lecturer taking you as a good example of 'hyponasal' speech and hypertrophic inferior turbenates, and having temporary relief from the nebuliser and DAMN i wished i could just buy my own nebuliser and keep it in my room... the air is getting tense... i suspect the world's air concentration is depleting its source,.. either i am very sensitive or it's just me... and worst of all not having to take my medication because of the sedative effect when i have a case presentation tomorrow, tons of procrasinated homework and an exam coming up in one and a half week time....

learning points:

1. i hope people do not have to fall sick
2. if there is no sick people, there will be no need for doctors
3. if there is no need to for doctors, i will not be trapped here with assignments, case-write-ups and exams despite being sick
4. there's how much my life can suck sometimes...
5.because, noone is immune to disease
6. therefore, there will always be sick people
7. and therefore, i will always be trapped here with assignments, case-write-ups and exams despite being sick
8. and HELL, my life SUCKS

(Written on June 25, 2007 at 06:07 AM)

COAMS #35 - A World without light, colors, dimensions... Are we too blind to care for the blind?

( pic: the picture on the right is the mould while the picture on the left is the embossed tactile diagram of the inner structure of a car. This is found in the form 4 physic textbook)

What is a world without light? An empty world without colors? A world without dimensions?

Last week, I visited the MAB, Malaysia Association of the Blind at Jalan Tun Sambanthan.

It is amazing how much the visually disabled can do. Braille is not an easy language to be learnt. I tried closing my eyes and reading with my fingers, and hell, it was tough… The dotted characters seemed the same, more like tiny sands. Kar Yuen, the 6-year-old kid I met there, was able to tactilely read all the alphabets and numbers as fast as I read with my eyes. Braille is based on only 6 dots, yet it is possible to emboss characters A-Z, 0-9, in codes to be read by touch. Reading Braille is difficult let alone typing it. The Brailler (a Braille typewriter) has only 9 keys. Nevertheless, I had my name embossed in Braille ^_^ (just in case you were wondering, no, I did not typed it, too challenging for me, hehe..)

What impressed me most is that MAB transcribes text print to Braille. Text from novels, to Reader Digest and even school textbooks! An average Reader Digest book, after transcription, would be 3 books thick, each about the size of a box file! With that, the blind or low vision students are able to attend school, both primary and secondary school, together with other ordinary students. Yes, they would be able to sit for UPSR, PMR, SPM, etc… Diagrams (as above) are embossed so that they too can learn. Embossing diagrams is a very tedious task. Reading it is equally difficult. Yet, these special people have a great sense of touch and imaginations, putting together the puzzles into a picture. Really, really impressive.

And there was this guy playing Pachabel Canon in D. He had a diploma in piano. And to think that passing piano exams was a struggle even for people with good vision. Well, at least I struggled, and hell, I don’t even have a diploma! And there was this girl who passed her SPM with flying colors and was awarded ‘Anugerah pelajar istimewa cemerlang’ by the Melacca government. She aspires to be a teacher however her application to a teaching school has been rejected. The world today is too blind to see how much these less fortunate people need our support.

Lastly, I suppose we should count our blessings… (yeah, all of you who are lucky enough to be able to read this)… sometimes, we don’t realize how lucky we are, having one of the God’s greatest gifts. Ophthalmology is a very important branch of medicine, aiming to prevent visual loss and blindness. MAB on the other hand, helps people to cope with visual loss. Education and rehabilation is important...

Can we make a difference? Certainly! It can be as simple as helping a blind people to cross the street or to find a shop. Let him hold your arm and walk slightly in front of them, not behind. If you are helping a blind into a car, tell him which way it is facing, and place his hand on the car roof over the open door. If you are eating with a blind, take the courtesy to tell them what food is served. Debone the fish, if any and never fill up drinks up to the brim to avoid spillage. If you are working, you may pledge to donate a portion of your monthly salary or even provide employment to the blind. Don’t be surprised that the blind is capable to use the computer. They have ‘talking computers’ and manage with hotkeys. They use windows and other special software. Visit www.mab.org.my for more information.

(Written on June 09, 2007 at 09:05 AM)

COAMS #34 - Opthalmology

The fundus, it is perhaps, the most beautiful thing i've ever seen on earth. I think i am falling in love with it, almost.

I can’t believe I am actually enjoying my ophthalmology posting!!  Maybe it is because it’s not exam week yet, and basically the lecturers at this department are very very nice… The fundoscope, is a very amazing tool. You can tell so much just by looking at the fundus, it’s like looking into another world, peeking into one’s secret chamber. (ps: a fundoscope is a mobile hand tool used to view the eye structure, basically looking at the retina for signs of bleeding, leakage, occlusion etc) I have to admit had that the first few days was a struggled, where I could only see the vessels, a glimpse of the optic disc and nothing more… it was depressing at first… I strained my eyes so much that the patient commented that I looked as if I was more in pain that she was, haha! When I first saw the optic disc,i was so excited i was like 'yeay!'.., silly me.. Ophthalmology is fun, really, when you start appreciating more and more findings.. but I shall not elaborate on them here as i do not want to bore you off with terms… I think I am starting to like this posting, I hope I will… ^_^

(Written on June 01, 2007 at 10:35 AM)

COAMS #33 - The End of the Beginning

Now, this is not the end. It is not even the beginning of the end. But it is perhaps, the end of the beginning... (Winston Churchill)

I had the ended this year’s orthopedics-surgery posting, starting my ophthalmology posting this week. And last week was a HELL of a week for me… not only that I was suffering from pre-exam-syndrome and pre-menstrual-syndrome; the EXAM was indeed DAMN tough!! When facing this kind of situation, I often wonder, have I not studied ‘hard enough’. Is there a ‘hard enough’ level of study? How do I put myself in a scale of 1-10? Any cures for brain freeze during exam? Very often I realized I know the answer AFTER exam, which is KILLING me, I just want to bang my head against the wall… then again, you can’t misdiagnose a patient and regret 10 years later that you actually know the diagnosis but couldn’t think of it at the point in time. Oh god, I hate the feeling,..

I decided to work harder this sem, or at least smarter, perhaps change the way I study. Yeah, no more last-minute… you’ll never know when you might get menstrual pain on the day before exam,.. and it’s really unfair that only XX gets it, and not even all XX-es…

Trust me Boon Lee, I am trying very hard to think positive… I tried following your advice, to start my day with the [I am happy today because…]… but it’s just too exhausting to fill in the blank. []... and the thoughts of having to pull myself out of bed at 7am,.. it sucks man, totally… *siGh *… guess I must really find the book – the secret. Need all the motivation I can get…

Goals provide the energy source that powers our lives. One of the best ways we can get the most from the energy we have is to focus on it. That is what goals can do for us; concentrate our energy –Denis Waitley

I really envy people who are certain of what they want, knows how to achieve it and goes all out to make it a reality!! Therefore, i shall try to make my own set of goals, it quite simple, really...

My goal : To worry about grades and not worry about passing/failing
Focus : WORK HARD, PLAY HARD

Ever since I entered medical school, all I worried is whether I’ll pass or fail an exam. I don’t understand why I allow myself to be contented with merely passing an exam with average results. Well, it shouldn’t work that way, should it? Not that I want to be kiasu and score a string of A’s but somehow, it’s too exhausting worrying whether you’ll pass or fail after EVERY exam… it’s not that I am paranoid, but I suppose, if one have studied enough, they will be certain that they passed, and it’s just the grades that matters, and it does matters… and this sem, I will make it matter!!

As for patients, it’s not fair trying to treat them with the ‘borderline’ knowledge you have right? Perhaps, if you had been more knowledgeable or skillful, you could have diagnose his problems earlier and offer the best management earlier and giving him a better life. He is not ‘just a patient’… so, got to study for patients and not merely for exams…

Like suk teng used to say: WORK HARD, play hard!!!

(Written on May 27, 2007 at 10:12 PM)

COAMS #32 - 0313

it's 0313am... i have 5 hours and 17 mins more for orthosurgery exam,.. my head is heavy, still have a stacked of notes in the TO-READ box, my Apley demanding for attention,.. yet i have neither the mood or energy... the facts kept bouncing away, i can feel short intervals of being conscious but not aware... BLANK... so SIEN...

drank 3 cups of coffee, can't sleep, can't read... trapped...

realised last-minute-study is not my cup of tea... vowed to work harder next posting... *siGh*... will i ever learn?

(May 24, 2007 at 12:06 PM)

Confessions of a Medical Student #31

i tried downloading Apley's orthopeadics into my cerebrum,.. but it's currantly it is infected with an highly-resistant virus which deletes the files... - tell that to my examiner!! ...siGh... suffering from memory loss... it's not that you can cram everything within such short period of time,.. orthopeadics, urology, plasticsurg, peadiatricsurg, neurosurgery... almost impossible... but the lecturers enjoyed torturing us and forcing us to perform the impossible,.. only to disappoint themselves... oh boy, i hate exams,.. and the load you are 'suppose to know' or at least pretend you do... and save them all in accessable folders in your hard disc... you really think i am robotically capable of that? gee.. i need to get an external hard drive...

(May 20, 2007 at 02:34 AM)

COAMS #30 - Craniotomy-Phobia

I was at the operation theater today to witness a neurosurgery on clipping of a Berry’s aneurysm at the branch of the left internal carotid artery. In layman’s term- simply clipping a dilatation of an artery in the brain to prevent it from rupturing and causing complications. And I MUST confess that it was THE MOST GROSS-EST thing on earth! (in my opinion) All my other friends were like excited and enthusiastic while I was desperately peeping from the corner of one eye… Imagine having part of the skull removed and seeing the bleeding pulsating brain… it was kind of scary, at first.. I can’t help feeling pain for the patient despite the fact that I am well aware that the brain tissue has NO pain fibers,.. oh well… well, it looks okay in the books and movies but to actually witness with your naked eyes, it’s well, a different thing all together… I’ll grow out of it, I hope…

p/s: craniotomy = making a hole in the cranium (skull bone) to access the brain.


(April 17, 2007 at 10:46 PM)