Tuesday, December 30, 2008
We are discouraged to actually clerk patients with medico-legal issues.eg rape victims.This morning, I did not even bother to check the big,heavy register book in the ward and straightaway TERrrr-clerk this one patient.I was with a chaperon of mine Kak Yang.Anyway,let us name this patient as Ms K.Ms K was admitted yesterday after being raped( I dont like to use this word actually but cant find any word for replacement) by her boyfriend.She was also beaten by him with leather belt, until there was this huge laceration(luka) over her shin.The laceration was quite deep! At the end of the clerking session, we asked her one last question, " How do you feel right now?What do you feel like doing?" She replied;
"I want to get a phone and try to call my boyfriend.I want to apologise to him"
I was utterly shocked.I mean comon girl! U have been beaten by him and raped!If I were you I wud have wanted to break his neck and shot his head to dust with a shotgun.End of story.I started to think that, Love is blind...
Next, Labour room.Witnessed my first Emergency Lower Segment Caesarian section today.C section had to be carried out due to poor progress of labour.CTG shows Late Deceleration; sign of fetal distress.There was also Light meconium staining,another sign of fetal distress.I also observed a few normal SVD(Spontaneous vaginal delivery). Terasa bersemangat nak conduct delivery next week!
Note1: Currently listening to Nickelback's "Gotta be somebody".Im a big fan of this band =)
Note2: Will be presenting in a seminar tomorrow regarding the "Investigation and Management of Diabetes in Pregnancy". Wish me luck!
Note3: Went to Pizza Hut again, second time this week.I MUST jog tomorrow evening!
Note4: Participated in a Treasure Hunt in Melaka last Saturday.My group was the second runner-up group.Not bad dowhh~~
Wednesday, December 24, 2008
A well circumscribed tumour.Whorling bundle of smooth muscle over the uterine fundus I guess.Hmm...
Tuesday, December 23, 2008
p/s: I am actually quite engrossed into the IJN take-over issue.This might be the first step for a complete privatisation of hospitals in Malaysia.It is such a big issue for me becoz I might want to work in IJN in the future and it might jeopardise my chance to do just that.There was an attempt to privatise our hospital sometime ago but it failed because most doctors oppose it( according to a lecturer of mine, not saying who tho ).Why? Becoz the young,the old , and the disables wud get the biggest hit!Did you know that the price of drugs in Malaysia is rising due to privatisation of pharmaceutical industry some time ago?Do tell me your opinion plz (If u have any dat is =) )
Friday, December 19, 2008
Tell me that its ok to not being able to meet your expectation...
Received an sms at 2.02pm today from my Surgery posting coordinator Mr Triple A.The message says 'Hmm, not very happy with your marks but jus remember clinicals r different,u gotta approach differently'...I'm sure dat he is talking about my Paediatrics result.All of the coordinators for respective postings had their meeting this morning.Oh well, dats life.You win some, you lose some.But for me, you dont lose too much! Once in a while yes, coz it makes you stronger and it serves as a wake up call.
Anyway, Ive been enjoying Obstetric & Gynaecology so far.I've started clerking patients.We learn many stuff regarding OnG already.Cardiotocography(CTG), Partograph, Labour, Episiotomy, vaginal examination,handheld Doppler (Daptone), pap smear.These are the basic skills that needs to be observe/perform throughout the whole posting.I have faith in this posting.
I was amazed while doing physical examination on the mother when the fetus/baby inside the uterus starts to moved.Thats life inside the tummy!Seriously, God is great.
Cases seen throughout the week:
1. Pregnancy-Induced Hypertension
Tuesday, December 16, 2008
Saturday, December 13, 2008
Friday, December 5, 2008
The exam question was tough.We had MCQ(Single best answer type- yang ni memang menggila la, pilihan jawapan semua betul so kena pilih yg mana rasa paling betul), Extended matching question,EMQ ( ni okay kut) and Short Answer Question,SAQ ( Ni laa yang susah, had 3 cases...one with bruising, periorbital swellling and dehydration). Nasib baik takde Essay!
This is the view from the ward.Paediatric ward is situated in the 5th floor of the hospital.This hospital have many, well-maintained Garden or Taman at each floor.So, you'll still feel like you are at the ground floor, though in fact you are actually not.
Byk betul soft toys kan?
The Asthma workshop was really informative.It holistically covered everything about asthma.The theory part, patient management, patient education and also the latest drug and treatment.Plus, the workshop were given by all the healthcare workers- Specialists, Sisters,Nurses, Medical assistants etc. I like the idea when we try to involve as many discipline as possible.In practicing medicine, we need each other.It's all about Teamwork,teamwork and Teamwork!
Monday, December 1, 2008
Alhamdulillah.Just completed my Observed Long Case Clinical Examination.I swear to God that my heart nearly stop beating while waiting for my examiner Dr Faizah the Paediatrician to take me for the exam at 2.30pm in Wad 5A.I had psychogenic polyuria all the way.The case was pretty straightforward ( compared to my last Surgery clinical exam, where my patient was a Bangladeshi who does not understand Malay OR English, had to use an interpreter in the end.Plus, he had 2 diagnosis and the case was hard; Bowel obstruction secondary to adhesion colic).My patient for today was a 9 month old baby boy presented to the hospital due to high grade fever of 4 days duration associated with chesty cough and episodes of shortness of breath.Took the history from the mother and presented to Dr Faizah.I did the physical examination the UNCONVENTIONAL way where I decided to auscultate him first before doing the rest .This is becoz he was sleeping and you dont want to auscultate him when he is crying later.My final diagnosis was Right lobar pneumonia.Air entry was reduced on the right lung.Bronchial breath sound was heard with crepitations over the right middle and lower zone of the lung with occasional,scattered ronchi.Tada~~! The discussion part was also alright.I suggested the appropriate investigation as well.The most happy thing was that my patient did not cry.Therefore, I did not have to use Mr Mickey Mouse at all.
Saturday, November 29, 2008
Written exam is on the Thursday.I dont know what to say.Buat je laa...
Tuesday, November 25, 2008
Monday, November 24, 2008
This baby have many trisomy18 features- hypotelorism, triangular shape face, prominent occiput, overlapping of fingers, clinodactyly etc.This baby is also having ASD and PDA with continuous murmur best heard at the left infraclavicular region grade 4.
Monkey-ing around is certainly another way to help them
Tengokla tu, ada aktiviti menconteng tangan dan muka budak-budak
As usual, like in any other health project a medical check up booth is a must.I 'happily' volunteered myself to man the physical examination booth.Tak check ape pun, just practice on my physical examination skills je, patient kan ramai :P
Friday, November 21, 2008
I am in the middle of completing my last long case write up for Paeds when I decided to update this blog.Today I would like to show you some of the pictures that I have taken today.
Above is the classical rash in dengue fever.It is described as 'generalized erythematous rash with areas of hypopigmentation in between'.OR 'White islands in the sea of red'.This is due to plasma leakage.Smal,multiple non-blanching petechial rash can also be seen.Petechial rash on the other hand is due to small capillary burst.You'll get more petechial rash if Hess test is positive( which I did on this patient)
Above are what we called 'ecchymoses'.This 4 year old child came in today with multiple bruises over the upper on lower limbs as well as the trunk of 7 days duration.He has no history of trauma or fall.No lymphadenopathy or hepatomegaly.He had history of URTI about a month ago.Therefore he was diagnosed with Immune Thrombocytopenic Purpura(ITP) and not Acute Leukaemia coz Leukaemia must be one of the differentials.
We had another new Kawasaki's Diseases today.Admitted just before I went back from the hospital.We also had a patient with blisters and looks like its going to progress to Scalded skin syndrome.I'm going to take the pictures tomorrow.
I do feel sorry for the patients, but for the sake of studying we as medical student need to take pictures so that we can use it in our presentation later.Thats what I've been told by the specialist ' Take picture,take picture and include this in your case presentation later!You should be taking pictures and videos as long as you gain permission from your patients and that pics or videos will not degrade your patients later by circulating it around in Youtube!' I do feel a little bit awkward when taking pictures of the legs and bodies instead of the faces.
A group presented a TBL on Paediatric Emergency today.Lucky for us that Dr H the Paediatrician did not bebel us too much today.My subgroup will be having a bedside teaching by Dr Faizah tomorrow at 10 am.I'll be volunteering myself to present 2 cases tomorrow.Bioethics class with Dr Musa at 2.30pm.I'll be on-calling tomorrow night but before that I am going to Hospital Putrajaya to the Medical Ward.A colleague told me that they have a patient with Steven-Johnson syndrome.That is like super duper rare, 1 case in 1 million patients!
Wednesday, November 19, 2008
Paediatric Ward 5 B
Tuesday, November 18, 2008
Soft toy.I have a mickey mouse as my mate.He helps me when I'm trying to build a good rappot with my patients.A child will open up to you easily after you have played with them.They become more cooperative and it helps when doing physical examination.
Tendon hammer.Is used to check for reflexes.The tip is used when trying to elicit the Babinski reflex
Saturday, November 15, 2008
I really think that the ward round is too long.Average is 4 hours everyday.Not to mention thenumber of hours that we need to be in the hospital everyday.Usually I came at 7.30am and go back at 6pm.Sometimes, it can go up to 11pm.
At last, Adik A my dengue patient was discharged yesterday.He requested for my autograph and my phone number as well as my email.He said he want to keep in touch with me, telling me about his progress in school.So cute.These are the things that money could not buy.The satisfaction.I felt great.
Presented my long case today to the head department of paediatrics.I got 7/10.Alhamdulillah.Never thought that I would get that kind of mark.You see, Paediatric history taking is so detail.All of the specialists in the hospital expect us to be able to clerk as well as present a good history.90 percent of the diagnosis were made from history taking.What a loong day today.Had TBL about approach to respiratory distress, then later after Friday prayer we had Bioethics class.
I spent the whole day yesterday in the Damansara Specialist Hospital Dr Musa's bedside teaching.In the morning, we were in the nursery where all the newborns were kept.He asked us to examine a few neonates and tell him our findings.The babies are so fragile.We had todophysical examination of the newborn from top to the bottom
Its not that hard really.The only annoying part is when they start to cry.We then spend the rest of the day in his clinic.
Monday, November 10, 2008
Sunday, November 9, 2008
Sometimes I made myself scared to death, especially when I think that I have woken up late.This morning my kakak woke me up at 5.45am because I need to be in DSH (Damansara specialist hospital) at 7 am for my bedside teaching with Dr Musa Nordin the Neonatologist.Anyway, to cut the story short, I woke up late this morning.It was 6.20 am.Yes I tertidur balik after that.Mind you, its Sunday morning and thats the best time to sleep.No need to worry about anything during the weekends.And so I managed to get ready within 10 minutes time(mandi pun tak basah sgt kut) and Super Subuh, and after having a sip of tea and a karipap I'm off to D'sara.I was lucky that the traffic was smooth and I have arrived on time.Dr Musa arrived at 7.10am.Yeay!
A Radiologist came to us and ask us to review this CT scan.He said 'This is a good CT scan finding coz they usually ask you during your exam, so plz see ar".Anyway, this CT scan shows Multiple brain lesions over the frontal and parietal region with vasogenic oedema.Its a secondary metastases of a lung cancer.
Interesting cases throughout the week
- a boy in the ICU showing signs of upper motor neurone lesion such as hypertonia and hyperreflexia.
2.Complex febrile convulsion - seizure unresolved by rectal diazepam and midazolam.Patient
eventually had to be intubated.All happened right in front of my very own eyes
3.Pyrexia of unknown origin
4.Another case of Kawasaki's disease - I'm starting to think that this disease is not rare after all.The child has all of the diagnostic criteria
- we went to the cardiac high dependency unit to see the boy.He has 3/5 of the major criteria in the revised Jones criteria of Rheumatic fever
6. Arteriovenous malformation
7. Haemolytic-Uraemic syndrome
Tomorrow ( as in Sunday morning at 7 am), I have a bedside teaching with Dr Musa Nordin the Neonatologist in Damansara Specialist Hospital.God knows what case is he going to give us tomorrow.No complicated case please!
Wednesday, November 5, 2008
Again, ward rounds was tiring.It lasted for 4 hours.Penat and nk patak kaki dah.However, manage to assist the specialist in doing physical examination.I ausculated many chest today, but sadly all of my findings did not tally with the specialists.Guess that I need to listen more attentively.
My group presented a TBL topic today with Dr Faizah supervising.It went well.
I really need to prepare for my case write up and my MIDPOSTING EXAM which is scheduled this coming Thursday.
Monday, November 3, 2008
1. 3 hours of ward rounds.Nak patah kaki
2.Clerking and examining patients
4. Clerk and examining newly admitted cases
Some interesting cases today
4. Ventricular septal defect with Patent ductus arteriosus
What do I need to do tonight
1. Complete my powerpoint for TBL presentation tomorrow
2.Write my case write up.
3.Need to finish reading the Failure to Thrived articles
-Kawasaki's dzs - criteria for diagnsosis, complications, investigations, treatment
5.Types of rash
6.Malaysian Immunization Programme- use Paediatric protocols of Malaysian hospitals
7. Finishing my Hutchisons
Sunday, November 2, 2008
Friday, October 31, 2008
Went to the NICU again later in the evening(Baik jugak Dr R ni rupenye siap ajak pergi NICU lepas tu).Examined 2 babies.One with Patent Ductus Arteriosus.Examined him and found that he has Continuous murmur( aka Machinery heart murmur), best heard at the infraclavicular region with bounding pulse,exactly like in the textbook!Second baby had Acidotic breathing (aka Kussmaul breathing).He is critically ill.
I'm having sore throat with coryzal symptoms.The paediatric ward is full with viruses!
Thursday, October 30, 2008
I had two bedside teaching today, one with Dr Faizah yg baik and another with Dr R yg kuat gile membebel.Has been selected randomly by her to present long case.I dont know why but she always makes me her target.My history was okay except for a few loop holes here and there.Normal lah kan? Didnt know that thee Feeding history as well as Child develpmental history must be THAT detail!!??? Kena tau how the mother prepare the milk, put the water first or the susu tepung later or vice versa,how many ounce, how many times per day, is it full of half-a bottle, when do you start to introduce formula milk, what brand, any allergic reaction,why that brand, when does the baby started to weened?If yes, wht kind of food,semi solid food?nestum? how many times per day? what do you give in the morning,afternoon and evening etc.Haish...blom masuk other history lagi...
Patients are so uncooperative.They will start to cry or run around once you approach them.Or they will start to make noise and monkey-ing around when you are doing the physical examination.Not to mention where there was this one episode when a baby started to sneeze right at my face while I was auscultating!It drains down all the energy and your patience.Seriously the Paediatric Clinic is just like any pasar malam in KL.
In short, Paediatrics is Kenerakaan dan sangat Leceh!I will never become a Paediatrician.A big NO NO
Tuesday, October 28, 2008
Monday, October 27, 2008
Some interesting cases
1. A child with acute Stridor
2.A child with measles- first time tgk
Saturday, October 25, 2008
Monday, October 20, 2008
I have another bedside teaching with her tomorrow morning.Need to do some reading.Not forgeting that my group have to give a lecture during our TBL session on the Development with Dr Rohaizah at 2.30pm.
Just checked my email and guess what I received 5 emails from my mentor Datuk Dr Musa Nordin...Why!!?? banyaknye kerja nk kena setel.Makan chocolate waffle je hari ni.I'm hungry
Saturday, October 18, 2008
In surgery, surgeons have been labeled as straightforward, no hanky-panky kind of person and will not hesitate to scold you.That's what I thought INTIALLY.I have encountered a few this type of surgeon during my previous clinical posting.They are more relax, cool in nature with non-radiating anger.They will scold you there and then and right after that, all is forgotten and forgiven.They might look stern,but all that image that you have for them were shattered once you listen to their ringtones.And so I have decided to judge them based on their ringtones! haha
Some of their bizarre ringtones are
Dr(Miss) A = A frog which sounded like he is about to puke.Its so funny and little bit annoying when you listen it during the operation.
Dr(Mr) H = A disco song! A cool and alim person with a disco kinda ringtone.Beats me!
Dr N = "Touch My Body" by Mariah carey.I mean like wow! I gaggle each time when her phone rings.She is in her 50's (so I persumed) but she certainly is berjiwa muda!Did I mention that she is using a new iPhone too???
Dr H = A song called 'My heart' by Acha Sep...whatever tu. She is garang and persistent PMS-ing.I never thought that she wud have this ringtone, its so contradictory with her personality!And yes, she uses a new iPhone too.Whats with the iPhones??? Apparently people in the paediatric department love iPhone so much.What they got a subsidy for it ar?
Anyway, dont get me wrong.All of them are nice, orelse they wont become a doctor in the first place.It takes a little bit of effort to get to know them.Know what to ask, how to ask and when to ask...
Friday, October 17, 2008
I like those little babies and kids.There were no problems in clerking their history from the parents.The parents are very helpful and will always try their very best to provide us with satisfactory answers.They are not too protective with their child and will assist us during physical examination.However, the tough part is when you actually want to do physical examination on babies.Kids are okay.But babies, phew, really a headache.Sometimes, they will start crying by just seeing the white coat that we wear.Occasionally I had to open my labcoat and not wearing it while in front of them.This is what we called "the white coat syndrome".Some countries like in the UK, it is highly discouraged to wear white coat while in the paediatric ward.It makes your life miserable when your patients starts to cry.
In paediatrics, we had to bring our own rattler, wood blocks and some soft toys.They are meant to attract attention but most importantly to assess development of the child.It is part of the history taking andphysical examination.The history taking and physical examination is significantly different from Surgery.In history taking, paediatric history is added.They consist things such as Antenatal,neonatal history,Immunization, Feeding and weening history,developmental history which consist of fine motor skills, gross motor skills, speech and vision and also social skill.I'm still learning in getting a good history.
I'm really missing Surgery so much!
Wednesday, October 8, 2008
I am not happy because
1) I got a patient who does not know how to speak or even understand Malay or English.He is a Bangladeshi patient to be exact.Came with central abdominal pain of 1 day duration.I had to use a translator for history taking, and it was tough and time consuming.It took 1 and a half hours for everything-ie history taking, physical examination,summary,provisional and differential diagnosis,investigations and discussion.Most of the HOs and MOs in the ward were in disbelief when I got this patient for my exam.They themselves have difficulty in extracting the history from the patient.
The case was a difficult case and I was the only one in my batch to get him as patient!Anyway, I think I did allright, though it could have been better.I manage to come out with the correct final diagnosis.The diagnosis was " Subacute Intestinal Obstruction secondary to Adhesion colic" .My reall really strong point for supporting the diagnosis was " This patient have a right paramedian scar due to his previous abdominal surgery in Bangladesh.During the process of healing, there will be fibrous tissue formation which will make the gut to adhere to each other".Something like that. Initially my provisional diagnosis was "Strangulated Incisional Hernia" due to the presence of that surgical scar but however during the physical examination the cough impulse was negative.So I've decided to change my provisional diagnosis to that adhesion colic thingy.
2) We did not know when is our examination, as in the time.We always need to be ready, handphones must always be with us at all times.I received and SMS from Mr Ahmed the surgeon(my examiner) at 10.45 am while I was at the Surgical clinic.I need to be at the Surgical ward 3A in 30 minutes time for my Long case exam.I was anxious for one whole day yesterday because 7 of my friends had their long case exam already.
I was happy because:
1) I did not really clerked the patients prior to the exam.I did now even bother to know the diagnosis of the patient in the ward.This is to prevent bias in exam.We tend to be bias if we've already know the diagnosis .We tend to forget to ask other relevant symptoms which might be related to other differential diagnosis.Bias is really really really dangerous in any medical examination
Currently preparing for my Best case write up report, SWOT analysis, Reflective diary, Peer assessment, and for my Written examination.Argh!
Saturday, September 27, 2008
We'll be amazed of how many superficial people around you, just waiting the right time to bite you...
Wednesday, September 24, 2008
Remove the previous dressing and throw it in the waste bin.
Use the plastic forcep, soak the cotton balls with normal saline.Apply that at the wound in circular motion,starting from inside to outside.Do not dab it for so many times.Remember, sterility! Since I am in a government hospital, so boleh laa membazir sikit.The goal is not to develop any nosocomial(hospital-acquired) infections!
Tuesday, September 23, 2008
1) Bed-side teaching by Mr Al-Amin, the Hepatobiliary surgeon.I presented a case of an anterior neck swelling.This patient is having a rare thyroid pathology known as Hashimoto's thyroiditis, which is an autoimmune disease where there is an infiltration of T-lympocytes, leading to follicular cells destruction.This patient is a textbook patient.During the acute phase of attack, this patient had transient hyperthyroidism symptoms, also known as 'Hashitoxicosis'.During this period of time, she experienced palpitations, sweating,agitation, loss of weight despite good appetite and anxiety.After a significant number of thyroid's follicular cells( cells that produces the thyroxine and Triiodothyronine) destruction, the patient slowly progresses to hypothyroid state.On neck examination, there is a visible, diffuse neck swelling only on swallowing and not on tongue potrusion.The mass is diffuse, soft in consistency with ill-defined margin.
2) Went to the Emergency department for orientation by an MO
3) Went to the Surgery clinic.Assist Mr Hisham in inserting Foley's catheter for Continuous Bladder Drainage (CBD) to a patient known to have BPH (Benign Prostatic Hypertrophy).Did some venepuncture, not by looking but by palpating the veins at the cubital fossa.Patient to berkulit gelap okay and tak nampak veins!Luckily, my first attempt of withdrawing blood from this patient was successful.
4)Had another bed-side teaching by Miss Sarinah, the Breast and Endocrine surgeon.I presented a new case of 4th degree Haemorrhoid.Did physical examination on him but unfortunately the patient refused to be PR-ed! However, on inspection, there appears to be a single mass at the anal opening which is ulcerated and and thrombosed.Will try to request for PR from him again tomorrow =)
Currently listening to Raya songs while writing my case write up
Monday, September 22, 2008
Encik A, who is only a 29 years oldmalay gentleman has come to the clinic with a left testicular mass of 2 weeks duration.Yes, its only 2 weeks duration and the mass is already as big as a tennisball.Anyway, I am not going into the details regarding the mass ( like we usually have to describein our case presentation).In order to differentiate whether it is a hydroecele or a solitary mass, me and the MO Dr Syikin did the transluminent test.And guess what the test was negative and the mass is nota hydrocoele.Our impression:Left Testicular carcinoma.The patient is scheduled for urgent ultrasound and we need to perform Orchidectomy(testicular removal) on him.Poor guy.I talked to him later while Venepuncturi-ing( withdrawing blood from veins), tried my best to console him.
I also managed to assist Dr Kerwin in doing Proctoscopy.There was this patient, Encik R who came to the clinic with a TertiaryInternal haemorrhoid ( Piles whichis prolapse upon defecation and can onlybereduce manually).I performed a rectal examination on him and seriously he was in pain whenever I touched the hemorrhoid.I had to slowly push back the pile with my fingers.Later, we used the proctoscopy and did Haemorrhoid rubber banding.He is scheduled to come again later in a month time, and if necessary a surgical procedure known as 'Staple Haemorrhoidectomy' will be done.Oh forgot to mention that this patient works as a Penjaga Kuda, and he used to take care Tun Dr Mahathir's horses.
I joined Hanan'sgroup for their bedside teaching.Hanan had to do clerking to a patient with a right breast lump in front of us and Mr Hisham ( the soon to be Minimally invasive and Bariatric Surgeon).The session ended with case presentation and case discussion
Saturday, September 20, 2008
The day started well.Observed an operation; Total parathyroidectomy.Mr A was mypatient for my 5th long case.He has a conctellation of past surgical and medical illnesses.He was diagnosed with Diabetes mellitus when he was only 16 yrs old and now he is 43.Had generalied oedema in 1995 due to nephrotic syndrome and was treated in Hosp Seremban.His kidney function starts to deteriorate from that day onwards and was diagnosed as End-Staged Renal Failure (ESRF) and is on haemodialysis since 1998, 3 times per week.Later, tertiary parathyroidism developed ( Autonomous secretion of PTH hormone despite normal serum calcium level).Anyway, the operation took 3 hours.It could have been shorter but the surgeons could not locate the right lower parathyroid gland.A parathyroid gland is located posteriorly to the thyroid gland and is only 4-6mm in length.Sgt kecik okay!
I decided to do on-call today.Managed to do a few things such as
1) Set a few new IV lines ( Brannula)
2) a few Venepunctures
3)Went to the radiology department with Mr Hisham and Dr Izyan to see a CT scan of a patient with head trauma.This patient had Extradural haematoma.Biconcave appearance were seen in the CT scan.
Tomorrow, I am supposed to go to a place called Sungai Pelek in Sepang to help out my friends who are currently doing their Public Health(or Hell) posting.They are having their 'HIP'-Health Intervention Programme.Malas tapi rasa mcm kena pergi jugak.Probably going to singgah the Hospital again tomorrow.Hopefully can do Arterial Blood Gas(ABG) again!
Thursday, September 18, 2008
We had a bedside teaching by our own lecturer Mr Al-Amin, the Hepatobiliary surgeon.A few of us presented a few cases to him.They did well.I think we have got a good grasp in terms of writing and presenting a good case write up, though it was hard at the beginning because of the nitty gritty stuff and thouroughness.
I did my first arterial blood withdrawal today from the femoral artery.I did not feel afraid anymore.In order to become good at any clinical procedures, I notice that we need to have a good grasp of the anatomy and also...GUTS.Yes, we have to be brave and trust ourselves.InshaAllah everything will be okay.I'm thinking of going to the hospital at 6am tomorrow, so that I will get the chance to do more venepunctures and other procedures.Life is good~ =) On-call at the wards and emergency department tomorrow night! arghh
Friday, September 12, 2008
Fast and efficient is the word for surgery.As a medical student, aggressiveness is an important asset!We cant afford to be left behind coz nobody will wait for you.Never ever wait for invitation.Make your own initiative.
I've presented my fourth Long case write up today and yet I have just received an sms from the coordinator saying that we need to prepare and present our long case by next wednesday.Usually, the presentation day will be on every Friday.Seriously, give me a break.Not only that, TBL and seminars must be completed by next Wednesday.This is what I called absurdityof life.
Thursday, September 4, 2008
Earlier that day, I was in the OT observing a Total thyroidectomy ( total removal of the thyroid gland).Makcik H had this one HUGEEEEEE anterior neck swelling.The operation began at 9 am with initial problem because the anaesthetist couldn't set the arterial line due to frequent thrombosis.I was standing like 5 hours straight until when the clock showed 2 o'clock, I had to leave the OT and rush to a TBL session.By that time the enlarged thyroid has been successfully being removed.Try to guess the weight? I bet its around 1 to 1.5 kg.Seriously, it was that hugee man...
Monday, September 1, 2008
Here's what gonna happened tomorrow
- Bed-side teaching at 7.30am.Lambat seminit Prof takmau sign attendance! Must present a few short cases.Huu..
- Have to srub in the OT.Later kalau sempat pergi Surgical clinics pulak.
-Afternoon: Now its Ramadahan so I plan to use the break to actually take a nap in the surau tingkat lima of Hosp Putrajaya hehe
- Later that afternoon, pergi ke wards and clerk a few patients.I need to select one of them for my Long case.Not forgeting the physical examination and the rectal examination!I need a chaperon because I really hope that I will get a thyroid case this week.Woman are the ones who usually have abnormal thyroid condition!
-Malam: On-call! I really want to Terawikh coz now its Ramadhan.I really love Ramadhan. I think I'll just do my terawikh alone at home.Sigh...
Tuesday, August 26, 2008
TCA-To come again
AOI-At own risk
TDS- 3 times per day
BDS- Twice daily
Stat - Immediately
PRN - Only when necessary
These short forms are usually used in writing notes during clerking patients, or being used in any forms that need to be written down by the nurses or doctors.
OGDS- Oesophagogastroduedenoscopy ( try to say it 10 times continuously.haha)
ERCP - Endoscopic Retrograde Cholangio Pancreatography
IND - Incision and Drainage
SNC- Suction and Curettage
DNC-Dilatation and curettage
In order to pronounce these words correctly, you have to be relax, take a deep breath and say it one syllable at a time.But, it is quite impossible to do that when you have to present in front of the Specialists, who are known to be bombarding you with lost of questions.Tak habis ckp lagi dah tanye next question.
What did I did today:
1) Ward rounds, clerk patients, do physical examination, prepare my short cases which I have to present this Friday to Dr ( Mr) Al-Amin.
Note: When a person is a surgeon, please do not call him/her 'Dr'.Instead, if he is a gentleman, call him 'Mr' or if she is a lady, call her 'Miss'.Pelikkan? Dah susah susah jadi Dr, tetibe nk kena panggil Mr and Miss balik.
2) Do Rectal examination on my long case patient in order to complete my abdominal examination
3) Perform ECG on a patient
4) Observe OGDS
5)Observe Colonoscopy with Punch biopsy
6) Observe insertion of Central Venous Pressure line (using Seldinger technique)
Monday, August 25, 2008
Few patients have actually asked me "Doktor ( altho I am not a doctor yet but they insist of calling me by the title 'Dr' ), saya ni sakit apa sebenarnye?" Can you believe that? The patients dont even know what they are suffering from.Where is the human touch? One of the ways of relieving the pain and the suffering of patients is actually verbally treating them well.Try to talk to them.Make them laugh.Listen to their stories about their family, their work ,their children, their hobbies etc. So far, it helped me in doing my task.I felt easier to clerk their history, do physical examination ( Per rectal examination included!) as they become more confident towards you.They trust you more.They know that you are there to help them.
I am currently doing my second Long case.It's about a 74 y.o Malay lady with the history of colon cancer.She was admitted to the ward due to epigastric pain with jaundiced.Due to the history, the doctors suspected of liver metastases and porta hepatis lymphadenopathy.It later confirmed with ultrasound and she will be referred to Hospital Selayang ( The Liver and Gallbladder specialist hospital).That makcik was very cheerful and comel( admitted by my other colleagues themselves)
I helped one of the HO to do wound dressing on an open book fracture of the pelvis due to motor vehicle accident.This patient had a big hole at his right upper buttock.The wound needs to be cleaned every other day.It was not easy as I had to wash the wound with saline, hydrogen peroxide and do suction.It was first my time and it was a good experience.Managed to assist in doing the Vacuum-assisted Closure(VAC).The surgical ward MO, Dr Zamaq asked me to learn and by next week, he wants me to do the dressing myself.Adeker????Dah gile ape?
Other than that, I clerked a few patients today and did some physical examination on them.I really like this one patient, where she was really cooperative.I totally respect her as she told us that she will helped us by telling her problems.She even let us to do PR to her.She work only as a cleaner.Why cant the doctors be as kind as her.
Hmm ok, gotta go.Long case under progress ...............