Tuesday, December 30, 2008

I still love you even after u have raped me

I was on-call today (yes, during Maal Hijrah holiday).Spend sometime in the Gynae ward and later in the Labour room.
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

Am I a boy or a girl



Today was the Gynae OT day.I observed a few operations.Assist? Nanti la, tak biasa lagi...


Case one: Its about a 16 Yr old girl who never had menses (turun haid).In medical term, it is called Primary Amenorrhoea.There are many causes to this.The O&G specialist had to resort to a procedure called Diagnostic laparoscopy in order to confirm the diagnosis.This procedure involves in making 3 small holes in your abdomen, with one hole from your umbilicus (pusat).The abdomen is being inflated with carbon diaoxide and the area underlying the skin is being viewed by a camera inside the abdomen.Its the 'in' thing in surgery nowadays coz it is minimally invasive.Faster recovery for the patient.Anyway,Dr J asked me a few questions and one of them is 'What wud u make up if we do not find ovaries?' Hmm, lucky for me I straightaway remembered an episode from House Season 2 (I guess..) and answered 'Androgen Insensitivity Syndrome'.In this condition, patient's body produces the guy's hormone ie Testosterone but the body cells are insensitive to it.Therefore, there will be no development of the secondary sexual characteristic of a male, and instead the patient will physically look like a girl.Genetically patient is 'XY' but phenotypically patient is 'XX'.But, in this patient, 2 ovaries were found.BUT, the Uterus was missing.We also assessed her vagina and it was short and underdeveloped (measuring 1cm in length).Therefore, our diagnosis is 'Mullerian agenesis'.Dont ask me coz I have forgotten Embryology of the reproductive tract.I'm always lousy with embryology.haha.Anyway, the surgeon told me that this case is extremely rare and that I am lucky to be able to see during my undergrad.I feel sad for the patient really, but this is fate.We still need to do karyotyping, to confirm that she/he is XY.KUB X-ray (Kidney-Ureter-Bladder X-ray) is next coz 40% of patients with this condition will have urinary tract abnormalities.

Case two: Its about a 49 yr old lady who had abnormal vaginal bleeding in which we called as Menorrhagia.Did a procedure called 'Laparoscopic assisted Vaginal Hysterectomy (LAVH)'.The surgeon had to remove her uterus because of a presence of a Fibroid (Leiomyoma).See pic.





A well circumscribed tumour.Whorling bundle of smooth muscle over the uterine fundus I guess.Hmm...

We had yet another bedside teaching with Dr Jamil the O&G specialist later in the afternoon.Discussed 2 cases, which were presented by my two colleagues Amilee and Faradiana.
Later, I went back to my home sweet home in Cheras.Had a nice nap coz I am not feeling very well the whole day.I had coryza with runny nose.I really blame the cold OT.I also blame myself for not wearing a long sleeve shirt inside.Hmm.



Hannan and Fizie came after Maghrib.We drove to Selayang to Amilee's house for Christmas makan-makan at her house.Merry Christmas!

p/s1: I used to remember the days when I was in Glasgow,Scotland where I was about 4-5 years old at that time.I used to receive many presents during Christmas.Soo happy =)

p/s2: Ish,malu la pulak rasanye letak gambar sendiri.Rasa geli geleman pun ade.Pasni nk delete la

p/s3: Tho tomorrow is a public holiday, I still need to go the hospital to do my long case write up.Sigh...
p/s4:BEWARE.Medical series such as Grey's and House is a piece of crap.Its only good for entertainment, not more than that.Don't get carried away by it.Plus, in medicine knowing rare diseases will not make you a good doctor.

Tuesday, December 23, 2008

O&G The First trimester




Like the title? Hehe...

Well where do I start.For the next following 2 weeks, I'll be attached to the Gynaecology Ward,Gynae Clinics and Gynae OT.Yesterday was the first day for me in the Gynae ward, and so yesterday was the day when I started to test my skills in clerking gynae patients.It was okay I guess.However, the only disadvantage for A GUY like me during O&G posting is that, we the guys will be needing Chaperon to do clerking or to do any procedures.We need another female colleague to be with us before we can do anything.This is to prevent any future issues.Our lecturer had told us that a few years ago there was a case where a med student had to be expelled from his/her medical school due to a false allegation by a patient.The woman patient claimed that the male med student had done 'something' wrong to her while he was doing physical examination on her and made a police report.There was no prove to suggest that this poor student had done so and neither that there was any prove that he didn't do so.A police report was made by the patient and after investigation by the police the student had to be expelled.I dont want to comment on the issue.I leave it to you to decide.But, for the time being chaperon is needed.Hate it when the girls came late, or have somethingelse to do and that you end up waiting for them.Sigh~ hehe =)

Today (Tuesday) was the Gynae clinic day.My group came early and clerked a few patient in the ward and later we joined the Specialists for the ward round.Later in the morning, we all went to the Gynae clinic.I was attached to the HOD(Head of Department) Dr Wan Hamilton.She is a strict but a nice lady.She'll be okay as long as you are able to answer her question and show that you know something haha.These are the few cases that we saw in the clinic today

1. Mdm Y, 48 yr old came in with Perimenopausal symptoms such as hot flushes, palpitation,depression,night sweats etc.She is actually on HRT (Hormone Replacement Therapy) already to alleviate her symptoms and was on follow up.The Dr did VE and also the conventional pap smear.Unfortunately , we the guys were not allowed to observe.Sigh.See, we are so at the disadvantage side.We learn about the management, things to look for during examination etc.

2.Puan N came in with secondary infertility.Turns out to be that she has PCOS(Polycystic Ovarian Syndrome) .She has Hirsutism- Misai, acne and was of course infertile.

3. Puan J came in with history of Complete miscarriage and was on follow-up.Did ultrasound on her and the uterine cavity was clear.Nomore product of conception.

In the afternoon, we had TBL session with Dr Sulaiha the O&G specialist.The topic was Early & Late Abnormal Per Vaginal Bleeding.It was an interesting session because all of us shared our cases and we discussed with each other.It's true that patient is your best textbook.

Tomorrow is the day when I have to go to the Gynae OT and observed some operative procedures.Therefore, had to go back yo the gynae ward and clerked those patients.Memang cari nahas la kalau nak observe operation tapi tak tahu apa-apa pasal patient.Tomorrow, I'll be observing
1)Hysteroscopy
-a 49 yr old, G0P0 patient came in with the chief complaint of abnormal per vaginal bleeding of 1 year duration associated with suprapubic pain.The bleeding had become worse 2 months ago.She will bleed everyday, sometimes the bleeding will be so severe that there will be flooding(yes thats the term used here) which was described by her as a gush of blood came out from her vagina.Not going into details here.

2)Diagnostic laparoscopy
- This is one is for a 16 yr old girl who had never had menses before.Primary amenorrhoea case

3)Cystectomy

4)Tubal ligation
There is no better way than ending your tiring day with a few Big Apple Donuts!





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...

Tell me that its ok to be at the bottom of the wheel sometimes...

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

2.Placenta Praevia

3. Oligohydramnios

Tuesday, December 16, 2008

Day1&2 of O&G

I've got no quality time to actually update this blog for the time being.Its only my second day of my O&G posting but many new,interesting things have been happening so far which I am eager to tell you all about.Will do that during the weekends inshaAllah. Oh by the way, I got A- for my Surgery posting.Alhamdulillah.That means my final mark should be between 75-79 over 100.Its something to celebrate really coz it is not easy to get that kind of mark.Alhamdulillah again

Saturday, December 13, 2008

What??!!




What~?????!!!!...Holiday dh habis.Hari ni hari Sabtu,esok hari Ahad, Tulat (hahaha) hari Isnin.Maka bermulalah chapter baru dalam hidup.I'll be doing my Obstetrics & Gynaecology posting for 2 months.Need to do revision for the pre-clinical topics, need to read more and more books and articles and most important thing is that need to do a lot of clerking from as many patients as possible and eventually able to come up with decent case report and ultimately able to present them to the Specialists.Sounds men-tension-kan.I have set a few addtional goals during the coming 2 months of which I hope I could achieve in time:-


1) Deliver AT LEAST 10 babies! ( Highest priority )


2)Spend some time in the Paediatric ward once in a while, especially during Friday when the Thalassaemia patients come for their routine check-up.At least I will be able to palpate more and more liver and spleen.Weee~~The Paed ward and O&G ward is at the same floor after all


[The list will be updated from time to time]


By the way, found a new blog disebalikitu.blogspot.com .I thought that his MotorBasikal ciptaanya was brilliant.Kengkadang tu terasa rugi pulak tak terima tawaran Petronas buat Engineering kat Aussie dulu.Ntah ntah dh grad dah pun... =(

Friday, December 5, 2008

Bye bye Paeds

Yahoo! I just completed one of the most horrible posting ever.No way that other posting will be as tidious as this.I began the posting with such a negative mind, and it was fairly negative throughout haha.Well probably that was because I fell in love with my Surgery posting.I did Surgery prior to Paeds.During this posting, I had to put a lot of crap with all the mellodramatic moment of the specialists yg tak habis habis nak bebel je.Otherwise, evertyhing would be fine and perfect.They expect a lot of things from us.Plus, they are all mothers and mungkin diorang asik fikir 'haih kenapala anak anak aku mcm ni' thus the bebelan pun sering berlaku.I actually enjoyed Paeds in the end, knowing that they actually care for their students.They want us to be as good as them if not better.I have always love those congenital heart diseases, even when I am still in my pre-clinical years.So, I'm not surprise if I become a Paediatric Cardiologist one day. (Nabil, biar benar ko cakap gitu!!! )
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.



Playing room in the Paediatric Ward



Byk betul soft toys kan?


Oh yeah, I went to an Asthma workshop 2 days before the exam.Little that I know that at the end of the workshop we had to answer a 4-paged mini test.Hidup asyik bergelumang dengan exam je.And luckily the test is not as tough as our REAL exam.Ni tutup mata pun boleh jawap hehe



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

Clinical Exam Paeds habis

Mr Mickey with his other toy mates, nicely being placed inside my Adidas bag!

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.
One thing that I would like to say is that Mother compared to the Father is a much better historian.Sumpah.I had a couple of times clerking history from the father.And it clearly showed that father is usually a bad historian.They are unsure with a lot of stuff.So, to all the Mothers out there,kudos to you and I really admire you all.
I still have a Written exam this coming Thursday.So,literally my Paeds posting is not officially over yet.Yikes.

Saturday, November 29, 2008

Exam Week

Next week is the final week for my Paeds posting.My observed long case clinical exam is on this Monday!My examiner is going to be Dr Faizah who is known to be Baik but very particular about clinical examination technique.To her, Hutchison's book is her clinical bible.Habis ar aku dah laa tak khatamkan buku tu.Hm rasakan ar wei.She also likes to ask things pertaining to your basic medical science knowledge (eg pathophysiology etc stuff).Differential diagnosis pun kena mantap.Just praying that I will get a cooperative patient who does not menangis or melalak.InshaAllah everything will be fine.
Written exam is on the Thursday.I dont know what to say.Buat je laa...

Tuesday, November 25, 2008

'I am happy'

My Teaching Hospital

Dr Rohaizah asked my group to follow her ward round in the Neonatal Intensive Care Unit(NICU)today.Right after that, we had to present to her 2 long cases.I presented one long case to her followed by discussion regarding appropriate investigation,like why do you want to do this and that, management and some theories regarding the case.For the first time she did not comment anything.I wanted her to give comments and therefore I asked her,' Umm Dr Rohaizah, don't you want to give comments ?(like you always do-ni dalam hati je)She replied,' Nothing to comment.Good.I'm happy' 'I AM HAPPY!!!' .What???? Weih biar benar ko ckp gitu!Hm begitula ceritanya.Sesungguhnye kita kena persistent and tahan dengan leteran Cikgu kita because actually they meant well.They want us to be good at the end of the day.

Monday, November 24, 2008

Trisomy 18

My group had a bedside teaching today with Dr Rohaizah.But this time it was held in the NICU.We had to examine two neonates as for our short cases before presenting 2 long cases to her.The first neonate is a Trisomy 18 baby and the other one was Hirschprung's disease.




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.

I love the incubator.It feels warm once your hand is inside it.Can I have one? This baby had a lot of wires and tubes around and into him.Nasal prong, brannula,BP cuff, Oxygen probe, ECG electrode on the chest, Orogastric feeding tube etc...you name it!Lemas gile hidup


This machine is super canggih.I wonder how much one incubator costs!

HIP

HIP stands for Health Intervention Programme.The goal is to promote health and to reveal the findings in a community regarding their health.It is a must thing to do for every group during their Public Health posting, and last Sunday was group 4's turn to organized it.As usual, many batchmates will come to help and support them.This time it was held in Kota Warisan,Sepang.


Monkey-ing around is certainly another way to help them



There are many posters that shows the public regarding their state of health ( or anything relating to their health for that matter!)



Tengokla tu, ada aktiviti menconteng tangan dan muka budak-budak


Teaching the public regarding the basic first aid stuff


See, ada akak yang mengajar mcm mana nk rescue baby




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


Ada akak yang ajar cara-cara pemeriksaan payu dara dekat makcik-makcik

Hmm bersungguh-sungguh ye rupenya mereka semua itu


All these will be part of the Public Health final exam assessment which constitute for ONLY 20%!!!!!Penat penat je tapi dapat 20 percent je!

Friday, November 21, 2008

Click!

Yes, the title of this entry is Click! as in like the noise made when you take picture with your camera


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

Just another day in the hospital


Paediatric Ward 5 B


In the morning

-Clerked and examined a few patients

-Bedside teaching with Dr Hafiza the Paediatician.Our practical class for assessing developmental milestones of child in a proper way.Bawak laa mainan byk gile, but most of them did not meet the right criteria :p



In the afternoon

-Had Clinicopathological conference with Dr Musa.We presented a quite number of interesting cases that we saw for the past one week bothwhile in Hospital Serdang and Damansara Specialist Hospital.They are Haemolytic-uraemic syndrome, Status Epilepticus, Autism(I presented this case), Infant of a diabetic mother and Haemophilia A. It was interesting that Dr Musa wanted us to share our own views and experience on the case and not only about the academic part of the case.

-A few interesting cases seen today in the ward: A patient suspected of having either viral myositis or Gullain-Barre syndrome.Had ascending limb weakness and urinary incontinence.Quite a number of Dengue cases and meningoencephalitis


Tomorrow

-Ward round as usual

- TBL on Paediatric Emergency

Tuesday, November 18, 2008

Things that you MUST have

These two books are essential.a must have.I've been scolded once for using that Sunflower book and eventually I have found the reason.That book is nice because its colourful and have lots of illustrations, however it lacks information.Sunflower book is not the kind of book for examination.Initially , I thought the book was sufficient but midposting exam result proved it otherwise.In short, please use Nelson coz it is known as the bible of Paediatrics.For clinical, plz use Hutchison's.


Every posting is unique and different.They are somewhat different in certain aspects.Paediatrics for example, are known to have a very detail history taking.Sampai cara-cara nak buat susu formula dalam botol pun kena tahu.There are certain things that a medical student need to bring while in the ward.There are also things that are prohibited in the ward, for example textbook!Below are the things that are always with me while in the ward.



ID card






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.







Toys.In paediatrics, toys are essential not only to divert your patient's attention but it also used to assess the development and milestones of a child.That is why we need blocks,legos and also drawing pad.We can use these item in order to determine whether a child is growing appropriately or not.This must be included as part of your history of your patient and must be mention during case presentation.In developmental history,we assess 4 areas:

-Gross motor skill

-Hearing and Fine motor skill

-Speech and verbal skill

-Psychosocial skill
I have an ample stock of toys at home coz I have a 5 yr old brother.I can always take whichever toys I want, without asking his permission first!





Tendon hammer.Is used to check for reflexes.The tip is used when trying to elicit the Babinski reflex








Measuring tape.Is used during physical examination for measuring the liver span.Is also used to measure any swellings or visible mass. Initially, I have refused to bring a measuring tape and prefer to use a ruler instead.But oneday, a surgeon asked me ' Why you didnt have a measuring tape? Oooo Its a girly thingy is it to have one? When I was a medical student I used to have this and that bla bla bla'



Growth charts! Yes, this is essential in paediatrics.Assessing the weight, height and head circumference of a child is part of the anthropometric assessment.Vital in determining whether patients are growing adequately







Penlight, A pen and a small notebook.Notebook is used to jotdown important points during clerking the patient's history.Penlight is used during physical examination.No textbook in the ward please!



Stethoscope. There's a teddy bear clinging on it.It helps to have lots and lots of toys during paediatrics.I call this teddy bear 'Mr Teddy the attention seeker'.He can help in diverting my patient's attention while auscultating.



My group presented a TBL topic named "Assessment of a child with congenital heart disease".I'm just glad that specialist did not bebel-ed us too much!



































































































































































Saturday, November 15, 2008

The Ups and Down

Medical school is really tough.Only a fit and strong person will survive throughout med school.The amount of work is unthinkable.The amount of emotional stress is another thing.Gosh, why do I want to become a doctor in the first place?Anyway, I really hope I could renew my niat.Doctor is Allah's personafication of mercy.Satisfaction is guaranteed.God will repay me in the hereafter,inshaAllah.
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

Dengue Shock syndrome

Yes, today we had a case with dengue shock syndrome.I clerked and presented the case to one of the specialist.This patient had interesting signs.He had petechial rash(non-blanching), "white islets in the sea of red".On PE, the air entry to the lung is decreased bilaterally,the lung was stony dull to percussion bilaterrally at the middle and lower zone of the lung.Breath sound is not heard bilaterally at the lower zone.This patient was having pleural effusion.He also had ascites.Shifting dullness was positive.Will be doing PE again tomorrow morning before all the signs disappear! :p

Sunday, November 9, 2008

OMG





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!




Today we learn many things about neonatology, a branch of medicine dealing with the newborns.The babies are so tiny, some of them is only as big as your palm.I SWEAR to god that I would have easily crushed them with my hands if I were not careful.We saw and discuss a case of a baby who was born 3 days ago and almost had a thing called "Hypoxic-Ischaemic Encephalopathy" .Her APGAR score was only 2/10!She was in a mess after a failed vacuumed SVD(Spontaneous vaginal delivery).We discuss her Obs record,how to do physical examination (PE)of a neonate,things to look for during assessment, her complications, things to expect, how to manage her, how to calculate her fluid intake etc.We also learn on how to assess a premature baby, ie-signs to look for during PE.


Later, Dr Musa belanja-ed us for breakfast - me, Hannan and Fizie and we talk about our schools.Dato' Dr Musa is one of the most famous Neonatologist in Malaysia.He is also the president of Federation of Islamic Medical Association and The Honorary Treasurer of the Malaysian Paediatric Association.He is a proud ex-KGV Seremban and was an English Debater.When being asked,'Dr, did you win the debates?" He replied' OF COURSE".Muke serious takleh blah! haha


After the breakfast we followed him to his business rounds and saw a few patients.I admire his profesionalism.He knows how to approach the parents and the kids(ie the patients) both at the same time.Both of them needs different approach.All I can say is that life as a private consultant is way much less stressful than Government.I still have a looong way to go in order to reach his level.I definitely will go the private sector, that is a sure thing!
There was this one time during the ward rounds that Dr Musa asked me,Hannan and Fizie to demonstrate to him the types of audible respiratory sound ie wheezing, stridor, snoring, expiratory grunting etc. Luckily there was nobody at the corridor at that particular time, orelse they would think that we are a bunch of monkeys trying to imitate peculiar sounds!



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.

Nagging

Yes, I declare week 4 of our Paediatric posting as the Nagging week.Where ever we go, we are sure to be nagged by our own professors and specialists etc.. I'm starting to get irritated by them.To that Dr H ,we understand when you have to cover 2 wards and therefore will have no time to do bedside teaching with us.We do not want to hear your nagging about your sad little life.We understand you and we are not dumb.Just say it.fullstop.no nagging plz! :p

Interesting cases throughout the week

1.Status epilepticus
- 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

5.Rheumatic fever
- 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

PUO

We have few interesting cases today in the ward. 3 cases of congenital heart disease, 1 case of pyrexia of unknown origin and 1 case To rule out arteriovenous malformation.
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

Just another day of Paediatrics

What I did today
1. 3 hours of ward rounds.Nak patah kaki
2.Clerking and examining patients
3. Break
4. Clerk and examining newly admitted cases
5.Jogging


Some interesting cases today

1.Kawasaki's disease

2. Pertussis

3.Arterivenous malformation

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

4.Revise about
-Kawasaki's dzs - criteria for diagnsosis, complications, investigations, treatment
-Arterivenous malformations
- Pertussis

5.Types of rash

6.Malaysian Immunization Programme- use Paediatric protocols of Malaysian hospitals

7. Finishing my Hutchisons

Sunday, November 2, 2008

Stress

A friend of mine used to tell me this.'Perubatan merupakan satu cabang sains yang mencabar fizikal dan mental'.And by 'mental' I hope she also meant 'emosi'.Its true that we have to work under pressure.We have to put a lot of crap from the specialists.I just hope that they, the specialists still remember that they were also medical students , juz like us!

Friday, October 31, 2008

Down again with URTI

I had 2 bedside teaching yesterday, in the morning with Dr Faizah and in the afternoon with Dr R. We did a few short cases with few patients in the ward.I had to examine a hyperactive girl and and who obviously not cooperative as one of my short cases.Gile stress.Dahla specialist garang and kuat membebel.
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

Kenerakaan

It's only my 3rd week of posting but I am already suffering.Initially you thought that paediatrician are motherly and caring but in actgual fact they are totally the opposite.I know that u have a 16 yrs of experience of becoming a Dr and paediatrician.Jgn laa nk compare your ilmu with my ilmu.Baru 3 minggu in Paeds.
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

Link or Tagged or whatever you want to call it

I've been tag/linked to a few blogs.D*amn...got to write a more sensible posts from now onwards! It was never of my intention to write a proper 'blog'.I dont even edit my posts...gaaa

Monday, October 27, 2008

Sacrifice

Sometimes we need to sacrifice in order to be good.I notice that I am still lacking in terms of my physical examination.Therefore, I sms-ed Dr Faizah and asked her whether I could join her ward round this Sunday.And she replied that I could join her.And so last Sunday I drove to Hopsital Serdang from my house in Cheras just to follow her ward rounds.It took 4 hours just to cover 2 wards; the 5A and 5B.I had to examined the babies and present my findings.No she didnt ask the houseman but me to do the examining.I was quite intimidated at first, sape lah aku hanyalah seorg medical student.But I improved later.Dats what I like about her.She will ask YOU to examine the patients for her.And she will teach you if you do wrong.I intend to do the same next weekend.

Some interesting cases
1. A child with acute Stridor
2.A child with measles- first time tgk

Saturday, October 25, 2008

Neonatal intensive care unit

Yesterday, me and my othe 2 group members had a bedside teaching in the neonatal intensive care unit with Dr Faizah, the specialist in-charge of the NICU in hospital serdang.We had to examined this one tiny preterm baby.It was awkward at first.This is my first time examining a tiny body.After doing physical examination on him,I presented my findings to her.This baby had pansystolic murmur of Grade 4,highest intensity at the tricuspid area.My colleague had to examined a neonate who is having bronchopneumonia.Apparently he had 2 out of 3 cardinal signs of heart failure.He had enlarged heart (cardiomegaly) and tachycardia.However, his liver was not enlarged.Dr Faizah had to break the bad news to the parents.It was really frightening after seeing the way the parents react.They were shocked and in denial.However, I admire Dr Faizah's way of handling the situation.She was straightforward and was being emphatatic at the same time.Life as a doctor is challenging.We still need to be able to handle all sorts of people.People,especially parents have high expectations on doctors.Its hard to be somebody who is a personafication of God's mercy

Monday, October 20, 2008

Finally!

Today is like finally I got to know the difference between crepitations,ronchi,wheezing,vesicular breath sound and bronchial breath sound.It's really frustrating to just read from the book but unable to differentiate it in a real practice.Had a bedside teaching with one of the Paediatrician,Dr Faizah.I presented a long case to her just know.History taking was good, although I need to reorganize my points so that it make more sense.Did a few short cases as well on respiratory systems.I learned on how to present my findings for respiratory system in a a short but systematic way.Dr Faizah and us had to go from one patient to another patient because each patient had different signs.I am really really glad that finally I get to know the difference!Its hard to just read from the book.We also discuss the case and try to colerate it with chest X-ray findings.

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

Ringtones

Yes, today I wud like to talk about ringtones,particularly the ones that the specialists have.
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!

In paediatrics...

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

Those cute cuddly little babies

Yes, I just completed my first week of Paediatrics posting in Hospital Serdang.My impression: A bit boring compared to Surgery.URTI, Asthma, diarrhoea and a few other common illnesses.Thats it so far.Not too interesting for me I guess.
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

Surgery Exam Week: Long case exam

Seriously, I didnot know whether I should be pissed off or be happy with my long case exam just now.
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

Nothing is enuff

Yes, no matter what you do, no matter how much you sacrifice yourself in the sacrificial pit, it will never be enough.So enough, I've had it, I am not going to become the saviour anymore.It's all about me now.Me first!You second!

We'll be amazed of how many superficial people around you, just waiting the right time to bite you...

Wednesday, September 24, 2008

Key-hole dressing

It's a type of wound dressing that is usually used for various types of drainage.It was an honour for me as a clinical year MAD medical student, to be given such trust by the nurses and doctors to perform such procedure.Ohhhh well... it's not that complicated anyway.The patient himself was giving me the instructions throughout the process.Haha.






First, make sure the sterility of the equipments and your hands must be clean.Perform the surgical hand washing (yes, there are many methods of hand washing)

What you need is basically a dressing set which contains other stuffs, povidone iodine,normal saline, Hapifax-wide body ( a type of plaster), cotton balls gauze and of course the working brain.Introduce yourself to the patient and make sure he/she is comfortable.Get a good exposure of the abdomen.





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!

This patient has a drain, which is connected to a plastic bottle.It contains blood, originated from the abdominal cavity.Later, wear mask, open the bottle and drain it into the sink.Rinse it with running tap water.Connect it to the vacuum port and depressurized it.Reconnect it to the tube.
Soak the gauze with iodine.Close the wound and secure the tube.Dont let it dangling like a yoyo.Apply Hapifax in order to close the wound with iodinated gauze.And voila my job is done.
Today, did a few venepunctures.I failed once and it was humiliating.Cant blame coz the patient was well built!Veins lari lari okay.Clerked a number of new patients in the ward and did physical examination on them.
Currently its 11.50pm, I'm only half way on my long case write up.I intend to present it tomorrow.I've decided to go to the Dewan Bedah tomorrow so that I can update my patient.Bye

Tuesday, September 23, 2008

23rd Septembr 2008

What did I do today

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

22nd November 2008

It really scares me sometimes that we can die, literally anytime when the time comes.Thats what I felt when I was in the surgical clinic today.
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

Post call

It's 12.50am now, juz got back from the Hospital due to on-call.

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

6th week already

What did I do today?Lemme see...I've just presented my 5th Long case.It was a difficult case to begin with.Even the surgeons said it was difficult.But I think I did just fine.I got 7/10, which is a good mark! Susah nk dapat...
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

The absurdity of life

I've just completed my 5th weekof Surgery posting.Frankly speaking, I like surgery.I can see myself as a surgeon one day.God willing,if I am destined to become one...I am really not that surprise.A friend of mine said that there is a theory that we medical students will fall in love to our first posting in our clinical years( Surgery in my case) and will tend to like it more than the other postings and eventually will become specialist in that area.I leave that to you dear readers for your own thoughts.

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

TOILET mastectomy O_o

I am currently doing my Long case.It is regarding a 56 year old lady patient who has an advanced left breast cancer ( TNM Staging: T4c, N1, Mx ) .She cried today right in front of me.I was speechless at first, but later managed to calm her down.I cant imagine if I were at her position at that time.She is scheduled for a CT scan tomorrow morning.She will be undergoing a surgical procedure called "Toilet Mastectomy" in order to remove a fungating breast mass ( which in my opinion doesn't look like a breast at all.There was a complete destruction of the nipple and the general breast architecture.It has active bleeding with puss collection already).Why the name 'Toilet"? hmm dont asked me.Miss Anita the surgeon had explained to me earlier but I still dont get it as to why it was named as TOILET mastectomy.I thought it was a typo error initially and had a great laughed, but seriously...the name is toilet.god knows why...
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...
K ciao~

Monday, September 1, 2008

Conserving energy mode

Can somebody teach me on how to conserve energy?I so really need this skill. Can I just put my body on Standby mode while in the OT (operation theatre)? Can I put my body to Hibernate mode during lunch break?

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

Short form

In Malaysia, we are flooded with many unauthorized, self-invented short forms.There are many reasons of inventing these short forms.First, it is easier to write notes or jot down something really fast when we have short forms.Second, medical terms can be sometime become a tongue twister, especially when they are combined with few other medical jargons.Below are the short forms that I have learned so far during my Surgery posting.Correct me if I'm wrong, or you have anything to add.

TCA-To come again

AOI-At own risk

TDS- 3 times per day

BDS- Twice daily

Stat - Immediately

PRN - Only when necessary

Imp- impression

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

How long does it take to greet patients?

It saddened me to see that the specialists and other doctors in the Hospital Putrajaya to not to greet their patients well.This is usually seen during the ward rounds.You can hardly see them greet and aknowledge their patients.All they do is straight away discuss the problems, complications, treatment plan etc among themselves, although the patient is staring, waiting helplessly in front of them.Sometimes its quite funny to see that it is the patients who greet the specialists.There is no doubt that these specialists are brilliant and talented people.They are always busy due to their tight schedule.But, is it so difficult to say Hi, or give salam and say How are you today?How long would it take? 5 minutes?? No it only takes only a few seconds.I just would like to remind myself and to those future doctors out there that our job is not treating the diseases only, but treating the patient as a whole.I always here that the HOs mention the patient by their diseases."Hey Timah, boleh tak ko check kan patient yang ada paralytic ileus tu, aku busy la" .I mean like...helloo...tak payah laa sampai macam tu skali kan?
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 ...............