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
-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


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~?????!!!!...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.