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.

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

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!

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.

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

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!