Ahoy! Crazy Week Ahead!

Day 1:
Paediatrics morning ward rounds, Paediatrics Surgery lecture, Ophthalmology lecture

Day 2:
Paediatrics morning ward rounds & lecture, Ophthalmology lab

Day 3:
Paediatrics morning ward rounds, Neurology lecture & lab

Day 4:
Paediatrics morning ward rounds & lecture, Tropical Medicine EXAM!

Day 5:
Neurosurgery lecture & lab, On-call session


Oh well, looks like there'll be no time for blogging this week I think. But then again, one can never halt the creative process once it has been set into motion, da?
One thing for sure though, I have a biiiig feeling that I'll be a walking zombie by the end of the week because we might also be joining the other groups for their on-call session on day 1 and 3. And there is also a case presentation to prepare, plus have to do some running around to settle some uni related matters.

HELLLLLLLLP!!!

*falls unconscious on the floor like a lump of log due to severe hypoxia from excessive hyperventilation induced by an acute panic attack*

"What do you mean you cannot drink milk??"

"It's because I have Lactose Intolerance (LI), ok? "

I got asked this a lot. And when I told them why, they automatically assume that I don't drink milk. Actually, it doesn't mean that I cannot take milk at all, in fact I love dairies, but consuming milk or any type of dairy products will eventually cause bloating, flatulence, abdominal cramps, and last but not least, acute diarrhea that could lead to dehydration if proper countermeasures are not taken.

Why me??
Well, thanks to the 1/8 chinese, and the remaining jawa part of me = Genetic predisposition, of course. And plus milk-drinking is never really a Malay culture, isn't it?

When will I have the symptoms??
Whenever I have appeased my cravings for something dairy i.e. milk, yoghurt, cheese, ice-cream.....YUMMM!!

How come??
Basically, we lack the enzyme lactase that breaks down lactose, a form of sugar found in milk & other dairy products. Lactose is a big-moleculed sugar and cannot be absorbed by the small intestinal (ileum) walls.
Therefore;
No lactase --> Lactose passes intact from ileum to colon --> Fermentation of lactose by the normal intestinal bacteria --> Production of a lot of gasses --------> Bloating, Flatulence, Cramps + Diarrhea (by lactose that attracts water into colon)

What to do??
Avoid dairy products (unless they are lactose-free), oral rehydration salt, water, water, water, water, water... + Oral enzyme substitution (never tried this before coz can't seem to get my hands on it yet)

Where??
Check out the prevalence of LI in the world population:

If you are still clueless and don't know what I'm talking about, go watch White Chicks the movie. Pay attention to what happens to one of the agents when he ate cheese. Oh yeah, I soooo know the feeling. Been there done that, sigh....

IMHO, being lactose intolerant really suck, big time. Especially for a person who loooooves dairy and can't live without them, like moi. And yeah, different individuals have different levels and degrees of intolerance. But 'lucky' me, I got stuck with the one-glass-of-milk-will-make-you-have-diarrhea-the-whole-night type of LI. And imagine what would happen if I'd have 1 glass milk+1 slice cheese+1 stick ice-cream, in 1 day. Berkampung kat dalam bilik air ler jawabnya...

A lactose intolerant gal who loves lactose-full dairies. What a bummer, ain't it?

Unproductive

Woke up early, got ready, took the tram and arrived on time for morning class. Waited and waited for the others to come, but they were late. Therefore, teacher said, "Sorry but you guys were very late, and so I put you absent except for the two of you who came earlier. See you next week then ok..."

Since it was too frickin' early too go home and do nothing while waiting for the next afternoon class, decided to join the others and went to the mall (which is just 10 minutes away on foot) from the Paediatrics Hospital. Had brunch, walked around a bit until 1pm and then went straight to the Infectious Disease hospital for class.

Came in, she talked about Leprosy and TB for like 1 hour, and then class was over. Hisy, itu aje? Nothing else?? Sabar je lah...

Went back home, and took a nap coz got a major headache. And woke up with a massive headache instead. Hmmmmm...I think it's time for the migraine meds.....

Sigh, what an unproductive day.....

NB: Tomorrow we might have neurosurgery. Maybe yes maybe no, nobody is sure. But I'm still gonna go nonetheless, just in case you know. And I'll also be doing garda with our paeds surgery lecturer tomorrow. Went last time with him and it was fun (had the chance to enter the OT and watched 3 surgeries, cool eh). And so that's how I will spend my friday night, sometimes the weekends too. Sigh, no wonder I have no social life here...

(garda = on-call)

Foreign vs. Local

If this is really gonna be implemented soon, then is it really worth it for me to go back and serve my country when they don't really need local docs anymore?

Maybe I should explore other options.

Maybe change is good.

Maybe it's a sign.

Just wondering, that's all......

Flu-ish Weather

Demam
Selsema
Sakit kepala
Sakit badan

The weather is driving me up the wall! Surrounded by sneezy+coughy+feverish people ain't helping either. Barely recovering from last week's bout of stomach flu, now this. Sigh.....

It snowed yesterday. Came with winds and thunder all. Just when you thought that spring is finally here, then suddenly snowflakes started falling down from the sky. Was practically covered all white on my way back from class. It was cold, but thank God the temp was above 0 degrees, else I think my body temp will sharply incline making me tres tres sick again. But thankfully all the medication and fluids worked, and only remnants of a mild stuffed/runny nose is present.

Sudah-sudah lah tu, penat la sakit lama-lama nih. Really I tell you, gone lah my liver like this kalau asyik dok sakit and telan PCM sokmo. Isy.....

Stomach Flu et moi

Gastroenteritis, or commonly (and mistakenly) known as the stomach flu, is an inflammation of the lining of the stomach and small and large intestines. Most of the cases are infectious, although gastroenteritis may also follow ingestion of drugs and chemical toxins (eg, metals, plant substances).

Infectious gastroenteritis is commonly caused by viruses (Rotavirus, Norovirus, Astrovirus, Adenovirus, CMV), and less commonly by bacterias (Campylobacter, Salmonella, Shigella, E.coli O157:H7) and parasites (Giardia, Cryptosporidium).

Generally, there is a sudden onset of symptoms, with anorexia, nausea, vomiting, borborygmi, abdominal cramps, watery diarrhea (with or without blood and mucus), malaise, myalgias, and prostration. The abdomen may be distended and mildly tender; in severe cases, muscle guarding may be present. Gas-distended intestinal loops may be palpable. Borborygmi are present even without diarrhea. Persistent vomiting and diarrhea can result in intravascular fluid depletion with hypotension and tachycardia. In severe cases, shock, with vascular collapse and oliguric renal failure, occurs.

Treatment is symptomatic, although parasitic and some bacterial infections require specific anti-infective therapy. Gastroenteritis is usually uncomfortable but self-limited. Electrolyte and fluid loss is usually little more than an inconvenience to an otherwise healthy adult but can be grave for people who are very young elderly, or debilitated or who have serious concomitant illnesses.

(Source: The Merck Manual of Medical Information)

This was what I had last weekend. A rather bad case of gastroenteritis. First it was diarrhea. I thought it was just a plain case of lactose intolerance (had a glass of milk Friday afternoon) which usually would pass after a few hours, or at least food poisoning. But then the symptoms got worse; non-stop diarrhea, nausea, abdominal cramps, a pulsating frontal headache, back pain and muscle cramps. And come Saturday afternoon my temperature spiked! I was dehydrated from the diarrhea and had chills all over that I couldn't eat anything. All I could manage was sipping plain lukewarm water now and then, swallowing a couple of tabs of PCM, gulping down home-made ORS (oral rehydration salt) mix, wrapping up myself under the blankets, and slept and slept and slept...

Alhamdulillah, the next morning the fever, headache, cramps, nausea were all gone. Still had some mild diarrhea though. All I could manage was some dry toast and soup. By nightfall I was almost normal, albeit a little bit weak. I was lucky that my recovery was speedy, I guess that my decision to rehydrate and control the fever worked in my favour. That and also the fact that although the urge to vomit was there I tried not to because I knew that if I do I'm gonna be more dehydrated. It may be bad to suppress the urge, but I do know my body well and how it reacts.

Until now I have been trying to figure out what had caused it. The only conclusion that I can come up with is that I may have had a viral gastroenteritis contracted from the hospital or from my colleagues. Why? Because apparently some of my classmates also fell ill with almost the exact same symptoms that I had on the very same day. It definitely wasn't food poisoning because we didn't eat the same food. Coincidence? I think not. Although, according to one of the doctors it could also be the fact that there was an epidemic of stomach flu at the time. And I think he could be right, because of this. Whatever it was, it affected my friends worse than me. Poor things. But as Ms MCL said there is an upside to it; she lost 5 pounds in less than a week! Good for her, but caution to all of you especially the bulimics: vomiting is NEVER the solution to weight loss, comprende?

It's been a long while since I was this sick. Thank goodness I kept some PCMs, aspirins, charcoal tablets, and paid attention during physiology class long time ago. Time and again the home-made ORS mix proved to be useful when no pre-packed ORS are available on-hand. Thanks Prof. Ruby, you're a life saver!

n.b. I'm laying off rice for now. My stomach can't seem to stand it anymore, too starchy I guess. Might go vegetarian for a while. Wonder how long till I'll start craving for some meat...

Busy Bee

I'm wiped out. Tired of running around town for our classes in different hospitals scattered all over the place. Thank goodness the public transport here is quite efficient, although one do have to put up with bau-bauan yang kurang menyenangkan daripada orang-orang yang tak reti nak mandi, ada yang sanggup tak mandi berbulan-bulan sebab nak jimat air. Sheeeeshhhh....

We're having a case presentation tomorrow. It's about a patient in our pediatrics clinic with Tetralogy of Fallot. Interesting case, nice and very accomodating baby. My group has the honour of presenting first, so I would really hope that we'll do good. Will give an update later on how it goes.

Now need to get some zzzzzzzs before revising for tomorrow's presentation, got a killer headache residual from a very bad case of Gastroenteritis (stomach flu) over the weekend. If got time I'll blog about that too.

Oh, did I mention that I HATE public speaking?? Urghhhhhhh...

Filtering my system away

Just got the results for Nephrology exam, and I am sooo glad that I passed. Having our seniors telling us that this is one of the hardest paper to pass, you can understand why my nerves were rattled with anxiety, sleepless nights and also bouts of diarrhea prior to the big day!

But then, it wasn't so bad after all. The exam I mean. If you go to all the classes and rounds and studied throughout the session passing won't be a problem. Heck, scoring an A won't be a problem either (and I am a proof of that miracle!)... Anyways, I'm just really relieved that it's over and now could start focusing for other subjects. Adoooiiiii.....

Going through the nephrology cycle wasn't easy for me personally. I have had to battle my own demons and sad memories whenever I set foot in the wards/dialysis units. Being there brought back memories of how it was for me when my late father had to be admitted for renal failure and I was practically living in the hospital too at the time. He was on hemodialysis but due to a lot of complications (post-dialysis hypotension was the major problem), he chose to continue his renal replacement therapy with a CAPD (continous ambulatory peritoneal dialysis). And although the CAPD was working, his heart gave out in the end.

Looking back I wonder how I did it and where did I had the strength to go through all that because now I can't imagine going through all that again. Maybe it's the power of love that was keeping me afloat and sane those days; when it's for someone that you love nothing is impossible. The only thing that I regretted until this day is if only I have had the courage to give him one of my kidneys maybe he would have a better chance of survival. Until now the what ifs plagues my mind, and how I wish I could have done it differently.

If only...

Sweet As Sugar

Had Diabetology exam recently, and what can I say? Diabetology rocks! IMO we should have had this subject when we were starting our clinical cycle. Things would have been clearer and easier for us. Oh well, I guess it's never too late to gain knowledge. Plus it's important for us future docs to know that the previous diabetes mellitus (DM) classification of Type 1 Insulin Dependent DM (IDDM) and Type 2 Non-insulin Dependent DM (NIDDM) is incorrectly used due to the fact that even Type 2 DM patients are prescribed with insulin as their treatment regimens nowadays. Therefore it's just Type 1 DM (insulin deficiency) and Type 2 DM (insulin resistance).

Note to self: DO keep up to date with the latest info on DM for future references. AND limit sugar and/or sugary products intake because prevention is definitely better than cure!

To Pee or Not To Pee...

Case 1:
Male 38 years old, with chronic unilateral lumbar pain.
Lab investigations and urinalysis are within normal limits and ultrasound scan (USS) reveals significant abnormalities. A kidney-ureteric-bladder (KUB) X-ray and an intravenous urogram (IVU) investigation was carried out. An additional investigation, a retrograde pyelogram (RPG) was also done for confirmation of diagnosis. --- (KUB X-ray, IVU and RPG films were shown for us to figure out the diagnosis and treatment.)

Diagnosis:
Stenosis of ureteropelvic junction (UPJ) with congenital hydronephrosis of the left kidney with secondary multi-caliceal stones in the left kidney, and a caliceal stone in the right kidney.

Treatment:
- Ureteropyeloplasty / Endopyelotomy to relieve the UPJ obstruction.
- ESWL (exracorporeal shock wave lithotripsy) to remove the stones.

----------

Case 2:
Female 60 years old, admitted in emergency due to excruciating renal colic pain. Patient was given medications for the renal colic and the pain subsided. USS reveals significant unilateral abnormalities. A KUB X-ray and IVU was carried out for further confirmation of diagnosis. --- (KUB X-ray and IVU films were shown to us for diagnosis and treatment)

Diagnosis:
Ureterohydronephrosis on the right side with stenosis of the right ureter due to a ureteric stone in the pelvic ureter.

Treatment:
- Retrograde ureteroscopy (method of choice) / ESWL - to remove the ureteric stone
- Ureterolithotomy (if other procedures are unsuccessful)


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


Well, there you go. That was the clinical cases for our group. Quite confusing especially when the stenosis and stones could be over-looked if one wasn't looking for it properly. I guess my decision to focus more on the urinary tract calculi chapter really did paid off. But it was kind of unexpected because whilst other 2 groups had 2 very different cases (renal tumor, horse-shoe kidney, bilateral hydronephrosis, Staghorn stone) ours we had both hydronephrosis and stones. So therein lies the confusion and misdiagnosis for some of my colleagues. Can't blame them though, it was just luck that made me see those tiny little opaque stones on the films and figured out what they were. Alhamdulillah, I am as ever thankful for the grace of Allah and humbled by His love and generosity...

And that marks the end for urology chapter. One thing for sure, I don't think I'm cut out to be a urologist. And if there's one thing that I would eternally remember from all this, it would be.... Priapism!! ^_^


Next up: Anaesthesiology and Intensive Care.


Two more exams and then we're done! Yippeeeee!!!

The Bone Specialist

We thought, that he was a bear of a man.
We thought, that he was mean and sarcastic.
We thought, that there was no way he's gonna let us go easy in the exam.
And so we thought, we were gonna be majorly screwed.....

Hah, but how wrong we were.
He wasn't mean, just a man of few words.
He wasn't sarcastic, but (rightfully) strict.
And he was fair and just and totally not who we thought he was....

Lesson learned: Never make quick judgements. People might just surprise you.

Well, if he was who we thought he was, many of us would not have made it.
And the thing is, for him, I guess it's enough if you know what you have studied, and most importantly, studied about what was important and the things that he had mentioned in class (provided that one attended his classes, of course).
And it does help to have a good attendance in classes.

So maybe, this time I did it right.
Because I did really really well.

Shocked?
Hell yeah I was.
Thought that my eyes were playing tricks on me when I saw the results.
But I guess I did it right, at least for now.


Next up: Urology.


I'm freaking out! HELP!!!


Mak, I need a break! Huwaaaaaaaa.......

What a Wonderful Day...

Yes, what a day indeed. Why?

Because I passed General Surgery with flying colours! YAY!! Alhamdulillah....

I guess this time luck was on my side. And plus all those sleepless nights really did pay off.

Started the day with pre-exam jitters with tachycardia and hyperventilation, as usual. If the exam would be anything like last year's (we had the same prof for general surgery then too), then I really should prepare myself for thorough Q&A session during viva oral, and that explains why I had a mild panic attack prior to it. Haih...

First phase: Practical with the patients. Each of us were given a patient and we were asked to interview and examine the patient carefully and thoroughly. My patient, a sweet 80 year-old lady, came in with only a complaint of irregular bowel movements and stool composition, and after a full check-up she was diagnosed with cancer of the right colon (ascending colon) and scheduled for surgery the next day. So when the examiner came to me, I was asked about the patient, her diagnosis, the investigations (blood tests for liver, kidneys, glucose, CBC; barium enema; colonoscopy and biopsy to check for malignancy of the tumor) and surgical treatment suitable for my patient (right hemicolectomy with ileocolic anastomosis, or, if the tumor is unresectable an ileo-transversostomy or bypass should be performed). Phew! Lucky thing I managed to do some last minute revision early that morning about colorectal cancers, else I might just go duh there...

Second phase: Written exam. Quite a tough one actually. 10 questions in all and none too apparent too. Had to do some major brain-digging to vomit out the correct info. It was a miracle I didn't have hematemesis at the time. Urghhhhh...

Third phase: Viva oral. Prof was in quite a good mood today eventhough there were more students today than yesterday (a couple of students that were supposed to go yesterday actually bailed and ended up joining us today, sabar je lah). As my answers were satisfactory (albeit a few mistakes that I made due to confusion, which thank God I had managed to figure it out during the viva and told her before she started to question me about it), she didn't grill me like I would have thought she would. And seeing that my marks for Thoracic Surgery and Cardiac Surgery was good (un-sangkarable betul lah!!) she added everything up and gave me an A!!

Melle got an A for surgery!!! Melle so happy and relieved... ^_^

Alhamdulillah, one down and four more to go. Got time will update.

Next up: Orthopedics.


n.b. Again I was lucky, to get such a nice and cooperative patient. At first she was a bit standoff-ish (which I suspect is due to the fact that I'm a foreigner trying to put my hands on her, hmmm....) but at the end of my practical phase she was talking away non-stop and as I was leaving she had even hugged me and kissed my cheeks, wished me good luck and all the best for my exams, and also reminded me to be a good and worthy doctor. Almost had a break down then and there, luckily managed to run out of the room before the tears spilled onto my cheeks. Sigh.... Tetiba rindu kat tokne lah! Waaaaaa...

Cardiac Surgery

EXAM. Arghhhhhhh...screwed from the get go, we should really have ignored the kind advices dispensed by the seniors. Oh well, no one else to blame but us, we should have known by now when it comes to our luck it's either bad or worse, and for sure we will be the guinea pigs, AGAIN. Luckily remembered most of what I studied for Internal Medicine though, but still.....Hmmmm, what to do.....


Topics for Group A:
1. Risk factors for CABG (coronary artery bypass grafting)
2. Mitral stenosis - Natural evolution
3. Types of mechanical valves

Topics for Group B:
1. Aortic regurgitation - definition, etiology, signs/symptoms, diagnosis, treatment, surgical procedures & types of grafts used
2. Surgical anatomy of mitral valve
3. Tetralogy of Fallot


Sheeeeesh....if only I could have that wonderful photographic memory, if only I had focused more on this instead of general surgery (eventhough cardiac surgery is a part of the surgery cycle and marks will be counted in the final general surgery final exam marks), if only, if only....

Well Melle, no use crying over spilled milk. What's done is done. Need to focus more for other papers. Life must go on...

Next up: General Surgery.

Wish me luck!!

TOMORROW...

..... is JUDGEMENT DAY. It will be the day that will decide if I have what it takes to do what I've chosen to do. It will be the day that will decide if I will be able to celebrate Eid at home. And it will be the day for me to verify my belief that an a**hole will always be an a**hole, even if I've done all that I could and gave all my best.

Tomorrow is indeed the Judgement Day. And it doesn't help that the judge feels it's right to screw people's lives. But by hook or by crook I have to get this done and over with NOW. Let's see if I'm still alive and breathing by Monday.

Double Dose of Surgery

Fridays for us are normally non-hectic days, sometimes we won't even have any classes on Fridays. But this week is a totally different story altogether. I had a double dose of surgical rounds; cardiac surgery and also general surgery. Go figure I was zonked out by the time I reached home later in the night...

First up; cardiac surgery. It's actually a part of the general surgery cycle, like thoracic surgery that we had that day. As we were only given only 2 weeks for each of these minor subjects, there wasn't much to see. But we have seen is enough. I mean, I have seen enough to say that no way I'm gonna be a surgeon of any sorts. I mean, I love surgery, but to do it day in day out, having the patients lives in your hands literally, would just be too much for me I guess. But then again, maybe it's too soon to tell. I might have a change of heart once I'm done here, and then again, maybe not. Oh well, we'll see...

The cardiac surgery department is in the same building as the urology and nephrology departments. We were shown the OTs (operating theaters) and the ICU (intensive care unit) wards, where some post-op patients were hooked up to several machines to monitor their vitals. The day before, we've had a lecture about valvular diseases and valve replacements. And so when our assistants showed us the tools and equipments that they are using for the surgeries it made perfect sense for us. I can now say that I've held a biological porcine valve in my hands! (Ok ok, it was in a bottle, so no need to samak or anything like that alright!)

At the end of the show and tell rounds, our doctor assigned one patient each for us, and we have to talk to the patient, do a physical examination and stuff, and she expects us to present our cases next week. I was lucky that my patient was very obliging and he was in a stable condition. He had a coronary bypass and was in his 10th post-op day with no other complications apart from fluid in his pleura which I had the chance to see it myself while he was doing his ecocardiography. At first he was quite hesitant to answer my questions, but after talking to him patiently he began to open up and was being very sweet indeed. You know what I've long since realized eversince we started our clinical rounds; that patients respond to you more if you could relate to them, treat them like their human not just a nameless patient, and have tons of patience especially if they were a bit grumpy in the beginning. Sometimes they are lonely, and sad and depressed, so they would be unwilling to talk to people especially to those nosy know-it-all medical students. Eventhough for me here language is a barrier, but with my level of competency I am still able to get enough information from my patients. Most of the time I would beg their pardon for my paltry command of their language, but almost all of them just shrug it off and said that it didn't matter, as long as we can get the message across with basic words. See? Sweet aren't they?

Next up; general surgery. Well, actually this was optional. But I had the chance to do oncalls with our main prof, so why waste it right. One thing that I love going on rounds with her is that she'll show us some interesting cases and let us see and talk to the patients as we please, just as long as the patients are not complaining of course. By the by, even met my doc-in-charge of our group for normal surgical rounds and he asked me about my friend. Before you jump into conclusions, this was what had happened:

Last week, a friend called and asked for the procedure to see a doctor here, because one of her friends is experiencing pain that was ulcer-like and it's getting worse by the day. You see, he has been having this pain for almost a month now, but he was too scared to g to the hospital to seek medical consult until he couldn't stand the pain anymore. So, I told my friend that I would talk to my doc, and when I talked to my doc he told me to bring the friend over so that he could have a check up. And when he came, my doc said that he needed to have an abdominal x-ray done to check for the cause of the pain upon physical examination that was not indicative ulcer. And after the results were in, he told us the news; the friend's x-ray showed 3 possible differential diagnosis; Appendicitis (which the doc didn't think so), Meckel's diverticulitis, or Crohn's disease which is in the acute phase (this was what he suspected). And as his white cell count was elevated, the doc suggested that he be admitted to the hospital for further investigations and monitorization. At first he said okay, but later on he freaked out and refused to go back to the hospital, and last I heard he's already flown back home to get medical treatment there. The doc had actually advised him against it because the friend was in a critical acute state, but like how they say doctors are the worse patients, it's also true that medical students are the worse patients too. He refused to believe that he was that sick, so he wanted to go back home and confirmed it. Tough. I've nothing to say anymore. It's his decision at his own risk. But I feel that that was a really unwise decision. Thing is, having had classes with my doc-in-charge, I could really say that he is a really good doctor and surgeon and knows what he's doing. He has a fellowship from UK, for goodness sake. And he never made us feel like we were some low life students, in fact he made us feel that we were a part of the team (but only if we made an effort to show that we're interested in medicine, that is). So, imagine how I felt when he said that maybe the friend didn't feel that they were good enough for him. Malu giler, siot...

Well, after the interesting rounds, our prof told us that if we were interested there was going to be an open appendicectomy operation for one of her patients conducted by her resident surgeon. I jumped on the chance and so stayed on to watch the surgery. Real cool. But I was more impressed by the anaesthesiologist actually. She was so calm, cool and collected even when the patient had some complications and they were unable to intubate him because he has respiratory problems. Hmmm...interesting prospect. Another choice for me; anaesthesia perhaps? Pros and cons from you is highly appreciated :) ...

So, when I got home I was so hungry but was too tired to cook anything. Imagine my surprise when Pinky was in my place and suggested we go to McD for dinner/supper. I thot, whaddahek, haven't had a proper meal for the past one week now. It was kinda nice walking around town at night in the cooling spring breeze. I wish that the weather would be as beautiful as this; not too cold and not too warm, but I have a feeling this summer is gonna be the hottest ever. I just hope that they won't have floods this year, not like last 2 years where the floods had practically closed off the roads and train tracks to the capital. The reason for the panic? We had to take the flight back home from the capital, so to miss the flight home is a suppposed nightmare for us here.....tak kira, nak balik jugak! At the time, some were even considering hiring boats to cross that part of the country that was flooded so that they could get to the airport on time, hehehe.... Oh well, luckily the flood subsided and all of us managed to catch our flights and arrived home in one piece....



Oh, and in McD, this was what I had:

and for dessert, this was my obvious choice...


"It ain't heavy, it's my dinner..." Abis ler keras arteri koronari ku....

Jokes Of The Day

In the Biology exam paper, the teacher asks the students to draw a female reproductive organ.

One girl looks shy, blushes and looks down.....


A guy shouts, "Sir, she's copying!!"


*******************************


WIFE: Honey, the doctor said I have a cute vagina!

HUSBAND to DOC: How dare you!! You're a heart doctor, how did you know my wife has a cute vagina?

DOC: Huh? I said she has ACUTE ANGINA!



LOL!

The HIPPOCRATIC OATH

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

- The modern version of the Hippocratic Oath was written in 1964 by Louis Lasagna, Dean of the School of Medicine at Tufts University -

A Day In The ER

Well, actually not really a day, but for a few hours I had stationed myself in the ER dept for another oncall. It was kinda interesting to observe and see how things operate here compared to most of the ERs back home. Endless endless patients pouring in through the door with various causes of emergency alarm, though interestingly enough most of the cases that I saw today was due to dysuria and and renal colic pain. Wonder what's up with that....

Anyways, as I was observing and helping out wherever I can in there, it suddenly struck me how disheartening it was to see some patients that came in from the countryside with poor hygiene and ragged clothings. Moreover, this one elderly guy came in to the ER from one of the surgical wards complaining of pain in the distal right leg (that suspiciously looked like superficial thrombophlebitis) and also on the left foot, and when he took off his shoes all of us were shocked to see that his toes were sooo dirty and muddy that when we asked him how it came to be (when he was just supposed to come from the surgical clinic which was only 2 blocks away) he only told us nonchalantly that his shoes had a hole in them where the seams had gave out, and that's why the mud from the streets could get in! And when they asked him why he didn't thought of getting new shoes, he just said, "What for?! I can still walk in this one, and I'd rather walk barefoot than starve to death..." Sigh....never before had the reality of life hit me so powerfully than what he had just said. And you wanna know what happened next? My supervisor, a resident doctor there, actually took out some cash from her wallet and gave it to him "for you to buy new shoes, ok sir".....

Then and there it hit me; the reality of what being a doctor entails. A doctor not only heals the body, but as a human being we could and also should help whenever and wherever it was needed. Although my supervisor were not obligated to help out that man financially, but the fact that she did, with no one's prompting and out of the goodness of her heart, made me realise that that is the kind of doctor that I want to be; empathic, kind, humane and ethical. Would I be that kind of doctor, could I? Would I still have the patience and remain calm and not explode due to tiredness even after 36-hours on the job? I wish I could say "Yes, I will!" for certain, but I am after all human. We make mistakes, that's undeniable. But as doctors we can't afford to make mistakes that could cause us lives. And as dilligent and careful we will try to be, there will still be the possibility that things can go wrong. So the only thing to do is do the best that we could do in that moment of time hoping and praying that it is enough, while not forgetting that life is fragile and we are but servants of God.

And above all else, I swear and abide by the Hippocratic Oath...

Surgery vs Emergency

Went for an oncall today with our resident surgeon here. As today is a weekend, there weren't too many cases that came in as opposed to in the weekdays. Actually this was my third oncall, the first two were done with our previous lecturers last semester. We decided to leave after the last patient from the emergency that came in for trauma was brought to the hospital and admitted, and we decided to come back again next day to check on him as was advised by our assistant. And so I went back and went ahead to start preparing and making my baked pasta for our friends' birthday party tonight. I promise I will give an update later about how it went okie...

Actually, I am not really sure in which department I am going to do my presentation for the licensing exam at the end of medical school later. Though I still have a couple more years to go, we were asked to choose a department/topic now so that we can start as early as possible and not do things at the last minute. So, my dilemma now is whether to do it under the surgery department OR in the emergency department. Honestly, in my opinion surgery is very interesting, but so is emergency too. They even have professionals whom specializes in the emergency department here. Prior to this I thought of doing it in the genetics department (which was my major in college), but the emergency field seems, for now, to be very very interesting and something that I can imagine myself specializing one day. Hmmmmm...I wish they have an infectious/tropical disease department here though, so that I can compare and identify which field could be my forte one day. Huh.. decisions, decisions.....

Another weekend passing by so bloody fast. Can't anyone invent a time stopper/decelarator device? Urgently needing them before June comes visiting!

n.b. Need to get surgical scrubs to be able to enter the OT. Which colour would be suitable huh? Isk isk, more decisions *shakes head*...

Another Day In Paradise...Not!

Wow, Surgery class was good. Had the chance to watch a laparoscopic cholecystectomy procedure carried out by our prof. Initial investigations showed only cholelithiasis, but during surgery they found out that the patient's gallbladder is filled with pus - empyema. Other than that he also had adhesions from previous abdominal surgery. Oh, and I think somebody is pissed with us because the prof seems to be paying more attention to us than their own kind. Hah, tough luck. Normally we will be sidelined but at least this time we rule! *laughs evilly*

Hmmmm....Was feeling a wee bit carniverous today, so it didn't take a lot of persuasion by Pinkie to have brunch at one of the halal joints near the uni during the break. Heavenly meat, alas. FYI this was my first proper meal in, oh, 4 days I think. Been surviving on fruits, chocolate bars, cereals and yoghurt these past few days. Too lazy and got no time to cook. Bad Melle, very bad...

Was and still am feeling baffled when friends and classmates started to come up to me and telling me that I've lost weight. I mean, come on, it can't be that I've lost that much kilos in one weekend, can it? Hmmmm....maybe it's due to the fact that there had been a fair amount of walking done in these past 2 months. Since it's a nice walk from home to the not-so-near hospitals and when the weather is superb, I much prefer to walk rather than taking the bus/tram. I guess those 20-30 minutes walk uphill/downhill really did me good, didn't it? But the funny thing was, I wasn't even trying to lose weight though I've wanted to but could not really do it in the past. Someone even made a remark saying that they noticed that I eat more when I'm depressed and less when I'm happy. Well, I guess it's true. And go figure, I am content nowadays. Content with my life, content with the fact that I am living the life that I've chosen for myself and doing the things that I wanted to. My life is my own to dictate, and I couldn't care less what others whom are so wholly unrelated to me want to say. The only thing that matters is that I value what the people that I love thinks, and that's what most important for me. Other than that, they can all go fly kites as far as I'm concerned... Hah!

Teddy didn't come to Urology class today. Hope he's ok. Am still in bemusement whenever I'm recalling yesterday's conversation with him. I was so touched when he asked me if things are ok and told me that he will do whatever he can do to help if only I asked for it. Said that he knew something was wrong at the beginning of the semester itself, but he didn't want to intrude. Awwww...so sweet... But, sorry Teddy, it was too personal to share it with you. Maybe one day, or, maybe never :)

Patch and Kruger made a remark in class that made me laugh. They told the prof that their friend, Bahlul, was absent. It was in jest of course, and the guy in question wasn't around. But the thing that was funny was that they thought no one else except for their own kind would understand the word. That's why when I first heard it I thought I had heard it wrongly, but when they kept repeating it I couldn't help myself and just burst out laughing! You should see the expressions on their faces when they realised I understood it. Haven't I told them like a million times that our language had incorporated their mother-tongue long long time ago? Talk about clueless, tsk tsk... Alamak, takleh nak ngumpat depan-depan diorang lah pulak lepas ni. Aiseymen... :(

Oh, and another thing, Pinkie and Brownie are considering to have a new hairdo and asked for my opinion. I told them to go for it if they really want to, but just make sure that they go to the right stylist to get the look that they want. Else it'll be a disaster. Mmmmm...well who knows, I might be considering cutting my hair too! But of course, it'll be done by none other than yours truly, as usual. Oh well, we'll see how it goes.