Neonatal intensive care unit (NICU) posting

Truly an extremely tiring posting. Every morning, we have to be in ward before 730, or in another word, before prof comes. Wash your hands and scrub your hands, repeatedly, repeatedly, and repeatedly...Basically  3 ward rounds daily, then we rush for tracking results and radiographes, help getting ABG results. And one more thing -  3 oncalls in one week WTH! Honestly, we couldn't learn much nor having own time for self-study as we need to be in the ward no matter how unless we have classes. Those doctors in ward were so busy too as there were so many procedures to be done and so many sick babies to be taken care of. Hate the arrangement but salute the spirit of those doctors, especially Prof Noraida.

One thing i love was the sucking reflex from babies. One of the most useful way to stop them from crying. There was one macrosomic baby, we named him as Abang Bob, was born with weight 5.96 kg. Hmm, surely one of the cutest babies there, and this is what the public usually think of. Big baby is definitely not a good new! (of course not to be underweight) This poor little giant needed to be observed and on IVD with glucose due to his on-going hyperinsulinemia. Hope he will get well soon. Apart from him, i saw some syndromic babies too. One of them was having the prune-belly syndrome. I wonder how bad the prognosis can be due to the malformation of abdominal wall and all the others GIT problems.

Anyway, one week has tortured me enough. I want to get enough rest and also prepare for the coming exam. Good luck to those entering NICU posting soon. Be prepared!

Obstetrics & Gynaecology Posting

     I would like to say that this posting is really one of my favourite. In the beginning, when i first knew that i would be in team C, the busiest team among the four, i was so frustrated. Covering cases was a must for us, which irritated me the most as i really hated covering cases in ward. It was just a waste of time in my thought but my mind changed after we joined the team soon. Finally i could see what was the purpose of covering cases. We discussed cases among ourselves, we cleared our doubts by asking the MOs (they were really willing to teach, unlike most of the other postings). The specialist stayed back each time after ward round to teach us something, which was really a huge difference from specialist of other wards, where some even didn't bother us at all. I didn't really mind to wake up very early in the morning and spent hours in ward each day of this posting as it was worth to do so. Hmm, i guess so.

     Everything was well organized. The classes, clinics, on-calls, just that we were a bit rush for the clinical teachings owing to the delay from the first few weeks. We learned and we practiced what we learn throughout the discussions with not just students, but also doctors. I felt like we were being respected and appreciated. It felt good man. Just that if the queen of team C was not that scary and treated us nicer, the team would be absolutely a perfect team for me. Anyway, i felt very grateful for everyone in team C that taught us and also my teammates, where we really worked as a team in covering cases and helping each other in study.

     There was another funny moment when we were having seminar with Prof S where he asked one of my friends "when was your last wet dream?" And, my friend answered it in few seconds without hesitating much. Prof didn't really expect him to answer it as this was a private stuff right? Soon after hearing the answer, the whole class burst into laughter. Oh my god! Luckily i was not the one who got the question.

     One of the most exciting thing in this posting would definitely about conducting the delivery. I conducted 5 deliveries and this was the very first time in my life. I still remembered that i was with my second patient for 3 hours inside the labour room. She was so scared about delivery and couldn't take her hands off my hands when the contraction pain came. She needed to grab my hands. Well, why me? It was all because her husband went out to pray for 2 hours!!! I wondered why he took so long to pray? Wasn't your wife important too?! You should be there as a responsibility of good husband, right?! Anyway i was okay with that. And i really felt touched when the patient kept saying thank you to me after the delivery. Later, in the midnight during my on-call, there was another patient yelling so loud and her eyes kept having nystagmus when the baby was about to come out. I was a bit uneasy during that time. I was just scared if the mother became eclamptic lol.

     Obviously i still lack of knowledge due to my laziness. Final posting for my fourth year already (unless i failed anyone of them and need to come back for remedial posting) and I was a bit homesick. It certainly drove my attention away from study. Anyway it's holiday now. Gonna enjoy my holiday first before i go for my elective haha.

Happy holiday everyone. :)

Neuroscience Posting

Well. 2 weeks of neuroscience posting is DEFINITELY not enough! We got really a lot of stuffs to cover, not to mentioned to hectic classes and teachings and whatever in the timetable. Neuroscience is not an easy subject in medicine obviously. I could see that doctors were expecting us to remember the knowledge from phase 2 and to know how to interpret those radiographes. Well, honestly, and very obviously, i did really bad in it as I was so lazy to study (post-psychiatry posting syndrome). That's really bad, right?

And i just had my earliest class in my whole forth year. 7am class with Prof J! And i was late by 10 minutes lol. Luckily he didn't get angry and scold me. But anyhow, i was like a fool also during that teaching for rushing from ward to computer to clinic to books just to find the one question he asked me to find out. What a good exercise before my exam in the afternoon on the same day :S

Hey i am telling myself to be more hard-working in coming O&G posting! Good luck yeah! (I must to!!!)

Psychiatry Posting

4 weeks? No, we got only 3 weeks as we had one week to get our butt lying at home! :)

Honestly, i was quite excited to enter this posting. It grabbed my interest the most compared to other postings so far. You don't study all those boring facts like you study in other posting. You don't clerk for history, you are just listening to stories. That's why i love clerking the patients in this posting lol :) Furthermore, you really have a lot more free time to do the things u like. Me? I finished 2 novels in 3 weeks time and watched a lot of doraemon lol haha.

Overall, it's quite free compared to other postings. As this is not the most important posting for our lives later as a doctor (unless you choose the psychiatry as specialty), doctor won't be expecting us to know too much about the knowledge here except those important ones. The doctors were so willing to teach us also. They discussed with us about the patients, asked for our opinions and listened to what we said. It made me feel like we were being appreciated. The leader also done a great job in managing the classes throughout the posting. Good job bro!

Enjoy the psychiatric posting if you haven't been through it. It's gonna to be happy posting!

Medical Posting

Hmm, another terrible and busy posting.

Basically it was all about ward round, classes, and study study study. We actually needed to follow the ward round every morning but it was really time-wasting for me. I really hate the ward round as the doctors were so busy with their routines and didn't really teach us or guide us anything unless we asked question. Being proactive was really a good way (perhaps the only way) if you really want to learn something from them, but i am not that type of person obviously. For the first two weeks, i didn't hear any word from the registrar talking to us.

ORL-HNS posting

Another 3 weeks has passed. Quite a short posting.

ORL-HNS = Otorhinolaryngology - Head And Neck Surgery

Not to say it was an interesting posting, but not really boring either. As usual, it was packed with clinics and classes but without any oncall. People usually will say that it's a honeymoon posting, but for me, hmm, not really. We got to study quite a lot of anatomy and diseases in merely 3 weeks,

ophthalmology posting + community eye service

It's was only a 3 weeks posting, but we learned a lot from it. As this posting was quite organized, we really could benefit a lot from it even though sometimes it was quite hectic. Doctors here was super nice. I could see they really put efforts in teaching us.

Orthopaedic Posting

Honestly, i don't really like orthopaedic stuffs. The feeling is like when i was studying physic in secondary school. (i don't like physic either).

Well, orthopedic was a totally different posting compared to surgery posting. I meant the the way how it was organized. Unlike surgery, everything has been arranged & scheduled nicely. Just that you got to wake up early to sign to your attendance before the clerk take away the attendance sheet. Next, you go for ward rounds, clinics, seminars and clinical teachings as scheduled, and also depending on which team you are in. After around 5pm, you will be allowed to go back and study at your room. I was in the spine team. The doctors were damn nice. They spoon-fed everything to us. The only drawback was i had to stick with spine things for 6 weeks, where i could hardly study stuffs from other teams. And i really hoped that my CT could be better. Almost every time doctor would be kept commenting on our history and after that, time was already spent up and he couldn't teach us much about PE. Till now, my PE still sucks!

Moreover, you may have to go for on-call occasionally if your team is in charged on that night. Luckily, i didn't have much on-calls, where i could have more free time for my study (or more time to waste?). Anyway, you can still learn a lot through on-call. you can see "fresh" cases like those mva cases in emergency ward, do dressing on those "fresh" wounds and learn the way how doctor manage the casualties there.

Hmm, not much 'great' procedures i have done in this posting. One STO, some dressings and assisted in some POPs. That's all. I knew that i should be more aggressive and asking more questions but honestly, i was quite tired with the log book requirements already and i chose not to chase blindly after signatures in log book. It was stupid attitude. And my reading was clearly not enough, most of the time i didn't really know what to ask and didn't even know what the doctors were talking about. Haiz. What a bad attitude!

My supervisor? Dr Halim, head of department! Omg! Till now, i am still scared of him. He scolded me few times during ward rounds as i couldn't cover my cases well. If i am smart enough to cover all cases fully and yet, manage to study well, i will definitely do it. But obviously i couldn't make it. I am so sorry to my doctors, and also my teammates, especially Prof Chong. My examiner? Dr Mohammad! Another scary doctor! Thanks god he was free finally after delaying for 3 times. I managed to answer those questions asked by him, even though i knew that my performance was just mediocre. Hopefully i was good enough to pass the posting.

Eventually, my turn to go home! My mood was so badly affected in the last week of orthopedic. I didn't really have the 'mood' to study for exam already. I missed my home sooooo much because i has been away from home for almost 5 months already. I felt so guilty for not studying well enough even though it was already the final week but i just couldn't control my mind. I needed a getaway and a nice rest after a long run in 4th year.


Therefore, as usual, i still couldn't manage to finish studying what i planned initially. Haiz. I knew i was quite lazy throughout this posting. Aargh! Got to be more hard-working next time!

Happy Chinese New Year and Happy Holiday to everyone! :D

BKA

BKA aka below knee amputation, is a surgery which cut off your leg at a measured level below knee.

This is the operation I saw during my second orthopaedic oncall during last Monday night. The patient was the one I clerked before for case report last month. He was actually admitted once last month due to diabetic foot. Ray’s amputation was done before he was discharged. And I thought that he would be okay after that. However, after another 10 days , he revisited our ward again due to the spreading of gangrene again in his left foot.

He said when he was in clinic, the doctor cut through his foot and found a lot of pus inside his foot. It’s a sad thing when you thought that you are already recovered after removing part of your foot, and now the doctor tells you that you have to remove another bigger piece of your leg. His wife once told me before that they were actually having some financial restraints. Even with the help from government’s welfare, it was just enough to drive through their routines. All his children but the eldest one are still schooling. He can no longer work as he feel tired most of the time. ( fatigue is one of presentation for diabetic patients, not that they are lazy. ) His wife can only earn a few hundred bucks by working in a school canteen.

During morning round, our doctor told him that BKA needed to be done on him as the foot was already not viable and also to prevent the colonization of microorganism there. He agreed without thinking too much. He understood. Just that I could not understand why he could be so calm when someone told him that his foot needed to be removed? I guess if I am him, I am gonna cry a whole day long.

Sometimes, it might be just an ordinary operation for us as medical students or doctors, but it plays a huge part for patient’s life. It might be vital for survival but it does affect a lot on patient. I just feel like the psychosocial part is a important part also in managing patient. They are human being, their hearts are still pumping, they still have their feelings which we can never ignore it. Don’t blame them if they are reluctant to accept your decision of management, especially the more invasive one, but try to understand why they feel that way. It does not always appear to be the good choice. It might treat the disease but not necessarily the patient himself.

Appreciate your patients as they are helping you in becoming a doctor. Without them, you can never be a doctor. That’s what I feel and learn from him.

Surgery Posting

Honestly it’s really a harsh time I have been through.

I love reading stuffs in surgery. But somehow, the system, especially the requirement in logbook, dragged me away from the interest.

In surgery, you will get to see how doctors manage the patients not merely through medications, but also surgical intervention. I went into OT (operation theatre) few times, watching doctors doing surgery on patients. I had studied anatomy on books, and now I got to see the real structures in front of me. I could see how careful the surgeons were when cutting the neck and trying to reach for the thyroid with all the great vessels beside it. One of the best surgeries I saw throughout the posting. It was really an amazing experience that made me felt like wanna to be one of them one day later.

Apart from that, we had more chances to perform some procedures compared to paediatrics. It’s so important for us to develop a good skill. Just a bit disappointed for not having any chance to perform some procedures. A good doctor should have a good knowledge, skill, and attitude right?

In the middle of the posting, I guessed most of us were so depressed. The routine was so hectic till we didn’t really have time for study. But, it’s still a great experience. It taught us how to appreciate the time we have for study. It reminded me that having enough time for study is really a blessing. And I feel so grateful for having some good friends in my group teaching me stuffs along the way.

Nevertheless, nothing is perfect. And logbook is really the killing and most stupid part of surgery posting. Logbook was meant to be guiding us in learning the topics that we should learn, but it was obviously not applicable here. Everyone, including me, was rushing for short cases and signatures somehow blindly. When the atmosphere became so tense just because of the stupid logbook, anger and frustration came behind. I knew it.

Anyway, I felt so relieved after finishing surgery posting. I guess everyone felt the same too. It’s over man!

Currently I am in the halfway of orthopaedic posting. Hmm, I am trying hard to hypnotize myself to love it.Aargh! :P I got a great quote from my supervisor, Dr. Halim,

“if your future job is something you like to do, then you will be like having holiday everyday and just doing something you like to do.”

It’s so true. Hope that I will love doing the thing I am gonna to do in the future. :D

道歉信

我想每个人的人生里其中一项娱乐就是讲上司、老板的坏话吧~
在他们面前总得摆出一脸恭维尊敬的样子
在他们的背后就高谈阔论地说着他们的种种不是
人生如戏嘛，为了求生活人总得演戏嘛~

我并不是真的因为他大骂我们而不爽，因为我知道那是我们的错误
我明白他也是为了锻炼我们，让我们更有正确的态度去学习行医
我超不爽的只是他骂人的语气很明显是经过了肤色及性别的衡量
结果我就是那个被骂得最狗血淋头还得交道歉信的学生

有时候不是我们不想念书，但log book的要求真的快要把我们逼疯
机会是不等人的，如果有些罕有的病患出现而我们不快点检查把报告写进log book
我们也许再也没机会在这仅仅六个星期的外科病房看到第二个病患了
试想每早630起床730就在病房巡病床过后又有clinic、CT和seminar
有时候连午餐的时间都没了一直到上完课还得去检查自己组的病人
如果有可以填进log book的病患我们又得赶快再检查他们
之后就赶快吃了晚餐就继续on call到晚上11时才离开病房回自己宿舍
再勤劳我也只有力气年多两个小时的书而已

也许他真的有有心想教好我们，让我们学习如何纪律自己
但attendance sheets这个东西对我来说是真的一个的负担
还有他的态度是我最讨厌的其中一种态度 - “hao lian” aka “串”
也许你很厉害但也别那么喜欢show off吧
把我们全当成白痴你就会高兴点吗？
我想一定是，所以你的生活一定是寂寞得非常可怜

终于假期了
选择了不回家留在学校把之前该念却没念的书好好念完
只希望自己的付出是有价值的。。。
为自己加油吧~

Paediatric posting

Finally, 6 weeks of paediatric posting has been ended.

It was quite an interesting posting. Every morning, we got to rush from USM to HRPZ ll. At there, we met children, we talked and played with them. Furthermore, only one on-call per week, quite “reasonable” lol. Overall, the arrangement was quite okay, just that part of me didn’t really like it as we could not follow up our patient’s condition after leaving HRPZ ll till the next morning. Clerking children is quite a huge difference from clerking adults. We need logical thinking a lot eg: babies can never complain about pain we can never mention things like headache, abdominal pain or dysuria when presenting our cases. And of course it’s tougher to do PE on them as they can be very naughty!

Honestly, I don’t really like children. It’s very irritating when your beautiful morning is full with babies’ cries. However, it’s sad too sometimes when you see those very sick babies or children. I have clerked a HIV+ child with multiple diagnosis found on him. He got a poor family background too. Can you imagine how the child will be next time without a supporting family and good social environment? Another thing is those patients with cerebral palsy or Down syndrome or whatever disease that will burden the parents. Are the parents willing to take care of them? How about their future? I can’t imagine how will I be too when my child is born with any disability. I really respected those mothers that could be so patient and caring in taking care of them in wards. Apart from that, we didn’t have much procedure to be done. BCG injection, baby bathing and a few more only. That’s the boring part.

The good part here was we didn’t have any “killer” doctors. They really judged us based on our performances. I didn’t do well throughout my posting. I know I didn’t cover a lot of things that I should study. I should do better. And I really appreciate all clinical teaching sections as I really learned a lot from doctors, especially those skills and knowledge that I couldn’t get or understand from books.

Anyway, paediatrics has came to an end. Surgery, the busiest posting, would be the next. Hopefully I can manage it better this time. Good luck to everyone. :)

谢谢妳的一堂课

她脸上的笑容跟常人都一样灿烂，但她的脸孔就是跟常人有点不一样。

实习的日子终于开始了。现在的生活真的很忙碌，也很充实。
每天从7am到5pm的‘上课’时间，就好像普通上班族一样，只是有时候得待在医院守夜而已。
剩下的少许时间就只好拿来埋头苦读那些一本又一本厚厚的医学书。 :(
所以娱乐及写部落的时间自然减少了~

我的第一个posting是儿科，所以我大多数的早晨都是在小孩子们的哭声中度过。
但我好像没看见她哭过。
那天帮她做检查到一半时她还睡着了呢。

是否曾想过自己的孩子如果是唐氏综合症 aka Down Syndrome 的话，你会怎么做？
哭？接受不了？
自己照顾或是送到智障中心？

多年前，我有机会随着佛教会佛学营的同伴们一起到一所智障中心拜访。
那儿90%的儿童都是华人。
工作的热心人士们都是印裔朋友，他们告诉我们多数华人都不愿意带着他们。
就算是亲生的孩子，带在身边也只是拖油瓶。其中的父母只是不定时，三五个月才来探望他们。
其余的呢？早已人间蒸发，丢下孩子不理了。

智障中心的工作人员都是自愿服务的。
政府或非政府组织的每个月津贴好像时而多，时而少，时而有，时而无。

当津贴不够或是没了，
又或者热心人士们无法帮忙了，
那些孩子会怎样了呢？

我们只是帮忙打扫四周，跟他们玩一玩，筹了点钱给负责人之外，什么也做不了。

多年后，我看见她满用心地照顾她。
 唐氏综合症的病人多数会有心脏有孔的问题出现。
她的心房 (ventricle) 中间的心墙 (septum)有着一个很大的洞孔。
她身体不好一直受细菌感染，让她无法如期得到该有的免疫注射，也无法进行手术把洞孔问题搞好。

两天后，她的细菌感染好转了，可以回家了。
我微笑地告诉她 “没事就好了。”
她也苦笑地说 “不知几时会再回来。”
我们彼此都知道事情没那么简单。
我心里酸了一下。

第一次看尸体叫恶心，第100次看尸体叫习惯。所以我的心也只酸了几秒钟，只是多了份感触。

到我真的佩服她对她的勇敢及付出。因为我也不知道我是否能像她一样伟大。

也很谢谢她让我上了医学加心灵的一堂课。

她好像也算是医院的常客吧。只希望她日后不需要再一直造访医院。
 
 不管脑袋好不好，我只希望靠着自己一点一点的努力慢慢往行医者的路走下去。
p/s 慢慢不代表可以怠慢哦。我不要考试不及格然后留级 T.T

year 4

Paediatrics 儿科

↓

Surgery 外科

↓

Orthopaedics 骨科

↓

Ophthalmology 眼科

↓

Ororhinolaryngology 耳鼻喉科

↓

Medicine 内科

↓

Psychiatry 精神科

↓

Neuroscience 神经科

↓

Obstetrics & gynaecology 妇产科

this is the schedule for my forth year. The flow is out together with the name list of our group members. I am quite happy with it. However, nothing is perfect. Something i hate & scare of happened to me. Gosh. Maybe i didn't pray enough. Good luck for myself in clinical years.

Enjoying my last few weeks of holiday :)

生活习惯

如果你问每一个医学生某个病有什么危害的因素？我想大多数的答案中都包括抽烟、饮酒及肥胖。

我想就算你是个路人甲，以上那些不健康的生活习惯大家也明白吧。但很明显且可惜的，周遭90%的人仿佛都好像犯了至少其中一个。你敢说你没吗？

过去的两个星期在内科里学习，看到的多数是肺炎、肺痨、以及好多好多的急性冠心症候群病患。



问病人是否曾经或依然抽烟时 ，10人里至少有7-8人有。有时候真的很不明白抽烟有什么好？危害健康烟味又臭到半死。除了帮助女人降低子宫癌的机率之外，都提高了得到其他疾病的机率。如果你不是女的，那你岂不是连那唯一的好处也没有？ = =

要是你得到了疾病，麻烦的不只是你一个人，而是连你的家人也受影响。要是你死了，大家还得流一流眼泪，浪费掉点水。舅舅离开的时候，母亲的泪泉像是断了三天三夜的堤。这是我唯一一次看她用掉那么多身体的水。




不是不可以喝酒，只是不可以成天都沉醉在酒色中。有没有发现有很多外国人都挺着一个大肚腩？酒精在身体内会防止脂肪被细目分类，结果那些脂肪就好像排队的人，在肝那儿越排越长，变成了脂肪肝。脂肪多了就积在身体各处造成肥胖。你喜欢这样吗？

今天看到了一位慢性胰腺炎的病患。这个病的最主要原因是什么？就是过度饮酒。

就连佛陀几千几万年前就明白饮酒是不好的，还叮咛我们不饮酒，但有多少人明白呢？还好意思在表格里宗教那格填上佛教。人类越来越笨了!!! = =



你平均一星期的运动量有多少？你的BMI有多高？你的三围多少呢？

也许自己也不是那么的理想，但至少目前我的BMI是正常的数字，一星期也至少运动几次（除了考试季节）。

运动真的很重要。那些每天8小时坐在电脑前的上班一族尽可能抽出10分钟做点运动或爬多点楼梯，一点都不难吧？。。。很难？等死吧。

饮食也很重要，病从口入嘛。吃多点蔬菜及水果，少点煎炸炒烤烘，少点盐糖油吧。



健康跟时间是同一国的，他们都不喜欢等人的。更糟糕的是，健康还是个女的。如果你不关心她，她老早就会离开你了咯。如果你多关心她多一点，他就呆在你身边多一点。所以？还是像女友般多关心她多一点吧~

Patch Adams

Well, it's not only about the name, it's about his life and attitude as a physician.

I just watched "Patch Adams", the movie, which is a 1998 comedy-drama film starring Robin Williams based on the true life story of Hunter "Patch" Adams. It's is a great a movie and every medical student should watch it, to understand your duty and responsibility as a physician before you receive the honor as a doctor.

Hunter "Patch" Adams is an American physician, social activist, citizen diplomat and author.And the most important thing is that each year he organizes a group of volunteers from around the world to travel to various countries where they dress as clowns in an effort to bring humor to orphans, patients, and other people.

"We are improving the health, not delaying the death."

This sentence is the one that gives me the most impact. Besides, i see the thing that we always talk about it in school - Don't treat the disease, treat the patient. Most of the time, our, the doctors concern more about the patients' files and diseases, but not the patients themselves. Do you ever go deep and understand what the patients' feelings or backgrounds, their stories? This is so true yet most of us didn't actually practice it, including myself. Whenever i was clerking case, i was so concerned about my report that i don't even spend much time chatting with the patients. That's bad, isn't it?

To become a doctor is really a meaningful thing in my life, perhaps the most one so far. I really wish that i can graduate and help people in the future. However, it's tough and obviously i don't have the confidence. I feel unsafe. Sometimes i really scared that i may be failed in exam and delayed in graduating because i am not a smart one, or maybe the weaker one. It totally sucks!

Dreams are hard to be fulfilled. I understood. But I hate the feeling of being unsecured. I hate to take risk. Isn't it ridiculous? It drives me down, it drives me away from the enjoyment in studying medicine. Sometimes, i am really like a bastard.

It's unsecured...

I am scared...