Rapid enough?

Exam! Major exam ! Starting this Wednesday is the theory paper Short Answer Questions and OSPE. and the next week , Monday and Tuesday , we’ll have our very first OSCE (clinical skills) exam in seremban clinical school.

*palpitations! *

*shortness of breath!*

*fit !

This years Chinese New Year was ruined by this professional examination.

These are the books I used during each posting.

 

And these are the ones used for my revision.

 

So colorful right ?

 

I like em for their brevity. It’s straight to the point and in point-form. It helps if you need a quick revision.It has the important points in there.However , it does not have any images or many tables or a differential diagnosis section though. Its mainly on the different diseases. An Approach and Differential Diagnosis section in their next edition would definitely be good. Then it would be quite complete. I think it’s better than OHCM because they provide the indications of the investigations.

 

That’s just what I think of the book. Hopefully , it’ll aid me in sailing through the exams. Clear pass.. Clear pass .. Clear pass is all I need. Before ending, just want to share this bible verse

psalm 37:8 Do not fret, it only causes harm. Trust in the lord and do good. Feed on his faithfulness. Commit your way to the lord. Rest in the Lord. God is in control.

My mum sent it to me via SMS  =) It never fails to reduce my anxiety.  =D

Mr.R’s Liver and Spleen

This, a post of appreciation to Mr.R.

Many many thanks to Mr.R who so willingly let my friends and I feel his enlarged liver and enlarged spleen.

Thank you also for teaching us a few techniques that other students / doctors used when examining you.

I hope you enjoyed the drinks and biscuits we got you =)

And I apologize for causing so much inconvenience and for disturbing you while you watched TV .

I hope your business with your partner goes well . May your business prosper =)

I am forever thankful to you for teaching me.

THINK

I had lunch today with Prof. L in the canteen. He imparted the importance of thinking unto me.

We were talking about the difference between IMU students and students of other universities. IMU students somehow seems more confident and are able to present themselves well as compared to other universities. The self-directed learning concept has trained us well to be independent in our own learning.

Of course , that’s just his opinion.

Then, he told me that our(us IMU students) only problem is that we don’t THINK which is the most important habit in medicine.

How ? Each time you see a case . Think about the likely causes. Think about what you would like to ask in history taking. Think of what you would expect the patient to tell you. Think of what you expect and want to see in physical examination. Think of the investigations you want to do and why you want to do them. Think of why there are abnormalities in the results from the investigations. Think of what kind of plans you have for the patient and why you want to do them.

I’m a severely lazy thinker. I tend to accept what is given to me and I don’t bother or care why something’s are not normal.

I’ve got to consciously remind myself to think and ask myself questions.

Hmmm… After that. I had nothing else to talk to him. Actually , I had lots of questions that I wanted to ask. Very shy lah. There were moments of really awkward silence. But, really , Prof L deserves to be The Most Approachable lecturer in IMU Seremban. And I think that it’s good that lecturers are approachable. Then ,students would be able to connect with lecturers and know what their experienced eyes sees.

No ?

The lesson learnt today : Be a hardworking thinker.

I have to .. because I told him that I’ll think harder from today’s lunch onwards.

“Most people would rather die than think; in fact, they do so.” by Bertrand Russell

So, don’t be the ‘most people’.

No problem can withstand the assault of sustained thinking. ~Voltaire

My Burning Fire

I stick that onto my wall. It serves to remind me that there’s more to life than just being a medical student. Don’t get me wrong. I love being a medical student. Figuring out cases and wondering why this and why that and how to do this and how to do that. It’s really interesting. I don’t really care much about my results. ( okay, maybe this line is just to console me because Im not prepared for exam ) it’s really very subjective. The results depend on so many factors right ? ( lecturer , case , and your anxieties) after all , the main aim is to graduate. Not just graduate. But to graduate as a person who can serve the community. And serving the community means to be a doctor who thinks , analyze , care and who holds responsibility over their actions and the well being of their patients.

But studying and studying alone is such a dull way to enjoy the wonders of gods creation . I can’t be telling God ,” sorry god , I was busy studying , I promise I’ll see the grand canyon the next time I’m on earth, I’ll make sure I take photos too .” =_=

My point is I want to do something else other than studying. I want to run marathons ! Go rock climbing , learn Tamil, learn how to play futsal , travel around the world.

And because by doing all these other stuff , I’ll learn. I’ll experience. I’ll love. I’ll appreciate. Most important. I’ll grow.

I want to look back in life one day and tell my grandchildren or maybe the 20 cats stories and life experiences that made me the bold old hag who runs marathons even at the age of 80 and still oversees the surgical department or psychiatric department of some hospital.

I want to impact another person’s life.

I want to be a blessing to , not only a person’s life. But many many people’s lives. And I want to do that by healing.

As crappy as it sounds coming from me , i just want to say :

I’ve found my burning fire. I want to be a different old hag.

Cheers !

Our eyes

In psychiatry ,I learnt that  you can diagnose a person just by watching , observing and really looking at him . Our eyes are one of the instruments we use to diagnose the patient .

The patient was speaking in Tamil with Dr.Shane . We couldn’t understand a word that came out from his mouth . So , Dr. Shane asked us to do a mental state examination just by looking at the patient .

What struck me first was the patient looked and sound depressed . He was slouching and had blunt facial expressions . Could say that it was mask like . His speech was sparse and monotonous . I could only assess his tone and body language . Thinking of depression as the diagnosis .

Then , i saw him picking his fingers and he had tremors . That really caught my attention . Spent some time looking at how he picked his fingers . Just like how i always picked my fingers actually . haha. And i pick my fingers when i am anxious . Then , the patient made a gesture to Dr.Shane . He made a fist with his hands and tensed them .  He could be telling Dr. Shane that he felt tense . So , i was thinking that he might have a anxiety disorder

Then i looked at his belly . Don’t ask me why i was looking at his belly . I just did because his hands were placed near his belly .  His belly was quite huge .  I was thinking if that was a beer belly ? XD  Then i looked at his fingers again . He had clubbing wei … Was his tremors observed earlier due to the withdrawal of his alcohol ? He might have drinking problems .

But in the end i, i decided his diagnosis was Depression .

But guess what …

The patient had depressive symptoms . He felt worthless and guilty . He had problems sleeping and cannot concentrate in his daily activities . He was diagnosed with agoraphobia ( an anxiety disorder) in the past and still has a problem going out to public areas alone . He needs his wife to accompany him or else he would have a panic attack  ( yep , his wife was there in the room ) . And due to his fear he has developed a drinking problem .

Haha  =)

Win .

You do not judge. You heal .

I learnt something from Dr.Shane today .

We were talking about a drug user .

Mr.P was diagnosed with depression for over 10 years . It all started when he had a divorce with his wife .  He had problems sleeping , lost weight , lost interest in the things he found pleasurable in the past , lost appetite  and even attempted to hang himself once . In order to relax himself , he took Cannabis aka Marijuana . Mr.P was a heavy marijuana user in the past . But now , he has reduce the use of it . He continues to take it each day .

So the question was : would you report him to the police ?

You and I know that Marijuana’s a drug that’s illegal in Malaysia . So . Report ? Don’t report ?

So i said ,” no i don’t think we should report . Because he wasn’t causing harm and he was using it for his own purpose .”

What if he was selling the drugs , what if he was a drug trafficker ?

Dr.Shane asked the whole class of medical students and psychology students from IMU BJ . Most of them answered -Yes – to both questions . My answer was a no and a yes .

And Dr. Shane said ,”All of you , common sense and ethics fail”

Actually , in this case  . We shouldn’t report the patient . The patient trusted you with this piece of information and it is to remain confidential only if you think that there is potential harm .

If he was trafficking drugs , you are not suppose to report him as well because , first of all , you are just getting yourself killed if you reported him . The other drug traffickers would hunt you down and chop you to be Char siew pau filling .

Secondly , the patients could sue you . You , as a doctor ,  breached their confidences .  You could lose your license .

Thirdly, just think about it . You would lose the patients trust . Once that’s lost , all form of therapy , counselling , drug medication would be just as good as rubbish and a waste of time . The patient would NEVER EVER trust you anymore . It would be better if you did not report him . Get him to trust you . Listen to you . Comply to the medication and therapies you have in plan for him . It would take time . But it would be the better option .

It IS the better option . After all , the patient’s life already sucked because of the illness . You wouldn’t want to further induce suck-ness in his life would you ?

The lesson : You do not judge . You heal .

Big Shot

Weird thing about being a medical student. Even after you are done with exams.

You still have a whole list of deadlines and things to do.

It does not end or have a pause.

I guess it’s something I’ve got to get use to from now onwards.

I’m not complaining about it. I actually feel very happy looking at the list.

It makes me feel like I’m some sort of Big Shot. Very important person. Wanna meet me , please talk to my imaginary secretary.XD

I think what I need is the new iPhone 4S.

Psychiatry and me

Hello ladies and gentlemen , how are you lately ? I hope that you’ve gained something new from the 5 weeks that just flew pass.

I was in psychiatric posting the last 5 weeks. In this posting , the main activities that IMU planned for us are the usual ward round/ward work sessions , tones of seminar on various topics , psychiatric clinic sessions and also TBLs. I find the posting somewhat busy in contrast with my senior and elder brother’s comments. Maybe because I went to the ward more often and studied all the topics from a proper textbook. A lot of my time was spent reading the textbook. Very very exhausting. The pages are completely covered with words. No pictures at all. But , pictures wouldn’t wouldn’t help us to understand the illness in psychiatry anyway.

Psychiatry , to me , was quite interesting. I actually enjoyed myself very much. Everyday , we had new stories to listen to. And the stories are all different. Not one patient’s story was the same as another patient. Might think of it as a choice of specialty. =]

You know, it’s just like reading a novel. Sometimes , it’s a thriller where the patient is being harassed and hunted down to be killed for no apparent reason; sometimes it’s a comic the patient has super powers . Casper the ghost and The Power Rangers are his ‘heng dai’. One of them believe in witch craft and voodoo magic. He believed that his neighbor was a bomoh who had a voodoo doll of him and was trying to practice her voodoo magic on him.

It’s interesting what goes on inside their mind.

But , it’s really sad to see how it has affected them. Their lives are totally gone just because of this illness. There were patients who were top scores and top students in their classes. But due to a stressor in life. That stressor turned their path 180 degrees around. And it goes downhill all the way after that.

Had my end of posting exam today with Dr.Rajan. It was pretty Ok. I’m hoping for a grade slightly above the borderline pass.

His style : 1 hour of clerking. 10 minutes of presentation , 10 minutes of questions on the case. 10 minutes more for random questioning. Haha.

Very fun hor. I kinda just vomited out everything that I’ve learnt the past 5 weeks. Made some mistakes eeeeeeeeek! But i can’t wait to see how I faired this time

Now I realize that I’ve been studying the wrong way all this time. My mistake: not recalling the information. Shall do some adjustments in the next posting

Me and my housemate have been cooking a lot in this 5 weeks.

Today. I made Gong Pao Chicken ! Haha. The short cut method though. Used a premixed sauce. Just had to stir-fry the chicken , mix the sauce in , add in slices of garlic , carrot , and baby corn. And it’s ready to be served. Will try to add in dried chilli next time. It doesn’t taste Gong Pao without dried chilli >_<.

I am very into cooking now. We tried cooking a chicken stew during the weekends. Turned out quite yummy. But had diarrhea after that. We suspect that it’s due to the 1 week old chicken that we used. Kesian the housmate, she had to rush to the toilet half way through watching a delivery. The baby come out already but she was still stuck in the toilet. Haha.

Alright. That’s it for now.

I have 1 report , 2 case summaries ,1 case formulation and 9 short summaries to complete by Friday. God bless me.

And you. And everyone. =]

Letter to Mdm Ling

Dear Mdm Ling,

I’m sorry that you have Hypertension, Diabetes Mellitus and also Ischemic heart disease.i’m sorry that you have to take the medications for a very long time.

but please dont worry. we are here to help you. we want to see you well. please dont give up.

i can see that you were very depressed when the doctor told you that your kidneys have been damaged by Diabetes. I know that you have been trying hard to control your illness. i know that you have been taking your medications as perscribed. that is very good. please keep up the good job.

There are some changes in lifestyle that you’ll need to make. it’ll be difficult in the beginning. but we’ll take a step at a time. I know so many people who have done it. and , i’m SURE you can do it.

I’m here if you have any queries . Feel free to come to me if you need any help. You have my number , call me if you need me .We will work hard together so that you can get better alright?

Solemn

what do i want to tell you today ?

i have a lot to tell .

Not in a cheery mood now . Not in  depressed either .

Just solemn .

Let me just let my thoughts flow .

One of my sister in crime , my bes tie  was in severe pain today .

Abdominal pain . Epigastric region . Sudden onset . Intermittent in nature . Aggravated on movement . Associated feature : menstruation .Had similar episode long time ago . Not as terrible as this time . Not as long as this time .  No vomiting . No diarrhoea  . No fever . No peri-orbital pain . No urinary symptoms .

What would you do ?

I don’t know . Seriously . I really blanked out .

She was in severe pain . Tears were flowing . She just kept repeating ,”很痛 ， 很痛 ， 很痛 。。”  And me … Useless . I couldn’t think of what to do . Pain killers taken .

She was struggling . Trying her best not to move at all .  Moving aggravated the pain . Sitting up didn’t help .

很痛 ， 很痛 ， 很痛

I watched in despair . I could see . I could hear . and I could feel her pain.

but so what .

i didn’t know what to do .

so the next thing i thought of .

CALL DAD .

yes . i called my dad and asked him what i should do . Pathetic person i am .

Dad suggested i wait for the medication to take effect . Or if its really unbearable . Go to A&E department . Go get a n injection for pain relieve .

But , no . She didn’t want to go to the hospital . I wouldn’t want to go too if  i was her .

So, we didn’t go to the hospital .

And i continued to just accompany her . watch her struggle in pain . T_T

useless .

After a while , she was getting better . The pain was not as severe as before but she was still struggling .

So i suggested that we head to the clinic near our place .

Clinic Hon .

The doctor suspected that she was having a viral fever with gastritis .

She was given antacids and  paracetamol .

By the time we were out from the clinic , she was feeling better . Much better . I guess the medication has started to take effect .

Sheesh . . . So slow . The medication cost us RM20 .

When we reached home , she was able to walk properly . She looked very much relieved from pain . She took the antacids and went to bed .

Thank God she’s better .

see … I’m a medical student . But i don’t know what to do in such situations . I’ve been studying . But have i learnt much ?

Definitely not .

sigh . that’s one thing that is on my mind .

Moving on .

to be suggested a leader . its a good thing right ?

to have your name called out to be a treasurer of SRC . its a good thing right ?

these are just minor post compared to being elected as president , batch rep and chairman .

What do the others see in me ?

Did they think i was capable ?

I don’t think i’m capable .

Or did they just called out my name because they knew i wouldn’t reject ( i have a problem rejecting despite being against an idea )

I don’t know .

I know how to help out . But to lead ….. Its different . No ?

To lead . You need to make decisions . You need to think of your members . You need to guide . You need to organize .

Your members are your responsibility .

Tough job .

I don’t want to be leader can . There are a few members who are super hard to work with . Don’t want can. ><

sigh . Its been a long day .

Good night .

P/S : the opposite uncle’s son still sms me lately . and i continue to ignore his calls and sms whenever possible . yesterday , he reminded me that i forgot to lock my gate in the middle of the night . creepy … i know . but i thanked him in the morning . because he help me guard my house  . i have a security guard XP.