leaving Melbourne

I will catch the flight tomorrow. I will be back to Melbourne by 8th February 2009. I might not be able to blog as frequently as I should.

Good bye

O&G OSCE

Obstetrics
- 2 days overdue. Take focused hx, do ex and Ix.
- Interpret partogram and CTG. Discuss appropriate management of prolonged bradycardia

Neonatal
- There are 5 photos. Diagnosis, DDx, and management. ?Chicken pox, Mongolian blue spot, nappy rash, Eczema, ?erythema toxicum.

Gynaecology
- Abdominal mass. DDx, Symptoms of fibroid, Mx of fibroid in someone who want to get pregnant.
- Pap's smear on a pelvic model. Manouevre to locate the cervix if could not find the cervix for the first time.

This was the hardest OSCE ever. We were allocated 9 minutes per question and there was no pre-reading time.

You just knock the door and straight away launching yourself to the unknown situation. You will be given the question from the examiner, and the time is ticking while you read and think on how to answer the question. You will be asked several questions and there was no turning back or any second chance. Once you answered the question, the examiner will move on to the next question. If you are wrong, you don't have time to reflect on that. The clock is ticking. 9 minutes is not that long. Scary.

I definitely failed the station on prolonged pregnancy. Everything on history is normal and I'm not sure what else to ask. Perhaps the topic that needs to be discussed with the patient is the induction of labour or complications from prolonged pregnancy. It was the hardest OSCE station in this exam.

For neonatology, I might be correct for 2-3 pictures and the rest were spend on guessing the diagnosis. The conditions were rare and not clinically significant.

Gynaecology stations might be the only chance for me to get at least enough mark to pass this OSCE. However, I'm not sure whether I did well in gynae stations. Pap's smear was awkward and I made few mistakes.

The end of this semester exam is marked with sombre mood. I'm not sure whether I would pass the exam and it has been raining non-stop since yesterday. This is certainly not a good way to end this obstetrics, gynaecology and paediatric block. Hopefully I would pass the entire exam.

O&G written exam.

There were 30 questions that need to be answered within 3 hours. There was only 6 minutes per question. The best part of it, most of the question came from the question bank and we were already given access to the question bank. So, if you have answered the questions from question bank before the exam, and memorised the answer, this exam will extremely easy.

It was an exciting exam since I just need to write down anything that I have memorized before the exam. If you could not remember the answer, you can either move on to the next question or try to write a little bit and come back later. This is the first time that I don't need time to think how to answer the questions but instead try to write as much as I could remember.

At first, I thought that the exam will be finished in 2 hours. Thus, for the first 2 hours, I was writing extremely fast without stopping for a break. If I could not remember the answer, I used the general approach. Take history, do physical examination and ask for investigation. You can always order for FBE and UE in most of the situations .

At the end of 2 hour mark, my fingers were stiff and I was out of breath. My right hand was shaking and I could not bend my arm for the next few minutes. Perhaps there was not enough blood flow to my fingers .It was like doing a marathon of answering lots of question in a short amount of time. My forearm muscles were exhausted and my handwriting were getting worst towards the end of the paper. Hopefully the examiner could read my handwriting.

Then, I realised I have another hour to go. I spend the last hour in improving my answer and checking for any mistakes. There was one grave mistake that was so funny that I had to suppress my laugh during the exam.

This was the question.

Outline the management of...yell0w-green discharge....

The moment I saw the word yellow-green, I instantaneously wrote; this is malrotation with volvulus until proven otherwise and I proceed on how to manage malrotation. I had perfect answer for this and could literally fill the entire page with the management of malrotation.

In the middle of writing the answer for malrotation, I caught a glimpse of the question again. Yellow-green discharge from the EYE.

This is a different medical problem and I had wrote the wrong answer. Malrotation with volvulus is a surgical emergency of the gut, but the question is asking on the problem with the eye. Fortunately, I have the time to rewrite the entire answer. This must be one of the embarrassing moments for me during this exam.

p/s: If you see any green-vomiting from an infant, you need to think of malrotation with volvulus and this is a surgical emergency. Unfortunately, the question is not on vomiting but asking on eye discharge

Moral of the story: read the question carefully and that includes reading the question until the end .

Paeds written exam

There were originally 10 questions and one question was cancelled last minute. 3 of the questions were surgical. Overall, the written exam was weird.

The first question was on ethics. I was surprised when I saw this question. I never thought that we would be asked on ethics. I was guessing all the answers and trying to remember all the four principles of ethics.

The next few questions were a bit OK and somehow, I think (hopefully), I have wrote enough points to get at least a pass in the exam. There was one question which was annoying. We didn't learned anything on how to answer the question and hopefully they will reconsider the question again.

In conlucsion, the paeds written exam is a bit OK.

Paediatrics OSCE and slide exam.

There were 4 stations

1. Vomiting and diarrhoea in 2 year old boy. Take hx and discuss management.
2. Surgical stations.
- Abdominal pain in 4 year old boy. DDx and initial management. Likely Dx and how to manage the condition.
- Exomphalos in term baby at rural hospital. DDx, initial management. Management of hypoglycaemia. Other risk factors associated with the condition.
3. Do cover test and describe the interpretation of the test. Diagnose type of strabismus from video and picture shown. Discuss DDx, Ix and management.
4. Take short hx from adolescent coming for vaccination of Boostrix (DTPA). Perform immunisation procedure and discuss risk associated with the immunisation including anaphylaxis.

Personally, I think the hardest station is the surgical station. The examiner keep asking what else I would do to diagnose the problem. It is hard because the time constraint and the nervousness of the exam.

Slide exam. We were shown pictures or videos for few minutes and need to answer the questions as soon as possible.

• Breath-holding spells. DDx and what would you tell to the parent.
• Eczema, principles of management, management of infected eczema, management in adolescent with eczema
• Down's syndrome, other anomalies associated with the syndrome. discharge plan from GP
• Oedema at eye, DDx and management of this condition
• Nut allergy, management of anaphylaxis, discharge plan.
• Developmental milestones. Normal range for walking. Three broad clinical conditions associated with delay in walking.
• Fracture of femur, describe appropriate analgesia
• Torticollis, Likely Dx and diagnose the abnormal side
• Imperforate anus, other associated anomalies

Hopefully I will pass this OSCE and the slide exam.

the exam is over

Alhamdulillah, now my summer holiday can really starts. There will be several tasks that I need to do during holiday and hopefully I will be able to complete the tasks.

I will write about the exam later. Right now, need to sort out few stuffs.

Revision Day 3

Today is the last day of formal revision. It was on gynae and I was surprised to know that I don't know much about oral contraceptive pills. Despite it is one of the most common drug prescription, we didn't learn in detail on how to prescribe it including telling all the side effects, contraindication and anything that might interfere with its efficacy.

I won't be blogging until my exam is over. That is until 12 December. Good bye for now...

Revision Day 2

Today was the revision for Obstetrics, Gynaecology and Neonatal Paediatrics. It started at 8am and finished by 12.30pm. There were lots of topics covered and at the end of the day, my fingers were extremely exhausted from copying down the notes. This was a good exercise for my fingers before answering the written exam on next week.

Now, I am quite nervous thinking that there are lot of stuff to be remembered. I wish my brain cells would retain as much information as possible until the end of next week.

For Obs and Gynae exam, there will be 30 questions in 3 hours. There will be only 6 minute per question and it will be a race against time next week. I now need to find a good comfortable pen for the coming exam. If not, my fingers will be extremely stiff like today. Wish me luck

Revision Day 1

We will be having three day of formal revision with the lecturers prior to the exam. Today is the first day and the revision was on paediatric and adolescent health.

There were many topics discussed and at the end of the day, I realised that there are lot that I don't know yet especially dermatology. The dermatologist showed us lots of pictures for spot diagnosis.

There are several differential diagnosis said by the medical students and most of the term were quite unfamiliar to my ear except one, Trichotillomania. I mentioned this condition earlier this year [read the post].

Trichotillomania is common among students who will be sitting for exam and I had to laugh when the dermatologist suggest for psychologist referral for someone with this condition. I don't think it is a serious condition unless you lose a lot of your own hair.

end of Paediatrics

Today is the last day of my paediatric rotation. After 9 weeks of fun with the children and adolescents, it is over.

Personally, I think the paediatric rotation is interesting but not as organised compared to my previous rotation, Obstetrics and Gynaecology. I'm still not sure how much I should know and what should I prepare for the coming exam. Paediatric rotation is similar to the general medicine and surgery rotation that I had last year, except instead of learning it in one whole year; this time I learned it in 9 weeks and this time the patient is smaller than adult and wear nappies .

I will list down the conditions/diseases that I have seen in my tutorials and outpatient clinics. It is totally varied from one medical student to another depending on how enthusiastic you are in getting involved in managing patients.

• Allgrove (AAA) Syndrome
• Osteogenesis Imperfecta
• Duchenne Muscular Dystrophy
• Turner Syndrome
• Tourette syndrome
• Kawasaki disease
• Undescended testes
• Hypospadia
• Apnoea episodes
• Ambiguous genitalia
• Bronchiolitis
• Asthma
• Orbital Cellulitis
• Non-accidental injury
• Febrile Convulsion
• Global Brain Ischaemia
• Meningitis (Herpes virus and Enterovirus)
• Failure to thrive
• Congenital deafness
• Cerebral palsy
• Pyloric stenosis
• Malrotation with volvulus
• Necrotizing enterocolitis
• Fractures
• Appendicitis
  

Few of the diseases are extremely rare and many of these diseases are common. I'm glad I had the opportunity to see wide range of diseases which will widened my clinical experience.

I might consider paediatric as one option of my future career but first, I need to pass the exam.

Wallpaper

This is my current desktop wallpaper.

two specialty rotations

The exam is getting nearer. I have lots to be covered. Obstetrics, Gynaecology and Paediatrics. Each of them has lots of concept to be revised.

I might not be blogging as often as I would be. The exam start on 5th December and end on 12th December. Hopefully this time around, I will pass the exam...

Living with a disabled child

I first spotted this article at Aliya's blog. I would to like to post it here since it is inspirational.

---

WELCOME TO HOLLAND

by Emily Perl Kingsley.

c1987 by Emily Perl Kingsley. All rights reserved

I am often asked to describe the experience of raising a child with a disability - to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It's like this......

When you're going to have a baby, it's like planning a fabulous vacation trip - to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It's all very exciting.

After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The stewardess comes in and says, "Welcome to Holland."

"Holland?!?" you say. "What do you mean Holland?? I signed up for Italy! I'm supposed to be in Italy. All my life I've dreamed of going to Italy."

But there's been a change in the flight plan. They've landed in Holland and there you must stay.

The important thing is that they haven't taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It's just a different place.

So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met.

It's just a different place. It's slower-paced than Italy, less flashy than Italy. But after you've been there for a while and you catch your breath, you look around.... and you begin to notice that Holland has windmills....and Holland has tulips. Holland even has Rembrandts.

But everyone you know is busy coming and going from Italy... and they're all bragging about what a wonderful time they had there. And for the rest of your life, you will say "Yes, that's where I was supposed to go. That's what I had planned."

And the pain of that will never, ever, ever, ever go away... because the loss of that dream is a very very significant loss.

But... if you spend your life mourning the fact that you didn't get to Italy, you may never be free to enjoy the very special, the very lovely things ... about Holland.

---

Taken from here.

Signatures

There are several tasks that I need to do in my paediatric rotation.

1. presenting a case in front of doctors
2. writing a report on a chosen elective
3. maternal child health nurse visit
4. taking and recording a child's vital sign
5. infant feeding
6. changing an infant's nappy
7. administer medication via MDI and spacer
8. shadowing a triage nurse
9. clinical skill ward assessment ie following a general medical team and clerk patients

The only thing that I have not done are no 1, 2, 6, 7 and 8. I have about 2 weeks to go to get all of these tasks signed. It is a bit annoying to get all of the signatures but I have to do it in order to pass the semester. Hopefully I can get the signatures by the end of next week.

No longer a parasite

After two weeks of following the general medical team, it is now over . It was a tiring job to follow the doctors all over the hospital doing their ward round and this also includes the on-call. If we are are on-call, we usually finished around 9pm. Please note that we usually started our morning with the handover meeting at 8.30 am, followed by registrar's ward round and consultant's ward round after that.

What do we do when we are on-call? Basically, during that day, the team will be the one receiving any patients that is admitted to the ward and as a medical students we are expected to clerk the patients and presented to the consultant on the following day.

In retrospect, I did not learn a lot but it was an interesting experience to follow the team. It gave me a glimpse of my own future career and which aspect that I need to improve as a future intern. It also taught me different ways of managing paediatric patients and their families.

Being a parasite when the exam is around the corner is not a good thing to do, especially when you have not covered a lot of things yet. I'm glad it is over now. Now, I can concentrate on stuff that matters the most, that is the exam .

leech

We are allocated two weeks to follow a medical team. Basically, we are required to follow them from morning till late evening. In the morning, there are few tasks that we need to attend. Starting from the handover meeting to the registrar's ward round and finally consultant ward round in the afternoon.

It is really a tiring job to follow the medical team around the hospital. We hardly ever sit down and by the end of consultant's ward round; I usually get so tired that I need to find a chair for me to sit down.

You will never appreciate the value of something until you lose it. That is true in my case here but the value that I really learn to appreciate is the opportunity to sit down on a chair :)

Another observation that I has gained in this week are that doctors need to have lots of stamina to work continuously. Imagine that during ward round, the doctors run up down the stairs and never sat down for 3-4 hours. We are used to climb up from the first floor to the 8th floor and then went down to 5th floor and up again. Despite I am cycling to the hospital every day, at the end of the day, my stamina just ran out of me. Fortunately I do not experience any symptoms of breathlessness climbing up and down the stairs.

I have another week with the medical team and I hope that by the end of next week, my stamina has improved a lot :)

new laptop

After more than two months having a laptop with worsening problems, I have decided to buy a new one. The main problem in the old laptop is most likely to be hardware in which the laptop continues to experience random shut downs and sometimes it could not be started at all.

Thus, I was forced to buy a new laptop since it has caused lots of problem and somehow, disturbed me from studying.

I bought the new laptop few days ago and it took me few hours to reconfigure all the softwares and computer setting :)

Hopefully I will be able to blog more frequently after this ;)

Blue screen of death

In the past few days, I have seen lots of blue screen of death in my laptop. Most of the time, the message will be different and I am more than confident that the problem is in the hardware. It is less likely to be from the heatsink eg the cooling system since I have fixed those last time.

I might persevere with this problem until at the end of this year and buy another laptop when I am back in Malaysia. Hopefully this problem won't disturb me from blogging and studying

recovery and Paediatrics

Alhamdulillah, I have almost recovered from my bronchitis. However, my laptop is going downhill. There has been several occasions in which my laptop suddenly shutting down. The problem is likely to be hardware and I think I might get a new laptop at the end of this year.

This is my second week in Paediatric. The first week was full with lectures although, I think there are more lectures in first week of Women's Health than Paediatric. This week....I had nothing except PBL. This is extremely different from the previous rotation. Previously, I had tutorial every day and had to come to the hospital every day and came to home late, usually around 7pm. It seems that this rotation is slightly better than and not as busy as the previous rotation.

I hope that I can enjoy this rotation and pass this semester

sick

After 5 years, my laptop started to show sign of old age. It continuously shuts down randomly. This has been happening in the last few weeks. Despite many times of reformatting the laptop, the problem persisted and I think the main culprit of this problem is the hardware. That is, there's something wrong with the laptop itself rather than Microsoft Windows.

It might be the time for me to get a new one. I have to think about this carefully. After all, this is a long term investment.

It is sad to be separated from something that you have been using for many years. This is the nature of life. Everything in this world has a limit on how long they can last for. Even human beings cannot last forever.

On another matter, since celebrating Eid on Wednesday, I have been sick. Sore throat, runny nose, fever and headache. The diagnosis is bronchitis and the temperature was around 38.2 yesterday. The fever was so severe that I had to rest at home and skip my PBL yesterday. I experienced chills and it was worst yesterday.

I saw the doctor yesterday and after taking the medication, I felt a little bit better today, so much so that I decided to attend Aliya's open house today. However, I started to get sore throat during the event and I had to reduce the amount of talking to my friends. It is a bit painful to talk when you are having sore throat and a little bit of headache at the same time.

Despite all of that, I pretty much enjoy the time of being there since it is not easy to meet all of my friends and catching up on what's been happening in the last few months . Thanks to Aliya for organising the event. I forgot to thank her due my headache that suddenly decided to come back again.

I believe that I will recover within the next few days. Till then, I will be resting a lot and may not be blogging until I have fully recovered.

Eid Mubarak

This year it will be the fifth time for me to celebrate Eid ul-Fitr at Melbourne. It is really different to celebrate Eid when there are exams or lectures on that day. I guess that's what made celebrating Eid overseas a bit unique.

Anyway, Ramadhan has already ended and I hope I would be still alive to see another Ramadhan next year. Let us celebrate Eid and do not forget the poor people around us. Hopefully we have become a better person after one month of fasting in Ramadhan. Hopefully all of us will be strong enough to fight against our own desire for the next 11 months until the next Ramadhan.

Eid Mubarak.

moving on to Paediatrics

It has been quite a long time since I have updated this blog. My life has been extremely busy lately. Alhamdulillah, I have finished my rotation in Obstetrics and Gynaecology last Friday. However, there are still lots of lectures and notes that I need to revise for the semester exam. Hopefully I would be able to find some time during my next rotation.

It was fun and exciting to see the newborn baby. It is hard to put into words, the joy of welcoming a baby to this world. There is a lot of teamwork involved in managing a woman in labour. Part of my job is to ensure that the pregnant women is pushing correctly at the right time and at the right pace.

Overall, the previous rotation was quite interesting yet it was tiring. I have tutorials every day and there is a lot of stuff that need to be covered within 9 weeks.

My next rotation will be paediatrics. I'm not sure how busy it will be but I hope that I will have time to blog :)

Ok, got to go now. Happy Eid ul-Fitr.

2 weeks

That is the length of time this blog has not been updated. Now, I shall tell you what has been happening in the last two weeks.

First week
The first week was a lecture week. We had lectures in the morning and student presentation in the afternoon from Monday till Friday. The student presentation was part of the assessment in this rotation. You need to present a selected topic within 10 minutes. Most of the time, 10 minutes was not enough the cover the topic and we usually talked in general. Some of the presentations were interesting, some were quite funny and some are boring.

One of the memorable presentations was on getting informed consent to perform a procedure to remove a pelvic mass. The procedure involves on opening your abdomen since the mass is quite big.

The presentation by the student was hilarious and scary. The student talked in detail the risk that could happen in the surgical operation. It is a normal procedure and you rarely mentioned rare and uncommon risks associated with the procedure. The student mentioned it is possible that the surgeons might cause incidental damage to the small bowel, large bowel, liver, gallbladder and stomach. The student continues on what kind of procedure will be involved if those organs are damaged such as anastomosis, stoma bag, cholecystectomy , liver transplant and at this stage, I could not help but to laugh .

It is true that there is possibility that these organs could be damaged while removing the pelvic mass but that surgeon must be a careless and hardly qualified person. If you mentioned in detail the possibilities of what could happen in the procedure, the patient might not give you the consent to do the operation. The operation is an important process and the informed consent should not be to the extent of scaring the patient away.

Overall, this week is a mixture of boring and interesting lectures.

Second week.
There are a lot of things happening this week.

First, it is the start of Ramadhan. It is the fifth time for me to celebrate Ramadhan in Melbourne. As usual, I try as much as I can to perform the teraweh and reading al-Quran. However, this time around, my hectic schedule prevented me from doing a lot of ibadah and I personally think that last year Ramadhan is better than this year.

Most of the time, I came home after Maghrib and sometimes, I have to cook for dinner after that. If I'm too tired, I usually bought food outside. I usually sleep early due to exhaustion and try to study in the morning. There are lots to be covered and I have about 2 more weeks in this rotation. My next rotation would be paediatrics and I'm not sure whether I have time to revise on Obstetrics and Gynaecology in the next rotation.

p/s: Despite all of this, I managed to send my picture to Salam Perantauan . Here is the picture and this is taken last year during ski trip.

Links

These are few of my favourite posts. I hope this may help anyone on the net.

Photoshop Tutorials
Creating Pattern in Adobe Photoshop: Part 1 and 2

ECG Tutorials
Understanding Electrocardiography (ECG/EKG) for beginner

Blogspot related

• Google Reader shared items hack
• Selective expandable post in Blogger
• Hide Blogger Navigation Bar, Search content in your blog and Change date header format into a calendar icon
• How to migrate from old classic Blogger template to new Blogger layout
  
• Useful Links for Blogger
  

New Blogger Layouts

• Ladybug (Green Theme)
• Ladybug (Red Theme)
• Silver Ray
  

catching babies

Last week was my turn to be in the labour ward. Every student is allocated one week to do the delivery. We are required to get at least 7 deliveries in any mode, vaginal delivery or caesarean.

Alhamdulillah, I managed to observe a lot of deliveries. In one week, I managed to observe 5 caesareans, 3 vacuum-assisted vaginal delivery and assisted in 5 natural vaginal deliveries. I'm still not an expert in labour but I guess that I might be able to help if someone is going to deliver a baby somewhere in the future .

Pregnancy is a risky condition. In one week, there were 2 fetal deaths in-utero, 1 neonatal death, few prolonged second stage of labour and I saw one patient with pre-eclampsia.

Second stage of labour refers to the period from the full dilatation of cervix to the delivery of the baby. This stage should not be too long as it can lead to fetal distress.

There were times when I'm happy to see the babies and there were times when it was sad to hear the news of stillbirth. Overall, you have to be prepared for any potential complication from labour.

Last week was exciting yet I was pretty exhausted at the end of the week. It was a memorable experience and I wish that I could deliver more babies.

twenty five

25 years may seems a short time to someone who is 100 years-old but it is a long time for someone younger. It has been an interesting and challenging journey throughout this time. I guess I have caused enough trouble and happiness to my mom and dad in the past twenty five years. I hope that I am able to look after them in the future and be a good role model to my younger siblings.

My wish is outlined in this birthday tag. I hope these wishes would come true someday in the future.

I used to write a long entry every time my birthday comes. This year would be a short entry since I'm lacking words to write today and I have wrote a lot in the past few years .

Related entries:
23/8/2004 - Another milestone...
23/8/2005 - 22
23/8/2006 - 23 0n 23

cute babies

Sorry for the lack of updates in this blog. My busy schedule prevented me from blogging as often that I would like to be.

For the past few weeks, I have been to the antenatal and gynaecology clinics and visited the special nursery unit which is for babies that have problems and need to be monitored.

I have yet to deliver any baby since my turn will come in the next two weeks. At least, I am in the process of learning everything that is related to labour.

It was an interesting experience to see babies in the nursery unit. Most of them are pre term babies that were born earlier than their expected date. Few of them are jaundice, that is the skin become yellow, and need to be put under phototherapy for a while until the colour of their skin become normal.

I'm not sure why but most if not all babies look cute. It must be something that baby possess to ensure that they will be looked after by adults . It was fun to see their primitive reflex and to see its relevance for the babies. For example, if you scratch their mouth laterally, on either side of the mouth, the baby will turn their head to the side being scratched. This reflex is important for breastfeeding.

I hope this will be enough for now.

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Women's Health - Week 1 part II

To read part I, please check the previous post.

A lot of things happened during the first week of my rotation.

After 29 hours of lectures, the last period in the timetable was the definitions exam. This exam asked us on various definitions and few concepts that we have learned in one week. There were 50 questions that need to be answered in 30 minutes and all of them are written questions. It was the fastest exam time in my entire medical course.

It was either you know the answer or not. You don't have enough time to think. If you were fortunate, you might have few minutes to think of the answer. I think I have written lots of wrong answers.

Anyway, I have to work harder to gain better mark in the next exam. I could not afford to lose a single mark this semester. I don't want to fail my exam again. Thus, my attitude of perfectionist

.

On the other hand, a lot of unexpected things happened to me personally this week. I don't know how things unfold this way but it already happened. It is mind-boggling if I am to look for reasons that caused things to unfold this way.

Back to my first week of Women's Health, in conclusion, this week is busy, tiring and will take few weeks of self revision to digest all the contents of the lectures. I will be busy catching babies after this so I might only update this blog on weekends .

Women's Health - Week 1

Finally, the first week of my rotation in Obstetric and Gynaecology is over.

It has been an extremely busy week with most of the lectures for this rotation was given in this week. I think we had about 29 hours of lectures in just over 5 days. At the end of day 5, I am already overwhelmed with the sheer amount of lectures and will need few weeks to digest the entire content of the whole lectures in the first week.

Every day we started at 8 am and it was freezing in the morning. The first two days was held at Mercy Hospital which was about 10km from my home and the last three days was at Royal Women's Hospital. The Women's Hospital is not that far and it is next to the university. It will took me around 10-15 minutes if I am cycling to the hospital .

The first day was spend on learning about labour and how baby navigate around the tight pelvis to come out to the world.

Few interesting quotes about the labour taken from the lecture...

“Pain in labour is the by-product of the body’s creative activity…

Sheila Kitzinger: The New Pregnancy and Childbirth

“recognition has come slowly that labour, especially first labour, may be the most disturbing emotional event in the lifetime of one-half of humankind…

Driscoll, Meagher, Boylan: Active Management of Labour

The quotes somehow describe how painful the birth delivery was. We were shown a video showing the whole process of labour. The video shows how baby navigate around the tight pelvis and turn around the head and eventually come out from the uterus.

It was an amazing journey to see how the baby head was squashed, rotated and flexed from the dark uterus to the bright world outside. Despite the video only showed the edited version of the natural vaginal delivery since the labour process was quite long, the painful expression of the mother throughout the whole ordeal was clearly shown. The pain may come from the uterine contraction and dilation of the vagina.

The most surprising fact for me was to see how big the placenta compared to the baby. It seems that both placenta and the baby are of the same size.

I think the video managed to convince most of female medical students to choose Caesarean section over natural vaginal delivery. Caesarean is quicker and perhaps less painful than natural process but it also has few disadvantages.

The long arduous process of delivering a baby was something that needs to be praised. I was immediately reminded of how tough it was for my mother to deliver me and all of my siblings without going to Caesarean delivery, and there are 8 of us. That's why we need to respect our mother and father but sometimes we always forget that fact, especially when we are in the rebellious period as a teenager.

I will stop now and continue later....

last day of holiday

My three weeks of holiday will end tonight. Starting tomorrow, my new semester will start and this will be another tough semester. In fact, there will be an exam right at the end of the first week .

This semester I will be learning about paediatric, obstetrics and gynaecology (O&G). For the first 9 weeks of this semester, my rotation would be around (O&G) and the next 9 weeks would be on paediatrics. I am expecting that I will be extremely busy and I will be blogging less than the previous semester.

So, please forgive me if this blog would not be updated as often as it should be.

First time....

I tagged myself to do this since I don't have any idea to blog at the moment . I found this tag from Intan.

1. 1st time naik kapal terbang
Masa darjah 6. Flight pergi ke UK sebab ikut ayah yang sambung belajar di Cardiff, UK dan tinggal di sana lebih kurang dua tahun.

2. 1st time beranak
not relevant to me .

3. 1st time gi overseas
Jawapan yang sama dengan nombor 1. Sampai di UK di penghujung musim sejuk tapi masih lagi terasa sejuk sebab perbezaan suhu yang agak besar.

4. 1st time duduk jauh daripada family
Ketika Tingkatan 4. Dapat tawaran masuk ke SBP tapi SBP tu pun dekat ajer dengan rumah. Tak sampai 4km dari rumah pun sebenarnya tu . Sekolah apa yer? Cubalah cari nama satu-satunya nama Sekolah Berasrama Penuh di Kuala Kangsar .

So, jawapan yang mungkin relevan untuk ni ialah ketika ditawarkan mengambil program International Baccalaureate di Kolej Mara Banting selepas SPM. Masa tu baru dapat pengalaman duduk jauh dari keluarga.

5. 1st time kerja
Selepas IB dan sementara tunggu nak pergi ke Melbourne, ada cuti 6 bulan. Dalam masa 6 bulan tu, sempatlah bekerja sebagai guru sementara di sebuah sekolah menengah di luar bandar. Pengalaman mengajar di situ sangat menarik kerana ramai di antara murid-murid tu tidak ada semangat untuk belajar dan hanya datang ke sekolah sebab nak jumpa kawan-kawan atau datang kerana dipaksa oleh ibu bapa. Pernah juga berlaku pergaduhan besar di sekolah itu membabitkan murid bangsa Melayu dan bangsa India. Satu pengalaman yang tak dapat dilupakan.

6. 1st time rasa diri gemuk
hmm, semasa zaman sekolah rendah dan menengah, berat badan selalu underweight dan hanya bertambah apabila masuk KMB dan berada di Melbourne. Sekarang ni BMI ialah 25. Untuk dikira gemuk, BMI perlu lebih daripada 25.

Tapi dari segi relatif, mungkin boleh dikira gemuk kerana berat badan sudah bertambah banyak sejak 10 tahun yang lepas.

7. 1st time bercinta
How do you tell when you are in love? This question will be quite difficult for me to answer since I don't think I have relevant experience in this aspect of life. Maybe I'm someone who is not able to love someone else or too busy to think about love yet .

8. 1st time rasa diri cantik??
Not relevant for me. In term of physical appearance, I think I only have average normal-looking appearance.

9. 1st time masuk cinema
Rasanya masa sekolah rendah dulu bersama keluarga tapi tak ingat tahun berapa pula.

10. 1st time admitted in hospital

Ketika berusia 5-6 tahun. Kalau tak silap, rasanya masa tu dapat demam panas dan kena tinggal di dalam wad selama seminggu, tapi tak tahu punca demam panas tu.

Saja tambah...

11. 1st time fail
Subjek Kimia semasa Tingkatan 4. Masa tu di awal tahun dan banyak lagi tak tahu dan hampir setengah daripada batch fail sebab soalan dia agak susah. Selepas fail subjek Kimia tu, untuk ujian seterusnya berjaya dapat markah yang agak tinggi .

12. 1st time gi national level in any co-curricular activity
Masa form 5 apabila berjaya mewakili negeri Perak dalam Kuiz Koperasi. Untuk Kuiz ni, perlu berdebat, berpantun dan menjawab soalan yang dikemukakan oleh panel hakim. Ketika kuiz ni, bakat berpantun memang sangat hebat sehingga boleh menjawab atau bertanya soalan dalam bentuk pantun dalam sekelip mata sahaja.

Hanya berjaya ke peringkat separuh akhir dan tumpas dengan wakil Negeri Sembilan ketika itu, Kolej Tunku Kurshiah. Sedikit kecewa juga sebab ini kali pertama berjaya pergi ke peringkat kebangsaan.

13. 1st time lost someone close to you.
I'm quite close with my grandma who used to look after me when I was a small baby. So, when she passed away 3 years ago due to old age, it was quite a difficult experience for me. That time, I was preparing to sit for my Semester 3 exam. That was about 3 years ago. I'm only able to visit her grave when I came back to Malaysia few months after that.

That's all for now.

Blogger in Malay

Now, that is an exciting news for me.

You can now enable your blog in Malay. Go to Blogger Dashboard, click setting and then formatting. Change the language to Malay .

And you may get something like this.


More info: Blogger Updates and Fixes

winter holiday

I've been pretty busy lately. Most of the time I'm not at home and if I'm at home, I will be busy doing something else. Hence, the lack of updates.

My next semester will be Obstetrics and Gynaecology followed by paediatrics. Some people says that this semester will be a bit tough and there are lots of things to do.

Paediatric will certainly remind me of my AMS. AMS is a year where I had to do a research and my research is about diabetes in paediatric patients. The hospital that I'll be going for my paediatric rotation will be the same hospital for my AMS. I might be able to see my AMS supervisor if she is not busy attending conferences overseas .

Anyway, I hope that I will be enjoying the next semester.

Gunner vs Sniper

All medical students are chosen based on excellent academic results, good participation in co-curricular activity and able to answer questions during the interview prior to enter medical school. Thus, it is safe to say that most of us are high achievers (and perhaps perfectionist) and among medical students, the competition to gain the recognition as the top students is extremely competitive. Any medical students who are perfectionist will consider themselves as a failure if they were not able to answer a single question.

With this kind of attitude, the level of stress is extremely high among some of us. After few years in medical school, some of us may choose to be satisfied to be just among the average students. I think I might be one of them too . I don't want to harm myself with unnecessary stress and worry with exam result.

....But the title mentioned something about gunner and sniper and how is it relevant to medical students?

I came across this terms when I read this article

The Gunners. Every med school class has them. Usually there are multiple Gunners to a class. Being a Gunner isn’t necessarily all bad, all the time. In fact, some people take it as a compliment, meaning they’ll go the “extra mile” to learn.

But it doesn’t stop there. There exists something much more evil and far more frightening. The evil med student archetype that you may not know about, though nearly every class has one, is The Gunner’s more extreme counterpart, The Sniper.

A few comparisons:

-GUNNER: Reads. A lot.

-SNIPER: Checks out all four library copies of the “suggested” textbook for your rotation.

-GUNNER: Puts his pager number at the top of the list on any given service.

-SNIPER: Creates the pager list on any given service, and accidentally mistypes the pager numbers for the other two medical students.

-GUNNER: Suggests during rounds that perhaps he could give a short presentation on Disease X, prompting you to follow with “And I can present Disease Y.”

-SNIPER: Approaches the attending after rounds to offer a similar presentation, and then surprises you by doing said presentation the next day, while you remain presentation-less and lazy-looking.

-GUNNER: Finds obscure online resources and/or notes from previous classes, posts 20 links to online forum under the heading “FYI”.

-SNIPER: Finds online resources and notes, denies having any study materials when asked by a classmate in need...

There are many comments to the article and I like this comment .

there are two sub-types of 'gunners'...

Type A is the 'follow-me, and I'll gun the crap in front of us' type who is boisterous to some degree but is willing to help everyone in their group with notes, extra(!) tutes during lunch-breaks, and other annoying but helpful things.

Type B is the 'I'll gun the crap in front of me - you included' type who is boisterous and makes sure everybody knows they're the incredibly hard-working gattling-gunner of the universe and that no-one is going to ever usurp their gunnery-sergeant position. Anyone deemed as a threat will automatically ignite the afterburners of the Type B gunner, who will proceed to turbo-charge their WoMD and blow away all competition. There will be massive collateral damage.

On the other hand, the 'snipers' in our cohort are more like assassins.

Type A assassins:
To consultants and tutors, they are the sweetest, most enthusiastic students who quietly approach them after class or during lunch breaks to suck-up. Everything they do is a ploy to set themselves up in an advantageous position compared to their peers. However, unlike the gunner, they cleverly mask their ways to those that matter to them....but anybody who is not important to their schemes are treated in a superficial way and eventually find out about their noxious ways. (And bitch about them on Medscape.)

Type B assassins are the people who may show type A traits but work to much more insidious and subversive levels as mentioned by most people here. They hide a copy of popular textbooks in a completely unrelated location in the library which only they know about, so that only they can have on-demand access the books, come exam time. Type B assassins love to claim they know nothing and that they don't study at all. They study ten million metaphorical hours a day and NEVER share information or tips they receive, in order to maximise their leverage over peers. (Or they share the info in a friendly way AFTER the usefulness of such info becomes zero) They end up doing well in whatever they aim for, but inevitably find themselves alone. They may form a bunch of similar minded snipers, not for friendship, but to maximise the benefits of herd-behaviour and leeching. Even then, are they poised to surreptitiously assassinate each other when opportunities arise.

read more: The scariest medical student of all

I'm pretty sure I've seen someone who can be described as a gunner but I never saw someone who fits the description as a sniper. Maybe because the snipers are always in stealth mode which made a bit harder to detect them.

Gunner and sniper eh. I guess after this I may need to a shield to defense myself from any friendly or unfriendly fires or from any collateral damage

childhood

It is amazing to see how people change with time. It is not just behaviour but the physical appearance as well.

My face has changed rather significantly and it still amazed me how I used to look when I was a little baby.The picture above shows my first few months of life. The first picture was with my grandmother.

two years old

four years old

My siblings have slightly different face from me and for a comparison, the pictures below are two of my youngest sisters taken few years ago.
...and now the latest picture of them. Their face have changed a lot and I wonder how they will look in the future.

Review of my clinical years

For the last two semesters, I have been going to hospital almost every day and hardly ever go to the university. Clinical years were the time for a significant change in my journey as a medical student. This is my observation throughout this two semesters.

Timetable.
The lectures back at the university usually started around 9am or 10am and the timetable was not that hectic. We always have free time between lectures. There is hardly any last minute changes. We always know in advance what the lecture is going to be.

The timetable during semester 8 and 9 is flexible and you should be expecting last minute changes. You have to work hard to chase the tutors and arranged for tutorials. Sometimes we can have 4 hours non-stop tutorials and sometimes we have to skip lunch as well.

The best/worst part of it, the tutorials/ward round can start as early as 7am. Some of the tutors expect us to come early and join the ward round and theoretically we should be in the hospital from 9am to 5pm. Some of the tutors were also clueless about what tute they had to give to the medical students. So, we need to look for any topics that we need to cover.

Food
If you see any free lunch around the hospital, expect that many hungry medical students to be there . Free lunch is synonymous with medical students and they will memorise the location and time of free lunch for every week.

Patients.
This is the biggest change when you enter clinical years. Pre-clinical years, we hardly see any real patients and we always have actor or actresses for our OSCE.

However, with the opportunity of seeing real patients, comes the challenges associated with them. Every patients are different and each of them have different medical and social problems. Not all of them like medical students and not all of them are compliant with their own medication. Some of them are still smoking despite having lung problems.

You have to be prepared for everything every time you see a patient. Sometimes, the biggest concern for them is not their own medical problems but the situation at home. The patient seems to be happy but after few minutes of interviewing, they may start to cry in front of you or scold you directly. This is certainly something that I've learned in the last two semesters.

Doctors.
Hmm, I'm not sure what to write for this section. Some consultants are nice but there are those who tend to scold medical students in front of the patients and nurses. Somehow, as a medical student and the lowest in hospital hierarchy, you have to be tough emotionally and should be able to cope with anything.

You have to be thick skin to survive all the criticism against you and at the same time, learn your mistakes.


Medical knowledge
I have learned a lot in the last two semesters but I am also forgetting some of the medical knowledge too. Hopefully by the end of next year, I should be able to know the important things in medicine .

Conclusion.
The last two semesters has been quite challenging but at the same time interesting. We are able to see some positive clinical signs and able to interact with real patients. We also learn the harsh reality of working in the hospital and see a glimpse of our future as a doctor.

code

This is what I've been doing since yesterday. There are few hundred lines of code that I am modifying currently. At least the code were colourful .

OSCE exam

I sat for my repeat OSCE today and it was quite tough. There were four stations; two history stations and two physical exam stations.

We are required to take history for epilepsy and dysphagia. I couldn't remember all the questions you should asked for epilepsy and I ran out of time in that station. There are a lot of questions that you need to ask when you are interviewing for epilepsy patient and I also forgot to ask about smoking and alcohol due to time limit. Dysphagia station was a bit easier but I think I could do better if I wasn't too nervous.

The first physical exam station is to perform shoulder exam on a real patient. Fortunately, I have studied well in shoulder exam. The diagnosis is painful arc syndrome (subacromial bursitis). The examiners ask us to name two anatomical structures in the shoulder girdle that can cause shoulder pain and sites that referred pain to the shoulder. They also asked to explain the pathology or mechanism behind painful arc syndrome.

The next physical exam station is to perform cardiovascular exam on a real patient with cardiac murmur. It was aortic stenosis and the examiner asked me to describe all the signs of aortic stenosis. Somehow I'm able to remember few signs of aortic stenosis but I couldn't finish my answer due to time limit.

This repeat OSCE exam was more difficult than the previous OSCE exam. I guess with limited number of students sitting for the exam, the medical faculty can make it harder and more challenging.

Alhamdulillah, I received an email few hours later telling me that I passed. I would not forget this experience and this is certainly one of the most difficult OSCE I've ever had.

Being late = typical Malaysian

I'm not sure why but it is common for Malaysians to be late. Expect them to be late more than half an hour for any appointment. Even Malaysian students who are studying overseas couldn't escape from this culture. Perhaps this culture is already ingrained in the genetics and requires several generations for this symptom to be eradicated.

The article below sheds some light to possible reasons why Malaysians like to be late

Given the perpetual dilatory of Malaysians, one would expect valid and even original excuses. Yet, the conciliations remain the same; traffic, work, bad directions, traffic again (both sides of highway). But what even Malaysians don't know, is that they are really late because subconsciously they enjoy the knowledge that they are the center of attention and that people are waiting for them. It makes them feel good to know people anxiously await their presence and they will milk every last possible second until they arrive (once they do, they will feign a profusely apologetic stance). By doing this, they create the illusion that they are too important to show up on time because they are busy juggling the hundreds of other events in their lives. This constant lateness lowers punctuality expectations and on a day that they actually turn up on time, their friends will be ever so grateful to them for it ("It's so thoughtful of you to show up AND be on time today!").

read more: being late.

Don't become a doctor

This is an interesting article. Although it is a bit old but some of the points were quite true.

Reasons why you shouldn't be a doctor.

new King of Wimbledon

Although I am avid fan of tennis, I rarely blogged about it. In fact the last time I wrote anything related to tennis was last January during Australian Open.

I'm surprised to read the news that Rafael Nadal finally beat Federer on grass courts. Nadal already beat Federer during French Open but that was clay courts. Nadal is quite dominant in clay courts but he wasn't that good in grass courts, at least until now.

Both players, Nadal and Federer are my favourite tennis players and both of them are able to display brilliant skills in tennis. Is this the sign that Federer era will end soon? I don't think so. Federer is still world number one but Nadal is quickly catching up to Federer. The battle between these two players is quite interesting and that's what made tennis world popular .

RAFAEL Nadal beat defending champion Roger Federer in five sets to win an epic Wimbledon men's singles final that was interrupted by rain and lasted for almost five hours.

The Spaniard won 6-4 6-4 6-7 (5-7) 6-7 (8-10) 9-7 to add a first title at the All England club to his four French Open victories.

Nadal's victory, in what was the longest final in the tournament's history, ended Federer's 65-match unbeaten run on grass and denied the Swiss the chance to become the first man since the 19th century to win six Wimbledon titles in a row.

read more: Nadal, the new king of Wimbledon

Boundary

I spend the entire day today with my cousin and his friends tonight. He came to Melbourne last week and due to exam, I'm not able to bring him around but at least, he managed to enjoy his time here at Melbourne with his friends.

In the middle of the dinner, one of his friends asked me that since I'm a medical student, I must have seen every part of human body. I thoughtlessly said that, we even saw dead people and cut them up....They managed to stop me before I completed my own sentence.

Then I realised my mistake. As a medical student, we have somehow managed to be a bit different from non-medical people.

It is normal for medical students to discuss human anatomy in front of food. Breakfast, lunch, dinner...we can nonchalantly talk about fascia, colon, small bowel, liver, nerve, brain, drugs and anything that we have learned so far. We can even talk about DRE while having lunch at the same time. Some medical students can even talk about food while cutting up cadaver (dead people)!

We forget the boundary that existed before we became medical students. Sometimes we are forgetting that non-medical people will find it disgusting or outrageous to casually talk about dead people. We can unconsciously use medical jargon while seeing patients and sometimes we hopelessly, forget the appropriate layman's term due to long exposure to medical vocabulary.

Moral of the story: I should meet more people outside medicine .

Famous high school alumni

In the past few weeks, Malaysian newspapers and blogosphere have been filled with lots of political headlines. Sometimes, I get tired of reading the news since I'm not sure which is the truth and which is the false facts. Perhaps we need to read between the lines in everything that we read in blog or newspapers.

The latest big news that is happening is another allegation to Malaysian ex-deputy Prime Minister, Datuk Seri Anwar Ibrahim and endless story on Altantuya case. An interesting opinion on Anwar's case by Ustaz Abdul Halim Abdullah.

I personally don't like to be involved in politics. It can be confusing at times and you need to read on both sides to gain a better understanding of the whole situation. You have to be careful of not being too emotional when read anything that is related to politic. The newspapers like to play with emotions and therein lies the danger.

Once your emotion clouded your mind and thought, it is hard to change your perception towards some politicians. I think it is better to be open minded in things that you do not fully understand.

Anyway, I hope with the current pattern of news in Malaysia, we do not forget the real issue that is faced by many Malaysians. With the increase price in petrol and goods, many people are being affected. At least the vehicle owner can get rebate from the post office but I wonder if there is any some sort of rebate or cash subsidy to those poor people who doesn't even have the capacity to buy a car or a motorcycle.

The petrol price in Australia is around AUD 1.70 / L (roughly equal to RM 5.10 per litre) and it has already affected me financially. At least I'm still single and does not have anyone to take care of, but to those people with children, they will be affected the most from the current high inflation rate.

Paper art

I'm not sure whether this is the correct term. I found this inspirational pictures and they were simply amazing and creative.

All of these were created from paper.





For more pictures and inspiration, check his website, Peter Callesen .