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 .

an unexpected twist

How do you handle bad news?

A. Depressed and lock yourself up in a room and keep crying.
B. Switch on your denial mode and think that it never happens.
C. Angry and try to blame everyone and everything except yourself.

D. Be optimistic and try to find the best way to deal with the bad news.

E. Share the bad news with your best friend or family and ask them for help.

I would choose option D and perhaps E, but sometimes I don't want to cause unnecessary worry to my family or friends . They already have enough worries and problems in their life and I don't want to burden them with my own little problem.

I was seriously considering myself to sit for repeat exam for long case. I was not able to perform well in long case and I gave terrible answers to the questions asked by the examiners. The case was also complicated with a rare disease which I regrettably don't know much about the disease.

I received an email telling me that I failed my OSCE. I was surprised to read the email since I thought that I did well in my OSCE. Anyway, I have to sit for supplementary OSCE on this coming Thursday.

I am being optimistic here and I will switch on my nerd mode after this. I will try my best for my last chance to redeem myself from this failure.

"Why do we fall, sir? So that we might learn to pick ourselves up."

Alfred Pennyworth

Birthday Tag - August Rush

I have been tagged by Lady Heart.

The rules...

1. Determine your birthday month and get a word that rhymes with it or you can affix to it. Caps lock your birth month (ex: MAYday! JUNE dune, APRILicious, JULYvely, AUGUST pocus, parched MARCH…). Be unique.
2. Your birth month plus the word affixed or rhymed shall become the tag’s title in your case.
3. Get your birthday and add the digits involved. Example, if your birthday falls on the 25th of July, add 2 and 5 you get 7.
4. Whatever is the sum, write a list of the MATERIAL gifts you wish to receive, the number of which shall correspond to the sum of your birthday. For example, applying the case above (in rule number 3), you will write seven (7) things you wish to receive.
5. After your wish list, put your name and birthday in the Bloggers’ Birthday Directory, with a link to your blog/s. Note: when you add your birthday, please place it in a way that the dates appear chronological (January, February… 1, 2, 3)
6. Pass this tag meme by tagging as many people as you want.

Answers.

I put August Rush since it is the title of a musical film . My birthday is on 23rd August. Hence 2+3 = 5.

So, 5 birthday wishes. It was supposed to be a list of MATERIAL gifts but I would like to cheat a bit. The numbers of birthday gifts are not that important and I hardly celebrate my own birthday since high school. So, instead of birthday wish, I might as well put my wishes that I would like to achieve in my life.

1. This is my ultimate wish that is easy to write but a bit hard to achieve. The wish is to be a person that is described in this verse...
   

   For, Believers are those who, when Allah is mentioned, feel a tremor in their hearts, and when they hear His signs rehearsed, find their faith strengthened, and put (all) their trust in their Lord;

   [al-Anfal:2]

2. Moving onto the next stage of my life .
3. To be able to pass all the medical exams and become a good doctor.
4. To be someone who is able to enjoy life in any circumstances or trouble. Someone who will not be depressed in any problems and always be optimistic.
5. When I'm no longer in this world, I hope that I will be able to leave good memory for my family, relatives, friends and to anyone who has visited this blog. I hope I can be forgiven for any mistakes that I've made.

Bloggers’ Birthday Directory:
| Jan 23 - Ladyheart | February 20 - Caryl | February 23 - Jammy | March 7 - Mari | May 3 - Vannie | May 8 - joanjoyce | May 27 – Zang Caesar | August 23 - Hafiz238 | September 2 - Chikai | September 30 - Mckhoii | December 12 - Janeth Vicy|December 18 - JoshuaOngYS | December 19 - Alpha | December 28 - Yen | November 29 - Lolli | May 12- Princess |

Now,I'm going to tag Diya, Fieqah, Kasyah, Sarah and Yasmin

largest number of software downloads in 24 hours.

It is official. With more than 8 millions download, Mozilla Firefox 3 is the largest number of software downloads in 24 hours.

Few interesting things that I have found in the current version of Firefox :)

Type about:config in the address bar and you may get something like this. about:config is used to change advanced setting in Firefox and this warning is cute.

Type about:robots and you will get this :)
I am proud to be part of this world record.

Related link: Mozilla blog

exam is over...

Finally, it is over. Let me talk what happened over the last two weeks.

MCQ
There are 120 multiple choice questions that we have to answer within 3 hours. It was held in Royal Exhibition Building. This is the building in my profile picture.

At first, the questions were easy since the questions were related to neurology. I spend lot of time revising my neuro. In the middle, it was getting harder, weirder and confusing.

There seems to be lots of question on medical imaging. I didn't expect that and there were many questions of which I'm guessing the answers.

Overall, MCQ was difficult and there goes my 40% of total mark.

OSCE.
We had 4 stations. Two history stations and two physical exam stations.

I think I did quite well in history stations but not the stations involving physical exam. The physical exam include screening for diabetes complications and targeted exam for acute abdomen.

In each station, once we finish the task, the examiner will ask us several questions. I couldn't answer all the questions in stations for diabetes and acute abdo.

OSCE was moderately difficult but the examiners and the patients were nice to me.

Long Case.
We were given 1 hour to spend with one patient and later presented the findings to the examiners.

I was literally running out of time for this exam. The patient was quite talkative and I had to stop the patient several times.

The patient had diabetes and alpha-1 anti-trypsin deficiency. I was dumbfounded when I heard alpha-1 anti-trypsin. This is a rare disease and I don't think I know much of this disorder.

When the time comes for presenting the findings, I had mental breakdown and I couldn't answer the questions satisfactorily. The questions were not that difficult but my mind somehow, freezes and not able to give the right answer.

I think I might fail my long case exam. This is a bit depressing for me.

In summary, the exam was difficult and I am hoping that I'm able to pass the exam.