THE WRONG IMPRESSION

I received some replies to my previous recent postings and I wonder if my blog entries since I started working have been putting the wrong impression about my personal view of a life as a houseman. People who read those posts might thought it is always the darkness that haunts a h.o. life. Well, it is nothing like that. At all.

To be honest, I usually write when I feel the need to express my feelings, so people know what it is like to be in my situation. It just feels good to let it out by writing. I am sure there are so many young doctors in my situation but nobody who just sees us as doctors would have understood our feelings. For example when a UK medical graduate stays to work oversea, people will say he forgets where he came from or he's so materialistic - like doctors are all crazy about money. They do not see the other issues that we are not satisfied with or we worry about.

Anyway, the fact that I very rarely write means that there were only few bad days in my life- if not I might have written more and more =P. There are always ups and downs in whatever we do, wherever we are. If you ask me now, I am happy with my working life, I just wish the system are more helpful and I could do something more. Nice M.O.s and specialists helps a lot of course. I am not an egghead, but I had survived O&G and soon to finish medical - the two most tiring postings (so they say), so I guess, it is not as bad as what I have been writing.

All the bad things that have happened that we do not like or disguise or regretted in doing them - they just add on to our experience. After all, experience is the best teacher, aye? And it is the mother of wisdom (so they say, again).



My advice to the future housemen: do not count your chickens until they hatch. Even though you might always heard about the bad side of our lives, it does not mean we do not enjoy our works. We just moan so people will understand. You will only understand when you become one.

BAD WEEK

These few days I have been feeling very upset with the lab, with the nurses, even with the patients, but especially with myself. The peak was on Saturday, when I actually lost my temper on a patient that I think every patient in my ward could almost hear me scolding him. And I feel very terrible, it is still haunting me, even in my sleep. All those advice to be a good doctor received when I first graduated keep haunting me. But words are those things you cannot possibly take back. You can only wish you can turn back time and do it differently, but the fact is there is no time machine available and there will never be and you just have to accept that.

I blamed myself the most for not being able to cope with it. Being post call, the tiredness and the hunger, also the upsetting blood takings which sometimes provided me with no results at all, and the nurses who were not as helpful as what I expected them to be, and the patients with difficult veins and high demands not when the m.o.s are around, but only when they have long gone and I am left on my own to manage, plus, loosing 3 patients in a day - these all just add up to the weakness in me - I thought I have been very patient so far, but I lost it. I lost it already. I gave up.

It is never the patients' fault if they refused to do things we told them too - it is so up to them to decide, as the outcome will eventually be on them. (but again, how patient can you be with a non compliant patient who turned up to the ward very frequently even on day 2 post discharge?). We doctors just help managing them, in other way 'fix' them if possible and allowed to. I know I should never have scolded patients for moaning because who are us to determine how much pain they were in? I might not endure the same pain as my patients are enduring now.

The Prophet (saw) said, "The real patience is at the first stroke of a calamity."
Sahih Bukhari Volume 2, Book 23, Number 389

It hit me straight to the heart when I read this post at facebook from a good friend of mine. Indeed the real patience is far from me.

Today is the first time in medical posting in which I doubted my decision of coming back to work here. It makes me feel terrible. I actually very much enjoyed being in nephro ward, that I even asked for Kak Salmi to place me in the same ward for another 9 days before I move on to the next posting - surgical. But I just can't help it anymore.

How I wish there are tubing system here like in the UK where I can make sure blood goes right to the lab and not being wasted after all the hard work of difficult venesections. It hurts the patients too ok - and it took time to plead them for femoral blood as peripheral veins are either too thrombosed, or they are invisible and impalpable.

It is upsetting when I called the lab for important blood results at night time, when I had to wake up all night to review patients, and even waked them up from sleep just to see if haematocrite was rising - but nobody at lab even bothered to answer the phone because they were BUSY sleeping. Or when I needed ABG sent stat at night time, the PPK is nowhere when there are no diet to serve, nothing to do at night time but sleep and chat - yes, and it was all my duty so I had to leave the patient with a GCS of 6, went down to lab in hurry but then had to ring the bells for 4 times (harshly) to wake the lab staff up. If this is the case, PPK might as well work up to 10pm only, because doctors have to send blood to lab anyway.

And why is there no ABG machine in medical ward at all? (supposedly no budget, of course, how I forget Terengganu is one of the poorest country in Malaysia despite the money we should get from the petroleum). I have sent this suggestion to have the machine at least at neuro ICU, and the last time I went to the lab it was still there in the suggestion box, which funnily provides no pen nearby, as if no suggestion is encouraged at all.

This week has been terrible. I accepted the fact I am weak, but being unsatisfied with the system and all, I am changing my opinion to why doctors in the end leave government, or why medical students from developed country refuse to come back to Malaysia - it is because of how the system works here. I have to agree to the first few parts of this article, honestly because I have on my own been in this situation.

WHY WE LEFT AND WHY WE WILL CONTINUE TO LEAVE...

"Why be a slave in your own country, when you are a king in another?" He replied.

Indeed, if anybody would want to find a reason why all of us left, either after housemanship, after being a specialist, or even after sub specializing, and now, even prior to doing housemanship, they need not look at our payslip, or the wealth that we have gained overseas, but only to the Medical System that has been rotting in the ignorance and politic-based stupidity that Malaysia has been well-known for (in the medical field).

I have served the system for nearly 2 decades of my career, waiting for it to improve for so long, and only finding myself in despair, quitting with a 24-hour notice and serving abroad. The system is, in my opinion, keeping doctors, since the beginning of their career as House Officers to the end of it, in the lowermost priority. When I was working there, doctors are so ill-treated, while the nurses and the medical assistants are overpowering us.

I still remember the days when I was doing seeing patients and rounds as an MO, while the staff nurses would mind their own business, having breakfast in the pantry, or having gossip chats at their own leisure. My House Officers would then have to do merely all the labour-work, up to the extent of setting intravenous drips, and serving medications. If I am to expect the nurses, my patients would have been dead, or the work would have been too slowly or incompletely done.

When I was a House Officer, I had to run down 4-5 floors just to review a blood investigation of a dying dengue patient. The ward staff would either be nowhere around, or will say that he is busy (busier than the doctor?) or the answer I got at that time:

"Doktor nak cepat, doktor turun sendirilah, gaji doktor lagi banyak dari saya"

Read the rest of article here.

I am loosing my innocence (konon) day after day, and I hope I won't loose my patience inappropriately anymore as I do not want to be who I am afraid I will turn out to be.

RINTIHAN KEPADA PESAKIT-PESAKIT

DI HOSPITAL KERAJAAN


1. Kepada pesakit yang dibenarkan pulang...

Ketahuilah, kami sangat-sangat gembira apabila anda dibenarkan pulang. Maka sekiranya kami lambat menyediakan surat discharge anda, itu adalah kerana kami sibuk dengan tugas-tugas lain yang terhad masanya, contohnya mengambil darah-darah pesakit lain yang perlu dihantar sebelum habis office hour atau menghadiri CME (satu-satunya sesi formal untuk menambahkan ilmu kami yang tidak seberapa) yang berlangsung pada waktu yang ditetapkan atau berjumpa dan merawat pesakit yang perlu diberi rawatan segera. Ketahuilah, bukan anda seorang yang mahu keluar dari hospital ini secepat yang mungkin, kami juga begitu, lebih-lebih lagi kalau malam semalam kami oncall dan tiada ruang untuk melelapkan mata, maka bekerja terus menerus lebih 36jam. Bukan niat kami untuk melambatkan proses anda keluar dari hospital, tapi fahamilah anda bukan seorang sahaja yang kami perlu cater. Dan bukan anda seorang sahaja yang mahu pulang awal. Kadang-kadang solat pun hujung waktu, makan pun tak....anda marah macam kami duduk goyang kaki sengaja melambatkan anda balik.

2. Kepada pesakit yang anggap kami bertanya soalan secara suka-suka...

Mungkin ada sesetengah pesakit terutamanya yang sudah lama berada di hospital dan ramah pula, maka mungkin doctor-patient relationship dah menjadi lebih informal, dan biasanya ini tiada masalah sebab rasanya boleh tahu siapa yang kita boleh bergurau-gurau dan bercakap lebih informal. Tapi pastinya bagi pesakit baru, soalan-soalan yang kami tanya menjurus kepada untuk merawat anda, bukannya saja suka-suka. Contohnya, 'kenapa pakcik datang sini malam ni?' atau bila dah diberi jawapan dengan pandangan serong 'sebab sakitlah!', kami bertanya elbih lanjut lagi kenapa malam-malam begini kalau dah 2-3 hari lepas start sakit, tolonglah jangan menyindir 'sebab terbuka hati nak datang'. Percayalah, ada sebab kenapa kami bertanya. Contohnya seorang makcik yang datang sebab terpijak paku 2-3 hari lepas. datang pukul 2 pagi sbb katanya dari siang bergaduh dengan anak takmahu datang. akhirnya datang sebab pening kepala tak buleh tidur. Pening kepala adalah sebab datang, bukannye sebab terpijak paku. rupanya ada tekanan darah tinggi yang emergency.

3. Kepada pesakit yang mengadu doktor suka ambil darah, macam drakula.

Percayalah, kalau bukan untuk monitor anda, kami (saya-lah especially) adalah sangat malas untuk ambil darah. lagi-lagi kalau yang banyak-banyak botol maka banyaklah pula kena mengisi borangnya - lainlah kalau hospital kat malaysia ni dah macam kat uk, a lot of time saved by printing out blood forms. Lagi-lagi kalau kena bangun pukul 2 pagi ambil darah ABG (darah nadi) semata-mata, ataupun darah PTTK. Bukan sengaja. Mereka yang ada sakit jantung dan diberikan ubat yg berjalan dalam mesin tu, memang kena monitor darah anda setiap 6 jam, sebabnya ubat tu mencairkan darah anda, kita nak monitor takut-takut darah terlebih cair, maka risiko berlaku pendarahan kat mana-mana pulak, contohnya otak. Ya, ada sebab. bukan sengaja. Sanggup lagi saya tidur daripada saja mengambil darah anda pada malam-malam buta, kalau fikir logik akal pun, betul kan?


Nanti sambung lagi....

DEMOTIVATED

It has been a while since the last entry. And with this entry, it is a goodbye to the story of people giving birth, or women with spontaneous abortion. Or being upset with those unmarried teenagers who can hardly bare the consequences of their own acts.

It is now all medical, and since I am placed in the male ward, I temporarily won't have to make any contact with the o&g department. The ward I am holding responsibility now is the worst one so far - it is always full and jobs never get done - the lists just go on and on and on like it will never come to an end. It has been nearly a month (omg) I am in medical now. And if you ask me how I feel; I feel like I have never been to medical school before! Too many stuff in medical, giving me reasons why I like o&g better.

But I still cannot see where my future lies. Definitely not medical, that is for sure. At least for now. Every day I found it hard to motivate myself - it is like I am a body without a soul, doing jobs just because I have to, and not because I enjoy doing it. The only thing that motivates me now are my nice ward M.O.s and specialist as well as a good team.

I need motivation, seriously.

DOCTORING part II

M.O. : Did you know what happened with .... (something about the current news which I can barely remember)
Me : What?
M.O : Ooo I forgot. H.O. doesn't really have time to follow news
Me : *sigh*

I'd normally do not read news anyway. I usually prefer to watch the news. I read only news that does not come out on telly e.g. what says PAS/PKR or whatever non goverment party re some issues.

But since being a houseman, I rarely watch the news, let alone reading any. I always do turn my laptop on when I come back home, but most of the time ended up in the bed, falling asleep unplanned. I think I slept too much already, but my body is still aching, I have no idea what the causes would have been.

And lately I have this weird thing at the end of my meals - strong smell of liquor always stopped me from eating further. Lucky it always happened at the end of meals, or else I would have lost lots of weight already! I guess too much of ARM (artificial rupture of membrane) already! Weird, as I left labour room for 2 weeks now, and never had that problems when I was in charge before.

Anyway, today marks 2 months of my working life in O & G department. Things have been going better than before - I believe I have learned loads of stuff especially the practical ones, but I long for more teaching as I know there are lots and lots of things I still need to know. Especially thinking that I might be sent off to anywhere; where I might need to decide on everything and will not have M.O.s/specialists to consult - trust me there are loadssss of stuff beyond my shallow knowledge I am holding on to. The first viva is soon expected, and I can confidently say i am not yet ready for it.

And I still hate making decisions, being h.o. sometimes you have no idea when to decide by yourself and when to consult if something is so obscured but I guess that is just the simple rule of being a houseman. Every week we are being audited for mistakes we have done(which I believe in some cases, h.o. should not be blamed at all), but I do like being there when the audit was done as we learn so much from mistakes. (but despite saying this, I hope I will never be the one being audited *sigh* God I just hope this wont jinx)

So that is 2 months of working life - I still have not taken any leaves yet (I gave up the last time I tried to apply one). Please pray I will get some at the end of this year as I really badly need some holidays.

THE VICIOUS CIRCLE

by Ija (who I usually agree with, and whom I miss so much - we are working in the same hospital, but very rarely seen each other)

It has been a circle from the earliest of human developement. But as we are living in a community which demonstrates such a cruelty, it is a shame if we can't see it with our very own eyes.

It is not far from me, seeing what is happening in Terengganu, a state taken as an example. Known for its glorious culture,food and OiL it is also known as one of the poorest states. It is.

Truthfully, the federal earnings from our valued source-OIL is such of a great number. The federal earns multi billions from that. The people in Terengganu should actually at least get something in return - a proper education, facilities and at least a proper health service. But they are not.

So many people had realised and claimed that if the earnings are 'used' properly by the federal, each of us can at least enjoy a decent allowance monthly. The gas for cooking will be free! Education should not be a problem. The villagers can have a proper transportation getting to the hospitals. The students from remote areas can enjoy schooling as they do not have to wait for hours and hours to get a lift to the school. What a shame to the superiors who had let these happening.

Now that the earnings are being swallowed and smuggled into their own pockets, they are the ones who are responsible for the consequences of these poor people.

I want to show a typical example. It all started from being in an unstable poor family. Imagine a boy having to stop school because there is no breadwinner and he has to be one. He does not like school cause it's very hard to get to. Starts working catching fishes in the sea with fellow adolescents, eventually gets into drug abusing. It is very common here. Or they get into this popular social activity -they went merempit. Got into an accident, and admitted to the hospital.

These rempits got somone killed. The rempits got comatosed. The parents are worried sick everyday, taking care relentlessly with sleepless nights. The mother patiently cares for the boy who is now require an attention of an infant. And when they are conscious , they get back into their attitudes-being rude and not thankful to the parents. But the parents keep being calm,thinking their child is unstable hence letting them to be as such.

I am pointing out that if at least if these people get their proper education, the chance of them being a social junkie is much less. And why did they not get the education they deserve? Because those responsible in providing it is not doing their jobs.

The circle of social problem does not start with poor home education. It starts from the government. It starts from the way resources are being given to the people. It is even worse when the money is there, instead it is going to the wrong hands. This is a circle which should be destroyed, as more poeple will suffer the consequences.

DOCTORING part I

1. Requirement for a houseman.

This part is specifically for medical students who soon are going to do noble jobs of doctoring. If you think the main criteria you are obliged to have is to know everything especially the theory part of medicine - you are completely wrong. When your university said they want to produce a safe doctor who are able to treat patient, they are totally right with the aim. As a houseman, this is your job: You will be seeing many patients with various different presentations, either as referred cases or first hand patients then you have to decide what to do next and if there is need to ring the senior, just pray that they are in good mood (and not just woke up from sleep!).

If you study in the UK and pampered with the rules of giving feedback - that is to start with positive things and then only go on with the negatives - in which case, no matter how stupid or how wrong you are, most of the time you will still get credit and be motivated that way because people will start with 'the things that u did good was....' and end with '...but you can improve on .......', so if you are being pampered with this kind of feedback, please please please prepare yourself for a total 360 degree change where most of the time you might be criticised and the only means of learning might be through critics, or even humiliation. Especially if your brain works very slowly particularly under pressure (like mine), there is no other things you can do apart from you motivating your own self and continuous prayer asking for a better tomorrow if not a better you. I am sure all the seniors want you to be good doctors even when you are being told off by them - it is probably like parents scolding off the kids so they become useful people later on

In summary, if you want to prepare yourself to become a houseman, learn this:
1. Familiarise yourself with learning by humiliation/critics.
2. Do your jobs very very very quickly or you will be stuck in the ward forever.
3. Be able to present patient very concisely.
4. Know the name (especially specialists) of the person you are going to talk to before talking to them. Make full use of the committee chart even though the picture might be too small or too old for you to recognise the person you are yet to see.
5. Agree wholeheartedly that doctoring is a noble job and you are not to become a doctor because of the typical reason 'my parents want me to'. Holding tight to religious teaching and having Him who always listens helps.
6. Able to say no to jobs during your tagging duration because that is the only time you can learn even though patients are supposed to be your everything once you become a doctor. If you don't learn during the tagging time, you are in big trouble to learn
7. Familiarise yourself being called 'doctor' on your first day of placement.
8. Have lots of practical knowledge not just theory and be able to put them together quickly and be able to impress the consultants.
9. Appreciate that H.O = humble orang. If you did wrong, you are wrong. If you did nothing wrong, you are still wrong. If you did right and being blamed for, you are still wrong. Try not to answer back. This is the hardest thing of all I think, as human beings naturally have the tendency to defend themselves.

(to be continued, if there is time and mood)

I know the way I am writing this, it sounds so bad, but what I know is I am learning and trying to improve every day (slowly maybe, but getting there hopefully), and it is not actually that bad when you are enjoying the learning and jobs and the talking to the patients bits. I just hope I will survive my 5 consecutive EOD (every other day) oncall starting Sunday. Wish me the best!

PRE PROLOGUE

"I do solemnly declare that as a doctor of Medicine from Newcastle University, I will exercise my profession to the best of my knowledge and ability for the good of all persons:

- I will make the care of my patients my first concern, keep my professional knowledge up to date, and recognise the limits of my professional competence;
- I will treat every patient politely, with respect and dignity;
- I will treat my patients considerately, respect their views, provide them with information and involve then im decisions about their care;
- I will work with colleagues in healthcare professions in ways that best serve my patients' best interest;
- I will respect and aid those learning to acquire skills and competencies for the care of the patients;
- I will be honest and trustworthy, respect and protect confidential information, ensure that my personal beliefs do not prejudice my patients care, act quickly to protect my patients from risk, and will not abuse my position as a doctor.

In all this matters I will never discriminate unfairly against my patients or my colleagues. I will hold in due regard the honourable obligations of the medical profession doing nothing inconsistent therewith. Above all, I dedicate my professional life to the service of those entrusted to my care."

This is to remind myself the oath we all (the Newcastle students) have taken when we graduated as doctors.

THE PROLOGUE

I have just completed my induction and BTN course this afternoon. By right, I have already started working six days ago, as the pay slip for new doctors starts on the very first day they attend the induction. Induction was ok although I was expecting more talks about how health system works in Malaysia especially knowing that more than 99% of the participants were oversea graduates. And I do not have any intention to make any comments about BTN - loads of the government servants must have already known what it is all about!

I had survived my five years MBBS course which tortured me the most in my third year. I had survived the nearly two months well deserved break which had turned out to be too boring at some points that I had crazy thoughts haunting me (thank goodness Harry Potter books saved me from those thoughts - and by the way, raya and having a full house was great!)

I had survived the six days period of induction and BTN course, learning more about being a government servant in general or the so called 'house officers' in particular, and being proud to be a Malaysian, and not to forget the latest slogan that we have - the '1 Malaysia'. I had survived the long journey back to home, being the passenger for the first time at the backseat of the soon to be TAW 997. I had survived the very long thought about future life throughout the whole journey (minus two hours of the badly needed fine quality sleep, finally!) although practically I am still left with no wise decision.

After hibernating for nearly two months, today is very tiring! But I believe today is just the prologue. Tomorrow is chapter 1 - where the new era begins!

ps: to the patients coming to Hospital Sultanah Nur Zahirah, Kuala Terengganu, please beware of this new doctor coming to serve you.

MEDICAL STUDENTS, CONSIDERING ...

BUYING THE LATEST EDITION OF THE OXFORD HANDBOOK OF CLINICAL MEDICINE?

RE: new edition (Oxford Handbook of Clinical Medicine Feedback Form)

Thursday, 20 August, 2009 4:36 PM

From:"Ox Med Comments"

To:"afifah jaafar"

Dear Dr Jaafar,
many thanks for your email (and congratulations on your recent
qualification!). You've done right to ask, as the eighth edition is just
around the corner - we're working on the proofs now, and will expect to
see it in the shops early next year. I would recommend waiting until
Jan-Feb, when the new edition will be available for purchase. Many
thanks for your interest in the book, and we hope you will like and
enjoy the new edition.
Best wishes,
Mark Knowles


Systems and Online Development Manager
Tel: +44 (0) 1865 35 4024
Fax: +44 (0) 1865 35 3817
Email: mark.knowles@oup.com

-----Original Message-----
From: afifah jaafar [mailto:fifa_0304@yahoo.com]
Sent: 19 August 2009 04:22
To: Ox Med Comments
Cc: fifa_0304@yahoo.com
Subject: new edition (Oxford Handbook of Clinical Medicine Feedback
Form)

------------------------------------------------------------
Comments sent via OXFORD HANDBOOK OF CLINICAL MEDICINE Feedback Page
------------------------------------------------------------

COMMENTS:
Hi,

I am just wondering if you are going to publish the 8th edition any time
soon, and if so, when? It is just that the last time I brought the 6th
edition, the 7th one came out a month after that and I was a bit
frustrated as the 7th one is much better I have to say (well done!). I
am thinking of buying the 7th one, but thought it is worth asking and
waiting if the 8th one is coming out very soon. Please could you advise
me on this matter.

Thank you.

Afifah Jaafar
Newly graduated medical student

THE GROWING ALARM

A few days ago when I was reading the NST, an article by Koh Lay Chin, "Growing alarm over sexualisation of young girls" caught my attention. She had been watching how girls as small as 4 years old, dancing like a grown up with all those sexy moves. She speaks her concerns over the topic wisely, and I would have to agree 100% to what she was saying.

"But there was something hinting at sexiness in those tiny moves, and I was not the only one who felt an awkward twitch by it. Apparently, parents and adults are getting more of those awkward twitches every day by the sexualisation of young girls, who feel the need to look, act, move or speak in a certain way to get attention or keep up with their peers."

May I also quote her last paragraph of the article:

"I can laugh about all this now since I don't have children, but I dread what I'll do in the future should I see my young child doing the provocative "booty shake". Summoning a crowd or videotaping it for posterity? Nay, I may just have to blow up the television set and lock Buttercup in a room forever. And ever."

I have been watching some ads on the telly promoting a tv show called bintang kecil or whatever equivalent (can hardly remember what the show was). Presumably, it is a singing competition between the young children since there were short clips of them singing in the ads. And dancing to the song, of course! Well, maybe I am just exaggerating the show, but I am sure there are lots of tv show nowadays that encourage kids to do some very provocative acts and I wonder what the parents think when they allow their kids to do such things.

May I quote again Koh Lay Chin last sentence:

"I may just have to blow up the television set and lock Buttercup in a room forever."

THE GRADUATION

I knew this is too late already, but just to thanks all that have made it all possible. Especially the batch, the family, housemates and friends, the teachers and most importantly The Lord of course. And thank God all Malaysians in our batch graduated this year!

*missing in the Malaysian batch picture: Iris, Nithia and Su Ann.

So that was the end of the student life, and honestly I do not really look forward to the working life that quick. At least not at the moment. I am back in the hometown now - but everyday, I wake up thinking that it is no more holiday this time. Unlike the previous summer holidays, I am not going back to Newcastle, not within few years time at least. And that makes me miss Newcastle so much, especially that I have no clue to when I will be seeing the people I love there.

But yesterday has gone and all I have is today.

OSCE 2009

Glad I have finished it now. Currently am sitting in the library cluster after picking up an EMQ and MCQ book for medical finals - to prepare for the next two papers. I feel like giving myself a rest today, I deserve one at least. Weather does not let me to wander around in the city centre - it is raining today, so here I am in the library writing up my blog.

Just to recall the OSCE stations I had this morning (and I will save this post until tonight so it will be fair for all the students in morning and afternoon circuit, just in case people do google for the questions). It was quite fair, although I agree with Helen, are we not supposed to take history anymore? No history station at all, apart from the suicide risk assessment.

STATION 1: EXAMINATION - respiratory system

STATION 2: PROCEDURE - blood transfusion, prescription, cannulation

STATION 3: EXAMINATION - Praecordium: not sure what murmur it was but there was definitely a murmur, loudest at mitral area

STATION 4: SUICIDE RISK - stressful;the actor was really reluctant to speak, the examiner was not smiling or as friendly either. I think I might have failed this one, although I hope I did not

STATION 5: EXAMINATION - Hand. Obvious psoriatic lesion on elbow, painful DIP PIP joints, onycholysis. This gave me wide smile, definite psoriatic arthritis. But I did not manage to finish all the function and movement test as not enough time. Probably spent to much time describing the psoriasis. Hope will pass this one.

STATION 6: ILS - as expected. A bit disappointed though coz it did not feel real, did not have to attach the machine, a bit blurr and kept asking the examiner do I need to do this or that, is the help here bla bla bla.

STATION 7: EXAMINATION - Diabetic feet. Glad I had a look at his footwear as he was wearing special one. Borderline pass/fail - I think I missed a few stuff. There was no obvious abnormalities that I can comment on. This came out in third year and I remember failing it despite the obvious findings I found on the patient.

STATION 8: PROCEDURE/EXAMINATION - Cervical smear and bimanual examination on dummy

STATION 9: EXAMINATION - abdominal but just asked to only examine the abdomen. Definitely a lump, very vague. Examiner not looking too friendly

STATION 10: EXAMINATION - Asked to examine the eye. VERY vague and unspecific instruction. And worse, I DID NOT NOTICE THAT THERE WAS A SNELLEN CHART PROVIDED, neither did I mention it. It was only when Kate asked how the Snellen chart should be in reality - then I went "Was there a snellen chart????". Arggghhh.

STATION 11: DEATH CERTIFICATE - straight forward case. Bronchopneumonia due to R anterior circulation stroke. Even had extra time drink, it was the last station for too. I will be very upset if I fail this one.

STATION 12: KARDEX - 3-4 pages of patient's notes. Asked to write down new cardex as it was lost during transfer to ward. Also to add Abx. My first station, was bit blank coz didnt look up at the instruction (as it was pasted on the wall/door and I was sitting looking down reading to the notes). But got there eventually except no time to prescribe any drugs on the plan list. Might have failed this one too.

STATION 13: VIDEO - Ward round notes. LOTS and LOTS of details, really impossible to listen and write down all of them (for me). Hope I will get marks for all the simple details on the sheet.

STATION 14: VIDEO - psychiatry video SAME as OSCE IN THIRD YEAR!!!!! Did not expect this was going to come out again, so did not pay much attention to it. Failed the one in third year, not sure how I did this time.

STATION 15: KARDEX - patient with NON STEMI. Was asked to prescribe 3 drugs (cant remember) but not sure if I need to add others. The only one I had time for was clopidogrel - not sure if I will be penalised to have prescribed that as it was not on the list.

So there you go. One fourth of the assessment of the five years torture in medical school. Can hardly wait to finish the other three...and to qualify! (insyaAllah if thats best for me)

OSCE TOMORROW

I have received some texts from few people wishing me the best for tomorrow - BIG THANKS to all. Yesterday, I wished the OSCE was this morning, coz I can hardly wait to finish OSCE so that I can move on to do some readings quickly. Today, I cannot believe it is tomorrow - the day we have to put in everything that we have learnt (or not) in the past 5 years of medical school.

I had a nervous breakdown far too early this time. I think it was between 2-3 weeks ago. Then, alhamdulillah it has been alright so far although frankly, at the back of my mind, there is still this worry that **** (but I am not gonna say this - I always, always throw this away as far as I can).

"Kalau Iffa buat camni, macam Iffa sangka buruk kat Allah, kan tak baik. Exam pun belum, kita usaha lah dulu". Yes. I had a moment of a serious breakdown, and I know that was bad. Shame on me.

Thanks to a friend who has always been there for me.

Everyhting that I have said previously is all coming back to me. Whether I pass or fail this one, it has all been written. All that I need to do is to put some effort into what I am doing, so to gain His mercy and as it is one important rule of sunnatullah. I have a few hours left before OSCE tomorrow - and to me, all I really need at this moment is to keep telling myself that I can do it. We all can do it. InsyaAllah.

I am just hoping and praying that we will all be very calm and able to understand the questions and finish it in 7 minutes each time. And hopefully I will not have that horrible sleep tonight where I will wake up every hour or so, looking at the time, worrying that I will be late for the exams. (I am sure lots of people do this too).

Okay, please pray for us.

ps: Hoepfully I will be able to take Dr Dark's advice til tomorrow; everything is in your head. You are going into the exams knowing that you will pass it. It really boosts up the confidence if you keep saying that. Try it!

RAHMA

I bought this CD so that I can play it in the car while driving around at least 35 miles every weekdays of my placement in Wansbeck General Hospital. Yes, I have to buy the original CD - the CD player apparently only accept ori ones.

It was worth the money. I like all of of the nasyeed in this album. Not a lot, only eight. But all have very deep meaning - and just today, I was paying attention to the lyrics of the fifth track (I think) - knowledge is light. Hit me straight to the heart.

Shakautu ila Waki` su'a hifdhi
wa arshada-ni an tark al-ma`asi
wa akhbara-ni bi anna ilman nur
wa nur Allah la yu`ta al-`as

The great Imam ash-Shafi', he went to his teacher Waki`
Complaining about the weakness of his memory.
He told him, 'abandon rebellion, for knowledge is a light
And the light of Allah is not bestowed upon a rebel.'

It is so frustrating to read the same topic all over again, yet not to be able to answer or explain when being asked about it. Very, very frustrating. Please help us all, Allah.

My CURRENT FAVOURITE NASYID

Kalimatan habibatan ila ar-Rahman
Khafifatan `ala al-lisan, thaqilatan fi al-mizan

Subhanallahi wa bi hamdih, subhanallahi al-azim

"There are two phrases which are beloved of the Most Merciful, light on the tongue, yet heavy on the scales (of reward): glory be to Allah and all praise to Him, glory be to Allah, the Mighty."

MY IMPORTANT DATES

STAGE 5 (MBBS)
EXAMINATION FOR THE DEGREES OF
BACHELOR OF MEDICINE AND BACHELOR OF SURGERY

Provisional Timetable

JUNE 2009

Friday 5 June 2009
9:00 AM OSCE


Thursday 11 June 2009
2:00 PM Paper 1


Friday 12 June 2009
2:00 PM Paper 2


Tuesday 16 June 2009
8:00 AM MOSLER

Wednesday 17 June 2009
3:00 PM Pass list published to LSE and noticeboard

As usual, please please pray for our success, may that be the best for us. Congratulations to those who have already passed your finals - I have to admit I am so jealous (but happy too) for you guys and girls. I can hardly wait for this to finish, yet I am very reluctant to sit for the exams considering the very little knowledge stored in my brain now.

Pray that we will put our best effort in this before leaving the decision solely to Him, and pray that we will accept whatever the results are.

***panic attack has now begun***

THE HIPPOCRATIC OATH

I swear by Apollo the healer, by Aesculapius, by Health and all the powers of healing, and call to witness all the gods and goddesses that I may keep this Oath and Promise to the best of my ability and judgement.

I will pay the same respect to my master in the Science as to my parents and share my life with him and pay all my debts to him. I will regard his sons as my brothers and teach them the Science, if they desire to learn it, without fee or contract. I will hand on precepts, lectures and all other learning to my sons, to those of my master and to those pupils duly apprenticed and sworn, and to none other.

I will use my power to help the sick to the best of my ability and judgement; I will abstain from harming or wronging any man by it.

I will not give a fatal draught to anyone if I am asked, nor will I suggest any such thing. Neither will I give a woman means to procure an abortion.

I will be chaste and religious in my life and in my practice.

I will not cut, even for the stone, but I will leave such procedures to the practitioners of that craft.

Whenever I go into a house, I will go to help the sick and never with the intention of doing harm or injury. I will not abuse my position to indulge in sexual contacts with the bodies of women or of men, whether they be freemen or slaves.

Whatever I see or hear, professionally or privately, which ought not to be divulged, I will keep secret and tell no one.

If, therefore, I observe this Oath and do not violate it, may I prosper both in my life and in my profession, earning good repute among all men for my time. If I transgress and forswear this oath, may my lot be otherwise.

ps: for medical students, this might be part of your job interview questions.

THE WAR

Balai Newcastle organised a wonderful program last weekend and one of the activities was paint balling. I have always wanted to play it to be honest. I thought of not playing while on my way as I was soooooo tired and exhausted I couldn't describe it, and I arrived there a bit late too. And I do not like the fact that they put us as a mixed team (girls and boys). But the moment Amni came up to me and told me that she just realised that she is actually not brave enough to be in the war, then I too wanted to feel and know how brave I am. So I played one last game and my group was left with only a few bullets.

I did achieve my objective of playing - I now know I seriouslly am not that brave. Of course I can give excuse that it was my first game, I had no clues how to play it when everybody else was immensed with the game. Only after that I had that adrenaline rush of wanting to go back and fight as much as I can, get the strategy on route etc, and that was only when I knew it was not so painful being hit by the paintballs. Otherwise, I believe I'd still be scared to death.

Before playing, I was a real coward. When I test my first shot, I saw and heard how hard the fake bullets hit the target and I was damn worried if they were going to hurt and bruise me. The trembles, the worries, the panics etc - I seriously can't describe it in words. I can flashback my act during that fake war in my head now and I hate myself for being such a coward.

At one point during the short game, I wondered if it was a real war. I started to imagine that it was the war in Gaza and I was left with only some bullets to be used PRN. How frightening that would be!!! And paintballing was nothing as compared to real war - the most horrible thing you can get out of it are short term stinging pain or worse, bruisings that will eventually heal (unless it is your time to die at that time anyway); but in real war, you know if you go out and careless and have nothing to protect you, it is death that you are looking forward to. I repeat, D.E.A.T.H.

No wonder Allah lifts up those who went to war because of Him. No wonder it was not easy for the munafiqun to be in the war during the past time. No wonder those who went for Badar were promised the jannah. I am amazed with all of them. I am amazed with the people in Gaza, the people in Palestine, in Iraq, elsewhere - I am amazed with the kids there - they have no weapons and they are really brave, throwing the small stones toward sthe illegal occupants when they are facing the heartless soldier holding real machineguns, knowing the bullets could go through their heads anytime. May be they have no world to live for anyway, so they are never afraid of the death which hopefully will lead them to the eternal lives.

I guess there is no such word as empathy, as you can never really be in someone's shoes and fit in the way that person is putting them on. Even if you be in their shoes for three days, a week, a year. I really don't think it is possible. But of course the least thing we can do is to show empathy and help praying for them. I just hope that I am not going to back up if I am going to be in that situation.

Let alone the physical war, we have to bear in mind there is a war that all muslims are facing now and that is the mind war with very obscured booby traps we can fall into - I can hardly face it and work my way through if I don't have people reminding me to be on the best path, always. And other than that, I am struggling to concentrate on the war in my student world - my exams is in 2 months time (plus minus). Pray for the best for me, please!

ps: after exams, paintballing again? girls only though (it will never be fun playing whilst being conscious to make sure you do not run into a guy, even harder when you have no idea who are behind the masks).

UDARA DALAM PARU-PARU?

'Pneumothorax' ialah udara yang terperangkap di sebelah paru-paru. Kebanyakan kes berlaku secara spontan (tiada sebab yang dikenalpasti) kepada lelaki belia yang sihat walafiat. kadang-kadang ia berlaku disebabkan oleh kecederaan pada bahagian dada ataupun disebabkan oleh penyakit paru-paru yang telah sedia ada, contohnya lelah (asthma). Simptom yang biasa adalah sakit dada yang tiba-tiba dan sangat spesifik di mana anda boleh tudingkan dengan jari anda di mana anda rasa sakit tersebut. Kadang-kadang sakit dada terasa bila anda menarik nafas, kadang-kadang anda boleh jadi lelah (tidak cukup nafas atau susah bernafas). Kebiasaannya, penumothorax tidak memerlukan rawatan selain daripada ubat tahan sakit seperti paracetamol (panadol). Jika perlu, doktor anda akan berbincang tentang rawatan lain.

Satu ketika dulu saya pernah tulis tentang penyakit talasemia dalam bahasa melayu. Ramai juga yang buka entry tersebut, mungkin disebabkan kurangnya website lain yang menerangkan tentang penyakit-penyakit fizikal dalam bahasa kebangsaan saya.

Sepanjang bergelar pelajar perubatan, memang saya sering ditanya tentang penyakit-penyakit oleh sahabat-sahabat dan sanak saudara, walaupun banyak kali rasanya tak mampu untuk saya terangkan dengan baik, tapi inilah hakikatnya - hidup sebagai seorang pelajar medik - soalan-soalan begini sangat common dan akan common untuk sepanjang hidup saya.

Sebentar tadi, saya telah ditegur oleh seorang sahabat yang bertanyakan tentang penyakit 'udara dalam paru-paru'. Saya copy dan tampal perbualan tadi kalau-kalau ada yang ada soalan yang sama, inilah jawapan ala-kadar saya yang hanyalah seorang pelajar perubatan.

t: assalamualaikum
iffa: wslm wbt
t: kalu x bz, nak tanye sket ttg hal2 medic
iffa: boleh nsyaAllah
x: tau tentang sakit, paru2 masuk angin?
t: ada udara dlm paru2
iffa: pneumothorax?
iffa: ye kot
iffa: tu je yg buleh fikir
iffa: ye kenapa ngan ade angin
t: camne bleh terjadi nya udara masuk dlm paru2 ye
iffa:t ke yg kene
iffa: byk sbb dia
t: x, adik ana
iffa: lelaki?
t: ye
iffa: ade asthma?
iffa: ie lelah?
t: setau ana xde
iffa: spontaneous biasanya
iffa: kalau young male
iffa: 20-30
x: aa.. dr 2 kat sini pon ckp camtu jgk
x: menyebabkan kami adik beradik x dpt bertanye lebih lanjut
iffa: http://www.patient.co.uk/showdoc/23069039/
t: camne bleh jadi spontan?
t: x paham..
iffa: rasanya dia panggil spontaneous
iffa: sbb tak jumpa sebab dia lagi
iffa: mungkin satu hari nnt jumpa dah x panggil tu la
iffa: takleh nak explain and kaitkan dengan apa
iffa: so far spontaneous ni sgt common esp in male 20-30 yr
iffa: dia dapat chest drain tak?
t: maksudnye?
t: tebuk lubang ke?
iffa: aah
iffa: nk keluarkan angin tu
iffa: oo lagi satu smoking tak
t: x
t: x merokok
t: so besanye treatment camne?
iffa: depends on symptoms
t: tebuk lubang, dan salurkan keluar..
iffa: kalau kecik je takde symptom eg shortness of breath
iffa: chest pain
iffa: biasenya bg pain killer je
iffa: seminggu lagi xray dah takde pape
iffa: tapi kalau makin teruk patutnya buat drain tu la
t: adik ana kena kali kedua
t: dah lebih 2 minggu, dr suspek ade leakage
iffa: die ade symptoms tak
iffa: ke dr tahu tu tru chest xray je
t: simpton and xray
t: dah 3 kali xray, tgh xde perubahan dalm paru2, udara mcm sama je kandungannya
t: jika kena buat opration, camne ye prosedurnye?
t: operation yang besar ke?
iffa: yg tu tak sure sgt
iffa: takpenah experience surgery ni
iffa: so taktau
iffa: chest drain dulu la patutnya
iffa: before surgery
iffa: keluarkan dulu angin tu
iffa: unless kalau mmg dr tu rasa buat surgery terus
iffa: masa surgeyr tu terus buang angin tu
t: dr ckp mmg bocor, bila tgk xray
t: cuma kena scan, nak confirmkan bocor katne
t: based on site yg iffa bg td, ada 2 kaedah buat opertion
t: yg 1, remove 'bleb', bleb tu ape?
iffa: bleb tu mcm bulla
iffa: aduh
iffa: camne nak cakap aa
iffa: die macam patutnya str8 je lung surface tu
iffa: tapi macam ade balloon out
iffa: kalau kat kulit tu mcm blister
iffa: blister = ??kulit yg ade air kat dlm
iffa: mcm kalau tangna kena air panas tu
t: oo
t: ok la, tima kasih kerana sudi explain

Mungkin tak membantu. Paling penting, tanyalah doktor anda, kerana selain Allah al-'Alim yang pastinya Maha Mengetahui, doktor yang merawat anda lah yang ahli dalam situasi tersebut.

[ada satu ayat quran yang cakap tanyalah orang yang ahli jika kamu tidak mengetahui...tapi tak ingat ayat mana]

DISCLAIMER:

1. Penerangan di atas adalah tentang 'pneumothorax' yang bermaksud 'udara di antara 2 lapisan paru-paru' yang mana 'udara dalam paru-paru' adalah sedikit misleading. Mungkin penyakit 'udara dalam paru-paru' yang dimaksudkan oleh 't' adalah penyakit lain, jadi mohon dimaklumkan jika istilah tersebut tidak sama dengan pneumothorax.

2. ID YM sahabat saya itu saya tukarkan dengan 't' untuk tidak breach confidentiality.

3. DO NOT rely solely for information on this post, especially the surgery bit. Tanyalah doktor anda.

4. Maaf, bahasa rojak. ada yang ambil masa lama sangat nak translate.

muhasabah: am i really a final yr student? and am i ready to go back to malaysia? and will i be able to give good explanation to patients, in malay? eee cuak. nak pass exam tapi cuak nak start keje. tak sabar nak start keje tapi takut tak dapat jadi doktor yang bes.