Temptations & Ambitions

It has somewhat come to an end, my surgery posting. All in all, I've been through 15 weeks of Surgery, if I am to count from Year 3. There are of course, ups and downs, some hardworking moments, some lazy moments, but I'd pulled through the 1st posting of Year 5. In one piece. I thought I would have developed some form of avulsion towards Surgery, but it seems kinda okay now and not that horrible. Perhaps I had to go through Pediatrics and Orthopedics to understand how interesting Surgery is (In relative sense). Now, I find the core postings rather interesting, from Internal Medicine, Surgery to (the most fearful) Obs and Gynecology. 


Clinical proficiency test (CPT) was done 2 days ago. We came all the way from Teluk Intan for it and had to return to Teluk Intan on the same day itself. Of course, I drove myself there, so I had an extra day off for myself before coming back to TI yesterday. That's how useful a car can be especially in final year. CPT was only 20 minutes, and it was somewhat not worth the journey to and fro. We were given 20 minutes to take history and do physical examination. The usual in the professionals for long case would be 45 minutes, and an extra 15 minutes of preparation (Or so I heard). So the time given was rather short for us. Of course, some may argue that targeted history taking and PE would only take 15 minutes for example in Family Medicine, but there's no referral to higher center, and you'll be the "final destination" for the patient. Plus, the spectrum of diseases may vary from center to center.


I started as one of the first few early candidates. After given the bed number, we were to rush to the beds to start our allocated 20 minutes session. I was having bad luck with Prof Ramdzi messing with me, with his usually undecipherable one-word conversation and also to ask me to present to him after that. Then, I arrived at Bed 15, with no patient. It was an empty bed. Cursing my luck, I panicked for perhaps, a few seconds and hasten my way to the invigilator to inform about my situation. I was directed to another bed, which had the case notes on the table. I flipped it over to avoid having a peep on it, and started my "mission". Throughout the session, there were at least 2 interuptions from the female house officer and a staff nurse for me to assist them in their ward work. Never mind the staff nurse who got the hint and walked off quietly, the new house officer was being rather rude in her approach. She demanded me to follow her to another bed, and I told her in a nice way that I a test was undergoing. Refusing to listen (maybe she had impaired hearing), she demanded again in a harsher tone. That was the last straw where I told her sternly that I was having an exam now, while giving a glare that I could eat her up if she kept insisting. The glare must have worked before she realized what was going on and she apologetically walked off. 

The 20 minutes session was not really well spent. It took around 10 minutes for my history of presenting illness before I realized that I was running out of time. Finished history taking in 17 minutes (I think), before proceeding to one of the most modified physical examination of the abdomen which would have gained at least a yellow card. Examining the hands while taking the pulse rate and breath rate, and a rapid palpation of the post-surgical site abdomen (after a proper quick glance of the whole abdomen, of course) while standing, before I realised my mistake and did it while kneeling down. It wasn't really a complete one, but I did what I could before Mr Christopher Ho entered. I knew I was lucky because Prof Ramdzi was not my examiner. All I knew next was I was presenting and answering questions in almost one breath. There were flaws in my presentation, of course, especially when I was not reading from my clerking sheet, using it only for occasional reference (A bold move when this was the first time of me doing it). Maybe the "no pause" moments gave way plus, Mr Christopher Ho was a nice and kind examiner. Hence it went rather well as compared to some of my colleagues who had examiners who are more malignant.  


Whatever it is, I'm just glad that it's over. What I'm looking forward to is Pediatrics, where I'd flunked last semester along with Orthopedics. It took much more courage to go over something you would dread to do, so I'm trying to be all optimistic. The next 2 weeks, I'll be in Slim River, so I'll be having a total of 5 weeks of nomading. Driving is really tiring at times, but I guess home is a place you can truly rest. Until then, I'm looking forward for a nice break this weekend.


P.S: I'll post some pics in the next post. :)

This blog, perhaps had evolved into another stage ala "Confessions of a Medical Student" by Shin Yin. Or perhaps a transient one, maybe "Confession of a Laidback Medical Student". Funny how we'd used to take a peep into the lives of final year medical students, their endeavour, their joy and pride. Funny how it felt that no matter how you prepare your mind for this day to come, taking that single leap is still as terrifying as it could be.

3rd week into Surgery, and somehow it did not felt as bad as it was in Year 3. Perhaps I was as lost as I could get, which is why I would empathize the juniors more. They may be our juniors in just these 2 years, but who knows they may even be your superiors, or seniors when you take your Masters program? I truly believe in the law of present karma, so be nice to everyone, or at least I tried to. 


Being a 5th year is different from a 3rd year. The consultants and specialists pay extra attention to you, because you are having the professionals exams soon, and any screw ups would spell trouble for their part. When would you get 6 consultants + specialists for a group of 5 students? Back when I was in Year 3, it was 2 specialists to a group of 8 students. Plus, as a 5th year, you get to do more procedures in the wards. You tend to be more proficient in the clinical procedures (or so we thought, or we'd master the art of pretense) and even the registrars acknowledge your presence. Even now, we get to scrub in to assist the doctors in the operation, although it's still not as much as doing the thing itself(not my cup of tea though). At least there was a purpose going to the OT, as well as Prof Rohaizak's teaching in the OT. Back in Year 3, operating theaters were strictly nono for me, because we as 3rd years were just like the neon lights on the Christmas tree. Nice, shiny, and yet insignificant. Or maybe white elephant. Or sometimes, we became the annoying flies being swatted off right from the start. Ignored most of the time, and learnt nothing, apart from desperate attempts to get signatures for the logbook for observing OT procedures.


As one of us did noticed that the house officer posted to UKMMC were getting younger and younger. Little did we realised that it wasn't them. It was us getting older and older. The house officer may even be of the same age as us, hence the decrease in the age gap between us and the house officers. Can't really believe that we're now 24 (alright, some may be 23, fellow rabbits)! We were so young and naive, and knew nothing much of the postings. The current revision did stir up some nostalgic memories and how we'd felt so old. The memories of the past seem so distant and yet the time ahead of us seem short and insufficient. 


Prof Rohaizak gave one of his teachings in the OT today. Again, he mentioned something and asked us to refer to page 400+ Forsythe. His trademark trick. Alex was quick to point out that he was lying, and Prof was laughing, because he knew each and every one of us back then in Year 3 would have believed everything that he said and even jotted it down (I didn't back then, FYI).

Now is the time for us to brush up our knowledge in history taking and physical examination. I thought I'd done it well, but yesterday proved me wrong. I wasn't able to do much with a lateral neck swelling(multiple) which proved to be cervical lymphadenopathy in a short case teaching with Miss Nani. That shows how much I'd not covered yet. And today, the diabetic foot patient, I could only stare for some time, and the sequence of order for the examination was rather awry. There's a lot more to learn, but I do know that this time, I am rather well-equipped with the knowledge compared to the me 2 years ago. Let's hope the spirit and zest shall prevail over a year's time at the very least.

This week had been on the quiet side due to anhedonia on my part. However, I'll try to make up with some updates now.

Wednesday was Peds Psychi Day. Well, we're supposed to tag Prof Susan, so we were there as early as 9am. Little did we know that she came at 11am. There were 2 new cases, but I'll talk about the 2nd case, because it was the one that drained all our energy away.

A pair of 4-year old twins came in with their parents. Perhaps this was my 1st taste of how Peds might be like. Being young, they were easily distracted and all hyped up with more power than the Duracell Bunny. The 6 of us in a group had to play with them to make sure they do not cause anymore harm to the clinic. Of course, kids should be allowed to run around and explore, but the clinic is just not a safe environment to do so. On the loose, they ran as far as they could, even to the Orthopedic clinic or the entrance of the hospital from inside the clinic. They must have thought that we medical students were having fun chasing after them!






In a way, well, we had helped out to assess the kids' developmental stage. It's true that kids would not be assessed through a rigid routine in the clinic, but sometimes this maybe regarded as too bizarre by going all out just for some simple assessment. *Phew*

But then again, all the running did load us up with endorphins (and sweat too). And yet, going after them makes us feel too old. We've really forgotten how on earth could we be like them when we were young? Looking back, I've passed almost 23 years of my life (26th July is the day, :P), and it could spell out a quarter of my life if destiny allows, or half of my life worse come to worst. It didn't really occur much to me that so long a time has passed in a blink of an eye. It seems like yesterday when I was running around in my diapers, climbing the window bar out of amusement and peer influence, for all my cousins did that.

And all that, flew into the far distance of time. And there's no return of goods.

How I wished I could turn back time.

How I wish I could be the me in kindergarten, young and innocent, with no worries of the future, and chatting merrily with my peer friends, and my 2 best girl(space)friends.

How I wish I was in the primary school, enjoying life as it goes, and scoring in exams without studying.

How I wish I could be in my high school, all I need to worry is just education and nothing else. Or perhaps also the Dragon Ball manga I anxiously wait every month, or the new computer game released every Summer (July-August season).

How I wish I was in my SPM, because that was the period I see many of my friends having puppy love and crumpled along the way to my amusement. And all I did was flirting and peeping, and yet still fell to the same state of sorrow for the last 3 months, fortunately without any permanent damages except for some laughter when I think of how stupid I was.

How I wish I was in college, enjoying the freestyle clothing without the need of collar, and with a rounded neck shirt. Waking up at 7.55am and wet my face before going for 8am lectures with the same clothes I wore to sleep. Rounded neck T-shirt and some khakhi on top of my boxers. Slippers were allowed, and I had all the time in the world to sleep. Sitting in the front row garnered attention, because the lecturer were willing to teach you.

How I missed my pre-clinical years, when everyone gave the confused look when I told them I was from TARC STPM. Fortunately for me, my coursemates were only puzzled, but were not insistent as my F6 friend's coursemates in other Uni who insisted that it was A-level that we took in TARC. Back tracking in time because it felt more like a kampung environment in KKL, especially when Chow Kit is the most underdeveloped area in KL. And how I miss the time when the lecture hall was so big that it can fit 400-500 when there's only 200+ of us. Sitting in front meant that the lecturers won't pay attention to you, because they stare blankly at the last row. Maybe that's why I could doze off in lectures in the first row without anyone noticing. And the time when Chow Kit monorail station was our portal of escape into the heart of the city. for movies, for food, and for any leisure activities.

And perhaps, one day, I'll be missing my clinical years, when I'd no need to worry of job and its politics. At least, now I can afford to sleep adequately, before offering myself as a sacrificial piece to the hospital as a house officer. And how we all miss what we had in the past.

And that, would only be known when we've reach the destination. Live life to the fullest, but not necessarily to the extreme or to throw caution to the wind.

Somehow, being in the Psychiatry wards brings no further emotions apart from that of uneasiness. Not from the patient, but rather from the environment, as mentioned previously. Till now, I've been flouting the pages in hope to finish in time. And the more I read, the more I'm confused.

A 3 days' perspective tells me that Psychiatry is more of a blame game of mental illness. Yes, you may deny it, but look at it this way. It is more of a retrospective view of an illness, pointing fingers at all sorts of possibilities. Notice that you've been under assisted delivery (forceps, vacuum delivery, etc)? Then you could have been at risk of mental illness. Have you ever thrown tantrum when you were a kid? That could be a risk as well. Such subtle and insignificant risks are generally blown up into a full blown issue the day your mental illness arrives. They(Psychiatrists) start pointing fingers at the past, and fortell what could have happen to arrive to such illness. They say that it is not your fault, but it was perpetually pointed at the past at what you've done to experience this. Isn't this a subtle way to tell that "It's all your fault" in your face?

Generally speaking, there is no clear cut borderline which separates the issue of psychiatric illness from normal behavioural issues. In fact, given the tenacity of the psychiatrist, one would expect that everyone would be having psychiatric disorder one way or another! The only thing which prevents them from intervening in everyone's life would be the guideline of the existence of social norms.

And the more time I spend in this posting, the more confused or absurd I can get. Let's hope I'll be surviving the 2 months as a student and not as a patient! :P

Today has been the 1st day of Psychiatry posting. Of expecting one to have more freedom out of an 8-weeks posting, it would rather seem to be of a cluttered one. The timetable clashes here and there, no thanks to its 20-pages long booklet catered for the students, with our names repeating over and over again. Such disarray can only be seen in Psychiatry maybe. Or just my hospital.

Anyway, back with the place, at least I've finally got to the wards, and it was quite deep in the territory. Grill bars can be seen at the entrance of the male and female wards, reminiscing of what may be seen from the papers of the Taman Sinar Harapan commotion. Well, of course, the patients were well-dressed (fortunately) rather than being in the nude. But generally, I would say that the wards seemed more dilapidated than other wards, being in a world of their own. (Including the students, nurses and doctors). I wonder if I could remain sane after 8 weeks there, not due to the patient factor, but rather the environment. One thing for sure, psychiatry wards could be one of the least conducive place. As far as I am concerned, a proper asylum hospital would be a better environment, with the outdoors welcoming them with open arms. But here? It seems more like we're trying to hide them from vicinity. It's just rather depressing, from what I can see.

And why I'm so free here? It's all because the professors have a meeting for the semester exam papers. Being treated like patients ourselves, we're not allowed to have our supervisor's phone number. Authopsies are generally unwelcomed on the 1st day of posting, so naturally, we'll skip it. Let's just hope some reading for tomorrow's lecture helps. :P

A tracheotomy can be done in 1 minute time. Particularly for emergency.

That was what Dr Ee mentioned merrily while whisking away from the changing room, towards the operating theatre. Crap, the last one I saw took at least half an hour from scalpel to needle. Wondering if he's just joking.

Well, I tagged along, because the patient was one of the many rare cases of trachetomy done under local anesthetic. And also because, the patient was my grandma. I did not tell Dr Ee (not intentionally) for fear of disrupting his focus. Well, you know, having a family member around can be intimidating for some doctors. I'm not a fussy one anyway, and what happens in the OT stays in the OT, with me well aware of all the potential risks and complications.

After a while there, Dr Ee was there giving instructions to the nurses and anesthetics. Lignocaine, size 8 tracheostomy tube, no sedation, etc. I was listening casually for I was just observing. No stress, no tension. It was another freezing evening in the OT.

"You can scrub in if you want to," Dr Ee gestured to me, giving the green light.

But crap, I wasn't prepared. I haven't scrubbed in for an OT procedure before. Call me a noob. I know some of my coursemates would be dying for this opportunity, but I wasn't one of them. I'm always the laidback, because there's plenty of chances when you're a houseman and I believed that opportunity presents itself (which is untrue, of course, I know). But today was one of the days when Mr Opportunity really presents itself right at the doorstep. Was I in the position to refuse?

Soon I was in the gown attire. The nurses and the attendant were helpful in aiding me scrubbing in. Gosh how funny can I look when no one could recognized me when I'm wearing a mask? And there I was, holding the retractor ala "pokok" style. Glad he gave instructions because O&G phobia of having to help without being told made me think twice before offering to assist. Plus O&G nurses can be mean. Very mean.

The whole process from scalpel to needle took just 10 minutes. The added time, he said was due to the fibrosis around the trachea as a result of post-thyroidectomy some 20 years ago. The incision was "minute" according to him, approximately 3-4 cm on the neck. I saw some incisions were done 2-3 inches, so I knew it's an exceptional case. Hope there's no problem with such a small incision such as stenosis! :P

Well, I must admit it was kind of fast overall. He has 8 years of experience, what else to say (Not to mention the ability to brag with pride-but willing to teach nevertheless). Grannie's stable now, waiting for the pneumonia to subside. It's a tiring day with another fateful event in ENT. I'm not sure if this is really called fate, or just another series of coincidental events. Or maybe it acts as a reminder of the purpose and meaning of being in this field. And the very sole reason why I'd preferred to study in UKM(despite its many dumb protocols and imperfections - guess humans need to adapt to imperfections after all).

Somehow, if the fateful encounters with ENT continues, perhaps it's a sign of fate. Should I heed the call or should I not?

I'll just worry of the present then. Until then... until then...

After what seemed to be a clinical hoo-haa for the past 2 months, a beam of excitement surfaced from the magentic horizon. It's the end of one posting, which meant, the mid-sem break is here. Somehow, it was quite a relief that I'd shrugged myself through. Time flies in the Triad posting, and the moment you could pause for your 1st gasp of air, it is already the end of the posting. Blame it on the 9 weeks holiday, the comfort zone which I needed to be pulled out of.

Looking back at it again, it didn't look that shabby after all. Maybe it was the "getting used to it" part that was hard. Having a 3-weeks encounter with the supervisor of each posting almost seem inadequate. Eating an exotic meal was challenging enough, what else it's like having 3 different meals one after another. (Authentic Sze Chuan Curry, Vietnam cold food and Thai's fried crickets, etc) But, if there's so many students who went through the same journey and survived, why not me? Maybe there's gonna be hiccups here and there, or possible diarrhea, but I guess I'll be able to vomit back a substantial amount for the exams. :P

Next, I'll be having my 8 weeks Psychiatry posting after the 1 week break. People told me its going to be an easy time there, so I'll just see how it goes. Seems that this year around, everyone is trying to compare who has the easiest posting of all. If I am to believe all the feedback, I'll be disillusioned that Year 4 is a stroll in the park. Compared to last year, there are always claim that the posting they are in are the hardest of all. Or maybe it's just that same few who made the noises all the time. It so happen that I haven't met them all. Yet.

And so, here it is, time for my Special Study Module meeting. Maybe I'll post more updates and thoughts during the holidays. I'll be having all the time in the world. So, whats the rush? :P

Just got my certificate that would maybe last 2 years in the freezer. The Basic Life Support skills, which are slightly more advanced than the layman's ones, would be put into waste. When would we really be helping a victim? With the rampant HIV/ Hep B viral spread, no one's gonna take the risk unless you have the face mask kit. And are we going to carry it 24/7?

I'd rather freeze the skill for 2 years and wasted it down. Muahaha.. End of story.

I guess among all the patients, brain death is a rare case scenario in the hospital. I happened to be there, in the ICU, by chance. All these while, I've only heard of it in the movies, Hong Kong TVB drama series (making it looked very common), and any novel stories of the fiction side. Never would I thought that I'll be encountering one yesterday.

Brain death may sometimes, be the most traumatic death one could ever imagine. With a mechanical ventilator along with other life support, the patient seems to be lying peacefully on the bed. Close family members would of course, wish that the patient was just in deep sleep, waking anytime soon. But all lies is but just a human body in a vegetative state, incapable of human function. A living corpse, as one would name it (perhaps that was what that gave ideas to the creation of zombies anyway).

The patient was in her 30's. Late thirties. A young one for that reason. After somewhat of her state, her family members were told of the outcome. A bleak one. The father had accepted it, but the mother was in denial. Sometimes, it is hard to swallow the fact that your beloved ones are gone, what else when you can see them unstiffed as one would expect a dead could be, with what seem to be chest movement with every breath of the ventilator.

We were taught on the brain death certification prior to the test. The widespan ethics enclosing the brain death matter can be a flinching idea for any doctors. To certify was rather easy, but to break the bad news to the family members was the hardest of all. On the moment of truth (brain death certification), she was still. No response. Her chest was moving up and down as a sign of surviving act, but the tests of the brain stem (Cranial nerves tests) indicated otherwise. Absent pupillary reflex, absent gag reflex, and absence of natural breathing exasperation when the ventilator was removed temporarily (apnea test). The eye balls were held in a fixed gaze despite turning her head left and right, although there were some wobbly motions of the eyeballs in the transition.

We've watched a lot of movies and series to tell us that miracles do happen. Comatosed patients waking after 5-10 years, or even 20-30 years, with no signs of aging nor muscle wasting. Not even any malnutrition was noted despite the long comatosed duration (And we audience believed the TV back then, even till now). But the cold hard truth was, no one would wait that long. No one could ever last that long.

There are reasons why brain death certification is more important in government hospitals. The Intensive Care Unit (ICU) houses limited beds, and each one is a rare commodity with a price tag numbered with the number of human lives which can be saved. The life support machine could be needed elsewhere, for those who would be able to benefit more than the sole one which had an extremely dimmed chance of living. Besides, the organ donation team would also benefit from salvageable parts, and saved the lives of many other patients. Some may think that it is a form of "harvesting the living being", but rather than allowing it to rot in years. Even if that patient manages to wake in 10 years time, the body function would be worse than an 80 years old man. Physiotherapy would not be able to substitute the "exercise" of our normal body function and activities, at least for that long period of duration. There are many more ethics and issues involved, but I guess it'll never end if allowed to continue. But, not all hope is lost. If you're as rich as Lee Kuan Yew, you'll be able to sustain a continued support of ICU maintenance with the life support in private hospitals. Mind you, the cost is no laughing matter. A few days' stay in ICU in private hospital can cost up to 5 figures, what else a year's worth!

In the end, it's all up to weighing the pros and cons. "Sacrificing" a life to save more lives may seem justifiable. But then again, who would do so if it happens to themselves?

This is the dilemma where even Big Bro would need some head cracking.

2nd day of Anesthesiology. Ophthalmology has been the past tense, with much sweat wiped off. This time? It's been a whole long day of standing. Walking and standing in the labor room OT in hunt for log book procedures and gobbling down the Anesthesiology book as soon as possible. Each book ought to be finished in the 1st 3 days by right, so I'm sure taking my effort in finishing it.

The labor room OT sure brought back some nostalgic memories. And of course, some attitude. Imagine when you greet two doctors and there wasn't any acknowledgment. You thought they didn't hear you, so you practically raise your voice to greet them. But all you get was some stare with the intent "Nonsense medical students, shoo away!", and you knew that they weren't exactly ENT's candidates of sensorineural deafness. They wouldn't need cochlear implants either, but perhaps some EQ implants. And mind you, they weren't the merely housemen or registrars, but prominent figures in the department.

And then, some doctors just never change . The hormonal level in O&G has always been a lingering high even in the bloodstream of some doctors. Mood swings, and disregard for others when it comes to petty quarrels. Our Anesthesiology professor was being pursued from 1 OT to the other just for the extension of time and the long-winded argument ala housewife from the O&G doctor who was of the same rank. Well, the anesthesiologists were right on one thing, they were treated just like nurses by the surgeons. Whether the surgeons respect you or not, depends on their very own personalities.

And the nurses? As usual, barking up on every tree they could scramble on. The superiority complex just never ceased to amaze me, for no other nurses act like those in the O&G department. Saving lives is one thing, keeping your head sane is another. If only they could realize that, I'm sure they'll be great doctors and nurses if not fantastic. But I guess they are humans after all, fallible to mistakes. Perhaps, it'll take some time before the realization sank, which by the time, I hope it wouldn't be too late as to see the freefall of the department.

On the bright note, I'm sure there are equally as many good doctors in the department. The doctors who are always involved in the Personal and Professional Development has always been the doctors with a respectable integrity. I wonder if the PPD gave them a good perspective or the nice doctors and PPD has always been having good affinity with each other. It's just that sometimes, it's rather frustrating when there are so many "bad apples" in a department that they influence the registrars and housemen. And this can give a hard time for us medical students.

I"ll just dread my return to O&G next year should I able to proceed to 5th year. It could be a torture if I got some "hawks" (as described by Prof Oteh), or it could be some paradise if I had one of the "doves". Anyway, lets just see how it goes for Anesthesiology for this 2 weeks, and we'll worry about the future, in the future instead.

I have been having allergic rhinitis from young. Just pick me up and I'll be a decent ENT "specimen" for nasal speculum. Engorged inferior turbinates, deviated nasal septum, etc. Plus, you can just diagnose me from many of my symptoms, from coughing, stuffy nose, sleep apnea to heartburns. The spectrum of complications would never seize in fact, and might worsen any day possible.

All I can say is that perhaps none of the ENT doctors would have notice it. Or it was too minor that it escaped attention. So common to them that no one really bothers about it. It's either I'm being compliant or non-compliant to medications (which I am definitely not a good one).

And then, there was 3 weeks in Ophthalmology, my supervisor would have notice it from my constant rubbing of nose. A prominent sign of "itchiness" for allergic rhinitis. Never mind that she might have missed some of my symptoms. But at least, she could know what I'm having. Seems like it takes an ophthalmologist to diagnose a nose problem.

I'm not saying that the ENT doctors are no good, but most likely it was overlooked and ignored. Seeing the same cases everyday, everything in your field becomes a routine that the minor signs can be ignored completely. Doctors are humans too. Most of the time, we even overlooked our very own health when we as doctors should be the most concern of ourselves. Have you heard of the case of a Cardiologist dying of myocardial infarction, or the doctor in the public health advising the public on healthy lifestyle when they can be obese themselves. Luckily, the male obstetricians would not have the chance to suffer from postpartum complications!

I'm heading towards the last week of Ophthalmology posting as well. Be it a pass or fail in the mini-CEx, I think I've learn a lot, especially from the fundoscopy. At least UKM's new must-buy-ophthalmoscope policy ensure that we would be knowing how to use the fundoscope properly. :P And coupled with a strict supervisor? Well, at least we're learning something.

Note: Case-write up is almost finish with the PPD component remaining and some amendments. Anesthesiology posting would start the following week.

Ophthalmology posting sent me back the memory lane: MAB. It was a surprise for me to be there for the 3rd time, and I'm going to know the place inside out soon.

It wasn't really a pleasant visit as I could say. We could make use of some punctuality as MAB people have to wait for 1 and half hour for us. Mind us for not even having any gifts or souvenirs of appreciation, but we were the ones begging them to show us around in the first place. Plus, 57 of us was way too much for them to handle since tours are done in 20 persons max (forcefully). I really felt shameful for how we are doing things in UKM. Everywhere we go, we bring such "fame" along. Not to be reminded that Dr Sheik Muzaphar did carry the same burdens and acts too, where more and more blogs are reporting on his infamy acts in schools and much much more, which might qualify me into trouble if I spilled out anymore. Until when will we be able to apply our PPD skills thoughfully?


Nevertheless, here's a brief summary of events with photos:

Tik..Tok.... The time bomb ticks every second. No one knows when it's going to explode. The legs had been shaking, and I'm sure I'd swallowed a thousand liters of saliva. The heart almost went still the moment the brain freezes. In countless situations, I was walking on a tight rope, and never failed to be amazed that I'm still balancing still fine. Still fine for the moment.

And that is what I felt like facing in the Ophthalmology posting. Somehow, it reminded me of O&G. Perhaps the similarity of the initials (O) played a part in the bad luck. Bad in the sense that, I'm forced to work the extra mile to survive. Maybe it's good for me that I'm working my a$$ off the calories, but it sure ain't good for the heart.

This would be the first posting where I'm having to do a case write up without the patient's notes, and seeing the patient once in the clinic. ONLY. My supervisor said it's going to be too bad for me because what I see would be what I get. And that was my 3rd day in posting, 2nd day in clinic, and 1st day with my supervisor in clinic. I'm not even sure what was I seeing, and there it goes. She promised that our mini-CEx would solely depend on our skills in fundoscopy, which a lack of skills which guarantee a failure. Hmmph.. I'm not sure if I should be grateful or fretful over such "good treatement". The thought of resitting a minor posting did occur now that I've seen my chances to pass as a glimpse of hope. God knows how long will it take for me to learn to appreciate the fundoscopic findings. My eyes are squinting towards the end, and I'm not even sure of the results of such hard work.

Where is the bed of roses in the Triad posting? I've had 2 supervisors who are enthuasistic to teach and drill us and made sure it's no honeymoon, while the rest seem to be having joy through their Triad. Is Triad really a minor posting? It felt like a super major posting after all.

Found these few pictures, so I'd figured updating it would be nice.

The final week of ENT posting where there are more registrars (Masters student) in the wards due to their impending exam.

As a matter of fact, I went Jogoya last week with my parents and my dear. A combined father-mother day celebration, and everything's on me including the twin seats in Pavillion for Anghels and Demons later. But truth to be said, after so many thumbs up from blogs and friends, I'd a hard time swallowing it down. A big letdown, probably due to its quality.

Perhaps Jogoya was at its prime, years back, but definitely not now. Firstly, there are VIP counters with food reserved, which made it a no-no in customer service. Secondly, I would say Jogoya would have been a fine display of decent food for its price. It's definitelt not fine cuisine as mentioned by many others. Maybe it's due to the fact there many have not really tried what is FINE afterall. Among many choices, I would have said that only a few made to the passing list, the baked tomato seafood cheese, potato wedges (which KFC would have done a much better job), the coconut juices with their recycled shells, and the other beverage section. The satay was way off with normal Maggi Mee curry sauce, and any Station One cafe can outperform Jogoya in terms of steaks and meat. in short, none of it was outstanding, which I have to give credit Saisaki which would have done a better job with half the price. the list of dissatisfaction grew so much, and I figured even a meal in Smokehouse would have been a much better choice, a small but enjoyable quantity.

And none of the meat were fresh.


Fine display of plastic "shark fins" and fake abalones which taste normal that even "Lala" would taste better.

A bunch of "freshly" stir-fried golden needle mushrooms lumped with too much flavoring and tasted terrible.

A generally 3/10 for Jogoya. Or perhaps my expectations were really too high.

Nevertheless, Angels and Demons was a fine movie with spectacular scenery. It's better than Da Vinci Code movie in terms of storyflow despite its rushing ending. But none should expect more for a 2 hour movie. I'll recommend those who would prefer a better story, to read the book. Movies are after all, just a snipped version of the novel.

All in all, spent Rm400 on that day, so at least the movie was a redemption of the previous not-so-fortunate incident. Well, at least my parents were happy, and it has been really some time since they'd entered a cinema. So, I guess that's worth it. :P

It was my first day in Ophthalmology posting today. For the first 10 minutes into briefing, I was almost very sure that I hated this posting. Eyes, are just eyes, it seems. The coordinator did not make it welcoming for us to be there. It promised misery so true that we'll wish we would not be there. And the rules and regulations? Crappy.

But soon, I was proven to be wrong after all (Glad it was). In the clinics, the doctors were friendly and willing to teach to us. Never mind our supervisor wasn't there, but we learned what we came to learn. Too bad that I could not appreciate any, and blind as a bat we could be as. There were many findings, enough to fill in a third of my 20 requirements of fundoscopy findings, if and only if we knew how to appreciate them. But that's besides the point.

There was this elderly man who came for follow up. All I knew was there was something wrong wit his lens, I guess. Something ICOL or like that, perhaps spelled backwards or anything. He was asking for guidance on cleaning his wife's eyes. There, the doctor was correcting him for he caused pain to his wife, which lead to a much more heated argument, as he claimed. Despite being taught the proper way, he was reluctant to help his wife, for admiting a mistake took a lot from his ego.

And there the doctor had to do a counselling job. Marriage counselling it seems. Ways to "tackle" the issue so the husband would help his wife. Ways such as explaining to the wife that it was an "alternative" method to clean his wife's eyes which was taught by the doctor. And ways to fish out his love for his wife from the sea of egoism. It wasn't an easy persuasion, but it sure was cute looking at a 60+ years old man acting like a kid when it comes to ego.

And there was this case of a 12 year old child coming for a followup. Her left eye was injured. Child abuse. The dad and her step mum did the unthinkable. And there I was disgusted at the thought of the father who was heartless. Until I heard that it was a doing from a hammer by her father. That is just way beyond the soul of a living being. Poor daughter who had almost been blinded by the hammer of the father's doings. What was he thinking?

There were many more interesting cases which can be seen in the clinic. One thing for sure, I was glad I was there. In the clinic, we "see" the world through the eyes of the patients. And we, became the eyes of the society, to observe and watch the flow of time. It sure does look interesting, but I'll have to make sure I'm finished with the requirements of the posting. Otherwise, I'll be "able" to come here AGAIN. (Note: There's no ophthalmology posting in 5th year)

It's been almost a year since I last set foot in the 18-operating theatre center of UKMMC. It was during Surgery posting last year. Nothing much of a memorabilia in a place where there's everything and you gain nothing most of the time. But this time, I set my foot again, as a 4th year medical student. ENT posting.

And it was eight in the evening.

The on-call doctor had called us to look at an emergency tracheostomy(creating an external opening at the throat to ease breathing) under local anesthesia, a rare case when usually it's being done under general anesthesia. So there we were, our group standing in the OT, with soft music in the background. At least not some hard rock music preferred by some surgeons.

The old patient was anxious, but he soon calmed down after attempts to put him down on the "stage". His laryngeal cancer grwoth was too large that it almost obstruct the whole airway. Being too old, he can't stand GA for too long, so it was reserved for the later biopsy procedure.

The cold air in the OT invoke some nostalgia. Partially Surgery, partially O&G. Was it that long ago? I'd remember that I understand nothing of surgery, being a clown bystander most of the time in hope for a signature. At least this time, I get to understand how it's being done. Surprisingly, the "cutthroat" was not that grueling as it seems. At least not like those cricothyroidectomy done in the movies which looked dramatic and the impending threat of death loomed. Done proper, it finished in no time. The environment began to stir some feelings of the past.

Once I'd thought of being an ENT specialist. Well, perhaps that was one of the many reasons that tipped me in here. My own conditions which had not improved after a long time made me even more determined to find the answer myself instead of being conned by those private ENT docs. Now that I'm here, I'm beginning to seek for the anwers that I had been looking for. Allergic rhinitis, laryngopharyngeal reflux, chronic cough, nasal septal deviation, polyps, some minor obstructive sleep apnea, lack of focus most of the time, mood swings faster than PMS at times, they all fell into pieces. What there may be missing some pieces of the puzzles, at least I got the general picture.

The X-files are not that "X" anymore.

The interest in ENT would grow better if not for the rush of a short posting, and what now lies ahead is a long journey. Would I really want to be an ENT specialist? The thought lingers, but the pre-requisite of a being a Surgeon prior to that is not a welcoming thought. Isn't there an Internal Medicine masters instead? Or dermatologist? One thing for sure, the future is undetermined, and who knows, I might not even be in this field after a long practice? Again and again, only time shall tell.

I thought Med School is supposed to turn our hands into healing hands. I thought cadaver was the last dead thing we had to touch.

But I guess the movie Pathology might have been inspired by the Forensic Pathology posting. Cadaver was one thing, fresh bodies is another. Cadaver feels fake afterall. But fresh bodies? I had no idea. I wonder how many would just faint at the sight. I wonder if I would be one of them.

Surgeries are just incisions, but post-mortem felt more like decapitation and mince meat. And I wonder if it would be something like this below: