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Int Med, Day 15

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Today was the first day in UKMMC for my Internal Medicine posting. The day is yet to be over, and I'm having my on-calls later as well. There's quite a variety of cases in the wards, a nice welcome for us after all. I was clerking an 82 years old Chinese lady who came in due to shortness of breath, diagnosed with decompensated chronic cardiac failure secondary to atrial fibrillation. She was ADL-dependent due to an episode of stroke causing right sided weakness 10 years ago.
 http://doctor2008.files.wordpress.com/2010/11/stroke_prevention2.gif
In layman's term, she had a stroke 10 years ago and have to rely on others to take care of her. She came in because of her heart problems. 


As usual, the common questions were asked. It was the point that I asked about her dependence on others that she almost broke in tears. At her age, I can feel her frustration. Not being able to take care of self may seem like a burden for others. Coupled with some children of theirs who think so too, it would only worsen her depression. Fortunately, not all children think so, but the elderly would require emotional support to reassure that they are loved.

http://www.wallcoo.net/cartoon/Mother_day_Lovely_Children_illustraion/images/Lovely_illustration_of_mother_daughter_reading_wallcoo.com.jpg

I was quick to switch the topic to her grandchildren. She had a few staying in the same house, mostly under 5 years of age. I could see her eyes lit with joy when she talked about them, how grandparents had always look forward to loving their grandchildren, when their own children had gone past the "sticking close to parents" stage. Perhaps, a few minutes chat about them gave back hope about going on. Before I left, I'd wished her to get well soon, so that she could see her grandchildren back at home. At least, she seems agreeable and would have something to look forward to. And I hope that the motivation would keep her going on.

http://thumbs.dreamstime.com/thumb_279/1213461766DOwgb4.jpg 

In life, perhaps we as doctors may think we've done a good job by keeping our patients free from disease, but all we do is healing diseases, but we could be lacking of the ability in healing hearts. Somehow, I'd wondered if a holistic approach may be ideal, although hard to practise. At least, we should try if we could.


Genesis

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http://apod.nasa.gov/apod/image/0204/MaunaLoaSkies_Magrath_full.jpg

When I was 5, I looked out of the window, staring at the starry skies when I had wondered, where did we came from. I’d asked my mother, and that was when I was told of the story of the sperm and the egg, minus the detailed process of the orgy sex that might be involved in the production of me. You see, my parents are truthful creatures/ people. They’d never believed in the need to hide these real facts from their child (me). And so that answers why am I being rather well-versed in the sexual reproduction when even lecturers of medical faculty in Malaysia would have flinched at the topic of sex or anywhere close. And so there was no stork, no bees and birds (I’d never really understand what’s with the mechanical incompatibility between these two creatures with sex), or any celestial gates or turtle head, etc.

When I was young, it didn’t take a long time to understand that if parents give birth to children, there would be one convergent point when we looked back at the ancestry. And so, voila, there would be a need for a man and a woman on Earth. Therefore, at the age of 5, I’d deduced that someone must have created a man and a woman to start the propagation, amidst the couple having to be stuck to each other with no real choice. The me now would feel lucky to be living in the modern world.
And later on, as I’d picked up reading, there were lots of evidence reaffirming that. From all sorts of religion and culture and folklore, there must be a man and a woman. So, I might have well been as well as been a descendant of any Higher Order of Above eXisted, to know it so young in life.
If you think that’s true, you’re probably delusional.

 http://t1.gstatic.com/images?q=tbn:ANd9GcRp9kVG-fDWTShRRVyK4yH_0JYGEP2OJOwVaw2lJLQYE8O9dpBK


The problem is, the explanation of the origin were really that simple, because men were the ones who created it. People like you and me. And people had only started writing and reading way after they were born, so it’s all in the speculation. We build our ideas upon the “evidence” accumulated through generation, which is culture. What we believed in may seem true may not be true after all, despite us not lying about it, and because we strongly believe in it. We once thought that the Sun revolves around us as well.

Let’s reexamine what would really happen if the theory holds true, just like how people would rather refute the theory of evolution totally because they think it is an insult to originate from the lower ends of primate level.

http://rdmblog.files.wordpress.com/2009/02/incest.gif?w=459&h=380
  1. Incest would have been really rampant. One man and a woman. Fine. And their children? Siblings incest. Subsequently cousins incest. And that is provided that we assume they are sound creatures, because when I’d put a pair of hamster together with their offspring, there would be father-mother, brother-sister, father- daughter, son-mother, grandfather- granddaughter, uncle-niece and henceforth. And if they would have been too civilized, there might even be brother- brother, sister-sister and those sorts of elements. I think you get the kinky picture by now. And so, we would have to conclude that incest must have been an acceptable practice, and perhaps should be accepted in the current culture.

    Ewh….

    However, I still think the best example to portray all these would be the Greek Gods mythology. I had no idea who’s who, so google each of them and get involved in the confusion. :P
  2. Your Higher Order Above eXisted, would have been belittled to be only just able to create a man and a woman. He must have been lacking in creativity to reproduce more, when He had all the resources to create the World in such a eccentric manner.
And theory goes on and on…

But you see, even researches were proven wrong from time to time. What makes a book written so long time ago to be that truthful? Can’t there be any revisions made, for example, like, the Higher Order Above eXisted created everything from a dot, or two dots? When we question the question, the world would become hysterical, lost, confused, and bound to head to doom as prophesized. I feel that it would be the best clause in any scriptures to put at the last of the chapters, so that people would fear to question or doubt it.

And the confusion goes on, because one would think that the other must be mad bestowing to non-living statues, and the other must be deluded talking to some revised ancient text, or eccentric by kneeling down to the walls or a building far far off. The problem is there is always a lack of understanding of one another’s faith. Even in interfaith discussion, one would see the “champion” of each faith “trying” to understand the others, while championing the faith in pride and glory, and explained how others can do better for their very own faith.

But yet the irony, the faith of the closest origins would always be the ones at each other’s throat, centuries and millennia. Could there never be of any peaceful co-existence? Must the so-called “heaven” be divided as if countries, or just dividing walls, so that each would think that they are the only ones there, shall there be eternal peace.

http://www.chrismadden.co.uk/caricature/jean-baptiste-lamarck-2-cjmadden.jpg
Lamarck

What if the Theory of Evolution holds true partially if not totally? Charles Darwin Jr could be right, otherwise we would all be of the same faces and looks. Or perhaps Jean-Baptiste Lamarck could be right about his theory of acquired inheritance. Recent research has gave light to Lamarck’s theory in the form of epigenetics. Nothing holds true forever. Galileo was almost sentenced to death via the Roman Inquisition by justifying that the Earth revolves around the Sun. And olden faith denounced him because of that, proving that perhaps their ancient scriptures said otherwise, the Earth being the center of the universe, and everything revolves around the Earth. And modern astronomy proved that even the Sun wasn’t the center of the universe, being a tiny young star revolving around the center of the galaxy along other stars. And who knows, the theory of The Beginning may truly be written along the lines of two dots, or She Bangs instead of the Big Bang?

http://goodbadidea.files.wordpress.com/2010/09/william-hung.jpg
It all began with....

Someone may thought of how to fly, but bear in mind that the Wilbur brothers were the ones who actually realizes it and that’s what really matters. You may think that some scholar thought of the Theory of Relativity, but Einstein realizes it (and also the nuclear bomb). But that does not make them truly right. In the future, who knows that e does not equals to mc square? The truth is, the world is there for us to explore. Why must we be bothered too much of people of different faith or race? Exploration serves no harm, and could not prove for or against any faith, hence, knowledge should be sought without any limitations (unless if it involves lives, of course, mind you) such as “because the Higher Order Above eXisted says so”. Ponder for a while, my readers, for this is an open question. There is no truth, there is no blasphemy. The answer lies within each and every one of you.

http://rlv.zcache.com/the_truth_is_out_there_does_anyone_know_the_url_tshirt-p235288188973380478qjha_400.jpg

Humor: The Medical Student, The Registrars and the Specialist

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Scenario 1:
Registrar: Come, medical students (8 of them), what is this chest X-Ray suggestive of?

M.S. 1: The X-Ray is suggestive of lobar pneumonia, with its......... (with its proper lengthy explanation)

Registrar: You're wrong, medical students. This is a case of atypical pneumonia. Look at this kid's chest X-Ray, it's not your typical findings. How on earth could you come to such conclusion? Medical students nowadays are just of poorer standard. *Sigh*

Specialist walks into the scene 5 minutes later, just happened to be looking at the chest X-Ray.

Specialist: Come, medical students (the same 8 students), what is this chest X-Ray suggestive of?

All M.S: Atypical pneumonia, as evidenced by.....

Specialist: What nonsense! This is just your typical lobar pneumonia. Who taught you that?

Medical Students pointing at the Registrar.

Registrar: No, no, no, no. I didn't teach them that. It's all in their mind. In their mind. I wouldn't teach them such thing. 

*****

Scenario 2:
M.S 1: Doctor, this child came in with an episodes of fits has a bulging anterior fontanelle. Could there be something wrong?

Registrar: No, this is just normal. It is not of any significance.

M.S 2: Doctor, it seems that this child also has hyperreflexia (increased reflex), as I've just examined him few minutes ago. Could this be meningitis?


Registrar: (Looking irritated) You medical students are just paranoid. The reflex is normal, as I've said. Just because you think he has bulging anterior fontanelle and hyperreflexia, you think he has meningitis? What bullshit this is.


Silence ensues.


Specialist walks into the scene 10 minutes later, for rounds.


Specialist: Registrar, what does this patient has?


Registrar: Prof, this patient came in with an episode of fits, and I've examined him. Everything seems to be unremarkable except for his oral examination where I can see ANGRY LOOKING TONSILS. So, this is a case of fits due to tonsillitis.


Specialist examined the patient's tonsils.



Specialist: There's no red or inflammed tonsils. It's just mildly enlarged which can be normal for kids. But it seems that his anterior fontanelle is bulging.


Specialist proceeded to examine the reflexes.


Specialist: There is hyperreflexia! Quick, proceed with CT scan of the head, and do a blood culture before starting on antibiotics!


Registrar: .........


And the case was confirmed to be meningitis the next day.


*****
Scenario 3



Registrar: Medical Student, what is the pain score of this patient?

MS: After receiving epidural, the pain score of this patient is at a scale of 0 over 10.

Specialist: Medical student, do you know that 0 divided by 10 equals to INFINITY? How can the patient have infinity pain? Remember that, there is no such thing as in 0 over 10. It is INFINITY. (And a 10 minute lecture on mathematics and infinity) Therefore, it should be 0 out of the scale of 10.


MS: (Looking innocently) Sorry, Prof, but wouldn't 0 divided by 10 equals to 0? Only if 10 divided by 0 equals to infinity.


Specialist: Come, let's move to another patient, we're running out of time. (And happily divert the subject away)

*****

Disclaimer: This is a piece of humor fiction and has no relation to anyone, alive or dead, and it would only be a coincidence if there happens to be some similarities in certain situation which you may relate to yourself.



Internet Withdrawal

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I am back from Teluk Intan, and I am really relieved that I am free from Internet withdrawal. No more relying on GPRS (frequent disconnection) for internet, as if I was living in the 90's with the dialup 56 kbps modem. I am just glad with my home's 4Mbps. Finally, heaven on earth. :)

And here's some random filler before I go on with some lengthy post in the not so far future.


Most Memorable Twitter Quote of 2010:
"I would like to complete my examination by getting the gold medal." - Wai Loong

31st Dec 2010

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I'd written a lengthy post on what happened in 2010. But sooner, I'd realized that all I wanna say to all is:

Happy New Year 2011!!



*Signing off in a less flambuoyant manner*

Dilemma: Choices in Life`

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I am not the wisest man on earth when it comes to choices. I knew the fact that I hesitated many times as I'd rather be non-committal. But again, time is a factor now as we need to decide. This time, to where I am posted for my housemanship training.


And the story goes again and again like this:


Primary six, post-UPSR:
I was offered a spot in a boarding school, SM Sains Selangor, Cheras. Yes, the one near UKMMC. I'd no idea why would my school applied for me without my consent for once. It must have been lucky to be among the 3 chosen ones from my school, but I had begged to differ. Boarding schools were never my culture, and never in my blood. It just meant strict discipline without the comfort of home. Some of you may boast of how disciplined you'd get, but that's your business (and your own consolation, not mine). So, boarding school means waking up at 5am even if you don't have to, because your dorm mates are already up for prayers. Boarding school means no television. Boarding school means going out of school twice a month, once for grocery shopping and once for spending the weekends with the family. It meant no life for someone like me who lives in an urban setting full of temptations and leisure. Why would I want to torture myself? It's not like my life depended on it. It's not like it's the only way for me to obtain education for the sake of social mobility. Mind you, I think I'd done better than I would have if I'm in a boarding school, if I did not suffer from depression, suicidal, or most likely homicidal given the nature of my temper when provoked. Oh, of course, not to mention that I cried, beg and pleaded not to be sent there. Oh well, that was the past.


Secondary 5, Post-SPM:
An offer for Singapore's A-level. Yes, the most unlikely offer, with no guarantees for anything. High chance that I'll be sent home post A-levels with nothing left for me. But then, it stood as an option, to experience something different from my local experience. Too many things and matters prevented me from going. National service, for once, had summoned upon me. And the poor response and inability of the Singapore officials in handling this matter, being always non-chalant and very irresponsible. I'd no idea why I'd always had bad experiences with Singapore until now with some sort of jinx, but that's another story altogether. If I'm there, I have to share a room for two, while at home, I'm having two rooms for my own. The comfort of home is just too tempting.


High school, Post- STPM:
Perhaps it was time to leave the nest. I was contemplating the universities at offer, with the possibilities wide enough for a choice of my own. Well, perhaps London was a loose choice, with LSE being my dream university I wonder why. At that moment, taking the path of an economist wasn't that bad an idea. But sooner than later, it was a graduated exposure, I know. It was slightly further than home, I'd to leave in a hostel, but I still had the freedom to travel to and fro home as I like. I know not many people could enjoy the luxury, which is why they would label "mommy's boy" or worse. But I know, given the opportunity, they would do the same too. It's just that I grabbed hold of what's mine and they couldn't.


Med-School: Pre-professionals exams:
There could be no turning back now it seems. Time to spread my wings and fly and breathe in the air from the higher skies. If I had not make a journey now, I would have to leave later without a promise of return. I'd taken my 1st leap. It is now up to fate if I would eventually glide and soar off in my maiden leap, or should I fall like how the great Humpty Dumpty did.

And suddenly, the poems came back to my mind:



TWO roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,

And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.

 http://www1.cs.columbia.edu/~kns10/images/road_not_taken.jpg