Tips for medical students entering intern year

Another article posted by a friend in FB.

http://www.kevinmd.com/blog/2011/06/tips-medical-students-entering-intern-year.html

After reading, maybe a bit of relief,huh? Eh............

On Doing Medicine

Wanna become a doctor?
You can check on the below link which, was shared by my friends on facebook. An article to ponder...

Undeniable, it is quite demotivating for those who wants to be a doctor. But, it is true in many aspects...it encompasses updates for the current system and situation in our country too...

http://http//pagalavan.com/2010/09/07/for-future-doctors-general-misconception-of-being-a-doctor-part-1/

http://pagalavan.com/education/for-future-doctors-general-misconception-of-being-a-doctor-part-2/

A mother asked me, whether it is okay to let her daughter, who is currently doing a "Pre-medical" programme for 5 weeks at X university, to study medicine...
Instead of promoting how good it is to study medicine, I told her all the downsides of doing medicine first...
Ya, maybe I wasn't suppose to say that.
It's better to tell the worse truthful facts first, so the mother and daughter will have anticipation of what kind of field she is going to embark on...
If she is still adamant, then good. She most probably can complete the 5 years course with her will.

I told her importantly, this is what your daughter wants... (and not what u wish)
I've seen friends who study medicine to fulfill their parents's vanity.
Despite so much of arguments, parents still believe medicine is the best for their brilliant children. There will be halos above their head wherever they go.
This is so wrong. Some give up themselves, some stop going to class, some stop attending lectures, even lose passion to do everything.

What I see is most people start studying medicine with great passions...
Or precisely before studying medicine people are so engross to pursue a place in medicine, but once they start their passion started to wear off day by day...
The passions are all eaten up by failure to pass the exams in medical school; feeling dumb at all times; feeling exhausted all the time due to busy schedule; being drilled and sometimes even humiliated by the superiors(to make u stronger of course...); sleep deprive; stressful environment,lack of freedom, etc...

If the will of becoming a doc is not from yourself, then forget about it...
It is hard to find reasons to keep going on when you encounter failures, or the above mention...

She ask me anxiously why doing medicine is so so tough, then you still choose to do it???
As if I wouldn't have ended up talking like that if I were to love medicine so much...
I said, I never thought that it will be so difficult, especially to deal with the pressure of passing the final exams....and no one ever tell me these~~~
It's not honest oso to tell you all the benefits of becoming a doctor without telling you the downsides. Always tell the good and bad things so that people can weigh it themselves.

Of course, doing medicine, at times, are rewarding...

At last, I wish her and her daughter all the best.

So good huh, nowadays, some universities offer "Premedical course"...
I totally agree with that.

B.U.T.T

Butt..erfly in my stomach~~
Ortho viva at 10.30am with Prof A~~
She's nice...shouldn't get slaughtered right...
Ah~2 of my examiners are lady, very man lady...
The way they walk, talk, dress...
Reminds me that they are rare species in the sea of men...
But, sincerely they are very professional.

Quotation of the day:

The goal of education is the advancement of knowledge and the dissemination of truth.

John F. Kennedy (1917-1963)

I like ortho, because they did well in achieving the GOAL.

改气还是该笑？

上两次被psy病人无缘无故骂我没关系。。。
当他们有mental illness看待就好。
吃个冰淇淋心情就好多。。。
他们说不可以跟这些病人吵，因为他们是失去理智的人。
如果不是今天的事情发生，我还以为我很可怜了。。。
怎知我和友人今天oncall抽血时，一个aunty边走边和“不存在的人们“说话时，突然跑向友人，捉着她边用手打她，
边骂：“你这个死人头！”
友人吓到不知发生什么事情，我赶快呼喝那aunty:"你在干什么??"

aunty突然清醒过来：“对不起，我以为她是我女儿。”

天啊。。。这种病，好严重。。。
已认不清现实和幻觉了。
所谓的loss of ego boundary.

weirdest conjoint twin....

告诉我,是我错了

当我正在看病人的case note时，一位华人aunty走向我， 说：“医生，我妈妈很辛苦，她的氧气管好像掉了。。。你可不可以看看她？”

“我不是医生。。。”
我看看附近没有医生，就建议aunty通知护士。。。我们一起到了隔壁房，看见一位护士A。。。
“护士，我妈妈呼吸很辛苦，可以做些什么？”
“医生不是告诉你了吗（你妈妈没救，要死了）？？”
“是。。。”aunty小声地说。。。
“然后你还要（我做）什么？？ ” 这恶劣的词语，竟出自一位白衣天使口中。。。


我自己不忍心跑去看那位婆婆了。。。
我看了那位婆婆，她的氧气管掉出鼻孔了，闭着眼，不清醒的用力呼吸着。。。她的呼吸很急促。。。
我把氧气管放好位置。。。再检查是不是有漏气。。。没有。。。为什么婆婆呼吸那么幸苦呢？
“婆婆嘚什么病，那么辛苦？”
“肺癌。。。医生说可能过不了今晚。。。所以我们在这里。。。”
她的眼神告诉我一种不安，她知道，她妈妈要离开了。。。
我拍了拍她肩膀，没说一句，只可用眼神安慰她，然后继续看我的case note。。。
我没即刻去找医生，以为告诉了护士A，一个看护使者，会做些什么，哪里知道态度那么恶劣。。。

我心里感到不安，觉得婆婆会辛苦，会不会因为我不理而真的死去。。。aunty一家人会失望。。。
所以我又跑去前面通知另一个护士。。。
这位护士B起码跟我一起朝病人病房走。。。

半途，护士A突然盯着我，指着我说：“你为什么要多事去叫人？？这个是我的病人，不需要你这位medical student插手！！” “你只是个medical student, 你以为你是谁？凭什么插手？？” （你以为你是sister吗？ ）

我站在那里愣住，从没看过披着白衣制服的天使，尖牙利嘴地对我呼喊。。。
当护士B走上前了，护士A继续轰炸我：“我要你拿你所有的东西，立刻走开，我不要你在这里！！”

我火滚了，坚持说 ： “我要在这里，我有我的东西要做，我要看case note。” 你不是sister,你没有权利这么做。
“我不允许，你在这里阻挡我做东西，我要你滚去conference room,不要给我站在这边!我要你即刻消失！"
我看了她五秒，给她一个disgusting look, 转身气愤走开了。。。

是的，婆婆是末期病人，可是不可能死到这么没尊严。。。要死了连最起码的安慰也不能给。死了也没护士照顾，每医生看。。。这是什么一个鬼医院？？？？？？？？
这种情况我们固然改变不到结局，也做不到太多。。。
但是你的presence, 你看一下病患，慰问家属，至少对家属是一种心灵上的支持，也是对病患的尊重！！

护士，如果那人是你妈妈你会怎样？？
护士，你是什么鬼？？？魔鬼！
护士，不要以为你批过毕业袍，就从此合格。
护士，不要以为你经验多，就呼喝我们这些hierarchy里最低层的人。。。
你是因为品德而高尚，不是经验！
这些护士，总以为自己是被欺负的一群，躲在高层保护人身后偷懒。。。自视甚高。。。
我漂亮的一天就给你毁了！！

There u go-3D vaginal delivery

In a Private Clinic

Did my general practice posting(GP) at Poliklinik Shaik at Kota Kemuning, Shah Alam. It's merely 4 minutes of driving from cousin's place. Was nervous the first day coz didn't know whether the Dr is going to be demanding or strict?Felt a little stressed up as i have to encounter this on my own.

The first day i went there, was wearing jeans and T-shirt before changing into formal attire. Didn't realise that i was in fact captured by 4 CCTVs it the clinic... 
I like the lamps and the lavender at the receptionist counter. The lighting and paintings remind me of Pizze Hut...

3 permanent staffnesses and 7 temporary workers working under this Poliklinik. Workers were busy at the receptionist counter.

                                                                                                         

Was suppose to spend 5 working day here, but since got tutorials and MPIS, i went there on the 4th working day at 7pm. I was worry whether i was able to complete my 50 patient's profile. But after 3 hours, I know it was not a problem. Dr seen more than 40 patients in 3 hours...

Inside the consultation room there was a framed stethoscope on the wall. It was Dr's first stethoscope given by his late father. Initially Dr's ambition was to be a pilot, but was then inspired by his late father to become a Dr. He graduated with first class from Manipal. Wow.

There were newly installed CCTVs, whereby Dr can monitor the receptionist counter, drug dispensing and waiting areas...

                                                 

UFEME and full blood count can be analysed by these machine at the bottom. The machine above is for what huh...

Drug storage...

ECG stress test.Just before i left the clinic today, was able to have a glimpse of ECG stress test. The room was well equipped with oxygen tank and defibrillator.....in case patient collapse.....

Advanced ECG recording..

Dr Shaik and nerdy I...

Despite just 3 days...i was able to see more than 100 patients...n befriended with the staffness.

A&E

星期五的A&E很精彩。。。
两个CPR(人工呼吸）。。。
一个motor vehicle accident...做bilateral prophylactic chest drain...结果病人失血超过七百毫升被送进OT (operation theatre)
一个myasthenia gravis 病人
还有身上各处淋巴球肿大，脾脏肝脏皆肿大，却拒绝西医治疗法，服用中药， 最终因为呼吸困难而进来的病人。

第一个CPR我错过了，病人死了，家属有整整15-20人进进出出，有人哭有人念经，气氛凝重。
第二个CPR有机会凑上一脚，chest compression轮流做了三十分钟（很多人轮流做，基本上我按了30秒就觉得累）。最后病人也没被救活。。。听说病人是孤儿。没有一把鼻涕一把眼泪的家属，只有一个阿伯，应该是孤儿院代表。
总会见到极端的例子。一种是有家人的病人，另一种则相反。
有家人关心的，很幸福。看过一个盲了的MAKCIK，儿子无微不至在旁照顾，把身边发生的事情一一一告诉她，做她的双眼。
没家人，很孤单。身边的人皆撇清关系，没人想留下照顾一个和自己没血缘关系的人。
那孤儿的丧礼很凄凉吧。没有嚎啕大哭的家属。

哭，是因为对死者有了感情。
哭，是因为舍不得。
哭，是因为死者已在心中烙下痕迹。
人生于这个世界上不是要被记得吗？
如果死了，没有留下脚印，好像没来过这世界。

completed minor posting, then elective

Finished my minor posting last week. Ended on last Friday with end of posting test.
Not really study for this exam. One of the question, causes of optic disc swelling and it's management...i left the page entirely blank and not even attempt it.really交白卷。 Coz i never study about it. And never paid attention while our friend was presenting the topic. So sorry...
Actually some of the aetiologies crossed in my mind, but i never attempt any word...coz for me by blinding attempting will show my ignorant. yeah, I Am at first. this is not good. will try to attempt next time.

Many first timess for doing procedures like giving intramuscular injection, setting lines, suturing, wound dressing etc. Funny funny experiences in accident&emergency(A&E) posting...One of it was inserting a urinary catheter. A Dr told me i have to squeeze the penis a bit in order not to let the local anaesthetic agent to regurgitate back and i had to hold it for 5 minutes for the anaesthetic drug to take its effect....what...anyhow have to get used to it~~

My elective topic is regarding non-invasive ventilation(NIV) in A&E setting in UM...erm...
The detail about NIV i ady forgotten. Have to revise before i go to see Dr I. Otherwise cant answer his questions...Now only i know that he is so influential and ppl call him boss...that terrifies me...>-<

Really don't like to go alone, work alone.:'( Luckily i have friends who are posted in A&E~~

viva voce for ENT posting

Today is our viva voce for Ear, Nose, Throat posting.
I was taken by Prof Raman.
I guess it took me around 10-15 minutes to answer his questions. you can be faster if u r good.
I didn't study very well for this posting. As my other friends used their weekend to study ENTs, i went to Langkawi for fun. But with no regrets:)
The whole 2 weeks were very hectic.1 written long case and 3 written short cases to be submitted, 1 long case and 3 short cases to be presented to "Prof" or "Lecturers" or "4th year master student".
Basically i only manage to present to 3rd year master student. Don't bother whether they wanna pass my log book or not. Just tried my best to sign all the impossible task. The department is in the shortage of human resources to teach us. It was impossible for everyone to present to prof. Anyway,I learned some useful clinical skills, such as using otoscope, do anterior rhinoscopy, etc. Most of the time was just observing. Observe how syringing(wash out the ear wax) was done, how Dr sucked out the huge ear wax via suction... But my history taking was near to zero.Need to polish myself. It's not the matter of history taking, it's about the gist and how u tie up everything.

Ok, the viva voce questions were:
1. Indications of tracheostomy-upper airway obstruction, protection of bronchial tree, broncheolavage,reduces dead space, easier access to operation.blah blah...
2. Management of epistaxis
3. A 40 year old man comes to u with right hearing loss. Take the history.(everything is normal) (sudden onset, no otalgia, otorrhea, itchiness, vertigo, tinnitus, fever,no ototoxic drug taken,no family history,occupation...)
Findings of ENT all normal. What further tests u wanna do?(Rinne and Weber test).The results were bilateral Rinne positive and Weber's test lateralised to the opposite site. Interprete.(sensorineural hearing lose of right ear) What investigation?(CT scan of head).(Diagnosis: acoustic neuroma)
4. Prof Amin: Haemotympanum

Maybe not that precise. Just to give u a picture of how it was conducted.
*i learned that perforated eardrum can be regenerated~because the epithelium can proliferate. So, my perforated eardrum is healed.
And actually we don't have to use cotton bud to dig our ears as the wax will migrate out naturally.
Wax isn't dirty, they can even moisture ur ear canal and serves as antiseptic purpose~

Hamsap patient or innocent patient?

ANGRY!!most of the time,we'll meet nice patient in the ward. This afternoon was an exception.
I accompanied SL to clerk a psychiatric patient which had attempted a suicide. I am not going to tell the story of how this patient attempted the suicide, but it is about the patient next to our patient who had committed the "crime".
Since we have to built good rapport with the patient, we need a good eye contact. So i slightly leaned forward to talk to the patient while SL sat on the patient's bed.
When i was talking and listening attentively, i felt a sudden struck on my buttock.
It was round and hard+firm, shape was like a fist, measuring a man's fist. It landed on my left buttock purposely and retreated immediately.
My intuition and instinct being a female commanded me to turn and i stared at the man behind me.
He was looking at me and asked:"Why? what happened?"
I stared at the patient. My heart was burning furiously. I wanted to shout FuXk YOU but my conscience halted me to do so. I replied:"your HAND!"and gazed straight into his eyes.
He said:"sorry, saya baru bangun dari tidur.TERKEJUT. saya tak boleh tidur nyenyak dalam hospital.Tangan terkeluar".
I was quite unsure whether he's real or talking big fat lie. But i did not want to misjudge a patient. what if he's telling me the truth?Moreover, it is not good for me to shout at him in front of my patient. and i was busy, rushing to finish the clerking before night falls.
So i persuaded myself to believe that he was innocent and turned to our patient and continued our clerking.
I changed my position and talked to our patient's mother while SL clerked our patient.
I asked the lady whether she saw the monster's act but she denied.
I did notice the monster look at my direction few times and i had no fear in returning back my stares.
The monster friends came to visit him. After around 1o minutes, the monster called me again. I went to his bed and again he asked:"what happened just now?"I saw NOT a bit sincere in his eyes.
I replied in a loud and higher tone:"You PUKUL PUNGGUNG saya dengan tangan awak. I was very angry! But if you didn't do it purposely, it is ok. But if u did it purposely, i will sue you and curse you not to reach paradise."of course, the last sentence was not blurted out.
If he was innocent, then my words didnt hurt him. if he really did it, perhaps he'll feel ashamed.
I think my voice was loud enough to reverberate to few beds around me.
He answered me the same thing again:saya terkejut dari tidur.
I couldn't do anything since i had no proof.

This is a situation commonly faced by female. many of my female friends encountered the same thing. but they usually dont know how to act.what to do?majority of the females are unsure whether they are molested or not since they dont have eyes at the back. Body to body contacts are normal in our daily life. sometimes i do accidentally hit someone's breast or buttock and vice versa. But why we dont care that much? because they dont do it with a bad intention, whereas the MONSTERs do.
If this happen to you,confront it bravely and don't keep silent. stare back at them and if they continue to touch your body part, shout for help.

What a busy posting

Struggling to finish case summary...while listening to favourite song "Crucify My Love" by x-japan...never feel bored of this song...

Haven't study much for obstetric and gynaecology posting until now.Honestly, only touched about history and physical examination. At the same time have to complete the 1st case summary by end of 1st week.then have to prepare one new case for Dr F,the tyrant, by tomorrow night. I wonder what will be on Monday morning.Many good appraisal for him.('-_-)

On 8 of April, there will be Environmental Health exam.Hell.Need to study about type of wells, processing clean water...waste disposal....blah blah....
I miss surgery posting now. So relaxing and there's ample of time. to sleep. to study. whatever.

Anyway, anticipate the moment i witness spontaneous vagina delivery next week!

End of 2nd Medicine Posting

3rd posting was over. Half year has gone. I am now having a break.
I got a thyroid patient this time. Luckily I've seen this patient the day before my exam. HEhe.
If not i will never know what was happening...
The question Dr Q threw to me was,"I want you to look at this young lady's neck and proceed." Huh...what's wrong with her neck? There was no goitre or any prominent swelling.
Her neck was beautiful and normal...but she was looking at me with a "staring gaze".
Ok, showmanship is vital. I pretended that i don't know her and proceeded.
My hands were trembling when i was doing a lid lag test and examine for ophthalmoplegia (eye weakness), as if i was the one who suffers from hyperthyroidism....
Initially Dr Q wanted to bring me to a psoriatic (niu2 pi2 xian3) patient.
Huhu...luckily the patient was not around...

People fight more bravely after every war...Or at least constantly.
But my energy seems to wear off...how should i recharge?
I need some inspiration. Hmm...gotta find the inspiration.

CRP(is an abbrevation of??) is coming next week. Not looking forward at all. No idea.
Will not have any lectures or classes for this one month. Heard that this year CRP at Pahang.
Good..near to Kelantan...

从返medicine ward

Surgery posting刚完，又进入第二个Medicine posting 了。
昨天配SL去clerk 病人。
病人是个66岁的老人家，得了肛门癌。扩散到肝脏去了。但病人显然对于自己的病情知道仅皮毛。并且相信这是以前得罪了某人而被下降头。
（它应该属于surgery ward的，为什么在这里呢？是的，他最终被referred去surgery ward了）
我们想摸摸看他那肿大的肝脏及脾脏（hepatosplenomegaly）。
应该会很硬。容易摸到。
和病人聊了一阵，病人很合作。SL便开始检查他的身体。我在一旁看。

检查开始不久，还没摸到肚子，病人开始哭了起来。SL起初以为pakcik只是伤风，吸吸鼻涕。我在一旁，却感觉到乌云布满天空。。。一时不知所措。

这不是第一次看到病人哭。之前看到的，都是病人诉说病情时，泪在眼眶打转，没掉出来，或是病人家属哭泣。

但这一次，pakcik哭了。

SL停止了检查。以关怀的语气问他，：“怎么啦，你有什么问题吗？”

我觉得很佩服她。一些人往往只想从病人身上套出病例及检查他们千疮百孔的身躯，而忽略了病人的情绪。

“没有，只是想到，爸爸妈妈走了，兄弟姐妹也离世了，现在只剩我一个，很孤单。。。” pakcik一边哽咽，一边说着。

也许，pakcik的第六感告诉他，他的身体已不再像以前那么健壮。
人是不是在茫然的时候，尤其健康亮起红灯，总会想起当初健壮时的美好，以及当初还健在的家人。。。是的，我每次生病的时候，觉得格外寂寞。如果有妈妈在身边多好。。。就算痛苦也不孤单寂寞。

我的泪水已经在眼眶里打转着了。也听到SL吸气。但是我们总不能和病人一起抱头痛哭吧。。。
是我们懦弱吗？不是，我相信我们是用心地去接近他。所以能感受到他的悲伤。。。
我尝试让他想些快乐的事情，所以把话题转开。。。

“你有孙子不会寂寞啊。。。他们会来看你的。多好啊，两个曾孙。。。他们什么名字。。。
听说在森林里，军人常常见到鬼呢。。。你见过吗？
你打败敌人，当堂手道冠军，全村人不是很开心咯。。。我也有学堂手道呢，但是打到绿戴而已，没你厉害。。。”

Pakcik开始往回忆里游走。。。

Pakcik有一段辉煌的过去。曾经是军人的他，告诉我们他那时身体多么强壮，而且还是堂手道黑戴冠军。打败了无数对手。现在，却一天天消瘦，也吃不下饭。

“你会好起来的。”最后我说出口，我知道这只是安慰他的话。扩散到肝去了。。。这句话的胜算有多少呢。。。
但是，pakcik擦擦眼泪点了头。。。像是得到满足的安慰了。。。

之后，我们走了。
有时候，接触病人，并不仅仅只为了得到病例。。。
病人心灵上的慰藉，往往被我们忽略。
感谢这位病人让我俩摸到了硬化的肝脏及脾脏。。。

我不会忘记这些病人的。他们是我们的良师。
我们的每一次学习，都在削薄着他们微弱的生命及光阴。
他们不是都用着生命让我们去学习？

Interesting Patients

#Patient 3

This elderly Indian man was looking at me when i was "supervising" Siew Li examined on a patient.

I didn't intend to start any conversation coz i was tired.

He seemed bored and wanted to talk. So he said to me:"Hi, where are you from?"

"I am from Kelantan."I said.

"oo...very rare.Not many Chinese in Kelantan?"

I've answered this Question more than 20 or 30 times in my life, so I gave him the same formulated answer.
Since he was so friendly so I began to "take advantage" by asking his permission to check his cardiovascular system.
While i was checking his chest, he demanded for my handphone number. I didn't know what to respond. I just smiled and ignored the request.
No abnormality was found except that his heart was beating very fast and his body was cold.
Before I ended my examination I stared at his leg while thinking what else to check since he was so co-operative.
"I have POLIO." He told me while pointing to
his leg.
Wow...1st Poliomyelitis in this ward.
"And my toe is bent due tight shoes I wore when
I was young."He pointed his left big toe.
I saw a hallux valgus.
Wow...1st hallux valgus that I saw.
Before I manage to examine his leg he requested for my phone number again...I got no choice. I gave him...For the sake that I could examine him.
Maybe because I felt guilty that i've checked him for a long time.
He said he'll send me a msg when he is free.Oh my god...I began to feel frightened...But I told myself it's ok as long as i don't reply him.
After examined his lower limb, we went back to hostel.
My friends told me not to give patient our phone number easily. It might be dangerous.
I did feel uneasy, but I thought he wont be able to find me.
After he was discharged, he sent me a message to wish me.
I think it would be cruel if I ignored him. Afterall, he is a nice and friendly guy who allowed me to examine him thoroughly. So I replied him saying thank you.
Even though he does not cause any harm to me(so far), I will be more careful next time.
Haha...

Interesting Patients

#Patient 2

I was wandering in the ward with Siew Li to find a patient for Dr. S.P Chan's long case.

Then I found this talkative man.

To avoid clerking patient with history not worth discussing, we usually flipped through the diagnosis 1st(DISAPPROVED by all doctors actually). His diagnosis was unclear-->COPD? His presenting complaint was progressive worsening of shortness of breath.And he had history of smoking for many years...

After clerking him, I was intended to advise him to quit smoking.

"Pak Cik, jangan hisap rokok lagi ya...nanti kesihatan Pak Cik jadi teruk..."I said.

"Pak Cik sudah lama tak merokok.Pak Cik akan berhenti."He replied.

"Ok, BAGUS Pak Cik!"I said.

"Tapi...Pak Cik hisap benda lain lah..."Said Pak Cik mischievously.

"Oh...Pak Cik hisap apa?"Curiously, I asked.

"Hehe...Pak Cik hisap puting..."OMG. Interprete yourself.

"Haha...bagus untuk kesihatan.Pak cik lebih gembira macam itu?" I continued stupidly.

He nodded.We chortled.

Interesting Patients

When I was in my 1st medicine posting at 7B&8B, I did encounter some funny patients.
They really cheered me up in the midst of boredom.
#Patient 1
This patient really impressed me. One day we noticed a Malay old man with hepatomegaly. Me, Siew Li and Chew Keat wanted to approach him. Chew Keat went and greeted him in Malay.

“Apa khabar Pak Cik….boleh tak kami periksa perut Pak Cik ….”

“可以可以。。。这边(in Hokkien)。”

To our surprise, he spoke Hokkien fluently to us. This was the 1st surprise he gave us.Oh my god, we guessed wrongly. Do not judge a book by its cover. Sometimes Chinese might look like Malay and vice versa. Don’t blame us. We tried not to express our astonishment, and continued to talk in Hokkien….

“这边痛吗？。。。”we asked.So we treated him as Chinese.

"一点痛咯。。。” （the exact conversation i ady forgotten)

After some time.....

“wa si hua na lang,bo si deng lang(我是马来人,不是华人)” He suddenly blurted out.

“哈，什么，我们以为你是华人，因为你福建说到很好！！”we said.

"wa si penang lang ma...Hokkien lang cheh..."( i m from penang, many hokkien ppl there)

"真的吗，别骗我们哦。。。”we said.(is it true,dont bluff us)

“是，我的名字叫Awang Bin xx,我有两位老婆，19个孩子。。。你看，他们都来了。”
Yes, i saw his wife with tudung and his children. So, he is a Malay. This was the 2nd surprise.

"我还会说很多语言，华语、潮州、印度话我都会讲，你可能都不会。” （i can speak multi language include Mandarin, Teo Chew, Tamil..you dont even know how to speak)

“是的，我不会。”we said.( yes, we dont know)
I thought he was just bluffing, so we continued to palpate his liver. He was in great pain. Yet he still allow us to palpate. He was a nice chap. We dare not palpate anymore.
After us, Chui Yee went to see him again. Before Chui yee left, the Pak Cik said something to her. She thought the uncle was conversing in Hokkien to her in a way that she didnt understand.She seeked help from me.So i went to him again.
To my surprise again, he spoke Tamil with me. I really didnt know what he meant but i think he was just showing off his ability, knowing that we would not understand at all...
I laughed out loud and answered him"AYA...ILEH ILEh..."
woah...impressed by his multi-language ability.

End of Medicine Posting

This morning just finished my 1st ever short case test.
Suppose this exam was held on 23 Oct afternoon. We were prepared for everything and on that day and went to ward 8 with excitment, not because of the test, but because I could go home on that night. But what came out from Dr Edmund really killed me,"Today afternoon short case is cancelled. Postpone to tomorrow morning.I have to go back to UMMC because my colleague is on leave and there's shortage of haematologist."Immediately I replied,"Sorry Doctor, i need to finish the short case by today......"Before i was able to complete my sentence, he interrupted,"U guys are suppose to stay until Friday. No one is allowed to go home. You guys are mature enough to think about it."I just couldn't control myself.Got so irritated.What about my ticket, what about my promises to my mom...Luckily Michelle wanted to go back Kelantan and I sell her the ticket.We went to buy waffer and eat to ease my anger.
No mood to study the whole night thinking that my plan was ruined.
Only manage to study NK Chew on Chronic Renal Failure coz heard that many ppl got that case...Didn't put a lot of effort on Respiratory System since so many ppl got that system.I thought i would get weird case like rheumato or CRF.or GI case.
These morning I was the 2nd candidate. I was quite nervous. Usually i am not that nervous during exam. For me nervousness is nothing but a killer. But this time i failed to persuade myself as I heard too many horrible stories encountered during short case exam.No matter how hard you prepared, sometimes the Question asked is beyond your expectation. OR even you're well prepared, you lost your word and mind due to anxiousness.
I saw the 1st candidate Hanani came out from 8B after a long wait. OK,it's my turn now.Be cool and confidence.No tremors are allowed.Dr Edmund brought me to a an Indian elderly male in 8A. Shit,Dr Edmun brought us to see this patient before...what was the diagnosis???I couldnt recall. Is it a Lung CA??
"I want you to examine this patient respiratory system".Dr Edmund.
Ok.I proceed with my own pace. I heard that his patient isn't co-operative.but weird he let me to examine.I check his peripheral signs and encountered some problem when i checked his posterior lung.
there was decrease in chest expansion and dullness noted in the middle zone...but no crackles...wait, i think i heard something...unfortunately, the patient started to call the nurse:"i want my medicine...i want my medicine....it's it xx...with xx colour...faster...i want my medicine...blah blah blah........."i couldnt spend much time on this auscultation any more since the time was limited. I presented the case as if it was pointing to lung consolidation.But i was wrong when Edmund gave me a 2nd chance to listen to the lung....shit,there's expiratory rhonchi...how could i missed that...this patient has COPD.(Chronic Obstuctive Pulmonary Disease)
Definitely, you can predict what he would ask me. It's all written in NK chew but i couldn't vomit out all.
"How do u differentiate between asthma and COPD clinically?"
"Tell me more about COPD and how do u diagnose it?"
"What do u mean by diurnal variation?can u elaborate further?"
"What will a severe asthmatic patient shows?"
These were the questions i was asked.
I tried my best to answer.
At the end of the test, he turned to me and said," Ong, theory wise not that good ah...."then i got what he meant.
I dont feel sad, instead i m happy because it's over. Afterall it costs less then 1% to our 3rd year final exam.
Lucky i didnt get any weird case.
Michelle was famous with her Rheumatology case.Winnie got Gout(again Edmund likes to ask about DNA,genetics and Biochemistry stuffs.be prepared with uric acid metabolism) and Shaun got Chronic Renal Failure.Rong Xiang's definitely not Marcus-Gunn Pupil.Tough.
Yay~!it's over~~~