Thursday, December 1, 2011

I am Done!


The topic seemed so horrible. A very horrible thing to say and written.

For the record, i've been confined in my room for 1 month straight. Without any books to read or do any academical stuff. I simply quit. I waited in my adequately large pink-walled room. I was wide awake at night but slept in day bright. I woke up to bath,eat and drink. When i gaze at my books, i simply emptied my mind, not wanting to feel any guilt or anxiety. Yes, that is all i do all these while.

I tried not to feel.

I tried really hard not to think.

Although i know that Ghandi did said the key to win the fight is not to fight. Not thinking is same as not fighting.
I guessed that i managed to do that. But, the more i try harder, the more it came. The feeling of incompetency and inferiority towards my own impossible standards. Who wants a second rate doctor rite? I HAD to set my target higher. I HAD to be the best. I had to. I need to. But, the problem is, i never want it. All i want is to feel enough.Yup, enough is enough. Why not be a moderate?Wanting something moderate for my self? Modesty is the the best policy is what all they say.

I may have been deluded  for being stuck in here doing the same routine everyday. Routine i had not much interest in . I need something. Passion. I want to live with enthusiasm. I want to be a person who loves their work and get rewarded for that. I know, in this world, not everybody are lucky. Not everyone can do jobs they love. Some people love their jobs, others just do it for the sake of supporting living expenses. Gregory House always say you can`t always get what you want. In Quran also mentioned that we may hate things that could be good for us and we may love something that could be bad for us. I always knew those. But , right now... i barely take it into my heart.

People say that life is priceless. That chances are to be taken. That all opportunities in the world should be grasped. I had that chance. So, what do i do with it? I've taken the chance. I had it in my hands. but, now it is slipping off my hands.........

I figured that if i am not suitable for this job, i should just quit from now. Before things gets nastier and uglier. Before its too late. I want to stop now. Take me home. Let me live my life as i want to . I want to live a simple life with peace and no unnecessary pressure from outside or inside myself. I just want to do what i like.

Then again, Gregory House whispered :  Hey crazy lady! *YOU CAN`T ALWAYS GET WHAT YOU WANT...*

URGHHHH ...


Then again, although future might be seemed to be so bleak and hopeless... Please know that even though you don't think that you have what it takes to become a  DOCTOR, know that there are people working their ass off just to become a MEDICAL STUDENT. Know that even though you think you don't deserve to be here, to have this kind of luxurious opportunity, know that if you don't hold it firmly in your hands others might take your place.That you are the chosen one, chosen by people to serve the people of the nation.

When you want to reminisce old the good and the bad times, all the bloodysweatytears,all the efforts you took to gain what you want, all the sacrifices you have done to get where you are, all the people who cared and cheriss your talent and persona, all the dreams and wishes you once carved deeply into you heart, all the pains and sorrows that brings you strength to cross the hurdles, all the bittersweet memories that inspired you to continue your journey and see the wide vast world on your own capabilities, all of that.

Remember, that everything is in order.

Be good, you're good.
Be calm, you're at peace.
Be angry, you're mad.
Be humorous, you're  funny.
Be sensible, you're sensitive.
Be pathetic, you're sad.
Be bold, you're strong.

Blah,blah,blah.

Its YOU that make it happen.
You decide your destiny.
Future is in your hands 98% of it.
Only 2% luck and fate MAY change the course of your life.
Event if it does change, YOU have the WILL to change it back to square one...

And that's why humans are gifted by God what we call as COURAGE.
It is the strong will of humans to overcome FEAR so that humans without BRAVERY can go forward not backward.




p/s: Finish your journey no matter what happens.

Sunday, November 20, 2011

Community Medicine: The Practical That I Hate

That day, we have to prepare early as the bus will get going by 8.30 am. That night, i flipped through all the spotters written in the record and memorize each and every answer to the question. That night is the first night that we actually preparing for community medicine practical.So, i had no idea what to do, in detail. I had not made any mistakes before and there is no possible way that i could improve or not to make the same mistakes this time because we never had any exams for practicals before. I can't really blame them for NOT having a LOT of practical exams during sessional. I understood , that it is a tedious job for the department to prepare the materials and allocating houses etc for each student.Not to forget the answer sheet is way difficult for the lecturers to mark, you know the lecturers are very old, true story. Hmm, they say why bother coming to class to teach when students were not even  interested to listen what they say  in class. I've always sit in front and blurr all the time. I've always felt bored and unease with people whispering behind,some were reading novels, the noisy drill at the upper floor and with  teachers yelling in front.

I make this entry to remind myself what to do and what not to do for exam. So, i shall start from the beginning of community medicine practical revision.

Revision Time - I have to read the 66 spotters, 8 epidemiological exercises and  statistical exercise. It took for about 5 hours to complete revision as well as memorizing everything by heart. Next, flip through all topic related to field case. For example,maternal  infant morbidity, nutrition,housing, primary health center, environment and a little bit of other topics.

What to Bring - Bring stethoscope,scale, calculator, language book for kannada malayalam and a sheet of copied format of field case. 

Our practical exam consist of 5 part. The field visit to local area, case exercise, spotters, case viva and theory viva..

Field Visit-
The bus goes by 8.30 am. We are not supposed to take our record or bag to the field as it may be considered cheating. However, i just kept mine in my bag and carry it in bus. Well, all equipment needed is in there and i am reluctant to leave my lovely beloved new bag without proper supervision in college. Anyway, we arrived at the supposed area by 9 am. and began to go separate ways under lecturers guide to allocated houses. Each student got one house each. All students are required to take the cases independently without help. For international students and students who did not speak local languages, we were told that translators will be allocated for each student during final exam. But, for that day, there were no translators or lecturers to help us with the translation and thus, i had to figure out everything myself. 

 I got an infant case in a house with family of 13 members. We were given 45 minit to finish the family case and the clinical case. I am so lucky because that day, because they can speak Kannada which is very easy to learn and understand. Plus, the family had a card that list all the members in the family. The card states everything i needed.but, the real problem is i had no idea what is it because it is written in Kannada. Thank God, the card had pictures and numbers on them and i simply 'cook' the rest info on the sheet. The vital info such as name,age,occupation, relation, education level,house environment  and income can be easily acquired. The real trouble is when i needed to figure out the nutrition and family planning. If only i bring the language manual book, i think it would be a lot easier to deal with them. I know  my sheet was totally messed up because it was my first time writing it. I forgot the nutrition table and the answer sheet looked horrible and unsystematic. I managed to finish the interview, physical examination of the infant and write the sheet. When i finished, we went to college at 10am. Attendance were taken in the bus  and the case sheets were given to respective guide lecturers.

Case Exercise
This exercise consist of 2 epidemiological case and one statistic case both to be written in separate answer sheet. The limit to answer the question is 40 minutes. From 20 students in the exam hall, i could see that everyone is trying their best to answer as fast and as they could. Some are like me, trying to figure out what to do without a calculator for statistic question. How could i forgot about the most important thing in practical? Pfftt... Obviously, all the equation and formulas should be remembered.

Spotter
Spotter session started at 11 am.For this part, we have to identify each spotter given on the table within 1 minute. 10 spotters from 66 spotters given in the record must be memorized well. No need to remember calories as we can see the spotters right before entering the exam hall. It will be pretty obvious. Pay attention to drugs and parasite spotters. I messed up a lot for drugs and parasite. So study that more!


Field visit case viva is easy. The batch was separated into two groups. Each group for one examiner.I am among the last students.So, i had ample time to read for the viva. Present the case like we usually do in the clinical subject if the examiner ask you to. If not, take your time to think the answer and answer with confidence. Do not hesitate to say that you do not know to questions you have no idea about. Study everything related to the clinical case. Since mine was infant morbidity case, he kept asking about the antropometry measurement. Well, i  didn't have the wight and height scale that time. I decided to cook everything up not realizing that he actually pay attention towards these  silly little things. I am busted for those question and end up giving excuses that i just jot down what the mother had said and i told him about the languange problem. It seems that he doesn't even care. Maybe next time i should just cheat something but make sure whatever i cooked up make some sense. In the end he gave me just 25/35. Well, quite good i think.

Theory viva. Gosh! It could be anything!Just read more on primary health center and diseases. They asked me this:What is primary health center? What is the meaning of disease? How many type of epidemic do you know? How to prevent rheumatic fever? What is transmissible disease? etc...


So, that is all what i can say about practical. i'm  pretty sure that i messed up a lot.

  Otoke?(What to do? = in Korea) 



Want to do it again? Oh hell yeah! I have to have at least one more time to do it right before the finals. Please don't screw it up next time okayh!  

Thursday, November 10, 2011

What i do to pass time in exam hall.


Tik tok tik tok...

I really can't wait any longer.Sitting in the chair with nothing to write on the paper.Pfftt... I was waiting for the right moment to go out. Well , here we can actually go out as soon as we finish writing our answer. Ahaha, to make time pass faster, i counted my future-marks. I assumed that i will not get full marks for all the question and from the total of 100 i will only get at least 78. From 78marks, deduct all the question left unanswered which means i have only 60 marks. For medical students to pass, we were only required to get half on the total points.

So, to take another factor into account, we have to include the leniency of the examiners. If they are really strict (which they won't unless if it is for sessional marks) you will bound to get lesser marks. Now, don't forget we also have to take overall performance of the students into account.  Come on, if the best student answer slash top scorer gets 3 out of 5, an average student will only get at least 1.5 0r 2..

Now, since i am used to write small words, my answers graphically looked shorter than my fellow local Indian students. Plus, as Malaysian, we were thought to write the words sebijik-sebijik and unlike me, they have a large, continuous handwriting on the paper. If my answer for a 10 mark question took at least 4 page, their's would be 6 or 8 pages! Even, for G head took one line, and the tail of the G took the line below! ( Well not all are like that...i exaggerate it  a bit O_0)

Luckily, this is not KTT where exams were conducted in the super-cool air conditioned lecture hall. I am a lizard. When i'm cold, i sweat a lot. Especially my hands and my feet. Sweating hands and feet makes things worst for me as i can't cover them like i cover my body with sweater. I can't use gloves because i can't hold the pen. But, if i wrote with my bare sweaty hands, my hands got cramped. Wearing socks in cold seemed effortless as the sweat trapped inside the socks and air ventilation makes my feet even colder. So, i am thankfull  to be here, where the weather are hot-cool like Malaysia. Oh how i miss Malaysia very much!

Oh yeah, another thing i used to do is counting. Hehe, since all we do is read and read in medical school, by 30 minutes before the exam ended, i used to count fans,windows, lights, or anything that will help me pass  time in the hall. Today, i counted the number of students went out earlier in last hour and the number of empty papers taken by the top scorers and the ones sitting next to me. Well, in short what i do in hall is just being a stalker. Yup, a STALKER!Don't worry, invigilators won't suspect me for copying because i am that good! I didn't do anything wrong really....So, whatever.

Why i do all those things? Why not sleep?

Okay, since high school  i tried to sleep like my fellow friends. They were so confident that they will get 100 out of 100 for the paper. What subject is that? Of course Additional Mathematics or Add Math! I admired their confidence of sleeping during exam just  45 minutes  after the papers were distributed. You can get full marks in Mathematics because it is just logic. If the answer meets what the question wants , then you get full marks. But, we can't do that for other subjects as we have to produce the same EXACT paragraphs from the TEXT book. The more you tried to hentam-keromo, the lesser marks you are likely to get. I wish i had brains like Adi Putra( you-know-who) , living and working you days with just numbers. Good luck dear, hope you'll be a famous Mathematician in the world. Huhu.

I really tried to sleep but to no avail i just can't do that in front of the invigilators.I think i will sleep if i have sooo much confidence in my answers.Plus, my brain just can't stop thinking and working!I can't really get my head a brake unless it is for sleeping.That's why people get insomnia. They think too much!

People, please let's pray that i pass. All i need is pass the 3rd year. All i need is to pass 5 and half year before i become a real doctor. If i pass, i can do whatever i want, the way i want it, whenever i want it.



Brain hangover after too much thinking in exam.

Tuesday, November 1, 2011

Opthalmology posting



Its eye day.

Here are some snippets of my optho postings in August. Hehe, too lazy to update blog because of eid.

This time, i am much aware of my eyes. I could not resist the temptations of applying my not-so-adequate optho knowledge in my daily life. Whenever i see a yellow eye, i will definitely make my own differential diagnosis. Whoever has a red eyes, i will immediately keep my distance two feet away so as to not contracting any transmissible eye disease. If i had any dark circles or colored halos, i am quite sure that i might have  glaucoma. Ni ler penyakit orang masuk medic. Hihi...Asal nampak je satu bende, mesti ingat ape yang dah belajar dan buat diagnosis sendiri. Orang puteh kate, What mind don't know is when eyes dont' see. Kalau tak tahu, macam mana nak kenal....ye dak? 


Lacrimal syringing test : Performed after 4% xylocaine local  anaesthesia .
Normal saline is pushed into the lacrimal sac from lower punctum with the help of the syringe and lacrimal canula. Free fluid passage from the lacrimal sac into nose rules out any obstruction to the lacrimal passage. Complete obstruction can lead to reflux of the fluid into the eye( indicating blockage at the same canaliculi) or the fluid will drain from the upper canaliculi ( indicating that the nasolacrimal duct or nasolacrimal sac blockage)




Next, these are the pictures during OT day. Although we had not been able to see  the traumatic induced cataractous lens  directly ,we were lucky enough to have a flat TV in OT. So, while the doctors explained the procedure we watch the whole procedure from the the TV in awe. 







This is from one of the not so eventful postings. That day we were thankful because this Dr care to show us some gadgets in the postings. Touched by his kindness, i was so pumped up and volunteered to become a patient. Here are pictures to assess the axial length of the eyeball in mm determined by A-scan ultrasonography.This procedure is indicated for people who needs an intra ocular lens implantation.




That's all for today!

Tada!!!!

  Tons of  topics yet to read.... Can i do it? 


Wednesday, September 14, 2011

No more Microb and Pharmac !

Ho yeah,

Last week i received my results.You know what ? I passed! Alhamdulillah...

Hurray!!! Ngeee~~*

Congratulation ! Omedeto! Tahniah!

Well, the raya festive is soo over and relaxation time is now come to an end!

Hope i will find my strength to keep holding on those heavy books and small fonts full with pure academic stuff.

Owh, someone please give me a spank if i malas-malas lagi...


Dear YOU! Yes You...Please wake up and Read! 


p/s: I miss tuition and hefty spot question books! 

Wednesday, August 17, 2011

Plummer-Vinson syndrome:


Guys, this is really important viva question as well as theory question.

Frequently asked for end posting!!!

link : Plummer-Vinson syndrome: MedlinePlus Medical Encyclopedia


Plummer-Vinson syndrome is a condition that sometimes occur in people with long-term (chronic) iron deficiency anemia. People with this condition have difficulty swallowing due to small, thin growths of tissue that partially block the upper food pipe, or esophagus.

Causes

The cause of Plummer-Vinson syndrome is unknown. Genetic factors and a lack of certain nutrients (nutritional deficiencies) may play a role. It is a rare disorder that can be linked to cancers of the esophagus and throat. It is more common in women.

Symptoms

  • Difficulty swallowing
  • Weakness

Exams and Tests

Some patients develop skin and nail abnormalities that the doctor can see during an examination.
Upper GI series or upper endoscopy may show the web. Tests to diagnose anemia or iron deficiency may be useful.

Treatment

Patients with Plummer-Vinson syndrome should receive iron supplements. This may improve the swallowing difficulty.
If supplements do not help, the web can be widened during upper endoscopy to allow normal swallowing and passage of food.

Outlook (Prognosis)

Patients generally respond to treatment.

Possible Complications

Devices used to stretch the esophagus (dilators) may cause a tear, which leads to bleeding.
Plummer-Vinson syndrome has been linked to esophageal cancer.

When to Contact a Medical Professional

Call your health care provider if food gets stuck after you swallow it or if you have severe fatigue and weakness.

Prevention

Good nutrition with enough iron may prevent this disorder.

Alternative Names


Paterson-Kelly syndrome; Sideropenic dysphagia; Esophageal web

link :

Monday, August 8, 2011

Snake Baby

Have you ever heard or watched about the snake baby in Saudi Arabia?

The baby is not alone.

It is a genetic-related disease called Harlequin icthiyosis.

One of the baby that survived spoke in here.












Want to help?

Got to this http://youtu.be/SM88sZZz2iY

Optho: Glaucoma








Good study and presentation material

Sunday, August 7, 2011

Eye Examination



Ehem!

~That day i wanted to see pupillary shadow. I hadno idea how the shadow will look like. Finally, i've seen it. 
  The shadow falls on the lens when the light is shined obliquely from the temporal site and seen through the pupil.

~General tests to be done.
  1. Visual acuity 
  2. Rosenbalm test
  3. vision test - by using Snellen`s chart and repeat Rosenbalm test
  4. Eye movement test - look up,down.left and right
  5. Confrontation test : The examiner closes his left eye while the patient closes his right eye. Move the finger in all four quadrant and repeat the test in the other eye.
  6. The H test - Move the finger from center outwards in H pattern.Repeat for other eye.
  7. Convergence test- From the nose, ask the patient to look far object .The pupil should constrict.
  8. Squint and Strabismus test : Shine torch on nose and see the light reflection on the pupil which is slightly deviated to nasal site. Assymetry indicates strabismus.
  9. Pupill reaction test- Shine from temporal site.See the pupillary constriction. See the other eye for consensual reflex.
  10. Accommodation test- Make the finger on nose. Ask patient to see far object . Pupil should constrict.






Friday, August 5, 2011

Optho : Operation Theatre Day



Friday is an OT day.








But,i didn't bring my OT slippers.
Its okay, they didn't bother at all. Hoyeah!

It was an awesome OT because the case is related to our theory class we just had that morning.
It was wonderful because i still have the Wow! moment in there. I need it badly. 
It is awesome how the eyes are numbed,cut,poked and rolled on the surgery table,while the patient still conscious and he/she could actually see the whole procedure!!! 










These are the highlights during OT.
Might be viva question too.




The screen. Thanks to it, i can see what is going on under the microscope.
















~Do you know what is biometry? Biometry is for intraocular lense power calculation. 
  Answer : P=A-2.5L - 0.9K.
  Where P is the power of IOL,A is a constant for lens type, L is the axial length of eyeball in mm determined by A-scan ultrasonography, K is average corneal curvature determined by keratometry.


~Traumatic induced cataract in a teenage girl following needle break in sewing lesson. The needle penetrated the cornea all the way through the vitreous and posterior capsule. Removal of the lense or lensectomy with anterior and posterior capsule removal  is done. Vitrectomy is completed using cutting ,irrigation and aspiration mechanism and implantation of IOL of 22D slightly higher than normal lense. He said even with loss of vitreous there will be no associated diminished vision or  post operative complications. Although, the damaged done is irreversible,they tried to save what they can since the patient is still young and they do not want to disfigure her.




~Pilocarpine injection into anterior chamber to asses pupillary reflex.


~Peribulbar anesthatic injection. I say you, it is painful and scary to us! Imagine a needle being poked straight  into the eye.!!! Gosh, i had anesthesia before, it was painful and i shed a tear. Well, a bit. But this is so scary and painful, even to those watching from bedside!


~Superior rectus muscle fixation. It is also know as bridle suture is passed to fix the eye in downward gaze manner.Sir said it was the most painful stage of cataract removal surgery.


~Tryphan blue dye to stain anterior capsule. A bubble is introduced between capsule and cornea. The bluish 
   tinged capsule is then teared with help of a knife to expose the pearly white cataractous lense.




~Phacoemulsification. 

  • It has three significant stage. Irrigation, aspiration and ultrasound.
  • Something about needle. Fact: Nucleus of the cataract is emulsified using a needle that vibrates at ultrasonic speed of 40000 times a second. One of great WOW! moments is OT, i must say.

~What type of cataract could develop after ECCE ? Answer: it is also known as after cataract. It has two types, Soemmering's ring and Elschnig's pearls.

~What is IOL related complications? Answer: CMO, corneal endothelial damage,uveitis and secondary which is frequently seen with anterior chamber IOLs. UGH syndrome refers to occurence of uveitis, glaucoma, and hyphema. 


~Students, where do we put the incision for lens delivery in intracapsular cataract extraction ? Is it from 6 o'clock or 12 o'clock?  With pure curiosity and without further thinking i asked " Sir, which clock sir? Your clock or our clock? " while standing on the bedside with surgeon sitting behind patient head. They burst into laughter. Pfft! What a bummer! I cracked a joke when the patient is STILL lying there.I didn't mean to. But, still it is a fair question! Answer: Indian smith method, fix the eye at 6 o'clock and by using another hand put counter pressure at 12 o'clock to deliver the lens out of the capsule through the pupil and anterior chamber.



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Optho:Methods of Drug administration



Ocular pharmacotherapeutics can be delivered by four methods:
  • —topical instillation into the conjunctival sac, 
  • —periocular injections, 
  • —intraocular injections and 
  • —systemic administration

a)Topical instillation 


Eye drops may be in the form of aqueous solutions (drug totally dissolved) or aqueous suspensions (drug is present as small particles kept suspended in the aqueous medium) or oily solutions








Eye ointment increases the bioavailability of the drug by increasing tissue contact time and by preventing dilution and quick absorption.





Ocusert is a system of drug delivery through a membrane. These can be placed in the upper or lower fornix up to a week and allow a drug to be released at a relatively constant rate. Pilocarpine ocuserts have been found very useful in patients with primary open-angle glaucoma; by efficiently controlling intraocular pressure with comparatively fewer side-effects.




——Soft contact lenses are also used to deliver antibiotics and antiviral drugs in patients with corneal ulcers.A pre-soaked soft contact lens in 1 percent pilocarpine has been found as effective as 4 percent pilocarpine eyedrops in patients with acute angle closure glaucoma.





b)Periocular injections

These are not infrequently employed to deliver drugs.

These include :
  • —subconjunctival, 
  • —sub-Tenon, 
  • —retrobulbar and 
  • —peribulbar injections.

Subconjunctival injections. These are commonly used to achieve higher concentration of drugs.
Further, the drugs which cannot penetrate the cornea owing to large-sized molecules can easily pass through the sclera. 




Sub-Tenon injections
.These are preferred over subconjunctival injection. Anterior sub-Tenon injections are used mainly to administer steroids in the treatment of severe or resistant anterior uveitis.
Posterior sub-Tenon injections are indicated in patients with intermediate and posterior uveitis .





Retrobulbar injection: These are used to deliver drugs for optic neuritis, papillitis, posterior uveitis and also for administering retrobulbar block anaesthesia.








Peribulbar injection: These are now frequently used for injecting anaesthetic agents. Peribulbar anaesthesia has almost replaced retrobulbar and facial block anaesthesia.










c)Intraocular injections

Such injections are made in desperate cases (e.g., endophthalmitis) to deliver the drugs in maximum
concentration at the target tissue.

These include:
  • —intracameral injection (into the anterior chamber), 
  • — intravitreal injection (into the vitreous cavity)




Saturday, July 30, 2011

CoMMed: The End Posting



At last.

Finished my postings.

Hell yeah, it was EASY.

I got the dark-bespectacled-short-dark-hair lecture.
I seriously forgot the name.

And so,we begin our end posting.Basically, it is about environment,water,housing and sosial health.




"Did you finish your record?"

"Yes sir."

"What type of family did you study?"

"Nuclear family sir. It consist of 3 member. Saji,Amitha and Sherine. The case sir."

Flipping through the pages.

"Owh i see. Okay, Tell me your observation ."

This is how you present your case.

"Sir, the family is nuclear type family, living in pucca house.The head of house is a bus driver,but the wife doesn't work. Hence the total income is around 8000 rupees( like 700ringgit per month). They spent the money wisely. No debts and had savings in account. They spent most of their money on food,fuel and house maintenance.."

He cut me before i could finish my presentation.

"Okay, tell me  the name of classification we used for assessing social class."

"Sir, its modified Kuppusamy scale sir.(Park:601 , Asma Rahim: 338)"

"Okay, what other classification you can name?"

"Erm...." totally blank.


"Its Pareek scale,Kulshrestha scale,Prasad scale..."

And i continued my presentation on my own.

"Sir, since the family spent wisely on food. There is no correction to be done regarding the menu. There is no deficit in nutrition requirement. They had balanced diet..."

He cut me again.

"Give me the total requirement of Vitamin A "

"Sir, for adult male and female its 600microgram for retinol and 2400 microgram for carotene.For children, it is 400 for retinol mcg  and 1600 for carotene." (Record 1 : 33)

He seemed to disagree.Aaargh, i didn't study the infant part because my case doesn't have an infant.

"How about infant?"

"Around 400mcg and 1600mcg..." totally from book, with slight alteration.

He disagree again.

"Look up for the answer in book okay?"

Waiting for another question, while he finished correcting my record.

"Finished sir?"

"Yes,you can go."


Hence, it is the very end of Community posting. Another term to go, one more community medicine posting to finish.I hope i've done well. Well, i wished i knew the answer for the vitamin part. Anyways, hooray! Finished commed posting already!




Friday, July 29, 2011

CoMMed: Community diagnosis presentation



Today we had a horrible presentation session for community medicine posting. All students were divided into individual topics to be presented using power point. But, we do not know what to do. At least , not about what the exact right thing to do. Basically, all lecturers seemed so agitated and quite furious with our performance. I was watching from the first row in horror as one by one scolded and yelled at presenter.

"Why in the world would you do like this? You think this department are so carefree ,so you can 'jack' us as you like? You people have no attitude! Not even interested in doing your duty. It is such a waste to sit here and watch your presentation. What ever you presented is already taken in theory class. We don't want theory part! We want to know the results from your observation. We want to know either you can deduce an inference from the observation. "

And another lecturer continued,

" Yeah, you people have no common sense. Not even one person came to us and ask what to do, how to do the presentation. You people don't even bother"

I just glanced to my fellow friends,and shared the what-the-hell-we-dont-know-bout-that-you-should-teach-us look. I hate to admit that i simply blur all the time and had no idea what is going on in theoretically. Seriously, i didn't hate Community Medicine, but i am not in love with it too. So, where should i stand?


I should study and finish writing 64 spotters in record book. Then, i shall study the environment,sociology and economy topic for viva tomorrow.

I hope everything goes well.





    

Thursday, July 28, 2011

Endoscopy and C. T scan


For those who had abdomen or git problem, the most common test to be done is endoscopy. Well,basically they shove a tube with camera down your throat.

The procedure took at least 5minit. First, a topical analgesic sprayed at the back of your mouth to prevent gag reflex. They put a mouth guard,and the tube is inserted. During the procedure, the patient tend to make a very loud horrible belching sound. I did. I was actually forced to breath through my nore becaure i kept on gagging. The moment the tube entered my stomach, then to duodenum,i can say that it is pretty painful. I am soo done with it!


CT scan? Nothing much to tell except painful intravenous dye injection. Maybe not really painful,just that the dye is somehow hot. I can actually feel the dye seeping through the vessels,into my chest,perineal region and gall bladder. In the end,they couldn't find what is wrong with me. All they can say, "don't take fatty food especially red meat.". Okay,i will try to fast and 'berpantang' from meat,mutton, and seafood. My consultant physician said that if i have another attack during fasting,they will do MRCP. What is that? Ask Mr Goo.





To kill the pain, i took Drotin. Its working this time. Not like cyclopam or spasmo proxyvon.
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Tuesday, July 26, 2011

A field trip again...



During community medicine posting, there are either theory class, field trip or seminars . In a week we will brought to the local area to ask question around and get ourselves a complete data of the family.

To be frank, i dunno anything or blurr all the time.

As long as it is in Kannada or Hindi, i can at least understand what they were asking or discussing. I tell ya, it is easy to ask questions in other language, but to understand the answer , took a lot of liberty to process the sound going through  the external ear canal, then into the middle ear cavity which is then processed by cochlea and transmitted to brain. I guess, my impulses always stuck midway, coz i always dont understand what are they saying. It gets tougher when it comes to elderly people, you know..the gummy-not-so-adequate-teeth speech.... Heheh...


My unitmate going into the house. This is a pucca house. 

Ventilation and lighting are inadequate.

Jot down the details...

See if the kitchen is high,medium or low in height.
We were also required to see whether the family used a LP or wood stove. 



They usually waash their clothes out side on the rock.
 Kasik hempas-hempas itu kain achi!!!

Field Trip : Police Quarters



Field trip again.

This time it is in the police quarters area.

Bet all the policemen here had an awesome mustache!!!

Yes, they did.

Like usual, i just stand and watch my friend asking around the details in the form provided.

Decide whether it is a pucca or kutcha house. 

How many rooms?

Gas or wooden stove?

Any family planning?

Income?

Details of family members.

Yeah, this trip is all about community studies.

We were supposed to fill in the form and walk away.

I'm glad there is a nearby store where we can eat ice cream.

And this is suppose to be an individual case.

Yeah, i don't speak their language.

Hence, a local friend is needed.

Like usual, i stood there, nodding and smiling and snapping pictures.










Saturday, July 16, 2011

Cetrizine c'est magnifique!!!

I had a lot to do list in my mind.
One by one, i completed one by one.
Tick the box and move to the next list.
A very long list indeed.



My eyes burning, my throat hurts,my body hot as a hare, and  i have a nasal-hoarse-husky but sexy voice. The flu won't take me down. I will complete my to do list what ever it takes within the targeted time!!!

I'm fighting against the cold breeze, fighting against the pouring rain to class everyday(which explains the fever), the sleeping inducing weather,the long hours or minutes of free time( waiting teachers,waiting bus to move,waiting in bus,waiting for attendance to be taken, etc... ), listening to lectures in class while trying hard not to doze in the first bench ( i sat there because i'm bit deaf,bit blind too, but most of the time i had to process what they say in Indian-English accent).

For the flu, i used cetrizine hydrochloride 10mg. Well, quite effective to treat runny nose,blocked airway and reduces sputum. Cetrizine is the common drug we had in the drawer other than Crochin( paracetamol for antipyretic and analgesic effect), Cyclopam (antispasmodics for period cramps), Prometazine(antimotion sickness,sedation effect for long journeys by bus or car), loperamide( antidiarhea)or chikit teik onn ( ubat herba cina yang bulat-bulat tue) , dentogel (ulcers in mouth), minyak yuu yee cap limau , minyak cap kapak and blah-blah.

 I knew i'm supposed to take antibiotics but since i thought the fever and cold would recede in few days, so i didn't take the precaution measures. However,  i am stuck with the flu  for almost 1 week. Padan muka ! Tomorrow, i have to go and buy some cefadroxil 500mg and take it for 3 days.

If i am not too lazy to walk out that door.


p/s: remembered 1st question in Kimia SPM, " Nyatakan cara-cara merawat batuk menggunaka bahan-bahan yang terdapat di rumah. I answered : Gunakan teh halia untuk melegakan batuk dan selsema. Cengkih juga digunakan untuk melegakan sakit tekak."

Friday, July 15, 2011

I don't like that you do abortions, but if you didn’t...

I don't like that you do abortions, but if you didn’t, I would probably be dead


I was paged by labor and delivery three times during the 10 minute drive from my house. I headed straight from the parking lot to the labor ward expecting a patient of mine to be close to delivery. I was wrong.
The chief resident and attending obstetrician were waiting. They looked tired and worried.
A woman had arrived on Friday with ruptured membranes. She was 21 weeks along in her pregnancy and now there was no amniotic fluid left at all. She and her husband wanted everything done. Despite the dismal prognosis for her baby, in respect for the patient’s autonomy, antibiotics were started. Within 24 hours it was clear she had an infection.
Delivery was recommended as these infections are potentially deadly. The parents refused. “The antibiotics might work,” they said. And no amount of discussion about the overwhelming medical evidence that supported delivery could sway their decision. Inducing labor at 21 weeks while their baby was still alive was abortion.
The infection worsened despite the antibiotics. The patient, who was rapidly deteriorating, and her husband reluctantly consented to an induction of labor.
And now it was clear why I was needed. Infected uteruses don’t contract very well. Prostaglandins and oxytocin both failed to produce even a cramp.
“They are very pro-life,” the resident warned. “It took several hours of convincing just to get them to agree to talk with you.” Considering I practiced in the bible belt this was not an unfamiliar scenario. I shrugged and walked into the room.
My patient was clearly very ill. Flushed, sweating, and drifting in and out of consciousness. The smell of anaerobes unmistakeable.
I reviewed what had transpired to date. The infection. The prognosis. And what I could offer. A dilation and evacuation.
They had two concerns. The first, their baby was still alive in spite of the infection. The second problem was that I was an abortionist. Couldn’t a doctor who didn’t perform abortions do the procedure?
“I understand your baby is still alive, but he or she cannot live. It is sad and it is unfair, but the pregnancy is now killing you. It is not a matter of if you die, but when.” I paused. “You have other children at home and they will be without a mother. If it is any consolation, at 21 weeks babies do not feel pain.”
The husband’s body language said it all. “How did you learn to do these procedures,” he asked.
“By doing abortions. Lots of them. I have done more late term abortions than most doctors of my generation. That makes me very skilled. But the privilege of helping women end their pregnancies safely also gave me the skill to help women like your wife. There is no other way. You have to do a lot of these procedures to become proficient. Even more to do them safely for a women at 21 weeks who has an infection.”
There was no response, so I continued. “This is a very precarious situation. An infected uterus is easy to damage. I could make a hole and injure other organs. Even if the procedure goes well, the bleeding might not stop. A hysterectomy could still be needed. The infection in the blood stream might still get worse. But without the procedure, your wife will die.”
My patient spoke. “I don’t want to die.”
Within the hour we were in the operating room. The procedure went well. The bleeding, though profuse, was controlled without a blood transfusion. Within 24 hours she looked like a completely different woman.
Several months later I was surprised to find her name on my schedule. Especially given the reason was a first prenatal visit. After the appointment was over, I expressed my pleasure to have her in my practice, but also my surprise.
She looked at me and said, “I don’t like that you do abortions, but if you didn’t, I would probably be dead and not celebrating this new life. My husband isn’t thrilled that I am seeing you. He just can’t wrap his head around the fact that women sometimes really need someone who can do what you do. But I don’t see how I could go to anyone else. You saved my life.”
I think of the many times I have been in this exact situation over the years and it makes me wonder what happens now to the women who rupture their membranes at 21 weeks in Idaho, Nebraska, North Carolina, and Ohio. These women can’t choose to have a dilation and evacuation or even an induction of labor. They must wait until their baby succumbs in utero or for a spontaneous delivery, almost always a grim prognosis for their baby. Unless of course an infection develops and her life and health are in danger. Only then, when it is more dangerous, can a woman terminate her pregnancy at 21 weeks with ruptured membranes.
And if the induction of labor fails, as they often do, will these women be able to find a provider in one of those states skilled enough to safely perform a dilation and evacuation at 21 weeks in the presence of an infection?

Thursday, July 14, 2011

Elder's shelter.

Today,we had a trip to an elderly shelter house. There are two unit houses separately each for men and women.

I wished i had something to give. They each needed basic daily things like slippers, toothbrush ( aik..ade gigi lagi ke?), toothpaste, machine washer,good thick blanket, and maybe some good rice too.

Well, one of the granma's there asked me to come front. I hugged her and embrace her hand.I knew they needed a hug more than money or materialistic things in this world. Yeah, most of them either left to die there, left by their own children, had no family at all, or came there for treatment. Some of them, still manage to communicate well. But, some had gone senile.

This is the third time we went here.We went there  last time during our 5th and 6th term postings. 



This amma is very friendly and sings alot. She even welcome us with her joyful singing. I am really gratefull for she can speak English.Go amma!!! We promise you we come again next time!
I aske her, what she do all day in the shelter. They do nothing. They had to hand wash their clothes  all by themselves.
Just have a look at her! Very charming granny rite! Siap ada bunga lagi kat sanggul tu...
This is one of the three dorms in the shelter for women section.
The entrance.
The weather is very cold and nice. The shelter is surrounded by green field.
Another scenery.
I guess this is the toilet.


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