A mock OSCE moment..

Scenario 1 (Nephrotic syndrome): Mr Azman, father of a 7-year old boy (Ali) took leave to accompany his son for his 5th hospital admission this year due to a swollen face.
What happened:
*enters room, greets Dr Paul (examiner)*
Me: Hi, good morning (even though it's afternoon) Mr Azman (simulated patient), my name is Gary and I'm your doctor for today. I understand that you brought your son Ali for admission today, right? Is it possible for me to get you to leave the examination room now? This is to ensure confidentiality as I talk to Ali *turns towards Dr Lai who happened to be sitting in*
Dr Lai: *horrified look* No no no, I'm not Ali. You are supposed to talk to Ali's father.
Me: Oh. *swt*

Addendum:
Scenario 2 (Emergency contraception):
Patient (speaking very fast): Hi, I'm very nervous coz last nite we had a party, and everything kinda got a bit wild and I ended up sleeping with this guy I met at the party.. i just don't want to get pregnant doctor.. how ar?
Me: Ok, first I would like to ask u a few questions 1st is that ok?.. let's see, So, let me just confirm, last night you had sex with a guy whom you did not know?
*silence as patient and examiner gave me that horrified look - there goes your mark for rapport as my friend put it*

Trio of reflections..

Currently listening: Phillips, Craig and Dean - When God ran

1. My IVDU patient with HIV is due for pre-HAART counseling soon.. bumped into him as he was playing with his beautiful young daughter (she's probably 4-5 years old) outside the wards. Can see her pacing up and down the corridor, dancing around the visitor's benches..

2. Have not studied for mock OSCE (what more the real one). Need to get my psychiatry log book done soon. And my handwriting is getting more horrible *swt* :p

3. As she stood in front of her 5th grade class, she told her children an untruth. Like most teachers, she looked at the children, and told them that she loved them all the same. However, that was impossible, because there in the front row slumped in his seat was a little boy named Teddy Stallard.

Miss Thompson had watched Teddy the year before and noticed that he didn't play well with the other children, that his clothes were messy, and that he constantly needed a bath. And Teddy can be unpleasant. It got to the point where Miss Thompson would actually take delight in marking his papers with a broad red pen, making bold X's and then putting a big 'F' at the top of his papers.

At the school where Miss Thompson taught, she was required to review each child's past records, and she put Teddy's off until the last. However, when she reviewed his file, she was in for a surprise. Teddy's 1st grade teacher wrote, "Teddy is a bright child with a ready laugh. He does his work neatly and has good manners. He is such a joy to be around." His 2nd grade teacher wrote, "Teddy is an excellent student, well-liked by his classmates, but he is troubled because his mother has a terminal illness, and life at home must be a struggle." His 3rd grade teacher wrote, "His mother's death has been hard on him. He tries to do his best, but his father doesn't show much interest, and his home life will soon affect him if some steps aren't taken." Teddy's 4th grade teacher wrote, "Teddy is withdrawn, and doesn't show much interest in school. He doesn't have many friends, and he sometimes sleeps in class."

By now, Miss Thompson realised the problem, and she was ashamed of herself. She felt even worse when her students brought her Christmas presents, wrapped in beautiful ribbons and bright paper, except for Teddy's. His present was clumsily wrapped in the heavy brown paper he got from a grocery bag. Miss Thompson took pains to open it in the middle of the other presents. Some of the students started to laugh when she found a rhinestone bracelet with some of the stones missing, and a bottle that was one-quarter full of perfume. But she stifled the children's laughter when she exclaimed how pretty the bracelet was, putting it on, and dabbing some of the perfume on her wrist. Teddy Stallard stayed after school that day just long enough to say, "Miss Thompson, today you smell just like my mum used to."

After the children left, she cried for at least an hour. On that very day, she quit teaching reading, writing and arithmetic. Instead, she began to teach children. Miss Thompson paid particular attention to Teddy. As she worked with him, his mind began to come alive. The more she encouraged him, the faster he responded. By the end of the year, Teddy had become one of the smartest children in the class, and despite her lie that she would love all the children the same, Teddy became one of her 'teacher's pets'.

A year later, she found a note under her door from Teddy, telling her that she was the best teacher he'd ever had in his whole life! Six years went by before she got another note from Teddy. He then wrote that he had finished high school 3rd in his class, and she was still the best teacher he ever had in his whole life. 4 years after that, she got another letter, saying that while things had been tough at times, he'd stay in school. He'd stuck with it, and would soon graduate from college with the highest of honours. Again he assured Miss Thompson that she was still the best and favourite teacher he'd ever had. Then, 4 more years passed, and yet another letter came. After he got his bachelor's degree, he had decided to go a little further. She was still the best and favourite teacher he'd ever had. But now, his name was a little longer.. the letter was signed 'Theodore F. Stallard, M.D.'

The story does not end here. There was yet another letter that spring. Teddy said he's met this girl and was going to be married. He explained that his father had died a couple of years ago, and he was wondering if Miss Thompson might agree to sit at the wedding in the place that was usually reserved for the mother of the groom. Of course, Miss Thompson did. And guess what? She wore that bracelet, the one with several rhinestones missing. And she made sure she was wearing the perfume that Teddy remembered his mother wearing on their last Christmas together. They hugged each other, and Dr Stallard whispered into Miss Thompson's ear, "Thank you for believing in me. Thank you so much for making me feel important, and showing me that I could make a difference." Miss Thompson, with tears in her eyes whispered back, "Teddy, you have it all wrong. You were the one who taught me that I could make a difference. I didn't know how to teach until I met you!"

You can never tell what type of impact you may have on another's life by your actions, or lack of action.

Adapted from: Three Letters from Teddy
by Elizabeth Silance Ballard

You can make a difference

Where: Taman Sri Skudai
When: 21 October 2009 (Wednesday). 7.30pm.

Of late night patient hunts,festival of light and gifted hands

1. Was planning to clerk an IVDU patient who is under psychiatric evaluation for my log book. Patient went out for a walk. Guess I'll come back tomorrow, since it's already 10.30pm.
Update: Had a chat with the patient,nice guy whom was actually married with 4 children - he did shared about his life as a former drug addict for 10 years, sleeping by the drains for months and being in-and-out of jail for years - which was why he did not get to see his daughter when she was born until she was 2 years old. Despite this, his wife stood by him for the past 15 years. He was admitted for splenomegaly, pain on his back and ribs, and there was a heart murmur. The diagnosis on the chart mentioned infective endocarditis, with vegetation on the aortic valve, and he is on antibiotics. Last week, test results came back that he was HIV positive, but his CD4 has yet to hit <200. I asked him indirectly whether he had any medical illness, but he said no - either he knew and preferred not to talk about it, or nobody has informed him of his condition..

2. Happy Deepavali, and have a wonderful long weekend :-)


3. Benjamin Carson starts out life with everything against him: an African American child from a single parent home with failing grades at school, ridiculed by others, glued to the television screen, and in need of glasses. But his mother, who dropped out in the third grade, experienced financial struggles, and at one stage was hospitalised for depression, never gave up on him, but instead started making decisions for him and his brother, shutting off their TV habits and ordering them to read two books per week from the library and writing a report of what they read, and Ben started developing his intelligence, imagination and belief in himself. Despite the odds, she also moves them to better schools, as Ben eventually tops the class.

He learns to spell, explore the world of books, grows in creativity. But he also begins to mix with the wrong crowd, and as a result of his short temper, nearly killed somebody. He runs to his room and cries out to God, praying for deliverance from his temper.

The foundation his mother helped to lay in his early days would later proved to be a driving force, as with hard work and a strong desire, he gets a scholarship to college, passing the exam which enables him to enter medical school. Carson faces adversity from fellow doctors and students while working at Johns Hopkins Hospital in MD. It is here he performed a surgery as a resident without attending supervision, risking his medical career to save a man's life. At one point, he also had to deal with the loss of his twins. Eventually it came to a point where he was tasked with performing a complex surgery to separate 2 7-month old German conjoint twins, and he worked out a miracle with success. Today, he is one of the world's leading neurosurgeons, and a professor and director of paediatric neurosurgery at Johns Hopkins University Hospital.

On success

Just a saying Ethan reminded me some time ago..

2 traders went to a few towns in a particular country to scout for prospective business opportunities on behalf of their companies. The 1st one returned and sighed in despair, "The people here don't wear shoes! There is no point for us to waste time here, as there is no way I can sell shoes to them." The second guy came back and proclaimed, "Wow, nobody here wears shoes! Great, we have a huge market!"

Which one are you?

Moving to our new home - Part 1

More updates to come..
Venue: Skudai Parade

Exam season - Snippets of God's faithfulness

"....give thanks for my shepherd, whose sharing deeply encouraged and renewed me in my walk with God. He did mention the importance behind every choices we make, and that one of the key to breakthrough in certain areas that we can see, is seeking 1st God’s kingdom and His righteousness, to lay down ourselves and put Him at the centre of what we do. Then, we see how God is able to open the floodgates of heaven, because 1st and foremost, God looks at the heart, not at your ability. As we continue to do so, we know that He will be with us always, in the things that we do. One example includes how despite his final thesis presentation scheduled the next morning, and he is only half-done with it, he made the decision not to compromise, but to sacrifice whatever little time he had left and attend the Vision and Philosophy class on that very night, and by the time he got home it was already past midnight. Nevertheless, despite the lack of time, able to see how God helped him pull through, and even provided him with the best thesis and overall top architecture student award in UTM. It definitely served as an encouragement to me as we approached the season of final exams.."
Christopher Heng

"....I wanted to testify to God’s goodness over the past week or so, where I have been extremely busy with submission. Although the presentation has been postponed to Friday, but I fell sick on Monday and it became so bad even on Tuesday that I was unable to get out of bed. I felt very weak and needed to rest, and initially did not intend to go for caregroup on Wednesday despite being rostered to come up with games for this week. Nevertheless, I got reminded of a passage where God loves a cheerful giver, and I want to give Him my best. Today, I resolve to tell myself not to complain, give excuses or do things just for the sake of completing it, but in our everyday ministry and serving Him, let us truly see it as a privilege to do so. Throughout the process of preparing and leading games, gradually I experienced God’s renewal not only spiritually, but also physically. All glory belongs to Him."
Jing Jing

You will never walk alone

Matthew 18:20 - For where two or three come together in my name, there am I with them.
Ecclesiastes 4:9 - Two are better than one, because they have good return for their work.

Where: Taman Sri Putri, Skudai
When: Wednesday, 7 October 2009, 7.30pm

Photo acknowledgements: Antonius Susanto Thambrin

Light of the world 2

Graduation photos - UTM

Looking back at what had gone down, how time really does flies.. soon my turn will come, probably as quick as next year [sigh]