Hectic week leading towards freedom (ie Merdeka)

I have 2 items due this Friday (29 August); 1 is my MCR (ie monthly practical test), and the second is my critical appraisal report. It took me until end of last week to find my article, so as I was trying to appraise it, there were quite a number of parts where I got stuck. It was a busy week, but since my tutor was not around on Monday and Tuesday, I thought I will see him on Wednesday, but he was on call in the ICU. I made an appointment to see him on Thursday.

So on Wednesday night, I was so tired wondering what to study for MCR and how to do assignment and PBL at the same time that I had to take a nap for a while doing PBL at Ben's place (before got woken up after just half an hour). Anyway, that night, slept only around 4 hours I think..

Thursday (28 August 2008)
So the next morning I turned up for PBL at 8am (it was the start of a long day)looking like a zombie, but thankful that my presentation was quite ok, and I had fun practising thyroid examination on E.K. :p

After PBL, rushed to the wards for my MCR. Since the next day is the deadline already, and it's my 1st surgical MCR, I was like; "Err.. God ar, it's my 1st surgical MCR and I'm actually not very smart wan, so don't give so difficult case can ar?" The patient I was supposed to examine has an indirect inguinal hernia. Easy you say? Actually, for the past 7 weeks in general surgery, I never got the chance to examine a patient with inguinal hernia before (I mean, for teaching purposes the patient allowed the tutor to demonstrate on him, but was shy when we wanted to practise). So what to do? Try to remember lor as much of what the tutor taught us last week; Monkey see, monkey do, right? Then got asked a few questions.. and I was actually very happy with the marks I got (people may say it's no big deal as this lecturer is quite lenient, but it's still my highest MCR mark so far :p). He actually commented that if I had been more composed (ie smoother flow and less prompting, probably coz I was sleepy), he would have given higher marks.

12pm.. PBL and MCR done, EBCP to go.. rushed back to clinical school for long case. Got the shock of my life when I found out that E.K. and I have the same article for the appraisal. I was like, "What?? You got to be kidding me.. No time to find another article already leh..tomorrow deadline." Fortunately don't have to, but apparently my appraisal lacks several things.. My initial plan was to let the tutor go through my report and adjust the changes later at home. However, the tutor whom I was supposed to meet had to rush off again to the wards. A second tutor was busy, but suggested I email her my assignment to have a look. I went looking for the 3rd tutor who helped me big time with my previous assignment. He had a meeting at 3pm, and MCR with 3 students at around 4 pm, so I thought maybe I will meet him at 5 pm in the wards. In my haste to print and get the sample draft ready, I accidentally slammed the printing room's sliding door against my left finger. *PAINFUL*

So when the time came, I ran to the wards as I thought I was late, but he still haven't finished his meeting, so walked all the way back to the clinical school, and came back at 6pm. Still not finished with the MCR. It's tiring leh to run up and down the sloped staircase from clinical school to the wards. In the mean time, called the hospital surgeon to arrange for afternoon class tomorrow, got sarcastically told off to call back tomorrow morning. I called my ex-shepherd who was supposed to pick me up for dinner at 6.15pm to postpone our dinner appointment but was not possible, coz the designated meeting up time before going together for combined prayer meeting at FGC was 7pm, and traffic jam means we don't even have time for dinner. So there, finished. Die lar my assignment.. The tutor only finished the MCR at 7.30 pm. So I had to arrange another time tomorrow. Was actually thinking "Gary, Gary... you got to be crazy and out of your mind, your assignment and a lot of work not yet done leh.. actually should exercise wisdom lar, just tell lar if you cannot make it due to last minute unforeseen circumstances. Furthermore, the drive there takes 30 minutes.." Was throwing up a lot of calculative thoughts in my mind (coz I'm actually very stingy with my time), but since I already decided to go, "God I know I'm super tired and stressed, but You have been faithful all this while, and I choose to honour You." After that, another night of only 5 hours of sleep. But how much can I do, since a lot of the sections of the assignment which I wanted to enquire of has not been corrected?

Friday (29 August 2008)
Another long day. Tutor came late at 8.15 am, class finished late and turns out that a lot of people wanted to see this tutor also (ie cut queue), so couldn't really ask much about the assignment. But he tried to help lar as much as possible. My subgroup asked me to help look for patient early coz they were packing to go home. Was busy correcting my assignment, how to go? Until I forgot about pathology class. To go or not to go? It's quite late already. Ok lar, just go. Not good to skip class. After class, as I was editing my assignment, I just didn't know how, but the bits and pieces just fell into place. Whether it's correct or not, that's up to the marker to decide lar. But I achieved more progress in that 2 hours than in the past 2 nights. The deadline was 5pm, but managed to submit it at lunchtime. Went to the wards and managed to find a patient, so I clerked and examined him. During the teaching, I learnt a lot lar as the person doing the examination. And after all these, still got plenty of time to spare and I 'tapau'-ed my pathology quiz as well, before catching a bus to replacement caregroup that night.

Thank you Lord :-)

The call to remember

Deuteronomy 8:10-18
When you have eaten and are satisfied, praise the LORD your God for the good land he has given you. Be careful that you do not forget the LORD your God, failing to observe his commands, his laws and his decrees that I am giving you this day. Otherwise, when you eat and are satisfied, when you build fine houses and settle down, and when your herds and flocks grow large and your silver and gold increase and all you have is multiplied, then your heart will become proud and you will forget the LORD your God, who brought you out of Egypt, out of the land of slavery. He led you through the vast and dreadful desert, that thirsty and waterless land, with its venomous snakes and scorpions. He brought you water out of hard rock. He gave you manna to eat in the desert, something your fathers had never known, to humble and to test you so that in the end it might go well with you. You may say to yourself, "My power and the strength of my hands have produced this wealth for me." But remember the LORD your God, for it is he who gives you the ability to produce wealth, and so confirms his covenant, which he swore to your forefathers, as it is today.

Remembering where I was 2.5 years ago. Reminding myself that God is faithful to finish what He started. Reminding myself that no matter what you're going through (multiple deadlines, exams, tiredness, emo-ness etc), one can draw strength by remembering how He has pulled you through.

Calvary
by Planetshakers

1st verse
I will lift my eyes to You
Where my help comes from
Lord I find my rest in You
Keeper of my soul

2nd verse
You gave it all for me
Maker of Heaven
You paid the price
So I could be with You

Chorus
Jesus, I remember the cross
Where You hung upon that tree
You won the ultimate victory
Jesus, I remember Calvary

Bridge
You reign
You reign over the earth

More snippets from past week and this

1. Went to the wards at night last Thursday to clerk a patient for bedside teaching. Tutor asked to look for the breast cancer patient with lymphoedema, but when I went at 8pm, I found out that the patient was already discharged from the ward. Then, the staff nurse whom misheard me gave me a patient with lipoma. Ok, fine I thought, as I approached the bed, there's this group of 4-5 student nurses from a private college attached here in HSA for 2 weeks for their practical training. When I approached the patient's bed, they backed off. Then I looked at them, and was wondering why they looking at me weirdly (the "Oh, this is what a medical student looks like" kind of look). Then, as I enquired the patient and looked at her file, they looked on curiously at what I was doing. I had a short chat with them lar, seemed like a cheerful bunch - laughed and appeared quite playful, despite patients looking at them. Someone was apparently very "happy" for me, for so-called being 'checked out', though that same person would get a dose of her own medicine the next day in the wards. Too bad on the next day also, when I went to the resting room for doctors in the wards to put my stuff, the same group of student nurses were there, with a larger bunch of their cohort. Can hear whispers among them, "Inilah doktor yang saya cakap semalam." *swt*

2. When I go to the wards, I make friends with housemen who would allow me to follow them around / do procedures / help identify interesting cases. There's one who asked me for my name, and when she saw my name tag; let's just say.. Imagine a female, who talks very fast, sounds like Doraemon (I deliberately told her that loudly in front of patients; though in a joking way) saying the following sentence, "Oh Gary... ah itu-itu.. itu dalam itu Spongebob drama punya siput!!!!" *swt* Anyway, the same houseman asked me, "You want to do Central Venous Line ar?" I was like, "What?", coz that caught me unexpectedly, and I didn't read up on the procedure, what not my anatomy.. I told her I can observe lar.. Then, a few of her friends said, that they performed it during their years as medical students. "Never mind, just 'cucuk' (poke around) lar. You learn more when you do". Later I noticed that the patient's clavicle was so massive, even the injection needle became bent. :p

Give and take

I got this from a friend's blog; in conjunction with the Olympics.

During a race in the one man Fin Class sailing competition, Larry Lemieux of Canada was running in second place and was well on his way to a medal ceremony. Suddenly, the sailor spotted Joseph Chan of Singapore, who was competing in a different race, flailing in turbulent water well away from his capsized boat. Chan had been thrown from his small craft and was in danger of drowning in the rough seas.

Lemieux immediately veered off course, sacrificing his chance of winning a medal and ferried Chan back to his overturned boat. Chan and his team mate were then picked up by a rescue boat. Officially, Lemieux finished 11th place in the event but International Olympic Committee President Juan Antonio Samaranch later recognised his act by awarding him the Pierre de Coubertin medal for sportsmanship.

..................................................................................................................

At the most recent Winter Olympiad, Canadian Sarah Renner was leading her team in the gruelling cross country team sprint ski race when her left ski pole snapped. She pushed on, but it seemed hopeless. On an uphill slope, several skiers passed her.

Then something truly extraordinary happened. An unknown man stepped forward from the side of the course and handed Renner another ski pole. She immediately got back in the race and with a mighty effort, managed to make up some of the lost time. In the end, it was enough to capture the silver medal for Canada.

It was not until after the race that Renner learnt the identity of her benefactor. He turned out to be Bjoernar Haakensmoen, the coach of the Norwegian team who finished fourth. Haakensmoen immediately became a hero in Canada. One Montreal newspaper ran a one-word banner headline simply proclaiming, TAKK the Norwegian word for thank you.

Haakensmoen didn't understand all the attention. "The Olympic spirit is the way we try to follow. If you win but don't help somebody when you should have, what win is that?"

(Reader's Digest, Aug 2008)

Like Sarah commented, at times I do ponder what will I do if I ever find myself in such a situation. Olympics is only once in 4 years, medical school is once in a lifetime. Yes, it is said that doctors work in a team. Honestly speaking, I'm not the smartest person around lar, but if say I had worked so hard for something (eg of gold medal standard), the clerking, the hard work, and put up a good impression, how will I respond if someone else who just somehow knows much much more than me just effortlessly rattled off the answers and won praises. Jealous? Annoyed? Why some people so smart one?? If I get my hands on some much coveted handouts / notes / extra sessions, how? Can't deny that the tendency to think along the selfish lines of "Aiya he/she so smart and doing better than me dy, no need to bother lar sharing a copy with them, or You are selfish and manipulate things to cause me so much trouble, that even if you die that's your problem lar." is always there. Sigh..

Guess there is a need to appreciate that at the end of the day, it's not about me. And it's a lesson I'm still learning..

Prayer meeting sharing: What makes an Olympic Gold Medal Christian?

As the Corinthians were having their own version of the Games, Paul was preaching this to them.

1 Corinthians 9:24-27

Do you not know that in a race all the runners run, but only one gets the prize? Run in such a way as to get the prize. Everyone who competes in the games goes into strict training. They do it to get a crown that will not last; but we do it to get a crown that will last forever. Therefore I do not run like a man running aimlessly; I do not fight like a man beating the air. No, I beat my own body and make it my slave so that after I have preached to others, I myself will not be disqualified for the prize.

1. All of us must have the desire to win the prize
As Christians, we want to win God's prize. Run to win the prize / hit the mark, not just simply for the sake of it. All of us like to win prizes, be it during our school days or when we take part in sports, even Christmas presents and lucky draws. God made us with a natural desire to be winners. In this case, not just any prize, but the prize that lasts forever. Example: You can't really bring your university degree to heaven and say you are an engineer, right? What is there for you to build?(That being said, doesn't mean don't study hard ya :p) Hence, all of us must set goals in our lives. Inspire people around us and in church to do so.

2. Need to go into STRICT training.
We read about swimmers like Michael Phelps breaking Olympic records and winning more than 6 gold medals already. Swimmers like these have been swimming since their teenage years (probably 14+). The Chinese identified young gymnasts' with potential at a very young age, and train them with one single focus towards performing their best in the Games. In order to win the prize, need to be trained so that we know how to be more effective in serving God. Of course those who have gone through university feel more confident in undertaking the job they are in now, otherwise if no form of training (eg university degree), how to embark in certain professions? Trained people should also train others. Need to challenge people to serve God in various ministries (no matter which group - student, working adult etc).

3. Challenge each other to be in self-control.
While we want to be equipped, we need to be able to control ourselves in the process. Sometimes when we get tired / discouraged / lonely, we don't want to run anymore, as we get the perception that it is too hard to win the prize. But are you willing to pay the price? Not easy.. Encourage one another to persevere and press on.

The need to go to gym more often

..especially after a triple whammy yesterday. What happened was:

A couple and their 2 little daughters entered the lift I was in. The elder one looked up at me (her height was only up to my waist). I was wondering why in the world was she staring at me. Then she blurted out, "UNCLE, why your stomach so fat fat wan ar?"

The parents who were horrified, especially the mum, tried to make amends by saying, "Shh!!!! Cannot like that wan! Faster say sorry to UNCLE."

Just when you thought it was over after the elder sister said sorry, the younger sister repeated the first statement. *swt*

You are very special

from Small Wooden People by Max Lucado

The Wemmicks were small wooden people. Each of the wooden people was carved by a woodworker named Eli. His workshop sat on a hill overlooking their village. Every Wemmick was different. Some had big noses, others had large eyes. Some were tall and others were short. Some wore hats, others wore coats. But all were made by the same carver and all lived in the village.

And all day, every day, the Wemmicks did the same thing: They gave each other stickers. Each Wemmick had a box of golden star stickers and a box of gray dot stickers. Up and down the streets all over the city, people could be seen sticking stars or dots on one another.

The pretty ones, those with smooth wood and fine paint, always got stars. But if the wood was rough or the paint chipped, the Wemmicks gave dots. The talented ones got stars, too. Some could lift big sticks high above their heads or jump over tall boxes. Still others knew big words or could sing very pretty songs. Everyone gave them stars.

Some Wemmicks had stars all over them! Every time they got a star it made them feel so good that they did something else and got another star. Others, though, could do little. They got dots.

Punchinello was one of these. He tried to jump high like the others, but he always fell. And when he fell, the others would gather around and give him dots. Sometimes when he fell, it would scar his wood, so the people would give him more dots. He would try to explain why he fell and say something silly, and the Wemmicks would give him even more dots.

After a while he had so many dots that he didn't want to go outside. He was afraid he would do something dumb such as forget his hat or step in the water, and then people would give him another dot. In fact, he had so many gray dots that some people would come up and give him one without reason.

"He deserves lots of dots," the wooden people would agree with one another.

"He's not a good wooden person."

After a while Punchinello believed them. "I'm not a good Wemmick," he would say. The few times he went outside, he hung around other Wemmicks who had a lot of dots. He felt better around them.

One day he met a Wemmick who was unlike any he'd ever met. She had no dots or stars. She was just wooden. Her name was Lulia.

It wasn't that people didn't try to give her stickers; it's just that the stickers didn't stick. Some admired Lulia for having no dots, so they would run up and give her a star. But it would fall off. Some would look down on her for having no stars, so they would give her a dot. But it wouldn't stay either.

"That's the way I want to be," thought Punchinello. "I don't want anyone's marks." So he asked the stickerless Wemmick how she did it.

"It's easy," Lulia replied. "every day I go see Eli."

"Eli?"

"Yes, Eli. The woodcarver. I sit in the workshop with him."

"Why?"

"Why don't you find out for yourself? Go up the hill. He's there. "

And with that the Wemmick with no marks turned and skipped away.

"But he won't want to see me!" Punchinello cried out.

Lulia didn't hear. So Punchinello went home. He sat near a window and watched the wooden people as they scurried around giving each other stars and dots.

"It's not right," he muttered to himself. And he resolved to go see Eli.

He walked up the narrow path to the top of the hill and stepped into the big shop. His wooden eyes widened at the size of everything. The stool was as tall as he was. He had to stretch on his tiptoes to see the top of the workbench. A hammer was as long as his arm. Punchinello swallowed hard.

"I'm not staying here!" and he turned to leave. Then he heard his name.

"Punchinello?" The voice was deep and strong.

Punchinello stopped.

"Punchinello! How good to see you. Come and let me have a look at you."

Punchinello turned slowly and looked at the large bearded craftsman.

"You know my name?" the little Wemmick asked.

"Of course I do. I made you."

Eli stooped down and picked him up and set him on the bench. "Hmm, " he spoke thoughtfully as he inspected the gray circles. "Looks like you've been given some bad marks."

"I didn't mean to, Eli. I really tried hard."

"Oh, you don't have to defend yourself to me. I don't care what the other Wemmicks think."

"You don't?"

"No, and you shouldn't either. Who are they to give stars or dots? They're Wemmicks just like you. What they think doesn't matter, Punchinello. All that matters is what I think. And I think you are pretty special."

Punchinello laughed. "Me, special? Why? I can't walk fast. I can't jump. My paint is peeling. Why do I matter to you?"

Eli looked at Punchinello, put his hands on those small wooden shoulders, and spoke very slowly. "Because you're mine. That's why you matter to me."

Punchinello had never had anyone look at him like this--much less his maker. He didn't know what to say.

"Every day I've been hoping you'd come," Eli explained.

"I came because I met someone who had no marks."

"I know. She told me about you."

"Why don't the stickers stay on her?"

"Because she has decided that what I think is more important than what they think. The stickers only stick if you let them."

"What?"

"The stickers only stick if they matter to you. The more you trust my love, the less you care about the stickers."

"I'm not sure I understand."

"You will, but it will take time. You've got a lot of marks. For now, just come to see me every day and let me remind you how much I care."

Eli lifted Punchinello off the bench and set him on the ground.

"Remember," Eli said as the Wemmick walked out the door. "You are special because I made you. And I don't make mistakes."

Punchinello didn't stop, but in his heart he thought, "I think he really means it."

And when he did, a dot fell to the ground.

Today, upon further evaluation and pondering, are we like the Wemmicks with many accumulated stars, stressed and concerned whether they will continue to receive any stars, and also afraid that somebody may put a grey dot on them? Or are we like those with many grey dots, who feel that they made too many mistakes or are unable to do much? When we see others excelling in certain things, are we able to remind ourselves that each person has a different purpose? (Jeremiah 29:11 - For I know the plans I have for you," declares the Lord, "plans to prosper you and not to harm you, plans to give you a hope and a future.)

(1 Samuel 16:7 - ...Man looks at the outward appearance, but the Lord looks at the heart."). Funny thing is that we are always compared to as a tree. The tree has 3 main different parts; most important part is the root, then you have the trunk, and finally the fruit on the branches. The root represents one's heart attitude. Your being will eventually be linked to your doing. If the attitude is right, it will be anchored solidly to the ground and spring up a tree trunk which is straight and steady. Then of course, bearing good fruit will come naturally.

Sometimes I wonder; why do I keep having things which I am beginning to hold dear to taken away from me? So much so that at times I'm upset of having to start over from scratch..again, especially when this year has been a challenge. One more transtion period to adapt to for the umpteenth time.

Whatever the case, I will uphold it unto You. If it needs to be done. Coz the theme surrounding QT for the past few days has been to trust and persevere (Connect Journal Day 6 on Matthew 2:13-23; What is God reminding you about the level of trust and guidance He promises to provide over your life?) But I really need understanding..

Addendum:

Psalm 46:1-3
God is our refuge and strength, an ever-present help in trouble. Therefore we will not fear, though the earth give way and the mountains fall into the heart of the sea, though its waters roar and foam and the mountains quake with their surging.

Psalm 121:1-2
I lift my eyes to the hills - where does my help come from? My help comes from the Lord, the Maker of heaven and earth.

Psalm 125:1
Those who trust in the Lord are like Mount Zion, who cannot be shaken but endures forever.

Tag after a hiatus

The Music Shuffle Meme
1. Put your iTunes/ music player/ phone on Shuffle
2. For each question, press the next button to get your answer.
3. You must put down the song name no matter what.

After you’ve answered all of the questions, tag 5 other people and then let them know they’ve been tagged to the meme themselves.
*******************
1.What would best describe your personality?
Sar-vivor - Phua Chu Kang

2.What do you like in a guy/girl?
Forever - Hillsong

3.How do you feel today?
Don't say you love me - M2M

4.What is your life's purpose?
All for love - Hillsong

5.What is your motto?
100 years - Five for Fighting

6.What do your friends think of you?
Hark the Herald Angels Sing - Jewel

7.What do you think of your parents?
Inside Your Heaven - Bo Bice

8.What do you think about very often?
I'm Just a Kid - Simple Plan

9.What do you think of your best friend?
Dreaming of You - Selena

10.What do you think of your crush?
My Immortal - Evanescence

11.What is your life story?
The First Noeal - Charlotte Church

12.What do you want to be when you grow up?
Hymn to the Sea - James Horner, OST Titanic

13.What do you think when you see your crush?
Hallelujah - Hillsong

14.What do your parents think of you?
You are Awesome in This Place - Hillsong

15.What do strangers think of you?
Somewhere Over the Rainbow

16.What will they play at your funeral?
The Time has Come - Hillsong United

17.What will you dance to at your wedding?
My God - Hillsong United

18.What is your hobby/interest?
****Selah - Hillsong United

19.What do you think of your friends?
Amazing Grace (bagpipe instrumental)

20.What song do you listen to when you are sad?
Oceans Will Part - Hillsong

21.What song do you air guitar to?
Heart of Worship - Matt Redman

22.What should be your signature karaoke song?
We Fall Down

23.What is your greatest desire?
Through It All - Hillsong

24.What does next year have in store for you?
Superman theme - John Williams

25.What's your outlook on life?
Ye Qu (Nocturne)- Jay Chou

26.How will you die?
If I Let You Go - Westlife

27.Do people secretly lust after you?
All of My Days - Planetshakers

28.The best advice you will ever get
Let Us Adore - Hillsong

29.What will I be doing for the next 3 months?
Ordinary Day - Vanessa Carlton

30.What do you think of the person who tagged you?
Every Move I Make (Na Na Na)

31.What will your future mother-in-law be like?
Ni Bu Jai (You're Not Here) - Wang Lee Hom

32.What is the favourite song of the doctor who will help deliver your baby?
Sovereign Hands - Hillsong United

33.If you wrote a book, what would it be about?
The Polar Express - Tom Hanks

34.What sort of world ruler would you be?
Southampton - James Horner, OST Titanic

35.Will you ever get a dog or cat?
It is You - Hillsong

36.What would you say at your Oscar/Nobel prize acceptance speech?
If We Hold On Together - Diana Ross, OST The Land Before Time

37.What is your superpower?
You're the Only One

38.Why are you attracted to enigmatic brooders?
All Rise - Blue
************************

I tag anyone who reads this blog.

My 1st mock paper :p

Leong GWK, Looi JK (2008), A case study on laughter - The best medicine? Or a potential cause of death? Annals of MED3062, 1:1-2

Abstract
Laugther has long been considered as an activity to stimulate the release of endorphins (endogenous morphine) in our body, which brings about a sense of happiness. In our case study, the effects of laugther were examined as it is unusual that an intense bout of laughing will cause syncope. Syncope can be considered as a natural protective mechanism which kicks in when cerebral perfusion is reduced. By falling onto the floor, the effects of gravity is eliminated and hence more blood can be channeled to our brain. Our evolution has not caught up with the current living environment, where the presence of many sharp objects might pose hazards when fainting occurs.

Aims
The study was devised when the 2 researchers had nothing better to do after returning home from a dinner cum talk on asthma, and felt inspired to conduct an experiment on the respiratory and neurological system.

Method
A 20 year old female patient was stimulated via MSN with a statement that she likes lalas. This was followed up by another statement that she has old taste, since the researchers were told that she was excited to meet up with a distinguished guest of our university from Australia (who happens to be an elderly gentlemen), so much so it was rumoured that she wanted to hug him if possible. The researchers waited for the subject to respond.

Results
True enough, the subject called up one of the researchers and started laughing and hyperventilating non-stop. The duration of the incident was recorded to have lasted 2 minutes before the subject hung up. The incident was witnessed by the subject's housemate, who was at hand to provide assistance when the subject experienced syncope as a result of hyperventilation, laughter and suspected vertigo attack preceding the syncope. The researcher's consider themselves fortunate that the subject did not refer the incident to an ethics committee, which would have barred the researchers from conducting such nonsensical experiments in the future.

Discussion and conclusion
A literature review conducted reviewed that the only related study so far was performed on a man. Findings from this case study may prompt the need to find out more about the effects of laughter (good or bad) in females via a larger study, since it was shown that women handle stress better than men. Also, there is also a need to exclude the diagnosis of hysterical attack in this case which fits the above description.

No doubt the benefits of humour cannot be denied. However, the risks of inducing intense laughter in a patient with a medical history of vertigo cannot be ignored. More studies will need to be conducted before laughter is being labelled harmful to health in these and other related groups of patients. All in all, we hope that this case study will not discourage people from laughing more.

Also, the researchers will bear in mind to take a proper history and perform a thorough physical examination, to ensure that the subject does not have any risk factors if recruited for future studies, which may include pregnancy, allergies, chronic alcoholism or altered mental function. The researchers may also consider some form of mass stimulation with rescue medication back up to improve the power of such studies if ever conducted in the future. No confidence intervals / statistical methods were employed because the researchers did not fully understand the principles of evidence-based clinical practice as classes on it were conducted too early in the morning.

References:
1. http://yougotanna.blogspot.com/2008/07/1.html
2. http://en.wikipedia.org/wiki/Lala_%28disambiguation%29
3. Bloomfield D, Jazrawi S, 1995, Shear Hilarity Leading to Syncope in a Healthy Man, JAMA, 293:2863-2864
4. Taylor, S, 2000, Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight, Psychological Review, 107(3):411-427

My brain is among the clouds

1. Was sick yesterday. Have been feeling tired and the urge to sleep alot too lately.
2. Was stressed over post-V&P interview, now have to decide whether to return the membership form on Wednesday.
3. MCR (ie monthly practical exam) went on longer than expected as there were 2 students doing it today (examiner was busy last week due to AMC visit.. but the case we were assigned was GIT / abdomen. How do you find an abdominal case in an outpatient clinic of which majority of patients come in with hypertension . diabetes?)
4. As a result of the MCR, I was unable to attend bedside teaching today. Our surgical bedside tutor was damn pissed coz as a result of some miscommunication, other group members didn't clerk patients beforehand 2 be presented. As a result, all had to bear the brunt of various not so nice words coming out from him lar.. "atrocious, unprofessional, worse than the group before this, horrible, lazy, not seeing enough patients, how are you going to become good clinicians, disappointing, last time we all camp out in the wards to look for cases and now u guys would rather sleep instead of showing up for ward rounds etc" And needless to say, there was a lot of explaning to do lar, since he also walked from the wards all the way up to the clinical school to hammer the faculty staff..

Overall, a lousy day for me.

Addendum: Thank you to someone (you know who you are) for cheering me up with this:
Ah Beng was asked to make a sentence using 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. Not only did he do it 1 to 10, he did it again from 10 back to 1. This is what he came up with...

1 day I go 2 climb a 3 outside a house to peep. But the couple saw me, so I panic and 4 down. The man rushed out and wanted to 5 with me. I ran until I fell 6 and threw up. So I go into 7-eleven and grabbed some 8 to throw at him. Then I took a 9 and try to stab at him. 10 God he run away.

10 I put the 9 back and pay for the 8 and left 7-eleven. Next day I called my boss and told him I was 6. He said 5, tomorrow also no need to come back 4 work. He also asked me to go climb a 3 and jump down. I don't understand. I am so nice 2 him but I don't know what he 1.

The Dark Knight

Went to watch The Dark Knight with a few batchmates last night. Although it's super long (2.5 hours), I must say it was money well-spent on an awesome show. Never knew that watching Batman can be this exhilirating.

However unknown to many, residing in Sri Samudera was someone, who at one point in time back in Melbourne probably (or at least he thinks he does) bore some resemblance to our favourite cape crusader lolz

Umm.. ok, maybe not..

Of conversations and a run in the gym

GaryLWK86 - Making a difference. Dream big. says:
holidays was abit redundant
GaryLWK86 - Making a difference. Dream big. says:
ie no work done
GaryLWK86 - Making a difference. Dream big. says:
though i tried.. lol u had fun?
S says:
i had a very good break
S says:
didn't study much, however got lots of time to think
S says:
and lots of time to change myself
S says:
so, ya...i'm done being a fool and i'm done acting stupid too
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
oh?
S says:
yeah, believe it or not... i have changed
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
in terms of?
S says:
everything...
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
except height haha..
S says:
yeah...that's true
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
i was expecting a "GARY!!!"
S says:
haha....it will come soon...sometimes soon along our conversation
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
ya, haha.. bt wats d reason lar
S says:
well, i was thinking too much, i was very childish and as the result...i hurt those people who really mean alot to me...i don'T want to be like that anymore
S says:
all those were just foolish acts
S says:
now that i got second chance, i will not ruin it anymore
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
*nods* hehe.. wish we all think like dat
S says:
why? what makes you say that? it seems like you had similar experince...
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
haha.. at times lar i guess
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
knowingly or unknowingly..
S says:
you mean you did act childish and hurt lots of people feeling, or...someone who means alot for you...hurt your feeling?
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
i think it cuts both ways
S says:
definitely...and it hurts so much
S says:
when i feel hurt, the other person felt the same way...
S says:
it's not fair for them
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
its give and take lar
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
whether u like it or not
S says:
again, you are right
S says:
Gary, congratulations! I'm really impressed with you and your way of thinking
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
thinking and putting it into action are 2 different stories ya
S says:
it is
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
slowly lar.. it has 2 start sumwhere
S says:
of course
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
n besides, nobody's perfect
S says:
i think you have grown up alot
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
ya.. and fatter too
S says:
not really, la...a bit only
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
bt still haf my own childish mindset on certain things
S says:
it's ok to be childish sometimes
S says:
you know...correct me if i'm wrong, but one thing that i notice last semester and all this long, was that you were actually someone who felt very insecure from time to time, do you think so?
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
in a way yes
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
but learning 2 deal with it lar day by day, 1 step at a time
S says:
yes, i can see that
S says:
i saw it today how you can slowly managed your feeling of insecurity
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
?
S says:
you know when people are insecure, they are unstable
S says:
that's how i felt when talking to you all this long...but i felt that you were much more stable today
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
u'll b surprised if i tell u dat past few months or so my emotional instability fluctuates
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
haha
S says:
yeah...i don't think i need to say much, you know yourself best
S says:
but no, i'm not surprised, i knew it all along that your emotional instability fluctuates a lot
S says:
that's why i didn't talk much with you last sem
S says:
i wasn'T in a very good emotional state as well...
S says:
i wasn't trying to avoid anyone, but i need my own time and i don't want to make anyone worried....that's why i withdrew myself from everyone
S says:
Gary, r u back?
GaryLWK86 - Making a difference. Dream big. Public holiday. says:
yea.. bt wanna to sleep dy.. tired
S says:
ya, me too
S says:
i was about to tell you that i want to go to sleep too
S says:
maybe we can talk again some other time
S says:
good night
S says:
bye
____________________________________________________________________

I can usually only run 1.5 km on the gym's threadmill, but for past few weeks (despite some weight gain), I've been desiring to run more. I clocked up 2.8 km on a few attempts. Duno lar.. on those few occasions, just felt like wanting to keep on running more and more, despite my legs giving in already. And surprisingly the more I ran, the leg power seemed to somehow have a backup source of energy just when it appeared to be running out of steam. Got reminded that in the race we are currently running now - no matter what comes our way, how hard, hopeless, empty and miserable it may seem, it is in such times that one realises that there is a need to press on and go for broke until the end of the finish line.. There is a need to desire to see some things come to past at the end of the day.

Reminded of my theme song at the beginning of the year..

So wrong..

Went to the surgical ward for the 1st time today.. and being just the 2nd day back from holiday, felt like the blurrest person on the face of the planet.. It was a female surgical ward, and I was clerking patients for an afternoon bedside teaching. It was an old Malay lady who was admitted for appendicitis lar.. due for surgery that evening. Took her history but later realised that I needed to do a physical examination on her too.. At the same time, she requested to borrow my handphone, which I said I didn't bring, so she turned to another stranger who happened to be a relative of another patient in the ward and kindly lent her his phone. She even offered to pay that guy back, which he refused.. Duno lar, as much as a friend told me that we are bound by professional guidelines, coz if anything happens we could be dragged into the mess, still feel not so happy lar, as in - "Why the barrier of being afraid that this elderly lady doing something to your phone? Couldn't it be practised as a simple act of showing kindness, rather than sticking to a rule which even sounds vague and subject to debate.."

Anyway, back to the physical examination. The surgical ward is unlike the medical ward (beds in medical wards are crowded into cubicles surrounded by blinds each, while surgical wards only have screens, and the beds are lined up parallel against the wall like a corridor). Before I proceed, I approached one of the staff nurses and HO's on the wards. "Hi, *trying very hard to smile* and act innocent good morning ya, I'm a medical student, and I'm posted here for the next few weeks or so.. I was wondering ar, coz you guys don't have blinds right? So how ar if I wanna do physical examination, coz it's a female ward.. any idea how the previous batch of students did it?" The female houseman said she doesn't know, the staff nurse commented that if it's only minimal exposure, then the patient probably won't mind lar..

So I proceeded with my last minute abdominal examination 15 minutes before the supposed bedside teaching, without a chaperon (coz it's abit last minute for me to save face from getting scolded by the tutor..) and with the patient's permission, exposed her from the lower border of her breasts all the way down to the pubic region.. The thing is, it was visiting hours. Relatives of the patient just beside us, and other patients ended up turning their heads towards our side as if there was some kind of free show.. and hence, got told off by the Ward sister for not using the screens.. super embarassing..

And on another note,
Me (holding an X-ray film): Hi Dr R, I'm a medical student. It's my 1st day and I'm abit lost. I was wondering whether could you tell me where is the X-ray..box.. Oh, it's there behind you.. (*swt*)
Dr R: It's not working. Maybe you can hold it up against the sunlight with the window as the backdrop..

Oh well, and to top things up, here are some photos from JB which somehow to me seem just either 'sesat' or wrong..



Acknowledgement: Photos courtesy of Anna

Don't quit

One day I decided to quit.
I quit my job, my relationship, my spirituality. I wanted to quit my life. I went to the woods to have one last talk with God.
'God', I asked, 'Can you give me one good reason not to quit?'
His answer surprised me.
'Look around', He said. 'Do you see the fern and the bamboo?'
'Yes', I replied.
'When I planted the fern and the bamboo seeds, I took very good care of them.
I gave them light. I gave them water.
The fern quickly grew from the earth.
Its brilliant green covered the floor.
Yet nothing came from the bamboo seed. But I did not quit on the bamboo.
In the second year, the fern grew more vibrant and plentiful.
And again, nothing came from the bamboo seed. 'But I did not quit on the bamboo.' He said.
In year three, there was still nothing from the bamboo seed. But I would not quit.
In year four, again, there was nothing from the bamboo seed. 'I would not quit.' He said.
'Then in the fifth year, a tiny sprout emerged from the earth. Compared to the fern it was seemingly small and insignificant. But just 6 months later the bamboo rose to over 100 feet tall.
It had spent the five years growing roots. Those roots made it strong and gave it what it needed to survive.
'I would not give any of my creations a challenge it could not handle.'
He asked me, 'Did you know, my child, that all this time you have been struggling, you have actually been growing roots?'
'I would not quit on the bamboo. I will never quit on you. Don't compare yourself to others.' He said.
'The bamboo had a different Purpose than the fern. Yet they both make the forest beautiful.'
'Your time will come', God said to me. 'You will rise high'
'How high should I rise?' I asked.
'How high will the bamboo rise?' He asked in return.
'As high as it can?' I questioned.
'Yes.' He said, 'Give me glory by rising as high as you can.'
I left the forest and brought back this story.
I hope these words can help you see that God will never give up on you.
Never, Never, Never give up.
For the Prayer is not an option but an opportunity.
Don't tell the Lord how big the problem is, tell the problem how Great the Lord is!

Thanks Chloe for the encouraging message at a time when I needed it.

Modifying a previous recipe (although not so pretty, still can eat)

Looks familiar? :p
Recipe get from here.
The idea of adding apples comes from a fellow dear friend's aunt..

2/3 weeks of holidays - I'm bored

1st week
Slogging to help finish compiling the AMC report
Recover from a sleepless night of food poisoning + high fever
Driving from Sungai Petani (Kedah) to Kuantan

2nd week (this week)
No friends back yet, so bored..
EMO-ing
Oversleeping
Euro 2008 fever (annoyed that Holland got knocked out, but at least Russia was fun to watch)
Trying to somehow finish reading:
- Chest X-ray Made Easy
- ECG Made Easy
- Robbins Basic Pathology (whatever that is relevant for sem 1): but due to thickness, probably won't finish..
- 3 Narnia books (will continue into week 3 if can't finish)
Practise driving mum's manual Toyota Corolla (while Kuantan traffic is still manageable)
New car for JB in a few months time? I like the Persona, but I try not to complain as I don't need such a big car now (harder to park + 1.6 = higher fuel consumption right?), so maybe a MyVi. (As a cost cutting measure in conjunction with petrol price increase, manual has less fuel consumption right? But that means I can't multitask while driving as compared to auto.. pfft)
Thinking of what to wear for friend's brother's wedding
Attempting to clear my laptop of tonnes of junk
Photo uploading spree on Facebook
Exercising everyday (forcing myself to jog a few rounds around the park; at least one round non-stop 15 minutes)
Treated a friend for birthday

What I'll probably do in Week 3
Go KL
Buy Surgery at a Glance (and ECG Made Easy if the new 7th edition has arrived, yes I know I'm obsessed with getting latest editions of books)
Go Monash to finish up my print quota from sem 1 (since JB does not have print quota)
Try to catch up with friends from Monash (CF or Year 2's or whoever lar I can grab hold off or who wants to grab hold of me) and Hope PJ..

Theme song to start off semester 2

Random holiday blues

1. I do not recommend taking the express bus from JB to Kuantan via the winding, uneven Mersing coastal road, especially if the driver thinks he is Kimi Raikonnen on a wet day.

2. I hate doing redundant work during holidays. (people I know will know that I mean)

3. I want a new car.

4. It's disheartening to realise that in the midst of my busy-ness, I kind of lost touch with a lot of people from my yesteryears, not to mention missed birthdays and forgotten faces as well..

5. I think I prefer to do work and remain in denial during the semester, than spend my holidays revisiting certain headaches that just won't go away.

6. After 1 semester, I just can't help but have the tendency to ponder whether during our 1st 6 months here, have we truly made a difference..

7. But I left JB last Sunday with a sense of hope that certain things which start small will bear fruit at the end of the year.

Things future doctors do in their mock OSCE

Station:
Mr X is a 53 year old asthmatic who came in to your GP. (followed by other patient details etc)

1. In 2 minutes, take the patient's history and try to elicit the severity of his asthma.
2. Measure the patient's peak flow.
3. Educate the patient on the use of an asthma medication.

Comments from tutors:
1. Use of medical jargon. (eg asking the patient things like, "How's your respiration?", "..inhale, exhale, peak expiratory flow etc"
2. Question: There is a glass of water here. What do you think it's for?
Correct answer: To rinse the mouth after using the inhaler, ie get rid of corticosteroids etc
Some of the answers given by students:
a) "Oh, if the patient feels thirsty ar, after the peak flow test and medication taking, he can drink it lor."
b) "If you don't know whether the inhaler medication is empty, you can put it into the water and see whether it floats or sinks."

The usual end of semester clinical skills log book + assignment rush

Of old people and venepunctures..

The thing with knowing a little bit more Mandarin (now that I'm in JB), is that you know what patients say about you (especially when it comes to criticism).

Went for blood taking today (coz of the mad dash to fill up the log books for physical exam and procedural skills before end of semester.), and did quite ok lar (for someone whose last venepuncture was 4 months ago), success rate of around 60%, (minus thom I pass to the staff nurse because their veins were hard to find).

There were 2 stations in the procedure room, and patients were lining up beside the tables lar.. 2 funny things happened lar:
1. While pricking the finger of a lady for glucometer testing, she jumped up of the chair. That was how sensitive she was to pain.
2. Second lady whom I pricked for glucometer asked me why am I shivering when I held her hand.

Then there was this Chinese lady who brought her mother for blood-taking. As me and a few of my group mates were practising, the lady (cradling a child), was standing at the door, complaining / nagging "Ni kan, chuen pu shi shue de leh.. chuen pu san ge shi shue de leh.." (ie Aiyoh, you see.. all 3 of them are students leh, students learning how to do stuff).. She repeated that same phrase at least 5-6 times that even while taking blood from other patients, that I felt annoyed having to listen to such distractions (we know who we are, so shut up and let us do our work lar). Then her mum's turn came and she sat beside me lar. Her mum asked me, "You doctor ar?" The staff nurse clarified to her that I'm a medical student doing my practical in blood taking. Her 1st reaction was to jump out of her seat and say, "Har??? Pelajar saya tak mau, saya mau missy cucuk" (Huh, I don't want students to poke me? I want the nurse to do it!). The nurse persuaded her that if she doesn't let us learn, how are we going to become competent doctors in the future.

I mean, fine lar.. if she doesn't want me to do, I can proceed with other patients, it is her right to refuse. What did she end up doing instead? On the spot, she went on ranting and grumbling in Mandarin on 101 reasons why she doesn't want students to do procedures on her (eg students don't know how to do procedures lar, painful lar etc etc). Even when I was changing into a new pair of gloves since there was blood on the old one (but I wasn't in a hurry to do so) she remarked that I don't know how to put on a glove properly - in plain sight of everybody lining up. *sweat*

And you have patients who tell you bluntly in the face, "Sorry ya, I want the nurse to take my blood, I don't want to become your guinea pig today."

Anyway, on a lighter note, bumped into a fellow church member from family group, who was visiting her father in Ward D for cancer and TB I think. Found it amusing for her young son to call me 'kor kor'.. (eh, at least he doesn't call me 'Uncle')

Today at the clinic, we saw a female Indian hypertensive patient. She had her whole uterus and ovaries removed, and apparently was rather depressed lar coz her husband divorced her after she could no longer fulfil his sex drive. Found out that she was a towkay (boss), maybe doing business. I was walking back and almost reaching home when she pulled over and offered me a ride, in her Mercedes E320! (quite some time already lar the model, but still..!! I kindly turned it down lar though, since I'm arriving at the front gate of my apartment already :p lolz).