Kite runner

Currently listening: 4Him - Be thou my vision

As we celebrated our 53rd National Day, our lifegroup came together and drove to Pasir Gudang on a hot day for an outing at Muzium Layang-layang. I believe that everybody had fun, amazing to see the excitement on everybody running off to fly their kites after the workshop and museum visit, and also to pray for our nation. We also spent some time making kites as a group, where like it or not, really need to learn to be patient and accept each other's different styles of doing things.

Winner of the kite-making activity depends on 2 criteria: creativity and flyability. Ethan's group decided to apply the basic method of designing the kite - the tried and tested diamond shape. Some of us actually went for the 'Wau Bulan' design.. Most of us, even himself wondered whether it will work out, whether his 3 diamond-shaped kites glued to each other to form a 3-storey structure will actually lift off. In the end, as he sprinted across the field with a string in hand, tugging the kite behind him against the wind, it turned out to be the one which soared the highest, and helped remind us to continue believing in things which seem impossible / yet to be seen happening.

Dominic and Jing Jing shared a relevant point - today as the times are becoming more developed and technologically advanced, the way we do things might change, so will the mindset of people, but the principles of God's word remain the same. It is a truth which has been proven to work for many generations. Therefore, as we soar higher like the kite, let us continue to remain grounded in God's word and not go astray, like the kite attached to the string of its maker.

Overall, it was an tiring but fun day. Happy 53rd birthday Malaysia :)

Photo reference: http://maplewood.blogs.nytimes.com/tag/floods-hill/

As it rains..

A pretty wet week to end my emergency department rotation.

I learnt that in emergency medicine, you cannot forget your anatomy and physiology.

Chinese patients can be difficult to please. Was asked to look for the patient card for a patient, and my mispronunciation of the patient's name earned me a sarcastic jeer from his wife, "You are Chinese, but don't know how to pronounce people's name properly.."

1 elderly patient with bladder cancer was brought in for body weakness, diagnosed with urinary tract infection. He was supposed to have an appointment with the oncologist at Hospital B*, but the wife thought that he was wrongly sent to Hospital A* where I am posted. The patient was discharged with antibiotics, and the initial plan was for him and his wife to go to Hospital B by taxi, but he complained of being weak and in too much pain to walk. The MO told her directly that there is nothing left for them to do, and despite repeated pleas, they cannot afford to use the hospital's limited number of ambulances to transfer the patient to Hospital B. The option of hiring a private ambulance service was deemed not worth the cost. Eventually, when nobody was looking, I took her aside and explained nicely to her that there is nothing we can do, since it is a policy set in place, clearly delineated.. She promised not to tell the doctors that I lent her my handphone to call her relatives to come and transfer her husband (I know I'm not supposed to, but it's something off the record as I see the need - of course I won't do it to everybody). I think she felt touched lor, as she replied in Cantonese "Thank you ar doctor, you are really a kind person." I think it's a sad case, as she can be heard cursing over the phone of how increasingly cruel and heartless the doctors in government hospitals are becoming, all simply because of a lack of empathy as people are just interested in getting their jobs done.

A baby was discharged from the neonatal ward with a poor prognosis of anencephaly (or some brain problem lar). The next morning, the parents awoke to find their child not responsive, and was most probably no more. They made a police report, and by right the police were supposed to arrange for a post-mortem and some kind of burial permit at the mortuary. It was not done. Before coming to the emergency department, the father brought the dead baby to the ward, going berserk when nobody bothered to explain to him what to do. When it was finally settled, I think it's ridiculous and disrespectful to observe undertakers from some casket company harassing and negotiating the cost of burial from the parents, trying to earn a living at a time when people are in grief.

End of medical posting + Love never fails Part 2

1. Pretty bad coughing fits for the past week or so, then Sunday had an onset of headache, fever, sore throat (no I don't have H1N1 - I took the vaccination 3-4 weeks ago). Bedridden for days, even dragging myself to the clinic under my supervisor becomes a chore.. Paying RM1 at the outpatient clinic for bacampillin (antibiotics), panadol and loratidine (antihistamines) did not work out - though they thought it's my usual pharyngitis secondary to post-nasal drip, as I do get allergic rhinitis from time to time, so had to look around JB in a taxi for an open clinic on a public holiday. Paid RM90, but the GP felt that it could be an infected rhinitis with underlying mycoplasma infection, so he gave me some stronger drugs (Azithromycin, Theophylline, Eterocoxib and Pseudoephedrine). Today felt much better..

2. Did my MCR with my academic supervisor for a 2nd time coz he expected and drilled me and my partner to do better. Really thankful for the privilege of having such a bedside tutor. Not to say it was my best performance (I know its formative), but I thank God for quite high marks, and the joy of discovering what the patient had (initially I had suspected TB / lung CA), but found nothing on respiratory examination - got told to repeat my chest examination more thoroughly, and to my surprise there WAS indeed dull percussion note on the right lower lobe, with bronchial breath sounds on auscultation!

3. Got reminded during devotion of the following verse:

When they had finished eating, Jesus said to Simon Peter, "Simon son of John, do you truly love me more than these?"
"Yes, Lord," he said, "you know that I love you."
Jesus said, "Feed my lambs."
Again Jesus said, "Simon son of John, do you truly love me?"
He answered, "Yes, Lord, you know that I love you."
Jesus said, "Take care of my sheep."
The third time he said to him, "Simon son of John, do you love me?"
Peter was hurt because Jesus asked him the third time, "Do you love me?" He said, "Lord, you know all things; you know that I love you."
Jesus said, "Feed my sheep. I tell you the truth, when you were younger you dressed yourself and went where you wanted; but when you are old you will stretch out your hands, and someone else will dress you and lead you where you do not want to go." Jesus said this to indicate the kind of death by which Peter would glorify God. Then he said to him, "Follow me!"

-John 21:15-19-

Why did Jesus had to ask Peter 3 times? Not that He is deaf, nor that He got nothing better to do, I believe it's coz:
1. People tend to be forgetful (especially when they become caught up with things).
2. We do not really mean it, or perhaps it has gradually become a routine (ie we might look fine from the outside based on the things we do, but unknowingly on the inside God is searching your heart for where your true motives lie)

4.
Watched an interesting movie titled 'I am Sam' during prayer meeting, and had a short but good sharing time with my shepherd. Synopsis as follows:

Sam Dawson (Sean Penn), a man with a developmental disability, lives in Los Angeles, works at Starbucks, and is the sole guardian of his six-year-old daughter Lucy (Dakota Fanning), after her mother abandoned them. Despite his limitations, Sam is well-adjusted and has a supportive group of friends with developmental disabilities, as well as a kind neighbor Annie (Dianne Wiest) who takes care of Lucy when Sam cannot. Though Sam provides a loving and caring environment for precocious Lucy, she soon surpasses his mental ability. Other children tease her for having a "retard" as a father, and she becomes too embarrassed to accept that she is more intellectually advanced than Sam. In preparation for a custody case, a social worker turns up at Lucy's birthday party and takes her away, allowing Sam two supervised visits per week.

On the advice of his friends, Sam approaches a high-powered lawyer, Rita Harrison (Michelle Pfeiffer), whose brusque manner, fast-paced schedule and difficult personal life have earned her a reputation as cold and unfeeling. In an attempt to prove to others that she isn't heartless, Rita surprisingly agrees to take on Sam's case for free (pro bono). As they work together to secure Sam's parental rights, Sam unwittingly helps Rita with her family problems, including encouraging her to leave her philandering husband and repairing her fractious relationship with her son.

During the trial period, Lucy is living in a foster home with Randy Carpenter (Laura Dern), but tries to convince Sam to help her run away, and continually escapes in the middle of the night to go to Sam's apartment, whereupon he immediately returns her. At the trial, Sam breaks down after opposing counsel convinces him that he is not capable of being a father. Ultimately, the foster family who plan to adopt Lucy decide to return her to Sam, with an arrangement that Randy will help him raise her.

The final scene depicts a soccer game, refereed by Sam, in which Lucy participates as a player. In attendance are the foster family, Sam's friendship group, Annie, and a newly-single Rita with her son...

It's an interesting observation to see that the very people trying to take away Sam's parenting rights (the lawyer, judge, department of children services etc) on the basis of his inability to provide financially and intellectually for his daughter, these people who actually lived normal lives and whose children have access to every physical need (ie money, education etc). However at times, these are the people who turned out not knowing how to take care of their own children (depicted in the movie through various relationship problems behind the scenes). On the other hand, I think we can learn from people like Sam, though intellectually disabled, in the area of going the extra mile when we care for someone, and being real (rather than putting on a projected image of oneself).

Back to chaos I suppose

Currently listening: Amy Sandstrom-Shoyer - Trust in the Lord

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My classmate commented, "Gary, how can you tell people of such misadventures of yours?! People will think you are a hazard!" It's my way of coping - just coz I tell people or laugh things off does not mean I'm proud of or find it funny, but I suppose it's a humble reminder that I'm surviving daily by God's grace. A friend of mine commented that medical training is perhaps one of the worst forms of training ever - people entrust you with their lives, and you don't know what might happen next with each thing you do.

My ward is PACKED with patients.. It's hot and stuffy, a 9am-5pm day can just leave you exhausted and drenched (patients are sweating despite bringing their own table fans), even with minimal walking. Specimen bags and patient's case notes lying strewn here and there. Things (eg forms, gloves, items for procedures) can just be SO difficult to find, and when they run out, nobody bothers to restock them. Nurses rushing to go off early not giving patients insulin at the right time (need to correlate with meals). A patient who arrived in the ward in the morning being overlooked and not clerked until evening - had to postpone a cardiac procedure. Imagine having to endure the patient's Chinese wife who kept complaining, and complaining, and complaining.. A patient with cardiomyopathy and heart failure symptoms got admitted to the ward from outpatient clinic. The management on the referral letter says '2 pints of normal saline' (ie you know the patient is probably already overloaded with fluid, and you pump in more fluids).

A trick I picked up (to reduce the number of times of the patient being poked, especially if he/she needs daily bloods), is to take blood from the IV cannula after its insertion and flush it later with heparinised saline. However, I think the patient must be wondering why a section of his hand suddenly swelled up like a balloon, but no blood is coming out into the syringe.. when the blood eventually came, it was clotted and unusable - ie houseman need to retake blood, IV needs to be re-done at another site.. *swt*

I volunteered to insert a urinary catheter for a renal failure patient with acute urinary retention due to an enlarged prostate. It seemed normal enough, with little resistance, and when it went in, there was a tiny bit of clot and clear urine flowed out. A few minutes later, I was wondering why the urine was changing to tea-coloured, and subsequently to my (and the ward staff's) horror, the urinary bag filled up with blood (gross haematuria) - had to immediately order blood tests, contact the blood bank to group and hold some blood for transfusion, refer urology for irrigation and ultrasound. Great, will only find out what actually is the problem tomorrow (hopefully not my fault) - what else could go wrong?

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.

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]

Random bits of humour

Long-overdue 1st semester updates - Birthdays of 3J's

Joo's, Ji Keon's, Jia Lin's

Musings in times of busy-ness

A few repeat incidents occured today..

1. In the gynaecology ward, I was flipping through the case notes of the patient I'm following up on, and the nurse asked me how come the file was so thick.. to my surprise, I realised I was reading the wrong case notes. So I reacted sheepishly as I returned the case notes to the patient in the next bed. The middle aged lady in the bed beside my patient's bed told her, "The doctor looking after you very 'cute' leh.. (hen ke ai) eh are you Malaysian Chinese ar? You got the Japanese look leh etc etc" I was like *swt*

2. I asked the specialist to sign my ward round attendance. She commented, "Ur name is Gary ar? Eh, macam itu Spongebob punya siput kan? Nama pun sama."

That aside,
3. I remembered a Vietnamese friend of mine in YA CG last year.. long time didnt talk to her already.. last Sunday I had the opportunity to catch up with her for a while, since it has been quite some time.. I remembered when I first met her then, was very encouraged to see that although she was a foreigner among Chinese, with language difficulties and despite her boss making it difficult for her to attend CG and camps, she still has the heart to try her best to come. I thank God for her testimony which she shared about her life being changed from being a very pessimistic person away from home, to one who found hope in the midst of a family away from her biological family. She is actively serving in Sunday school and recently she shared that she had been retrenched, and might be sent back to Vietnam soon by her employers. But it is encouraging to see her still hanging in there optimistically, and in return she did comment that I changed a lot since my days in YA. I guess in due time, we all need to grow :-)

Reminiscence

Belated AngPao Sunday photos


Currently listening:

My Redeemer Lives - Stream of Praise

Little things..

Exams over already, but I'm thankful for my shepherd lor yesterday afternoon for driving down all the way from Skudai to pass me a bottle of chicken essence as a little token of encouragement :-) It rained super heavily after that, so I was actually wondering how did he drive off to Jusco Taman Universiti after that..anyway, thanks!

Philippians 4:6-7 Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests unto God. And the peace of God, which transcends all understanding, will guard your hearts and minds in Christ Jesus.

MEDBALL 2008

For more photos, do visit my Facebook :p

Conversations

1. Just finished class and was walking home from the wards last week.
Out came a man in a wheelchair grimacing in pain due to a leg ulcer.
A Chinese lady wheeling him appeared lost, wondering where is the clinic. I couldn't speak much Mandarin, so she spoke to me in Bahasa Melayu.
A daughter with dyed hair and punk clothes scolding her mum loudly in public as to why she was wasting her time trying to speak to me in Bahasa Melayu if I could speak Mandarin. Had to explained to her that my Mandarin was limited, then she shyly apologised. Anyway, walked the family to the Mahmoodiah outpatient clinic. Ms punk said "Mmm koi sai yi sang kor kor." ("Thank you doctor." in Cantonese)
*walks back home, shakes head at what has become of today's younger generation*

2. Went to City Square to buy mooncakes. Upset that most were already sold out 2 days before mid-autumn festival. Decided to buy a few of those biscuits shaped like rabbits and fish (inside got lotus paste). Asked the promoter how much were they selling it for. "RM5 for 3, sir. You can mix and match whichever ones you want to buy - rabbit or fish for your children."
*swt*

Blood donation

Those who are interested, please let me know :-)

Mid-autumn 2008

Mooncake caregroup group photo :p

Haha, lantern and mooncake season last week.. Ever wondered where the story of mooncake started? Of course there's this legend / myth about Chang 'Er who drank the elixir of life to save her people from her husband's tyrannical rule, and hence became the lady on the moon. The historical version which I find to be more logical is that the rebel leader in China found out that Mongols do not eat mooncakes, and hence managed to trick the emperor into distributing mooncakes with secret messages stored inside for fellow rebels, "Kill the Mongols on the 15th of the 8th lunar month.". This apparently led to the eventual downfall of the Mongol dynasty, and China was free.
Me and my lantern :p
Evolution to become tanglung monster lolz
Fulamak.. like Transformers :p

Posers as usual :p

Honour God and He will honour you

After finishing 3 days of Hope JB's bible conference, it's rather discouraging lar to get scolded badly with a earfull by parents for not planning the holiday trip back for Hari Raya in advance, coz newspapers reported that bus tickets to the East Coast (apparently the most popular destination for the season) has been sold out 2 days ago. Was busy with my MCR and assignment last week, so no time to read newspapers lar.. anyway, when in doubt of what to do, pray lar :p

It doesn't help that it was raining cats and dogs in JB in the afternoon. Amazing that the rain stopped the moment my shepherd whom was fetching me home from Skudai arrived at the Larkin bus terminal :-)

It doesn't help that when we arrived in Larkin, there was a massive traffic jam and the place was loaded with taxis. Then out of nowhere, a car reversed out and there you go; a parking space :-)

It doesn't help that in a terminal crowded with people, you see the notice at the bus ticket counter 'East Coast tickets for Hari Raya season to Kuala Terengganu-Kota Bharu-Permatang Pasir from 26 September-9 October has been sold out.' What more, JB is not like KL which has buses leaving every hour, here it's like 2 trips in the morning, 1 in the afternoon and 1-2 at night to Kuantan. Logically speaking, and also from experience, confirm gone case already (coz the same thing happened last time while in KL, and tickets were sold out long in advance). But somehow I'm thankful that I still manage to get a ticket to Kuantan; the best part is that it enabled me to leave after Sunday service (28 September, 3pm) and I even managed to buy a return ticket to come back on Saturday (4 October) so that I don't have to miss next day Sunday service :-)

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

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*

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..

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