Malaysian medical student goes Aussie

Day 2 of neurosurgical posting

Registrar: Eh you, later you scrub in ya, assist me with inserting a ventriculoperitoneal shunt. You know how to scrub in, right?
Me: (blur look since I last enter an operating theatre half a year ago) Err..yeah? U mean the handwashing and gowning part right? *proceeds to show handwashing gesture*
Registrar: .....*horrified look*.... Oh.my.lord..
Nevertheless, I remembered a bit here and there, and managed to assist during the surgery.

Next we witnessed a craniotomy for a patient with small cell lung cancer metastasised to the temporal lobe. My consultant supervisor joined in and operated.
Registrar: Gary, come over here and help me with the computerised CT scan.
Me: Ok! *rushes over and pressed the monitor screen a few times*
Everyone: *again, a horrified look*
Registrar: Ehem.. Hello dude, its not touchscreen lar.. the mouse is over there.

I put a stool behind the surgeons who are operating so that I can stand on it to have a clearer look. Another medical student who was assisting didn't see it, and tripped, and..... (on 2nd thought, never mind)

Nearly walked into the glass wall of the emergency department.

Registrar said nothing much in the wards, so can go home early - 4.30pm.

Triple post

Back to the start, where a new beginning awaits (I hope)
It has been a journey back to where it all started.. Before I came to Australia, one thing shared that has been a struggle and prayer point for me on behalf of my shepherd and caregroup in JB is the need to learn to listen and be humble. So happened that somehow that point hit home when the 1st Sunday service I attended here - the topic was none other than, 'Putting on the mantle of humility'.. How God works in higher ways I just could not comprehend :-) I'm only here for 12 weeks, still seeking God of what I should do (or can do) in those 12 weeks, and also in terms of decision-making. Things I observed of what people do, and listened of what some said, actually made me ponder on why we do the things we do..

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Currently listening:

改變我，改變世界 (Change me, change the world)
讚美之泉 (by: Stream of Praise)

許多次，我就像是那浮雲，不知要往哪裡去。
(Many times I wander with no future, without a place I could go)
而如今我可以停止追尋，
(Now I know it's Your voice calling out to me)
是你的愛填滿我心，引領我與你同行。
(You've touched my life, filled me with hope, drawing me closer to You)
耶穌我懇求你，來改變我的生命，
(Jesus I ask of You, come change my life forever)
使我在患難之中喜樂與剛強。
(And when all my hope is gone, let me take joy in You)
耶穌我懇求你，使用我來改變這個世界。
(Jesus I ask of You, change me to love and to change the world)
賜我信心與勇氣，邁向這新的世紀，
(With faith I can live each day, to stand and proclaim your name)
願你榮耀的國度早日降臨。
(Establish Your kingdom here full of glory.)

Food outing
We went to Sofias - this Italian restaurant in Camberwell.. and to show you how large the portions are, check my Facebook later when I upload the pix.

Why I nearly KO on Day 1 of Australian posting
My posting is in the city, so since the orientation briefing starts at 8am, to get there required me to wake up at 5.45am (didn't get a good night sleep though, woke up at 2 and 4 am respectively), take the 1st bus from the Halls at 6.37am to Clayton. By the time I got dressed its already 6.30am, so I had to dash to the bus stop although was feeling super sleepy like a zombie.. Upon arrival at the hospital, after a short orientation briefing, we were sent to look for our supervisors. Mine for cardiothoracic surgery was away, so we decided to look for the neurosurgery one instead.

As we entered the seminar room, he was seated there, and looked at the 3 of us one kind.
Consultant: Now, I might as well be honest and give you the shock treatment now, so that you guys can work harder later. Firstly, I don't care what you think of me, but I will not hesitate to fail you if I'm not happy with your performance - and I will not apologise for it, for I am a very hard person to impress. You should count yourselves privileged that this is the most sought after rotation in the whole of Monash, with over 100 students fighting for it, and sorry to say that we can only accomodate limited students at any 1 time (around 3-4). Is this your 1st choice?
Me: No, we were allocated (do we have a choice? apparently Australians do have a preference).
Consultant: Ok.. tell me, what will the patient with L5 radiculopathy present with?
A group member: Foot drop.
Consultant: Yes, foot drop! Both of you knew it but hesitated. I don't like that. This will not be tolerated. I'm going to give you both homework - pick 1 of back pain or neck pain. 1stly, come up with a 20-minute presentation on the topic regarding causes, reasons for referral, evidence-based treatment etc. And I want PEER-REVIEWED JOURNALS.. Don't copy and paste from textbooks or websites coz that insults our intelligence. 2ndly, clerk a patient, follow that patient pre-op, during the surgery and review him post-op, then present to me a detailed long case. These 2 will contribute to me marking your PIA assessment, clear?
Me: *swt*
Later got clinic from 2-4.30pm, and I asked the registrar whether we are done for the day, and he told me to ask the consultant.
Consultant: What? Eh, you come here.. *points to registrar* Medical student wants to make a move wor.. How ar? Not yet even 6pm.. I tell you what, this hardworking registrar of mine came and slept overnight at the hospital previously when she was a medical student, and she got to see all the late night exciting cases.. She is on call tonight. You follow her to the wards now, and do whatever she asks you to do, until she decides to dismiss you. And make sure you come in before 7am for rounds every weekday morning (meaning I have to wake up at 4.45am for the next 6 weeks, since cardiothoracic surgery rounds also start at 7am)..
Registrar: *sympathetic* I think ar, you better not plan anything or go out for the next 3 weeks. Neurosurgery is fun, you see.. but it is only so if you know your stuff.

My quiet time and plans would have taken a beating, and I'm not really the smartest of students (neuro is my weakest point), but as I sneaked in a short devotion over lunch fast and pray, I got reminded of a line from the movie 'Facing the Giants'..

David Childers: Why would God make me so small and weak?
Larry (father): To show how mighty He is.

I know it's a challenging 3 weeks, but I wanna believe that I will pull through by God's grace.

Psalm 121:1-3; I lift up my eyes to the hills — where does my help come from? My help comes from the LORD, the Maker of heaven and earth. He will not let your foot slip — he who watches over you will not slumber.

Busy holidays

26-29 November - Malaysia National Convention, Putrajaya
4 December - Go back hometown, Kuantan
7 December - Back to JB: helping someone with exams
9 December - Down to KL: HIV Summit in Sunway from 10-12 December
14 December - Medical checkup in KL for visa, then back to Kuantan
18 December - Back in JB: Farewell my housemate
23 December - Christmas caregroup
24 December - Hope JB Christmas countdown
26 December - Fly down from JB to Penang
27 December - Cousin's wedding in Ipoh
29-30 December - Down in JB: Moving stuff out of Samudera
1 January 2010 - Go down KL
2 January - Bruce and Elene's wedding, then go down JB in the evening
9 January - Go down KL to buy stuff and pre-departure briefing
10 January - Back in Kuantan

A beautiful day

7am - Went for an early morning jog at Hutan Bandar. Nice place for devotion and reflection amidst the cool morning air and nature. God reminded me that the best lessons taught are through life examples, more than through words of teaching.

8.40am - Hua Mui kopitiam.. it's been a very long time since I last had 'roti bakar', French toast, half-boiled eggs and a nice hot cup of Horlicks for breakfast. Don't mind passing by Kemaman again for their 'roti kahwin'.

11.00am - As the defining hour draws nearer, felt a sense of peace; I made quite a lot of trivial mistakes, so confidence was not high, but there's a sense of realisation that things are no longer in my hand. I have done my part. Felt like signing out from MSN as panic attacks and freaking-out remarks are flying.. oh well, instead of staring at the PC screen and panicking, time to get something useful done, house chores and laundry will do.

2.45pm - Was told to call uni. Friends are jamming the school coordinator's phone lines, anxious about their fate. Decided to take a walk to uni and print some stuff. Might as well drop by the office and ask.

3.15pm - 3 familiar faces came into sight. Dr Siva offered to shake my hand, "Congratulations." Dr Vanassa looked on and smiled. I looked kind of stoned. "I,..I passed? I don't have to re-sit?". Sister Asmah 'shoo-ed' me out of Monash House 2, "Well, if you want, we can always reserve seat for you. Now go and enjoy your holidays!"

Relief.. elation, joy, words just could not describe it :-) Thank you Lord, for the past 4 years.

14th Malaysia National Convention and Global Conference

The Core Part I covered 5 core values:
Christ Centered, Bible Based, Covenantal Relationship, Life Enriching Community and Holy Spirit Empowered.

The Core Part II should cover these 5:
Vision driven, Disciple makers, Leadership developers, Church planters, Apostolic oriented.

Some random things I don't mind having - Part 1

Flying to Melbourne in an Airbus A380 - biggest passenger aircraft in the world

2 days to exams..

Isaiah 26:3 - You will keep in perfect peace him whose mind is steadfast, because He trusts in you

Currently listening:
Laura Story - Perfect Peace

Stay close by my side
Keep your eyes on me
Though this life is hard
I wlil give you perfect peace

In this time of trial
Pain that no one sees
Trust me when I say
I will give you perfect peace

And you'll never walk alone
And you'll never be in need
Though I may not calm the storms around you
You can hide in me
Burdens that you bear
Offer no relief
Let me bear your load
Cause I will give you perfect peace
Stay close by my side
And you'll never walk alone
Keep your eyes on me
And you will never be in need
Though this life is hard
Know that I will always give you perfect peace
I will give you perfect peace

Year 5 postings

Provided I pass my exams (which I'm now cramming :p), my next year's posting in Melbourne would be:
1. Cardiothoracic surgery and neurosurgery in Alfred Hospital, Prahran.
2. Aged care and rehabilitation in Dandenong.

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]

When 2 become 1 :-)

Whatver the case, You are in control

Currently listening: Planetshakers - Jesus Reigns

Psalm 62 (NIV)
1 My soul finds rest in God alone;
my salvation comes from him.

2 He alone is my rock and my salvation;
he is my fortress, I will never be shaken.

3 How long will you assault a man?
Would all of you throw him down—
this leaning wall, this tottering fence?

4 They fully intend to topple him
from his lofty place;
they take delight in lies.
With their mouths they bless,
but in their hearts they curse.
Selah

5 Find rest, O my soul, in God alone;
my hope comes from him.

6 He alone is my rock and my salvation;
he is my fortress, I will not be shaken.

7 My salvation and my honor depend on God [a] ;
he is my mighty rock, my refuge.

8 Trust in him at all times, O people;
pour out your hearts to him,
for God is our refuge.
Selah

9 Lowborn men are but a breath,
the highborn are but a lie;
if weighed on a balance, they are nothing;
together they are only a breath.

10 Do not trust in extortion
or take pride in stolen goods;
though your riches increase,
do not set your heart on them.

11 One thing God has spoken,
two things have I heard:
that you, O God, are strong,

12 and that you, O Lord, are loving.
Surely you will reward each person
according to what he has done.

Note: Thanks Sze Yean :-)