Random snippets of my life

Gen Med - A brief reflection

2010-04-26T11:06:00.006+10:00

Four weeks had past since I finished my Gen Med rotation. Not intending to be boastful, I knew I would survive the rotation. However, I was surprised that I had not suffered a mental breakdown (thankfully) from the busy rotation. To be honest, I was at the brink of it:

It was a Monday - we had loads of new patients - ward round ended late - it was my reg's half day - she had to leave early - I was left to manage a sick patient who was actively bleeding - I had to reverse the warfarin effect which I had never done before - that took me a while to organise - my pager kept buzzing the whole day - blah blah blah!

To keep it short, it was crazy. I wanted to scream and run away. But, I kept reminding myself to maintain calm and keep things under control. Eventually, the day past by without significant issues. After all, it was a learning experience.

Each day at work, I would never fail to receive a new patient who presented with either dementia, delirium, falls or (near) syncope. Yet, I am by no means an expert in managing them. Almost all would have long significant past medical histories, and hence thick medical files - one even with almost 20 volumes of medical history!!! Imagine needing to make referrals for these patients and you are bombarded with lots of questions from the other end of the line. It is still a challenging and nerve-wracking task, but I certainly believe that I'm making some improvements.

I still vividly remember the day I had to call a Code Blue during my weekend cover shift. It was a 70+ year old patient who came in with rapid AF and developed some fluid overload. She was given an increased dose of metoprolol and frusemide in the morning. Just before dinner, I was called to see her as she was quite sick - she was quite pale and peripherally cool/shut down. Her HR and BP kept dropping (to the point that the BP was not measurable) despite giving fluid boluses. It was harrowing to see the patient deteriorate in front of my eyes and I decided that Code Blue was the most appropriate thing to do.

Perhaps, my experience in managing sick patients may not be as bad as dealing with families. I can't forget the day I was reproached by a patient's daughter. The patient suffered a rapid decline in her function and cognition for the last six months; its cause unknown and hence she was admitted on a Friday for investigations. An urgent MRI was organised by the admitting unit, but for some unknown reasons, was not performed over the weekend. She was then transferred to my unit on the following Monday and before I knew anything about the patient, her daughter called and vented her anger at me for not doing anything. I understood that she was in distress (who wouldn't), but I found it difficult to accept that she directed her resentment at me. I wanted to tell her off, but did not see any point in doing so as it would only escalate the problem. I must admit that I was a little upset after the phone call. I did my best to hasten things, all which eventually occurred. At the end of the day, it was satisfying to see that the patient's daughter was appreciative.

Overall, Gen Med was a challenging but valuable experience, which many of my colleagues agree. Some despised it but I enjoyed it very much.

As you can see, I ramble a lot about my work. I like speaking to and listening to my friends/colleagues for they are excellent ways for us to learn, to share our experiences, to provide support and also to de-stress from our ever demanding jobs.

Penang 2010

2010-03-14T19:03:00.022+11:00

As a child, my family often made an annual trip to Penang, mainly for prayers. My grandparents never failed to join us too. Not that it bothered me much, but it made the 3-4 hours journey a little uncomfortable as the car would be packed. We usually stayed at my grandaunt's apartment which had a swimming pool facility, and that was always the highlight of my trip.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Given that we had been away from Malaysia for a long time, Mummy suggested a visit to the Pearl of the Orient during the 2010 New Year weekend. This time we stayed at the Northam Suite. I was looking forward to the trip, mainly for the food!

We left our home on New Year's Day at 4.30am. Despite sleeping for only 4 hours, I was very wide awake and volunteered to drive the family. We stopped by at the old town of Ipoh to have breakfast at Foh San, which was one of the well-known dim-sum restaurants. I heard that the restaurant open at 6am and by 7am, all the tables would usually be filled-up. We were lucky to have the last available table. Others who came after us needed to wait.

Foh San Restaurant

An early breakfast

Overall, the dim-sum at Foh San wasn't too bad. However, I wouldn't say it was as good as the Hong Kong's Yum Cha I had in Melbourne. The variety wasn't too great as well, but the price was very reasonable. We resumed our journey after breakfast. I was quite tired and started to feel sick, most probably attributed to my sleep deprivation. Daddy was the driver since then.

We arrived at Penang Island at about 10am. Our first stop was at "Di Mu Niang Niang", a small temple which my family frequently visited. We then went to the famous Kek Lok Si, which was not too far away. Daddy did a bit of prayers here; but the main agenda was for shopping and sight-seeing.

Kek Lok Si Temple

View of Penang from the temple

The many little shops selling goodies in the temple

Huge Kuan Yin statue at Kek Lok Si - the temple is expanding at a rapid rate

Halfway through our visit, I felt terribly unwell - light-headed and cold+clammy. I had trouble walking and keeping my head up. Rest - that was all I could think of. My day was spent sleeping in the suite and hence, missing all the excitement.

I thought that I feel better in the evening and joined my family for a dinner at the famous Gurney Drive hawker stalls. I was wrong! Before I could put anything in my mouth, I felt nauseated and threw up four times, which hadn't happened to me for years. Retching was such an awful feeling. I missed my dinner and retired to bed for a good snooze thereafter.

Gurney Drive's hawker stall - the food here is overpriced and isn't as good as in the past

The next day, we travelled around Georgetown. Feeling so much better and hungry after my horrible ordeal the day before, I started to indulge as much good food as I could grab - Penang's famous cendol and nasi kandar. After lunch, we left Penang for home

Standing by the stall to savour Penang Road's famous cendol...the Malaysian way!

Penang's nasi kandar for lunch

We dropped by at Ipoh again on our way home for dinner at Lou Wong where we had Ipoh's famous bean sprout chicken. It tasted real good!

Lou Wong

Ipoh's famous dish - Kuay Teow soup with bean sprouts and steamed chicken

A good trip although I would enjoy it much more if I didn't fall ill. I had missed so much food! Oh well, detoxification on New Year's day might not sound like a bad idea.

Pangkor 2009

2010-02-27T15:23:00.014+11:00

21st - 22nd December 2009
During my trip back home, I joined my fellow Uni mates - Rebecca, Rachel and Kevin for a 2D1N trip at Pangkor. We didn't stay on the island, but at the Swiss Garden Golf Resort and Spa Damai Laut, which overlooks the Straits of Malacca and Pangkor Island.

View of Damai Laut and the Straits of Malacca from our room on the top floor

A great thanks to Rebecca's father who organised almost everything for our trip - transport (including a driver), accommodation (in a spacious suite!) and even lunch at a FuZhou restaurant in Sitiawan.

Our suite with 2 bedrooms attached

Complimentary dessert, which we decorated with elephant chocolates, bought by Becky when she was in Bangkok

We initially wanted to spend more time on the island. However, we soon found out that the resort was a marvellous place and there were lots of activities for us to enjoy - archery, beach volleyball, tennis, kayaking, swimming, island-hopping, snorkelling as well as indoor games. Hence our original plan was abandoned.

Archery...concentrated very hard; yet I missed the target

Posing after a game of tennis Kayaking...ah, it reminds me of my gruelling 5-6 hours trip to Pangkor Island from Lumut when I was in Outward Bound 11 long years ago! Snorkelling and fish-feeding

A giant squid...help!!!
The smell of dried seafood...mmm - yucks!

Certainly a great trip to remember - Thanks for the good times, friends!

*Credit to Kevin, for I had attached some of his photos here

A Good Time Back Home

2010-02-26T23:48:00.011+11:00

Arghh!!! I haven't blogged for a long time - I am just plain lazy. Anyway, some updates which were meant to be posted long ago...

I had a memorable time in Malaysia during my December break, prior to the commencement of my internship.

Immediately after graduation and registration with the Medical Board, I flew back with Daddy. Mummy and my siblings joined us a week later. And so, after four long years, we were all together again back home in Klang. It was indeed a great peaceful time to be cherished.

Apart from visiting family members, I spent a lot of my time relaxing at home. Not that it bothered me - I just love to be in my comfort zone where I spent most of my childhood and grew up.

It was the Malaysian end of year sale throughout December and hence my many visits to shopping centres - the nearby AEON Bukit Tinggi, 1-Utama, Mid-Valley Megamall, The Pavillion etc. Things are no longer cheap as they were before. As a poor student who hadn't earned money, window-shopping was my main itinerary.

What is a Malaysian trip without indulging myself with the great variety of mouth-watering local delicacies? Four meals a day (including my regular supper) didn't seem enough - there was simply too much to gobble, hence my frequent gluttony and gain in adiposity.

It amazes me that I still keep in touch with my Malaysian friends after so many years away. My special thanks to Joanne, Andy and Weng Phoon, who I met quite often either over for meals, movies or shopping. Not to mention the meet-up with my ex-ACS schoolmates for a drink. It has been a great pleasure to see them all.

More to come......

My first week

2010-01-23T22:51:00.007+11:00

I survive my first week as a doctor! It's unbelievable!

As I am not working this weekend, I decided to spend some quiet time to reflect on my first week of internship, hoping to share it with my friends, many who are in the same boat as me.

My first attachment is with two different units: general medical & rheumatological. Although I don't have much active involvement with the latter, it can be a challenge to handle both units at a time. On the whole, I have a good and gentle start. With about 12 patients on average in the general medical unit, many who are waiting for rehab or placement, it is managable although I am still quite slow with carrying out my tasks. I just need more time to familiarise myself with my new role.

I am rostered to start at 8am. Nevertheless, my day usually starts at 7.15am so that I can catch up with my work, for instance ensuring as many discharge summaries are kept up to date and that all pathology tests are requested before the path nurses arrive. Some days, when I feel too tired to get up early, I arrive just before 8am for handover, when interns and registrars from each medical unit gather to get an update of admissions/issues encountered during the night.

Ward round begins immediately after the meeting. As my consultant or registrar reviews the patient, I attempt to catch what they say and scribble my notes in the patient's file and at the same time, looking at the many different charts (e.g. observation, fluid balance etc) recorded. I try to stay focus but it's not always possible especially when my beeper goes off and I have to return the call to find out what's happening and if it's urgent, thankfully often not.

Ward round is followed by paper round, when I clarify with my registrar the jobs that needed to be done, putting them into a list and ticking the ones completed. Making referrals is my greatest weakness/fear and biggest enemy. I dread doing them, either because I'm asked lots of difficult questions over the phone or the referrals are refused or that my calls are not returned. Yet, it is a task which I face everyday, if not almost. With more practice, I hope it will be conquered soon.

There is no "full-stop" in my job. Just as I am about to finish ticking all the boxes in my job list, my beeper goes off again: often for IV resites and patient review on pain control and blood sugar level. When these are done, it is only then I realise that it is already 3pm and that I haven't had my lunch yet or hydrated myself or even gone to the toilet. It amazes me that I can be quite fixated to my job and not aware of the basic requirements of life.

When I have time, I will find a computer to do discharge summaries, hoping that my beeper doesn't go off. It may sound like an easy task, but half of my patients have been in the hospital for more than a month and their cases are quite complex. Imagine going through all the voluminous notes written since a month ago - it takes a while to decipher the illegible writing and extract the correct information, as some notes written by different units are contradictory to each other. Soon, it is 5pm - yes! - no more pages. My registrar happily says goodbye and urges me to leave too. But I stay back for a while, sometimes up to 7pm to do my paperwork. If not of my inefficiency, I could have gone home earlier to have life out of med. Often, I'm just so tired when I reach home that the only thing I do is continue my 'Mousehunt' on FB.

Twice a week, there is an allied health meeting which I am expected to attend. And once a week, there is a compulsory intern education session. So, it is not just about work. But also education for continuing professional development and working with other members of the healthcare system.

Help is always available around the hospital and hence I shouldn't be too worried (although I did). It was my registrar's half day on my very first day of work and an incident had already happened! A patient of mine was accidentally given an increased dose (5x) of methadone! He was alright but a bit drowsy. I was just dead worried that he might have a respiratory depression and that I could not handle the situation appropriately. Thankfully, the cover registrar came to my rescue immediately and all was fine thereafter.

My first evening cover happened to be on my second day and I had to work for 14 hours till 10pm. I thought I had the time to do more paperwork and unfortunately, it turned out to be a little busier. My beeper went berserk that evening with loads of calls for IV resites and patient review for various issues. I felt HALT (hungry, angry, lonely, tired). I tried to remain calm and keep cool, which I fortunately did. After all, everything went fine. Dinner was at 10.30pm and I arrived home at 11pm, dead tired.

Overall, my first week of internship has been an overwhelming yet an exciting experience. As a medical student, I can choose to avoid doing things that I hate/fear. I can come and go at anytime I like. Now, I am responsible for each patient under my care. I can't run away should problems arise. Instead I have to manage it and/or refer to other senior doctors if I feel it's beyond my level of expertise. I expect that it will be a tough and stressful job, but I must always remind myself to keep strong and not to take any criticisms too personally. I may not be the hero in my patients' recovery; however I feel glad that I can contribute to the care of my patients. It gives me great satisfaction that my patients improve during their hospital stay and that they are discharged in optimal conditions.

I love my job! =D

Happy New Year!

2010-01-17T20:43:00.004+11:00

First of all...to all my blog followers, Happy New Year!!! I know that it's already past mid-January, but better late than never, right? May 2010 be a great year for you all!

Just a brief update - I haven't kept in touch with my blog for more than a month as I was quite "busy" since graduation. A day after my graduation, I attended the medical registration ceremony at Monash University (it was only then that I'm officially called a doctor!). And the next day, I was already on my to Malaysia to enjoy my well-deserved 4 week holiday, before I embark on my medical career - internship. It was indeed one of the best times I had, with loads of memorable moments especially with my dear family. Mainly relaxed at home and also did a bit of travelling as well as catching up with friends. Will elaborate further if I have the time.

Time flies...Right now, I'm already back in Melbourne, for almost a week to attend orientation which began on Tuesday and concluded on Friday. It was quite an exciting exercise though I felt a bit overwhelmed as there were lots to learn within a short time.
And in less than 12 hours, I will officially begin my internship! I'm thrilled but at the same time, feel extremely nervous. I'm dead worried that I can't perform my job well and do not meet my reg's and consultants' expectations. Although an intern is just a step above a final year medical student, it is a HUGE gap and I don't know if I have managed to take such a big leap. I am now accountable for each of my patient and can't "run-away and hide" if problems arise. RESPONSIBILITY - that's the big word which I must learn and hope to adhere to throughout my internship and beyond.
Well, let's see if I survive my first day (i.e. tomorrow)!

Graduation

2009-12-10T22:46:00.010+11:00

A short speech which I dedicated to my beloved parents on the night of my Graduation Day......

*******************************************************************

My dearest Mummy and Daddy,

Today, 10th December 2009 at approximately 4.50 in the evening, dressed in academic regalia, I received my MBBS (Hons) degree from the Chancellor of Monash University (Dr Alan Finkel) and hence, it officially marked the end of a chapter in my life – education.

After 12 years of schooling and 5 years of pursuing a medical course, I have finally graduated!

I know you have waited for a long time to celebrate this joyous moment. You have toiled very hard; you have given up the many pleasures in life which you could have otherwise enjoyed; you have always poured in your unconditional love and support to me. Yes, there are difficult times...yet, you have never complained. But you persevere.

You have sacrificed so much to see who I am today. And I hope this is one of your proudest moments in your parenting life. I must convey my most sincere gratitude for everything you have (and still) done for me – your greatest gifts to me...love and education.

And so another chapter of my life will soon begin. Yes, I must admit that I’m afraid and nervous but I will boldly face the challenges that lie ahead of me; and hopefully achieve more successes for us to cherish.

I don’t know what else to say, but...“THANK YOU. I LOVE YOU BOTH VERY MUCH”

Love,
Andrew
*unashamedly written with tears in my eyes*

A "collection"

2009-12-09T20:45:00.006+11:00

Presenting my 5 years worth of collection...

This is the voluminous amount of study material which I have gathered over the last 5 years of my undergraduate course. Plus the many textbooks which I bought from Kamal bookstore in KL.

And more notes and presentations which remain in my laptop. So much resources used for my studies and yet, I wonder how much information is retained in the little organ sitting in my cranium...not much I guess - perhaps 1% at most?

Now, I'm not sure what I should do with the study materials in my folders - to keep or not to keep??? I have thought of recycling them to reduce the utilised space in my room. Also, most of them haven't been referred to for a long long time, especially the 1st and 2nd year stuff. Perhaps I'm superstitious, but doesn't that mean I'm 'throwing' knowledge away? What if I need them one day, only to realise that they are gone?

Another decision to make......argh!!!

A new interest???

2009-12-03T17:24:00.007+11:00

I am currently reading...

" The House of God", by Samuel Shem, a book that I was recommended to read since I started medical school 5 long years ago, but for whatever reason, haven't got a chance to read, until I found it in a bookshop in Union Station, Washington DC.

Disclaimer: This is NOT a book review
This medical novel portrays the life of Roy Basch, an intern in a distinguished American hospital called "The House of God". It is a satirical story about him being a junior doctor and its impact on his life - relationship; psychological well-being etc. It also tells how his initial "innocent" approach to medicine, the one he learnt whilst in medical school, is greatly influenced by the Fatman (a resident he was earlier attached to)...

From my three years experience as a clinical student, I find Shem quite accurately (though not entirely) depicts the life of junior doctors - the challenges and stresses they encounter at work. Not very much in a depressing way, but hilarious and outrageous. It is kind of a great relevance to me, being a soon-to-be intern, which is just a month's away! Still halfway thru the book and I'm loving it. Highly recommended - A great book for those about to enter the medical workforce.

I am not someone who really read books, well apart from The Lord of the Rings and Harry Potter series along with a few selected academic books, the latter only to help me pass exams - yes, I'm not that nerdish as you may think.

So, how am I suddenly engaged with this interest?
It all started when I began my elective placement in India about 3 months ago. I bought Jodi Picoult's "My Sister's Keeper" from Big-W and brought it to the sub-continent to read - well, an accompaniment along with my brother's iPod for my long, often boring journey to different places. I was very immersed with the story and thoroughly enjoyed it...that's how the interest started to grow.

Also, many of my fellow elective mates read too and we sometimes came about to discussing books. I was recommended Khaled Hosseini's "The Kite Runner" - brilliant! Also read his 2nd book: "A Thousand Splendid Sun" - extraordinary!

Books can be dirt cheap in India (e.g. Rs80 or AUD2) if you find the right shops.
As soon as I finished reading a book, I started to hunt for a bookshop to buy another one. And that includes Dan Brown's "Angels and Demons", another book I bought in the US, the story which always puts the readers on the edge of their seats.

Books that I'd read during my travel

Now thinking of the next book I should read IF I have the time once internship starts. Not a bookworm......yet =P

USA 2009 - Washington DC

2009-11-30T17:54:00.007+11:00

Although my uncle lives in St Louis, he works in Washington DC. So, he travels there every Monday morning and flies back on Thursday evenings. Great!!! It means I had the opportunity to follow him to the nation’s capital, which is about 2 hour’s flight from St Louis. So, while he was busy at work during day time, I travelled around the city, which was very close from his apartment.

Most of the “must see” places are located within the National Mall, which stretches about 2 miles from the US Capitol in the eastern end to the Lincoln Memorial & Potomac River, in the western end. The White House, the Washington Monument, the Library of Congress and the US Supreme Court are other iconic features of the city/country situated within this national park. A visit to these places is another memorable moment of my US trip – it reinforces the feeling that I had been to this wealthy and powerful nation.

The White House - the Obamas were not there to greet me =(

Lincoln Memorial

During my 4 day stay, I joined a short tour in the US Capitol, where I watched a short historical video before taken around to different sections of the building including the dazzling Rotunda where lying-in-state and lying-in-honor funerals were previously held for notable Americans, such as Ronald Reagan.

The US Capitol

The Rotunda

Somewhere in the centre of the mall is the Washington Monument, a 555+ feet tall obelisk structure built to commemorate the first US President – George Washington. I went up the monument and from there I was able to enjoy the panoramic view of the city.

The Washington Monument
Facing east from the Monument - the National Mall with the US Capitol on its eastern end and the many museums along the national park

The park is also home to the Smithsonian Institution, where many of its museums are located – my favourites include the National Air & Space Museum, National Museum of American History, National Museum of Natural History, and Holocaust Memorial Museum. There are at least a dozen more and each has a huge displayed collections. Too many things to see and one needs to spend quite some time there to appreciate all of its collections. A great learning place especially for school students and those who want to know more about America.

The Smithsonian Castle

Inside the National Air and Space Museum

Best of all, the entrance fee for everything in the National Mall is zero (i.e. free)!!!

**********************************************

And this concludes my USA 2009 entries. I certainly had a great time during my 4 week trip, travelling to places which I have never dared to dream of.
I will definitely want to return, but this time to travel in other places and hopefully, someone to accompany with =D

USA 2009 - St Louis

2009-11-30T00:23:00.004+11:00

St Louis, a city in the mid-west, is probably famed for its Gateway Arch, which is part of the Jefferson National Expansion Memorial. At a height of 630 feet, it is the tallest monument in the US and signifies St Louis as a gateway between the eastern and western sides of the great country.

The Gateway Arch

Cathedral Basilica of St Louis

Well, my main reason of being here is not to see the St Louis’ iconic structure, but to visit Uncle Daniel (Mummy’s cousin) and Yee Po (i.e. grandaunt), who had always urged me to go over, either for a holiday or for good. I had an unforgettable time during my stay – they were just so wonderful...took me around to visit different places; shopping (prices here are very reasonable) and good food (I put on a few pounds).

St Louis pork ribs - yum!!!

Eagles Nest Onion served with Chiptole Sauce

This is Salt Lake City (Utah), viewed from the air, during my stopover en-route to St Louis. It was only fall and there was already lots of snow in the city - love the view of the great mountains and lake in the background.

USA 2009 - Oregon Road Trip

2009-11-27T00:30:00.009+11:00

I didn’t know anything about Oregon until Kenneth planned a 4-day road trip around the southern part of the state, which is situated just north of California. And I must commend him for the excellent itinerary he had organised for us.

Oregon is truly blessed with nature’s gifts – it offers various landscapes with breath-taking views, especially during the fall season as the foliage can be quite intense.

Mt Shasta - a snow-capped mountain seen on our way to Oregon

For this trip, I’ll split it up into 2 main parts:
1st part –inland Oregon...We drove through the dense forests of a few of Oregon’s national parks, mainly along the Rogue-Umpqua Scenic Byway, which were lined with conifers on its sides.

The highlight of this leg of the trip was to visit the Crater Lake, a caldera lake. Unfortunately, it was too foggy on the day we arrived and hence, we couldn’t appreciate its grandeur. =(

Click here to see its true beauty......

2nd part – Pacific coast...For this part of the trip, we headed south towards California, along the Pacific coastline, which is abundant with rock formations, almost all which are created by the great ocean’s constant erosions – just like the Twelve Apostles along Victoria’s famous Great Ocean Road.

Also during our way back in northern California, we drove along the Avenue of the Giants, another scenic highway running through Humboldt Redwoods State Park. This was where I saw the towering giant sequoias, the world’s largest tree species...many of them are thousands of years of age, almost 300ft tall and 20ft in diameter – impressive!

Drive-thru tree! Age: 5000 years; Height: 275ft; Diameter: 21ft; Cir: 64ft - what a giant!

USA 2009 - One week tour trip

2009-11-26T17:37:00.010+11:00

My itinerary appeared packed – only 10 days left to visit many different places in and near California before going off to somewhere else, which had already been planned prior to my arrival. Although not my preferred method of travelling, I decided to join a one-week tour with a group of Chinese visitors, which covered all the places I wanted to visit. Great! It saved me from the hassle of planning these trips within a short time.

Yosemite National Park
A UNESCO’s World Heritage site since 1984, this national park features stunning views of granite cliffs, waterfalls and clear streams as well as a diverse range of wildlife. Unfortunately, it was raining and foggy the entire day; hence the view wasn’t as clear as I hoped it would be...

Las Vegas
Dubbed as the “Entertainment Capital of the World”, this popular city of lights and casinos lies within the Mojave Desert in the state of Nevada. The city was particularly beautiful and lively as night arrived. Everyone expected that I did the obvious thing (i.e. gambling), but surprise surprise, I didn’t! Maybe I tried to be good =P
In fact, I spent a lot of my time sleeping as I didn’t feel too well, which might be due to motion sickness from the long travel on the bus.

Grand Canyon
It is the highlight of my USA 2009 trip! About 2 hours away from Las Vegas, passing through the Hoover Dam, the Grand Canyon offers a magnifient view, especially with a clear blue sky backdrop. I paid for a $179 helicopter ride, which included a short boat ride along the Colorado River. Expensive - but the experience gained was just incredible! Love it, love it, love it!!!

Los Angeles
The “City of Angels”, the 2nd largest city in the US after New York, it is very busy with lots of traffic almost everywhere almost everytime - not a city I like to live in. The main itinerary here was to visit Hollywood and the 2 well-known theme parks - Universal Studios and Disneyland.
My childhood dream of visiting Disneyland had finally come true! I really enjoyed the experience , though there were so many people on that day - I even had to queue for 2 hours to ride the latest thrill ride! I spent 12 hours there and it was still not enough. Next stop - Disney World in Florida =D

USA 2009 - San Francisco

2009-11-25T23:45:00.007+11:00

My long-time desire to step my foot in the United States has finally come true with my recent trip to the country in October during my Year 5 vacation rotation. Many of the trip photos can be found on my Facebook; but as promised, here is a brief summary of my trip along with some of my favourite photos.
****************************************
My first stop was San Francisco, where I spent about 8 days and stayed in the East Bay area with Kenneth, an ex-schoolmate from ACS. Thanks to him and his younger brother for their hospitality and taking me around during my stay. One does not visit San Francisco until he/she stops at the Golden Gate Bridge, the city’s most iconic structure. I was quite mesmerised by the view of the famous suspension bridge, which connects the northern tip of the San Francisco peninsula to Marin County.

Other sites visited included......
The infamous Alcatraz, a federal penitentiary located on an island in the San Francisco bay, which housed prisoners from 1934 till its closure in 1963

The popular Pier 39 on the Embarcadero in Fisherman’s wharf, which boasts a wide range of restaurants, shops and attractions

The Palace of Fine Arts, a splendid Greco-Romanesque structure originally built for the 1915 Panama Pacific International Exposition

Golden Gate Park, apparently the largest man-made park in the world

Coit Tower on Telegraph Hill, built to fulfil the bequest of Lillie Hitchcock Coit,
who left funds to be used to beautify the city she loved

Lombard’s “crookedest” street with eight hairpin turns on a 40-degree slope, with beautiful (and expensive) homes and gardens lines its sides

Well, these are the highlights of my San Francisco trip!

Overall, I find it a city very similar to Melbourne – vibrant with a diverse ethnicity; though there are a lot of homeless people, probably due to the cost of housing, which is very expensive and to make matter worse, with the country’s current economic recession.

Med school...the finale!

2009-11-25T19:39:00.004+11:00

After 5 long gruelling years with much blood, sweat and tears poured out, med school has finally come to an end. And that completes the first phase of my life - schooling years.

B2B week has been very informative and educational to me as I have not attended any placements for a long time, and hence forgotten quite a lot. It was a time to revise important things which I should know that will (hopefully) prepare me well for my internship next year. Great lectures were delivered by dedicated staff members, including Prof John Murtagh who will retire soon and gave his final lecture to us - what a great privilege for us to listen to his awesome stories about being a country practitioner. Also, it was a time to catch up with friends who I have not seen for ages. What's more...free lunch everyday from different sponsors and a cocktail evening organised by the faculty!

I must admit that I'm a little sad that my schooling years have finished. I have been very attached to it for it has been a major part of my life for at least the past 17 years. Now it's over and I'll soon be thrown into a working world, which I'm not so ready for despite attending clinical placements for the last 3 years.

In the meantime, will enjoy my holiday (or rather my transition poeriod) as much as I can before the harsh reality sets in next January.

A thought...to continue or not

2009-11-25T19:20:00.004+11:00

I had been very lazy and not motivated to update my blog, even to the point of deleting the whole thing (blog).

Firstly, I wonder again why I started this blog...I could not think of the exact reasons. Maybe because I felt a bit lonely all these years, not having regular close contacts with friends here. So, by creating this blog, I hope my thoughts, experiences and life events can be shared and be heard. Not that I yearn for popularity and ask for sympathy; but just a means of communication, in a different way.

Perhaps...it's just a diary, mainly for personal keepings and reflection, which I 'stupidly' share with everyone - anyone around the world has access to it. Hence by doing this, I sometimes feel a sense of insecurity and humiliation.

But right now, I think I'll continue what I had started almost a year ago and reconsider my current decision at a later time.

Any opinions from friends are greatly appreciated...

1 final week...

2009-11-09T19:20:00.007+11:00

My blog has not been attended to for quite some time as I was busy travelling in the US. I had a fantastic time although I must admit I was a bit home-sick by the end of my 2nd week there.

I am now back in Melbourne since yesterday morning, after a long 33 hour journey from the mid-west, St Louis. Glad to be home again together with my loved ones. Surprisingly, I didn't feel much jetlag - what a relief.

Well, after having a long break, it's time to attend med school again (yay!!!)- one very final week of my 5 year undergraduate medical course --> back-2-base week!

United States of America!

2009-10-11T07:21:00.004+11:00

I'm currently in the United States of America! Woohoo!!! I just can't believe that I am here...

Being the cheapest option, I took Air New Zealand, which to my great satiafaction, provided an excellent service! I had initially thought of flying with Qantas so that I could sit in the jumbo-jet Airbus A-380, but as a poor student, the price put me off. Nevertheless, I had a glimpse of it in Melbourne Airport...

"One day, I'm gonna make sure I'm in it - just for the experience!"

The journey to USA was relatively a long one - first, a 3h30m flight to Auckland, where I transited for 2 hours before boarding the next flight to San Francisco which took almost 12 hours. I have not taken a half-full flight for a long time and was glad that I could have a whole empty row to lie down and sleep...wasn't too comfortable though.

My first glimpse of the land of the USA from the sky

The plane touched down at San Francisco International Airport at around 1130 on 9th October (when it was already 0530 on 10th October in Melbourne)

Upon arrival, I was delayed at the Customs and Border Protection for almost an hour - was being asked lots of questions. Anyway, I had already anticipated that this would happen, probably because it was my first visit to the US and that I'm a Malaysian citizen. By the time I went to the carousel to collect my baggage, they were already placed on a trolley, ready for me to push through the customs and then exit, where I was greeted by Kenneth, a friend who I have not seen for almost 7 years.

Will be writing more about my US experience later - not too soon as my itinerary at the moment looks packed!

"Stop-over" in Melbourne

2009-10-07T21:15:00.004+11:00

I have just arrived Melbourne after a long journey from KLIA – the plane was delayed for almost 2 hours due to technical problems + an hour transit in Jakarta, where I had to remain in the aircraft. I was surprised that I slept quite a bit during the flight...perhaps I was too tired due to lack of sleep for the past few days.

My stay in Malaysia was simply too short – I had a great time there. Nevertheless, it’s great to be home in Melbourne seeing Mummy and my brother and sister, who I have not seen for almost 8 weeks!

Will be here for only less than 48 hours before I resume my vacation...this time in the United States of America for 4 weeks – a country which I really really want to visit since I was a little boy many many years ago! Yes, I’m quite excited although I’m starting to feel a bit weary from my recent travel.

Well, gonna continue unpacking my luggage before repacking it...again.

A very relaxing time

2009-09-30T16:40:00.004+10:00

Right now, I am in Starbucks Bukit Tinggi slurping my cup of Green Tea Frappuccino (which tastes just alright) and writing up my elective report - my final assignment of the year, the final task of my undergraduate course!

I initially planned to finish it up in India, but I had such a great time there that I couldn't be bothered sitting down and typing it up.

So far, I have a great time in Klang. I don't have any plans (e.g. travel), but to enjoy the very relaxing moments I have now, when there is nothing too stressful to think about. I love times like this!

Spending time with a few friends who I haven't seen for ages has been fantastic!

Met up with Joanne for a dinner + Starbucks in Sunway Pyramid
Met up with Andy & his family at his house for lunch and dinner
Met up with a few ex-ACSians - Andy, Weng Phoon, Lui, Chin Yong, Chin Teik for a drink...I can't believe it has been more than 10 years since we knew each other in Form 1!

Thanks everyone for the good time - I hope there are more to come!

For some unknown reasons, I am in love with Starbucks - have been spending a bit of my time there 4 times in just 5 days! I wonder what potions it uses in its products that make me go back there almost everyday, hmmm...

Home!

2009-09-27T00:14:00.007+10:00

I'm finally back in my dear old hometown after surviving India for the last 6 weeks. It is a great relief that I am now in a familiar place, where I feel comfortable and with family and friends, who I have not seen for ages! At this moment, I am home alone until Daddy gets back from Melbourne on Wednesday night.

Thanks to Venkates, an ex-schoolmate who I met in Chennai on my last day in India – he knows a person who works for MAS in Chennai and hence, my return economy-class ticket was upgraded to a business class – something totally unexpected! What a superb way to end my Indian trip...lots of good food in the air (which I eventually had to refuse); cosy seat with roomy leg space; great ambience; and even sitting beside a Malaysian diplomat in India!

With Venkates in Chennai

Thanks to Sue Kor and family too for coming to the airport so early in the morning to pick me up.

It’s Ah Mah’s birthday on the day I arrived and the family gathered that night at Ah Mah’s home for dinner – great way to catch up with uncles, aunties and cousins who I last saw almost 4 years ago. After 6 weeks of Indian cuisine, the authentic Chinese food was just simply scrumptious!

My mouth was just watering when I looked at this!

Happy Birthday Ah Mah!

Mahabalipuram

2009-09-25T16:30:00.006+10:00

Dear Matt, Thukirtha and Louise,
I feel blessed that you all accompanied me to Dindigul to send me off – glad to have known you all. I believe we had a fantastic time in the pub in Parsons Court Hotel. Thank you so much – greatly appreciated!

I finally bade farewell to CFH, my ‘home’ for the last 5-6 weeks. A bit sad to leave, but looking forward to be back home! However, a trip to Mahabalipuram should not be missed.

After taking the overnight Kanyakumari-Chennai Egmore Express train and a 45-minute bumpy bus ride from Chengalpattu Bus Stand, I am now in Mahabalipuram (since yesterday morning), a small town about 60km south of Chennai. One of UNESCO world heritage sites, it is famous for its ancient rock carvings.

Once I had checked in at Siva’s Guest House (which is a great accommodation), my little adventure around the laid-back town began.

First a visit to the Shore Temple...

Then to the Five Rathas...

Along with many other beautifully carved stone sculptures scattered around the town...

As well as the Krishna’s Butterball...

Not to forget Mahabalipuram Beach...

Overall, a good trip although it was really hot and I was wearied from the constant hassles by the shopkeepers, trying to sell me tourist goods.

Will be leaving soon for Chennai to meet an ex-schoolmate before taking the flight HOME!

Final week!

2009-09-21T22:50:00.002+10:00

This is it......final week of rotation 6; final week of my elective at CFH; final week of me here in India – before a proper ‘full-blast” 6-week holiday begins, which I am really looking forward to.

***
What a great way to start the week – Mondayitis!

I locked my key in the room this morning. For the 2nd time in 5 weeks, I had to ask someone to break the lock.

“What a nuisance!”

I was very tired after the weekend trip that I nearly dozed off during the ICU ward round.

“Who needs a lazy-bum like him here?!”

Perhaps I’ll be kicked out first, before I’m due to leave......

Kanyakumari (Cape Comorin)

2009-09-21T22:43:00.007+10:00

There are so many famous places to travel in South India: Mumbai; Hampi; Goa; Allepey; Madurai etc. However, it isn’t called a South Indian trip until one visits Kanyakumari (Cape Comorin), a small town in the southernmost tip of the Indian sub-continent. There was where I spent my last weekend in India, with my fellow elective student friends – Matt, Anna, Thukirtha & Louise.

After buying a few medical books from Madurai Medical College (which were really cheap), we left for Kanyakumari in the evening. It was a very long journey – almost 7 hours! Travelling in a crowded old rickety government bus, I obviously felt very uncomfortable and became quite exhausted & grumpy during the ride. Nevertheless, I never regretted making the trip there – we all had an awesome time!......

From watching the sunrise early in the morning at about 0610...

To island-hopping, visiting the Vivekananda Rock Memorial and Thiruvalluvar Statue, the latter dubbed as India’s Statue of Liberty;

To enjoying the breath-taking view of the vast confluence of 3 great seas surrounding India: the Indian Ocean, the Bay of Bengal & the Arabian Sea;

To swimming in a nearby beach, not too far away from a wind-farm with thousands of windmills;

To visiting the Gandhi Memorial (picture not shwon) and the Kumari Amman Temple - where guys have to be topless to enter the temple;

...And after a long tiring day, having fun in a pub.

Certainly, one of my best trips here! =D

Almost There...

2009-09-18T15:31:00.003+10:00

Time flies! Last night, we bade farewell to Alex (my roommate from the UK) at Dindigul bus stand, after having a great time in a Dindigul pub.

I have been here, in India, for 5 weeks already and it feels like I had only arrived here yesterday. In 5 days time, I’ll bid my farewell to the wonderful doctors and nurses who I’m fortunate enough to have met; and in exactly a week from today, I’ll be leaving this incredible country.

This week has been terrific. I returned to the dermatology clinic on Monday morning and the experience gained was rewarding. In just under 4 hours, I’d already seen a wide range of diseases – more than what I’d encountered so far in my almost 5 years of MBBS course. Unlike Australia, the prevalence of skin malignancy over here is low – haven’t come across any yet. And I have finally met a patient with leprosy!

Attending surgeries has always been fascinating. Again, I got to scrub in, assisting the surgeons in a few surgeries – appendicectomy; amputation of 3rd right toe (under LA – patient was shrieking in pain – OUCH!) and removal of a lump in the head, which turned out to be an inclusion cyst.

Best of all, I finally managed to do some suturing – closing up the wounds using different techniques. But it wasn’t an easy task – partly due to the very large and blunt needles (as the hospital reuses them) but most probably because of my inexperience (as I haven’t done much) – it was so hard to pierce the patients’ skins. One of the doctors kept on correcting my techniques – I was afraid that he might get frustrated and I nearly gave up. But, he insisted me on finishing them and with his continuous support and encouragement, the wounds were closed beautifully; although the initially curved needles had now become straight...OOPS!

Gotta go now...will be leaving for Madurai and Cape Comorin for the weekend, this afternoon after lunch.

A weekend in the hospital

2009-09-15T18:30:00.007+10:00

I was alone last weekend – well not quite...Anna was here too but she had her own plan. Alex, Matt, and the 2 Danish elective students (Thukirtha and Louise) had left for a houseboat trip in Kerala, which I had already enjoyed in my 1st weekend here. I could go somewhere, but I didn’t want to – preferred a rest from trips, all which had made me thousands of Rupees poorer each weekend.

Saturday (12/09/09)

If I were to undergo a surgery, say a hernia repair, please give me a full general anaesthesia. Not spinal anaesthesia – I can’t bear the thought of lying awake throughout the surgery, thinking which parts of my anatomy are being incised, burned, gripped, stitched etc by the surgeons. And definitely not local anaesthesia – it’ll be just too painful, although it shouldn’t hurt, well theoretically.

Poor old man who, for some reasons, had a left inguinal hernioplasty under local anaesthesia; being widely awake and aware of his surrounding; moaning and wincing from the agonising pain in his groin for at least 15 minutes before given a light sedation with benzo. And in under a minute, snoring sounds were heard...ah, the pleasure of being in dreamland, not bothered that he was under the hands of the surgeons.

So, I spent the day in the operating theatre with the surgeons. It was a long tiring day: the first incision of the day was made roughly at 8am and the last stitch was sewn at approximately 8pm...12 hours of surgery on a weekend; my back was killing me from the prolonged standing! But it was worth my effort....

I got to observe a few different surgeries for the first time.

I got to scrub in (right-hemicolectomy; laparotomy for suspected tuberculous abdomen, instead we found a huge faecolith out of his gut, multiple abscesses and a perforated appendix; trans-tarsal amputation of a diabetic foot, which was quite gross – the surgeon was just like a butcher!).

I got splattered with a patient’s blood on my forearms – we weren’t fully gowned.

I got my glove and right middle finger accidentally scraped by a surgeon – thank God the patient was viral negative!

Oh...what a day! But it was a great one!

Sunday (13/09/09)
Morning: My bag was packed. It was very hot outside. To go to Palani or not? Nay, best to stay indoors, in the computer room.

Evening: It rained – for the first time in CFH since I arrived 4 weeks ago! Love the pleasant cool change.

Night: Another power failure – room was dark & hot; my torch didn’t work. The weather was a little wild...flashing lightning which brightened up the whole room; roaring thunder; and more drenching rain. Electricity was back, but it was very feeble – light bulb was flickering; fan wasn’t rotating at its maximum speed...and soon it was gone again (No!!!), only to fully return about an hour later (Yes!!!). Ah, finally I could catch some good sleep......

Mix and Match

2009-09-14T22:09:00.004+10:00

On days when I didn’t attend village clinics, I did various things – rocking up at different places around the hospital, as if I’m the owner. Highlights include...

Gynae surgery: observed a few procedures including perforation of imperforate hymen

Orthopaedic surgery: first time attended one, so everything was interesting and they were indeed quite brutal – poor little old lady’s leg was twisted at odd angles and yanked with sheer forces when the surgeons replaced her hip

Dermatology clinic: was told that it’s the best to see leprosy cases; haven’t seen one yet – probably because I didn’t stay long enough – might attend again

TB ward + clinic: as the name implied, saw lots of patients with TB, not newly diagnosed ones but follow-up to ensure they responded to the given medications – found out that patients had to pay a deposit of Rs400 – 500 to ensure they came back to the clinic and completed their course of antibiotics

ICU: who dare to say it’s boring? – have seen many fascinating cases including a rare disease which I was told that I’d only encounter once in my life

Village Clinics

2009-09-13T18:06:00.005+10:00

I was supposed to spend 3 days this week to attend the village clinics, but only managed to attend 2; missed the 3rd one due to some miscommunication. It didn’t bother me too much as it would be much similar to the others that I had attended earlier.

CFH runs various village clinics, which is basically a community outreach program. The concepts of these clinics are practically similar to general practice in rural areas: to provide primary care to the villagers who otherwise may have difficulties in accessing to healthcare services at CFH (due to various reasons like ill health and transportation problems) and at the same time to reduce the workload burden at the extremely busy hospital.

Thumichampatty – Monday (07/09/09)

Thumichampatty is a village about 15 minutes bus ride from the hospital. In the morning, I spent time with the nurses doing home visits. The aims were to identify sick patients who need to be seen by the doctors; to ensure that patients were compliant to their medications, whether they required further prescriptions or not; overall to ensure the well-being of patients and their families at home. T2DM and hypertension were the 2 most common problems I encountered. Most of the villagers were welcoming; offered me a seat on the chair instead of the floor (which I politely refused); and seeing me as a foreigner, enquired lots about me (in a good way) from the nurses. I learnt a bit of Tamil from the nurses and tried to converse with the villagers, only to find out that I articulated the language in a very funny way!

Most of the homes I visited were small and very basic – an almost empty lounge room with no couch or table save for a little old TV set in the corner of the room; 1 or 2 bedrooms – some with beds without mattresses, others without beds at all; a kitchen; and a bathroom/squat toilet, some outside of the house and drained directly into little gutters. Many of the houses were erected with bamboos, the walls made of woven coconut leaves, covered with huge leaves. Yet, these people were very grateful to have shelters over their heads.

Thumichampatty village

In the evening at 1500, after having lunch at the mess, I accompanied the doctors back to the village for the clinic, which was held in a church building. Patients were already queuing to be consulted, the nurses sang hymns and the doctors immediately started their work. Most of the cases encountered were primary in nature: coughs and colds; headaches; fevers; repeat prescriptions; long term management of T2DM and hypertension etc. Consultation fees were charged at the discretion of the doctors according to the patients’ socioeconomic status; drugs were dispensed carefully as many patients could not afford them, some received a significant discount. The clinic ran until 7pm, when we then packed up and made our back to CFH.

Church building where the clinic was held

Gandhi Nagar – Tuesday (08/09/09)

Another clinic today, this time in the village of Gandhi Nagar which was about 10 minutes by van from the hospital. There was no home visit; instead it was a full day clinic, run by a registrar and a consultant, who had recently returned from Melbourne after spending a few weeks there for work. The cases I saw were not dissimilar to the ones I had seen yesterday. I was totally surprised that almost every 2nd patient who I met had T2DM, many with its horrible complications, especially nasty diabetic foot ulcers. I thought I would see more exotic diseases of India but was told that they were more prevalent in poorer areas which were mainly in Northern India.

I asked the consultant why T2DM was so common here: poor diet and sedentary lifestyle were the leading factors. With government subsidy, 1kg of rice only cost Rs1 (i.e. 35kg for Rs35 = AUD1) – how cheap is that! On the other hand, 1 kg of vegetables costs about 30 times more. Obviously, being the much cheaper option, rice is eaten in huge quantities here. In fact, some have rice only, nothing else – they are contented as long as their stomachs are filled up. Rice, if taken in large amount is bad given its high GI value; that is, it is digested much faster, causing the blood sugar level to shoot up quickly and the poor pancreas has to overwork to secrete more insulin. Over time, the pancreas wears out and no insulin is produced to control the blood sugar level; hence diabetes develops.

Kodaikanal + Indira Gandhi (Annamalai) Wildlife Sanctuary

2009-09-07T13:28:00.006+10:00

Friday (04/09/09) – Kodaikanal

“Kodaikanal is a stunningly situated and easy-going hill station on the southern crest of the Palani knolls, some 120km northwest of Madurai. It’s surrounded by wooded slopes, waterfalls and precipitous rocky outcrops and the winding route up and down is breathtaking”

Lonely Planet

Alex and I left the hospital on Friday morning at 0630 to catch a bus to Bathalagundur (which took about 1.5 hour) where we then changed another bus for Kodaikanal (located in the Western Ghats; elevation 2100m) – the 57km journey up the mountains took another 2 hours.

After having a quick breakfast and checking in at Hilltop Tower, we walked around the little town and then pedalled a boat in Lake Kodaikanal. I have never imagined a place like Kodaikanal in India – the view was stunning; the weather was pleasant (+cold) and the town wasn’t very busy at all. It is akin to Malaysia’s Cameron Highlands. Although there wasn’t much to do there, it’s an excellent area for relaxation and escapism from the intolerable heat in the lowlands.

The town of Kodaikanal

Picturesque views of the Western Ghats

We visited Bryant Park and later headed to Manna Bakery (as recommended by the Lonely Planet) for lunch, only to find out that it was closed as the owner had returned to the US for good. Since we were already out of town, we proceeded to the nearby Shola Bear Falls, which was a great disappointment as it was dry (due to the recent drought) and the area was strewn with rubbish – yuck!

We were back in town for a late lunch at Astoria before I made my way to get some souvenirs from the row of stalls along Lake Kodaikanal. At night, we had a buffet dinner at Silver Oak Restaurant in Carlton Hotel, the most prestigious hotel in Kodaikanal. The food was impressive: leek and thyme soup with bread as starters, various salads, mains (which were predominantly Indian) and desserts + a bottle of Sprite...all for Rs500+! By far, it was the most expensive meal I have in India!

Saturday (05/09/09) – Pollachi

After checking out at 0900 and making a short visit to Coaker’s Walk, it’s time to bid farewell to Kodaikanal. The 3.5 hours downhill journey towards Palani on a government bus wasn’t comfortable at all and a little terrifying. The winding road was narrow with multiple hair-pin bends – if the driver wasn’t careful enough, the bus could easily fall off the steep cliff. I prayed hard – prayed for a safe journey. We eventually arrived safely at Palani – another typical hot bustling Indian town; and immediately changed another bus for Pollachi, which was about 1.5 hour west of Palani.

A heavy downpour greeted us upon reaching Pollachi at 1500. We took an auto-rickshaw towards WWO, hoping to get an accommodation that night at Topslip, but it was fully booked weeks ago! Given that all the better hotels in Pollachi had been booked out, we had no choice, but to stay at the hotel which Alex had reserved days earlier, Hotel Vijay – the worst hotel I’d stayed in India thus far...the receptionist wasn’t friendly, treated us as if we were invisible; the room wasn’t AC; there was no shower; there was power cut; it took ages for the blankets to arrive etc. Looking from the positive side, it was only Rs400 per night. We just looked forward to flee the next morning.

Sunday (06/09/09) – Indira Gandhi Wildlife Sanctuary – Top Slip

"Indira Gandhi Wildlife Sanctuary – one of the three wildlife sanctuaries in the Western Ghat along the Tamil Nadu-Kerala border, this cool, misty mountain park covers almost 1000sq km of mostly teak forest and evergreen jungle"

Lonely Planet

It was 0545 and we were already at the bus stand to catch the bus towards Top Slip, which departed at 0615 and arrived about an hour later. I hoped the rain would stop falling that day – it didn’t happen – the rain came and went, came and went......We joined in a jeep safari with a large Indian family – I was hoping to spot at least a tiger, but that didn’t happen. Well, at least there were a few elephants in the training centre deep in the forest.

Elephants!

After the 1 hour safari trip, Alex and I decided to go for a 3-hour jungle trekking. I vividly remember the only 2 occasions I did this – first in 1998 (immediately after my UPSR exam) at Outward Bound School in Lumut, Perak and second in 2002 during a Prefects’ Camp somewhere in the forest of Pahang.

For Rs150, the friendly and knowledgeable guide took us into the forest, showing us the wildlife we encountered – hornbills + other birds, squirrels, wild-boars, monkeys and best of all, a wild elephant! I was out of my mind, still hoping to spot a tiger, but unfortunately (or rather fortunately) that didn’t happen. Given the recent wet days, it wasn’t an ideal situation to trek – the path was filled with puddles of mud, making it very slippery. I was very cautious to avoid falls and almost always had to look down on the path, to avoid soaking my shoes and feet. There were leeches on our shoes, trying to hook to our skin and suck the fluid of life out of us. Alex and I became a bit paranoid, flicking them away and checking on our shoes and legs every now and then. It wasn’t so lucky for our guide who only wore sandals – sandals for trekking? Unbelievable! Overall, it was a great unforgettable experience!

Deep in the forest where we did our trekking

We were back at the headquarters at about 1200, had a rest in the canteen before starting our journey back to CFH, with the government buses, which again was a nightmare. We were glad to be back at 1700 and found out that another elective student, Matt also from the UK had joined us in CFH.

Surgery - Operating Theatre

2009-09-04T00:51:00.001+10:00

As part of my surgical rotation, I spent a day in the operating theatre where the surgeon invited me to scrub in for the first surgery – a left inguinal hernioplasty (i.e. hernia repair).

Given the hospital’s limited resources, almost everything are re-used here...even surgical caps, masks and gloves! Everyone enters the operating suites not with shoes, but with the slipper provided in the changing room! Imagine doing that in Australia......one will be grilled by the Occupational Health and Safety personnel.

I didn’t do much during the surgery, but to hold the instruments (e.g. retractor) so that the surgeon could use both his hands. To be honest, I didn’t find the surgery too interesting as I had observed lots of hernioplasty early this year. Oh, another interesting fact...2 operating tables in one room – 2 inguinal hernioplasty (but on different sides) happening simultaneously. I really enjoyed being in the OT, as it is the only part of the hospital (I think) which is air-conditioned...great to be away from the heat outside!

Other surgeries that I had observed included removal of sebaceous cyst, haemorrhoidectomies (removal of haemorrhoids) and positioning of an exposed testicle – this man has an interesting history – he presented to the hospital almost 2 weeks ago with an abscess in his scrotum (right sided) secondary to untreated cellulitis. The skin appeared gangrenous and the surgeons had to debride it, leaving the right testicle exposed. This time, the surgeons attempted to position it into his right thigh, but thankfully he had enough skin flaps so that both testicles were in the right place albeit in a more confined space.

Surgery here is quite interesting. I may consider spending another week with the surgical department again.

Surgery - OPD

2009-09-04T00:40:00.003+10:00

This week, I am attached to the surgical department, where most of the workload occurs in the operating theatre (twice weekly) and in the out-patient department (OPD); not so much in the ward even for junior doctors.

Attending the OPD has been a very interesting experience. It is held for the whole day 4 times each week, in a small room occupied by 4 doctors with their patients, all who are in close proximity to each other – again, I wonder if confidentiality is an issue here. At least 100 patients are seen every OPD day, sometimes up to 150+!!! The waiting room is always packed with patients and their families until late in the evening. As for the doctors, they hardly stop working (well, apart from lunch break), continuously consulting one patient after another. Some patients would just simply walk into the room and stand in front of the doctors, even though they (the doctors) are still busy consulting other patients. Some would just hand me their OPD-notes, hoping that I would consult them. Great! I would be very happy to do it – but it’ll be a conversation between a chicken and a duck! The room subsequently becomes crammed and noisy – it is not surprising that tension can be high.

Given the high workload, consultations are usually quite fast. Despite that, the doctors perform their duties efficiently and the patients (some who travel quite far to CFH) are very appreciative even for the few minutes they spend with the doctors. All consultations are carried out in Tamil; hence I find lots of difficulty to comprehend what’s going on. Although they are very busy, the doctors kindly explain to me certain situations and allow me to examine patients with remarkable clinical findings – many patients here present late and hence the pathology is gross! In half a day, I’ve already seen lots of lumps and bumps (often huge ones) in the neck, breast, limbs, back, groin...everywhere! Extensive gross foot ulcers where deep tissues and bones are exposed are not uncommon here – seeing so many in a day is enough to put my appetite off.

The OPD is definitely a good place for the junior doctors to improve their consulting skills, where history and clinical examination are heavily relied upon, not investigations (as they are limited and add costs to the patient). However, given the language barrier, I believe it is not beneficial for me to spend my time there every day.

Madurai

2009-09-03T02:49:00.005+10:00

We spent a day in Madurai en route to Oddanchatram.
We arrived here on Monday morning at 0530 – again, too early to travel around! We rested at the lobby of Hotel Residency, where I went to the rooftop and discover this marvellous view...Sri Meenakshi temple against a sunrise backdrop. With 4 main gates/towers (NEWS), it is apparently the largest temple complex in South India.

After breakfast at the hotel, we made our way to the temple, only to find out that we were there on the only day of the year it closes for religious function!!! What a coincidence! So, we spent the morning walking around the temple and did some shopping – tried to hunt for the shop which sells cheap medical books...but, without success.

Sri Meenakshi Temple

Then, we took a taxi to Hotel Taj Retreat, on a hill 5km west of the city. Being the most luxurious hotel in Madurai, things don’t come cheap. I refused to pay Rs300 for a swim in the pool; instead I spent the day napping, reading My Sister’s Keeper and walking around the posh hotel.

Madurai from Hotel Taj Retreat

In the evening, we returned to the city for a dinner on a rooftop restaurant before we caught a bus back to Oddanchatram, which took about 2 hours.

Dinner on a rooftop with the temple in the background

Upon arrival, I found out I have a new roommate for the next 3 weeks.

Pondicherry

2009-09-03T02:20:00.006+10:00

My 2nd weekend in India was spent in Pondicherry. After dinner in Dindigul on Friday night, we took the bus heading for Villapuram at 2000. Six hours later, at 0200, we arrived at Villapuram where we then took another hour of bus ride towards Pondicherry. We reached Hotel Surguru at nearly 0400, and being so tired from travelling at such ridiculous hours, I immediately went to bed.

Pondicherry, being a former French colony (largely in the east side of the town), is unlike anywhere else in South India, as many people have described. There is a variety of cuisine here – I had eggs with bacon and toasts for my breakfast at Satsanga the next day...I didn’t expect bacon! We then walked around the town, mainly along the Heritage Walk, which include the seafront promenade, the Gandhi statue and the quiet streets with French names. It was at least 36degs that day – HOT!

The seafront promenade

Gandhi Statue

A quiet street and beautiful architecture

Rues Suffren & Du Bazar Saint Laurent

In the evening, we went to a beach, 8km north of the town. Since it was almost dark, I didn’t swim but strolled along the beach and enjoyed the sunset view (though at the wrong side as the beach faces east). We had dinner on the rooftop terrace of Au Feu de Bois restaurant, where I had chicken steak – tasted great but the service was terribly slow.

The next Sunday morning, breakfast was at Le Space, where I indulged myself with baguette and eggs scrambled with tomato and potato. Later, I rode on one of my friend’s hired mopeds. It was a thrilling ride especially on the empty streets, but it was no fun on the busy ones – one must use all his senses whilst travelling on Indian roads to avoid accidents; and I don't think I am one.

My breakfast at Le Space...yum!

Me on a moped

We spent the rest of the day at Paradise Beach, another beach 8km south of the town. I had a great time there – swimming, reading and “sun-tanning”. In the evening, we headed back to our hotel, checked out and had dinner at Daily Bread before catching the overnight bus to Madurai.

Paradise Beach

Crab...I thought of catching it for dinner =P

Overall, Pondicherry is a fantastic place for food – I’m glad I’ve rested my poor stomach from the spices of Indian food over the weekend; although it makes me many more Rupees poorer =S

A Warm Indian Hospitability

2009-09-02T02:15:00.005+10:00

27/08/09 (Thursday)

John (a friendly and helpful hospital path lab technician) invited me and the other elective students to join his family for a dinner at his home. We gathered at the chapel before taking auto-rickshaws to John’s home, which wasn’t too far away.

Upon arrival, we were warmly greeted by his parents. His father, who works for the hospital too, was the chef for the night. We dined the way Indians do at home – sitting on the floor and using our hands (apparently it enhances the flavour of the food). We were very well fed...chicken briyani, chicken curry, Indian coleslaw, chapatti – ahhh, they tasted so much better than the mess food.

Dining the Indian way

It was very comforting to hear that our generous hosts treat us as a family while we are in India, away from our loved ones back home.

With our gracious hosts, John (far right) and his parents and another Andrew from the UK

After dinner, we headed upstairs to the roof for coffee and star-gazing. I felt so relaxed there that I refused to return to my room an hour later! Oh, the people here are just so nice!!!

Back to MED4082 again – Paediatrics

2009-09-02T02:06:00.004+10:00

My 2nd week at CFH was spent in the paediatrics department. Just like the ICU, the ward is a huge room filled with 18 beds, although there are separate beds in the isolation rooms for infectious diseases such as gastroenteritis. The hospital also has a 5-bedded level-II special care nursery where sick neonates (e.g. pre-maturity, jaundice, sepsis, respiratory distress, poor feeding etc) were admitted and treated.

In the paediatric ward, I’d encountered children who presented with asthma, pneumonia and other respiratory infections, T1DM etc – all which are quite common in Australia. However, interesting cases that I’d come across included......

A 17 year old girl with a very white tongue and who had a haemoglobin of only 35 due to iron deficiency anaemia, which is not uncommon here given the widespread malnutrition among the poor
An 11 month old infant with a Thalassaemic facies and splenomegaly
An 8 year old girl with rheumatic fever who had arthralgia and severe mitral regurgitation with cardiomegaly
A 6 month old infant with military TB involving almost every organ - lungs, GI tract!!! Thank God her meninges was still spared and she that was treated 'sooner'
An 8 year old boy who presented with unconsciousness; most likely due to snake bite. I managed to observe the resuscitation process and the boy was given about 10 vials of anti-venom, each costing about Rs450 (AUD13), which is quite expensive in India...imagine the huge cost to his poor parents

The doctors here regularly encounter cases of gastroenteritis, which reflects the poor sanitation in this area. Feeding with milk bottles are generally discouraged; instead parents are advised to feed their children with cups or little spoons.

Kerala 2 - Houseboat trip; Cherai Beach

2009-08-28T18:50:00.010+10:00

The second day was spent on a houseboat in the backwaters of Alleppey, also known as Venice of the East. Again, it is difficult to describe the experience in words. The landscape is just breath-taking – one really has to view and feel the atmosphere in order to appreciate its grandeur.

The backwaters of Kerala

There are hundreds of houseboats here

Boating is one of the main modes of transport here

Rice field

One of my little friends

Lunch on the boat after a swim in the lake

Me! On the houseboat

After an overnight stay on the houseboat, we headed back to Ernakulam where we then took another bus towards Cherai Beach, which was about 25km north. The weather was just perfect to be on the beach, which faces the Arabian Sea. The water wasn’t too deep and the waves weren’t too rough, which was excellent for a swim.

Cherai Beach

Just as the weather started to turn wild, we left for Ernakulam again where we then watched an Indian cultural performance, which mainly depicted Hinduism. I did not really understand the plot though. As soon as the show ended, we immediately left for a quick dinner at Pizza Hut (yes! something different although it’s quite expensive!) before catching an overnight bus back to Oddanchatram. We paid more to sleep on beds; however, it turned out to be much worse than we had expected...it wasn’t comfortable and we didn’t sleep well.

Pizza for dinner...a good break from Indian food!

We arrived at CFH on Monday morning at 0400, ‘well-prepared’ to begin our clinical placement again.

Kerala 1 - Fort Cochin; Vaikom; Alappuzha (Alleppey)

2009-08-28T17:22:00.017+10:00

My first weekend in India started early. At 2230 on Thursday night, along with the other elective students, I took an overnight bus ride to Kerala. It was a semi-sleeper class, with comfortable reclining chairs and I was surprised that I slept well throughout the journey.

We arrived at Ernakulam the next morning at 0450, but it was too early and dark to travel around. We then found a nearby hotel (Hotel Excellency), which refused to permit 6 travellers to cram in a room for a few hours of rest. Instead, we were allowed to occupy the lobby for free! But, in return to its favour, we had breakfast at its restaurant.

Once we were all freshened up, we walked towards the boat jetty and caught a ferry to Fort Cochin, which only cost Rs2.5.

View from the ferry

We walked around the beautiful little town...

A street in Fort Cochin

Chinese Fishing Nets...beautiful, aren't they???

...before taking an auto-rickshaw which drove us to various places including cathedrals and shops, the latter which really annoyed me, as I was repeatedly approached by various salespersons.

Dried ginger

Different spices at the Spice Market

We had lunch (with beer) before heading south to Vaikom, another town, where we cruised along narrow canals on a small boat that looked like sampan. The atmosphere was serene and we were able to observe the activities of daily living of the villagers, which were simply basic.

2 hours later, we caught another bus, this time heading further south to Alleppey, where we slept at a guesthouse for a night.

We Need More Help!!!

2009-08-28T16:21:00.004+10:00

20th August 2009
Whilst waiting for the consultant to turn up for the afternoon ward round, I tried to do something useful by doing some reading. But the heat made me feel drowsy that I almost took a nap...in the ICU in front of the nurses, patients and their families! Speaking about professionalism...

Just before I managed to doze off, an intern from the casualty department hurriedly wheeled in an unconscious patient with a cardiac arrest. With the help of a nurse, he dragged the patient onto a vacant bed and immediately started pumping her chest and in less than minute later, attempted to intubate her. No one was giving the patient chest compression, when it was the most vital component in any CPR. For a second, I stood in awe, bewildered by the whole situation in front of my very eyes. But then, my sense told me that I should get involved......NOW! Without wasting more time, I jumped onto the bed and promptly continued the chest compression whilst the intern struggled to intubate the patient and the nurses, some rushed to get the required medications and machines whereas some seemed to be stunned, not sure what they could do. This was my first CPR on a real patient!

Where were the other doctors when help was desperately needed??? In Australia, a code blue would have been called long ago and there would always be more help available than needed. 3 attempts of intubation – all failed. 3 times withholding chest compressions – chances of survival decreased as each second went by without cardiac output. The patient was in VF. Where was the defibrillator??? I tried my best to do what I could, continued compressing despite the fatigue that had started to kick in.

Almost 10 minutes later, another 2 doctors including the consultant arrived. A nurse took over my role. The patient was intubated, was shocked, was injected with different medications and was continued given CPR. Everything seemed to happen so slowly. After about 40 minutes, the patient reverted back to sinus rhythm with multiple ventricular ectopics. But, with such a prolonged downtime, I doubted her prognosis would be good.

The following Monday after my weekend trip in Kerala, I sadly found out that the patient died 2 hours after admission. I wish we could have done better to save her.

My first Indian Bus Ride Experience

2009-08-28T16:16:00.003+10:00

On my 2nd night at CFH, I went to the town of Dindigul for dinner with the other elective students. We took a bus, which I initially hesitated. But it was so much cheaper than catching a taxi – it only cost Rs9 (about AUD0.25) for a one way ride (about 30km). A taxi trip would have cost at least Rs500.

The experience was unlike any other bus rides which I had previously commuted. It was just very crowded – we were packed like canned sardines, with hardly any room for movement. The doors were wide open and many people stood there, simply because there was no space in the bus. Many commuters jumped in and out of the bus although it had not totally stopped. The sleeky bus conductor, who could easily move around the bus despite the crowd, seemed to have a very good memory, recognising those who had or hadn’t paid the bus fare; or was it because I was outstanding (i.e. not an Indian)?

The ride was a very bumpy one as a result of a combination of various factors – fast-driving with sudden braking; uneven road surface; frequent overtaking and dodging from other vehicles/pedestrians; honking etc. To make it really an Indian atmosphere, loud Indian music was played in the bus.

About an hour later, I reached Dindigul (and yes safely in 1 piece).
It is difficult to describe the experience in words. You just have to feel it! I would say my first Indian bus ride as being “THRILLING”! It wasn’t too bad after all – the bouncy ride made it fun and exciting.

ICU/CCU Placement

2009-08-28T16:09:00.003+10:00

I spent my 1st week at CFH in the ICU/CCU. The ward was guarded and only one visitor per patient was allowed to be in the ward. The rest had to stay outside and could only observe through the open windows. All beds were crammed into one large room and without curtains between beds, there were no privacy and confidentiality. Everyone could easily see the doctors at work and the patients did not appear to be bothered. In fact, they were so humble and felt very grateful to receive medical attention.

All the doctors and most of the nurses here speak English but not the patients and their families, who mainly converse in Tamil. The language barrier prevented me from understanding the whole clinical situations, but it was great that the doctors kindly translated plus their teaching was excellent. Whereas each ICU bed in Australia is equipped with machines (e.g. ventilators), the doctors here have to utilise the limited resources carefully.

The very first patient I encountered presented with APO. She was treated with frusemide but instead of oxygen, the doctors immediately intubated her...without pre-oxygenation and cricoid pressure. In fact, everything was done hastily and I must admit it was kind of chaotic. Despite that, the intubation was successful and a few days later, the patient was able to walk home. Other cases I’d come across included heart blocks, CVA, COPD, ARF, ascites and pyo-pneumothorax. Poisoning (commonly organophosphates), especially among young people is not uncommon here. On my very first day, there were 3 people admitted with attempted suicide; sadly all within 2 months of their arranged marriage. Patients with TB, who were actively coughing and spreading their germs around, were allowed to walk freely and mix with other patients. This is so different from Australia, where even patients with low probability of suspected TB have to be isolated and a whole lot of protocols involving infection control have to take place. I guess it must be the prevalence of TB here that makes its containment almost impossible.

When I was free, I would walk around the hospital to familiarise myself with the locations of different departments. I was just shocked with the amount of people who visited the hospital – thousands of people...in the pharmacy, out-patient department, cashier, outside different wards...everywhere!!! I must admit even though I’m not a “gwai lo”, I received lots of attention, with many people staring at me...not that I like it, but I guess seeing a Chinese here is quite uncommon. Although a small hospital with 80 doctors and 100+ nurses, CFH apparently treats almost 2000 cases (both in-patients & out-patients) per day! What a marvellous accomplishment!

Arriving CFH

2009-08-27T22:57:00.009+10:00

I couldn’t sleep well for the 2nd consecutive night – noisy air-conditioner; unfamiliar mattress; being afraid that I’d wake up late the next morning, hence miss the train. By 0630, I had already checked out from the hotel and made my way to Chennai Egmore Train Station, which was only 500m away. The weather was very humid and in less than 5 minutes, I was already drenched in sweat. The road leading to the station was super busy even on an early Sunday morning! Traffic was heavy with lots of auto-rickshaws offering to give me a ride and countless number of pedestrians thronging along the street. It was just plain madness. My walk wasn’t a pleasant one either – needed to avoid accidents and drag + carry my heavy luggage – I knew I shouldn’t have packed much!

Chennai Emgore Train Station

However, I was glad that my train ticket, which was initially on the waiting list, had been confirmed. Hence, I boarded the Chennai Egmore Guruvayur Express (Train No 6127), which departed at 0750. My train ride to Dindigul was a comfortable one as I got an AC 2-tier class ticket, which was air-conditioned with spacious seat cum mattress. The journey was a long one – 7h25m. With so much time to spare, I read 3 chapters of Jodi Picoult’s My Sister’s Keeper and tried to catch some sleep. Apart from that, I spent most of the time sight-seeing from the little window in my cabin. And the views were truly India...from picturesque sceneries to small ramshackle houses, built either from mud or some sort of huge leaves, depicting the widespread poverty in India.

At 1515, I arrived at Dindigul Train Station, took a cab and 45 minutes later, reached my destination, Christian Fellowship Hospital.

Upon arrival, I was greeted by a lovely ENT surgeon, who guided me to my room, which is just above where she lives with her husband, who works as a psychiatrist. A warm welcome note was stuck on my room door – it was from Meena, the student elective coordinator who organised my program and who was away for a holiday. My room was very basic but liveable – much better than I had expected! Beds were provided, electricity with fan and light was supplied and a bathroom/toilet was attached to the room. I immediately had the impression that I would be well taken care and there shouldn’t be any reason for me to worry too much.

My room for the next 6 weeks

When it’s time to unpack, I realised I had ‘lost’ my luggage key! Crap! How could I be so careless?! All my things were in the huge heavy bag and I felt so hopeless without access to them. I needed help and the first persons I could think of were the doctors. So, I paid them a visit and explained my problems. They were just simply amazing...not only did they offer me the necessary toiletries, they also served me evening tea! Later, I went to the medical library to send an e-mail to my beloved family to inform them of my safe arrival – they must have waited so long to hear from me. It was there that I met the other elective students who live with me...2 from the UK and 3 from Germany. At least, I’m not alone!

Just before I left the dormitory for dinner, an Indian man came to help me open the luggage...instead of breaking the lock, he broke one the zippers! Well, the bag opened but now I couldn’t lock it! It was then that I found I locked the key in the luggage...arghhh – how clumsy could I be???!!! Again, it showed how much the doctors here care to make my stay a comfortable one. I attended the Sunday evening worship with the other students before having dinner together at the doctors’ mess – vegetarian meal...rice with curry (tasted like dhal) with Indian style vegetables and pappadam. I was back in the dormitory at 2030, had a shower and feeling exhausted from the long journey, went to bed early.

India Day 1 (15/08/09) - Makan-makan in Klang + Arriving Chennai

2009-08-25T18:54:00.004+10:00

After months of planning and days of packing, I finally left home for Melbourne Airport on Friday night (14^th August 2009), to catch my flight to Kuala Lumpur, then to Chennai (previously Madras) for my Year 5 elective at Christian Fellowship Hospital, a 300+ bed missionary hospital in a small town of Oddanchatram.

Having said “Bye bye” to my dearest Mummy, brother and sister, I boarded the Malaysia Airline’s Boeing 777-200, which took off at 0015 (GMT +10) and at 0625 (GMT +8), landed at KLIA, where I was greeted by my dearest Daddy. We went home to unload my stuff and then visited Ah Mah, who I have not seen for almost 4 years. Later, we had breakfast at Kin Sun Kopi-tiam where I had fried ‘yong tau foo’, ‘char kuay teow’, ‘chai kuay’ and not to forget my favourite ‘teh si peng’ – ahh, the taste of authentic Malaysian food!!! I was just too excited that I forgot to take photos of them to show my brother and sister =P

I then met up with a close friend and we had morning tea together at Pappa Kopi-tiam in Bukit Tinggi. Thanks for the box of ‘char siew pau’ and egg tarts, Joanne! They tasted great but too bad, I couldn’t finish them on my own. In the afternoon, I had my favourite ‘ngoh heong’ at home for lunch, which Daddy had bought the previous night as the stall only opens at night. It was soggy, but still tasty. Then, it was shopping time at Jusco Bukit Tinggi to get stuffs which I didn’t pack in Melbourne. After finalising my packing and saying goodbye to Ah Mah and Dua Ko, I headed to PJ for an early dinner at Oriental Inn where Daddy treated me shark-fin soup and soft-shell crab (my brother and sister must be really jealous now =P).

I was back in KLIA again to catch the 2135 MH180 flight, which arrived in Chennai at 2245 (GMT +5.30). Upon leaving the aircraft, an Indian lady scanned my head to detect any rise in body temperature, given the recent H1N1 swine flu pandemic. As soon as I had cleared immigration and collected my luggage, I walked out of the airport, only to find there were masses of people everywhere, even though it was already late – night seemed to be still young for these people.

The driver who was meant to drive me to the hotel which I had booked couldn’t be found. This left me no choice, but to catch a taxi, which was really a wild adventurous ride – speeding; frequent honking and overtaking despite the presence of oncoming vehicles; tail-gating; running through red lights; non-functioning traffic lights etc. I had to hang on to dear life throughout the journey. Worse, I wasn’t sure if the driver understood what I’d told him (re desired destination) and started to panic, thinking that he might drop me at a deserted place, where no help could easily be called. Eventually, I arrived at Nest Inn Hotel in one piece and felt so much relieved. I immediately checked in, had a shower and went to bed, hoping to catch some sleep before I resumed my journey......

A safe arrival

2009-08-19T16:37:00.003+10:00

Hi, just a short update...
After almost 2 days of travel via aircraft, train and taxi, I have finally arrived safely at my destination - Christian Fellowship Hospital in the town of Oddanchatram. Though the travel was long and tiring, it was a great and enjoyable one.

In fact, it is my 4th day here - currently doing ICU.
Will write more later. I'm thinking of creating another blog, exclusively for my India trip......

India...here I come!

2009-08-14T19:15:00.003+10:00

This is madness. I will be leaving for the airport in an hour's time and still sitting here, rambling about my very uninteresting life - I sometimes wonder who read my boring blog. It's nothing much, but just about me!

After years of waiting, the time has finally come! But, am I prepared for the challenge? I have always been looking forward to this trip; now I feel a bit apprehensive...not surprising given that I'm travelling on my own for the first time. Who knows what lie ahead of me......

I'd certainly miss my family, especially my most beloved Mummy, who I am sure is quite anxious too though she does not express it. I've spent most of my life with her and being away from home sounds a little scary for me now. I guess I have separation anxiety, just like a little child.

Hopefully things will turn out fine. Please keep me in your prayers...
India...here I come!!!

Gen Med

2009-08-14T00:01:00.008+10:00

My medical rotation has finally come to an end; but not the way I would want it to. It has been very busy this whole week with a sudden influx of patients, presenting with a variety of conditions, ranging from conscious collapse to life threatening illnesses such as acute pulmonary oedema. Many have a lengthy hospital stay, either waiting for rehab beds (which are severely limited) or waiting for review/clearance from other medical teams, sometimes with different opinions, which is very frustrating. Ultimately these prolong the patients' stay; thus increase the risk of hospital acquired infections and subseqeuently healthcare cost...not pleasant at all!

Overall, this rotation has been one of my favourites despite the madness of never-ending ward rounds and referrals; perhaps due to my bias in liking medicine over surgery and ED. I must say I'm fortunate to be in a great unit, with a dedicated and friendly registrar and a hardworking intern, who is my role model for next year!

Anyway, I don't have time to write much. Gotta pack for my elective in India and it's driving me nuts!

Elective preparation: Pre-travel clinic

2009-07-31T22:06:00.016+10:00

Going to India for an elective does not come cheap as I had initially thought. In terms of preparation for this adventure (which I have been looking forward to since my early years of medical school), the only things I have done so far are purchasing my air-ticket and travel insurance, the latter which is recently made compulsory by the University. And so there goes my $1300.

As I will be leaving in two weeks time, I reckon it is high time to start preparing seriously; hence my visit to the doctor today for some travel advice, prescriptions and vaccinations. Seeing the doctor 2 weeks prior to my travel is considered quite late, as some vaccinations (e.g. for Japanese Encephalitis) need to be given a few weeks apart for them to be complete. I know I should have attended his clinic at least 4-8 weeks earlier. But I was either too busy or just plain lazy/tired when I had the time. In fact, I had even contemplated if I should seek his consult...just because, with my limited knowledge of infectious diseases, I had the perception that the risks of travelling in India is almost the same as travelling in Malaysia - Hep-A, malaria, dengue, typhoid etc are equally prevalent in both countries. Yet, I do not see doctors for my Malaysian trips. Anyway, after careful consideration and given that I have not been in India before, I took the wiser step by paying him a visit this morning.

The consultation was uneventful with lots of prescriptions: Maxalon for nausea+vomiting; Vibramycin (doxycycline) for malaria; Noroxin (norfloxacin) for bloody diarrhoea; Fasigyn (imidazole) for giardia; Dukoral for cholera etc. Basically, medications for traveller's diarrhoea which I hope does not happen to me!

Then came the vaccinations. It was decided that I needed 5 different vaccinations: Hep-A + Typhoid (comes in 1 vial); Meningococcal ACWY; Polio booster; MMR booster. That means 4 shots in a day - 3 in my left arm and 1 in my right! Not surprisingly, my arms (especially the left one) were sore throughout the day and I could barely lift them above my head...still it was well tolerated. However, the more painful bit is the out-of-pocket expenses...$225 in total! And my health insurance doesn't cover them!

I have not even bought the many different prescribed medications, which again are not covered by the PBS! Not to mention the other items which I may need to buy in the following 2 weeks. The university's $1000 travel grant does not help much either. Perhaps, I'll be broke well before I commence my journey!!!

Maggi Mee Goreng

2009-07-25T22:47:00.010+10:00

Since Mum has been cooking all the time, I thought she should deserve a break and I volunteered to be the chef tonight. But, what to cook? Well, given that we have not returned to Malaysia for a long time, I decided to prepare Maggi Mee Goreng - a famous mamak dish which we love and have not seen in Melbourne restaurants so far.

These were the ingredients I used...

Maggi Mee
Eggs
Fish-cake - sliced
Chicken - cut into pieces
Onions - sliced
Garlic - chopped
Firm tofu - diced
Choy Sum
Tomato - sliced
Curry + Chilli powder

Now comes the fun bit, combining these ingredients together to come up with the dish.

Pour the Maggi Mee seasoning into a small bowl. For extra spiciness, add a little curry and chilli powder. Mix with some hot water to form a paste, stir it and set it aside.
Boil the Maggi Mee noodle in a pot of hot water. Make sure the noodle is not overcooked (otherwise it'll be very soggy). Drain and rinse with cold water. Set the noodle aside.
Beat the eggs in a bowl and fry them until cooked. Set them aside.
Similarly, fry the firm tofu until they turn golden brown and set them aside.
Fry the garlic and onion in a wok of hot oil. Add in the chicken pieces, fish cakes slices, choy sum and tomato.
Once cooked, pour in the seasoning paste followed by the noodles immediately. Stir well.
Add in the fried firm tofu and egg. Continue stirring until it is dry.

And finally, garnish with slices of tomato and fried shallots...and the dish is ready to be served!

So, this is Andrew's first 'cooking class' =p - a ridiculously simple yet tasty (self-proclaimed) dish. Everyone enjoyed it although my bro & sis said I'm still not qualified to join the MasterChef series yet...evil!

US Visa

2009-07-22T19:05:00.003+10:00

My passport arrived in the mail this afternoon. Mum rang me and asked if she can open the envelope. That's very nice of her to seek my consent. Love you Mummy! I guess she must be very excited. On the other hand, I was quite nervous as I only applied for the visa last Thursday. Surely it won't take that fast (in less than a week) for the application to be processed in Melbourne? Many people I know (who are in similar circumstances as me) had to wait for about 2 weeks. I thought my application failed and I had to re-submit everything again =(

But how wrong I was! I got my US tourist visa finally! Now, what shall I do???

I got a job!

2009-07-20T17:16:00.004+10:00

Just a super-short entry...
1) No nightmare yesterday
2) 9:15 am today - I found out that I got a job! And it's my 1st preference! Woohoo!!! A whole new world of excitement awaits for me =D

That's all for now...back to Mouse-hunting!

Jobless Nightmare

2009-07-19T19:49:00.004+10:00

I was wide awake early this morning after having a little nightmare. I dreamt that my internship application was unsuccessful and that I was jobless - I was really freaked out and hope it doesn't come true.

Tomorrow...on 2oth July 2009 at 10:00am, I will find out if I have successfully received a match (i.e. a job) in the first round offer.
If not matched, I will have to wait for another 2 weeks to see if there are any more vacancies in the second round offer, most likely at places which I'm not too keen to go. That's bad enough...the 2-week waiting period would be a nerve-wracking one, enough to drive me insane.
Even worse...What if I don't get a 2nd round match??? I guess I'd be doomed - jobless for the year. Or perhaps returning to homeland for a 2-year internship, which I heard is very tough and stressful!

Oh, I hope that nightmare doesn't recur tonight.

5th Rotation

2009-07-10T17:06:00.006+10:00

A lil' update - Emergency rotation is finally over...yay!!! Now, I am undertaking my 5th rotation (general medicine) which has just started this week. It is my last one for the year in Melbourne before heading overseas for my elective in India and vacation (location yet to be known - perhaps back in Melbourne again?).

The week started with an orientation, which I didn't find particularly helpful as I had been at the hospital for a few times already. Yet, it was compulsory to attend. Perhaps finding out which medical team I'd be attached to was the most useful information.

Right after the orientation at 10am, I paged my registrar and met him in the medical ward...only to find out that the day had only just begun and it would be a super-long one. 30 over patients, including 15 new ones over the weekend to be seen during the endless ward round! And to make matters worse, the unit's medical intern was away sick. My poor registrar (who is such a nice and friendly person) who had so much to do: evaluating patients; making referrals; answering that damn annoying pager etc - working non-stop! On top of that, he is going to sit for his physician exam soon! I can't imagine myself in that situation although I am very keen to undertake the physician training program =S

I find myself very hopeless as I did not do much to reduce his workload --> I was overwhelmed by the different environment; not knowing how the unit works; not knowing the patients etc. If only I could do something. Later in the day, I was asked to insert IV drips for 2 elderly patients who had tiny veins. I thought I would fail both and wanted to leave them for the registrar (for fear of poking the patients too many times). But I gave them a try and my attempts were successful! The next day, the reg told me that he went home late but my assistance enabled him to leave half an hour earlier. I would say that's a small contribution. Hopefully, I will be more proactive from next week.

What else can I say?

2009-06-30T17:51:00.009+10:00

"That's all we have to ask.

Thank you for coming in today.

You may leave now."

As I peeked at my mobile screen...

15:27 30-Jun-2009

That's the end of all my interviews for internship

Reflecting on my performance

I realise I have so many things to tell them

But why didn't they come across my mind?

Perhaps I was too ego to 'sell' myself

Or maybe it was due to intense anxiety

Which inadvertently led to mental blocks

Perfect time to bid farewell to my prospective employers =S

I won't that say I did terribly bad

Nor exceptionally well

Just an average applicant

But that isn't good enough, right?

There are so many outstanding talents out there

The competition is fierce

Everyone wants a job here

I wish I could have prepared better

I wish I could turn the clock back

But I know that's impossible.

In the meantime

I do not want to think of them

As they just make me more worried

There's no point crying over spilt milk

I had done my 'very best'

All I can do now is to wait

Waiting for the not so far-away match results

Hoping and praying for the best.

Heal the World

2009-06-29T19:44:00.004+10:00

Trying to post a video here. Let's see if it works......

Farewell MJ

2009-06-28T19:35:00.023+10:00

A tragic life and a tragic death - I guess that's MJ's life in a nutshell on top of his successful musical career

It was Friday morning...I was watching the tele whilst having my breakfast - lots of MJ's music video clips. Never thought it was anything unusual until I listened to the shocking radio news whilst driving to the hospital! Well, I won't talk about his death and the various issues he encountered in the later years of his life as they are hot topics in the media recently and they will be for at least another week.

As a child many years ago, I enjoyed listening to and even singing (unshamedly coz I was a little boy!) his songs. But somehow, as I grew up, going through my teenage and young adulthood years when music was part of my life, I disregarded him...totally! Was it because his popularity had been overshadowed by other rising stars? Or was it because I had preference for other genres? It saddens me to know the untimely death of my childhood idol.

MJ's tragic situation is not unique. Just look at the fate of the late Princess Diana, Elvis Presley and Heath Ledger...all famous people with some degree of drug intoxication who lived under the limelight and often haunted by paparazzis wherever they went. As my mum had correctly pointed out, what't the point of living such a life without much privacy and freedom. Perhaps, being well-known, especially in the entertainment industry isn't particularly the best thing in life.

I will end this entry with one of my most favourite MJ's songs - Heal the World, which I personally feel is very meaningful. It speaks about peace, humanity, hope and the devastating harsh circumstances that many innocent children face. This was, is and will be a major problem, unless the issues of war & poverty are addressed appropriately. MJ's dream has not been realised yet, but lets hope it will one day in the near future.

Heal the World
spoken (by a lil' girl):
Think about the generations and to say we want to make it a better world for our children and our children's children.
So that they know it's a better world for them; and think if they can make it a better place.

There's a place in your heart
And I know that it is love
And this place could be much
Brighter than tomorrow.
And if you really try
You'll find there's no need to cry
In this place you'll feel
There's no hurt or sorrow.
There are ways to get there
If you care enough for the living
Make a little space, make a better place.

Chorus:
Heal the world
Make it a better place
For you and for me and the entire human race
There are people dying
If you care enough for the living
Make a better place for
You and for me.

If you want to know why
There's a love that cannot lie
Love is strong
It only cares for joyful giving.
If we try we shall see
In this bliss we cannot feel
Fear or dread
We stop existing and start living
Then it feels that always
Love's enough for us growing
Make a better world, make a better world.

Chorus

Bridge:
And the dream we would conceived in
Will reveal a joyful face
And the world we once believed in
Will shine again in grace
Then why do we keep strangling life
Wound this earth, crucify it's soul
Though it's plain to see, this world is heavenly
Be God's glow.

We could fly so high
Let our spirits never die
In my heart I feel
You are all my brothers
Create a world with no fear
Together we'll cry happy tears
See the nations turn
Their swords into plowshares
We could really get there
If you cared enough for the living
Make a little space to make a better place.

Chorus (3x)

There are people dying if you care enough for the living
Make a better place for you and for me.
There are people dying if you care enough for the living
Make a better place for you and for me.

You and for me / Make a better place
You and for me / Make a better place
You and for me / Make a better place
You and for me / Heal the world we live in
You and for me / Save it for our children
You and for me / Heal the world we live in
You and for me / Save it for our children
You and for me / Heal the world we live in
You and for me / Save it for our children
You and for me / Heal the world we live in
You and for me / Save it for our children

I don't know how to attach a youtube video here, but here's the link to this wonderful song...... http://http//www.youtube.com/watch?v=W61Q-EZ8R7M&feature=channel

Farewell MJ, the King of Pop - may your soul RIP.

12 hours in Canberra

2009-06-20T16:05:00.053+10:00

With a passport validity of less than 6 months, it's time to get a new one before I can apply for an Indian Visa for my elective. Trouble is...I can't do it here in Melbourne as the Malaysia High Commission (MHC) is in Canberra; hence my recent day trip to the heart of the nation.

Took a Virgin Blue flight which departed at 8.30am and in just under an hour, landed at Canberra Airport...

Then, immediately caught a taxi and managed to reach the MHC by 10am.11am: All 'formalities' completed; now needed to wait until 3pm to collect my new passport. With so much time to kill, I went for a little holiday, touring around the capital city, mainly on foot...

First stop - Parliament House which is within a stone's throw away from the MHC

The Parliament House is surrounded by a small forest of gum trees

Capital Hill

Front view of the Parliament House - The white building is the Old Parliament Building whereas the Australian War Memorial is at the far end

Then, headed towards the city centre, which is about 4km away from the Parliament House...

The Old Parliament Building

Lake Burley Griffin - a large lake separating the Parliamentary Zone & the city

Arrived at the city centre 45minutes later - there wasn't much to do there...a quiet city with a few office buildings and a large shopping mall - The Canberra Centre......

Had lunch, walked around the mall and did some reading before catching a bus towards the MHC for passport collection. My mission was accomplished at 4pm when the new passport was in my hand. I took the bus back to the city centre before walking to the Australian War Memorial

Front view of the War Memorial - The Parliament House!

Back in the city centre again at 6.15pm, had a quick dinner at a Korean restaurant and finally took a shuttle bus to the airport for my flight back to Melbourne at 9.40pm.

Reached home at 12.15am - I was extremely exhausted; my hips & legs were really sore - muscles stretched to the max from walking the whole day - felt that I walked like a heavily pregnant woman.
Well, I had a good sleep that night. Now, to the India Consulate for Visa!

Thanks Rachel for helping me to save $25 on my passport photos!

Tis the season for job-hunting

2009-06-11T19:48:00.006+10:00

The last few weeks have been very hectic for me. I have spent a significant amount of time attending various information evenings and writing up CVs as well as cover letters for an internship in Victoria. So much serious thinking was put in to produce those two precious documents, which I hope will get me a job. On top of that, I have to attend my clinical placements in the emergency department......such a stressful time indeed.

Now that I have submmited all my applications *slight sigh of relief*, I will need to attend for interviews, which again would shoot up my stress hormones, and perhaps leading to panic attacks! Urghh......why the application process here is so much more complex than in other states???!!! Everyone says that with my (prospective) qualification, I will DEFINITELY get a job - unfortunately, that's not the case for me...like any other non-local applicants, I am NOT guaranteed a job! =(

On a positive note, after months of waiting, my elective in India has been approved! Woohoo!!! I have bought my air-ticket to Chennai and now, need to apply for a visa. Yes, I am excited! But at the same time, feel anxious about my prospect of getting employed...

A bit busy......

2009-05-24T19:23:00.003+10:00

I have not been actively posting any entries over the last few weeks......not that I'm neglecting it.
Just a bit tired and busy with job applications recently.

Apart from that, I have just finished my aged care rotation...3 down; 2 more to go.
Will be starting ED tomorrow. Somehow, I feel nervous to work in the ED - I imagine it would be a hectic environment plus...there would be lots of thinking for diagnostic and management work-up......a skill which I find most difficult.

Anyway, I'll see how it goes for the next 6weeks. Hopefully, it'll be exciting with lots of learning.

A short 'touching story'

2009-05-15T20:39:00.009+10:00

He was only about 11 years old when his mother, sadly passed away suddenly from a heart attack. He had no contact with his estranged father, who was a drug addict. Who can this young little boy turn to for love and care, but his elderly maternal grandmother who was in her early 80's? She was the only family member he had left. Poor Nanna...despite the aches and pains of aging, without any hesitation, she again assumed the role of a 'mother', this time nurturing her only grandson.

Things initally went well but not long - tragedy seemed to struck. Nanna had been having some problems with her memory - she gradually became more and more forgetful to the point that she encountered difficulties to cope functionally well at home. A neuropsychology assessment was subsequently carried out, which revealed a cognitive impairment. Yes, Nanna had Alzheimer's dementia, a disease which most people fear as their memories slowly fade when they get older. Nanna did not seem to be aware or fussed about it - together, she and her grandson still live under the same roof. But, their roles have now been reversed......

With a case manager and some help from a few services and a family friend, he manages things at home, from cooking to laundry to taking care of Nanna. On top of that, he has to prepare for his Year 12 exams, which he splits into 3 years instead of the usual 2 years. As Nanna's cognitive function declines, she thinks her grandson is her cousin. Behavioural symptoms begin to emerge too - she can be verbally aggressive towards her grandson. But, how can we blame her for that? It is part of the disease as it progressively becomes severe. Yet, he does not neglect Nanna and fulfills his role in looking after her, which is a challenging task for a 17 year old boy! He mentions that he is coping alright both physically and mentally, but how much more can he take???

When Nanna has a fall and fractures her hip recently, she is brought to the hospital for surgery and then, transferred to a rehabilitation unit for further management. He still finds time to visit her after school to chat with her. However, one would wonder if she knows who is the person she speaks to. Plans are now being organised to help both Nanna and her grandson - with a view of high-level care placement after discharge and appointment of a Guardian. Hopefully these measures would ease off the heavy burden that poor kid is carrying at the moment......

****************

What I wrote up here is not a fiction! It is a brief summary of the life of a demented patient, who is one of my patients during my aged care rotation. More importantly, it highlights the impact of dementia on her young carer, who I must say is really a marvellous person. His good demeanour and tolerance with his Nanna's problems 'melt' the heart of the treating team. I wish I could do something to help him, but what can I do??? Yet again, as a future doctor, it is important to maintain my professional relationship with the patient and his/her family (i.e. not to "bleed for every patient").

Personally, I think I would be able to do what the grandson has done......BUT just for a few days at most and I would then definetely crash!!!

Of catching mice and playing poker

2009-05-06T22:05:00.006+10:00

Geez...am I too free these days??? No, it shouldn’t be!!! There are loads of things to do – researching on my prospective employers, writing up CVs & cover letters for my internship application, completing my modules, chasing-up the progress of my elective application etc.

Yet, I find myself spending so much time in front of Facebook recently, not to keep in touch with friends, but to catch mice (MouseHunt) and play poker (Texas Hold’em).

MouseHunt: I’m on a mission to catch all the different kinds of mice available (ranging from the common Grey Mouse to the rare Leprechaun Mouse) whilst earning points and gold to improve my weapons. You now know who to call if you want to get rid of the mice in your homes =D
Texas Hold'em: With 500K+ chips at the moment, I’m currently aiming to be a 1M Pro – hence playing the game each night. Even though it’s not real $$$, I’m very addicted to it. Getting a Royal Flush would be great and I found its probability is roughly 0.00154%, which I assume would be less than being randomly hit by a lightning =D

Oh, what a "productive" way to kill time!!! Time to start getting things organised......

Who's the confused one now???

2009-04-24T21:41:00.008+10:00

It was a busy day for me yesterday.

Firstly in the morning, 2 patients needed IV-lines......1 for a blood transfusion (successful - hooray!!!); another for antibiotics (failed despite 2 attempts - sobz). Then, I was asked to change a urinary catheter - the procedure went quite smoothly but the series of events after the insertion was a disaster. I forgot to collect a urinary sample as requested by my registrar - I forgot to lower the patient's bed - I forgot to dispose the plastic of rubbish which was left on the patient's bed. Hence, the nurse had to fix up all the "cardinal sins" that I had committed - repositioned the bed to a safe level and cleared up the mess. I did not realise my mistakes until I returned from the continence clinic in the afternoon. My registrar explained to me what had happened and feeling remorseful for my irresponsible actions, I approached the nurse and apologised - thankfully she was not mad at me; in fact she was very pleasant to me - such a nice lady! Reflecting on these mistakes now makes me realise how a simple error could lead to major mishaps (e.g. falls) and appreciate the importance of keeping good relationships with other staff members, who could be very helpful if we need their assistance.

In the afternoon, my registrar was away for her weekly training. Hence, the resident and I were left to do a patient transfer - the patient recently had an incisional hernia repair and she developed a wound-breakdown with fever and raised inflammatory marker during rehab; hence the need to transfer her to an acute hospital for further management. Having done that, I was then requested to make phone calls regarding a patient's medications, chase up blood results and ensure that patients had their X-rays taken.

In the evening, whilst the resident was busy preparing discharge summaries for patients who would be leaving the next day, I volunteered to do an admission for a patient who was brought in earlier. So, I did the usual stuff - took a history, performed an examination, checked her recent investigation results and documented all findings in her notes. Part of the admission process was to assess the patient's mental state to detect for confusion/delirium - this was done through a series of 10 questions (one point for each correct answer) - one of them included asking the patient to estimate the time without looking at the watch/clock. She told me that it was about 5.15pm - I thought it was only 3.30pm and was about to score her zero for that question. Given that she had done so well in other questions, I asked her again, hoping that she would make sense of the time. Again, she gave me the same response, this time with less confidence and she became a little bit confused. I looked at her watch...yes it showed 5.15pm and I thought her watch must have shown the wrong time. I double-check it with the time on my mobile - and it was indeed 5.15pm!!!!!! So, it happened that I was the delirious one! And worse, about to add another confused patient in the ward!

Gosh...I did not realise time past so quicky that day. Perhaps, I could be quite busy till I lost track with time. Just before I left, another acute transfer was needed - thankfully, the registrar who had already been informed of the situation returned to the ward and along with the resident, did the transfer. Otherwise, staying there any longer would create a very delirious Andrew......

Aged Care

2009-04-19T21:59:00.007+10:00

I am now in my 3rd rotation - aged care in a rehabilitation unit which is located very close to home. With parking provided for students, I only need 5 minutes from home to be there on time (8.30am). Great......extra sleep for me each morning!!!

On the other hand, it is a rotation which I'm not quite looking forward to - partly because of personal reasons. Anyway, it's a core rotation and hence I have to endure it for 6 weeks - 1 week is over; 5 more to go......

My 1st week has been quite unexciting, which isn't too surprising. All the 30 patients in my ward recently either had a fall and/or an orthopaedic surgery (due to fractures or arthritis). They had been stabilised in the hospital prior to discharge to the rehab unit; hence they require sub-acute care. This is in stark contrast to my previous ICU experience, which as its name suggests - very "intense"!

All I did this week was familiarising myself with the ward - talked to patients; observed the doctors doing admission (which I will do in the coming weeks); learned how to fill in drug charts; organised clinic visits; attended ward rounds. I had also attempted to do a few IV lines - which to my great disappointment, all failed!!! =(

Well, 5 more weeks of aged care - hopefully things will get brighter......

Never judge a book by its cover

2009-04-18T15:52:00.011+10:00

I received an e-mail from an uncle in the US a few days ago. I find it too amazing (well, at least for me) and so, want to share with those who have not seen it......

Never-kissed woman wows Cowell, becomes YouTube sensation
LONDON, England (CNN) -- A 47-year-old British charity worker who says she has never been kissed has become a YouTube sensation after singing in front of Simon Cowell.

Susan Boyle, from West Lothian in Scotland, appeared on the television show "Britain's Got Talent" at the weekend.

A YouTube clip of her performance now has more than 5 million hits.

Before appearing on stage to sing "I Dreamed a Dream" from the musical "Les Miserables," Boyle told the show's hosts that she lived with her cat Pebbles and had never been married or kissed, adding that it was "not an advert."

"I'm trying to be a professional singer... I'm going to make that audience rock."

Before singing she told Cowell, also a judge on American Idol, that she wanted to be like singer and stage star Elaine Page.

A skeptical audience laughed. However, as soon as she began singing the crowd leapt to their feet.

Afterwards, Cowell said her performance was fantastic.

"I knew that the minute you walked out on that stage that we were going to hear something extraordinary."

His fellow judge, Piers Morgan, said it was "the biggest surprise I have had in three years on this show."

"When you stood there, with that cheeky grin, and said I want to be like Elaine Page everyone was laughing at you. No one is laughing now. That was stunning. An incredible performance."

Amanda Holden, the third judge cried, describing it as a privilege to hear.

Boyle said afterwards that she felt "bloody fantastic" and that she was very "emotional.”

Watch & listen it ... http://www.youtube.com/watch?v=9lp0IWv8QZY

*********************************************************************************

I was moved into tears when I heard her sing - and a standing ovation from the audience... how incredible is that!!!

A few important lessons to learn from here - especially for those who showed their expressions like the ones in 1.25 & 1.35 (who I hope have buried their fat ugly faces deep in the ground!) - never judge a book by its cover - nothing is impossible - where there's a will, there's a way!

Well done, Susan! I hope your wonderful performance would provide courage to those with poor self-esteem (who always think that they "can't") to bring up the best in them.

Back to school...

2009-04-13T21:18:00.003+10:00

NOoooo!!! My long Easter weekend is over - and I did not do much over the holidays. I planned to get up early for exercise, but sleeping in seemed to be a better option...gosh, the guilt is killing me now!!!

Anyway, back to school tomorrow.

Easter

2009-04-11T20:52:00.001+10:00

It’s Easter and a 4-day long weekend...woohoo!!! Time to relax and do some work + get a few things organised – cleaning up my utterly-messy room; helping Mum to do the gardening (and that includes pulling weeds & planting the lovely rose which my siblings and I bought for her birthday) and more importantly, start doing something for my internship application!

In terms of clinical placements, I have just finished my ICU specialty rotation. It is definitely an exciting and eye-opening 6-week experience which is enhanced with friendly & approachable staff members and a great supervisor who is very keen to have students and teach. A bit reluctant to leave but it’s time to move on...that means 2 core rotations down and 3 more to go...with my elective & vacation rotations coming nearer and nearer!!! =)
My next rotation will be aged care – one which I’m not looking forward to but need to endure for 6-weeks =S

On a positive note, I’ve already got 2 referees for my internship application...how they will assess me – I don’t know. But, the most important thing is getting a job at a place where I want to go.

Anyway, Happy Easter everyone!!!

The meaning of "wealth"

2009-04-07T20:37:00.007+10:00

Life experiences thus far have taught me a very valuable lesson in defining "wealth":

Wealth......is defined a by life which is filled with love, happiness, tolerance and companionship - one which everyone can sit together and have a laugh in good times or cry & provide support for each other in bad times - one where there is minimal misunderstanding and not much worries to think about...

...NOT one which is rich in money and assets, but constantly filled with endless greed, conflicts, domination, hatred and abandonment/neglect/isolation.

I have seen both situations from my very own eyes...and still lived with them.
If given a choice, I would definitely choose the former.

What do you think???

Update?

2009-04-04T23:50:00.007+11:00

It is almost 2 weeks since I posted an entry. I guess it's time for an update. But I don't know what to write!!! There are lots of interesting stories from the ICU recently, yet I don't feel like writing about it now - perhaps later.

Apart from that, life has been quite unexciting - just its usual ups and downs.
Glad for the freetime I have, which is often spent at home with my dearest family, doing some housework and sitting in front of my laptop for studies & random stuff like internet & games - online poker addiction is a real problem for me now!!!
Wish there is something out there for me to do......

I've been thinking a lot about holidays - although it's still months away. I'm quite thrilled about it as I haven't travelled for more than 3 years and thus looking forward to it. However, I have this very funny mentality - I'm afraid that the more I think about it, the more unlikely it will happen. Hence, I'm trying to suppress my thoughts of vacation, but who can resist it???

Perhaps, seeing a psychiatrist could help......

Wasted!

2009-03-23T21:03:00.004+11:00

It is supposed to be a day of celebration with happiness and laughter.
We had planned to make it simple by going out for some coffee and cakes after dinner.

But that very unwelcoming news spoiled the day......
6 years of efforts & hardship all wasted --> it just makes us yet again very upset and frustrated!

Why are there so many obstacles in this path??? Yes, they are not unexpected but there are just too many!!!
Why all the pain and suffering when we feel like we are back to square one???
Life could have been much happier & simpler and I could have enjoyed a much better social life if we were to know this would happen. Yet who can predict the future???

Yes, I have not been very explicit in what I have written up here. But, all I want to say is -
Life is just so unfair......

Frustrated!

2009-03-20T23:26:00.003+11:00

I am feeling very frustrated now. I want to talk to someone but who can I speak to? Will anyone listen to me? Perhaps, writing it here will help to release my anger and disappointment......

I simply don't understand...

Why must they always create endless problems for us?
Why can't they live their own life and not bother about others?
Why must they be suspicious all the time? Bloody paranoids!
Why do they always think they are right? They can't accept other people's explanation - Hey,we are living in a democratic society!
Why can't they understand the meaning of "tolerance"?
Why do they always have thoughts of violence? Hello, we are civilised people! Perhaps they are not!
Why do they always think that they are kind and helpful? Your friends may think you are - sadly, your friends are making fools of themselves!
What will they gain from doing these to us?
Why must they be so selfish?
Why must we be hurt time after time?

Well, we have enough! And that's it! We can't tolerate any further! We have other more important matters to think about and carry out - we do not need the extra unreasonable troubles from you lot! Please leave us alone and mind your own business - that will be greatly appreciated. We just want to have a peace of mind......

"I believe all suffering is caused by ignorance. People inflict pain on others in the selfish pursuit of their happiness or satisfaction. Yet true happiness comes from a sense of peace and contentment, which in turn must be achieved through the cultivation of altruism, of love and compassion, and elimination of ignorance, selfishness, and greed."

->Dalai Lama<-

My ICU Experience

2009-03-13T20:05:00.017+11:00

My ICU placement so far has been an exciting and enriching experience yet at the same time a challenging one. As implied by its name, the unit provides critical care for the sickest of the sick patients in the hospital - mainly those who require constant monitoring; respiratory/ventilation support (the lungs); inotropic support (the heart and the circulation); renal support - haemofiltration (the kidneys) & metabolic support (the electrolytes and acid-base balance). It is a place where patients battle to survive; a place where family members harbour hopes that their loved ones would see the light at the end of the tunnel; a place where doctors and nurses work closely together with the aim of bringing patients back to their pre-morbid state. Whatever it is, each case always ends with either tears of joy when patients recover or tears of sorrow when patients lose their fight to live.

Ward rounds start at 8.30am, which means now I don't have to wake up at bizzare hours to start at a crazy time. Despite usually having 8-10 patients, ward rounds take hours, occasionally until past mid-day, as the doctors make thorough assessment of every patient - from sedation to ventilation to feeding etc. With that comes good teaching, especially from the consultants who are physiology experts. I must say I'm quite fortunate as my supervisor who I meet almost everyday is an avid tutor.

On my very first morning, a "Code Blue" (i.e. medical emergency) was called, which the ICU doctors must immediately attend to assess and treat the patient who deteriorated clinically during his/her stay in the normal ward. I tagged along the doctors to observe their duties in response to such emergencies. The patient recently had a right total hip replacement and developed sudden shortness of breath with low blood pressure and fast heart rate 2 days after the surgery. Not accustomed to such situations, I stood back and just observed the whole event. It amazed me that a high number of medical and nursing staff (at least 20 from different units - intensive care; anaesthetics; emergency; coronary care; patient's bedcard unit + other busybodies like myself) responded to the code and attended to the scene to help. Whilst their goodwill would be greatly appreciated, I find that managing a patient with so many people around could be detrimental - over-crowding, noisy, chaos, confusion, medical errors and the list goes on. For example, when the ICU consultant requested for the patient's heart rate, 3 different people responded with 3 different readings!!! Thankfully, no medical errors occurred and the patient's condition improved dramatically after administration of a drug.

To date, I have observed a number of procedures which are not performed in the normal ward and these include insertion of arterial lines, central venous lines and endo-tracheal tube. It was interesting to see how they are done and I'm very keen to perform each one of them during my placement, though not too sure if I'm allowed to or not given the invasive nature of these procedures. Even more interesting, I had the odd opportunity to observe a pulmonary artery (Swan-Ganz) catheterisation in a patient who suffered a massive AMI (heart attack) and cardiogenic shock. It was so rarely done in the hospital (last one about 18 months ago) that the staff had to get the equipment from the nearby private hospital. Patient went into persistent VT twice that he had 2 DCRs during the procedure; which was subsequently withdrawn. Assisting the consultants in inserting tracheostomy tubes is one of the highlights of my placement.

Patients in the ICU require continuous critical and complex care which can only be provided by experts who are trained in intensive care medicine. As an inexperienced student, there is nothing much I can do and hence the helpless feeling. At least, I had the opportunity to do an IV line for a patient who amazingly recovered after suffering a massive PE (clots in the lungs). He was sitting on the chair and was alert and we had a chat before I fully concentrated on the IV line insertion. It was at the end of the procedure that his nurse noticed him drowsy, sloping on his right side and was bradycardic + hypotensive. It was my first procedure in the ICU and I thought "Oh @$#%! what have I done?!?!" Nurses came to his aid and transferred him back to his bed, when they found poo. We then realised he had a vasovagal episode triggered by his defaecation, which I hadn't realised!!! A shot of atropine was given and he was back to normal again......Phew - what a terrifying experience - I don't want to kill a patient especially when I'm still a student!!!

Attending family meetings with the consultant and the nurse who looks after the patient is a good learning experience but often a heart-breaking one. 1 in 7 patients in the unit would either suffer significant deterioration or have extensive disease that the slightest improvement is only a miracle. Even if it happens, the quality of life would be very poor. Often, decisions have to be made about removing life support machines (e.g. ventilators) or weaning medications that keep these patients alive. As a student, I find it an extremely difficult decision to make. Call me naive - but as doctors, don't we have the responsibility to treat and as per the Hippocratic Oath, "never do harm"??? But, what does "never do harm" exactly mean? Is it continuing to treat and put these patients on life support in the hope that they may wake up one day (i.e. not "killing them")? Or is it to prevent further suffering by "calling it a day"? Is this an act of compassion or one which causes guilt? Where is that "critical line" to make such judgement??? We are speaking about life and death issues!
I clearly remember the first family meeting I attended. When the consultant mentioned that there was nothing else he could do, not surprisingly the family members cried which was a fuel for me to do so too!!! I am one who can easily feel the sorrow experienced by others. Despite that, I kept my composure as I understand that there must be a barrier between professionalism and personal feelings. Having attended a few such meetings, I'm getting used to it now eventhough I sometime still have that emotion. Friends say I have a high EQ, but is that so???

Think about this: You see a 80+ y/o patient with myelofibrosis (a disease of the bone marrow)who is admitted into the ICU because of respiratory failure. He is conscious but finds it very difficult to breath and has required higher concentrations of oxygen in his breathing tube. Without it, he will deteriorate immediately. The doctors tell him that there is nothing else they can offer him and ask his opinion about dying. How would you feel??? What about the patient??? What if you were the patient? Remember...although he heavily relies on the tube for oxygenation, he is quite awake and aware of his surrounding.

The above are some of the interesting cases I have come about - I guess that there will be more for some other days.

Earthquake in Melbourne???

2009-03-06T21:11:00.005+11:00

This is unbelievable!!!
I was browsing the internet at home when suddenly I felt the whole house shake for a brief period of 5seconds!

Possums often run on my roof. Not surprisingly, the first thought that came into my mind: "Damn! Was that a HUGE possum running on the roof and about to tear the whole house down???" I must admit I was shocked and felt that I could have a heart attack anytime. I just don't understand why I didn't have the instinct of survival at that time by running out of my home......

A few moments later, I read this breaking news on the Herald Sun website:

Quake 'shakes Melbourne'
BREAKING NEWS: RESIDENTS across Melbourne have reported feeling the earth tremble as a quake appears to shakes the city.
Melburnians contacted the Herald Sun to report feeling the trembler from Carlton to Frankston.

The intesity of the tremor is not yet known.

MORE TO COME

So, it was not the possums...
BUT...an earthquake in Melbourne??? Now, that's definitely a very scary thought!!!

ICU

2009-03-06T19:54:00.004+11:00

I am currently at ICU as part of my specialty rotation. It wasn't my 1st choice; perhaps the 3rd or 4th one. Paediatrics was the specialty that I wanted to do - desperately tried to find someone to swap my placement last year; but my attempts proved to be futile - many students in my year seem to enjoy it as much as I do.

Anyway, I will not whinge further as I certainly had a good time so far - the consultant was all-prepared for my presence and the regs & HMOs were approachable, which made me feel welcome. Superb teaching as well......I had learnt a lot and also seen a lot of things in my very 1st week. I have so many things in my mind that I want to write, but I guess I will do that at a later time.

Meanwhile, many thanks to the faculty and its 'clever' computer matching system for allocating ICU for me - the experience that I gain to date is brilliant and hard to describe in words......

Goodbye surgery!

2009-02-26T20:42:00.007+11:00

Today is the last day of my surgical rotation. I will be heading down to Phillip Island tomorrow for a weekend camp - isn't that a splendid way to celebrate the end of my 1st rotation???

The activities that I was engaged in over the last fortnight had not been dissimilar from the previous weeks - ward rounds; chasing results; discharge summaries etc. It was also time to get all my assessment completed in order to pass the rotation satisfactorily - that included assessing a post-op patient's fluid balance in the ward & assessing a patient's fitness for surgery in the pre-admission clinic.

Also, I ran a mini-tute for my 3rd year meddies - taught them cannulation. Given that they had never done it before, I thought that inserting IV lines into each other (not patients) would be a great start. I had good visible veins - so I volunteered to be their 'guinea pig'. Not done properly, it can be a painful & messy procedure. I was screaming in my head & blood was dripping out of my forearm & the student panicked. Despite this, I kept my composure and single-handedly attempted to rectify the mistakes the student had done. So, whenever patients tell me that it doesn't hurt, it makes me wonder if they really mean it or is it a word of reassurance? Either way, I would always be grateful for the opportunities they provide to practise my procedural skills and with more practice, comes improvement.

The last day has been quite exciting. I began the day with my case presentation of a patient with liver abscess to my surgical unit - 3 consultants, 1 fellow, 1 registrar, 2 interns & 2 3rd year meddies were present. Presenting a case in front 3 highly experienced surgeons really freaked me out. The thought that always came into my mind was what if I could not provide an adequate response to their questions? Lots of effort were put in and I managed 4 hours of sleep the night before, reading up journal articles & rehearsing my speech. However, I was still nervous throughout the presentation, but somehow to my great relief, it went quite well.

As usual, we had our weekly grand round, radiology meeting & outpatient clinics. It was in the clinic when my supervisor gave me feedback about my attachment over the last 6 weeks and filled in my 1st PIA form. Yes, he said that he was happy with my progress but as per the faculty's instruction, I was not allowed to see him fill my assessment form. Did he really mean what he said? Could he have given me borderline scores? Could he have written a few positive comments but loads of negative ones? Or worse...failed me??? I must admit that I'm quite paranoid, but from this rotation, I've learnt from my fellow and registrar that it is better to be paranoid, rather than missing something big and important!!!

In the afternoon, I shadowed the registrar to the ED to admit a patient who presented with acute severe upper abdominal pain. We were excited as we thought that the patient had a perforation which required immediate laparotomy (I know it was an evil thought - but I hoped it would be a 'nice' way to end my surgical rotation). To our great disappointment (I know I'm wicked, ok?), the CT-scan showed the patient had the very common appendicitis - nothing too exhilarating. I concluded the rotation by attending theatre - observed my 1st laparoscopic fundoplication...It was an interesting case as the patient had a type 3 hiatus hernia, where almost all his stomach slided/rolled into his chest behind his heart!!! I was hoping to scrub in, but did not as it was done laparoscopically, hence not many people was needed - damn, I hate key-hole surgeries! At least, I managed to perform another male catheterisation.

Well, time really flies, isn't it??? 6 weeks have whizzed through in a blink of an eye. I must say I'm a bit sad to leave the team which has been very supportive and approachable. But at the same time, I'm looking forward to advance further and learn other areas of medicine...ICU - here I come!!! Before that, after having weeks of 7am start every weekday, I'll make sure I have a good break in Phillip Island!

R1: Surgery - week 4 in review

2009-02-15T10:53:00.003+11:00

This week hasn't been much different from the previous one. The registrar is away for the whole week to prepare for her exams and there are two 3rd year medical students newly attached to the unit......hah, I'm no longer the most junior in the team! Two years have gone so quickly...I can clearly remember my 1st week of clinical placement when I had just started my 3rd year. Not much support I must say (or maybe I was too afraid to ask for it) - hence I was left wandering around the hospital & wasting my time. Having experienced that awful time myself, I was 'kind' to them and told them that I would be more than happy to offer my assistance should they need it. I guess this is one of the many pleasures of being a final year meddie =)

Well, another quick review of the exciting and boring bits of the week......

Monday

Ward round with the fellow who takes over the registrar's jobs while she is on her study leave
Pre-admission clinic - clerked a patient who is expected to undergo a lap chole
Procedures - inserted an IV cannula...still a messy job due to blood dripping on the drape - have finally found out why! - forgot to release the torniquet before I withdraw the needle

Tuesday

Ward round again
Operating theatre - right hemi-hepatectomy for a patient with metastatic colorectal cancer - couldn't see much as the surgeon's back was facing me most of the time - the whole procedure took about 3 hours
2x discharge summaries
Admission for a patient who presented with dysphagia
Observed medical assessment of sudden dyspnoea in a surgical patient - always remember DVT/PE & APO!!! ECG; CXR; O2 (nebs); cardio & respi exams etc...
Took bloods - still need more practice

Wednesday

More ward round
Gave a 'mini tute' to the 3rd years on respi exam without realising I haven't done a full exam for well over a year and hence missing some important bits...well, a good revision for me though
Attended a family meeting of a patient with a newly diagnosed metastatic pancreatic cancer that carries a grim prognosis
Pre-admission clinic - clerked a patient who was due to have a right upper lobectomy - his daughter is a GP and hence I have to be extra 'careful' with this gentleman - although I know I should do the same thing to all my patients

Thursday

Grand round day! - coffee with the consultants; grand round; radiology meeting
Outpatient clinic - Clerked in a patient who presented with progressive dysphagia since she had her CABG 6 years ago...presented her case to my supervisor who organised an urgent endoscopy and laparoscopic GOJ biopsy next week
Attended the intern lunch meeting on managing aggressive patients - code grey!!!
Operating theatre - another right hemi-hepatectomy (for malignancy) for a patient with previous colorectal cancer - assisted my supervisor and I had a clearer view this time - the surgery took more than 5 hours as there were lots of adhesions given that the patient had his left segment of his liver resected 2-3 months ago for the same reason - my back and legs killed me at the end of the day!

Friday

Last ward round of the week...
Procedures - took an ABG for a patient who presented with acute pancreatitis of unknown cause - it was my first time + observed by the 3rd years and so it was nerve-wrecking...thank god it was successful under the supervision of my intern
Tute with a haematologist about anaemia......he was quite intimidating but a very good tutor and I learnt loads from his session
Did my case presentation on the patient with metastatic pancreatic cancer
Attended an endoscopy session - nothing really exciting as I had observed a few ERCPs already

Finally, it was Friday evening - the best time of the week for me as it was the beginning of the weekend......yay!!!

Of Valentine's Day celebration

2009-02-14T21:06:00.003+11:00

14th February - hearts; doves; cupids; roses; chocolates; greeting cards; romantic dinners etc -needless to say it's Valentine's Day - a day when lovers exchange their affection for each other.

And here I am...still happily being single - not having to commit in a relationship and bear the reponsibilites that follow. Perhaps I haven't found the right person yet??? Or could she be one of the people I already know but the time has not arrived yet?

Love and career - I believe these 2 are the significant parts of a young man's/woman's life. Some are able to handle both at the same time and others, like myself, can only focus one thing at a time. I am one who prefer to secure a successful career and be financially stable first before I embark on the other part of life - a rather concrete thinking, I must admit. My 'po po' (i.e. maternal grandmother), on the other hand, keeps asking if I already have a partner or not and that I must quickly get married if I have found my other half - too bad, I'm not ready yet and it is unlikely to be too soon.

I guess the best advice comes from my most beloved mum. Yes, she prefers me to concentrate in my studies and career first, but as she points out clearly to me and my brother "Who knows what would happen in the future? We shall leave fate and time to decide......"

In the meantime, whilst more and more of my friends become engaged in a relationship, I will enjoy my freedom and singlehood - Valentine's Day means nothing to me now =D

R1: Surgery - week 3 in review

2009-02-06T17:43:00.004+11:00

Another week of my surgical rotation has ended - 3 more weeks to go!

Having promised myself to put in more effort (after 2 lazy weeks), I find myself more engaged with the activities of the unit. This week, I'm glad to say that I had never taken a 'leave' (yay!!!) and had been in the hospital at approximately 7am and left around 5pm everyday - 10 long working hours =S
A change in the members of the unit occurred too. The unit's previous registrar is now replaced with a new one in addition to 2 new fellows, making the team even bigger - 4 consultants/surgeons; 2 fellows; 1 registrar; 2 interns and last but not least...1 medical student - me, who I daresay played an important role by helping out the interns and hopefully reduced their workloads.

Most of my time was spent in the ward doing housekeeping jobs - writing up slips for pathology & imaging; chasing up their results; preparing discharge summaries; attending ward rounds; not to mention, wandering around the ward to look for my interns for more jobs! Ward rounds have been much longer this week - what used to be a quick 30 minutes has now turned into almost 2 hours!!! Not that the unit had a sudden influx of patients, but unfortunately one of the fellows had high expectations and wanted every single thing to be done thoroughly, causing more stress to the poor registrar and interns who already had jobs that did not seem to end. Internship has now started to haunt me......

Anyway, a quick review of other exciting things I had done this week...
Monday

Attended the upper GI pre-op clinic - assessed fitness of surgery for a 46y/o female patient who was due to have a lap chole
Inserted a urinary catheter for a male patient who had acute urinary retention - my 1st experience and it was a success! =)

Tuesday

Scrubbed in theatre - it was an open common bile duct exploration to remove an impacted CBD stone...an almost 2 hour procedure as the stone was huge and the surgeon had difficulties in extracting it out

Wednesday

Attended the thoracics pre-op clinic - again assessed fitness of surgery for an 81 y/o male patient who would be having a right lobectomy for lung cancer

Thursday

It is a 'grand' day when all the consultants of the unit would join the more junior doctors for the morning ward round (i.e. grand round) to see all the patients; attend the weekly radiology meeting; have coffee break together (i.e. free coffee for me!) and lastly attend the outpatients clinic - for the 3rd week in a row, I again clerked in a patient with an inguinal hernia
Attempted IV cannulation on 3 patients for the first time without supervision - hardly did and never succeeded this procedure even under supervision for the last 2 years - but, I succeeded twice today and I must unashamedly admit that I'm proud of this little achievement

Friday

Spent the entire day in the ward doing clerical jobs as the unit was busy with many admissions during the previous night

And now it's the weekend, I will surely relax and enjoy as much as I can before the next dreadful Monday morning arrives......

Sizzling summer: a global warming effect or just a rare phenomenon???

2009-01-31T10:35:00.012+11:00

Presenting Melbourne's max temperature over the last 5 days...

Mon - 25.5C Tue - 36.4C Wed - 43.3C Thu - 44.3C Fri - 45.1C

Yes, it had been incredibly hot this summer. In fact, it is the first time the city suffered 3 consecutive days over 43C since records began in 1855 & without a single drop of rain for the past 27 days so far, Melbourne is experiencing its driest period since 1965. With the overnight mercury ranging only between the mid-high 20's late this week, night time isn't particularly comfortable either.

Not surprisingly, the weather has been a hot topic recenty and the effects of the extreme heatwave are devastating:

Bushfires ripping through the state, destroying homes and forcing residents in affected areas to evacuate;
Victoria's power supply was on the brink of meltdown as electricity demand soared, resulting hundreds of thousands of homes to face blackouts for hours or even days;
Travel chaos due to train cancellations as a result of power failure and buckled tracks, causing much frustration to commuters;
Heat-related illnesses and deaths, especially among the elderly and young children, triggering hectic times for paramedic and ED staff.

I must say I'm quite fortunate as the weather hadn't affected me too much - my home's power supply wasn't cut and I had my lil' old car to drive if I needed to travel. Apart from lots of fluid lost and replenishment, I slept in the air-conditioned living room over the last 3 nights as the heat in my room was intolerable. And the poor plants in my garden could not withstand the heat too......

Happy Chinese New Year

2009-01-28T16:13:00.006+11:00

It is CNY again!!! And this year, it is the Year of the Earth Ox. As usual, there is nothing exciting about CNY in Melbourne - just the usual reunion dinner at home (with plenty of food) and a bit of angpows from relatives. Nevertheless, I enjoyed it very much as the 1st day of CNY coincides with the Australia Day public holiday. Hence a long weekend for resting & relaxation at home, which I shamefully extended further by skipping class on Tuesday =S - well, at least 1 module was completed on that day.

Despite having started uni a week ago, I am still in a holiday mood - maybe it's due to my super-short summer break + CNY + Dad's presence. Anyway, absenteeism isn't a great idea and so, I forced myself to be at BHH by 7am today but was contended to be back home by 2pm, travelling under Melbourne's notorious 40+ degree afternoon summer heat.

Back to BHH, nothing really exciting happened anyway - patients gladly got discharged and some new ones unfortunately were admitted over the weekend (that means more patients' history to know). Apart from that, I managed to observe 3 gastroscopies and an ERCP, the latter on a patient (with a history of biliary stent insertion, chronic pancreatitis, T2DM etc.) who I had followed through from my first day in the surgical unit. She had been well when I saw her everyday last week but suddenly went down the hill last night which necessitated ICU admission. A diagnosis of cholangitis (due to her obstructed stent) was subsequently made, hence the procedure was needed to relieve the obstruction. One moment she was well and next, she was in trouble - life is just so unpredictable......

But one thing is certain...sizzling 40+ degree in Melbourne for the next 3 days!!! And yes, Melburnians, we'll walk out naked if that helps to cool us down =P

Surgery: 2nd day

2009-01-20T18:35:00.009+11:00

So the day started with a strong boost of caffeine (not to say I'm an avid coffee drinker), but I had to be in the hospital really early (7am!!!) plus I had a poor sleep last night - it was hot! Hence, was quite tired when I woke up.

Anyway, I managed to show my face in time. Ward round began at 7.15am with the registrar and the intern - both who are (to my great relief) friendly, kind and helpful. I am attached to the General Surgery B unit which mainly deals with thoracic and upper GI cases - cases seen today included oesophagastrectomy; perforated gastric ulcer; obstructive jaundice; hiatus hernia; splenic infarction & pneumothorax. 15 patients in my unit and unfortunately I can't remember half of them, let alone taking care of them! "Andrew, Andrew...how are you gonna be a doctor if you are so forgetful?!?!"

8.30am - proceeded to the operating theatre. There were 2 patients in the list - 1st case: lap chole & 2nd case: huge incisional hernia repair. I only observed the 1st case but was asked to scrub in for the 2nd case as it was a more complicated problem and the chief (i.e. the consultant surgeon) would be there too...yay!!! He was an amiable person but at times can be quite sarcastic.

The very 1st question he asked: "So Mr N-G (yes he spelled out my last name), can you describe the anatomy of the anterior abdominal wall?"

"Oh dear..." were the 2 words which were blurted out from my mouth immediately!

"Oh dear???" repeated the consultant who was now staring at me with his two big 'lovely' eyes.

"C'mon Andrew, think think! Don't make a fool of yourself in front of everyone!" I thought to myself.

"Yes, there are three muscles in the anterior abdominal wall - the transverse abdominal, the external oblique and finally the internal oblique being the innermost layer!!!" I was so happy at that time that I could describe part of its anatomy correctly only then to realise that I'd got them in the wrong order!!! "arghh...Andrew, what are you doing today???" At least, I know what I need to study tonight! The surgery was finally over at 12.30pm after a long 2 hour of standing - I was tired and my back was killing me!

That wasn't the end of the day yet - had a short lecture on lung function testing and sleep studies. Sleep - that's what I really needed! It was meant to be a useful teaching session but the lecturer's monotonous voice and the hot afternoon (it was at least 41 degrees in Melb today) made me really sleepy and I think I must have dozed off when he was talking about sleep studies. It was only when he had finished his lecture that I woke up. Damn! Why do I often sleep during lectures??? Maybe this explains my extreme lack of medical knowledge!

I was glad that the day ended early - really needed a nap and to brush up my poor anatomy!

A humble beginning......

2009-01-19T22:52:00.006+11:00

Hi! After many months of thinking & hesitancy, I have finally decided to set up a blog. And here goes a very brief introduction...

Why blog now??? Simply it's because today is my first day back to uni (in fact hospital) as a final year medical student - and I would like to nurture this blog as a memoir of my progress through my final year of undergraduate studies and the years beyond - the experience I'll gain; the knowledge I'll acquire; the many different people I'll meet etc etc etc. Also, I want to share any thoughts that come across in my mind - life; family; friends; anything random...... + keeping everyone I know updated about me.

Having a blog in the past, I daresay it's not easy to maintain one - it requires commitment and time (minutes or perhaps hours if one has lots to write) - but I'll endeavour to keep this blog regularly updated.

My first entry - will keep it short and simple.
Any comments are most welcome =D