My Blog

life is a series of pre-determined events, carefully laid out by the force well beyond our grasp or understanding. every single decisions we make may appear as our own, but unbeknown to us, our minds have being programmed to make such decisions since time immemorial. or the events occuring around us have swayed us to make decisions that were always meant to be.

life can also be a blank white canvas that was entrusted upon us. we paint it as we wish and use whatever color we want. we are fully in control with every stroke of the brush, every drops of the paint. hence our life, is what we make of it. we are in charge of our own destiny.

so which one is it? if i believe in the first theory then what differentiates me from a schizophrenic who thinks that an alien has implanted a chip into his brain that control all of his actions, feelings and thoughts. if i support the later, then i may be going against my own faith and belief.

maybe there is no simple answer. it may neither be a or b. it may be both a and b.

i envy friends who have it all sorted out-work by 23, own a house by 24, married by 25, first child by 27, phd by 29 and so on. i have lived 24 years of my life without a carefully laid plans of my future. i sure can live another 24 years more without it. work hard, pounce on opportunities as they come along and make an informed decision as and when i need to. i will be alright. i guess.

so what if i remain undecided for now.

A bloodbath that systematically killed 400 people by air raids in 5 days is an act of self-defense and retaliation, to

A meagre campaign that launch home-made ground rockets whose targets were pretty much hit and miss.  2 people has been killed in the last 5 days. And this is an act of terrorism by thugs.  

One promised another a home in a country already densely populated by a non-willing third party. However absurd it may sounds, this proposal was endorsed and came to fruition in 1917.

In a six days war in 1967, an army of a country which has came into existence for mere 19 years could defeat an army consisting of three big nations, supplemented by troops from six others.

What difference is there between concentration camps built for the purpose of killing by gassing and torture, and a barricated area wherein bombs constantly fall from the sky and supplies of necessities almost never get through.

A race of people whose past are haunted chooses to subject others to the same destiny.

60 years and a generation of Palestinians later - even after man-made palm islands, ski slope and buildings of dizzying height and grandeur appear in what was previously a neighbouring desert- the end to the sufferings is still not in sight.

What the rest of 2 billions people of the world can do is shout out loud in the street and burn flags, only.

“If their suffering are not meant to end soon, if their lost today is to be forgotten by an even bigger lost tomorrow, and if there is no one to avenge innocent lives lost, then please don’t take away from them one thing, and one thing only. Hope.”

I hope that 2009 is able to bring many other years gone have failed to do-peace and good tidings to all oppressed and suffering people the world over. Happy new year. Hope is a fragile thing. Take good care.

General practice. Family medicine. I hate it with vigour. To me, 30% of patient who come have viral infections, 30% are depressed, and another 30% want the doctor’s signature for sick leave or incapacity benefit or what not. That leaves the rest 10% with real signs and symptoms, those whom I consider to be proper ill. What do I know, eh.

Until I was to take up the hot seat and do my own consulting. Then the pressure was on.

My first patient’s urine test result was very suggestive of chlamydia. I turn around to face him and his wife thinking, oh shit what should i say. The next lady had shoulder pain. Mid-examination, I frozed there trying to think what special test of movement for shoulder is there??” The next gentleman had a rash, at the natal cleft. That’s in between the buttocks for me and you. I looked at it, very closely, and then had to tell him, “i dont know what it is.” Next was this cute kiddie who has been vomiting for days. Luckily I didnt end up prescribing metoclopramide, or else she’ll come back eyes rolled back into her head, and neck twisting at odd angles and arms flailing. Another lady i had to see on that morning came bursting to the door, anouncing,”i did a pregnancy test 3 times and they were positive and i think i am pregnant”.Huh? The next (and the last thank God) lady I saw that morning complained of not being able to eat as much as she liked but didnt feel sickly at at all but just wouldnt want to eat. I asked her what she had for breakfast and she said two slices of toast and a banana and did she finish them and she said oh yes she did. Double huh?

I can still feel my head reeling when I had to start again for the afternoon consultation.

So no general practise is not easy peasy as i poohed paah it to be. It’s not all about medicine. After a few days I think I could tell whether the patients left the room feeling satisfied or not. And the thing that is most important to them is the explanation and reassurance. The drug prescription is just an added bonus. I mean, not having a course of antibiotics for a simple sore throat would not kill anyone. The antibiotics probably will do more harm in fact.

Now i have a different view of general practice altogether. It is not that hard to become a general practitioner (as long as one passes the mrcgp of course). But to become a good one, one must have a good diagnostic skills (differentiating the urgently sick, fairly sick and not sick at all but what is thehidden agenda?) Most importantly, one must have brilliant people skills.

Am i looking forward for the next 2 weeks? oh yes more so that i ever has been when on community placement. Am i cut out to become a brilliant general practitioner. Afraid not.

However I have a few tricks to survive the next couple of weeks.

1. Sore throat? lets do the triple dance: Say aaaa, a neck massage, and poke the ear and have a peek. (It doesn’t matter if you dont know what you are looking for, almost all is viral anyway)

2. Dont know what the hell to advice/say? Say to the patient;”you know what, there’s a very good website that will help explain things, lets have a look at it together”. Then open the browser patients.co.uk

3. After 10 minutes talking and not getting anywhere, the thing to ask is: of all the things u have mentioned, what concern u the most?

Just the thing u will expect of a manchester medical student ey?

On another matter, more junior doctors doing housemanship (in Malaysia) are suffering from mental ilnesses. Said the star online. The news didn’t startle me. But I was not unfazed either. A minister (a minister!!) had the cheekiness to suggest that the doctors themselves are already having personality traits and predisposition for mental illness. and it was the university’s and jpa’s fault for not being able to pick it up these “rotten lots” before they enter university. Helloo? If someone has this so-called personality trait/predisposition, surely 5 years of medical school will bring out all sort of mental illness one has. Why during housemanship only? Because the housemanship period is riddled with bullying, lack of sleep (and eating and showering for that matter), and unreasonable expectations and demands. It is not a commando training for goodness sake, have some common sense, and mercy!

Am I afraid of my future? Hell yeah. Surely being able to communicate well and  deal with patients concerns and expectations wont get me anywhere during my housemanship. Dont want to get admitted to any mental ward if i can help it.

viewers’ discretion is advised.

i sat in clinic the other day. and this man was wheeled in by his wife. the doc asked how he was feeling. lo and behold, it promts a  littany of complaints. i tuned myself out of the conversation as quickly.

“i’m having soup for lunch. what, soup? no way, dont be too healthy. hmm maybe chips in gravy then..sounds good” my daydreaming halted abruptly when i caught him saying. “i felt trapped in my own bedroom. i’m a burden”. with that simple sentence, a feeling of deja vu swept over me. i was overcame with overwhelming thoughts of my late grandfather. then and there i could literally see him lying in bed, peeping at us through the slit in the door. his sad eyes pierced my heart.

the story with that man was, he has end stage renal failure on home peritoneal dialysis since a year ago. early this year he was above knee amputation due to gangrene. a fortnight ago tragedy strikes again. he had a heart attack. now he is depending on his wife for even the simplest thing. as i look at this yellowish-grey one legged man sitting in front of me, i realised that i miss my late grandfather. very much.

it was very depressing indeed. but somehow, in ways i cannot fathom, i feel good. because all week i encountered very sick and even dying patients and i didn’t feel a thing. like this morbidly obese 54 year old who has foul-smelling leg ulcers, blind in one eye, and all i could say when i left his room was,”gosh he looks 70!”. having been in the room when a woman was told that she has metastatic cancer and there is no cure, my friend and i made a joke about halloween moments later. and when this 30 year old chap who has sclerosing peritonitis and he wasn’t even certain whether he will be around for christmas, all i could think of is all those acne on his face. when encoutered with such human tragedy and all i can feel is..nothing, i started to question my own humanity.

this one-legged man not only reminded me of my late grandfather, but reasssured me that i’m still human. that am still able to feel the pain of others.

most patients will come and go, and be forgotten. it is my way of coping and i have to allow myself that. but a few will get under my skin. and i have to make allowance for that too. but as i look at the doctors, having to encouter such human pains day in and out, I wondered to myself, have they ever reached a point when they just had about enough, and think-why bother? everyone is going to get sicker and die no matter what so why bother.

on a completely different issue, news form mudcity. the big man is out. he’s deemed innocent. the police a.k.a body guards are going to be charged instead, and i’m betting that the charges wil stick this time around.

what do i, a normal citizen, think of all this? i think if i commit a crime, i will be charged and pay dearly for it. but if big mans (and womans) commit a crime against me, they will go free. every little details in the system will work miraculously for their favor. justice will NOT be done.

what.a.joke.

then i dont know what is.

Let me relate to you my encounter with this one couple i met during the week.

The elderly wife was in a wheelchair. the stoke she suffered 10 years ago left her semi-paralysed; overnight she realised she had no use of her left hand and leg anymore. She also lost control of her bladder and bowel function, among other things.

She was wheeled into the examination room by her husband. He is and elderly gentleman, not frail but upon questioning, admitted to having a bad back.

When taking the history, I was strucked at how much the husband was able to give me a very detail answer, down to the description of his wife’s stool. It turned out that they live on their own and the husband has been the sole carer of his wife for all these years. He changes her diapers 4 to 6 times a day. He bathes her daily. He cooks for her. Not only that, he also mushes the food before she feed it to her. He transfer her from the bed into the chair in the morning, take her out for a breath of fresh air, transfer her to the sofa to watch tele in the evening; simply put, he becomes her pair of legs.

But the thing that strikes me the most as we went on with our conversation was how he, from time to time, glanced affectionately towards his wife before turning back to face me.

For the examination, I need the wife to be lying on the bed. He stopped me before I could go get the nurse to help. Then he walked round the bed to his wife, and as he said “Come on now, J..” the wife instinctively put her right hand around his neck whilst he scooped her up into his arms, make a small turn, and rest the wife gently on the bed. It all happen within a matter of seconds. I simple can’t believe it as the events unfold in front of my eyes. How could that be possible for a man in his seventies?? “let me change her diaper first, love, easier for you” And he expertly does that in a matter of seconds too.

I was touched when I saw Never been kissed, 10 things i hate about you, A walk to remember, etc, I have to admit. But then and there, I could feel a tear coming.

It was the best display of love I have seen, probably ever. For it is not simply a matter of a mutual attraction. It is about becoming responsible for and fulfilling your obligation towards your loved ones, whilst your affection to him/her never wavers.

Trust me to find a heart wrenching love story in a surgical ward eh?

The events of the week have left me doing some serious thinking on my own. Of right and wrong and the in betweens.

The first event was when a man in the ward went into cardiac arrest. He was resuscitated successfully. But after the event the decision to resuscitate came into question. Because he has metastatic lung cancer. To make matters more complicated, he hasn’t got a histological diagnosis just yet -so technically the diagnosis remained unconfirmed. (but then again what else can cause masses in the lung, the nodes and bones?)

Is it right to get a ‘do not resuscitate order’ now??what if the family said no, and the patient remains undecided? (like in this case).

From the medics’ point of view, DNAR is most appropriate. But when I asked the patient, this is what he said,”I’ve been well before i came into hospital, you know, playing golf and all. I want to see my granddaughter performing, she took this dancing class..and there is a family wedding next year, you know.”

He was recuperating well now. walking in the ward freely and entertaining his visitors. What if they did not resuscitate him before? Does this mean we deny him a few more months of quality life? of being with his loved ones?

But what if the resuscitation was unsuccessful? and he end up comatose, but breathing? Are we tempering with nature and preventing what should have been?

We had this lecture about ‘letting go’ a while ago. about knowing when to stop to interfere and let nature runs its course. But this is the first time i am faced with situation when we are ready to let go, but the patient is adamant to hold on.

The second event was when this highly regarded (by friend and foe alike) blogger cum political journalist in mudcity was detained without trial. Because he was alleged to be a national threat.

I could see teh point of the act. when it comes to people that pose clear and imminent threat to the security of the community or the wider nation. For example someone who is about to take off on a plane and hit the twin tower. Or some one who propagates racial hatred and people are getting ready to march in the street and kill everyone that come across them as having a darker or fairer skin shade. Then the use of this act is not only appropriate, but the one and only alternative to take.

But of course real cases are not this clear-cut. And when inconsistencies exist about the crime someone commited, would it then, be fair to impose detention without trial? If half of the nation belief that someone is innocent, then who have the right to jail him without hearing his side of the story?

And because of this act, we will never know about the people who are detained under it. Never knowing whether they did commit the crime as alleged. And whether we did make the nation a better place by jailing these individuals. The saddest thing is, we may have a hand in letting innocent men rot in jail by supporting this act. We never know.

Personally, I belief strongly that everyone is innocent until proven otherwise. As strongly as I belief that first, we must do no harm. And for these two principles alone, this act neither has my support nor acknowledgement. I am happy to know why other people think otherwise..

I do learn in the ward. From the patients mostly. Here’s what I learned this week alone..

1. On the art of listening..

Patient:”what do you want me to do doctor?”

Doc: “I want look at your neck to see if your vein is bulging, have a tap on your chest to hear what it sounds like, and listen to your chest with this stethoscope. I am looking for any signs of the fluids in your lung getting any less. If it hasn’t that I would hear a crackling sound..bla bla bla”

Patient:”What do you want ME to do, doctor?”

Doc:”Ohh..just lie still please”

2. On getting old

Patient:”It’s hard work this..”

Me: What is, Mr. B? (thinking to self: is it because he has to drag his catheter bag everywhere he goes? oh, wait a minute he needs to get to the wheelchair first coz he only has one leg, or is it because he is tied down to the oxygen..?)

Patient: Getting old.

3. On showing your appreciation to your loved ones

Doc: we need to get the tube in so that we can feed you. Your wife and son agrees that it is the best way to go from here. is that ok?

Patient: ghhhee..raaaa…mmeeeyy..hghhrrrrr (while pointing at the wife and son)

Doc: What is it sir?

Patient: theyyy..ghraaa..dentttjj..lifeeee..

Doc: hmm?(leaning closer)

Patient: (trying again)

Doc: Oh, they are the most important people in your life, your wife and son!

Patients: yesss..

*the patient had vocal cord plasy by the way.

4. On the unpredictability of death.

Me: thank you for letting me examine you. I hope your breathing continues to get better.

Patient: No, thank you love. You know what, next time I see you, you will be my doctor.

Me: gehehehe (grinning sheepishly)

*The next time i saw her was the day after. she was dead then.

An esteemed colleague once told me. In medicine you’ll always be frustrated by people. But you will never get bored. Because people is never boring. They will never cease to amuse you.

They are amusing, yes. But above all, they teach me loads. About the reality of life. About humility. About being nice to people -just because, and not having to have a reason to. I bet there is no better way to learn.
And that is why medical students are let loose in the ward, despite knowing for a fact that we are accidents awaiting to happen. Ha!

It is now 3.30 a.m. I vowed to myself 3 hours previously that I will read about peripheral vascular disease. This is the punishment for sleeping the whole day today. And thus far I’ve only covered 2 pages. 10 more to go. I give up.

Let me reminisce about happier times. A time when books and exams are distant memories. My Eurotrip!! Yeah I (and my friend) did it on our own 4 feet! Within the span of 19 days, I’ve set my foot on 9 different countries all over Europe: Budapest, Hungary-Bratislava, Slovakia-Vienna, Austria-Krakow, Poland-Pague, Czech republic-Munich&Fussen, Germany-Lucern, Interlaken, Laussane&Geneva, Switzerland-Paris, France-Brussels, Belgium.

We brave sleepless bumpy nights on the train, confusing maps and road signs, annoying beggars, unrelenting fatigue, rice-less and meat-less days and open shower. And in doing so we met some very lovely people, sample interesting cuisine, witness breath-taking views of natural beauty and man-made architecture and generally had so much fun. Oh yeah, I learnt a lot too. Seriously I did. Here’s some (+advices too)..

1. Don’t trust the exchange rate quoted in the guide book. We get less for our british pound wherever we go.

2. If u can’t find your hostel, go into another hostel/hotel and ask. Chances are, the receptionist speak English.

3. If people stare at you, they are either: 1. Never seen someone as pretty before. 2. Never seen someone as exotic before 2. Had a bilateral squint-so they are actually looking at something else. The main point is, don’t take it to heart.

4. If you book a couchette on an overnight train, don’t expect to be able to sit at all. Lie on your tummy, sides or back to get comfortable. Just don’t sit up, not unless you want a head concussion.

5. Taking a wudhu’ (ablution before prayer) on a moving train can be tricky. having a good vestibular function helps.

6. Dont pass bowel motion in the toilet of a non-moving train. Chances are, people at the platform can see your stools once the train get moving (not that they can tell it’s your n’way). Passing water is less of an offense but is still frown upon.

7. Expect to just go to museums and lazing in starbucks / mccafe on sundays. All teh shops are close. Every single one. I guess people in Europe don’t have any emergency on Sundays. They don’t run out of baby napkins/milk, women’s tampon or paracetamol on Sundays.

8. Mc Cafe is even greater than starbucks. Do try.

9. If you are offered a cigarrete by a drunk man carrying a radio (blasting German rock song at full volume) do decline it politely, regardless of how tempting it is. I girl accepted, and the man ended up sleeping on her lap- and she ended up having vascular insufficiency/nerve compression of the lower limb after some time (or more famously known as ant-ant in malay)

10. Don’t offer Germans, Swiss or French people the shower before you. Chances are, they are going to strip right in front of you. Also keep your gaze low the whole time you are in the shower. Also expect no curtain or door to go with your shower cubicle.

11. Dont bother going to Lido or whatever in Paris-unless you have loads to spend. Various performances can be seen in the metro stations, in the train itself, or in the streets. From classic Chinese songs to puppet shows. It’s even free!-if you pretend you dont understand them when they come for money.

12. Learn to drink coffee in bowl, using spoon in Paris.

13. There are so many elderly people working for a living. They stand from morning to night trying to make a sale. And as it near 10 p.m, one old man looked dejectedly at the dying flowers by his feet. It touches the heart. This is not supposed to happen.

14. Let yourself be 7 again in Disneyland Paris. Scream in excitement when you catch side of Minnie. Wave and jump like crazy at the processions. Run up the stairs of Sleeping Beauty’s Castle, imagining you are Beauty. Believe in true love, for one day. Ha.

15. Be prepared to be spellbound by the beauty of switzerland. Blue skies, Green Mountains, with splashes of whites from the distant Jungfrau and greenish blue lakes. You have to see it to be spellbounded.

16. King Ludwig WAS crazy. Certified by Dr B, my previous PBL tutor whose great3x grandfather was the psychiatrist treating the king. He was found dead alongside with the king-who drowned in a lake, but who was known to be a good swimmer. After all, genius borders insanity. There’s a thin line between them. It takes a genius and a madman to envision and build a magnificent castle with the backdrop of mountains, waterfalls, lakes and valleys.

17. There is never a shortage of sadist psychopaths who take pleasure in killing and torturing fellow humans. Austwich-Birkeneau concentration camp is a testament to this. Sadly, there is no ‘Austwich-Birkeneau’ in Sebrenica Bosnia, Darfur Sudan, or Shabra and Shatilla in Palestine. We must take heed of all these, because “if one does not understand history, one is bound to live through it again”. “Unlimited, however, are the moral and physical powers that man has within him” to face the oppressors.

18. If you think you have been to the biggest, greatest museum on science and technology, you have seen nothing yet till you’ve been to Deutsche museum in Munich. Proper hydration and lots of sugar-based food is advised. Be selective. Just visit displays that interest you. After you have decided, half the list. Even then, you will still feel like vomiting after 5-6 hours. For the brave hearted, you can push to 7 hours maximum. Once you experience the following symptoms, I advise you to get the hell out of there; dizziness, unsteadiness, leg cramps, blurry vision and difficulty differentiating a ship from an aeroplane. And i do mean get out quick. The same advise is applicable when visiting the Louvre in Paris as well.

19. Go to Brussels just for the waffle and the chocolate. Unless a monument of a-3 year old growth hormone deficient boy doing what a boy does (peeing in public) is your cup of tea.

That’s it. I cant think of anything no more. 19 lessons for 19 days. I think that is enough. There’s a lot more lessons that is too complicated and intricate that requires more than one lousy paragraph. It need a proper face-to-face story-telling with lots of high-pitched squels and hands flying in the air. Enough said.

Like the dell ad. Difference is, I was eager and excited when i received my dell. I am neither of those now.

Not all is bleak and gloomy like the current preston weather, though. For a start, the new accomodation is great (most of the greatness comes from the fact that everything is free). In hospital I feel more confident (and find more enjoyment in) when i disturb, interogate, prode and prick patients with needles. So all in all life is not bad at the moment. Not bad at all. If manchester suddenly realize that we can graduate without sitting for the finals then it will be much better. Great, even.

so what is the point of this entry. None actually. none at all.

I laments how politics is very dirty all the time. and yet here i go again..

The situation for the past couple of weeks have been mind-boglingly shocking to the point of hysterical.

Fingers are pointed accusingly to all different directions. The people becomes more confused and fragmented, backing whoever they think are the heroes and hating the lowly villains.

This is no bollywood. The heroes don’t always win. it is not a given that the villains would get killed or arrested. and sadly, truth doesn’t necessarily emerge at the end, covered by layers and layers of cleverly woven lies.

So i am neither hoping for an answer nor the truth. i hope all this will go away so that people can move on with their lives. so that real issues like how to encounter the impact of global economic crises and growing inflations can be debated. so that money will be spent on education and health care instead of funding investigations that would’nt bring us any closer to the truth.

And to those who started the ball rolling in the first place, making politically-backed accusations and claims just to achieve political mileage, this is all i want to say..
grow up.

on a totally different issue, the king has fallen. long live the king. the king of tennis laa not any coutry’s king. he didnt hide his disappointment, nor took the lost graciously. i guess the bigger they come, the harder they fall. from kipling’s "if you can meet with triumph and disaster, and treat those two imposters just the same.." he didn’t remain true to the poem he recited, did he? n’ways, i’m sure he’ll come away with this lost and achieve more grand slams in the coming years. go fed!