Medical Monday

Hi again. I have been searching for a club to join for a while. Since there is no real one around in my part of the world I decided to look online and traa I found the beautiful: Medical Monday. I don't know about you but I upgraded it to a club.

I'll start by explaining why I feel I need to be  a club member. See I've been in medical school so long. My hometown friends are all starting their own families and busy with their lives. My medical classmates and clinical group are busy all the time. We are together most of the time but I feel detached! No real conversations: have you seen that patient? Did you complete your portfolio. But no human talk. I happen to be in the most introvert clinical group. My clinical partner is reluctant to go out or spent time in non medical thing. Actually, non of my clinical group is interested in  starting a study group. An important thing in medical school.

So, here I am . Released early from the hospital today. Yet I've not done much! I have no  idea how time passed. I can feel the stress accumulating. I need to turn in my reflection, get my file signed, go back to assess my patient again, prepare for my upcoming exam. What about my research… uhh . In the middle of all of this I need something to help me breath. I need to be  a club member. Or so I think at the moment!

Please welcome my  Medical Mondays.

Fun in Malaysia

Hello all. It has been long time since I last blogged. I passed my finals Yayyyyyy. I did my elective and it was the best 2 months in my life.  And now I am a final year medical student. It is scary a little, but so far so good. I'm liking the attention we get : Where are my medical students? Ehh didn't know such line existed.

I am doing hematology ( blood related diseases) at the moment. It amuses me how much I thought I already know about sickle cell disease, SCD, which is one of the commonest hematological disorders,  and how much I daily learn. When to start hydroxyurea, exchange transfusion and why, what is the complication of different chelating agents, what is the average life of sickled cell ( 20 days compared to 120 days in normal red blood cell), MoyaMoya ,…. How to manage an ischemic stroke in a SCD? Definitely not by antiplatelet/anticoagulation/beta blocker alone. That is a misconception. ! And according to our  consultant it is a common one! The treatment is by exchange transfusion, in which you take blood from a patient and replace it with a normal healthy blood. The idea is to decrease Hb S level, the source of the problem. Many patient retain their neurological function afterwards. (if recognized and treated early). The following paragraph explain the mechanism, so feel free to skip it.

SCD starts at the DNA level while making the building blocks of the hemoglobin (Hb: the oxygen transport in red blood cells (RBC)). A new protein formed by faulty coding: mutation. This makes The Hb less stable. Any hypoxia ( reduce oxygen pressure due to high altitude, dehydration …) will cause the Hb to precipitate, pulling the membrane along and causing leaking of potassium & water out of the RBC and calcium influx. This will result in red blood cell dehydration and the RBC loose it's biconcave disc form to a sickled one. If the hypoxia corrected in reasonable time the RBC may retain to normal shape, and it is only called pseudosickled. If not it'll take a more lunar shape and become sickled for good: sickled cell. Such cell has sharp surface and it affects it surroundings ( blood vessel, activate platelet..) and it clumps with each other occluding small blood vessels causing the famous pain. The smallest vessels are the easiest to clog, hence bone is the most common site of such crisis. The vasooccluasive crisis can happen anywhere in the body, including the brain and that is why the SCD patient has high prevalence of strokes – and at younger age-compare to the general population. Other common sites are the spleen ( which they usually lose by adulthood due to frequent infarcts, a phenomena known as autosplenectomy) and the lung, where it cause the life threatening acute chest syndrome.

Back to life as a senior medical student. Will we are expected to work like interns except we got some teaching and don't have to write stupid discharges and referrals. But we need to clerk , assess, format a plan and write it up in the hospital system. And we have a tiny tyny book that we need to fill with procedures and reflections and such.. and that reminds me I need to write my case  now and read about Hodgkin lymphoma!

See you soon.

Old Up date

 Hi,

I wrote this months ago. I guess I'll post it because it was written in the middle of exam chaos and I need to document my feeling, the uncertainty I am sure every med students will experience! Thankfully it turned  out I did quite well.

====I had finished my OSCEs.   I blow them big times. The easiest stations especially.  I think I'll need to  take a reset. It was so awful I could see the disappointment in my doctors –mentors_ faces. 

I am not sure what went wrong because I  kept omitting major parts of each station.  Example: I kept telling myself not to forget PR & genital exam & at least mention about the ideal exposure .. I walked out of the exam room without even mentioning them.  Every time I get out of an examination station I remember things I was supposed to do.  This happen with every station. Every single one.

Never mind,

Tomorrow  I'll have my first written.   Couldn't study today or didn't want too! I covered the whole material last week & I know I need to reread but I spent half an hour staring at my notes & then decide not to read. 12 hours break..I repeat my exam is tomorrow..  no feeling. Not even A tiny winy feeling of guilt.

Oh and the elective things, it is cancelled. I will do it locally now.

I just need to read the cardio part, not only for the exam but also because I hate cardio & rarely read about it.

2 more exam blocks . Let's pray I pass.

Merry Christmas everyone