Absence

So it happened: I've missed a working (school) day!  The first day of my new placement. ( how bad is that?).
I'm still a student (preintern).  A horrible threat have been sent through one of my colleague. Was she exaggerating?
My new placement is in a place when one of the consultant think I crossed my line when I offer to look for financial help for a mother who wanted to take her child (not the consultant patient by the way) to a specialized center ( I asked another consultant first if that was ok I swear).

I am thinking have I been in a better state of mind when  I received the call I'll barely think of it. We see/interpret  things based on our prexistence state of mind and prejudgments. That is why, my dear self, keeping an optimistic cheerful attitude is the way to go.

Any way, I guess the right thing is not to catastrophize  and use the best of my negotiation skills and my character charm ( hey, I can see you rolling your eyes at me)
and my hard work to please who ever my absence had upset.
The Final MD exam is in two  months, I guess the right thing is to revise and chill. There is no place for worry and freaking out because that is a waste of life and time.

In a brighter side note: I had an interesting weekend.
Happy mother day by the way.

See you soon;)
Keep those finger crossed

Student intern

3 weeks!! Working as preintern is fun. Here is a glimpse:
Me:  Mrs S blood sugar yesterday were 1, 2, 3. Do we adjust her insulin or refer to endo?
Resident : how much were her blood sugar readings yesterday?
Consultant : what about her glycemic control ?

Mr H is on so and so1 medications
Registrar after she discovered later px is on drug so1. WHY haven't you told me px is on that drug? Who put him on that drug? ( worse yet if you repeat the drug list extra time for the attending and she took your written list and read it)
Ehh nothing personal, but it seems as you go up in the medical hierarchy your responsibilities gets bigger. I no longer feel upset when scolded for things I have no control on. I sympthies with my seniors, they are under a lot of pressure. Hey, if screaming at me make them feel better, I'm totally fine. ( I guess! )

This doesn't mean preinternship is awful, it is so beautiful thankfully. It is just we are working so close to the real doctors, we got to understand them more.
Bonus: lovely resident who gives revision sessions after we do ward work! Heaven.

 Preinternship is simply working as interns: you clerk patient, investigate them, discuss with seniors the plan and then follow them up and update the team in ward rounds about patient status , lab results  and response to treatment . And a few calls here and there ( we put a referral in the computer but follow that with a call : so we call anesthesia , physo, dietician ., and sometimes we go personally to ask for thier consult) and we document everything in the system.

It is really a good way to learn!

And one of the medical student ( ehhhmm , I know I know! I keep telling them I'm not a doctor yet) thanked me profusely today and  said I'm a very  helpful person ( yahhooooooo). Seriously I had to brag about it to you guys. I pray to be helpful and kind (dear lord please make me pass my MD , please , please , please and make me safe and excellent doctor)
I really do want to be a nice person.


P.S. In a revision session:
- so Peace, PatientX is post total thyroidectomy. The nurse calls telling you the patient is desaturating. What will you do ?
- I'll call my senior!  ( I have been told this and "check vitals" if within normal take hx and do brief exam" will help when in doubt ;)  ( oh, I know removing subcutical sutures when px is having trouble breathing because of neck hematoma post op is not fun) 

But you'll be doctor!

I guess it is not uncommon for medical students to be approached by people asking about various medical (and non medical) things.
A number of times now people asked me if I can measure their BP to make sure they are fine. I guess that is a privilege and part of preventive medicine. The problem is I don't have symphengomanometer! And I am quite sure those particular individuals will not go to a health center to do so for various reasons. (Money included)

Anyway, I am planing to buy one and just curious if anyone has other suggestion to things I can keep. I mean gauze, antiseptic swap, bandages, paracetamol, antihistamine , burn cream what else ? Any suggestions

Oh and the chest infection seems to settle thankfully. I slept most of the day and I feel human again. If everything is good I'll start revising my surgical notes, write some reflections tomorrow morning and will have a chilling afternoon.  That or I'll over sleep again. 

Sleeping in the OT!

Hi, funny thing happend yesterday. We finished the round very late and we had a couple of referrals so we got to run from place to another and finally landed in the OT. I was having the flu for a couple of days and my system was filled with antihistamine, ibuprofen and caffeine! I kept going. So today in the theater I was shivering , sweating and my legs were no more strong enough! I walked out of the OT fighting  an urge to throw up and just collapsed in the OT changing room. ( it seemed way too far at that time, and I just you know peacefully fainted). Any way after throwing up a couple of times I felt better. But was still dizzy and weak. So I decided to get a power nap in the changing room ( hey, no judgement I mean I wish I had a bed in my pocket).  A very sweat students came in and brought me juice ( oh I felt them checking out my pulse and calling my name asking if I was a live. Funny I know). anyway it seemed I looked so blue and they couldn't feel my faint pulse at that time (I guess my cold hand scared them, I am sure I have good pulse. My heart was going crazy) 

So I was escorted by group of happy students to the staff clinic. ( I know the feeling, hehe I will be happy too! I love escorting people. )

 Turn out I had pneumonia and dehydrated. Oh but I guess the reason I collapsed is because my beloved body was screaming for food. My morning start way to early and the intern is alone so I think it is unfair to ignore that even if it mean no break for us. I usually sleep once I get home and get up for a 3 hour or less study break then I sleep some more. I would drink coffee and some chocolate and it never occurred to me I am not actually eating! 

Oh, how humiliating collapsing like that. Let's hope it is the last time and that the bugs will give me my lungs back. 

As for those sweet students I can't thank them enough. 

They called back to check how Am I doing. So sweet of them. In such a horrible time they were a blessing. I know they will be great doctors and I'm honered to meet such people. 

As for going to work sick: the guilt was eating me. I was afraid of infecting people ( I could not get an N95 mask so used a regular mask) My college made it clear unless you are in the ICU you are not excused.

The idea of becoming a doctor is scarring me. My new mantra is " Lord please make me safe and excellent doctor"

Love you all

Blessing

Praise to God!
I've passed my finals. Yaaay. I didn't know one can be so excited to see a C+ .  Excited is an understatement I was ecstatic almost euphoric. Best yet: all my friends passed as well AND there was one friend who was a magent for bad examiners and who despite hard working ends up with bad marks because of the examiners. She finally got the grades she deserves. Happiness. Her sister called inviting me to a trip to Dubai. Joy.
I feel so blessed.

Thank you all

B plan

Hey, A plan is to pass my finals. B plan? I need your help with suggestions as what to do if - dear lord please forgive my self doubt- didn't. Any suggestions? What would you do with a Bhs in health science?

Study wise: done with some subjects.    Had lazy day yesterday.
Note to self : buy lovely friends something nice ( they keep helping  and supporting me). I had recieve so many chocolates and flower on the past couple of days. I feel blessed. Dear lord help me pass my finals.

Wish me luck 

end of year exam

 Hi

One week to end of year exam. I hadn’t blog for a long time, but I am planning to write about some rotations later on.

So 2014 ( happy new year by the way) was a rather interesting year, I visited 4 countries, was about to get married ( thanks lord I am still single), and it involved lots of new experiences and money expenditures.

Study wise, I am worried I could have done better. The most important thing I learnt ( though I knew/read it before) was to be careful with whom you spend your time with. This include your clinical partners. Last year I was with very enthusiastic students who I can easily engage in discussion and quick ward revision ( i.e. whenever we are waiting for a consultant or a procedure I'll open a page and we'll read it together or we will go through some topics and that really did enrich my learning).  This year …uhh  let's just pray I pass with good grades and be a safe doctor.

The written exam will be in blocks over  3 days, it'll cover:

-          Obs& gyn

-          Pediatrics

-          Medicine/hematology/emergency

-          Surgery/urology/ ENT

-          ICU

-          Therapeutics and labs!

-          FAMCO

-          Radiology

 

Many topics! I need to find a way to motivate myself and concentrate more.

Wish me luckJ

What happened?

In my first day of obs/gyn rotation the following happened:

-          me entering the morning meeting room 5 five minutes before it is due.

-          F***  up consultant, who has the reputation of chewing people (not only students) a live: HEY, GO TO THE FRONT SEAT ( though no visual aid will be used!)

-          Me smiling anxiously as I realize I am the chosen one and drag myself to the "hot seat"

-          10 minutes into the meeting, they were talking about a non reassuring CTG, and that they had to rush the patient to the OT.  F**** up consultant get up from the back of the room, took the CTG trace paper, hold it less than 15 cm( I kid you not) from my face and shout: READ IT.

-          I freaked out, I had reads tens of them before- as I did my elective in oby/gyne-, but for some reason I feel uncertain and scared. I start analyzing but the panic exaggerate and I start shaking and told the f*** up consultant: You are scarring me and I don’t know how to read it. Panic took over and I start silently sobbing and had to excuse myself out.

I was surprised by my reaction, my colleagues were traumatized and concerned what just happened!

Anyway, living alone and not taking a good care of oneself would certainly lead to that. AND, definitely listening to horror stories about a particular person will make thing worse.

Now I have to work extra hard to prove myself, especially since I am considering oby/gyne as a future specialty.

As of the f*** up consultant, he/she is mean to everyone including the patients. I have yet to see a more manipulative doctor who make fun of their patients in their face.

I think I had a couple of panic attacks symptoms after that incident, but thankfully didn't miss a  clinic/round because of it (except that morning meeting)

I was impressed by the amount of the support I received. I know what I did was not professional, but S*** happens.

P.S:

To reassure myself if that F**** up consultant tried to bully me  I came up with 2 plans:

1.       Go hug him/her very tight

2.       Video record the incident, and hope the attack will be aborted.

But I might as well start shaking and sobbing again, who knows!

 

I  am truly surprised by my reaction, never knew there were a chicken hen in me J  

P.S2:

I'll appreciate any feedback/analysis of the incident!

 

 

 

Elderly

 I met a lovely elderly women in the clinic today. She was charming to say the least. I was lucky I got to spend extra time with her as the real doctor was called for another consult. I was his nurse( taking the vitals, calculating BMI, and drawing blood) plus do the physical  exam.  As a reward he taught me a couple of things.
As she left, she looked me in the eyes and said : thank you child.

Then she opened her handbag and gave me a candy.  - and had to give the doctor too because he was feeling jealous😝-

That was the most sincere thank you I had ever received.
Moments like this, keep us going

P.S. Do you think it is okay to hug patient? I was like : aww you are so sweet,  can you be my grandma. 😁

Oh , and my answer would be no.

 8 hours later: I am still smiling

Grammer, spelling and their other siblings

Oh dear lord, I read some of my posts here and I feel irritated by the quality of  my writing. I want to apologize for any potential reader. I am too lazy to fix the tons if mistakes I found, and obviously can't commit myself to proof reading in the future. ( me being on energy saving mode and stuff ).

So, if you are feeling an itch because of the quality of my English .. Idk maybe do scratch yourself that'll distract you? Just know I am thankful you are giving me from your precious time. Thank you :) and I mean it.

The lab week revision: nailed it. One day was more than enough. But to no one surprise the questions was not related to what we did! I don't know people I only know one equation to calculate positive predictive value, and there are programs  to calculate it. So no need to twist the question you know. Oh and yes that was totally unrelated to what we did this week.

Oh and someone proposed; to marry me!
Idk people. Everyone keep pushing and express their concern over my singleness. I don't know the man, never heard of him or his tribe. Do you remember the movies where ladies wear big seemingly very heavy dresses that they drag? -19 century - and they talk about arranged marriages? Will technically we are still stuck in that era. And that is how marriages happen in my part of the world.  Anyway, my reaction to previous proposals was no brainer: not ready yet. But now, with all my friends married and settled and busy and having kids- do I need to go on?- I feel old. Mostly alone, but old. So I am considering the offer.

10 years earlier I would laugh at the idea of me getting married the traditional way. Whom I kidding I would laugh at the idea of me getting married.
But things changed. Or maybe that is Nutella withdrawal symptoms!

Starting Family medicine next week. Not so enthusiastic, I feel I'll do better sleeping. But again, that might be the Nutella withdrawal. Oh and I am meeting old friends next week.

Oh people
How could my little sister do that to me? How could she finish the whole Nutella jar?

Making a problem out of nothing

Thanks to the curriculum changes in  my college we have frequent "lab weeks", we basically go over many aspect of the diagnostic tests and concepts in hematological, biochemical, molecular, genetics, etc

The thing is: I hate such weeks. I HATE them. They are a waste of our valuable time. We can spend these weeks attending clinics or being in the wards strengthening our clinical skills.

What makes matter worse is that they are stupidly designed: Let's teach those brats what waiting is (insert the evilest laugh). We have to be present from 8am to 4pm for a total teaching worth of 2 hours. I kid you not . ( mentally punching myself, I can't punch the consultant you, respect and stuff). Our day is a block of waiting.

My dilemma is: how to study lab things! I don’t know how I convinced myself non clinical stuff is to be read the night of the exam only. So here I am feeling guilty for not studying and unable to study not the least enjoy myself.



Many copies of the DNA are synthesized in

PCR

And not to feel guilty in involving you in my ranting, let's talk about PCR; polymerase chain reaction. (we had a session about it, AGAIN). This is a time saving technology where you amplify particular segment of the DNA( in case the mutation you are looking for is in the interon; aka non coding part of the DNA) or RNA( if the mutation is in the axon; the coding part of your DNA) , so you can examine it better for abnormalities. It can be used in many conditions, but its high cost narrow the list. One example is after bone marrow transplant. You want to know if the lymphocytes are of the donor or the patient himself (to check the success of the transplant for example). It also enable the early detection of leukemia and lymphomas.  

In this picture, amplified segments of DNA from both parents are used to confirm they are the  biological parents of their child. You know you get half the DNA from each parents, and this is  the simple idea behind the paternity test. In A no similarities between the dad's DNA and the son, so he is not the father. In B the child belong to this couple.

  

 

Maturing

It is 1 am. Morning meeting is 7 hours from now.
Today happened to be the last day of 5 weeks long college break.(they were lovely, thanks for asking J). I felt unsettled.
Moving back to campus did cause such feeling of despair in the past. Will I make it? What if missing the feeling of being unique and irreplaceable at home took over me and render me helpless. But tonight, although some tears were shed, that feeling was not overwhelming. I grew up. I finally did. ( finger crossed I don’t wake up to find myself 13 again).
I think I know me!  I started to feel  blue 2 weeks ago. It worsened whenever someone mentioned  school. I knew the doubts of continuing on the medical rocky road are back. So I talked to myself like a wiseman. ( I once failed myself in purpose in a hope that will liberate me._yup it is that bad_ Worse thing I did ever. And yes, it was NOT liberating at all. I repeat it was not. I can be crazy sometimes. no regret though( or plenty of it, depend from which angle I'm looking at it hehe).
 
Half year to go. Let's keep praying ( and meditating and eating those medical books).
Pray for me.
My love to you all

what's up?

It seems I abandoned my baby blog. What a horrible mother! Probably medical Monday was not a good idea, either. I am such a lazy, advocate procsteneator and I am enjoying being so.

So what is new?

Lets' see

I am supposed to be good enough in handling  patients with common hematological problems, got the chance to spent time in ICU and understand some cool things. I am almost done with my medical and surgical rotations.

  I've had the chance to explore many restaurants and places recently, which is a good change.


I gained about 3 kgs (horrray), but I stopped exercises. AND I SLEEP LIKE A POLAR BEAR. crazy I know! I had missed many clinics and classes. I am afraid I'll be in trouble because of this sleeping problem. I guess I need to exercise more and be strict in regulating my biological watch. Don't worry though my blood test confirmed how healthy I am.



So next post, no rambling... will share some medical knowledge.

Ameen
---
that is an old post. i clearly have problem keeping my blog promises

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

Briefing



Oh I miss my nephews already

Day one in campus after a week at home.  Exams are in 2 weeks. This week we have set of lectures about legal medicine( aka forensic medicine).  I really feel blue & just think I need and pull myself and go for a run. Oh God can I quit life!

I guess I'll do some aerobics in my room, then will revise today's note, prepare for tomorrow  ( 5 articles hmm I may skip them  & do some ophthalmology.)

So grumpy & have no one to talk too.

Anesthesia

My surgical placement is over. So is the passive aggressive attitude of surgeons.  We got to spend some time with anesthetist as well. Did a load of  intubations.  It is fascinating how people willingly put their lives ( literally) at stranger s' hands (C'mon your medical team is).

      At the induction of general anesthesia, you receive muscle relaxant that paralyzed all your skeletal muscles, including the diaphragm. You stop breathing for a while until the anesthetist intubate you and connect your lung to a machine that breath for you.  It is scary. Especially if you are the one who intubate.  Then what if you paralyzed the patient but the pain medication you gave is not sufficient, and he could feel the surgeon cutting his abdomen open and can't complain. Yes, the patient will be monitored. Any raise in his blood pressure or heart rate upon inducing a painful stimuli will be taken as a sign of pain & fast acting analgesic will be administered .  But the fear, of causing harm … at every stage of anesthesia. I can't help but admire those fighters, who in addition to their critical task, have to endure arrogant surgeons. 

It  made me think, about those who work sincerely and are sure the credits will go to someone else.

Oh anesthesia, I enjoyed you so much.

3 weeks to final.  A year and half work to be examined. Family medicine, pediatric, internal medicine, general surgery , ortho, anesthesia, genetic, microbiology, forensic, …. How to re read tons of information.

Can I sleep and woke up to find them over.

Surgery

I wrote these 2 posts a while ago but couldn't publish them.

----------------

Just finished surgery. It was not that fun , with the resident, SHO, and aspiring interns fighting to scrubs in and do all the doable. We were left to re-clerking and examining. But no real hands on!  Shoot me now. I don't know how I feel about surgery. I know it was less stressful in term of the amount of information you need to know.  But I left wondering  why I choose medicine as a career? It is rarely rewarding. It is draining.

For the majority of the past 2 months I was feeling " unconnected".

I really need friends to chat with

I need to exercise

To do list

Sleep properly

Study

Read outside blogosphere

Study more

Spend some random time in the hospital

Do some aerobic

Buy some clothes ( the current ones stink before I put them on).

 

Holidays

Hi,

It has been a while. Thanks to the refreshing  Eid holiday I am back. (uhmm  let's pretend someone will read this).  

I am sure most people know about Christmas at least from movies. So I thought  to give you a glimpse about Eid.

Eid might be the  Islamic equivalent for Christmas. Basically lots of family gathering an visit exchanges. It can get crazy. Hardly an hour pass without the door ringing.  People usually stay for few minutes for the "Eid greetings"  and then go ahead rotating between acquaintance .

My favorite part is food. There is plenty of it. I think the sweet I ate in the 3 days  of Eid holiday is more than what I ate the whole year. Yummy

Also, there is a special prayer in the Eid morning. Then there is a ritual of sloughing a sheep ,usually, as memorial for prophet Abraham sacrifices. At least 1/3 ( I think) of the meat should be presented to the poor.  The rest can be used for  barbecues/other dishes and shared with relatives. I am a vegetarian so I skip this part.

Ohh and children  dress in new clothes and go knocking doors and people give them sweets or money .  ( Like in Halloween, but with less scary theme).

I know I am not a child but I am happy to say I received gifts and money, too.  Yahoooooooo

O and we are blessed  with two newborns in the family.  

*** I guess writing about happy times makes me happy. I started writing initially by stating the series of unfortunate events that made me think my life was dull and depressing. I am counting my blessing right now.