Afraid....

A words that really explain my current situation...medical wards really terrify me...so many management that I did not know...I could not remember the patients...It is like managing blindly....Ya Allah please help me...please  do not make my ignorance become harmful to my patients

wish could end this posting quickly and peacefully. Amin

One down another to go..

Alhamdulillah..end of orthopedic posting..and welcome dear medical into my life.

thank you Allah for the blessing. Thank you to the specialists, my supervisor Miss I, and my colleagues. It's been a very pleasant posting..I've learned a lot and need to learn more...

Allright, it's medical posting. haha being houseman "jonah" since day 1. Good God! Need to learn fast..need to work fast..yet efficient. Go go go!

p/s: bila nak balik ni...

cuti ...cuti....hehe

bestnya cuti lepas sebulan keje.

jumpa keluarga, kawan2...

Time up!

It is the end of the days of unemployment for me...I will attend an induction course for the job tomorrow...the 3 months that I took for granted had long gone...I always took for granted for the things that I had and regretted it later after it gone.

That's it Afif. It is time to move forward and hope for the best. Time to start a new chapter in life. I've even cut my 3-month-long hair. Hope for the best in the future! Fighting!

How to Love

Let a person who want to depart, go

Let a person who want to sleep, sleep

And yet in the time that remains, keep silent

And towards the flowers..

And towards the heavens..

And towards the grave..

Do not rush, keep silent

(The sad way to love...Taken from Korean Drama Midas. Quoting a drama..I must be pretty much b.o.r.i.n.g now haha)

Alhamdulillah

Alhamdulillah for answering my prayer...thank you, mama for hearing my whining..thank you lecturers for all the teachings and thank you friends for helping the inadequate me.

To those who did not manage to come thru the exam, seriously it is not the end of the world.. I know you will be the best clinician if Allah may..InsyaAllah. Never lose hope ok!

To all my juniors... keep study, study & study. Never forget to seek guidance from Allah. Final pro is not easy. Mainly because of overwhelming anxiety. I remember when I clerked my long case patient. I completely blanked how to proceed. So many loopholes in history and I forgot my basics. He is a 13 years old boy known to have cyanotic heart disease and possibly syndromic but had good school performance came with no active complaint. Short cases were quite ok. I've got tophaceous gout for hand examination, multinodular goitre and multiple gestation.

After they announced the result, I went to Perlis last week for my cousin wedding (eventhough I unable to see him "bersanding"), one of my cousin had laceration wound on her head... so here comes lots of questions regarding this, and that...well I guess as a doctor-to-be, people expect more from us. We not only need to treat but to reassure them. A doctor cure seldom, treat often, comfort always, always and always... InsyaAllah hopefully I'll be one.

Good Luck!

Wow final professional exam is coming....only two days left. It's been 7 years of study in IIUM. Guys good luck for all of us. Give the best, and pray to Allah for the rest.

Not to forget to my sweet young sister...good luck for you too and welcome to college life! Study hard, pray hard...play smart. Even if I wasn't there but I will always pray for you.

So everyone good luck in what ever you do.

La takhaf wa la tahzan innallaha ma'ana (do not fear or sad because Allah with us)

anxiety is failing me...

2 weeks to come before my final professional exam and anxiety is building up..And I did not even dare to go home for de-stressing myself. Thanks to my last Surgical posting exam that I did it horribly (seriously no kidding!). Here a little bit of what happen during my last exam.

Me: I'm presenting my patient 55 years old Malay lady from KT, Para 3 came w complaint of per rectal bleeding for 1 day duration.

Mr C: Why did you mention about Para 3? Does it relevant? (I kept silent)

Mr N: We are not gynecologist.

Me: Oh ok I'm sorry.

Mr C: You're wearing long sleeve or short sleeve? You should not fold up your sleeves. Button it properly!

Me: Sorry Dr. (OMG...previously I've been scolded for not standing straight, now this? I curse my bad attitude.. In instance, all my confidence had been flushed away)

Summary of my case...

55/M/Lady came with painless fresh per rectal bleeding for 5 episodes in a day that was not mixed with stool. It associated with passing out blood clots, abdominal discomfort and symptoms of anemia. Patient also had loss of weight but no anorexia. Known to have DM and hypertension. On examination, she was pale and per rectal examination revealed there was altered blood.

My diagnosis was anemia secondary to bleeding hemorrhoids

Well in my presentation, I did mention about tenesmus...

Mr N: What is tenesmus?

Me: Feeling of defecation but no production of stool..

Mr N: No..So what is tenesmus? (I think more than 3 times he asked me)

In my history I did say patient had undergone banding.

Mr C: Why did you said that? Did patient see it? Is patient is a doctor?

Mr N: What is the treatment of hemorrhoids?

Me: Sclerotherapy, banding & hemorrhoidectomy...

Mr C: Yes.. May she undergone sclerotherapy..you never know.

Mr N: Ok.. what are the causes of massive per rectal bleeding? 4 causes..

Me: Sorry Dr. I did not know.

Mr N: You are 2 weeks behind professional and you did not know? (This time around I know I flunked it). In this patient what is your diagnoses?

Me: Hemorrhoids, angiodysplasia, colon cancer, diverticular disease.

Mr N: Yes.. At least you should know that for massive per rectal bleeding.

Mr C: Your history has many loop holes & you are assuming too much...What you want to do for this patient?

Me: Resuscitation, admission, blood transfusion...investigations, proctoscopy and colonoscopy.

Later the discussion mainly about colon cancer

Mr N: What is the surgical treatment of colon cancer.

Me: Right & left hemicolectomy, anterior resection, anteroperineal resection.

Mr N: Yes, so that why you have to know what is tenesmus...because if tenesmus occurs, patient may have sphincter involvement.

*sigh*

Then move on to short case, well it was Prof S & Mr Z.

Prof S: Examine this patient upper limb.

I did examine the patient horribly...partly because the patient unable to understand my instructions...when I asked her to grab my fingers, she just pull my hand..seriously it look totally bizarre even from my own perspective.

Mr Z: What are you doing? (Hmm..sorry Dr)

I continued with my examination & found that patient had hypertonia & hyperreflexia of the right upper limb.

Prof S: So what is your diagnosis?

Me: Upper motor neuron lesion involving right upper limb. (The bell rang..time out)

Prof S: Why did you say that?

Me: Because of hyperreflexia & hypertonia on the right side.

Prof S: What else? Ok last question, did you know difference between rigidity & spasticity?

Seriously at this point I have mental block. It is the same question during our teaching. So I ended up resiting for another short case..*sigh*

So moral of the story never ever let your anxiety control your mind or you will end up talking/doing bizarre things...and always be prepared. My poor preparation prove it all.

p/s: tenesmus is a feeling of incomplete defecation. Patient may feel like going to defecate but no passing out motion. If you have any more info do response ok!

[update: Mr C said that tenesmus is after defecation, patient feeling there is still something inside]

. . . .ermm

my..my...nothing can I say at this time. I have examine 1 patient, but I do not know the diagnosis...last word I heard "Give your diagnosis and you can go". Frustrated with myself...this is when the saying "sesal dahulu pendapatan, sesal kemudian tidak berguna lagi" seem applicable... 8 weeks of posting and know nothing about a simple case...totally unacceptable.
I just pray to Allah make it easy for me. Seriously no more foolish act or goofing around for me.
Prioritise, prioritise, prioritise!

COMEL and MERCI

Haha...it's no about being cute or else...just a mnemonic that I learn during class with Prof Z...but seriously being in paediatrics is full with cute faces haha. Thanks to Prof for very enjoyable and meaningful session

1) MERCI

Medical

Empathy

Right

Communication

Insight

During clerking we should have this thought in our mind. Not only think for medical aspect only. Every person have it right. "Janganlah kacau patient tidur." That one of the things that Prof emphasized. And some of us talk less and less to patient and never try to educate them on their disease (insight component). Should change our mindset.

2) COMEL

Cognition

Optic

Motor

Emotion & Social

Language

For developmental assessment. Prof said that tr to assess playfully and creatively..

3) VITAMIN BCDE

If we stuck during clerking, always remember this to exclude diagnosis

Vascular

Infective

Trauma

Autoimmune

Metabolic

Idiopathic

Nutrition

Behavioural
Congenital

Drugs/Degenerative

Endocrine

It can be done...

"It can be done"

That what Dr Suraya said...insyaALLAH we can...

Good luck for exam everyone!

Good Luck exam!!

hm..musim exam sekarang ni...haha aku pun exam esok. tension sekali..ok la good luck kengkawan...mcm org slalu kata, bring it on...doa byk2 moga Allah permudahkan.Amin

Ramadan Karim...

Ramadan is here...time for us to enhance our 'ibadah and good deeds... let's us reduce our bad deeds...

May ALLAH give strength & barakah for every good intentions & deeds..

here is a Quranic verse regarding Ramadan & saum. MAy ALLAH include us among them who are muttaqin

183 O ye who believe! Fasting is prescribed to you as it was prescribed to those before you, that ye may (learn) self-restraint,-

184 (Fasting) for a fixed number of days; but if any of you is ill, or on a journey, the prescribed number (should be made up) from days later. For those who can do it (with hardship), is a ransom, the feeding of one that is indigent. But he that will give more, of his own free will,- it is better for him. And it is better for you that ye fast, if ye only knew.

(AL-BAQARAH verses 183-184)

p/s: if there is any mistake, do correct me...

Final Year....

I will enter my final year as student in 4 days..insyaALLAH

It will be psychiatry posting first..hopefully it will be as thrill as 3rd year.

I wonder which books should I read? Anyone?

bola...bola...bola...

world cup dah start!!!

choose your fav team...ada yg minat team2 kuat cam brazil, spain...ada yg suka sokong pemain haha

ni 5 team yg aku suka tengok diorg main...

jepun & korea selatan - sebab semangat juang yg 200%

argentina - sebab dia main ada strategy plus samba bukan mcm brazil guna individual skill je

itali - sebab aku suka defense n counter attack dia... kuda tua pun kuda tua la..

england - sebab aku suka tradisi bola dia & diorg main ikut strategy..

anyway semua team power2 n potensi menang tu ada...

may the best win!!

kepada peminat bola jgn gaduh2 sbb jabulani tu bulat..dan jangan tuang kelas & kerja ok!