Of growing up

Assalammualaikum!

You know, I think I've aged quite significantly these past two months.
Ending my student life means I no longer receive the monthly living allowance from the Malaysian government, a privilege I have enjoyed for the past 7 years of my life.

Photo by Brendan Church on Unsplash

I now have to start thinking about other things.
Not only to THINK about them, but TO WORK to get them.
I will need a car, I do not know where I will be posted to.
I want to get married, I need to plan it.

If I get a job in a nearby hospital, I can stay at home but if I get somewhere further, I will need to relocate myself there. That means I need to find a house / room and move myself out of this house now.

Renting a house will usually requires two months deposit + one month rental. I may need to furnish the house, at least a stove, rice cooker, some plates and kitchen stuff.
It's Preston all over again. But in Preston, there were 4 of us in the same boat.
I had Kiew, Syahidah and Ibrizah. We divided the cost, we bought vacuum cleaner, ironing board, pots and pans, broom and mop etc. I need to find new housemates now.

I may need a car. My mum's second car; the very useful Kelisa is for home-use. If I get a job in a different state, the car may not be able to survive a weekly or two weekly drive to and fro different states.

My siblings need the car off and on.
Buying a car needs thousands of RM for the downpayment.
All the RM0 downpayment scheme is a con. Do the maths, you will end up paying a lot more in total.

Bila la nk dpt keje ni.
My medical school final exam was in January, that means I have not studied properly for the past 9 months.

That's scary.
I graduated and came back to Malaysia mid July.
The next job intake is in December.
If I am chosen to be in the December intake, that means I was unemployed for roughly 5 months.

People say I should enjoy my unemployed time now.
Time like this will never come again.
True. It will not.
So I should really use the time wisely now.

I just hope some people will stop using the "Work first, then we can talk" attitude.
It is as if as long as I am not working yet, I am not a complete adult.
I am still a child if I am not working.
It makes me angry with this "months of unemployment" because some people still see me as a child because I do not have a payslip yet.

Blergh, these are just some thoughts constantly in my mind now.
Enough of ranting.
I need to get ready to go somewhere now :)

Bye!

-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

Strawberries; nice but fragile

Assalammualaikum!
I've been quite busy for the past few days, I didn't have time to pen down my thoughts.
But let me write something short and simple today.

So a few days ago I typed "Malaysian doctors blog" into Google search.
I want to read about a doctor's life, better if it is a houseman's life, so that I can have a rough idea how will it be like.
But I guess once one become a houseman, one won't be able to write much eh?

But I stumbled upon this blog: In My Father's Footsteps.
I didn't know who this guy was, but his writings were very funny, short and simple.
Then there were posts about him being the examiner of medical students' OSCE and the silly things the students say out of nerve.

So I kept reading, and found out that he is an IMU lecturer!
He works in Seremban, and teach IMU students.

There was this one post that really hit me hard.
It was titled Teaching Strawberries.

He first talked about strawberries being very nice to see, to smell and to look at.
But they are also very fragile, they deflate, change colour and turn bad if exposed to heat.

And some of the senior doctors actually call the new generation of doctors in this country as The Strawberry Generation.
The Strawberry Generation is the generation of young doctors who can't stand working in bad conditions, whine about lack of rest and unsympathetic superiors.

And he was unhappy with one of his bedside teaching session where none of the students clerked patients and prepare to present the case.
And he ended the post with:

"I want my students to be made of better stuff and avoid being labelled strawberries when they graduate and start work."

It was as if I was struck by lightning.
Am I going to be a strawberry when I start working?
Will I be seeing strawberries around me?

I hope I will not be one of the strawberry doctors, who break down and wilt at the slightest adversity.

p/s: But I don't see why young doctors should continue working in less than optimum condition. I hope our lives will be easier. But what doesn't kill us makes us stronger, ain't it?
I just hope I will be a safe and competent doctor, if not extraordinary.

-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

Applying for a Medical Job in Malaysia (for overseas graduates)

Assalammualaikum!

As an overseas medical graduate, it was very hard for me to actually understand the procedure to apply for a job in Malaysia.
For students from local medical schools, the school will usually do most of the things for them.
The interviewers even came to the school to interview them in batches.
For overseas graduates, I'm sorry to say, your life ain't gonna be that simple.
You need to everything on your own...

So, let me share with you the steps I took the apply for the job.
I hope this will be beneficial for future medical graduates, and from my experience, many years later, someone will email me asking how did I first apply for the job. By then, I would have forgotten all these!
I'd better type them down now.

STEP #1 - Apply for a place in SPA

SPA stands for Suruhanjaya Perkhidmatan Awam.
This is the first stage of applying to be a government servant.

The online application form can be found here.
The link might change a few years from now, but just go to SPA Portal and look out for "Pendaftaran Pekerjaan dalam Perkhidmatan Awam".

What they need in the online application:
1) Personal details (obviously!)

2) Academic Results (I had to key in my PMR results but for some reason they already have my SPM results automatically. I wonder if it was because I am a JPA sponsored student?)
I am not sure where to place my A-Levels results since there does not seem to be place for it.

3) Extra Curricular Activities (meh campak la segala jawatan dulu kt sini. Setiausaha kelab la, Bendahari rumah sukan etc etc)

After you submit the application, remember to save the pdf confirmation!
This is because MMC requires the pdf confirmation. If you do not save it now, you will have to resubmit the application and your application date will be the date you re-submit it.
Get what I meant? Means even though you completed and submitted the form on 1st June but you did not save the pdf confirmation, then if you realised you needed the pdf confirmation and pressed submit again on the 20th of June, your application date will now be 20th of June.

STEP #2 - Apply for Provisional Registration with the MMC

[Source: Blog Orang]

MMC stands for Malaysian Medical Council.
Just like we have to have the P driving license for two years and have the big red P sticker on our cars at all time for the two years, we also need to apply for a P medical practitioner license from the MMC.
During these two years, you MUST work in a training hospital certified by the KKM i.e. certain government hospitals as a House Officer (HO). Once the 2yrs is over, the private hospital can now hire you; a fully licensed medical practitioner.

To apply for this provisional license, go to the MMC website.
On top of the page, you will see a "Download (Forms)" tab, clicking that will bring you to a list of forms provided by the MMC, in English and Malay.
Choose the
"Provisional Registration" form. If you just click on my link above, you will get the form directly.

The form has a checklist ready for you, that will make your life a lot easier.
You will need to send:

1) A completed form (with the Appendix A)

2) A certified copy of your degree certificate or dean's letter.
I finished my hospital placement on May 16th but my graduation is on July 8th. That means I can only start applying after my graduation.
I was afraid that it will be too late because my friends in local medical schools started applying even earlier. Hence I requested for a dean's letter from the school administration; to say that I am a student there, have completed my course and will graduate on the 8th of July.

The problem I had with this one was that my name on the dean's letter and my name on my IC were different! You want to know what was the difference?
It was a real silly one.

My name in the dean's letter contained no "binti" but my IC has "binti".
For example, my dean's letter stated "Akmar Ali" but my IC stated "Akmar binti Ali".

So when MMC received my application, the person in charge emailed me stating they could not process my application.
I had to go to the Commisioner of Oath to say that "Akmar Ali" and "Akmar binti Ali" are the same person.

Lawak la, kt Malaysia pun ada masalah camni ke? I've never had this problem kt UK pun, even when my passport wrote binti but my flight ticket did not.
So make sure your name on the letter and in your IC are EXACTLY THE SAME. =.="

3) Results Transcript
4) And many other straight forward documents lah. Malas nk tulis kt sini haha.

You can either post the forms to MMC, or just go to their office in Jalan Cenderasari to submit the forms.
I will strongly advise you to go personally.

After posting the application, you may need to keep calling MMC to ask if they have received your application.
And if you decided to post, please please use the PosLaju.

I posted my applications, but decided to go and submit my oath statement personally.
After waiting about an hour there, the girl gave me my temporary letter.
The MMC registration system was not working for the past 2 months hence they could not provide us the provisional registration certificate.
They can only give us a temporary letter, but that will be sufficient for SPA interview.

STEP #3 - Call the SPA

Now, you have already registered with the MMC.
Next step is to tell SPA that you are already registered.
I did not know this step.

It was quite a long time after my registration that I found out I have to call SPA to let them know =.="
I called and called their hotline to ask what to do next but no one answered the phone.
Eventually Kiew filled in the e-Pertanyaan form on SPA portal, and she received a reply within an hour.
They gave her the direct number for the Unit Perubatan; it is 03 - lapan lapan lapan 563 satu 3 =p

You will be asked for your IC number and only then will they put you in the interview waiting list.

I called them on Aug 6th, and was told that I will be called for interview somewhere in Sept or October.
But a few days ago they called me asking me to come to the SPA interview on Sept 3rd! That's next week~
Weee~

STEP #4 - The SPA Interview

OK, at the time of writing, I have not reached this stage yet.
My interview will be next week, exactly 7 days from now.

I've asked around and found out that dengue is a must know, we need to know some things about Ebola (or any other current issues) too.
Know the government policies e.g. What does "Rakyat Didahulukan, Pencapaian Diutamakan" or "1Malaysia" mean.
You can read about them in 1Malaysia portal.
I've not read them yet so I can't explain them to you yet.

For those you don't know, Malaysia's clinical guidelines are called CPG (Clinical Practice Guideline).
The dengue CPG is very comprehensive and if you can remember the facts from there, you should be fine.
I ought to read them again, I forgot about them already. I used to read them whenever I felt bored in Hospital Serdang during my electives 5 months ago.

STEP #5 - Register with KKM
KKM (Kementerian Kesihatan Malaysia) / MOH (Ministry of Health)

Go to the KKM Portal, and look for "Muat Turun Borang".

Find the "Borang Maklumat Diri (BMD)" under the heading "Pengamal Perubatan".
Download the BMD for Pegawai Perubatan Tetap.

I hyperlinked this blog post to all the mentioned forms but in case the link changes in the future, I've also written the step-by-step guide.

In this BMD form, you will need to fill in three placement choices. Only THREE hospitals, in any state.
There is a list of training hospitals provided at the end of the form.
We can only work in these training hospitals.

I plan to submit my forms straight to the KKM office in Putrajaya after my interview next week.
I think we can post it, but I'd rather hand it in personally.

STEP #6 - Just wait, I suppose?

As far as I am concerned, registering with KKM is our last step to apply for the job.
KKM will then send us a "Surat Panggilan" to a specific hospital.

I've asked the SPA staff how long will it be roughly from interview to the start of the placement, he said it'll be around two months.
So yes, I may have two more months to tanam anggur kt belakang rumah, haha.

With that, all the best!

p/s: I am going to create a new tag for this post, called "Profession". Hihi..
After this, whatever I write about my job will be under this tag, not "Medical Student" anymore.

-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

No More a Medical Student

Assalammualaikum!
Dah! It's already 06 June 2014!

Today is the day I "get discharged from" School of Medicine, Faculty of Medical and Human Sciences, University of Manchester.
This morning the final result arrived by email. It says: MBChB.
Woohooo~

So yes, starting tomorrow I am no more a medical student.
I am officially an unemployed medical graduate :)

My convocation will be on July 8th, that's one month from now! *gasp gasp x sabar*
My outfit for the day is ready, so has my hijab.
I still have no suitable shoes to wear, so I am going shopping with Kiew in Manchester next week. Hopefully, TK Maxx has something nice and cheap :D

Haritu struggle gler when I wanted to measure my head circumference to order the graduation hat.
When I measured with Kiew, we have decided that I will take 155cm. Well, I need to wear my hijab and I don't want to squash my hijab awning kn. Nti forehead nmpk besar gler. So I measured only my crown bit, not exactly the frontal-occipital circumference. This pict is almost like a wedding pict, once-in-a-lifetime kind of thing. I can't afford to look awful!

But then, when Akmal came to measure his (because in Preston, I am the only one with a measuring tape lol), I suddenly remembered that most likely I will wear the lilt2 kind of shawl hence my head WILL be bigger. Will 155cm be enough? And when I googled images of girls wearing the graduation hat with hijab, most of them HAVE their awning squashed. That means, they really wear it like a proper hat, not just a crown.

So, I had to re-measure my head with an extra hijab some more. So most likely I will take 159cm now.
I'd rather a loose hat that I can pin it to my hijab than a tight one that will squeeze and cramp my head for hours and I'll end up with tension headache at the end of the day.

Lol, I can't believe I am no more a student now.
Dh xde identiti dh lepas ni. If ppl ask, obviously I can't say I am a doctor. But I am not a student anymore either.
Fortunately, though, my student card says 30-JUN-2014 as the expiry date. Hence I can still use it for student privilege until 30th June 2014. That's good. Because I will be going to Ireland and France with Aisyah when she comes. And I NEED that student discount.

Ok, that's all for now.
Goodnight!


-Because life is a test-

Yeayyy! Nak buat mcm ni lah nti on my graduation day. I hope other people will join me! 

06.06.14
11.41pm

-AkMaR-
http://nur-akmar.blogspot.com

Still A Student

Assalammualaikum!

I'm really enjoying my life now, because I have finished all my clinical placements and am now in the honeymoon period - except for the fact that I have thousands of things to pack into boxes and ship back to Malaysia, it has started giving me headaches plus the fact that money is always a problem and I can't go travelling as much as I want because it cost a lot.

My sister is coming over mid June and we will go travel together, my mum and aunts joining us early July for my convocation and we will be sightseeing again! So I have been spending the past month worrying about planning the trip and the past two days actually planning and budgeting it.

I am officially still a student until June 6th, when I am no longer a student of University of Manchester.
So I have about one week left. After that, I am an officially unemployed female - looking for a job in Malaysia. Hmmm... being a doctor is quite nice so I hope I can get a post.
If I don't, I will consider being a temporary school teacher AND a private tutor. Life goes on you know?

Today I plan to stay at home and rewrite my notes. Yes you read it right - "REWRITE.MY.NOTES"
Every placement/semester I will have this mini notebook that fits into my scrub pocket for me to bring around the wards and clinics etc. I will jot down random facts that any consultant/doctors/nurses/patients blurted out.
But not all the pages are filled with facts. Some of them were artworks - those flowers and houses and rivers I drew during boring clinic hours or lectures or PBL discussions.
Some of them contained conversations with me and my clinical partner e.g. "Dr ni byk ckp la, I boring" or "Lps ni u nk buat spa?" or "Mat salleh ni sume ckp je lbih" or "I ngntukkkkk".
Some of the pages were just blank pages as I tried to make the notebook "more professional", containing many sections e.g. Pharmaco and Patho and Physio but it always ended up in vain because doctors just do not blurt out facts according to sections of the textbooks and I do not have time to flip my notebook to that section in time.

So...all these mini notebooks that I have collected over the past three years may contain duplicate facts, many empty pages but also memorable conversation pages. I cannot bring all of them back home, they take space and weight.
So I plan to rewrite them all into a proper notebook AND this time, really organise them into the sections I mentioned.

Wish me all the best!
May the force be with me today! :D

I am now downloading You Are All Surrounded Korean drama - it's 91% now.
I might have to take an hour break to watch it haha..

'til then.

-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

Half Day On Call

Assalammualaikum.

Two days ago was my Simulation Session; Bleep Day.
All fifth years who are on the hospital block will get a bleep day, and on this day as the name suggests, we will go and collect our bleeps from the simulation suite.
We will be the "on call F1", and we are on call for everything; surgery, medicine, obs gynae or even orthopaedics.

I'll tell you a little bit about our Simulation Suite. Our hospital boasts our well equipped, high-tech Simulation Suite. We have at least two very expensive mannequins and these mannequins talk! They have a speaker attached to them and someone behind the scene will speak. The mannequins can breath (the chest can expand), they can shake like rigors, they may vomit (said the man, I've never seen it yet), they can bleed (I've not seen this too), and they can die. We can attach cardiac monitors, ECG, blood pressure cuff and oxygen saturation device to this mannequins and the readings will appear on the screen. All these numbers will be controlled by someone from the control room. See the excitement?

Well, the concept of this day is, while carrying our bleeps we should follow our normal routine in the hospital ie we stay in our own wards and whenever we are bleeped, we should answer it.
Various cases will be presented to us, we may get a phone call from a "nurse" asking advice about a patient etc.

I am free on Tuesday mornings, I am not sure what my consultant does on Tuesday mornings, but he has clinic in the afternoon.
Anyway, I collected my bleep at 9am and was nervous since then.
I do not know what to expect, what kind of patient will they "give" me and what kind of scenario will they put me in.

My first bleep was just them making sure I know how to answer a bleep. Lol.. My heart almost jumped out when I got it.
I was sitting quietly trying to digest the "Emergencies" section in my loyal Oxford Handbook.

My second bleep was a phone call from a "Staff Nurse" saying that the registrar (a senior doctor, at least 4 yrs ahead of me) said that one of the patients can be discharged if the blood tests came back fine. So I was asked to review the blood test results. Well, everything was quite normal. The FBC was fine, so were the electrolytes. And I said carry on, discharge the patient.
Then only I realised I didn't even ask who was the patient. The most I know was he was a chap who came in drunk last night and is now stable. I immediately recognised my mistake and was really contemplating whether I should call the "nurse" back and asked further details. Heck, I didn't even ask what was the liver function, alcoholic patients might have very deranged liver enzyme.

But I didn't.

My third bleep was a post-op patient having low BP, 90 systolic. Our normal range is about 120-140 systolic, so you can imagine how low it was.
I asked the nurse to administer 1000ml fluid to be given within an hour first, while I get to the simulation suite. As I walked from Education Centre 1, where the library is to Education Centre 2, where the SIM suite is, I flipped through the pages of hypotension in OHCM. I didn't realise I should have given 250ml stat (ie in 15 minutes) rather than straight away 1000ml in one hour, although both of them are the same. I knew I have to, it just didn't occur to me that I knew it. I panicked.
When I get there, the patient was still responding to me. She was desaturating, her BP was low and she was tachycardic. I asked the nurse to give high flow oxygen, and wait to see if the IV fluids brought her BP up. I examined the abdomen as she just had her abdomen open 12 hours prior.

After a while her BP came up again and I asked to continue the fluids and monitor her urine output (ie measure every drop of urine she passed). Sometimes if people develop kidney failure, they don't wee. If after 1000ml of fluid she still doesn't wee, I will be concerned.

Then I left.

My third bleep was a patient who was pyrexic (spiked temperature) 30mins after blood transfusion being commenced. Everything else was normal, said the nurse.
So I ordered the blood transfusion to be stopped and call the transfusion nurse for advice. Truthfully, I don't know what to do. I know I have to stop the transfusion but spiking temperature after transfusion is quite normal, I am not sure if we can recommence the blood transfusion in 30 mins or so? That's why I asked the nurse to call the transfusion nurse. Oh God.

10 minutes later the "nurse" called me back. He said he can't get hold of the transfusion nurse and now the patient has started to be agitated and started to drop her BP.
I had to rush to the SIM suite again. This time, I read the blood transfusion reaction page on OHCM.

While walking from EC1 to EC2, I really hope I bump into a familiar doctor so that I can get a friendly advice on how to tackle this problem. But none passed by. Haih.
When I got there, I had the same page of OHCM opened in my hand, but was unable to understand anything. My mind just went blank.
I've been thinking what is it that this patient is having? Contaminated blood? ABO incompatibiltiy? Simple febrile reaction? Anaphylaxis?
When I got there, the patient talked to me but in a while she quickly deteriorated, she started to wheeze, shakes (yes, the mannequin shook!) and I was like "Oh God...is this anaphylaxis?"
So I ordered epinephrine 500mcg IM, hydrocortisone and chlorphenamine (Piriton) IV and another lot of epinephrine after 5 minutes, seeing the BP has not gone up yet.
I don't know why, I have ABCDE in my mind but I can't remember where to start. The only thing in my mind was the mental image of putting my ears near the patient's mouth and at the same time look at the chest to see any expansion. But the patient has oxygen mask on, how do I assess the breathing? Can I just use the monitor? Her saturation was dropping and respi rate was high. But is that all? How do I assess Circulation God, I forgot! So I just stood there, and then say "Lets call the anaesthetist!". Haih... Anyway I think I could have done much better but being nervous really hit me hard that day. Mike (the SIM coordinator) still say I did a very good job during managing that patient. Nope, I dont think so. But I was too hungry to keep the discussion any longer.

I hope they have more of this SIM sessions. I really do.

-Because life is a test-

-AkMaR- http://nur-akmar.blogspot.com

95% a Doctor

Assalammualaikum.

I have finished my electives, and I am back in the cold land, UK.
I have even finished my Student Assistantship placement, wow.

I have only one month left, to be called a medical student.
InsyaAllah, in June I will be an official jobless post-medical student but not yet a doctor.

I can't believe my medical school years are almost over and I am going to be a doctor soon, bearing the huge responsibility of dealing with life and death.

I did not finish my Istanbul experience, my psychiatric institution as well as my electives experience.
I have so much to tell about my Student Assistantship experience where, for the first time I voluntarily stayed in the hospital till 10pm, because one of the patient that I have been seeing for the past 3 weeks had to be wheeled off to the theatre for an emergency operation. That night, I held in my hands, human fat tissue, intestines, abdominal wall and even some shit (literally!).

I really need to put pieces of my life back together.
I have been a useless person since the end of my exempting exam.
I went thru my days as a bare minimum person, not wanting to do any more neither can I do any less.
Anyway, that's the emo side of things.

The bright side of thing is, I will be home in Malaysia for good, by Eid this year!
I will surely miss this place. UK is where for the first time I tasted privacy and personal space.
Maybe I'll talk more about that in next posts.

For now, let me dwell with useless stuff.

'til then!


-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

Hospital Bahagia Ulu Kinta

Assalammualaikum wrt wbt.

This is my third day in Hospital Bahagia Ulu Kinta (HBUK), Perak.
For those who didn’t know, HBUK is the first and the biggest mental health institution in Malaysia. It reached its 100th birthday in 2012. When it was first built, it was called Federal Lunatic Asylum. Interesting isn’t it?

Syahidah and I will be spending a few weeks here, for the first block of our elective placement. We rented a room in the hostel for only RM6.50 per night, but no beddings, blanket nor electrical appliances i.e. kettle and iron provided.

The Hostel

There are two blocks of girl’s hostel. I think there are 4 floors altogether, including the ground floor. But only the ground floor is occupied. I think there are 10 rooms on this floor but only 4 are occupied (including mine). There are 3 beds in each room; and I share a room with Syahidah. That means, there are maximum only 11 people in this huge building!

On Sunday, there was no one in the building. It was very scary. By 8pm, one by one of the occupants arrived. Perhaps they went for CNY break. They are freshie nurses. And that night, I couldn’t sleep! There were so many mosquitoes!! (I wish I can put that whatsapp emoticon here, u know the one where the yellow head has its yellow hand on its cheek like “aaarrrggghhh” with bluish forehead and big white eyes)

The next day, while talking to one of the staff in the hospital, they were surprised that we are staying in the hostel. They told us to “be careful”, the building has been empty for a very long time. And when I went back to the hostel, I asked one of the nurses and she said they have been here only for the past 2 weeks. Well, enough reason for us to be scared. That night, we recited Yaasin. I imagined a cold hand running its fingers down my sole while I was trying to sleep. Thank God it was just my imagination, but just thinking of it froze me up.

Until now, we have not been “disturbed”. Alhamdulillah.
And re the mosquitoes; we bought the Ridsect Lingkaran Penghalau Nyamuk, and even mosquitoes didn’t come near us. Alhamdulillah too.

My Electives

On my first day here, I didn’t get to see any patient but rather was given an overview of the psychiatric service in Malaysia. I am actually amazed at how well developed our psychiatric service is. We have home visits, by thoughtful Medical Assistants, we have walk-in specialist clinics, and all GHs and some District Hospitals will have a Psychiatric Unit. <br /> <br /> We do not have much deliberate self-harm (DSH) cases here in Malaysia (or at least in HBUK), unlike in the UK, thankfully.

Over the next 3 days, I see more patients but I can’t really disclose much about them; due to the confidentiality principle. But enough said that the patients I’ve seen in these 4 days (I took one day to write this!) are very variable. I didn’t see much female patients. The males are either laughing inappropriately (at the same time lifting up my mood), or scolding doctors inappropriately, or trying to go near a female nurse (disinhibited maybe?) or keep changing stories, making his mental illness suspicious.

My Food


Haizzz…
This hostel has no cooking facilities AT ALL.
No fridge, oven, microwave, kitchen hobs. Nothing!
So I can only boil some water in the morning and make my 3-in-1 Old Town White Coffee with some buns that I bought previously. We then had to go for proper breakfast in the main canteen. Lunch in that canteen as well.

We will then drive out to look for dinner.
For the first two days; we don’t really feel the burden. But now, after 4 days having to spend for all the 3 meals, I started to pity my wallet. I spent a lot for food!! It was the same when I was in INTEC, wasn’t it? But somehow it felt worse now. I felt poorer than when I was in INTEC 5 years ago. OMG, 5 years already??!

Yesterday we went to Ipoh Parade for dinner and window-shopping. But the surau was closed! OMG, I was so frustrated and disappointed with the management. They should have opened a temporary surau while renovating the current one. We arrived at 7pm, thinking we can pray Maghrib there. After knowing the nearest mosque is next to the Ipoh GH, far enough that it can only be reached by car (Msian definition of far), we had quick dinner and rushed like crazy monkeys to the mosque. I drove so fast and we managed to pray just before the azan for Isya. I can feel such serenity when praying in the mosque. I’ve not prayed in a Malaysian mosque for over a year! I really missed it.

Anyway, I need to sleep now.
I know I still owe this blog the Part 2 of my Turkey trip.
It’ll come, I promise!
But I really need to sleep now. Goodnight!

-Because Life is a Test-

Year 5 Exempting Exam; Univ of Manchester

Assalammualaikum.
My exempting exam is Day 2, in South.

I tried to remember as much of the wordings of the questions as I could.
I know it is easier to practice when we know the question structure.
To maintain confidentiality, where possible I will not disclose the patient's gender as well.

Station 1

Please examine this patient's cardiovascular system.
You may need to tailor your examination according to your findings.
Please tell the examiner what you are looking for and what are your findings.

The patient's blood pressure is normal.
An ECG taken last week is provided for you to refer to.


Ok, this was apparently an AF station.
When I felt the pulse, at first I thought it was irregular.
But when I tried to tap the rhythm with my head, it became regular. Haih~
So the chest was clear, I could not find any other signs.

When I was given the ECG, it was clearly AF.
But the examiner challenged me saying I did not pick up the AF while examining the patient.
But he wasn't mean. He asked why wasn't I able to get the irregularity of the rhythm.
So I mentioned the patient might be having paroxysmal AF and when the bell goes off, I managed to say "because he has been rhythm controlled!!" literally while walking out of the station.


Station 2

This patient had a cerebrovascular accident (CVA) affecting one or both arms.
Please examine the patient's arms.
Please tell the examiner what you are looking for and what are your findings.

At the end of the station, the examiner will ask the nerve and muscle groups that are affected.

OK.
So this is quite a straightforward upper limb neurological examination.
I performed only the motor bit, I did not do sensory or coordination.
It was UMN signs on the left arm.

For the muscle groups and nerve, I managed to say deltoid, biceps, triceps, anterior compartment of the forearm, posterior compartment of the forearm, and lumbricals for shoulder abduction, elbow flexion and extension, wrist flexion and extension and fingers abduction and adduction respectively.

The examiner did not prompt me of the nerve supplies. I am not sure if that means she is satisfied with my examination/answers but to be fair, I only had like 30secs left.

My friend said he would have done the coordination and some sensation as well.

But I did offer saying I would to do sensory of the upper limb and full neuro of lower limb to see if the CVA has affected the legs as well.

Station 3

You are the Foundation Year doctor in the general practice.
This is Natasha XXXX, a 28 year-old woman who has recently given birth and is now breast-feeding.
She is here for oral contraceptive pill.

Please discuss the options available for her.

It was an SP.
Since the question specifically mentioned ORAL PILL, it became a lot easier.
Pt is breast-feeding so we cant give the oestrogen bit, and I don't have to explain all the implants and coils. Only PILL.

Pt asked about:
1) Side effects - irregular bleeding.
2) Immediate protection - yes if taken on day 1 menses.
3) What happens if she vomits aft the pill - if within 5 hours, u may need to take another dose. Check the leaflet in the box.
4) Does it protect against STI? - No. (I cant understand why she ask this. She's married! Ok, being judgmental here. Anyway...)
5) Why can't she go back to her microgynon (a COCP) - bcos oestrogen affect breast milk production.


Station 4

This is XXXXX. She was admitted 4 days ago for severe iron deficiency anaemia.
She was given blood transfusion and an upper GI endoscopy was normal.

She is going to be discharged today.
A colonoscopy has been arranged for her as an out-patient next week and she has been given sachets for bowel prep.

Please discuss with her about the discharge issues and the colonoscopy.

Woohooo...
New type of Q from the university!
Discharge planning has never came out before.
When I knew it came out in Day 1, I was so surprised and luckily I read about it.
Or else I would not know what to say.

Well basically just ask how she is feeling, is she ready to go home..
Who is at home with her - husband.
It was all okay until I asked, "Is your husband well?"
Then only the drama begins...
"Oh..my husband has severe Parkinsons......."

She asked about:
1) I am the patient, but I don't need carer. My husband will need carer. Can the ward arrange carer for my husband? - I dont know the exact ans for this.
2) What will the social services do? - plan care package, tailored to individual needs.
3) What does OT do? - come to ur house and see how they can help with the condition of the house to make it easier to live in.
4) What is the bowel prep? - STRONG LAXATIVES to empty your bowel.

I FORGOT TO ASK ABOUT MEDS! Haih~
DC planning will always include meds changed in hospital stay.


Station 5

This patient has pain in the right hip.
Please examine the patient's hip.
Please tell the examiner what you are looking for and what are your findings.

Again, a straight forward ortho exam.
My patient was a medical student I think.
He understood all my instructions. So nice~

Was asked by the examiner what is the diff with true and apparent leg length.


Station 6

This patient have difficulty passing urine.
Please take history to find out how it was diagnosed, include discussion about complications and any plans for definitive treatment.

This was a REAL patient, without scripts.
I don't think I can divulge the case here, since it's supposed to be confidential.

Enough said that I think UoM is trying to test us on how we communicate with actual patients.
All this while we are tested on our ability to EXAMINE real patients, but never actually TALK to them.
So I really felt like those days where I spend a very long time talking to patients in the ward, that most of the time they didn't understand what you asked and went completely off-tangent.
Sometimes you can't even understand what the patient said.
It was exactly that same feeling just now - the difference is there is someone watching you from behind and ticking the boxes.

My pt knew quite a lot of things - it was almost just a case of me sitting there listening to his story.

Station 7

This patient has pain in his/her legs while walking.
Please examine the arterial circulation of the patient's leg.
Please tell the examiner what you are looking for and what are your findings.

There is an Duplex provided. You need to use the probe.

At the end of the examination, the examiner will ask what your diagnosis is and next management plan.

Again, a straight forward PAD exam.
This was a real patient.
I cant feel pt's pulses - all the way till popliteal.
But apparently no one couldn't.
But the arterial flow via Duplex was very clear.

Examiner asked Dx: PAD
What to do now: Straight leg raising, as it is one of my differentials. ABPI. Fasting glucose and lipids.


Station 8

Please examine this patient's hands.
Please tell the examiner what you are looking for and what are your findings.

At the end of the examination, the examiner will ask your diagnosis and the conditions associated with this findings.

When I was outside the station, I was very happy thinking it is going to be a RA hand. I hummed pulmonary nodules, pulm fibrosis, vasculitis etc to myself.

But when I got in and started inspecting - turns out it wasn't RA.
At first I thought it was trigger finger but then I realised this is Dupuytren's!

So I did the hand exam just like I would for RA. But it was very hard because patient's hands were in severe fixed flexion deformity.

Qs: What is this? - Dupuytrens
Where can u find this? - idiopathic, cirrhosis bla bla bla
How would u say the severity of this contracture? - moderate
Rx? - reconstructive fasciotomy


Station 9

You are the FY in A&E.
This patient has blurred vision last week, but it has resolved since.

Please examine the patient's visual field and perform fundoscopy.
You are not required to examine the visual acuity and pupillary reflexes.

Please tell the examiner what you are looking for and what are your findings.
At the end of the examination, the examiner will ask for your findings, and diagnosis.

Again, straightforward eye exam.
Examiner very nice~~~

All normal, I can't visualise the optic disc.
Was asked:
1) Present ur findings
2) If the Hx is blurred vision for one week and has resolved since, what do you think is happening? - Optic neuritis.
3) Cause? - MS
4) Ok, if it is MS, what findings will u expect? - Central scotoma, pain on eye movement and I just simply said blurred optic disc. Truth is, I dont know! What is the findings on fundoscopy in optic neuritis? I forgot. You better check.


Station 10

You are the FY in A&E.
This patient has come in with acute chest pain.
Please take a focussed history and perform a focussed examination on the patient.

Please tell the examiner what you are looking for and what are your findings.
At the end of the examination, you are required to present your findings, diagnosis and management plan.


Acute chest pain.
Pt had this a few times for the past 2 weeks - all on exertion.
Usually it goes away with resting. Today the pain persist even after 2 hrs.

Obs given were all normal. I cant remember if they gave respi rate - sorry.

Examiner was mean.
Didn't even respond to me, I asked if I can get the observations and he pointed his CHIN to the wall. I didn't understand at first.
Then only I realised that the set of observation is pasted on the wall!!

Station 11

You are the FY in general practice.
This is Mrs XXXXXX.


Please take a history from her to find out the problem.
In the last 2 minutes the examiner will ask for your diagnosis and management plan.

I knowww....the question was so unhelpful..
I sat outside banging my head on the wall. Nothing to prepare.

Anyway, this pt kept saying she was very embarrassed to talk about this matter.
I thought she has dyspareunia or PCB or something.
Turns out she has heavy menses bleed.
Well to be honest, by this stage of med school, I am no more embarrassed about heavy menses bleed.

Remember ICE ICE!
Pt's concern was cancer - as usual...
I mentioned that cancer of the womb usually happens to older women, it is not the first thing that came to my mind for a woman of her age. But we will still do all the necessary investigations. She seemed very happy for that.

Examiner asked:
1) What pt has - menorrhagia
2) Possible causes - DUB, bleeding disorder.
3) Mx - bloods: FBC, U&E, TFT, Prolactin. What else did I say jz now? Forgot adi. USS to check endometrial thickness.


Oh...I'm getting more tired of typing now..

Station 12

You are the FY in general practice.
This is Mrs XXXXXX.

She has come today because she is feeling very anxious.
Please take a history from her.

In the last 2 minutes, the examiner will ask your diagnosis and the reasons.

Generalised Anxiety Disorder with secondary panic attacks.
Did some MSE but not risk assessment.
I wanted to explain the possible Mx but pt cut me off and jz said she wants leaflet. Weird..

Station 13

You are the FY in general practice.
This is Mrs XXXXXX.

She is a regular patient in the practice.
She usually sees Dr Rayburn.
Dr Rayburn is on leave today hence she has booked in to see you.

Please talk to her and discuss the reason of her attendance today.

Jz by reading, I know this is ethics adi...
Pt said she has STD, she doesnt want me to put this on her note bcos Dr Rayburn will know about it. Dr Rayburn is a close family friend and she doesnt want her husband to know.

I said I need to write about our consultation, it is a legal requirement.
And Dr Rayburn and I are duty-bound to keep the confidentiality. She wasn't convinced.

I asked how did she know she has STD - she said because she vaginal discharge.
I said she can go to GUM clinic to get treatment, everything there will be confidential. No letter will be sent to us. She said can I then not write anything about today, because she wants to go GUM. I said cannot, I have to write it down.
She said then no point she go GUM, I will write anyway.
I told her I don't know if she has STD. I have not tested her yet. So I cant write she has STD, I can only write that she suspects its STD.

Anyway at the end pt agreed to go GUM and did not make any trouble anymore. I managed to advise safe sex until complete treatment. She said it's gonna be very uncomfortable anyway with the discharge. Lululz~

Station 14

You are the FY doctor in the ward.
You are required to administer the first dose of IV medication for this patient that has been prescribed by a senior member of the team.

This medication is usually given as a slow infusion but for the purpose of this examination, you are to give it in a bolus injection.

You will all learn this in OSS block.. So lazy to write. Anyway, got Px chart but no BNF or product leaflet. Confirm with the examiner to mix the med with saline or water for injection and how much to mix it with.


Station 15

You are the FY in A&E.
This is a patient who came in because he vomited blood.
He is very upset.

Please take a focussed history and discuss the need of admission with this patient.
You do not need to examine him.

Weird Hx. At first I didn't know what was it at all. It didn't sound like ruptured varices (but pt is a heavy drinker) because pt shd not be able to talk to me if it is varices.
Didn't sound like Mallory-Weiss tear either. He vomited a pint of fresh red blood this morning! No stomach content. No assc pain, just some dizziness.

Vomitted once 7-10days ago, but small amount.

Halfway through I found out that he regularly takes Nurofen 2tabs 3x a day, every day.

So at last I can say we suspect you are bleeding from your gut. We may need to keep you in. And he was unhappy because his vry busy at work. But it didn't take him long to agree - because I said we need to pass scope in to see what actually is happening.


Station 16 AAAhhhh.. last one~

You will be given a case history of a patient together with blood results, ECG and CXR.
You have minutes to look at the information provided.

You should then tell the examiner what was going on and your next management plan.

Bloods: all normal apart from 8.5kPa pO2 on ABG.
ECG: AF
CXR: some say collapse, some say pneumothorax. Whatever...

I dont think I did well in this station.
Thank God it was my last one. I would have felt very stupid otherwise, while doing the other stations.

With that, I bid goodnight~

Hope this helps!


-Because life is a test-
-AkMaR-
http://nur-akmar.blogspot.com

9 hours post-OSCE

Assalammualaikum!

My exam is finally over.
I am now officially a free bird! Until next Thursday, Jan 23rd; the day my results will be released.
I am not sure if I will post about my results. I might, if I pass.
If I don't......

I woke up very early this morning, I set my alarm at 5.45am but I was awake well before that. I didn't even want to look at the clock too see the time, I tried to sleep until my alarm rang.
The undergraduate department has kindly provided a shuttle bus from Preston Hospital to the hospitals in Manchester, where our exams will be in. We will not have our OSCEs in the same hospital that we studied in, this is to avoid bias from the examiners, seeing a student that may have been working with him for so long. Hence all students will be allocated randomly within the 4 UoM teaching hospitals.
My exam was in University Hospital South Manchester (UHSM) or better known as Wythenshawe Hospital or even better know among student as South.

The day started off hectic.
I was walking out with Ibrizah towards the Education Centre where the shuttle was waiting for us and half way there, I realised I did not bring my phone! I can't imagine going without my phone, I am sure I want to scream to someone when the exam is over so I ran back home to take my phone.
Imagine running within a hospital compound, without anyone around, at 6.50 in the morning with full smart formal wear, and smartie shoes. The ktak ktak ktak ktak ktak sound of my shoes was so embarassing.

Anyway, due to the heavy traffic, we reached South at 8.30am!
1.5 hours in the shuttle, I slept in countless postures and positions.
I think everyone was sleeping and it was also very dark so I dont think anyone actually saw me sleeping.

I will write the stations in the next post. I think it is very beneficial to actually have a set of questions from seniors to refer to.
So I hope this will be beneficial for the next generation, cewah.

Today also is the day my brother, Amran will be flying to Jordan.
He enrolled in the Ana Arabiy program, which is a reality TV show covering Malaysian students in Jordan trying to learn Arabic and the Quran.
Apparently it is going to be aired in April 2014.
Whoa.. But I feel good for him. He has always wanted to learn Arabic.

His flight was at 2200 Malaysian time so when I called him, it was only 10 minutes before the boarding gate opens.
So I quickly all the XOXO I can give on phone.
When I said I am so afraid of the results, he laughed it off.
I can't believe he laughed it off. He said it has never occurred to him that I can fail any examination.
He believes strongly that I can pass.
I was so touched with the trust. I didn't know that was the impression I gave him.
What if I really fail? There is always the possibility.
He must be very surprised, and perhaps disappointed too.

Anyway, right when I reached home, I cooked lunch and went to Kiew's room to debrief her.
I told everything about the stations today and how did I tackle the Qs.
And after that I went straight and practice with Akmal. Both Kiew and Akmal are going to have their exams tomorrow.
Akmal's in the morning while Kiew's in the afternoon. But they will not meet each other because Akmal will be quarantined after he finished his exam while waiting for Kiew to be quarantined. And after Kiew is quarantined, Akmal will be released. If that makes sense?

Anyhow, today I felt like eating big but I didn't defrost any chicken so I went Amonbagh and buy some dinner.
Lamb Rogan Josh, which cost me £5.45.
It's not that good. I won't buy it again.
I forgot what did I order before, that was very tasty.

I watched Running Man happily, without any guilt.
And I laughed and laughed and laughed with Ibrizah and Syahidah; my 2 housemates who have finished exam.
Poor Kiew, she is the only who have not finished her exam in this house. The 3 of us are free, she must be so stressed now. As stressed as I was yesterday.

Now, I am writing this. In a gooooood moooood~
Plans for today and tomorrow:

1) Write some love letters (haha)
2) Pack for my trip with housemates (I'm keeping the destination secret for now)
3) Pack for Malaysia (8 days till home!!)
4) Start reading again. I have left non-medical books for such a looong time. I keep buying books (bcos they are cheap) and just putting it on my shelves make me feel good. Now I have to start touching them again.
5) Running Man. I have about 5 episodes left.
6) Perhaps I will finish off Gye Baek; the Korean drama that I left halfway.
7) Online shopping. I wanna buy stuff and get them sent to my house in Malaysia so that I can wear them in time for CNY!

Wah, it seems there are a lot of things that I have to do!

With that, byeeee~


-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

1 Day Before OSCE

Assalammualaikum.

At last, that day has come.
For my medical school final exam, I have to sit for 2 written papers and 1 clinical (OSCE) examination.
I have done the two written papers and my last ever exam is tomorrow.
I hope this is my last ever exam in medical school; I don't want to sit for the May exam. I can only be exempted for the May exam if I pass this one.

Today, I was calm until a friend of mine posted the list of stations that came out today (There are altogether 3 days of OSCE, and mine is on Day 2. They do change the questions!)
I was calmly practicing the stations with Akmal, trying to drill the examinations into me so that it became ingrained in me. Reading, again and again, the management of chest pain, breathlessness, how to examine a patient with neurofibromatosis, hip pain, knee pain, etc.
It was all calm, albeit nervous.

But when I find out the questions of Day 1, I panicked.
The horrible thought of "TOMORROW IS EXAMM!! TOMORROW IS EXAMMM!!" came rushing into my mind, ruthlessly sweeping my composure away.
And I thought, "Have I studied enough?" "Am I prepared enough?" "Can I pass this exam?" "What happens if I don't?"

From then on, I flipped through my OSCE for Finals book like a mad Asian girl, googling every single thing that I forgot or unsure of; non-invasive ventilation, osteoporosis scores, driving and heart attack, and even the sizes of cannula!

Now, I'm tired.
So I start writing.
Next, I have to continue reading.
May Allah ease~

14.01.2014
6.19pm
Preston

-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

Down with Flu

Assalammualaikum wrt wbt.

18 more days. 18 more days for my final exam, the exam that is gonna test the knowledge I accumulated (and kept in an unknown area of my brain) throughout these 5 (5.5actually!) years of medical school.
I hate this kind of exam. Why can't they give us exam after each posting? Like a lot other med schools, the exams will be held after the posting hence we need to gobble up all the topics in that block only.
In this exam of mine, I need to revise every little thing from acute asthmatic attack to myocardial infarction (heart attacks), to premature birth, to soiling in children, to menopause, to intrapartum care (care of the pregnant lady in labour), to taking cervical smears and swabs to administering oxygen, performing ECG and prescribing medications!
Such a wholeee lot of things to revise! Thank God they won't be many questions of the basic biochemistry; Kreb's Cycle and all. I cant even remember them properly now.

And I've been down with flu since like, 3-4 days ago.
It started with simple sore throat which progressed to blocked nose, some sort of sinusitis and headache and stomach "dizziness" today.
Most of the people in my house are walking around with rhinorrhoea (read: running nose, and we have to catch them). One of them asked me, "Could it be because we did not take the flu jab this year? Did you take yours? I didn't"
And I can't help but to doubt that could be the contributing factor.
As someone who works in a hospital, my friends and I are always offered free flu jab as part of the occupational health "requirement". I've never taken one, for the past 3 years. I can't remember if I was down with flu as well last year. But another of my housemate, the only one who took the flu jab this year, is not walking around with nasal voice and blocked nose. She's studying happily comfortably. And I had to drink litressss of water to "flush everything out" of my system and of course, run to the toilet several times during the day.

I've been reading a lot of headlines on vaccines these days, with one of my teachers being one of the most influential anti-vaccine person in my life. Hence, I always doubt vaccine that's why I did not take them for the past 3 years. And to be honest, I haven't read in detail about how vaccines are dangerous to us, but I can understand the fact that they may not be that beneficial to us, the pharmaceutical company may be just making money out of us.
I did read however about the autism and MMR vaccine, and that the link was apparently made by a doctor who published a fraudulent paper in The Lancet. I had to read that article because I need to convince mothers that vaccines are very good for their children. It came out in my mock OSCE that day! I can imagine how much my teacher is gonna hate this kind of station; brainwashing future doctors to brainwash future parents and damaging future children.

Since I have not read any further about any other vaccine (because...I have so much other things to readddddd~ *facepalm*), I cant really say much. If vaccine is not that beneficial, why bother injecting something that is potentially dangerous in the kids' bodies? But why have they been telling us that the incidence of certain diseases have remarkably reduced after the introduction of vaccines? Haemophilus influenza B, the causative agent of acute epiglottitis being the most "sold" to us. Acute epiglottitis is a very dangerous condition where the child can lose his/her airway at any time but thanks to the Hib vaccine, we don't have them that much anymore now. Paediatricians sell that stories to us. "I've been working for 10-15yrs, I've only seen 1-2 cases of it"

Anyway, I gotta get back to my notes (and water) now.
Enough of rantings.
Bye!

-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

Two Weeks in Renal Medicine

Assalammualaikum.

Let me start with a bit of introduction on how year 5 in U.o.Manchester is structured.
First of all, we have 8 blocks altogether - each block is 4 weeks.
Blocks 1-4 is before the exempting exam while blocks 5-8 is obviously, after the exempting exam but before the final exam.

What's with these two exams?
Well, an exempting exam is in January and the final is in June.
If you pass the exempting exam in January, then as the name implies, you are exempted from sitting for the finals in June.
That means, if you pass the January exam, you are pretty much in your honeymoon months from Febuary onwards. If you don't, you bury yourself in books and stethoscope, sometimes with a tendon hammer or fundoscope and try to put everything into your brain, revengefully while the bulk of your friends enjoy their blocks 5-8.
Clear on the exam bit?

Now let's get to the blocks per se.
Blocks 1 - 4 are the blocks in which you will do ONE community block; that means you are gonna travel to a GP surgery (basically klinik kesihatan in Malaysia) and see patients on your own and try to make these poorly people well. The other two blocks are in the hospital and one more block is an OSS (and I can't remember what it stands for). Anyway, OSS block is the block where you revisit all the skills you've learnt for the past 5 years (wow) such as poking needles into patients, sticking a catheter up their urethras (that's where people pee from), perform blood cultures etc etc. On top of that, the OSS block is also your Oncology block (that is what the "O" in the OSS mean).
So juniors (if any of you ever read this), you'll know roughly what to expect.

After block 4, is the winter break (read: crazy last two weeks b4 finals). And then the Jan exam.

Blocks 5-8 are hopefully, my honeymoon months. I really hope I can pass this exempting exam (which will be in 58days time!)
So out of these 4 blocks, 2 will be elective blocks ie you can go anywhere in the world to help doctors save ppl or, you can do what I will be doing, go back to Malaysia and enjoy life as a medical student in a Malaysian hospital before coming back to work as a junior doctor.

One more block is a Student Assistantship, which basically mean you are gonna shadow a FY1 (the most junior doctor in the hospital) and help him/her with everything so that you can do his/her job when you start working. It doesn't really apply to me since I am not going to work here in the UK but I think it'll be a good exposure to know the system in and out. The other block could be another hospital or a community block, just like in blocks 1-4.

So for my fifth year, my blocks allocation are:
Block 1: Endocrinology (Hospital block) in Royal Blackburn Hospital
Block 2: Community (in Accrington. The bus fare cost me £51 per month and two hrs of journey everyday)
Block 3: Renal Medicine (which is the block I am in now)
Block 4: OSS

EXEMPTING EXAM!!!!

Block 5&6: Electives in Malaysia woohoooo!!
Block 7: Student Assistantship
Block 8: Hospital (cant remember what exactly)

Blocks 1-4 can be switched around, you may start with OSS and end with Community etc.
Same goes with blocks 5-8. That means you will nvr do electives before the exempting exam in January.

As I've said earlier, I am in block 3 (already third week now!) and I am doing Renal Medicine.
Guess what, my first day in this block was in a Renal Clinic.
And within that one morning, I know for sure I do not want to do Renal Medicine for the rest of my life. It is definitely one specialty I am going to avoid specialising into. Last year, we were asked to rank the blocks we'd like to do for fifth year and I think I put Renal Medicine as my second choice. That was because my mother has diabetes and I know it inavariably affects the kidney so it WAS always the specialty I consider. But after that first clinic, the interest and consideration went down the line. There is nothing wrong with my supervisor, NO.
It is just the fact that a Renal Medicine specialist could not do much for the patients. Kidney is just so important that when it goes, we cant really do much anymore. But because our kidneys are very good, we can lose about 60% of the function before they pack up.

You see, chronic renal failure (that is the failure of the kidney that happens over a long period of time, most commonly caused by diabetes and hypertension) is divided into 5 stages according to the severity.

Stages 1 to 3 can be managed in the community, means any doctor can deal with it with the patient coming over yearly or 6-monthly for health review. But at the same time, optimise diabetic or blood pressure control to slow down the damage to the kidney. Most of the patients will not progress further.

When it reaches stage 4, the guideline in UK recommends referral to a Renal specialist. I don't know at what stage do the doctors in Malaysia refer a patient with chronic renal failure (CRF) to the specialist.
And what will the specialist do? Not much, apart from keeping the diabetes and the blood pressure in tighter check. Well, most commonly CRF is caused by these two culprits. If it caused by any other diseases, then it will be a diff story.
Since the patient is now in the specialist's renal patient list, any deterioration of the patient's condition can be acted upon faster. Ultimately, when the kidney fails, we will be looking at either dialysis or renal transplant.


Hence in the clinic, patients will come in with a creatinine level of 280 (the normal level is less than 100), and the doctor will not be surprised, because the patient has been having a creatinine level of 260 and 270 all these years (remember the renal failure is already stage 4 when the patient is referred). Hence, the doctor is going to do the usual examination of the abdomen and BP la and everything and really2 monitor the medications the patient is taking (since so many meds can effect the kidney) and stop/slow the kidney damage. Hence a specialist might see the same patient for many many many years monitoring his/her renal function all the way, without actually treating it because we can't cure diabetes or hypertension.

That idea of seeing the same patient for 10 years but not being able to actively do something for him/her apart from keeping an eye on his/her renal function two or three times a year does not appeal to me, at all.

As a dramatic and active person, I would love to see my patient get better and not just monitoring them waiting for the kidneys to pack up, on one bad day in the future.

They say Orthopaedic Surgeons are very proud of themselves because their patients come into the hospital having broken their bones in an car accident or something and under their care, the patients can then literally walk out of the hospital. So I think literally, the patients of an Orthopaedic Surgeon will have the greatest improvement in their physical appearance, from a bent, bleeding almost crushed leg to an almost perfect leg (in a lot of the cases).
But no, I am not going into Surgery :)

'til then,

-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

Helping in Year 3 OSCE

Assalammualaikum!

A year ago, I had my end of year 3 OSCE and it was in my opinion, very terribly done. But I passed, Alhamdulillah.
I'm not sure if I wrote abt it here, let's check.

CHECKING......

CHECKING......

CHECKING......

CHECKING......

CHECKING......

Err, no.
I did not write about the exam itself. I wrote on how I felt before the exam.

Anyway, I splashed a good amount of IV fluids onto my (simulated) patient.

For this exam, I was the simulated patient for an Arterial Blood Gas station.

That means, I sit there and pretend to be a lady who's suffering from pneumonia and needs ABG.
The students have to talk to me, explain the procedure, gain my consent and then proceed to take blood from a dummy wrist next to me.

There were 8 students altogether. Generally, they did well.

But there was one who did not know what he was doing! I felt so bad for him.
He looked like a nice boy, who studies a lot. But looks can be deceiving, can't it?

And an exam is always nerve-wracking anyway.

He did not clean his equipment, neither did he wash his hands with the alcohol gel.
He took a pair of gloves and then throw one away. He tore a packet of alcohol swab and left it there next to me. He really looked as if he did not what he was doing. And I felt so much for him. Haish...

Too bad, but not surprisingly though, the examiner failed him :(

In conclusion, the experience of becoming a volunteer in an exam gave me a whole new perspective. Being in an exam but on the side of it. Not as a student taking the examination but someone backstage. I saw how the skills centre staff busily set up the place for examination. How they gathered the simulated patients and what briefing they give.

After this I won't be afraid and scared of the patients anymore :D

They're just students like me. Haha

Apart from some who are real patients with real findings, the rest are normal people :)

-Because life is a test-
-AkMaR-

http://nur-akmar.blogspot.com

New Layout! and Project Options.....

Assalammualaikum!

Yeayy!! New layout at last!
I am so satisfied :D :D

It took me so long to get this layout. Not that it is too hard, but just because I can't find the few hours to concentrate only on the designing. Well actually, I didn't do much but whatever.

All year 4 medical students in UoM need to complete an 11-week project called "Project Options".
My my my...11 weeeeks? I'd prefer it if they take 2 weeks of this project and put the 2 weeks into my Neurology block.

But anyway, in this 11 weeks, we can choose to do any project we want; research or non-research. Non-research can be critical appraisal or an audit. I am doing an audit on bisphosphonate therapy in symptomatic multiple myeloma. Well yes, it does sound posh. But what I am actually doing is just looking through patient notes and fill in the proforma, analyse the data, and at the end, write a report and present it.

I really think anyone can do that.
I prefer doing a case study.
And I'm too timid to do a research. I didn't even know what to research on for just 11 weeks.

This is already the 3rd week of my 11 weeks. And guess what, I have just started doing it today.
This is because my consultant asked me to do another audit for the past 2 weeks, for his department. Aigoo..
Not that I have a lot to complain but I think it is almost an exploitation of my time.

But I promise myself not to take up any other audit suggested by him until my bisphosphonate audit is finished.

'til then!

-Because life is a test-


-AkMaR-
http://nur-akmar.blogspot.com

Post GE-13, Pre Exam.

Assalammualaikum wrt wbt.

Oh well, the GE 13 has passed.
LOADS of things are in my mind re the GE, but let's keep it in there for now.

I've changed my layout again. This is not the end result.
I've just decided to republish previous posts because I feel bad for keeping my blog "Under Construction" for too long.

I have my Progress Test next Monday, I will continue working on this blog after that.

Dh la, jom study!
:D

-Because life is a test-




-AkMaR- http://nur-akmar.blogspot.com

(Almost) The End of Year 4

Assalammualaikum!

Pergh, lama gler x tulis dlm blog ni dh.
Busy with other things (and kemalasan nk menaip panjang. Idea byk sgt, x smpat nk put them into words).

Anyway, I've just finished the last OSCE of my 4th year last Friday! And the results will be released exactly two weeks from today. *dupp dapp dupp dapp*
All the OSCE stations started with "You are the FY1......" (FYI, FY1 = Foundation Year 1 = first year houseman).
So I proudly introduced myself, "Hi, my name is Akmar, I am a junior doctor here. Can I confirm your name and DOB?".

I am already at the end of my first week in "Children and Adolescent Psychiatry" posting.
This is not really a posting, this is a Student Selected Component (SSC), which I chose about two months ago?
Gler la, most of the budak2 / teens yg msuk sini are due to self harm. And their self harms usually stem from a family crisis, childhood abuse etc.

Apa lagi nk bgtau?
Oh! We can already feel the spring, the temperature started to get higher than 5° already, which means we can reduce the hours the heaters are switched on, significantly.
But, Syuruk is at 6.03am! Oh God..
I don't usually sleep after Subuh so I tend to wake up towards the end of Subuh, before Syuruk and start my day early.
But when Syuruk itself is 6.03am, I am facing a great great dilemma whether to sleep after Subuh or not when Syuruk started to be 5.30am later in the month. Aigoo.

And oh, I am now watching the korean drama, "Gentleman's Pride".
Cite tu sweet smpai rasa nk meletup.
Ok dh..
Get back to work.
It's 7.49am now :)

Haishh!! Camne nk hilangkan these annoying video ads on my blog?
Anyone know?

-Because life is a test-


-AkMaR-
http://nur-akmar.blogspot.com

Depression

One question I really would like to ask doctors/medical students/nurses in Malaysia; "How often do you see a patient coming in with depression as their presenting complaint"?

"Oh doctor, I can't stand it anymore. Everything is just not going the way it should be. I don't think I can take this any longer...."

I've seen that many times her in the UK, in the GP (GP is equivalent to Klinik Kesihatan in Malaysia).
And I feel like smacking the patient every time and tell her/him right on her/his face, "Life is not a bed of roses anyway, you gotta go through it like how people used to. Stop dwelling on your problem and sort it out yourself. Come on, pull yourself together!"

OK, maybe I won't smack the patient.
Maybe I'll just slam the desk.
Or maybe I'll just hit my forehead hard.
Or maybe I'll be nice and pat her hands and say everything in a nice, sweet and loving manner.

But the point is, I don't think Malaysia will have this much of depression cases.

It may be because our society does not acknowledge Depression as a medical illness. So our depressed people came in with somatic symptoms instead. "Oh doctor, my back kept aching. I don't know why. I've been putting ointments everyday"
"Oh doctor, my knee hurts"
"Oh doctor, my ankle hurts"

Maybe we do not have the "help seeking behaviour" as much as we are supposed to have.
So our depressed patients are left alone, not getting any help, left to commit suicide on their own.

Or may be, our society truly does not get depression as much.
Or may be, depression in this society has been overdiagnosed.
And in my honest opinion, I think the last two are the most likely.

I think depression is an illness of the modern society.
When expectations get too high, demands get ridiculously overwhelming, it is easy to be disappointed and frustrated. Not being able to cope with the failure or loss, or rough life, people sought for help.
I acknowledge it. But help does not come in the form of tablets and pills. Not in this case.

The society here KNOWS about antidepressants. They know antidepressants work.
Most Malaysians do not know that when you don't have energy to do anything; be it work, eat, or even getting out bed, tired all the time and you find no interest doing anything you used to enjoy or not finding the motivation to do anything, then you are suffering from "Depression".
Well, I didn't.
In fact, I only grasped this condition when I came here. I didn't even know much about it when I was in IMU. Or maybe I was dumb.
We may see that as lazy, unmotivated, sad or depressed but whatever that is, it is never a medical condition where you can get pills that will make you feel better in 3-4weeks time. So we deal with it. We started dealing with it even before it gets that bad.

And we still have good family support and religion, Alhamdulillah.

When someone in our family dies, we do bereave.
We do get sad.
I can imagine myself crying for days if something bad happened to my parents or siblings, or uncles or aunts or friends I'm close with, or anybody I'm close with for that matter.
But I know I'll still have other people who I can talk to and turn to. And if someone find themselves not having anyone to talk to, we can still talk to Him, the Almighty.

Rasulullah was sad too during the period where he lost his wife Khadijah and uncle, Abu Talib, the two beloved people of his life.
But Islam taught us to turn to Him in times of despair and joy, times of sadness and sorrow, times of rich and poor. And to accept loss and failure, joy or sorrow as not only a consequence to our actions but also as His destiny and test upon us.

So our society does not know about depression and antidepressants.
Hence we don't get hooked or dependent on it.

I know depression can get very bad.
People commit suicide from it.
They lost their personality, job and life because of it.
And that's why we'd want to catch them before it reaches that stage.
But that doesn't justify handing out antidepressants like candies to patients coming in feeling sad and low mood.
Isn't it better to prevent depression than treating it?
Isn't it better to hold family bonds stronger?
And I think one of the first steps is to stop sending elderly parents to care homes.
Take care of them in your own house, and you'll feel better. The children will see that their own parents are taking care of their grandparents and they'll take it as an obligation to take care of their parents.

Start having religion. Start having God.

And by the way, in my recent conversation with a Psychiatrist, he agreed that most "depressed" patients in GPs are not truly depressed. Antidepressants might have only a placebo effect on them.
And from this Psychiatry placement, I learnt that we can judge a patient's mood ourselves. We can use our own sense to decide whether or not this patient is really depressed. A patient coming in with full make up, blue eyelashes and green eyeshadows with flowery boots is most likely only mildly depressed, if at all. What more if the patient coming in looking bright.


-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com