dua ratus lima puluh enam : day 92 Obs & Gynae

mashaAllah.. cepat sungguh masa berlalu. tahu-tahu dah 92 hari berlalu... 4 rotation minor, sekarang I'm doing my Major rotation Obstetric & Gynaecology. Total buku yang dibeli : 3 buah sebab bukunya saling melengkapi. ZzzzZZZ... member 6th year pulak pesan,

"Ko baca 10 teachers tu untuk Osce, mini Osce... tapi Hackers ko kena baca untuk final pulak".

Obviously, as you can see OnG is not that exciting for me. which explains the 38 days gap of my dua ratus lima puluh enam series update. Of course in OnG you learn to appreciate your mother more. I myself was born at 4.32 am in the morning, C-section due to fetal distress. Well, I bet having to deliver at such wee hour and going under the knife - that, itself was highly risky for my mom ok. not that I want to bring up the issue la that my birthday is coming in almost 3 months time ^_^ oi...makin hari makin tua.. i'll be 24 omg.. (even had to pause a bit to count my age. wattaaa??) no idea lah what to request... Maybe this year I'll just ask for cash from my siblings. senang kan. bagi duit je. emas sekilo ke..muehehehehe...

Just some points I think worth-mentioning.

• I have met a patient who thinks LMP means the last EXPECTED menses.. Let's say real LMP 1/11/2012, suspected next menses 1/12/2012 (for illustrative purpose). This patient thinks LMP is 1/12/2012 and did pregnancy test like few weeks later - positive for pregnancy. Wrong gestational age = wrong management.
• Today was my first day in military hospital. I was amazed with their uniform. I even have the thought of joining the army forces after I graduate - just because of the uniform, of course. Unfortunately today my patient was quite difficult to understand. I asked her for how many years did she BF-ed her son, 1 year... 2 years..? She answered me with "Aa..ya3ni...1 year...2 years...". When did you go for booking visiti? " I go to the clinic every day". We nearly burst into laughter in front of this particular patient. 
• Your local colleague doesn't always understand the patient history. One day we shared a patient with some students and once we stepped out of the room they tells us they don't understand the history. Patient was an Arab too. Also they claim that the patient was annoying and wanting to punch her in the face. and I was like ??????

of course there are happy days in OnG department. Like seeing the look on your patient's face who just got married in her late 30s, primigravida seeing her baby on the ultrasound device, exclaiming "Oh, My baby....". And some mommies who are very excited to deliver their first child, supportive husbands and stuff. And your hormone goes crazy from all these emotion roller-coasters... 

and last but not least. the screaming! traumatizing. enough said!

BTW I'm back on 30 day shred - again! Tapi susah laaaaa takde support group.. So if you want to lose weight, but don't want to spend money on H****L***, gym membership, diet and protein shake.. Come and join me lah. Kita exercise and eat healthily je.. I promise no calorie counting. No product. No nothing. Just a huge amount of your willpower and some imagination. ;-)

Till next time. Toodles!

dua ratus lima puluh enam : day 54

now, where were we? day 54! kejap je kan dah dekat dua bulan dah... cuti banyak pulak tu in between... hehe.. Alhamdulillah sekarang ni I dah start rotation Anaesthesiology.

memang best ye sebab kalau dah dari kecik cita-cita nak jadi surgeon dapat masuk OT tu rasa macam budak dapat pergi zoo or playground..hehe.. tapi dah duduk dalam OT terus tukar cita-cita? Our day start as early as 8 a.m.. kalau sampai OT around 8.15 usually part anaes dah berlalu pun, so tunggu la untuk next surgery pulak... group I around 9.30 akan start seminar. Lepas seminar boleh balik, and you can also hang around in the OT and see other surgery. Best kannnnn!

First and second day, I was in Gynae, then Urology... Harini I duduk dekat general surgery, so I saw 2 laparoscopic cholecystectomy + hernia repair... tapi hernia tu tak tengok habis sebab I was exhausted berdiri lama... 1st case tu acute cholecystitis, start around 8.15, 9.40 I pergi seminar... 11 am I balik OT tu still tak habis lagi oi! And that team have one patient after another...

First day and second day tak ada drama sangat lagi... Harini baru ada drama sikit, most probably sebab muqim general surgery? And I witnessed consultant anaes yelled at the residence, technician. I pun kena buli dengan consultant tu.. Suruh cakap arab ammi kampung.... The whole OT were laughing at me sebab not only doc tu suruh cakap, siap suruh buat gaya... mommyyyyyyy... worse than kena marah tau perasaan dia!

Tapi takpe la, belajar banyak... I also learnt a lot from technician.. technician laparoscopy and technician anaes. Technician ni bukan tahu mesen je, dengan anatomy semua tau sekali. Siap bagi opinion pulak dekat attending. (?)

Sabar je la, round radio minat radio...round anaes minat anaes.!

dua ratus lima puluh enam : day 17

bismillah.

"cukuplah maut itu sebagai peringatan"

Semalam, pada hari kedua rotation forensik, I dah syak dah kemungkinan nak tengok autopsy disebabkan sampai-sampai je pagi tu terdengar alunan ayat suci alquran entah dari mana. Orang ofis kot pasang. Dan bau kemenyan arab or setanggi. (This is my theory, sebab on Sunday, and today Tuesday tak ada pun, dan tak ada kes for us to see). Also when we walk pass one of the rooms nampak macam ada ramai-ramai orang pakai kot putih tengah duduk semeja macam morning report je kan.

 Then Dr. datang bagitau pagi ni kita ada dua kes, satu RTA, satu cardiac arrest. Dua-dua umur 27 tahun, one male, one female. Bila kita rotation forensic ni, autopsy is priority. Kalau tak ada autopsy, kita proceed dengan seminar, kalau ada kita turun pergi tengok dulu, then only kita sambung dengan seminar. Sebab bukan every morning ada kes kan. So, we were told to leave our stuff, and took barang penting je untuk turun. No laughing and smiling allowed. So, kalau excited pun jangan nak buat muka excited eh.

Nervous jugak la kan, tapi tak de la takut rasa nak pengsan macam first time masuk morgue dulu. Rasanya semua orang pun ada perasaan yang bercampur baur pagi tu. Kita teruja nak belajar, at the same time kita tak tahu what to expect, dan perasaan ingat mati pun datang menyapa jugak sekali sekala. Lepas tu kita pun masuk dan mayat tu masih berbalut dengan cadar dia, lepas tu Dr. suruh kita keluar dan panggil staff untuk prep kan mayat tu untuk autopsy. Remove her clothes and basuh-basuh skit kan.

Lepas tu masuk balik, dan proceed lah dengan teaching. Tengok hypostasis, primary rigor mortis and stuff like that. As for me, I do have this feeling takut bila tengok mayat yang mayat. (ha?). Kalau tengok movie pun, mayat, especially yang berkapan, berselubung ke, muka pucat lesi tu, I memang tak berani - I blame it on the fact that I jarang ikut pergi ziarah orang meninggal - well vicious cycle of fear. Once the Dr. cut her open, rasa takut memang hilang sebab I detach from the fact it's a mayat sebab I dah focus dekat the anatomical details of her internal organs. Ok now I sounded creepy - tapi kalau benda fresh memang I rasa macam tu. Fresh blood is OK for me, even kalau banyak pun, tapi kalau darah kering dekat dressing luka, or cadar I memang tak berapa selesa nak tengok. I have to admit, memang jaaaaauh beza tengok organ waktu autopsy dengan organ dalam lab anatomy kita tu. Walaupun dalam lab kita pegang-pegang kan, tetap tak sama. 

Walaupun I was hoping to see more autopsies masa first day of forensic, after that one autopsy rasa macam hmmmm... cukup lah kot dulu. Sebab post-traumatic distress syndrome dia...Ha.. sampai ke malam nak mengenangkan. Sampai balik rumah, dah nak masuk tidur pun dok terbau-bau lagi ye. Selama ni what I perceived as bau mayat is actually bau kapur barus. Abah kata sepatutnya tangan tu siap-siap sapu belacan, so that bila dah masuk dalam bilik mayat, agak-agak nak bau tak best, just bau je belacan kat tangan sendiri. Malam tu before abah n mama tidur masing-masing pesan supaya tidur je dan jangan ingat-ingat dah pasal autopsy t - heh, ye la tuuu.

We didn't get to stay sampai habis autopsy doc dah suruh keluar for some medical reason - which doesn't really make sense. Tapi kiranya masa tu heart, lung, spleen, liver, kidney, uterus semua dah bawak keluar for investigation. Besar jugak kidney ye rupanya. Isi perut pun doc amik sikit specimen. 

Terkedu jugak ye lepas tu. Laki ke perempuan ke semua sama je. 

Itulah, mati tu tak mengenal usia kan. Mama kata actually ini semua rezeki. Sebab ada jugak mama pernah jumpa doktor yang tak pernah tengok autopsy dari sejak belajar sampai dah 25 tahun kerja pun. Ha.. ada tau. Bak kata along pulak yang  moleknya kalau peluang tu kita guna untuk mengingatkan diri kita tentang kematian. 

One more interesting thing tentang morgue ni, adalah cara dia susun tempat tu. We won't bump into family members. I don't think people will be comfortable knowing 20+ med students are there to see the autopsy. Kalau kat sebuah hospital di Malaysia tu, mayat masuk ikut situ, family pun tunggu situ, student masuk ikut situ, pekerja masuk ikut situ. Ada ka patut... Apapun semoga Allah ganjari lah si mati dan keluarga dengan balasan yang setimpal, kita ni dapat ilmu pulak dari dia kan.. 

Yang sayunya tu sebab muda lagi kan. Lepas tu, bila doc bukak tu, aku terfikir pulak. Mintak-mintak bila aku mati nanti tak ada kena autopsy, nak-nak orang arab yang buat, kasar nampak gayanya.. Takde beradun macam ko tengok dalam CSI tu...tipu daya je semua tu... Dan terasa sangat nak jaga kesihatan sebab malu rasanya kalau mati, memulangkan barang pinjaman dengan keadaan tak sempurna.. 

Sekian.. renung-renungkan dan selamat beramal!

dua ratus lima puluh enam : day 10, i supposed?

Bismillah.

Ok ladies and gentleman. post kita pada hari ini adalah berpaksikan kata kunci " Orthopaedic, bidang kepakaran untuk insan penuh kesabaran ". You see, kalau you tak penyabar, it will not be good for both you and your patient. Eleh, dah tak sabar tu memang bukan sifat yang murni kan..

The vast majority of treatment in orthopaedic - is no treatment. Kadang-kadang just suruh rest... kadang-kadang suruh "'ilaj tabii" a.k.a physiotherapy... even kalau you initiate treatment pun, you still kena wait and see. bukan wait and see sekejap pulak tu. you waaaaaaaaaaaaaaaaaaaaaaaaaaaait and see. haa.. gitu...

walaupun you orthopaedic surgeon... you try as best as possible to avoid or at least delay the need for surgery. jadi kalau you jenis gila nak cut someone open je, pergi nun duduk department jarahah dengan Dr.T bukan nama sebenar... suspect je appendicitis terus operate kan... 

i heard one of the resident, trying to impress attending pagi tadi, quoting that he read from a text book that says "You spend five years to learn how to do surgery, and another fifty years on how NOT to do surgery". as for me, I tak sesuai lah di department ortho ni, sebab I ni kurang sabar bab menunggu. I'm very bad at waiting. If I want to know something, I want it quickly. If I want something, I want it right away. teruk betul perangai... 

also, today we have this conference on neurosurgery... our group attended the first talk about new surgical technique to treat spondylosis. DTRAX facet namanya... very interesting you know..I terus call rumah la balik tu tanya abah what was his condition yang doctor bagitau, and  yes he had spondylosis... memang kesian sebab tangan asik kebas-kebas je tidor pun dah bertahun-tahun tak lena... sob3.. tapi disebabkan before ni surgery untuk spondylosis ni very risky - major surgery... biasanya dah teruk baru doc akan bincang option untuk surgery..

tinggi lah cita-cita saya supaya one day abah pun boleh buat DTRAX ni and tidor lena di malam hari..ok, mungkin mmg dtrax ni bagus, ataupun mungkin Medi Rep tadi tu je yang pandai sangat kempen...hehe

till then, toodles!

dua ratus lima puluh enam : day 9

bismillah...

Hola gorgeous ladies and non-ladies.... :-) nothing new about orthopaedics except for the fact today we were asked to take history and present our cases. OMG.. dah 5 bulan kau tak amik history, baru la nak ek uk ok ha kan depan patient... component of history pun hilang melayang...rasa macam budak tadika je hihi.. nak-nak pulak time present attending (baca : akhisso', pakar, specialist) suruh ko explain about the x-ray... 

So, harini our patient is a Syrian revolutionist, blast injury to the knee. Muda lagi tau, baru 25 tahun, anak isteri still in Syria.. Semoga cepatlah selesai kekecohan di syria ni, May Allah bless the Syrians. 

yesterday i kena present pasal bone of the tumor...sabar je la...makan 2 hari buat slides nye sebab buat kerja tak tumpu...alih-alih ade la dalam 5 slide je yang kena present.. So, kepada yang bakal rotation Ortho, my advice kalau nak buat presentation : JUST PUT PICTURES and know your material very well... lepas tu, TEMBAK audience with questions - make sure you know the asnwers la..camtu la kaedahnya... tapi takpe la, belajar dari kesilapan..berjela-jela salin dari APley's tu, doc taknak tengok pun slide fakta, die suruh bukak gambar, explain gambar dan tanya kat audience kita soalan berkenaan fakta penting untuk tumor tu.

4th Year Intro

wokey.... as promised la ek, since my day in Ortho is not that interesting. *ops terlupa,ok xpe2 taip kat atas*   nak berkongsi petua ewah2 petua lak kau kan... dengan adik-adik kesayangan lah batch 4th year ni.. ni dah minggu ketiga kan korang intro... next week last, pastu exam.. yang syabab mahupun akhaat masing-masing seronok tangkap gambo OOTD lagi... tau ke OOTD dik non? 

anyway... kalau by this week korang rasa bahasa arab korang tunggang langgang lagi, tak teratur lagi amik history, don't worry... you still have a long way to go.. ape yang penting sekarang ni, kena la dah start study untuk exam.. ko cakap arab berabuk sekali pun di bulan intro ni, means nothing kalau exam tak terjawap dek kerana tak habis study... aku la tu jenis intro pun menggelabah adeeee jugak tak habis baca. kata kuncinya - STICK TO ONE SOURCE. source yang mana? tepuk dada tanya selera... kalau nak pakai lecture notes mmg bagus, sebab itulah bendanya nak keluar exam, cuma yang tak bagusnya, dikhuatiri ada kesilapan... jadi, buatla fact check..

past year questions penting tak? penting... tak rugi pun buat...kalau tak keluar exam pun, at least dia bantu kita untuk tahu what's going to be asked in the exam.. so, susun la strategi...sehari buat 10 soalan pun, kalau ada 14 hari dah 140...tak gitu dik non?

regarding bahasa arab tu... ni boleh la korang nak buat sama ada sekarang, or bila dah start rotation betul nanti... ade kan, list soalan dalam bahasa arab tu? so you practice la one day one section... hari ni bagi terer patient profile..esok, GIT... begitu lah seterusnya... inshaAllah kalau istiqamah, dalam masa 2 minggu boleh tanya soalan dengan baik... nak faham dengan baik? itu rahsianya pada banyak amik history, dan fahamkan kaedah pembentukkan kata.. you learn the most from your patient, diorang pun akan bantu kita faham sebenarnya... for me, kalau malas amik history baru amik dengan budak arab..awal-awal seminggu ok, ikut diorang, just to get the common words patient say.. lepas tu, pergi la sama-sama melayu...for me, I rasa orang melayu punya history dari segi teknikal mmg lagi kemas dan tersusun, tanya soalan bersistematik.. then, you will encounter some words you don't know - if it's urgent, find your arab friend and tanya apa maksudnya. kalau tak urgent, tulis la dulu lepas tu tanya... 

how did I do during intro course?  I'm not proud of my effort yang tak semenggah... but above everything I'm thankful as it could've been worse. So, don't worry...kalau you go all out, mesti you puas hati.. :-)

one of my regret is tak hafal betul-betul milestone in paeds... yup, it was asked in the exam. jadi, you better start memorizing those things. apa-apa pun ingatlah pergantungan kita pada Allah, rezeki masing-masing...yang penting, kita usaha, tak gitu? 

ok selamat berchentaaa lah you all dengan Mc Leod. tee hee hee.. 

nantikan part seterusnya...i tell you pasal rotation pulak. ewah gaya2 abernathy's secret pulak.. onebonez's secret gitu...

p.s : dipersilakan abang-abang dan kakak-kakak untuk menambah nota kaki... adik-adik pun boleh jgn segan-segan.

dua ratus lima puluh enam : day 6

bismillah..

it's our first weekend. phewwww one week went by so quickly! I find Ortho rotation very interesting. The doctors are half medical professional, half a carpenter and a dash of engineering and physics master. Yes, I saw one of the attending doctors use a ruler with protractor (jangka sudut).

After a week, what to expect in your Ortho rotation?

Waiting, waiting and more waiting. Okay, memang itu lah bab paling tak best sekali untuk group A1 sepanjang minggu first ni. Kejap melangut dekat department, kejap dekat lecture hall, kejap dekat klinik, ditendang ke kiri dan kanan ibarat pola dalam permainan. ewah! ok la i'm being over dramatic. Tapi, bayangkanlah, we waited for one and a half hour for resident to came and teach us shoulder examination which lasted for about 20 minutes only. And most of us end up zzZzzZZ je pun during the clinical teaching.

We complained to coordinator about it, and still the next day we waited for half an hour pulak. Ok waiting time tu tak termasuk gap sedia ada ye. I find it disturbing bila deparment mintak kita be punctual but ends up they didn't walk the talk. So my advice - get your notes ready, make them interesting so that during those dreadful waiting session - you have something beneficial to do.

In the clinics...urghhh... I though we'd learn more in the clinics, but not really. I prefer ward round personally. Or ikut resident in the clinic. the problem bukan pada tenaga pengajarnya but the fact that they don't assign students accordingly. So, please push ketua kumpulan masing-masing untuk lebih proaktif, and yea I miss my 4th year CR..... 

Interesting quote of the week... "You are medical students, the best students in the Kingdom". OMG. and you wonder why budak-budak medic ni ramai besar kepala and disrespectful to others. Memotong barisan dekat mujamma3, kafe dan tak hormat jururawat. 

I busy tau weekend ni sebab nak study dan siapkan power point untuk presentation on Sunday... now I know la kenapa orang asyik pakai presentation lama sebab memang susah nak buat tau... gather information and nak pilih which one to put in your slides... jadi, hargailah lecturer anda yang bersusah payah siapkan presentation for the lectures ye adik-adik... :-)

ok lah. till then. toodles!

dua ratus lima puluh enam : day three

Bismillah...

Ok so today dah masuk hari ketiga kitorg dekat department Ortho... Residents and Specialist semua baik-baik je so far.. A little bit spoon feeding method of teaching nye..

Today our seminar was on "The Spine". Tiap-tiap tahun, tiap-tiap group pakai je slide lama yang dulu-dulu punya... I hope I can make my own lah nanti... My presentation nanti on Sunday on Tumor of the Bones... Kalau pakai slide lama ni, very risky...Kalau tak kena gaya pemahaman kita tu, boleh makan diri tau!

I enjoy Ortho so far. Every case has a story behind it, all the way from sad story, funny and severely depressing. A 20 y/o female pt. was found to have malignant tumor in her knee + metastasized to her rib :-( kebetulan je tahu sebab ada jatuh waktu tengah bermain..Eloklah dia jatuh at least tahu ada tumor...Ada orang langsung tak tahu, tahu-tahu dah metastasized.. Lagi sian kan...

And then there's war trauma patient. Lagi depressing! Kesian tau... one of our patient yesterday (we attempted to take history) was mentally traumatized - he was tortured back in Syria. Harini pun ada jugak.. Kena baling grenade masa tengah duduk depan rumah. Yang kelakar pun ada... Jatuh waktu panjat tembok sekolah..hehehe... macam-macam lah you all...

Ok.. nanti inshaAllah kalau ada masa lapang I will post something for junior 4th year... Things I know now, I wish I knew then gitu... ewah..!

OK lah tatatititutu

dua ratus lima puluh enam : day one Orthopaedics

Bismillah...

Alhamdulillah hari ni hari pertama untuk tahun akademik 2012/13. Bila kita masuk alam klinikal di JUST ni, cuti mula tak mengenal semester, tahu-tahu dah habis setahun je nanti. Mulai hari ini nak menuju ke hari terakhir tahun 5, ada 256 hari yang perlu dilalui dan kita akan mengakhiri journey to the final year ni pada 30 Mei 2013, inshaAllah... Lepas tu, ada rezeki inshaAllah ke final year lah kita ye rakan-rakan dan adik-adikku sekelian..

I group A1, so I start dengan rotation Ortho. The thing is, bila dah tahun 5 ni, mana ada back to school dah kan. (Eleh, macam la pegi pun kalau ada kan). But I did ask around la regarding 5th year to my friends. Tapi, mostly tak berapa ingat dah pun sebab diorang pun dah melalui 11 rotation, mana nak ingat satu-satu kan. So, I berniat nak tulis lah setakat termampu, supaya bila orang tanya next year, I can recall or, kalau I malas I cakap, ok, adik boleh tengok blog akak ye..ada tulis semua.. 

tapi tak la tiap-tiap hari pulak nak tulis kan...karang ada la orang mengata I ni duduk Jordan belajar ke blogging je?

Orthopaedics.

""L'Orthopedie, ou l'art de prevenir et de corriger dans les enfans, les difformites du corp"

Translated as - "Orthopedia: or the Art of Correcting and Preventing Deformities in Children "

-source-

Tempoh rotation : 2 weeks only. tapi, 8 days je yang kita akan berpeluang belajar dari patient. First day ni, intro je dulu. So, 4 hari minggu ni, and another 4 hari minggu depan because on Thursday dah exam MCQ. 

Textbook : Apley's Conscise System of Orthopaedics and Fractures. (15jd kedai buku bayan)

Supplement : Toronto notes (as suggested by seniors).

Mid exam : MCQ

My group of 21 people akan dibahagikan kepada 3, A,B,C.. Setiap hari 2 group round dekat ward, 1 group dekat klinik. As for today ada 58 cases admitted to KAUH in ortho's dept, so... hopefully tak ada masalah nak ambil history and perform PE.

Pasal ward, nanti tunggu I dah round, I'll share with you guys ok... InshaAllah siri "duaratuslimapuluhenam" ni I akan buat at least awal round, and post-mid term lah plus anything interesting in between. Dah tau otak kita ni limited capacity, hendaklah ditulis ya catatan-catatan sebegini...

Routine : Pagi-pagi attend morning report.. dengar resident bentang kes.. Sambil tergamam tengok specialist tanya muscle insertion and origin sambil terkenang Dr. Rashid kan... haha.. lepas tu day one usually lectures, lepas tu balik.. esok start morning report + round + seminar  lah inshaAllah.

Ok lah, till next time :-)

p.s : teringat ada my friend marah because i don't know that "#" stands for fracture...kih3...