I was attached to the clinical genetics department for three weeks before the Christmas holiday. The department deals with genetic referrals for the north west of England. I sensed that it was rather academic and research based. I have never been in one department with so many professors before.
I enjoyed the non-medical side of things more than the medical. Contrary to my expectations, there were quite a lot of 'touchy-feely' issues to think about. We human always long to know the future. Advances in genetic testing have now paved the way to knowing the future. Little do we naive human realize that sometimes knowing (or even given the choice of knowing) is so much more tormenting than not knowing.
For example: for a couple has a child who has Duchenne muscular dystrophy (DMD) and have cared for and watched him wheelchair bound by the age of 10, prenatal testing seems to be the logical option for any subsequent pregnancies. But what if the next baby in the womb has the disease? They have brought up the elder son despite his ill health, so is it fair to kill off their unborn child without giving it a chance to be born? If they keep the pregnancy and currently with no cure for DMD, can you imagine life for the parents and the child at the younger age before the disease starts to appear, playing the waiting game?
This is only a simple case of genetic condition with complete penetrance. (I.e. if you are tested positive = you will get the disease at some point). What about those tests that cannot predict a disease with certainty? If you have four family members who died from bowel cancer, and you have been tested positive for a gene that increases your chance of getting the bowel cancer (but you won't necessarily get it 100%), would you take a gamble and get on with life as usual? Or would you play it safe by mean of a major operation to remove your bowel and live with a stoma for the rest of your life?
Perhaps I have not described it eloquently enough for you to gauge the complexity. Medical student would have come across these issues in the course. Yet honestly, informing real people their fate and then leaving them with life and death choices to make did stir my emotions up a little more than the books and the lectures. There are guiding principals but there is never right or wrong answer in these dilemmas. Another thing I like about genetics is that every patient or family is treated so individually. The typical appointment is 45 minutes personalized consultation, giving long enough time for the professionals and the patients to talk through any issues. Every patient is allocated to a genetic counsellor whom they can contact anytime. The doctors and counsellors often know the patients really well as a result.
Clinical genetic is entirely outpatient based, with very decent working hours. Other than taking blood pressure, drawing the odd family trees and playing with the children, there was really nothing else hands on to do. Many of the referrals included odd looking children with some physical or learning disabilities seeking for a diagnosis. I sometimes wonder if they are necessary. I have worked with disabled children and adults before and there must be loads of them out there with these odd looks without a specific label, and they still live a normal life. Is it that important to 'find' the microdeletion or tranlocation or subtle mutation responsible for the child's short statue+small head+slanted eyes+curly hair+delayed speech development, when the most important thing is to get the best support for the child to grow up as normally as possible? These syndromic diagnoses often have no cure or treatment for these syndromes anyway. I understand that sometimes a disease label can help the patient and the family cope better, and sometimes to advise on future pregnancies. But if the syndrome is not too severe, what difference does it make whether the cause is found or not? I do think that geneticists are sometimes carried away by their own curiosities and try too hard to pin down syndromes to genetic causes. We are all different because of our different genetic make up, and all of us have faults in our gene, that’s why none of us are perfect. While these odd looking, slightly disabled children might have more and worse faults in their genes than us, it is still what make them unique in the same way they make each of us uniquely special.
I finished the attachment feeling that I haven’t learnt much. However in hindsight, I have seen a few more prevalent rare conditions like Marfan’s, NF1, CMT. And as you can tell from this blog entry, it has been a very thought provoking experience overall. Would I become a geneticist? I don't think so - endless thinking and I would get too many headaches.
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Saturday, December 27
Saturday, December 20
Today is a sad day.
It's result day. I managed just a pass. I don't understand. Especially the 3/7 in the psychiatry history station. I have been getting 3-4/7 for all the history stations for the past three OSCEs now. I don't know what was wrong. I was sure I asked all the necessary questions. Perhaps the examiners think I was being too nice to the patient - I do have a tendency to do that and I don't think I'm sorry for that. I have spoken to one of my tutor about this but she thought I was fine as far as real life practical medicine is concerned. I'll probably email her again after christmas. Overall I'm upset about the result eventhough I promised myself on exam day that I'd be only too happy to just pass.
I have just finished a 3500 words essay - spent about 3 nights awake writing it. I couldn't do it over the weekend as I was too busy. Sitting beside me, my supervisor spent about 5 minutes reading through the 3500 words, and gave me an above average. It's not that I'm not pleased about the results - it's just that I thought she would be a little more detailed in her assessment. It made me wonder what was the point of fussing about the whole night making sure everything is perfect.
Now I'm free. Will write more over the weekend. About chorus, and about clinical genetics.
.
It's result day. I managed just a pass. I don't understand. Especially the 3/7 in the psychiatry history station. I have been getting 3-4/7 for all the history stations for the past three OSCEs now. I don't know what was wrong. I was sure I asked all the necessary questions. Perhaps the examiners think I was being too nice to the patient - I do have a tendency to do that and I don't think I'm sorry for that. I have spoken to one of my tutor about this but she thought I was fine as far as real life practical medicine is concerned. I'll probably email her again after christmas. Overall I'm upset about the result eventhough I promised myself on exam day that I'd be only too happy to just pass.
I have just finished a 3500 words essay - spent about 3 nights awake writing it. I couldn't do it over the weekend as I was too busy. Sitting beside me, my supervisor spent about 5 minutes reading through the 3500 words, and gave me an above average. It's not that I'm not pleased about the results - it's just that I thought she would be a little more detailed in her assessment. It made me wonder what was the point of fussing about the whole night making sure everything is perfect.
Now I'm free. Will write more over the weekend. About chorus, and about clinical genetics.
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Tuesday, December 16
The attention and concentration part of my mental state is very poor. Must be those rubbish food that I have been eating for the last few weeks. Why does this always happen when I have a million things to do?
Do not despair. Everything will be over by Friday.
No it won't. I hate christmas. Like many psychiatric patient, I find it a difficult time of the year to cope. My heavy workload and busy schedule are discontinued all of the sudden. What am I to do? There is no one to talk to. It's too cold to go out, and what for anyway?
Back to the essay. May come back and whine again later.
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Do not despair. Everything will be over by Friday.
No it won't. I hate christmas. Like many psychiatric patient, I find it a difficult time of the year to cope. My heavy workload and busy schedule are discontinued all of the sudden. What am I to do? There is no one to talk to. It's too cold to go out, and what for anyway?
Back to the essay. May come back and whine again later.
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Monday, December 15
I hate people who want to be right all the time. Unfortunately it's very common among Malaysian, especially those with Y chromosomes. So frustrating talking to people like that - don't they realise that each time I talk to them, I don't want an argument, or indeed to expect any opinion from them? I find these people often exceptionally egocentric. No one else in the world matter other than himself. Why don't you go and live in your little island by yourself? That will do the world a lot of good because NO ONE IS PLEASED WITH YOUR PRESENCE HERE!!!!!
Friday, December 12
Stresses of the week
Another week with constant rush of adrenaline am afraid. Will not bore you with every single details. Am waking up with morning headache almost every day, accompanied by blurred vision and poor balance. Am very deprived of sleep at the moment, so will try increase my sleep and see if the symptoms disappear.
Four things which stressed me out this week:
1. CB cake sale
We did it last year but I did not bake anything (I just manned the stall for the whole day). This time, I contributed some baking. Went to two supermarkets to get the necessary ingredients. Slept for two hours and spent the rest of the early morning baking. Headache was awful, I prefer not to do that again. But am so flattered that they sold out!
2. SSC
I planned to do something paediatric related but did not have enough opportunities to sit in the relevant clinic. Felt panic by Tuesday. Now have decided to do medullary thyroid cancer. Kind of glad that my supervisor is not the expert of the experts in this disease. However she is going to ask one of the other consultant who specialises in cancer genetics and had written books on it to read through my essay - very very intimidating.
3. Project option
My supervisor is lovely, but she is not very good at replying email. I emailed her since last month to remind her that the deadline for title submission will be next Monday, to which I received no reply. Understandably I was getting extremely anxious, risking failing the component and having to repeat fourth year when the project option hasn't even started (not until May 2009), as the guideline clearly states 'student's responsibility: to register a project option title by 15th December 08'. Fortunately this time I guess she gathered the sense of urgency and replied me straight away. So now it's sorted. Relief!
4. Chorus
The concerts are this weekend! I'm so excited! Will be performing at the front row as there were no seat left at the rows behind by the time I arrived for rehearsal on Thursday. Stressed because am not very confident with the sitting and standing, as well as some singing, especially the beginning of a new chorus without having some singers in front of me to ensure that I am indeed doing the right thing. Our conductor always say make mistake confidently, and I've always done so without feeling too embarrassed. But I can't do that in a concert. Imagine, suddenly standing up at a wrong time with everyone else still sitting and having the audience wonder what is my problem... Nevertheless, really looking forward to it. It felt amazing singing with a full orchestra, in the magnificent whitworth hall.
.
Four things which stressed me out this week:
1. CB cake sale
We did it last year but I did not bake anything (I just manned the stall for the whole day). This time, I contributed some baking. Went to two supermarkets to get the necessary ingredients. Slept for two hours and spent the rest of the early morning baking. Headache was awful, I prefer not to do that again. But am so flattered that they sold out!
2. SSC
I planned to do something paediatric related but did not have enough opportunities to sit in the relevant clinic. Felt panic by Tuesday. Now have decided to do medullary thyroid cancer. Kind of glad that my supervisor is not the expert of the experts in this disease. However she is going to ask one of the other consultant who specialises in cancer genetics and had written books on it to read through my essay - very very intimidating.
3. Project option
My supervisor is lovely, but she is not very good at replying email. I emailed her since last month to remind her that the deadline for title submission will be next Monday, to which I received no reply. Understandably I was getting extremely anxious, risking failing the component and having to repeat fourth year when the project option hasn't even started (not until May 2009), as the guideline clearly states 'student's responsibility: to register a project option title by 15th December 08'. Fortunately this time I guess she gathered the sense of urgency and replied me straight away. So now it's sorted. Relief!
4. Chorus
The concerts are this weekend! I'm so excited! Will be performing at the front row as there were no seat left at the rows behind by the time I arrived for rehearsal on Thursday. Stressed because am not very confident with the sitting and standing, as well as some singing, especially the beginning of a new chorus without having some singers in front of me to ensure that I am indeed doing the right thing. Our conductor always say make mistake confidently, and I've always done so without feeling too embarrassed. But I can't do that in a concert. Imagine, suddenly standing up at a wrong time with everyone else still sitting and having the audience wonder what is my problem... Nevertheless, really looking forward to it. It felt amazing singing with a full orchestra, in the magnificent whitworth hall.
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Monday, December 8
Adrenaline flood
Last week, I was bordering the state of manic following the frantic revision for OSCE, meeting my family and fighting my way across London (along with six people from Malaysia) and back to Manchester. Good old adrenaline kept me going.
OSCE was on Thursday, testing our competence on neurology, psychiatry, orthopaedics and rheumatology. Almost none of the pathological signs and symptoms I spent hours upon hours revising came out. Instead we were tested mostly on basic history and examination skills, which was fair enough I suppose. To me this seems a little foolish, but it would be more foolish of me not to practise the examination sequence to a certain level of slickness. The majority of the stations are what I call (monkey) skill demonstration, a performance of a polished and well rehearsed routine. I don't think we have to even mention the obvious abnormality to pass. It was not easy for me because when I examine a patient, I'd like to do it thoroughly, in a practical way (eg I would not percuss and auscultate the thyroid routinely in real life, so why should I remember to do it to a healthy volunteer in an exam?). Nevertheless I thought it was a well organised and fair exam. There wasn't anything that I didn't know. I did a few silly mistakes, but hopefully I have compensated by doing well enough in the other stations. The residual adrenaline left me feeling high for the rest of the day.
On the evening, I met my family in London. I was so thrilled to meet them. We spent the next few days touring London and some other places. Mum was rather skeptical about the idea of wandering around the intimidating streets of London without any tour guide with arranged itineraries, but I managed to convince her that I'm perfectly capable of being their guide. In two days, we managed to visit the British Museum and Greenwich, watch a west end theatre and a Pantomime, experience the London underground and bus services. Mum even had time to very briefly see the place that she used to live in 30 odd years ago. A very expensive trip though, I must say. But we all enjoyed everything, apart from the freezing temperature. The weekend was like The Amazing Race. Two days + seven people and I have not managed to lose one of them, what a feat! On the last day before parting, we went to my mum's friend's house. She was so kind to accommodate us and to cook us a Christmas dinner. My first sister had a wee bit too much alcohol and spilled out some secret that my mum never knew...
The return trip back to Manchester was a memorable one. I had to change train at a little place called Wolverhampton. I arrived there at 1:30am and the train to Manchester was not until 6:21am. By the time I arrived at Wolverhampton by bus replacement service, the train station was closed. So I had to wait at a bus stand. I was freezing (I am pretty sure that temperature then was well below 0. So I devised various ways to keep warm, which included pacing around and lifting weights using my luggage. I felt vulnerable, there was a taxi driver who offered to drive me to a hotel free of charge. In short, I was an exhausted, sleepy young lady carrying valuables alone in the middle of no-where trying hard to fight off the bitter cold for nearly five hours. A worker at the bus stand sympathised me and gave me a cup of tea and a pack of crisp (I probably shouldn't even have accepted that). I was and am still crossed with the train company for selling that sort of ticket (which wasn't cheap by the way) and not providing a safe and comfortable waiting area for their customers and I intend to complain.
Eventhough the weekend did not go as smoothly as I expected, spending time with my family can only be the best post-exam reward for me. The only thing left to say is I was proud that I managed to stay awake and focused for the next day for my first day placement in clinical genetics. Thanks to the left over adrenaline again from the night before, no doubt.
.
OSCE was on Thursday, testing our competence on neurology, psychiatry, orthopaedics and rheumatology. Almost none of the pathological signs and symptoms I spent hours upon hours revising came out. Instead we were tested mostly on basic history and examination skills, which was fair enough I suppose. To me this seems a little foolish, but it would be more foolish of me not to practise the examination sequence to a certain level of slickness. The majority of the stations are what I call (monkey) skill demonstration, a performance of a polished and well rehearsed routine. I don't think we have to even mention the obvious abnormality to pass. It was not easy for me because when I examine a patient, I'd like to do it thoroughly, in a practical way (eg I would not percuss and auscultate the thyroid routinely in real life, so why should I remember to do it to a healthy volunteer in an exam?). Nevertheless I thought it was a well organised and fair exam. There wasn't anything that I didn't know. I did a few silly mistakes, but hopefully I have compensated by doing well enough in the other stations. The residual adrenaline left me feeling high for the rest of the day.
On the evening, I met my family in London. I was so thrilled to meet them. We spent the next few days touring London and some other places. Mum was rather skeptical about the idea of wandering around the intimidating streets of London without any tour guide with arranged itineraries, but I managed to convince her that I'm perfectly capable of being their guide. In two days, we managed to visit the British Museum and Greenwich, watch a west end theatre and a Pantomime, experience the London underground and bus services. Mum even had time to very briefly see the place that she used to live in 30 odd years ago. A very expensive trip though, I must say. But we all enjoyed everything, apart from the freezing temperature. The weekend was like The Amazing Race. Two days + seven people and I have not managed to lose one of them, what a feat! On the last day before parting, we went to my mum's friend's house. She was so kind to accommodate us and to cook us a Christmas dinner. My first sister had a wee bit too much alcohol and spilled out some secret that my mum never knew...
The return trip back to Manchester was a memorable one. I had to change train at a little place called Wolverhampton. I arrived there at 1:30am and the train to Manchester was not until 6:21am. By the time I arrived at Wolverhampton by bus replacement service, the train station was closed. So I had to wait at a bus stand. I was freezing (I am pretty sure that temperature then was well below 0. So I devised various ways to keep warm, which included pacing around and lifting weights using my luggage. I felt vulnerable, there was a taxi driver who offered to drive me to a hotel free of charge. In short, I was an exhausted, sleepy young lady carrying valuables alone in the middle of no-where trying hard to fight off the bitter cold for nearly five hours. A worker at the bus stand sympathised me and gave me a cup of tea and a pack of crisp (I probably shouldn't even have accepted that). I was and am still crossed with the train company for selling that sort of ticket (which wasn't cheap by the way) and not providing a safe and comfortable waiting area for their customers and I intend to complain.
Eventhough the weekend did not go as smoothly as I expected, spending time with my family can only be the best post-exam reward for me. The only thing left to say is I was proud that I managed to stay awake and focused for the next day for my first day placement in clinical genetics. Thanks to the left over adrenaline again from the night before, no doubt.
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Saturday, November 15
Annoying question
Just about the most annoying question that medical student like me come across is 'Which specialty to you want to do?'. People love this question: patients, doctors, nurses, parents, relatives, strangers. Why do I hate the question? Because I truely don't know. So is more than half of the medical students. We are seeing new things everyday and everything new we see would interest us in one way or another. But I have to say I do think about this question more intensely nowadays. Finals is looming and before we know it, we'll be asked that same question in our job application form.
I love acute stuff. My favourite placements are A&E and emergency assessment unit. I love to see fresh patients, thinking and making diagnosis from scratch, getting investigations to confirm my diagnosis and see the patient benefit from my immediate management right in front of my very eyes. The variety of presentations and the hands on approach turn me on. I also like the teamwork, communication and support from your peers. I know I would be under pressure all the time, but that's exactly what I am after. The downside would be the lack of opportunity to form long term therapeutic relationship with the patients. But that's not entirely true. In my short 4 weeks stint in A&E, I came to know an alcoholic man living on the streets who came in every other night quite well.
I'm still keeping my options open. I think I'm geared more towards medicine rather than surgery. The one type of disease that perpetually gets me excited is vasculitis. I find multisystem involvement because of the underlying pathology fascinating. I hated surgery because I found it boring, yet this perception has changed since I was allowed to scrub in for the first time in my life. I'd love to learn all the physiology behind anaesthetics, yet I find the working condition (sitting through surgery, listening to beeps, plotting obs charts) rather unbearable. However I won't mind working in ICU. I used to like psychiatry, but not anymore. I loved the stories of delusions, before I realise that most of them are just the same. The pace is just too slow for me. GP is ok, I had two brilliant placements, one OK and the current one horrible, and it's the horrible one which puts me off completely. The variety is there, but the support is not - you work on your own most of the time, which will depress me eventually. Lots of paperwork. Yet it's so rewarding when you become almost a part of someone's family, and home visit is the best part of being a GP. Most of the time the only treatment that patients needs is so simple - a pair of lending ears, good explanation and reassurance, which my current GP fails to realise.
So this is my elaborated answer to the annoying question. Please resist the temptation to ask me again.
.
I love acute stuff. My favourite placements are A&E and emergency assessment unit. I love to see fresh patients, thinking and making diagnosis from scratch, getting investigations to confirm my diagnosis and see the patient benefit from my immediate management right in front of my very eyes. The variety of presentations and the hands on approach turn me on. I also like the teamwork, communication and support from your peers. I know I would be under pressure all the time, but that's exactly what I am after. The downside would be the lack of opportunity to form long term therapeutic relationship with the patients. But that's not entirely true. In my short 4 weeks stint in A&E, I came to know an alcoholic man living on the streets who came in every other night quite well.
I'm still keeping my options open. I think I'm geared more towards medicine rather than surgery. The one type of disease that perpetually gets me excited is vasculitis. I find multisystem involvement because of the underlying pathology fascinating. I hated surgery because I found it boring, yet this perception has changed since I was allowed to scrub in for the first time in my life. I'd love to learn all the physiology behind anaesthetics, yet I find the working condition (sitting through surgery, listening to beeps, plotting obs charts) rather unbearable. However I won't mind working in ICU. I used to like psychiatry, but not anymore. I loved the stories of delusions, before I realise that most of them are just the same. The pace is just too slow for me. GP is ok, I had two brilliant placements, one OK and the current one horrible, and it's the horrible one which puts me off completely. The variety is there, but the support is not - you work on your own most of the time, which will depress me eventually. Lots of paperwork. Yet it's so rewarding when you become almost a part of someone's family, and home visit is the best part of being a GP. Most of the time the only treatment that patients needs is so simple - a pair of lending ears, good explanation and reassurance, which my current GP fails to realise.
So this is my elaborated answer to the annoying question. Please resist the temptation to ask me again.
.
Sunday, October 26
A fantastic last week of Rheumatology/Orthopaedics
Monday was so eventful. In the morning, I was at Hemsley House in Salford for a consultation process event with the PCT about the future of the Horizon Centre. I was so happy to meet Naj and Rebecca, and a few asylum seeker patients. I love talking to asylum seekers – I feel I interact with them really well and reminded me of the good times I spent doing voluntary work with refugees and the SSC in Horizon. I was glad to see so much support from the patients to the Horizon. And I am determined to do my bit for them as well. Plus there were free sandwiches. After that I attended the evening surgery back at the GP. Right after that I rushed back to Stopford building to deliver a workshop to some medical students on MDG 4&5: Maternal and child health, which we (Two friends and I) have been preparing for ages. It went really well, I think people enjoyed it and we received plenty of positive feedback. I too enjoyed it thoroughly, teamwork was great and it was a rewarding experience. At night, the PBL group went to Cloud 23 at the Hilton for Khai Wei’s birthday. I ordered a cocktail, I didn’t like it very much – smelled too alcoholic. But I really enjoyed the view, the amazing night scene of Manchester. Then we also went to a few more places. I was getting more tired then so I went home early.
On Tuesday, lecture only started at 1pm so all of us had a lay in, which was appropriate as I felt lightheaded as I woke up. I bought a pair of boots for myself – it felt nice to wear at the time but over the week I realize that the heels are simply too high for my liking. But I have to say it does look rather stylish. After the lecture, I went up to the orthopaedics and rheumatology wards and talked to one patient each (atypical gout and rheumatoid arthritis with vasculitis). I then went to the French class and reached home at 9pm.
On Wednesday, we started off with Rheumatology bedside teaching at 10am. I requested for knee examination today. Dr Herrick said ok and found a patient with knee signs for us. Then I was asked to come up and examine the patient’s knee. It was slightly nerve wrecking and I fluffed around for a bit. Yet I know it’s meant to be a teaching session, a good time for me to make mistakes so I’m not too bothered about it. We also saw a patient with ankylosing spondylitis. Next we went to the RA patient I met the day before. Dr Herrick found out that I have seen her before the day in my own free time. And she said that’s very commendable – my heart leaped in joy. So I told the group the lady’s history before everyone went on to examine her grossly deformed hand. After lunch, I attended Dr Herrick’s rheumatology clinic, which did not end until 6pm! I missed the Crossing Borders meeting as a result.
Thursday morning, I went to a fracture/orthopaedic clinic, and I'm glad I did because it was one of the most enjoyable clinic I have ever been to. It’s like me being back in A&E or the acute wards – I clerked the patients and then present it to the surgeons and see them together later on. The surgeons were really casual and friendly lot, and very flattering – the consultant said I know too much, that I know more than many of his SHOs do and that I should read the books less! Afternoon onwards was slightly duller; we had a group revision sessions in rheumatology and orthopaedics. After that I spent the small time gap to do some essential shopping – got mummy some free gift of facial products. Then I was off to the chorus rehearsal. We had a replacement conductor today and I learnt a few new things from him. I like the part we sang and I think my sight singing skill has improved a wee bit.
Friday morning was PBL. I brought some (unhealthy) breakfast for the group – Jaffa cake and Snickers, seeing that it’s the last PBL session for this rheumatology/orthopaedic rotation. It finished early. We were then informed that lunch time lecture was cancelled so others went home apart from Khai Wei and I. I said I wanted to go to theatre and Khai Wei followed. We went to the ward and clerked the patient about to go to theatre. I am so glad that we went. It was the same cool consultant and registrar that I met in clinic on Thursday who were operating. We saw the anaesthetist giving spinal anaesthetic. And then we were asked us to scrub up. I fumbled a bit as I have never scrubbed up before, but managed in the end. It was such a fun experience. I helped hold some retractors and hammer the prosthetic joint into the tibia.
On Saturday morning I went to another chorus rehearsal. It was really fun, although there were a few shouting from the conductor. I am so proud to be in soprano 2 – undoubtedly the best section in the entire choir. Later on, after a quick food shopping, I went to the gym to build up some muscles and increase my lung capacity. I then chatted with my family, and then made roast dinner for myself (which turned out yucky).
Today is Sunday. The clock goes backwards for an hour so I slept for an extra hour. I plan to have a relaxing study day today, maybe go to the gym for a bit.
.
On Tuesday, lecture only started at 1pm so all of us had a lay in, which was appropriate as I felt lightheaded as I woke up. I bought a pair of boots for myself – it felt nice to wear at the time but over the week I realize that the heels are simply too high for my liking. But I have to say it does look rather stylish. After the lecture, I went up to the orthopaedics and rheumatology wards and talked to one patient each (atypical gout and rheumatoid arthritis with vasculitis). I then went to the French class and reached home at 9pm.
On Wednesday, we started off with Rheumatology bedside teaching at 10am. I requested for knee examination today. Dr Herrick said ok and found a patient with knee signs for us. Then I was asked to come up and examine the patient’s knee. It was slightly nerve wrecking and I fluffed around for a bit. Yet I know it’s meant to be a teaching session, a good time for me to make mistakes so I’m not too bothered about it. We also saw a patient with ankylosing spondylitis. Next we went to the RA patient I met the day before. Dr Herrick found out that I have seen her before the day in my own free time. And she said that’s very commendable – my heart leaped in joy. So I told the group the lady’s history before everyone went on to examine her grossly deformed hand. After lunch, I attended Dr Herrick’s rheumatology clinic, which did not end until 6pm! I missed the Crossing Borders meeting as a result.
Thursday morning, I went to a fracture/orthopaedic clinic, and I'm glad I did because it was one of the most enjoyable clinic I have ever been to. It’s like me being back in A&E or the acute wards – I clerked the patients and then present it to the surgeons and see them together later on. The surgeons were really casual and friendly lot, and very flattering – the consultant said I know too much, that I know more than many of his SHOs do and that I should read the books less! Afternoon onwards was slightly duller; we had a group revision sessions in rheumatology and orthopaedics. After that I spent the small time gap to do some essential shopping – got mummy some free gift of facial products. Then I was off to the chorus rehearsal. We had a replacement conductor today and I learnt a few new things from him. I like the part we sang and I think my sight singing skill has improved a wee bit.
Friday morning was PBL. I brought some (unhealthy) breakfast for the group – Jaffa cake and Snickers, seeing that it’s the last PBL session for this rheumatology/orthopaedic rotation. It finished early. We were then informed that lunch time lecture was cancelled so others went home apart from Khai Wei and I. I said I wanted to go to theatre and Khai Wei followed. We went to the ward and clerked the patient about to go to theatre. I am so glad that we went. It was the same cool consultant and registrar that I met in clinic on Thursday who were operating. We saw the anaesthetist giving spinal anaesthetic. And then we were asked us to scrub up. I fumbled a bit as I have never scrubbed up before, but managed in the end. It was such a fun experience. I helped hold some retractors and hammer the prosthetic joint into the tibia.
On Saturday morning I went to another chorus rehearsal. It was really fun, although there were a few shouting from the conductor. I am so proud to be in soprano 2 – undoubtedly the best section in the entire choir. Later on, after a quick food shopping, I went to the gym to build up some muscles and increase my lung capacity. I then chatted with my family, and then made roast dinner for myself (which turned out yucky).
Today is Sunday. The clock goes backwards for an hour so I slept for an extra hour. I plan to have a relaxing study day today, maybe go to the gym for a bit.
.
Saturday, October 25
Old lady in orthopaedic clinic
On inspection: Index finger was missing on the right hand
Me: Why is one of your fingers missing here?
Old lady: My husband bit me. I had to had it removed
Me: (Speechless...)
Me: Why is one of your fingers missing here?
Old lady: My husband bit me. I had to had it removed
Me: (Speechless...)
Sunday, October 5
PBL dinner party
My PBL group had a potluck dinner on monday. I made 'Prawn cake mummy's special'.
Other food on the table were:
Other food on the table were:
That was a hell lot of food. We had 12 courses in total! Some of the people were so overwhelmed that they went back home and dreamt about the dinner.
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Monday, September 29
GP (1)
Sometimes sitting in with GP can be very frustrating. For a start, I resent the university forcing us to attend the GP every monday throughout the whole of the fourth year. That's a fifth of the time spent at the GP. And it has to be a full day - I was told off for going back to the hospital one monday when the GP let us off at lunch time. I'm not saying that there is nothing to learn in GP surgery. I just feel that our time as medical student is limited, I much rather be learning and seeing as many specialised things that I might not see again until I qualify as possible. For example, I spent the last four weeks attached to Neurology and I am still not sure if I am absolutely confident diagosing and managing neurological disorders. I thought four weeks were simply not enough to grasp everything in such a massive specialty - and this is worsened by compelling us to spend bloody 20% of the time seeing cough and cold, sick note, medication review etc. The community medical education advocates argue that the common things are what we are expected to face most of the time when we qualify. But people expect doctors to know not only common things, but also a breadth of weird and wonderful disease. Whether it's rare or common, it's irrelevant. I mean that's what people go to doctor, isn't it? Every sensible parent know sore throat in children is quite normal and may well be aware that bit of calpol, fluid and rest will suffice, but they see the doctor 'just to get it checked out'. I certainly want my doctor to have at least seen some very ill patient, so when he sees one himself, if he cannot diagnose it, he would at least think about it. There's an old saying in clinical medicine 'if you don't think about it, you'll never find it'. One day I must compile a statistics on the proportion of time we spend on each specialty throughout medical school.
GPs are not all bad. When I do get enthusiastic tutor, the day can be rather enjoyable, sometimes to the point of inspiring me to contemplate a career in GP. When I am allowed to do stuff, like taking history and examination, apply plaster, dip some urine or play with baby for example, I'd be even more elated as oxygen fills my dying brain. Unfortunately, medical students are shoved to the corner for the entire surgery most of the time.
This semester, the GP is a let down. He's alright - he goes through the PBL case with us before the start of surgery every morning. But he just rambles on and on. I like to talk and demonstrate my knowledge but I hardly have the opportunity to open my mouth. He's so patronising. We are fourth year now and he talks to us like first year students. More often than not, my monday morning freshness is killed just 10 minutes into his incoherant lecture. With the patients, his listening skill was awful (doesn't surprise me - it's all about him talking). And my goodness, the way he drags his sentences drive me up the wall! However, the good thing is that he does arrange patient with conditions relevant to our PBL case for us to meet each week. So PBL wise he's been quite helpful.
To be continued.
GPs are not all bad. When I do get enthusiastic tutor, the day can be rather enjoyable, sometimes to the point of inspiring me to contemplate a career in GP. When I am allowed to do stuff, like taking history and examination, apply plaster, dip some urine or play with baby for example, I'd be even more elated as oxygen fills my dying brain. Unfortunately, medical students are shoved to the corner for the entire surgery most of the time.
This semester, the GP is a let down. He's alright - he goes through the PBL case with us before the start of surgery every morning. But he just rambles on and on. I like to talk and demonstrate my knowledge but I hardly have the opportunity to open my mouth. He's so patronising. We are fourth year now and he talks to us like first year students. More often than not, my monday morning freshness is killed just 10 minutes into his incoherant lecture. With the patients, his listening skill was awful (doesn't surprise me - it's all about him talking). And my goodness, the way he drags his sentences drive me up the wall! However, the good thing is that he does arrange patient with conditions relevant to our PBL case for us to meet each week. So PBL wise he's been quite helpful.
To be continued.
Sunday, September 7
Gloom
Sorry about the somber post. Don't know why am I feeling so gloomy and grumpy lately. Maybe it's the weather. Manchester weather has been terrible!
Rain rain go away
Come again another day
Ah Yen wants to go out and play!
.
Rain rain go away
Come again another day
Ah Yen wants to go out and play!
.
Monday, September 1
Guilty conscience
I am beginning to doubt if I have made the right decision to work in this profession. I am a perfectionist, by nature and nurture. I hate mistakes. It used to take me very long to get over a tiny thing although I'm getting better at the art of ignorance (or any better word for it?).
There were many times when I have done things the wrong way and have result in some damage. I am going to give three examples:
1. Tanjung Rambutan visit while I was in college
It was a work experience visit in the forensic psychiatric ward. I found it extremely interesting talking to rapists, murderers and other offenders about their illness, One particular guy showed me the various long scars of self harm across his neck, tummy and wrists and how stigma from his family meant that he had to be locked up in the unit for the rest of his life eventhough he was cured (since his family was not prepared to receive him back home which was one of the conditions for discharge).
Then we went on to observe some consultations with the house officer. A guy was trying to convince us about him hearing voices from Erra Fazira (a local singer) and that they were getting married. I distinctly remembered that all of us - the doctor, the medical assistant and us the three students burst into laughter and couldn't stop laughing for another 5 minutes. The patient was reduced to tears that we thought it was a joke, and the medical assistant threatened to put him in seclusion if he was to throw a tantrum.
I didn't actually think it was unprofessional until recently when I thought back and realise how horrible was that for the patient. We were encouraging him to keep to telling his 'wedding plan' while continuing to laugh uncontrollably, as if watching a comedy. Sure, I can blame the more experienced staff for not setting the right example. But I wasn't coerced into following the crowd. I was genuinely amused with the patient's story and wasn't giving any thought about he would feel in response to my behaviour. Perhaps that was one of the early signs to suggest that I lack the human quality required of a good doctor.
2. Old man who loved his sago pudding
I don't know much about this old man's history as the ward doesn't give handover to auxillary nurses. After spending a few minutes with him, it was obvious that he was bed bound and he was trying hard to talk but I didn't understand most of what he said. Dysarthria? Could it be stroke? Anyway from his body language I could tell that he wanted the unopened sago pudding in front of him. So I opened it and put a spoonful in his mouth. It was quite a watery bowl of sago pudding. He seemed to enjoy it. Only that as soon as he tried to swallow, he coughed and made some gurgling noise. I instantly felt uncomfortable and hesitated. Before I could think, he was making gestures to want another spoonful. I looked around his table to see if there was any powder to thicken the fluid. There wasn't. So I gave him another spoon. The same thing happened again. He struggled to swallow. So I told him that I didn't think it would be a good idea to carry on. But he wouldn't take any of that. He really wanted some more, and was making more vigorous gestures for more of the pudding. I gave in. Then he choked again. Only then I decided that I must insist to stop and I explained to him why I did it. He looked really disheartened. I rarely see hospital patients with such good appetite. I felt sorry for taking away the pudding that he loved so much. I told his staff nurse what happened after that.
A few hours later I walked pass this old man, and I heard something funny. He was wheezing so loudly that I can hear it without a stethoscope. Shit - I've definitely given him aspiration pneumonia. Shit shit shit!
But there was more bad news to come. I was allocated to the same ward again a few weeks later when the staff told me that he has succumbed to a nasty chest infection and that he was dying. They are just trying to keep him as comfortable as possible. My heart sank. I was swamped with a terrible sense of guilt. I wanted to read his medical notes but I couldn't bring myself to. What if it really was me that made him go downhill to the point of disrepair? I tried to redeem myself on that shift by giving him good patiance and care. But in my heart I knew the damage has been done. I am really sorry.
3. The ligature made of paper towels
I was at a young people's unit of a psychiatric hospital. I hate working here. I have never heard more alarms going off or seen patients being restrained more often anywhere else. I find it awfully difficult to get through to teenagers, even for a normal conversation. On that occasion I thought it was not going to be too bad because I knew all of the patients having worked here not too long ago.
I shouldn't have been complacent at all. I brought a girl into the toilet. We were supposed to supervise them but I wasn't clear if I should have a clear view of them all the time. 'TURN AROUND', she shouted at me. I thought it was understandable to give her some privacy. She then went to the sink and washed her hands when she finished and we went out. I didn't notice anything suspicious.
About an hour later, one of the staff asked me if I saw her taking any paper towel out of the toilet. I said I didn't but I did admit that I wasn't really looking.
I was just walking along the corridor after dinner when I saw that girl with her hoodies over her face and upper body. She wouldn't answer anything I asked, and wouldn't let me see her face and neck. So help was summoned and four people were needed to restrain her to take the hoodies off her. It turned out that she had made a ligature by tying knots from several paper towels and she actually had the ligature around her neck!
Again, I was overcome with a deep sense of guilt. Given that she was able to physically resist four people while trying to remove the ligature, she probably wasn't dying in any way then. Yet I just can't get over the fact that (had we not caught it in time) she could have been died, and the reason would be me: because I didn't watch her properly in the toilet. Things like that really knock my confidence off. I don't think I would be going back to any young people's unit to work again. I can't bear to see things like this happening.
___________________________
I think I have been extremely naive to believe that to be a doctor is to help alleviate human suffering. Patients are always physically, mentally or emotionally vulnerable when they come into hospital. They often have lost independence and are at the mercy of the staff to help them around. And what do we do with this more often than not? We use to our advantage for our own convenience. It's just so easy for us to do harm, to be negligent, to make mistakes, to be ignorant. I always pride myself as patients' advocate. I know no one is perfect. But sometimes I find it hard to forgive myself. If a person dies because of me, what amount of forgiving is going to bring back someone's daughter or granddad or good friend? After all the things I have done do I still deserved to be trusted?
One of the GPs told me even after 30 years of experience, things like missing cancer diagnosis still happen to him once every two or three weeks. Does this mean that I HAVE to ACCEPT that mistakes just happen? Because I don't think I can practise medicine knowing that there is a chance that things will go wrong because of my incompetence. Maybe I should consider doing histopathology or something like that - that way at least I know that I am not directly responsible for a person's life.
Sorry if this piece doesn't sound coherent. My brain is churning.
.
There were many times when I have done things the wrong way and have result in some damage. I am going to give three examples:
1. Tanjung Rambutan visit while I was in college
It was a work experience visit in the forensic psychiatric ward. I found it extremely interesting talking to rapists, murderers and other offenders about their illness, One particular guy showed me the various long scars of self harm across his neck, tummy and wrists and how stigma from his family meant that he had to be locked up in the unit for the rest of his life eventhough he was cured (since his family was not prepared to receive him back home which was one of the conditions for discharge).
Then we went on to observe some consultations with the house officer. A guy was trying to convince us about him hearing voices from Erra Fazira (a local singer) and that they were getting married. I distinctly remembered that all of us - the doctor, the medical assistant and us the three students burst into laughter and couldn't stop laughing for another 5 minutes. The patient was reduced to tears that we thought it was a joke, and the medical assistant threatened to put him in seclusion if he was to throw a tantrum.
I didn't actually think it was unprofessional until recently when I thought back and realise how horrible was that for the patient. We were encouraging him to keep to telling his 'wedding plan' while continuing to laugh uncontrollably, as if watching a comedy. Sure, I can blame the more experienced staff for not setting the right example. But I wasn't coerced into following the crowd. I was genuinely amused with the patient's story and wasn't giving any thought about he would feel in response to my behaviour. Perhaps that was one of the early signs to suggest that I lack the human quality required of a good doctor.
2. Old man who loved his sago pudding
I don't know much about this old man's history as the ward doesn't give handover to auxillary nurses. After spending a few minutes with him, it was obvious that he was bed bound and he was trying hard to talk but I didn't understand most of what he said. Dysarthria? Could it be stroke? Anyway from his body language I could tell that he wanted the unopened sago pudding in front of him. So I opened it and put a spoonful in his mouth. It was quite a watery bowl of sago pudding. He seemed to enjoy it. Only that as soon as he tried to swallow, he coughed and made some gurgling noise. I instantly felt uncomfortable and hesitated. Before I could think, he was making gestures to want another spoonful. I looked around his table to see if there was any powder to thicken the fluid. There wasn't. So I gave him another spoon. The same thing happened again. He struggled to swallow. So I told him that I didn't think it would be a good idea to carry on. But he wouldn't take any of that. He really wanted some more, and was making more vigorous gestures for more of the pudding. I gave in. Then he choked again. Only then I decided that I must insist to stop and I explained to him why I did it. He looked really disheartened. I rarely see hospital patients with such good appetite. I felt sorry for taking away the pudding that he loved so much. I told his staff nurse what happened after that.
A few hours later I walked pass this old man, and I heard something funny. He was wheezing so loudly that I can hear it without a stethoscope. Shit - I've definitely given him aspiration pneumonia. Shit shit shit!
But there was more bad news to come. I was allocated to the same ward again a few weeks later when the staff told me that he has succumbed to a nasty chest infection and that he was dying. They are just trying to keep him as comfortable as possible. My heart sank. I was swamped with a terrible sense of guilt. I wanted to read his medical notes but I couldn't bring myself to. What if it really was me that made him go downhill to the point of disrepair? I tried to redeem myself on that shift by giving him good patiance and care. But in my heart I knew the damage has been done. I am really sorry.
3. The ligature made of paper towels
I was at a young people's unit of a psychiatric hospital. I hate working here. I have never heard more alarms going off or seen patients being restrained more often anywhere else. I find it awfully difficult to get through to teenagers, even for a normal conversation. On that occasion I thought it was not going to be too bad because I knew all of the patients having worked here not too long ago.
I shouldn't have been complacent at all. I brought a girl into the toilet. We were supposed to supervise them but I wasn't clear if I should have a clear view of them all the time. 'TURN AROUND', she shouted at me. I thought it was understandable to give her some privacy. She then went to the sink and washed her hands when she finished and we went out. I didn't notice anything suspicious.
About an hour later, one of the staff asked me if I saw her taking any paper towel out of the toilet. I said I didn't but I did admit that I wasn't really looking.
I was just walking along the corridor after dinner when I saw that girl with her hoodies over her face and upper body. She wouldn't answer anything I asked, and wouldn't let me see her face and neck. So help was summoned and four people were needed to restrain her to take the hoodies off her. It turned out that she had made a ligature by tying knots from several paper towels and she actually had the ligature around her neck!
Again, I was overcome with a deep sense of guilt. Given that she was able to physically resist four people while trying to remove the ligature, she probably wasn't dying in any way then. Yet I just can't get over the fact that (had we not caught it in time) she could have been died, and the reason would be me: because I didn't watch her properly in the toilet. Things like that really knock my confidence off. I don't think I would be going back to any young people's unit to work again. I can't bear to see things like this happening.
___________________________
I think I have been extremely naive to believe that to be a doctor is to help alleviate human suffering. Patients are always physically, mentally or emotionally vulnerable when they come into hospital. They often have lost independence and are at the mercy of the staff to help them around. And what do we do with this more often than not? We use to our advantage for our own convenience. It's just so easy for us to do harm, to be negligent, to make mistakes, to be ignorant. I always pride myself as patients' advocate. I know no one is perfect. But sometimes I find it hard to forgive myself. If a person dies because of me, what amount of forgiving is going to bring back someone's daughter or granddad or good friend? After all the things I have done do I still deserved to be trusted?
One of the GPs told me even after 30 years of experience, things like missing cancer diagnosis still happen to him once every two or three weeks. Does this mean that I HAVE to ACCEPT that mistakes just happen? Because I don't think I can practise medicine knowing that there is a chance that things will go wrong because of my incompetence. Maybe I should consider doing histopathology or something like that - that way at least I know that I am not directly responsible for a person's life.
Sorry if this piece doesn't sound coherent. My brain is churning.
.
Sunday, August 31
Petronas and petrol price hike
Letter 1
Dear all,
After reading all the chain mails and blogs, I feel called to reply, because of the relentless attacks and allegations -- most of which are inaccurate or baseless -- against PETRONAS.
PETRONAS' STAFF SALARY & BONUS
1) The salaries paid to PETRONAS' employees are not as high as people think. At best, they are just industry average. And these are not attractive enough for some who left PETRONAS to find work at other companies (mainly from the Middle East) which are willing to pay more. Why do they pay more? The oil and gas industry worldwide has been facing acute shortage of qualified or experienced personnel, so most companies are willing to pay lots of money to entice and pinch staff from their competitors.
Bonus? There has NEVER been a bonus amounting to 6 months or 12 months throughout the 33 years. On average, it is 2 months. But don't ever think we don't deserve it. We more than deserve it. A lot of us work really hard, some in the most extreme of conditions. Those who have been to and worked in northern Sudan, for example, would testify that it's like working in a huge blower oven. Southern Sudan, on the other hand, is almost all swamps and mud. Imagine having to go through that kind of heat, or waddling in muddy swamps, day in and day out.
QUALITY OF CRUDE & REFINED PRODUCTS
2) Malaysia produces about 600,000 barrels of crude oil per day (and about 100,000 barrels condensate). Of this crude volume, 339,000 barrels are refined locally for local consumption. The rest is exported (and yes, because it has lower sulphur content it fetches higher prices).
Malaysia also imports about 230,000 barrels of crude oil per day, mainly from the Middle East, to be refined here. This crude oil contains higher sulphur and is less expensive (so the country gains more by exporting our crudes). In Malaysia, this crude is processed by PETRONAS at its second refinery in Melaka, and also by Shell at its Port Dickson refinery.
Different refineries are built and configurated to refine different types of crude. And each crude type yields different percentage of products (diesel, gasoline, kerosene, cooking gas etc) per barrel.
But most importantly, products that come out at the end of the refining process have the same good quality regardless of the crude types. That's why PETRONAS, Shell and Exxon Mobil share the same pipeline to transport the finished products from their refineries to a distribution centre in the Klang Valley. The three companies collect the products at this centre accordingly to be distributed to their respective distribution networks. What makes PETRONAS' petrol different from Shell's, for example, is the additive that each company adds.
PETRONAS' ROLE, FUNCTION & CONTRIBUTION
3) A lot of people also do not understand the role and function of PETRONAS, which is essentially a company, a business entity, which operates on a commercial manner, to mainly generate income and value for its shareholder. In this case, PETRONAS' shareholder is the Government.
In 1974, when PETRONAS was set up, the Government gave PETRONAS RM10 million (peanuts, right?) as seed capital. From 1974 to 2007, PETRONAS made RM570 billion in accumulated profits, and returned to the Government a total of RM335.7 billion. That is about 65% of the profits. That means for every RM1 that PETRONAS makes, 65 sen goes back to the Government.
Last year, PETRONAS made a pre-tax profit of RM86.8 billion. The amount given back to the Government (in royalty, dividends, corporate income tax, petroleum products income tax and export duty) was RM52.3 billion. The rest of the profit was used to pay off minority interests and taxes in foreign countries (about RM7.8 billion - PETRONAS now operates in more than 30 countries), and the remaining RM26.7 billion was reinvested. The amount reinvested seems a lot, but the oil and gas industry is technology- and capital-intensive. Costs have gone up exponentially in the last couple of years. Previously, to drill a well, it cost about US$3 million; now it costs US$7 million. The use of rigs was US$200,000 a day a couple of years ago; now it costs US$600,000 a day.
A lot of people also do not realise that the amount returned by PETRONAS to the Government makes up 35% of the Government's total annual income, to be used by the Government for expenditures, development, operations, and yes, for the various subsidies. That means for every RM1 the Government makes, 35 sen is contributed by PETRONAS.
So, instead of asking what happens to PETRONAS' money or profits, people should be questioning how the money paid by PETRONAS to the Government is allocated.
CRUDE EXPORTS & FUEL PRICES
4) A lot of people also ask, why Malaysia exports its crude oil. Shouldn't we just stop exporting and sell at cheaper prices to local refiners? If Malaysia is an oil exporting country, why can't we sell petrol or diesel at cheaper prices like other oil producing countries in the Middle East?
I guess I don't have to answer the first couple of questions. It's simple economics, and crude oil is a global commodity.
Why can't we sell petrol and diesel at lower prices like in the Middle East? Well, comparing Saudi Arabia and other big producers to Malaysia is like comparing kurma to durian, because these Middle Eastern countries have much, much, much bigger oil and gas reserves.
Malaysia has only 5.4 billion barrels of oil reserves, and about 89 trillion cubic feet of gas. Compare that to Saudi Arabia's 260 billion barrels of oil and 240 trillion cubic feet of gas.
Malaysia only produces 600,000 barrels per day of oil. Saudi Arabia produces 9 million barrels per day. At this rate, Saudi Arabia's crude oil sales revenue could amount to US$1.2 billion per day! At this rate, it can practically afford almost everything -- free education, healthcare, etc, and subsidies -- for its people.
But if we look at these countries closely, they have in the past few years started to come up with policies and strategies designed to prolong their reserves and diversify their income bases. In this sense, Malaysia (and PETRONAS) has had a good head start, as we have been doing this a long time.
Fuel prices in Malaysia is controlled by the Government based on a formula under the Automatic Pricing Mechanism introduced more than a couple of decades ago. It is under this mechanism that the complex calculation of prices is made, based on the actual cost of petrol or diesel, the operating costs, margin for dealers, margin for retail oil companies (including PETRONAS Dagangan Bhd) and the balancing number of duty or subsidy. No retail oil companies or dealers actually make money from the hike of the fuel prices. Oil companies pay for the products at market prices, but have to sell low, so the Government reimburses the difference -- thus subsidy.
Subsidy as a concept is OK as long as it benefits the really deserving segment of the population. But there has to be a limit to how much and how long the Government should bear and sustain subsidy. An environment where prices are kept artificially low indefinitely will not do anyone any good. That's why countries like Indonesia are more pro-active in removing subsidies. Even Vietnam (which is a socialist country, by the way) is selling fuel at market prices.
PETRONAS & TRANSPARENCY
5) I feel I also need to say something on the allegation that PETRONAS is not transparent in terms of its accounts, business transactions etc.
PETRONAS is first and foremost a company, operating under the rules and regulations of the authorities including the Registrar of Companies, and the Securities Commission and Bursa Malaysia for its listed four subsidiaries (PETRONAS Dagangan Bhd, PETRONAS Gas Bhd, MISC Bhd and KLCC Property Holdings Bhd.
PETRONAS the holding company produces annual reports which are made to whomever wants them, and are distributed to many parties and places; including to the library at the Parliament House for perusal and reading pleasure of all Yang Berhormat MPs (if they care to read). PETRONAS also makes the annual report available on its website, for those who bother to look. The accounts are duly audited.
The website also contains a lot of useful information, if people really care to find out. Although PETRONAS is not listed on Bursa Malaysia, for all intents and purposes, it could be considered a listed entity as its bonds and financial papers are traded overseas. This requires scrutiny from investors, and from rating agencies such as Standard & Poor and Moody's.
BOYCOTT PETRONAS?
6) The last time I checked, this is still a democratic country, where people are free to spend their money wherever they like.
For those who like to see more of the money that they spend go back to the local economy and benefiting their fellow Malaysians, perhaps they should consider sticking to local products or companies.
For those who like to see that the money they spend go back to foreign shareholders of the foreign companies overseas, they should continue buying foreign products.
FINAL WORD (FOR TODAY)
I'm sorry this is rather long, but I just have to convey it. I hope this would help some of you out there understand something. The oil and gas industry, apart from being very capital intensive, is also very complex and volatile. I'm learning new things almost every single day.
Appreciate if you could help to forward this response to as many contacts as possible to counter the subversive proposal out there.
Thank you.
Wilson Lee Gain Loon (CAU_MEDIARELATIONS/PETH)
Letter 2
Do what you like.
The price of gasoline at the petrol station is set by the Government, not PETRONAS. PETRONAS has done its patriotic duty by paying the dividends, royalties, corporate tax, petroleum tax etc to the Government for YOUR benefit (rakyat lah).
And bear in mind that 30% of its revenue comes from overseas operations, thus bringing in foreign exchange to the country.
OK. Assuming that you buy this idea proposed by whomever it was.
So PETRONAS will have reduced revenues. Bear in mind that the costs of operations are also increasing. So the profits are reduced. Then PETRONAS and other oil companies pay less tax.Then the Government will have less revenue. (Note: at least 40% of Government revenue for 2007 came from the oil industry). With less revenue, there will be less Government projects (you can then forget about bridges and highways, and rail tracks, and smart schools and not-so-smart universities, and hospitals, etc). So contractors and consultants, and con-sultans and con-cronies will cry and scream. Makan batu lah..
The Government has already announced freezing of recruitment. So, many new graduates will be unemployed. Makan batu lagi. Maggi mee pun tak mampu dah. Later, all sorts of allowances for civil servants will have to be withdrawn. Treasury tak cukup duit.
On top of that the oil industry may have to scale back many of its new investments, totaling about 45 billion ringgit over the next few years. Contractors, service providers, steel fabricators, maritime service providers etc will join the ratapan tangisan – no jobs.
Don’t forget that PETRONAS is sponsoring thousands of students in universities and even high schools – at any one time there are more than 4,500 university students being sponsored by PETRONAS in Malaysian universities and overseas. Also more than 2,000 high school children receive minor scholarships – children of poor families.
Kalau PERTRONAS tak ada duit, kesian lah mereka di atas tu. Shall I ask them to see the proposer of this idea (to boycott PETRONAS) and seek help from them instead?
So, it is to YOUR benefit that you make sure PETRONAS keeps making enough money to support YOUR Government so that your children can continue to go to school without paying for fees and books, and to go to universities at peanuts rates.
CONCLUSION: Help yourself and your family and your country by making sure that PETRONAS keeps making profits. Go to the nearest PETRONAS station and fill up now!! Don’t forget that if you go to non-Petronas station, the profits that these companies get will go their shareholders OVERSEAS.
So, be patriotic. Do your duty.
Go to PETRONAS!!
(I hope you guys will help to send this response to as many contacts as possible to counter this subversive proposal).
Rosti B Saruwono - Datuk Dr (VP_Edu/PETH)
Taken from http://www.karthiben.blogspot.com/
Dear all,
After reading all the chain mails and blogs, I feel called to reply, because of the relentless attacks and allegations -- most of which are inaccurate or baseless -- against PETRONAS.
PETRONAS' STAFF SALARY & BONUS
1) The salaries paid to PETRONAS' employees are not as high as people think. At best, they are just industry average. And these are not attractive enough for some who left PETRONAS to find work at other companies (mainly from the Middle East) which are willing to pay more. Why do they pay more? The oil and gas industry worldwide has been facing acute shortage of qualified or experienced personnel, so most companies are willing to pay lots of money to entice and pinch staff from their competitors.
Bonus? There has NEVER been a bonus amounting to 6 months or 12 months throughout the 33 years. On average, it is 2 months. But don't ever think we don't deserve it. We more than deserve it. A lot of us work really hard, some in the most extreme of conditions. Those who have been to and worked in northern Sudan, for example, would testify that it's like working in a huge blower oven. Southern Sudan, on the other hand, is almost all swamps and mud. Imagine having to go through that kind of heat, or waddling in muddy swamps, day in and day out.
QUALITY OF CRUDE & REFINED PRODUCTS
2) Malaysia produces about 600,000 barrels of crude oil per day (and about 100,000 barrels condensate). Of this crude volume, 339,000 barrels are refined locally for local consumption. The rest is exported (and yes, because it has lower sulphur content it fetches higher prices).
Malaysia also imports about 230,000 barrels of crude oil per day, mainly from the Middle East, to be refined here. This crude oil contains higher sulphur and is less expensive (so the country gains more by exporting our crudes). In Malaysia, this crude is processed by PETRONAS at its second refinery in Melaka, and also by Shell at its Port Dickson refinery.
Different refineries are built and configurated to refine different types of crude. And each crude type yields different percentage of products (diesel, gasoline, kerosene, cooking gas etc) per barrel.
But most importantly, products that come out at the end of the refining process have the same good quality regardless of the crude types. That's why PETRONAS, Shell and Exxon Mobil share the same pipeline to transport the finished products from their refineries to a distribution centre in the Klang Valley. The three companies collect the products at this centre accordingly to be distributed to their respective distribution networks. What makes PETRONAS' petrol different from Shell's, for example, is the additive that each company adds.
PETRONAS' ROLE, FUNCTION & CONTRIBUTION
3) A lot of people also do not understand the role and function of PETRONAS, which is essentially a company, a business entity, which operates on a commercial manner, to mainly generate income and value for its shareholder. In this case, PETRONAS' shareholder is the Government.
In 1974, when PETRONAS was set up, the Government gave PETRONAS RM10 million (peanuts, right?) as seed capital. From 1974 to 2007, PETRONAS made RM570 billion in accumulated profits, and returned to the Government a total of RM335.7 billion. That is about 65% of the profits. That means for every RM1 that PETRONAS makes, 65 sen goes back to the Government.
Last year, PETRONAS made a pre-tax profit of RM86.8 billion. The amount given back to the Government (in royalty, dividends, corporate income tax, petroleum products income tax and export duty) was RM52.3 billion. The rest of the profit was used to pay off minority interests and taxes in foreign countries (about RM7.8 billion - PETRONAS now operates in more than 30 countries), and the remaining RM26.7 billion was reinvested. The amount reinvested seems a lot, but the oil and gas industry is technology- and capital-intensive. Costs have gone up exponentially in the last couple of years. Previously, to drill a well, it cost about US$3 million; now it costs US$7 million. The use of rigs was US$200,000 a day a couple of years ago; now it costs US$600,000 a day.
A lot of people also do not realise that the amount returned by PETRONAS to the Government makes up 35% of the Government's total annual income, to be used by the Government for expenditures, development, operations, and yes, for the various subsidies. That means for every RM1 the Government makes, 35 sen is contributed by PETRONAS.
So, instead of asking what happens to PETRONAS' money or profits, people should be questioning how the money paid by PETRONAS to the Government is allocated.
CRUDE EXPORTS & FUEL PRICES
4) A lot of people also ask, why Malaysia exports its crude oil. Shouldn't we just stop exporting and sell at cheaper prices to local refiners? If Malaysia is an oil exporting country, why can't we sell petrol or diesel at cheaper prices like other oil producing countries in the Middle East?
I guess I don't have to answer the first couple of questions. It's simple economics, and crude oil is a global commodity.
Why can't we sell petrol and diesel at lower prices like in the Middle East? Well, comparing Saudi Arabia and other big producers to Malaysia is like comparing kurma to durian, because these Middle Eastern countries have much, much, much bigger oil and gas reserves.
Malaysia has only 5.4 billion barrels of oil reserves, and about 89 trillion cubic feet of gas. Compare that to Saudi Arabia's 260 billion barrels of oil and 240 trillion cubic feet of gas.
Malaysia only produces 600,000 barrels per day of oil. Saudi Arabia produces 9 million barrels per day. At this rate, Saudi Arabia's crude oil sales revenue could amount to US$1.2 billion per day! At this rate, it can practically afford almost everything -- free education, healthcare, etc, and subsidies -- for its people.
But if we look at these countries closely, they have in the past few years started to come up with policies and strategies designed to prolong their reserves and diversify their income bases. In this sense, Malaysia (and PETRONAS) has had a good head start, as we have been doing this a long time.
Fuel prices in Malaysia is controlled by the Government based on a formula under the Automatic Pricing Mechanism introduced more than a couple of decades ago. It is under this mechanism that the complex calculation of prices is made, based on the actual cost of petrol or diesel, the operating costs, margin for dealers, margin for retail oil companies (including PETRONAS Dagangan Bhd) and the balancing number of duty or subsidy. No retail oil companies or dealers actually make money from the hike of the fuel prices. Oil companies pay for the products at market prices, but have to sell low, so the Government reimburses the difference -- thus subsidy.
Subsidy as a concept is OK as long as it benefits the really deserving segment of the population. But there has to be a limit to how much and how long the Government should bear and sustain subsidy. An environment where prices are kept artificially low indefinitely will not do anyone any good. That's why countries like Indonesia are more pro-active in removing subsidies. Even Vietnam (which is a socialist country, by the way) is selling fuel at market prices.
PETRONAS & TRANSPARENCY
5) I feel I also need to say something on the allegation that PETRONAS is not transparent in terms of its accounts, business transactions etc.
PETRONAS is first and foremost a company, operating under the rules and regulations of the authorities including the Registrar of Companies, and the Securities Commission and Bursa Malaysia for its listed four subsidiaries (PETRONAS Dagangan Bhd, PETRONAS Gas Bhd, MISC Bhd and KLCC Property Holdings Bhd.
PETRONAS the holding company produces annual reports which are made to whomever wants them, and are distributed to many parties and places; including to the library at the Parliament House for perusal and reading pleasure of all Yang Berhormat MPs (if they care to read). PETRONAS also makes the annual report available on its website, for those who bother to look. The accounts are duly audited.
The website also contains a lot of useful information, if people really care to find out. Although PETRONAS is not listed on Bursa Malaysia, for all intents and purposes, it could be considered a listed entity as its bonds and financial papers are traded overseas. This requires scrutiny from investors, and from rating agencies such as Standard & Poor and Moody's.
BOYCOTT PETRONAS?
6) The last time I checked, this is still a democratic country, where people are free to spend their money wherever they like.
For those who like to see more of the money that they spend go back to the local economy and benefiting their fellow Malaysians, perhaps they should consider sticking to local products or companies.
For those who like to see that the money they spend go back to foreign shareholders of the foreign companies overseas, they should continue buying foreign products.
FINAL WORD (FOR TODAY)
I'm sorry this is rather long, but I just have to convey it. I hope this would help some of you out there understand something. The oil and gas industry, apart from being very capital intensive, is also very complex and volatile. I'm learning new things almost every single day.
Appreciate if you could help to forward this response to as many contacts as possible to counter the subversive proposal out there.
Thank you.
Wilson Lee Gain Loon (CAU_MEDIARELATIONS/PETH)
Letter 2
Do what you like.
The price of gasoline at the petrol station is set by the Government, not PETRONAS. PETRONAS has done its patriotic duty by paying the dividends, royalties, corporate tax, petroleum tax etc to the Government for YOUR benefit (rakyat lah).
And bear in mind that 30% of its revenue comes from overseas operations, thus bringing in foreign exchange to the country.
OK. Assuming that you buy this idea proposed by whomever it was.
So PETRONAS will have reduced revenues. Bear in mind that the costs of operations are also increasing. So the profits are reduced. Then PETRONAS and other oil companies pay less tax.Then the Government will have less revenue. (Note: at least 40% of Government revenue for 2007 came from the oil industry). With less revenue, there will be less Government projects (you can then forget about bridges and highways, and rail tracks, and smart schools and not-so-smart universities, and hospitals, etc). So contractors and consultants, and con-sultans and con-cronies will cry and scream. Makan batu lah..
The Government has already announced freezing of recruitment. So, many new graduates will be unemployed. Makan batu lagi. Maggi mee pun tak mampu dah. Later, all sorts of allowances for civil servants will have to be withdrawn. Treasury tak cukup duit.
On top of that the oil industry may have to scale back many of its new investments, totaling about 45 billion ringgit over the next few years. Contractors, service providers, steel fabricators, maritime service providers etc will join the ratapan tangisan – no jobs.
Don’t forget that PETRONAS is sponsoring thousands of students in universities and even high schools – at any one time there are more than 4,500 university students being sponsored by PETRONAS in Malaysian universities and overseas. Also more than 2,000 high school children receive minor scholarships – children of poor families.
Kalau PERTRONAS tak ada duit, kesian lah mereka di atas tu. Shall I ask them to see the proposer of this idea (to boycott PETRONAS) and seek help from them instead?
So, it is to YOUR benefit that you make sure PETRONAS keeps making enough money to support YOUR Government so that your children can continue to go to school without paying for fees and books, and to go to universities at peanuts rates.
CONCLUSION: Help yourself and your family and your country by making sure that PETRONAS keeps making profits. Go to the nearest PETRONAS station and fill up now!! Don’t forget that if you go to non-Petronas station, the profits that these companies get will go their shareholders OVERSEAS.
So, be patriotic. Do your duty.
Go to PETRONAS!!
(I hope you guys will help to send this response to as many contacts as possible to counter this subversive proposal).
Rosti B Saruwono - Datuk Dr (VP_Edu/PETH)
Taken from http://www.karthiben.blogspot.com/
Friday, August 29
Back to uni
I hate being back to uni. I'm so tired. Trying to overhaul my sleep pattern. And trying to overcome the residual laziness from holiday. Some many other things about hating to start again. Too many.
Thursday, August 21
Angry
I don't usually get angry when I'm at work. The hospital that I normally work at is fantastic, and I think the patients in this hospital are very lucky to receive such great care. Today was an exception.
H is a 94 year old man who has 'deteriorated' and 'dying'. Eventhough he couldn't express himself in words, if he is in distress, his body language would tell. It was 10 minutes before the end of my shift when I discovered his hands stained with poo, so was his blankets. He was in a mess. I looked at the clock. There was no way I could clean him up in 10 minutes on my own. So I asked for help from a permanent staff, she told me to ask the night staff as they had begin their shift 5 minutes ago. But the night staff said no. They were making themselves a brew and I had to ask another day staff (agency) who kindly agreed to help. We both went home 15 minutes later than we were supposed to.
I didn't mind staying longer to help a patient in need. I just felt bad for dragging the other girl along. The thing is, how can anyone prioritize having a cup of tea over cleaning up a dying patient literally covered in poo? That just left me fuming for a bit. I could have left H sleeping on his poo and go off duty, but I just couldn't do it. I really can't say for others, but if I'm the one dying, I won't want to be left in that state at all. And I believe in karma if I choose to ignore, things will get back on me in one way or another.
I think I did the right thing and had the right to be slightly angry.
H is a 94 year old man who has 'deteriorated' and 'dying'. Eventhough he couldn't express himself in words, if he is in distress, his body language would tell. It was 10 minutes before the end of my shift when I discovered his hands stained with poo, so was his blankets. He was in a mess. I looked at the clock. There was no way I could clean him up in 10 minutes on my own. So I asked for help from a permanent staff, she told me to ask the night staff as they had begin their shift 5 minutes ago. But the night staff said no. They were making themselves a brew and I had to ask another day staff (agency) who kindly agreed to help. We both went home 15 minutes later than we were supposed to.
I didn't mind staying longer to help a patient in need. I just felt bad for dragging the other girl along. The thing is, how can anyone prioritize having a cup of tea over cleaning up a dying patient literally covered in poo? That just left me fuming for a bit. I could have left H sleeping on his poo and go off duty, but I just couldn't do it. I really can't say for others, but if I'm the one dying, I won't want to be left in that state at all. And I believe in karma if I choose to ignore, things will get back on me in one way or another.
I think I did the right thing and had the right to be slightly angry.
Friday, August 15
Olympics
Just watched the men badminton single's semifinal which featured top Malaysian player Lee Chong Wei. Gosh it was so exciting to watch. I kept jumping up and down, huffing and puffing, cheering and shouting, clapping and banging my table. It's funny to listen to those BBC commentators talking. They kept saying that Lee is 'a reactive player', 'lack urgency', 'passive' etc and I kept shouting 'shut up you two!', 'don't say things like that about my countryman!'. It was a really good match. Finally when Chong Wei won, I really felt for him and there were tears in my eye. I sincerely hope he'll go all out and win the gold back for Malaysia!
MALAYSIA BOLEH!
MALAYSIA BOLEH!
Monday, August 11
Nightmare
I don't usually remember my dream but last night was an exception. In the ward I was working yesterday, there was a patient, RH, who was a bed bound patient, confused and noisy. He kept shouting very loudly for attention. He wanted help to make him more comfortable, which required arranging the pillows and moving him up the bed. I tried my best but he still wasn't comfy. So I asked for someone else to help me. But everyone else was busy, and later on I became busy with other patients as well. I told him I'd be back but I just couldn't get anyone else to help me. So he was left there shouting on top of his voice. The other nurses told me to just ignore him. And last night, I dreamt that he died. I was cleaning his room after he'd gone. And I distinctly remember feeling so guilty.
This must be the worst kind of nightmare that a person with my job (with conscience) can have, knowing that I have not done my best to make sure a person die a good death. It has actually happened once in real life. During the first week of my clinical year, this old man kept telling us that he was in pain and he was not comfortable at all. We tried to make him comfortable to no avail. So he kept complaining. And the other nurses told us to ignore him. On the next day when I came on my shift, his bed was empty. Apparently he passed away the night before. I remembered being so overwhelmed by a strong feeling of sadness and guilt. That's why after that I always take any patient's concern genuinely. It doesn't matter whether they are confused or manipulative. If a person is in pain, he or she will know best.
A while ago, we had a group discussion on an interesting topic on the role of a doctor. When I say 'Hi, my name is Yee Yen and I am your doctor', what does that actually mean? Should a doctor only be dealing with the medical side of things and leave everything else to the designated professionals? I once had spent half an hour holding an old lady's hand so she could fall asleep without fear - would that be little too much of a 'touchy-feely' job for a doctor to do? I don't think so. I think a doctor is part of the big team of health care professionals who work towards the overall well being of a patient, and a doctor should do everything he or she can to support the colleagues. And most of all I think being compassionate is just the basic attribute that every health care professionals should have. If one can't demonstrate that, he or she doesn't deserve a patient's trust to work as a health professional.
This must be the worst kind of nightmare that a person with my job (with conscience) can have, knowing that I have not done my best to make sure a person die a good death. It has actually happened once in real life. During the first week of my clinical year, this old man kept telling us that he was in pain and he was not comfortable at all. We tried to make him comfortable to no avail. So he kept complaining. And the other nurses told us to ignore him. On the next day when I came on my shift, his bed was empty. Apparently he passed away the night before. I remembered being so overwhelmed by a strong feeling of sadness and guilt. That's why after that I always take any patient's concern genuinely. It doesn't matter whether they are confused or manipulative. If a person is in pain, he or she will know best.
A while ago, we had a group discussion on an interesting topic on the role of a doctor. When I say 'Hi, my name is Yee Yen and I am your doctor', what does that actually mean? Should a doctor only be dealing with the medical side of things and leave everything else to the designated professionals? I once had spent half an hour holding an old lady's hand so she could fall asleep without fear - would that be little too much of a 'touchy-feely' job for a doctor to do? I don't think so. I think a doctor is part of the big team of health care professionals who work towards the overall well being of a patient, and a doctor should do everything he or she can to support the colleagues. And most of all I think being compassionate is just the basic attribute that every health care professionals should have. If one can't demonstrate that, he or she doesn't deserve a patient's trust to work as a health professional.
Tuesday, August 5
Mathematics in french
We learnt simple mathematics in french today and it had been very very difficult. The process of thought just takes so long. In english, malay or mandarin, I can do 34-12 = 22 in 2 seconds. In french, it took me about 2 minutes to work out and say out the whole thing. I have to change the number from french to english, then calculate in english then translate the answer into french again. Seriously math has never been this hard for me ever...
Monday, August 4
Testosterone shift
I don't like working in psychiatry wards. The job itself may seem relaxing but I just feel mentally drained each time I finish a mental health shift. I was working in a male psychiatric intensive care unit (PICU) today. I was really scared when I first went in (but I was experienced enough to put on a confident face) because all the guys looked so strong and muscular, and they talked about how they want to kill each other all the time.
I had a good chat with T, who was charged with a criminal offence and held in for psychiatric review. He is just one year older than me and I hated him calling me 'miss'. Then D, a really muscular big guy, came along to chat with me. But then, I felt really uncomfortable when he wanted to share a chair with me and asked me to be his girlfriend. When D started putting his arm around my shoulders, I genuinely felt I wanted to get off, and the other two staff told him to keep his hands off me as well. He did, but he just wouldn't stop asking me to go out and give him my mobile number. At that time I was doing a 1:1 observation with T, but T walked away and went to talk to another staff. So I followed. Apparently he was upset about D's indecency towards me. He told me to keep on smiling and not let D get me down, but in fact it he who let D bring him down. He was at the verge of puncing D. I was so happy that he was able to control himself. However later on, they both nearly broke out into a big fight again because of this.
I felt slightly guilty. I suppose it's partly my fault. It wasn't because I was flitatious in any way (I do not wear make up, I wear conservative clothes and my hair is always tied on a pony tail. I take 5 minutes to dress). I am just never good at asserting myself. I am too nice to people. I said 'no' to D, but when he said 'come on.. why.. (blablabla)' I didn't reaffirm myself with another firm 'no'. But I was scared, the other staff said he has a problem with authority (and I can tell from interacting with him), what if he starts to be aggressive to me when I contradict him? I seriously didn't know what to do. I just tried not to react too much when he tried to get my attention. Anyway I finished my shift unharmed. What a relief...
Despite what I've said earlier, this has been one of my best shift. The reason being that I was able to have a proper conversation with T, not the usual patronising, 'pretending to listen but not really taking in' that I do with many patients. Maybe it's because we are of a similar age group, so we can relate to each other more. Today I've had a fantastic lesson listening to an experienced nurse talking therapeutically to T, and I really respected him for being able to speak so wisely. But I think I'm just too young to speak like that, for if anything like that comes out of my mouth it would sound more patronising than actual wisdom.
Finally I just want to mention that my favourite psychiatric illness is bipolar disorder. Extremely fascinating!
I had a good chat with T, who was charged with a criminal offence and held in for psychiatric review. He is just one year older than me and I hated him calling me 'miss'. Then D, a really muscular big guy, came along to chat with me. But then, I felt really uncomfortable when he wanted to share a chair with me and asked me to be his girlfriend. When D started putting his arm around my shoulders, I genuinely felt I wanted to get off, and the other two staff told him to keep his hands off me as well. He did, but he just wouldn't stop asking me to go out and give him my mobile number. At that time I was doing a 1:1 observation with T, but T walked away and went to talk to another staff. So I followed. Apparently he was upset about D's indecency towards me. He told me to keep on smiling and not let D get me down, but in fact it he who let D bring him down. He was at the verge of puncing D. I was so happy that he was able to control himself. However later on, they both nearly broke out into a big fight again because of this.
I felt slightly guilty. I suppose it's partly my fault. It wasn't because I was flitatious in any way (I do not wear make up, I wear conservative clothes and my hair is always tied on a pony tail. I take 5 minutes to dress). I am just never good at asserting myself. I am too nice to people. I said 'no' to D, but when he said 'come on.. why.. (blablabla)' I didn't reaffirm myself with another firm 'no'. But I was scared, the other staff said he has a problem with authority (and I can tell from interacting with him), what if he starts to be aggressive to me when I contradict him? I seriously didn't know what to do. I just tried not to react too much when he tried to get my attention. Anyway I finished my shift unharmed. What a relief...
Despite what I've said earlier, this has been one of my best shift. The reason being that I was able to have a proper conversation with T, not the usual patronising, 'pretending to listen but not really taking in' that I do with many patients. Maybe it's because we are of a similar age group, so we can relate to each other more. Today I've had a fantastic lesson listening to an experienced nurse talking therapeutically to T, and I really respected him for being able to speak so wisely. But I think I'm just too young to speak like that, for if anything like that comes out of my mouth it would sound more patronising than actual wisdom.
Finally I just want to mention that my favourite psychiatric illness is bipolar disorder. Extremely fascinating!
Stripping yourself naked, emotionally
S is a driver of the nursing agency I work for. He brings us to and from hospital which is miles away. I am not much of a chatter in a minibus especially as I feel sick really quickly. So I've not really know him much eventhough we've met on quite a few occasions now, but I know he's a really nice fella. Today he picked me up first and we spent about 20 minutes waiting outside another place for the other carers. I thought it would be awkward to just keep quiet, so I started chatting. We talked about the journey, the agency and our jobs. Then he said something unexpected. He told me about his low mood, about problems in life and how this job is just to force him to get out of the depressive mood. I didn't know how to react. If I were with my patient, I would sit down and have a proper chat to find out more. Yet just now I wasn't sure if I should dwell in at all. It just didn't feelt very natural - would you tell someone about things like relationship problems to a stranger? I wouldn't. I just listened. Our conversation abruptly ended as people started getting onto the minibus. It has given me a lot to think about. He has certainly hidden his low mood very well as I'd never have guessed that he's just barely coping. It challenged my judgement on people's mental state based on their behaviours.
But why did he tell me those things? In my last GP placement, I had the privillage of sitting in with a clinical psychologist in one of her therapy sessions. I can tell that these sessions were very painful for the patients because they relive their terrible ordeal. I personally am quite an expressive person, but I (and everyone else I suppose) have bad memories that I shall never ever want to think about. Making me think and talk about them would be akin to stripping myself naked. It would make me feel extremely insecure and allow others to invade me. So what made a S tell me about things so intimate to a stranger like myself? Was it normal? Was it an outburst? Was it because I was in my nurse uniform and I told him that I'm a medical student? Was it not really stripping himself naked emotionally after all, or was he simple not an emotional virgin anymore?
But why did he tell me those things? In my last GP placement, I had the privillage of sitting in with a clinical psychologist in one of her therapy sessions. I can tell that these sessions were very painful for the patients because they relive their terrible ordeal. I personally am quite an expressive person, but I (and everyone else I suppose) have bad memories that I shall never ever want to think about. Making me think and talk about them would be akin to stripping myself naked. It would make me feel extremely insecure and allow others to invade me. So what made a S tell me about things so intimate to a stranger like myself? Was it normal? Was it an outburst? Was it because I was in my nurse uniform and I told him that I'm a medical student? Was it not really stripping himself naked emotionally after all, or was he simple not an emotional virgin anymore?
Tuesday, July 22
Asking money from God?
I don't believe in god. But if I do, I would ask god for things I have no control over. I would ask god to keep my family and friends to be safe and sound, strong and healthy, happy and enjoying life. Sometimes I would ask god to take the rain away and give me a sunny day, or let me do well in an exam. I won't ask god for money. But would anyone do that?
My relatives do. Some of us chinese pray to many deities, gods and goddesses. Different gods are in charge to different things. For example in my old house, we had four gods: The three main buddhas, a 'de zhu gong' (the god in charge of the land), a kitchen god and another one outside the house (I think its the god in charge of guarding the house). These are the standard altars of a chinese family home in Malaysia. But other people have more.
Many of my relatives are very obsessed with money, and very superstitious. Bad combination. They spend lots of time, effort and money praying to gods in charge of finance, so they can be rewarded with more financial luck. I remember once when I was in primary school, I followed one of my aunt to a temple to ask for a lottery number. The ritual was weird, involving throwing coins, rubbing the idol's face with taufu, writing stuff with chinese brush then burning it and bringing the ash home to mix with tea and drink it. I didn't remember how did the miracle numbers pop out and had my aunt won. But I remember my aunt putting quite a big sum of money into an angpau (red packet) for the old lady performing the ritual. Very good profession to go into for anyone who wants to earn lots of money by performing peculiar entertainment since my aunt couldn't be the only greedy person in the world.
My family, being quite middle class (we get what we want often but we are not spoilt) is naturally quite disgusted with my relatives' behaviour. I sometimes wonder what makes them so obsessed with money. Perhaps it's their poor upbringing. My grandmother had 12 children and she was a single mum who brought up all of them by tailoring. My mum told me they can only afford to eat chicken once or twice a month. Only one out of the 12 siblings made it to university. Many of the elder ones had to drop out of school early to help generate income for the family. Since they are unskilled by the time my aunts and uncles were married, their jobs bring them just about suffient income to pay for food, shelter and other basic stuff. It's really hard for them to fork out extra money for say, university fees. But I have seen poor people who are content with their simple life. Why can't my relatives be a little happier about who they are now? Are they just trying too hard to get out of the vicious circle of poverty, to the point that they lose sight of everything else in the world, that they have to ask for money from god? My aunt said people like me, who had sailed through life smoothly, would never understand their predicament. Perhaps I never would.
My relatives do. Some of us chinese pray to many deities, gods and goddesses. Different gods are in charge to different things. For example in my old house, we had four gods: The three main buddhas, a 'de zhu gong' (the god in charge of the land), a kitchen god and another one outside the house (I think its the god in charge of guarding the house). These are the standard altars of a chinese family home in Malaysia. But other people have more.
Many of my relatives are very obsessed with money, and very superstitious. Bad combination. They spend lots of time, effort and money praying to gods in charge of finance, so they can be rewarded with more financial luck. I remember once when I was in primary school, I followed one of my aunt to a temple to ask for a lottery number. The ritual was weird, involving throwing coins, rubbing the idol's face with taufu, writing stuff with chinese brush then burning it and bringing the ash home to mix with tea and drink it. I didn't remember how did the miracle numbers pop out and had my aunt won. But I remember my aunt putting quite a big sum of money into an angpau (red packet) for the old lady performing the ritual. Very good profession to go into for anyone who wants to earn lots of money by performing peculiar entertainment since my aunt couldn't be the only greedy person in the world.
My family, being quite middle class (we get what we want often but we are not spoilt) is naturally quite disgusted with my relatives' behaviour. I sometimes wonder what makes them so obsessed with money. Perhaps it's their poor upbringing. My grandmother had 12 children and she was a single mum who brought up all of them by tailoring. My mum told me they can only afford to eat chicken once or twice a month. Only one out of the 12 siblings made it to university. Many of the elder ones had to drop out of school early to help generate income for the family. Since they are unskilled by the time my aunts and uncles were married, their jobs bring them just about suffient income to pay for food, shelter and other basic stuff. It's really hard for them to fork out extra money for say, university fees. But I have seen poor people who are content with their simple life. Why can't my relatives be a little happier about who they are now? Are they just trying too hard to get out of the vicious circle of poverty, to the point that they lose sight of everything else in the world, that they have to ask for money from god? My aunt said people like me, who had sailed through life smoothly, would never understand their predicament. Perhaps I never would.
Thursday, July 17
Learning french
Bonjour!
I'm determined to learn french well. I met lots of patients from African countries who spoke french in my GP placement and I hated not being able to understand their conversations with the GP (who spoke very good french). Many other reasons to learn french: it's (one of the) language of love, it's one of the official languages within the UN and it is my secret ambition to work one of the African countries one day. I'd also like to visit France once my conversational French is up to the minimum standard.
We've just started with the alphabets, numbers, self introduction and some of the other basics. It was a real pleassure to learn a new language. Repeat after the teacher. Watch the spelling. I have almost forgotten how long did I took for me to feel comfortable using English. In lesson, I met my old self: feeling insecure, shy, reluctant to speak, and fear making mistakes, and envious of the other students who were better than me. But as I say I want to learn it well and I am revising it every day.
I really like pronoucing 'r' from the throat. But it's very hard, dismantling and rebuiliding the part of the brain which makes the connection between the visual 'r' and the motor action of the tougue to make the 'arrr' sound. Had to consciously stop myself and say 'r' from my throat each time I see the letter in a word.
And I didn't know there's even a french way of saying Malaysia! (Malasie)
Au revoir.
I'm determined to learn french well. I met lots of patients from African countries who spoke french in my GP placement and I hated not being able to understand their conversations with the GP (who spoke very good french). Many other reasons to learn french: it's (one of the) language of love, it's one of the official languages within the UN and it is my secret ambition to work one of the African countries one day. I'd also like to visit France once my conversational French is up to the minimum standard.
We've just started with the alphabets, numbers, self introduction and some of the other basics. It was a real pleassure to learn a new language. Repeat after the teacher. Watch the spelling. I have almost forgotten how long did I took for me to feel comfortable using English. In lesson, I met my old self: feeling insecure, shy, reluctant to speak, and fear making mistakes, and envious of the other students who were better than me. But as I say I want to learn it well and I am revising it every day.
I really like pronoucing 'r' from the throat. But it's very hard, dismantling and rebuiliding the part of the brain which makes the connection between the visual 'r' and the motor action of the tougue to make the 'arrr' sound. Had to consciously stop myself and say 'r' from my throat each time I see the letter in a word.
And I didn't know there's even a french way of saying Malaysia! (Malasie)
Au revoir.
Wednesday, July 16
Greenwich-Amsterdam-Bruges-Canterbury
I am back from the first round of my summer travel.
Thursday:
Went to London by megabus (surprisingly comfortable for £10). Then went to Greenwich and visited the the Royal Observatory and the Prime meridian, the Old Royal Navy College, the Queens house and the National Maritime Museum. The view was breathtaking! Spent the night at the Malaysian hall.
Friday:
Joined the tour group and travelled across the English channel, France and Belgium to reach Amsterdam. Went for a canal cruise ride, followed by a tour of the red light district, which was a little disturbing.
Saturday:
Excursion to a cheese and clog factories and took pictures at the countryside in Holland. After that we visited the Anne Franks house, a diamond factory and the sex museum. Also saw lots of other attractions from outside.
Sunday:
Spent some time in Bruges. Beautiful churches. Went to the chocolate factory. Stopped by at a alcohol warehouse in Calais and bantered a bit with some drunken men. Stayed in Kipps hostel which was fantastic.
Monday:
Saw Canterbury. Learnt about Canterbury tale, went into a castle in the UK for the first time and visited the Canterbury cathedral and the Eastbridge hospital for the poor pilgrims.
Tuesday, June 24
My GP placement
Some of you might be wondering why the long silence. The answer is simply laziness, specifically the post-exam laze, although at the moment it seems ages ago since I've had my last OSCE. Time really flies....
I'm now on the third week of my SSC attached to a GP practice. Unlike ordinary practices, we specialise in providing primary care for asylum seekers only. In February this year when I volunteered in an event organised by the Manchester Refugees Support Network, I met this GP (who is now my supervisor) who works here and I asked if I could do a placement with her, which she happily agreed. I was naturally looking forward to this placement as (many of you might have know) I am passionate about issues surrounding refugees.
It couldn't have been a better placement. We see lots and lots of patients with post traumatic stress disorder. Although it was quite boring for me to see the GPs prescribe antidepressants after antidepressants, I enjoyed listening to their stories. It was extremely rewarding to see a patient who started off obviously unable to trust anyone and almost mute, to start to give bits of eye contact on the next visit, to start talking, to joke and finally to trust us enough to tell us their horrible ordeal. I have seen the most terrible scars from torture while examining these patients, yet it is often the unseen scar deep in the heart which is even more worrying. The sufferings that the asylum seekers face make the biggest problem in my life so minute, so insignificant. Similarly, because the close knit staff here know what's more important in life, they never complain about petty things. They are the nicest people ever, like the buddha, they are always calm and smiling and I get along with all of them very well.
I don't mind the heavy emotion involved, instead I usually get quite excited about it. But I can't help but notice that many of the patients see the doctor not for medical reasons. Many of them come in for a letter from the doctor for various reasons, eg to support an legal appeal, for a bus pass, to complain against the housing provider, even to report a hate crime etc. I mean some of these things are not even a doctor's job, but I have never seen the staff here refusing to help a patient. These asylum seekers are really desperate people. Besides having to deal with the stress from previous trauma and leaving home, they have to deal the the painful process of applying for asylum in the UK, at the same time not able to speak English and not allowed work. If we don't help them they just have no where to turn to. Thus the staff in this GP practice spend lots of time making phone calls and writing letters to sort out logistic/practical day to day things for the patients. I have helped a patient write a complain letter and another patient write a claim letter for compensation of lost item in the post. They were just tiny favours but the patients were extremely grateful, which gave me much satisfaction in helping them. Medically, I learn a few useful stuff not seen in ordinary GP practices in the UK. For example in unexplained anaemia I have to think about tropical diseases like tape worm, which is a deviation from the standard differential diagnosis; or in generalised myalgia before I write off one as a heart sink patient I would remember to exclude vitamin D deficiency.
At the end of the placement I need to submit an essay related to a chosen topic. I thought about the people I have seen and helped, and I thought about why I became so passionate about refugee issues since the college days. It was because I have a great family, and a warm home, a place I can seek shelter in and feel secure no matter what happens. And I think everyone should have a good home No one should be left homeless. And if you must know, the house that asylum seekers in the UK are provided with are often of the lowest standard. So I have decided to write an essay on the housing problems faced by asylum seekers and how their health are affected.
I'm now on the third week of my SSC attached to a GP practice. Unlike ordinary practices, we specialise in providing primary care for asylum seekers only. In February this year when I volunteered in an event organised by the Manchester Refugees Support Network, I met this GP (who is now my supervisor) who works here and I asked if I could do a placement with her, which she happily agreed. I was naturally looking forward to this placement as (many of you might have know) I am passionate about issues surrounding refugees.
It couldn't have been a better placement. We see lots and lots of patients with post traumatic stress disorder. Although it was quite boring for me to see the GPs prescribe antidepressants after antidepressants, I enjoyed listening to their stories. It was extremely rewarding to see a patient who started off obviously unable to trust anyone and almost mute, to start to give bits of eye contact on the next visit, to start talking, to joke and finally to trust us enough to tell us their horrible ordeal. I have seen the most terrible scars from torture while examining these patients, yet it is often the unseen scar deep in the heart which is even more worrying. The sufferings that the asylum seekers face make the biggest problem in my life so minute, so insignificant. Similarly, because the close knit staff here know what's more important in life, they never complain about petty things. They are the nicest people ever, like the buddha, they are always calm and smiling and I get along with all of them very well.
I don't mind the heavy emotion involved, instead I usually get quite excited about it. But I can't help but notice that many of the patients see the doctor not for medical reasons. Many of them come in for a letter from the doctor for various reasons, eg to support an legal appeal, for a bus pass, to complain against the housing provider, even to report a hate crime etc. I mean some of these things are not even a doctor's job, but I have never seen the staff here refusing to help a patient. These asylum seekers are really desperate people. Besides having to deal with the stress from previous trauma and leaving home, they have to deal the the painful process of applying for asylum in the UK, at the same time not able to speak English and not allowed work. If we don't help them they just have no where to turn to. Thus the staff in this GP practice spend lots of time making phone calls and writing letters to sort out logistic/practical day to day things for the patients. I have helped a patient write a complain letter and another patient write a claim letter for compensation of lost item in the post. They were just tiny favours but the patients were extremely grateful, which gave me much satisfaction in helping them. Medically, I learn a few useful stuff not seen in ordinary GP practices in the UK. For example in unexplained anaemia I have to think about tropical diseases like tape worm, which is a deviation from the standard differential diagnosis; or in generalised myalgia before I write off one as a heart sink patient I would remember to exclude vitamin D deficiency.
At the end of the placement I need to submit an essay related to a chosen topic. I thought about the people I have seen and helped, and I thought about why I became so passionate about refugee issues since the college days. It was because I have a great family, and a warm home, a place I can seek shelter in and feel secure no matter what happens. And I think everyone should have a good home No one should be left homeless. And if you must know, the house that asylum seekers in the UK are provided with are often of the lowest standard. So I have decided to write an essay on the housing problems faced by asylum seekers and how their health are affected.
Wednesday, May 28
Exam
The much dreaded year-end OSCE is next week. I'm glad that I'm finally feeling a little panic. Clinical OSCE is not an exam I've sat for many times, so there's a worse fear of failing compared to sitting the other written test that I've grown quite accustomed to.
Yesterday I've finally found the jasmine tea that I've missed so much in the supermarket. I'm loving it!
Yesterday I've finally found the jasmine tea that I've missed so much in the supermarket. I'm loving it!
Sunday, May 18
The Apprentice
My favourite quote from the apprentice in this series was from Lucinda. Being one of the three candidates on the firing line in the board room, Sir Alan Sugar asked Lucinda who is a risk manager by profession 'What's the risk of you getting fired?', then she coolly answered 'The probability of me getting fired is one out of three.' That's such a genius answer! British Apprentice is so much better than the American version, probably because it's much more authentic as the BBC doesn't censor off all the swear words...
Friday, May 16
Presentation
Every friday, we have a session called Clinical Debrief. The a few of us from the two PBL groups usually take turn to present and discuss interesting cases we've encountered throughout the week. Our tutor have been quite open to suggestion in terms of what to do in these sessions. The activities range from heated debate on ethical and philosophical issues to OSCE practice. Last week I asked the tutor if he could teach us basic fundoscopy. Neither he nor the rest of the group looked keen, but just mumbled some websites and library books that I'd find useful. I don't like fundoscopy, but in view of the coming OSCE, I really want to take this opportunity to understand the common things properly. So I decided to prepare a surprise presentation to the group in the next session on diabetic and hypertensive retinopathy.
Throughout the week after the progress test, I researched on the internet and made sure I know the stuff myself. I put togather a power point consisting many different fundi pictures. Because it consisted of about 38 slides, I wanted to make sure that it doesn't drag on so I practised and practised in my bedroom.
And I did it today. It went really well!
'Did you said last week that you wanted to do some fundoscopy because you weren't very confident in it?' My tutor asked.
'Yes.' I said.
'And now you're speaking like an opthalmologist!'
And feedback from my friends had also been incredibly positive. From the quiz I put on later on people were definitely more knowledgable about the two conditions than they were before.
I know I'm not the most chatty person and I can be quite a boring geek. But I'm glad that I was able to contribute something to the group. And also on making presentation, I know I can present well even in front of large and critical audience provided that I prepare well before hand.
All in all, it was a really happy day for me.
Throughout the week after the progress test, I researched on the internet and made sure I know the stuff myself. I put togather a power point consisting many different fundi pictures. Because it consisted of about 38 slides, I wanted to make sure that it doesn't drag on so I practised and practised in my bedroom.
And I did it today. It went really well!
'Did you said last week that you wanted to do some fundoscopy because you weren't very confident in it?' My tutor asked.
'Yes.' I said.
'And now you're speaking like an opthalmologist!'
And feedback from my friends had also been incredibly positive. From the quiz I put on later on people were definitely more knowledgable about the two conditions than they were before.
I know I'm not the most chatty person and I can be quite a boring geek. But I'm glad that I was able to contribute something to the group. And also on making presentation, I know I can present well even in front of large and critical audience provided that I prepare well before hand.
All in all, it was a really happy day for me.
Sunday, April 20
Arrogance
Last week, I was in the ward with two other final year medical students. I like being with them. They are so busy catching up with revision and I get to learn stuff essential for exams. One of them was really nice, teaching me lots of mnemonics and loved playing the teacher, quizzing me on various things and enthusiastically predicting the OSCE stations that may come up in my end of year exams. The other one was alright I thought, but he became more annoying as the day went. He didn't really want to engage in conversation with me and the other nice guy. And then later on, he observed my cannulation technique and kept on telling me all sorts, building up the pressure, and finally I thought he was quite happy that I failed so he could have a go. The nice guy said he's over the top, sometimes feeling that he's better than everyone else. He jokingly said that I would be like that in two years time.
Which really made me wonder. I could actually turn out to be arrogant like the other guy when I reach his stage. I don't want to turn out like that. But, really, can what should I do to avoid it? What should I do if I already know more than I should? I sometimes try to keep quiet to give others a chance and to not show off too much. But sometimes others may see that as arrogance. I have clear weaknesses too - everyone who knows me can tell that I can't make idle conservation easily and I rarely attend social events, which makes others misjudge me.
In a recent portfolio review, I told the tutor that I feel bad for taking extra initiative to learn more than I am expected to. And she told me that's nonsense. My most enjoyable placement was the SSC in A+E, not only because it was a great learning place, but also because I don't have to lower my standard according to the ability of the medical students of my year group. It's complicated.
At the end of the day, I don't want to be better than anyone else. I just want to be a good doctor, a doctor who knows my stuff well. I don't know how is it like to practise medicine in Malaysia. But I would expect less senior support given the shortage of doctors in the rural areas. So when I am alone in the deep jungle of Sabah treating the indigenous people, I don't want to make mistake on my patients because I haven't learn enough in medical school.
Which really made me wonder. I could actually turn out to be arrogant like the other guy when I reach his stage. I don't want to turn out like that. But, really, can what should I do to avoid it? What should I do if I already know more than I should? I sometimes try to keep quiet to give others a chance and to not show off too much. But sometimes others may see that as arrogance. I have clear weaknesses too - everyone who knows me can tell that I can't make idle conservation easily and I rarely attend social events, which makes others misjudge me.
In a recent portfolio review, I told the tutor that I feel bad for taking extra initiative to learn more than I am expected to. And she told me that's nonsense. My most enjoyable placement was the SSC in A+E, not only because it was a great learning place, but also because I don't have to lower my standard according to the ability of the medical students of my year group. It's complicated.
At the end of the day, I don't want to be better than anyone else. I just want to be a good doctor, a doctor who knows my stuff well. I don't know how is it like to practise medicine in Malaysia. But I would expect less senior support given the shortage of doctors in the rural areas. So when I am alone in the deep jungle of Sabah treating the indigenous people, I don't want to make mistake on my patients because I haven't learn enough in medical school.
Monday, April 7
Sunday, April 6
Next year
A while ago, I have decided that I don't really want to be too actively involved in Medsin next year, although I'll probably still continue coordinating a project and do some training occasionally. But last week a friend said I should go for the post of Manchester Medsin president next year. Then I had a rethink - it's nice to know that there are people who think that I can do it. But, no thanks. For two reasons really.
Firstly, I have underestimated the time commitment necessary in the clinical years. It's true to an extent that most of the firm allows medical students to 'do whatever you want'. However that's exactly my problem - I love medicine so much that I don't mind being in hospital from 9-5 everyday, in fact I really want to. That makes me thoroughly satisfied but perpetually exhausted, leaving me with no energy to deal with attending meetings, sending and replying emails, chasing up with what's happening with the other student projects.
Secondly, I thought I really want to have a life of my own, specifically a get away from medicine. I've always wanted to join the choir, drama group, dance classes, learn foreign languages etc, but I choose medically related extra curricular activities over those for the past years in university. Next year will be my last before my final year, and I don't really want to leave university regretting because of not doing things that I've always wanted to do. And being the vice president for Medsin as well as a medical student this year (and coordinating Crossing Borders Manchester and working as a part time auxillary nurse), I just find myself really struggling to do anything properly. I have no social life at all - all my spare time is spent on catching up with some rest. So next year I just want to enjoy myself, not take on more responsibility than what I can cope with.
Firstly, I have underestimated the time commitment necessary in the clinical years. It's true to an extent that most of the firm allows medical students to 'do whatever you want'. However that's exactly my problem - I love medicine so much that I don't mind being in hospital from 9-5 everyday, in fact I really want to. That makes me thoroughly satisfied but perpetually exhausted, leaving me with no energy to deal with attending meetings, sending and replying emails, chasing up with what's happening with the other student projects.
Secondly, I thought I really want to have a life of my own, specifically a get away from medicine. I've always wanted to join the choir, drama group, dance classes, learn foreign languages etc, but I choose medically related extra curricular activities over those for the past years in university. Next year will be my last before my final year, and I don't really want to leave university regretting because of not doing things that I've always wanted to do. And being the vice president for Medsin as well as a medical student this year (and coordinating Crossing Borders Manchester and working as a part time auxillary nurse), I just find myself really struggling to do anything properly. I have no social life at all - all my spare time is spent on catching up with some rest. So next year I just want to enjoy myself, not take on more responsibility than what I can cope with.
Monday, March 31
What makes a good medical student?
In Manchester, we have to fill in the same form entitled 'What makes a good medical student?' every year, enlisting five virtues that makes a good medical student. It is to be filed in our portfolio so we can see the changes over the years.
My views have certainly changed especially since I started third year. I personally really like the self-directed learning approach the Manchester adopts, eventhough it really is like DIY medicine (which the medical school has denied time and again). They say they monitor our learning but I beg to differ. There is no one to tell me if I am going to the ward often enough. When tutors have to fill in feedback forms at the end of the firm attachment they just write a few generic positive words and the words are more or less the same with my other groupmates who goes to the ward not even nearly as often as I do. Those tutors who had filled in my forms had never really watched me talk to patient and observe my clinical skills. Student support, they say, is there. But getting an appointment with the dean last term is like having to beg for his time, so I just didn't bother. I hated that aspect of things.
Yet, I am happy. I get to spend as much time doing whatever I want. In a week, we generally have 2-3 days of spare time. I can play with sutures and airways in the skills lab, work in the ward (which is my favourite), go to theatre, sign up to clinics or sleep in bed. While most of my groupmates have always opted to have a lay in and leave at the earliest opportunity, I always make it a point to spend some time in the ward doing some 'self-directed learning'. Sometimes it's shit but at other times staying late is well worth it.
I'm a little uncomfortable with many of my groupmates who always expect to be 'taught' formally before trying to learn things themselves. ECG for example - almost every patient in my ward has one done as they are being admitted. But you would wonder why my groupmates, after four weeks being attached to the ward, still struggle with reporting a simple ECG. Whenever asked a interpret an ECG, the most typical response from my groupmates will be 'umm, we haven't been taught how to read ECG'. Everyday, when fazed with new things, all I hear is 'We haven't learnt neuro', 'We are not in the GI module', 'We haven't been taught cardiovascular examination' etc etc. It really gets on my nerves! Even with things that we've done for a thousand times already, I still hear them say 'We haven't been taught to interpret ABG' - O yes, you bloody well have! They would literally wait for a lecture or an teaching session to be arranged so they can be officially taught. That makes me feel nauseous. Why can't people be more resourceful themselves? Be curious, make mistakes, ask questions, read up and we wouldn't need any formal teaching at all. After all the learning resources are all around us - fantastic library (including electronic journals), friendly doctors, interesting patients - what more can you ask for?
I don't know why I always seem to not agree with the general attitude of my current and previous groups. I don't think I'm a bad group member. I am certainly a bit of a control freak, but I generally work well in a team. At the end of almost every nursing shift that I do, the sister/staff nurse would tell me to come back and work again. They must have found me helpful. And I seem to get along well with the doctors and other senior medical students on the ward. So I think I must have been ok.
I think I just can't accept the fact we, being a group of motivated high flyers would rely on such a ridiculous amount of spoonfeeding. It just made me think that these people aren't ready to be a student doctor yet - they are just a bunch of naive, immature teenage school kids.
My views have certainly changed especially since I started third year. I personally really like the self-directed learning approach the Manchester adopts, eventhough it really is like DIY medicine (which the medical school has denied time and again). They say they monitor our learning but I beg to differ. There is no one to tell me if I am going to the ward often enough. When tutors have to fill in feedback forms at the end of the firm attachment they just write a few generic positive words and the words are more or less the same with my other groupmates who goes to the ward not even nearly as often as I do. Those tutors who had filled in my forms had never really watched me talk to patient and observe my clinical skills. Student support, they say, is there. But getting an appointment with the dean last term is like having to beg for his time, so I just didn't bother. I hated that aspect of things.
Yet, I am happy. I get to spend as much time doing whatever I want. In a week, we generally have 2-3 days of spare time. I can play with sutures and airways in the skills lab, work in the ward (which is my favourite), go to theatre, sign up to clinics or sleep in bed. While most of my groupmates have always opted to have a lay in and leave at the earliest opportunity, I always make it a point to spend some time in the ward doing some 'self-directed learning'. Sometimes it's shit but at other times staying late is well worth it.
I'm a little uncomfortable with many of my groupmates who always expect to be 'taught' formally before trying to learn things themselves. ECG for example - almost every patient in my ward has one done as they are being admitted. But you would wonder why my groupmates, after four weeks being attached to the ward, still struggle with reporting a simple ECG. Whenever asked a interpret an ECG, the most typical response from my groupmates will be 'umm, we haven't been taught how to read ECG'. Everyday, when fazed with new things, all I hear is 'We haven't learnt neuro', 'We are not in the GI module', 'We haven't been taught cardiovascular examination' etc etc. It really gets on my nerves! Even with things that we've done for a thousand times already, I still hear them say 'We haven't been taught to interpret ABG' - O yes, you bloody well have! They would literally wait for a lecture or an teaching session to be arranged so they can be officially taught. That makes me feel nauseous. Why can't people be more resourceful themselves? Be curious, make mistakes, ask questions, read up and we wouldn't need any formal teaching at all. After all the learning resources are all around us - fantastic library (including electronic journals), friendly doctors, interesting patients - what more can you ask for?
I don't know why I always seem to not agree with the general attitude of my current and previous groups. I don't think I'm a bad group member. I am certainly a bit of a control freak, but I generally work well in a team. At the end of almost every nursing shift that I do, the sister/staff nurse would tell me to come back and work again. They must have found me helpful. And I seem to get along well with the doctors and other senior medical students on the ward. So I think I must have been ok.
I think I just can't accept the fact we, being a group of motivated high flyers would rely on such a ridiculous amount of spoonfeeding. It just made me think that these people aren't ready to be a student doctor yet - they are just a bunch of naive, immature teenage school kids.
Saturday, March 29
Joke of the day
My sister Yee Leng told me 'My rats are toilet trained - they know how to go to the designated place to poo'...
Forgive my ignorance, I just can't help but to laugh!
Forgive my ignorance, I just can't help but to laugh!
Friday, March 21
Being judgemental
I had a great day yesterday at hospital. In fact most of the time spent on the Emergency Admission Unit (EAU) had been good. I've seen five lumbar puncture now (including two from my previous attachment) and the house officer said when the next one comes I can do it! I was in the ward from 0830 - 2100 yesterday. Saw amazing things: two LPs, ascites tap, elicited shifting dullness, SVC obstruction, and got my first ever successful blood gas! One of the lady which we did LP (whose CSF was a little yellow) on turn out to have subarachnoid haemorrhage, which was totally unexpected! So I got a free teaching on SAH since the house officer who did it was all too excited. The doctors kept telling me to go home but first it was raining outside all day and secondly there's so many interesting things to see how could it let such rare opportunity slip?
But I wasn't too happy about myself yesterday. This is kind of like a reflective thing. I clerked a patient who came in with collapse. He is a widower living alone who was just discharged from this ward yesterday morning and who reluctant to go home. The house officer was mourning about him suggesting that this must be an inappropriate referral. So, having the idea in my mind I did not really concentrate hard when I talked to him. And I thought his symptoms was so all over the place - non specific dizzyness, weakness, loss of balance, blurring of vision, tingling for a year or so. I quickly swept through the CV and resp examination which was nad in my opinion. I was reluctant to do a neurological examination because I can't do it properly yet, but the registrar insisted. So I did it. He kept telling me that there is weakness on the left side of his arms and legs but I thought the power was equal on both sides except for his hand grip on the left, and there was also a loss of sensation on the left foot. Finger to nose and heel to shin were ok but slow on the left. Visual field testing was so difficult with him because it was so grossly abnormal and I didn't want to repeat it because I just can't intepret the finding it all. So in the clerking sheet I wrote: 'Impression: I don't know, it's way out of my depth!'. In my mind, I thought he just can't cope living alone and trying to get attention by these psychologically induced signs. How wrong was I! When the registrar and consultant repeated the examination, they found clear cerebellar signs (nystagmus, buzzing noise in the left ear, abnormal left finger-to-nose and supination-pronation, left homonymous hemianopia, romberg positive). So he might have had a posterior circulation stroke or worse an intracranial lesion and would need a CT scan of the head. I was extremely ashame of myself. Not because I failed to elicit those signs (they were honestly out of my depth), but because I made a judgement of a patient even before I talked to him. I was already thinking that it must all have come from his mind. I didn't take his concerns seriously. And I thought he was faking the loss of sensation and stuff. All because he had just been discharged on the day itself, is a (miserable) widower and smells. How can I be a good doctor when I'm already such a judgemental person as a medical student? I found it difficult to believe that I'm actually this kind of person - ignorant and arrogant. If I have been a qualified doctor with the same attitude who clerked this patient, I could have let a man with an acute stroke go home with a 'heartsink' diagnosis. Why did I think that way? Partly it's me trying to conform to the views of the other doctors - you know how sometimes doctors would look at the patient's background and presenting complaint, and straight away say 'this must be a time waster' or something like that. But I cannot do that. I'm not experienced enough. And I mustn't ever do that even when I'm already well experienced. Judging someone from the surface is a dangerous thing to do. I should have know that.
But I wasn't too happy about myself yesterday. This is kind of like a reflective thing. I clerked a patient who came in with collapse. He is a widower living alone who was just discharged from this ward yesterday morning and who reluctant to go home. The house officer was mourning about him suggesting that this must be an inappropriate referral. So, having the idea in my mind I did not really concentrate hard when I talked to him. And I thought his symptoms was so all over the place - non specific dizzyness, weakness, loss of balance, blurring of vision, tingling for a year or so. I quickly swept through the CV and resp examination which was nad in my opinion. I was reluctant to do a neurological examination because I can't do it properly yet, but the registrar insisted. So I did it. He kept telling me that there is weakness on the left side of his arms and legs but I thought the power was equal on both sides except for his hand grip on the left, and there was also a loss of sensation on the left foot. Finger to nose and heel to shin were ok but slow on the left. Visual field testing was so difficult with him because it was so grossly abnormal and I didn't want to repeat it because I just can't intepret the finding it all. So in the clerking sheet I wrote: 'Impression: I don't know, it's way out of my depth!'. In my mind, I thought he just can't cope living alone and trying to get attention by these psychologically induced signs. How wrong was I! When the registrar and consultant repeated the examination, they found clear cerebellar signs (nystagmus, buzzing noise in the left ear, abnormal left finger-to-nose and supination-pronation, left homonymous hemianopia, romberg positive). So he might have had a posterior circulation stroke or worse an intracranial lesion and would need a CT scan of the head. I was extremely ashame of myself. Not because I failed to elicit those signs (they were honestly out of my depth), but because I made a judgement of a patient even before I talked to him. I was already thinking that it must all have come from his mind. I didn't take his concerns seriously. And I thought he was faking the loss of sensation and stuff. All because he had just been discharged on the day itself, is a (miserable) widower and smells. How can I be a good doctor when I'm already such a judgemental person as a medical student? I found it difficult to believe that I'm actually this kind of person - ignorant and arrogant. If I have been a qualified doctor with the same attitude who clerked this patient, I could have let a man with an acute stroke go home with a 'heartsink' diagnosis. Why did I think that way? Partly it's me trying to conform to the views of the other doctors - you know how sometimes doctors would look at the patient's background and presenting complaint, and straight away say 'this must be a time waster' or something like that. But I cannot do that. I'm not experienced enough. And I mustn't ever do that even when I'm already well experienced. Judging someone from the surface is a dangerous thing to do. I should have know that.
Friday, March 14
Who would I be in the Harry Potter world?
I think I would be a cross between Dumbledore and Hermione. Those are my favourite characters anyway. I don't think I am born as intelligent as Dumbledore. And I don't think I will ever be as charming and as chilled he was. But I do like to make strategies alone and act in solitary. I have a lot of friends but hardly have any that I could trust with my weaknesses. I am definitely as hardworking as Hermione. Like me, she is always very resourceful and cares about her other friends. People say I am clever, but in fact I think I'm just a well read ordinary person (well, probably with a slightly good memory). And I don't take risk if I don't have to - always go for the logical and acceptable option. But I am not as popular and as pretty as Hermione.
Sunday, March 9
The people's spoken - Loud and clear!
Malaysia had just had its general election yesterday and the result was shocking. For many years, the Barisan Nasional party (A coalition of parties representing the Malay, Chinese, Indians and other ethnic minorities) have been given very strong mandate to govern by the people. This time around, the BN did not even manage a 2/3 majority. It has only won by a simply majority (winning over 50% of the parlimentary seats) to form the government. Also BN lost five states to the opposition, the new states lost being Peneng, Perak, Selangor and Kedah.
This must have been far beyond BN's expectation. But if have they not see it coming at all, I'm glad that the truth has been smacked right on their faces. My initial prediction for this election was that BN would win but definitely by a reduced majority. I didn't expect not even a 2/3 majority.
What do I think? I think the people has really exercised their democratic rights and send the BN strong messeges. I always have a feeling that in the fifth prime minister reign, the government seemed to be always out of touch with what is actually happening in the country. Politicians from the government often saw it ok to brush off things that groups have to say. Things like 'if you don't like our policies you can leave' and '1000 people in the street protesting doesn't represent the general public and therefore has no relevance' etc had left people fuming in silence. And worse there is always these cocky politicians who would arogantly say rubbish like 'we have the people's support and what we do must be what the people wants'. I felt that they treated us, the public, like very simple beings who still thinks like the older uneducated generation giving undividing support to the party who brought Malaysia independence some 50 years ago. Certain people in the ruling party kept telling the mainstream media that no one in the country reads political blog on the internet, and would not hesitate to critisise bloggers as if bloggers are just a bunch of naughty school boys there to make trouble. They have clearly underestimated the power of internet as a mean to campaign. They need to realise that people (especially the urban, educated ones) are no longer so simple minded to hail whatever a minister/politician in the right wing says. We want our concerns to be taken seriously. And if they can't do that, then out they go.
One of the bloggers thought that many voters did not actually want the opposition candidate to win, but voted for the opposition candidate anyway because they did not want the BN to win. So many of the good BN candidates suffer as a result. And in fact if you scrutanise the results in detail in most constituencies, the winner only won by a tiny majority. That means people's view are still fairly splitted. It'll be interesting to see what the opposition can actually do for it's voters now that they have a stronger presence in the parliment.
Would Malaysia soon be in chaos? Malaysia have not faced such political situation ever in history. The last time the BN sustained such set back (which was not even as bad as the present election) in 1969, riots happened. There were violence between the different races. There were killings and a state of emergency had to be declared. Would it happen this time? We don't know but I don't think so. There is some issues of racial inequality but I think this time around the people didn't really voted for the benefit of their own race. The winners for this election (both from the government and opposition parties) are made up of quite a good mix of different races. The BN formula for power sharing is proven to bring stability, but it can't be the only thing that works. It's time for some social experimentation. This is history in making. Only with change can a civilisation progress. We'll see.
This must have been far beyond BN's expectation. But if have they not see it coming at all, I'm glad that the truth has been smacked right on their faces. My initial prediction for this election was that BN would win but definitely by a reduced majority. I didn't expect not even a 2/3 majority.
What do I think? I think the people has really exercised their democratic rights and send the BN strong messeges. I always have a feeling that in the fifth prime minister reign, the government seemed to be always out of touch with what is actually happening in the country. Politicians from the government often saw it ok to brush off things that groups have to say. Things like 'if you don't like our policies you can leave' and '1000 people in the street protesting doesn't represent the general public and therefore has no relevance' etc had left people fuming in silence. And worse there is always these cocky politicians who would arogantly say rubbish like 'we have the people's support and what we do must be what the people wants'. I felt that they treated us, the public, like very simple beings who still thinks like the older uneducated generation giving undividing support to the party who brought Malaysia independence some 50 years ago. Certain people in the ruling party kept telling the mainstream media that no one in the country reads political blog on the internet, and would not hesitate to critisise bloggers as if bloggers are just a bunch of naughty school boys there to make trouble. They have clearly underestimated the power of internet as a mean to campaign. They need to realise that people (especially the urban, educated ones) are no longer so simple minded to hail whatever a minister/politician in the right wing says. We want our concerns to be taken seriously. And if they can't do that, then out they go.
One of the bloggers thought that many voters did not actually want the opposition candidate to win, but voted for the opposition candidate anyway because they did not want the BN to win. So many of the good BN candidates suffer as a result. And in fact if you scrutanise the results in detail in most constituencies, the winner only won by a tiny majority. That means people's view are still fairly splitted. It'll be interesting to see what the opposition can actually do for it's voters now that they have a stronger presence in the parliment.
Would Malaysia soon be in chaos? Malaysia have not faced such political situation ever in history. The last time the BN sustained such set back (which was not even as bad as the present election) in 1969, riots happened. There were violence between the different races. There were killings and a state of emergency had to be declared. Would it happen this time? We don't know but I don't think so. There is some issues of racial inequality but I think this time around the people didn't really voted for the benefit of their own race. The winners for this election (both from the government and opposition parties) are made up of quite a good mix of different races. The BN formula for power sharing is proven to bring stability, but it can't be the only thing that works. It's time for some social experimentation. This is history in making. Only with change can a civilisation progress. We'll see.
Sunday, February 24
Day out with the ambulance
One of the most memorable days in my attachment with A&E is my day out with the ambulance. I joined a two man crew for the whole day, J and S - a paramedic and a technician respectively. They were proper gentlemen and took care of me well. It was a fairly busy day, one job after another. I thought riding in a blue light ambulance would have been a thrill, and it was – only that I was busy focusing to look far ahead out the window to prevent myself from getting sick. We had the sort of routine collapse, chest pain etc.
After lunchtime, we received a call for an unresponsive baby. We arrived very quickly, within minutes. The sense of urgency loomed in when we actually saw the baby. The father was holding an extremely pale two month old baby. It turned out that the baby had been like that for half an hour. At that point we knew we really need to speed up and get to the hospital quick. J quickly asked mum to get into the ambulance. The other baby she was holding cried as she passed him on to dad, and mum said she would call dad. Until that point, my role with the crew was only as an observer. But the paramedic could really do with another pair of hands in this life-threatening situation. So I connected the oxygen and did the chest compression while J dealt with other things. S alerted the ED and drove off. I was nervous. I have read about it, but I have not been formally trained in immediate paediatrics life support. J just taught me how to do it then and there. That was helpful as this allows J to concentrate on maintaining a patent airway. The airway was really good – there was good bilateral chest expansion, but only after we manage to make a mess of the vehicle because J couldn’t find the oropharyngeal airway of the right size. I caught a glimpse of the teenage mum wiping her tears. ECG was disappointing, asystole all the way. After a few minutes of roller coastal ride, we made it to the ED and lots of doctors and nurses were already anticipating at resus. J delivered the baby and gave a brief history. I watched the team commence the resuscitation for a minute or two. Then J and S went out of the resus, so I thought I better follow. We went back to the vehicle, J and S started typing the ambulance report and tidying up. They were not very chatty but pretended to look fine. I stood at the side and also kept quiet. J asked if I was alright, and said I can have a brew if I wanted. I said OK. But in fact I didn’t go for a brew. I felt shaken, I went to my locker and have a gulp of water. Then I went back to resus expecting the worst. The registrar was walking out, so I asked him how the baby was. He just shoke his head. I was speechless. I went back to the ambulance to tell them. They both carried on doing what they were doing. Then the ED consultant came up to the ambulance to check if we were alright. After about half an hour we went back to the ambulance station. The three of us sat down to have a chat. It was the first time for S to encounter death of an infant too. He said he just felt strange. J had been a paramedic for 30 odd years and had seen quite a few of these before and had never seen any survive. But I still saw him staring at the television, not watching the programme but contemplating on something else. The other ambulance staff was really understanding. They showed concern and tried to cheer us up. Was there anything that we could have done differently? Possibly, but it probably wouldn’t have changed the outcome. The three of us sat there quietly with our thoughts until the next call.
It was an interesting day. I felt more acquainted with the crew and learnt quite a bit from them. But I cannot deny that I was rather traumatized by the death of the baby. I didn’t know the baby’s name, didn’t know whether the baby was a girl or a boy. I knew the baby was still warm when I did the chest compression. And sadly it is no longer the case. Like the others I pretended that I was fine in front of everyone. It was only when I was alone in my bed room that it all sunk in. We have not managed to save the baby. And we had left the mum, dad, baby brother and grandparents very heartbroken indeed.
After lunchtime, we received a call for an unresponsive baby. We arrived very quickly, within minutes. The sense of urgency loomed in when we actually saw the baby. The father was holding an extremely pale two month old baby. It turned out that the baby had been like that for half an hour. At that point we knew we really need to speed up and get to the hospital quick. J quickly asked mum to get into the ambulance. The other baby she was holding cried as she passed him on to dad, and mum said she would call dad. Until that point, my role with the crew was only as an observer. But the paramedic could really do with another pair of hands in this life-threatening situation. So I connected the oxygen and did the chest compression while J dealt with other things. S alerted the ED and drove off. I was nervous. I have read about it, but I have not been formally trained in immediate paediatrics life support. J just taught me how to do it then and there. That was helpful as this allows J to concentrate on maintaining a patent airway. The airway was really good – there was good bilateral chest expansion, but only after we manage to make a mess of the vehicle because J couldn’t find the oropharyngeal airway of the right size. I caught a glimpse of the teenage mum wiping her tears. ECG was disappointing, asystole all the way. After a few minutes of roller coastal ride, we made it to the ED and lots of doctors and nurses were already anticipating at resus. J delivered the baby and gave a brief history. I watched the team commence the resuscitation for a minute or two. Then J and S went out of the resus, so I thought I better follow. We went back to the vehicle, J and S started typing the ambulance report and tidying up. They were not very chatty but pretended to look fine. I stood at the side and also kept quiet. J asked if I was alright, and said I can have a brew if I wanted. I said OK. But in fact I didn’t go for a brew. I felt shaken, I went to my locker and have a gulp of water. Then I went back to resus expecting the worst. The registrar was walking out, so I asked him how the baby was. He just shoke his head. I was speechless. I went back to the ambulance to tell them. They both carried on doing what they were doing. Then the ED consultant came up to the ambulance to check if we were alright. After about half an hour we went back to the ambulance station. The three of us sat down to have a chat. It was the first time for S to encounter death of an infant too. He said he just felt strange. J had been a paramedic for 30 odd years and had seen quite a few of these before and had never seen any survive. But I still saw him staring at the television, not watching the programme but contemplating on something else. The other ambulance staff was really understanding. They showed concern and tried to cheer us up. Was there anything that we could have done differently? Possibly, but it probably wouldn’t have changed the outcome. The three of us sat there quietly with our thoughts until the next call.
It was an interesting day. I felt more acquainted with the crew and learnt quite a bit from them. But I cannot deny that I was rather traumatized by the death of the baby. I didn’t know the baby’s name, didn’t know whether the baby was a girl or a boy. I knew the baby was still warm when I did the chest compression. And sadly it is no longer the case. Like the others I pretended that I was fine in front of everyone. It was only when I was alone in my bed room that it all sunk in. We have not managed to save the baby. And we had left the mum, dad, baby brother and grandparents very heartbroken indeed.
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