Aunty visited late this month. I'm not usually glad to see her but today I am. This marks the end of my the low mood, low confidence, low motivation and generally low in everything for weeks.
Busying myself with clinical work has definitely made me happier. I'm on my second day in geriatric medicine. I am really enjoying it. My consultant is very enthusiastic to teach, my SHO has been very accommodating and the nurses are really friendly. Communication is difficult with old people as half the time I am talking to confused or deaf people, but they are manageable challenges.
Yesterday, I examined a lady who was quite ill. I think I have built a good rapport with her even with her advanced dementia. She has a lovely smile. Yesterday I was quite worried about her being unusually drowsy. But today she was much more alert. During ward round, I said hello and smiled at her. And she held her hand out towards me and looked at me like a child wanting sweets... But my body language in response was terrible! I hesitated and did not go ahead to receive her hand and she was left holding her hand out for about 10 seconds before the nurse took her hands, and then she said to the nurse 'don't leave me' repeatedly... Ohhh... I felt so bad. I just wasn't sure what to do for at that moment because I don't want to look rude interrupting the consultant's ward round. So to all medical student or anyone looking after patients in any way, never be like me.
In the afternoon, I went on another ward round by prof, another consultant geriatrician. This ward was duller, most patients were medically fit but remained in the ward with 'pending social issues'. Things went a little more interesting with a lady with advanced dementia who had unexplained depressed level of consciousness and refusing to eat or drink since two weeks ago and was 'dumped' to prof with the recommendation: 'for palliation only', which I wasn't entirely comfortable about, not least because it seemed no one had really looked into any reversible cause for her presentation. Possibilities like extradural haematoma, post-surgical bleed, depression are amenable to treatment and I felt we shouldn't give up just yet. Plus she wasn't drowsy all the time as the notes and nurses reported. I went to her bedside myself, offered her a glass of water and she took sips herself! I usually keep my opinion to myself but because I really don't want to go back home today burdened by another guilt, I asked prof if he would consider any reversible causes. He rambled (ie I didn't understand what he was saying), but in essence he wasn't comfortable with giving up on this lady as well just yet, so the plan was for the nursing staff to actively encourage food and drinking with charting for the next 3 days. I hate to think that the nurses would secretly be thinking that she's really on her way already, but I have a feeling they well may. I am not saying that they are lazy or unprofessional, but I just know from experience that preconception and prejudice can really influence how much effort you would put in with a patient. So I think I'm going to pop upstairs just to check on her for the rest of the week. In addition, at prof's request I am currently studying hypo- and hypernatraemia management using this lady as a case.
At the end of the round, we walked passed a side room and prof showed us the lady who had been on the care of the dying pathway. He commented on the irregular breathing, saying that she may well 'on her last minutes now'. We then literally watched her took three more breaths, and then she stopped. She has died. I have never seen a person die in front of me like this before. It was weird. I wasn't really upset because I didn't know her. But one minute she was alive, and the next she was gone. I left feeling weird, I still feel it now. The SHO and I then went in to confirmed her death. It was also the first time I have heard a doctor announcing the time of death of a person for real. I have now witnessed the process of a person both arriving and departing this world. Very, very humbling.
I like the person I am now. I am thinking and I am motivated to learn. I feel driven to read because otherwise I would not be of any help to my patients. Lets hope this will sustain.
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Wednesday, September 30
Sunday, September 27
Cervical cancer vaccine
Government considers extending cervical cancer vaccination to adults
KOTA KINABALU: The government will consider expanding the free human papillomavirus (HPV) immunisation programme to include protection against cervical cancer for adults.
However, Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said that providing the vaccine free to adult women would depend on whether her ministry had sufficient funds.
From next year, the government will immunise all 13-year-olds in a programme that is expected to cost about RM150mil a year.
“The decision to provide the vaccine free for 13-year-olds was made because cervical cancer accounted for the second highest number of cancer cases among women in Malaysia, after breast cancer.
“If there is a need, the ministry will extend free jabs for others,” she told reporters at the her Hari Raya open house in Kg Pengalat Besar in Papar yesterday.
She said the vaccine has been found to be more effective when given to younger people compared to those in the 40s.
On Friday, Health Minister Datuk Seri Liow Tiong Lai announced that some 300,000 13-year-olds would be given free HPV immunisation jabs.
The vaccine is available in the country and costs about RM1,200 for three doses at private hospitals although the government was negotiating with the suppliers to reduce the price to about RM500.
I wish this Very Important Person would consult the expert and think before she make such popularity-enhancing statement, for when the public finds out the truth, would make her look stupid anyway (not that people like this would ever admit to it). The HPV vaccination is 'more effective when given to younger people compared to those in the 40s' because the vaccination doesn't work on women that's already have sex, i.e. those who are not virgin. This is because the Human Papilloma Virus (HPV) which causes cancerous changes on the cervix is very easily sexually transmitted. A senior doctor once told me even using condom will not prevent it from being transmitted, as it's one of those naturally occurring opportunistic microorganism which usually doesn't cause much trouble other than wanting to find a nice warm host. Once a lady have had sex, she already has this virus, although I have to emphasize that it doesn't turn cancerous in the big big majority of women. A woman only puts herself at high risk of cancer if she has multiple partners, doesn't use regular protection, smokes etc, you get the picture. HPV vaccine prevents the virus from infesting the cervix, but if they are there already, the vaccine is useless.
I'm not surprised that the introduction of this vaccine has not sparked a debate like it did in the UK. When the HPV vaccine was introduced in the UK, much information on HPV and cervical cancer were disseminated in order for parents and teenagers to make informed decisions. I was examined on counselling a worried parent in my fourth year gynae exam. UK parents were worried that endorsing this vaccine means condoning sex among teenage girls. I can only imagine what a ferocious issue the Islamic politicians would blow this into if they have been clever enough to find out. Cross our fingers they won't because if we just give it a second thought, we'd realize that it is just like any innocent vaccination we've ever had. It's there to protect the girls against cervical cancer in the future, nothing to do with the choice of sex lives they want to lead.
Take home message for politicians from the right, left, top and bottom wings who want to make the lime light: Whatever you say won't make me like you more because I frankly don't believe any of you anymore these days. Please check your facts first, don't waste the precious taxpayer money, don't give people false hope.
KOTA KINABALU: The government will consider expanding the free human papillomavirus (HPV) immunisation programme to include protection against cervical cancer for adults.
However, Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said that providing the vaccine free to adult women would depend on whether her ministry had sufficient funds.
From next year, the government will immunise all 13-year-olds in a programme that is expected to cost about RM150mil a year.
“The decision to provide the vaccine free for 13-year-olds was made because cervical cancer accounted for the second highest number of cancer cases among women in Malaysia, after breast cancer.
“If there is a need, the ministry will extend free jabs for others,” she told reporters at the her Hari Raya open house in Kg Pengalat Besar in Papar yesterday.
She said the vaccine has been found to be more effective when given to younger people compared to those in the 40s.
On Friday, Health Minister Datuk Seri Liow Tiong Lai announced that some 300,000 13-year-olds would be given free HPV immunisation jabs.
The vaccine is available in the country and costs about RM1,200 for three doses at private hospitals although the government was negotiating with the suppliers to reduce the price to about RM500.
I wish this Very Important Person would consult the expert and think before she make such popularity-enhancing statement, for when the public finds out the truth, would make her look stupid anyway (not that people like this would ever admit to it). The HPV vaccination is 'more effective when given to younger people compared to those in the 40s' because the vaccination doesn't work on women that's already have sex, i.e. those who are not virgin. This is because the Human Papilloma Virus (HPV) which causes cancerous changes on the cervix is very easily sexually transmitted. A senior doctor once told me even using condom will not prevent it from being transmitted, as it's one of those naturally occurring opportunistic microorganism which usually doesn't cause much trouble other than wanting to find a nice warm host. Once a lady have had sex, she already has this virus, although I have to emphasize that it doesn't turn cancerous in the big big majority of women. A woman only puts herself at high risk of cancer if she has multiple partners, doesn't use regular protection, smokes etc, you get the picture. HPV vaccine prevents the virus from infesting the cervix, but if they are there already, the vaccine is useless.
I'm not surprised that the introduction of this vaccine has not sparked a debate like it did in the UK. When the HPV vaccine was introduced in the UK, much information on HPV and cervical cancer were disseminated in order for parents and teenagers to make informed decisions. I was examined on counselling a worried parent in my fourth year gynae exam. UK parents were worried that endorsing this vaccine means condoning sex among teenage girls. I can only imagine what a ferocious issue the Islamic politicians would blow this into if they have been clever enough to find out. Cross our fingers they won't because if we just give it a second thought, we'd realize that it is just like any innocent vaccination we've ever had. It's there to protect the girls against cervical cancer in the future, nothing to do with the choice of sex lives they want to lead.
Take home message for politicians from the right, left, top and bottom wings who want to make the lime light: Whatever you say won't make me like you more because I frankly don't believe any of you anymore these days. Please check your facts first, don't waste the precious taxpayer money, don't give people false hope.
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When will political stupidness end in Malaysia?
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Saturday, September 12
Charmed
Did you realise that charming people are such rare breed? I met one. It was the consultant in the clinic. Actually his most charismatic moment was when he did the introductory lecture last week. I remembered that I was still so busy talking to my friend when he was already ready to start and he looked at me, and I instantly fell silent... I don't know how he did it, it was as if he was able to connect to each and every one in the audience by his powerful eye contact. Very enthusiastic as well. This morning's clinic has been a bliss. Then we had another lecture with him after the clinic. Again I was really drawn in. Then there was an interactive exercise bit, and I couldn't believe that I sticked up my hand instantly after he asked 'who wants to do the first question' because while the mic was on the way to me I realized that I didn't actually know the answer... It's as if my right hand was acting from a remote control command, not from my brain. Nevermind. Didn't have time to panic. Albeit that extremely stressful situation (time pressure, all attention on me including the most charming person in the auditorium and my voice was to be amplified - I can never be comfortable with microphones etc) a bit of quick thinking I managed save myself from embarassment by giving the right answers. Maybe that's why he is a consultant at such a young age.
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Friday, September 4
I wish
that if i'm rubbish, people would just spit it out at me. I wish they would not keep on saying that it's fantastic and it's excellent and and it's a job well done and all that shit, when in fact it's just a pile of truly dispensible shit. Then I may not think all along that I'm such a star as they described and be so disappointed and so sore in my heart and to be feeling so ridiculous and humiliated when the final judgement comes.
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Thursday, September 3
Monday, August 31
5th year resolution
Tomorrow I will be a final year medical student. As I mentioned in my previous post, 3rd year was an unhappy year so I made action plans in order to make 4th year less miserable one, and 4th year was BRILLIANT! Now I think in a way it is nice to have had a bad year because I was able to make changes and look forward to a better year. With my 4th year being so full of moments of euphoria, I'm not sure what I should do to match that up in my 5th year. There is only one specific thing that I really want to improve: my interpersonal skills. I want to learn how to be a 'nice' person. It's difficult to sum up a 'nice' person in a few words. I don't even know what it is exactly, but I know that talking to some people makes me feel equal, listened to and comfortable. I aspire to be like these 'nice' person and I know I'm not to some people. I am the kind of person who avoids my weakness at all cost, but I think this ego of mine and the lack of empathy to people surrounding me are holding me back. There is definitely room for improvement and I want to be the best person I can be. I hope being 'nicer' can make me happier. I strive on 3 'S' from now on - Sympatique, Souriant et Sincerite (copied from a French movie Mon meilleur ami [My Best Friend]).
But I still feel a bit like driving aimlessly without specific goals for my 5th year. Any advice? Help...
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But I still feel a bit like driving aimlessly without specific goals for my 5th year. Any advice? Help...
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Sunday, August 30
Chorus
Joining the chorus was one of the best thing I have done in university. I only joined this year for several reasons. Third year wasn't a particularly happy year for me and I spent a lot of time reflecting on why this had occurred. One of my action plans was to participate in activities where I can get away from medics and meet some non-medics. Watching 'Last choir standing' and 'Maestro' over the summer holiday also re-ignited my enthusiasm for music. So I decided that I'd join this choir.
Rehearsal was always interactive and fun. It was handy to be sitting beside a music student during the first rehearsal as she had spare pencil to lend me. We were supposed to bring pencils to mark things in the score, just like piano lessons. First rehearsal was intimidating I have to admit. First of all, I've never seen a choir with that many people in it: there must have been 300 of us in the hall! The chorus is a non-auditioning choir and it's easy to assume that this translates as 'no experience required'. Incorrect. After the warm up, the conductor told us the page number to open, cued the pianist, and when the bars for vocal parts arrived, everyone just started singing! It appeared that we do need to know how to read notes, rhythms, time and key signatures, markings, italian terms etc. The pieces was quite long, so half of the rehearsals in the year consisted of sight-singing. Our conductor wanted us to do everything right at the first go, everything included not only the notes (i.e. the sound and words) but also the dynamics, expressions, diction etc. How demanding! Even in my grade 7 piano exam sight reading I had to completely ignored the expressions because my concentration was fully occupied in getting the notes and timing right. But I also loved the rehearsals because of this. It's challenging, but I knew I have the knowledge to do it right if I try hard enough. It was just wonderful to be engaging my brain in non-medical stuff, as though my brain have been straving of some vital nutrients that stimulation from medically related exercises cannot provide.
We performed two pieces, one for the Christmas concert and another one for the end of year concert. I fell in love with the first one, Elijah by Mendelsohn, from the first time we sang. It's a typical classical period music and I love classical period stuff. It's vibrant, yet still confine to certain rules and structures, rendering it predictable, makes sense to sing and easy to understand. On the other hand, the War Requiem by Britten took a while for me to see how the sound fitted togather to make any sense. I felt that it was not my cup of tea to begin with, but later on I came to understand how the theme of peace in Wilfred Owen poem was interwoven in the mass for the dead (Requiem) to make the whole song a messege/warning from mourning and deceased people to the world, and suddenly everything became very moving and meaningful.
Concerts were very exciting to prepare. I would always remember how I felt the first time we rehearsed with the orchestra. It was too overwhelming. The orchestra were so magnificent that I felt compelled to sing to the best of my ability to contribute to the grandiosity of the sound. Now I know that the pleasure of watching a concert can never ever be compared with that of performing. I was bursting with sense of pride along with the other singers and musicians when the conductor led us to stand and receive applause from the audience, especially on the second night of the Elijah concert when a few friends came along.
Being in the chorus had truly revived my interest in music again. I am going to continue singing with the chorus and when I go back home, I will continue learning piano until grade 8 or diploma. I endeavour to learn as much about music while I'm on the western side of the globe and start a group, perhaps involving children and charity, things that I'm passionate about. I really really really enjoyed this and I'd love to share this with others especially those not privileged enough to know music.
.
Rehearsal was always interactive and fun. It was handy to be sitting beside a music student during the first rehearsal as she had spare pencil to lend me. We were supposed to bring pencils to mark things in the score, just like piano lessons. First rehearsal was intimidating I have to admit. First of all, I've never seen a choir with that many people in it: there must have been 300 of us in the hall! The chorus is a non-auditioning choir and it's easy to assume that this translates as 'no experience required'. Incorrect. After the warm up, the conductor told us the page number to open, cued the pianist, and when the bars for vocal parts arrived, everyone just started singing! It appeared that we do need to know how to read notes, rhythms, time and key signatures, markings, italian terms etc. The pieces was quite long, so half of the rehearsals in the year consisted of sight-singing. Our conductor wanted us to do everything right at the first go, everything included not only the notes (i.e. the sound and words) but also the dynamics, expressions, diction etc. How demanding! Even in my grade 7 piano exam sight reading I had to completely ignored the expressions because my concentration was fully occupied in getting the notes and timing right. But I also loved the rehearsals because of this. It's challenging, but I knew I have the knowledge to do it right if I try hard enough. It was just wonderful to be engaging my brain in non-medical stuff, as though my brain have been straving of some vital nutrients that stimulation from medically related exercises cannot provide.
We performed two pieces, one for the Christmas concert and another one for the end of year concert. I fell in love with the first one, Elijah by Mendelsohn, from the first time we sang. It's a typical classical period music and I love classical period stuff. It's vibrant, yet still confine to certain rules and structures, rendering it predictable, makes sense to sing and easy to understand. On the other hand, the War Requiem by Britten took a while for me to see how the sound fitted togather to make any sense. I felt that it was not my cup of tea to begin with, but later on I came to understand how the theme of peace in Wilfred Owen poem was interwoven in the mass for the dead (Requiem) to make the whole song a messege/warning from mourning and deceased people to the world, and suddenly everything became very moving and meaningful.
Concerts were very exciting to prepare. I would always remember how I felt the first time we rehearsed with the orchestra. It was too overwhelming. The orchestra were so magnificent that I felt compelled to sing to the best of my ability to contribute to the grandiosity of the sound. Now I know that the pleasure of watching a concert can never ever be compared with that of performing. I was bursting with sense of pride along with the other singers and musicians when the conductor led us to stand and receive applause from the audience, especially on the second night of the Elijah concert when a few friends came along.
Being in the chorus had truly revived my interest in music again. I am going to continue singing with the chorus and when I go back home, I will continue learning piano until grade 8 or diploma. I endeavour to learn as much about music while I'm on the western side of the globe and start a group, perhaps involving children and charity, things that I'm passionate about. I really really really enjoyed this and I'd love to share this with others especially those not privileged enough to know music.
.
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