It's The Last Day of The Year 2011

Yes this is one of those entries where I reflect upon the year that is about to come to an end. So feel free to stop reading now as it may bore you.

I remember being really busy preparing for exams. In April, I sat Part 2 MRCP. This was quickly followed by a failed attempt at PACES in June. And as a result of my failure, I was unable to proceed to the next stage in my career. Fortunately, my 2nd attempt in October was successful, and because of that, I have completed my membership exams.

Should I say that obtaining full MRCP was somewhat life-changing for me? Well, I guess it was. I mean when I failed PACES, I felt really low. My confidence was down in the dumps, and I felt really embarrassed. The embarrassment was due to the fact that my junior colleagues passed theirs without much problem, and I seemed to be struggling with it. Yes, I have some ego in me. When I found out that I passed PACES, I was really super-duper overjoyed.

Then, it was time for me to choose which specialty I wanted to specialise in. I received 2 job offers; one in diabetes/endocrinology, and the other, in neurology. I chose the latter as I felt it was more interesting diagnosing the weird and wonderful neurological disorders. I am thoroughly enjoying the job at the moment, although I have alot to read up on.

Work aside, the only other exciting achievement for me was running and completing my first ever 10k. I was happy that I finished it in just over an hour. However, I regretted not training for it properly because I ended up with a very bad left knee injury, which left me inactive for a few months. I will definitely try to run it again this year, and aim for a better time!

My unhappiest moment in this year was when I was informed of my beloved doggie, Kiki's death in September. She suffered from septicaemia. I really do miss her alot, and think about her sometimes, especially, when I see other dogs walking in front of me with their owner.

This year saw me spending 2 holidays back home (which is unheard of since I came to the UK in 2004). =) Hopefully I would be able to repeat this next year. Nothing, absolutely nothing, beats spending holidays back home with my family and friends, whilst enjoying the comfort of being in the country where I grew up in!

2011 has been great. The 4 goals I set for myself in January have all been achieved; running 10k, travelling abroad (spent a week in Belgium in summer), passing exams, and going home. I am very grateful for what I have. I have also been very fortunate to have met new colleagues, who are now my friends, who have supported me while I prepared for my exams/job interviews.

What does 2012 hold for me??

I am looking forward to catching the London Olympics because I have tickets to watch badminton finals!! woohoo!!! Lee Chong Wei...dun disappoint me! I want to see you in the finals!! :P

I hope that 2012 will take me closer to my partner. I am seriously tired of the distance. I really just want us to be together everyday, that isn't too much to ask for, right??.... and deep down in me, I am hoping that we could settle down, get a house and slowly build a family.

I need to work hard and be geekier (is there even such a word?!) as I gradually build up my confidence, skill and knowledge in the field of neurology. It will be interesting to see how much I would have hopefully learned after 1 year.

Watch this space!

Happy 2012!!!

Cheers!!

It's Christmas!

Christmas celebration started off with lunch at our favourite restaurant, The Waiting Room, in Eaglescliffe. It is a wholesome vegetarian restaurant that serves delicious vegetarian food! The menu was rather christmassy, and we decided to order the traditional Christmas dinner. The turkey has been substituted with a carrot, walnut and apple loaf, with roasted parsnip, carrots and beetroot! delicious!

This was quickly followed by dessert at the same restaurant. I ordered the chocolate and raspberry roulade, served with ice cream....Mmmmm

On Christmas day, I was feeling very festive, and in the need to do some baking! I spent the whole afternoon baking 2 things; Speculoos (traditional biscuit baked before St Nicholas' feast), and cherry + hazelnut biscotti!

Speculoos in the jar, and the biscotti is on the baking tray.

After all the baking, it was time to treat myself to a lovely dinner. It was a very non-british dinner.... which really reminded me of the times where I spent xmas back home. The main dish was chicken briyani. There were also cucumber with sesame oil + chili flakes as the appetiser, and a vegetable salad with lemon + olive oil dressing.

A closer look at the cucumber dish.

Merry Christmas!!

=)

10 days & counting

Christmas is not too far away!

I put up my christmas tree during the first weekend in December. Mum said that my tree was fairly bare, so I decided to buy new xmas decos. Here is a picture of the new decos on my tree:

(note the dog with a santa hat, russian toy soldier, snowflake, and an angel on top)

One of my colleagues at work was really trying to get us into the christmassy mood by bringing this in.

Yeah...a Gingerbread House!! 100% homemade!

I thought she did an amazing job. It was too beautiful to eat...but, in the end, we all couldn't resist it. I started to pick on the choc buttons on the roof. Her gingerbread walls tasted very gingery and yummy...

Now, I just need to complete my xmas shopping. I have yet to get a present for my ex-housemate. I have left it a little too last minute, as I am planning to see her this weekend. So I will have to do some xmas shopping over the next few days!

A Weekend in Neuro

I survived the weekend.

Yes. It was my first 48 hour weekend on-call in neurology. I was rather worried about it. My fellow reg offered to swap the on-call with me, but I didn't want to. I would need to do the on-calls whether this weekend or later. Therefore, I might get it over and done with, and build up the confidence plus experience as I go along.

I did mini ward rounds in the ward on both Saturday and Sunday. I was finished by about 11 am. Then, I proceeded to review 2 patients in the high dependency unit. Both were in respiratory failure secondary to dermatomyositis and myasthenia gravis respectively.

So far so good, I thought to myself. No referrals yet. I decided to hang around in the hospital until about 3pm, just in case anything happens. But it was all under control. This would never be the case had I be doing general medical weekend on -calls!

The only phone call I received was early this morning at about 10 mins after midnight. Apparently, the medical registrar from this nearby hospital has been trying to contact me all evening. The switchboard dept in my hospital has got my name wrong, and they claimed that I was not on their on-call list this weekend; despite me ringing them on Saturday morning to confirm that I am on-call and even gave them my mobile number.

Anywho, the med reg was asking for advice on a patient whom they suspect might have Gullain Barre Sydrome (GBS). He was just wondering whether he needed to transfer the patient overnight to us. The patient was stable, and was not in any respiratory compromise. So I suggested that the patient remained in their hospital overnight, and be transferred in the morning. I ran that past the consultant and he agreed too.

The weekend was, otherwise, uneventful. I am glad that it was ok, but I was also hoping for a few more phone calls just so I get more experience etc. I look forward to more on-calls this week, and the months to come!

Day 3 Neurology

It's my turn to be on-call.

Any problems or referrals from 5pm to 9am the next morning will be directed to me.

I have done so many on-calls before this. They were mainly medical on-calls, and I almost always have a senior (who is not a consultant) that I could contact easily. This on-call is different, as I am further up the pyramid, just under the consultant. So I have about 4 to 5 years of knowledge and experience to back me up. And also, I have to admit that I am a little intimidated to contact the consultant on-call with me.

I am not going to lie....I am really scared and worried about the on-call yesterday. I mean, if the ward rings me about how to manage medical issues, you know, such as pneumonia, tachycardia, sepsis, etc, it wouldn't be a problem. What I am concerned about is managing the hard core neurology things....for eg, advice on changing anti-epileptic medications, or reviewing patients with weird neurological presentations.

I know I am still very green in this field. But I can't help but worry. And also, I will no longer need to be doing the on-call on site. I will be contacted from home. Yes, it is nice not to be running around the hospital in the middle of the night. But it is also a challenge for me to be able to provide advice/opinions over the telephone. I have to learn to trust the person on the other end of the telephone. I am not saying that they will be providing me with wrong information, but you know, it is different being in the hospital (where I could easily review the patient), and listening to the condition over the telephone. I really need to get used to this.

Interestingly, I didn't get any call until 10 something at night. It was a call from A&E.

"Hello, its the neurology registrar," I mumbled.

(mind you, I struggled to say the word "registrar," which shows how much confidence I'm lacking).

"Yeah, it's A&E here. Do you remember that lady with gallstones?" asked the doctor over the telephone.

"Errm...gallstones? Who are you talking about?"

"You know, the lady with gallstones whom the urology SHO reviewed earlier?" replied the doc.

"I'm sorry. But you are speaking to the wrong person...I am from NEURO, not UROLOGY," I told her.

"Oh...haha...I'm sorry to trouble you. Thank you!"

"ok bye" I said and put down the phone, somewhat relieved it was not a neuro call.

I couldn't really sleep for the rest of the night. It was probably because I was worried that I might not hear the pager, and also, worried that if were half asleep, I would not be able to provide good advice/suggestions, and speak with a clear mind.

The rest of my on-call turned out to be a quiet one. There were no further phone calls.

Honestly, I really need to take a chill pill, and stop worrying so much!

Day 1 Neurology

I have been building up myself towards this new role of mine....you know, from being the Senior House Officer (SHO) to a Specialist Registrar (SPR).

Today marks my first day as a SPR, in neurology, a field which is very much new to me. My knowledge and experience in neurology is pretty limited. I mean, I have a bit of stroke in the past, and also had a month's attachment in neurology. However, those experiences are certainly not enough to prepare me for what is to come!

I am the allocated ward registrar for the month of December. The day started off with a handover between me, the nurses and the SPRs who have been in the dept already. The handover took at least an hour, as they had to tell me important details about every patient (we have 15 patients). I know it is not many, but it took quite awhile for us to get around them.

By the end of the handover, my head was spinning. Alot of questions were running in my mind... What is this about limbic encephalitis? And what is ventriculitis? How do you treat it? What is TBM? (I soon found out that TBM = TB meningitis).

After that, I started my first ward round as a SPR. It was not an easy task, just because most of the patients have been there for a number of weeks. So it took quite awhile for me to grasp what was wrong with them in the first place. By the time I completed the round, it was already 1pm!

We all went for a quick lunch. Upon returning, the nurses were looking for me. They wanted me to review a few patients in the day room, there were 2 difficult lumbar punctures to do, and a few other bits and bobs. It really didnt occur to me that there were so many decision making tasks as a SPR. I also had to attend to a few phone calls from patients who needed some advice.

When I was a SHO, all I had to do was to ensure that the ward runs smoothly, get all the requests done and do as the registrar tells me to. But now, I am on the other end of the stick...it is me who gives advice, it is me who makes some of those decisions that SHOs can't make, it is me who have to take on more responsibility than before....

The only positive thing I found today was that I am starting my new role in a familiar environment. I know the nurses in the ward from my previous attachment. I am working in the same hospital, therefore, I know how to get my way around things. I couldn't imagine starting work in a completely new hospital...it would be even worse.

It was a wee bit overwhelming for me today. Thankfully, my senior registrars have been pretty helpful, in giving me some very much needed support and advice.

I hope for a slightly better day tomorrow.

ps. one last problem is that i need to constantly remind myself to write down my correct grade when i write in the notes. So far, i have been calling myself a "CT2," whereas it should have been "spr."

Can't Stop Beaming!

YESSS!!!! YEEESSS!!!! YYYYEEEESSSSSS!!!!!!!

Hooorayyy....yipppeeee!!!

Words cannot describe how happy I am feeling right now!
I finally passed all my membership exams!! :D
Finally I have earned MRCP (UK).
I know it is only a small step towards a long career in medicine...but heck, it is by no means an easy exam.

I can't stop telling everyone about it...even the nurses, and the ward clerk!

I knew that results would be out today. I've been checking my online account like 3-4 times already all day. Finally at about 5pm, I saw the word "pass" ....and oh my goodness, I felt such huge relief...it was like a heavy weight has been lifted off my shoulders. It means even more to me as I failed by 2 points previously.

Anywho, as much as I would like to celebrate, I am on-call over the weekend. But its ok!!! I don't mind, and I surely won't be complaining!

:D

congratulations to me!!


oh...ps. did I mention that I have finally decided to take up the neurology training job!

so double happiness for me:

MRCP +ve + neuro job = happy me!!!

Post Exam Stress

I took my clinical examination (PACES) today. It was my 2nd attempt...I failed it by 2 points previously. I arrived early at the hospital. It certainly didn't do anything to calm my nerves.... The other candidates and I waited anxiously for the exam to start. And with a blink of an eye, the exam ended, just over 2 hours later. It's amazing how quickly the time flew by.

How did it go??

To be honest, I was definitely more confident. I presented fluently, and was not hesitating much. I started with station 4 again, similar to my first attempt. I can't stop thinking of all the stations that I went through...therefore, I need to let it all out!

Station 1 (respiratory/abdo)

The chest station was a case of pulmonary fibrosis, which was pretty straightforward I thought, and lucky of me. I finished the clinical examination well before the time limit ended. The abdomen station was a patient with only splenomegaly. I gave a few differential diagnosis for splenomegaly, however, none of them relate to the patient. The examiner then asked me, "Have you not heard of hairy cell leukaemia?" "No." *krrriiinnng (the bell indicating that the station has ended ). I dunno if I were sort of "saved by the bell" so to speak...

Station 2 (History)

The history was on a patient presenting with bilateral ankle joints swelling and a dry cough. It was not too bad a station. The patient was pleasant and I was able to build rapport quite quickly. I gave my differential as inflammatory arthropathy with pulmonary fibrosis or sarcoidosis.

Station 3 (CVS/Neuro)

This went ok. The patient I examined had a metallic AVR. I don't know why, but somehow, I found consultants who wear bow ties pretty old school. He didnt help to ease my anxiety.

I was glad that I could hear the metallic click at the end of the bed. However, he tried to make me doubt myself by saying, "Are you sure it is his heart sounds? Don't you think the sound is coming from this clock above?"

Why is he making my life difficult?!

Neuro, on the other hand, was not straight forward. I did not have time to complete my neurological examination, as I had to also perform full sensory examination. The patient's signs were not classic. On hindsight, I think it was either a case of spastic paraparesis or brown sequard syndrome. arrghh... my brain failed to perform adequately during this particular station!! I felt really awful.. hope i didn't fail it!

Station 4 (communication/ethics)

I've been asked to speak to the daughter of a patient who is comatose following a major stroke. She was not responding to any stimuli, but was still able to breathe on her own. She also has mild dementia. As her daughter does not live locally, she has been placed in a nursing home for some support. We, doctors, have thought of feeding her through a nasogastric tube, but felt that it would be futile. My role was to break this news to her daughter and also tell her that we are going to withdraw treatment.

I guess this is the type of scenario that I have and will continue to face throughout my career. The conversation went ok. I introduced her to the end of life care pathway. But, I didn't manage to answer all of the patient's daughter's questions, as she began to fire them to me towards the end.

After the conversation ended, it was the examiners' turn to ask me questions. One of them asked, "So, if this patient presents to you in A&E, what would you do? Is she someone whom you consider thrombolysable? " I replied, " If she turns up in the hospital within 4 hours of presentation, I would assess her against the criteria to see if she is suitable." The examiner then said, "Well, would you? She has dementia, and dementia itself is a contraindication for thrombolysis."

I really disagreed with him. The patient only has mild dementia, but she is still able to conduct her daily living with just minimal assistance. I kept my thoughts to myself. It is never a good step to disagree with examiners!

Station 5

This is the most dreaded station! In this station, you are expected to review 2 patients in 8 minutes (which includes a brief history and quick targeted clinical examination). I was really nervous as I sat outside the room while reading my 2 scenarios. The examiner didn't help to ease me either by saying, " You have 2 cases, 10 minutes each. You have 8 minutes to examine the patient, while the other 2 minutes is for you to shine!" Shit. I dislike it when he said the word "shine." I felt like there was alot more pressure on me now!

My first case was a review of a lady with unilateral leg swelling. The second case was on chronic diarrhoea. Looking back, I felt I could have done better in the latter case. I think the patient probably has inflammatory bowel disease, so therefore, apart from examining her abdomen, I should have also looked for other signs of IBD, you know, like skin rashes, anaemia etc. Oh well, can't do anything about it now!

hhhuuhhh.....

I am feeling SO STRESSED that my heart is aching and I could still feel intermittent palpitations until now. All I can say is I have given it my best shot...but is my best shot enough for me to pass it this time?? Fingers-crossed! I will find out 2 weeks later!

Mid Autumn Festival!

It is the time of the year where the chinese amongst us welcome the Mid Autumn Festival (Zhong-qiu Jie).

From my point of view, this festival is all about playing with lanterns, and eating mooncakes! I shall not go into the various versions of the legend that lead to this festival.

I'm sure everyone is familiar with mooncakes. A mooncake is typically round or square in shape, and is filled with a thick filling, and also with the yolk from salted duck eggs. When I was younger, mooncakes where either filled with the traditional filling of lotus paste or red bean. However, things have changed now. The modern mooncakes come in variety of flavours; chocolate, green tea, yam, pandan, and even durian! There are even mooncake ice-creams around! And to make those health conscious people less guilty, there are reduced sugar and reduced fat ones as well!

Being so far away from home, I really miss this festival. If anything, I enjoy this festival more than chinese new year!

Weird huh?

I don't know. Its probably because I like the idea of lighting up funky shaped or traditional paper lanterns. I like the idea of exchanging mooncakes with my friends/families. And of course, I enjoy eating them too. My personal favourite is lotus paste mooncake, without any yolk! Many people will disagree with me, but I think the yolk just ruins the natural taste of the mooncake.

I haven't savoured a mooncake in 2 years! :( The mooncakes being sold in the local chinese stores here are not as yummy as the ones back home. Therefore, I stopped buying them. Maybe I should hunt for a chinese paper lantern, just to humour myself. Or maybe, I should plan a visit back home during the festival period next year!

A Parting Prayer for Kiki

Dear Lord,

Please open your gates
and call St. Francis
to come escort this beloved companion
across the Rainbow Bridge.

Assign her to a place of honor,
for she has been a faithful servant
and has always done her best to please us.

Bless the hands that send her to you,
for they are doing so in love and compassion,
freeing her from pain and suffering.

Grant us the strength not to dwell on our loss.
Help us remember the details of her life
with the love she has shown us.
And grant us the courage to honor her
by sharing those memories with others.

Let her remember us as well
and let her know that we will always love her.
And when it's our time to pass over into your paradise,
please allow her to accompany those
who will bring us home.

Thank you, Lord,
for the gift of her companionship
and for the time we've had together.

And thank you, Lord,
for granting us the strength
to give her to you now.

Amen.

I Love You Kiki

Kiki, my beloved doggie, has gone to doggie heaven.

I love you so much Kiki, and I want you to know that I will miss you loads!

You have been my lovely companion, friend, and family.

I hope that the last few days of your life has been comfortable, and that you didn't suffer too much.

My life without you is going to be very difficult....

I will miss the way you smile when you see me

I will miss the way your whole body "wriggles" in happiness when you see me

I will miss your lil antics, your bark, and will miss playing with you

I will miss hugging you, patting you, and tickling you...

I will miss everything about you.......

I LOVE YOU KIKI.

May you rest in peace.

God bless you.

HUGS!!!!

Left: Puppy Kiki Right: Elegant grown-up Kiki

The Great North 10k

Yes! Finally I have ran my first ever 10k. The event was held at Gateshead on a very wet Sunday morning.

I was really dreading it, to be honest. I haven't been able to train much as been pretty busy with exams and work....so I only squeezed in 4 x 1 hour sessions of running 2 weeks before the actual event. I was starting to think twice about running the 10k, as I wasn't able to run 5k without stopping for a short rest. And to make matters worse, my left knee began to hurt during the last training session. I probably had a lateral ligament sprain. So I gave myself a 4 day rest before the event. The pain in my left knee also disappeared...phew!

I looked up the weather forecast a few days before the 10k. "Heavy thundery showers" was forecasted....*shit I thought. How am I going to run in the rain? My shoes would be soaked wet...and it would be uncomfortable. Anyhow, I reset my mind, and made myself ready for the day.

Sunday morning has pouring rain, just as it was forecasted. I got myself to Gateshead by 9.30 am. The rain was still present, but not that heavy. Thank you Berghaus for keeping my body dry.

I began the run. I felt good, my mind was ready....unfortunately, 10-15mins into the run, my left knee began to give me trouble. It was beginning to hurt, but I continued to push on...it somehow felt slightly better after more exertion, which was slightly odd, I thought.

I got to the 5k mark in just less than 30 mins. I was happy with that. Surprisingly, I was not too breathless, and my legs still felt strong.....

6k....7k...then, I had to run up a rather steep slope...that killed my pace. I stopped just for about 5 secs at the top of the slope to catch my breath, and continued to run.

*ouch....I felt a sharp pain in my left knee, and lack of energy... I told myself, there's just 2 k left...come on...just get it over and done with! I persisted. The rain had stopped, and the sun was starting to shine!

8k...yet another killer slope....9k...and finally yes! I crossed the finishing line!

I stretched out my legs...and oh dear...my left knee wasn't feeling good at all. I was aiming to complete the race within an hour, but I was still pleased with my official time of 01:02:56. Guess I could have been faster if it wasn't because of my knee problem.

This morning, I woke up feeling stiff all over...the muscles in my thighs are aching...and left knee still hurts, especially on flexion. I am kind of walking with a limp at the moment. I am really concerned over my knee....There are two possibilities: iliotibial band irritation or lateral collateral ligament sprain/tear. Whatever it is, I think I deserve a rest for the rest of the week, and probably next week too.

Here are a few pics!

A wet day!

The finishing line in the background...the sunshine appeared in the end!

My complimentary T-shirt & medal!

My List

I remember making a list of things I wanted to do before I turn 30. I know there's no need to make such lists...but somehow a list makes life somewhat more interesting! So here is the list I've created when I was quarter of a century old. Next to some of the statements are my comments/thoughts on them.

1. run a marathon or 10k (yeah....doing a 10k this weekend)

2. skiing/sledging (making too many excuses for this; "no time")

3. go sky diving (know for a fact that wont happen coz i'm a chicken)

4. own a pair of manolo blahnik/christian louboutins (i can only dream, with my horrible bunions, i cant even fit into these lovely shoes, or walk on them!)

5. fall in love again (yeap, in love now)

6. married with a at least one child (this thought is down the drain)

7. learn hip hop dancing (probably getting too old for this now - so unflexible/stiff/uncoordinated)

8. go to wimbledon to watch fedex/nadal play live (tickets way to pricey)

9. get horribly drunk (yeap...done dat, not a good feeling)

10. wall climbing (yeah, went to learn this on my own...havent been back coz I need a partner)

11. see the world (still haven't visited my countries yet)

12. take up a new hobby ( i did, which is beading)

13. not to grow up (aha...still dun plan to)

14. cycling trip in an EU country (still planning)

15. own a convertible (dream on)

16. dancing like an idiot, and no one watching (well, did dance like an idiot at a night out...and i'm sure loads of my colleagues were laughing at me!)

17. do some sexy dancing with a hot guy (ermm...haha...yes, i will say, yes. i sexy danced with a hot guy from work 3 years ago!)

18. own a beautiful house/apartment (been moving around too much to be able to buy a place permanently)

19. learn to play the drums (hmm...bila ada masa?)

20. have a one night stand (why not?)

Why Do I Crumble At Times of Anxiety?!

"Mind over matter."

"All too frequently, anxiety crushes not only your spirit and your potential, but your ability to take care of your mind and body." ~ Jonathan Davidson and Henry Dreher, The Anxiety Book: Developing Strength in the Face of Fear.

"Nerves and butterflies are fine - they're a physical sign that you're mentally ready and eager. You have to get the butterflies to fly in formation, that's the trick." ~Steve Bull

Have you ever wish that you could just behave abit more normally when you are anxious/nervous?

Have you ever looked back and think, "Oh man, I can't believe I just said that?"

Have you told yourself that everything will be fine, and yet it doesn't turn out that way?

Have you ever wish that you have never ever have to go through this whole frightening situation again?

I guess most of us would probably have said "yes" to at least one of the questions above. The second quote certainly applies to me. I just sat for one of final medical exam, called "PACES." It is a clinical skills examination, where the exam candidate rotates through 5 different stations, and if you pass it, you will gain membership into the royal college of physicians, which then, allows that person to further specialise into the medical field.

I took the exam only yesterday. I have been building myself up to the exam over the past few weeks. When the examination day arrived finally, I told myself, "Just be calm, and you'll be alright."

Guess what?

I was really really really nervous. I tried to take a few deep breaths, but still felt much the same. I started off with a communications/ethics station. I was asked to discuss whether ventilation is appropriate for a lady with end stage COPD. I thought that invasive ventilation is probably not appropriate, but non invasive one, would be her ceiling of care. However, the feedback I got from the consultant was not good at all. From his point of view, ventilation would still be appropriate in her case. hmmm...

Then, I moved on to the dreaded Station 5. There were 2 cases in the station. The first one was a guy with vision loss....I was only given 6 mins to talk to him, and explain what I thought was the problem. I didn't have much time to explain to him what I thought was the problem....so I guess I lose marks for that. I did better in the 2nd case.

I moved on to examinations skills stations. I had to examine 4 different patients. I think I did worst in the respiratory one...purely because I totally missed the 1cm scar at the side of his chest! yeah...it was 1 cm long!! my eyes really have failed me. And I didn't get the diagnosis right in his case. :( A few questions were directed at me...and honestly, I really don't believe the answers that came out of my mouth!

I finished the exam at the history taking station. This didnt go well either because I couldn't finish on time....the patient was so long winded, and I think he didn't know his history properly. So I faltered there.... sigh.

Is this all just nervousness? If it is, I really need to know how to overcome this. I personally don't think that the cases were too difficult...but my brain has just decided to work separately from my body...and everything just seemed to have gone wrong on the examination day!

:(

I am very disappointed with my performance. I can only blame my ownself for this. I am most likely going to fail it. The only consolation I have is that it will not be the end of the world if I do fail. I can try again in December...

Guess I probably have to do more locum shifts to get some money back to pay for this very expensive examination. Results won't be out till next month, I better enjoy the time off I have, before I start preparing for the examination again!

A Pool of Blood!

For the first time in my life, I have felt alot....I mean, seriously, ALOT, of blood pouring through my fingers.

So far, I have dealt with minor bleeding in patients after venepuncture, or angiograms. But, today, patient X, fell onto the floor after having a seizure. Patient X cracked the back of X's head, and subsequently, bled from the wound.

When I arrived at the scene, patient X was already lying in a puddle of blood....One of my colleagues applied pressure on the wound with his bare hands as he wanted to stop the bleeding quickly. I offered to take over from him, as I had gloves on.

I used some gauze to help seal the wound. However, blood kept pouring out of the wound...I could actually feel the warmth of the blood through my fingers. The nurses kindly got me a surgical pad, which I applied with good force on the scalp. I had to place the entire surface of both of my hands on his scalp, and also at the same time, trying to stabilise his head, as he was very agitated. It was quite a difficult task I must say! Finally, after about 10mins or so, the bleeding stopped.....thankfully!

After that, my arms ached. The muscles in my forearms were twitching. The shaking was definitely not due to nervousness. I have no problems looking at blood. I think it was probably due to the way was trying to put pressure on the wound, and also, the amount of persistent pressure I had to apply to patient X's scalp. Imagine having your fingers spread out on a person's scalp to hold and stabilise it as well. I have to admit I have pretty small hands, which made it a bit more difficult.

It was quite an experience for me, as so far, I have never been involved in any moderate-major trauma. I would never ever forget the sight of pouring blood and that warm sensation of blood when is just seeps through my fingers.

Take That Rocks!

TAKE THAT is FANTABULOUS!

Yeap....their Progress tour has began. They started off in Sunderland as usual. And I was one of those lucky fans who managed to get tickets to watch them live in their next stop, which was Manchester, where they all came from.

I am a mega fan of Take That. I loved them since I heard their song "Babe" and "Back for Good." I was very excited when the boys (or maybe I should call them men) decided to reunite a few years back! I was slightly sceptical when Robbie joined them last year...but I have to say, it was really nice to see them all together on the stage.

The show kicked off with The Pet Shop Boys....unfortunately, I didn't manage to watch their entire performance, as I was running late.....and....ermm....coz I was too busy choosing which t-shirt(s) to buy from the stall outside. hehehe...

...............75 pounds less later (yes i know!), I eventually went in and saw about 15 mins of The Pet Shop Boys. They were entertaining, and certainly, got the crowd going.

Take That (minus Robbie) began their gig with "Rule the world," one of my favourite songs. The interesting thing to note was that this particular song was the closing tune for their Circus tour. It was like they were continuing their gig from where they last toured in 2009. A few songs later, the 4 of them went behind the stage....and Robbie appeared on the stage, on his own.

I never was a huge fan of Robbie (the person)....but I do like his solo music. He started off his own mini gig by singing Rock DJ! I loved the fact that Robbie sang a few of his own solo songs on stage...and at the end of it, he was joined by the other 4, singing tunes from their new album, and popular songs when they were a team back then.

I really enjoyed myself! There were fireworks, confetti, human chess board, amazing dancing troupe....wow...the gig was brilliant!

The Circus vs Progress tour?

I personally think that The Circus tour is the better of the two. I thought that The Circus tour was more extravagant and playful, which made it special. The Progress tour was more serious & grown-up. It really showed how much the guys have "progressed" and moved on.

Having said that, the stages were set with similar ideas. For example, in the Circus, there was one main stage, and another that tracked into the middle of the concert venue. This concept was maintained in The Progress tour. The other similarity was the use of robotics. It was a robotic human in the Progress tour, while in the Circus, they created a robotic elephant.

For those of you who are unable to catch the gig, I would highly recommend that you buy the DVD when it is out later this year, you will not regret it!

Let the show begin!

Yellow confetti!

The grand finale (the robotic human is in white)

Interesting yet controversial

Here are a few interesting statements that I came across this week in the the hospital. Some of them were overheard, some of them were directed right at me.

In order to maintain confidentiality, I will not mention who said it, but will just label them as Staff A, B, C etc... (my thoughts on the statement will be written in Italics)

"Oh, I hope he hasn't gone away to google the solution to the problem here!" said staff A, on a cardiologist registrar. (how rude and unprofessional, and its not like staff A knows much about cardiology anyway)

"That surgeon has no idea....she is so stupid!" said staff B. (other specialty commenting on other specialities is a very common thing in the hospital)

"Out of these few names, who will you choose to put the CPAP hood on? Chantelle, Fred, Tiffany, Kieran?" asked staff C to the team members. "Of course you will choose Fred, coz he sounds more like someone who will cooperate....Chantelle/Tiffany will be too worried over their looks." (judging people even before meeting that person)

"Most haematologists think that all their patients have an excellent prognosis." (hmm..i dunno, I am no haematologist. if the specialists think so, i would believe them)

"Are the registrar here?" asked staff D to me, after reviewing his patient. "No, I am the SHO here," I replied. (Staff D looked at me up and down, and turned away. He did not want to tell me his plan for the patient...prob coz I am the SHO)

"I don't expect you to know anything." said a fellow registrar to me. (hmm....i might not know alot about advanced ITU things, but I do have medical knowlegde, you know?)

Any thoughts about these statements?

Freaking Out!

Now that I'm back in the UK, reality has started to sink in, once again.

There are 4 weeks left to my PACES exam in June....and honestly, I am shitting myself.

The last time I had a proper OSCE style examination was during medical school years, which was many moons ago! I recalled sitting outside the examination rooms extremely nervous. My heart was thumping hard, fingers icy cold, palms sweaty, and I had a churning/crampy feeling in my tummy. Gosh...I really hated that feeling. It was worse than taking my UK driving test or Grade 8 piano exams or presenting at a regional meeting. I also remembered saying to myself," I don't ever want to have these feelings ever again."

Well, come 20th June, I know that these feelings will come back to haunt me. Ok, I know that I have no choice. I have to take the exam in order to make a step closer towards specialisation. If I pass, then I will be over the moon! But if I were to fail, which is a very high probability, then, I will have to face the exam again...

Life is so unfair! :(

Today, I attended my first PACES teaching session. I really thought that cardiovascular examination is probably the only examination skill that I have mastered properly.

Huh! dream on!

I forgot to test for a collapsing pulse, missed palpation for the apex beat and got my special murmur manoeurve all mixed up! Its amazing how being put on the"hot seat" made me fall deep into a hole.... sigh.

Bearing this in mind, I don't even want to think how I would perform a good and sleek neurological examination!!!

I seriously need to put my arse into gear...practise! practise! and more practise!!

Monkeys Caught in The Act

I visited the Botanical Garden in Penang on Monday. I haven't been to this garden for yonks! And I have to say, I am pretty impressed with the garden. The landscaping was beautiful, and there were some information written about specific trees/plants in the garden.

Dad suggested that we take a tram ride around the gardens first, and so we did. Sitting on the slow tram reminded me of my childhood days....hmmm

One of the things that haven't changed is the presence of monkeys. These monkeys are pretty wild, and they could potential bite you if you are not careful. There are many signs in the garden asking visitors not to feed them, but as usual, Malaysians being Malaysians will naturally ignore them. And as a result, the monkeys can be seen fighting for the food given to them. Check these pics out:

The battle to see who gets the food first!

The winner, enjoying an ice cream.

I know that history has linked us to apes in the past. Just look at the way the above monkey held the ice-cream. It kinda looked like a little boy enjoying an ice-cream on a sunny day. Recently, The Star newspaper published a picture of a orang utan smoking a cigarette! hmm....bit disturbing, no?

Anyway, while strolling in the garden, I also saw a few monkeys shading themselves under the trees.....and this was what they were doing.... (look at the pic)

This is what we call "kutu searching." Too bad the pic is abit tiny, otherwise, the monkey on the left actually had its eyes closed during the kutu hunt. haha.

We spent about 2 hours at the garden. Although the weather was burningly hot, I thoroughly enjoyed myself, soaking up the tropical breeze, and letting my skin tan a little!

Here are more pics (not of monkeys) taken at the botanical garden.

Big Cactus at the cactus gallery

Interesting plant coz its new leaves are white in colour

Cannonball Tree (named so coz of the shape of the fruits)

At the entrance of the botanical garden

Home Sweet Home

6 months later, here I am again, back at home, and absolutely loving it!

=)

It was a last min decision to come back here, coz I only found out that I have been given 2 weeks off work 2 weeks ago. Managed to get my air tickets from Emirates, although, they were definitely more expensive compared to my previous trip back here. But it doesn't matter, spending time at home with family is well worth it!

On the day of arrival, I guess I was lucky to not have to embrace the burning sun. It was pouring heavily. I have to admit that it has been a long time since I last experienced such heavy rain. It was rather humid, and visibility was very poor. Luckily my dad was the one behind the wheels. The only poor visibility I get in the UK is with fog, and heavy snow!

Anywho, once I got back, I had a quick shower, and before I knew it, we were out for dinner!

And.......right after dinner, mum, dad and I put our feet up, and enjoyed a 2 hour performance by MLTR at the convention centre!

yes...i know...MLTR!! haha...yes, they still exist, but I have not heard much of their newer songs. I kind of grew up listening to their music, and I will admit, that I can still sing their oldies word for word! oh yes!

Just in case you're wondering who MLTR is, they are a danish band, called "Michael Learns to Rock." They are more famous in Asian countries...and they are known for catchy tunes like, "25 minutes," "Paint my love," "Actor" etc...

So it was a pretty nice start to my 13 day break back home!

I plan to just chill, eat, shop and catch up with old mates when i'm here! I know that time will pass really quickly, and before I know it, it will be time to fly back home. I should enjoy it as much as I can right now!

DECISION TIME!

The time that most of us doctors at my level dislike has arrived.

Yeap, it is decision making time. The much dreaded job application has began. Now, I have to decide what I want to specialise in.

hmm.....is it respiratory? diabetes/endocrinology? gastro?

well, definitely not cardiology...neurology... renal...

or, is medicine what i really want to do for the rest of my career as a doctor??

or, should I switch to something that doesnt involved so much medicine, ie, psychiatry?

or, should I switch to something less frustrating, and more lifestyle-friendly job of GP?

or, should I go to a specialty where I do abit of everything...like acute medicine?

I really hate filling in forms...I hate deciding on things like this. The thought of choosing one specialty and the thought that I might not like it in the end is rather frightening. And, even if I want to do that particular specialty, I might not get the job at all....

Imagine, each deanery only has about a maximum of 3 available spaces for each specialty...

competition is tough.

arrghh....

R-U-B-B-I-S-H

The week has panned out to be pretty rubbish.

This is Day 9 of my 12 day working week. As the week progresses, things seem to be getting more out of control, crazy and frustrating.

On Sunday, I spent at least 6 hours in one of the wards sorting out a very ill patient. The thing that frustrated me the most was the fact that there was no proper plans created for the patient. The diagnosis made by the patient's usual team was of X, however, when the patient was seen by another team, the diagnosis was Y. The interesting about this was the team that diagnosed the illness X, is a specialist in the illness Y. So the diagnoses were sort of going against each other.

I was stuck in the middle, and I was asked by one of the teams to get ITU to review the patient....Unfortunately, they gave me a big mouthful because the diagnosis was unclear. So I resorted to telling them what I personally think it was. I am sure many junior doctors out there have been in the same position as me. It is just so difficult and uncomfortable being in the middle of an argument between 2 teams.

To add to the misery,

I really wanted to "aou huit" today.... that is a chinese phrase, which literally means "vomit blood." A patient was extremely agitated in the ward because of a severe infection. The patient has no capacity whatsoever to make decisions. A few doses of sedation was given earlier, but they had no effect on the patient at all. The interesting thing was again, there was no clear plan from the ward round about addressing the agitation.

So there I was, holding a syringe filled with diazepam, gently sedating the patient intravenously to allow us to provide treatment. I dislike doing that....but had no choice because I was doing it in his best interest.

The joys of being a doctor.....NOT!

If Wagamama Can Make Teriyaki Sauce, So Can I

=P

I finally made teriyaki sauce from scratch!

Yay! I am very proud of myself. I am a huge Japanese food lover....I love sushi, teppanyaki, teriyaki, green tea, miso, bento...etc...etc.. Wagamama is a popular Japanese restaurant that can be found around the UK. I love going there to savour all the delicious chicken katsu, ramen, and gyoza. Unfortunately, living about an hour's away from the city, I haven't been able to frequent it as much as I would like to.

Feeling all miserable, and in order to satisfy my cravings for Jap food, I challenged myself to make teriyaki sauce. It is NOT difficult! All you need is a small saucepan, sugar, light soya sauce, dark soya sauce and sake. Mix them all together...and VOILA....

TERIYAKI SAUCE!

The sauce tasted exactly like the ones you buy off the shelves...but at least I know, there isn't any preservative or msg or anything like that. I decided to use the teriyaki sauce to marinate a piece of salmon. I grilled the salmon for awhile.

While waiting for it to be ready, I stir-fried some mix vege - using pak choi, button mushrooms, carrots, broccoli, sugarsnap peas and garlic. I also added a touch of teriyaki sauce and a bit of lemon juice into the stir-fry......just to give it a sweet tanginess.

And the final result:

Grilled Teriyaki Salmon served with a bed of vegetables!

I munched it down with a bowl of white rice...and I can happily say, my dinner was absolutely delicious!

Inspired by MasterChef!

The brand new masterchef series has started! And remember that one of my new year resolutions is to prepare more homecooked food?

Yes...both Kevin and I were very inspired to prepare our own fine dining in the comfort of your own home! =D I have to admit that it does take quite abit of an effort, but the end result is well worth it. And it is definitely nicer to cook for two!

So...here they are!

Stuffed apple with ice cream
(pardon the apple, it kinda exploded in the oven...hence it had lost its shape)

Brown Rice Kedegree with side salad

Pan Fried Seabass, topped with tomatoes and olives salsa, and grilled courgettes on the side.

We attempted to present the dish well! Guess we didnt do too badly.

I wish I could take credit for creating such lovely food...the recipes are taken from Sophie Dahl's Cookbook, "Miss Dahl's voluptous delights!"

I highly recommend this cookbook if you're looking for nice homely healthy food!

Today is The Day

Today is the day that I felt I have failed to be a doctor.

=(

It hasn't been a good week so far. Things were disorganised, consultants were being difficult, nurses were being pushy, and patients were very ill.

There is a death in the ward for the past 2 consecutive mornings.

However, the death this morning has made me feel like a complete failure. This poor patient has metastatic cancer...lets call this patient B. B came in with increasing abdominal/chest pain, with episodes of diarrhoea. We have thought it was gastroenteritis, and attempted to get on top of B's pain with opioid based analgesia. B was very settled before we all left for home yesterday.

Unfortunately, when I came to work this morning, B was in severe pain overnight. I went to review B. B was screaming in pain and was writhing around the bed. B apparently had a shot of diamorphine, which seemed to work for a few mins, before B was in severe pain again. The tricky thing about B's pain control was B was quite sensitive to morphine, and had an episode of presumed opioid toxicity, which he responded quite well to naloxone (an antidote for morphine).

I didn't know why B had such bad pain. But my initial plan was to give B some intravenous morphine to get him comfy. However, just as we going to get some IV access in him, B just suddenly deteriorated. B's breathing became very laboured, the colour on B's face disappeared very quickly, and just less than 1 minute, B just stopped breathing, and died.

I was shocked that B deteriorated so quickly. The worse thing was B died in pain! How could I possibly allow a terminal cancer patient die in so much pain...B was screaming in pain seconds and minutes before B's death.

I was very disappointed with myself for not doing anything sooner. One can only imagine how much pain B was in, and that B's death was so uncomfortable for B. I seriously felt I failed to be a doctor today. I also could not understand why B's pain relief was not addressed properly overnight, when B was in so much agony. Who knows! B's death was certainly inevitable, but we as doctors should have made sure that the journey towards B's death was as painless as it can be.

I was very disturbed after that death. My deepest sympathy goes to B's family.

* sigh.

How Unthoughtful!

This is no laughing matter.

And, this is NOT the first time that I have encountered this problem.

Yet, I still DO NOT understand why there is a lack of modern technology in this era!

Now, what am I talking about?

Well, simply the fact that there are quite a number of obese patients in the country that could not fit into MRI, or CT scanners.

One of the patients in the hospital needed an urgent MRI scan to investigate for spinal cord compression. Unfortunately, although he is not obese, he still could not fit into the MRI scanner. The radiographers have blamed it on his big tummy! There are no larger MRI scanners in this region....and I heard someone mentioned that there might be a specialised MRI scanner for obese patient in Sheffield, or the patient could use the scanners build for the use of animals.

What I do not understand is, why aren't there many larger scanners available in this country? I mean, surely, the government realise that obesity is a problem in the UK. And surely, this problem occurs quite frequently. Ok, I admit I do not much about the physics and mechanics of these scanners...but one would have thought that if there are scanners available for large animals, why can't there be ones build for larger patients?

MRI scans are more helpful in identifying spinal cord problems compare to CT scans. Are we depriving larger patients more accurate diagnostic investigations? If building larger machines is not the answer, then what is?

I guess you can ask these patients to try to lose weight...but that would take quite awhile. Moreover, the scans are needed to be done on an asap basis. I guess health professionals just have to treat empirically and use their best clinical judgement for such cases. Or, utilise other investigative methods to investigate an illness by the process of elimination.

Do Not Miss The Black Swan!

I am a big big fan of Natalie Portman. I simply love the way she carries herself, her intellectualness, beauty, and her acting skills. I last seen her in the movie "Closer," which I really enjoyed. So when I first saw the thriller for Black Swan back in December, I told myself, I NEED to watch it.

Yes, I watched it about a week ago. Oh my, Natalie was A-M-A-Z-I-N-G. She was so graceful as a ballet, yet extremely mentally disturbed. Thumbs up to her for being able to portray the character Nina so well. I know this whole movie is fictional...but heck, it was brilliant!

It was rather intense. I cringed when I saw "Beth" stabbing her own face with a knife, and also the scene where Nina slammed the door against her mother's hand. There were scenes where I was just not sure whether she had made it up in her mind, or were they for real? The lesbian sex scene was also really sexy and steamy. Well down to Natalie and Mila. Imagine being good friends, and having to kiss each other, and pretend to have sex?! that must be SO UNCOMFORTABLE!

So, if you haven't heard of the Black Swan, you are definitely OUT OF DATE!

If you have heard of it, then I would highly recommend it. =)

Harmless Flirting

FLIRTING.

According to Wikipedia, "Flirting" is non-physical sexual communication between two people to negotiate mutual attraction through body language and verbal tactic.

Flirting can happen anywhere really, whether at a shopping mall, dinner, parties, or work.

In the hospital setting, a lot of flirting takes place, particularly, between young female nurses, and male junior doctors.

It is really quite interesting to see it happening in front of your eyes. I had the luxury of observing one the other day.

The junior doc working in my ward at present is a young male, who is very much into gymming. Let's call him X. He is bald, and has a muscular V-shaped body.

You get the pic?

It was a busy day at work yesterday. We were all rushed off our feet. Later in the morning, I returned to the ward after reviewing a few patients in a different ward. As I approached the doctor's table, I saw a group of female nurses crowding around the table, where X was sitting. They were all giggling in a very flirtatious way. I was wondering what was going on, and I found out that they were flirting with him.

"Aww...X, would you mind prescribing this for me, please? I will stare at you until you prescribe it....hehehe (giggling)....." said one nurse.

Another said, "Hey X, you not been for your lunch yet? Aww...would you like a cup of coffee or tea? I will make one for you."

"Hey X, I will send that off for you, just pass it to me..." offered another young nurse.

The nurses hardly ever offer to make any one cups of tea/coffee, unless we are on our night shifts, or you are a consultant. I wanted to laugh when I saw X blushing. He suddenly received a surge of attention and TLC from the nurses.

After all that, I heard one of the nurses whispering to another, "Oh...he is so cool and hot...look at his body."

I have nothing against all these harmless flirting. But it could make the person in the hot seat quite uncomfortable sometimes.