30 years on...

Happy Birthday to me!

Just realised how long I haven't updated this blog. I have been busy and too lazy to type anything!

It has been 6 months or more into my new job. It's going ok. I am slowly learning, getting more confident in giving advice over the telephone. Hope I continue to grow as the days go on. However, I am still rather intimidated by the weekly Neurology Grand Rounds. It is frightening, and makes one feel very very inadequate. I will share my experience of the grand rounds later in another post.

30 years sound like a loonnng time. I guess to a certain degree it is, but I think these past few years, in particular, is flying by!

Reaching 30 years old is considered a "MILESTONE", however, I think it is not so much the number that is the milestone. All my life experiences and life changing decisions so far have been my milestones.

Think about it.

Going into primary school was a big step.

Passing UPSR and going on to secondary/high school is yet another milestone.

This was subsequently followed by 2 major public examinations; PMR and SPM.

Successfully obtaining certificates for both these exams was a major life achievement.

Then it was decision time.....A-levels? University? What do I want to do?

Dunno if many knew, but I actually wanted to do actuarial science (coz of my love for mathematics), or civil engineering. And of course, there was medicine in the background.

I was fortunate enough to be offered a place in the local university to do civil engineering. However, after much thought, I turned it down. I do not why I turned it down, I think I was still rather unsure, and felt that engineering might be a wee bit boring. I was not successful in applying for actuarial studies which was disappointing, because I really love mathematics. Having said that, I did not try to hard to apply for it. I only send an application to one tertiary centre.

So I decided that I should pursue A-Levels and then apply for med school.

Ever since young, I have told everyone that I wanted to be a doctor. There was no reason given. It was just one of those things when you were in primary school, and asked my your teacher to write an essay about your ambition. I recalled writing about wanting to be a doctor. But when it was decision time, I was unsure about it.... I was scared about the difficulty of it, worried about having to deal with people's lives, and also the need to spend so much time studying like a geek.

I put myself up for the challenge (yet another milestone!)....and here I am now.

I must admit it required a lot of hardwork, dedication and perseverance! But I am loving it!

Well, after graduation, I thought that is me! I'm all sorted...can be a fully fledged doc, and work myself up to a be consultant. However, little did I know that there were more challenges ahead of me!

First it was to decide whether I want to be a medic, surgeon or paediatrician.
Then applying for that particular specialty.

Again, my decision changed...and so did my life. I knew I am not a surgeon in the making, coz I dislike standing long hours in theatre, and I preferred the medical side of things. I was rather interested in paediatrics since uni days...however, doing the job itself, really put me off it.

So being a medic was my choice. Even in medicine, you have to choose whether to be general medic or specialise in a certain field, ie cardiology, respiratory, gastroenterology, diabetology...etc..

You know the rest of the story....I was planning to do endocrine/diabetes...but after another life changing decision....I am now training to be a neurologist!

I sometimes wonder how my life would be if I had taken up the civil engineering course or worked harder to apply for actuarial science.

See? It is interesting isn't thinking/reflecting on all past events?

These are major milestones for me, not so much, turning 16 or 21 or 30.

So happy birthday to me once again!!!! :D
No celebrations planned really. Family and close friends are not nearby. And I am not one to have big parties...just like to keep it quiet.
But, I will bring in some goodies for me colleagues :)

wow...what a rant today! haha.

I have only a few wishes on my bday:
1. to be loved
2. to be blessed with good health
3. and wish that all my loved ones (family and friends) will be blessed with good health, and happiness.

What's coming next??

Well, I hope that I will get married and build a beautiful family in the future.
I hope that I will be able to complete my training, and maybe spend some time to do research or a fellowship...

Watch this space!

xx

All New People

Last weekend, I was fortunate enough to get tickets to watch a play written and directed by Zach Braff, called, "All New People."

Zach Braff is one of my favourite actor/writer. Of course, we all know Zach Braff as Dr John Dorian or J.D in Scrubs. Yes, he is the dorky geeky one! :) But he is also very funny. I could watch Scrubs every day, and will not get bored of it. I just love that all the characters are so different, and also the fact that they create banter in the hospital.

Ever since Scrubs, I have been sort of stalking Zach Braff....so I've watched his first ever movie, "Garden State," which starred Natalie Portman. It was an excellent movie. Zach also starred in "The Last Kiss," another movie that was written about the struggles in life as one gets older. They were all brilliant movies....so when I heard that Zach was coming to UK to perform his play, "All New People," I got really excited, and bought the tickets asap.

I got tickets for his performance in King's theatre, Glasgow. It was a sold out performance!

The play was about a 35 year old man attempting to commit suicide, after making a big error in his career....he didnt manage to end his life as he met 3 new people in his life, who changed his mind.

I love that the play was dark yet hilarious. I love that they played recorded clips in between the scenes of the play.... I love that the casts worked so well together, and the chemistry between them all was so good.

There were 2 minor glitches towards the end of the play. Apparently, at the very last scene, it was meant to be snowing, but the machine holding the fake snow failed to operate, and also made a loud grinding noise....but that aside, the play was fantastic.

At the end of the play, Zach Braff held a short 25 min Q&A session. One of the questions that made me smile was this, "Zach, have you tried the fried Mars bar yet?"

For those of you who have never heard of the famous fried Mars bar, I would not recommend it. The fried Mars bar is a delicacy of Scotland. Basically, it is a Mars bar.....deep fried.

Zach replied, "Yes, I've heard about it. I do not understand why one would want to make something already unhealthy, even unhealthier."

=) You can check out the website for the play here: http://www.allnewpeople.co.uk/

The Making of Pineapple Tarts

Following on my previous entry on baking for CNY, I decided to be more adventurous and attempt something I've never done before......The Pineapple Tarts.

Yeap....."pineapple tarts" in Malaysia do not look like typical tarts. The dough, when baked, is not flaky and crispy, and the filling is not made from custard or filled with fresh fruits. Pineapple tarts are basically biscuit filled with pineapple jam....i guess, you could say it is almost similar to fig rolls in the UK, just that the biscuit tastes more buttery.

Pineapple tarts come in different shapes. Some looks like cylindrical fig rolls, some looks like sushi (as in a roll filled with pineapple jam in the middle), and the others look like raspberry jam biscuits.

I grew up eating pineapple tarts. We have them as treats during Chinese New Year. I recalled watching mum making the tarts, and I all I have to do is to eat them! They tasted divine. I haven't had a pineapple tart for such a long time....and obviously, I have developed a sudden craving for them. So since I can't get any pineapple tarts at home, I shall make them! :)

I used mum's recipe. I was meant to make them last week, before Chap Goh Meh (the last day of CNY), but unfortunately, I fell ill at that time, and was not in the right state of mind and energy to make them. However, I recovered quickly, and decided to give it a go last weekend.

The most time consuming part of the process was making the pineapple jam. I grated fresh pineapples, and then, boil them slowly with sugar in a pot for more than an hour. The end result being a thick sweet sourish pineapple jam. I added cloves and a bit of grated nutmeg into the jam just to add some extra flavour. The jam was made the night before I made the batter for the biscuit, as it needs to cool down fully.

Pineapple Jam! :)

The next morning, I made the dough. Mum would usually use a mould to create a nice flower shaped biscuit with a small hollow in the middle to allow one to fill it with a tiny portion of pineapple jam. As I do not own one, I decided to make the ones that look like fig rolls. So the idea is to wrap some dough around a small portion of pineapple jam. I also made the rolled ones too.

This is how they looked before popping them into the oven.

I baked it in the oven for about 20-25mins....and here they are:

Don't they look like cylinder shaped fig rolls?

The end result! :D

Not bad for a first timer....But the looks can deceive you. It looks nice and brown...but I think I might have over baked it a little as the biscuit tasted a tad too crunchy for a pineapple tart. Nevertheless, the pineapple jam was brilliant! :D

In The Spirit of The Lunar New Year

Celebrating Chinese New Year (CNY) in a foreign country is pretty boring. There isn't any CNY atmosphere here. The day goes on as usual. There isn't any red lanterns hanging around, and there aren't any loud cheesy CNY songs playing in the background when you enter the shops. The only CNY-related event is the "Buy 1 Get 1 Free on Chinese Sauces" in Tesco and Morrisons, or the "10 pound meal deal" for Chinese food in M&S. Well, at least, they have us in mind.

CNY away from home also means missing the ang pows. And it would also be extremely difficult (or impossible) to savour the usual delicious goodies one can get back home.

I miss my grandmother's reunion dinner dishes. She would make a big pot of "ham choi" or preserved vegetable duck soup. Her "lo-bak" is to die for. "Lo-bak" is basically fried bean curd skin roll filled with pork. Then, her acar is so good....hmmm.... Thinking about them ismaking me hungry!

The other lovely thing about CNY is the traditional biscuits that we only eat during this festive period. Kuih kapit, peanut biscuit, kuih bangkit, spicy prawn roll, ribbon biscuits, pineapple tarts....I could really some right now!

So....because I'm missing home, and dreaming of all those goodies, I decided to usher in the Water Dragon New Year, by baking the famous Dragon biscuit. My mum managed to persuade my aunt to share her recipe. Her Dragon biscuit is, by far, the best I've ever tasted! She does make them to sell, and undoubtedly, they sell like hotcakes! Therefore, her recipe is super top-secret.

This is my first time baking the Dragon biscuit, and I was really enthusiastic. Halfway through mixing the dough, I realised that it is not as easy as it seems. It involved quite abit of mixing action with just a wooden spatula. My arms were aching, and I decided to use my fingers instead.

In order to get the dough to resemble a dragon, I have to put the dough into a piping bag and squeeze it out with a star-shaped nozzle. This is where I failed miserably! My dough was not soft enough to go through the nozzle! I decided to add a wee bit more of my leftover beaten egg to it....My dough became wetter, but I was still unable to squeeze it! I was frustrated. In the end, I used my fingers to try to create the "dragons." I also used red colouring to dot the eyes. And the result is ..........ttaa-daahhh.....

They look more like worms/snakes!! :(

I also made some squares, which definitely looked much better and pleasant! LOL.

Well, on a more positive note, they tasted quite yummy, but not as good as my aunt's. I think I will try a cookie press to squeeze the dough out next time!

I am pretty knackered now, having spent the whole afternoon baking these. The thought of going back to work tomorrow makes me even more tired!

Anywho, here's wishing everyone a very happy and prosperous new year!

Kong Hei Fatt Choy!

Wan Shi Ru Yi!

One Month Later...

One month into the job,

1. I am definitely more confident in managing epilepsy, migraines, Gullain-Barre, and myasthenia gravis.

2. I can perform a slick neurological examination.

3. I have survived all the on-calls so far, but still feeling stressed at the thought of more to come!

4. I have invested in a neurology textbook written by Brazis.

5. I am still quite slow and need to pick up my pace.

6. I have seen 4 "functional" disorders.

7. I really need to learn how to interpret MRI brain and spine images.

8. I really need to pick up a copy of Practical Neurology, and start reading it.

Am I coping?

Yes, I am. I am slowly finding my way up my learning curve...I am just at the beginning of the curve. I hope my skills and knowledge will continue to grow exponentially.

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.