Hidup mulia

The time is 12.03 a.m .. I just finished print out a few cpg i download from the net ..  I’m not sleepy but i have to sleep early .. got a big day tomorrow .. not as big as for some people..  some people got exam, some getting maried , some got first day job, some got a baby … depends.. Me well tomoro is my 1st day attachment with MO in klinik kesihatan seremban .. hehe not so much la huh …

I see a lot of deadline i have to fullfil in front of me .. CFCS visit and presentation, end of posting exam, research project submition which i haven’t start a thing .. well there are lots of time but failing to plan is planning to fail.

As for my friend in sem 7, their dead line to submit research project was last week, end of posting exam next thursday and friday .. And their big sem 7 final exam is coming .. In this exam their teory, practical skill for all 7 posting will be tested.. It is a huge exam .. They have another 5 weeks if i’m not mistaken.. It’s not such a long time ..

My friend in semester 3 will have their final exam tomorrow.. This exam is slightly or shall i say more easier .. They only have to cover 4 system and 2 foundation most of which are only theory .. They also have practical question .. however it is very basic .. A good friend of mine, Rizal and Hafizuddin a.k.a Tawel is taking this paper tomorro .. I really hope they pass this exam .. All the best my friend…

There are lots of thing i wish to write .. perhaps next time ..

Good night ..

Assalamualaikum …

Time surely flies so fast .. The last time I wrote my blog was before surgery exam .. Alhamdulillah I pass the exam comfortably .. And now ramadhan already pass by and i’m in internal medicine female ward ..

So far internal madicine has been quit confusing .. The last 2 weeks was rather like orientation for me .. I couldn’t appreatiate the patient presentation hence the learning process was heazy .. what evr that mean ..

Most of the presenting complaint has a vast spectrum of causes and the associate symptoms seem unrelated to the presenting complaint .. Therefore it’s preety much difficult to come to diagnosis straight away .. most of simple cases like asthma, myocardial infarct or denggue fever were easy to diagnose .. getting investigation was merely a protocol .. the big headache is when patient is deteriorating with abnormal blood count and renal profile but have a negative results of focus unvestigation.

Apart from that, it was exciting ..

Assalamualaikum everyone … as usual today we had case presentation in the ward .. this time Mr Lionel take us … hanisa present a case of pancreatic carcinoma .. this is the first time i saw such case during 5 weeks of surgical ward .. then izni presented a case of brest lump of right breast .. benign tumor grow into malignant .. 50 years old female .. note one thing fellow friends .. if a 50 years old female come with a lump on her breast … it is malignant tumor until proven otherwise .. As Mr Lionel finish I ran down stairs to SOPD .. coz the time is 9.35 a.m and Prof Ramesh mention earlier .. if we come to his clinic later then 9.45 we better don’t come in .. as i reach his room some of sem 9 student were already there .. waiting for "Boss" … we waited and he came around 10.05 a.m…. as usuall we had several hypospadias cases, one came with mild fits, 2 cases of hydrocele and others.. i remember seeing two of the patient in the ward .. one 1 years old femlae patient had cloacal anomali where her bladder, uterus and rectum fuse into one tube and open into her vagina… a major surgery was done by prof ramesh and she came for folllow ups .. her new rectum need to be dilated once a day using candle and so prof ramesh teach the mother how to do it .. the first time he did it there was a little fresh blood on the candle .. then time for the mother to do it .. there you go …  fresh thick blood came out  and the poor girl was screming and crying in pain .. prof explain that it’s normal to have gross blood discharge after performing the procedure but it was too scary for me .. scary woo … then come a young male patient age 8 with a hereditary spherocytosis .. he has to undergo splenectomy and cholecystectomy as the spleen has enlarge and he develope stone in her bladder .. when there is stone in the gall bladder it is useless and can cause choledocholithiasis which can lead to secondary ascending cholengitis .. for the spleen due to his abnormal blood it will rupture as it floes into the spleen and that leads to haemolytic condition which cause the stone formation and generalize jaundice on him .. poor kid .. such a young age  .. already losing his spleen and gall bladder .. in the future he will be passing lot’s of bile every time he eats fatty food .. and prone to infection .. the rest is okey .. not so bad but there is difficulty he has to overcome …. all the best  ..

our last patient came for a follow up .. he is 10 years old male malay patient had trauma on his left abdoment 2 months ago .. some kid kick a ball and hit his abdomen causing swelling associated with haematuria .. ct scan and abdominal x-ray was taken and the swelling resolve a few weeks later… he doesn’t passing out blood anymore as well .. to me the kid appear healthy and their parents smile at us as we talk to the boy .. they actually came to get the result of the ct scan and abd x-ray..  as I observe the ct-scan .. i couldn’t make out any abnormality … so as the others .. then prof open his mouth .. the kid had an enlarge pelvic of his left kidney and the right kidney appear to be enlarge .. the mild visibility of contrats dye on the right kidney showed that there is hydronephrosis of the right kidney .. it is clear to me that this kid is in big trouble … the worst thing is the whole family doesn’t have a single clue what is going on .. we were talking in english and unfortunately they don’t understand us .. probable due to all the medical term we used during the discussion … as we read trought the x-ray report .. the radilogist explain that the left kidney does not take up any contrast dye .. and the right keidney appear dilated .. prof ramesh refuse to except the report .. he feel that there is some error on the evaluation .. the 1st question is … what is the underlying pathology .. a 10 years oldoy had a ball hitting his abdoment and suddenly develope left kidney failure and right kidney hydronephrosis ?? odd you see .. we can’t make out any reasonable explanation .. then the prof open his mouth again .. a trauma that leads to this kind of condition usually due to underlying pathology .. it means that the kid already had some illness affecting his left kidney … the trauma worsen the underlying pathology  and that’s why suddenly he develop such a severe conditin from a mild trauma .. otherwise it’ll remain asymptmatic until one day all of the sudden .. the boy will present with bilateral kidney failure … basicly the guy who kick the ball have save his life .. a surgery has to be done in order to asses the left kidney .. prof remesh feels that there is obstruction some where along the left ureter .. he feel the left kidney is stilll working .. .it doesn’t pick up the contrast dye due to the obstruction .. accumulation of fluid cause the kidney not able to filter anymore fluid  not bacause of left kidney failure as mention by the radiologist .. thats why prof disagree with the evaluation … the decision will be made during the operation itself whether to keep the left kidney or remove it .. the importen thing is to save the right kidney … left kidney failure if we left unresected will cause right kidney failure .. the kid can still live a normal life with one functional kidney so .. thank good a ball hit his abdomen ..

Prof ramesh ask one of us to explain this to the parents .. i was the only malay in the room so no choice .. it has to be me ..  you guys know can i’m only sem 6 and I tough it is like any other normal explanation .. so i just shoot to their face … guess what happen ???

the father was stunt and satnd up .. the mother turn away and came back crying … there was 6 of us .. thank goodness the other was sem 9 student and they help answering the question the father had .. you know the kind of question when you are confused and dissaponted and sad and surprised in denial .. why why why kind of question .. why my son appear normal and healthy all this time and you said he has been having this illness since earlier age ?? that was the bomb thrown to my face .. from the father of the child ..  then i realize that the situation is very serious and tense .. we explain slowly and thank god the father is a rasional man manage to control his emotion and except the shoking news ..

I went back for zohor after wards and had a long tough a bout what just happen .. I feel that i should have been more sensitive in letting out the news .. i’m telling a parents that their son will lose his kidney just like that .. without explaining the underlying situation ..

the best way is to sit down with them ..  then i should explain that the kid has got some problem with his left kidney since younger age and it remain asymptomatic .. and so on until the end ..  i’ll tell them that he has to undergone surgery and the likehood that he might lose his kidney .. i felt sorry for the kid and his family .. the news i let out today will change the family  ..

It’s is something valuable for me to learn this today .. Perhaps it make me a better Doctor in the future ..   

exam is within 3 weeks time including this week .. There are just to many things to know and i just don’t have the time and stamina to go for it .. finally i find out my eye is the source of my headache problem .. and now i need at least another week to get use to the glass .. headache for another week .. wish i can buy time .. i’m still not provision enough in history taking let alone presenting one .. Dato’ kanda will surely kill me if don’t do anything fast .. The problem with history taking is to correlate the finding and telling the story .. to make sense of your finding of course you need to know the classical sign and symptom of the disease and for that you must read .. and that is what i need .. everyday most of the time spend in the ward to see patient .. i need atleat 1 hour to clerk 1 patient and 1 day i must clerk 3 patient .. there goes my 3 hours in the morning .. then after that i will either follow my teacher to clinic pakar and observe him clerking his patient, or to the operation theater to observe procedure or observe endoscopy  .. there goes another 2-3 hours… i usually miss lunch coz the clinic session usually last till 12.30 … i need to use the time to read up and prey before tutorial or csu starts at 2 .. … the day at imu ends at 4 p.m. then we all go back ..  at this hour my body is aching all over … the only thing in my mind is lie down … tried to force myself to study twice .. can’t go on doin it .. body say i need some rest … and now since there are so many things to read .. i can’t start .. jamm la .. every time i tried to read .. i tried to read quickly cos want to save time .. and that create the headache again .. i hope with this glass i’m able to read 5-6  hours which seems impossible before .. i admire those who can do it … anyway … my fault also la kan … tak study awal .. tapi settling down take some times you know .. the transition from preclinical into clinical is difficult .. for me atleast .. i’m only human .. a weak human being .. huk huk huk .. good night people ..  i have to continue reading ..

This is the 4th week i’m in seremban … So far things has become easier … ward round still difficult though … prof ramesh bomb us with tons of easy question on anemia, kidney stone and stuff .. things i know i knew but too damn difficult to spell it out .. acute brain wash secondary to chronic fatigue syndrome i guess… had a good time today at the SOPD with Dr. Han’s and Dr Koh … They teach a lot and allow us exmine patient … the key word is practice csu on real patient as much as possible ..

I guess to those out side medical field wont understand a thing i mention huh .. Try to keep up key … no time to elaborate more … got any question ask … hehe .. anyway back to me .. this is my blog kan so i write bout my self laa kan .. tengah mereng sikit nih .. chronic fatigue syndrome ….

ainon said got kecoh sket kat OT tadi .. tak sure detail cite tapi easy said they all tak dapat masuk OT .. gaun sergery habis kata sister OT … dengar cam sengaja tak nak kasi IMU student masuk .. sampai cerita ke telinga DAto’ kanda katanya .. entah aaa hope dato’ do something bout this .. otherwise kitaorg tak dapat masuk OT and junior pun suffer gak nanti ..

ezran plak baru dapat discharge dari orthopedic ward … masuk ward 2 hari sebab ulcer kat medial part of left thigh … they perform I&D then dressing member sampai jerit2 kat treatment room .. sian zee … tak pe pengalaman .. tanda dari Allah tuh kau nak jadi orthopedic surgeon…. okey what …

HAdi plak ponteng study circle tadi .. tak pernah nampak muka dia sejak first meeting .. ape le masaelahnye ..

Dr zain tadi cakap pasal camne nak galak patient solat … dia harap kita bila pegang post kat ward esok cuba ajar patient camne nak solat kat atas katil, amik air semayang on POP atau burn injury ke … ade le 3 jejaka kacak yang datang .. yang lain sume bidadari IMU … cantek2 wooo .. sejuk hati aku .. tp tuh bukan matlamat datang meeting .. aku nak dengar kata-kata hikmat Dr Zin …

Mula start english now nih melayu plak eh .. chronic fatigue syndrom … 

byk lagi yang jd since the last time i post blog … antaranya my phone 6260 ilang, balik shah alam hujung minggu, main futsal ngan dak sem lain and MO … experience2 meeting patient … a lot laa … and i know alot more will come soon ..

good night everyone .. and to Aidah … I love you so much sayang..

No matter how difficult life is over there … I know you can do it …

Selamat hari merdeka semua … cuti merdeka nih takde makna sgt pd aku tahun nih .. yang ada dalam kepala aku sekarang report case summery yang kene submit friday nih, cari research title, cari patient untuk cfcs follow up and prepare scatch untuk presentation Isnin depan … sedar-sedar pg tadi dah pukul 7.04 … aku blink sekali lg pukul 7.30 and another blink dah pukul 8 pg …. gitu lah tahap kepenatan aku minggu nih .. TApi kata-kata dato’ kandasamy semalam menaikkan semangat gak tambah lagi telatah sister rosalind masa demonstarte safety precaution kat OT … dengan bdn yg lethargic cam kene denggi nih aku tarik tuala gi mandi … matlamat aku hari nih  nak exam patient untuk case summary and jumpa group untuk discuss scatch … sesampai wad shudek ngan ain tgh clerk patient .. bapak awal … jalan terus cari patient yg bleh "sembang" lekat kat sorang patient .. aku start lah sembang .. rupa2 eh member ada bengkak kat kemaluan .. so takde byk sgt la nak PE nye kan … habis sembang keluar tulis history .. dato kanda tak kasi amik Hx and tulis kat note book dppn patient ..dia kata nanti patient marah .. so terpaksa ikut lah cikgu … tgh2 nulis faezah ngan ainon sampai .. ajak turun kantin .. asal ada awek ajak makan ape lagi follow je lah .. then discuss scatch ngan group and balik pukul 12 tgh … dalam pukul 1.30 call dija minta contoh case summary and case report dia …. perghhhh complete betul …. basicly kerja aku pg tadi wasted … tak cukup …. kene pg balik wad jumpa patient tadi balik … lepas zohor terus siap gi ward .. sesampai ward rupa2 eh tgh visiting hour .. patient tuh dah takde kat katil merayap tah kemana … aku pun decide cari patient br… jalan2 punya jalan nampak ada brother tu sorang2 tak de visitor … aku pun masuk aaa "sembang" .. member baru lepas laparotomy … ada intestinal obstruction… cam biasa setel Hx taking aku pun salam dia and blah aaa nak buat case note and refer bed tiket … mula2 bukak bed tiket  tuh nampak Dr tulih Ex-IVDU ..  aaaaaa sudah  …. hati dah tak sedap … then nampak hepatitis B suface antigen -ve … key tuh dah buat aku lega … kemdian ada satu line sentence yg buat darah aku bergelora …. dia tulih retroviral +ve …. aku pun tutup ticket and basuh tangan …. aduh hai … tadi masa amik history hidung aku dekat je ngan mulut dia … mmg bagus kan … kalau patient tuh ada TB aku pun telan semua bacili yang ada …. aku tanya staff nurse … betul pun … member tuh HIV +ve …. nape leee tak letak warning sign ke hape ke kan …. mak aku kat post-op patient takleh isolate sebab susah kalau ade pape emergency … tapi kat tiket tuh ade sticker kuning aaa yang symbolize patient to ada HIV … Aku pun terus takde mood balik hostel tido … On this matter kan mmg aaa as a medical professional aku tak leh discreminate camtuh sekali … tapi this is my first time and it came out of warning confront HIV +ve … it takes time .. mmg susah aaa untuk aku jumpa brother tuh lagi kan tapi I hope the next HIV +ve yg aku jumpa … aku dapat bersikap lebih professional and handle the case well … 

letihnyeeeee … Pagi-pagi dah menapak nak tangga imu jek dah 4 tingkat … tambah lagi 3 tingkat untuk sampai ward aku …. cari pakcik Yaacob y aku clerk semalam … tak de plak …. mana pulak org tua nih dah lari … tanya mici … mici kata dah naik wad 7c … dia dapat privilage wad kelas A … ape lagi aku pun naik lagi 4 tingkat … Guess what sampai atas patient dah discharge …. mak datuk …. 11 tingkat aku panjat .. dapat le execise di pagi hari … lemah rasa satu badan … turun jek wad 3 balik docter lebih ramai dr patient. HO buat ward round ngan MO and sem 9 tgh ikut Dato’ KAnda and batch mate aku plak amik Hx baki2 patient yg ade.. patient aku ?? dah balik … sangap 2-3 minit nampak attendent tgh sponge patient aku menyelit same … terperanjat beruk gak … kepala patient tuh berlekuk cam tak bertengkorak … baca2 bed tiket kata due to alleged asault and intra cranial bleeding .. patient tuh mmg cam tak sedar diri … nak amik Hx mmg out of the question … then empet ain ngan nisah … boring2 gi plak kat shudek ngan sasha .. then nampak one pakcik tgh termenung .. ape lagi pasang langkah … kesian dia .. muntah darah then kene endoscope … teringat aku dulu man nak sangat kene endoscopy sebab nak tgk stomoch ulce die … habis amik Hx aku pun masuk SOPD jumpa Mr Shakir … Brest specialist by major tp basicly sergeon … DApat 3 case thyroid … Rasa bodoh gile .. Sume pasal thyroid yg aku ingat masa phase 1 dulu lupe dah.. berdiri lagi … ade gak Mr Shakir suruh aku Hx … meraban2 gak aku … die cool jek .. faham gaknye ngan kerenah student …

HAri nih cam amaizing race plak .. Bawak motor aidah ke BP then jalan cari bus stand kat batu pahat tuh .. bapak penat .. BAs balik seremban ade satu jek pukul 4.30 ptg.. tgk jam pukul 11.30 pg .. pergh lama plak nak tunggu .. amik bas kl pukul 12 … bAs jalan aku pun naik bulan .. sesadar kat nilai dah … turun Pudu menapak sampai masjid jamek amik putra gi KL sentral beli tiket KTM komuter straight ke seremban … what a day … Turun seremban br makan 1st meal of the day … Demi kekasih hati … Sanggup beb … Sesampai rumah hadi tgh gentel hand phone … Mintak gamba konvo aku yg dia amikkan semalam .. CAntek … My second U convo … Bole laa .. NAk nengok sile dtg rumah kami di kondo tasek mewah .. HAdi kata nak beli kete second hand … abg2 yg reramai tuh tak bg dia bawak moto .. Gitu leh biasanya .. mak bapak aku pun gitu gak dulu tapi akhirnya diaorg belikan aku Kris .. Moto nih bahaya kalau bawak tak pakai otak .. tapi ade gak la elemen ajal dan maut kat situ … tapi bw papepun leh mati kalau dah ajal tul tak .. Mind set … Tgh2 selak study guid kantoi beberapa perkara plak pasal posting surgery nih .. angkat phone call dell then cakap ngan dija .. pendek cerita pastu dija turun floor aku and sembang pasal posting nih kat depan swiming pool .. perghhhh power sial … baru satu sem terasa cam aku cakap ngan senior tue gile .. phase 2 mmg beza giler ngan phase 1 .. glad I’m here now … habis discuss aku br sedar schedule aku salin untuk masuk PDA dah salah … aaaaaaaaarrrrrggggggghhhh .. penat sial .. mampos ah .. besok buat lain … Tak bace pape lag nih … better start lepas semayang isyak karang .. jam dah pukul 2357 … boleh kot .. selamat malam MAlaysia …

London

was bomb several times 2 days ago .. And guess what? The BBC reported the europian al-qaeda admit that they are responsible trough their web site .. On the contrary Harian Metro  today (9th July 2005) reported that the the right hand leader of Pakistan ISlamic Political party, Liaqat BAluch says the europian and the americans did it to subotaj ISlam… What do guys think… How far can we trust the world wide web ? IS killing civilian becomes the teaching of Islam ??   

During usrah today, we discuss about this and I wish to share our discussion …

Allah says in Quran that the Christian and Jews will never redha ISlam till end of time .. The jews belive that near apoclipse, the Muslim will rise and that Jerussalam will be ours again .. They belive this because it is stated in their Holy Taurat … ANd they belive it so much there doin everything to make us weak .. What were they thinking .. Their affort againts the word of God … Anyway back to the main topic.

Today as a muslim, I admit we are lacking in many areas such as military power, numbers of scholars, our economy is very weak, we are not united and even worse there feeeling of Izzah (rasa mulia sebagai Islam) being a muslim have disappear from many of us. Despite all this, why are they still pressing us ?? Are we more smarter then them or richer perhaps..  No .. It is the Islam itself that they envy..

Perhaps this is an opinion or I prefer to refer it as our stand ..