Just keep telling yourself you deserve it...

Leg of lamb, marinated in worcesteshire sauce, black pepper, sesame oil, oyster sauce
Semi mashed potatoes with garlic and butter
Terung goreng (malas nak check english translation) in the steak sauce,
Steamed carrots

Cost = 4.89 euro

My doodly notes

As I was browsing through my old notes, I noticed a recurrent theme. Lotsa doodles.



Depressed Much?



The ECT Misconception



if only my brain was a sponge...



An accurate self potrait




Making full use of the girls' colourful pens





WHO?




Maternal smokers should be hung

Tik tok

It finally snowed. For about 10 minutes.

I love snow. Especially when it’s all white and fluffy.

I hate rain. It makes you all wet.

Less than a day left till the final winter exams.


In 12 hours, it’ll be over.
Then I’m off and away from this wet gloomy place (which I is still love though) to Belfast, Galway and finally Scotland.

I’m already mentally filling up my shopping list. If only I could mentally add a few extra zeros to my bank account, grrr.


Ahh drama.

Hart of Dixie is a new show I discovered while studying really hard for the finals. 10 episodes (+ two packs of Cadbury choc cookies) later, I realized that I was hooked.

So a hotshot (and hot) young doctor dreaming to be a cardiothoracic surgeon is sent to a small town in Alabama, to do General Practice, in order to refine her somewhat flawed bedside manners.

Then all hell ("H E double hockey sticks", according to one of the characters) breaks loose.



So much for a medically-themed blog huh.

Four magic words

“Boss, pendek, tamau cukur.”

Then it’s just sitting back without a care in the world. I’m in safe hands.

For the past 10 odd years (I’m that old), getting a haircut has been an uneventful, safe routine back home.

Then I arrived in Dublin.

I’m not used to being pampered with a hair dryer. I get easily impressed with the fact he uses more than one type of scissors. There’s even ‘neck tape’ to make sure my hair doesn’t fall into my t-shirt.

Then he asks,

“How would you like your hair cut?”

“Short and neat,” I answered

“Well, can you be more specific?”

I panic. No I can’t be more specific. You’re the barber. You tell me!

“Em, use your imagination,” as I looked at him hoping for sympathy.

...............

It took more than an hour. He seemed reluctant to chop off my “soft, curly” hair, continually asking whether I was sure that I wanted it short.

At the end, I thanked him and paid off the 8 euro I owed. I left the ‘salon’ looking like a schoolboy. Urgh.

I miss home.

Oh, I finished the friggin essay.

High five!

All the luck I can get!

Numbers and figures

Pre- Clinical – check

Medicine – check

Surgery – check

Legal Medicine - check

Paediatrics – check

Obstetrics and Gynaecology – check

General Practice – check

Psychology – check

Public health - pending

I hope to god I passed GP and psych.

On a side note, there's HALAL JAPANESE FOOD people!

DUCK-ing Delicious

Chicken Katsu : ie ayam serbuk roti + kari tak pedas.....

Public Schmublic

Cohort. Case control. Systematic review. Meta analyses. Positive predictive value. Specificity. Sensitivity. Randomized controlled trial. Forest Plot. Prevalence. Crude mortality rate. Confidence interval. P value. Confounders. Bias.

Now that’s public health and epidemiology studies. Three weeks of lectures and tutorials full of numbers and figures. ( music starts : Noooobody said it was eeeaaassaayyy)

I can’t for the life of me comprehend the amount of effort it takes to critically analyze a research paper. Oh so many numbers!

A 3500 essay needs to be finished by Thursday. Current word count stands at 1998.

Basically data needs to be analysed in each research paper chosen. Up to 15 references are allowed. I currently have 8.

Each research paper references other research papers. The more you delve in the more confusing it gets; a never-ending rabbit hole.

I keep finding more research within research.

RESEARCH WITHIN RESEARCH WITHIN RESEARCH......

Hang on.........

res-CEPTION!

Finals Fantasy - Amateur Transplants

End in sight

8 minutes. 8 ECGs. I was screwed for time. Ironically my heart was beating so fast at that moment. Where’s the ECG machine when you need one?

It was indeed a challenging (ie I might fail) OSCE set, 12 stations of totally random stuff. I guess since I’ve technically finished the ‘theory’ part of medicine, everything’s fair game.

“What advice do you have for me regarding contraception,” the young lady asked.

“As you are well aware, there are a huge range of methods available nowadays,” I started my typical opening schpeel.

In truth, there were a few good stations and a few calamitous ones. All in all I hoped I did enough to warrant at least a credible pass. At this point I couldn’t care less about my grades.

A certain friend described my current situation perfectly.

Burnout.

Idiocy

“Doctor, I’ve been having hallucinations, of a woman in my room. I know she’s not real though,” said one of the actors in my OSCE station

Great. Just great

“Err, tell me more,” I stalled. I had no clue what was going on.

“I think you have schizophrenia,” I blurted out for some reason.

The invigilator groaned. So did I.

I rambled on.

“Yeah, and my wife says the memory ain’t too good nowadays,”

That was the clue. Memory. Hallucinations.

LEWY BODY DEMENTIA.

“Ok ignore my initial diagnosis. You don’t have schizophrenia. I was being daft. I would like to do further investigations in order to confirm my suspicion of dementia,”

Good save. Good save.

True-flu-blues

With exams starting Monday, this weekend was reserved for the last minute cramming that so often gets me through these dreaded exams.

Instead I spent both days under the covers of my duvet, trying to keep warm as the flu hit at an opportune time.

“Bedrest and fluids and vitamin C!”, says mom. Who am I to disobey?

Have faith.

Advice for our aspiring doctors

"Abang dah final year. Ada apa-apa tips tak untuk kami yang baru-baru ni,"

I looked at their faces. Eager, so full of hope. I couldn't let them down.

" I have one tip for all of you. Get out while you still can,"

I turned away from their stunned faces feeling pretty proud of myself.

Messed Up

Empathy.

As medical students, one is taught to be empathic towards patients. In OSCEs, it is common to hear phrases such as, “that must be really hard for you,”, “I’m so sorry to hear that”, “You’re so brave,”, yada yada yada.

To be given the “empathy” mark, all you have to do is find the right time, the exact moment to use these classic phrases.

Then there’s real life.

If GP has taught me anything, it’s the reality that comes when a patient genuinely suffers from pain, anxiety and even low mood.

No matter how good the OSCE actors are, one can never substitute what happens to real people with real problems.

“That’s just so messed up,” I kept saying to my newfound friend, a fourth year medical student studying in Galway.

It seemed that every other patient that came in had some sort of darkness that was just…messed up.

Independent Medical Checkup

Ireland has one of the highest rates of litigation in the world per capita (population: 5million people ++).

One of the most frequent claims made is the right for compensation due to road traffic accidents.

Insurance companies are obliged to send their clients to get expert, unbiased medical opinions from GPs such as Tony. He’ll assess the medical side of things, getting a thorough history on the mechanism of injury, the degree of disability and the impact it has on the quality of life.

After examining Mrs PD, a 25-year-old housewife with three kids, Tony looked at me and sighed. (She had of course at that time left the room)

“Bloody cheat,” he exclaimed

“I don’t mean to be racist, but their kinds have been at it for so long. It’s the same modus operandi each time. They purposely slow down their car, brake suddenly and “bang”,” he was referring to the traveller community (wiki says) in Ireland.

A clinical examination of the purported “pain and stiffness” had so many inconsistencies that it just didn’t make sense.

“If it’s so obvious that they’re lying, why do they keep doing it? ” I asked, empathetically (snicker).

“Well it costs more to go to court, so most of the time the settlement is paid before it goes to a judge,” he said.

Wedding Bells

My aforementioned Iranian-Pakistani Galway-born medical student friend was extremely warm, courteous and kind. I felt that we connected a lot and shared many things in common.

Within an hour, we were already discussing the concept of marriage.

He had just got out of a 2-week marriage with an Iranian girl he hadn’t met before. His parents set him up to deter him from mixing with the wrong crowd, as he already had an Irish girlfriend.

Citing “cultural difference” as the main reason behind the divorce, I could understand how someone brought up in a western environment would struggle to adapt to the very rigid and authoritarian-like principles imposed by the girl’s family.

I'll spare ye the details.

“Marrying a girl also means “marrying” her family” he said with a distinctive Galway (Galwaegian?) accent.

Well said, my friend.

Moral of the story :

Life’s messed up. People have problems. You’re not the only one. Deal with it.

Believe

When you're searching for the light, and you see no hope in sight

Be sure and have no doubt, he's always close to you....

Just what the doctor ordered

I had high hopes for the GP rotation.

Meeting “Tony”, my designated GP for the week was indeed interesting. The man is passionate about his profession. He also earns my respect for having strong morals that stem from a belief that there is a higher power that will hold you accountable for your own actions.

“Now, I do not care what you believe in, as long as you believe in something, because God, whatever you call him, gave us this opportunity to do good to people. So you should be thankful.”

His relationship with his patients extends further than the formal clinical appointments. Everyone goes to him for everything.

After all, studies have shown that medical doctors are the ones most trusted compared to other professions. Lawyers lie at the bottom. I’m just saying.

Then there was drama…

“My husband is having an affair,” then she cried.

It turned out that he often hit their children, especially when drunk. He watches porn on his son’s computer. Their daughter is graduating on Friday. She doesn’t want her to know about the affairs. He openly admits to “f***ing tramps” when intoxicated. He bullies his wife.

Bastard.

The lady didn’t need any medication. She needed someone to listen.

Tony was the man she sought.

Anger, anxiety, agitation

Reading about anger, agitation and anxiety can never prepare you for the horror show of what it really is.

The man was a garda officer who had depression, Whoopadidooda.

Ironically his wife was a psychotherapist.

“I feel unsafe around him. He talks of harming the children with a knife” she said.

The alarm bells rang at once. This guy needed to be admitted immediately.

He had tipped over for the worse. Earlier he tried to poison himself with carbon monoxide. He couldn’t go through with it and came in to seek help.

Tony was the man he sought.

In grave danger

Next up is an engineer who works in a cemetery. He was depressed. He needed time off work due to “work related stress” He basically had to tell grieving families that there was no more space. Their loved ones would have to make way for “fresher” bodies. He couldn’t handle the pressure.

Tony was the man he sought.

The opposite side of the table

Then there was a medical student who sat in the corner, listening to it all. He had his own problems to deal with, yet he masked it ever so expertly. He took notes when he had to; he even made eye contact when prompted. He kept quiet most of the time. He knew that his life was nowhere near as screwed up as theirs. He had no reason to complain. Yet deep down inside, he felt like he could easily be the one sitting on the opposite side of the table.

Brain Waves

After three weeks being constantly updated on the latest celebrity gossip (bieber oh baby), I needed an outlet to boost my dwindling testosterone levels. Something manly. Something, macho….

Meh, I went shopping instead. Burton had a 50% sale on shirts. Add 10% if you show your student card. Need I say more.

Galway Trip

My peripheral GP placement has brought me to county Galway, a place of significance due to the fact that I once asked the interviewer to send me to Galway instead of Dublin. Let’s not go there. Some other time, maybe.

Eidul-Adha

Free food never fails to gather a crowd. A feast to commemorate Eid, organized by the Malaysian Embassy gave me an opportunity to meet up with many of my long lost friends/fiends.

I don’t know what to make of this, but I found myself congratulating quite a few colleagues who either got new wives or new babies. Speaking of babies, there were so many!

The cuter ones were being passed around, all getting their cuddle time as well pictures taken, destined to end up on Facebook.

I can’t believe typing “facebook” in MS Word causes a spelling error. Get with the times Mr Gates!

Without being judgemental (not), here are a few speech bubbles of what might be going through people’s minds when they post pictures of them holding babies.

Look at me, I can carry a baby without dropping it.

Look at me, I’m parent material.

Look at me, this baby is so cute just like me.

Look at me, Look at me, no don’t look at the baby, Look at me(Ka-ching)

Look at me…… You fill in the blanksJ

If this blog went public I’d be in for some walloping. Hey, we’re human, I’ve posted my fair share of pictures with babies as well.

I might just do that again in the near future just to gauge people’s reactions

Jokes aside babies are just too cute. I felt like stealing one to bring home. (Dear future me, I hope you don’t get into trouble for this)

Disclaimer : I AM JOKING. (Just covering my bases)

Buzan you genius!

Imagine my hand dipping into a huge pail of really smelly but white MILK. (just go with it). It stays there for a whole minute, and I almost GAG because of the smell. My STOMACH growls in protest.

I finally take my hand out of the pail. To my shock, the hand turns purple, then blue, then red again, then back to its normal COLOUR.

I gasp. My fingers start to GROW right in front of my eyes. Blood vessels start to DILATE on the surface of my palms. My whole hand explodes.

The end

White MILK : Calcinosis

GAG & STOMACH : esophgeal and gut dysmotility

Change in COLOUR : Raynaud’s

Finger GROW : Sclerodactyly

Vessel DILATE : Telengectasia

There you have it my fellow nerds, CREST syndrome.

Two chapters into the MEMORY BOOK by Tony Buzan and I already feel the 20 Euros invested paying dividends. Whoopadidooda.

6 months and counting

“You are only 6 weeks away basically completing your undergraduate training,”

Said Nick Breen, one of our General Practice lecturers

“Your level of knowledge at this time is probably at its peak, as you are fresh from completing almost all of your specialties training,” he continued

Gulp.

He was right. My GP rotation would mark the last specialty-training block in the course. In a mere 6 months, I’d qualify as a fully-fledged junior doctor.

To add to the pressure, the exam dates for the finals as well as the convocation ceremony have already been posted.

Gulp.

Psych was a relative breeze. The OSCEs weren’t too bad in terms of the subjects covered. A few curve balls here and there but nothing exceptionally tough or mind-boggling to say the least.

On to the last rotation of my undergraduate training.

Motivation, where art thou?

Marvellously Mediocre

Round one of exams : Done

Status : Two to go

Emotional status : Apathy

I wonder if it is possible to feel both anxious and confident at the same time?

Aine’ (pronounced onyah) was my examiner for the day. Hardly the scariest of tutors around, yet my nerves were starting to betray me as I walked into the huge conference room in the basement of St Vincent’s University Hospital.

Yet despite my heart threatening to dislocate itself from its connecting arteries, the conscious part of my brain was surprisingly calm, almost confident that there was no way I could inherently screw this up.

I had put a lot of work in perfecting my case, endlessly editing, re-editing, and re-re-editing.

I knew she wanted it to be concise yet detailed. No beating around the bush. It is understandable that after listening to 10-20 people present their cases, one’s concentration would tend to drift. This meant that it was a matter of sentencing and word choice, which would determine a huge percentage of marks this time around.

“You did well, good job,” said Aine’

Applause?

Neh.

I’ve learnt over the years that in UCD, to “do well” means, “Congratulations, you didn’t screw up, but that doesn’t mean you’re getting an “A”. So a C would indeed suffice.

Soldiering on, an MCQ and an OSCE to go.

Rambling on..

I would like to present the history of MRS X, a 55-year-old lady who was admitted four weeks ago due to alcohol dependent syndrome and low mood, with a 10-year history of depression, and a history of hysterionic personality disorder

History of Presenting Complaint

This is her second admission for alcohol dependent syndrome.

MRS X had her 1^st drink at 17, and admitted to “heavy drinking” since her first marriage at 19. She currently drinks 10-30 bottles of beer a day, mostly at night. Her last drink was 2 bottles of beer, the night before admission.

With regards to alcohol dependence symptoms,

She has developed tolerance, needing more than 20 beers to get intoxicated; she only drinks beer, showing a narrowed repertoire of drink. She denies any changed in her alcohol preference. She prefers to drink alone, but does occasionally drink with her friends. She still enjoys gardening and walking her dog. She has never tried to abstain from alcohol, and continues to drink despite the being aware of its negative effects. She admits to have a strong desire and losing control when having a drink. She had a road traffic accident 20 years ago due to drink driving. She does not take any illegal substances, and does not gamble. She has had no hallucinations or seizures.

With regards to her low mood; MRSX has no anergia and no anhedonia. Her appetite and weight is fine. She has sleeping problems, with difficulty falling asleep, and denies any early morning waking or disturbed sleep. Her libido is normal. She also admits to being in financial difficulty.

2 weeks ago she took an overdose of seroxat, and was admitted to SVUH A&E. She described the attempt as an impulsive one, with no prior planning, and with no intention to die. Her reasons for it were to “forget her difficulties” and as “a cry for help”. She immediately notified her family, after taking 20-30 pills. There was no will or suicide note. She felt regret for what she had done, and had no plans to commit suicide.

With regards to personal history

MRs X was abused and hit by her father when she was a teenager. She denied he drank. In terms of education, she got through high school, then married at 19.

Her relationship history reveals an annulled marriage, attributed to her alcohol problems. She has one daughter and currently maintains a good relationship with her.

Mrs X admits to having subsequent unstable relationships with many men throughout her life. She recently broke up with her long-term partner of 22 years, who had been living in Spain for the past 4 years. She feels that it has “somewhat” contributed to her excessive drinking

With regard to employment Mrs X has problems at work. She skipped a “few days” due to alcohol effects. She also has received multiple warnings due to poor performance. She attributes it to the new HR officer who does not like her.

Forensic history. She was arrested once due to drink and driving 8 years ago

In terms of patient insight, MRs X wants to change but NOT WILLING to fully give up alcohol. She is uncertain that abstinence is for her

She feels that her troubled life lead to drinking, and that her drinking has NOTHING to do with her troubled life.

She is willing to enter the rehabilitation programme to help her cut down on her drinking.

Management Plan

Biopsychosocial approach :

Bio : maintain the current medication, seroxat 30mg Daily

History of Depression was not clear, obtain more information, contact GP

Monitor withdrawal symptoms - tremors, seizures etc

Disulfiram/Acamprosate : consider, though patient does not want to completely abstain

Psychosocial

RPU, SMAG

CBT

Monitor emotional symptoms,

Psychoeducation on addiction (insight)

Collateral history from family.

Damn. I hate pysch

Crunch Time

“A good little bit of heat in ‘ere, righ’ lad,” said the naked old man beside me.

It was the archetypal “Irish” way of mentioning the plainly obvious in order to start a conversation. We were after all in the sauna.

It had been a long day. My two-hour session in the library was followed by a two-hour session in the gym.

The over-exertion of both the mind and body was probably a coping strategy for what had happened earlier in the day.

The mark sheet for the formative (ie : useless) MCQ read :

14.5/40

A clear fail.

Whilst the results had no bearing whatsoever on my overall GPA, it was a telling sign that things aren’t all too well in terms of study.

A week to go. And I’m still writing.

PS : No, I don't go into the sauna naked

The Cuckoo's Nest

End of Summer

“Are we ready people?” said Dr Matt Sadlier, our chirpy tutor on the first day of class.

His enthusiasm was met by groans. Summer had ended. Welcome to final med. It’s official.

Ciaran and I were paired up to attach with Dr O’Gara, the addiction team consultant. Yes rugby fans, he is in fact the brother of the legendary full back Colin O’Gara. More about him later.

Psychiatry and the media

Prior to my psych rotation, my perception on what psych really is probably measures up to the general public; crazy people intent on hurting other or themselves. Case and point: Hannibal Lector sprang immediately to mind.

What I found out was that psychiatry deals with a whole load of other “stuff” that are genuinely medically treatable, with both pharmacotherapy and an element of psychotherapy.

My initial first few days in the wards were let down stemming from my over the top imagination on what a psych “facility” should look like. Again I blame the movies.

There wasn’t anyone running around naked. No one set themselves on fire. And they don’t wheel people around in white straps. Overall it has been pretty tame so far. Save for the odd lady who followed me around the hospital because she thought I was a spy. Lol.

Acceptance

The ward rounds in psych are totally different from the medical ones. The patients are interviewed on a one-to-one basis. All cramped in a room consisting of the consultant and his registrars, psychologists, occupational therapist, social worker, nurse, and of course medical students, yeay.

Also different to my previous experiences in medical teams, I actually feel part of the team.

“What just happened in there?” asked Ciaran, looking quite puzzled.

“I’m trying to make sense of it all,” I answered.

“They actually acknowledged us! Oh god, I feel so needed” added Ciaran

Being part of the team really ups your motivation. For a while at least.

My first psych interview

“ I’ve thought about it you know, ending it all,” said PT, who was battling depression

“What do you mean” I asked, taking good care not to put any thoughts into his head.

“I thought about hanging myself. But I never thought I could go through with it” he continued.

The interview went on for almost an hour. We delved into his childhood, relationships, family problems and a whole host of issues that one would never think to share with a stranger. I guess part of the appeal of psych is having that privilege of information, which is why confidentiality is a huge part of it all.

Some of the stuff gets really dark and messed up. For some reason, it affects me more than I’d care to admit.

Suicide in Ireland

Ireland has been a relatively religious country over the last century. Suicide was definitely frowned upon in the old days. In fact ,suicide was a capital offence up to 1993. In other words, if one failed in an attempted suicde, the punishment would be death. I lol-ed so hard. Gotta love the Irish.

“I’m an alcoholic”

MOG was an alcoholic. She didn’t want admit it at first, but the signs were all positive. She even scored 3/4 in the CAGE questionnaire (google it). Throughout our conversation she revealed to me a lot about her torrid past, the abuse she endured as a child and her series of failed relationships with numerous men.

At some level I felt we developed a connection, evidenced by her brutal honesty on what the root of the problem was. Alcohol.

Admitting that you’re an alcoholic is as easy as it is made out to be. It’s a huge first step toward recovery. Most patients take a long time to see that it wasn’t the beatings, or the abuse;or the bullying; or a whole crapload of excuses, until they admit they have a problem with alcohol.

“You know, there must be something about you. I’ve never been so open to anybody before,” admitted MOG.

“You should really consider this as a career,” she added.

I smiled.

Yeah. Right.

Vindication

“Interestingly Dr O’Gara, one of our patients, MOG told me during our one-to-one session that she felt that talking to a certain medical student was more helpful compared to the treatment and counselling she’s been getting during ward rounds with us,” said Roisin the occupational therapist

All eyes focused on me and Ciaran. I looked down not knowing how to react.

“Was it you?” ask Dr O Gara

“Yes I think it was” I answered, still looking down.

“Well ladies and gentleman, I believe someone is starting to show a knack for psychiatry,” he said, winking in my direction.

Old-age psychiatry

I have nothing against the elderly. Let me rephrase that. Excluding family and friends, I feel that I wouldn’t able to tolerate treating old people. If given a choice, I would stay away from any branch of medicine that deals with them.

It’s just simply depressing.

One of the patients, CK, is a 63 year old woman, who just a few weeks ago was swimming in the 40 foot (off the shores of Dun Laghoire), but then developed severe depression due to an unknown cause. Since then, she has regressed to the point of developing hallucinations that she “smells rotten”.

She also has delusions that everyone else is talking behind her back on how smelly she is. I can’t help but feel sorry for the old lady each and every time we meet on the ward. The thing is, for these patients, their experience is undeniably real to them. This means, she wakes up every morning to the stench of rotting flesh; she walks around corridors hearing voices of people talking bad about her. Now how would that make you feel?

Her constant tearful episodes and genuinely sorry state has affected the whole team as well, probably me more than anyone else. Old age psych, another tear jerker.

A conclusion, somewhat

Im in my 5^th week and already feel like a veteran on the wards. With the OSCEs ever so close, it’s a wonder why I haven’t gotten the palpitations I’m so used to by now. The lack of anxiety is proving to be a factor in my general laziness and reduced drive to actually pick a book up to study. Distractions are aplenty and in fact welcomed in order to mask the reality I dread to face each day.

Am I losing the plot? Or is it just the (hopefully temporary) depressive state induced by my time in the psychiatric wards?

I don’t know.

And so it begins

“Ni apa pakai baju gelap ni! Kau ingat kau ni SYAITONNNN ke pakai gelap-gelap?!” bellowed the A&E consultant.

“ KASUT! No brown shoes mister!!!” he continued.

Welcome to Malaysia. My ‘home’ for the next three weeks.

(note I refuse to name the hospital for fear of legal action, it shall henceforth be known as MH)

Final Med

“So who do we have here,” said Dr Ding, the elective coordinator. There were about 20 students from all over the world, converging to do a short stint in MH . Most of them were Malaysians studying medicine in Russia.

“Ah, I see we have students from Dublin. Final year summore” She continued

The room was silent. All eyes were on us. It dawned upon me that the tag ‘final year’ medical student has its own merits. Though I had a feeling that most of them would be disappointed with these so called ‘final years’ on show that day.

“Would you like to share something with us, seeing that you have been very privileged to study in such a high esteemed place, di negara mat salleh....”

I looked at my partner. Awkward silence ensued.

I finally found some saliva to ramble on about ethics, taking great care to praise the national system for producing very competent and skilful doctors compared to their European counterpart, which focused more on the professionalism aspect.

That seemed to impress her enough for the time being.

She went around the room asking questions. It was clear by then that she held us in high regard.

“We are expecting a lot from you, and hope that you can share what you’ve learnt with us” she added.

So no pressure huh?

Impetigo?

It would be hard to describe my shortened stay at MH. I skipped the last week due to a suspected impetigo infection. Though I cast some doubt into the diagnosis made by the local GP, as there were no typical crusty lesions associated with impetigo. No complaints as I took the last week off.

How to Take Blood, by a Medical Assistant

1. 1. Don’t bother washing your hands

2. 2 Prepare your gloves

3. 3. Use the gloves as a tourniquet (!!!!)

4. 4. Using your bare hands, find a vein in the dorsal aspect of the hand and stick a brannula in

5. 5. Push in the brannula and take the needle out

6. 6. Stick the needle into the chair (!!!!!)

7. 7. Take blood as needed.

8. 8. Dispose of clinical waste into yellow bins

The Tutorial

She was a third year medical student from Moscow State University. Chloe was her name, and she was my partner down in A&E. If I could use one word to describe her, I would choose ‘innocent’

I made it clear from the start that I would have my own schedule, and made up my own rules. Chloe was very diligent and followed me around wherever I went. She also wasn’t shy in asking questions.

“Can you teach me X-ray ah?,” she said in her unmistakeable Chinese accent. She was from Jinjang.

I picked up the film and held it against the light. As I was explaining to her the basics of reading a chest X-ray, a few more Russian students joined in. I acknowledged their presence and welcomed them. Suddenly it turned into a crowd.

I realized that I was in the middle of giving my first tutorial. Soon enough, one of the doctors walked in and interrupted.

“Excuse me doctor, is this room free?” he asked, looking directly at me

“Sorry, I’m just a medical student, of course we will leave this room at once. I was just talking through a chest X ray with my colleagues here,” I explained, feeling very embarrassed.

He was nice enough to let me use the room. The tutorial continued. They were actually jotting stuff down. God knows if what I said was even half true.

Half Day

My mornings would start at 8am. The teaching in the A&E department was good. It usually lasted for an hour. After that my partner and I would trot up to ward 27, where another classmate of mine was stationed. There we joined a ward round that usually lasted an hour or two, depending on the patient count. All in all it was a solid routine. My day would end at noon-ish. I wasn’t going to exert myself and stay the whole day.

WARD 27

There had to be at least 50 patients in ward 27. It was a general ward, and they presented with varying illnesses. The acute cubicles consisted of suspected TB infections (almost unheard of in Dublin), HIV, and alcohol withdrawal. Dengue was also a prominent disease that one would be expected to know inside out if practicing in Malaysia. I knew nothing.

The beds were very close to each other and privacy was at the bottom of the list. Patients all wore the same fungi green overalls. The ward was stuffy and smelt like pee. It was depressing and felt like a prison.

Pakcik rasa....

One of the patients presented with warfarin overdose. He developed bruises due to an elevated INR, caused by ingesting too many warfarin pills.

He had a artificial heart valve that necessitated the use of warfarin, a drug with severe side effects if used without caution. His valves were replaced due to rheumatic fever, again, almost unheard of in Dublin.

“Pakcik, apasal pakcik makan lebih itu Warfarin?” asked the consultant, evidently of Indian origin.

“Oh, sebab pakcik tengok banyak lagi pil tu, jadi pakcik makan aje bagi cepat habis. Lagipon pakcik rasa....” he went on to explain how he made a decision on why he thought it was prudent to increase the dosage of the drug.

The consultant frowned. So did the rest of the team. We were dealing with ignorant people and couldn’t do anything to remedy it.

PUASA?

I made it a point to ask Chloe if she understood everything that went down in the ward round earlier.

Chloe : Can I ask you a question?

Me : Sure, go ahead

Chloe : Kamu ini bukan melayu ka?

I somehow knew where this was going. I’ve had enough of people dissing me about my Indian heritage. I let her continue anyway

Me : Kenapa, awak ingat saya orang mana?

Chloe : Kamu bukan orang Singh ka?

I humoured her even further

Me : Why do you say that?

Chloe : Sebab kamu tak puasa?

That caught me completely off guard. Curious indeed.

Me : Bulan puasa lambat lagi

Chloe : Tapi kenapa kat ward ada patient yang ada itu ‘sign’gantung tepi katil, “PUASA”?

Oh so naive!

Me : (still very polite) Oh that means that they’re not allowed to eat due to disease or imminent surgery, bukan puasa sebab ramadhan

Nurse Wars

After seeing patients in the acute cubicles, I disposed of my mask in on of the many bins by the side of the bed. The ward round continued.

Suddenly I heard a shrill voice from the end of the corridor.

“Ni siapa buang mask kat sini?!!”

A few of the patients even woke up to watch the drama unfold.

I looked for the source. It came from a smurf-like figure in blue uniform and white tudung. Only that smurfs are cute. She looked like more like a troll.

“SIAPA?! CEPAT MENGAKU!!! NAK SAYA CHECK CCTV KE?!!” the Troll went on.

I took a deep breath and stepped forward.

“SIAPA KAMU?”

“Saya medical student”

“MEDICAL STUDENT! BELUM DOKTOR PON DAH TUNJUK PERANGAI! KAMU TAHU TAK KAMU TAK BOLEH BUANG MASK DI SINI!!!

Despite me having at least 10 inches in height advantage, she made me feel really small. I looked to my left, Chloe stood next to me for support. Good girl.

The rest of the students cowered behind us.

I was on my own though. I picked up the mask and threw it in the yellow bin after being told to do so.

“KAMU TAU TAK SAYA SIAPA?! SAYA HEAD NURSE DI WARD NI. KAMU KENE REPORT KAT SAYA TAU, BUKAN DOKTOR. SAYA PERMANENT STAFF KAT SINI, SAYA YANG JAGA KAMU, BUKAN DOKTOR”

I merely nodded disinterestedly. The rebel in me surfaced

“KAMU INGAT KAMU BAGUS SANGAT KE HA?! BELAJAR OVERSEAS JAUH-JAUH, TAPI PERANGAI MACAM SAMPAH!”

I continued to roll my eyes. I could see that I was pissing her off further. I knew she couldn’t do anything.

It was a mask. As if that would be the cause main of infection in a ward crowded with TB and HIV patients. I kept my thoughts to myself.

Yes, she had a point. But her method of embarrassing me in front of the whole ward was in my cards unacceptable and unprofessional. Then again they don’t bloody teach professionalism in Malaysia do they?

Pre-Conclusion

At times, it was very hard to see myself working in this environment for the rest of my career.

I hate to be the pretentious one. The so-called overseas final year med student. Yang tak tahan panas. Yang banyak tanya soalan. Yang skema pakai glove time ambil darah. Yang asyik-asyik basuh tangan lepas jumpa patient. Yang sibuk tutup curtain mase nak jumpa patient.

Darwinism has its merits in the concept of 'survival of the fittest'. To survive the houseman years, one must be able to adapt to the surrounding change, so as not to be driven to 'extinction’. However it remains to be seen, whether I would be able to maintain thus far the values and principles i have learnt as an 'overseas' trained doctor-to-be. I challenge myself to uphold upon these principles, and not be diluted amongst the current (sorry to say) archaic habits of the local doctors. The question remains to be answered. Am I strong enough for this?

Conclusion

No, I don’t wish to end on a negative note. Most of the posts were written when I was in the heat of the moment, ie pissed off at the world for treating me so bad. I do look forward to the challenge.

Dr Ding summed it up nicely during our initial briefing.

“I find that Russian students may lack so basic core knowledge when it comes to practicing medicine. However, they are so used to being shouted at that most of them do make it through the houseman programme. Students from UK and Ireland on the other hand, have this perception that no one can marah them because they are so used to the environment in Europe. Let me tell you that most of them cannot tahan and end up having emotional breakdowns in the middle of the housemanship. My advice to you is to toughen yourself up, learn to be patient, and most of all accept that fact that you will be shouted at, you will be insulted and you will be scolded. Then I assure you that you can make it through,”

Dublin has spoilt me. I lived in a cocoon where consultants fart rainbows and interns break out into random songs at will.

As I prepare myself to face my final year in Dublin, I can’t help but wonder what the future holds for me.