Thursday, September 17, 2009

GERIATRICS ATTACHMENT

My first ever rotation in final meds - Geriatrics.While others had already steamed up,I just warming up..after "having fun" for two weeks of self directed study,now I began my clinical days.The thought of being in Clonmel for the third time did not bother me.Clonmel is a nice town to be in and STGH is a good teaching and learning hospital.Despite being away from home and from friends,I have no worry at all.


This time again,I stayed at different place - in a house [or should I say a bungalow] rented by UCC with three other students.Well Ms Moylan said that UCC made a last minute decision on placing us in a house,instead of a BnB,so they could not get a house nearer to the hospital.It's 30 minutes walk,not too bad.


After three days,I haven't had any complaint.Dr Donellan is still being nice to me [thank God] and my days were filled with useful activities.
Monday -ward rounds from 0900-1300.My legs hurt!!
             - MDT from 1400-1600.Felt sleepy though.Even Tony dozed off.
Tuesday - Went to St.Patrick Hospital in Cashel for some ward rounds and MDT.
              - Journal Club about tight glucose control
              - Tutorial on chest pain
              - Should be on call and admit patients in AnE but errr...had a bad experience in that AnE,so only stayed until 1800.
Wednesday - Ward rounds 0900-1230.Dr Donellan started asking questions.
                   - OPD : clerked two patients.Hmmm.


Had been to ALDI and Dunnes Stores to get some food.


Ramadhan is coming to the end..how sad that I actually spent it alone here in Clonmel.Friends were saying that it is good that fasting is almost over.I just smiled and said ," but I feel sad because I like Ramadhan and I'm gonna miss it.I hope it will not be over this fast."


Missing the good old days - Ramadhan in Malaysia.

Friday, September 11, 2009

TAK SAMPAI HATI

Features of rheumatoid arthritis - pain, swelling, redness,warmth, stiffness especially in the morning,loss of function, symmetrical deformity - Boutonniere,swan neck,z deformity,ulnar deviation and dorsal wrist subluxation.


Penat menulis nota Rheumatoid arthritis,aku beralih tangan,guna tangan kiri pula.Dahulu masa kecil-kecil,aku menulis guna tangan kiri.Bila balik kampung, tok selalu tegur aku,katanya tak elok tulis guna tangan kiri.Aku pun mulalah practise tulis tangan kanan,sampaikan masa nak gosok gigi pun aku practise cara nak pegang toothbrush dengan tangan kanan.Bila masuk tadika,aku dah guna tangan kanan,tak ingat sejak bila aku hilang kidalku.


Semasa di Matriks,aku terpaksa menulis guna tangan kiri selama hampir tiga bulan akibat kecederaan pada jari telunjuk,somewhere near metacarpophalangeal joint.


Pada malam itu,aku hampir menghabiskan makan malamku apabila telefonku berdering.Tersentak dengan bunyi telefon,aku terlepas pinggan yang kupegang lalu jatuh ke lantai.Tak jauh pun jarak dengan lantai,kerana waktu tu aku tengah duduk bersila di atas lantai.Pinggan pecah berderai,tetapi tidak menghasilkan bunyi yang kuat.Selamat.Namun tanganku terluka.Besar bukaannya,nampak isi di dalam.Aku kira luka ini memerlukan jahitan untuk ia sembuh dengan sempurna,lagipun melihat pada kedalamannya,risau juga kalau-kalau ada nerve yang terpotong.Sebelum darah manisku mengalir keluar,cepat-cepat kukemaskan pinggan yang pecah,kutip dan letak dalam surat khabar lama,bungkus dan buang ke dalam tong sampah.Masa ni darah dah mula membuak-buak...aku cepat-cepat mencapai plaster dari dalam dompetku dan terus applied.Kalau ikut first aid,kena basuh dan apply pressure dulu ni.

Tiba-tiba mak panggil,suruh bancuh teh.Aku segera ke dapur,sambil cuba cover kecederaanku ini.Ayah yang berada di dapur pada masa tu pun tak perasan.Dengan kesakitan yang amat sangat,aku segera buat teh panas dan hantar pada mak dengan tangan kiri.Mujur mak aku tak cerewet,kalau tak,mesti dah kena tegur sebab serve guna tangan kiri.Aku kembali ke dapur untuk membasuh tangan,ayah dah tiada di sana.Sakitnya bukan kepalang,darah dah berhenti mengalir tetapi cukup untuk memerahkan keseluruhan plasterku.Masa tu aku cuba gerak-gerakkan jari telunjuk,nak test nerve function.Alhamdulillah,boleh gerak,walaupun sakit sangat.


Masa kejadian tadi,aku panik juga,ingin saja aku ajak ayah ke klinik/A&E,tetapi mengenangkan bahawa ayah baru saja balik tak sampai setengah jam,aku jadi tak sampai hati.Dah la balik lambat,penat,takkan aku nak menyusahkan dan merisaukan ayah lagi?Akhirnya aku senyap saja walaupun jariku berisiko untuk &*$%#^.Malam itu aku tidur dalam kesakitan,tak terfikir pula nak telan paracetamol.Esoknya bantal kecil yang kugunakan untuk meletakkan tangan kanan habis berlumuran darah..terpaksa kusembunyikan agar mak tak nampak.


Siangnya aku terpaksa kirim kat mak untuk beli plaster,kebetulan mak keluar dengan kawannya.Alamak..esok pagi-pagi buta aku dan mak akan mengikuti rombongan ke Langkawi,dengan jari sakit macam ni? 


Semasa di Langkawi,banyak kali sangat tanganku terlanggar benda,sakitnya hingga ke tulang sum-sum...kadang-kadang terpaksa angkat barang-barang berat hasil shopping mak dan makcik-makcik lain..Aduh...


Apabila kolej dah mula balik,aku terpaksa menulis guna tangan kiri...slow dan tak cantik macam selalu lah..tapi at least aku masih boleh menulis..masuk bulan kedua,aku dah guna tangan kanan tapi time matematik saja,sebab tak banyak nota untuk disalin dan tak rush.Masuk bulan ketiga,aku tulis guna tangan kanan,tapi tak boleh lama-lama..dia akan sakit balik.Selepas bulan ketiga juga barulah aku boleh angkat jari telunjuk masa tahiyat akhir...alhamdulillah function dah kembali normal lepas tu..


Parut pada first metacarpophalangeal joint ni masih ada,tapi sebab dia atas joint so tak nampak jelas sangat..


Moral of the story,pegang pinggan tu kuat-kuat,jangan sampai terlepas..dan biarlah diri sendiri yang susah,jangan susahkan ibubapa...   

Thursday, September 10, 2009

MY ENGLISH DAYS...

I was born in a family where English is not the first language,not even the second.Mak dan ayah are not so highly educated,so they just humbly used Malay language.English is a language which I obtained in school.Now that I think all over again,I am really grateful to those who contributed into my way of learning English,either directly or indirectly.


During primary 1,my English teacher was Miss Khoo.She was nice and gentle,never been strict at all..I guess that's why I did not learn English properly during that year,a year when English should be so much fun.In primary 6,there was a huge difference in my English life.Mrs McIntyre,a fabulous name for a Penang Chinese woman,taught us English with so enthusiastic,making me tachycardic and anxious every time she entered the class.She always asked each and every student to say something, or to answer her questions even when she ran out of questions related to the topic.No body would be missed! I still remembered one morning,I,as a prefect,had to leave the class 10 minutes earlier before recess time,because I was on duty that day.Unfortunately,I was not allowed to leave before I gave an example of ...[couldn't remember].I tried to escape by migrating to a seat somewhere at the corner,hoping that she would stop asking questions when she reached the middle of the class.But that did not happened!!!In the end I volunteered myself to give the 'example' and was permitted to leave the class.Despite her eagerness in teaching English,she is still remembered by her way of pronounciating "pembedahan".She pronounced it as we said "kak bedah", not as we said "belah".Thanks to her,I scored A in UPSR.


I still remember when I was in primary 5, I joined Wushu as part of co-curricular activity.During school holidays,we went to Fern Hill for a camp.I enjoyed the activities but communications were very limited,my English was so poor and I could not speak Hokkien as well.All contestants were Chinese and I was the only Malay.I didn't even know the meaning  of ''homesick'' back then.So when I entered primary 6, I was really determined to improve my English.I mixed with Chinese and Indian friends,whose English were good,and my Maths improved as well.At that time,I felt that I had abondoned my Malay friends for quite some time.


During secondary 1,my English teacher was Datin Ratna,a woman with patience and passion.Her style - everyone should stand up until they read a few lines from the story book.Because of her,my reading skills had improved a lot!!The thing that I failed to please her was my essay,never I obtained a satisfactory mark from her.


In secondary 3,I took an extra tuition class for English,as I was worried with my preparation for PMR.The class with Mr Felix was fun and so helpful.My first essay was published and shared with the whole class!I scored A in PMR.


During secondary 4, I rejected an offer to a religious school for several reasons,including my concern that English was not properly taught in that school.I got through MRSM Taiping,where I had the nicest teacher ever,Puan Aishah.I like her idea of asking us to write a journal and during an oral test during secondary 5, I obtained 99%,almost perfect!When I was on sick leave for chickenpox,teacher Aishah prepared everything for me,so when I returned to school,I was already given a selected time to sit the pre trial for SPM.I scored A1 for SPM.


In matriculation college,again,I got a sweet and nice lecturer,Miss Wahida.I scored A in both semesters and obtained Grade 5 in MUET.Grade 6 is the highest anyway.During second semester,I was the only one in my class to be called for a MARA interview for a scholarship.I realized that I was the only Bumiputera in my class who obtained A1 in SPM.After the first interview with MARA officers,I proceeded to the second interview with Irish professors and now here I am,in University College Cork.


Before I entered university,I had to take IELTS.I was sooo lazy that I did not prepare for the exam,and so I had the worst oral exam ever,yet I still passed the minimum requirement.I once wished that I failed the exams,so that I did not have to travel far abroad and just accept the offer from USM.


Doing pre-med in UCC was fun.I had 4 English classes per week; the culture class where we learnt about Irish culture like the Leprechauns, IELTS  class,which I later dropped out,because I had taken the exam, the functional discourse class,where we learnt about the Irish healthcare system and how to communicate as a doctor and the academic writing class,where we learnt to write and read properly.Thanks to all the teachers,particularly Mr Brian O Shea and Mr Brian McEnery.


From first medicine onwards,I no longer attend a formal English class,but my lesson continues till today,every hour and every day.All people around me are my teachers - friends, classmates, lecturers, tutors, doctors, nurses, patients, strangers, passers by,radio DJs, tv ads, movies,dramas,songs and many more...

Sunday, September 06, 2009

BERTEMU MANUSIA

Variasi manusia yang kutemui pada hari ini.
1.Pemimpin yang tidak melindungi pengikutnya.Hampir saja nama baik pengikutnya tercalar dek tindakan pemimpin yang ingin ''terbuka''.Mujurlah sempat ditahan dan diberikan cadangan lain.
2.Pejuang yang merajuk.Islam diperjuangkannya,tentulah dengan berhadapan dengan manusia.Jika bukan manusia,pada siapa lagi Islam akan disampaikan?Namun hatinya rapuh dan tidak dapat menahan hentakan emosi.Lalu rajuklah ia, menjauhi diri.
3.Pendakwah yang tidak menjaga solat.Mendakwa dirinya pendakwah,sentiasa berpesan pada sahabat supaya komited dalam kerja dakwah,namun hablumminallahnya boleh dipertikaikan.Dahulu tidak begitu.Apa yang terjadi?
4.Sahabat yang bermasam muka.Besarnya makna sebuah senyuman yang diukir.Malangnya itu tidak berlaku.
5.Orang yang bermulut laser.Tidak salah menegur,tetapi biar kena pada tempatnya.Buruklah akibatnya jika berbicara tanpa berfikir terlebih dahulu.


Manusia,memanglah pelbagai.

Friday, September 04, 2009

QUICK NOTES

Suddenly remember this:
1.When taking a social history in paediatrics, don't forget to ask

  • living condition - people in the house,type of house,environment e.g. farm
  • parental smoking and drinking
  • pets
  • vaccination status --> very important!!!
  • travel
  • parental job,if related 
2. For pre eclampsia, talk about:
  • symptoms of headache,visual disturbance
  • proteinuria, hypertension, oedema
  • eclampsia - knee hyperreflexia,clonus
 3.Vaccination schedule from July 2008 in Ireland:
at birth - BCG
2 months - 6 in 1,PCV
4 months - 6 in 1, Men C
6 months - 6 in 1, PCV,Men C
12 months - MMR, PCV
13 months - Men C, Hib
4-5 years - 4 in 1, MMR

6 in 1 = diphteria,tetanus,pertussis,polio, Hib,Hep B
4 in 1 = diphteria,tetanus,pertussis,polio

4.Risk factors for endometrial carcinoma:
- obesity
-late menopause
-nulliparity
-smoking

CHALAZION AND STYE

CHALAZION, also known as a meibomian gland lipogranuloma, is a cyst in the eyelid that is caused by inflammation of a blocked meibomian gland, usually on the upper eyelid. Chalazions differ from styes (hordeolums) in that they are more painful than styes, and in size (chalazia tend to be larger than styes). A chalazion or meibomian cyst could take months to fully heal with treatment and could take years to heal without any.
Signs and symptoms:
  1. Swelling on the eyelid
  2. Eyelid tenderness
  3. Sensitivity to light
  4. Increased tearing
  5. Heaviness of the eyelid
TREATMENT: The main treatment at the moment is a cream that should be applied to the inside of the lower eyelid four times a day. The duration of this treatment is set by your doctor usually for a couple of weeks .If they continue to enlarge or fail to settle within a few months, then smaller lesions may be injected with a corticosteroid or larger ones may be surgically removed using local anesthesia.[1][2] This is usually done from underneath the eyelid to avoid a scar on the skin. If the chalazion is located directly under the eyelid's outer tissue, however, an excision from above may be more advisable so as not to inflict any unnecessary damage on the lid itself.
COMPLICATIONS: A large chalazion can cause astigmatism due to pressure on the cornea. If a chalazion is left untreated and does not heal it could eventually lead to blindness.
STYE, is an infection of the sebaceous glands of Zeis at the base of the eyelashes, or an infection of the apocrine sweat glands of Moll.
CAUSES: Styes are commonly caused by a Staphylococcus aureus bacterial infection and by outdated mascara. They are also caused by a blocking of the oil glands at the base of the eyelash. Although they are particularly common in infants, styes are experienced by people of all ages. Styes can be triggered by stress, poor nutrition or sleep deprivation. Using the same razor to shave hair near both the eyes and a mustache can also spread staphylococcus bacteria, potentially leading to styes or other eye infections. Styes are contagious, and proper hygiene should be observed. Do not share washcloths or face towels.[2] [3] Styes will last from up to 3 weeks to 2 years without treatment, and only up to 1 week if treated properly.
TREATMENT: While most styes will drain on their own, this process can be accelerated by the application of a warm compress. There is also a specialized Polysporin topical ointment for styes. With treatment, styes typically resolve within one week. Lancing of a stye is not recommended without technical expertise[6] given its proximity to the eye.
________________________________________________________________________________

Dengan nama Allah yang Maha Pemurah lagi Maha Pengasih,
terima kasih ya Allah...
terima kasih pada yang mendoakan...
syukur, Alhamdulillah.

Thursday, September 03, 2009

HARAPAN ITU ADALAH DOA

Petang tadi berbual panjang dengan mak, ayah pulang lewat dari tarawikh kerana ada ustaz memberi pengisian pada setiap hari Rabu.Sekarang ini,jika tidak menelefon mak/ayah lebih daripada 3-4 hari,menjadikan aku tidak betah…sepatutnya dengan usia lima tahun aku disini,aku semakin biasa berpisah,rupa-rupanya separation anxiety itu masih menebal,lebih-lebih lagi dengan keadaan mak dan ayah yang kurang sihat.

[bukan mak dan ayah saja,ramai lagi mak dan ayah sahabat-sahabatku yang turut diuji dengan kesakitan..semoga Allah memberikan kekuatan dan kesihatan kepada mereka,ameen.]

Besarnya harapan keluarga padaku…amat jelas kelihatan dan kedengaran pada tahun ini,tahun yang sepatutnya menjadi tahun terakhir aku di sini.Aku anggap bahawa harapan itu adalah satu doa, insyaAllah doa-doa mereka didengari oleh Allah.YB dah banyak kali bertanya padaku,bila grad?Berapa haribulan?Mungkin dia sedang merancang untuk memohon cuti untuk sama-sama menemani mak dan ayah ke sini.Dalam emailnya baru-baru ini,YB kata,ini adalah Ramadhan terakhirku di sini,insyaAllah tahun depan boleh berRamadhan dan berAidilfitri di tanah air bersama keluarga tersayang.

Kawan-kawan mak di tempat kerja juga rajin bertanyakan keadaanku.Mak dengan gembira menjawab bahawa aku tidak sempat puasa di rumah tahun ni,insyaAllah tahun depan bolehlah,dah tahun akhir ni.Mereka juga menaruh harapan tinggi padaku untuk pulang pada tahun depan bersama segulung ijazah di genggaman.

Baru-baru ini,mak diserang gastritis pada hari ketiga berpuasa sehingga diberikan cuti sakit.Bak kata mak,aku dan mak punyai intuisi yang kuat,boleh ‘’merasa’’ jika sesuatu berlaku.Hari itu,aku menelefon ke rumah ketika Malaysia pukul 12 tengah hari.Walaupun aku tahu mak kerja pagi,aku tetap menelefon,dapat bercakap lama dengan ayah.Rupa-rupanya ketika itu,mak sudahpun berada di rumah,sedang berbaring selepas terpaksa buka puasa dan menelan ubat,tetapi ayah merahsiakannya daripadaku.Ayah dan YB sepakat untuk tidak memberitahuku,kerana bimbang tumpuanku terhadap pelajaran terganggu,dah tahun akhir,kata mereka.

Namun,perbualanku dengan mak petang tadi telah revealed segala-galanya.Mak mempercayai dan meyakiniku,apabila aku katakan bahawa aku adalah pelajar perubatan,dan mak tak perlu risau tentang tumpuanku terhadap pelajaran.Mak ceritakan semuanya, termasuk keadaan ayah yang sakit kaki.Kini alhamdulillah,mak dah semakin sembuh,ankle eodema juga dah tiada,Cuma mak perlu terus mengambil Gaviscon [yang mak liat nak telan tu] dan menjaga pemakanan.Mak selalu tak berselera untuk sahur,hanya meneguk segelas Anlene dan kadang-kadang sebiji dua kuih.Mak,jika aku ada di rumah,pasti aku akan masak apa saja untuk mak…nasi goreng panas-panas beserta milo panas macam dulu-dulu…Ayah dah berjumpa doktor untuk sakit kakinya tapi biasalah doktor di hospital awam,buat endah tak endah saja [geram betul,nanti aku buat begitu pada ahli keluarga kau, baru kau rasa!!!Astaghfirullah…] Harap-harap tiada perkara serius berlaku.

Juniors di sini juga menaruh harapan kepadaku dan seniors lain.Mereka sering berkata,’’Wah, dah final year!!!Bestnya!” Hakikatnya hanya aku yang tahu,best atau tidak final year ni.Lecturers juga ucapkan tahniah kerana berjaya sampai hingga ke tahap ini.

Ketika buat elektif, abang atendan di Oncology OPD juga memanggilku doktor,malah memintaku berjumpa dengan patient.Di oncology ward,ahli-ahli keluarga pesakit juga menyangka aku seorang doktor..:) Ketika aku membuat final year project di eye casualty,pesakit-pesakit di situ juga menyangka aku seorang doktor..Semua ini adalah doa..semoga ia akan termakbul,insyaAllah.

Sekarang ni aku hanya boleh meyakinkan diri bahawa aku boleh,jika orang lain boleh,aku juga boleh.Walau apa rintangan sekalipun yang melanda,aku tidak sesekali berputus asa daripada rahmat Allah serta mintalah kepadaNya dengan sabar dan solat.Ingat Allah pada setiap masa,mesti Dia juga akan ingat padaku.

Aku perlu tabah untuk menggalas harapan agama untuk menjadi seorang Muslim professional yang cemerlang,harapan Negara untuk menambah bilangan doktor pakar dan harapan keluarga untuk menjadi doktor pertama dalam keluarga.

-Gementar rasa di hati apabila menantikan kebenaran untuk menampakkan wajahnya.