I will be flying off to Sandakan in less than 24 hours to do my month long elective attachment with the boys in Duchess of Kent Hospital, department of Internal Medicine. I am feeling quite excited as I've never been to that part of the world yet. 4 of us will be doing some travelling around Borneo as well so do wait up for pictures of proboscis monkeys, sea turtles and orang utans.
A few days ago, a close friend of mine who is also a final year engineering student approached me and asked: “I’m currently trying to come out with an idea for my final year project and I am thinking of integrating engineering into medicine. What do you think? Any ideas?”
Well, since it’s the end of year holidays now and I barely have anything intellectually stimulating to do, I decided to help him with some information gathering. Below are some interesting video clips that I have come across.
Nathan Myhrvold and team's latest inventions -- as brilliant as they are bold -- remind us that the world needs wild creativity to tackle big problems like malaria. And just as that idea sinks in, he rolls out a live demo of a new, mosquito-zapping gizmo you have to see to believe.
From designing a device that could prevent breaking the cold chain of vaccines to diagnosing malaria infection by just looking into your eyes/nail beds, if only more geeks would put their skills to use like this, the bright future that we long for is definitely not far away. Who needs to learn how to do a BFMP(Blood Film for Malaria parasite)? Diagnosing malaria is going to be a no brainer! And since this gadget could specifically exterminate the mosquitoes other than some other harmless insects with wings, I believe Dengue fever/DSS all can be put to a stop.
Next, how about using an I pad during a surgery to view high resolution CT/MRI scans? A team of surgeons in Kobe University Japan actually put this device into good use. The touch screen seems to be working fine although it is covered by a sheath of sterile plastic film and the surgeon has donned on his gloves.
kobe surgery [japanprobe]
Uploaded by jdx459. - See video of the biggest web video personalities.
Not a big fan of these products(I-phone/I-Pad) tho, just another over-rated, highly glorified mobile phones around. One of my housemates once told me:" The sole reason of me getting an I-phone 4 is just to impress the chicks, nothing else".
Anyhow, we all have to admit that advancement in the field of medical technology has certainly improved our quality of life and revolutionized how medicine is being practiced today.
Exam has finally ended. Time to rejuvenate and reward myself back at home-the pearl of orient. I would like to extend my sincerest thanks and appreciation to all the people who made this year a memorable one.
It is incomprehensible that while our beloved country is planning on building a 5 billion ringgit 100-story sky scrapper.On the home front, HSA has run out of normal saline infusion solution. All the patients are now on either dextrose solution or half saline regardless whether they are diabetic or the fluid replacement therapy is apparently inadequate!
Another year has zoomed past and we are almost at the end of third year medical training. Time flies as they say. The end of another year is always the time when one looks back and reviews our achievements, what we did well, what we did not do so well and then look forward to set goals to rectify them.
Year 3 has been uneventful to me so far in the sense that life practically revolves around texts and patients. With the end of year exam approaching soon, I am starting to spend more time hitting the books instead of roaming around the wards acting like a house officer. Now don’t get me wrong, it’s not that I am better or comparable to them, it’s just the method of learning that I have adopted since the beginning of the year. Osler once said: To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.
A few things that I’ve learnt to appreciate over 12 months being posted in different departments:
Respect patients
All students should ask yourself, “Who taught me medicine?”
“Prof A is really good, he taught me this and that. He even printed notes for us!” one of my colleagues answered. At the end of the year, most students will be going around, knocking the doors of their lecturers to thank them for making them a better doctor. But how many actually pondered whether these individuals really taught us the art of medicine? Did they develop heart failure to teach us what an elevated JVP looks like? Did they suffer from cyanotic congenital heart disease just to show us clubbing of the fingers?
Then who taught us medicine? Obviously the patients.
Patient came in with wheezing to show us the signs of asthma.
Patient came in with a myocardial infarct taught us what are the ECG changes that you could pick up in an acute coronary syndrome. Without these patients we would never have learnt. Yet there are students who are capable of performing examination without even obtaining consent just to satisfy their hunger for good physical signs. They come, they strip, they auscultate and they leave.
Our parents taught us to always respect our teachers. That’s the reason why we should have utmost respect for our patients-Our great teachers. And not treating them like dummies for you to practise on.
To wish
Make it a habit to wish the patients and their family members when you clerk them. You’ll be surprised to see how cooperative and pleasant the patients become when you wish them. Always be polite to patients irrespective of their socioeconomic status, education level, ethnicity, language, culture and religion. I’ve learnt tremendously from drug abusers, inmates, people from the lower socioeconomic background throughout the year. They never fail to make me realise that I am indeed so lucky and blessed to be living in such a comfortable life and to pursue what I like in life.
"Healing occurs when you let another human being know that his suffering and fears matter to you"-Anonymous
Choose your friends by their character. Choose your socks by their colour. Choosing your socks by their character makes no sense and choosing your friends by their colour is unthinkable-Anonymous
Be less intimidating
Always stand or sit at the same level with patients when you clerk a new patient. If you are standing and patients are lying down, it can be very intimidating for them. Pull up a chair and sit beside the bed if necessary. Try to calm them down especially during bedside teaching sessions. I learnt to routinely shake/hold their hands while introducing them to my colleagues and teacher before each session starts. Trust me, this will ease their nervousness tremendously. Thank them before you leave, not because they have been cooperative but for the fact that they have imparted some knowledge in you.
Refer to them by their names, and not “cases”. They are not experimental subjects and don’t you think it’s rather dehumanizing to be referred as such?
Duties
Never do things half heartedly. What you do now will definitely reflect who you are going to be next time. Clerking without examination is unacceptable and it just shows that you are not interested in learning. It sucks to be the group leader in the sense that you are directly responsible for the group’s learning progress. Inevitably you will meet people who clerk a patient 15 minutes before bedside and expect the tutor to show them the clinical signs and to finish up all the remnants. Excuses like “The patient was eating when I wanted to examine” or “ Patient was not in bed when I wanted to examine” are commonly given as they fail to step up to their responsibilities. Be responsible when you carry out your duties. If you don’t know or haven’t done it, just admit it and remember to do it properly next time. You must be responsible towards yourself and your colleagues.
However, I’ve learnt to accept and adapt. Confucius once said: If I am walking with two other men, each of them will serve as my teacher. I will pick out the good points of the one and imitate them, and the bad points of the other and correct them in myself.
And finally Attitude
“Attitude , not aptitude determines altitude”. It is the attitude in learning that makes all the difference. Although you can argue that why take things so seriously? You'll get the same degree anyway, since you still call the person who ended up last in medical school -Doctor. It is up to us to decide whether or not to be a 99% doctor or a 50% doctor.
The pathologist reported
Sections show fragments of gastric mucosa with sheets and nests and occasional glands of malignant epithelial cells invading the stroma. The tumour cells are pleomorphic, have increased N/C ratio, vesiculer nuclei and eosinophilic cytoplasm. Abundant mitotic figures are seen.Impression: Adenocarcinoma, poorly differentiated, infiltrating
She looked outside the window and started crying. Her tears welled up in her eyes, rolled down her chicks and then subsequently she broke into a full out sob. She tried to suppress the urge to cry, wiping away the tears with her tudung.
5 months in the Department of Medicine, Hospital Sultanah Aminah JB, was undoubtedly the best experience I've had so far in my medical schooling life. I owe it to the fantastic team of people in the ward I was assigned to. Because of their teaching and guidance, I am actually quite functional and versatile in terms of ward duties. I've done most of the procedures so far including a pleural tap, assisted in several peritoneal dialysis and peritoneal tapping. Venepuctures and IV cannulations were so frequently done that they call me a vampire.
People take different roads seeking fulfillment and happiness. Just because they're not on your road doesn't mean they've gotten lost. I am ashamed to admit that there used to be a time when, if a colleague told me he/she wanted to be a GP, my first thought would be "you're only doing it because you want to have a family." I was harsher on my female colleagues because I somehow felt that the only proper execution of modern-day feminism was to work hard. I would feel a little sense of masochistic pride that my own ambitions were a little more time-consuming. Now I look back and think how foolish, patronising and downright idiotic those thoughts were. The concept that medicine, to many others of my colleagues, was simply an interesting and satisfying way to make a profitable living was alien to me. The concept of medicine being a way to pay the bills hadn't even featured on my radar. I guess, somewhat naively, I had looked upon medicine as a calling. I hoped, and still hope, to contribute in a big way to our knowledge about disease and treatment. In the specialty I hope to pursue, I have found a real passion. To me, medicine will never just be a job. But the whole point is we live in a free society in which we can choose our mode of happiness. No-one should be criticised for wanting to spend more time with family or even for wanting to give up a career to raise one. Least of all, women should not criticise other women for that choice. The specialty I wish to pursue is not what anyone would call family-friendly. It's a long, hard slog. It's a competitive arena. Because of this, people seem to respect this decision. However, those people wanting to do family-friendly specialties, even if their decision is motivated by genuine interest, may come across derision from people who see it as ‘slacking off' or a ‘cop-out'. I can't help but wonder if this sort of attitude is borne of the need to justify their own sacrifices; they have sacrificed their own family lives for their career and, in moments of self-doubt over whether these sacrifices were worth it, their frustration manifests in ridicule of others. I confess to being a little bit daunted by how much I may potentially have to sacrifice of my personal and family life in order to be successful in my chosen specialty. Nevertheless, I have my heart set on it, I genuinely believe it will make me happy. And that choice, the choice of what will make you happy, is what is worth celebrating, irrespective of why you chose it. ‘Ambition' is not a dirty word. And neither is ‘family'. Even as a medical student, I often contemplate on the family vs career dilemma. And yes I'll have to admit that at this stage, career is still prevailing. However by saying that, it's easy to be young and say " I will work my ass off, providing the best for my patients, and I shall put my family planning on hold." But when you are no longer a gung-ho 20 year old medical student or a 25 year old senior medical officer, seeing your colleagues going into a less competitive field, living comfortable lives, will make you think twice about the decision you have previously made. I had a conversation with my dad recently in the car: Me: I'll be graduating in another 2 and a half years. After completing my housemanship in Malaysia I'll try to further my studies as soon as possible. And perhaps after that join one of the university's medical center for practice and academic teaching. Dad: Ok, but if you see any good candidates(girls) along the way, just approach them and be friends. Me: Haiya, no time la. Besides, it's hard for me to settle down. I might get posted to some rural areas in the inner Sabah/Sarawak. Who knows? And I can't afford to be distracted. The amount of money you are paying for my degree should produce an outstanding doctor, not mediocrity. Dad: Ya la, I know, but don't wait too long. Me: Don't worry la, some of my tutors get married pretty late as well. Dr Y completed his MRCP at the age of 35 and when he returns to Malaysia, he's still single. Dr K too, he just got married last year. I even know of a professor who dedicated his life to medicine, now still single(trying to scare him) Dad: That's not success, no matter what, don't put it on hold for too long! I'm not blaming my dad, I guess he's just a little worried that I will become too career minded. Medicine can be like a jealous mistress- These words were spoken to me by a few wise tutors. I listened to them but still could not fully appreciate the gravity of my chosen career. I'll just let maturity and experience change my views on things. I don't think its impossible to achieve a great career and family, because at the end of the day, you make your own time. And I believe, one will never be too busy for his/her love ones. Everybody has their own interest and it's important to respect them. "Ambition" as what the author mentioned is not a dirty word. I admire people who dedicate their life to medicine, serving the Rakyat who really need them. Afterall it is an honor and privilege to be called doctor. This is why I want to have a MBBS after my name. That is why we are allowed to handle life and death situations. That's why we don't mind staying up late in an operation theater for our patients. It's a life, a calling, not a business. And I seriously couldn't imagine how hard it is to do that all, if you do not possess the heart and passion. Be the best doctor you can be, make time for what you love, the rest are just excuses.
A fancy way of doctors saying that they have absolutely no idea what is causing the fever is PUO- Pyrexia of unknown origin or more commonly termed FUO, Fever of unknown origin.
A 55 y.o patient with a known history of DM and HPT presented with generalized edema, ascites, peripheral upper and lower limb swelling and facial puffiness. 
Patient came in c/o light-headedness , provisional diagnosis of uncontrolled DM was made.
When I saw him going into cardiac arrest, and subsequently his death announced, I had a sense of futility, then sadness. I was just talking to him yesterday, asking him whether he felt better, eating well and ect. It was as though he just disappeared.
No doubt this is the biggest I've seen.
The reason why I make it a point to drop by my designated ward everyday(at least for the morning) is not only to clerk patients for my learning, learn new procedures and etc, but also to experience bizarre incidents that could really baffle and puzzle my mind as a medical student. I often walked out from the ward smiling, telling myself I've enjoyed my day.
My clinical training started officially and I will have to admit that this week has been the best week throughout my medical training so far. Had the opportunity to auscultate 2 pan systolic murmurs in a 15 year old kid with VSD and another 70 year old uncle with a mitral valve prolapse complicated by infective endocarditis. Although it is physically and mentally exhausting at the end of the day, i know that the more patients i see, the more i learn.
A wise physician said to me, " I have been practicing medicine for 30 years and I have prescribed many things. But in the long run I have learned that for most of what ails the human creature, the best medicine is CARE."
Thanks for dropping by. Welcome to the 15th edition of SurgeXperiences, the only Surgical Grand Rounds that is devoted to the best surgical related posts!
Without further ado,
Dr DJ, a surgeon from Mumbai, India who blogs at “Dr DJ’s Surgical Adventures” brings us two great posts. First he chronicles about a difficult situation where things are not in their expected places.
“The doctor doing the CT suddenly yells, “Where is the doctor that managed to do this”. The intern accompanying the patient almost had a fit”
Read on to believe it for yourself!
Medical practice is not universal, medical customs and indications differ widely between countries and indeed patients’ expectations differ even more. The second piece of literary from Dr DJ sheds some light on how cultural differences between doctors and their patients are common and may have important clinical implications for clinical encounter.
“I would love to have a middle ground and say it is our duty to inform the patient that a complete medical examination is required, but how many would agree to strip down completely just for a fever?”
Next up, ER Doc over at “Tales from the Serenity Now Hospital” shares a story of complete lack of common sense.
“I try to educate my patients as much as possible on things. I don’t always do a good job when its really busy. But this time I was sure to explain what milking the prostate really is”
Over at “Two weeks on a trolley” is a post titled Dr Ima Toilet that explores the worst things that could happen to you on the wards. Read on to discover how he was peed directly into his eyeballs during a delivery, drenched in liquid poo after inserting a tablet into a child’s bottom, not forgetting an encounter where a patient approached him from behind and urinated on the back of his legs. Poor guy!
There is also a mention about a med student who gulped a piece of cadaver adipose tissue and eventually became a surgeon. Read on for a good laugh!
Romana, a plastic surgeon in Little Rock, AR reviews a journal article about “Histologic Relationship of Pre-auricular sinuses to Auricular Cartilage”. [Read Here]
With the number of injured casualties continues to escalate, MSF’s surgical units in Haiti continue to work around the clock, providing relief and treatment despite having limited staffs and resources. However as the death toll in Haiti continues to climb, frustration appears to be overwhelming as relief efforts are seemed to be slow and disorganized. [Read Here]
Over at the “Forensic Scientist Blog” that covers the life, times and interests of a real life forensic science technician, he explores how forensic scientists use body parts to identify and perform criminal examinations of the deceased. He highlighted the role of prosthetics implanted by surgeons as well as scars from routinely performed operation such as appendectomies are indeed handy in aiding the process of identification.[Read Here]
Though I strongly believe that everyone should have access to a good defense, even I wondered how some lawyers can help defend people who have done horrendous things. When lawyers help killers and child molesters off the hooks my finding some legal loopholes, you got to ponder if they’re really upholding the legal system or merely just thinking about monetary gain and their ego.
Bongi a south African surgeon who blogs at “Other Things Amanzi”(my all time favourite) mourns over the death of his patient and rants about why he hates lawyers.
And that’s it for this edition of SurgeXperiences, please send submissions for the next edition via this form. Also , for anyone who wishes to join the ever growing family of SurgeXperiences, do not hesitate to contact Jeffrey who runs the show.
Thank you for paying a brief visit. SurgeXperiences is the one and only blog carnival that assorts the best surgery related posts in the medical blog sphere today. It was pioneered by one of my esteemed counterpart, Jeffrey Leow of Monash Medical Student who is adventurous enough to open up new areas of thoughts and bringing something new to the surgical blogging community.
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