Unwell

I'm feeling a little bit unwell for the last few hours. Feverish. I'm worried that it might last long enough to affect my revision. Hopefully I will get well soon.

This is one of the reasons why last minute revision is not good for students. If you are the ones with such habit, please break it. You'll never know what might happen to you in future at the crucial moments. Accident may occur, or at least you might end up being unwell just like me. An orthopaedic specialist cum visiting lecturer once shared with us the story of his friend who suffered from sports injury while playing rugby weeks before their final exam. He suffered a blow to his face during the scrum which resulted in basal skull fracture and amnesia. He was lucky to survive and managed to sit for the exam. He passed the exam. He's a specialist now. If I were him, I don't think I will be able to sit for the exam, let alone passing it.

Of course, it is never too late. "It ain't over till it's over" - quote from a song. Keep on struggling with all the resources that you have, within the period of time left. Just make sure not to repeat the mistake. I don't want to be the last minute man anymore. That's for sure.

===============

To-do list for the remaining 2 days:

1) Obgyn and Ortho physical examination.
2) Travel to nearest teaching hospital to practice on real patients
3) Respi and CVS
4) Abdominal and Neurological
5) Paediatrics - especially Developmental Assessment.

Long Case - Lessons Learned

The key to guide your history taking during long case exam lies within the line, "Which ward are you admitted currently?", "Which doctor?" or "Which clinic that have been following you up?" ; because it will indicate what is the chief complaint that should be tackled. Of course, it may not be entirely true as some patients may have been followed up for certain chronic diseases but they volunteered for the exam with different presentation or with a totally different diagnosis that has no relation to those chronic diseases at all.

I may be wrong, but it is imperative to make sure that you try your best not to refer to the written text when you are presenting the history to the examiners. It is part of the "showmanship", so as to make us appear confident and well prepared to answer any questions that will be asked later. Unfortunately, I still have to take a peek to the scribbled text during presentation. Apart from that, like any other "interview", other soft skills such as mastery of English, proper use of terms, smooth narration (rather than point by point), manipulation of tones (to stress some points from the others) etc are just as important. However, like I have mentioned prior, "showmanship" is my biggest weakness. Even though there are much improvements, yet I'm still not at my personal best. There's still room for further improvement.

If the patient is not a good historian, do mention about it to the examiners earlier during case presentation. It will affect their perception towards your history taking and presentation skills, which in turn will affect your marks.

Never ever forget to include systemic review in your history. Most of us will forget, unless we are consciously reminding ourselves about it.

Don't wait for the examiner to prompt you, keep on presenting unless you are stopped by them.

Summary - Keep it short and simple. Summary must lead the examiners to your working diagnosis rather than repeating the chief complaint. E.g. Chief complaint: Low mood, loss of appetite, reduced sleep for three weeks, and suicidal ideation. Summary : [Patient's particular] , presented with symptoms suggestive of depressive disorder, associated with suicidal ideation for the last three weeks. [I still have to practice... T_T]

Usually after the presentation, we will be brought to the bedside to perform physical examination or mental status examination for psychiatric patients. Plan with the patient on how he/she should respond when she was given certain instruction in front of the examiners as you proceed with physical examination prior to presentation. E.g. "Makcik, nanti bila saya minta makcik beritahu saya bahagian mana yang sakit, makcik tunjuk pada bahagian yang paling sakit kemudian baru beritahu kawasan lain yang turut sakit..." (Ma'am, later when I ask you to show me where the pain is, please pinpoint the site where it has the highest intensity and then show me the rest of the site that is less painful if any).

This is just my 2 cents worth of advice. I am not the best, just feels like sharing so that you won't repeat my mistakes. Hopefully this will be my last long case presentation as a medical student. Hopefully I will secure a pass for this examination... Ameen.

===============

Next: Short Cases examination on Saturday. The final 30 minutes for this examination.

Long Case... 8 hours to go, and counting...

This is it. The day has come. Approximately 8 hours left before it's my turn to sit for the long case examination. I'm prepared... But perhaps I would still have to revise for the last few hours. Just to refresh my mind, especially on the aspect of management as well as the normal values for the investigations.

This session, and the short cases on Saturday would be my final few 'official' hours as a medical student. Hopefully I can make it and doesn't have to extend my studies for the next 6 months. Hopefully I will get a simple and straight forward case, answerable questions, a cooperative patient, and finally nice and helpful examiners. Ameen.

Come what may, I will accept whatever the outcome will be with open heart (figure of speech). Yet I will still struggle for the short cases session no matter how well I perform during the session later today.

p.s. Nervous... Have to calm myself down.

"Dear Me, don't compare yourself with others, whether the ones who were doing much better than you, or those who were not doing well. Just focus on yourself and pray hard. You can do it~!"

Long Case! (btw, it's my 40th post - deleted ones included)

From tomorrow until Wednesday, we will be sitting for long case examination. Then followed by another three (3) days for short cases examination. My turn for long case will be on Tuesday, whereas for short cases will be on the last day, i.e. Saturday. Hopefully I will perform well for the last two 'papers'. Facebook statuses of my fellow batchmates have already shown aura of nervousness and anxiety especially for those who will be sitting for the exam tomorrow. Me? Surely I am extremely nervous and anxious to the extent that I don't know what else to do. So, I turned to God and prayed hard that I will be given a simple and known case, in a package with kind and cooperative patient as well as good & 'angel'-like examiners. However, I still have to revise more, especially on the aspect of management. Perhaps I should flip through the CPGs for the purpose of covering the aspect of management.

Hints? I don't know much. And based on previous recent history, I don't want to rely much on hints. It didn't work out for the CPC and Theory Paper. Neither it was during OSCE day 1. However, I should not totally ignore them. So, I decided to flip through the case summaries that I have made throughout the clinical years based on the hints, as well as based on "common cases" that have been listed by my seniors.

A friend of mine once told me, "For long and short cases, these three study weeks are not the key. It is either you practiced enough throughout the clinical years or not that really matters". He may be right, but I'm not taking any chance. In fact, there is still time for me to prepare. At least physically and mentally. Should practice more on showmanship and brush up my presentation skills. "There is still hope..." (quoting from the LoTR trilogy).

Basically, that's what I am going to do from tonight onwards until the end of examination. Once I'm done with short cases exam this Saturday, I will take a break for half day before preparing just in case my name were listed in the viva list. Obviously not viva distinction, if you were asking... lolz...

Till then, see you again next time (as if there is anybody reading my rantings... ^^) ~!!!

Earth Hour Malaysia - March 27, 2030H - 2130H

Earth Hour is here again. Last year's Earth Hour had caused an intense debate among my peers regarding its role and impact. Some even argued that with all lights being turned off, crime rate will increase and many youngsters may get involved in immoral activities. Others responded that all those things can occur at anytime, any place even before and after Earth Hour. However both sides agreed that it's just a symbolic awareness campaign rather than having powerful impact by itself. However, this is the moment for us to show our solidarity and raise the awareness towards saving the Earth. We have observed how humanity had recklessly manipulated and squeezed the Earth resources to the limit. We have also observed so many destruction made by our hands. Now it's our time to do something to make sure that Earth is still safe for our future generations. We can make a difference - no matter how small it is, it really matters.

To all Malaysians out there, let's forget our differences and support Earth Hour. Just for one hour, please switch off the lights and don't use the cars starting from 8.30 p.m. tonight. Unless you have urgent matters, of course.

Post OSCE - Gloomy yet the light of hope still flickers

Yesterday was a gloomy day - literally. After nearly 5 hours of quarantine, soon the sky became gloomy and there were lightnings and thunders for approximately 30 minutes before the rain poured. And it suited my mood as well, after doing quite terribly in the OSCE Day 2. I was so silly that I missed to ask patient's name and RN before I perform venopuncture for blood test. And I made a mistake that could not be forgiven - defibrillation for unconscious patient with pulseless electrical activity (PEA) at the Accident and Emergency department (A&E) CPR station! I've cried enough for the spilled milk (terrible performance in OSCE). Hopefully I managed to secure at least minimum pass for OSCE and other components. I must focus on the upcoming rest of the clinical component i.e. long case and short cases.

OSCE Day 2

Station 1: Primary Care Medicine. Patient presented with urethral discharge and back ache for 3 days. Obtain the sexual history and advise the patient accordingly.

Station 2: Rest Station

Station 3: Otorhinolaryngology (ENT). Two exhibits. First, acute tonsilitis - we were asked about the clinical findings based on McIsaac score. Then we were asked about the first line antibiotics and duration of treatment. Second exhibit showed picture of ear toileting. Questions, what's the indications, precaution, and complications of the procedure?

Station 4: Anaesthesiology. Patient presented with trauma due to MVA. Suddenly developed respiratory difficulty. We were given arterial blood gases (ABG) results and had to interpret. Then followed by the management of the patient (ATLS - primary survey). After intubation and ventilation, another set of ABG results given for interpretation. Lastly, patient was put under FiO2 0.8. What does this indicates?

Station 5: Emergency Medicine. There's video showing patient with signs of paradoxical breathing. Asked about the diagnosis and further management of this patient.

Station 6: Otorhinolaryngology (ENT). Two exhibits. First: Inflammed inferior turbinate and it's management (medical and surgical). Second: Cholesteatoma, the complications, and whether the hearing loss secondary to it is reversible or not.

Station 7: Rest Station

Station 8: Anaesthesiology. Venopuncture for full blood count and renal profile. (Missed a lot of marks here. Silly mistakes, should have scored full mark!)

Station 9: Obstetrics and Gynaecology (O&G). Running commentary on how to prepare for episiotomy repair and demonstrate on how to do the suturing.

Station 10: Emergency Medicine. CPR and then given an ECG. What's further management? (Follow the algorithm). If VF or pulseless VT, defibrillate. If otherwise PEA or asystole, continue CPR and at the same time ask for assistant to give IV adrenaline 1ml. (I failed miserably despite practicing it so many times).

==========

Ok, now let's get back to business. Should revise more on managements of common diseases - starting from O&G first for tonight. But first I want to have some hearty meals for dinner... =)

OSCE Day 1 - Checked. 3 more clinical exams to go~!

I fell asleep relatively early yesterday, so I didn't have the opportunity to blog on that day. Now, the first part of OSCE is done, with 8 stations plus two rest stations. Tomorrow will be the second half of it, comprising of the remaining disciplines in the syllabus. As for today, the eight stations were as such:

Station 1 : Primary Care Medicine. A young male adult (Damn, I forgot to ask his name. I only introduced myself to him) presented with history of back ache for 3 days. After detailed history and physical examination, you have made the diagnosis of muscle sprain. However he requested for an x-ray. How do you respond?

Station 2 : Rest Station

Station 3 : Ophthalmology. Picture of cataract given (My friends answered with complete full mark i.e. posterior capsular cataract). We were asked about the findings and give the diagnosis. Then we were asked to list one local cause and 2 systemic causes. We were also asked to name two procedures that can be used to treat the condition and list 4 complications that may arise from the procedures.

Station 4 : Radiology. We were provided with two exhibits. The first one is a PA erect chest x-ray with haziness and consolidations all over the lung fields - diagnosis: miliary TB. Then what is the other test to confirm the diagnosis? - Sputum culture and sensitivity or smear to look for acid fast bacilli (choose one).

The second exhibit shows the x-ray of knee joints from two views, AP and lateral. A male patient in his 30's presented with history of sudden pain on the left thigh associated with swelling while he was playing badminton. Comment on the findings (AP view, no visible fracture but there is multiple cystic lesions on the distal part of the left femur. Lateral view, there is spiral fracture at the distal part of the femoral shaft of the left lower limb). What is the diagnosis? (Pathological fracture secondary to aneurysmal bone cyst).

Station 5 : Surgery. You as an HO in the ward saw Mr. Z unconscious following a surgery. Re-assess the Glasgow Coma Scale (GCS) level. It was written on the question "Treat mannequin as a real patient". After assessing, summarize the findings (supposed to be at the minimum, because a mannequin will surely not respond to any stimulus. Hence it will be 3 over 15.) . Then the examiner will give you another set of finding and asks you what is the GCS? Finally you will be ask what is the GCS level that you would intubate the patient? (I answered less than 8. But please check because I'm not sure. Some of my friends said 8 and below.)

Station 6 : Primary Care Medicine - Drug Prescription. 2 year old (weight and height provided) presented with history of fever. Prescribe antipyrexia for this patient from what is listed. Tablet Paracetamol, Syrup Paracetamol, Tablet Aspirin, Soluble tablet aspirin. (I'm sorry I can't recall the dosage.)

Station 7 : Rest station.

Station 8 : Ophthalmology. Do visual acuity test. Since the test was done in limited, confined space, mirror had to be used. ( I knew the "patient". She is a doctor. lol)

Station 9 : Psychiatry. Patient presented with history of low mood for three months, and had suicide intention for two weeks. Assess the suicidal risk in this patient. Use SAD PERSONS scale, and "SAMPAH" mnemonics to assess whether the suicide was well planned or just to gain attention from others. [S - Suicidal note. A - Avoidance (e.g. want to commit it in a locked room) M - Method (e.g. overdose, hanging, or slit wrist etc) P - Plan (when, where) A - Arrangement (I think it's redundant, but that's what the mnemonic is) H - Hint (e.g. by writing will, buy insurance).]

Station 10 : Orthopaedic Surgery. Patient had a fall and suffered anterior dislocation of the shoulder on the left arm. Ask for written consent for this patient for the close manipulation and reduction (CMR).

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So, for tomorrow there will be no more stations for Ophthalmology, Surgery, Primary Care Medicine, Radiology, Orthopaedic Surgery and Psychiatry. Let's revise for Obs-Gyn, Paediatrics, Emergency Medicine, Anaesthesiology, and Otorhinolaryngology (ENT). Medicine? I'm not sure, because some said that it won't come out because we have had our CPC under Department of Medicine (SLE with Anti-phospholipid syndrome). But, I think I still have to prepare just in case it may come out tomorrow. But for sure, I have to cover the rest first!

Let's do it...

p.s. Have to struggle for tomorrow because I think I'm not doing well enough. I must secure at least pass for this component. After this paper, there will be a gap before my long case paper on Tuesday and Short cases on Saturday (the last day!). Please, please, please, dear God please guide and help me to pass this exam and become a good and safe doctor. Ameen.

Wohoo... 2 days to go~

Yes, two days to go and yet I still feels 'empty' without much input for the last few days. Even though there's much progress but I felt like I'm not doing enough for this exam. Just like previous exams. Hopefully I will be able to pass this exam. I think I should stop from blogging for now. Maybe, just maybe, I will come back after I'm done with theory paper, the day before OSCE. Please pray for me.

Action plan:

1) Proceed with Past Years Questions attempt

2) Review on the investigations and their interpretation (including radiology)

3) Flip through short notes that I've prepared prior.


That's all for now. Till then, bye~

Graphics from HERE. Special thanks to Mr. Adnan i.e. the owner of the blog for the pic. Now it's my turn for the exam. =)

SIGECAPS - Mnemonics for Major Depressive Disorder

Another mnemonics. This time it's for symptoms of major depression and dysthymia.

S - Sleep disorder* (insomnia or hypersomnia)
I - Interest deficits (anhedonia)
G - Guilt (worthlessness*, hopelessness*, regrets)
E - Energy (lack of energy)*
C - Concentration deficit*
A - Appetite reduced*
P - Psychomotor retardation or agitation
S - Suicidality - (to assess suicidal risk, use SAD PERSONS scale).

NOTE: To meet the diagnosis of major depression, a patient must have four of the symptoms plus depressed mood or anhedonia, for at least two weeks. To meet the diagnosis of dysthymic disorder, a patient must have two of the six symptoms marked with an asterisk, plus depression, for at least two years.

Reference: American Academy of Family Physicians (AAFP)

An Act of Stupidity

As far as I can remember, I never openly call someone stupid. But this, I think, is an exception. There is no other suitable word that I can use to describe such act. It's a waste of valuable life saving resources. Allow me to enlighten you, if you are not following the news lately. Please read the news HERE. For English version, click HERE.



One could not imagine what's the rational behind such act. Even if there is any, I don't think it outweighs the benefits that can be gained should the blood were donated to the proper cause. It's a pity that even blood was used as political tools, when it was supposed to be used for greater life saving purpose.

[Special thanks to BangkokPost.com for the graphic]

5 days to go~

... before the beginning of the final professional MBBS examination. I hope that I can manage to pass the exam. Otherwise I will be spending the next 6 months for extension and resit for another exam (God forbid). And it won't be easy too. So, I will try my best to score as much as I can in the exam to the very last minute.

Our batch has created a history I guess, with the highest number of students being barred from the examination. However I could not be sure of that. But one thing for sure, it is a stark contrast as compared to the previous batch, whereby there was none of them being barred.

Most of them, not to say all of them, were being barred mainly because of lack of attendance. Our faculty has set up minimum 80% of attendance, and we were all had been warned of the consequences of failing to fulfill the requirement. Yet, obviously some of us were not bothered by such reminder. Hence, they were barred from sitting for the examination.

Some of them have their reasons, while the rest were simply not coming from the class for no reasons. Of course, they would be asked to write a show-cause letter. But unfortunately none of them were accepted by the dean's office. It's a pity for them, for not even having a fighting chance. It's a pity, because some of them are very,very,very knowledgeable as compared to myself. And one or two of them had once ridiculed me before for my "lack of knowledge and skills" - according to their definition. But that's another story. I don't mind, and of course I won't say to them "serves you right!". Yet, what really hurts my feeling is that they would still hope and pray that I would soon join them. They even sarcastically wish me luck by saying, "Nanti jangan tinggalkan kita orang jauh sangat ye. Jangan buat master cepat sangat."

I won't judge them, there's no point of doing so. It won't affect the outcome of our exam anyway. Some of them have their own reason and problems that hindered them from attending the classes. But it is all written then. I wish them luck, and of course I hope for the best of me too~

As for me, I will try my very best and leave the rest to God. I will accept whatever the outcome of the exam is, but I really hope that I will pass the exam and become a safe doctor once I've graduated.

Ok, it's time to get back to the business. Five days to go. I should bombard myself with past years' questions and quick revision based on them. This would also be the time for proper sleep hygiene and diet so that I will be at the best of my health for the upcoming exam. Ganbate~ Chaiyo~ All the best~ Bittaufiq wan najah~ Semoga berjaya~!!!

I would also like to take this opportunity to wish all my coursemates the best for the exam (if they happened to read this blog, obviously).

Mode: RED ALERT

Schneider First Rank Symptoms

This is the mnemonics of Schneider's first rank symptoms. Presence of these symptoms proves the likelihood of schizophrenia (but bear in mind that it is not diagnostic for schizophrenia).

A - Auditory hallucinations (third person, running commentary)
B - Broadcasting of thoughts (thought broadcasting)
C - Controlled thought (delusions of control)
D - Delusional perception.

and thought insertion, thought withdrawal

Possible OSCE question for Psychiatry; apart from SAD PERSONS, mental state examination, or mini ental state examination.

Mechanism of Vaginal Delivery

We can be asked by the examiner to demonstrate the mechanism of vaginal birth in the OSCE station for O&G. While explaining the mechanism, we would also have to use the exhibits (mannequin - baby's head, and pelvic bone). Here's the steps in the mechanism:

1. Engagement (definition)
2. Descent and flexion of fetal head
3. Internal rotation - fetal head rotate and assume occipito-anterior position, facing towards maternal rectum.
   
4. Delivery by extension - fetal head extended.
5. Restitution - Fetal head turns 45 degrees to the maternal right hand side, restoring normal relationship with the shoulder.
6. External rotation of the shoulder.

Then, we would assist the delivery by gently pulling the fetal head downward in order to deliver the anterior shoulder before we pull it upward to allow the passage of the posterior shoulder.

Bipolar Affective Disorder

"DR ABC"

It would be much beneficial if I practice the cardiopulmonary resuscitation instead of just simply write about it. But in order to do what you are supposed to do, first you would have to know the steps. In short, it can be summed up in an acronym DR ABC. This method has been taught to us since our first year of med school. I still remember the whole batch gathered at our college's Dining Hall with our final year seniors as our supervisors and not forgetting the instructors (lecturer and nurses from EM). Approximately 100 mannequins were brought to the hot and humid Dining Hall for the program. I remember, one of my supervisors (cum senior) even wrote the 'magic' word "DR ABC" on my forearm using pen. Future fast forward, it was our turn to supervise our juniors doing the CPR a few months ago. But I forgot to bring a pen, so I could not do the same. In fact, I don't think I will do it anyway, because the juniors in my group were all females. Anyway, let's go back to the main business, what is DR ABC? And how do we perform the CPR? Again, this is just for my revision.

Patient suddenly fell unconscious. First of all,

D - danger; look for any danger to the patient as well as to yourself in the surrounding.

R - response; ask the patient to see whether he's conscious or not. "Sir, do you hear me sir? Please respond to me, sir. Sir, sir!) and simultaneously pat patients shoulder with both hands.


A - airway; head tilt - chin lift if there was no suspicion of cervical spine fracture/dislocation. Clear the mouth from anything (food etc)

B - breathing; put your ear close to the patient's mouth - to hear his breath and turn to face patient's chest - to see chest movements indicating the respiratory effort.

C - circulation; check for carotid pulse.

If the breathing and circulation are normal, turn patient into recovery position. (steps, check for any injuries - don't move them if patient is hurt; bend the right arm to avoid him from rolling; gently turn patient to the right side; bend left leg to support the position; tilt his head up and tuck in the left hand underneath the cheek; call for help while someone is watching over him).

If breathing and circulation are abnormal, then call for help from people nearby and ask for AED (automated external defibrillator) if situation took place outside hospital setting.

Give two rescue breaths (don't forget to pinch his nose) within 2 seconds and 30 chest compressions (rate 100/min). Make sure it is uninterrupted for at least 5 cycles or until help arrives.

In the hospital setting, there is further management of patient involving defibrillation and drugs. There is an algorithm to follow in the guideline. However, I do not wish to further elaborate upon that, because it would be easier to revise by looking at the algorithm. Thanks, that about it for now. ^^

Ovarian Mass - approach

History: (hypothetical) A 24 year-old lady presented with complaint of mass over suprapubic region.

Further history: Onset? Is it single mass or multiple? Any associated symptoms? Such as dysmenorrhea, menorrhagia, or pain over the private part? Constitutional symptoms (fever, loss of appetite, loss of weight) - possible : ?germ cell tumor in young women? Abdominal distension? Swelling over other part of body? e.g. Virchow's node (enlarged and hard lymph node at left supraclavicular area - common site for metastasis from abdominal/pelvic CA). Sexual history: ever had sexual intercourse? When is the last menstruation (possible - ?ectopic pregnancy)?

Physical examination (abdominal + 'lumps & bumps')

General condition: Alert? In pain or comfortable? Cachexic? Pallor?

Abdomen: Observe for mass; or distension, everted/flat umbilicus (ascites). Palpate for mass, ascites. After that, move on to describe the suprapubic mass (site, shape, size, uni- or multilocular, well-defined edge, central or lateral, can get below? mobile or fixed? - to differentiate between ovarian and endometrial origin).

Complete the examination by checking left supraclavicular region for Virchow's node as well as breast examination - mention only, examine only when you are asked to do so.


Investigation

1. Full blood count; mainly to look for evidence of anemia.
2. Renal profile, liver function test (to rule out other causes of ascites; hydronephrosis, liver metastasis)
3. Tumor markers: CEA (usually CA colon, CA rectum) , CA125 (normally serous type, non-specific; irritation of peritoneum).
4. alpha fetoprotein - for germ cell tumor in young patients.
5. Ultrasound scan; doppler's - echogenicity to differentiate between benign cyst and malignancy.

Differential diagnosis: ovarian cyst, ovarian tumor (germ cell tumor), endometriosis, leiomyoma, molar pregnancy, ectopic pregnancy (less likely, because patient will come with different complaint)

Further management

Surgical intervention (exploratory laparatomy). Surgico-pathological staging ('washing'cytology, liver surface, peritoneal cavity) - if normal = 1a, if presence of tumor = 3c. Even if 1a, lymph node biopsy is required to confirm the staging. If already 3c, plan for adjuvant chemotherapy post-operatively.

If patient has completed the family, opt for TAHBSO, omentectomy, and cytoreductive procedure for enlarged lymph nodes - in advanced stage of ovarian CA.

Post-operative

1. Chemotherapy if confirmed stage 3c. (cis-platinum)
   
2. Long-term follow up: observe, CA125 (if raised, do a CT-scan), any signs and symptoms of recurrence / metastasis. alpha fetoprotein (if confirmed germ cell tumor)
3. CT-scan : normally done after completed chemotherapy, and repeated after 1 year unless there is rise in CA125 as mentioned before.

Prognostication - 5-year survival

Palliative care

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p.s. This is my personal answer based on what I have been taught. Should there be any mistake, please kindly inform me. It was not meant for academic purposes (such as research study etc.), instead it was just for my revision. Thank you.

And I always thought 'F' is never good before...

Fuh, it has been a while since the last post. My apology, it's just that I was preoccupied with my studies (which is good, anyway). This post may not have much significance towards my study, but I was quite amazed by such event that took place. I was listening to a local English radio station when suddenly a commercial break caught my attention. Perhaps most of you might have heard about it long ago, but to me it is something new. The commercial is about F-cup cookies.

I was surprised by the way the commercial is presented. It involves a conversation between two person, a guy and a girl. That guy is promoting F-cup cookies to the girl, but the girl hesitated because she was on "diet". Then that guy would go on elaborating the fact that the product is widely accepted in Japan etc. What catches my attention the most is the fact that the guy openly mentioned about the girl having "two apples" and said that he would have preferred "two watermelons". Oh my... That was way too straight forward. I dunno about your culture, but it is not widely acceptable in my culture. And definitely not something to be discussed openly with your female counterpart (unless you are spouses, of course).

Is it true that "the bigger they are, the better"? Well, I think it depends. To me, any size would do as long as they are not too massive or too flat. Opss, am I being naughty here? Uh-uh, not really. By the way, I have to admit that I don't know much about the measuring and classification of breast size (except the Tanner staging, but that's for pubertal sexual developmental assessment and has nothing to do with the bra size). But from my simple internet search, I noticed that almost 70% of women worldwide are wearing the wrong size of the bra. So, it is not something to be ashamed of if I don't really know much about it. It's not that I am going to wear it anyway. lol

Honestly, I really don't mind about "the shape". Partially because I am no "muscle man" or "six-packers" to begin with. Apart from that, what really matters are the personality and the quality of the girl. Of course, considering the fact that I am planning to spend the rest of my life with that girl (as my wife). Physical attribute won't last forever. Soon, those hour glass figure and flawless complexion will fade away as the time goes by. If you are equating love as being directly proportionate to physical attribute, then for sure the love will fade away as the women you are married to is becoming older.

Oh, not forgetting to mention that, being a Muslim I will always consider her religion as the main criteria. She can be from any race or country. Pale white, pinkish with freckles, dark, brown, yellow, whatsoever. As long as she is willing to accept my flaws and understands me. And of course, it will be mutual. I swear that I will try my best to become a good husband and treat her well.

But that will come later. First I must focus on my studies. That's for sure. With 11 days to go, there's not much time left. This is the final lap, I must gather all my strength and "sprint" my way towards success.

"Dear God, please grant me health and peace of mind so that I can sit for the exam in a proper way. I will try my best, and leave the rest to You. Please grant my wish and make a good and safe doctor out of me. Ameen..."

Study weeks...

Our first week out of three study weeks has started. It seems like yesterday when we started our clinical years in Klang and then in UMMC. Now it's our juniors' turn to 'suffer' from what we've been through. I can see white coats roaming through the dining hall after Maghrib prayer, but this time with different faces. It used to be us being the ones struggling to clerk the cases for tomorrow's ward round or staying in the ward for on calls (which is much,much,much relaxing as compared to the HO's oncall). Sometimes, we have up to 8 beds to be covered in details within a day. Of course we'll be able to do so, provided that we're free the whole day. (and we're dedicated to this field). But the truth is, half of the day is usually filled with teachings, tutorials, seminars, etc. Now, it's their turn to experience this. And not forgetting the facebook statuses such as "Post call syndrome", or "Case summaries~!" etc.

But that's nothing when compared to the life as a house officer. Even though I'm not there yet, but I knew it based on what had been told by my seniors. Some even mentioned that they were too busy to the extent that they do not have much time for themselves anymore.

Well, I am mentally prepared for that ever since the very first day I stepped into the college approximately five years ago. It's just that I have to brush up on my knowledge and skills so that I can become a competent HO and sailed safely through the career as a clinician. Lately, there has been news about how terrible some HOs were. But I believe they were just isolated cases. Generally speaking, our med schools have been producing qualified and safe doctors throughout the years. Especially UM, followed closely by UKM, and USM. No, I'm not saying this just because I'm from UM Med School. Even though there has been some decline in the sense of quality as compared to our super-duper seniors (as being mentioned by a senior paediatric consultant during a ward round), but I can safely say that the public can put their trust in our very own locally trained doctors.

Enough said, it's time for me to continue revising. Oh, my GI disturbances had somehow subsided. Now I only had loose stools from time to time, but there's no more increase in frequency of visits to the toilet. Hopefully I will fully recover by tomorrow so that I can focus on my studies... Ameen.