Sunday, October 5, 2008

Clincal Skill - relfection

This is an assignment I was required to do for my Clinical Science Learning (CSL) module. Well, I prereleased it here, before I hand in to my mentor tomorrow.

Ooi Zhi Hao A116684
Clinical Skills Learning 5 (CVS3) Reflective writing

On the 5th session of Clinical Skill Learning, I, as with my other colleagues, were required to perform skills that we learned from 2nd till 4th session, which including general and cardiovascular system examination on a standard patient. We were informed that the particular session was going to be a mock OSCE, just like what is going to be in our real final examination. As differ from 1st year standard patient session, this time, we were not only be tested our clinical examination skill, but we are also going to the particular cubicle in order and solo, without other colleagues watching what we were going to do. During that session, I offered to be the second person to be tested.

When it was my turn, I walked towards the cubicle and was told to read the question. During reading the question, I committed my first mistake as I was spending too much time to organize chain of question I was going to ask about history of presenting illness. Till my examiner / mentor reminded me of the limited allocated time, then I started to panic and began my history taking by greeting the standard patient. During the first question of taking history of presenting illness, I ended my question 2 minutes before time up. My examiner broke the silence by reminding me about asking patient’s symptoms at night. Before I could asked further question about patient’s paroxysmal nocturnal dyspnea, it was time up and I had to present my history taking. After my history taking presentation, my mentor told me that my history taking wasn’t impressive as the biggest flaw in my HPI was the lacking of any childhood disease that would suggest rheumatic heart disease.

Next, I was required to perform a cardiovascular examination on the same standard patient. This time, I couldn’t stop myself by thinking my mistake during history taking. This distraction caused my performance worse than I used to be during usual session. Couple of things I missed during my CVS examination, included radio-radial pulse, collapsing pulse, carotid pulse etc. With this poor performance, my mentor finally pointed out in her feedback that I was behaving nervous during the whole mock OSCE, and I will need a lot of practices to be more professional next time, which I couldn’t agree more with that.

As my reflection on my mistake during history taking, I realize how important it is for a medical student / doctors to be well prepared anytime with any situation of how the patient might be. Organizing chain of though when the patient is in front of me is surely not an impression I want to be in front of a sick person who might need emergency medical treatment. Patients seeking our help because of trust, hence, any delay in approaching to patient is not a good thing to do, but in fact, causing patient to doubt our professionalism. In more serious level, delay in approaching a patient because of “organizing chain of though” is not an excuse, as time is very precious especially patient attend to us with a serious medical problem which might be life threatening. A fast response and well-react to a patient’s medical problem can sometimes mean saving a life. Be well-prepared anytime is the first lesson I learn in this session.

In order to improve my approach of history taking, I realize that I was missing the part of nocturnal symptoms and childhood history is because I wasn’t formulating differential diagnosis in the process of asking history form the patient. Making use of clinical manifestations of various diseases I learned from books, I should be able to form a provisional diagnosis after knowing chief complaint of the patient. Based on this case, patient was young and presented with shortness of breath. I should have suspected rheumatic heart disease, on the ground of its prevalence among young population, and hence it would lead me into probing any history of rheumatic fever during childhood. From here, I learned that conversation with the patient and simultaneously making provisional diagnosis in my mind is a multi-task ability I should practice a lot. This is a big step from history taking in 1st year when there weren’t many diseases that we learned which limited our differential diagnosis in first year, but it shouldn’t be in second year right now. With our maturation during this year, it’s time for us to make differential diagnosis during history taking, and not after.

In the physical examination part of this mock OSCE, I should learn to overcome my distraction next time as it would influence my performance. From here, I realize that steadiness is very crucial when we are going to approach a patient physically. Steadiness would mean making sure oneself is not influenced by distraction, no matter what. With a clear thought, we will be able to complete all things that we need to do when we were examining particular system of a patient. Lacking any step would sometimes result in missing a sign that might suggest a particular disease. Furthermore, steadiness also enables us to appreciate some clinical signs even more, e.g. heart murmurs, apex beat etc., which is very fundamental to make every our action merely action, but an investigation.

Lastly, I should keeps reminding my weakness always, but not allowing them to influence me when attending a patient. I should also keep my mentor’s advice in mind, which the only way to perfectionism is through practices, and lots of practices.

Thursday, October 2, 2008

My Way

Shit!

What a good word to start this blog. Shit because I spend two days in revising anemia, which was only one hour lecture + two hour MES (meet expert session). Shit! (again)

Why was I spending so many time? After comparing what I read from books with lectuer notes ... it's like comparing a kindergarden maths exercise and a pre-U one. What the fuck! Isn't that medical school suppose to train doctors who are going to save some lives in future? And this is the fucking lecture notes and are going to teach these bunch of people to handle lives of people in future. Well done, Dr Azma from UKM! (Okay, I confessed that I missed the lecture because I was sick that day, though part of me intentionally...)

It is making me wonder: whether all I'm doing right now worth? I have been puting so much effort persuing a different path from others. While others are making lecture notes thier bible, I'm struggling to understand text from a 1.5 kg pathology which is only secondary source for others. Other people's lecture notes are beautifully highlighted and jotting foot notes in every corners, mine are as clean as unsed toilet wipe (this metaphore is just intend to make more sense how I feel lecture notes are nothing more useful than a toilet wipe). The keyword of survial in UKM Medic: DIGEST YOUR LECTURE NOTES and you'll pass the exam. This is a proven fact seeing how my friend was making diagnosis of the last question based on excluding other already-choosen disease in lecture notes. (What a good way to save lives!). But, I don't want to survive, I want to LIVE! (quoted from WALL-E). That's why I have been choosing different path from others... the question now is: is this all worth?

Doubts and uncertainties are always exist in no matter which path I would have choosen. Time is allocated equally for every contestors in this Medic game. If I'm going to walk on this path I chose, I need to work harder to reach to the same progression as others. This is like a gamble because the final is just in less than one month. After all the humiliation of first year, I'm not going to humiliate myself more. Back to the same question: is it worth what I'm doing right now? Neglecting lecture notes and reading mostly textbooks? ... ... (moment of silence) Out of sudden, I think about a shoutout which I wrote on my MSN two years ago (I don't know why my memory still so clear about this)... ...exactly the night when I decided to reject matriculation offer (but in the end, I still went there and experienced a hell of life)... the shoutout was (not is) the reason why I wanted (not want) to stay in Form 6:

A person who follow the crowd will never be the person.

I tell myself again tonight, "A person who follow the crowd will never be the person". That was the Zhi Hao I was in secondary school. I lost myself during matriculation, and I need to find myself back. This path of becoming a doctor is about finding myself again and continue the principle of my life before I gave up two years ago and let myself deteriorate in matriculation. Becoming THE person. There's no replay or restart in this non-return life. I had two options: follow the crowd or be THE person. (Note that I use "had") I already made my choice, I want to be THE person. For once and the last time of my life, I want to be THE doctor, and not a doctor like others. This is the difference of me from others, and my path as well.

Life keeps screwing with me. Being born in a broken family, entering matriculation, poverty ... My shrink told me that all my background have been working synergically to contribute to my depression today. Growing under the best medium of cultivating depression, how can't I not develop depression. I've been having depressional breakdown since I graduated from matriculation (thanks to my triggering factor ex-girlfriend). I'm not going to let life screwing with me. Fuck the life! Screw the fate! I'll be THE person.

It doesn't matter whether I can achieve it or not. Because the worst scenario is: I die with the dream just steps away from me. I rather die this way than never begin step my foor on path to be special. Even if the worst case, I wouldn't just merely die, I die HARDER.

I think I can answer my doubt of the worthness of my current effort right now. It is not the matter whether it's worth or the other way. This is the matter that I have nothing to loose. If I follow the crowd and read the lecture notes, I lost many important things, top of the list: the ability of making differential diagnosis as a doctor, and the opportunity to be special as an ordinary human beings. Conversely, I lost nothing if I work harder (and die harder) and read the textbooks. The conclusion is: I have nothing to loose, so, continue what I have started these two days -- screw the lecture notes and read the textbooks.

Before I continue to work on digesting "bleedind diatheses", here are some quotes that I want to tell myself tonight and share:

做医生,就要当第一的医生;因为没有病人会想把生命交给第二第三的医生。
-- 蓝泽耕作《Code Blue》(日剧)

被嘲笑的梦想才有被实践的价值;即使跌到了,姿势也会很豪迈。
-- 九把刀 (台湾作家)

A person who follow the crowd will never be the person
-- Reno

Hence, the name of my blog -- My Doc Path.

Sunday, September 21, 2008

One step at a time

One step at a time.
I tell myself. There's no room for me to allow myself to be influenced by depression, nor my judgement clouded by negative emotion. I must study hard and be the one. In order to achieve that, I realise that I need to stay tough ... keeping myself from falling apart, no matter what the challenges are.

Indeed, I'm trying to clear myself from the effects of escitalopram -- altered personality. It is all because I just resume a therapy after a hiatus of 10 days. Everything need to restart, even the effects of the drugs ... and I'm now suffering severer altered personality since commenced my drug in the afternoon today. I need to stay clear and calm ... even this altered personality is making me weak and vulnerable ... but, this is part of the treatment itself. I keep telling myself it's the escitalopram is making trick with serotonin in my brain...it's not me. Once the serotonin fluctuation trick is over, I'll be fine - even better than the begining of my treatment. So, stay clear and clam ... and plan carefully, Reno.

Now, first part of my plan, identify what side effects I'm suffering from escitalopram
1. Nausea and lost of apetite
2. Dizziness and lightheadness
3. Rebound depression
4. Lost of libido
5. Daytime somnolence
6. Lost of interest in everything

Those are the drugs, not me. I'm now clearer of that. I sufferred that before when the first time I start on escitalopram. They all will be over in days. In the coming days, I should not let those negative side effects predominant in my live ... I'm the owner of my life, not you, escitalopram.

With this, I proceed to the next step in planing: what do I need to do?
1. Resume pathology on glomerular diseases of kidney and so on
2. Leave the footnotes from lecture notes to be reviewed during revision
3. Stay clear and sharp to attend Medicine and Society mini test tomorrow
4. Start revision of module 1 from tomorrow night

I satisfy with my list of thing-to-do of tomorrow. I feel better. No worry, but stay focus that I must make sure myself ahead of others ... and I should keep reminding myself that I study for sake of understanding, not speed. So, with this moment of depression attack, I couldn't pull myself together to read more, so, I choose to rest, watch a movie or whatever ... even if I study right now, it would be a disrespect to the art of medicine ... I'm not in the fit form of reading ... take a break, Reno.

Now, what was making me angry just now?
The stupid self-learning notes of tubular functions, produced by asshole physio lecturer

Do I need to angry?
No

What my pass experience that can help me to cope with this problem?
My analytical and collaboration ability. So, I was angry because I was influenced by the transient moment of frustration over some asshole's work...which I shouln't be. I could make a picture of acute kidney failure and chronic kidney disease from 3 books and digest them as one ... so, I can make the fucking tubulat function lecture notes to be corporated into my current understanding of tubular function. The only additional things in the notes are:
1. mention of principal cell and intercalated cells of collecting tubules
2. ...
that's it. I was frustrated because I never meet those terms before. The other part about proportion of reabsorption and regulation ... It is exactly what I undersatnd from Sherwood. So, don't worry, I'll sort out functions of I and P cells of collecting tubules when making revision. Somemore, the function is differently described in different book, could be just a trivia. The pathophysiology and regulation of kidney function is much more important.

Now, I'm clear of what was happening. It's just the drug effects. I still have my ability to analyse the situation ... and I should live with my ability. But, right now, I can't fight the central effects of escitalopram ... retreating but not give up. I need a rest.

One step at a time, Reno.

Monday, September 8, 2008

Suffering

Damned! It has been two days since I finished my last pill of escitalopram...suffering from serotonin functional deficiency now...altered personalities, clouded judgement, insonmia...you named it...but, I don't know how to describe this feeling. High? Maybe...high because I'm testing myself with abrupt withdrawal of escitalopram which my shrink warned me about all the potential adverse drug effects...God knows what's gonna happen to me next.

By the way, I also got another high from reading lung carcinoma while a smouldering cigarrete in my hand...cool! I was like looking into what's gonna happen in my lung...even to the level of cellular or molecular (genetic lesions) level! It's a gift to know how I'm going to die in future...don't ya think so?

Friday, September 5, 2008

受伤的天蝎

出生于1988年寒冷的11月17日,
我天生就是注定是只天蝎;
一只被命运注定逆命而行的天蝎。
但,在这一刻,我只是一只受伤的天蝎...

从我懂事开始,妈就教导我什么是自律,什么是自我要求。
自律,就是要对自己严厉;自我要求,就是除了最厉害那个,什么都不要。
慢慢的,在处罚的瘀青伤痕下,我学会对自己鞭策。
因为我深刻的明白为什么我的名字里的“浩”字 -- 我的宿命。

一路走来,看着别人都是来自幸福的家庭,我也开始了解什么叫做失败。
一个没有计划的人生就是失败。
我生命中最好的例子就是我的父亲。
父亲二字不过是课本告诉我:妈妈的丈夫就是我的爸爸。
所以,这些年来,除了因为这个信念我称他为爸爸,
其他的,他的存在不过告诉了我什么事世界上最失败的失败。
所以从那个叫“父亲”的人的身上,我知道我决不可以容许自己失败。

失败的定义是:只要不胜利就是失败。
所以,我只允许胜利、只能够赢--我别无选择,
因为除此之外的选择都是失败。

抱着这些信念,我走到今天。
走到我又再次受伤的今天。
看着身上伤痕累累的疤,我知道今天我又多了一道疤。

我不明白为什么我的身上会一次又一次因为感情,而一道一道地刻着疤。
天蝎不会像蝴蝶一样从毛虫进化蜕变。
天蝎没有蝴蝶与生俱来那缤纷灿烂的翅膀,只有身上一道道的伤痕,刻画着自我提醒的记号。
天蝎敢爱敢恨,爱恨分明...
为什么我一直都那么的小心翼翼提醒自己是只天蝎,我还是会因为爱收了伤呢?

尽管朋友们告诉我,我不过是被那女生利用,为什么我还是跌进那个陷阱?
我被人甩了,因为我没钱买寿司请她,因为我没车开来接她去走街。
我只不过是当她的功课有问题时,我才会收到她的讯息的人。
我身上唯一有价值的就是我的头脑 --
那个懂医人,却不能自医的头脑。
朋友总是那么的告诉我。

我爱上了一个不该爱的女人...难道我的一生就注定一次又一次被伤害,
然后一道又一道地在身上画着伤疤,直到我伤痕累累,再也认不出原来的我....
一直到我变成受伤得不能再爱上人的天蝎...
这就是天蝎的“蜕变”吗?
难道受伤是“蜕变”的条件吗?

如果这是蜕变,
如果受伤是蜕变的条件,
我愿意受伤,我愿意爱上那个不该爱的女人后受伤。
累积了那么多年的伤害,我还在等待我这只天蝎蜕变的那天。
等待对的风为我吹走身上残破的战甲,
等待更黑的黑夜让我把敌人杀得片甲不留...
等待...等待...

我就是穷,但我决不会穷到像那个叫“父亲”的人一样失败。
我就是逆流行舟、我就是逆命而行。
就像我妈,就算嫁给一个没用的家伙也能养出姐姐和我一样成功。
我只有一个妈妈,没有爸爸!
那个告诉我逆命而行的妈妈!

我发誓有一天我会向命运十倍要回生命亏欠我的所有!
我现在穷,我现在没有能力去追求我要的东西;
但,我会用我的能力一步一步往上爬...
天蝎无论受伤与否,悲伤还是开心,总会把毒蟄面对眼前的敌人,双钳随时准备把面前的障碍瓦解...这就是天蝎!
天蝎不会像猫一样喋着伤口,而像狮子一样带着自傲的伤疤走着...这才是天蝎!

我是只受伤的天蝎,因为我是只蜕变中的天蝎!
Stop licking your wound, and walk proudly with your scars!

2008年9月5日 21:22
又被人甩了,这一次是因为自己穷...
黄之浩!穷也要穷得有骨气!

Monday, September 1, 2008

Life is like a box full of chocolates

After the Dark Knight, I hardly find any movie that I really enjoy in cinema...standing in front of GSC counter, staring on the screene with various "now showing" movies... It doesn't stimulate my appetite anyway....so, I choose to watch movies "retrospectively"...which means I'm watching old movies from....well, nowaday, you can download anything from the internet. Pirated...but not my fault because I'm born in this decade where I can hardly find a movie that suit my appetite. And, don't be shock when I tell you that I'm downloading movies like "Titanic", "Speed", "Gladiator", "Band of Brothers (an old series)"...and (here come my most unbelievable part) "Casablanca".

And in this little post, I'm going to write about one of Tom Hanks' movies -- "Forrest Gump". (And yes, I just watched it couple hours ago)

Well, I watched that on TV3 once...when I was too littele to appreciate it and ended fall sleep on couch when the show ended. As I'm gettin more mature now (at least I think), I think it worth to win the Oscar indeed. It is one of the greatest movies of all time...and it's about too many things that every moment scene in the movie has its own meaning...which I feel strongly part of that, but confusing of the other because I'm not familiar with US history.

Hm...the part of the movie that pushed me deep into though is last part of Forrest's narration about he's running. He ran for no reason. It started with one day when he felt like he wana run, he ran; when he felt tired of running after 3 years 2 months 14 days, he went home to Alabama. Simple. He lead a simple life...and, though his love one has a complicated life, love simply. He ran for sake of running, and he loved for sake of loving; and the most important part, he did for no particular reason (He even went to war for sake of....maybe because war?)

How life can be so simple...and yet contended if we just do things for sake of doing it? I wish I can...and I'll learn. If we can do things that we are destinied to do...we don't need reason. Why don't live for just sake of living? And life will be hell lots easier.

Life is like a box full of chocolates, you never know what you'll get.

Pursuit of happiness

I have been thinking of writting this down for couple of days since I watched "Pursuit of Happiness", which is basically the last great movie that Will Smith ever participated before he became so self-horoism in "I'm Legend" and "Hancock". Well, why I watch this kind of sentimental movie out of nowhere? If it wasn't for the Personal and Professional Development (PPD) module, I wouldn't watch it. The watching was actually part of our assignment for sake of discussion in the following days. What I'm going to write here is my answer to my facillitator during the small group discussion (SGD): what is the scene that affected you the most in the movie? People in class talked about each of their favourite scenes in turn, touching scenes, funny scenes, phylosophical scenes etc.

When it was my turn, my reply was: My favourite scene in the movie is when Gardner's life hit a new ground and he started to question whether happiness is something only meant to be pursued, but never be reached?

Actually, the title of the movie originated from a quote from USA Declaration of Independence -- the right of every citizen to the pursuit of happiness...(and blah blah blah) Pursuit of happiness. What a good choice of word -- pursuit. Is it mean that happiness is something that we can only run, and pursuit for the whole of our life, but never meant to be reached?

I don't know. Happiness is just a feeling. A chemical reaction of various hormones and neurotransmitters in your limbic portion of your hypothalamus...that your brain perceive as "Happy". And hence, from the collaral branch to the motor cortex to make the expression "smiling"...and if the electrical activity too strong, it can even stimulate your lacrimanl gland to produce what so callled "tears of happiness". How wonderful it is?

But, you can't always be happy. There are moment where happiness is gone, and it left you in dark, creepy feeling called "sadness". Where the hell is the happiness wthat we though we've grabbed it when we are smiling? Happiness is in your hand in this moment, but it'll slip away...anytime. For this I have postulated two theories:

First, is happiness is where there's no sadness?
or, second, is sadness is where there's no happines?

Again, I don't know. But, anyway, I feel the former would be more likely be the reality of this world. This is just like the concept of light and darkness. Darkness is simply where there's no light; you can't hold on to light...just like you can't have happiness in your hands always. So, we back to the root, are we just going to persue for happiness for the rest of our lives? I think... and I strongly feel that: YES

So, conclusion is: we are going to pursue for happiness, which is something never meant to be reached. We are running everyday...we make friends, we find our love one, we watch comedy...because we're so hell desperately for happiness. We need happiness; happiness is created as a necessarity, just like food, water, and air. We can't be sure that we ever obtain happiness forever, just like we can't stop needing for food, water, and air...

We are pursuing happiness...never reach, but we still pursuing...for our whole life.