What really happen?

 He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all

 A Pre-Clinical Year day with only Clinical Teaching sessions.

Today, I had 2 clinical teaching sessions. A day likened that of clinical year.

Lesson/Inspiration obtained from today's teaching is Don't bother about what your mind thinking, what your patient's mind thinking, what's your colleagues' mind thinking, but contemplate on what really happen!

Human mind is flawed with lots of cognitive error. We think we're correct, but still we reach the wrong conclusion, because there's systematic error on our thinking!

Patient, as a person in this society, has different background, personal or cultural.

Different personal encounter will conceived different kind of pathology! Even the same pathology will present differently in different patient.

Our job, as a medical personal, likened a detective to find out what really happened. This is not a blind or empty minded detective, we must have sufficient basic and clinical medicine knowledge! Of course, we can't denied the uncertainties and probabilities inside medicine-pathologist knows best, sometimes, postmortem diagnosis can be bizzarely different from the treated alleged provisional diagnosis.

What basic and clinical knowledge that we need to have?

Basic medical knowledge, such as anatomy, physiology, biochemistry, pharmacology, pathology, microbiology and immunology

Clinical medicine knowledge, an extension from basic medical knowledge,for me mainly consist of a clear, rational mind that can see what really happen, deduce various possible,relevant causes of disease with critical thinking, ample of bed side manners and well-practiced physical examination skills.

There's a lot of new disciplines emerges each day, for me that's the outward florishes of basic medical knowledge. Therefore our main job in medical school is to grab a firm stand on basic medical knowledge, acquire a clear, rational, critical thinking mind and last but the most important one, be courteous to patient with satisfactory attitude,ample of empathy, tactical communication, integrity and altruism.

For me this last one aspect, differentiate a doctor from a non-doctor. Any smart guys can perform the previous 2 tasks well, if they devoted some of their time on that. However, only doctor (I mean persons who are really passionate and meant to be a good doctor) can bear the pain and joy of taking up the latter skills.It will be rewarding.

Personality goodness is normally distributed, so do among doctors, who aren't flawless human, but remember to give patient, their family, our colleagues, our co-worker, our teachers and our family their due. Personality is what we are born with and can be molded.

The theme back to What Really Happens?

At times, I felt the hard time to come out with a clerking question or a case report - Because I simply don't know much about what really happen. I have only text book knowledge, or even worse, I don't have them. The tips here is to see, look! this is what happen to our dear patient, think and integrate our textbook knowledge, our common sense, our non-academic knowledge of patient background and critical thinking together. Then we'll know what really happen. Then we can come out with a rational report and plan of management.

Next time, note to self, ask What Really Happens?

Journey to be a doctor is hard. Much efforts are paid off, passion and interest are the fuel that keep us moving on. Medical education on university undergraduate level is meant for us to acquire the learning skills so that we can continue our learning even without an institution- well that's useful for a medicine practitioner.

What we get from medical school is really meant for Treat Disease, Prevent (unnecessary)Death!

However, much we can empower and top-up for our own learning sphere, so that we're well rounded, so that we're really practicing medicine that approaches sick people-We will not become Dr. who expertised in treating the leg/heart/liver/guts....so on...

Look, what really happens! It is a sick person drawn from his/her normal daily living in the society and go to your institution to seek help.

Another case of diabetic foot? Think twice before you said that next time. That poor guy/girl have their own story to tell, swallow them, but don't believe them anyway. Don't believe what your mind's thinking anyway, don't believe what's your colleagues' thinking anyway. Look, and feel and project, what really happens?

Deadly silent

This the the night view (8:00p.m.) of Library (Perpustakaan Hamdan Tahir) at Health Campus, Universiti Sains Malaysia, Kelantan.

Maybe in line with moral principle of living in Kelantan, night life is absent everywhere, even in a university campus, which serve as a knowledge hub, where campus dynamics and academic dynamics serve as an indicator of students' dynamics.

No group discussion inside library, only few students doing occasional self study inside library, needless to mention about academic dynamics among students.

All the halls are empty, except during March, April and November where Chinese Students, Muslim students, and Indian students are organizing own cultural and religion activities.

No activity on stimulating the young mind on solving social or community problems. A lots of man-powering work, i.e volunteering, which is good. However, hidden problem arises when the role of leadership is not well performed or carried out. Man power simply do not match the work done.

Perhaps, in the evening, we have the most happening event, that's sport. Sport especially football is very famous here. Even non-campus students are allow to come in our campus to use the football field. Sometimes, sport carnival being organized at inappropriate time, i.e nearing exam, somehow, affects students' life. Anyway, badan sihat, otak cerdas!

Sports might be the second most happening activities other than cultural events. We've school of sport science here. They are successful perhaps!

Where's campus dynamics? Students are all dwelling in hostels, Self-studying,Facebooking, Movie-ing, Game-ing,

How to draw them out?

Here comes the deadly silent.

Male Toilet

Male Toilet!

I feel particularly uncomfortable using this kind of toilet shown in the photo.

It is so "unprotected", even if there's a barrier for such standing toilet.

I prefer toilet inside closed space. LoL. Personal preferance though.

Additional to the closed space toilet privacy aspect, I can always tell how sound is the civic awareness of that society.

Often, I can see funny genitals drawings and telephone number for massage and gay sex at the door!

I wonder if the person is real gay guy or a horny heterosexual man who long for sex with partner of same sex.

The society is getting filthier~ All they want and can offer is FUN!

Often, I can see pieces of feces floating at the toilet bowl (high fiber diet huh!) and urine splashed all over the place. I wonder what happen when he do the job. Perhaps a T-rex attack his toilet ?

Next time, enjoy your toilet session, there's tell-tale signs inside.

Thing is more frustrating when  you actually paid to get into the toilet (Like what I had yesternight at Bus Terminal)

Where's the money goes and what is it used for ?

Anyway, this is up to the user to keep it clean!

Haiz...Guy...

Rabbit Rabbit Rabbit!!!

The photo depicts the White Rabbit Candy, milk flavor.

Gift from PBL mate, a happy Chinese New Year gift  for sure.

This candy bring up a lots of memory of mine.

Back then, when I was primary school, I can have that during Chinese New Year at my maternal grandmother house with siblings and cousins.

Now, it is quite hard to find this small candy.

I know it is available at Nirwana, Kubang Kerian.

I bought them at Nirwana before, however, it tasted differently.

Maybe the secret recipe underlies it's deliciousness is White Rabbit + Family Reunion.

I'm thankful to have this during CNY 2015, despite having short holiday,

Didn't have much chance to taste various CNY snacks this year!

The holiday will be shorter I tell everyone.

What to do?  Accept and go on.

Cherish every moment we have!

CNY day 4-everything back to normal (almost)

The photo depicts Health Campus of Universiti Sains Malaysia at Kubang Kerian, Kelantan.

It's day 4 of Chinese New Year.

We had class on Physiology of Menopause, Pathology of Ovary and Pathology of Uterus.

I reached Kelantan early in the morning, 5:00a.m. Class started on 9 a.m. I took my bus on 10p.m. yesternight. 

Though sleep deprivation, still I'm glad that I can fall asleep in the bus soundly for the first time.

Thanks to the thick sweater I bought during CNY. Transnational bus has the best air-conditional. Perhaps they can plan into delivering goods that require cold storage.

The reason I chose USM, Kelantan as my tertiary education is it is located at east coast of peninsular Malaysia, and I like the beach.

I knew how beautiful it is because I had my matriculation study at Pahang.

However, what I never know is that the monsoon season at east coast really affects my health to some extent.

I am afraid of cold weather, cold air-conditioner. Hypothyroid-oid huh!?

After CNY hopefully the sun will shine again, which I think the days are near!

They starts to established automated watering system at football field beside Nurani, to prevent the green to dry up.

The football field is another good indicator of current weather apart from my coughing due to cold weather and weather forecast apps.

Professional Exam is near, I felt so unprepared, likened unarmed soldier fighting a big group of villains? 

Anyway, move on and just do it.

Chinese New Year Song

I'm having 1 week holiday for CNY as Year 3 medical student.

The first CNY song i heard when i was back in hometown was: 《新年歌儿大家唱》 trans

I heard this old recording when I was having breakfast with parents at old town kopitiam (not franchise OldTown Kopitiam!) at my hometown. Old radio with old song in an old shop, everything is authentic.

I prefer old CNY songs, back then life's so simple, people and friends are closed. Of course society back then has less room for individuality. Life is more community oriented.

Enjoy the song!

Gong Xi Fa Chai as Med Stud ?

This is Day 2 of Chinese New Year(CNY)- Wooden Goat they said.

According to traditional custom, day 1 of CNY, Chinese will pay visit to elders, relatives and friends.

I would like to share some of my special greetings from friends and colleagues at day 1 of CNY

Happy Chibese New year Boon Seng, jusr want to ask u regarding the topics tht u spotted for me last time. U expected bilaminar and trilaminar will be coming out in osce, do u mind to giv me the dxample of question of bilaminar&trilaminar osce question. Cuz i m not sure what kind of style they gonna come out in osce with this topic.  Besides, u expect respi anatomy to come out in seq, does it include all the innervation and blood supplies?

Anonymous 1

Hi boon seng, happy CNY! wanna disturb u agn... >< about this ques: Discuss the karyotype of down syndrome, if 5 marks are allocated for this ques. what should be the answer? I only manage to think a few pts 1. results from non-disjunction (failure of chromosomes to separate during meiosis) 2. karyotype: 46, XY, 21+ (presence of 3 chromosomes 21) 3. (listing down features)

Anonymous 2

hi boon. hpy cny to u and your family. i came across smtg related to hypocalcemia and it seems to be confusing. thought maybe u can help me to solve my confusion. i read that hypocalcemia causes muscle tetany and muscular spasm. and the reason given was that hypocalcemia causes increased muscular excitability (increased Na+ permeability of cell membrane) caused by a deficit in Ca+ which will keep Na+ gates closed. This increases depolarization. Depolarization therefore becomes much more excitable. Bcause as we knw in action potential, there are voltage gated calcium channels which are slightly permeable to sodium ions, and they are present numerous in cardiac and smooth muscle. this makes sense. but what i am confused is that, at the very first place, calcium is needed to move from ECF to presynaptic membrane to cause opening of the vesicles containing Ach to be relased from presynaptic membrane into the synaptic cleft. then only the subsequent steps can be taken to ensure a proper nerve impulse transmission. so if calcium itself is low in blood, it cant even help to release the Ach, (i suppose), so hw this leads to hyperexcitability. isnt it supposed to cause weakness ?? tx for ur help boon.

 Anonymous 3

Guess what, I did according to custom in Traditional Chinese way, if people gave you gift, you must do the same. I replied their inquiries even at CNY day 1.

No life you would say.

Part of me argued, by doing so you are positively re-inforced them that you're time is less important than theirs.

Part of me argued that they must be have trust in me by seeking help from me, I must offer help that within my ability.

Part of me argued, these questions can be directed to others. I'm not the only one with answer.

It's truly a mixed feeling to received a text message that start with Happy Chinese New Year and I wish to...

I would prefer if they hit the nail on the head. At least, I don't feel the sorry.

The hidden meaning were: I'm really sorry but i have to disturb your CNY holiday anyhow, would you...

hahaha... anyway, this is my own explanation that make myself looks pathetic.

Later bunch of guys out there will criticize me as attention seeker and act pity as victim.

Let it be, Let it go.

如果你是卖菜的菜市，就别责怪别人一直跟你买菜。

If you want a duck to be a chicken, a chicken to be a duck, you suffer.
Ajahn Chah

Life's unsatisfying, thus human created festives and special events to have fun.

The happiness and the glorious moment come and go.

You'll wake up the next day discovering that life's still going on as normal.

The cycle repeats.

Stop sounds so gloomy

Let's have some CNY song!