Friday, August 31, 2012

It's the knowledge

It's been a while. I know.
Assalamualaikum w.b.t and hi people!

Today is the final day for my final Internal Medicine posting but I decided to take a half-day off before entering Paediatrics tomorrow. It's going to be even more hectic in Paediatrics,I heard. Plus,I had to prepare for my ECG seminar next Monday.

Final end-posting exam(OSCE as some people called it) for Internal Medicine went well,I guess. I attempted to each question my examiners asked in a way that they didn't asked me to elaborate more and more.Not that I know so much okay, it's just a confidence voice, pauses and interjections here and there with a little bit of body gestures.I owe this so much to my debating days in high school...LOLS! 

Some scenes worth replay.

When they asked me, "patient is already hemiplegic, so we did craniotomy, removed the clot but he's not improving also, can you justify the need for craniotomy here?" Ouch,I straight away turned to my patient,hiding my "ouch" facial expression from the examiner, I only know 2 phrases for that. 1)Cushing reflex 2)cerebral oedema . Last semester Sir had taught us during clinics but I couldn't find it in the textbook so basically what I knew are patchy, yet I had to patch them up.A quick silent prayer I had-God,don't let him ask me further about that Cushing thingy. Took a breath and went "Sir,we have to,..if we don't remove the clot, cerebral oedema can develop (he nodded) The Cushing's reflex...there will be further compression on the other sites of  the brain" A fast and a bit of interjection (affirmative tone)in saying Cushing reflex, open hands with pointing index fingers ,quick rise of eyebrows with blinking eyes (which indirectly means well,we all know this!) And he nodded for 2nd time. Saved!Alhamdulillah

At one point of time, he wanted me to list down all the causes for stroke in young. So I went on and on till I think there's no other causes possible but he didn't seem to be satisfied and so he hinted at me,"there's a pipe in the brain,and it has broken".HAHAHAHA!That means "rupture of Berry's aneurysm" people! Only when I said that they moved on to next questions. Phewwwww~

Finishing case discussion, he just asked me to elicit a knee jerk on my hemiplegic patient. I suppose that should be good, because the more you messed up with your theory, the more practical stuffs you will be asked to show. That's how it works here,according to my unit staff. But that good feelings didn't last long. I answered his last question wrongly and it gave him that victory moment to leave my bed with that I-have-an-intact-memory-kind-of-smile. And I found out later that one of the examiner is a neurologist!Ummmpppphh! 

* where is the location of stretch tendon in the knee reflex arc? It's in the Quadriceps muscle!
Gosh!How come I miss that? I know the effector is quadriceps, even had mapped the reflex arc,the internuncial neurone etc in my mind. But why did I say the receptors is in the patellar tendon itself? Booooo!

As for my short case,I still have to work on it more. I had to do General Physical Examination , cardiovascular examination and came out with the diagnosis in 15minutes. No history, no conversation with the patient was allowed. Well, even if it's allowed also,I didn't not get any advantages since my patient had deaf mutism (basically you call this people deaf&dumb) And I was instructing him to open his shirt,to lie down,to look up,to open his mouth and etc etc using sign languages,can you imagine?TOINK! 

Thank God he's very cooperative,and hyperactive too. When I was checking (and obviously touching) him,he would come near my face acted like wanting to give me a kiss and later jiggled at my jolt. At one time,he was so busy flipping through my Ishihara booklet so I let him be while I continued doing some examinations and in the next few minutes,my Ishihara had been rolled into a cigarette-like thingy. He smiled happily when showing it to me -___-"  And lastly a funny moment when at the very last minute I realized that I had not measured his height and weight.So I rushed for the apparatus and brought it to the bedside,he said "aaaaaaaaaaaaa" (with a facial expression that I interpreted as "you have forgotten the first thing that all other doctors had asked me to do"),excitingly jumped from the bed,straight onto the weighing machine. HAHAHAHA!

This guy has been in Wenlock for years.Always see him wandering near Psychiatric ward but the ignorant me had never bothered about him all this while. When I saw him on the exam day I was so surprise. And only that day I know that he's actually suffering from a syndrome called Noonan. Poor guy! 

All in all,I'm still happy with my performance giving that I haven't examined both patients beforehand.No single clues about what they are having. I mean, if I'm a little bit "smart & dilligent" I can actually go to Wenlock hospital everyday to check-out on cases that have high possibility to be kept during the exam. I went there once and concentrated on patient with heart diseases since we were lacking of that in Attavar.  That's all, and I think I've benefited much from my Attavar posting. Anyway,if I do so, it surely helps me to do better in the exam.But to be a good doctor in the future? I HIGHLY DOUBT IT!I've done it once for my last semester posting on Paediatrics and IT JUST FEELS SO WRONG! 

My husband is actually worried seeing me reading from quite a "thick&tough" books for exams.So I tell him (and I keep telling this to myself) "the score is not what I'm after, it's the knowledge".

Not that I don't care about attaining good marks in exams, indeed I'm so scared thinking about this coming final exam in December.What if I fail? What if I'm the only one who fails among my Malaysian friends? Will people blamed my marriage if I fail?I had so much questions going in my head and I only have one ultimate  belief to dissolve all the thoughts - I'll do my best, and let Him decides the rest.His decision is nothing short from the best.

"Surely there is ease after hardship. Aye!surely there is ease after hardship. So when thou art free,strive hard. And to thy Lord do thou attend whole-heartedly" - Al-Insyirah (Solace) 94:6-9

I don't think I have to babble about the importance of seeking knowledge in Islam. It's the first revelation to our Prophet =)

I've got to go. See you!

Shu & I were the only Malaysian in this Medicine unit.AAAA..we just can't be separated!

Seek Allah's pleasure in anything you do,peeps!

LillahiTaa'la =)

Friday, August 17, 2012