Kembara di bumi Malaysia

The Last Rotation

2012-01-11T12:07:00.002+11:00

I am now in my last rotation as a houseman. ETD (Emergency and Trauma Department) and once it was called as A&E (Accident and Emergency).

This posting is one of the best posting as it combines all of your previous learning experience in the the other postings and sharpen your skill to diagnose and manage life threatening conditions. Apart from that, this department has one of the best shift system and even the tagging period, the period whereby the new houseman enter a department, is also enjoyable.

Personally, I might be thinking to join this department as a medical officer in the future too.

La Tahzan

2011-11-28T11:58:00.001+11:00

Dari Abu Abbas, Abdullah bin Abbas r.a :

" Bahawa pada suatu hari saya sedang berada di belakang Rasulullah SAW ( di atas binatang tunggangannya), lalu sabda baginda : ' Wahai anak kecil, sesungguhnya aku telah mengajar kamu beberapa perkataan. Peliharalah ( perintah ) Allah, nescaya Dia akan memelihara kamu, peliharalah ( kehormatan ) Allah, nescaya engkau akan merasakan Dia berada bersama-samamu. Jika engkau memohon, pohonlah kepada Allah semata-mata. Jika engkau meminta pertolongan mintalah kepada Allah semata-mata. Ketahuilah bahawa jika semua umat manusia berkumpul untuk memberikan kepadamu sesuatu menafaat, nescaya mereka tidak akan mampu memberi menafaat itu, melainkan dengan sesuatu yang telah ditaqdirkan oleh Allah. Begitu juga sekiranya mereka berkumpul untuk menentukan suatu mudharat untuk kamu, nescaya mereka tidak akan mampu menentukannya, melainkan dengan suatu yang telah ditentukan Allah ke atas kamu. Telah diangkat kalam ( tulisan ) dan telah kering ( tinta ) buku catitan. '

The Shift System

2011-11-21T13:54:00.001+11:00

With the recently introduced shift system for the houseman officers in Malaysia, I found that this system is better than the previous system.

There are more free time available for the junior doctors. The old system has produced an environment consists of overworked and sleep deprived doctors. The shift system helps to reduce those burden and help to improve the quality of the lifestyle for houseman officers. With more time to rest, I find that I am able to give more concentration to the work compared to the old system.

Regardless of this, there are still room of improvement in the new shift system. Overall, I hope that the entire healthcare system could be improved without any external pressure and ultimately, to give the best quality of health service to Malaysians in the future.

3 years old blog entry.

2011-05-19T13:17:00.005+10:00

This entry was written on Monday, 19th May 2008 using Blogger scheduled post.

I'm not sure whether this entry will be published on this date or not. This is my promise to Crayon Kakak that on this day, I would write something for her.

This is her old entry 3 years ago...
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.....3 tahun akan datang, kakak tidak harapkan anda, anda dan anda masih terus di sini. Tapi, untuk tarikh ini, 19 Mei 2008, kakak mahu langsaikan “hutang” entry yang kakak tak buat di blog AA sebelum ni. Kakak cuma ada satu permintaan. 3 tahun akan datang, pada tarikh 19 Mei 2011 [sila buat reminder, 19 Mei 2011], kakak harap kakak akan terima e-mail, mesej, komen or what-so-ever yang menyatakan bahawa “Saya Masih Ingat Kakak”. [Ini bukan paksaan. Biarlah datang dari hati yang ikhlas].
Dan ketika itu, tentunya kakak akan tersenyum dan terus tersenyum . Maaf kalau permintaan kakak terlalu tinggi. Kakak tak minta hadiah apa-apa, cukup-lah dengan yang ini.
crayon said … Kenapa 3 tahun? Kerana kakak sudah berblog lebih dari 3 tahun. Masa 3 tahun juga kakak rasa bukan satu masa yang lama, dan bukan juga satu masa yang singkat. Cukup untuk menentukan siapa kakak di mata anda ....

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So, who is this blogger? She has been blogging in various blog platforms. I started to know her as Aria Ayumi back when she was still blogging using blogspot. After a while, she moved on to Wordpress platform and start to use the nickname of Crayon Kakak. On 21st June 2008, Crayon Kakak was officially closed. Now, she is blogging as Diya in blogspot again.

Is this cheating? I hope it is not. The reason I wrote this entry 3 years in advance is that I'm not sure whether I'm going to live when that time comes. Death can come unexpectedly and I don't like to break my own promise to my friend.

If this entry is managed to be posted today and her blog is still available on the internet, this is my message to her.

I still remember you and your blog.

I started to know you when you were once called Aria Ayumi. Your blog was entertaining and interesting to me. It gave me a different perspective towards life and helps me to gain experience from your own personal writing.

I hope that on this day you are a bit more closer to reach your dream and not being burdened with sadness. I hope that the person that you are now, is a better person than 3 years ago.

Anything that you have learned so far....please remember those lessons. Anything that is positive, keep it and practice those lessons. Anything negative, use it as a guidance for your future.

Hafiz
19th May 2008.
Melbourne, Australia.

p/s: Interestingly, on 19th May 2008, Tun Dr Mahathir quits from Umno and later joined again on 4th April 2009.

a reminder from the past

2010-11-14T03:53:00.000+11:00

5 years ago, I wrote an email that will be send in 5 years time. It was an interesting experiment to see whether I could receive this email later in the future. There were several uncertainties such as

I might not be using the same email in the future.
I might already passed away
The company who kept those email has bankrupt or the database has been ruined by unprecedented event
If the email is ever received, it might not passed through the spam filter.

Nevertheless, I participated in this experiment and to my surprise, I received that email few days ago. This was the post I wrote 5 years ago.

This email had certainly brought many memories. It contains my hope and prediction for the future. It contains several important personal milestones that I wished to be achieved in 5 years time. Few of those milestones, I have managed to achieve it, but there were several which are still in progress or somehow has dropped off from my priority list.

Now, the big question for me would be to do some self-analysis whether I have become a better person in those 5 years time. Those day I was a student and now I am currently a husband and a government employee. I used to have lots of free time and now with the working environment I am in, the concept of free time need to be modified and adjusted according to the opportunity available to me.

An interesting email indeed. A good and unexpected twist after 5 years

The life of a houseman officer

2010-07-29T00:38:00.000+10:00

In a short word, it is extremely busy and stressful.

Once you graduated from a medical school, you need to work for at least 2 years as a houseman (junior doctor) before you can pursue further specialisation in medical field. That is the scenario in Malaysia.

Within these 2 years, you need to do 6 postings which are Medicine, Surgery, Orthopaedic, Obstetric and Gynaecology, Paediatrics, Accident and Emergency (A&E). This year, the Ministry of Health introduce the seventh posting which is Anaesthetic. You can choose either to do Anaesthetic or A&E as your final posting. If you choose Anaesthetic as your last posting, you will be automatically being absorbed into Anaesthetic department once you finished your housemanship years.

How is the routine lifestyle as a junior doctor? Depending on which posting you do, you can either start working as early as 4-5 am or come to the hospital around 7am. You typically finish your work by 10-11pm every day. Although there are few postings where you finish your job by 5pm and you can go home to rest in bed.

In term of oncall, basically you start your work as usual and continue working throughout the night and finish the on-call period by the end of next day. If your routine working day finished at 10pm, then your oncall finish at 10pm the next day. Sometimes where the oncall is not that busy, you may get few hours of sleep. Otherwise you won't be able to sleep at all for the next 36-48 hours. You will be extremely sleep deprived by the end of your oncall.

Despite that, the situation in Malaysia is improving. There are more doctors graduating from various medical schools in Malaysia to some extent, there has been rumours that doctors may be jobless within the next few years due to the sheer number of doctors in Malaysia.

Will continue writing about this some time later. I have to sleep early tonight as I will be oncall tomorrow.

an old dusty blog

2010-07-20T21:48:00.000+10:00

That's how I would describe my blog. It has been 7 months since I last updated this blog. So many things have happened and I'm not sure what I should write here as my first post in many months. In fact, this would be my first post in this year!

I have been working for about 3 months now. Working life has been busy and I have to learn how to cope with stress and all sort of challenges working in Malaysia. It is quite different from being a student in which you don't held any resposibility looking after patients.

Hmm, I think I would stop here and continue writing some other time :)

Wedding Invitation

2009-12-19T12:14:00.000+11:00

Assalamualaikum, I am inviting you, my blog readers to my wedding reception. May your presence bring blessing to the ceremony. Thank you.

The adventure

2009-12-18T11:00:00.000+11:00

Alhamdulillah, I have arrived at Malaysia on 7th December. Since then, I have been extremely busy managing all of my wedding preparations and greeting few of my relatives here.

My adventure at Melbourne has ended. I have changed the blog title and haven't decided what will be my next blog title.

Graduation day on 5th December was one of the happiest moment in my life. After 6 years of studying at medical school, finally my friends and I have managed to pass all the exams and celebrate the graduation day together. It was not an easy journey for all of us. Sometimes, when the challenge was too hard, few of us were thinking of quitting from medical school.

When I came to Melbourne 6 years ago, I don't have any idea what will I be in 6 years time. To get a place in a medical school is a challenge in its own right and to graduate as a doctor is another difficult hurdle too.Alhamdulillah, my journey is over.

The next chapter of my journey will be a test to measure my own capability to cope with continuous daily stress at workplace. Working as a young doctor and at the same time managing your own family will be an exciting adventure. Hopefully I will be able to be a good doctor and a good husband at the same time.

I will upload my wedding card in my next entry. Till then, I am inviting all my blog readers to come to my wedding reception on 26th December 2009 and 2nd January 2010.

Year One - The adventure begins

2009-11-25T19:57:00.005+11:00

On January 2004, 20 students from Mara College Banting arrived at Melbourne for their one-month orientation programme. The orientation programme was filled with random activities comprising of lectures, PBL tutorials and orientation to the university and visiting the city of Melbourne.

Accommodation

Out of 20 people, 7 of them are JPA scholars and the rest are MARA. 7 boys and 13 girls. Before coming to Melbourne, JPA let us to find our own accommodation but will not pay for any accommodation above the monthly allowance. At that time, the monthly allowance was only AUD 637 and the average rent for accommodation around the university could reach up to AUD 300 per week.

The JPA scholars were stranded and at one point, we had to ask permission from Malaysia Hall at Melbourne for temporary accommodation. Alhamdulillah, few days before arriving, one of our friends from Monash University managed to find an accommodation for JPA scholars (only for boys though). As a result of this, our female friends were left stranded randomly hopping from one house to another house for the next few months.

p/s: I have been living in the same house for the last 6 years. I guess I'm too lazy to get involved in the hassle of moving house.

Bicycle

I bought a bicycle in the middle of the first semester and has been using it to travel from home to university. I think the distance is roughly 4km. It was a good form of exercise for me. Whether it is summer or winter, raining or extremely hot weather, I persevere to use my bicycle as my main mode of transportation around the neighbourhood.

Right in the middle of the winter holiday, four of us, managed to cycle to Monash University, Clayton. It took us few hours to cycle from Melbourne to Monash University since we choose a route that was full of steep hills. It was a memorable experience for me and it was exciting to think that we have enough stamina to cycle for a trip that was roughly about 20km.

Grandmother
My grandmother passed away during my first semester exam. I was pretty close to her since she has been looking after me when I was little. I think the hardest bit when we are separated from someone is not having the chance to show how much we love that person. Occasionally, the memory comes back to haunt me since I've never got the chance to say goodbye to her. Al-Fatihah to her.

Blog

On 15th of August 2004, I started this blog. Alhamdulillah, I managed to persevere with blogging until today despite that I have been blogging less frequently in the last few years.

Fruit picking and packing
During my first summer holiday, my friends and I tried various jobs to earn a bit of cash. Initially we went all the way to Mildura looking for job. Mildura is right at the border of Victoria, roughly about 300km north from Melbourne. Having no luck looking for job overthere, we went to Cobram which is also along the state border. Alhamdullilah, after few days searching for job, we got a job in one of the big farms over there.

My first job was as a cherry picker, but I quit after few days. The salary was not that attractive compared to the workload. Next, we worked as strawberry pickers. This job is quite good but it won't be good for your back since you have to squat throughout the day to pick the strawberries. Again we quit from the job.

Next, we went home to Melbourne and try our luck looking for job at Yarra Valley, which is about 50km west from Melbourne. We managed to find a job as a cherry picker again and this time, we managed to persevere with the job until the end of cherry season (middle of January).

I've written a lot of posts about my working experience as a cherry and strawberry picker. Read these post below if you are interested to know more :)

Cobram 1
Cobram 2
Cobram 3
Cobram 4
Cobram 5
Cobram 6
From Cobram to...
Wandin East 1
Wandin East 2
Wandin East 3
Wandin East 4
Wandin East 5
Final Note

p/s: I'm not sure whether I still have the talent to write that kind of post anymore.

I think that is a pretty good summary of my first year :)

The Final Hurdle

2009-11-20T16:24:00.001+11:00

As part of my final year exam at University of Melbourne, I had OSCE and one long case in the last two weeks.

OSCE stands for Objective Structured Clinical Examination. It means that you spend roughly 9 minutes either taking history from an actor or performing a brief but concise physical examination in front of an examiner or interpreting radiological images such as chest x-ray and answering several questions.

Long case means that you are given one hour with a patient in the hospital. In that one hour, you need to know why the patient is in the hospital and to perform relevant physical examination and at the same time, think of appropriate management plan for that patient. You then present your history and examination findings to two examiners. The examiners will be either a general surgeon, physician or a general practitioner. The examiners will asks several questions relevant to the patient and test the depth of your knowledge based on your answer.

OSCE
I had two OSCE at two different location for two days. The first day OSCE was held at the medical faculty and the second OSCE was held at the hospital.

Medical Faculty

Patient presented to you with dizzy spell. It was benign paroxysmal positional vertigo. I was not sure what else to ask in this station and was asking weird and random questions towards the end of the station.
Interview patient who was referred from Emergency Department to Neurology Outpatient. The ED doctors felt that her epilepsy is not fully controlled. Again, I was not sure how should I approach this station. I have to read the question several times and in the end, running out of time to answer the questions from the examiner.
Pregnant women who is vomiting. Take history and discuss the differential diagnosis and the relevant investigation. Hyperemesis gravidarum is the keyword for this station. I totally forgot about the intravenous fluid therapy.
Interpret peak flow chart and teach good inhaler technique to asthmatic patient. Was running out of time in this station.
Radiology station. CT Brain: Haemorrhagic Stroke. Chest X-ray: Tension Pneumothorax. Interpret lab result: Nephrotic syndrome. I don't have enough time in this station.

Clinical School

Interview a patient who is feeling unwell. He had malaria. I think I did pretty alright in this station.
Interview a patient who had recurrent abdominal pain. It turned out the patient had acute pancreatitis. Need to know the differential diagnosis and the relevant investigation. Despite memorising all the causes of acute pancreatitis before the exam, I forgot all the causes due to anxiety attack.
Procedural skill station. Need to perform airway management and CPR.
Perform cardiovascular examination on a patient who had a murmur. I think the murmur was mitral regurgitation. Not really sure about the murmur since I was pretty nervous thinking the differential diagnosis for both diastolic and systolic murmurs.
Perform relevant examination for patient who had right hip pain. Need to do gait, Trendenlenburg test and hip joint examination. After that, need to interpret the hip X-Ray (Osteoarthritis) and discuss the appropriate management of osteoarthritis.

Long Case

I had the opportunity to interview a patient who came in to the hospital with acute asthma attack in the background of nephrotic syndrome (I already had nephrotic syndrome as part of my OSCE).

I don't think I did well in my presentation and the examiners does not ask me any particular question related to asthma management. Instead they opt to ask me questions related to nephrotic syndrome. It was quite difficult since I haven't learned in detail about nephrotic syndrome. When they asked the type of glomerulonephritis causing nephrotic syndrome, I stumbled a bit and just said maybe diabetic nephropathy and rapidly proggressive GN. When they asked me to explain the mechanisms of hypercoagulability state in nephrotic syndrome, I guess this must be my limit. I'm not sure which clotting factors or proteins that will explain the symptoms. I mentioned several clotting factors, protein C and S and antithrombin. I don't know the real mechanism to explain those symptom.

Anyway, up to this point, they haven't asked me anything about asthma. If they were to ask me about asthma, I guess I could do a bit better in my long case.

Hopefully all my friends and I could pass the final year exam and able to graduate together on 5th December 2009.

Year Zero - Before Melbourne Uni

2009-11-05T22:40:00.000+11:00

Back in 2003, when I graduated from Mara College Banting (MCB) with a diploma in International Baccalaureate(IB) , I have roughly about 7 months of holiday before going to Australia. The IB programme was initially designed for students who are going to universities in Ireland and United Kingdom (UK). Therefore the IB programme in MCB finished in the middle of the year and gave their students 2-3 months before starting their studies in UK or Ireland. Most if not all universities, at Ireland and UK start their intake on August/September.

At that time, there were only two Australian universities available to MCB graduates, namely University of Melbourne and University of Monash. I am among the first batch from MCB who are going to study at Melbourne Uni.

My friends who were going to study at University of Monash, Australia had their 3 months orientation programme starting from September that year. Their orientation programme is held at Melbourne, Australia. I guess at that time, I felt a bit disappointed to learn that my friends at Monash were having fun and getting allowance at the same time whereas I have an extra long holiday after finishing my study at MCB.

So, what did I do at that time? After few weeks discussing with our MCB principal, and confirming that I don't have any similar orientation programme similar to Monash Uni, thus began the era of me looking for various sorts of jobs.

I initially planned to work in a factory but the working condition and the low salary immediately turn me away from the job. Then, I thought of working as a cashier in a nearby petrol station but the position was not vacant at that time.

My mom suggested to me to work as a substitute teacher in her school. So, I took the opportunity and immediately got the job. I had to teach the entire Form Four in the school from the topmost class to the last class in the Form Four. It was an interesting yet challenging experience for me.

The last class in Form Four were filled by students who were not motivated to study or even came to the school. They had to come to school because their family forced them to come. They don't have any insight on the importance of having education for their own future. Compare this situation with the topmost class students who were quite motivated to study and willing to do lots of homework to improve their knowledge.

I had to be flexible in teaching these students and need to adjust the level of teaching according to their level of interest and knowledge. It was certainly an eye opener for me to learn the skills to teach students who are not motivated to study in the first place.

After two months of teaching, I retired from the job when the original teacher came back from her maternity leave. Thus, I was jobless again. I had to look for another job but what could I do then at that time? I had only SPM certificate and IB diploma, and hardly anyone knows what is IB programme anyway.

If I'm not mistaken, I retired as a teacher on middle of September and I had few months to go before I started my study at Melbourne Uni. Waiting for my flight to Melbourne was certainly a lesson in patience for me. Doing nothing during an extra long holiday is not something that suits me. I need to do something interesting. Otherwise I will be extremely bored killing all those free time.

After early retirement from teaching those students, I had to stay at home and look after my two younger sisters. My youngest sister was only 3 years old and her older sister was only 5 years old. Early in the morning, I had to sent them to a neighbour who will be looking after them and pick them up in the afternoon. Both of my parents are working and no one is at home to look after them. I'm not qualified enough to look after young children :)

It was during those days that I had the chance to learn how to cook. I never cooked any meals before. Hmm, looking back at those days, it was funny to see how I approach cooking. I always think cooking as a chemistry experiment where you add few of stuffs together and boil them in a frying pan. To get the taste right, you need the right amount of stuff and this ingredients need to be balanced. I constantly tried to find the right chemistry equation for different type of meals but I failed miserably in the end :) There are too many variables that need to be adjusted to get the right taste and it was certainly will take me ages if I were to write equations for all the meals. In the end, I had to use my own taste bud to adjust the ingredients.

This is an already long entry for Year Zero. I guess I will stop here and continue later whenever I have free time :)

Final Year

2009-10-26T22:29:00.000+11:00

It has been busy, but it is expected. My final year exam will be in another two weeks and yet there are lots that I haven't revised. Speaking of revision, I don't think it should be called as revision in the first place since I pretty much forgot everything that I've learned so far. Hopefully I won't be extremely anxious when the exam comes in the next fortnight.

Apart from studying, I'm also in the midst of selling my first car. It is not easy to sell an old car and it has been a bit stressful for me. The experience of selling a car certainly taught me a lot on how to deal with potential car buyers. I'm also looking for cheap courier service to bring my stuffs back to Malaysia. Maybe I would do that after the exam.

And finally, I am also inviting you, the blog readers, to my home at the end of this year (to be exact 2nd January 2010) for a small ceremony :D I am getting married at the end of this year. The wedding preparation has kept me extremely busy and I still haven't finished printing all the wedding invitation cards. Hopefully it will be done by next few weeks and I will be able put up the scanned wedding cards here in this blog.

Last but not least, I have already booked my flight ticket home. This time, the flight ticket is paid by my sponsor :) I will be going home few days after the graduation ceremony.

p/s: After 6 years living in Melbourne, it is sad to see how things will end. After reading my friend's blog, I think I should reminisce about the past 6 years.

Anaesthesia

2009-10-09T22:44:00.002+11:00

Over the last five days, I have spend most of my time in theatre. As part of my surgical rotation, I need to do a week of anaesthetic.

Anaesthesia is defined as loss of bodily sensation with or without loss of conciousness. There are three main components of anaesthesia, namely hypnosis (being put to sleep), relaxing your muscles and sedation (this means that you lose your awareness of your surrounding).

As a specialty, anaesthetic is one of the toughest training program to get into. There are high level of competition for young doctors to participate in anaesthetic training. It is quite attractive to become an anaesthetist since there are wide range of skills being involved and in term of salary, it has one of the highest salary grade among specialist.

Over the last week, I had the opportunity to practice putting a laryngeal mask into few patients. I had the chance to sharpen my skills in performing intravenous cannulation.

A laryngeal mask is a tube that is inserted inside your throat during an operation. The picture below shows how to put the laryngeal mask inside your mouth.

Picture from Merck Manual.

Intravenous cannulation simply means of putting a needle inside your blood vessels. This link will describe in detail how you perform the procedure.

As a medical student, putting a cannula (needle) inside the blood vessel was initially a hard task to be performed. You have to overcome your anxiety of hurting the patient and develop a good technique to insert the needle into a blood vessel.

Anyway, back to my anaesthetic rotation, it was exciting to be at the other side of the theatre. I used to be helping surgeons with the operation and hardly have any chance to sit on the other side. The anaesthetist usually sit behind the curtain and will monitor the anaesthetist machine to ensure the patient is breathing appropriately and is comfortable throughout the operation.

It is interesting to see how the anaesthetist handle the emergency cases. I had several emergency operation throughout the week such as emergency caesarian and emergency laparotomy due to unknown abdominal bleeding. There was a patient who had laryngospasm at the start of the operation and the anaesthetist taught me how to handle this emergency. Laryngospasm is uncontrolled contraction of the muscles inside your vocal cord and will cause a person to stop breathing. This is certainly a dangerous situation since it will cause lots of damage to your organs especially your brain.

In summary, being anaesthetist is fun but at the same time, it is hard to get into their training program. My next four weeks will be in theatre assisting the surgeons with their operation. This will be my last four weeks in medical school.

p/s: I'm looking forward for graduation but at the same time, I've to study hard for the final year exam. Hopefully, I will get a good mark from the exam.

General Practice rotation

2009-10-03T22:20:00.003+10:00

It has been 5 weeks since the last time I blog. A lot has happened in the last 5 weeks. Alhamdulillah, I have finished my general practice (GP) rotation.

This rotation means that you are spending time with doctors at their own clinic and observing how the doctors managing their own patient. You will be given lots of opportunities to interview the patient on your own and then presenting your findings to the doctor. It is a good practice for my final year exam.

This rotation gives you an insight on what are the most common illnesses around the community. Sinusitis is more common than temporal arteritis. Otitis media is more common than croup. Pneumonia is quite common but it is not that severe to warrant the patient to be admitted to the hospital.

Having been spending few years in the hospital, it certainly give me a bias perception towards finding out what is the most likely diagnosis. If I were to see a patient in the hospital, I'm more inclined to think of rare or life-threatening conditions rather than to think of more safer illnesses.

I did my GP rotation in rural Victoria and there were several opportunities for procedural skills. I managed to excise a skin mole and suture the wound. After 6 years of studying medicine, I finally performed my first PR examination on a patient. It was an exciting experience to learn how normal and abnormal prostate gland feels like. I managed to deliver a baby in the hospital which is quite exciting considering that the last time I delivered a baby was almost 12 months ago.

It is certainly an interesting rotation and it certainly boosts my experience in managing the more common variety of medical illness.

p/s: Since I hardly been able to use the internet in the last 5 weeks, there are a lot that I need to catch up with. My google reader is already been filled with few thousands of unread items.

General Practice

2009-09-01T09:09:00.001+10:00

For the next 5 weeks, I will be spending time at General Practice (GP) clinic. This means that I will be having lots of opportunities to clerk patient individually and present the findings to the doctor. This will be the best time for me to get lots of procedural skills done.

During winter holiday, the medical school asked us to choose 10 places for our GP placement. Unfortunately, since many medical students choose city placements, not many were able to get their place of choice. In my case, my placement was not even in my list. I was given rural GP placement which is quite far and close to the border of Victoria. I might be celebrating Eid over there as well. There won't be any Muslims within 50-70km radius from my GP placement.Now, that is something that I would call as celebrating Eid'ul Fitr in a foreign land.

I don't think I would be able to get free internet access over there. Hence, no more blogging or even facebook-ing in the next 5 weeks. As this will be my last post before going to my GP placement, please forgive for all my wrongdoings and Happy fasting. Happy Eid in advance too.

Medical Rotation

2009-08-29T19:21:00.001+10:00

Alhamdulillah, I have finished my medical rotation. After 5 weeks of spending time following a general medical team, there has been lots of stuff that I've learned yet at the same time, I managed to find out the limit of my knowledge. Clearly, after studying medicine for 6 years, there are still a lot that I don't know.

6 years of studying medicine does not really teach you how to works as a doctor. There seems to be a big gap on how to put all your medical knowledge into practise. Doctors do lots of paper works and referral. Medical school won't teach you how to fill in those paper works. You are supposed to observe it from the interns during this semester and learned it by yourself.

Referring patients to the other specialty is not an easy task to do. Interns are supposed to refer any suitable patients to the specialist for further management. The most difficult part of this process is to answer questions from specialist on reason for referral. I've seen how interns were scared to death when referring to the specialist. If you are not able to answer the questions from the specialist, the referral won't be accepted and you have to tell this to your own consultant.

Many patients who are admitted to the hospital require lots of medical imaging such as chest X-ray, CT scan and MRI. Radiology department is always busy and it is not easy to get a slot for your own patient. Somehow, the young doctor has to plead or find convoluted ways to get permission from the radiologist. Asking for permission to do medical imaging for your patient will always be one of the most difficult tasks for an intern.

Drug chart is one of the most common tasks that every young doctor will do. Yet up to now, I have never been taught formally about all of the doses of the medication. The university asks us to learn it by doing online course.

In the last 5 weeks, I have learned more on how to do my future job more efficiently than learning anything on medical knowledge. Hopefully, my next two rotations will be interesting :)

2009-08-24T07:20:00.002+10:00

وَمَن يُشَاقِقِ الرَّسُولَ مِن بَعْدِ مَا تَبَيَّنَ لَهُ الْهُدَى
وَيَتَّبِعْ غَيْرَ سَبِيلِ الْمُؤْمِنِينَ نُوَلِّهِ مَا تَوَلَّى وَنُصْلِهِ
جَهَنَّمَ وَسَاءتْ مَصِيرًا (4:115)

If anyone contends with the Messenger even after guidance has been plainly conveyed to him, and follows a path other than that becoming to men of Faith, We shall leave him in the path he has chosen, and land him in Hell,- what an evil refuge!

[An-Nisa:115]

closer to the grave

2009-08-23T23:07:00.002+10:00

Alhamdulillah, I have been blessed to be given 26 years to live in this world.

Whenever I went to the ward, the average age of the patient would be around 75 years old. 26 years seems not a long period to me. I gained lots of reminder each time I met an elderly patient. Looking at their face and thinking of what sort of experience they have gained in the past, it helps me to re-orientate myself to the reality of this world.

Every time you reach an anniversary of your life, you are one step closer to the graveyard. It may seem far for now, yet sooner or later, you will meet the judgement day.

Sometimes, I'm a bit hesitant to celebrate my own birthday. Maybe unconsciously, I'm afraid that I will realise that all this while, I have been wasting my time. I hope that in the past 26 years, I have done enough good deeds and repent for all my sins to Allah and for any wrongdoings to any human being that I have met in the past. Insha-Allah, I will try my best to be a better person and controlling all my negative attitudes.

I'm grateful for all the birthday wishes that I received. I hope that everyone will remain steadfast in Islam. Happy Ramadan.

5th Anniversary

2009-08-15T19:58:00.002+10:00

This blog as of today, will be 5 years old. A lot has happened in the past 5 years. Let me tell you a little bit about my blog.

This blog was started as a personal blog. A place for me to jot down all the ups and downs of my life as a medical student. The initial title of this blog was paradigmshift and the initial url was hafiz_238.blogspot.com. I chose paradigm shift to reflect my motivation to be a better person and to be brave to face all of the challenges in the future.

Later, I changed the blog title to 'kembara di bumi Melbourne'. I think I have to change the title of this blog at the end of this year since I won't be living at Melbourne. Not sure which title I should choose.

I used to be blogging frequently. However, in the last few years, especially when I started my clinical years, I haven't been able to blog as frequent as it used to be. Perhaps, life has been busy or I don't have any inspiration to put my mind into writing. Nevertheless, I hope that I would be able to maintain this blog for the next few years.

Pergi tak kembali

2009-08-13T21:31:00.002+10:00

Al-fatihah to Ustaz Asri. Read more.

Gen Med

2009-08-09T22:05:00.004+10:00

Tomorrow will be my third week of doing rotation in General Medicine. So far, alhamdulillah, it has been fulfilling. The consultant expects the medical student to participate in the ward round everyday and try to admit patient and presenting on the ward round. The ward round usually lasts between 4-5 hours everyday. It has been busy, but that will be my life starting from next year. So, I guess I shouldn't be the one complaining.

I usually arrived at the hospital around 8am and only came back to home around 10pm. I like to do my revision at hospital rather than studying at home since it can save me lots of electricity bills and prevent me from wasting my time doing unnecessary things.

There are lots of things that I need to revise for this semester. I am still trying to find time to revise my Obstetrics and Gynaecology and Paediatrics since those subjects will be part of my semester exam. Hopefully I can find time to blog and visit other blogs as much as possible in the next few months.

Ok, that's all for now.

Semester 12

2009-07-26T20:17:00.003+10:00

This will be my final semester at Melbourne. There will be three rotations during this semester (Medicine, General Practice and Surgery). Each rotation will be 5 weeks and at the end of 15 weeks, there will be 10 OSCE stations and 1 long case.

I am looking forward for this semester since it means that my 6 years of studying in Melbourne will end very soon. At the same time, I am feeling a bit anxious knowing that I will be working as a doctor in less than 6 months time. This will be my transition point from being a student to someone who will be looking after many sick people.

For GP rotation, we were instructed to choose 10 places that we would like to go and at least 3 of them have to be rural places. For this rotation, I was hoping to get somewhere close to home. Unfortunately, I got rural place for my GP rotation. It is so far that I don't think I would be able to return home every week. Hopefully, there will be internet access over there.

My first rotation will be medical rotation and it starts tomorrow. Despite being a final year student, I still believe that there are so many things that I didn't know and I am expecting a busy semester ahead. Hopefully I can survive this semester.

p/s: It is interesting to read what I have predicted 5 years ago. Read future predictions (In Malay)

Winter Holiday

2009-07-17T07:47:00.004+10:00

I haven't been updating this blog regularly. Perhaps I am having writer's block which is perpetuated by the cold temperature of winter season. This condition might be precipitated by not having much interesting activities to be written on the blog. However, I believe there are few protective factors that will protect me from giving up blogging.

p/s: The paragraph above was written in the format of formulating a psychiatry history. Usually, you need to mention 4P (Predisposing, Precipitating, Perpetuating and Protective factors) at the end of your presentation

Swine Flu (H1N1) in Melbourne

2009-07-04T22:17:00.002+10:00

In response to one of my commenters, I will try my best to illustrate what is happening in Melbourne regarding to the famous swine flu.

Up to 2nd July 2009, there have been 1691 cases in Victoria out of a total of 4568 cases in the whole Australia. Melbourne has among the highest swine flu cases per capita in the world.

However, this does mean that there is a widespread panic among people living here. Despite there were many school closed down and intensive media coverage, there were not many deaths associated with swine flu.

You should know that swine flu is not a dangerous disease. It is known to be extremely contagious but it is less likely to kill you. The normal seasonal influenza kills more people than the current swine flu.

Right now, I'm glad that the media has shifted their attention from swine flu and focus more on the death of an artist .