Miss a class is a great loss :)

Many people asked me, why am I going back to KL so early...

I am sad because I need to go back to Cyberjaya on the second day of the Chinese New Year, which is today. Right now I am in Starbucks, Kuching International Airport, waiting for my next flight to KL and my cousins are waiting for their flight to Singapore.

This morning, I reached Sibu airport at around 6.30a.m.

The morning was SO EARLY,
Sibu airport was SO EMPTY,
Flight MH3693 was SO EMPTY...

I remembered, a few months ago when I was talking to my friend, she said that I should stay in Sibu longer and spend time with my family. However, as for me, of course I want to spend more time with my family members but then at the same time I do not want to miss any classes tomorrow. A few weeks ago in Manjung, a friend of mine missed a class and I realized that she missed so many important things taught by my lecturer. I DO NOT WANT THAT to happen to me.

And another friend of mine said that I can take longer leave because I am still a medical student. But then, I think now is the only time I am learning so I do not want to missed any opportunity to acquire knowledge and skills in the hospital. Tomorrow, Thursday and Friday...I only have THREE days in antenatal ward :( wish to have more :)

Yes, family is IMPORTANT AND I LOVE THEM SO MUCH AND I HAD ENJOYED TO THE FULLEST SINCE I REACHED SIBU LAST 3 DAYS. I didn't open my O&G books since last 3 days and since I do not know much yet, I guess I need to start reading the books after I take some rest in Cyberjaya later.

This morning when I was in the flight, they served us milo, 2 muffins and a box of small cookies. When I saw the cookies, I was thinking, at that period of time, my other friends must be enjoying cookies in their home or maybe in others houses. But, i was having cookies in the flight, sad right?

However, something suddenly came into my minds which made me give thanks to God with what I have. Suddenly, a picture of some kids in rural areas or poorer country who do not have any food to eat flashed in my mind. I should give thanks for the food I had even it's in the flight on the second day of Chinese New Year. Someone, somewhere in this world do not even have any chance to enjoy the delicious cookies.

I must always know how to give thanks with all that I have. Only then I will learn how to appreciate :D Happy Chinese New year to all...

Thank you for your supports!

2011 will end in less than an hour yet I still owed those who donated during my 21st birthday for cleft lip children a reply from Operation Smile.  


Thank you very much for the donation and the supports. To know the amount that I had collected, you can find it here.We can't actually know which child we are helping because all the money will be directed to the fund and the volunteers from Operation Smile are doing the surgeries at one go whereby there will be lots of patients in one mission. Hence, it's difficult to track back which child we are helping with the amount that we had donated.  

 An email from a person whom I was contacting with all this while, 

Hello Evelyn,

I just received confirmation that the donation came through on October 26^th. Thank you again for your support of Operation Smile.

Sincerely,

Shannon Donovan

An email on 23rd Nov, 2011.

"Dear Evelyn,

As Kathy and I prepare to spend time with our loved ones this holiday season, we are reminded of the care and commitment of friends like you who have helped change the lives of so many children around the world.

Children, like Luis from Honduras, who will never know your name, but will never forget your generosity.

As you gather around the Thanksgiving table and reflect on your blessings, I hope you can imagine hearing the voices of children and parents saying:

"Thank you for changing our lives."

Please watch this special video so you can see for yourself how grateful we all are for your support.

On behalf of Kathy and our family here at Operation Smile, we send warmest wishes for a Happy Thanksgiving and holiday season.

Dr. Bill Magee
Co-founder and Executive Chairman

P.S We hope you are inspired to share this special video by forwarding this e-mail to family and friends or posting it on Facebook and Twitter."


From me: Really, thank you very much for helping those children. Altogether, we had supported two child with cleft lip to undergo the surgery :)

Pediatric Posting (Pre, Posting and Post)

     Not much to share :) I have never been through Internal Medicine Posting yet, but I heard most of the seniors said that pediatric posting is actually same as internal medicine, just that now we are dealing with the kids! The only additional thing is neotanalogy. In pediatric posting, you are also expected to know some neonatal disorders for example neonatal jaundice and you can find this a lot in HPJ.

     Besides, you may need toys to attract kids. Trust me, communicate well with the kids and you will rewarded with precious opportunities to practice physical examination on them. As for me, I love to perform magic tricks in front of them, some mothers will be entertained as well and this is when you need to grab this chance to take a complete history from the mother. ;) My experience: There was once I entertained the mother with the magic tricks and I got the chance to hear the murmur that her daughter has! So :) pls know how to build the rapport! Equip yourself with TOYS!

1. Pre-posting preparation:

To know what book you might need to use during the pediatric posting, you can visit here. It is a sharing about books for pediatric posting. You can also download ebooks from there. Don't forget to print out or photostat the normal child development assessment table in Malaysia Paediatric Protocol page 12 and 13. You can print it in multiple pages per sheet so that it is smaller and then laminate it. It is very helpful when you take the developmental history of a child. I made a clerking template based on the lecture's notes. You can have it here.

2. Posting:

In HPJ, the rate of discharge is not as fast as Hospital Manjung so if you had already finish clerking your beds (in average each of you will get 2 beds), try to ask permission from your friends and if your friends allow you to clerk their patients, just go ahead. Do not forget, please ask their PERMISSION first before you simply clerk their patients.

In HSM, the rate of discharge is quick fast except those patients in HDU (High Dependency Unit). Those in HDU are under intensive care. Normally you will get interesting cases in HDU, and please share the cases with your friends.

Besides:

• try your best to follow the ward rounds with medical officers, not the specialists. Preferably at night. During the night rounds, they will only go and check some critical cases only. I always followed the night rounds and I met a very good MO, whereby he will always let me auscultate the patients and ask me to present the findings. Also, sometimes, he will ask some questions during his rounds and you need to find out the answer. This is when learning is fun, just ask your lecturers or MO whenever you are not sure of anything.

• On every Tuesday and Thursday, there will be a numbers of kids suffering from thalassaemia who will come to have their regular blood transfusion. Normally they are asymptomatic but grab this opportunity to clerk them as well. However, when there are newly admitted thalassaemia cases in the wards besides Tuesday and Thursday, it means that the kids are admitted to the hospital with several postive signs and symptoms for example like pallor, dizziness and so on. Clerk the patient!!  This is what the HO told me.

• There will be lots of dengue cases in the wards. You can get a very useful reference from WHO here.

3. Post-preparation:

     Basically you will be busy preparing for your end-of-posting clinical exam. What I did was I used In A Page Pediatrics and also Pediatric Protocol (the green book) for my revision. Make sure you really know the common diseases and also the management. Learn the management from the green protocol book. Do the group discussion as group discussion helped me a lot in my theory part after performing the history taking and physical examination during the clinical exam.

p/s: email me at evelyn6757@gmail.com if u want the pdf. copy of Malaysia Paediatric Protocol. I will email it to u, sorry, I haven't repair the broken link.

Introducing books for Pediatrics Posting:

    

A must have for those who are doing pediatric posting in Malaysia Governement Hospital. Basically it is a book of guidelines mostly on management for the governement hospitals all over Malaysia. And doing pediatric posting in CUCMS, the lecturers expect us to know some outlines of management for our case presentation or case write up. Hence, this book is really helpful. Unfortunately you can't buy this book from Kamal Bookstore. You can download the pdf file here.

In A Page Pediatrics

     I found out this book, at the 7th week posting. It was late but then I can tell you, this book is really wrth buying. For the clinical exam preparation, I read this book plus the Pediatric Protocol, the green book that I introduced above. I will share more about my preparation for my exam in the Pediatric Posting sharing. Of course not all the information was available in this book but then this book comprise of most of the common cases and for every diseases, it has the epidemiology, signs and symptoms, differential diagnosis, lab investigations, management and also the prognosis. I really make full use of this book. Whenever I found any additional information in Nelson or Essential Pediatrics by OP Ghai, I will write it in this book. For me, this is also a must have.

Illustrated Textbook of Paediatrics

      I bought this book. People call it SUNFLOWER. I like the classification for hematological disorders in children, meningitis, the pictures of types of rashes, neonatal jaundice, nutrition and normal development for children in this book. :) Dr. Rosman love to use this book!

Nelson Essential of Pediatrics

GHAI Essential Pediatrics

     I suggested that you can borrow this two books from the library. That is what I did. Nelson is good but it is really thick. So as Dr. Azlina suggested to us, read only the points in the table form. Those are all the important points. Seriously, I love to read tables in Nelson as compared to Ghai Essential Pediatrics. It helps! It is really informative!


      If Dr. Rosman will suggest you the Illustrated Textbook for Pediatrics, Dr. Azlina will prefer you to use Ghai Essential Pediatrics. However, up to you which want you prefer! As for me, I love the In A Page Pediatrics, the green Protocol plus reading up the tabulated points form in Nelson. :D By the way, Ghai Essential Pediatrics is the only textbook that has some explainations on dengue hemorrhagic fever. :)


*p/s. if you found any broken links, please kindly email me at evelyn6757@gmail.com to request the ebooks or the pdf. files. :) Hope this piece of information helps!

I love Manjung..

Hospital Manjung is really awesome. I fell in love with this place. Not only the patients here are polite, the staff nurses, sister, HO, MO and the specialist here are so nice. Seriously if u are so passionate to learn here, the housemen, medical officers are so willing to help you. Every night, I will follow the ward round. Yesterday, I met this MO, Dr. Brandon...he was really nice to the kids. Besides, after examining his patients, he will let us auscultate those kids and tell him the findings. He also told one of the patient's mum that he was once a medi al student also, and because of the patients allowed him to clerk them and learn, he can become a doctor today. That really touched me because he understand us, the medical student...

After he examined the kids, he will hug the kids and give a signal to my friend and I, to auscultate the kids immediately before the kids started to cry. He really look into the patient's eyes. Most of the doctor will only go to the patient, examine and leave but so far there are 3 doctors that I have seen, who really treat the patient as a whole...Mr. Ahmed Awil Adam, Dr. Zahirah and now, Dr. Brandon. Seeing the way Dr. Brandon treat the patient, I was so inspired. Last night, before leaving the ward, I saw there are a few kids who cried and they looked so depressing. I go to them, and performed some magic tricks. They smiled and I was so contented. In the ward, it was so depressing, hence, besides clerking patient and doing physical examination, I felt the needs to make them happy ans smile!

History taking and PE for a lump

History taking:
1. When  was the lump first noticed?
2. What made the patient notice the lump?
3. What are the symptoms of the lump?
4. Has the lump changed since it was first noticed?
5. Does the lump eber disappear?
6. Has the patient ever had any other lumps?
7. What does the patient think caused the lump?

Physical Examination:
1. Local examination

• site
• size
• shape
• surface
• depth
• colour
• temperature
• tenderness
• edge
• composition
• consistency
• fluid thrill
• fluctuation
• transluscence
• resonance
• pulsatility
• compressibility
• bruit

• reducibility
• relations to surroundings structures - mobility/fixity
• regional lymph glands
• state oflocal tissues
• arteries
• nerves
• bones and joints

*words in yellow = it's either solid, fluid or gas
*words in red = vascular

resource: BROWSE's introduction to The Symptoms and Signs of Surgical Disease
               page 29, 30
  

The story of 3 friends

So here is a story of 3 friends who went to an island, where there is nobody else there.. :)


The adventurous 3 friends went to an island for fishing. When they reached the bolehland island, they realized that there are no one else there except 3 of them. For them it's ok, as long as they stay together all the time, they shouldn't be any problem.


Unfortunately, after 3 days staying there, they were out of food. They left only one more last boiled egg. Alice cut the egg into 3 parts they managed to share the egg and filled their empty stomach. At last, they decided to depart back home to Realityland, their hometown. Just before they leave, Beatrice just remembered that the main purpose that she went to the bolehland was to look for a type of plants called my hearto breakus sp. This type of plants can cure cancer patient. Amazing right? She asked Alice to accompanied her because she was afraid to walk alone at night. However, Catherine was a bit tired that day so she preferred to stay in the raft to wait for Alice and Beatrice until they came back later. Also, he did mentioned that she was afraid to stay alone. However egg can be broken into 3 parts but human being? I don't think so.


In the jungle, while looking for the plants, suddenly they heard a loud cry from the direction of the beach, and they knew it's Catherine's shouting. Hence, just like Doraemon, Alice had this teleporting machine. She took out and both Beatrice and Alice used the teleport device and appearred in front of Catherine. She looked so pale and frightened. At last, Alice made the decision to go back to Realityland. They will come back next time to look for the mystery and legendary plants, perhaps in four so that no one will be left alone ANYwhere!


In Bolehland, of course they can do anything they want to but then when they are back to Realityland, they was no such thing as teleporting machine. Human can only appear in a place at a time, and human will have to choose one and leave the rest. However, there are always solution, which is 3 of them can come to a conclusion and stay together.


In my diary, I didn't priortize anyone.. I give choices, it's up to you to choose.! And I will choose to stay with Beatrice (after my rational and logical reasoning), although I might love Catherine the most. She is strong outside but I just realized inside, she is not. She hide it. And sorry if I missed out anything, maybe I didn't get her message that she was afraid, and I know after this I need to understand her more. Hope our friendship last forever. So, what's next?