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You spent whole night thinking whether you want to grab this chance of making something useful out of yourself. You look at the statement and started to imagine who would you become in the future years. You picked up the pen, put down your name, and said ‘Yes’ to med school.

Everyday’s classes is a bit of this and that. The base of this pyramid is really big. You fear the volume of medicine, that it covers everything from a wink of eye to a big eye and even the back of the eye. You fear the things that you forget might cause you big shame and trouble. You fear that you missed out something really important.

And thus the principle of repetition. Time after time, same paragraph and topic, again and again, hammering the facts into your brain, like nails of 2m length.

From time to time you gotta tell yourself that even this process is slow, you will taste the fruit of your hardship. Not now, maybe not later, and maybe nobody would even care to acknowledge you in the future, but somehow someday, that day, you will do something that at least make yourself feel good.

You kept yourself motivated all the time. You protect yourself from not appearing like a stupid student. You told yourself what you study is important, that it makes a difference, that one day in the future you might be remembering this exact same sentence that you read now, and that sentence would have stop you from killing, that it would most probably save some people, or stop some people from dying too early.

You sold yourself to this profession.

You might not know whether you would end up a good doc in the future. But instead of aiming too high, you would want to be a safe one. Safe enough to practise.

I built my pyramid of big base. Another 3 days, I wouldn’t be finishing the peak. Don’t get me wrong. I’m just finishing building the FOUNDATION. How strong is it? Time will tell.

Had my O&G exam this morning. Let me think what is there to tell.

Errrr…

Nothing.

Seriously nothing!

Too uneventful. I got a normal menogram and normal numbers for pelvic sizes. Even normal salpingography! Well. Maybe I should say, since we study pathology all the time, it is also very hard when you get normal readings. LOL!

However, I discovered one joke this morning - ‘Let’s do a menogram on the pregnant lady’.

Get the joke or not?

-_-’

Yea.. I know, kinda sweat. Anyway, uneventful day. My answering process would be the fastest of my same batch that day, I didn’t even get to warm up my seats, but it took more than 30 mins waiting for my turn.

Let me relax for a day first, LaiChee is cooking for me later (suddenly so good don’t know why) so I’m going to the hostel. Tomorrow, classmate Chong will be cooking for us (including me) instead. LOL.

Last paper on 17th! A week break for me to relax. Hehe. Upload today’s dinner’s picture later. Ciao!

Today is my internal med paper. I’m starting to think that both my examiners till now are those poker face type (po.. po.. po.. po.. po.. poker face).

The previous batch that had this exam told that most of the time the interns will kinda help out a little bit you are in trouble. Hehe. Let’s listen to my part of this story.

I reached around 8am, went in the room, took my slip and my patient’s name. I went up to the ward, and a big bouncer intern came stopped me.

Bouncer : “Where are you going?”
Me : “824, my patient is there.”
Bouncer : “Okay, go see the intern first, she has something for you.”

I went to the ward, and a female intern was there standing, pulled me aside, and when she was about to say something, another 2 fellas came asking for her helped. I waited for quite long as they started asking her about those small things. (Walao, anamesis also wanna ask, go ask the patient yourself la!)

Since I got kinda bored waiting. So I just went to the patient. After clerking, when I was about to exit the room, the examiner approached me, and told me to present, in a not fully prepared stage!

Me : “Can gimme 2 minutes so that I can write down some stuffs?”
Examiner : “You already wrote down, let’s present and see what you have.”
Me : (-_-’) ” Okay.”

The process was uneventful. Pretty straight forward angina pectoralis. But the patient is not so pleasant to talk to. Grumpy and all but I think I know the Russian style pretty much. (Just talk and ignore the face).

Came out, filled in the paper, and got back down to take my theory questions.

Nothing really special except for one part. I got xray for osteoarthritis of the knee joint, and extrasystole + anterior (-) Q infarction.

The analysis is funny. I appreciated the anemia, hyperbilirubinemia and the decrease time of erythrocyte resistence. And because of this, i started to think of the possible causes - both congenital and acquired, spherocytosis la, sickle cell la, thalassemia la, G6PD deficiency, drugs induced, warm cold autoantibody.

Teacher : “Tell me the diagnosis.”
Me : “I think this is analysis is not complete…. (wanted to continue)”
Teacher : (with the face like i stepped on her shoes) “Tell me the diagnosis!”
Me :”This is hemolysis but the cause is unclear…”
Teacher : “The diagnosis please..”
Me : (-_-’) (habis, hancur, can see any diagnosis from the lab test meh?)
Teacher : (waited impatiently)
Me : (sweating)
Teacher : “Hemolytic anaemia”
Me : (wtf!)

Well, she didn’t considered I didn’t know as I already told her what I think and etc. So she is pretty lenient with the mark for that.

Got a question on hyperosmolar coma in diabetic patient. Also a bit of poker face there when I say out the dosage of the insulin. Sometimes it is really tricky.

Teacher : “How much insulin to give?”
Me : “6 unit bolus and then drip together with the saline later on”
Teacher : “How much insulin to give? (see she likes to psycho me!)”
Me : “6 unit bolus (answering again, i thought she didn’t heard!)”
Teacher : “How much insulin to give? (with the tone like wanna kill)”
Me : “6 unit!”
Teacher : “after bolus how much?”
Me : (cham, don’t really know, usually depends on sugar level)
Me : (tembak lah!) “6 units also, thru out the hour.”
Teacher : “you are suppose to say, according to sugar level! But 6 is too much, usually 2-4 units.”

Okay I admit maybe I a bit too gan cheong. Sometimes it is really good to say what you think to the examiners. Let them know how you think and maybe your unimportant process of thinking is the answer itself!

I got an endocrinologist for me to answer my questions. Talking about answering to the experts.

Anyway. Marks are good. 3 down. 2 left to go!

Felt like uploading these pictures…

Taken when I went to overnight in the hospital. Never know that there is such a nice view from the doctor’s office.

Closer look of it.

This is how it looks like mid night when there is nobody around. I can assure you that the other side is almost identical.

Lotsa food during rest :)

A bit more and all these can be cleared!

Bought this for 100 rubs (abit more than 10 ringgit) after my exam yesterday. It is a 1953 operative surgery book. I found out this store from my pediatric surgery teacher near Kim and I thought it would be quite cool to collect some real old surgery atlas or book from USSR.

Actually, a lot of things written inside is still used today.

I’m happy that it is not expensive. Actually I wanted to get something like Grandma’s mega atlas which is really useful but I can’t find any. New stocks of old books will only reach this coming autumn so maybe I’ll tell my housemates to keep an eye for me on it. Hehe. (If you are reading this u know what to do).

Back to exam preparations. 4 more to go!

So far I guess I always record down my exams. I think it would be cool to look back and laugh at myself and remember back how I had mumble during exams. So here is the first one for this finals.

Grandpa once said : “You are going to graduate from a university. You spent 7 years studying. So you must look smart, civilized, converse in the correct language, cultured, and know everything, even thou it means a little bit of this and that.”

Yes, indeed I look smart with tie today :)

What he said is nothing but the truth. Sekolah lima tingkat, hospital 9 tingkat.

A junior of mine recently said that she knows the thing but she is just lack of words to explain it. I think this is not the proper way. In order to know something, we read the words, imagine how things happen, and of course at the end of the day, it is a must for us to know how to express ourselves scientifically, and say those words that make communication possible. we can’t say that we are lack of words to explain!

This is the exact thing that happened today to me. My examiner was the notorious Prof. Mihin (youngest prof in Volgograd). Known for being super outstanding.

Prof : “Tell me how to differentiate direct and indirect hernia clinically, there are 6 points all together.”
Me : “????”

I had read a few surgery books (don’t dare to say a lot but for sure more than 2), most of them stated that it is almost impossible to differentiate direct and indirect hernia when you see the patient. Most of the time the correct diagnosis will be post op. Even Dr. Ravi who I attached to during my India elective posting (people MRCS holder leh) also said that. But this prof is now asking for SIX characteristics?

I know arguing is no use. So I use common sense and some basic knowledge.

Me : “Err.. When we use the finger to search for the external ring and ask the patient to cough, the direct hernia will be pushing my finger from the front and the indirect will be pushing from the side.”
Prof : “(nod) You have the correct idea but you say it the wrong way.”
Me : “(wonder, how can this be said in another way?) Errr…. ”
Prof : “If should be ‘pushing medially from the lateral side’.”
Me : (-_-’, what’s the difference laa abang..)

I managed to named some 4 characteristics (by location, shape, coughing and going into the scrotum or not) which later after that he got a bid bored and jump to the next question.

Seriously 4 is like using all my brain juice d. I don’t know the other 2. Haha. Safe.

Other than that it was kinda uneventful until I answered my theoretical question. It was the first aid for tetanus.

Prof : “What is tetanus? A virus, a bacteria or something?”
Me : “Is a bacteria.”
Prof : (Look at me with a lot of question marks).
Me : (Huh? I answered wrongly)

I swear that time a mind game was going on.

Prof : “Are you sure?”
Me : (Cracking my brain and suddenly I remembered)
Me : ” Is a bacteria, rod shape, with spore at the ends.”
Prof : “Oh yea.. is a bacteria.”

See I fully utilized my infectious disease knowledge in a surgery exam. Don’t play play! But phew.. luckily I remembered. However, I got problem remembering the victims will have photophobia. But anyway, he kinda directed me to that because I don’t really understand what he wants from me. I always guess the words that they want me to say.

Later on he asked me about the patient that I clerk.

Prof : “What makes you think it is an indirect hernia.”
Me : “Because before this I read some journal and direct inguinal hernia is actually very rare for women.”
Prof : (……………..)

Thanks for grandpa for asking that SAME question during class and I went to do some research on it.

Other than that I guess things are pretty okay. He asked me about the Forrest classification. And I got a patient to clerk who had strangulated hernia. Put quite a lot of diagnosis.

So, 1 down. 4 to go! Happy day. Hehe.

Exams are like shells. Gotta grow over it and then…. blossom.

Today, grandma came in and say “Сегодня празничный день, это у них последний день студента. Такая жизнь больше не бывает.”

I got stunned.

Yea. It is correct, today is the last day as a student.

Такая жизнь больше не бывает.

Quite touched by that last sentence. It is true, for 7 years, or should I say, since the day I know my own name, I had been going to school all the time (except holidays), bothered with homework, exams (even thou there are more in the future). If I think back, I had always been waking up early, going to school, sit in the class, listen to what the teachers gonna say, and answer questions, do exercises, and it had been like this since kindergarten till med school. Yea.. since kindergarten to med school, which unofficially ends TODAY!

Because TODAY is the last day, and this life that had passed would not repeat itself. Today is the last day of all my academic activities in Russia. Last class, last morning report, last time clerking a russian patient as homework (have 2 more times during exams), and most importantly, last day for my profs and teachers to consider me as a student.

Change of life huh? Not feeling it yet. But exams will come so quick that I wouldn’t even have time to think of it, and later on, it is like metamorphosis, changing to another being.

7 years ago when I was still a little boy, ‘freshly’ exported to Russia.

Tomorrow will be my last day as a med student (hopefully). Sorry readers for not updating this blog as frequent as before because my finals is round the corner. And seriously grandpa had been making us learn and think a lot that I do not really have time to stop and do some mundane things like blogging.

However, would like to inform all that my finals would be on -

2nd June - Surgery practicals
5th June - State MCQ
6th June - Internal Med practicals
9th June - O&G practicals
17th June - Last final paper

Time will pass so fast from this moment onwards that my brain will go beng from time to time. Hopefully I can manage this like how I managed those that came before this.

This is emo post, read at ur own risk.

And no, I don’t mean the real brain thrombosis.

Yesterday I overnight-ed in the hospital. The so called ‘on-call’ but I guess it is more like an off-call, because nobody really cares what I would do and how I spent my time. Anyway, it was quite a good night with patients that test my brain. Working with the physicians on-call is very challenging because she always want feedback from us, and she wants it fast, and I gotta think fast, so that I would look like a complete idiot 1 month towards my graduation.

Anyway, I felt bad because this happened.

There was a woman who came in with complains of abdomen pain, and basically she is just mumbling pain all the time. During examinations she has a big post-op hernia at the left flank, almost the size of a volleyball (I said almost, maybe just 1 or 2 cm smaller by diameter). The surgeon on-call (I tag him because I’m having my surgery cycle now), once saw the hernia, claimed the patient and left the room while waiting for the physician to come.

Well, having so much time there, I took a closer look at her, and happened to find out that she experience pain on her right shin (pain at gastrocnemius muscles on the right). I automatically proceed with its palpation (Mosesa signs) and told her to try to dorsiflex her ankle. Both of the signs came out to be positive. I told the physician on-call and she agreed with my findings. I thought that since she knew it already, most probably she would include it into her conclusion on the patient’s history.

The next morning, when I was presenting this patient (in class, not bed side) to my teacher, it struck me that which diagnosis should be the first? I stopped to think.

DVT obviously is more dangerous. BUT, later on when I look back at the patient’s history, there is nothing about the DVT. The physician didn’t include it as it is a surgical disease and the surgeon is not informed about my findings.

So I thought maybe I could tell my prof, show him the signs, and hopefully she got admitted with her proper pathology, which is in another department.

And the next thing I know! The son came and took her back home. Well, the son is psycho and I guess he wants his mum to die earlier. A volleyball size post-op hernia and he wants to take him home?

I felt kinda guilty for being brain blocked when I see the surgeons all the time but didn’t mention my findings to him. All I had in mine is who am I to say anything? I’m just a small peanut. Plus lack of experience, lack of knowledge, lack of thinking skill (this one is obvious since I didn’t say a word).

I think I would feel even guilty if she came in with PE these few days or just *choi* touch wood, die because of a PE instead of the diagnosis that she got from the surgeons.

Since the woman was not there, my prof tried to ask the docs around whether they see her legs or not. And all they could say is some arthritis. What do you mean by some arthritis? It is so obvious it is not arthritis lah!

Even thou I don’t know who I want to be in the future, but I definitely don’t want to be like them. Didn’t see but answer? That is so damn dishonest.

But I was stupid, I kept quiet. Garggghhhh…