Milan

Just to prove I did more than shop, here's the scoop on our Milan trip. The merry throng consisted of Jack, HP, Shaun from Liverpool and we were joined by HP's mum and younger sister. We started off all enthusiastic to go to Venice - I had two travel plans ready; down to the type of wine we'd be drinking, until we found out that planes can't fly when there's fog.

Will Ryanair give us our holiday?

After 2 cancellations that saw us tearing back and forth Liverpool, we finally got on a flight to Milan, arriving in Milan a day earlier than planned. First sight of Milan proper:

It looks like some big historical place but its actually the train station

Our comfy abode for 3 nights

We made our way to the main square, where the huge Duomo, or church, hid shyly behind an equally big advertisement.

Apparently the last one was a reclining lady promoting perfume.

Inside it was suitably huge (the 3rd largest in the world according to Jack) and walking around its huge stone pillars reminded me of the scene of the underground dwarven cavern from the first Lord of The Rings. We went all the way to the top too, where we got a view of the city.

According to Jack, there are over 1000 statues all around the roof

Outside, the square was bounded off the other side by a shopping complex again cunningly disguised as a historical site with a name to match - Galleria Vittorio Emmanuel 2 (in roman numerals, just in case you were wondering).

Hope this place stays this way

Some pretty interesting stuff to see here, apart from all the high street brands. There was a cafe where guidebooks raved about, and where composers and kings alike had visited, so that was our lunchtime settled. No McD's for us in the fashion capital of the world!

Though even the McD here seemed a class above

In the gallery/shopping place, legend had it there was a mural of a bull, which featured a particularly prominent set of testicles, against which people would rub their feet for good luck. Being the nosy bunch of Malaysians that we were, we sought it out and did the necessary.

Wonder where the legend came from anyway

Poor bull - the people who thought this up must be laughing their heads off now

Anyway, a short walk through led us to La Scala, the famed opera house. Inside the museumy bit, we watched an orchestra rehearsing through a box gallery seat and saw clips from a production of Aida, an opera by the composer Verdi. The museum also happened to have the original manuscript written by Verdi himself. Looking at the notes, which were not at all like what you see in modern music manuscripts, I wondered how musicians back then were able to read them.

La Scala by night

The next day saw us wandering around town visiting what seemed like an endless stream of churches. The first visit though, was to a castle, in the middle of Milan. It was easily the biggest castle I've visited so far, housing a museum and an art gallery inside. Unfortunately couldn't get pictures of the garden, which was being replanted or something.

Housing works of Leonardo da Vinci, among others

First off, was a church which was founded in the first few hundred years AD, by this chap Saint Ambrose, who was responsible in bringing Catholiscism to Milan. It was a quaint old church with a courtyard that seemed to echo with the footsteps of the priests of long ago.

The embalmed body of Saint Ambrose is actually on view inside

Another church we visited, contained the famed Last Supper, by Leonardo da Vinci. However, tickets to see it were all booked up till February, so we had to content ourselves with a replica.

The actual painting covers an entire wall

The Chiesa Santa Maria della Grazie (St Mary's church) housing the Last Supper

We had dinner at a posh restaurant. Trying to be adventurous for a change, I ordered carpaccio, which was on the top of Food To Eat in the guidebook I'd been reading. Out came this glorious creation:

Raw beef sliced thin with cheese slices and rocket

Not to say it wasn't nice, actually it tasted better than I'd expected, just that I probably wouldn't place it on my Top 10 food list anytime soon. The dinner went well for everyone in general though, with Shaun having the Milanese breaded veal cutlet, and others having the saffron risotto. The staff were pretty helpful in planning a song and cake for Jack's upcoming birthday, so the night ended well.

Right before we surprised Jack with the help of the staff

High street in Milan

Where we saw prices for clothes going up to thousands of Euros. Where Shaun got scolded for trying to take photos in a store, and we theorized it was because they didn't want their designs stolen by other people prematurely. Where almost everyone seemed like models and the Hummers sat beside Ferarris and Porsches and Mazeratis on the sidewalk.

The Galleria Vittorio E2 at night

Little Venice - a canal in Milan

On the as-yet unfulfilled quest to eat really great spaghetti in Milan

Traffic - trams in the middle of cars and pedestrians

A walk through a park

Trying to reach the arch - similar to the one in Paris

A spoon embedded in the concrete - weird

Gelati - cinnamon flavour rocks!

Things I'll remember about Milan: Dogs that are small enough to be stepped on walking all over the place, each in their individual clothes, old-fashioned bicycles yet not looking out of place in a town, the disco roller bladers and spray painter street artists, the way shop prices are displayed outside shops so you know whether to go in or not.

Still want to go to Venice though.

Over Christmas

I've learnt a few things, among them, being my clothes sizes. I have a collar size of 15 1/2 inches, a shirt size M and a coat size one larger, 36 inches waistline (34 by the end of the year..come on!) and a shoe size 10 1/2 - 11 depending on the shop. All this from a day of shopping with my cousin at Blue Water, one of the biggest, if not the biggest shopping place in Europe.

When more people find out that Marks and Spencer, Topshop, Topman, Burton, Gap, Next have online services, though, I predict the night of the 25th of Dec will see many people crouched in front of their computers waiting for the Boxing Day sales to start. No more waiting through queues 4 lines long and wading through clothes thrown all over the floor.

Also had my first milkshake in years, a weird flavour at Ed's Diner, but a must-try if you haven't had it before; peanut butter and banana. Would've tried making it at home if Ed and HP were more forgiving, and if I had a blender.

Christmas 2

For its the mystery of the universe,
You're the God of holiness,
And yet You welcome souls like me,
And with the blessing of Your Father's heart,
You discipline the ones You love,
There's kindness in Your majesty,
Jesus, those who recognise Your power,
Know just how wonderful You are,
That You draw near.

Cos when is God nearer to the hearts of the people around us, than at Christmas? Even for those who do not celebrate it, or call themselves Christians, there's a different air about this season than at other times in the year. There's a reason Christmas is called the season of giving, and of forgiveness, in most parts of the world.

Its pretty amazing the way God welcomes everyone and calls them His children, the way a human being might welcome dust mites as children. Despite the fact we don't understand Him in the least, that we have been living for years causing Him a lot of bother, and that we're on a whole different level of existence, He singles us out and accepts us into His family. Not a one-time invite, but a standing invitation that extends till He comes again.

Hope everyone reading this will have a great Christmas. Don't forget the love waiting for you out there.

Christmas 1

We are the reason that He gave His life
We are the reason that He suffered and died
To a world that was lost, He gave all He could give
To show us the reason to live

I remember first hearing my seniors at youth group back in Sitiawan rave about this song, how it was so full of meaning, so tuneful to the ears. This was when everyone used to get excited about going for carolling practise in the mornings at church. It seems pretty amazing actually, now that I think about it, how people with no vocal training or musical background could be taught in a matter of months to sing in parts. We used to come together and warm up our voices...usually by singing along to a pianist playing scales or arpeggios going higher and higher till it became ridiculous, then going back down again. Then we'd split into our 4 parts; sopranos and altos would be made up of the girls, the tenors and bass would be the guys. Each part had a leader who was responsible for learning the part and teaching it to the rest. And inevitably, we'd clown around in the MYF room, the hall, the sanctuary, or wherever else we'd be practising at the moment, while the leader tried his level best to teach the songs with his guitar/keyboard.

We'd gather back and sometimes, when one group would finish practising earlier than the others (usually the girls), they'd go in and sing their part while the other groups were frantically trying to learn theirs, resulting in a battle of voices, as each part tried to confuse the other as much as possible. When order was restored, we'd sing through the favourites, with a guitarist/pianist at the helm. In time, we'd learn that each carol had a specific guitar intro and could pick it up immediately. Joy To The World, Silent Night, Angels We Have Heard On High, Hark The Herald Angels Sing were the staple SATB songs we sang back then, now since joined by Not That Far From Bethlehem and A King Is Born.

Christmas carolling, one of the staples of December in Sitiawan in the years gone by. Still think the song is pretty deep even now.

Out of control

I've invited my tutor in Uni of Liverpool (a doctor that I was assigned to for my 4th year, whom I've only met once or twice) to join Zorpia. Along with a whole bunch of other people whom I don't ever recall.

Which is weird, because I don't remember ever feeling so short on love and companionship that I've had to sit down and painstakingly invite my email list to join my hitlist on Zorpia! In fact, what in the world is Zorpia? And do I even have an account there?

Wonder what the poor doc's thinking about me now...

Palliative Care 3

Visited the hospital chapel for the first time today. Wondered whether it was closed, cos I'd just been talking to a patient who was telling me about having Holy Communion on her bed last Sunday. She's got high hopes to live till her wedding anniversary next year, after which anything else is a bonus. Remembered her as I was on my way back so I was just going through to the stairwell, I decided to make a detour into the chapel.

FUrness General's chapel is actually quite a nice room, with lighting that is not too dark that you can't see five feet in front, but not too bright that everyone's nose stands out in stark contrast. Chairs with cushions lined up, a small pulpit in front, and a raised platform, above which is a small cross. Across the wall near the entrance are prayer notes written, with a big bold disclaimer underneath: Do Not Breach Confidentiality.

Spotted my patient's name there, and was reading through the rest. Though instructions on the board said just to leave the patient's name on the board, many had written short messages alongside. Some were obviously written in frustration and anger, others seemed to be almost pleading in their tone. At least one had the words thank you on them. A girl had written a few, her requests for quite a number of patients to get better spilled over a few pieces of paper, Last of all, she wrote her own name there and said she hoped she would get better too.

Palliative care 2

So not only are we a bunch of noisy people, we smell bad too. This from my consultant in palliative care.

"We've been getting feedback from some of our patients. Try to keep the noise levels down when you have discussions. Also, they have mentioned that they cannot tolerate your BO."

Stunned looks all around the table. Suddenly, we're the group that stinks, literally. Well, at least some of us, but she's not telling who.

Later on, while talking about gangrene:

"So, what's the patient's main worry going to be?"

Silence

"Anyone ever smelt gangrene before?"

Adnan, our resident joker pipes up, "Well, it's us that are going to smell worse anyway..."

Palliative care 1

On the oncology unit, talking to this elderly man with prostate ca and bilateral legs full of fluid(oedema). Not a nice time, as he became emotional more than once as we discussed his condition. Hearing about the puddle of fluid that burst out of his leg every morning from the swellings that had formed overnight.

As I was about to leave, I patted him on the back. "See you around then."

He looked me straight in the eye. Soberly, while pointing upwards, he said "I'll be up there soon, just so you know."

Silence for a while.

"Erm, I'm sure you'll be around a while yet..." I started to say.

"What do you mean?", he cut in. "They're transferring me to the medical ward on the 5th floor, aren't they?"


....sometimes, I really don't know where to hide my face....

Watchdog

Just watched this programme on TV called Watchdog or something similar.. They do a good job of exposing scams and warning the public about potential cons. This segment they did a slot on mobile phone companies offering cashback, in particular a company called mobs (mobile solutions online).

Having friends who were on similar schemes and having been interested before, I leant back with a glass of mango cum orange juicy bits and watched as they exposed mobs' schemes.

Apparently what the whole cashback offer is based on the assumption that only around 1/3 of customers would claim their cash back(for those unfamiliar to the cashback scheme, its an offer where people get a mobile phone and pay a monthly tariff. They then receive a voucher from the company every 3 months and theoretically when they return this voucher, they will receive a certain percentage of their cash back). When more people claim their cash back than the company expects, they have to delay the returning of the cash.

Watchdog even interviewed a former employee who told viewers the numerous strategies the company told her to use to delay the customers. Excuses ranged from "the money's in your account already" to "our computers are undergoing a upgrade" to "cash will be deposited in the next 1 week".

Watching this, I found it interesting because I was actually considering signing up for it at one point. In a sad sort of way, it reinforced my underlying assumption (from past experiences) that everytime eveyrone approaches me for something, its definitely a scam, and I treat them appropriately. This extends to giving to charities and beggars on the street, based on the premise that most of them are part of a huge money making scheme.

How in the world it's supposed to reflect God's love is something I've not yet reconciled though, as there really ARE people in need out there.

Anyways, on a parting note, mobile online solutions are liquidating, so it seems those still waiting for their money back will not be getting it anytime soon.

Equality

Biker chick stands beside kindly old grandma, stands beside tall lanky possibly basketball player stands beside petite college student. Lawyer beside doctor beside patient beside dock worker. Rough bouncer together with redneck, black, brown, tanned, fair. Conflicting stereotypes glaring along the row. Long haired standing beside tattooed and pierced standing beside Mr. Studious Spectacles. Racial polarities lose their magnetism as Indians stand with Malays with Chinese nearby and countries lose their borders with British standing by Africans holding hands with Jews and Russians.

In a time of worship, everyone's no different. When the focus is off us and onto someone far greater, we take our hands out of our pockets, stop brushing our hair and checking our reflection in the mirror, or worrying about how our breath smells like, because its no longer about who we are. No longer about what we've done, or what we could have done. What can anyone possibly do that can matter, when you're approaching your Maker?

Hands stretch forth, heads are bowed. Everyone's confronting Him in their own way. Worry, guilt, contentment, uncontained joy, quiet happiness, fear, apprehension all chasing each other. At some point though, when our faces have relaxed, our hands no longer clenched and our feet no longer tense in our shoes, we know we're there. At peace with Him, relaxing in His presence. We've accepted His presence and all it entails. It's then that the real worship starts; from this point on, He is truly the centre of our current existence.

Different people, from different lives and speaking different languages, all declaring

"Jesus I believe in You. Jesus I belong to You."

I've seen.

"How great is your goodness, which you have stored up for those who fear you, which you bestow in the sight of men on those who take refuge in you." Ps 31:19

Blind?

The last 10 years of her life have not been kind to her. A rapid descent in fortunes, from being relatively well-off to having next to nothing. A father-in-law whom she loved and respected, a husband whom she adored, all gone. Dust to dust. And now, faced with a move to an alien country together with her mother-in-law, whose people would regard her as an outcast. But more than that, facing the prospect of dying childless, with no one to carry on her family name, to remember her by.

Her mother-in-law saw her consternation and urged her to stay behind. Why join in her bitterness? Why stay and continue to experience hardship one after another? Far better for her to stay back and try to look for another husband and rebuild her life.

"But Ruth replied, 'Don't urge me to leave you or to turn back from you. Where you go I will go, and where you stay I will stay. Your people will be my people and your God my God.' " Ruth 1:16

Amazing that even after 10 years of seeing how God dealt with her mother-in-law (Naomi), Ruth, who was not an Israelite, would say such a thing. Why associate herself so strongly with someone whose God seemed to bring nothing but misfortune? What caused her to stay on?

Manc Weekend

Today was one of those days which come too few and far between. Met up Sam, Prakash, Bobby, Jessica, Nadeesh and Pooja plus all the Liverpudlians and Mancunians in Manchester. I finally got to taste the dim sum that everyone has been raving about since last year. 16 people at a table is a sight not many waiters have seen before apparently, cos they just kept coming and coming with fresh plates of food for us.



All the newcomers spent the afternoon visiting Old Trafford, home to the Man Utd team. Initially , I thought the stadium was smaller than I'd expected. Walking around the grounds though, it was larger than it looked. It was pretty interesting seeing where players would bathe, where the VIPs had their pre-game lunch and where the press conferences were held etc etc. The climactic big run onto the pitch, complete with cheering recorded from an actual game, was hampered by the fact that the pitch was, pitch dark, owing to the time. Not many have seen it at night though.


Tourism in Malaysia is definitely well publicised.


A Christmas present for the fans out there?

Never again

Four pairs of eyes.

Gazing at a sentence on a piece of paper about half the size of an A4. A consultant, his registrar and two medical students. The registrar speaks first. "She's your patient from before isn't she?" Consultant doesn't look too happy. It's hard, telling someone that she may be terminally ill.

Patient in the room, consultant explaining the results to her. Watching a woman suddenly break into tears is something I've not become used to seeing yet. Found myself wishing I was elsewhere, that I suddenly intruded in on a private moment that I had no right to witness. While I'm dwelling on things, the patient is being told she needs to stay for another test to determine extent of the disease.

Patient exits, and consultant makes the call for the test. It is then that he realises his mistake. Being slower than usual (afternoon post lunch syndrome), it takes me a while to get it. When I do get it, I feel even worse than before.

Four pairs of eyes..

Gazing at the test results, all failing to spot the unfamiliar name at the top of the page. The consultant throws the notes on the floor in anger. We've gone and told the patient she's had something she doesn't have. And someone else is in for some bad news.

There may be mistakes that I'll definitely make later on, but this is one which I hope will not happen again.

And yet

Sometimes I forget I have plenty of what I need. And I want more. Which just makes me happy for a while before I start wanting more again. So, in an effort to help others get their 'more', I've started filling shoeboxes.

Memo To Self

DONT put potatoes in a rendang unless I want it super thick.

Sigh.

Free Game

For the med students out there, if you ever wanted to brush up on ECGs and have fun at the same time, go here.

Wait a minute..

Me: Well, am goin out tmrw night with a Malaysian couple I met last week.
A : Hahaha so it's a little Malaysian gathering is it? How did you meet these people anyway?
Me: Oh I met them at church last Sunday.
A : Ah you go to church? Was it interesting?
Me: Yup, pretty much. And its great to see young people there too. Most churches here seem to be made up of older folk.
A : Haha, well, that's pretty normal actually in the UK. There seems to be 2 types of people in church, the old ones who go because church is something they are used to, and the younger ones who are all crazy, which you don't really seem to be.
Me: Crazy? How do you mean?
A : Oh, you know, they won't shut up about believing in Jesus, and keep inviting you to church though you say you've been before.
Me: ???
A : They seem pretty evangelical, you can tell they're Christians pretty easily. It's funny how they won't can't seem to stop talking about what they believe in.

Sunset Story

Boy, all alone, contemplating future and other meaningful tidbits.


A girl appears, also in search of answers.


Having met, they decide to continue their journey together.


Had a great day accompanying Jane and Jan Hoong from Preston around Barrow's coasts, where I took the pics above(haha couldn't resist!), and ate the best fish and chips I've ever had since coming here.


At the town hall.


After a long day, some stony pillows to sit on.

Jon sucks

There are days when everything seems so instinctive, when all the patients seem to present with familiar symptoms, when that last insignificant little bit of knowledge is so easily recalled and when naming the different things that could be wrong with the patient seems second nature.

There are also days when the brain seems to have taken a holiday and when your knowledge seems to have been lost along the wayside; when you cough and whisper your answers instead of speaking confidently, afraid to show your apparent lack of knowledge, when suddenly you find you're not so secure and able a student that you thought you were.

Today's been one of the latter days.

Must see for IMU folks

If you have a couple of free minutes, check these videos out at Esther's blog.

What's my house look like?

"This is what the Lord says, 'Heaven is my throne, and the earth is my footstool. Where is the house you will build for me? Where will my resting place be?'" Isaiah 66:1

"Is it a time for you yourselves to be living in your paneled houses, while this house remains a ruin?" Haggai 1:4

"In a large house, there are articles not only of gold and silver, but also of wood and clay; some are for noble purposes, and are for ignoble." Tim 2:29

Spotted in the tea room of the Psychiatric Ward

Translations in Chinese


Why is it so dark in here?

Wai So Dim


That's a small horse

Tai Ni Po Ni


Get over here ASAP

Kum Hia Nao


Thought you were on a diet

Wai Yu Man Ching

I lied today

Scene 1(to set the scene):
At my GP's. I'm sitting with my partner after lunch.. She practices taking my blood pressure: 80/40. She goes, "Wow, Jon, your blood pressure is reaaallyy low. Maybe you should eat more!" And all because I had just one Cornish Pasty instead of combining it with a pie and/or a sausage roll.

Scene 2:
Gp consultation is starting. A patient comes in, and with her, comes the post-prandial gush of sleepiness I always have to deal with in the first hour or two after lunch as I digest my food. She drones on and on, and my eyes, desperately trying to look interested as I try to keep them from looking droopy..."Jon, are you alright?" from my GP all of a sudden.

Great. A dilemma. Options;

1. Tell the truth. Sorry, I was feeling a bit sleepy. And have the patient look at me like I'm some jerk who doesn't give 2 cents about her problems.

2. Which was-

"Er..(Rubbing forehead to conceal my suddenly awake face and frown) I just had a bit of a headache. Sorry doctor.."


Scene 3:
My GP partner going, "You know Jon, you should really eat more. Let me feel your pulse." And my GP going, "Jon I have some paracetamol and some ibuprofen here. You sure you don't want some?"

FYI

Among the interesting things I learn in psychiatry are how to make coffee...indian style. According to my SHO, what you do is you put the coffee beans in the cup, then add your milk. Mix thoroughly till most beans are dissolved. Then add hot water and sugar (if needed). Apparently the milk added to beans at teh start is supposed to get rid of the bitter taste of the coffee beans.

If you ever go to my SHO's house for a visit, she'll offer you coffee made in a even more different way. She'll boil water mixed with milk first till it's frothy, then add coffee beans/powder and sugar. Will try that when I get back to liverpool. Am in michelle's and ben's place in liverpool now...They have rooms bigger than our living room in barrow!

Full day out tmrw with basketball, football, frisbee all in, so an early nite is in order.

That time of year

Nope not Christmas, but a special time nonetheless.

Miss Chong Hsu Pheen, or Josephine as she likes to be called in the UK. Why, I don't know. Seen here with Alice at the food fair in IMU, for those of you who are going 'hey when was this?'

Aiky Goh, who I'm sure has grown since this. Pictured with David at ChikIan's surprise bday

And lastly, TNF aka Tan Nam Fei who eats a lot and yet doesn't gain weight, unless he hides it really well. Caught stealing food from WenChyi's bday dinner.

Happy birthday guys.

superficiality

At first:

"Phew, I've passed my SSM(Special Study Module)...No need to stay back next summer. Thank you Lord."

Next minute:

"Walau, Alex and Hsupheen got distinction ar...#$@%^&*"
Plus, like I was telling hsupheen, can't even blame different tutors cos we were under the same tutor.

Goes to show how subjective emotions can be. And how superficial I can get sometimes; a side of me I don't show as much as possible.

*btw, nice work alex, hsupheen and whoever else who got top marks. No hard feelings ya?* :-)

For what is in the light....

Disclaimer: This post is not anti-establishment or anti-authority in any way. It merely reflects the author's views and personal journey of discovery. He may not know enough or know any better, preferring those who read to form their own conclusions. Also, non-medics are advised not to read this unless they want to be extremely bored.


This post will probably make sense more to the medics, but I posted it because its a sort of revelation to me how things happen behind the scenes in the 'system' in the UK. Recently the small surgery in the community I go to brought up some interesting issues. Most of the GP visits have been good fun so far, with my only regret being I wasn't at another practice when a certain celebrity visited.

Anyway, my GP asked me to look up results of a trial called ASCOT, which basically compares medicines for treating high blood pressure, which is pretty common in the community. The results of this trial was supposed to be groundbreaking(jargon coming up). Results showed ACE inhibitors and calcium channel blockers were more effective in the treatment of hypertension (high BP) than the traditional treatment of beta blockers and diuretics. Being a typical student who doesn't look up trials and journals for 'self-development' often, I had no idea where to look. What I did find out, was interesting though. To cut a long story short:

- ASCOT was considered so groundbreaking it influenced the British Hypertension Society and NICE (National Institue of Health and Clinical Excellence) to change their guidelines.

- Soon the entire country will experience a change in the drugs given to treat hypertension due to the change in guidelines mentioned above.

- However an increasing number of doctors are concerned about the validity of ASCOT, as large and as effective as it sounds.

- A search of letters in BMJ showed doctors from all over the country writing in to say:
- ASCOT's primary outcome was statistically insignificant and most of its successes were in
achieving its secondary outcomes.
- Failure to achieve primary outcomes would constitute a Type 1 error which would make any trial irrelevant.
- The treatment regimens in ASCOT compared an established regimen (amlodipine) with a
underpowered regimen of atenolol, which could potentially mean the trial was skewed from
the outset.
- If anyone is so inclined, you check the various feedback here if you enter BMJ via your uni's
Athens code.

Bottom line? even though I am not a fan of looking for problems when there are none, and creating controversy out of molehills, I think I've seen enough to understand why evidence-based medicine is both necessary and yet so dangerous when wrongly manipulated. Consider this maybe hypothetical situation:

NHS is in the unenviable position of having to govern the medical profession in the UK and having to promote and encourage drug research as well. In between keeping both happy, compromises have to be made, sometimes at the cost of the public. Say due to the results of trial A sponsored by drug company X, reception by the public is great. Suddenly everyone who has that illness wants to be on drug A. New guidelines are drawn up to accomodate drug A while people request that their treatment be changed to include drug A. What people do not realise is that these results, while looking good in the news, may not necessarily hold water under critical analysis. And while changing people to drug A may not cause any unwanted side effects (even if real evidence shows that actual benefit is negligible), people forget the cost involved.

Case in point: Cervical ca screening guidelines changed from 5 yearly to 3 yearly.

Surely more money involved rite? But is it cost effective? To get an idea, listen to the question as proposed by a article:

"Suppose you are faced with the decision about investing GBP 385,000 annually to benefit your local population. You can prevent one death every 22 years by routine 5 yearly screening beyond age 50, one death a year and harm an extra 1,000* by switching to 3 yearly screening under 50,

OR

10 deaths a year through support that helps smokers stop, and have enough spare to provide first rate nursing care and family support at home for 183 patients facing death from cancer.

Which would you choose?"

*by false positive diagnosis

Which means, hypothetically, NHS are going to lose even more money and the public are not going to get healthier, and docs are not going to get paid more, rather the reverse. Which has implications for those of us wanting to stay back.

Haha I sound like a bitter old cynic now.

Guess the whole point (wow if you're still reading you must really be into this. *pat on the back!*) of this is, the realisation never to take anything at face value, no matter how amazing the news sounds, and how credible the source may sound. And the need to really start keeping myself up to date on these things..cos patients know so much more than us its scary.

"These people come near to me with their mouth and honor me with their lips, but their hearts are far from me. Their worship of me is made up only of rules taught by men." Isaiah 29:13

"...In repentance and rest is your salvation, in quietness and trust is your strength, but you would have none of it. You said, 'No we will flee on horses,..' " Isa 30:15,16

"Woe to those who go down to Egypt for help, who rely on horses, who trust in the multitude of their chariots and in the great strength of their horsemen, but do not look to the Holy One of Israel, or seek help from the Lord." Isa 31:1

"For the sake of Jacob my servant, of Israel my chosen, I summon you by name and bestow on you a title of honour, though you do not acknowledge me." Isa 45:4

"Even to your old age and gray hairs, I am he, I am he who will sustain you. I have made you and I will carry you; I will sustain you and I will rescue you." Isa 46:4

The Importance Of Barrow

What's to stop countries from launching nuclear missiles at each other? Why, the knowledge that retaliation would occur swiftly and surely in the form of nuclear missiles aimed right back at them.

And why is Barrow involved in all of this? Barrow the 'ulu' place that people fear being thrown into for a year, the place where people excape from on weekends in lieu of bigger cities, where you can see sheep from your window; this small quiet town is actually, the base of Vickers Shipbuilding and Engineering Limited. This company manufactured 4 Vanguard-class nuclear-powered ballistic submarines, which are, at the moment, the United Kingdom's ONLY nuclear deterrent. For the military buffs, read about it here.

So do not mock Barrow. Especially since got ASDA and Tesco and plenty of bookstores.

The zoo

A nice hot day for a walk to the zoo..Just to give you guys an idea of Barrow countryside. This is a view of the small village of Dalton.

Arrived but minus friends, so settled down to wait. Got bored so started snapping. These flowers were at the entrance.

Car park looks nice and full.

Finally they arrived. From left to right, Ed, Tom, Alice(hidden behind Jay) and Hsupheen. This is when we saw:

Not the most reassuring sign to start with. Somehow we began to think that there was some kind of discrimination going on too:

Anyway, most of the animal photos can be viewed here. The highlight of the trip was seeing the tiger feeding session where they put huge chunks of meat on top of poles about 2 stories tall. The idea is to get the tigers working for their food so they won't be fat pussycats who sit around waiting for their dinner.

The downside was, seeing the giraffes. All seemed well at first, until one of the 3 giraffes present began to spread its legs. I kid you not. And started to wee. That was ok in itself...when you've got to go, you've got to go, no matter how many people are watching you. But what was even worse was that the neighbouring giraffe, for some reason known only to itself, began to duck under the weeing giraffe and lick its wee.

That was not the worst, by any means. What was worse was directly after that, feeding time came around:

If only they knew. And even though she saw the whole thing, someone just couldnt resist:

All the while I was trying to avoid the animal and stay within camera distance.

After that Ed was on animal touching mode too. But all too soon, it was time to leave. (Actually we had to do groceries) But before leaving, one more shot.

South Lakes Animal Park: Well worth a visit. Just remember to bring a Asda receipt when you come, cos for some reason that gets you GBP 5 off the price.

Just came back from playing pool at the docs mess in hospital where we were joined by this paediatric SHO from Pakistan. We had quite a conversation while he was trying to get his shots lined up. Among the stuff we discussed:

"So, how much are all of you paying to study here?" (On the list of Top 10 Questions to ask a Malaysian student)

"Erm, about 16,000 pounds a year."

- stunned silence -

"So how much did you pay to graduate back home?"

"Well, (and he gives an apologetic look) I paid 150 pounds for my medical education back home."

"Actually (he continues), I am very pitying you. How in the world are you going to pay back all that money? I am earning about 2000 pounds a month as an SHO here and I am only saving about 12,000 pounds after working here for 2 years. And do you know now the NHS is paying doctors less and less per year?"

Maybe becos I'm fortunate to have parents and a family that always assures me not to worry about cost whenever I attempt to broach the topic, or because I am heartless enough to forget time and again that I'm being sponsored and cash doesn't just magically appear in Natwest for me, but I've not really sat down and considered that part of the question yet.

But its one to think about nevertheless. Cos in 2 years I'll be graduating. And the big question; stay or go back. And all the other factors to consider. Can't avoid it forever.

At least i won the game.

embarassing

another sign of age. was at the hospital shop to get an envelope and stamps and on paying the GBP 2 bill, found the only note in my wallet was a GBP 50. Looked up at cashier, shaking her head. First thing I heard was a loud sound of compressed laughter from someone behind me. Looking back, could see a long line(mostly women) laughing at me.

Ok, embarassing...move on. Right.

So today I took a history from a couple who came in worried because their 16 month old baby had a breath holding attack. They were pretty worried, understandably but the child seemed fine. Did the full history and wrapped it up quickly as they were about to leave. As I walked out with them, the lady asked me "Weren't you the lad with the 50 pound note at the shop yesterday?"

"Oh (rats)..haha. Yes that was me." (should have stopped here but...) "Yup wasn't that funny? Did you know there was someone just behind me who went 'pfffft!' and started laughing?

Mum looks at me.

"That would've been me"

birthdays

so I was wondering what would happen at 11.59pm 20th september and during the next 2 minutes. will I be endowed with 'the wisdom of 23-ness' and pass on from the naivety of 22 all at once? Would I be a better person, better equipped to deal with people and relationships and work and responsibility and blame and bills and all the other stuff adults tend to be bothered with?

22 to 23. Isn't it just numbers in the end? Change is never instant (except in some blinding flash I alluded to in my previous post) and I believe thats what marks growth, not age. Speaking in that sense, I hope I grow up 2-3 years before I 'turn 24'.

Hard to undstand leh...

One of those instances when something stands out above the muck and mud of life. Like lightning that stabs out the surroundings in stark white contrast. When what's really vital is revealed and all other preconceived notions, petty jealousies, future plans and accusations fade away in a second.

And when we finally understand, something of what it cost to say, "Not my will but Yours be done."

random

'knock knock'
'who's there?'
'the interrupting sheep'
'the interrupting sheep wh-'
'BAAAA!'

How many have we killed?

"He can be a handful at times." The consultant twiddling his pen and alternating between his notes and the slightly ruffled mother in front of him. "How's he at school?" Mum frowns for a while, trying to decipher the Indian accent, then "Well, he's all right. The teachers know about his condition and all." The consultant turns back and scribbles on his notes.

"What does he get excited about?"

"Well, he goes mad over pipes and plumbing. Before that it was anything purple." Mum smiles apologetically. At that, the kid looks up. "Long ones, mum!" For the first time he looks interested. "I like.....long ones, short ones.....around and around." Pulling at his mum's sleeve.

****

"Now, you should all be able to tell it when you see it. Can you point out the signs of PVS in him?"

"Erm...not being able to maintain own respiration, in a comatose state....erm"

"Ok you lot, that's your reading job for today. Case reports in by end of the week, please."

....


"I appreciate your concern, Mrs.. but I'm afraid that keeping him on any longer will not be of much use."

****

Disregarding the definition of consciousness in a patient in exchange for his signs and symptoms. All along we thought they couldn't hear and had no chance of understanding. Even the ones who seemed to be in a world of their own making, whether by familial association or otherwise. Put together by classification and labels made to ease the labour of trying to describe a difficult and complex presentation. But what if they had, in fact been aware all along?

-Prompted by the news that MRI scans showed a patient in a vegetative state responding to verbal conversation in a similar way to a normal person.

barrow in furness

After a long flight, am still having the jetlag and having only a day to move in a whole living room-ful of stuff into a 1st floor flat, I've started my 4th year in this wonderful place, this idyllic retreat, this bucolic residence, a veritable heaven-on-earth called Barrow In Furness. If anyone is in the mood or has too much free time on their hands, please do the good deed and send a mail to

CAR2A Carley House
Abbey Way
Barrow In Furness
Cumbria
LA14 1BP
UK

And you'll make a certain medical student's life that much better. Am going in with a bang straight into paediatrics. SHOWED my ignorance earlier this morning already when asked to define urinary tract infection. My holiday-rusted mind struggled to come up with a definition suitable to the occasion (it was handing-over session with a consultant hearing patient reports from the doctors on the previous shift) and he caught me out, polite laughter sounding as he did so. Lots of other stuff to read up on...which makes this short break at the library pretty guiltifying.

Good news is, edward's applying for broadband and should get it fairly soon. we're getting to know the other people on rotation, all of whom seem a nice friendly bunch, if a little prone to over-imbibement. haha! Btw the next big attraction is a beer festival in nearby ulverston this weekend which is receiving no end of attention here.

Else, all still normal and in my email list today heard good and bad news from people back home. Keep me in prayer as I keep you guys too. Wil be heading out looking for a church this weekend and hope to see a bit more of barrow than i have at present. Hopefully my next post will be from a nice fast wifi connection.

What I've Been Doing 2

From my testimony in Prof Paul Chen's church last Sunday about the visit to the Jehai Orang Asli (indigenous people of Malaysia):

It was my first time:
- Going on a trip with so many females (Prof and me being the only males)
- Sleeping next to a professor whom I'd previously only seen way up front in a huge lecture hall
- Going on a 6 hour drive constantly either praying, singing, or sharing stories
- Praying and sharing my testimony in Malay

What I've come to know in some small way:
- The needs of the Orang Asli; education, a source of clean water, better housing being some of the more pressing ones
- That in a mission field, one has to be prepared for anything. As in each of us were given specific tasks to do ranging from snail gathering to mapping to dispensing medicine to praying for the sick, but everyone was doing everything by the end of the trip
- That I often believe in God for only what I can possibly see Him doing, nothing more
- That I don't have to look far abroad for a mission field


More of an exposure than a real mission trip, and I was really pleased to meet the group of IMU CFers who are going on the next trip to the Jehai village. Friendly bunch of people with a lame streak; but radiating an expectancy and excitement about going into the field...not many of those left.

Not going to upload any photos here as I'm a bit dubious about the wifi connection in Vista, but will put them up soon. Ditto for the Penang photos.

Penang was great to eat in, and Grace's aunt's place was the nearest I've been to a ski resort. Beef noodles, kuay teow, fried chicken skin, Hokkien mee; you will all be missed sorely. The company was good too, especially sarah who probably has a few extra strands of gray hair from rushing us to one foodie place after another. And thank God we made it without a scratch from the motorcyclists who seem a breed apart in Penang.

Things are winding down nicely, and after a movie with Sarah and Cindy, I'm gearing up towards my last few weeks at home.

New

Back at home, life is a blur of eating, reading Tintin which my sister sneaked from the school library, playing Neverwinter Nights, watching movies and catching up with friends, all while attempting to pracpost. tice cooking in the meantime.

One thing i havent been doing, though, is going online, which explains my late post. Its been a month, and am entering the second and final phase before heading back to cold, gloomy and miserable UK. Its the last thing on my mind now. Another first is using my laptop's WIFI for the first time, when the technology is already obsolete (i'm using b instead of g).

Next week will see me going to the Belum Forest area for a medical missions trip to the Jehai community. Before this I had no idea that there existed at least 4 unreached people groups in Malaysia, which have little contact with the main population groups. Nomadic hunter-gatherers since the dawn of time, they have now, thanks to Prof Paul Chen and his ministry, been able to start growing their own food and are no longer so difficult to locate due to their constant mobility. I'm supposed to map out the village for an ongoing research into the infectious diseases endemic in the area. Being the ignoramus that I am, I was given my first lesson in compass-ing just yesterday. The trip should be great, if a bit wet, as we're staying on a houseboat.

Meanwhile I'm bunking at Sarah's and Zhao's place in Vista, where people come and go during breaks. Here's to the next month!

The Wait is over

Few things at this time in life can compare with the tense feeling in the pit of my stomach when I saw the words 'Resit' on my exam transcript. Well, not totally unexpected, but still, having to fly back early is no fun to ay the least.

Fewer things can compare with the feeling of relief when I saw the email from faculty which told all medical students to ignore the 'Resit' notices because there was a failure in the system reulting in all students getting the message. As long as we'd passed all the individual exam components (which, praise God, I did), we were considered to have passed.

After congrats from the Liverpool bunch (who all passed, btw - yay!), congrats from parents, and while waiting for this page to load on my dailup account, I am overwhelmed with thankfulness to God. A second chance of sorts. An act of mercy. Without going into all the musings about what would''ve happened had I failed, I'm truly grateful to Him for this journey He's bringing me on and all its realisations in between.

Now I can go into OT tmrw relieved.

Last night blues

In a well populated kitchen

Our last night in Liverpool, our last day really, was a blur of packing, struggling with huge boxes up and down 2 floors and a mad dash 2 hours north to move our stuff to Barrow. That was just half; tmrw we're moving Alex, Tricia and Jack to Southport. If we're knackered tonight, tmrw will be no better.

For our troubles, we managed to get hold of a van which Hsupheen drove around. Acording to her, refined girls do not drive vans. This I leave to your discretion. Against all odds, we managed to get back in time for dinner and to hear England beat TnT 2-0. Woohoo.

Our last lunch in Liverpool? By some common consent, though we were miles apart, all of us for some reason ate fish and chips for lunch. Except Edward, who had a chicken burger and chips, so its probably not significant. Dinner was of course the necessary finishing up of all the frozen food that we'd not managed to cook so far. Sausages, chicken and chips/hash browns galore. Aiky, you'd have probably died.

And now, the sound of vaccuum cleaning fills the house as one by one, rooms are being dusted up, vaccuumed and polished, just so that none of us incur the wrath of the management after leaving, forcing to pay an exorbitant amount of money for 'notvacuuming under the bed'.

Our kitchen on the last night

As I write this, Hillsongs' Through It All is playing on my laptop, the only thing left on my tabletop. Pretty apt, as He definitely has been faithful, to His word to keep me/us safe from harm this year. I can think of at least 2 occasions where serious consequences might have ensued if things had gone otherwise, but didn't. He's been faithful to bring us through every obstacle, from fitting in with an alien culture to doing relatively well in studies, to bringing people like Christine Tierney to help us out. Forthcoming exam results notwithstanding, I just have to mention that He's definitely played a big part in providing for us as well, from a church to settle in, to friends who've been a great help and jobs for those who needed them too.

My last night sleeping on an empty bed with no sheet or duvet.

Next post in Malaysia. Whoopdedoo!

A year has passed Set 1

Settling bills night - where we try to push all the coins to one unfortunate person, then having to get coins from them for laundry

A chance meeting in Nottingham

In Paris for Christmas

In Scotland

Kitchen - where we spend our evenings

Future docs - your lives are in our hands..bwahahaha

BBQ@AgnesJones

I3 2006