Monday, December 26, 2011

A belated happy Christmas!

In his hand is the life of every creature and the breath of all mankind. job 12:10

For whoever wants to save his life will lose it, but whoever loses his life for me will find it. matt 16:25

Obsession with slf in these matters is a dead end; attention to God leads us out into the open, into a spacious, free life. Rom 8:6

It's in Christ that we find out who we are and what we are living for. Long before we first heard of Christ and got our hopes up, he had his eye on us, had designs on us for glorious living, part of the overall purpose he is working out in everything and everyone. Eph 1:11

Sunday, December 04, 2011


According to this list, I'm living in the 153rd most liveable suburb in Melbourne. Oddly, my hospital is a ten minute walk away from where I live and its in the 37th most liveable suburb. Apparently house prices where I live are roughly 400-600K Aussie, which is supposedly good value-for-money.

And thats out of 314 suburbs in total!

I think I need to go order some takeaway pizza now. Menulog - what a great discovery.

Tuesday, November 29, 2011

My Marianas Trench

I think I've probably reached my lowest point today. And really, it can only get better from here. And step 1 to making it better: sleep early.

Saturday, November 05, 2011


From the Encyclopaedia Britannica
'Nineveh, the oldest and most populous city of the ancient Assyrian Empire...'

First mentioned in the Bible in Genesis 10:11, where a chap called Cush 'built' it.

Not seen until Jonah, where the focus was on Jonah running away from a summons to preach against it.

'That man deserves to die for what he did.'
'Why do I do stuff like this to myself?'

Like Jonah, it's easy to pass judgement on everything, even on ourselves (probably why anyone could judge X-Factor!).

'But the Lord replied, "Have you any right to be angry?"

The right to be angry is a given, what isn't is how we proclaim judgement and refuse to take God's considerations into account. Self-pity, jealousy, anger, bitterness, unforgiveness; all are part of the emotional spectrum implanted into us but if I let these take over my actions without allowing God any say, its not going to produce the best results.

But what stood out for me in this reading of Jonah 3 was how the king of Nineveh responded to Jonah's message.

The king of the city 'rose from his throne, took off his royal robes, covered himself with sackcloth and sat down in the dust.'

No one responds to a wayward prophet like that, certainly not the king of an important city unless he recognises the God behind the man.

More PACES stuff

1. Before doing anything, check for scars - a midline sternotomy scar without a corresponding vein graft scar on the legs suggests a valve replacement (AVR has a flow murmur with a loud 2HS)
2. In Blalock-Taussig shunts - there is usually a midline scar + L/R posterior thoracotomy scar
3. Whereas in complete repair of VSD the only sign may be pulm regurg/stenosis

1. In 3rd CN palsy, check with cover test to exclude lazy eye.

4 causes with scars (pneumonectomy, thoracoplasty, lobectomy, lung transplant)
4 causes without scars (effusion, fibrosis, bronchiectasis, COPD)

Thursday, November 03, 2011

How I prepared for PACES

I had thought about writing this post for a while, if only to serve as a reminder to myself because I'll likely be needing to repeat the exam next year. But also I guess I'm hoping to give other first-timers to the PACES bit of the MRCP some idea of what to expect. Most of the following can actually be found on the PACES bit of the MRCP UK website as well.

First up, the format:

PACES is 5 stations of 20 mins with 5 mins break in between each station.

Station 1 is Abdo Exam (10 mins) and Respi Exam (10 mins)
Station 2 is History taking (20 mins)
Station 3 is CVS Exam (10 mins) and Neuro Exam (10 mins)
Station 4 is Comm Skills (20 mins)
Station 5 is 2 cases of either skin, eyes, locomotor or endocrine (10 mins each)

For the examination stations (1 and 3) you'll get 6 mins to examine and 4 mins to present your findings and be questioned by the invigilators (there'll be 2 in each station with one doing the talking).
For the history/comm skills station you'll get 14 mins to either take a history or resolve a comm skills situation (eg breaking bad news or calming a patient after a prescribing error), 1 min to put everything together and 5 mins to present to the examiners.
For station 5, you'll have 8 mins to take a history/examine each patient and 2 mins to present and be questioned by the examiner.

At the start of the exam you'll be ushered into a room with your other 4 candidates (5 to a stream) and have to fill out your name and examination/center number on 16 marksheets. These, togetherwith your steth, and a pencil are all you have to bring around as you go (though people have also brought their own opthalmoscope/pen torch etc - all these are provided).

You'll then be brought to your stations and have to wait for the bell to ring, signifying the start of the first 5 min break. When the bell rings again, the door opens, a friendly examiner's head pokes out and the exam begins!

In terms of preparation, the key books that I've been told about are Ryder's Aid to the MRCP PACES, Cases for Paces and Baliga's 250 Cases in Clinical Medicine. Certainly most people I've spoken tohave read through the first 2 of these. The other key is to form up a practice group with other PACES candidates and start compiling a list of patients with signs to practice on 2-3 months before the exam and testing each other(trying to get consultants/regs to supervise whenever possible).

A PACES course is a good idea just because of the sheer amount of patients with signs to see - there is always some practical advice worth gleaning from these courses as well (some of which I will try to reproduce here) and to get an idea of how you stand with other candidates in terms of preparation.

Practicing comm skills and history taking with your PACES buddies is also a good idea to get an idea of time (so you have a sense of how long 14 mins is in an exam situation) and the comm skills in particular are worth working through as there are some points to be gained from practice (eg remembering to ask how a patient is going home after breaking bad news - ideally someone at home with her and not driving alone)

Paces Tips I Should Remember:
1. When presenting after each case, its a good idea to take the steth off and put my hands behind my back and to NOT look back at the patient while presenting to the examiners.
2. When presenting a CVS patient, always a good idea to mention the presence/absence of 'peripheral stigmata of infective endocarditis and/or heart failure'
3. When presenting a Respi patient, always good to mention the presence/absence of 'pulmonary hypertension'
4. When presenting a renal transplant patient (in the Abdo station) always good to mention the presence/abscence of 'modes of renal replacement therapy eg AV fistulas and whether they are working or not, signs of immunosuppression'
5. Always good to give an idea of the diagnosis of why the patient has had a renal transplant, or an enlarged liver, or pulmonary fibrosis etc
6. Always mention the key phrases 'I would like to complete my examination by...' (differs according to each system eg CVS - doing an ECG, checking the urine for haematuria and checking the BP / Respi  - checking the bedside obs incl O2 sats, looking at the sputum pot, doing peak flows and checking for signs of heart failure / Abdo - checking the hernial orifices, checking for inguinal lymphadenopathy and doing a PR / Neuro - doing a full upper/lower limb neuro exam and checking for cerebellar signs)
7. So a complete presentation might sound like 'I've examined Mr X who looks tachypnoeic at rest with a RR of 22 breaths per min. He has evidence of clubbing and central cyanosis and has a productive cough. His positive findings on his chest were coarse crepitations on both lung bases which changed in nature with coughing. He had no evidence of pulmonary hypertension or pitting oedema to suggest heartfailure. My diagnosis for this patient would be that of bronchiectasis. I would like to finish my exam by checking the sputum pot, checking his bedside obs incl O2 sats and confirm my findings by doing bld tests to exclude infection as well as a CXR to look for evidence of basal consolidation. I would also send the sputum off for culture/sensitivity.'
8.Cases for Paces should really be the baseline reading book I think - its a good springboard to more xomplex stuff however Ryder is also well worth a read, if only for the pictures and the comm skills/history taking scenarios in Book 2.
9. I also used the Pastest Online website which is not, as you might imagine, an ideal way to practice for this exam - but it does give some idea of what to expect as well as some good pictures/spot diagnoses to look at.
10. Do a mock exam - useful to get an idea of what to expect and to gauge where you stand with other candidates - its useful after you'vedone some work, but even if you're not fully prepped, its good for that figurative kick in the butt! Also those who've done one don't seem to have that fear of the unknown on the day of their actual PACES.

All the best if you're prepping forit and if you're prepping from Australia, specifically Melbourne Australia, let me know and we can buddy up!

Tuesday, November 01, 2011

So it's the 1st of Nov is it?

Happy birthday Pa!

The second photo is from Linda Tan who took both of you recently - a pretty good one I thought!

Saturday, October 29, 2011

Liverpool One has a Lego shop!

So its only fair I celebrate this with some cool Lego videos.


If they don't get their act together, how will I get home next Thursday?

Friday, October 28, 2011

Cool songs on Scrubs

Or other ways to spend the time when I should be studying

Tuesday, October 25, 2011

Monday, October 17, 2011

Friday, October 14, 2011

pub fish pie and leffe.

back in London

UK Part 1

Arrived safely am and installed in 84 Cleveland Road where the landlady keeps a typical establishment reflecting a cosy London townhouse lifestyle. Plush carpets, old bookshelves (self restraint!), leather armchairs sitting beside polished wooden bureaus and an upright piano which I'm also tempted to try out.

Am not looking forward to the course this weekend but am resigned to the fact that I DO need the practice and that I'll probably be the noobiest of all PACES candidates ever to be involved this late in the process, but never mind. I'll be as thick-skinned as I can and put in as much work as possible these next two weeks and we'll see how it goes. Hopefully the fat lady will leave her song till the very end.

The flight was really a bit long, even for me. 12 hours in a plane - 4 movies and 2 longish naps plus 2 meals - perfect DVT-genic material. No way I could do this for any length of time, UK, as much as I love coming back to you, I'm glad I'm that much nearer home nowadays.

Saturday, October 08, 2011

Sunday, October 02, 2011


'I will meditate on the glorious splendour of Your majesty, and on Your wondrous works."

Saturday, July 30, 2011

What I've come to realise

"It always protects, 
always trusts, 
always hopes, 
always perseveres."

Saturday, May 07, 2011

To Elaine and Gus

Have a brilliant start to your lives together!

Sunday, March 27, 2011

What's better than Glee?

The clips I enjoyed the most from the Youtube selections off Season 2 of Sing Off!

Sunday, March 13, 2011

Tuesday, March 08, 2011

Remember this?

Back in the day of MYF musicals, this played out on a stage in a church in Sitiawan. A story of Peter's journey as a staunch follower of Jesus to his denial of Jesus at his capture and Jesus's redeeming love that forgave him; this paralleled with a modern day married young professional faced with the daily choice of acknowledging Christ at work and at home.

THough they did use backing tracks, the singers/choir really did it justice as you'll hear below.

And my favourite, echoing the call that embraced, loved, empowered and sent out, all at once.

Thursday, March 03, 2011

Every small step/-

Funny how we sometimes expect things to change overnight and the next day - the sun rises as usual, we are our usual grumpy selves as we shuffle towards our morning coffee. Small steps.

What I've done this week so far:

Supervise a knee aspiration on a patient with septic arthritis.
Realise that I need to make more effort to chase patients up after they've been discharged under my care - just to see if I'm doing the right things.
Done a load of discharge summaries - felt good at the time but the cupboard will soon be full again.
Took my first look at the hospitals on offer in Melbourne.
Reminded that before resisting, I need to submit (James 4:7).
Bored out of my head prepping for Part 2 - though I do feel it IS making me more confident clinically.
Intermittently spending time on Battlefield Heroes - lvl 26 never seemed so far off before.
Spent an hour reading through the Junior Doctor's blog - and laughing about people mouthing off in the comments section (seriously Jon, get a life!)
First long distance landline call to Squeaks, wish Skype would work better.
KFC for lunch! Seriously tempted to eat the other 2 pieces (got a repeat order for free off a coupon) but decided not to have too much of a good thing.

Btw, if anyone is up for 15 mins to spare, have a gander at The Lost Thing. The trailer looks pretty good, and it won an Academy Award for Best Animated Short Film at the Oscars just gone.

Also, Bethany Dillon rocks.

Saturday, February 26, 2011

A cOg in a well oiled machine

When the music starts playing and the playing field is silenced
Drum beats and the scrunch of newly mown grass underfeet
Palms slightly wet from equal halves nervous perspiration and acute anticipation
Gripping icy cold microphones waiting for the solo sequence

Eyes traversing passages of music, breathing in time echoing to either side
Raw numb fingers on steel strings, pick trembling ever so slightly
Blinding lights reminding us we're on display
An undertone beyond that swells and ebbs, a sign of the crowd awaiting

There have been moments when we skim effortlessly (it seems) through the opening strains, when the guitar riff heralds an anticipatory applause, when dancers weave in and out in perfect timing to the music, when the drum solos herald a faultless march and the formation square stays tight through a full rotation, expanding out into a 6 pointed star, when we don't even notice we're gliding through the most difficult passages because it all feels so natural and in tune with each other, when the stage turns from a living room into a busy bar in a heartbeat and the video transitions go off without a audio/video hitch, stage helpers running through with no wasted effort, people at their markers on time and anticipating the key change, when the baton is caught after a 20ft high throw and the ribbons and flags cut through the air, biting and weaving at exactly the same moment, when the last lilting woodwind passage melts into a perfect decrescendo, when your entire body trembles from being emotionally caught up in the song/dance/performance; a frisson of excitement from being in the zone, when the audience is forgotten and perfection suddenly moves from the realm of impossibility to being tantalisingly within reach.

Was listening to the OST of Wicked - and it brought back memories of being in musicals and military band performances, of being a cog in a well-oiled machine.

Sunday, February 20, 2011

Malaysia 2010 - good times

On the ferry to Penang

Oyster omelette Penang style

The family photo that nearly never happened

Kampung Baru


Vincent and Maureen and Brayden!

With Wima in Ayer Tawar

Claypot rice in Penang

With Wen Jen, Suet San and Hang Sheng @ Old Town Kopitiam

On Penang Ferry

Saturday, February 19, 2011

Am I a gamer? Part 1

While SOME PEOPLE may find it hard to believe I didn't go in for all night DOTA and wake up at 3pm the next day, I definitely dabbled in my fair share of games growing up. Here's some that I'm looking forward to this year (if I get time to play them that is):

Thursday, February 17, 2011

Business Class @ Emirates

A number of really cool things happened over the course of the past week but today's really all about me flying one step up from cattle class with Emirates.

To begin with, checking in was a breeze - though the red carpet felt a bit contrived - perhaps they think while you're paying a few hundred quid more for your tickets you're entitled to possibly have slightly more cushioning for your feet?

The Emirates lounge at KLIA was something I'd almost forgotten I could access - just in time for a nice snooze away from the rush of the airport as it WAS midnight at the time. Also a good chance to grab a shave (see? taking your advice already squeaks!).

But of course the moment I'd been waiting for was when i presented my boarding pass (though the lady did ask me whether I was sure I wasn't in Economy - probably didn't dress the part enough). The usual bustle faded away as I entered the private section of the plane normally reserved for the suited and the booted.

Having secured an aisle seat, I briefly wished i'D actually put on a coat just so I could've asked the stewardess to take it away and hang it up for me. Turning my attention to the seats - my first worry was that the TV screen was way too far away for comfortable viewing however it was substantially larger than what I'd been used to. And my were the seats roomy.

Essentially you got two personal reading lights, a central console for controlling your chair's various positions which could be saved for future use (meals, sleep etc), tv controls and privacy controls. This last one meant raising up a screen that separated you from the guy/girl sitting right next to you. I spent quite a bit of time getting used to the chair's controls - not being very deft with the fingers and puzzling out techy stuff but before too long, paraphernalia started arriving to keep me busy elsewhere.

The first thing I was given was a sock and eyepatch combo - I suppose just in case peopl needed a change of socks? Stuffing them into the pouch underneath the screen with the complimentary blanket (which I never use), I contemplated the second item they gave me - a travel bag complete with everything a sophisticated traveler could need down to Bvlgari eau de cologne. Another stewardess then appeared with the menu and a wine list - by this time I'D Kicked my shoes off and was preparing to enjoy myself thoroughly - helped by a glass of juice and bottles of mineral water they offered even before we'd taken off.

After I was handed a noise-cancelling headset and was done watching a couple of episodes of Friends, the snacks arrived - none of your usual peanuts with a plastic cup - these were sandwiches of capsicum, feta, tandoori chicken and salmon with a slice of chocolate topped sponge to help it all go down. I'd been puzzling about where the table was - needn't have worried as she basically reached into the center console and pulled ou a huge foldable table overlaid with polished wood. Over this she placed a white cloth and then proceeded to set the cutlery and meal down. Huge salted nuts did get served later (still not sure why nuts are such a big deal on airlines in general) which were a bit much at that point.

THat led nicely on to a snooze (the most horizontal snooze I've ever had in the air) from which I was awoken by the stewardess tapping lightly on my knee to ask ever so quietly if I'd like some breakfast. This whole process started again with the folding table, upon which a tray with yoghurt and a plate of fruit was placed. The stewardess then brought out a hot tray of rolls, from which we made our selections - while we were making our way through these, the main bits of the meal (these came not in plastic packaging but in proper plates) were served separately. Though I think the quality of the main meal itself was pretty similar to what we'd normally have in Economy - which isn't bad at all.

On preparing to disembark - the stewardess noticed I'd left the eyepatch/sock combo and the travel bag behind and pointed out they were mine to take away which was nice - we left the plane on a separate exit and basically entered Dubai on a walkway above the main central floor away from the duty-free crowd where we proceeded to the business lounge to await our transits.

I'd definitely do it again!