I'm normal

6 weird things about me, then tag 6 other people to do the same.

I think I'm pretty normal however. Nothing interesting about this boy in particular. In fact, after reading about Jack's deformities, all I can come up with are

1. My deformed jaw. In fact, it's best shown in my side profile:

In fact, when you look at me from the front, and take a few moments to appreciate my teeth and how gloriously white they are, you'll notice that my upper set of teeth settle far behind my lower set of teeth, like so.


This gives me the appearance of a constant pout. And a very ugly pout at that. This jaw apparently is known as an 'overbite' and is a dental condition that can only be corrected by surgery. If at some point in future I become sufficiently interested in joining America's Next Top Model, I will have to let some orthodontist drill into, and cut out bits of my jaw in order to bring the upper and lower jaws back into their normal position. For now however, I rest in the knowledge that, should I ever enter a head-on collision with something, my jaw will give me plenty of warning before any other part of my face gets hit.


2. Maybe due to my jaw, my second claim to fame is my constant blowing air upwards towards my hair. I'm still not really sure why I do this. One theory is that it was a way to keep my hair from falling over my eyes way back, before I succumbed to water-based hair gels. My only consolation is that I don't do it so often now. Only when I'm alone.


3. I pull at my hair.

Especially when I'm stressed/thinking/when I have absolutely nothing to do. Again, I have no idea where this came from, but its a habit that has stuck with me since secondary school. I have fond memories of friends assigned to hit me hard every time I pulled at my hair way back when I was in Sitiawan. The amount of hair that I pull out on a daily basis is frightening, even to me. Leading to my friends' and family's predictions that I will be bald before I turn 40.

And scarily, I still do it. Right before exams, and even during exams. And considering I'm among the minority of people my age to still be studying and not working, it means I'll go on doing it for a while yet. Actually, come to think of it, I will probably carry it on even when I'm working.

Can't do it when I'm in a operating theatre though. Which leads me to believe I'll never make a surgeon. Imagine being stressed out in the middle of a operation, but not being able to pull at my hair!


4. I tend to swallow air down my esophagus, and burp it silently to myself. Well, sometimes not that silently, and people have scolded me for making 'funny noises' before. Funnily enough, I've discovered there's actually a medical term to this: aerophagia, which literally means swallowing air. I tend to be able to control this to a great extent now though, thankfully.


5. I'm really scraping the bottom of the barrel for weird thing to talk about now, so I'll mention the way my head tilts to one side when I think I'm looking straight ahead. Like in the photo I think I'm looking straight, but actually:

My head's tilted to the left.

I first noticed this when I was marching in my school military band way back in secondary school. We were standing at attention when a senior came up to me and barked "Stand straight boy!" I replied I was, and he said no your head is crooked, or words to that effect. And I've lived with it ever since. Talk about stigma.


6. I've run out of weird things body-wise. So I'll end by saying I'm scared of spiders. Especially the ones with furry legs. I think thats just wrong.



People I would like to tag:
1. David Yu
2. Edward
3. Siew Lee
4. Philip Ong
5. Shawn Kong
6. Chik Ian

'Everyone's normal, some are just more normal than others' - Anonymous

Happy Year of the Pig

Or boar, which I think sounds more polite.

Chinese New Year for me brings to mind huge family gatherings, specifically on my mum's side. When I was younger, and all my cousins were still in Malaysia, we'd all meet up in my grandma's place in Ayer Tawar. The days would be filled with visits from family friends, the nights with lighting fireworks and doing our best to add to the din from the houses around. Later on, late nights were spent telling ghost stories before the adults came up to bed.

This was before everyone grew up and moved to NZ, Aus, UK etc etc. Although we did manage to have one last gathering a couple of years ago. Definitely the weirdest CNY ever, that year when we met after not having seen each other for ages all together. Made even weirder when our CNY dinner consisted of a mix of nasi lemak and soft shelled crabs and sotong, and when all of us cousins dragged the adults to a after dinner game of bowling and indoor football.

This year, CNY is, by personal choice, a quiet weekend in Barrow-In-Furness. And when I think of it, rejoining my family for CNY is going to be harder than ever in the coming years. Still hopeful for another get-together within the next decade, though.

I've realised

That I'm still not very good at picking up pathology on clinical examinations. Missed easy things like koilonychia and abdominal masses. Hoping that practice really makes perfect.

How crappy I am at looking into people's ears. When I think I can see ossicles (ear bones), others actually see the big mass of wax blocking any possible view elsewhere.

That I still suck at making decisions. Some things don't really change.

That I'm developing into a stay-at-home guy. Nothing beats having my room to come back to.

How much I miss music. As in playing it. On a piano.

I don't really take very good care of myself. Still refusing to stoop to multivitamins though.

My interests are slowly being limited to my laptop.

That I have no idea what's happening with my church back in Liverpool. I bet they're still surviving, though.

I need to start studying seriously. Seriously.

I haven't finished reading the Case for the Creator, almost 6 months after I'd bought it. Tht's definitely a record.

That its possible for others to see me in a totally different way than what I'd expect. And that I would have absolutely no clue they were thinking that way.

That along with the previous statement, honesty and openness is something precious. Or maybe it seems that way because it appears so rarely.

That I don't always make sense with these blog posts.

That it doesn't really matter anyway what people think. (wow thats a first)

That I'm grateful for friends who track me down after having lost contact with them for years. Wish I could do the same.

As much as I seek to mix around with others, I still feel comfortable with Malaysians (yes Steve, call me rascist).

Moving on

This is the most anatomy I've done in a while...looking at all the different structures in the head and neck: reminds me of how much I've forgotten since IMU. Piriform fossa? The only thing I recalled about that is its where fish bones can get stuck sometimes. All the different neck tumours needs a bit more reading up before bedtime tonight as well.

Currently am reading Labyrinth by Kate Mosse which I'm devouring bit by bit in my free time. Note to self: Next Christmas sale must look out for a cheap bedside lamp. Its another of a list of books which I've 'borrowed' from my GP and which they don't seem to miss. Weaving a tale of conspiracy through the middle ages to the present, its not much different from the current crop of thrillers, but the main characters all being women, makes it a refreshing read. No male muscling out of problems this time around!

Also reading Psalms 119 equally slowly. Centering on why God's message (eg the Bible) is such a big deal, it mirrors the life of an average person striving to be faithful. Picking truths out of it isn't as hard as from some other books I find; a 10 min breather before starting a hospital day pretty refreshing over a hot mug of coffee.

Back to the books.

If I've not been regular

Its been because there's not much to talk about. Days meld into cycles of hospital, free lunches, back home, a quick TV serial/sleep, work, cook, wash, movie on weekends, wash rinse repeat. On one hand, its what I'm supposed to be doing; this is the one year where no one wants to fail. On the other hand, its getting pretty monotonous.

A few posts back I mentioned how it'd be nice to get back in touch with ppl I've lost contact with. Over the last weeks, I've emailed a few friends who are now working back home in KL, found out how they're doing etc etc. Its sadly true, though, that once distance and time gets in the way, stuff like common interests, rapport and easy chats get left by the wayside. Friendship is indeed something to be treasured. Mushy, but true.

Am recovering from a virus that decided to take up residence in my throat and nose. It's probably gotten tired and moved on to fresh pastures, so I'm left with a mouth ulcer that, to me, is even more debilitating. To enable me to enjoy my food as much as I usually do, I've taken up soup cookery. Still in its infant stages, I'm still experimenting with how much soup is one soup cube good for.

On a side note, anyone interested to keep me company in an overnight queue early July for Wimbledon 2007?

Random stuff

Over the last few days:

My GP caught me reading gossip magazines. "I bet he gets Cosmopolitan at home" he told my partner.

My consultant broke off teaching me about the radiological features of osteoarthritis to pick up a lingerie magazine and say "Do you think those are real?"

I fell sick again. Second time since Christmas.

Muffed up my mock OSCE by mixing up left and right. In 4th year!

Felt what a real head of femur felt like. Not much to shout about.

Watched The Island and thought it was a pretty good copy of The Matrix.

Downloaded The Transformers wallpaper for my desktop.

So there.

Surgical Upper GI

Two weeks of a rotation about the digestive system only served to show me how much hasn't changed since I failed my GI assessment in IMU. Its coming along though. And I've discovered what will probably be my routine for the rest of the year.

I've come to the conclusion that the best way to get stuff out of a rotation is to go around and see all the patients that my consultant takes care of, and follow them throughout the weeks that I'm with him. That way, I learn more when I go around with him, cos I've seen the patients before, and know whats wrong with them. If any new patients come in, I'll know as well. Sounds pretty obvious, but we don't get told to do these things in Liverpool, its our own learning routine that we have to come up with.

And, in the meantime, I've pretty much resolved to try to take more interest in what goes on outside the confines of Barrow as well. So much so that its going to be a weekly reminder sort of basis. A New Year's resolution, if you must. Though I generally don't go in much for that sort of thing.

See, up to now I've basically not been privy to whats been happening elsewhere in the UK, or the world. Most news I get from my housemates during dinner, but at other times, I would either be on the laptop, gaming, or getting work done. In fact, I guess I've become pretty reclusive (!) and up to the point where I just can't be bothered with chatting, or whats going on elsewhere.

When I was back in Msia for the holidays, a friend from school was updating me about how all our yearmates were doing, when she commented on how I rarely kept in touch with ppl. How true.

Don't sweat it; doesn't mean i'll start spamming mailboxes or dveloping a burning desire to see whats on BBC Online or the Star Online every single day. Just that if you've received an email from a sitiawan boy whom you haven't met in ages, try to be kind.

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.