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

Well, well, well

Its all over but the shouting. I finally finished my OSCEs today and have just finished the 1st round of packing b4 going home. The next few days are going to be really hectic, needing some planning; change of addresses with the bank, getting our elective confirmation slips, passing around all the stuff we couldn't finish throughout the year, moving to Barrow and packing to go home...well, at least exams are over and I'll be back in msia this time next week.

God did a good job in guiding me though the stations today I think. I messed up a few at the start because I was just too nervous, but He managed to pull me together to get my other stations more or less up to par. Don't think I could've done it on my own.

The Wait

Is going to be a long and anxious one. Part of the disadvantage of going overseas is you're never sure when you have to take an early flight back home for resits. Yup, exams are over, and I'm left with a slight(ok mayb a bit more) feeling of worry. Not for lack of trying, but maybe trying in the wrong direction. Like when I see how others know so much more that I maybe should have known, that I found questions hard when others tackled them routinely. Which culminates in the general feeling of not being on par with what's expected of me by the end of 3rd year. And which brings me back to the very real fact that I may be faced with an early flight back during summer. I hope not though.

Not that I found the papers extremely extremely hard, either. Just that there weren;t a lot of those moments when you know for sure that this IS the answer and had to guess based on what you knew. And as I told my housemates, when that happens, 50% of the time I'm wrong.

If there was ever a time to change from the pseudo self studying method that I've been in and out of since secondary school(its true), it's now. And if I make it 4th year, I hope that it's not going to be about passing exams, but of shouldering the responsibility of keeping other's lives safe.

Which really goes to show where I am on the way to becoming a doctor, I'm supposed to be halfway through, but am now having to play catch-up growth, like a poor IUGR baby.

Its all about You, Jesus,
And all this is for You
For Your glory and Your fame,
It's not about me,
As if You should do things my way,
You alone are God, and I will surrender
To Your ways.

Considering the way things went, I'm ashamed to even claim this song. But seeing as it really helped me through the uncertainty and worry, I'm going to keep right on singing it. And to all those who kept us in prayer, from all over the world, thank you. Really.

Deja-vu (which btw, is caused by a temporal lobe seizure)

Exams are tmrw. And as usual, perhaps even more so, I don't think I'm ready. To put it mildly, I was really freaked out when doing the past years.

Praying helps some, but I have to admit there is a lingering bit of doubt about whether I'll make it. And this after going thru sem 3 and 5 in IMU! Really, you'd think God bringing us through those would have given me enuf faith to believe this time will be no different. And when I think about it, its pretty pathetic from the perspective of those suffering due to the earthquake in Indon. Those guys are in bad shape and need far more. OK before i continue babbling on...

The plan is to finish up, then go thru the 20 pages of ethics one more time b4 sleeping tonight. Hopefully dinner QnA wont scare me too much, as it usually does. Normally its good, but not the night before the exams!

Btw, props and thanks to ben, mel and ant who are cooking soup from tudor close for us. Hopefully one shot is all we'll need and we can all go home safely on the 18th as planned.