After 5 freaking long years, on the 20th of March, 155 of us were liberated from the Medical School Syndrome (MSS). That morning, we all gathered in the hall, anxiously awaiting the announcement from the Dean. As he couldn’t make it, the Assistant Dean took over and read out the names of all those who have passed the final MBBS, one by one. We clapped from the first name all the way to the last, and there was this air of relief and joy filling the hall. Nevertheless, some were crying not just in joy, but in sorrow for those who did not make it.

These 5 years would be what I describe as the most trying times in my life, and I had hoped that everyone would make it through together. A math teacher once said to me, in an exam, there will always be students who get full marks and students who fail (based on the normal distribution). If no one scores or no one fails, then the exam is skewed. I guess it’s part and parcel of life, nevertheless in the midst of our happiness, the pain of knowing that these handful of friends will have to stay back and relive the stress and horror of the exams once again, sent us into a turmoil of emotions.

I quote Cyanide who wrote this elsewhere…

“At the same time, our hearts ached for those few friends who didn’t make it. See, this is life in reality. I knew I’d be devastated even if one of us failed to leave with us. But I didn’t expect the feeling to be so intense. I guess it touches everyone’s hearts and leaves a mark. The saddest of all is that there is nothing we can do or say to help ease the pain. Anyhow, I’d like to see this as a special challenge that God has set aside for the bravest and strongest of all. As always, God will never put unto our shoulders a burden too heavy for us to carry. For my dear friends who are to walk this difficult journey ahead, I pray that God will also grant you the courage, strength and patience to reach the finishing line. I believe you will come out of this better than any of us.”

That night, we were all invited to the alumni dinner with our professors and lecturers. For the first time, we got to see a different side of them and some of the intimidation and fear of them fled. They are no doubt our teachers and source of inspiration, however they are also only human, like us. It was really fun to see our Dean and Head of Orthopaedic Department singing songs as well as our professors and lecturers dancing on stage. Awards were announced and tribute was given to our 2 top students of the year, Dr. Lee Zhi Shan and Dr. Lim Li Han. Congratulations to them both, as well as the 15 students in the Dean’s List and the other winners of the other various awards.

The following day, we had the “swearing in” ceremony, where we took the Hippocratic Oath, and were also presented with our temporary certificates. Parents were invited and we had the ceremony at the Dental Faculty’s Hall, as they had a bigger hall to accommodate everyone.

I really didn’t expect you to come. It was a really brave thing to do. Thank you…

Everything felt so surreal and sometimes, I just can’t believe it’s actually all over. No more classes, no more typing of case summaries, no more “covering wards”… Hmmm, come to think of it, there will still be more of this when we start working but what the heck, at least for the next few months or so, we are spared from it.

We do not know what the future holds, but we will definitely enjoy this break to the fullest. Thank you to everyone who has kept me in prayer, supporting me emotionally and believing that I could do it, when often I felt I could not. Thank you for everything.

Praise be to God!

It’s been one day after our final MBBS exams have officially ended. Viva list will be out on Monday and the results will be announced on Tuesday, that is if all goes well. I would say that I’m half relieved that the exam is over, however I will only be really relieved on Tuesday if I pass. I sincerely pray and hope that my whole batch will make it through. The last 5 weeks was a real torture. Palpitations, sweating, sleepless nights, loss of appetite, generalized anxiety disorders…no wonder they only gave us 2 weeks of study leave (excluding Chinese New Year holidays). More time for revision would be nice as it is definitely not possible to revise 5 years of studies in just 2 weeks, however any longer than that would have precipitated heart failure in the faint-hearted (like yours trully) due to palpitation and sympathetic overdrive…

Anyway, it is now time to sit back, relax, wait and hope for the best…

Finally, tomorrow will be the last official day of class for us. It will start with our end-of-posting exam at 9 am, CPC at 3 pm and a extra haemato class after the CPC. I can’t believe it’s been 5 years. 5 years is as long as going through Form 1 to Form 5 and that felt pretty long to me. However, this time round, it feels really fast. I can still remember the very first days of university life, stepping into the medical faculty and perpetually regretting my decision to take up this course. Nevertheless, the end of the beginning is near…after 3 weeks of study leave and 2 weeks of exams, if all goes well, we will leave this place for good unless we end up working here in the future, or doing some post-grad thingy.

Anyway, just felt kinda nostalgic, melancholic and apprehensive of the future…

Once again, the freshies have enrolled and its the return of the ragging orientation week(S). This time, we are the SUPER SENIORS, a stupid name nevertheless but still a mark that I’ve survived 4 freaking years of medical school life. The freshies this year are blur as usual, as after 2 weeks of unofficial orientation, they have not figured out what should and should not be said, what needs to be known and what needs to be done, in summary, how to be streetwise in this sadistic “game” of survivor.

4 years back, the whole thing was probably many times worse than it is now, but the threshold of the current freshies is terribly low. They no longer have to look down and recognize the seniors by the colour of their slippers, the shape of their feet, and the hair on their shins. No more being screamed at the volume of 100 dB or having to do ultra-humiliating things. Only scoldings for not remembering the list of their own state senior’s names and having to find out 10 things about this senior or another.

I am not for one, pro-orientation but neither am I totally anti-orientation. I mean, I do remember the horrible time I had, and I definitely do not wish the same fate upon these poor freshies. However, when a junior looks so forlorn and when asked what is the worst thing that happened to them during the orientation and the answer is “having to find out details about the super-seniors”, I really feel like fainting. If you can’t remember the names of 10 seniors who come from your state, how are you going to remember the 100 different bacterias, viruses and parasites? If you hate having to find out details about this person and that person, what about having to look up information for the problem-based learning classes?

Yes, finding out 10 things about S.Senior X and 10 things about S.Senior Y may seem rather silly, but why don’t you fellas thank your lucky stars that you don’t have to do things worse than that. 4 years back, we would so gladly accept that sort of assignments as it was considered chicken feet, compared to the vast variety of horrible stuff one could be subjected to. One freshie looked at me in horror when I asked him to find out all the capitals of the states in Malaysia, as when he did not know where I was from, I mentioned that I was from the capital of Kedah, and he had totally no idea what was the capital of Kedah. Did he not learn geography? Was I being unreasonable? I think not…

Anyway, another thing that bugged me about this year’s new intake is that a large sum of them have a terrible command of English. They are unable to sustain a decent conversation in English and keep wanting to switch to Mandarin. One girl looked blankly at me when I asked her how many siblings she had. After repeating my question 3 times, I realised that she did not understand what “siblings” meant. So I asked her, “you ada berapa adik-beradik?” She looked wide-eyed at me and answered, “Empat.” WTH.

Another girl claimed to be a fan of classical music. Out of curiosity, I asked who her favourite composer was. She hesitated for a long time, and finally said, “Senior, what is composer?” I said “It’s the person who made the song.” She said, “I don’t cares the lyrics or who sing the song, as long as the sound is nice, I will listen.” Since when does classical music have lyrics to it?

Seriously. I rest my case.

Well, one week flew by. We were waiting in anticipation for this short break, however it seems that the break is now over. Just with a blink of an eyelid, precious time of doing “nothing” has passed. Then again, if there was too much time to slack, we will sink into deeper denial and not want to continue threading through the “hell” of final year. Ah well, not as though we have much of a choice anyway.

Next up is the minor postings, and it seems that the insane student had a swell of a time. So I really hope that it will be somewhat more refreshing and relaxing compared to the stressful and miserable Paediatric posting.

Looking forward to the France vs Italy finals tomorrow night, or rather morning. I hope France wins!!

Teran, teran. Tarik nafas kuat-kuat, tahan dan teran panjang-panjang, ya? Teran kat perut, bukan kat muka. Angkat kepala, tengok perut. Tarik besi itu, ok? Bagus! Macam itulah. Teran, puan, teran! Sambung! Lagi. Lagi. Ok, curi nafas, sambung lagi. Betul, puan. Teran! Teran! Macam mahu berak. Geram! Geram! Rambut sudah nampak. Selagi rasa sakit, mesti mahu teran!

Kuk ah, kuk! Hou ah, kuk, kuk, kuk! Tau hei. Tui ah, tui! Kuk, kuk!

I was initially apprehensive of the labour room on-calls. First of all, there’s a lot of blood, screaming and pain. Apart from that, there is the suspense of waiting for the cervix to dilate from 1cm to 2cm, to 3 cm, to finally 10 cm. Not to mention those 24 hour-calls where you barely get any sleep and end up walking around like a zombie the next day.

The first day on-call, the doctors and the nurses scolded me for not cheering the patient on enough. I couldn’t seem to bring myself to cheer, as I’m generally an introverted person, who just doesn’t like to do this sorta stuff. To all you introverts out there, I’m sure you know what I mean. We hate making a big scene of ourselves.

Anyway, 6 weeks later, the cheers above have become spinal. What I mean is, all those words come so naturally, its almost like a spinal reflex, which by-passes the brain. I can do it at 5pm in the evening, I can also do it at 4 am in the morning, regardless. It has become so natural, that I actually feel as though I am watching myself do it from outside of my body. Seriously.

Nevertheless, I am so glad it is OVER. I conducted 6 deliveries. Assisted in more than a dozen others. Weighed and checked tons of placentas. Observed a couple of Caesarean sections, and scrubed-in once. I’m sure CN- did a lot more, as during her calls, the deliveries always seemed to be endless.

The stress, the fun.

The scoldings, the occasional appreciation.

The horror, the joy.

The tears, the happy smiles.

Whatever it was, it’s time to move on.

Paediatrics, here we come…

Episiotomy. Baby. Happy mother. Episiotomy repair. Log book. Sleep. Hehe…

I am too exhausted to even tell my tale in detail. It is similar to what CN- has described in the previous post…I clerked the patient, followed her up, listened to her scream in agony for 1 whole hour (as no one else wanted to), gave her water to drink, let her pinch, whack, slap me while she was contracting, finally gowned up and gloved up for her impending delivery, screamed my lungs out to encourage her to push and to push effectively, watched the tip of the head of the baby pop in and out of the vagina, and finally, someone else strolled in, scolded me for not giving the patient enough encouragement, delivered the baby, and left the placental mess and work for me to do, and strolled off.

Baby. Happy mother. No self-conduct delivery. No log book signed. No sleep anytime soon.

Frustrated, sleepy, annoyed, tired, aching legs, bullied, tons of backlog work to do, burnt out.

What a way to spend the weekend.

Sh+T

We are expected to conduct at least 5 deliveries on our own in this posting and you can probably imagine our anxiety when we see a good opportunity come by the labour ward - a multip (a woman who had previous childbirths prior to this) whose childbirth will most probably be faster and easier, or a primip (a woman who is having her first childbirth) where an episotomy cut is quite likely during labour. Sometimes we make a 7 o’clock cut (episiotomy) at the edge of the vaginal opening to facilitate passage of the baby’s head and to prevent severe, jagged vaginal tears. This is usually performed on a primip and an episiotomy means an opportunity to give local anaesthesia, cut at the appropriate area when the baby’s head is crowning at the vaginal opening and later on an episiotomy repair - administration of local anaesthesia and suturing.

I was exhausted by the 20th hour of my labour ward on-call when a primip turned up with a cervical dilatation of 6cm indicative of impending labour. Determined to deliver her baby, I clerked the lady, performed the necessary physical examination, monitor her contractions and baby’s heartbeat via the CTG machine and closely follow vaginal examination reviews. At 7am, I mustered all the energy and passion for obstetrics that’s left in me for the delivery when her cervix dilated to 10cm.

Come on, baby… it’s time for you to come to this world and I shall receive you with my very own hands! The mother was anxious and in pain, leaving me with multiple fingernail imprints around my wrist and forearm as “souvenirs” whenever she could reached over the bed rail to grab hold of me as I check the CTG machine by her side. With approval by the house officer, I dutifully prepared myself - wore the apron, put on sterile gloves and got ready the delivery set by the bed, swabbed the labia and introitus and taught the woman how to breathe properly and when to strain. A staff nurse willingly stationed herself by the side of the woman to be “gripped” at each uterine contraction.

Soon the perineum began to bulge and the vaginal gaping enlarged. I was elated to see the baby’s hair and felt its head pushing forward. It shall be an easy delivery with a possible episiotomy, I thought. I could get my log book signed for another self-conducted delivery and go back to my room for some much needed rest - yippie!! I was still smiling to myself when the medical officer sauntered in, saw what was happening and put on gloves to check the progress of the delivery. I stepped aside to make room for her, eagerly waiting behind her to allow me continue with what I was doing.

Episiotomy. Baby. Happy mother. Episiotomy repair. Log book. Sleep. Hehe…

A few minutes passed by. She was still there. I inched forward but she didn’t acknowledge my presence. The labour was in good progress. An episiotomy was inevitable and I was told to prepare the local anaesthesia. After the episiotomy, the medical officer still refused to budge and give me a chance. The next instant, the mother gave a full effort push at the peak of her contractions and the baby’s head, shoulders and the rest of the body was delivered! Not by me, but by the medical officer who nicely came by, took over the case from an exhausted by enthusiastic medical student and enjoy the climax of the entire labour process herself!

Who clerked the patient? Who stayed awake to monitor her progress and report to the house officer in charge once every half an hour? Who got gripped once every few minutes by the patient until the hands turned red? It’s me , myself and I!! But I was denied the chance to deliver the woman’s little prince… argh…

7am. The medical officer finally acknowledged my presence and said, “MS (medical student)… please weigh the placenta, clear the mess and repair the cut.” All I could do was to nod and comply. Then she turned and left. I continued standing there trying to stay calm.

Baby. Happy mother. No self-conduct delivery. No log book signed. No sleep anytime soon.

I smiled back at the mother who thanked me profusely for god-knows-what. I was perched at the side watching the baby being delivered into the hands of another person. Well, at least there’s a baby and a happy mother.

Everything was completed by 9am long after the next on-call group came in for their duty. A 25 hour on-call. Exhaustion, no sense of accomplishment plus frustrations. Some nice feelings to start my Sunday.

Sigh… Wish me good luck for my on-call tonight: Self-conducted delivery. Baby. Happy mother. Signed log book. Sleep Ok, I can trade my sleep and rest for that.

It’s 1.30pm and I just had my lunch after my attachment with a gynaecologist in the gynae clinic. I’ve to meet the chest specialist who is handling Dad’s case in the medical clinic at 2pm and in the meantime I’m not sure where to go so I made a trip to the computer lab. Going back to my room will take me about 5mins and in about 10mins time I gotta walk all the way to the hospital again so that seemed rather time and energy consuming. Waiting at the medical clinic means me taking an extra seat at the waiting area knowing that the place would have been sardine-packed with patients on appointment by this time of the day before the afternoon consultations start. So here I am deleting the hundreds of mails in my inbox and try to compose a post… which is basically full of NOTHING by now other than explainations as to why and how I ended up here. Crap. I think I’m losing too much brain activity to my Obstetric and Gynaecology posting nowadays I don’t seem to be able to do other things right, including activities of daily living (ADL) like eating, bathing, etc.

Jel and I have been super busy lately. Our day starts at 8am and ends at 5pm during the weekdays with morning tutorials and clinics, ward rounds, faculty lectures, department lectures, etc. We’re on-call (be on duty in the labour ward or gynaecology ward) lasting from 5pm to 8am the next day once in every 3 days and if it falls on weekends or public holidays, we gotta be in the labour ward from 8am to 8am the next day delivering babies and placentas, cutting open vaginas to facilitate passage of the baby’s head and then suturing/repairing the cut at the vaginal mucosal, muscular and skin layers. To add icing to this nice gigantic cake, we’ve to submit 4 case reports and 1 cytology report by the end of this posting.

Here’s what we need: We need sleep. We need rest. We need some time to go buy groceries. Jel’s feet are hurting after standing for many hours in a pair of old, hardened leather shoes so she needs to go shop for more comfortable ones lest her feet becomes deformed by the end of this posting. We’re not sure of what’s happening around the country or the world for 2 weeks coz we’ve absolutely no time to read the papers and even if we do, our eyelids can barely hold up. We need time to study and write case summaries.

We don’t need irrational scoldings from the nurses in the ward. We don’t need more lectures and workloads. We don’t want any more postponed classes or ward rounds by the consultants. We don’t need anyone to lecture us about “not trying hard enough”. We don’t need patients who look down on us and refuse to cooperate during history taking and physical examination as soon as they learned that we’re medical students. We don’t need patients’ relatives and friends to crowd around us, watching us like hawks and generating anxiety in us poor souls when we’re taking blood from the constricted blood vessels of a cancer patient who just underwent chemotherapy.

Final year is lovely. This whole lot of stuff that I’m learning and experiencing now are priceless and they truly make me feel blessed and lucky. Lots to see and learn. Many more to come. I can live with it. At least I’m willing to. I can trade my leisure time, sleep and mealtimes for medicine, patients and their concerned relatives. But we need more time. And we need chances.

God be with us

(Gambate Jel!)

Yes, the needle is a sharp object. Poke one into your flesh and some of you will squirm, some will merely utter an “ouch”, some grimace, some scream, others take it like just another harmless pinch at the arm.

I was taught to give intramuscular injections for vacccination against tetanus to a number of Form 3 students in a local secondary school this morning. Before that the nurses gave short anti-smoking speeches to class after class of young brats and oh boy, they sure had a difficult time keeping those monkeys seated on their chairs just to pay attention! Not only did they refuse to listen like they have ears, they shot nonsensical questions which made your blood boil. When the nurse gave them a grave look, they giggled and rejoiced in their victory. The next instant, they were hatching more cheeky questions and pranks to attack the medical staff. I stood at the back of the class and watched the entire drama. I’m sorry for feeling relieved not being the person in front giving that speech and facing these youths. I seriously don’t know whether to laugh or to be mad. How did students these days become like that? Or have they been this way for centuries?

When the students are ushered to the injection stations set up in the school hall, the “tough” and “cheeky” ones began to show their true fear. It was an amusing sight. Most were avoiding the needle, cooking up various tales and excuses to be exempted from the prick. Some were in pure denial - walking around the hall, subconsciously rubbing their left arm just to stall time. A few became expert researchers… moving from station to station interviewing their classmates before, during and after the prick trying to decide which nurse/medical student gives the least painful injection. Some had to be coaxed. Other had to be forced or shouted at.

So much drama for just one simple anti-tetanus injection which is for their own good. Truly, the smart-aleck and the big bully may not be the bravest!

The next time you are irritated by a naughty student like that, look them in the eye and say, “Shut up. Here comes the needle.”