tHE CHiaYewnian EFFecT

A Tribute to A Great Orthopod Teacher- Professor Subir Sengupta

2011-12-31T03:50:00.000-08:00

Tree of Andry- The classical Symbol of Orthopaedic Surgery.

Today a Malaysian one has whithered.

I am not one who is fully acquainted with the nuances and practices of Death yet. I have only to date been to one funeral (which was this year- its still 2011, mind you).

Today however, I received a shocking sms from Dr Nilesh, my anatomist-teacher from the IMU regarding the passing on of Professor Emeritus Subir Sengupta, one of the pioneer Orthopaedic talents of Malaysia, formerly Professor Emeritus of Orthopaedics in UM and most recently Visiting Orthopaedics Lecturer to the IMU.

I will have to admit at this point of not being exactly close and not being a student directly under his tutelage.

My first and only encounters with him occured this year during my Musculoskeletal module in the IMU when he presented two clinical lectures on Fractures and Disorders of the Back and Spine respectively, introductory plenaries considerably early on our medical curriculum on the clinical Orthopaedics.

I also have had the honour of dutifully hosting him as a student in the IMu when he came for the said second lecture ( bringing him from the carpark to the lecture theatre and back to his car and thanking him for his lectures) when the programme coordinator was not available due to other work commitments. That arguably explains why I felt so strongly when I received the message that Prof passed away at 3.30 am today, on the 31st of December 2011, just less than a day short of the new year.

Although brief, his lectures gave us an overview of who he was (as with any other pewrson who gives a lecture).They were succint to the point and as expected clinical and cut through like a scalpel. As all people knowledgeable and experienced enough, Prof had an air about him of timeless wisdom. He embodied his discipline. He had become a Malaysian Grandfather of Orthopods, an expert or even I dare say, a Master Yoda of sorts that all the Orthopod-jedi/Padawans looked up to and hoped to emulate in the future.

Coincidentally I have picked up through net surfing a few other medical men who have left legacies and are remembered till today. Their contributions are crystallized in time for all to admire as a result of good documentation and good historical archiving. These great people and their endearing spirits are preserved in PDF files as a result of the good practices of their institutions (in this case these 3 eulogies I read belonged to the same one- The National University of Singapore, no less)

It is important and pertinent we preserve memories of those who have gone on. I have always drawn inspiration and renewed vigour from the lives lead by these greats, especially in Medicine. Reading their stories and thus somehow being transported into their world where one can almost feel the rich textures that constitute and define their dreams and hopes.

For truly the only reason and the only way we can see further is to stand on the shoulders of giants. If these giants are allowed to fade from memory, how are we going to find a place to stand on.

I extend my deepest condolences to Prof Sengupta's family. I hope by writing this blogpost, I am also contributing towards the memoryscape that serves to keep these giants living.

Nicholas Introspects 2012

2011-11-14T05:34:00.000-08:00

In keeping with tradition, this post will outline Chiayewnian Life in the coming year. It is a post that I am writing fully aware that this very moment is just short of 2 weeks before the dreadful (but necessary ( I have to console myself)) exit exams that all 3rd year IMU students have to go through.

Right after the exams, I will be diving straight into activity. I will be inducted and trained as a Peer Tutor in Clinical Skills in December.

I will also immerse myself once again in Malaysia's theatre scene: I am due to catch George Orwell's Animal Farm in klpac (an adaptation by Pentas Project) in early December, fresh from sitting my exams.

I will also seek to develop myself by picking up Mandarin, lomography (got overexcited when I entered the lomo outlet in Pavilion KL last Saturday), and perhaps if time and patientce permits, guitar.

I will also then put weight and focus to my year-long job as Section Editor of the Journal of the Asian Medical Students' Association and help develop it in its formative years.

In January, I will make my way down south to beautiful Singapore to attent their EAMSC (admittedly my first time in an overseas AMSA Conference after my stint as a group moderator in the KL EAMSC). I look forward to finally be serviced (for lack of a better word) by a Group Moderator (from the NUS, no less).

February marks the start of my career as a Peer Clinical Skills Tutor (and I hope not the end of my career as an Anatomy Demonstrator). I look forward to teaching Clinical Skills to the younglings and consolidating my own.

Then the biggest change in my life will happen in September, I shall fly off to the University of Glasgow to continue on with my clinical studies.

Starting a UK education in undergraduate Medicine will be awesome, opening up a whole new world of the medical student (the UK scene being one of the most vibrant in the world).

Notably also is the fact that my transfer to the UK will allow me to gain student membership of the Royal College of Surgeons of England, Edinburgh, Glasgow and America. I am also looking forward to joining the British Association of Clinical Anatomists and the the Anatomical Society of Great Britain and Ireland.

Life, in short, is awesome.

Now back to the books!

The Malaysian Surgical Health Carnival: An Emergency Dissection

2011-10-10T05:05:00.000-07:00

Only in Malaysia can you find the people upstairs organising rather whimsical stuff such as

The Surgical Health Carnival

When thinking of a health carnival, a sprawling fair in an otherwise abandoned park or open area comes to mind for most of us. There would be the oversized canopies that have become the stigmata of these huge, sprawling fairs.

Banners of all shapes, sizes and colours serve to distract any driver along the roads that feed the abandoned park or that are adjacent to it. Then there will be the customary paraphernalia that always accompany these kind of fairs, those huge human-form things that must have a continuous stream of air in them to stay upright (I dont think putting the exact name of those thingamajigs would help either- I dont think any of you would know it, or more likely there isnt even a name for those horrendous things).

Ironically, if it is a health fair in the traditional sense of the term, will surely have side stalls selling all manners of fried delectables and any soft drink under the great big sun, provided its legal for sale in Malaysia.

But back to the crux of the matter now.

Today the Ministry of Health Malaysia announced that they will be holding Health Carnivals in each state, but not of the variety we are all accustomed to.

These health carnivals announced today shall be carnivals where surgeons and their anaesthesia counterparts are recruited from all over the country, asked to converge in a state on a pre-determined date and time to conduct elective surgery for the primary purpose of reducing the current backlog in elective surgery in the country.

Now, at first look, many a person would consider the whole thing a brilliant proposal, if only because it is so unique and groundbreaking.

But we often fail to realise and reflect that something thats unique, groundbreaking and unthought does not and should not earn automatic merit just because of the aforementioned values.

Now allow me, if you will, to dissect the issue.

The Whole Concept

Now calling the whole concept, simply a campaign to reduce the backlog of elective surgery by inviting practicing surgeons to perform it in one area at a given time, a Health Carnival doesnt quite fit and sounds slipshot. Its like calling a fish a donkey.

And making that error in naming the programme unsuitably may point to the heightened possibility of other flaws popping out here and there in the policy and implementation of the whole programme.

Comprehensive Care

From whats been reported in the papers, the plan is, as mentioned, to get surgeons from all corners of the country to converge in one place at a given time to operate. Presumably, these surgeons, exhausted and spent after their respective surgical marathons, will then return home. And everybody then lives happily ever after.

That is until someone notices the purulent discharge seeping out of the laparotomy scar that nicely decorates Miss Jansri's abdomen.

Mrs Khalid over there coincidentally starts complaining of a constant dull ache in her abdomen. A post operative abdominal X-ray (if anybody remembers or bothers to do that after the operating surgeon has left) shows that a blunt forceps (phew... not a scalpel or a pair of surgical scissors) was left inside.

Mr Chong there starts developing early signs of a shock there in bed 4. In his rush to finish up his 5th operation of the carnival and 16 more to go, it is soon evident that Mr Chong had a anastamotic failure.

Questions that hopefully crossed the policymaker's mind when he came up with this health Carnival programme #1

To whom does the responsibility of post operative care of these patients fall to? Should it not be the surgeon who actually did the operation?

Right, there are a lot more issues that are in conflict that hopefully was taken into account by those organising this most whimsical programme, but these I have to deal with a little later because just as the public sector has a lot of backlogged surgery, so too do I have a whole lot of backlogged work.

The Incisions Gown

2011-05-03T22:01:00.000-07:00

I was randomly surfing the web one day when I came across a most elegant and ingenious contraption:

The Incisions Gown, an invention of Professor John McLachlan of the University of Durham, an anatomist-embryologist who envisions it to be a teaching tool which combines both artistic elegance and anatomical precision.

This incisions gown while not groundbreaking or epic in its impact, seeks to heal the wounds when dissection was resected off from most undergraduate medical curricula. The gowns put things into context and consolidates the content by a visual and active learning approach- a powerful well known tool in teaching- one which I wholly believe in and practise obsessively in my own practice.

The rather brilliant Incisions Gown: one notices how it is not just a body suit but something quite cultured and also arguably rather fashion sensitive. It has zippers at appropriate and anatomically accurate surface sites which are labelled with the names of the surgical incisions those zippers or discontinuities in the fabric represent.

But what finally drew and captured my imagination whole was of the symbolic significance of the contraption, succintly captured by Prof McLachlan:

"Students react with shock and dismay when I suggest cutting or slashing the gown, or spilling ink on it. Yet we cut skin and spill blood during surgery - and the body is more precious than silk"

Where are your academicals?

2011-04-30T09:05:00.000-07:00

A vigorous campaign to inspire thought and imagination in the masses has begun!

POp Anatomy 1: Comparative Anatomy between the Arm Bone: Human and Avian

2011-04-29T09:02:00.000-07:00

These series of anatomical writings are not meant for the purpose of reproducing the content that great books already have such as the magnum opus of Anatomy, Gray's by Standring.

The elucidation of the anatomy of any particular structure in these posts will naturally be exhaustive.

They are meant to lend a personal and fresh perspective on Anatomy from a medical student who's quite knackered on Anatomy.

Just the other day, I was at this mamak joint eating conventional mamak food when one of my eating companions ordered a quail, which essentially is a rather adorable, cute and plump bird (see Exhibit A)

Exhibit A: A quail, although I am not sure if it is this particular species I partook of in my meal

She offered me the right upper quadrant of the poor quail's torso, which I gladly took because clearly I had not seen how adorable a quail can be (Refer Exhibit A again).

Now when given such an anatomically rich food piece ( as opposed to something like minced meat or blanched noodles), I dug in in two senses of the word- I started dissecting the anatomical specimen bluntly, with my incisors (and perhaps my canines occasionally) and my nimble phalanges as my only tools (knowing full well that this was a rather asterile and unconventional technique).

It was all rather uneventful (yes the ribs can be seen, but havent we all seen them in all dinosaurs in the museum or some science programme on TV?) until I fully dissected the muscles off the 'arm' bone of the bird.

What met my eyes was a scaled down humerus bone. The exact visual replica of a human one (as opposed to a truly anatomical replica for it seems that the capitulum in birds is functionally replaced by the medial condyle of the same bone) , only that it was about 15 times smaller. I was in awe.

Now one must ask, what did I get my knickers in a twist over all this. Aren't all bones just straight or weirdly shaped.

Well yes, that would be a fair classification for the laymen. But those who have the privilege and the staying power to observe the intricacies of bones will know the amazement I experienced in my dinner table dissection session.

I present to you the Humerus: the bone of your arm shielded from the elements by what is most probably the two most well publicised muscles of the body: the biceps and triceps brachii.

Now looking throughout the length of this bone onfirst impressions leaves the reader much to desire. It just looks long and its proximal end is shaped like a ball and socket. Don't all bones have that? Whats so special then?

To the first question, no in fact very little of our bones have those ball and socket thingies.

And to the second,

Now if the reader will shift your gaze downwards, you will see a peculiar appendage of the bone. It's most distal part has a most strange and peculiar protuberance.

They are if you are to read the labels the trochlea and capitulum. These two portuberant components and the epicondyles (on both sides) form what I would describe as a fist like process.

And ladies and gentleman, this particular formation can be found nowhere else in the human body. It is perfectly formed to articulate with the two distal bones forming the structural framework of your forearm, the ulna and the radius. (which reminds me that when eating the quail, one cannot too roughly blindly dissect. I could not make out the distinct processes of the ulna especially) It already lay crushed somewhere in the tortuous course of my digestive tubes.

So to have a rendevous with it while eating a hemisection of a hemisected quail was rather delightful.

So what does this all mean in a larger context?

Well apart from admiring the distinct design template/framework shared by many species around the world, it more importantly tells us of our common origins with the quail, our shared evolutionary heritage.

It hits me that no matter the size and the appearance of that creature ( I am sure anyone can see differences between the human and quail form), that the anatomical framework remains the same. A no frills concept. The economy of anatomy.If it serves a particular function in almost the same environmental circumstances for a certain creature and another creature performs that same function or action, then it goes that the means towards procuring it to the species must and should be the same regardless of its overall form and niche.

We share that same design naturally selected for for survival so that we may move our limbs, play, eat, fly and do whatever else you do with your hands... :P

Culture and Sensitivity

2011-04-24T07:04:00.000-07:00

Culture and Sensitivity can mean boring holes in one's artistic spirit if one's not careful

It is dangerous being a medical student.

One gets lost but if one is not careful one often cant find himself again.

That was what happened a year ago.

I lost myself in Medicine. I could not string an unscientific sentence. It was a dreary time. Some perverse replay of a Mao-ist Cultural Revolution.

Yes I did often make that trip to theatre. But contrary to what theatre virgins think, theatre is a two way thing just like reading some higher books. Its not like TV or slapstick comedy where things are as they are.

One needs to derive meaning. One needs to fill in the core of that theatrical perfomance.

Culture and Sensitivity has a whole concrete solid scientific meaning behind it. It is the cultured medical students job to also live his life with culture and sensitivity ( the more generic artistic and elegant meanings of the words now being implied).

In medicine, we are placed at a crossroads between Science and Art, Machine and Man. The difference in this crossroads is that we do not get to get pass it. We remain there for the rest of our lives

A good student of medicine must read, watch theatre, feel, love and feel the brush of passion against their inner scientific core.

I was lost.

Thank Goodness

I have found myself again.

Standing Space

2011-04-21T09:18:00.000-07:00

20 years on, there is one place I want to stand on, and that is next to this statue down here:
This of course being a statue of John Hunter, Father of Scientific Surgery at The Royal College of Surgeons England

And I want to be wearing my elegant Hunterian Robes, as in this picture below:

The Hunterian Professorship is an award for those surgeons with original research. Very prestigious indeed!

The Political Game

2011-04-21T07:31:00.000-07:00

The Potter series by JK Rowling is a metaphor of political gameplay. Well intertwined into the plot of young pubescent wizards flying around in black robes playing Quidditch and chanting curses at each other is a very dark interplay of power, one that reflects the undertones and overtones of todays increasingly political world.

Voldermort was in fact describing the political world with his succint and catchy ideal: ' There is no such thing as good and evil, only power and those to weak to seek it".

While this may not apply to the world in the larger context, I again reiterate that it resonates as truth and principle in the world of politics.

This post was prompted by the Sarawak elections generally and in particular a question by a friend who was all riled up by Mahathir's response to the election results in Sarawak.

Mahathir in a nutshell claims that the DAP by winning so many seats in the elections was playing racist politics. This was comically parallel to the insinuating posts by Utusan to punish the Chinese for not voting the BN and using the racial card (thus making you think if the people over at Utusan actually have gone through any form of education at all let alone education into what democracy meant)

The question was a simple one: Why did I admire Mahathir?

I responded that Mahathir had two dimensions to him (although we all know anyone and everyone has many more).

One was being a person of action. He wanted to see progress and modernisation. This was examplary. He was someone who had innovative ideas on how to develop and build a country that was backward and at a very early and important stage.

The other dimension of course was the ugly political monster. The one who feels that he needs to get the support of his fellow Malay men. who wants to be popular with them.

and thus is politics!

None of the people who survive a rspectable amount of time in politics will genuinely want to contribute to society at large anymore. Their conscience will start to be shaped according to the rules of the jungle.

Some Key Principles in the Rules of the Jungle by Kong Chia Yew

1. You must survive no matter what, or you die!

2. To survive you must say the right things!

3. There is no need to do those things because the people have generally very short and poor memories. If you actually get down to doing them people will forget. If you don't people would have forgotten what you said in the beginning as well.

4. Note that in contravention to No. 3, if you have done what you have said you will do, it will provide further material for the next time you need to say nice things!

5. Always disguise your political ploys as acts of conscience or moral principles.

Example 1 to No. 5: A party ACM, a member of the NB coalition, which represents a certain race of people called the Esenihc claims that if it does not perform well in elections, it will not allow any member to become a Cabinet Minister.

Its President, Kel Ios Auch claims with dignity and an air of profoundness in his speech " It is only right that we do so in such an event. We would have failed the coalition and rightly should not be in it"

The rakyat naturally swoon over such a President. That man has principles. All this then settles down to an unsaid of fear.

"What if that happens?? We know NB will still win. But if this ACM party performs poorly, then what will become of us Esenihc people. Who will be our voice in the Cabinet?!?"

Conclusion: Ok la better vote for ACM.

The President Kel IOs Auch will then be in rapture, He has just won in so many ways!

Dear Santa

2011-04-20T05:45:00.000-07:00

or for that matter, anybody who is dying to please me or make me very happy...

Something called the 39 part Dual- Sex Life Size Human Model!

Le magnifique!

Rescaping

2011-04-15T21:26:00.000-07:00

It's high time to rescape my blogging avenue. Half of the links on my link menu yield an ERROR page. So I threw out all my links including the working ones. There were too many random images and other horrid things on the side. They had to go. And there's that uncomfortable truth : there being a hiatus between my spoken and written English (This should apply to anyone and everyone, for that matter). my competence in the spoken part of the language has remained top notch. The same however does not apply to my grasp on the written component. Here and there whenever I write, I cannot help but notice that language does not flow as smoothly from my hands to the paper or keyboard anymore. There are those few but uncomfortable and irritating times that I take lengthy pauses (more than 10 seconds) from writing so that I can string a complex sentence that has been corrected of the occasional misordering of words or misplaced tenses. I need to blog again. I need protected time to blog! It has grown from leisure when I first started out to become a necessity. My written work has now become almost mathematical. It is succint, truncated and brief. It is free from wordplay. My written language has become scientific at its best and bare like a skeleton at its worst. There is a lack of richness to it. It is pertinent therefore that I reverse these circumstances before they start to permanently define my style of writing. After that long discourse, my sharper readers would then see that the only solution to this is to rescape my blog. The only solution towards resolving and ending this masa resah is for me to start blogging again!

Kuala Lumpur

2011-04-15T20:48:00.000-07:00

I have been getting a whole lot of urges recently.

The urge to watch more theatre. Which I did. Two episodes of Brickfields Now and Then, a monologue, a one man show pulled off quite nicely by Thor Kah Hoong.

And just this morning, i got the nagging urge to just walk through the streets of Kuala Lumpur.

Kuala Lumpur has always had that rustic appeal for me.

I cant quite put my finger on why I feel that way for Kuala Lumpur.

perhaps it is a combination of its many different charms.

The whole heterogeneity of pace and rythm in the adjacent streets of KL for example.

Moving from one street to another separated metres away can mean being transported 30 years back in time.

In one corner, a mass of people march single file while in the corner a few blocks away, an elderly uncle sits in his rocking chair, some of its golden rattan fibres jutting out from the main frame of the chair in awkward angles, looking at the that mass of people.

His laidback pace seems to mock those always trying to catch up with time.

Then again it is perhaps the people who throng these city streets. Each with their own whimsical reason to be out, exposed to the elements.

Everytime I walk on any pedestrian pavement in KL (oh and I have done exactly that many times over), I always feel energised and revitalised. Like somehow a small but potent part of the feverish rythm and vibrancy of KL had diffused into my soul.

Everytime I go down to KL, I can just feel my heart racing just a little bit. There's the hope of something exciting.

It still seems that the maze of life that is Kuala Lumpur still calls for me.

To explore

To get lost

and To find myself again.

Nicholas Kongs: They Now come with Sir Roy Calne specs!

2011-01-26T08:20:00.001-08:00

Introspecting 2011

2010-12-24T08:30:00.000-08:00

As the new year approaches, this blog is projected to fall down further below, neglected by its owner. Nicholas Kong introspects and reviews his plans for the year 2011 that will prove to be as interesting and challenging as the year before.

February:

The Asian Medical Students' Exchange Programme between AMSA IMU and AMSA National Taiwan University. This will be my last major activity before I wrap up an awesome year heading AMSA with my brilliant EXCO and ambassadors.

Elective Postings at The National Heart Institute, Kuala Lumpur in the Cardiothoracic Surgery and Cardiology Departments. It's always good to attach yourself to departments that you will not rotate in in clinical years rather than going to Departments of Internal Medicine or General Surgery. Nice as I need to buy my own scrub suit lol :P. And this being a tertiary care centre and national referral centre, it will sure be one hell of an experience.

The National Undergraduate Surgical Conference 2011, London. Read post below.

March:

The Asian Medical Education Association AMEA Congress 2011. I will be presenting my first ever research paper under the tutelage of my supervisor Associate Professor Dr Nilesh Kumar for the research project on Formative Quiz Assesments in an Integrated Medical Curriculum. Nervous for sure but a challenge nonetheless.

These were all the confirmed activities. Below are activities I plan to go for

June:

either the AMSA-IFMSA Joint Conference on Integrated Medicine in Hong Kong or/and

Malaysian International Medical Student Conference on Trauma Medicine in Melaka, Malaysia.

The Ghostly Surgeon

2010-12-24T07:49:00.000-08:00

tHE rOYAL cOLLEGE OF sURGEONS sURGICAL cHRISTMAS tREE

The Ghostly Surgeon: a persona I would like to evolve into

It's been ages since I have posted here.

Life has been hectic (albeit exciting and challenging), but a series of events has just made it uber sweet.

I was searching for photo of Professor Harold Ellis, Surgical Superstar. (Dont bother asking why... If you know me well enough, you would just brush this off as something that I do)

And clicking on a link- it brought me into the website of the National Undergraduate Surgical Conference 2011. Within minutes, I made that decision. I had to go.

Professor Vishy Mahadevan, Anatomist to the Royal College of Surgeons. Notice the passion in his eyes.
Professor Sir Roy Calne, Revolutionary of Transplant Surgery

Professor Harold Ellis, Surgical Superstar

Showcasing a n impressive spread of faculty including Prof Ellis himself, Professor Sir Roy Calne, and Professor Vishy Mahadevan. Other bigshots are Professor Michael Baum. This is one conference any aspiring surgeon cannot miss.

Then there are the workshops- suturing and the surface anat by prof Mahadevan are the ones that stand out.

Then there's the chance of seeing what kind of research my UK peers are doing specifically in the field of Surgery. So much to learn.

What more, it coincides with when I will step down as AMSA president, it coinicides with the start of my semester (can be absent for first few days), and it will right after my IJN elective posting in the Cardiology and Cardiothoracic Wards. Everything clicked.

And what more Dhruva Murugasu good friend and genius extraordinaire has offered me a personal tour of Cambridge, a site of such intellectual and academic richness that I amy just fall dead when I go there to visit.

So when my father came home, I presented my case straightaway, and won it straightaway too. I know he knew I needed to get out of the country. From his viewpoint he has been seeing me do a lot of weird things- the mass of papers I transport home after every AMSA event, the late nights I spend, peering into my computer screen typing away, the days I sit in downstairs preparing materials for my workshops and conferences. I realy need this break, (ironic isnt it how I call this a break) That night itself, I booked my flight ticket and the conference ticket.

And the whole conference proceedings for 40 pounds. Real value for money.

So excited!

Lol looks like I am pretty much set that my career will be academic general surgery. Hopefully I dont change halfway lol :P

Clinical Medicine

2010-10-04T05:39:00.000-07:00

Medicine will never be a true science. It is dubbed gloriously as the youngest science, but after years of maturing it has failed to actually present itself as a science.

Yes it does use science to propagate its agenda and grow. But it falls short of that.

And I am not complaining.

What I have just elucidated is afterall, the reason I chose this calling.

Medicine is a science with a pathos, an eccentricity that not many people notice.

This pathos is oft termed categorically as uncertainty. Uncertainty underlies the basis of medicine. I fact it can be argued that medicine men will only be technicians if this kink of character did not exist.

A patient comes in with sudden severe chest pain. He has a history of constipation, weight loss and rectal bleeding. No chest abnormalities on examination.

An exam question. After good thought it struck me " Pulmonary Embolism" which isnt a respiratory disease and may be a consequence of Pemberton's phenomenon. BINGO.

Something not explicitly mentioned in the notes. It had to be synthesised and a statistical weighing performed in the mind.

William Trotter is author of one of my most favourite quotes of medicine: Diseases often reveal themselves in casual parentheses.

In this respect and many others Medicine is an art. An art with pathos

Thus there will be many who will fall out, entering Medicine and treating it as if it were a Science only to get a lashing, being hit by a train of realisation that certain methods cannot aplly to these uncertain vocation.

The bard speaketh through his work

2010-09-18T09:57:00.000-07:00

Queer

2010-08-22T00:00:00.000-07:00

It is queer how a single image can evoke a whole range of suppressed memories and past perceptions.

It is good once in a while to tame that ruthless teleologist in me, allowing me to reacquaint myself with the days back then when I could dream of random nothings.

Just when I thought I was no longer capable of being emo, I fell in love again. Mind you, the falling in love here presents a bigger context to what it is normally understood as.

I have fallen in love again. But alas, I know soon I will have to fall out of it again

The Problem With Medicine

2010-06-25T07:28:00.000-07:00

Medicine has always been a problem field, in terms of it being a profession.

Those who are sucked in into this profession for want of fame or money or glory will find that they have entered a field with a steep upward mobility, a pyramid with a needle tip.

Competition is exceedingly fierce for top specialties, such as orthoapedic and plastic surgery ( No surprise here, seeing the financial propects these two fields promise and the relatively low ratio of emergency consultancies).

A medical student is now told that he needs to be THE multitasking prodigy if he ever wanted to reach that needle point tip of the pyramid of Medicine. Otherwise he gets stuck, dispassionate and sore at one of the bottom rungs, cursing his decision to enter this cursed profession years ago.

Interviewers for specialties training look for evidence of not one of the criteria below, but all of them in ADDITION, I strongly suspect, to some other things they do not expect a multitasking prodigy to be:

Academically superior to all other people in his or her cohort, meaning proof ofposession of Academic Prizes and top grade transcripts. This should take up 99% of a medical students time to achieve. Wait for the remaining criteria!
Having had (preferably extensive) high quality experience in both clinical audits/research and lab based research ( the latter something quite impossible at least in Malaysia, I tell you)
Sugar glazed reports filled with unearthly praise from hospital consultants, supervisors and mentors, indicative of impeccable clinical skill (diagnostics and management and dealing with pesky hospital protocol and staff and bedside manner.)
An unwavering interest and drive ever since he or she was 5 to pursue that profession and thus a proof that everything that person has done, is doing and will do will be in the vision of entering that profession. ( affiliate memberships, involvement in student societies catered to such.
An unquestionable record of leadership skills and acumen and wide involvement in extra-curricular activities.
Excellent knowledge of the politics, economics, sociology and philosophy pertaining to medical practice and care.
Compassion, empathy, basically the whole works on moral and ethical 'must-dos' ( or more appropriately 'must-feels')

Even more worrying is the predicament of translocated medical students: those who go overseas to read Medicine find that neither the country who nurtured them into doctors nor the country which nurtured them since birth want to offer them any offers for further training. This leaves them in a lurch. They will all say " I went overseas for excellence and quality for the hope of reaching the top but now I am left here unwanted, a refugee.'

And the whole argument of upward mobility pales in comparison tothe price we must pay to become a doctor. A primary Medical qualification itself ranges from RM 300, 000 (the very lowest) to RM 1, 000, 000 (excluding books and living costs)

Add in these components:

Specialty training Courses (eg. Basic Surgical Skills from the Royal Colleges of Surgery)
Postgraduate qualifications ( Master of Medicines and Master of Surgeries, Postgraduate diplomas- Diploma of the Royal College of Obstetricians and Gynaecologists)
Royal College Examinations ( RCS, RCP, RCOG, RCR)
Training Programmes cost ( in real payment and also lost income)
Continuing Medical Education ( travelling costs for courses, the number of journals subscribed, online courses)

Yes the education that went into your consultant pretty much sums up to Rm 3 million (very rough estimate, up to consultant status neglecting the cost of continuing medical education)

The problem with medicine ironically is not a problem with medicine, ironically enough.

It is a problem of the inflation of medical students. Medstudentmegaly.

As bad as it already sounds, the mere problem of there being too many medical students, a double blow is that many do not want to pursue medicine with passion. This equals poison in medicine regardless of how many prizes the student has bagged. It means poison for the patient.

Too many enter medicine because of the simple conditioning that having good grades predisposes one to Medicine. It is something which is thrusted upon the student.

And this forms a perpetual cycle.More medical students equals more competition equals more outrageous criteria equals more prestige equals more medical students.

The funny thing about those multiple outrageous criteria is that only two small subcriteria is truly useful to the patient. Competence and Values. They however go to the backseat during interviews.

And being part of the system I must confess to sometimes going overkill to achieve the criteria set above ( I do many things now that people describe as overkill. ) I must then constantly remind myself that rather than looking at that needle point pyramid, I must look at the faces of my suffering patients instead.

How different is Past Perfect From Future Tense? A Short Note on Malaysia-Singapore Relations

2010-06-17T20:46:00.000-07:00

I went for a play which featured a freind of mine in KLPAC last night. It was a venture I looked forward too after too long a hiatus from attending plays. My last one was a few months ago": The Swimming Instructor by Desmond Sim. Damn Medical School.

This was a groundbreaking play for it was a two part play: Past Perfect and Future Tense. They are written by two different writers: Past perfect adds a feather to Malaysia's Mark Beau De Silva's cap while Future Tense was Singaporean Desmond Sim's domain. Both plays run concurrently for 40 minutes, after which the audience for both switch places ( past perfect being in the Lawn area of KLPAC while Future tense was in Pentas 2).

So you could actually get two interpretations if you had come on two different nights for the play. You could choose between wanting to go retrospective or prospective. Travelling from Singapore to Malaysia or From Malaysia to Singapore. More on that later.

But first, Past Perfect and Future Tense is in fact a single play running along the theme of a family secret kept from the younger generation, how that secret feeds a gamut of human emotions on all the little people that make up that family, even a dog by the name of Ah Fook (played by the only Indian guy in the play- not exactly politically correct but when are plays politically correct anyways?) Ah Fook did hit a raw nerve when he started licking the grass and picking up newspapers with his jaws though: He mimicked exactly how a friend of mine was :P.

Skeletons. In the dusty cupboard in your late grandmother's room we children never ever dared to open either because doing such a thing would either render our buttocks numbed by the rotan or because that cupboard somehow wasn't meant to be open. A sort of pandora's box.

Let's go back to our dolls and trains.

We were scared opening the cupboard might bring out something we were not ready to accept. It was good sometimes to not know what was behind those wooden doors of the cupboard.

This play is something like that. It was about a skeleton no one ever wanted to see again but never could get rid off. It so happens that skeleton was a small boy pushed between different families like a rag doll. And he is kept in the cave without any hint of light. Haih, such are family secrets.

Past Perfect sets the scene while Future Tense resolves the tension built up, an atonement of the sins of the older generation upon the younger, the day our mother opens the creaky doors of that old cupboard, and we peer from a distance, half expecting a person to awake from his or her slumber in that cupboard. But all we see are exquisite sarong skirts and a box of letters. All is now light.

So which was better? The play by the Singaporean or the play by the Malaysian? I couldnt resist but compare, afterall, Past Perfect was filled with naughty subtle references of how we over at the northern end of the Causeway feel about our Southward neighbours, Made up of rubbish, small and filled with Ah Fook's canine faeces.

The overall take was that Singapore was filled with secrets, uncomfortable ones, yet modern and flourishing and grand.

I went in blind ( I did not know at first which one was Mark's Malaysian take and which was Desmond's Singaporean style).

After the play without a doubt, Future Tense won it all. It's set was more sophisticated and metaphorical, its jokes were less slipshot, and it set a darker tone, a more serious one, one that stirred more emotions.

But perhaps it was made that way. Past Perfect, telling the past, is supposed to be playful and set in a lighter mood. Perhaps it did not build up enough emotion because it was suppose to sacrifice that to Future Tense, where true atonement happens. Diasppointedly though, Past Perfect built up the tension only reasonably so-so ( not up to my expectations).

Perhaps its because I have always been more savvy to Desmond's style of theatre, dark and dramatic and murky.

But overall, technical errors aside like tone and accent(these are afterall first time actors), it did carry its theme well.

But at least now I have a strengthened conviction that indeed when it comes to theatre or anything in fact, size doesn't quite matter.

Results for my Medical Specialty Aptitude Test

2010-06-14T10:29:00.000-07:00

As from http://www.med-ed.virginia.edu/specialties/

Rank Specialty Score
1 general surgery 49
2 plastic surgery 49
3 nuclear med 49
4 thoracic surgery 48
5 physical med & rehabilitation 46
6 pathology 46
7 neurosurgery 46
8 nephrology 45
9 hematology 44
10 orthopaedic surgery 44
11 urology 44
12 occupational med 43
13 emergency med 43
14 allergy & immunology 43
15 colon & rectal surgery 42
16 gastroenterology 42
17 neurology 42
18 radiology 41
19 endocrinology 41
20 cardiology 41
21 general internal med 41
22 pulmonology 41
23 infectious disease 41
24 radiation oncology 40
25 aerospace med 40
26 ophthalmology 40
27 obstetrics/gynecology 40
28 otolaryngology 40
29 psychiatry 39
30 preventive med 39
31 anesthesiology 39
32 rheumatology 39
33 med oncology 37
34 family practice 37
35 dermatology 37
36 pediatrics 33

The Symbol of Transplant Surgery

2010-06-02T08:30:00.000-07:00

Introducing The CHIMERA

Cases from The Chiayewnian Clinic: File 04

2010-05-27T07:14:00.000-07:00

A Plantar Splinter

Mr Nicholas presented with pain in the superior-lateral plantar surface of his left foot. He had got a wooden splinter lodged in that area after slipping while trying to sit down. He then successfully dislodged the wooden stick.

In a few hours the site exhibited the five cardinal signs of inflammation: calor, rubor, dolor, tumor and functio laesa or respectively heat, redness, pain, swelling and loss of function.

Rubor was however not obvious at presentation due to the anatomy of the plantar surface. The keratinised stratified-squamous type stratum corneum in the epidermis over the plantar surface is significantly thicker, and there is the presence of an extra layer of stratum lucidum giving the surface a very thick and 'fleshy' covering.

Dolor over the site resulted in significant functio laesa, with Mr Nicholas limping to his right. Clearly a shift of his weight to the right foot was therapeutic for the pain.

Inflammation is part of a dynamic response of vascularised tissue to injury and is a mediator of healing and testament to the body's innate capacity to heal.

Rubor and tumor result from the exudation and extravasation at the capillaries adjacent to the site of injury. They are important for many things including the facilitating the diapedesis of polymorphonuclear neutrophils to the site of injury, efficient transfer of pathogenic contaminants of the injury to adjacent secondary lymphoid organs, dilution of microbial-derived exotoxins, and efficient transfer of cytokines and growth factors inportant for wound healing.

Dolor is mediated by prostaglandins and other mediators and is one direct reason for functio laesa. It serves as a warning for the organism in question to allow rest for complete un-disturbed healing. For it is the immobile tissue that provides for undisturbed and prompt healing.

A wound caused by such a splinter would be in most cases healed by first intention. Healing by first intention is healing whereby the wound edges are in constant communication and not segregrated. This kind of healing is ideal and fast. True enough, Mr Nicholas could do without his limping after 2 days, even though the plantar surface is a hotbed for potential infection- always in contact with an external surface and facing constant reactive pressure from the ground.

Cases from the Chiayewnian Clinic: File 03

2010-05-27T06:41:00.000-07:00

I have come to witness a few cases of psychosomatic disorders in my colleagues.

This high rate of morbidity is probably correlational with the amount of stress in the environment: a medical school would therefore surely yield one or two cases at the very least of psychiatric somatoform disorders.

The two forms of psycho somatoform disorders that I have witnessed are somatization disorders and conversion disorders.

Somatization disorder primarily precipitates either as a heightened perception of one's symptoms (primary) or a seemingly idiopathic somatic pathology (which in fact accompanies the presence of stressors) .

William R Yates, MD also observes in e-Medicine that autonomic arousal may play a role in pathogenesis of somatization disorders:

Autonomic arousal may be high in some patients with somatization. This autonomic arousal may be associated with physiologic effects of endogenous noradrenergic compounds such as tachycardia or gastric hypermotility. Heightened arousal also may induce muscle tension and pain associated with muscular hyperactivity, as is seen with muscle tension headaches.

Conversion disorders meanwhile are defined by their specificity in promoting the loss of neurologic function, which may result in physical findings such as pseudoseizures and paralysis.

Presented here are two such cases. Patients' names and details of their presentation have been changed to protect their privacy.

Case 1

Franklina Gray complains of GI inflammatory disorders and bowel irritation everytime a significant stressor is put upon her. Franklina frequently complains of angina and most recently developed retinal haemorrhage, affecting her vision and providing her with significant morbidity such as to affect her daily life.

Case 2

Muthusamy Karrapaiah, a 3rd year medical student after receiving his finals results collapses to the floor, with severe tense muscle paralysis, with a high level of pain, and rendering him unable to walk or move.

Treatment should involve behavioural therapy and psychiatric treatment rather than aggresive surgical and medical intervention. Conversion disorders however are usually acute and will resolve spontaneously.

The best available treatment therefore lies with the psychiatrists. A blocking cultural behaviour related to this involves the feeling that the psychiatrist remains a doctor for the crazy.

Bibliography

William R Yates,Somatoform Disorders, http://emedicine.medscape.com/article/294908-overview (accessed 26/5/2010, 10 pm)

Copyright The Chiayewnian Clinic May 2010

The Moonless Cycle Back the Long Road Home

2010-05-23T08:36:00.000-07:00

Uncle Lim is 87 years old.

He still holds hands with his Mrs Lim.

In fact they even hold hands to sleep.

And every Saturday,

Uncle Lim takes his Mrs. to the midnight food haunt near their house on bicycle

They buy all their comfort foods.

At home after their cycle back home on mostly moonless nights,

they will hold hands again while eating porridge and fried noodles.

"I shall fight as long as I have a bowl of rice on my table..."

2010-05-17T21:08:00.000-07:00

These were the words uttered by the selfless Dr Selva in the Future Doctors Forum in IMU. I am shocked and saddened by such a news, which of course main stream papers neglected.

Where is the Ministry of Health, or the Minister in fact?

Courtesy of The Nut Graph

Whistleblower gets show-cause letter
13 May 10 : 8.00AM
By Ding Jo-Ann
dingjoann@thenutgraph.com

PETALING JAYA, 13 May 2010: A doctor who went public with serious allegations of mismanagement and cronyism in an Orang Asli hospital in Gombak has continued to be targeted for her outspokenness.

Dr Selva Vathany Kanapathi Pillai told The Nut Graph she received a show-cause letter from the Jabatan Hal Ehwal Orang Asli (JHEOA) last month.

"The JHEOA asked me to explain why I took part in a Bar Council press conference without my department head Dr Saaiah Abdullah's permission," Dr Selva said in a phone interview.

"The letter said that if I did not reply with an adequate explanation, action would be taken against me."

The Bar Council press conference was held on 11 Feb 2010 to highlight Dr Selva's complaints about the Gombak hospital. It raised issues such as the high rate of malnutrition among Orang Asli children, and the use of hospital facilities by non-Orang Asli patients. This was despite the fact that the hospital was specifically set up to improve Orang Asli health.

The Bar Council had also called on the hospital to be placed under the purview of the Health Ministry instead of the Rural and Regional Development Ministry, which is currently the case.

Dr Selva was also present when Orang Asli representatives handed in a memorandum to the Malaysian Human Rights Commission (Suhakam) on 16 March, complaining about poor services at the hospital.

JHEOA pressure

Dr Selva had earlier told The Nut Graph how she was sidelined by the hospital's management due to her raising of mismanagement issues.

Dr Selva (Courtesy of Bar Council)Shortly after she sent a formal complaint letter to the Health Ministry in late 2009, she was told she was to be transferred to Kedah.

"I am not under JHEOA's authority anymore because of my transfer. I am now directly under the Health Ministry," said Dr Selva.

"It doesn't make sense that I am sent a show-cause letter by the very department and people that I have been making complaints about."

Dr Selva was unable to supply The Nut Graph with a copy of the JHEOA letter as it was marked "sulit".

Dr Selva said the show-cause letter had also asked her to give an explanation about why she had participated in a demonstration in front of the Gombak hospital on 24 Feb 2010.

"I wasn't even at the hospital on the day of the demonstration," Dr Selva said. "I was already preparing to leave because of my transfer to Kedah."

The Nut Graph previously tried to reach JHEOA director-general Datuk Mohd Sani Mistam for comment on issues affecting the hospital, but was told he was away till 17 May. Requests for his deputy, Nisra Nisran Asra Ramlan, to respond were also in vain.

No resolution

Dr Selva is vexed that despite the recent attention the Gombak Hospital has been receiving, the authorities are focusing on issuing show-cause letters instead of dealing with the malnutrition issue among Orang Asli children.

"There is already a comprehensive Health Ministry food-basket programme in place. It is not just for the 'hardcore poor', as claimed by JHEOA's director-general, but for all malnourished children," said Dr Selva.

Under the programme, underweight children receive monthly food baskets from the Health Ministry. The children are monitored until they fall within the recommended weight for their age.

Joseph Entulu Belaun (Source:
parlimen.gov.my) On 17 April 2010, The Malay Mail reported that Rural and Regional Development Deputy Minister Datuk Joseph Entulu Belaun had refuted Dr Selva's claims in Parliament.

He stated that a thorough investigation had been carried out, which showed that there was no truth to her statements.

"In short, she is lying," the deputy minister reportedly said.

Dr Selva, however, pointed out that the Rural and Regional Development Ministry was not the appropriate body to investigate her claims. "They are not medical practitioners, nor do they have expertise on medical ethics or medical management," she said.

"I have full faith that the Health Ministry would be able to conduct a fair and transparent investigation through the Malaysian Medical Council."

She added, however, that if concrete steps were not taken to improve the situation, she would not hesitate to raise the matter with international organisations such the World Health Organisation .

Outspoken doctor persistently "sidelined"
16 Mar 10 : 8.00AM
By Ding Jo-Ann
dingjoann@thenutgraph.com
Corrected at 12:20pm, 22 March 2010

PETALING JAYA, 16 Mar 2010: An outspoken doctor has charged that her attempts to highlight the mismanagement of an Orang Asli hospital in Gombak were persistently undermined by the authorities.

Dr Selva (Courtesy of Bar Council) Dr Selva Vathany Kanapathi Pillai, who went public recently with serious allegations of cronyism and unprofessionalism in the hospital, alleged that she was constantly sidelined due to her outspokenness.

(Corrected) In one instance, Dr Selva claimed, hospital director Dr Saaiah Abdullah tried to exclude her from a meeting with the deputy rural and regional development minister when he visited the hospital in September 2009.

"This was despite her earlier instructions for all unit heads to be present," Dr Selva, who was the hospital's outpatient department head, said in a phone interview.

"When I went to the meeting room, I was told [by Dr Saaiah's clerk] I need not attend because there were not enough chairs," Dr Selva told The Nut Graph.

"Only when I said I would ask the deputy minister myself why I was not included, did they say I could attend."

Dr Selva said the deputy minister had appointed her to join the ministry's focus group on rural health after she voiced her concerns on Orang Asli health.

But, she said, further problems developed. According to Dr Selva, there was a focus group meeting in Kelantan in October 2009. She claimed that the hospital director told her to wait at the hospital for a car to take them to the meeting. But the car never arrived.

"I flew to Kota Baru at my own cost the next day and rented a car to drive to Gua Musang [for the meeting]," Dr Selva said.

Two months later, Dr Selva, who has worked at the hospital since March 2009, was transferred by the Jabatan Hal Ehwal Orang Asli (JHEOA), which runs the hospital, to Sungai Siput in Perak.

"There's no pharmacy, laboratory or medical assistants at Sungai Siput. It's just a transit point. Patients are treated at a nearby hospital," she said.

Click on image to view letter of promotion"Why would they want to put a doctor there when there was a vacant position at Gombak Hospital?"

When she sought clarification from the Health Ministry, she found out she had, in fact, been promoted since September 2009 and a letter had been sent to Gombak Hospital.

"The hospital director had been hiding [my promotion] from me," she claimed.

Dr Selva asserted that Dr Saaiah wanted her out of the hospital before she found out about the promotion, which was backdated.

Shortly after these incidents, Dr Selva sent a complaint letter to, among others, the Health Ministry, on the alleged mismanagement in the hospital and the attempts to sideline her. The Health Ministry is currently investigating her allegations.

New posting

Click on image to view transfer letterDr Selva said that on 29 Jan 2010, she received a letter from the Health Ministry transferring her to Kedah, and out of JHEOA. "This was despite my last letter from the Health Ministry [announcing my promotion in December 2009], saying I was to continue serving JHEOA.

"No reasons were given for my transfer, except a letter from JHEOA to the ministry dated 17 Dec 2009 was mentioned. I have asked to see that letter, but [the ministry and the JHEOA] have not allowed me to do so."

The JHEOA, however, has denied involvement in Dr Selva's transfer, telling theSun in 25 Feb 2010 report that it was a Health Ministry directive.

Dr Selva gave an 11 Feb 2010 press conference at the Bar Council on the state of affairs at the hospital and started her Alor Setar, Kedah posting on 1 Mar 2010. When asked by theSun about her transfer to Alor Setar, the Health Ministry said it was done based on "needs for service" in Kedah.

When contacted and informed about Dr Selva's allegations, Dr Saaiah said," I am aware of Dr Selva's allegations. She has written a letter containing these complaints. My department and I have been in discussions with the Health Ministry and we're in the midst of preparing a response."

Dr Saaiah declined to elaborate pending the completion of the official process

Awaang Kolo's Slumber

2010-05-03T05:08:00.000-07:00

Awaang Kolo took a somnifacient.

He now sleeps in perfect supinity.

Shhhhh...

No one wake him!

Awaang Kolo is asleep.

Spasm here and there

His expression without a care.

Shhh...

No one wake him.

Awaang is asleep.

_________________________________________

The writer's writing has trickled to almost nothing on this blog. This screen here now becomes a store of words put in a certain order that pleases the writer. The reader must bear in mind however the fact that most of these writings are more recently not his own.

BMJ: Academic Surgery

2010-05-03T04:58:00.000-07:00

Rajarshi Mukherjee describes changes in training and practice ( Originally published:http://careers.bmj.com/careers/advice/view-article.html?id=20000004 )

Academic surgery is the perfect balance between practical and cerebral. “You must be interested in the intellectual challenges of the broad discipline of surgery and not just want to be a cog in the wheel,” says Robert Sutton, professor of surgery, conducting research into pancreatitis at the Royal Liverpool University Hospital.

Legacy and demand
Contrary to common belief, academic surgery is not an oxymoron. Physicians may scoff, but often it has been surgeons who have advanced their field, such as to deny themselves the opportunity to practise the surgery they love. Surgeons have gone on resiliently to develop and refine other applications of surgery, here to stay for the foreseeable future. It was, for example, a German cardiothoracic surgeon, Forssmann, who performed the first cardiac catheterisation, and a Canadian surgeon, Banting, who was central to the discovery of insulin, both receiving one of the nine Nobel prizes won by surgeons over the years. In this age of evidence based medicine, it is even more important for some surgeons to analyse, interpret, and convey advancements to patients, peers, and the public.

Need for fresh talent
The 2007 report by the Medical Schools Council highlights developing deficits across academic specialties, including surgery.[1] Whereas some specialties, including medicine and general practice, have seen increases, surgery has had nearly a 20% decrease in total numbers of clinical academics from the turn of the millennium, in line with the overall decrease in total clinical academic numbers. There is now half the number of lecturers in academic surgery than there was in 2000.

The Walport report of 2005 addressed the general deficit in academic medicine and sought to ensure a strong future across all fields, recommending new posts to address this problem—of vital importance to the future of academic surgery.[2] Professor Sutton says, “Training in academic surgery is distinct—there are now, by and large, two streams. While many trainees conduct research to expand their portfolio for personal marketability, those in pursuit of an academic career must approach research with long term aims in view, to advance their specialty.”

New approaches to filling in the gap
A higher research degree (MD/PhD) along with successful completion of clinical training is an essential initial first step. The adopted Walport reforms bring in three new types of clinical academic training posts to make it easier to do this, available in the various surgical subspecialties at selected UK institutions—academic foundation year 2 placements, academic clinical fellowships, and Walport clinical lecturer posts. These are aimed respectively at individuals in their early (foundation years), predoctoral (specialist training (ST) years 1-3), and postdoctoral (ST4 and above) phases of clinical training. Research is likely to become more specific and focused as the progression is made through these respective posts.

The beauty of these posts is that they provide clinical training but with protected time for research, to either assemble a successful fellowship proposal to gain research funding for a higher degree (MD/PhD) at the predoctoral level, or to complete specialist surgical training with intercalated full time research experience at the postdoctoral level. There is also inherent flexibility in that individuals in pursuit of a long term academic career can join this path at any point. The amount of clinical work carried out depends on the source of funding for that period, with some fellowships specifying that no clinical work is done to allow full time focus on research. Subsequently, individuals are expected to continue research along with their clinical commitments. They can then move competitively up the promotional ladder towards a senior lectureship, then increase their research productivity, funding and leadership, until they are in the position to apply for a professor of surgery position.

Choice of specialty and academic department
Professor Sutton explains that for surgeons determined to pursue a career in academic surgery, place and subject are usually the most important issues. “The key decision is what research project you do along with whom you do it with. You should aim to be in an international centre with a thriving biomedical and clinical research community and strong sources of funding. The majority of significant clinical science depends on major groupings such as these, so joining an established programme is likely to offer far more than starting effectively from scratch where there is little track record.” This is ever more crucial if you consider that with the new academic training pathway, starting as an academic clinical fellow at ST1 would mean you potentially staying in the same centre for another nine years (until ST6), including three years of PhD research. There is a large geographical distribution of academic departments of surgery and if the projected allocation of academic surgical posts is examined on the National Co-ordinating Centre for Research Capacity Development’s website (www.nccrcd.nhs.uk) it can be seen that these posts are generally spread out across the country.

There are a multitude of options in specific surgical subspecialties, with posts in general, vascular, paediatric, transplant, and orthopaedic surgery, neurosurgery, and cardiothoracic surgery the main choices. The choice of specialty is often linked directly to a centre, and not all regions offer an academic surgical unit in a particular specialty.

Core qualities needed
Professor Sutton says that, “Academic surgeons need to be versatile with excellent written and verbal communication skills, and a reservoir full of perseverance, patience, zeal, and resilience to cope with the hurdles of publishing, securing research funding, and being able to move smoothly between clinical and research training.” Effective time management and organisation are important, as is the ability to think outside the box of routine practice and to question why something is or is not done. The desire to develop educational skills is also important for most academic roles (box 1).

For entry into academic training, desirable achievements include academic prizes, distinctions in examinations, and a high class in an intercalated BSc/masters. There is no better mark, however, than to have obtained original research publications at the earliest opportunity. An interest in research is important and this may be in the form of theses or projects, but presentations and most particularly publications will always put you ahead of your competitors. Finally, evidence of interest in teaching is also useful, especially a formal teaching role as opposed to standard opportunistic clinical teaching.

Box 1: Pros and cons of academic surgery

Pros
You can be an all rounder in your specialty—short term practical surgery combined with long term academic research

You are in a unique bridging position, the main interpreter of translational surgical research applying a pragmatic focus to basic science research

You can contribute to society clinically and academically

You will have a perfect platform to directly influence peers in allied research fields

There is potentially a large amount of national and international travel involved with development of rewarding collaborations

The ability to directly supervise and train at all levels as well as contribute to medical education

Substantial personal and public reward.

Cons
Extra effort required to acquire and maintain operating skills through periods of research, with possibility of long hours

Stiff competition in field (funding, papers) and for posts to advance career

Limited scope for personally remunerative private work.

Transition between research and clinical work
“The transition between a long period of dedicated research and heading back into clinical training, particularly for a surgeon, can be a difficult period,” highlights Professor Sutton. “After taking time out of clinical practice to pursue a higher degree, there may be some rustiness at the higher end of clinical decision making. This period is one that needs to be recognised and special considerations applied with deliberate support and mentoring.” He assures, “With this support the transition into top level clinical practice can be rapid, however.” With new dedicated training pathways that this should be readily available, and what has previously been a testing time will be more comfortable. Long term, academic clinicians must perfect the ability to switch readily and effectively between research and clinical practice.

Box 2: View from Janet Wilson, professor of ENT surgery, Freeman Hospital, Newcastle upon Tyne
The advent of the academic clinical fellow and clinical lectureship programme has provided a much needed injection of funding and potential for new blood in academic otolaryngology. ENT academic surgeons have always been a fairly rare species in the United Kingdom in contrast to North America or Europe, for example. One of the huge attractions for someone committing to an academic ENT surgery career is that within otolaryngology there remains a huge diversity of different clinical directions. It is very challenging, I think, for someone emerging from their foundation years to reach a triangulated decision of (a) being a surgeon, (b) being academic, and (c) opting for a specific subspecialty all at the same time. Within otolaryngology we have opportunities for research in all ages from the tiniest of neonates (or even fetus when you consider our interuterine research), to the most elderly members of our population.

For those who are interested in work with patients who have cancer there continues to be the very technically challenging and constantly advancing field of head and neck cancer surgery within the context of multidisciplinary teams. For those who are of a more physiological bent there is a huge range of opportunities from the sublime—miniaturised implantable hearing devices—to the, well, rather less sublime of habitual snoring. Coupled with that, ENT surgeons traditionally have been somewhat more relaxed in their approach to themselves, their patients, and their careers than has traditionally been the case with certain other branches of surgery. I think it is this that makes us good team players, striving to maintain some sort of work-life balance, albeit against the odds.

Box 3: View from David Neal, professor of urology, Addenbrooke’s Hospital, Cambridge
Academic surgery provides a wonderfully exciting mixture of clinical practice, technical surgery, research, and teaching. I have found that the precise ratio of these various events changes throughout your career, and indeed can be tailored to one’s individual and particular talents. Academic surgeons are extremely driven and desperately want to improve their specialty. This is the key thing that would drive a surgeon to move into academic practice. Career opportunities are expanding in academic surgery and there is now a structure for academic training, which will be a big help, I think, in formulating people’s careers.

There is no question that choosing your research supervisor and clinical mentor is extremely important. A PhD rather than an MD probably provides a better training for a future academic career, but this need not necessarily be so. I am very fortunate in that my clinical practice has been the springboard and inspiration for my clinical and laboratory based research. Together with two of my colleagues (Professor Freddie Hamdy in Sheffield and Professor Jenny Donovan in Bristol) we are running what has now turned out to be the largest randomised trial of surgery in men with early prostate cancer ever carried out. This trial is coupled with a collection of a large biorepository that has generated material for exciting genomic and biomarker research. The trial is recruiting more than 100 000 men who are being screened for prostate cancer. Those with early prostate cancer are being asked to join a randomised trial of treatment comparing surgery, radiotherapy, and monitoring. My laboratory programme of work is to try and better understand how prostate cancers become aggressive and how they become resistant to hormonal treatment. We hope that we will be identifying targets that will be useful in developing biomarkers of aggressive disease or potentially new targets for innovative treatment. The other thing that I have found really exciting during my career is training other younger colleagues who have been an inspiration to me as well. I have also been exceptionally fortunate in my clinical colleagues, firstly in Newcastle and more recently in Cambridge, who have been very supportive of endeavours to improve academic surgery.

Keeping on top of the game
The key to being successful in academic surgery, Professor Sutton highlights, depends on being an all-rounder. “You must maintain your productivity in original research while also excelling in clinical work.” Although the overall numbers of posts are low in comparison to other specialties, and competition is stiff, the new health training reforms mean that there are clear opportunities laid out for motivated and committed individuals to pursue. The new Intercollegiate Surgical Curriculum Programme’s syllabus can give interested individuals an idea of what the specialty involves (boxes 2 and 3) and further information on training posts in various specialties and regions is available on the National Coordinating Centre for Research Capacity Development’s website.

Further information
Society of Academic and Research Surgery—www.surgicalresearch.org.uk

National Institute for Health Research. Integrated academic training—www.nccrcd.nhs.uk/intetacatrain/index_html

Intercollegiate surgical curriculum programme (academic surgery)— www.iscp.ac.uk/Syllabus/Overview.aspx?Spec=GS

These demons of the flesh we purge

2010-05-01T21:55:00.000-07:00

" It is time we purge. We purge for the greater good. It is this final act of kindness with which we shall progress. We purge so that we can renew. We renew so that we can be reborn."

Anatomy, Surgery, Oncology, Evolutionary Medicine, Research

2010-04-01T07:54:00.000-07:00

Cases from The Chiayewnian Clinic: File 02

2010-03-20T09:43:00.000-07:00

Mr Nicholas presented with "overtearing and eye redness". It was a sudden onset diffuse right ocular erythema with a focus at the medial border. Excessive lacrimal secretion was not evident but the cause of complaint was found to be nasolacrimal punctal occlusion secondary to local site inflammation. Mild Pain was focu...sed at the medial border with no radiation. There was no complain of itchiness. Discuss

Follow Up (22/3/2010)

A day later, Mr Nicholas developed right cervical lymphadenopathy. It finally developed into bilateral cervical lymphadenopathy. On the 4th day the symptom of epiphora stopped. However, the once fine vessel like erythema developed into deeply erythemic patches, indicative of haemorrhage. He was diagnosed with a complication of inflammation induced epiphora, subconjunctival haemorrhage secondary to secondary acquired nasolacrimal drainage obstruction coupled with the bad habit of "making hand contact and rubbing the eyes with the hands"

Mr Nicholas however was cheeky to also note that he had read from emedicine the list of pathogenic agents involved included a substantial number of pathogenic agents that are sexually transmitted such as Treponema pallidum, The herpes viruses and Chlamydia sp.

Mr Nicholas therefore wanders about how he actually got the infection. It is most likely non-idiopathic and infection-linked. He can theoretically perform investigations to confirm the pathogenic agent by taking a lacrimal swab, performing crude microscopy, then proceeding to culture it on an enriched, possibly selective medium, performing a further microscopy, and supplement it with antibiotic sensitivity tests.

Mr Nicholas would however most probably get a Rapid Antigen Detection Test. Further levels of investigation may include PCR test to detect pathogen RNA or DNA, immunoassay tests or antiody titres. Toxin titres are sometimes valuable tools as well.

Mr Nicholas was however concerned with the epidemiological pattern of this condition. He thinks an epidemic is going on in the IMU. Three separate friends have developed the same symptoms. They have not performed any activities for a prolonged time together in the past two to three weeks. He is also concerned about the ethics employed by the primary care received by one of his friends: His friend was given an antibiotic without confirmation of pathogenic agent via laboratory investigations. He asks whether diagnosis on clinical grounds provided sufficient justification to provide antibiotics, whether or not the antibiotics were broad spectrum.

Overall Mr Nicholas has been happy in observing first hand the sequelae and complications of a disease in his body and how healing takes place. Through his process of disease, he has reviewed a multidisciplinary facade of learning material in the broad subject of pathology and medicine. For this he is grateful. For there is no greater teacher than the living human body.

Copyright 20th March 2010 The Chiayewnian Clinic (First published on Facebook

The Chiayewnian Clinic: Research File 01

2010-03-20T09:35:00.000-07:00

Just completed my anatomic inquiry into the avian viscera. The contents of the gall bladders harden but do not discolourise. The livers pale on touch with boiling water. The flesh and muscles of their feet become taut.

Cases from The Chiayewnian Clinic: File 01

2010-03-20T09:28:00.000-07:00

Sudden onset tonsilitis and anterior cervical lymphadenopathy. Negative presenting associated symptoms include coryza, headache, generalised lymphadenopathy. Mild Myalgia, most likely not secondary to viral pharyngitis but secondary to physical exhaustion. Shame on you Streptococcus pyogenes. Differential diagnoses li...ke viral pharyngitis, infectious mononucleosis, etc. but can be clinically ruled out

1. What symptom will be given by all patients with pharyngitis?

2. Coryza and generalised lymphadenopathy each are associated with what pathologic agents?...

3. These symptoms were given by a medical student who took a self history. Explain what is meant by Medical Student's Disease and evaluate the likelihood that Chia Yew Kong has this disease.

4. In what type of pharyngitis is myalgia commonly secondary to?

Copyright 15 February 2010 The Chiayewnian Clinic (First published on Facebook)

Thanks! This may look like a copy and paste msg but you have to trust me it's not :P

2010-03-13T05:05:00.001-08:00

The Birthday post

2010-03-12T20:38:00.000-08:00

It's my birthday. It's a weekend. I'm working.

Spot the odd one out.

In medicine, one must continue to work and study. One joins a league of professionals, a fraternity that has certain expectations of you.

I am happy I am doing work. It reminds me of the fact that in doing things, one can never stop, one cannot fight for a cause during a 'campaign period'. It's a lifelong passion, a suffering that extends throughout life. Just because I want to do something, that is not just reason to stop working.

And the implications of such a stance have begun to manifest in my life. I have drifting friends. The last time I truly went window shopping was in July last year.

A doctor must work 18 hours a day and 7 days a week. Martin H. Fischer was of this view. "if you cannot console yourself to this fact, get out.

Yesterday, very symbolically marking my birthday, my father took me to a scientific meeting with general practitioners on the current review of N-acetylcysteine/ glutathione in the relief of upper respiratory tract infections.

It was through dinner that a true sense of the medical fraternity weighed down on me.

My father's GP firends all telling me how it was like to be a medical student "just like you" in their times. How Professors hounded them for the course of the arteries, something we do not have the misfortune or privilege to learn because of the ever growing medical syllabus. A GP graduating now would never be able to tell you all this. He would have to be a surgeon to even hear the bare mention of this arterial anatomical courses.

They talked about the female genital surface anatomy, at one point they were a bit hesitant . Then one female doctor came out and said "What's the matter? Future doctor... You would have learnt about it, rite?" I nodded.

And I was then invited by them to a whole string of other scientific meetings.

Suffering for my for my passion. Now thats one heck of a brithday gift.

Curiosity

2010-02-22T06:53:00.000-08:00

Dr Mala Maung keeps on insisting we need to be curious to do medicine.

That Medicine is interesting yet challenging.

That we don't read enough.

That we are not curious enough.

She should know. She's a PhD MBBS. Sharp in mind and wit.

My whole view of medicine has changed in these few months.

It's no longer about being laidback, as I have been all these years.

You must fight to earn your right in this fraternity.

You must be overly competent.

You must know.

You have to be curious.

Gambar Gambar Tersisip Siri 1

2010-02-15T02:34:00.001-08:00

This guy, my senior from UKM Fakulti Perubatan (yes, UKM and IMu has good ties through AMSA Malaysia) epitomizes the ideal medical student.

He is cheeky, adorable in this picture, kind to people of all walks of life (it's his grandma of course), outgoing, and more subtly he is wearing the red band of Multiple Sclerosis, a neurologic debilitative disease.

Why I Must Know

2010-02-04T07:51:00.000-08:00

An essay soon to be released on why achieving is so important in Medicine

The KL Canine Rhapsody

2010-01-24T07:40:00.000-08:00

The dog crawls out of that lone rubbish bin behind Wisma Long Hong Gong.

It snarls at some blue shadows.

A lamp light flickers, almost as if it had a rythm of its own, a logical sequence.

The dog howls at a non existant moon.

It knows death will befall a few leaves come morning.

The dog limps on its left apparatus, pacing like a drunkard in search of his long dead wife.

The dog seeks an inner peace.

The dog stumbles upon a half finished packet of nasi lemak, extra sambal.

One ponders why it remains unfinished.

Sambal too ravishing?

Or rice gone sour?

The dog sniffs.

The dog expresses disgust.

The dog paces.

A homeless person bows to The dog.

He knows of The dog's majesty.

He knows the things The dog promises.

the dog promises a future Malaysia

Untainted and Unhurtful.

The dog gestures back.

By arching it's skinny back.

The dog then enters the lone rubbish bin behind Wisma Long Hong Gong.

The dog will rest.

Yes, it will rest till it awakes,

when the winds start blowing

the next winter.

Think not of organ donation as giving a part of you so another can live but a person giving his or her whole self so that a part of you can live.

2010-01-24T07:28:00.000-08:00

Finding our Wild thing inside

2010-01-21T06:14:00.000-08:00

They say, or at least, the trailer of the movie Where the Wild Things Are, says that There is a Wild Thing in All of us.

How nice if we released this inner child, this passion, this glee in ourselves.

We have to embrace this nonsense, this non-adultness I am sure we are, or at least, were familiar with at a not so distant past.

Too many a time, I see people fussing over rudimentary things, things that are fluid and in flux.

If we do this then maybe we can live and dream.

Where is your wild thing?

Masa Resah

2010-01-08T07:50:00.000-08:00

We are in troubled times.

Some idiots burnt down 3 churches.

No they don't get to be heroes of Islam. They get to go to Hell.

Firstly, they break a covenant granted by the Prophet Muhammad pbuh to St Catherine on Christians who are to be protected by Muslims till the Last Day.

What has happened to this?

Once again, people are too stupid to realise that things like this cannot be resolved by violence and acts of intimidation

That acts of malice and mischief only deepen already painful wounds.

That their religion Islam is about peace understanding and dialogue.

What was going on in their minds?

Hate?

Just because some people wanted to use Allah as their God's name.

And why do you Catholic people need to use Allah anyway. Tuhan is enough. Yes, you all have the right to use whatever name you like to call your God. But for Heaven's sake, if it makes people angry and uncomfortable, why still insist.

Malicious intent?

You people should be maintaining peace. Allah and Tuhan are the same. Naming Tuhan Allah won't make it easier to convert people. God himself practises His will to convert and put faith.

We hae to resolve this amicably and divinely, that is by peace, dialogue and aceeptance.

Don't bloody use your bloody politicking anymore.

Have a heart and a conscience. What would an ever merciful Allah or Tuhan do?

He wouldn't throw Molokov cocktails at you.

Seriously, stop behaving like children!

Advertisement by the Most Peculiar Imaginary Advisory Council

2010-01-02T07:18:00.000-08:00

Notice is hereby given on the induction of 5 Fellows, 2 Honorary Fellows and 3 Historical Fellows to the Most Peculiar Imaginary Advisory Council of Chiayewnian Doctors.

The 5 Fellows being

Professor Dato' Dr Khalid Kadir,

Dean of Clinical School, Monash Malaysia
Winner of Merdeka Award
Professor of Clinical Medicine in Endocrinology

PhD (Monash)
Professor Dr John Paul Judson
Professor of Anatomy, IMU
International Reviewer for Grey's Anatomy

A Professor Dr Nilesh Kumar Mitra,

Professor of Anatomy, IMU

Dr Kim K Tan

Microsurgeon

Associate Professor of Surgery, UM

Cleft Lip Surgeon

A/Prof Bulathduwage Joseph Joachim Francisco Perera

Former Surgeon

Professor of Anatomy, IMU

The 2 Associate Fellows joining Tun Mahathir Mohammad and Dr Chua Soi Lek are

Professor Ong Kok Hai, PhD

Professor of Medical Microbiology, IMU

Biomedical Entrepeneur

Professor Toh Chooi Gait

Dean of Dentistry, IMU

The three Inaugural Historical Fellows bestowed with fellowship are

Mr John Hunter

Father of Modern Scientific Surgery

William Osler

Revolutioniser of Medical Education and Legendary Clinician

Hua Tuo

Only Surgeon in Ancient China and bestowed the title "Divine Doctor"

As with other Fellows, the citations justifying their fellowship will be revealed in due time.

Pawning myself to the Lord of Medicine and Surgery

2009-12-30T01:44:00.000-08:00

Semester 1 finally ends today after an exam.

I like how IMU exams are conducted. Right after all the papers are collected, the lecturers have a FEEDBACK session, where they reveal all the answers to every question through an overhead projector.

So you know your marks instantly. If nothing awry happens such as technical errors, or fault of memory (thinking I marked that correct answer, but what I picked was in fact the silliest one), or a mismark of the answer sheet, then I can savely say I got an A, my second in IMU, and I pray to God hopefully not my last.

But I don't feel quite right. You see I only studied for five days- 150 Powerpoint sets of notes that amounts to roughly 2000 sheets of paper and every system in the body. There were of course huge gaps in my revision. I did not memorise all the innervations, vascular supply and lymphatic draingae of the Gastrointestinal tract. If it were a Short-Answer -Question format, I would have failed.

I had to use my own internal sense and reason to search for answers. That is not Medicine.

I am just thankful I scraped through an A. Fingers kept crossed of course that when I get the slip it won't be A- or C or E, due to reasons listed above.

Therefore I have planned an Area of Good Practice for my next semester, when I will officially lay in servitude to the Lords of Medicine and Surgery and the Underlords of Anatomy, Physiology, Biochemistry, Molecular Biology, Statistics and Research, Pathology, Immunology, Pharmacology, Clinical Skills, and Microbiology.

Operation Blue Death

where tentatively from 8-10 am every day, I will give interactive two way sessions on( me trying to teach on white boards with people). In medicine, you see one , do one and teach one... or read one, memorise one and teach one.

These lectures will be all encompassing of what we need to memorise in SEmester 1.

Then from 1-3 pm, I will have interactive sessions on Semester 2 stuff.

Then 3 pm pnwards till 4 or 5 I will handle ECA stuff.

Stop this Amalina a failure nonsense

2009-12-24T07:47:00.000-08:00

Malice is in the air when people simply defame Nur Amalina Che Bakri, claiming that she failed her Medicine in the University of Edinburgh.

I see a green eyed monster behind all this.

The facts:

POint Blank: She did not fail Medicine.

She is taking the Intercalated Bachelors of Medical Sciences in Pharmacology with Industrial Experience. This is not a separate degree that needed withdrawal from Medicine. It's a kind of gap year exceptionally bright students are offered to take. An extra degree in 1 year.

That implies a double degree in 1 extra year. And that also implies being imparted with skills that are not covered in the core Medicine syllabus. Skills such as research and in her case Deeper or Higher Pharmacology.

The blogger who first insinuated this nonsense should be the one checking whether he or she has failed anything, incluing researching and thinking skills. Don't comment on anything you have not researched on.

A top Edinburgh Medicine Scholar being labelled a failed Medical student.

Now that is some f**ked-up reasoning.

And to think that it may be a skin colour sterotype induced thing....

That makes it even more f****d up.

Can YOu HeLp me FInd my LoSt See-Harm?

2009-12-23T18:31:00.000-08:00

An experimental arts project by Awaang KOlo

Coming Soon

The Charter of Compassion

2009-12-21T07:06:00.000-08:00

The Charter for Compassion

The principle of compassion lies at the heart of all religious, ethical and spiritual traditions, calling us always to treat all others as we wish to be treated ourselves. Compassion impels us to work tirelessly to alleviate the suffering of our fellow creatures, to dethrone ourselves from the centre of our world and put another there, and to honour the inviolable sanctity of every single human being, treating everybody, without exception, with absolute justice, equity and respect.

It is also necessary in both public and private life to refrain consistently and empathically from inflicting pain. To act or speak violently out of spite, chauvinism, or self-interest, to impoverish, exploit or deny basic rights to anybody, and to incite hatred by denigrating others—even our enemies—is a denial of our common humanity. We acknowledge that we have failed to live compassionately and that some have even increased the sum of human misery in the name of religion.

We therefore call upon all men and women ~ to restore compassion to the centre of morality and religion ~ to return to the ancient principle that any interpretation of scripture that breeds violence, hatred or disdain is illegitimate ~ to ensure that youth are given accurate and respectful information about other traditions, religions and cultures ~ to encourage a positive appreciation of cultural and religious diversity ~ to cultivate an informed empathy with the suffering of all human beings—even those regarded as enemies.

We urgently need to make compassion a clear, luminous and dynamic force in our polarized world. Rooted in a principled determination to transcend selfishness, compassion can break down political, dogmatic, ideological and religious boundaries. Born of our deep interdependence, compassion is essential to human relationships and to a fulfilled humanity. It is the path to enlightenment, and indispensible to the creation of a just economy and a peaceful global community.

I, Kong Chia Yew, affirm this Charter.

I have always tried to be compassionate in my doings. I live by the principle 'better I suffer than the others'. On public transport I will always stand, less the train gets packed and there are no more seats. I always fetch people, not mutually exclusive to friends, to places that they may need to go without question. I have always not stood for the discrimination of the weak and continually try to act kindly to every person, no matter whether he or she has illed against me or has been a god-sent to me. I hold no grudge and show no anger, as it is not this weakness of humans that I want to portray and propagate. I will strive and work harder towards doing good without expecting or wanting redemption. I will try to phase out anger and frustration and replace them with calm and acceptance, looking towards and not disregarding the ultimate aim of detachment, unboundless compassion and unwant for material things.

I will do whatever good I can now, for in retrospect of Associate Professor Bulathduwage Joseph Joachim Francisco Perera's reqoute of an anonymous quotation, for I pass this Earth and time only once. Let me not procrastinate and say I can wait. For doing good is never about oneself but it is for others.

I will not fall into the trappings of a distorted view of Buddhism that whatever good I contemplate on doing, I do it on the basis of diluting unwholesome past actions and reaping good deeds. Compassion transcends this distorted principle, which in fact is not Buddhistic in nature at all.

Let my strive for compassion not be weathered by the cultural conditioning in my society. Let me not forget or brush compassion aside because my family, my friends, my acquaintances or my community tells me to.

Let me not practise compassion in hope for recognition and societal approval. Let it be for the nourishment of my inner self. Let it be for the joy of others.

Let me not be jaded by the fatigue that comapssion sometimes entails. let me instead be inspired to carry on.

Let me not collapse and say I've had enough for suffering is endless and no amount of compassion is ever sufficient or enough.

Let this affirmation not be rhetoric or cosmetic.

May I always feel compelled and forced to take the road of compassion.

Cauliflower Lungs and Gingeric Intestines

2009-12-19T09:09:00.000-08:00

"Vegetables are all your body needs"

from The International Vegetarian Union

Aurora Oculi

2009-12-19T08:23:00.000-08:00

Medical seniors can be rather interesting. This is because we medical students all have an air about us.

To this day, we who claim ourselves enlightened still swear by the notion that in a university, we can pick out which are medical students and which are not. The non-medical students, IMU's muggles for example, are more, blonde, if you are savvy with the notorious reputation blondies have. This being said by a fellow medical student, mind you. Don't prosecute me.

Contact with senior colleagues from the National University of Malaysia UKM, has been fascinating, as earlier revealed. It is nice especially to meet the bordering on overzealous ones. The ones that overchant critical thinking and cannot bear, even if their life depended on it, to utter a single dollop of nonsense. Those who chant medical euphemisms like "Doctors do everything for a reason and we will never do unnecessary things"

These are the interesting senior colleagues that i have encountered, the ones that have their souls pawned to the Two Lords Medicine and Surgery.

There are also those who bear the distinct mark of servantship to these two lords, what I coin the Aurora Oculi or Lights of the Eye. It is actually quite misnomeric in the sense that lights do not emit themselves in the eyes of the Marked. Rather it is a distinct Black Ring. It's just that I am too lazy to look up what Black Ring is in latin.

I have seen many Marked Men.

Marked Men differ quite a lot from lay muggles by for example the washing of hands. Marked men like us use 6-7 distinct steps to wash our hands spending roughly 30seconds on what is usually done for 10 seconds.

Marked men speak in tongues. Headaches are not just stress induced but may sometimes be caused by the incapacity of the sella turcica to accomodate the hypophysis. Two of the 6-7 steps in handwashing must account for removing dirty elements from the palmar and dorsal surfaces. The aetiology of Arrythmias are most probably ectopic foci. Cones are most abundant in the fovea centralis which is central most in the macula lutea which lies lateral to the optic disk. Marked men speak dirty words.

Doctor Patient Communication

2009-12-17T04:07:00.000-08:00

1. Read the article, “Key Communication Skills and How to Acquire them” (McGuire & Pitceathly, 2002) – see website reference below. 2. Apply the knowledge obtained from the article to the following scenario – “Mr Ahmad has been diagnosed by you with hypertension and has come to see you for a follow-up visit to discuss his treatment plan”. 3. What considerations do you need to make (1) to ensure that you communicate effectively with Mr Ahmad and (2) promote treatment adherence.

This is my first A grade scored in IMU. Let's hope it is emulated by all other grade-able descendants in IMU.

Key to good management of Mr Ahmad's condition are effective healthcare provider communication skills and treatment adherence.

We should practise certain non verbal cues, such as maintaining sufficient eye contact with Mr Ahmad, lowering our position to his position and comforting him with actions like patting his shoulders. These cues establish a safety net between us and him, to show him that he can be open with us. We should not be patronizing as this will only promote fear and worry.

When performing the medical interview, it is important to ask about his main problems, covering all physical, psychological and social aspects. We can do this by actively listening to him, asking open ended questions to prompt fuller descriptions of problems from him, not interrupting and repeating important details of what he has said, thus acknowledging the patient's problems and being empathetic.

When discussing his problem, we should explain to him the details of his disease in layman terms and how he plays an active role in managing it.

It is important to finally review and ensure his understanding of what was explained.

To promote treatment adherence, it is important to ask Mr Ahmad about any problems that he may have had since his previous visit. We must gauge his beliefs and views and acknowledge that he may have problems with adhering to treatment and changing his lifestyle. We must encourage active questioning and offering of his opinions. We must get him involved in the management plan, and have a mutual agreement on what is feasible and what is not. The key is to form a doctor-patient partnership. We must take care to notice warnings of non adherence in patients such as passivity and blind obedience. It is also worthwhile to get his support system (eg. family) involved in his lifestyle change

Taylor's knows how to appreciate her students

2009-12-13T06:33:00.000-08:00

The key to a good university is a healthy respect that is mutual between the student and the university. This allows for liberty and airspace to fly and triumph.

I thank Taylor's for allowing me and my friends to soar. We were featured in the Teamwork and Leadership Panel on Taylor's Open Day.

Other universities, learn from the best.

Sleep Paralysis

2009-12-11T01:18:00.000-08:00

The last night was quite amazing because it was the first time I had what is more scientifically called sleep paralysis.

This sleep paralysis is the same experience people report as ghosts sitting on one's chest, feeling a heavy opressive dark force sitting on them such that their whole upper body and sometimes, lower too, is rendered immobile. Popular culutre has it that such heaviness arises from the cheeky actions of a supernatural being who has taken a fancy to sitting on your chest.

it was an amazing experience.

I woke up. I saw my dark ceiling.

I tried to move but to no avail. My arms were not responding. Neither was anything else heeding my urge to move.

It then hit me. This is sleep paralysis and what most likely comes next is some ghoul is going to cross my field of vision and scare the life out of me. Now this is important because I now know that at the time I was fully concious of my environment and could even extrapolate this sensation to references in popular culture

Instinct told me to close my eyes instantly. I did not want to encounter any other-worldly ghouls. And I was even concious enough to think of how I will not be able to ever bring myslef to stay in this room again if such a thing entered my field of vision

But the thing was even that did not heed control. Bast*rd....

So the next thing I did instinctively was to adduct and flex my hands ( medical jargon for a set of actions that would bring my hands to cover my face). I even had proprioreception then, the knowledge of the relative positions of my limbs. I was in crucifix form. body straight and facing upwards, both hands abducted almost at right angles to the trunk of my body.And the sheer force I used. The numbness of the limbs turned into characteristic pins and needles associated with low blood flow to the area.

Pandemonium made its entry.

But no ghouls bothered to make a visit into my field of vision. Thank Heavens. I would have been scarred for life.

Within 15 seconds or so i regained full control. I had the chills and put a blanket over. The sound of motion from next door reassured me that everything was alright.

Sleep paralysis is in fact a medical state. Your body is kept in a state of paralysis so that no actions borne of the mind during dream like states can be acted out.

It is when conciousness or the start of the wakeful cycle does not coincide perfectly with the halting of paralysis control on the body, that this happens.

The panic, trauma and cultural conditioning may all create the pathology of hallucinating and allowing the eyes to see other worldly creatures to come to terms with the heaviness that one feels in these states.

The surgeon speaks

2009-12-09T04:23:00.000-08:00

The very first time I met Dr Kim K Tan, he was rushing to surgery.

"Ahhh... This is Chia Yew..." he said to his nurses, in his superb accent.

"I am rushing to surgery"

and so both of us got caught in the lift. I had to rush to lessons in IMU and he had to rush for surgery.

The first noticeable generic surgeon behaviour I saw was in that lift. Two nurses were entering the lift at a lower floor on our way down. One went in and kept the doors open while another hesitated to enter ( she must have wanted to do something else)

"Cepat!.... Cepat!...." said Dr Kim exasperatedly to the nurse gesturing towards his watch. Surgeons are walking alarm clocks. Their time is the most expensive of all. It was a few seconds hesitation but he wouldhave none of it.

"I will see you tomorrow Dr Kim Tan"

"Yes and I will give you a call when I get there"

Shift scene to Wednesday.

After a horribly dry lecture on Paediatrics, (i had no control of this as it was IMU- organised. They wanted to put the paediatrician-alumni talk before the surgeon's talk),

A call came.

Private Number.

"Chia Yew, I am at the lobby and the guard here is threatening to not let me in!"

"Ok sorry, Dr Kim I will be right there"

I bring Dr Kim to the venue. And he took the room just like that. His voice grabbed everyone's attention and his slides also were designed to not only touch the brain but the heart.

He was excellent, articulate and charismatic.

His hands are in a default semi-flexed bilateral supinated manner, another generic surgeon behaviour. Pants elevated, and shirt all shifted backwards/dorsally. Posture slanted but strong. And the characteristic air about surgeons when they talk. Everyone shuts up. Everyone fixes both eyes and mind at him.

And he brought up something very strong. the concept of cleft lip and palate not bwing cosmetic, about how the psychosocial issues and problem with speech and hearing come in. Self esteem.

When promoting the event, I and Shahd faced a lot of problems about the lopsided views that plague plastic surgery. They think its all about breasts augmentation and smoothing those wrinkles. I was no less guilty of that view as well. And I expressed this to Dr Kim Tan. These perception of the surgical specialty. I told him that I have now renewed faith and respect in this specialty.

I realised and shared with him how the reconstructive part of plastic surgery never does get the limelight. These surgeons repair faces and self esteem, they treat crushed faces, burnt skin. The word plastic is indeed a misnomer in the sense that what these surgeons practise are always far from plastic.

The way Dr Kim Tan animated his slides with the children who were once defaced by cleft lip and palate grew to e beautiful people, no more bearing the mark of a genetic error. These people do not only gain aesthetics but they regain life.

What drew you to surgery?

Dr Kim Tan said practically the same thing all surgeons have said, He revels in the fact that it is one of the most logical in the broad area of medicine. You see something wrong, you cut it, its solved. You don't have to be like a physician who has to diagnose and think of an action plan. then you prescrie medicine and then asks the person to come back. Are you really capable of doing something as a physician. We have the skills of hour hands, our dexterity. These hands do something. I don't want to be a physician who waits for grass to grow. There and then after my surgery, smething has been done and corrected. Let the smart ones do medicine. We are the mechanics.

On his epiphany.

He had it in his Medical Officer years. he realised that he could change lives with his hand skills. he noticed he could do things with his hands and he then realised I can reattach a finger back rather than throw it away.

On Women in Surgery

Most of them are unmarried. Because you will need to seek your priorities. Career or family. Surgeons spend a lot of time training. If you want family, better go for a 9-5 job.

On Cosmetics

You think that it is not beneficial and necessary since its not medically useful. But you will come and see me at 60.

On Perfection

Perfection is the Surgeon's Enemy. We can never be perfect. Only Him is perfect. Points up. We can strive to be almost perfect.

On 100%

In surgery it must be 100% successful. If it less than it is a failure to the patient. It is not alright to lose focus in surgery

On how good you need to be in surgery

good surgeons are those that can tie their shoe laces with 1 hand. If you cant tie shoe laces with two hands, then dont do surgery.

This was a surgeon that caught our imagination and lit a flame of passion. We were seriously high after that. There were my batchmates who went up to him personally and thanked him from the heart for such a good talk. He was in fact I think much more charismatic than Mahathir.

And of course you know how good he really was when the attendees all came up to me asking Where I found him and thanked me for bringing him to speak.

That really makes my day, knowing that I had helped changed perception.

Thank you Dr Kim K Tan

The disgusting face of war politics exposed!

2009-12-08T07:47:00.000-08:00

The Swimming Instructor

2009-12-08T07:07:00.000-08:00

I seriously needed rest so I thought I would go for a theatre play, something I have not gone too for ages. I have been working too hard for too long

My emo-ness has all but atrophied to the size of an atom. I was in serious need of therapy.

Undergraduate Medicine is an erratic field . It proposes to produce caring doctors but what I see are all people sitting in libraries looking at dirty words and dirty diagrams, and chanting and whispering incoherently for hours till end. Hearts naturally atrophy. They turn from a Vaso Animi (vessel of feelings) to mechanical muscles.

I will not stand and condone such zombie-fication. What are you people going to think 20 years from now? What have I done these few years...

So I picked The Swimming Instructor which received a lot of press attention.

I picked it because it had eye candy. It was set in the swimming pool and therefore notorious for being promoted as one where the costumes department was almost non-existant (this of course not being true, since all manners of tight hot spandex was worn..:P.)

Guys and girls alike will not leave disappointed... seriously. This is Malaysian theatre at its boldest and naughtiest... *grin*

And at first eye candy in the form of bust and buttock thrusting was the main attention grabber, but soon a very emo story unfolded.

It was a tale of how this swimming instructor was caught in a dilemma.

To follow convention and love a person to make a perfect picture, or to go boldly and follow your heart.

The swimming instructor is a floater. He releases all the air in his lungs in the water, letting himself glide downwards slowly.

Till he reaches the bottom, slowly watching the bubbles emerging from his mouth rushing to the surface.

There is a darker and yet ironically more poetic and beautiful reason to why he actually does this, which ties a knot to a very emotionally fulfilling story.

The swimming instructor of course is an instructor in many levels. He leaves one poignant message at the end.

Accept when love happens. Any decisions, no matter how small, changes life.

The drowning metaphorises and points us rudely to how trapped homosexuals really feel. They make bold the discrimination and institutionalised hatred towards them.

I have used this metaphor of drowning before in my SPM English essay, starting this way: Have you ever felt like you were drowning?

The play, with all the naughty butt smacking, thrusting and spandex bulges here and there, and kissing and sexual tension lures you in like a small boy, excited to enter a theme park for the first time.

But then you enter the theme park, and the person bringing you shows a whole different side to things. The merry-go-rounds and tea cups fade to show the children who want to enjoy but have no means to do so, those forgotten children.

This was the style of the swimming instructor. You can have fun by all means, but here's the thing, I am going to give you point blank,

We are all drowning.

What matters is whether we choose to float up or sink down.

Either way, happiness can exist, for what is happiness but a state of mind.

Somthing that lures you through carnal desires and then turns you emotional and thinking slowly but surely in 1 and a half hours.

Now that's good theatre :)

Testing Chiayewnian Patience

2009-12-07T06:03:00.000-08:00

I am well known for being very cool and non-temperamental. Many have never seen me angry to date. I always make an effort to stay cool, calm and collected.

I have lived up to it even after what happened today.

I was lazy. I did not want to drive to Carrefour Endah Parade, Bukit Jalil from IMU to post laju a letter to Dr Kim K Tan, from hereon called the Surgeon. It was an official thing saying that his lecture is postponed by 2 days. He has in fact been informed a week ago and agreed to it already.

But what troubles laziness and formality brings you.

So I drove to Pantai Medical Centre.

It's located in Ampang...

Or so I thought till I was rudely slapped with the fact that it was not.

It hit me after spending 2 and a half VERY NAUSEATING HOURS in the Jalan Tun Razak jam. It would have taken me 20 MINUTES in normal conditions.

When I arrived at where I thought Pantai was, guess what greeted me..

Hospital Ampang Putri.

You see I got the Surgeon's contact from a friend, Ken Lek, who happened to stay in Ampang and I visualosed the Surgeon to be there.

So I made a U-Turn, still slightly nauseous...

and took another 30 minutes to reach Pantai in Bangsar. If i had known where Pantai was, it would have taken me 10 minutes.

Plans to go 1-Utama to buy a Clinical Anatomy text by an Indian Anatomist smashed, I went into lobby.

" Where can I pass this letter to?"

Guy in receptionist uniform. " Sorry but there is no one here"

Wow....

"Can I give it to anyone then?"

"No one is here to receive it..."

I am not one to argue even though I've been stuck in a nauseating jam that has no apparent cause for genesis (the most irritating thng about KL jams), so I asked

"OK, Can I just leave it at the offices then?"

"The offices are all closed. Come back tomorrow."

Haih..

Then I circumambulated the lobby once trying to restrategise.

When I came back to ask what time I can come back tomorrow (letter needed to be in The Surgeon's hands by tomorrow morning...), he was gone.

"Please Go To Emergencies" the sign said

Indeed this was quite an emergency.

Thank God the nurses were nice.

"the Offices opened at nine. You can see the doctor then"

So I have to skip my lectures tomorrow to send this important letter. And hopefully meet my Surgeon for the first time.

I am now in a mild mood. Cool Calm Collected.

I am not angry at anyone because this is still and soluble issue and it is partly my fault for not going to the post office. I was in fact discussing theology and politics and was so engrossed I did not want to leave the IMU discussion room.

Which reminds me of what Dr Selva from the Jabatan Hal Ehwal Orang Asli Medicine shared with in the Forum on Malaysia's Doctor of Tomorrow in IMU.

She claimed that doctors no longer make the impossible possible.

She then related of a tale in which she was still a housemen.

The two housemen had looked at a lung X-ray and could not confirm TB.

So they had to consult the higher Doctor.

This higher doctor was to be consulted on a certain morning as he was leaving Malaysia that morning's evening.

So the other HO or MO was asking Dr Selva to ask the Higher Doctor before he leaves.

But due to the workload she completely forgot till late afternoon when the Higher Doctor was in the airport.

Dr SElva panicked aand did a most extraordinary thing. She rushed to the airport. The gates were closed but she begged to be let in to see the Higher Doctor in the plane and consult him.

She succeeded.

It is stories like this that drive me to continue even though a pile of shit is thrown on me.

My First IMU Brainchild

2009-12-05T07:10:00.000-08:00

This event above was the e-backdrop of the auditorium which was my first as Organising Chairperson. Previously, I had been Co-Organising Chairperson and External Affairs Liaison in the Breast Cancer Week. Thank God and The Buddha of Anatomy it went smoothly and well acclaimed.

My Prof, Dr Nilesh Kumar had first declined my idea of a lecture linking surgery to anatomy. So I had a good brainstorm before realising that MOCK OSPEs did not exist while MOCK OSCEs do. So I started working and got Dr Nilesh's approval. What followed was a lot of management and working.

Ever since being elected into power as Academic Officer of Asian Medical Student's Association IMU, I have set my own KPIs and KRAs. One of them is creating advocating students. Maybe when I am more senior in AMSA, I will come up with a full strategic plan that IMU must take to produce good medical students. I have just attended a forum (later post) where I gathered input. Going for continuous self development is one key result area to fulfil my key performance index.

I have a lot of events in store and await a time to implement it including a full fledged partnership with MERCY Malaysia.

On the Biro Tata Negara

2009-11-28T07:25:00.000-08:00

For time immemorial, I have had a very distinct dislike that borders on disgust for the Biro Tata Negara sessions. While my memory fails me on when I first heard of the infamous BTN lectures, I do remember the very first time I was made aware of the BTN's existence. I was in the backseat while travelling through Port Dickson ( I think) when I first saw that ominous building with a big sign saying BIRO TATANEGARA MALAYSIA.

The first thing that came to mind naturally was What did they do? Clearly at that time, I was not yet acquainted with the horrors that went on in that building.

Now the issue has flared up again, thank God. The Biro Tatanegara is given to all civil servants entering the Government service, all scholarship students leaving Malaysia to their respective foreign universities and other public university students?

There's an interesting article in Malaysian Insider which really blew me off. I have heard of propagandal nonsense such as how the ruling government had sacrificed and thus won a God goven right to rule Malaysia, no matter how poorly it does it and how the Government must always be defended no matter what nonsense it does and blasphemous its views may be.

This is still ok. In fact I can imagine myself sniggering while they propagandise us like that.

But the humor ends abruptly.

the Malaysian Insider article here clearly is not at all funny.

Asrul Hadi Abdullah Sani speaks of how they said among other things

THe Chinese are Jews of Asia and are conspiring to rob the Malays of political power once the Malays are divided and weak. The irony is of course that Muslims view spreading false claims or fitnah as a greater sin than murder.
"All Muslims are Malay regardless of whether they are Chinese or Indian." on being asked whether we should treat Muslims of different races with respect. My God, shouldn't Muslims treat all people: God's creations with respect?

Intellectuals giving lectures it seems.

When hate, prejudice and mistrust is instilled into certain ethnic groups concerning another, thats when there can be real potential for pandemonium.

and then there's the thing about having so many 'force patriotism down thy throats' actvities.. What's up with that la dey...

There is also a difference in what views are expressed based on the demographics of the audience. If there are no non bumiputras in the audience, then all hell is set loose and such disgusting propaganda is propelled.

MUhyiddin should not have defended something he did not attend. This will put him in the dsirespect category of many people. Shahrizat is also guilty of such things.

This will be one of Najib's greatest tests for 1Malaysia. He stands in good stead of becoming the best Prime Minister of Malaysia if he stops all this racist nonsense once and for all in Malaysia.

He has claimed a need for revamp of the BTN but only time will tell if he is just letting the steam cool down before he continues doing nothing or he will use his powers to see that the ugly devil of racism is fully exorcised from this land, doomed to never return.

Berfata morgana di hari khamis

2009-11-27T19:58:00.000-08:00

Akan dikuatkuasakan sesuatu dasar bahawasanya,

Hari Khamis setiap minggu, Kong Chia Yew akan bertutur dalam Bahasa Malaysia,

supaya pada masa depan apabila balik ke Malaysia berkhidmat,

dapatlah dia merawat pesakit-pesakitnya tanpa sebarang masalah.

Dapatlah dia berempati sepenuhnya denagn pesakitnya dan

maka, dapatlah dia merawat pesakitnya denagn penuh teliti dan sempurna.

I am a Doctor- Mahathir Mohammad

2009-11-22T05:33:00.000-08:00

I missed Part 1 of Mahathir on History Channel last week but I managed to catch Part 2 today. A line that caught me was

" The lawyers are always fussing about what is legal and what is not. They always focus on the legal aspect, whereas we doctors want to heal. When we see something bad, we want to improve it. When I saw the country was not progressing as fast as I would like it to, I needed to do something"

I also caught the part on how Mahathir claims he has failed in uplifting the Malays, which will form part of my argument in reply to fellow political commentator Lek Ken Vin who is absolutely perplexed how I could love such a hate-able man.

Forbidden Fruit: Retelling of A tale most queer

2009-11-21T06:47:00.000-08:00

Last sunday an experience most queer happened right in front of me, a love story so unexpectedly dropped upon me that for a few moments I did not know what actually was happening.

I was at a secluded vegetarian restaurant in Section 14 PJ, eating vegetarian food with my dad. There was only one other table occupied in that restaurant.

The occupiers were a man and a woman. Man 50 over years old. I could not identify the woman's features as she was faced away from me.

Nothing to shout about. This kind of things are like fungi. They are everywhere regardless of wether u notice them or not.

However as our meal was about to end, things started spicing up.

The man was speaking in Bahasa.

Unless his wife was Nyonya, the women then would surely not be a chinese.

A series of Interesting events was about to unfold.

I started tuning my ear to eavesdrop.

The following were taken from the best of my memory. Whetehr it did follow the order I am going to unveil is uncertain even to me.

Apek: " Saya sangat Cinta mu"

what the girl said was inaudible.

Girl: Saya sangat takut. (orsomething to that effect)

Apek: Kamu tak payah takut. Kamu hanya perlu takut pada saya.

Apek: Saya sangat sukak kamu. Kamu sangat comel.

Then something about claypot mutton curry.

I could not resist.

I went to the toilet, a route that would get me to peer closely at the lucky gal.

She was from Indonesia, confirming my suspicions that an employer-employee love story was unfoliding before my very eyes.

Two things could have been happening at that time:

He could have been having an affair- his wife being ignorant. He picked the vege restaurant for good measure. It wans't a "Chinese people eat vegetarian day" so he knew a crowd of potential naysayers or overzealous joykillers wouldnt make an appearance.

He could have been a widower who wanted love.

The ketakutan showed by the female i think is more telling of the 1st story.

But this was agood story. being the sour boring academic I am, I will look at the metaphysics of such an experience, seeing such an unconventional scene.

It came at a weird time, when Malaysian Indonesian relations were at a peak. This scene was in many ways forbidden fruit. Indons were carrying sharpened bamboo sticks while Malaysians were abusing maids ( although both sides would argue this happens all the time and and has been happening all the time).

Then comes the ultimate irony. This affair they were having, if it was an affair, was done in a vegetarian shop. A place which is of course associated with purity and cleansing.

The female's fear is very nicely fitting as well. She is very much Indonesia, having fear and worry. ( It was the nation of Indonesia which first felt insecure about themselves, insecurity being a trait quite similar to fear)

But maybe it was a reminder of how the Malaysian Indon scene needed love and cleansing.

That apek and that maid becmae large metaphors, metaphors that are symbolic of how bigger things should be done.

For it is when people start sweeping you, that you must embrace them.

a statement much in line with Yasmin Ahamd's Gubra tagline,

Why do we hurt the most, the ones we love the most?

Broken Ties

2009-11-18T06:40:00.000-08:00

Time and time again Malaysia fails to act fast. This is concerning the dress code for doctors.

The National Health Service in the UK has banned white coats and ties, but Malaysia still has its archaic laws of forcing doctors to wear ties. They have even implemented a nothing beyond elbow rule.

Ties are never washed by people. Thus they are very lucrative habitats for infectious agents.

Dr Jimbo (blogging name) a consultant with the IMU, recently had this on his blog

This study was conducted by IMU consultants and students and was published in the Malaysian Journal of Medicine and showed a 52% positive presence of MRSA on doctors' neckties.

Now would then wearing a tie that has a 0.52 chance of having MRSA when seeing an immunocompromised patient be an unethical thing to do?

Professionalism vs. Patient Care.

I think we are smart enough to choose.

And there are always bowties...

This day shall live in infamy

2009-11-18T03:09:00.000-08:00

Let it be known that on this day Kong Chia Yew interviewed his first ever patient and he did it confidently enough and did develop good rapport with his patient but missed out on some questions in our Assesment sheet.

My First Berita Malaysian Medical Association

2009-11-16T06:59:00.000-08:00

My first Berita MMA has arrived. Glee accompanies such an event.

But then serious stuff follows.

the MOH is projected to go kaput in 2012.

Blame those little Napoleons of the MOH.

It is now appropriate to let out a deep sigh.

Sigh

The Exorcism of Anatomist John

2009-11-10T21:52:00.000-08:00

John growled an inhumane growl.

"In the name of He who lives in Heaven, Who art stays in this body?"

Hyoid

, Incus

Stapes

" Be gone you evils of form. Do not disturb this man and void him of his sanity!"

has pledged

servitude to us

He chants our names in the deep night before the morning rises.

How then do we not grow fond of this servant you name John?

" Begone you devils of mind. Do not torture this man"

He has grown fond with us.

In days to come

The fraternity shall enter.

Medulla Oblongata

Crista Ampullaris

Crichoid, Arytenoid

Arachnoid, Dura and Pia,

Hilum and Azygous,

Deltoid and Adductor Magni

Brachial and Temporal,

Styloid and Sinus,

Arquate and Medullary Rays,

Vasa Recta

Fosa Ovalis

Utricle and Saccule,

Pharyngotympanic duct

Organs of Sharpey

The Parietal And The Visceral

Sulci and Gyri

"Heavens. Such a band of evil"

John's skin pulsed in anunnatural rythm.

The Pons had entered.

John was now the antithesis of emancipation

The Kuala Lumpur War Crimes Commission and Tribunal

2009-11-09T03:20:00.000-08:00

I only attended Tun Mahathir's plenary in the whole Criminalising War Conference. The first three days, I had to organise and carry out The Breast Cancer Awareness Week as Vice president of In Support of Women (I brought in Merchandise and Breast Palpation models from Breast Cancer Welfare Association- associated with Breast Cancer Surgeon of Malaysia Prof Yip Cheng Har) and I had to attend Group moderator trainings on the last day for the upcoming East Asian Medical Student's Conference)

This conference was unique in the sense that it was not only some lectures by big names but it had a commission hearing and tribunal deliberation (both of which I really could not fit into my schedule)

This is the first time that Malaysia has set up a Tribunal Of Conscience for War Criminals, led by legal persons o eminence from quite a few countries. A tribual of conscience has no powers of prosecution but that of advocacy.

It puts out an advisory declaration eg

So and So is wrong of war crimes

that has no binding powers on the person So and So but
it advocates the ostracising of So and So internationally.

All this would not have been possible without Tun's influence.

He has done very well from just talking to setting up a Tribunal of conscience.

We all know very well big fish that create wars will never be caught through international organs of justice such as The Hague.

This is the first step to take and one that I truly support. i hope to see in my lifetime that the Kuala Lumpur War Crimes Tribunal morally prosecutes the tonnes of perpetrators of war and that War becomes a crime like any other, rape for example.

It is only when wars are criminalised by law that war can be viewed with digust and contempt finally.

As Tun Mahathir said in a prayer,

"May Allah help us make war a crime, the worst crime that the human race can be guilty of "

I disagree with Barack Obama that there can be smart wars.

I also openly disagree with how the tone of the Conference was set. It was tainted with Anti-USA sentiment.

War is not the USA and USA is not the War. If a Muslim counrty were to attack the USA then that Muslim country is no less bloodied than the USA.

This I believed was the most important message that needed to be said but did not in the conference.

Retaliatory War to 'defend' is the same as any other war. Fire fight fire mentalities should be exhausted.

When the sambil lewa attitude stops, the killing can too.

Pop Non Fiksyen Version 3.5

2009-11-08T06:10:00.000-08:00

There is this uncle who sits outside his house every night.

Everytime I pass him, he always puts up his hand in acknowledgement.

He does this to every car.

One day I might just stop and ask him why he puts up his hand at cars all the time.

He might very well answer.

Thats the morally right thing to do.

And all I can do is to nod my head.

and await his palm again the next night.

Has Awaang Kolo died?

2009-11-07T06:53:00.000-08:00

"I am afraid I can't comment at the moment."

"Investigatons are still ongoing"

"There is no need for panic"

Error 130

2009-11-05T07:04:00.000-08:00

I don't seem to have anything to blog about anything nowadays. Or I have no mood for it.

Instead I keep chanting things like Lingula and paranasal sinuses and levator palpebrae superioris.

I keep on listening to Jim Reeve's Rosa Rio and keep asking in a Sri Lankan accent "Where is my heart?" because the surgeon anatomist of IMU suddenly burst out singing that 1 day> I wasn't there. I was a few tens of kilometres away listening to Mahathir lambasting Bush.

Yes Mahathir lambasting Bush is Chiayewnian Effect worthy. but that must wait.

I must get the 'arytenoid cartilage' out of my head first.

Malleus Incus and Stapes,

2009-10-25T06:02:00.000-07:00

which one will have my true love's kiss?

Menjadi Seorang Doktor oleh Kong Chia Yew (Projek Kalsom 2009)

2009-10-24T21:04:00.000-07:00

This article was published for the Projek Kalsom children 2009.

Saudara sudah tahu bahawa doktorlah yang mengubati kamu apabila kamu menghidapi selesema atau demam. Saudara tahu bahawa doktorlah yang akan merawati kamu jika tangan kamu terpatah semasa bermain bola sepak.

Walaubagaimanapun, dunia perubatan memberikan peluang yang jauh lebih luas daripada apa yang saudara jangkakan.

Rencana ini bertujuan bukan sahaja berkongsi dengan saudara apakah peluang-peluang pekerjaan selepas menjadi doktor tetapi secara ringkasnya, bagaimana menjadi doktor juga.

Pada asasnya, saudara tentulah perlu menelaah bidang perubatan sebelum menjadi doktor. Di Malaysia, terdapat pelbagai peluang untuk saudara menelaah perubatan.

Sebanyak 6 institut pengajian tinggi awam mempunyai sekolah perubatan manakala lebih banyak lagi institut pengajian tinggi swasta mengajar perubatan, tetapi pada kos yang lebih tinggi.

Jika saudara bercita-cita lebih tinggi, anda boleh memohon kepada Jabatan Perkhidmatan Awam untuk menelaah perubatan di luar negara, di negara Ireland misalnya.

Mungkin apa yang saudara tanya sekarang ialah apa yang perlu untuk saudara menjadi doktor mahupun seorang pelajar perubatan. Keputusan peperiksaan merupakan salah satu aspek yang penting. Setiap pelajar perubatan dipilih mengikut keputusan peperiksaan STPM atau peperiksaan yang setaraf dengannya.

Oleh itu, saudara perlu bekerja keras dari sekarang juga jika ingin menjadi seorang doktor.

Walaubagaimanapun, perlu ditekankan bahawa keputusan baik tidak boleh disamakan dengan ciri-ciri seorang doktor yang baik dan dihormati. Menelaah perubatan dengan alasan bahawa telah mendapat keputusan yang baik dalam peperiksaan juga adalah salah.

Sebab saya sendiri ingin menjadi doktor perubatan terbahagi kepada dua. Pertama, saya medapat kepuasan daripada menolong orang lain. Senyuman daripada seseorang pesakit yang telah sembuh dengan rawatan saya merupakan salah satu penghargaan yang paling penting dalam kareer saya pada masa depan.

“Keinginan menolong orang lain” merupakan salah satu sebab yang sering diberikan pelajar perubatan orang lain tetapi adakah ini dapat menjadi pendorong saudara sepanjang kareer saudara dalam perubatan. Hal ini mesti saudara renung-renungkan.

Sebab kedua ialah perubatan merupakan salah satu bidang sains yang membolehkan saya berinteraksi dengan manusia. Misalnya, bidang fizik yang juga saya minati hanya mengkaji objek-objek sahaja.
Dalam menjadi seorang doktor yang dihormati, saudara perlu mempelajari apa yang dipanggil good bedside manner, iaitu senarai sikap-sikap dan amalan-amalan yang perlu ada pada saudara supaya pesakit saudara dapat sembuh dari segi emosi juga.

Setelah mempelajari perubatan selama 5 tahun dan menduduki ujian yang pelajar perubatan menganggap sebagai paling susah dan tentulah lebih susah daripada peperiksaan UPSR yang telah kita semua duduki, seseorang menjadi seorang pegawai perubatan.

Saudara telah menjadi seorang yang begelar doktor. Tetapi ‘glamor’ seorang doktor yang selalu diuar-uarkan tidak kelihatan. Saudara terpaksa berjaga dan dilarang tidur seperti kayu lebih daripada 36 jam dalam proses ‘on call’.

Saudara akan dimarah oleh pakar-pakar perubatan. Saudara akan mula sedar bahawa selepas 5 tahun mempelajari perubatan, apabila kecemasan berlaku, masih kekok saudara menghampiri si pesakit yang meraung kesakitan itu.

Selapas itu, saudara akan disuruh dan dipaksa memilih jalan seterusnya yang dipanggil ‘specialisation’. Saudara akan disuruh memilih antara dua kumpulan besar dalam perubatan, sama ada untuk menjadi pakar perubatan ataupun pakar bedah.

Jika saudara lebih berminat menyelesaikan teka-teki maka, saudara boleh cuba bidang perubatan am. Saudara boleh memilih organ atau bahagian badan yang saudara berminat untuk merawati. Seseorang pakar perubatan bertanggungjawab mencari punca-punca sebarang penyakit yang dihidapi pesakit dan merawatinya. Misalnya pakar kardiologi merawat penyakit penyakit jantung manakala pakar nefrologi merawati penyakit-penyakit ginjal. Pakar paediatrik pula merawati penyakit kanak-kanak, khususnya.

Jika saudara lebih berminat mengambil tindakan dan menggunakan tangan, maka saudara boleh menceburi bidang pembedahan. Pakar bedah bertanggungjawab melakukan prosedur-prosedur seperti mengeluarkan tisu kanser daripada badan. Seseorang boleh menjadi pakar bedah kardio- thoraks yang antara lain melakukan pembedahan semasa sakit jantung.

Saudara juga boleh menceburi bidang obstetrik dan gineakologi atau doktor sakit puan. Saudara juga disyorkan menjadi pakar perubatan keluarga (doktor inilah yang biasanya merawat selesema) yang bertanggungjawab menjaga kesihatan seisi keluarga dan berpeluang merawati pelbagai jenis pesakit.

Walaubagaimanapun, saudara tidak perlu bekerja di klinik sepanjang hidup. Ini betapa luasnya peluang pekerjaan seseorang yang telah mempelajari perubatan.

Misalnya saudara boleh bekerja membantu penghidap-penghidap HIV-AIDS di majlis AIDS Malaysia dengan mengunjungi kawasan-kawasan pengguna dadah. Saudara boleh menjadi seperti Tun Mahathir Mohamad, menjadi seorang negarawan dan pemimpin setelah mejadi doktor.

Saudara juga boleh pergi ke merata dunia, membantu mangsa-mangsa perang ataupun bencana semula jadi melalui badan-badan di Malaysia seperti Mercy Malaysia.

Saudara mungkin suka mengajar dan boleh menjadi akademik perubatan di universiti yang unik kerana saudara boleh mengamalkan perubatan di samping mengajar pelajar-pelajar saudara.

Duit juga bukan merupakan sebab yang baik menjadi doktor. Doktor dibayar gaji tinggi kerana ujian ujian dan kursus yang terpaksa dihadiri oeh doktor juga tinggi. Misalnya, Ujian kemasukan bagi pakar bedah kardio toraks ialah lebih kurang RM 14 000. Gagal dalam ujian ini dan terpaksa dibayar lagi.

Kualiti kehidupan doktor juga kurang baik. Doktor lazimnya kurang mempunyai masa dengan keluarga dan sebuah kajian oleh persatuan perubatan di United Kindom mendapati bahawa 50 % peratus doktor tidak puas dengan pilihan kareer mereka.

Pada masa yang sama, doktor merupakan salah satu pihak yang dipandang tinggi masyarakat dan kepuasan daripada penyembuhan seseorang pesakit cukup untuk seseorang doktor yang bagus.

Oleh itu saudara perlu merenungkan ini semua sebelum membuat keputusan melompat ke dalam dunia perubatan.

Kong Chia Yew merupakan pelajar perubatan di Universiti Perubatan Antarabangsa, Malaysia. Saudara-saudara yang mempunyai soalan mengenai dunia perubatan dijemput bertanya dengan saya di kchiayew_133@hotmail.com. Saudara juga dijemput menjadi Facebook friend saya. Saudara juga terus boleh memanggil saya di 016-3533321.

matahati

2009-10-24T20:29:00.000-07:00

Apakah penting mata?

Jika hati tak seiring.

Apakah penting hati ?

Jika mata tidak bersama

It Begins With Us

2009-10-17T04:08:00.000-07:00

A group of 5 of my IMU friends and I won the third prize for the "It begins with us" Medical Student HIV AIDS Exhibition hosted by medical drug company MSD, Malaysian AIDS Council and Malaysian Society for HIV Medicine (MaSHM)

It is amazing how this programme led me into a whole new dimension in HIV medicine.

How amazing it is that we health professionals still stigmatize HIV patients. We who have been educated and professionalised.

There's the story of how a nurse commanded a positive HIV patient to not urine into the cubicle but to instead urinate in a bag and to take that bag home.

There are even more stories of doctors and nurses talking about the patient and potentially how he or she could have got the disease. and the patients are within earshot.

HIV AIDs as I have said many times to quite a few people is no more a death sentence but increasingly a chronic manageable disease.

Days before this event, a newspaper opinion was published criticising UMMC HIV AIDS Specialist for this stigma that they felt as well. I took it as a sign that we were on a very important breakthrough. We have to destroy the stigma from health professionals before the public.

When we health professionals treat these patients without empathy, care and respect, we shut their only door.

Members of the public will then say," Really gone case lah this person. Even doctor don want to treat."

In traditional medical and nursing courses, not enough emphasis is given by faculty and even more, the students on the psychosocial issues of the disease.

Everything is more like a diagnosis, prognosis, treatment and management plan.

Dr Christopher Lee, the most famous HIV specialist of Malaysia said that not enough emphasis is given on the patient.

We should try to change that.

It begins with us.

"I am not shaking your hand Mr Blair. You have got blood on it".

2009-10-15T23:53:00.000-07:00

Run up to The Crimimalising War Conference Kuala Lumpur October 2009

Orbicularis Oculi

2009-10-15T04:59:00.000-07:00

I think it's a very good thing to have Indian educated anatomists, including a former surgeon, to teach Anatomy.

Politics should be banned

2009-10-14T03:31:00.000-07:00

We should all mimic what happened in Jose Saramago's novel "Watching".

To not turn up for elections at all.

This is because politics has become tainted (It may have been always tainted, as I like to believe, but it's taint was further aggravated by Abdullah Ahmad Badawi)

The situation in Malaysia now closely follows what I call the "First Time Swimmer's Dilemma"

Imagine a first time swimmer in a big wide ocean. He is given the job of moving a weird gay looking ball from spot A to B.

But he doesnt really know how to swim. He spends all his energy staying afloat. and his antics in keeping afloat, thus swimmer proudly analogises as a labour of love that shows his commitment to the task.

But the thing is the weird gay looking ball stays in its place in that deep ocean stuck at A.

This is what has been happening to every big shot in Malaysian politics post Mahathir.

It did happen during the Mahathirian regime but it was partly masked due to some motion of the ball by the swimmers.

It all went down hill with Abdullah Ahmad Badawi.

Now we see immature MCA people doing the same thing. They should all reform.

Yes by for example renaming their party The Malaysian in-need-of-a Cuddle because I am a baby afterall Association.

They have been motionlessly doggy-paddling all these years. They claim Ong tee Keat speaks the truth and is brave. But has he done anything?

No. He is just supporting himself from being drowned like our friend over in the MIC who is like in an Ocean G while the weird gay looking ball is in Ocean W 300 km away.

When you fight to stay afloat, you dont do your job.

And people like us, the spectators on the boats will start to get frustrated. When is the weird gay looking ball ever going to move to B.

Such people in the MCA should step down. You all are hindrances to national progress. While they should be at their Ministries formulating policies, instead you have got everyone fighting at a hotel (as reported in the Star, some to be MCA leaders met in ahotel. The meeting ended in a fiery end). Where is the logic in that???

We elected you people with the trust that you will lead and govern. We want to see what we saw during Mahathir, results.Instead we see our moey being flushed down in you in a perpetual campaign to stay afloat of your party.

How can then you say you want to keep Ong Tee Keat? He perpetually has to stay afloat. No action whatsoever in governance

There is this distinction between leadership and politics. I call for an uncoupling of these two. We should make politicians jobless and bring in the leaders, those whoalready know how to swim.

Malaysia goes downhill when we start picking leaders because of their popularity. Singapore on the other hand, however dictatorial and archaic they may seem, stays steadfast by their principle of bringing in scholars to lead (even in Medicine, as I was enlightened during a recent talk by an IMU alumni working in Singapore's Healthcare).

A comparison from a famous email circulating around will show stark differences.

PM Lee Hsien Loong
Cambridge University - First Class Honours (1974)
Harvard University - Masters (1980)

PM Abdullah bin Haji Ahmad Badawi
University Â of Malaya Â - Bachelor of Arts Honours (1964)

SM Goh Chok Tong
University of Singapore - First Class Honours (1964)
Williams College , USA - Masters (1967)

Deputy PM Dato’ Sri Najib Razak
University Â of Nottingham Â - Bachelor of Arts Honours (1974)

MM Lee Kuan Yew
Cambridge University - First Class Honours (1949)

Minister of Foregn Affairs Syed Hamid Albar
(can someone tell me his univeristy? )- Bachelor of Arts [ UITM ]

Minister for Law Prof. S Jayakumar
University of Singapore - Bachelor of Law Honours (1963)
Yale Univerity - Masters (1966)

Ministry of Works- Dato’ Seri Samy Vellu
(Education Unknown) [ Form 6, Anderson School ]

Minister for Home Affairs Wong Kan Seng
University of Singapore - Bachelor of Arts & Business Admin (1977)
London Business School - Masters (1979)

Ministry of International Trade & Industry Rafidah binti Aziz
Universiti Malaya - Bachelor of Arts Honours

Minister for Foreign Affairs BG George Yeo
Cambridge University - Double First Class Honours (1976)
Harvard Business School - MBA w/ Distinction (1985)

Minister of Agriculture Muhyiddin Yassin
(Education Unknown) [ Polytechnic Ungku Omar ]

Minister for Trade and Industry Lim Hng Kiang
Cambridge University - First Class Honours w/ Distinction (1976)
Harvard University - Masters (1986)

Ministry of Domestic Trade Shafie Apdal
(Education Unknown) [ Form 5, Failed English ]

Minister for Defence Teo Chee Hean
University of Manchester - First Class Honours (1976)
Imperial College, London - Masters w/ Distinction (1977)

Minister of Education Hishammuddin Hussein
(Education Unknown) [ Bachelor of Arts, Social Science ]

Minister for Education Tharman Shanmugaratnam
London School of Economics - Bachelor of Arts
Cambridge University - Masters
Harvard University - Masters

Minister of Home Affairs Radzi bin Sheikh Ahmad
(Education Unknown) [ Kolej Islam Malaysia , Diploma Â ]

Now what I want to prove here is actually an open question to Malaysian politicians:

WHY DID YOU BECOME A POLITICIAN?

From above I think it is reasonable to hypothesise that there exists a difference in why people become politicians in Malaysia and Singapore.

I see a deadlock in Malaysian leadership. The best solution in sight that I see is to ban politics. :P

Then maybe the balls will start rolling.

Inner Medial Femoral Trauma: Etiology and Treatment (CY Kong, 2009)

2009-10-10T21:29:00.000-07:00

Inner Medial Femoral Trauma or Inner Thigh Trauma (ChiaYewnian Syndrome) was first described by Kong CY in 2009 in an isolated case involving a patient named Chi Ko Pek*, a 19 year old male . Chi Ko Pek presented with numbness of the inner thigh and distinct post traumatic stress disorder. After further inspection of the site of trauma and interview, it was found that Chi had presented with a disease that was never reported before in Medicine.

Etiology:

This trauma is humanovector borne. A humanovector in this case Ah Piang the Garang*, an 18 year old female, had inflicted trauma by touching the inner thighs of Ko with her phalanges. This disease will only manifest with cranial (upward) progression of phalangeal stimulus onto the medial inner thigh. Trauma is remarkably more marked if phalangeal stimulation proceeds to the pubic area. Humanovectors of Chiayewnian Syndrome have exhibited abnormally high amounts of oestradiol in females and testosterone in males and very pronounced levels of pheromone secretion. They however curiously are rarely sexually active. This an be explained by the fact that their celibacy actually drives them to out put any suppressed sexual needs to committing Inner Thigh Trauma. Inner Thigh Trauma has a higher incidence in females than males. Patients almost always are atrichomic (hairless) in the lower limb.

Diagnosis:

The signs and symptoms include the universal sign of embarassment- the obsessive adduction of the lower limbs. The adductor magnus muscles of the legs are in a contracted and stimulated state for a prolonged period of time. This can be considered biopsychosocial manifestation of the trauma to prevent further stimulation of the site and to protect from any more trauma. There is marked pathology of mindset in the patient, with vasodilatation especially in the facial area, indicating a sympathetic response (from stimulation by cervical outflow). There is marked numbness indicating sensory fatigue of touch receptors in the medial inner thigh. There is marked psychological trauma: post traumatic stress disorder has been reported in many such patients with Inner Thigh Trauma.

Treatment and Prevention:

The Adductor Magnus muscles

The best method of preventing such incidents are strengthening of the adductor magnus muscles of guys. Posture when sitting is also important. Sitting with legs closed (aductor magnus muscles contrated have shown to significantly reduce levels of Chiayewnian Syndrome.

When patients have exhibited symptoms, there is nothing much health care givers can do. It is as much a psychological disorder as it is a somatic pathology. The first thing to assess is as to the extent of the trauma. It is classified below

1 cm- 0 cm from pubic region: Highly SEVERE (needs immediate psychological intervention)

5 cm- 1cm from pubic region: SEVERE ( counselling)

More than 5 cm from pubic region : No intervention needed, surveillance recommended

Numbness in the leg usually subsides within a day while massage with deep heat on the adductor magnus muscles relieves it from contraction and promotes relaxation.

Stress medication should be prescribed if needed.

Published in the Peeamfourianic Journal of Medicine October 2009.

*All names have been changed in accordance with medical ethics.

A little aftertaste of the Nobel Prize Announcements

2009-10-08T08:42:00.000-07:00

It is rather noteworthy that unlike many or even all of the previous prizes awarded, all this year's Nobels were awarded for the discovery of concepts that are were introduced to Cambridge A level Students.

Medicine: Telomere and Telomerase Activity ( introduced very briefly in the mitosis chapter concerning carcinogenic growth)

Physics: Optic Fibres (introduced in the Applications of Physics Component)

Chemistry: Structure and Functions of Ribosomes (introduced at the very start and partly in Protein Synthesis)

Unlearning Institutionalised Inaccurate Science (The "Not Your Level" Phenomenon)

2009-10-08T08:12:00.000-07:00

I first came across the concept of unlearning in a book (which title and author i have forgotten.) He (99% sure the author was male) put forward a strong argument on how we were all unlearning stuff all the time in our current science syllabus.

This is due to oversimplification in the science when it is taught to people who are presumed to be inable to grasp such complex concepts yet. It's valid. Imagine telling 7 year old children on their first science lesson that they must know for a fact that all postganglionic neurones that arise in the sympathetic ganglia trunk MUST all exit the trunk through a piece of anatomy named the grey ramus communicantes.

Or telling them that they must memorise the Heisenberg Uncertainty Principle. Such things are no brainers.

In our plenaries today, I witnessed a girl in the heat of somewhat impolite argument with our Associate Professor of Human Physiology, a Prof Nagaraja. Kiasuism aside, she seemed adamant that the reflex arc of pain was a single loop passing through the dorsal root of into the spinal cord and out of the ventral root back to an effector muscle. THIS was what we learnt in Form 5 or so. We were even told that this was why it was so fast, how we respond to pain like a sharp prick.

It is not so. The spinal cord in fact is not a sole coordinating centre and must act in accordance with the brain.

In Form 5, this reflex, now formally known as the pain withdrawal reflex showed just one loop. Bad Science. And this itself is by no means correct. For in this reflex at higher levels (1 more year for me), there is the concept of reverberation.

Let me not dwelve into that.

Then there is also another parallel to Physics. Einsteinian dynamics versus Newtonian dynamics. Newton's equations fall out of place at extremely high velocities but Einstein's equations are universal.

But we still work with Newton's equations (still perfectly ok with the normal situations exams ask). But some students in all ignorance assume Newton's equations to be infallible.

This all relates to the "not your level" phenomenon.

This is especially apparent in The IMU, where 6 months is dedicated to a bridging course with less rigour before going into the serious stuff, codenamed the systems. This is where the physiology, anatomy, applied pharmacology, pathology, disease, homeostatic and microbiological aspects are applied to each of the body's 11 systems.

So we ae quite left hanging. The books say so much but they are to be 'censored' because it is 'not your level'.

"You do not need to memorise the names of the 5 cranial nerves yet"

"only memorise the name of this neurotransmitter and not its function"

Now the kiasu exam oriented people feel blessed when showered with these instructions.

I myself sigh. I am going through all this 'not your level' and 'institutionalised censure' all over again, just like what I have been doing for the past 11 and a half years.

Fail-ing

2009-10-04T06:14:00.000-07:00

FAILBlog never FAILS to amuse.

Masa Muda : Intellectualisme in The Classroom

2009-10-04T05:49:00.000-07:00

Rarely do you find intellectual discussions that are nice in the classroom in our Sekolah kebangsaan

The most pleasurable ones we ever had were Miss Duray's veerings-off into Popular Culture and Literature with a big L.

The milder ones were factoids here and there like how tody can make u blind by oxidation of methanol to toxic methanal by Chemistry's Mr Subra and stories about Einstein from the Physics teacher, Pn Fahrisah. There was also mention of Pavlov's salivating dog experiement.

However, a rather different dose of intellectualisme came in my BM teacher.

It was somewhere inside her but could never really manifest becos she was too caught up in finishing the irritating syllabus that force fed us more than 10 pieces of horribly written BM stories (eg who will give u a nobel prize for saving trees?)

There were times when it was to be expressed

"Tau tak perkara Jebat dan Tuah amat kontroversi"

But it died down

"Untuk level Universiti sajalah tu"

she has a very monotonous granmotherly voice that never failed to put the whole class to sleep.

But she was intellectual no doubt.

She read voraciously and bought an e-dictionary for RM 400 ++.

When I ordered a science book that was actually was for 5 year olds I gave it to her (she loved books the most). She was Exhilirated, to say the very least, asking me to write and sign an inscription on the first page.

The classroom took no pity on her.

But the same cant be said about the universe of knowledge

Blood is thicker than water

2009-09-30T03:44:00.000-07:00

No this is not a story of brotherhood and family ties.

It is simply about blood.

Your blood should sink in Copper Sulphate solution showing that you are not anaemic.

Participating in a Blood Donation drive is highly rewarding.

You get to act in a video with all your very own awkwardness you know and did not know you had all showcased to your university mates. (Video in my Facebook Page)

You learn lessons like "Thy shall not immunise thyself with vaccines less than 3 weeks to a blood donation.'

Thus I did not undergo yet another self proclaimed rite de passage. (I am going for it next time in March)

Chiayewnian Collections of Natural history: The Fish Mandible

2009-09-26T08:32:00.000-07:00

Inspired by Mr john Hunter, I have started my very own collection of Natural History.

The fish Mandible, teeth inclusive.

Half a fish mandible that is.

Procured from a mean fish head curry in Petaling Jaya.

The interesting thing about fish mandibles are their tendency to curve inwards.

This trait has evolutionary benefit.

As the prey of the fish tries to escape the bite of the fish, it actually gets bitten deeper. So they get hooked in deeper when they are in fact trying to escape.

to release themselves from the teeth, they will need to go towards the fish's inner mouth (and thus risk being swallowed just like that)

A Catch 22 situation in nature.

Next specimen porcine heart fixed with formaldehyde?

I wonder where does one get formaldehyde...

Mr JOhn Hunter and The bloody meaning behind the Barber's pole

2009-09-22T08:19:00.000-07:00

It has been an engaging read, this 500 page biography of John Hunter, Father of Scientific Surgery, The Knife Man by Wendy Moore.

There is method in what Shakespeare famously said: There is method in Madness.

For Hunter, there was genius in his eccentricity, as many geniuses of our age will show.

John Hunter was a brilliant anatomist dissecting thousands of dead bodies, albeit illegally, to further the knowledge of medicine and chirurgia.

He was a staunch believer in the scientific method, not willing to accept the theories of old like bloodletting and trepanning and the hippocratian theory of humours but instead experimenting and conducting what maybe the first clinical trials (albeit being flawed).

Such was his zealousness that he even introduced himself to syphilis and gonorrhea by lanceting his very own penis with 'factors' of these diseases.

He was also a zoological expert, thereby providing precursory theories to evolution theory by natural and sexual selection, but was perhaps cautious with expounding such theries in lieu of potentially being labelled a heretic (although such claims of heresy were very common among his colleagues at St George's Hospital)

he is also Father of Scientific Dentistry (thereby creating a pathway which now allows dentists t specialise and gain a diploma from the joint Royal College of Surgeons), and provided the first recorded transplantations of tissues- performing such things like attaching a human tooth to a cock's comb.

His ideals are the same ideals I strive for. He was I believe the first person to make medicine a career worth taking, by combining three cores into 1 profession, treatment of the sick and infirmed, teaching of theories and practice and thridly research.

He was teacher to many influential surgeons, including the illustrious Edward Jenner, inventer of the smallpox vaccine, the only vaccine which was able to entirely wipe out a disease from the whole face of the earth.

Wendy Moore has also succeeded in putting in little bits of trivia that so enthrall such as the origins of the Barber's pole which we see outside barber shops.

This queer pole couldn't be any queerer. It is telling of the very origins of surgery.

For it actually symbolised the pole clutched by patients undergoing surgical operations by barbers. The pole was bandaged white and the streaks of red was the crimson coulour of blood stained from the patient. (there were no anaesthetics at that time and ths patients fully concious would vent their torture and direct it upon the bandaged pole)

He ven has a few museums scattered here and there over London and UK, must visits next time
I am in UK. The photo above talks about the skeleton of giant Byrne whose story is told in detail in wendy's book.

A Malaysia Day Pop Fiksyen

2009-09-16T05:01:00.000-07:00

Azim makan dodol hari itu.

Dodol itu rosak.

Dodol itu rosak walaupun nenek Azim mengambil 10 jam mengacau dodol itu.

"Nek, dodol ini rosak..."

" Aduhai..."

Nenek Azim sejurusnya mengalami miokardial infaksyen.

Sambil nenek memegang dadanya,

Azim mula panik.

"Ok ke nenek?"

Nenek kata " Sudah masanya Azim."

" Bereon-eon lepas saya telah disumpahi nenek moyang kepunyaan Tok Seman bin Budiman"

" Kata mereka, capai masanya saya memasak dodol rosak, masa itulah, jiwa dan hati saya akan mengalami keganjilan

Azim mengangguk kepala.

Azim faham.

Inilah maksud sebenarnya perjuangan dan pertumpahan darah nenek moyang kita

The Man who shook my hands a hundred times

2009-09-12T05:32:00.000-07:00

and also the boy who would not respond to any of my head scratching gestures or offerings of Mamee

Fast For Malaysia

2009-09-11T05:39:00.000-07:00

Berpuasalah this 16th of Malaysia in an excellent show of solidarity regardless or religion.

Sahur (pre fast meal) at 5.35 am and berbukak at 7.30 pm

I pledge my support for it and confirm my participation in it

go to Marina Mahathir's blog for more info.

Why we are all happy we got in IMU...

2009-09-10T04:41:00.000-07:00

Rite De Passage, Not?

2009-09-10T04:22:00.000-07:00

When you first enter medical school, you practise how to prick (not how to be a prick) and be pricked.

It is a somewhat excessively mild rite de passage.

Alcohol swab your partner. Set the lancet in place by some mysterious steps only taught to you if you are in medical school or have hyperglycaemia (I love to show off with complex words.. such retardedness)

A snap of the lancet and blood starts dripping. No pain. Baptism of fire my foot.

You get a snakes tongue scar on your hand, the lancet being a double edged blade.

A nice afterthought is how my very own erythorcytes crenated looks like mini flower patterns on some auntie's blouse or skirt.

POP NON Fiksyen sempena 09/09/09: Hari Berlakunya Kehilangan Hati dan Jiwa Kong Chia Yew

2009-09-09T04:47:00.000-07:00

My phone for no apparent reason developed a void overnight.

Yes a black circle of blackness on the LCD display.

and my wall paper was the weird jiwang photo of me in Bumblebee mask with semi untucked shirt.

That black circle formed on my left chest.

Metaphor for a heart at odds with itself.

metaphor of a blackened and lost heart.

The black circle grew bigger.

I took my SIM Card off.

The blackness enveloped the entirety of the screen.

I knew then that that night a random old woman was crying

for a loss that wasn't quite hers

A trip to a Sri Petaling Clinic

2009-09-09T04:10:00.000-07:00

I have never been into a clinic examination room before- except my father's.

all my medical treatment ( flus and excess air :P) were treated at the bedside- my very own of course, and i dont get treated also. Let it pass, I say.

So when I took Marcel to a Sri Petaling clinic, it was rather interesting. I had to follow Marcel in.

A grand framed Masters of Medicine (Internal Medicine) from the National University of Singapore hung in his waiting room.

"we should do that," I told Marcel. It is good to plan ahead.

Next to it a Diploma in Dermatology. Ermm maybe not.

Enters Examination room.

"So Marcellus, what problem do you have?"

The doctor has an almost feministic touch to his voice, a somewhat forced politeness. (he was an extremely nice guy though.

Checks temperature in ear (ottic area)

Checks nose and throat. " Your nose and throat is highly inflammed"

Feels Marcel's neck area and applies pressure at lateral sides. Checking for lymph node inflammation it screamed.

"Is it painful? Marcellus?

then lift's Marcel's shirt and takes his hot red stethoscope and puts its to the chest area.

"Ok Marcellus. Breathe."

"OK Marcellus. The infection is not in your lungs. So its most likely just a bacterial infection larrr.."

" So I will prescribe you some antibiotics larr"

"YOu most likely can't concentrate, so I write you an MC?"
Marcel : huh.. non needla...

and then we exit.

Tonnes of medicine.

like 5 or 6.. crazy

Together learning, for Health until we all end up in unhealth

2009-09-08T03:55:00.000-07:00

Netter MDs Atlas of Human Anatomy on the bed opened at the page entitled Omental Bursa: Stomach Reflected

We were just briefed on a PBL trigger about a wife worried about her drunk alcoholic aged depressed male husband.

Lectures started with symports, antiports and uniports.

I have not read my Assigned Independent Reading topic at all yet about yet another aged man who has hypertension and how I as a doctor can ensure his treatment and lifestyle adherence.

And as cliched as it sounds, I am on Facebook, randomly adding lame comments to people's Shout Outs.

I have not researched how alcohol is related chemically to the breakdown of the B Complex Vitamins

I have not researched about how age correlates with alcohol tolerance.

I have not researched about how alcohol is a hepatotoxin.

I have not researched the histopathological features of hepatic cirrhosis, myocardial infarct, Deep vein thrombosis.

I have not researched the psychosocial issues that affect alcoholics

In IMU, we are perpetually Together Learning, For health

We were warned it will never be Together being lectured at, for health

I as usual, have not yet studied.

I have just started reading Tolkien's Fellowship of the Ring.

The Professors don't like how we say We research this and that. It should be gather info, You see it takes value from their PhD (UK)s, which they had to do research, real research mind you.

Did I mention we always learn and are never taught.

yes we are, in IMU, perpetually Together Learning, for Health

The Extermination of the Innocents

2009-09-07T03:52:00.000-07:00

"They were all lined up, sprayed with toxic showers and shot at the head at close range, execution style"- Eyewitness who was incidentally blinded a few days ago before the massacre due to someone wrongly practising supraorbital exertion of pressure.

Brave Newcomers beware. These unrested souls seek vangeance and simulated patients

Checkmate

2009-09-04T08:51:00.000-07:00

Orientation ends.

Lights close

Curtains draw.

Actors and puppets exit stage left

Kerana dia menghidapi karsinoma

2009-09-02T06:15:00.000-07:00

Alim telah menggigit aku sehingga aku mendapat rabies.

Aku mula berbuih di mulut dan menyalak seperti anjing nampak pocong.

Aku tiba tiba hendak makan ayam Ayamas.

Aku tiba tiba boleh rasa kutu menggigit badan aku.

Alim gigit saya kerana saya yang mengdiagnosakan dia menhidapi karsinoma.

Kasihan Alim

Badan Berkarsinoma

Mulut ber-rabies.

Weather Update

2009-08-29T18:56:00.000-07:00

Mendung.

Selalu pun Mendung.

(insert sigh)

A Delayed Label to the blogpost below: Who's who in IMU I

2009-08-28T09:17:00.000-07:00

Refer to the below. You will see a few grandfatherly figures. Don't mess with them. They are IMU people, Prof Hematram Yadav, former MOH and WHO consultant, now IMU Professor claims that IMU has the best staff there is.

Eg. We have Prof Ong Kok Hai who has Einstein like hair very rich and walks around in a labcoatwho developed rapid tests for some disease that has seen passed my memory and my Dean Professor Yasmin who's a cross between Yasmin Ahmad and Adibah Noor when she's lecturing (ignoring her clinical acumen)

two prominent people

the one on the second picture to Tun's left sitting is Tun Mahathir's cardiothoracic surgeon Tan Sri Mr Yahya Awang, who is member of the Board of Directors of the IMU and de facto Head CardiOthoracic surgeon of Malaysia

the one in the third picture on Tun's left as well is our Tan Sri (when Tan Sri is mentioned, it is him we refer to in IMU). He is our President of the IMU, former DG of MOH, former Master of the Academy of Medicine Malaysia, former clinical nephrologist: Tan Sri Dr Abu Bakar bin Suleiman

Mahathir Mohammad, MD Hon. (IMU)

2009-08-27T21:17:00.000-07:00

The Daily Prayer of The Physician by Moses Maimonides

2009-08-26T04:26:00.000-07:00

I just loved this prayer IMU displays . It is by Maimonides. I now utter this same prayer:

Almighty God, Thou has created the human body with infinite wisdom. Ten thousand times ten thousand organs hast Thou combined in it that act unceasingly and harmoniously to preserve the whole in all its beauty the body which is the envelope of the immortal soul. They are ever acting in perfect order, agreement and accord. Yet, when the frailty of matter or the unbridling of passions deranges this order or interrupts this accord, then forces clash and the body crumbles into the primal dust from which it came. Thou sendest to man diseases as beneficent messengers to foretell approaching danger and to urge him to avert it.

Thou has blest Thine earth, Thy rivers and Thy mountains with healing substances; they enable Thy creatures to alleviate their sufferings and to heal their illnesses. Thou hast endowed man with the wisdom to relieve the suffering of his brother, to recognize his disorders, to extract the healing substances, to discover their powers and to prepare and to apply them to suit every ill. In Thine Eternal Providence Thou hast chosen me to watch over the life and health of Thy creatures. I am now about to apply myself to the duties of my profession. Support me, Almighty God, in these great labors that they may benefit mankind, for without Thy help not even the least thing will succeed.

Inspire me with love for my art and for Thy creatures. Do not allow thirst for profit, ambition for renown and admiration, to interfere with my profession, for these are the enemies of truth and of love for mankind and they can lead astray in the great task of attending to the welfare of Thy creatures.

Preserve the
strength of my body and of my soul that they ever be ready to cheerfully help and support rich and poor, good and bad, enemy as well as friend. In the sufferer let me see only the human being. Illumine my mind that it recognize what presents itself and that it may comprehend what is absent or hidden. Let it not fail to see what is visible, but do not permit it to arrogate to itself the power to see what cannot be seen, for delicate and indefinite are the bounds of the great art of caring for the lives and health of Thy creatures. Let me never be absent- minded. May no strange thoughts divert my attention at the bedside of the sick, or disturb my mind in its silent labors, for great and sacred are the thoughtful deliberations required to preserve the lives and health of Thy creatures.

Grant that my patients have confidence in me and my art and follow my directions and my counsel. Remove from their midst all charlatans and the whole host of of ficious relatives and know-all nurses, cruel people who arrogantly frustrate the wisest purposes of our art and often lead Thy creatures to their death.

Should those who are wiser than I wish to improve and instruct me, let my soul gratefully follow their guidance; for vast is the extent of our art. Should conceited fools, however, censure me, then let love for my profession steel me against them, so that I remain steadfast without regard for age, for reputation, or for honor, because surrender would bring to Thy creatures sickness and death.

Imbue my soul with gentleness and calmness when older colleagues, proud of their age, wish to displace me or to scorn me or disdainfully to teach me. May even this be of advantage to me, for they know many things of which I am ignorant, but let not their arrogance give me pain. For they are old and old age is not master of the passions. I also hope to attain old age upon this earth, before Thee, Almighty God!

Let me be contented in everything except in the great science of my profession. Never allow the thought to arise in me that I have attained to sufficient knowledge, but vouchsafe to me the strength, the leisure and the ambition ever to extend my knowledge. For art is great, but the mind of man is ever expanding.

Almighty God! Thou hast chosen me in Thy mercy to watch over the life and death of Thy creatures. I now apply myself to my profession. Support me in this great task so that it may benefit mankind, for without Thy help not even the least thing will succeed.

Med Student life

2009-08-26T04:12:00.000-07:00

When blogging gets this infrequent, facebook visits tend towards zero,

u know Kong Chia Yew has entered his Art,

shouting war chants till ur voice changes, getting splashed with chinese ink, sos tiram, pink paint, being hosed by water

fyi, yes thats what medical students do throughout five years of study.