Day 5
There was a multidisciplinary meeting this morning, whereby, as the word implies, it involves medical professionals from different disciplines in case discussion. The focus was mainly on the lung oncology. It involved pathologist, radiologist, and physicians. CT scans were being projected on the screen, mainly lung nodules, mediastinum mass and metastatic tumours. (I still need some more practice in reading those CT scans I guess.)
After that, I went to the library to do some reading. Seriously, I missed the library that used to be there in our faculty in Lot 77. It was the place where I could really concentrate. *sigh*.
“Asthma, diet and microbiota”. Another interesting respiratory grand round presentation presented by Dr. Alison from Monash University. It was being held at ICU lecture theatre. She had done a clinical study on mice models to find out whether diet had anything related to asthma. Interestingly, high fibre and high acetate concentration in blood (short chain fatty acid) were found to be able to suppress allergic airway disease in immunological view. (However, there was no effect in an established asthma). Besides, same effect was found in foetus of the pregnant mice models which was being given acetate in the drinking water. It was a fascinating topic. Now, that is the power of research. Without it, there will still be no cure for many diseases.
And never forget that today is FRIDAY! Another weekend! Yeah!
Friday, April 24, 2015
Thursday, April 23, 2015
Clinical Elective at RMH (Day 4)
Day 4
Set off for RMH at 730am. Another windy day and my body shivered badly when I headed to the tram stop. However, I was full of anticipation of what I would encounter today in the hospital. Ward round is always the early morning routine in all hospitals. There was a patient in a myasthenia crisis which affected his respiration badly. It was quite sad to see patient suffered. However, the team was always ready to bring comfort and to ease the pain that the patient had gone through. And Dr. David had set a good role for me as I observed how he listened, comforted, convinced and reassured two patients who broke into tears due to their illnesses. I could sense that patients were one part of the team. They had the right to know what is happening to them; what had been done on them; what are the outcomes.
There was that one time when we came out from patient’s room, Dr. David turned to us the medical students and asked,
“What did I do when I meet patients?”
“I shake their hand and I come to their level. Remember that.”
This is the basic thing we should know, but, most of the times we tend to forget. Always respect the patients.
That was a long morning ward round. I was quite excited when I heard that a registrar was going to assess one of the medical students to perform respiratory examination. Frankly speaking, it has been a while since I practised PE. What a shame. Hence, I joined them and observed. The steps were more or less the same as what I had learnt. The registrar was impressed by the examination skill of Morgan, so did I. He was so confident and the flow was smooth. It was a case of pleural effusion. There was obvious sign of decrease breath sound and stony dull on percussion on the affected side.
It was 1.00pm when the grand round presentation started. It took place at Charles LaTrobe Lecture Theatre. The topic was “Solving Big Clinical Problems through Research”. The presentation began with the History of Walter & Eliza Hall Institute, which is a medical research institute. The other sub-topics included the history of Influenza pandemic and how research had contributed to the invention of its vaccine, followed by research on finding the cure of hepatitis B, coeliac diseases and chemo-resistant leukemia. They were delivered by infectious diseases specialist, gastroenterologist and haematologist respectively, who were involved in the researches.
Lastly, I attended a pathology lecture. (My basic knowledge is …. Urgh ! I forgot many things which I had learnt in preclinical years. Damn!)
Finally, I decided to call it a day !
Set off for RMH at 730am. Another windy day and my body shivered badly when I headed to the tram stop. However, I was full of anticipation of what I would encounter today in the hospital. Ward round is always the early morning routine in all hospitals. There was a patient in a myasthenia crisis which affected his respiration badly. It was quite sad to see patient suffered. However, the team was always ready to bring comfort and to ease the pain that the patient had gone through. And Dr. David had set a good role for me as I observed how he listened, comforted, convinced and reassured two patients who broke into tears due to their illnesses. I could sense that patients were one part of the team. They had the right to know what is happening to them; what had been done on them; what are the outcomes.
There was that one time when we came out from patient’s room, Dr. David turned to us the medical students and asked,
“What did I do when I meet patients?”
“I shake their hand and I come to their level. Remember that.”
This is the basic thing we should know, but, most of the times we tend to forget. Always respect the patients.
That was a long morning ward round. I was quite excited when I heard that a registrar was going to assess one of the medical students to perform respiratory examination. Frankly speaking, it has been a while since I practised PE. What a shame. Hence, I joined them and observed. The steps were more or less the same as what I had learnt. The registrar was impressed by the examination skill of Morgan, so did I. He was so confident and the flow was smooth. It was a case of pleural effusion. There was obvious sign of decrease breath sound and stony dull on percussion on the affected side.
It was 1.00pm when the grand round presentation started. It took place at Charles LaTrobe Lecture Theatre. The topic was “Solving Big Clinical Problems through Research”. The presentation began with the History of Walter & Eliza Hall Institute, which is a medical research institute. The other sub-topics included the history of Influenza pandemic and how research had contributed to the invention of its vaccine, followed by research on finding the cure of hepatitis B, coeliac diseases and chemo-resistant leukemia. They were delivered by infectious diseases specialist, gastroenterologist and haematologist respectively, who were involved in the researches.
Lastly, I attended a pathology lecture. (My basic knowledge is …. Urgh ! I forgot many things which I had learnt in preclinical years. Damn!)
Finally, I decided to call it a day !
Wednesday, April 22, 2015
Clinical Elective at RMH (Day 1-3)
Day 1
Met the elective coordinator, Debra, a nice and friendly person she is. She brought me around the hospital and introduced me the place where I can find good food to eat. Ha! After that, she helped me to settle with the ID Badge and there, off she went. And it was time for me to head to respiratory department to meet with Savi and my supervisor, Professor Lou Irving. I was quite confused on what I should do on the first day. I was then being introduced to the registrar, Dr. Mary and interns at the respiratory ward at Level 5. And here I started to join their ward round. It was great to be warmly welcomed by them and greeted by one of the respiratory physician, Dr. David Smallwood. From the ward round, I could observe how the physician approached the patients in a good way. He was able to build up good rapport with them. He set a good example for me. Not only him, but all the staffs! They were really good examples for me. And what was different from what I had observed in Malaysian hospitals was that the team will review on the patients’ condition, their clinical investigation results, x-rays, CT scans etc in front of the nursing counter first before they went to the patients’ beds. And everything was computerized. Staffs could obtain patients’ profile, clinical results and other investigations with just a few clicks. It is really convenient.
After the ward round, I followed 2 medical students (Laura and Ian) to interview a patient who presented with cough, high fever and shortness of breath. Those students had good interviewing skills. They made good use of open-ended questions and they tried to figure out the possible differential diagnosis by asking relevant questions to the patient. Again, they built a good rapport with the patient. The patient was a kind man and very cooperative. Another thing which I had learnt from the students was that having discussions with the colleagues is one of the best ways for learning. We share, we discuss and we learn together. That was pretty awesome.
Finally, I followed the intern, Dr. Eugene to a meeting. Interns were presenting the case summary of each patient and their progression to the physicians and there the discussions took place. I could see the spirit of team work in solving the problems and deciding a better management for each case.
Day 2
Another story began. First we started at the Respiratory care unit, a place where patients were being observed closely (It is some sort of ICU but it is in a respiratory ward). After the registrar reviewed on the patients there, we went to a radiology meeting. Before the meeting started, there were students who were presenting their research progressions to the physicians. Their topics were really deep and heavy! During the radiology meeting, CT scans and Chest X rays of the patients were being shown on the screen.
About an hour later, I went to the respiratory clinic. Medical students distributed themselves into different rooms. I was lucky to join Dr. Rubinfield’s clinic as she was friendly and was willing to teach. We had four patients that day. The first patient came for follow-up and complained of chronic dry cough, usually worsened at night and exercise. According to the Dr., it could probably be asthma. However, her lung function test was normal and there was no abnormal finding on auscultation. In order to confirm the diagnosis of asthma, Dr. suggested to have a bronchial provocation test (with methacholine) done. This would help in deciding a proper management for the patient.
Another patient had a past history of hospital admission with SOB, hemoptysis and epistaxis (septal perforation was the cause of epistaxis). She also experienced loss of weight and loss of appetite. Radiology findings showed ground glass opacity in her left lung (which according to Dr. the ground glass opacity could be infection). When I was being asked on the relevant examination I should do on that patient, respiratory examination was what I could think of. In fact, I should have looked at the hands for sign of clubbing, examine the abdomen as well for any lumps (as the patient presented with LOW and LOA, we should look for sign of malignancy on other systems as well). Gosh! I shouldn’t have deemed that as trivial complain!
Here came another asthmatic patient with sleep apnoea. During the examination, I could hear wheezing after she took her steps to the bed. She seemed to gasp for air while she was sitting on the bed. Obvious rhonchi could be heard bilaterally on auscultation.
Lastly, a middle-aged gentleman stepped in, bringing his son who was a four-year-old cute little sweetie. I was being told that the gentleman had hereditary hemorrhagic telangiectasia. It is a condition with small vascular malformations which can occur in the skin and mucosal linings of the nose and gastrointestinal tract. He suffered from frequent nosebleed and he had rhinitis. There were obvious sign of telangiectasis on his skin, lips and mucosa of the tongue. Interesting case!
Again, there were good communication skills and good patient-doctor-relationship. She spent around 15-30 minutes on one patient. And I really felt grateful as all patients smiled and wished me have a good stay in Melbourne. The last patient even wished me to be a good doc when i go back to Malaysia. They were wonderful persons! Teehee !
Day 3
As usual, we started with ward round. And then we went to the emergency department to see a patient with clots in her lungs. This was followed by another clerking with Morgan, a medical student. Oh! By the way, the medical course here is only a 4-year-course and they all will start their clinical years at year 2. Wow!
We clerked a patient who presented with decreased effort tolerance (20ft to 5ft), SOB, extreme exhaustion for 6 weeks and the symptoms worsened. She had medical illnesses of hypertension, diabetes mellitus, atrial fibrillation, and liver cirrhosis. She suffered from heart failure which contributed to her current symptoms caused by fluid overload and pleural effusion. She was a cheerful and cooperative patient. Got to know she had a good hobby of reading especially bible. She also did missionary work. May God bless her so that she will get well soon.
Met the elective coordinator, Debra, a nice and friendly person she is. She brought me around the hospital and introduced me the place where I can find good food to eat. Ha! After that, she helped me to settle with the ID Badge and there, off she went. And it was time for me to head to respiratory department to meet with Savi and my supervisor, Professor Lou Irving. I was quite confused on what I should do on the first day. I was then being introduced to the registrar, Dr. Mary and interns at the respiratory ward at Level 5. And here I started to join their ward round. It was great to be warmly welcomed by them and greeted by one of the respiratory physician, Dr. David Smallwood. From the ward round, I could observe how the physician approached the patients in a good way. He was able to build up good rapport with them. He set a good example for me. Not only him, but all the staffs! They were really good examples for me. And what was different from what I had observed in Malaysian hospitals was that the team will review on the patients’ condition, their clinical investigation results, x-rays, CT scans etc in front of the nursing counter first before they went to the patients’ beds. And everything was computerized. Staffs could obtain patients’ profile, clinical results and other investigations with just a few clicks. It is really convenient.
After the ward round, I followed 2 medical students (Laura and Ian) to interview a patient who presented with cough, high fever and shortness of breath. Those students had good interviewing skills. They made good use of open-ended questions and they tried to figure out the possible differential diagnosis by asking relevant questions to the patient. Again, they built a good rapport with the patient. The patient was a kind man and very cooperative. Another thing which I had learnt from the students was that having discussions with the colleagues is one of the best ways for learning. We share, we discuss and we learn together. That was pretty awesome.
Finally, I followed the intern, Dr. Eugene to a meeting. Interns were presenting the case summary of each patient and their progression to the physicians and there the discussions took place. I could see the spirit of team work in solving the problems and deciding a better management for each case.
Day 2
Another story began. First we started at the Respiratory care unit, a place where patients were being observed closely (It is some sort of ICU but it is in a respiratory ward). After the registrar reviewed on the patients there, we went to a radiology meeting. Before the meeting started, there were students who were presenting their research progressions to the physicians. Their topics were really deep and heavy! During the radiology meeting, CT scans and Chest X rays of the patients were being shown on the screen.
About an hour later, I went to the respiratory clinic. Medical students distributed themselves into different rooms. I was lucky to join Dr. Rubinfield’s clinic as she was friendly and was willing to teach. We had four patients that day. The first patient came for follow-up and complained of chronic dry cough, usually worsened at night and exercise. According to the Dr., it could probably be asthma. However, her lung function test was normal and there was no abnormal finding on auscultation. In order to confirm the diagnosis of asthma, Dr. suggested to have a bronchial provocation test (with methacholine) done. This would help in deciding a proper management for the patient.
Another patient had a past history of hospital admission with SOB, hemoptysis and epistaxis (septal perforation was the cause of epistaxis). She also experienced loss of weight and loss of appetite. Radiology findings showed ground glass opacity in her left lung (which according to Dr. the ground glass opacity could be infection). When I was being asked on the relevant examination I should do on that patient, respiratory examination was what I could think of. In fact, I should have looked at the hands for sign of clubbing, examine the abdomen as well for any lumps (as the patient presented with LOW and LOA, we should look for sign of malignancy on other systems as well). Gosh! I shouldn’t have deemed that as trivial complain!
Here came another asthmatic patient with sleep apnoea. During the examination, I could hear wheezing after she took her steps to the bed. She seemed to gasp for air while she was sitting on the bed. Obvious rhonchi could be heard bilaterally on auscultation.
Lastly, a middle-aged gentleman stepped in, bringing his son who was a four-year-old cute little sweetie. I was being told that the gentleman had hereditary hemorrhagic telangiectasia. It is a condition with small vascular malformations which can occur in the skin and mucosal linings of the nose and gastrointestinal tract. He suffered from frequent nosebleed and he had rhinitis. There were obvious sign of telangiectasis on his skin, lips and mucosa of the tongue. Interesting case!
Again, there were good communication skills and good patient-doctor-relationship. She spent around 15-30 minutes on one patient. And I really felt grateful as all patients smiled and wished me have a good stay in Melbourne. The last patient even wished me to be a good doc when i go back to Malaysia. They were wonderful persons! Teehee !
Day 3
As usual, we started with ward round. And then we went to the emergency department to see a patient with clots in her lungs. This was followed by another clerking with Morgan, a medical student. Oh! By the way, the medical course here is only a 4-year-course and they all will start their clinical years at year 2. Wow!
We clerked a patient who presented with decreased effort tolerance (20ft to 5ft), SOB, extreme exhaustion for 6 weeks and the symptoms worsened. She had medical illnesses of hypertension, diabetes mellitus, atrial fibrillation, and liver cirrhosis. She suffered from heart failure which contributed to her current symptoms caused by fluid overload and pleural effusion. She was a cheerful and cooperative patient. Got to know she had a good hobby of reading especially bible. She also did missionary work. May God bless her so that she will get well soon.
Monday, October 24, 2011
Be Strong
In life full of torments
I endured the pain
Greeting others with a shining smile
But never did they know
There was something glew dimly inside me
It was sadness
Alone I stood
In the middle of battlefield
Struggled to fight
Against the oncoming obstacles
It wont be known as a battle
If no scar is left
Lonely I cried
Silently I sobbed
Firmly I rose from where I fell
Looked into the mirror I knew i had became stronger
Bandaged the wounds
And from here I departed
Confronted with the terrors and difficulties
which were just ahead of me..
Monday, August 8, 2011
It's Not Just Like What You Think
Don't tell me , "It's just a tree."
Please tell me , "It's a life."
A life that speaks inaudibly
A life that dances elegantly with the gentle wind
A life that sheltered other lives from tormenting nature
A creation of God which one should protect it and cherish it with L.O.V.E.
Please tell me , "It's a life."
A life that speaks inaudibly
A life that dances elegantly with the gentle wind
A life that sheltered other lives from tormenting nature
A creation of God which one should protect it and cherish it with L.O.V.E.
Sunday, July 3, 2011
A Kingdom We Never Meant To Take A Glimpse
Open up the window
What do you mean to see ?
People walking by
Couple behave affectionately towards each other
Or simply take the chance to eavesdrop on others' conversation in order the get the 'latest news'?
Well
Instead of sticking on the same routine
Why don't we take some time
To take a glance at another kingdom
Rather than the kingdom where we had spent most of the time in it.
Magnificent it stood
Right in the middle of the emerald green ground
There it swayed
with the melody of the wind
So gentle
So sweet
Never did we notice
Under its green veil
There were lives
Having their great time
Enjoyed the moment of freedom and merriment
There came the birds
Together they sang
Together they chattered
Oh !
What a talented singer with the golden throat!
Never did they forget to play hide and seek
One moment they were there
Then in a wink
they were on the other side
It seemed to be a fabulous playground for them
Look closer
You will see
Hardworking creatures were on their duty
The ants
Marching in a line
Ahead they went
To the big hole
Which inside
Full of their harvest
Never did they groan for tiredness
As they know distinctly
What their responsibilities were
Something else was wriggled under the veil
It's a caterpillar
Slowly he crawled
Searching for his daily meal
To get his belly filled
Never did he forget to stretch out his head
Having a look at the fantastic ambience
There were more and more creatures
Intended to join the party
The squirrels
Bringing the nuts
Jumping up and down
Chasing one another
The butterflies
Flew with their gorgeous wings spreading wide
And also the baby birds
Rolled within the egg shell
Cant wait to have a look at this small yet beautiful kingdom..
What do you mean to see ?
People walking by
Couple behave affectionately towards each other
Or simply take the chance to eavesdrop on others' conversation in order the get the 'latest news'?
Well
Instead of sticking on the same routine
Why don't we take some time
To take a glance at another kingdom
Rather than the kingdom where we had spent most of the time in it.
Magnificent it stood
Right in the middle of the emerald green ground
There it swayed
with the melody of the wind
So gentle
So sweet
Never did we notice
Under its green veil
There were lives
Having their great time
Enjoyed the moment of freedom and merriment
There came the birds
Together they sang
Together they chattered
Oh !
What a talented singer with the golden throat!
Never did they forget to play hide and seek
One moment they were there
Then in a wink
they were on the other side
It seemed to be a fabulous playground for them
Look closer
You will see
Hardworking creatures were on their duty
The ants
Marching in a line
Ahead they went
To the big hole
Which inside
Full of their harvest
Never did they groan for tiredness
As they know distinctly
What their responsibilities were
Something else was wriggled under the veil
It's a caterpillar
Slowly he crawled
Searching for his daily meal
To get his belly filled
Never did he forget to stretch out his head
Having a look at the fantastic ambience
There were more and more creatures
Intended to join the party
The squirrels
Bringing the nuts
Jumping up and down
Chasing one another
The butterflies
Flew with their gorgeous wings spreading wide
And also the baby birds
Rolled within the egg shell
Cant wait to have a look at this small yet beautiful kingdom..
Thursday, June 2, 2011
"The Shift"
Time slips away silently just like a sneaky thief , I idled away the hours reading a book , from the very beginning till the end. And there comes the glorious sunset . Imagine what will happen after a few hours . I can tell , the burning ball will start to hide , leaving the sky with a dim glow. Then , it's time to say good bye. For what replace it is the gorgeous little moon. Not as glaring as the sun but is enough to beautify the sky , to illuminate the paths engulfed by darkness. The moon will never be alone , as the sparkling stars are always be there with her.
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