It's lonely to oncall sorang

Oncall kali ni bersama seorang teman. Kakak sulung empat beradik dan nak jadi doktor. Maka saya pun "beres harini tagging dengan saya" dalam usaha nak patahkan semangat dia apsal la kecik2 nak jadi doktor jadi la nelayan tuna ke.

Beliau dipanggil tagger dan disuruh bantu saya review dan buat procedure untuk patient. Benda simple seperti labelling blood yang dah di ambil, pasangkan Upin Ipin untuk adik2 tengok sambil menjerit kena cucuk (padahal tagger tu sendiri nak tengok Upin Ipin), tolong tenangkan adik2, tolong amik barang simple2.

Thanva berumur 11 tahun, chronic lung disease on prolonged antibiotics, day 10 or so dalam wad.

This one should go under Smug category. Yeah so I am vain.

Have I told you my all-time favourite case is Down syndrome? Babies with Down syndrome are probably the cutest ever and so far I've never been unable to tell one apart. We once had a baby in tutorial and my classmates disagree with me when I said he has Down syndrome. So I went up to the professor and asked her if he indeed has Down syndrome.

"Yes he does," Dr. Nadia Zaghloul was impressed. She commended my spot-on observation before proceeding to ask the mother follow up questions.

I once saw an adult male with Down syndrome walking towards me in the street near AR Hospital and my initial reaction was to run towards him and give him a bear hug. He was wearing a maroon jumper.

"Good things will happen in life. You have to work hard to make it happen."

The discussion of the first two patients in Paediatric today bored me. I lost interest soon and went to stand at the very back. I liked Paediatric so it was a mystery why I was bored and restless. Possibly from the too small ward relative to our number.

Then we came to our third patient. I forgot the history (I was restless and couldn't focus) but the patient was two months old (or older?) male named Hassan with poor suckling and on tube feeding. He developed complications after prolonged oxygen therapy in the NICU following his birth and had hemorrhagic ischemic encephalopathy plus chronic lung disease.

Dr. Nour said it was common in preterm but the mother said he was born fullterm. For some reason they did a CT abdomen and they found cirrhotic liver and a choledochal cyst for surgery. Dr. Nour said his kidneys appeared abnormal as well with dilated calyces.

Brain, lungs, liver, biliary system and kidney. This kid had it all.

His cry was weak, his Moro reflex was weak and Dr. Nour said his eyes wasn't focused that could either be from his HIE or retinopathy of prematurity. The doctor asked the mother if they did any fundus examination on him, which she denied. He immediately note the resident to get one done promptly.

Add in potentially blind. As if life wasn't tough enough. I felt sorry for him and for his family especially the mother and thought of all the bills and tribulations they were going to face. It was going to be a hard, below average productive life if he makes it to adulthood. As I stared at him, I thought how similar his size was to a whole chicken and if they just behead the boy, he would die and the trouble ends there-

I blinked out of my dangerous thoughts. The baby was alive and not giving up, the mother wasn't giving up and the doctors weren't giving up either. So what was I, a stranger in this case, doing thinking of ending a life?

I felt like someone just slapped me. What was I doing succumbing to my boredom when Paediatric is a lesson on not giving up on life. I regained my focus and volunteered when Dr. Nour asked to measure his head circumference. I manipulated the baby and saw he was barely the size of my two forearms side by side; painfully too small. The reading came to below the 3rd percentile.

Surgery is cool but I was reminded why I like Paediatric in the first place

We have a paediatric patient in Plastic Surgery nowadays. 8 years old Mostafa with a broken left jaw from falling from a height. He came in yesterday with his mom and Nisa took his history from his mom (mom said he fell from the stairs but Mostafa told Dr. Mostafa he fell from the asur which according to the doc is "the bridge surrounding the house" whatever that means) while I chatted him up.

He appeared smaller than an 8 years old, swollen left jaw, distorted teeth alignment, somewhat adenoid facies, and definitely looked like a buas kid. No wonder he fell from a height.

Today he came into our class again, wearing a white jubah commonly worn by patients. He came in without his mom, carrying his xray and CT films in a Nestle plastic bag bigger than himself. Sort of looked like a pakcik, haha. He played with some coins while the Dr. Hosam taught us a separate case of palatine fistula.

The coins fell on the ground, he picked them up. Coins fell again, he picked them up. "Shh Mostafa, the doctor is teaching!" I mouthed, and he stood there watching me silently, as if wondering what to do now that he couldn't play with his coins.

It wasn't that noisy, but his innocence was distracting me and I just like to bully kids, so I gestured for him to come near and held my palm open demanding for his coins. He obediently gave me all, hahaha. Someone needs to teach this guy to hold on to his money.

I put them back in his jubah pocket and patted him. "Keep them there."

---

The doctor was showing his xrays and CTs to the class. Mostafa was standing by the bed, obediently passing the doctor one by one of his films.

He looked like Assistant Lecturer Mostafa, hahaha. I pray this guy grow up soleh, happy, healthy and successful.

Proud cat

The first time I auscultated apical heartbeat on the right side, it was a case of dextrocardia complicated in the Paediatric Cardiac Care Unit of red brick hospital in Abou Rish. I was a noob medical student then (now even noober) and was elated. Dextrocardia bro, you don't come across that everyday.

Last Wednesday the police attacked the peaceful anti-coup demonstration in our faculty with liberal shots of tear gas canisters and shotgun. They came with their team of gangsters who attacked with bricks and glasses.

The day after, security was (every person passing through the gate has to brandish his student ID as proof of studying here. The downside of this checkpoint is that I can no longer freely enter whichever gate I want.

But the upside is that whenever I pass the guard flashing my ID, he'll cock his head respectfully in a "tafaddholi" and I feel acknowledged and cool.

Dude, I'm a Kasr el-Ainy Medical Faculty student. Not just some medical student, but a Kasr el-Ainy's. I study under THE Dr. Hussein Khairy.

decision

during my 23rd birthday, i told my parents i'd like to donate my organs when my end comes. dad was pretty nonchalant when he agreed, but mom made this solemn face. i'm not sure whether that's a yes or no, and i'm not even sure whether i was asking for permission or telling them my decision. i'm 23, legally i'm matured enough to decide what to do with my life.

but parental consultation is wise at any age, so i've been holding on to this form until i can properly discuss this with them. that time, it was me and dad watching TV and mom was at the kitchen and i popped out "hey mom, dad, when i die i want to donate my organs. okay with you guys?"

this summer, inshaAllah.

my reason for such? i'd be dead by then and will have no use for such organs, might as well contribute as much as i can for humankind. and it's not like i'd be that externally disfigured if it's aesthetic value my family is concerned of. hehe.

---

dad prayed for me as an "intensivist" the other day, i wondered what he meant. i took up medicine to follow in dad's footstep as a neonatologist and i really do enjoy paeds. but i also like traumatology. the ability to perform coolly under duress scares and excites me at the same time and several times i envisioned myself patching up broken soldiers back to their working condition.

i want to be able to be dispatched anywhere on earth as a medical field worker and to tick off my to-go list i am unable to fulfil with my time and financial restrictions as a mere student (it's usd4000 per person, i want to cry). doctors without borders so far has need for paediatricians, intensive care physicians, emergency physicians, surgeon even, so i'm good.

but when in doubt, MERGE. haha. yeah, too early to decide. i'm not sure at what stage you get career consultation, but i think if you get it as earliest as possible, you'd be able to decide what to concentrate on during student life thus how to use your time-off wisely. i'd have dad in the summer to consult paeds career, so this winter i'll use it to consult on intensive pathway.

it's going to be a tough career life either way. i suppose it's lifestyle modification that i need now. either a supportive household or a lonesome household, bwahaha. there will be a cat either way.

so today, i read the syllabus for post-graduate critical care medicine with awe. 

Nuclear Bomb

The first Paediatric case I presented in class was a 6 years old boy named Ziyad complaining of abdominal distension.

His mom told me during the course of history-taking that her son was admitted 12 times because of respiratory infection, but that week we were supposed to cover Gastroenterology so I was too caught up with the abdominal part of the case and my pissing off with myself for not understanding some of the mother's word, his pneumonia simply went loss on me.

And so I presented the short case to Dr. Samuel Makar that day.

He asked about chest symptoms. I told him the mother mentioned but I didn't understand everything. He turned to the mother and asked her in their mother-tongue.

"12 times admitted from chest infection," the doctor turned to me. "This is a nuclear bomb you missed. A nuclear bomb."

You should have seen his face when he said those words to me. It was grim. I was stunned. I felt damn stupid, I was a disgrace to my family, my Paediatrician dad would be so ashamed of me I wouldn't blame him if he declare I was actually adopted.

"Abdomen and chest symptoms. What do you think?"

I don't know, so I told him so.

"This case might be tough for you, it's not a very common case," he continued. "This is a case of cystic fibrosis."

I reemerged from my self-pitying state with those words. Cystic fibrosis. I swore I will not forget that disease, the importance of good clerking and Dr. Samuel Makar who taught that class.

Anyway, since I presented the case, I got to examine the patient. Dr. Samuel seemed strict and firm with us but he was gentle with the boy, distracting him by asking what was his favourite show on TV and his favourite characters while examining his abdomen. He showed us the trick of palpating a kid's liver (running your fingers like playfully poking the child, but you're expected to palpate with the lateral border of the hand in an exam) and he let me palpate Ziyad's hepatomegaly.

I used that trick a month later while independently taking history of a naughty 4 years old boy with ITP. He chuckled.. so cute.

Other classes we had with him include a rheumatology case in which he taught the sheet for Rheumatology (a first for us) and a sad case of complicated hydrocephalus boy. I could see clearly his grim face as he addressed us, away from the mother, at the poor overall condition the baby was in and how his mother sought medical help late. Hydrocephalus was a relatively straightforward case, the boy's condition was generally preventable.

"I will not comment."

I learned the value of teaching without judging, how medicine is an art of educating people to do good to them without passing off judgement. We all have our battles.

Which reminds me of a story my dad told us about when he was stationed in Sarawak.

One time he frowned at a patient's son for bringing the patient late to the hospital. The son answered him calmly, that they lived far away from the hospital and the trip took a week or so via the river if the water-level is up to it, or else it would take a fortnight.

Dad was rightfully humbled.

"You have to be proud even if you are stupid."

There was this one or two questions that I gleefully answered and didn't bother to recheck it even though I finished early. Because I was confident.

Lulz.

Post exam, it bothered me that I was too quick with those questions. Turned out my answers were wrong. Served me right.

I most probably would have gotten it right if I used my brain instead of my instinct. It wasn't that I didn't know, it's just I was too full of myself to take a moment to think.

But I blame my eyes' need for a couple-more-minute shut. They get congested rather frequently lately, it was uncomfortable. (Okay that sounded lame).

---

During our Paediatric posting last year, Dr. Ahmed ElBeleidy when teaching us radiology mentioned the importance of using the brain to think instead of jumping at that moment with your instinct. Otherwise, you can easily mistake a pleural effusion for a collapse.

"Causes of failure in exam; ignorance and stupidity."

---

Instinct is something developed after years of experience. At this point, all my instincts might as well be a bag of bull, haha. 

"all is well, all is well, all is well."

hi. just an update on how everything is going now.

i busted my laptop the other day and haven't got around to repair it, well it's actually a matter of finance and yes the usual lazy ass issue. until then, it has been five years of loyalty and continuous service from the laptop, hontouni arigatou gozaimasu. i named it haizen during the earlier year with it but it's kinda too weird, i dunno why i named it such. bleach-influenced perhaps.

so i am hanging on to doing stuffs from my phone, which is a little over the top when one's job includes heavy documenting. a little pain but nothing a good dose of music couldn't heal, haha. i am writing this from freeloading off umair's laptop :)

we finished our paediatrics round last thursday and i miss it so much, it has been great fun. i should keep on studying paeds regardless, because it felt weird not to study hard for something lol. although i must say my sanity almost died and i bothered everyone with my incessant whining and impending suicides during the end round exam period.

at the abou rish children hospital lobby. this place is cool it has aquariummmmmm~

anyway, i miss paeds. the doctors, the patients, the subject itself. last night i revised a teeny bit over whatsapp with abang ayep. great fun :D

that night we had our long-overdue usrah and voila, strawberry crepe!

we started surgery yesterday. imagine, only two hours of class everyday. this is bad. i can see myself sleeping more and more and the general consensus of hibernating brown bears will be so proud of me. already made a pact with umair and faiz on how to manage this too much time so let's see me sticking with it. i really can't study at home. it won't work.

and last saturday, we went for futsal and i still! have the lumbago and leg cramp until now. which is not surprising considering it has been a year since i last played seriously and we went crazy on the field. in my defense, we did properly warmed up and down and i even got farahnur to walk with me to fro mounira - zenhoum.

spot the imported striker from ain shams.

my back. it makes me feel old. now where is that aspirin patch? anyway, it was awesome. typical me to go reckless where passion lies, haha. ara's team won with 2-1 and my hat's off for them. ara herself is one formidable opponent.

this coming winter break. well i only have something planned for the first week and another one day with kak elle, so i have a lot of time to do some other stuffs. this is again a financial issue, because i cannot bring myself to think of going somewhere not here when i can't dish cash out freely. haha.

where did all my money go, you ask? well it was written in Previously in 2012.

so.. maybe i will use this winter to plan next year's winter :) need to do a hell load of researching to make this work. plus this is a good time to reorganize my internal medicine and paediatrics "encyclopedia" and analyze someone.. which brings me to my next point.

i have been looping CN BLUE nowadays since i found their JAPANESE songs a day before the paeds exam. haha, crazy right? actually i have been listening to them (i only have three of their songs on my ipod, but anything goes) since 2011 but only now i am officially infatuated. this is mostly because my ears are made for japanese songs rather than korean language; it doesn't get digested much.

and the japanese songs has been shared with umair. i selected my most favourite best which was sang by jonghyun. guy is so.. heh. told you i was infatuated.

what else? oh yes. yesterday we went and got our first dose of hepatitis b vaccine. well mom said i should check my antibody against it first since we had been vaccinated during infancy, but that's like dinosaur ages ago. plus we were already on the way to vacsera at that time, can't go back now.

so. it wasn't painful at all! i was the first up and it was done in a blink, i was surprised because i expected it to hurt. but post vaccination, the arm wasn't really as strong and i was tired. not sleepy tired, but yawning-four-times-in-a-minute-worse-than-a-morphine-addict kind of tired.

happy faces post vaccinated.

right now i am having breakfast. umair cooked fried noodle. awesomeness. i only have breakfast when i freeload at her place haha. so not good at taking care of myself.

i should add that the cardiotrophic parasite is now fibrosed. i need a surgical incision or maybe a heart transplant.

:) see ya,
hana

D for Dramatic

Dr. Nadia was supposed to give our clinical session today but she was absent, so I joined Class D's clinical session. The following scenes took place there and made me realized how my class was Class B for Brilliance and theirs was Class D for Dramatic, hahaha.

---

Two and half years old Sama was crying and grunting. Crying and grunting. Someone took out a squeaky Pikachu toy and squeaked the toy out.

Sama stopped crying.

"That is a pig or what?" Dr. Hala asked, clearly amused at the child's reaction.

"It's Pikachu!" Class answered. Thankfully it wasn't in the tone of that 'Who's That Pokemon' segment or I would have doubled over in laughter.

---

The students lined up to auscultate ten-year-old Latifah's hemic murmur. I was asking Diyana why the doctor used the term edema of abdomen instead of ascites when I noticed said doctor's eyes were on me.

Probably my voice was too loud. I smiled at her sheepishly and said "Ops sorry doctor."

She looked at me intently. "Enti syatroh?" (You are clever?)

"Erk." I grinned awkwardly at her sudden out-of-place question. Now what was the correct answer for such question? "Ameen?"

She turned to Epul who was standing next to her and helped her to find the correct word. "Not that.." She said. "What I wanted to say was.. She is very, very, very..."

Doctor please don't say talkative. The guys would never let me live it down if you say talkative.

"...caring, kind, cooperative..."

Where on earth did that came from?

"...blablabla... And she asked question in the class." Dr. Hala turned to me. "Are you in the top 10 of the class?"

"No!" Now this one I know the answer to by heart.

"Why not?" She looked taken aback at my abrupt happy denial.

"Because I am too lazy to study," I shot back laughingly.

"So who is the top in the class?"

We pointed directly to Aisyah Mardhiyah, Amirul Yunus and others. Haha.

So I did asked a question in class. And probably have all the making of a top ten student as well (OMG so narcissistic. Somebody slap me please) except for my pathological laziness. Dr. Hala is either highly intuitive and superbly deductive or she needs a total enlightenment in the art of profiling hehe.

Thank you doctor. You restored my faith in my own self :')

---

Walked pass Epul on the way up the stairs to our lecture hall. He smirked and dished out his usual sarcastic flattery parroting what Dr. Hala commented.

I laughed, thanked him and amen-ed to his 'prayer'. I actually had a piece of banana crumble I wanted to give to him but seemed like he had too much fun today.

I ate half the banana crumble during lecture. No wonder I was more hyper than a monkey.

LE200 richer

The doctor gave me LE200 for summarizing today’s neonatal jaundice lecture. Even the Egyptian girl Marwa got LE100. I was surprised when the doctor handed me that amount. Allah bless her heart. She said it was because I am “a Malaysian and extremely brave.” She said if she was in my place (a foreigner asked to speak up in a foreign country), she will mum up.

It wasn’t not so much bravery as it was obligation to the doctor’s order, who picked me because the rest of Malaysians pointed at me. And I was in my default seat in class; in the middle part of the mid front row and directly facing the lecturer without any other student in between. My gain, hehe.

I didn’t volunteer myself because I was sitting in the middle and it was so much hassle to go out to the front of the class. Plus money never motivates me.

So maybe I will buy stuffs with the LE200, cook something and share it with the whole class? But I am too lazy to cook.. Ooooh I want banana pie!

Welcoming Them Cuties

A young nurse came to put on the baby girl's clothes. She put on the diaper after wiping up the meconium but the stain remained, so I asked her about it. She said the mother will do the proper clean-up.

I sweat-dropped.

She continued putting on the baby's beige undershirt. It was on inside-out. And the blue and white striped outershirt was also inside-out. She picked the baby up, bundled her in her-mother-provided blanket and carried her away.

I turned to Umairah. "When you go into labour, I'll make sure your kid's clothes are right-side out."

Iskandar laughed. "Why are you doing that? Isn't that her husband's job?"

He was right. I think I had become too independent that I forgot there is supposed to be role for a male.. somewhere.

Standard picture of a hyperexcited medical student. Mock me, haha.
He was the first baby we saw from a CS delivery. Handsome baby boy of 20112012. 

We went to the Department 10's labour room because we just took Neonatal Resuscitation on Monday and wanted to see how they really do it on a fresh baby. Though according to our esteemed leader, "We have to see the before process; the delivery!" with so much enthusiasm it was ticklish. Even declared a smug "My first delivery" after seeing his first vaginal delivery, hahaha.

We haven't taken Obstetric yet but Dr. Hend Mahmoud was very helpful and went through the normal delivery process with us in English and Syazwani tutored us through the Cesarean section. Paediatrically speaking, we saw what we came to see, revised the management of a baby of diabetic mother, grunting baby and some more.

Alhamdulillah. May God be forever kind to the cute babies and the heroes who worked for the safety of both mother and child.

Smokers Are Stupid

Egyptians smoking in hospital is a very low level of humanity. A standard of stupidity and ignorance in itself.

But smoking in a children's hospital? Kids are already susceptible to respiratory infection, coming in crying for air and the air reeks of smoke. What kind of brainless stupidity is this?

Paediatric makes me seethe at stupid adults and one of these days I might just go homicidal. I can see myself at the end of the round coming down with bipolar depression; happily cooing at cute kids and turns amok at the adults.