Tough Love during Clinical Years

If you are a medical student, you would be able to relate to this post or find it useful (HOPEFULLY :P).

From where I graduated, clinical years starts off once you enter your third year. During my first and second year as a medical student, I used to hear horror stories from my seniors and friends from other universities regarding some TERRIBLE/HORRIBLE/SCARY/PSYCHOTIC consultants and lecturers that I might be facing during my clinical years and yes, I admit that I was pretty much really nervous before entering my third year. 

From third year until final year, we are expected to go to our respective teaching hospital and see patients. By, 'seeing', I mean clerking and examining patients. We are then supposed to present our cases to consultants/lecturers that are in charge of taking our teaching session for that day. So, this was definitely something more challenging as compared to our previous years because it involves mainly soft skills like being able to build a good rapport with patients and also presenting the cases rather than just reading them. This process then continues on with discussion of the patient's condition. So this whole process could be overwhelming at times especially if it involves really scary lecturers/consultants. 

Now, let me tell you what I have gained from all those so-called TERRIBLE/HORRIBLE/SCARY/PSYCHOTIC consultants/lecturers. I admit that it was sometimes, a nerve-racking ordeal. Looking at them itself was scary enough, imagine presenting to them and then, answering their questions during discussion. Worse still, demonstrating an examination method on a patient in front of them and all your group mates. I still have nightmares about some of those sessions until now. :P 

BUT, the thing is I realize that these teachers are the ones who made me a more confident person and less nervous during my real final bedside examination. Yes, the more you present to them and get scolded, the less you feel anxious when you present to anyone else the next time. Which is good because confidence is really important during your bedside examination. 

Most of them aren't psychotic. REALLY. They are notoriously strict because we are after all going to be future doctors and a single careless mistake could be harmful to a patient's life so can you blame them for being that way? 

Let me tell you about this one consultant who used to give us that IMPENDING FEAR OF DEATH when we waited for her at the ward. I can't reveal no more to protect the consultant's identity and more importantly, my life. LOL. Anyway, I don't remember ever feeling that afraid of ANYONE else in my life because believe me, this consultant could make you pee in your pants only by staring at you. But guess what? After all the classes and training we had with this consultant, we learnt so much about things that we thought we could never master or memorize. We could just look at one patient's investigation chart and point out what was abnormal even WITHOUT referring to the normal values. And this was only after a few clinical teaching sessions with her. She made sure we practiced our examination methods again and again and again until we had it on the tips of our fingers. So you see, it was tough love that made us improve. 

I also had this one consultant who was a real DISCIPLINARIAN. Believe me when I say this lecturer was another one of those who makes you think if you should just call in sick because you don't want to face him no more. But this consultant made me realize the importance of having the correct attitude as a medical student and later on, as a doctor. His scolding and nagging really drilled through my thick skull and went right into my brain because I could never forget those things that he used to say during our classes. He was a real perfectionist when it comes to anything that involves patients and again, I think this is really important for us as future doctors. The irony is, I have met him a few times outside of hospital setting, and he was one of the NICEST person I have ever met. So you see, he wasn't that terrible after all, was he? Just the exact opposite he was.

Finally, I would like to talk about this one surgeon whom many of my friends really disliked but personally, I really thought that he was amazing. Let me tell you why he was disliked by many of my group mates. During ward rounds, he expects the students to present. Not the housemen doctors. Not the medical officer. Not the junior specialist. BUT THE STUDENTS. In front of the entire team and the patient. Not only that, but he expects us to be perfect in our presentation. So you can imagine now how we would have felt. SCARED TO DEATH. Yes, I admit that sometimes I pray he wouldn't turn up during ward rounds. But, I thought to myself, this would be another learning experience and he must have something to teach me as he was a surgeon after all. So a couple of my friends and I decided to put in more effort and learn how to present better. And most importantly, to stop being so negative about that surgeon. So what happened next? He turned out to be a real good teacher once he noticed that we were willing to put in effort and improve ourselves. We used to follow him a few times for ward rounds even when we were not required to do so and he taught us so much. I also noticed that after presenting to him, I really did not feel afraid to present again to anyone else because I had good practice presenting to that surgeon and getting scolded in front of an entire team of HOs, MOs, specialists, nurses and patients. LOL. So you see, tough love again prevails! :P 

So what I am trying to say here is that sometimes the scariest experience could really change you for the better. The most intimidating teacher could impact your life in ways that would be beneficial to you. The thought of facing these tough lecturers/consultants could even motivate you to work harder to become responsible doctors. Don't pray that you don't ever have to face them in your classes. Instead, try to grab as much opportunity you could to learn from them. Don't be afraid to learn from them but aspire to gain as much as you could from their experience. I know I did!

Professor Snape is an example that could relate to what I have written above. (Well, what did you expect from a die hard Harry Potter fan? :P) 

Remember, YOU made it this far!

This post is about reminding myself that I made it this far when many people out there told me that I should let go. It is to remind you about how far you have came when you thought you couldn't. It is for us all to remember that sometimes life may seem so tough that you feel like giving up but you always get up after every fall because we are strong! 

I wouldn't say that I have had an easy life though many people might disagree. Yes, I have very supportive family members and that made my life much better. I have parents who never made me feel that I was lesser than anyone around the world. I do wonder at times if I truly deserve such a wonderful family. So why would I say life was tough? I mean who wouldn't say that life isn't easy? Except for motivational speakers who would say that life could be easy if you THINK that it is. That is true in someways though. 

At school I would say that I was a bright student because I was a fast learner and I loved studying, being a NERD and all (Yes I am very proud of the fact that I still am :P). I loved my teachers and I would like to think that they liked me too. So after completing SPM, I started with my A-levels and I thought that I would do great in it but I found it difficult. I couldn't grasp many things that were being taught by the lecturers and for some reason, I was also disinterested. So, as expected I did very badly in exams and I had to retake many papers during the next semester. I was told that it was going to be tough to pass because it isn't going to be easy to revise for all those previous papers together with the current ones. I had doubts on whether or not I would make it but I worked hard and made it. Well I do have regrets about not obtaining better grades but in the end, do grades even matter after all these years? 

Then I left to Russia to venture ahead in my journey to become a doctor and again, I heard so many negative remarks about how bad a place that is. 1) It used to be a communist country so they HATE foreigners. 2) During winter, you would not be able to survive the cold there because you definitely WOULD FREEZE TO DEATH. 3) You have always been so attached to your family so are you sure you would be able to cope with it? Moscow is so far away! 4) You are a vegetarian so are you sure you would be able to get enough nutrients over there? You can't even cook. I am not going to lie by saying that these remarks did not intimidate me at all. I was afraid really but I kept in my mind that experience is the best teacher in life. So, I thought to myself, "No matter what, I would learn as much as I could from this journey!" And after all that has happened there, I don't regret anything because whatever I have gone through during that part of my life, it made me a stronger person. If I had not gone to Russia, I wouldn't have known that I had the strength in me to endure all those obstacles that I had to face when I was there. 

And if you have read my previous blog, you would know that I was involved in a fire incident there and for a year I was on medical leave. At that time, I had countless doubts regarding what I was going to do with my life. 1) Should I continue my medical studies? 2) Should I just go back to Moscow? 3) Should I start over and just venture into something else? 4) Would I be able to live normally with these scars? 5) Am I ever going to get over the fact that I am never going to be as beautiful as those girls without any scars? 6) How on earth am I going to make it up to my family for making them worried sick when I was still hospitalized? Honestly, I had thousands of insecurities about myself and about my life at that time. That incident was really a life changing one for my family and I. In spite of all that happened, we still got through those hard times. We supported each other and again, my life was back on track. 

After that, life was never the same again. Throughout medical school, I know that people noticed me because of my scars and that wasn't easy. But I also knew that I had great lecturers and friends who appreciated me and I was more than thankful to have all of them. I learnt so much and gained so many new experiences which made me a wiser person (I HOPE! :P) and despite of all that has happened, I made it! With much help of course. GOD; FAMILY; FRIENDS; LECTURERS; PATIENTS and many random strangers who showed simple acts of kindness towards me whenever I needed it. 

So, my point is no matter what people say or whatever negativity that is shoved towards your way, remember that YOU CAN DO IT. Don't let obstacles run you down because you have come this far after all. You came this far not to just give it up but to go on until you have reached your destiny. I have always believed that the journey is more important than the goal. The journey matters because you learn so much along the way and it makes you realize how beautiful life could be if you allow yourself to appreciate it. Most importantly, learn from people's experience but never believe them completely until you yourself go through it because what people perceive may often differ from your own perception. 

So, my ranting ends here. Do ignore grammatical errors if at all possible! :P 

~ A hero is an ordinary individual who finds strength to persevere and endure in spite of overwhelming obstacles! ~ Christopher Reeve 

That's me looking like a Frankenstein monster after I was barbecued :P 

This is me 6 years later, finally a medical graduate. Phew! 

                                                

The Perfectly Imperfect Me

It isn't easy having scars in this world. SERIOUSLY. No kidding. But it really depends on how you take it as an individual. My family members are always there to remind me that people are often just curious rather than judgmental but I am not entirely sure how true is that. Perhaps they are just trying to make me feel better.

I find it very difficult to go out and answer the same questions over and over and over and over, alright I should stop but you get the point right? I respect teachers who have the patience to answer the same questions they get from their students year after year.

Sometimes the questions and remarks I get are really silly. Or maybe I just find them funny because never in my life I would have thought that I would be in such a situation. I used to look normal you know. My sisters and I have this weird coping mechanism to deal with all these questions. We just burst out laughing whenever someone asks me, "Oh hey, what happened to your hands?". Don't ask me why. Certainly don't ask them why because they have no idea too. But we laugh and often get scolded by people because, "This is no laughing matter young ladies!". LOL.

So here is a list of remarks and questions I get whenever I go out. No exaggeration here. HONESTLY. Well maybe I did modify the way it was said because you know how we Malaysians really speak. These are just a few examples. It'll take ages to list down every questions that I have been asked before.

1. The most popular one - Oh dear Lord, you have such a pretty face, you don't deserve this at all. (ERR excuse me are you saying that only if you're pretty, you don't deserve to get into a fire accident and get third degree burn scars? Otherwise it is alright? *Roll eyes*)

2. What happened to you? Where? How? Were you a student there? Which year were you in? Was it in your room or bathroom or living room? (I don't see the relevance here? Since I have already answered the, 'how') Wait, Moscow you said? Which season was it over there at that time? (Again, why is this relevant, summer causes more fire and winter's too cold for any fire to occur? Really? :P)

3. You're a girl. It is going to be tough for you. (Ok I am not really a super feminist material type but God this remark usually really ANNOYS me. VERY MUCH. Excuse me, I am a girl and I don't think this is going to be tough because I really don't care if boys don't find me attractive because I am no longer a teenager. Yes I went through that phase A LONG TIME AGO).

4. Have you tried aloe vera? Have you tried, 'minyak biawak'? Have you tried skin grafting? Have you tried plastic surgery? Have you tried ayurvedic treatment? Have you tried Chinese medicines? Have you tried silicone gels? Have you tried laser? Have you tried getting treatment in Singapore? UK? Korea? India? (Well you see, my family and I did try many things. We didn't just sit around waiting for miracles to happen.)

5. You're lucky in a way because the person you are going to get married to will love you for who you are on the inside and not just for what is on the outside. (I still can't decide if I am irked by this statement or if I'm neutral towards it or if it is actually SWEET but it doesn't matter because I THINK the person in love with me right now feels that I am gorgeous. No this is not considered as blowing my own trumpet. :P)

6. Non verbal communication by means of STARING WITH HUGE EYES and sometimes pointing with index fingers. Yes I get stared at a lot. Initially after the accident, I used to think that there was something behind me, an alien maybe and that is why people are staring but now I know it is just ME. Apparently humans are very curious creatures. NOT JUDGMENTAL. According to my friends and family. I just pretend to believe them. Although now if they read this blog, they're going to know that I am pretending. OOPS.

7. This is my all time favourite and it happened ONLY ONCE. But this unique question makes me laugh even until now. I went to this clinic a few years back and was sitting in the waiting room. This very hyperactive boy, about 7 or 8 years old came up to me and very LOUDLY asked while pointing at my arms, 'EH YOU SPIDER-MAN AHHH?' His voice and tone actually made every single person in that waiting room to turn towards my direction and again STARE at my beautiful scars. I looked at him incredulously until his parents apologized and brought him away though really I was refraining myself from bursting into laughter. THAT BOY MADE MY DAY. No made my day EVERY SINGLE DAY since then. :P (In case you're wondering, I am so not SPIDER-MAN )

So yes, it is not easy to look even a little different nowadays. Please note that I usually answer all of those questions with very polite answers and a huge smile. So the ones in the brackets is just me talking to myself in my mind at that time. That is not weird. AT ALL.

I know I am not alone though. I know that there are so many people out there who have worse physical imperfections and they are fine with it because they know that God and their loved ones see them as BEAUTIFUL human beings. They know that they are PERFECT just the way they are.

~ Wear Your Scars With Pride! ~

That is me so-called wearing my scars with pride :P 

Something Really Random for My Parents

Yes I have much time to kill right now so I decided to write a blog about my parents. Ignore the grammatical errors because I don't feel like caring about them anyway.

My mother and father are the people that I look up to. They are my role models/inspiration/idols/superstars, well you get the idea. They both came from a very humble background. They worked hard and overcame many obstacles to reach where they are now. They did not have the privilege to study in an air-conditioned room during the school days or even when they were receiving their tertiary education. Yet, they made it through school and finally graduated from university. Every time I feel bummed about studying, I would think of what they had to go through to get a degree and I would realize how lucky I am to have a nice room, delicious food, good moral support from my family and so many other things that they never had during their time. 

They also taught me to respect my mentors because teachers are the ones that shape us into who we are. I know that they are amazing teachers. I love mathematics because of mother. She makes solving numbers so easy! My dad is superb in our national language, Bahasa Malaysia. I love teaching too because of them. 

Many times, I have hurt both of them and yet, they have never given up on me or intentionally hurt me back. On a number of occasions, I have snapped at them but never have they stopped talking to me. I know for a fact that I was never an easy child to handle but, that never stopped them from loving me and I am so eternally grateful to them for that kind of love. They have always been there for me, throughout good times and difficult times. 

My parents are my guardian angels. If I am ever to be a parent someday, I hope I would be just as amazing as they are. Thank you mom and dad for everything! :-) 

~ Love your parents. We are so busy growing up, we often forget that our parents are growing old. ~ Anonymous 

Why is God Great?

So why is God great? This may seem like a question with obvious answers to some people and to certain other, it may seem like a biased question because they may think that the, 'Almighty' isn't that mighty after all. But to me, without God, life is pointless. I could give infinite examples of why God is great to me. 

I have always had the tendency to make wrong choices and at times, I never seem to learn from those mistakes. But during all those times, I always thought that no matter what happens, no matter how many mistakes I make, God will always be there to guide me through and believe it or not, He has always. I guess to some of us, the positive energy that gets us going through our lives is just something that emanates from within. But to me, that has and will always be God. 

I remember when I had a near death experience, I was stuck in a room which was surrounded by fire and I was suffocating, feeling the excruciating pain of heat on my body. I was ready to give up and I remember blacking out and collapsing on the floor. I was wondering if I should just close my eyes and die so that the pain would stop. All I did was close my eyes and chant the holy names of God or at least whatever that I could remember at that time. I also thought about my family and what I was going to put them through if I had decide to give up. So I didn't give up. I wanted to live my life for my family and for God. We all survived the fire. Nobody died. I still thank God every single day for giving me the chance to live. 

God is great because I know that He would always be there for me. God is great because I know that His love is infinite and He never expects anything in return except for my love. The beauty about believing in God is that I would never have to be afraid of where I am going because I know that He will be with me all the time. So that is why, GOD IS GREAT! 

~ God will not permit any troubles to come upon us, unless He has a specific plan by which great blessing can come out of the difficulty. ~ Peter Marshall 

My Experience during Final Year MBBS Long Case Clinical Examination

So I decided to write a blog about my long case clinical examination because it was a great learning experience for myself and I wanted to be able to read about it whenever I was going to attend any other examination feeling all nervous and jittery.

We had 2 days of clinical exam sessions, the first day for long case followed by short case the next day. I had my long case at Hospital Sultanah Bahiyah (Alor Setar) and at that time I was staying at my campus hostel in Sungai Petani. So very early morning on the day of examination, a friend of mine and I drove to Alor Setar. I wouldn't say that I felt prepared because I have always felt that way before any exam. That happens at times. No matter how much you study, you get that dreadful feeling that you might have missed something really important. 

Once we reached the hospital, we were brought to a waiting room and we had to wait for our turns according to roll numbers. I wasn't feeling that nervous up to that point but when my turn was nearing, I started feeling all those butterflies in my stomach and somewhat a little nauseous. After about an hour maybe, it was my turn. 13 of us were brought to another room and we were asked to draw lots to pick our cases. I was praying that I should not get an orthopedic case because I was not very confident in it but I guess on that day, my law of attraction was so strong that among the 13 of us, I was given an orthopedic case. I was feeling really doomed already but I was thinking that life goes on and whatever it is, I will just enter the room and give it my best. 

For long case we were given an hour to clerk and examine the patient. After that, 2 examiners will enter the room and question us. So my patient was a middle aged Chinese lady and she was very friendly. I greeted her, introduced myself and started asking her history. I asked her what was the reason she came to the hospital and she actually replied that she was asked to come specifically for the examination. I wasn't sure if she was asked to say that or maybe she was just being honest but to be safe I asked her again. She replied that she had pain in the right knee. 

So the thing about this patient is her story started a long time ago. When she was 11 years old and since then she had multiple trauma to the same knee. She underwent many surgeries to correct the problem. This meant I had to really rush and get the history quickly since I only allocated about 20 minutes for history. But my plan didn't really work out well because I took almost 50 minutes only to understand her very long history and thank God I was able to come up with a provisional diagnosis and a few differentials. Since I only had about 10 minutes to examine the patient, I did a few special tests to confirm my diagnosis. I was really so tensed up at that time because I knew I was going to have to present my history and examination findings without worrying about what I have scribbled on my papers since I didn't have time to rewrite my history at all. 

When the examiners entered my room, I really thought that I was going to do badly, firstly because I was so tensed up and secondly, I didn't have time to thoroughly examine the patient and thirdly, I wasn't sure if any of my diagnoses were actually correct. But I have done this so many times, presenting cases to specialist during our clinical teachings feeling the exact same way. The only difference was this was a real exam that was going to decide whether or not I am going to get my MBBS degree and I thought to myself that no matter what happens, I will take this as a learning experience to improve myself. With only that in my mind, I started presenting about my patient. 

I wouldn't say the presentation went very smoothly, I did stutter here and there but I would say it went alright overall. Then I was asked to summarize my history and that I had to do without referring to anything because I didn't really have the time to write a summary anyway. Summary is very important because at times the examiners are too tired to listen to the rest of your history and the summary is all they want to listen to. 

I was asked to say my provisional diagnosis and then proceed to show the examiners the technique of examining the patient. I did the standard examination method of knee joint and then proceeded with the special tests. My patient had a positive posterior drawer test and even that, I was entirely sure because there wasn't much of a posterior translation but there was a little bit of laxity (apparently that is considered as positive). So at the end of examination, I told the examiners that my provisional diagnosis was posterior cruciate ligament tear with underlying secondary osteoarthritis of the right knee. They asked me to justify my diagnosis which I did. During physical examination, I was asked the reason for doing each steps and also the difference between a fixed flexion deformity and an extension lag. I was asked regarding the management of this patient and also to interpret the patient's knee joint X-ray. One of the consultant asked me, if I was a houseman officer and I had to request for an X-ray for this patient, how would I present the case and request for it from a new radiologist that has never seen this patient before. They asked a few other basic questions and finally how would I manage a similar problem in a patient who's very much elderly and I answered total knee joint replacement as subjecting an elderly patient to multiple surgeries would only give the patient more harm than benefit and this justifies the reason to replace the joint completely. 

At the end, one of the consultants asked me if I would like to be an orthopedic surgeon someday and I replied definitely if there is an opportunity. So it was a real good experience for me because I was hoping to get a medical or surgical or O&G patient for my long case instead, I got an orthopedic patient and it went pretty well I would say. I thank God for giving me wonderful examiners who taught me so much on that day. :-) 

~ I never lose. I either win or learn. ~ Nelson Mandela