DAY 2240-2266

Oct 20 - Nov 15

1) After what seems like an eternity, I am finally back with another edition of my blog. It's hard to believe that almost a month as passed since then. Anyway, we're approaching the tail end of our first rotation, mine being gastroenterology in Ward 230. Honestly, gastroenterology has been a great rotation thus far, and I could not have asked for more support and guidance from my seniors and colleagues alike. I've found myself on the liver team (hepatology) more often than gastro, but overall working in both sides has been really rewarding. 

2) For my next rotation, I'll be in trauma and orthopaedic surgery. Like my current rotation, it is also split into two sides - two months in trauma and two months in spine. Recently, the T&O team have been organising weekly teaching sessions, which aim to cover common conditions encountered in the ward - such as cauda equina syndrome and spondylodiscitis. I have been attending these and have found them really useful. I have heard stories about this rotation from my colleagues, so I am hoping that by reading up on some basic managements before starting, I would be able to settle in a bit better. 

3) Working is honestly quite different from studying for exams. Firstly, the learning is a lot more opportunistic and less structured. There are of course teaching sessions but they cannot hope to cover the vast knowledge required to manage the ward jobs efficiently. Therefore, you have to be proactive and keep asking around to understand how and why things are done the way they are. I've found the trust guidelines really useful in that respect. It provides a brief overview of steps to manage many common conditions encountered in the wards. 

4) Secondly, you can get as little or as much as you want out of working. For example, you could spend the whole day in the wards carrying out ward jobs like a clerk, and not getting anything out of it at the end of the day. Or you could choose to take the time to understand why certain changes to medications were made, why certain scans were ordered, or why certain patients require additional close monitoring. All of this is part of personal development, which is something heavily emphasised in our portfolio.

5) In addition to all this, as a foundation doctor on the academic pathway (SFP), I am also required to undertake a module called research methods in health, taught by Keele University. It basically comprises statistics and study designs that will be useful when we are start our research block in Foundation Year 2. At the end of the module, we have a written exam consisting of MCQs and SAQs, as well as a 2000-word essay to submit. All in all, plenty to keep me occupied for the rest of this year. And with that, I shall end my blog post here. Thank you for visiting as always, and have a great week ahead. Cheers!

Breakfast after a long night shift (9pm-9am)

Some people get a little queasy at the sight of blood, but for most of us here, it's a relief that we've gotten the blood required for analysis

Remembrance Day today

My first real purchase of anything other than basic food and amenities

Back to being a student then :)

Trauma and orthopaedic teaching Mondays

Unfortunately yesterday's session had to be postponed due to last minute changes

You know it is the correct location when there is a model of the human spine lying around

Free teaching and free lunch - what's not to like?

A nice assortment of sandwiches for lunch

DAY 2218-2239

Sept 28 - Oct 19

1) Finally some time off to manage my blog - it's been a while since I last updated this. Anyway, I've been busy these past few weeks, starting with my first set of night shifts (from 21:00-09:00), then switching back to regular day shifts, then back again to nights. Night shifts are quite interesting in that generally, the management is less curative than it is supportive. For one, the management plans have already been laid out by the consultants on the day team. As the night team, our aim is to ensure these plans are actioned throughout the night. We'll also adjust any medications / intervene according to the patients' condition, and basically keep them going until the morning handover.

2) Conversely, patients also tend to do poorly at night. Whether this is sundowning in patients with dementia, or diurnal variation in patients with asthma, patients tend to deteriorate easily overnight. Given that there are less staff in each ward, the burden then falls on the night team to prioritise patients who are the most unwell first. During my short stint in the AMU (Acute Medical Unit), we would clerk and examine all newly-admitted patients that had not been seen in the ED. Over the course of the night, some patients would desaturate, some would spike temperatures, yet some others would self-discharge against medical advice, and some would unfortunately pass on. Come morning, we would post-take (i.e. see) the new patients with the consultant, before handing over any outstanding jobs to the day team.

3) In addition to ward work, doctors on any training pathway are required to maintain a portfolio. At the end of each year, this portfolio is reviewed by a committee that decides if the doctor is allowed to progress to the next stage of training. To fulfill the criteria set out in the portfolio, we are required to engage in a variety of supervised learning events, including case-based discussions (CBDs), direct observed procedural skills (DOPS), and mini clinical evaluation exercises (mini-CEXs). In addition, we need to log in a minimum of 60 hours of learning, write some reflections, and get involved in an audit / quality improvement project. In short, there is always something to do throughout the year. 

4) All in all, while it is indeed challenging, there are many good learning opportunities working as a junior doctor in the NHS. And with that, I'll end my blog post here. Thanks very much for visiting as always, and have a great week ahead. Cheers!

An apple a day might keep the doctor away, but a cup of coffee keeps the doctor awake

(My first set of night shifts was brutal if I'm honest)

Privileges of being a member of the doctors' mess

Stocked up on some white boards - very helpful in penning my thoughts or for doodling...

Doodle exhibit A: One can dream XD

View from home

Hearty breakfast after a long night

Still happy as always :)

Full moon tonight

DAY 1607-1622

 Jan 26 - Feb 10

1) It has been a good while now since my last post. Usually, I would have quite a lot of interesting material to share on my blog after such a long period of time. However, due to the fact that we are all in lockdown, and clinical sessions have not yet resumed, there is nothing really exciting going on in my life right now.  Meanwhile, we have received news that clinical teaching will resume on the 22nd, which gives us some time to relax revise.

2) I have been spending the past week revising data from my previous dissertation. It has been a long week for me, having to sift through and conduct further analyses on what seemed to be lines of never-ending data. Thankfully, I have managed to complete the bulk of the analyses, and I shall now wait to discuss the next steps with my supervisor. 

3) At the start of the new year, a lot of us would been led to believe that we would witness a sense of normalcy from the current COVID-19 pandemic. That has very clearly not been the case. While numbers have been dropping in most countries, it is clear that mass vaccination will take a while to implement, and even longer to build up immunity in the general population i.e. herd immunity. This could take anywhere from months to a year. Therefore, it is important to maintain social distancing, practice good hygiene, wear a mask, and obey local public health guidelines. 

4) Having said that, the situation in local shopping complexes and other small businesses is really quite depressing. Just the other day, I walked to Gurney Plaza to get some groceries and stock up for Chinese New Year. Around 80% of non-food outlets were closed, and of the food outlets, no dine-in was permitted, with takeaway being the only option. For added measure, all the chairs and tables in these outlets had been tied up to prevent any dine-in customers. In general, the whole complex looked empty, safe for the  Grab/Food Panda delivery drivers who were queuing to pick up items for home deliveries. 

5) It is quite clear now that I would not be returning home for CNY. There is just too much uncertainty with when I might come back for clinics. At the very least, I will be fully occupied with things to do throughout this continued lockdown - mostly revision if I'm honest haha. That's about it for this edition of my blog. Hopefully there will be more exciting posts in the weeks to come. Have a great week ahead, and stay safe and healthy. Cheers!

Beautiful Chinese New Year decorations @ Gurney Plaza :)

Too bad there were so few visitors to admire the lovely decorations...

DAY 1548-1563

Nov 28 - Dec 13

1) A lot has happened since my last blogpost. For starters, I have finished my psychiatry rotation, and have begun family medicine. The scope of family medicine is very broad - it's a complete mix of all rotations, and it's quite impossible to predict what type of complaint the patient might come in with. There are, however, some problems that are more commonly seen in family medicine. These include diabetes, hypertension, and dyslipidemia (collectively known as "the big three"), Nevertheless, it's been really interesting visiting the different health clinics (Klinik Kesihatan) and private GP settings to see what goes on behind the scenes.

2) I am of the opinion that family medicine gives medical students the most exposure in terms of practical skills. We have a clinical logbook to fill, which includes a list of procedures which we should ideally observe, assist, or perform. Some simple procedures include taking blood pressure and pulse, calculating BMI, the different types of injections (e.g. IM, SC, IV, ID), wound dressing, using the ECG machine and interpreting the results, and many more. As the saying goes, practice makes perfect! Hopefully, we'll have practiced enough before sitting for our end-of-rotation exams.

3) Assessment for family medicine consists of two - the OSLER and DoSKE. OSLER stands for "Objective Structured Long Examination Record" - it is basically a 15-minute observed clerking of a patient, followed by a discussion on the differentials, investigations and management plan. The 40-minute DoSKE (which stands for "Documenting Skills Examination") assesses candidates on four tasks - writing a referral, writing a prescription, requesting an appropriate X-Ray, and requesting a blood investigation. At the end of the year - they will be the usual OSCE as well as written examination, consisting of single best answers, extended matching questions, and short answer questions. 

4) Studies aside, I've been quite busy with other events as well. I was an invited panelist for the "Aspiring Doctors Virtual Event", where I talked about my journey through medical school and intercalated masters. Here's the link of the entire video if you're interested - https://www.youtube.com/watch?v=a-ZCEj23vsY. Besides that, I presented a poster for the 31st International Symposium on ALS/MND, which was the culmination of my year long research as a Masters student. It was exciting to hear the progress made in the field of amyotrophic lateral sclerosis (also known as motor neurone disease) research.

5) Yesterday, I again went hiking up Penang Hill (Bukit Bendera) with my good friend Mad Noor. This time, we went up earlier, and I felt great going up the first half (to the lower station). A third way up the second half, however, I had a really bad stomachache. Knowing that I would not be able to reach the top in time, I had no choice but to descend back to the lower station where toilets were available. The worst thing is when I tried to resume hiking later, my muscles had cooled down and become a bit stiff. That made the second leg of the hike very arduous. Nevertheless, I made it to the top - eventually. We had a nice drink to cool off, before taking the tram down (that has become our routine).

6) All in all, it has been a productive two weeks for me. I anticipate that the days leading up to our Xmas break will be very busy, as I have a lot of catching up to do with my studies. That's all for today's blogpost - thanks very much for visiting, and have a great week ahead. Cheers! 

Dinner @ Lagenda House & Cafe, as recommended by Kuhan

(l-r: Melvin, Myself, Esther, Kuhan, and Melissa)

Dinner with Afifah and Sharifah - after a very long (but productive) day at Bayan Baru Health Clinic

Lunch at Tesco Food Court with my group mate Sharifah and our other two 

"group mates" Rachel and Afifah :)

Meet up with my buddy Zi Yan at the unlikeliest of places - college!

Chilling with a drink after reaching the summit of Penang Hill - with Mad Noor :)

Now that the highlight reels are finished, here are all the pictures in chronological order:

I ordered the fish meal - which came with butterfly pea rice, soup, and a "congkak" set of appetizers! :)

A close up of the "congkak set" - which consists of omelettes, crackers, tomatoes and onions, cucumbers, and dipping sauces

The same dish, but after removing the pandan leaf which covered the butterfly pea rice

Here are all our meals!

For dessert, a beautiful panna cotta with strawberry sauce

Some sago pudding with coconut milk

Caramelised bananas with ice cream - yum!

Today, Sharifah recommended that we try this popular franchise called "3 Budak Gemok" (lit: Three Fat Guys") - after our morning clinic session

Their specialty is "ayam kicap sambal power" (or sweet soy sauce chicken with sambal chilli)

I really liked the sambal, as it had a nice kick to it!

We're in Pusat Sejahtera USM today, specifically the lab department. Here are some interesting charts on urine microscopy (and what to look out for).

This is a Roche Urisys 1100 urine analyser

(you can see the test strip - which is dipped in the patient's urine before being placed in the slot for automated analysis)

Guidelines for the measurement of HbA1c - an important diagnostic and screening tool for diabetes

This is the A1care Analyser

Sysmex KX21N haematology analyser - basically where all the full blood count reports are handled

The tubes with lavender tops are called "vacutainers" - they contain EDTA as an anticoagulant, and are used for collecting blood samples for analysis (using the haematology analyser above)

The name of the restaurant is Bangkok Tomyam

We ordered "tom kha" (Thai coconut soup), "ayam gajus" (cashew nut chicken), and "kangkung belacan" (stir-fry water spinach)

The "tom kha" was very rich in flavour, but could have done with a bit more spice :)

Getting ready to celebrate the most wonderful time of the year!

This was just the beginning - they've now added photo booths and other shops surrounding the Christmas tree!

Tried the sizzling mee at Gurney Plaza - extremely filling!

Lunch with friends

Sharifah swears by these - the Swiss Roll from Bread History

(upon her recommendation, I decided to try one myself)

I must say, presentation wise, incredibly beautiful and delicious-looking Swiss rolls

Blueberry and chocolate combo!

Originally planned to use the gym - ended up in the Mezzanine instead XD

Getting ready to present my poster to the world!

A fruitful and rewarding experience indeed! Next year's symposium will be in Basel, Switzerland

My apartment is getting a makeover

In case it wasn't already clear, the newly painted side is on the left (the grey tone colour scheme)

At the lower station again

The view from the lower station was amazing! Too bad it was also a lot hotter than usual

Not sure how anyone would bring their bicycles up here in the first place XD

Map of Penang Hill

Just 200m more to go (the summit is basically just Cliff Cafe)

There are at least ten stores just like these on the lower deck - ready to capitalise on the tired hikers (myself included!)

Oreo milkshake

That's the face of someone who doesn't care about the calories soon to be consumed

Another spot recommended by Mad Noor - Ali Nasi Lemak Daun Pisang (translated loosely as Ali's banana leaf-wrapped nasi lemak). They come in different flavours - cili bilis, udang, and sotong (chilli anchovies, prawns, or squid)