DAY 1787-1801

Jul 25 - Aug 8

1) We are entering the last few days of clinical teaching before our exams (Obstetrics & Gynaecology). It has been a hectic two weeks, as we juggled between morning bed-side teachings in the wards, filling in our clinical logbook, as well as completing our case write-ups in time. Thankfully, all of that is a thing of the past. Monday will be our final bed-side teaching before our O&G end-of-rotation examinations on Thursday / Friday. This is followed by a 9-day study break before the end of fourth year examinations, consisting of written papers and a 20-station OSCE practical session.

2) Let's see if I can explain how the clinical exams work. Each exam candidate is assigned a patient, either in the obstetrics ward or gynaecology ward. We are given around 30 minutes to obtain a coherent history (i.e. ask the patient questions) and perform any physical examinations as we see fit. Then, we have a 20 minute session with two examiners, which will include presentation of the case, demonstration of the physical examination, as well as discussion on management and long-term follow-up. That's basically it.

3) Looking back at the rotation, I have found obstetrics and gynaecology to be very interesting and challenging at the same time. Doctors frequently remind us that the job scope involves managing the long-term care of not one but two lives - that of the mother and the baby. Also, a lot of management decisions (especially during labour and delivery) is time-sensitive - there is absolutely no room for any delay whatsoever. A good example would be when my friends and I were awaiting a mother to deliver in the labour ward. Having waited for more than an hour, we decided to go outside to take a breather. A few minutes later, we returned - only to find that she had already delivered!

4) This rotation also made me aware of the sacrifices that mothers have to make - before, during, and after birth. Going into the rotation, I was aware of the pain and stress that comes with childbirth, but nothing could prepare me for actually being there as it happens. We witnessed various types of delivery, including spontaneous vaginal deliveries (natural childbirths), assisted deliveries (vacuum, forceps), and C-sections. Babies who were delivered healthy and well would be immediately placed on the mother for skin-to-skin contact and subsequent breastfeeding. Babies who were not active or not breathing well would be immediately handed to the paediatrics team for neonatal resuscitation and evaluation. This further highlights the importance of inter-departmental coordination, specifically between the O&G team and paeds team. 

5) In the gynaecology department, the doctors manage patients with reproductive system issues. A common presenting complaint is abnormal uterine bleeding, which comprises heavy or prolonged periods, painful periods, irregular periods, reduced periods, or absent periods. There is a laundry list of causes to explain these symptoms, ranging from mild, benign causes all the way to cancerous causes. Therefore, women are constantly reminded of the need to undergo regular pap smears, especially with advancing age. During my posting, I had the opportunity to clerk patients with fibroids, cancers, and miscarriages. It also taught me how to approach sensitive issues (e.g. past relationships or sexual partners, past miscarriages or C-sections) with tact and diplomacy. All in all, it has been a huge learning curve for me.

6) It has been a great experience thus far, and hopefully the exams will go smoothly as well. I'll end my blog post here, as I should probably get back to work haha. Thanks very much for visiting as always, and have a great week ahead. Stay safe and stay happy, cheers!

Me, Aida, and Ainin outside the labour room

(it was a very long but productive day!)

DAY 1719-1732

May 18-31

1) Since my last post, the COVID-19 situation in Malaysia has reached a critical state - the usage of ICU beds nationwide is now at 104% (that's not a typo) capacity, while COVID-19 hospital beds are at 85%. This means that soon enough, Malaysian doctors will be forced to make the tough call over which patient should be prioritised for an ICU bed. Penang General Hospital is overwhelmed - many wards have been converted to COVID wards and the hospital is now running 4 ICUs to cope with the patients who require more intensive care/ ventilation. In line with this, the Ministry of Health has made the very wise (if long-overdue) decision to impose a full nationwide lockdown (similar to the first lockdown we had when COVID-19 first hit our shores), for the next two weeks. Essentially, all businesses and schools are closed, as well as any dine-in at restaurants. Yesterday, the number of infection was at an all-time high of 9,000, although today has seen a sharp decline, with "only" 6,999 infections. However, we cannot afford to be complacent - we currently have the unenviable record as the country with the highest infection rate. 

2) A few days ago, we were informed of the changes that this lockdown would have to our education - clinicals have been completely cancelled, and replaced by ever-changing online schedules. At the start of the semester last year, our elective period was 8 weeks, and I had been very fortunate to be selected to represent my university as a bilateral exchange student to the National University of Singapore (NUS). After all the necessary preparations, this was completely scrapped, and the electives shortened to 4 weeks. We were once again required to look for elective opportunities, and only locally this time (amid fears of another lockdown). Once MCO 3.0 rolled along, this was cut to just 2 weeks, and then it really was not worth seeking out another elective placement. True enough, electives have now been cancelled entirely, and all the time, money, and effort spent in securing those placements - all for nothing. But you can bet your last dollar I'm adding the NUS elective to my CV. 

3) Speaking from a medical standpoint, it is difficult for me to envisage all of this going away anytime soon. First, vaccine uptake has to be sufficient to ensure herd immunity (to protect those who are vulnerable and/ or are unable to receive the vaccine). Second, we need enough time to build up that immunity, so it is not feasible to just remove our masks the moment we have been vaccinated. Third, there is a possibility of booster shots being required in the future, as lifelong immunity is unlikely after just two shots. Fourth, there is a chance of seasonality in COVID-19, a bit like the influenza virus which spread seasonally each year due to a phenomenon called antigenic shift. In the case of COVID-19, we are seeing variant strains and even hybrids of these strains of virus in the community, making it all the more likely that infection rates may never disappear completely, but instead remain endemic in local areas. This may not be the news that everyone wants to hear, but it is something that we have to keep in mind.

4) But I would much prefer to end on a more positive note, which is that pandemics do end. The 1918 Spanish flu ended. The H5N1 influenza pandemic (Avian flu) ended. The 2003 SARS pandemic ended. Undeniably, at some point in time (in the very near future, I hope), the COVID-19 pandemic will end. Then it will become a thing of the past; a story to regale our children and grandchildren with. For as the old saying goes - this too, shall pass. And with that, I end my blog post here today. Stay safe, stay healthy, and stay strong in this most trying of times. Take care, and have a great week ahead. Cheers!

Okay, so this cat has decided to call my front doorstep home :)

DAY 1705-1718

May 4 - 17

1) Malaysia is currently undergoing its third iteration of the Movement Control Order (stylised as MCO 3.0). While initially limited to a few key states, the MCO has since been expanded nationwide due to new coronavirus variants with higher infection rates, increasing constraints on the capacity of the public health system, and suboptimal compliance of the standard operating procedures (SOPs) amongst the general public. This includes a blanket ban on inter-district and inter-state travel, to last until June 8th. 

2) So what does all this mean for us as medical students? Well, all education has switched from face-to-face to online. This has put a halt to our clinical training in hospitals and wards. For now, our learning is conducted via lectures and online tutorials, with new timetables being circulated every now and then to accommodate the latest updates from the Ministry of Health. 

3) Group B (my group) is in their final rotation for the year, obstetrics and gynaecology (O & G). Assuming no changes, we have one week after this rotation before having to sit for our exams. Having the constant reshuffling of timetables and disruptions to our learning is not ideal, but I agree that it is necessary and in our best interests. On a positive note, the MCO extension gives us more time for self-study and revision, which can only be a good thing given our upcoming exams.

4) Just yesterday the fifth years finished their final year medical exams - a massive congratulations to everyone! I'm sure the coming weeks will provide a much-needed break for most of you, and richly deserved indeed. I've been really lucky to call many of you my friends, and I look forward to seeing where you will go from here. All the very best in your future endeavours :)

5) Yesterday was also Teacher's Day - a very special day where we showcase our appreciation to all the teachers out there. As a secondary school student, there was a particular poem by Malaysian poet Usman Awang that I really enjoyed, called "Sajak Guru O Guru" (lit. "Teacher Oh Teacher"), and which is commonly read during Teacher's Day celebrations. Here is a particularly poignant stanza from the poem (in the original Malay Language and then translated by yours truly into English):

Jika hari ini seorang Perdana Menteri berkuasa
Jika hari ini seorang raja menaiki takhta
Jika hari ini seorang Presiden sebuah negara
Jika hari ini seorang ulama yang mulia
Jika hari ini seorang peguam menang bicara
Jika hari ini seorang penulis terkemuka
Jika hari ini siapa sahaja menjadi dewasa
Sejarahnya bermula oleh seorang guru biasa
Dengan lembut sabarnya mengajar tulis baca.

English translation: 

If today exists a Prime Minister come to power
If today exists a king ascending the tower
If today exists a President of a nation proper
If today exists a noble scholar
If today exists a lawyer upholding one's honor
If today exists a famous writer
If today exists someone who became wiser
Their story started with the humble teacher
Teaching in calm collected demeanor

6) I liked the poem so much that I actually committed it to memory, in anticipation of our SPM Malay Language examinations back when I was in secondary school. Unfortunately, the theme "Teachers' Day" did not come out for our exams that year. Nevertheless, I've never forgotten my teachers, not even those from primary school. Hopefully, I'll be able to come back and meet up with some of them in the near future. And on that note, I shall end my blog post here. Thanks very much for tuning in, and hope you have a great week ahead. Take care and stay safe, cheers!

Happy Teachers' Day 2021

To all the teachers out there, thank you for being so kind and inspiring!