DAY 1772-1786

Jul 10 - 24

1) It has been a good two weeks since my last blog post. Things have been chugging along for us in Group B, as we continue our clinical exposure in Obstetrics and Gynaecology (O&G). This is our last rotation before the end of fourth year examinations. As expected, the pressure of exams is building up, as we barely have a week's respite after O&G exams before having to sit for the final examinations. 

2) Regardless, I have found O&G to be a very interesting, if challenging field. Essentially, obstetrics covers care before, during, and after pregnancy, including childbirth and the post-partum period, while gynaecology covers the health of the female reproductive system i.e. vagina, uterus, ovaries, and breasts. Our curriculum is structured such that we spend a week each in the obstetric ward, obstetric clinics, gynaecology ward, and gynaecology clinics. We also have a session each in the fertility clinic and urogynaecology clinics, as well as five labour on-calls (essentially "night-shifts") where we are given the opportunity to witness childbirths. 

3) In addition, we have a total of five case reports to write: three labour cases, one obstetric case, and one gynaecology case, where we discuss the management of the patient as well as outline any learning points from each case. It's a busy rotation to say the least. I'm not going to lie - waking up early to clerk at least one case for presentation before 8.00am is not something I look forward to, given that we have two bed-side teachings in day - one at 8.00am and another at 12.00pm. At the end of the day, my mind is usually saturated with information. Thankfully, we have the rest of the day for self-study. 

4) Last Monday, I was pleasantly surprised to find out that an art submission of mine had been selected as one of the top three winners for the "Artist's Impression: The Heart" competition organised by the RUMC Peer-Led Assisted Learning Society (PALS). As the title suggests, the theme revolved around the heart - so that inspired me to draw a heart undergoing a heart attack, along with the progressive build-up of plaque leading to atherosclerosis, which can result in a heart attack. It was really fun to take my mind off studying medicine and instead concentrate on one of my old hobbies i.e. drawing.

5) Next week, it is our turn to enter the gyanecology wards. So I think it best to end on here. Thanks very much for visiting as always, and have a lovely weekend. Stay safe, and stay happy. Cheers! 

My submission for the art competition:

i) The main picture shows a heart undergoing a heart attack, with the shaded zones representing myocardial (heart muscle) necrosis (death), injury, and ischaemia 

ii) The diagrams on the right show the sequence of plaque formation, which can result in a heart attack

iii) The wavy lines on the bottom show the ECG changes over time in a patient with a heart attack

My O&G group mates @ the infertility clinic

(l-r: Myself, Ainin, Vinny, Ain, and Aida)

A negative COVID-19 swab test was required for us to resume our clinical training in the wards

We booked our free screening and received our results in under two hours :)

DAY 1760-1771

Jun 28 - Jul 9 

1) Malaysia recorded its second highest number of daily infections (8,868 new cases) today. Things were looking good for us at the end of last week, before an unrelenting surge of new infections brought us to our new tally today. The worst part is there seems to be no signs of a turning point to this worrying trend. Of course, vaccination efforts have been ongoing as well, with a record-high daily vaccination rate of over 340,000 jabs yesterday. This means we have over 20% of the population who have received at least one dose of vaccination - definitely a huge milestone, and a testament to the combined efforts of our healthcare workers and volunteers.

2) To add to our Covid-19 woes, there has been an exponential rise in suicide rates in our country, with statistics showing 468 people having taken their own lives over the first five months of 2021, versus 631 suicides over the whole of 2020, and 609 the previous year. This is undeniably due to the massive socio-economic burden imposed by the lockdown, particularly in lower income families. In lieu of this, the #benderaputih ("white flag") campaign gained considerable momentum as a means to help out those in need, by providing food and other essentials to families displaying a white flag outside their homes.

3) All across Facebook, Malaysians have been sharing photos of groceries and essential items they could spare, as well as information on nearby food banks. Small hawkers displayed signs welcoming those in need to grab some food and beverages at their stalls, while other netizens posted pictures and addresses where assistance was required. Truly a heartwarming sight and in keeping with the spirit of "kita jaga kita" (we care for each other) that has been the slogan for our Covid-19 campaign. 

4) On the background of all this, RUMC medical students are to resume our clinical teachings on Monday. For the past six weeks, we have been attending online lectures from 8.00am to 1.00pm daily. Before being permitted back into the wards, we need to submit a negative Covid-19 test first. My appointment is due this Saturday, and fingers crossed I'll be able to return to wards on Monday. Truth be told, I have been rather ambivalent about the return to clinical training, as I felt that more of us could be vaccinated first, and of course another week or two of revision would do a world of good. But on the other hand, the longer the time spent out of the wards, the faster the clinical/ practical skills fade away.

5) A quick point about depression and suicide, especially in this difficult time. Firstly, it is important to be empathetic and non-judgmental when talking to someone who is going through a difficult time. We do not know, and will probably never know, what is going through their minds. The old saying goes - if you have nothing nice to say, don't say it. Secondly, talk to your family and friends often. Be aware of any changes in their behaviour and mannerisms, and never dismiss their problems (or threats at self-harm or suicide contemplation) as being too small or just empty threats. Thirdly, respect the privacy of the victims and their families - do not distribute pictures or videos on social media about suicide attempts. Fourthly, reach out for support at any of the following hotlines below, where professional and confidential help is available 24/7. These are just some simple steps we can take to help our fellow rakyat to pull through. Due to our various beliefs and cultural background, our understanding and perception of what depression and suicide is may vary considerably. However, sometimes it is better to choose being kind over being right.

6) On that note, I shall end my blog post here. Thanks very much for visiting, stay happy and healthy, and have a nice week ahead. Cheers!

Here are some useful hotlines:

i) Mental Health Psychosocial Support Service (MHPSS): 03-29359935 or 014-3223392

ii) Talian Kasih: 15000, or WhatsApp 019-2615999

iii) Jakim's Family, Social and Community Care Centre: WhatsApp 0111-9598214

iv) Befrienders Kuala Lumpur: 03-76272929

A laudable effort by the New Malaysia Herald and other NGOs 

to help out those in need via the White Flag campaign

DAY 1746-1759

Jun 14 - 27

1) So this week I got my first dose of vaccination! This may sound like a thing of the past for those in other countries, but in Malaysia, vaccination uptake has been very slow. Thankfully, in recent times, vaccination rates have been increasing exponentially, with the latest data showing at least 15% of the population having received their first dose. 

2) My vaccination appointment was at the SPICE Convention Centre, so I carpooled with my good friend Daniel (who coincidentally had a morning appointment as well). My appointment was an hour earlier, so I thought I would wait for him after I was done. In the end, they allowed him to be vaccinated at the same time, so we could go home even earlier. The entire process was very quick and efficient. All we had to do as we progressed through each station was to keep showing the staff our app ("MySejahtera") which contained all our particulars, and our identification card. 

3) After about 15 minutes, we were led into the actual stadium, where multiple booths had been set up for mass vaccination to take place. I was asked if I knew which vaccine I was getting (the AstraZeneca vaccine), and whether I had any allergies or previous reactions to anything. The staff then briefed me about the vaccine and asked me if I had any questions. Next, I sat outside the booth waiting for my turn to get vaccinated. The doctor went through the same quick screening, and then proceeded to show me the syringe containing 0.5mL of AZ vaccine. 

4) Before I knew it, the contents had been injected into my left deltoid, and it was all over - I did not feel a thing! The last part was to wait for 15 minutes in the waiting area (just to monitor for any immediate reactions). Daniel came right after me, and we both left without any reactions. All in all, it was very smooth-sailing and uneventful. Barring a little tenderness over the injection site, I have had no reactions/ adverse complications since getting vaccinated. Before leaving, they gave us a card with our next appointment (within 3 months), which would complete the two doses necessary for immunity. Half way there, half more to go then.

5) The rest of the day (and week) was uneventful. I had missed the whole morning session that day, so I had to take down notes from my friends. Thankfully, I will not be missing any more classes after this (until my next vaccination of course!) And on that note, I shall end my blog post for today. Thanks very much for tuning in as always, and have a great week ahead. Stay safe and stay healthy, cheers!

The card reads "I've been vaccinated!"

Daniel and I, waiting for our turn to register :)

Translation: I've been vaccinated - you should too! :)

That's exactly how the COVID-19 vaccine looks like 

(not to scale of course XD)

DAY 1733-1745

Jun 1-13

1) This week has been a particularly rough one for me. To start off, I had an eczema flare-up for the past week, which really affected my concentration and sleep. Besides, there was a sudden complete black-out in my apartment. Also, my internet wi-fi decided to give up on me when I needed it badly, and finally, my phone decided not to charge properly. When taken individually, these seem like quite trivial matters (which indeed they are), but when you consider that most of us medical students at RUMC are already at the brink of anxiety and depression having to study for exams they have no idea how to prepare for, then it is easy to see how this may be the straw that breaks the camel's back. 

2) Regardless, the week has ended on a particularly high-note: my article on motor neuron hyperexcitability, which I co-authored with Dr. James Bashford (my supervisor from my MSc course) has been published! I still remember writing sections of this paper during my two-weeks quarantine in Tune Hotel, KL shortly after my return from UK. There was no chair to use in my hotel room, so I had my laptop propped up on two spare pillows as I hunched over, reading papers and making notes for the article. And today, just shy of a year later, this very article has been published in Clinical Neurophysiology, a high-impact peer-reviewed medical journal. 

3) In other news, Malaysia has extended its nationwide lockdown for yet another two weeks. Infection rates have indeed been dropping, with yesterday recording just 5,793 cases (compared to 9,020 cases a week ago), and the highest number of recoveries, at 8,334 discharged. For us medical students, this means more online lectures and self-directed learning. I have also registered for and received my appointment date for the COVID-19 vaccination next week (June 21). Compared to many countries, Malaysia has been slow in mass vaccination with only 4% of the population being fully vaccinated, but things look to be speeding up. My grandfather recently had his second dose, and has had no symptoms whatsoever. 

4) That's all for this edition of my blog. Thanks very much for visiting as always, and have a great week ahead. Cheers! :)

P.S. If you are interested, here is the link to the journal article:   https://doi.org/10.1016/j.clinph.2021.03.053

Title: Demystifying the spontaneous phenomena of motor hyperexcitability

https://doi.org/10.1016/j.clinph.2021.03.053

Saying goodbye to Ice: senior turned classmate turned senior again

Safe trip back to Thailand! :D

Thanks for the birthday cake Rach!

Hope you had a great one :D

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!

DAY 1690-1704

Apr 19 - May 3

1) Having finished our eye posting at Bukit Mertajam Hospital, Group B1 has continued with the ENT (ear, nose, throat) posting in Penang General Hospital. ENT medicine, or to give it its proper name, oto-rhino-laryngology, is a surgical subspecialty within medicine that deals with the surgical and medical management of conditions affecting the ears, nose, throat, head, and neck. For the past week, we'd had clinical teaching at the hospital, where we learnt how to use an otoscope (a medical device used to look into the ear canal and eardrum). We also had a chance to see how hearing assessments are conducted (usually in sound-proof rooms).

2) Throughout our two weeks in ENT, we are attached to two different doctors, with three 4-hour sessions each week. At the end of the second week, we have a clinical exam, which involves an otoscopic exam and a short viva requiring us to interpret results of various ENT diseases. So far I am really enjoying this posting as the workload is not too heavy, giving us time to self-study and revise. I like to think that less is more - by focusing less on exams, case reports, and group presentations, there is more time for the medical student to actually focus on what they are weak in, as well as to delve further into what they might later specialise in.

3) After obstetrics and gynaecology (O&G) posting and the ensuing fourth year finals that I've repeatedly mentioned in previous posts, we will commence our clinical electives. The idea is to give students a chance to explore an area of their own interest, in any hospital of their choice (subject to approval of course). Initially, the duration of our electives was to be eight weeks (2 months), but this was slashed in half due to the ongoing pandemic. The only problem now is that most hospitals have closed their doors to external medical students, leaving very few options behind. That being said, I have been really fortunate to be accepted as an elective student at Raja Permaisuri Bainun Hospital (otherwise known as Ipoh General Hospital). 

4) I guess that is all for this edition of my blog post. I wish it were more fun and exciting, but I suppose that is the downside of being smack in the middle of an ongoing pandemic. Anyway, thanks very much for tuning in, and have a great week ahead. Stay safe and stay healthy, cheers! 

Lovely decor spotted at Gurney Plaza, 

to commemorate the beginning of the fasting month of Ramadan

Tracheostomy tube - a tube inserted into the trachea of a person who is unable to breathe using their nose or mouth (can be used in emergency situations or for long operations)