Turbulent Times of 2012

It's the final few hours that I am embedded with the tag of a forth year student doctor. Thereafter, it's going to be the second final year before graduation. I would cite it is going to be the most paramount year ever in my medical studies. 

Like any others, it has been somewhat a rocky year filled with purple patches. Adapting to a new environment encapsulated with people from various backgrounds was interesting. Though I did not have to dig deep mentally, it was a challenge to find the resources to face the turbulent times and uncertainties. The emotional backings by my parents, sister and various friends (rather than seniors) made a difference. 

The following adage from Buddhism teaching was part and parcel of my reference in dealing with the annoying souls, viz:- 

In the sky, there is no distinction of east and west; people create distinctions out of their own minds and then believe them to be true.

It would be another cycle of zodiac since primary six - it's my year! Not many of the same year would enjoy the same privilege. I am looking forward to live with my new housemates and seeing a change of power regime in the Malaysian political arena through a democratic, lawful and clean 13th General Election to vividly tell the world we anak Malaysia shall be a force to be reckoned in the next 10 years to achieve our 2020 Vision of becoming a first world country.

He

Before going into the core of this, I would like to share the following adage by Buddhism teaching, viz:

Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned.

Twelve years ago, I crashed down emotionally when I received the news of the passing away of grandpa. It was the first time I faced someone dear leaving me. This time albeit slightly different, but it was of the same cause. It is something that I always talk about, being passionate about, being tirelessly determined to achieve the yardstick yet to be drawn by anyone. It is the deadly dividing cells with the given name of Cancer. 

Just like any Chinese especially from the Asian demographics, he had been predisposed to the genetic make-up of nasopharyngeal carcinoma (NPC). I am no longer a medical student in such scenario; I have turned to be a family member to be hit with such news. I had to be mentally resilient to face off any shaky moments of other extended family members that lack the understanding. It is still an advantage gained where NPC is radiosensitive combined with the newer machine in Image-Guided Radiotherapy (IMGR) to acquire the best possible outcome for an aged.  

Penning DXT on the prescription form is just a beginning. The subsequent proper care that takes into account the side effects caused by radiation is one to be remembered. Losing appetite and not able to feed may as simple as encouraging him and seeing a dietitian. When his fighting spirit gave up, another trouble fell upon. Resorting to feeding tube was the last resort. We do not live with the constant and persistent throat irritation. Just imaging putting your finger behind your mouth, you would already feel so unwell.

May God bless him and wishing anyone who reads this a Merry Christmas!

You Forget

Mount Miriam Cancer Hospital

It feels entirely different when you step into the hospital not as a medical student. You forget about your role for that moment. The solemn surrounding encompassed with lovely and caring nursing staffs is just something to ponder about the actual conducive place for palliative care. Quietly, it is filled with the passion of the medical team, the hope of the patients, and the true feelings of the family members.

Accidentally, found this in the lift - Colonsentry

CME Evening Lectures

I am lucky to be in the state that has two active medical bodies (MMA Penang Branch & PMPS) where Continuous Medical Education (CME) evening lectures are constantly being organized. And, I am grateful to the drug companies that sponsored me. The lectures are of the following:

Pantai Medical Group at Eastern and Oriental (E&O) Hotel, Penang:-

1. The latest treatment of Urinary Stones
2. The use of navigational system in brain surgery - it goes by the use of coordinates to precisely locate the tumour for surgery.
3. Chronic Limb Ischemia - the landmark trial BASIL (The Lancet 2005) is pertinent for the management. Rutherford Classification with  6 being the worse - gangrene should be used to categorise the patients for appropriate treatment. Angioplasty with or without drug-eluting stents or graft bypass are currently the gold standard for treatment. The non-healing ulcers should be given adequate time for healing following reperfusion strategies; angioplasty may be needed again after 3 months due to re-stenosis of the artery.
4. The use of stem cells in cardiac surgery - observational studies have shown that stem cells injected for cardiac failure secondary to cardiomyopathies improved the ejection fraction after a few months and correlated with the an improvement in New York Heart Association (NYHA) grades. Observational studies tend to be biased. Randomized controlled trials have been approved by the National Heart Association of Malaysia and will be carried out next year.

kombiglyze XR Launch Invitation by Astra Zeneca at Traders Hotel,Penang:-

It is a combination tablet of saxagliptin (Onglyza) and metformin, once daily. Prof Harold Lebovitz (The State University of New York Health Service Centre)'s lecture was definitely a pleasure to attend. 

The current statistics provided is alarming to the Malaysian community. The prevalence rate has reached 20% of the population (above the age of 30) or in other words 1 in 5 of us has diabetes. When comparing the figures with our neighbouring countries like Thailand and Singapore in terms of ensuring the HbA1c is less than 7%, we have not done enough.

What's so great about this new combination is that it addresses the two culprits - fasting hyperglyemia and post-prandial hyperglycemia with metformin for the former and saxagliptin for the latter.

Individualized treatment was discussed as tailoring it with proper consideration of other co-morbidities such as renal impairment and age would help to ensure better quality of life rather than being plagued with complications like hypoglycemia unawareness. For instance, when an aged 85 years patient who has been on  any oral hypoglyemic for the past 5 years and his HbA1c has always been around 7.5% with good renal function and no diabetic retinopathy, there is no need to add on another drug to lower the HbA1c.

The Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) is a good guideline.

13th Malaysian General Election in a Small Box - Why We Must Vote Pakatan Rakyat?

"You don't have to be worried about a job placement, it's guaranteed!" he laughed.

Like one of the usual catch-ups with secondary school mates, we had a chat about the education we are receiving and our future directions.

Recently, I have been doing some background research on different courses available locally and abroad with particular note given to the future job prospects. It seems that nowadays, every field is overproducing - for instance,  pilots do not have jobs and become taxi drivers; freshly graduate doctors do not have internship places and hence their degree is equivalent to nothing. At least the Commonwealth of Australia is actively seeking solutions to address them. Look at the Malaysia, for a population of 28 million, we have 26 medical schools and not forgetting the students who are on scholarships in overseas!

"He said he understood the Chinese in towns were not overly dependent on the government but they must be aware their successes as individuals and a community were the result of government policies." Najib's message to Chinese Voters, The Malaysian Insider, 25th Nov 2012

Though I do not belong to the Reformasi Generation (of 1998), I witnessed one of the historic moments in Malaysian politics - the 308 political tsunami that saw the BN lost two-third majority in parliament and the opposition pact (composed of DAP, PKR, PAS and the other smaller parties) sweeping five states (only to lose Perak in 2009 after a series of undemocratic hopping of lawmakers orchestrated by the then BN state leader, the very dear Prime Minister Datuk Seri Najib Razak.

Since then, BN has always claimed that they have reinvented themselves, understanding the mistakes made, pledging to listen to the voices of the people. To be honest, it is some utter nonsense. One Malaysia being the favourite tagline for any BN events, even for business activities! Have I become more Malaysian just by citing this again and again? I feel a sense of pride when I am able to converse in various languages and dialects overseas, making me feel unique as compared to even Singaporeans! I cannot understand why is Umno still raising the issues of removing the mother tongue education of different races. Malaysians are able to compete globally when you master the three main languages of today - English, Malay and Chinese/ Tamil.  Can you seriously think with your brain?

Regarding the so-called Talam Scandal of Pakatan Rakyat, although I am not an auditor or accountant, I still understand simple logics. Chua Tee Yong, why can't you understand it? Even when the White Paper has been tabled by the Selangor Government, why is MCA still harping on the issue tirelessly? And shame on you Chua Tee Yong - you were given multiple chances to prove your allegations but you are such a coward!

The above mentioned are just like the tip of the iceberg. There are so much to talk about especially on matters like the NFC scandal.

Mad to be in Penang Again!

Scream it out from my lungs - call me a fifth year medical student now! Results were officially released yesterday via Student Connect. I fared well in all the papers and clinical exams. I am even more elated with a HD obtained in the surgical rotation.  Anyway, enough said on academics.

I feel mad to be in Penang once again. After being in Perth, a place dubbed to be serene and blissful, I feel foreign to be driving on the roads again. People crossing the roads despite being red on the traffic light; illegal double parking; sudden switch of lanes and etc. You name it, we have it!  And I was pretty used to saying "Hi, how are you?" - time to dump that away for two months!

Am I losing my hopes to return to Malaysia one day? I feel annoyed and disgruntled to see the rubbish on the streets, to see the vandalised bus stops, to see the poor town planning done by the previous state government...I just have to much to complain about Penang though it is still the best state in Malaysia. 

When Penang fails, Malaysia fails!

I wonder when can the natives in East Malaysia wake up given that our current national political arena is dominated with a whole bunch of incapable, corrupted, sexist, racist BN leaders. Can you imagine a printer bought at RM700 is being maintained at a cost of RM50,000 for five years according to the latest Auditor General Report 2011? 

And yet some crappy Sabahan was still lamenting that their state resources were being tapped and used to develop Peninsular Malaysia. Come on! You guys receive a hell lot of allocation yearly, but thanks to your fellow Sabahans that pocketed them.

Time to wake up!

So Far, the 11th in Perth

It's nearing a year since I first came to Perth signifying I am about to introduce myself as a fifth year student doctor provided that I pass all my exams (results are still pending).

Exams ended one week ago. Two more nights I will get to shout out on the piece of land I am familiar with; I will be relieved from the hell surrounded by two disgusting, terrible and annoying souls. Nonetheless, it is another lesson in life learnt. 

at Cottlesloe Beach

I travelled quite a bit over the past week - been to the Hillarys Boat Harbour & the AQWA with Xiong Jun and Fremantle (Little Creatures Brewery) with Danny and Eve. Perth unlike other cities in Australia like Sydney or Melbourne is blessed with its serene and blissful sceneries. Probably, next year I would be looking to travel to Rottness Island and other states.

The Upper GI Surgical Team - From Left: Siva (Registrar), Vijay (Fellow), Debbi  (Intern), Mr  J Tan (Consultant),  Zi Yun (Intern) and lastly Me standing behind.

It is a year that I indulge myself into the clinical setting. Albeit the adaptation was at a slower pace during the first rotation, things just improved markedly in the second half of the year. Being posted to the Upper GI Surgical team was just perfect to gain the missing piece of puzzle in my surgical knowledge. Previously having  assisted in surgeries like Anterior Resection, Whipples Procedure, Hepatectomy, Mastectomy, Subtotal Thyroidectomy and etc, some rarer cases are still missing in my archives. It was just too memorable to observe the cases of Wilkie Syndrome (Superior Mesenteric Artery Syndrome) and Achalasia where Laparoscopic Duodenujejunostomy and Heller's Cardiomyotomy & Partial Fundoplication were done respectively. Bariatric surgery is not popular among Asian countries. It was a good eye opener to clerk and try to manage a patient, needing to deal from the point of multidisciplinary approach.

Patients are the best teachers. 

I am considering to seek for another month of self-arranged electives in Obs & Gynae and maybe Paeds if time permits.

And I am looking forward for a great holiday ahead, meeting with my buddies. Penang, here I come!

I Gotta Feeling

Tomorrow, I will be starting my long-waited General Surgery rotation. Leaving the best for the last, it is filled with excitement and tension.

I may be facing serious identity crisis again. Perhaps, I should really consider for an alternative. Nonetheless, all out to enjoy. I Gotta Feeling!

When the Patients...

There is always a notion that goes this way - the surgeons spend little time with patients as compared to the physicians.

It is actually not true. Perhaps much longer. Just that they face the patients while they are asleep on the flat table, for hours.

I enjoy the quiet atmosphere, the inner sense of peacefulness; I enjoy facing the patients in that way. Hate it when you are not respected by the bossy theatre nurses.

Hate it when you are told to build more rapport and another side telling you are wasting too much time. Hate it when there is so much expectation from the surrounding. Hate it when you can't achieve that level deemed to be competent enough. Hate it when there is extra pressure in impressing the future ones.

Hate it when all that hinder your progress in building a career.

Life away from the fatherland.

The Voice of A Malaysian

Just few weeks ago, I remember one of the Orthopaedic lecturers when in regard to his experience in China asked "who comes from China?" An Australian Chinese originated from there raised her hand spontaneously.  I did not as I know I am a Malaysian first, Chinese second. 

Few days back, it was once again the celebration of Merdeka, the independence day of Malaya to be exact before the formation of Malaysia with the inclusion of the eastern states. There was not a sense of a elation amid the feeling of being proud to be a Malaysian that has enjoyed the peacefulness throughout his 21 years. Till today, the ruling leaders have not woken up; still playing with all the racial cards instead of focusing on bringing new radical changes to the country. Note the word radical, just like in surgery, radical corresponds to not only eradicating the wrongdoers but also implementing new and fresh just policies.

I have been in Perth for almost 8 months. I feel I have lost part of my soul at times. I introduce myself as Zi as if as Qin is my middle name. It now reads "Zi N G".

Even with the Malaysians around, we no longer speak about the Hokkien Mee (prawn noodle), we no longer speak in a dialect we used to, we no longer work in a way it used to be. Look at the demographics in Perth, we should not be proud of the number of  Malaysians here. We should feel ashamed of why they have chosen to settle down. The reasons are vivid.

But have we once thought of what we can offer to our country instead of what our country can offer to us? It is another shame when you are worried about getting a job here after graduation. Look at Australia, they protect their citizens, they value their talents. Whereas Malaysian graduates have to think of elsewhere, not Malaysia definitely for job opportunities before considering their dear homeland in their last resort.

Recently I spoke to a friend doing law in University of Queensland and another friend doing Land Survey studies in RMIT. Both are definitely talents. Both have high hopes. Both want to return and serve the nation. But the question is whether there is a platform?

Think about what you can offer to your country instead of what your country can offer to you.