Life as a medical student #9 About Death

Every doctor will experience the loss of a patient at some point of time. Some of the patients will fade peacefully. Others will fight until their last breath. Some plan their funerals, others plan a future they won't have. However, nothing in medical school prepares us for dealing with death. In my third year of medical school, I experienced my first patient death. 

On the last day of my surgery rotation in HKL, I met a lady with both of her legs amputated. Yes it was her. I wrote about her story on my blog few weeks back (You can read about it here). I fulfilled my promise and went back to her on Monday, but she was too tired and weak to have much to say to me. The amount of analgesics used on her was so huge that it made her drowsy. And for the rest of the week, other than sitting by her bed and waited, I couldn't do anything else. When I returned to the hospital after another weekend, she was not doing well. Her condition deteriorated. More and more infection. She could no longer undergo dialysis. The nurses told me her wound was not going to heal. The doctors told me her prognosis was bad. My heart sank. 

On that day, I had a long talk with her mother. Her mother told me how her daughter struggled with her health despite her young age, and she showed me a video of her daughter happily spending time with her family just few months ago. Then everything just happened, so fast and unexpected. She told me how much she didn't want to lose her precious daughter. I was on the verge of tears as I held her hands and said: ''Aunty, remember to stay strong and take good care of yourself.'' 

When I went to find the lady on the next morning, she was no longer there. A nurse told me that she had died last night.

I stood there, realizing that this was supposed to be a meaningful moment, yet I didn't feel anything. I didn't cry. I don't know why but it was not as emotionally difficult as I anticipated. I was pretty calm, maybe because the outcome was expected. Or maybe, I had no right to mourn a patient that I'd only met for weeks. I was merely a passer-by in her life. It was short, but I am glad that our paths crossed.

Does increased exposure to death as a doctor going to ease the pain, does death ever get easier? I don't know. But doctors are human too. We are frail. We should be allowed to feel.

I said my goodbye to her in my head as I left the ward. 

''I hope you had a wonderful life.''

Life as a medical student #8 My First Oncall Experience

For many housemen, on call is daunting. The rest of the world is asleep - their consultants, most of their peers, and in many cases even their supervising medical officers will be asleep. But not them. They need to stay up and be alert at the time when they are physiologically programmed to be asleep. They are responsible for admitting new patients and managing emergency cases in the middle of night. I've always wondered how it's like to be on call. So to take self-torture to another level, I volunteered to be the only medical student who was on call in Ward 18B last Thursday night. It was an impromptu one - I didn't even have enough sleep the night before, or at least had some preparation - I was working in the ward and soon when I realised it was already 10 o'clock at night so I thought I would just stay in the ward. Truth to be told, medical students are not obliged to on call, but to have a taste of it, I stayed.

Hospitals have a different character at night, so quiet you could have heard a pin drop. I was lucky to have Dr Chan and Dr Wong together with me for the night. They are the most dedicated housemen I have seen. Starting from 8 o'clock at night phone calls kept coming in. A lot of new patients were admitted and both of them were on haywire. Hence I offered my help to clerk some of the new patients. It was exciting - to assess patients first hand - because normally when we clerk patients, we would have already know what the patients were presented with by looking at their charts. (Yes we play cheat like that) Clerking new patients give me a chance to implement my own management plans and deciding my differential diagnosis. Also good for me to practise my history taking skills. 

I also got to perform procedures I might not otherwise get to do during day time, for instance, blood taking. Now this is one of the things I have mastered in these few weeks. ....Okay la maybe not 100%. Success rate 80% la kay. Still need more practice. There were so much else in the ward to learn and do. The big shock was that the majority of the job was administrative rather than practical and academic. I learnt where the lab forms were kept, how to label the blood samples, and how to send bloods I had taken. Nonetheless, I enjoyed being the housemen's assistant by helping them in and out. Well, all because I would be happy to have medical students to help me out one day when I am a houseman? :)

It was about four or five in the morning when I started to get tired. I had been up all day. I opened my patient's charts and tried to read and digest the information in it. But my eyelids felt as though they were attached to lead weights. My body went into shutdown mode. Weren't there moments when you said to yourself, what have I got myself into here?

The next morning, ward rounds with the specialists and consultants started at 8 o'clock as usual in the morning. I cleaned myself up a little and contiued to join the rounds. After having my early morning caffeine fixed, I tried hard to pull myself together until the end of the day. So this was how my first on call experience was like - I was in the hospital for a total of 30 hours.

I was so tired that all I wanted to do was to crawl into my comfortable pyjamas, plopped into my bed and hit the sack.

花。语

花样年华指间过。
不再是懵懂的年纪，也不再是做梦的花季。
如梭的岁月写下了流离的往昔。
潺潺的生命之河，花开花谢的旅途。
风风雨雨。
点点滴滴。
在心湖里开出了一片涟漪。
逆流而上的思绪，
随风飘起。
在这个花花世界里，
看见了蹉跎的脚印，看见了斑驳的伤疤。
一点一滴，迷乱了眼眶里晶莹的泪花。

明明只是沧海一粟，为什么非得承载那么多的情非得已？

[DIY TUTORIAL] Melted Crayon Art #2 - Happily Ever After

You meet thousands of people and none of them really touch you, 

and then you meet one person and your life is changed forever.

 “Happily ever after is not a fairy tale. It’s a choice.”

-Fawn Weaver

''Happily Ever After''

I grew up believing in fairy tale weddings, princess and happily ever after. Therefore, words cannot describe how happy I am when I know my friend, Audrey is getting married! Feeling so sad that I had to turn down the offer to be one of her bridesmaids, I decided to prepare something for her - it's time to get my crayons out again! She is a TN lover so I customised a card for her to keep in her TN. :)

 You can read about my tutorial HERE. The steps are basically the same! You can play with any colours you like. I used rainbow colours last time, so this time I use red, pink and purple to create the joy and happiness of the newly married couple. :)

Dear Audrey, you are a strong, fearless and caring lady who helped me so much throughout my blogging journey. When I wasn't given a chance, you pulled me up and gave me encouragement.  You are a sister to me. Although we don't get to meet often, I am grateful to have you in my life. May you create your own very special fairy tale. Your own happily ever after. I wish you a lifetime of happiness and love. :)

[BEAUTY REVIEW] Klairs Illuminating Supple Blemish Cream SPF40 PA++ ft. Natta Cosme

BB creams are in vogue these days. Yes today I want to talk about BB creams - they are everywhere these days, but finding a great one is not an easy task. BB cream (short for blemish balm or blemish base) is a must-have in every beauty lover's makeup bag. It combines the benefits of skin care and makeup in one simple step by acting as a moisturiser, primer, concealer and a light foundation to provide an even, natural-looking complexion. Most BB formulas also provide anti-aging properties and sun protection. So what's not to love? :D I always love to try out various different brands of BB cream, thank you Natta Cosme once again for sending me Klairs Illuminating Supple Blemish Cream SPF40 PA++ for review purposes. You can read about my previous review on Klairs product HERE.

Klairs Illuminating Supple Blemish Cream promises whitening, anti-wrinkle care and protects skin from sunlight. Compared to the older version, this BB cream is upgraded by adding hyaluronic acid which enables deep moisturizing effect and sebum control powder which maintains makeup all day. With SPF40 PA++, it gives complete coverage of all spectrum of UV rays. No wonder it is one of the best sellers of Klairs!

Its unique smart color system is suitable for any skin tone and type, even sensitive and acne-prone! Capturing your natural skin tone color, Klairs BB Cream pulls out the natural beauty of individual skin tone.

Another thing I like about this brand is the fact that it is alcohol and paraben free and it does not contain artificial colors, allowing us to enjoy low irritants with safe ingredients. Also against animal testing!

Packaging wise, it is very handy, sleek and chicly designed. 40ml may be too big for some girls, but I think the size is just nice. I love the black on almost-beige colour theme and all the details you need to know about the product is on the tube and the box. Some are in Korean words though since it is manufactured in Korea, but it is not a very big problem after all. The narrowly-pointed opening allows you to control the amount you want and easily clean it up after.

Upon swatching on my hand, the cream looks a shade lighter than my natural skin tone, but once blended out and left to settle for a couple of minutes, it matches my skin tone quite well. It has a light scent when applied, which I really love. Not visible under the camera but I like how it seems to brighten my skin

Gentle reminder from Natta Cosme: if you have oily skin just like I do, it is recommended to apply BB cream with a sponge! By using a gentle patting pressure near your eyes, you prevent the fine lines that may show up when the dragging, stroke motion strain the skin around your eye, which especially sensitive. It is easier to achieve that flawless finish by using a sponge, too! Here we have Cerro Queen Natural Emulsion Powder Puff :)

How to use?

Get your vintage-bow hair claw ready! Apply an adequate amount of BB cream onto the sponge. Blend out from the under eye area to the lateral part of the cheek. Dab gently around the applied area to blend in well to the skin. Continue with the rest of your beauty routine like normal.

In my opinion, Klairs Illuminating Supple Blemish Cream gives off natural-looking vibe, it doesn't cake nor feels heavy on my skin, which is the last thing we want on a hot and humid day. Throughout the day the coverage wears very well, and I was really impressed that it looks just as good at the end of the day as it did at the beginning! The coverage is so light you can barely feel it. But like any other BB cream it's light coverage, so don't expect major transformation. But when I apply under foundation I can see a real transformation - it gives my make up a flawless look. I find it more suitable for people with drier skin type as it is rather moisturizing.

You can get the product from Natta Cosme HERE at the price of RM71.20. In conjunction with Mother's Day, if you purchase above RM100, you can even get RM6 discount! Here's to all the mothers who are brave and selfless, who protect and love us unconditionally, who are always there for us. Happy Mother's Day in advance! :)

Do you use BB cream? Which is your favourite?

Let me know by commenting below this post! :)

You look so wonderful just the way you are.
Be natural, Klairs.

For more information, log on to:

Natta Cosme's Website: http://www.nattacosme.com

Natta Cosme's Facebook: https://www.facebook.com/NattaCosme  

Natta Cosme's Twitter: https://twitter.com/nattacosme

Natta Cosme's Instagram: @nattacosme

Life as a medical student #7 Empty Promise, No More

When you look back on your life, is there anything you wish you'd done, had done differently or had never done at all? I believe most of us would say yes. Guilt feels terrible. But the worst thing about guilt is that it sneaks up on you. You are filled with regrets and ''if onlys'', and what you did keeps playing and replaying in your mind. Today I have a confession to make. For if I were given another chance, I would act differently.

She was 42 years old, with underlying long-standing Diabetes Mellitus for more than 10 years. One of the most potentially serious complications of high and uncontrolled blood sugar in the body over many years would be neuropathy, which at its most severe can lead to amputation. This lady just had both her legs amputated. Up until the knees. She was lying on her bed when I see her, eyes staring at the ceiling, almost expressionless. She needed help to cut her fingernails, so I offered her help since I was free in the ward.

I had experience cutting fingernails for my mum but it was slightly different in this case. This is because diabetes and wounds are a dangerous combination. There is no such thing as a minor wound - even a small cut can turn into an ulcer, which is what happened to her legs. I have to make sure I don't cut her skin, not even a single bit. I held her hand up gently and slowly, I started to cut her fingernails, one by one. The lady thanked me, and while I was cutting her nails, she told me none of the nurses in the ward willing to cut her fingernails for her. They scolded her because she requested this and that. Her mum just got robbed of her money which was supposed to be her medical fees. She has no medical insurance. Her husband doesn't like her and finds her a nuisance. She couldn't stop crying after the amputation. The pain was unbearable. The only thing she knew was that she lost her legs. No legs. Cannot walk. Cannot run. Cannot go to places. No, nothing. All gone. Shattered dreams. Unfulfilled promises. Her life was totally changed.

I can't feel anything but pain. I am better off dead. 

I paused for a second, holding back my emotion. I wish I could pretend that I was all focus on cutting her fingernails, but no I had to say something. So I told her that with her hands she can still achieve a lot. She has perfect eyesight. She can still see the beauty in this world. She can still eat all the good food. She can still breathe. She is not alone. You are not alone.

She looked at me with gratitude. I guess it has been a while since someone spent time to talk to her and listen to her. She started to cry when she knew that it was my last day in her ward. I promised to still come back to her ward to visit her after my surgical rotation. Meanwhile, the nurses came in to clean her wound, so I left the lady, and I said, ''I will come back later.''

I didn't realise how much this sentence would mean to a patient the moment I said it. I continued with my work and at the end of the day when I was about to leave the hospital, I suddenly remember I made this promise to the lady. I knew I had to go back, but it was a Friday, laziness got the better of me and I thought I could just go back to the ward on Monday. So I left the hospital. But very soon after that I knew I made a wrong decision. I began to feel guilty for not going back. The lady might just be waiting for me to go back! How could I make an empty promise to a patient? The thought of the lady waiting and thinking that another person in this world cheated her and abandoned her again.....I can't believe I could be this cruel.

For the first time ever in my life, I don't look forward to weekends. All I want is to go back to Surgical Ward 11 on Monday. To fulfill my promise.