Life as a medical student #17 Be A Different Doctor

When I was in Taiwan, I went to Shifen train station to release a sky lantern, inspired by the movie 《那些年，我们一起追的女孩》(You are the apple of my eyes). I first prayed for health for my family and friends. Then without hesitation, next on my list was: I want to be a different doctor.

Can you imagine that? In less than two years, I am going to be a doctor. I want to know, what kind of doctor am I going to be? I have seen both the incredibly passionate ways some of the doctors in the hospital treat their patients, and the behaviours of the others that I will never emulate in my own practice in the future. I've seen medicine serve some of its patients well and completely change their lives, while failing others. I had the chance to work on extremely effective teams and surprisingly dysfunctional ones, too. I've shared intimate moments with patients who placed their confidence in me - rather than the other senior doctors of the team - to treat them well.

Therefore I know, without a doubt, what kind of doctor I want to be.

But the truth is, I am scared. I don't know what future lies. I am afraid that one day, after committing my life to this profession, the sparks won't be there.

What if, one day I gradually become the kind of doctor I hated the most?

I believe most doctors went into medicine to help people. We want to practice medicine the right way, but too many forces today are causing us to have diminished enthusiasm for medicine. While taking care of people in their most vulnerable states, we make ourselves somewhat vulnerable in the process, too. It is hard, to stay motivated.

Therefore, I write. Ten years from now I am going to read what I have written today as a student. I want to replay the image of that female doctor, in the small consultation room of HKL, who would bend down on her knees just to adjust the footrest of the wheelchair for an elderly patient. Or the one who would put his pen down just to listen to what the anxious-looking old man was trying to tell him, and acknowledged the worry in his eyes.

Don't you ever forget that.

Life as a medical student #16 My Love-hate Relationship with O&G

It was a long, long haul for her.

After eight hours in labour, two midwives came in to check on the mother. It was time, they finally decided. She didn't have time to panic. ''Next contraction and you are going to push,'' one of the midwives announced while getting the gloves on and equipments ready. She shut her eyes tight and started to push. Push and wait. Push and wait. Every time she pushed, the baby would come down, but then the contraction would end. The baby would pop right back up again. After a few tries, she looked as if she was going to be torn to pieces. But she was making little progress. The midwives asked her not to scream or yell, as it ''wasted her energy''. She tried her best to follow the instructions to just ''breathe through her nose''. However, she kept letting out sounds and the midwives were getting impatient. Time was ticking. CTG showing that the baby wasn't having a good time - he needed to come out now. Every second matters! Things got real, I saw the two midwives exchanged glances and the next thing I know, the doctor on-call was called in, and he decided in that moment a vacuum delivery would be best.

Immediately there was horror in the mother's eyes when she heard the word ''vacuum''. But there didn't seem to be any other way. The doctor applied the metal cup on the baby's head and tried the first vacuum and it failed. Then the second. She pushed, and pushed and pushed with all of her might. Her face turned beet red with sweat dripping down her face. Then time for episiotomy - I clenched my fist and held my breath.  Please God let this baby be okay. Please. 

Then that was it. The woman made the final push and the baby made his way into this world!

I panicked a little when the baby didn't come out wailing. It took a moment for his lungs to fill with the world and to bellow his frustration at being torn from his cozy home. The midwives quickly brought the baby to the Paediatric Team after clamping and cutting the umbilical cord.

I had never seen a vacuum extracted baby before, and my heart broke when I saw his poor little head, misshapen from the pressure of the suction cup. Although the swelling was temporary, I couldn't stop thinking about the traumatic birth the baby had to go through.

But I am so glad that all is well.

Life as a medical student #15 Hello, Psychiatry

I am not sure about my interest in Psychiatry, but I have always find myself having a tremendous curiosity and genuine interest in people. People, and all their complexities, are fascinating to me. The what, why and how behind people's action. The connection between the brain and behaviour. The very subtle things about human characters. So when I first started my Psychiatry posting, I was intrigued by it.

Before I actually go to the wards, I must admit that I was nervous. When most people picture a Psychiatric ward, they envision a dark and dreary place filled with severely incapacitated people. So do I. But the truth is, it is totally the opposite. The Psychiatric wards are very calm and peaceful. Most of the patients are not bed-ridden like in medical or surgical wards. They walk around, smile to you and talk to you. They are friendly and interact in the same way as the average person on the street. The atmosphere is just too normal that it becomes.....a little odd. This is because the environment only becomes intense and intimidating when patients are in their psychotic states. They shout, they threaten, they hit. They cannot handle their inner emotions, they lost their minds, they will erupt at anytime - like a volcano. They are unpredictable.

Violence is a risk that we deal with. But I believe when I mean no harm, I will never be hurt by them. I remind myself that we are all born kind. They act that way because they are ill. They have come forward to us for treatment, so we must not afraid of them. We must not give up on them.

Maybe, Psychiatry is my cup of tea. Along with learning about a patient, I learned more about myself. I find enjoyment when the patients are willing to open up to me and share with me their inner feelings. It wasn't that scary if we can relate to one another to some degree. As humans, we all experience fear, anger, hurt and pain. Psychiatric patients experience just the same, maybe to greater depths, plus a bit of interruptions of the neurotransmitter in their brains. And thus they are ill. If we can all put ourselves in their shoes, they would be treated differently. Some people wonder how I can listen to patients' problems and so many sad stories and not let it take away my own happiness and joy.

But I say being part of a patient's progress is the joy.

Life as a medical student #14 Sexual Harassment in Hospital - What would you do?

Image source: Google Image

I recently had an uncomfortable encounter with a specialist in the hospital. He is thirty-ish and decent looking, in a green colour surgical gown. We were both in the waiting room outside of the operating theater. He introduced himself, and asked for my phone number immediately. I was a bit reluctant, but he explained that getting phone number makes him easier to contact me if there's any interesting cases in the operating theater. So I gave in. He continued the ''oh so which medical school you are from'' small talk, until I found a quick exit when my friend came in to look for me. I said, ''It was nice to meet you.'' I turned around and walked out the door.

Just few seconds after I left the room - in only a few seconds. He whatsapp-ed me. He said it was nice meeting me too. And he asked if I have time so that he could treat me to a meal. I didn't reply him immediately as I was caught up with work (Yes why is it that a specialist has more free time than a medical student *rolling my eyes*). But I replied him afterwards, I said there's no need for a treat. Then that's when it became creepy - he started to text me everyday. As the conversation progressed, he started telling me how good he is on bed, how he could easily make women happy. He asked if he could have sex with me.

What would you do?

Fortunately I am not in a direct subordinate position. At least not now. But if the person doing the harassing is your boss or a superior, do you complain? What if they threaten to make you lose your job, are you able to take this risk? The harsh reality is that sexual harassment occurs within a culture of silence, especially in male-dominated professions. I am sure there are women targeted by their superior for sex and their refusal will eventually lead to limited career progression. Of course hospital administrators will turn a blind eye to such complaints because these surgeons/specialists/consultants are the ones who bring prestige and money into the hospital. So why even bother to make noises? Knowing that there's no point to report, majority of women choose to eat the humble pie. So did I. I didn't make any reports. Am I silly? I don't know.

Although I didn't make any official reports, but after his few repeated requests to go out with me and sex-based text messages everyday, I braved myself and told the specialist off. It was too much. Although it was just text messages, I felt offended, humiliated and intimidated. My body was trembling, and my eyes even got a little teary - not with sadness, but with anger. ''Go fuck yourself.'' I said. Luckily that was toward the end of my rotation, so I didn't see him again after the incident. And he stopped harassing me.

Trust me, I didn't want to talk about this disturbing and uncomfortable encounter. But today I am posting this because I hope that some readers out there that may be in a situation similar as mine can know that they are not alone. We do not have to tolerate this behaviour. Defend yourself. Walk away. Report if you have to. Most importantly, be strong with your words when you say no. Never put yourself in a vulnerable situation.

I despise men who are successful and rich on the outside but show no respect to women 

and only want a young vibrant woman whom he can enjoy in bed.

Life as a medical student #13 Yayasan Chow Kit

Around the corner from the glittering glass and concrete buildings in the heart of Kuala Lumpur lies a seedy part of town where prostitution, drug sales, crimes and undocumented immigrants are nothing unusual. It is the Chow Kit Road, where hundreds of innocent children roaming and living off the streets, with nowhere to go and no one to rely on.

We come across them almost every day on the busy streets but all we do is hurry away and avoid them. We never stop and ask ourselves where they sleep, when they had their last meal, what they do if they fall ill. When most of the kids in schools nowadays come up with all sorts of excuses to skip classes, the kids in Chow Kit can't go to schools. Their parents are busy making a living. They are left on the streets to deal with their sorrows and harsh living conditions. Shattered dreams, abuse of all kinds, hunger and lack of affection are the only reality they know.  For most of these children, the future is dark and unpromising. All that matters to them is day-to-day survival, something to eat, something to wear, and somewhere to sleep.

As part of requirement of Student Selected Component (SSC), I spent 6 weeks volunteering at Yayasan Chow Kit (YCK). YCK is an NGO which takes care of the street children's health and welfare. It provides a temporary shelter for these children. While I was there, I saw how the children lacked adequate health care access and knowledge pertaining to health and medicine. They were born with no legal documents, and because of this, they are not entitled to the free health care services provided by the government. Our task is to look into these inequalities, and make suggestions of how the condition could be improved.

One of my most memorable moments at YCK has got to be the hand hygiene programme. Chern Meng and I decided to come back after completed our SSC to conduct this programme for the kids. We wanted to teach the kids what has already become a routine for us medical students - the seven proper steps of hand washing.

We first showed them a video. Then by using body powder, we demonstrated how germs transmit from one person to the other if they do not wash their hands properly. Finally we instructed them to use the hand sanitizer to clean their hands thoroughly. All the kids LOVE the powder. They had so much fun playing with the powder. I stood at a side and watched them. Their smiles were contagious. I could not stop thinking about how I could actually influence these children to live healthier lives. 

I was hopeful, but at the same time wondered if they would remember anything from this short teaching session. Would they even remember me? Would they ever be able to educate themselves about their own health?

Then there's a voice in my head. It tells me that it's the action, not the fruit of the action, that's important. Do the right thing. It may not be in my power, may not be in my time, that there'll be any fruit. But that doesn't mean I stop doing the right thing. Yes, I won't be able to stay at YCK forever to guide the kids. There's only so little I could do. But who knows, what we taught them today would plant a positive thought into their mind. I don't expect much - so even there's only one - one of the many kids here think differently after today, this is a success.

Do the right thing. And we could all make a difference.

Life as a medical student #12 When a baby is born

As a medical student, I am blessed with chances to see and experience things other people do not get to. When I was allowed into an elective Caesarean Section for the first time, my heart pounded in excitement. I was about to witness the bringing of a new life into this world!

When I entered the room, the epidural was being administered by the anaesthesia team. Surgeons and assistants were scrubbing in, putting on sterile gowns and gloves. Doctors and nurses were moving about, readying the room for delivery. Everything was in place. Then there it was - a strong pregnant mummy sitting on a cold operating table, considering what lies before her - probably feeling scared and alone. Her partner was not allowed in the operating theater. And in these moments, she must hold onto the strong love she has for her baby. She didn't know how long she'll have to wait before she could hold her baby in her arms. She let fear washed over her, and then she let it drifted away. She must be a strong lady. All the mummy.

I made a quick silent prayer in my head for her and her baby.

And then the actual surgery happened. An incision was made in the mummy's lower abdomen by using a scalpel. A few more incisions were carefully made to separate layers of fat tissues, fascia and peritoneum underneath. After the uterus was opened, it was then time for the surgeon to reach into the uterus and pull the baby out. I could feel the atmosphere of the room became so tense that everyone in the room was holding their breaths.

I couldn't contain my excitement when I saw the tiny little baby girl out of the mother's uterus, arms flailing, lungs wailing. The room was filled with joy, everyone was delighted.

''Happy Birthday, to you, the little one. 

Welcome to this beautiful world.''

And thank you, to all the brave women who birth their children with such strength and beauty.

Life as a medical student #11 The end is the beginning of all things

It's only the beginning now

A pathway yet unknown

At times the sound of other steps

Sometimes we walk alone

The best beginnings of our lives

May sometimes end in sorrow

But even on our darkest days

The sun will shine tomorrow.

So we must do our very best

Whatever life may bring

And look beyond the winter chill

To smell the breath of spring.

Into each life will always come

A time to start anew

A new beginning for each heart

As fresh as morning dew.

Although the cares of life are great

And hands are bowed so low

The storms of life will leave behind

The wonder of a rainbow.

The years will never take away

Our chance to start anew

It's only the beginning now

So dreams can still come true.

Another year of medical school has come to an end. 

Thank you Group C1, I am going to miss all of you. 

Let's ace the exam together, shall we?

Blog hibernate mode turns on.

Life as a medical student #10 About inferiority complex

I just feel incompetent.

I remember how I was always the top of my class in high school. I knew I had to do well in SPM to get the college admission I desired and the scholarship I needed. So I scored 9A+ in SPM, enrolled in matriculation - the fastest way to degrees, and when everyone was complaining of not being able to study medicine, I was awarded the highly sought after JPA scholarship to study medicine in Perdana University. It's all been smooth sailing; everything has gone exactly according to plan. I thought I was a blessed child. As soon as I entered medical school, I realized that this kind of success is everywhere. I was surrounded by geniuses. It no longer makes me special or stand out. I don't think I am smart, in any way.

I struggled, a lot. I feel inferior compared to the others in the hospital who always seem to know more than me. I still have to look up things when I don't understand during the ward rounds and flipping my books like crazy for things I have already studied. I get frustrated and just feel like I shouldn't be there. Every two weeks we move on to a new posting and new environment. So just when I feel like I know what's going on, I am back to square one. Incompetent, clueless, and most importantly, being doubtful of my ability. Sometimes, it makes me wonder, whether I would make it, to be a good and competent doctor. Some days my best is just not good enough.

After three years in medical school, I am still struggling to learn how to be good at medicine. But in order to be the person I have always envisioned myself to be, I will continue to find my way.

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.

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.

Life as a medical student #6 Just a touch of a hand

Dear Mrs E,

We didn't know each other well. You might recognize my face from ward rounds, I was the girl in the corner holding my books, looking at the ground or out the window. I occasionally asked you how you were, and you always told me the same thing - pain, so much pain. I didn't know what to do. I wanted to hold your hand and tell you you will be okay, but something held me back. Because there is nothing I can do to cure you. I am just a medical student, and even if I was a doctor, there is no medicine to make you better. We can give you pills and injections and fluids. But they can only prolong your life. All they gave you was just more and more pain.

I was there when your family was told the news. I saw how they reacted to your prognosis, did you see it? Did you see the pain they were in? Did you realize just how loved you have been. I looked at them, unsure of what to say, knowing that no words could take away their sadness and their grief.

As your condition deteriorated, you couldn't even tell me that you were in pain. I still went to your bed every morning and asked you how you were. But you could only stare at me, mouth wide open, no words coming out from your mouth. You started to lose appetite, you didn't even have a look at the food they served. Your son, who is a great chef who owns a restaurant brought you your favourite food. But yet, you turned your head away.

My heart aches for you.

Finally it was my last day in Ward 23. I came to your bed and said good morning to you. And as usual I asked you how you were. You looked at me, as if you knew that I won't be there with you anymore starting from tomorrow. You reached out your hand to me. I thought you wanted to tell me something so I bent down. Your fingertips found my skin, then you touched my face, gently.

Until today I don't know what it means. But I wish for a miracle - that this illness which haunts you will be gone one day. Stay strong.

Life as a medical student #5 What I learnt from Ward 23

Two weeks in Ward 23, Hospital Kuala Lumpur.

I wish I could tell you stories about an impressive tracheostomy, or how I performed chest compression on a patient and brought her back to life. Nahhh. But I can't. All I can tell you is the little things that happened - what Ward 23 has taught me.

In Ward 23 we have our General Medicine rotation. Patients are from diverse cultural backgrounds and have different life circumstances. Some have been relatively healthy and it was their first hospital admission. Others were chronic disease patients who probably have twenty years of long standing hypertension and diabetes. This is my first opportunity to meet real patients in a hospital setting - it is a much less structured learning environment than I have experienced up until now. A lot of self-directed in my learning is needed, which is a challenge for me as I am used to be spoon-fed -  we all are. On the first few days, I entered the ward and not knowing what to do or who to speak to. All I did was standing there watching the specialists and doctors discussing cases which I don't understand. The busy environment was intimidating, I almost started doubting my decision of becoming a doctor again.

But as I started to talk to some of the patients, things changed. I remember one woman in particular. I was walking from one bed to another, reading their charts. Then she started to make sounds. I knew she was trying to gain my attention. So I closed my files and walked towards her.

''Kenapa mak cik? Mak cik okey?''

She started to complain to me about her calf pain and how it affected her sleep. She frowned talking about the pain like a little kid. She told me how she hated staying in the hospital and her children never came to visit her. I looked at her lunch plate and realised she only ate the fruits. I asked why didn't she eat the porridge, the vegetables and the chicken. She said she had no appetite. And that she only likes fruits, especially the watermelon selling at the cafeteria downstairs. But she is wheel-chair bound and it is difficult for her to go down to the cafeteria. So I offered to buy her the watermelon. 

She was all happy when she saw me coming back with the watermelon. She had one bite and told me the watermelon was sweet. The juice of the watermelon was dripping everywhere on her neck and shirt. I helped her to wipe them away.

I made a promise to myself to always remember the sparks that she had in her eyes and the smile on her face when someone in the ward finally willing to listen to her and satisfy her wish.

Ward 23 taught me something -  that patients are always our best teachers. I am grateful for patients who are happy to let me talk to and examine them. Thank you for seeing me as a member of the medical profession - although I am just a medical student. It reminds me to behave in a professional manner at all times. I know that my rotations will have even more to offer me in terms of interactive, hands-on learning. Finding real life connections between the diseases I learned and the presentations I saw in my patients is interesting. But it is going beyond the disease presentations of my patients and getting a glimpse into their lives that really are the heart of medicine. Thank you, Ward 23.

"Medicine is learned at the bedside and not in the classroom”

Sir William Osler (1849 - 1919)

Life as a medical student #4 Sweet Revenge

From left: Abby, Chern Meng and I

Have you ever met someone that just weren't very nice to you? It wasn't because of anything you did - or maybe it was - but they just weren't very kind or friendly. I remember writing about how I embarrassed myself in front of my supervisor and how it made me think and reflect on my own performance. (You can read about it here) After some time, I realized there were only two possibilities - either I really performed badly or he was trying to pick on me. I wish it was the first one. Worst comes to worst, I have to be the type of incompetent people who know that I am not good, instead of those who are clueless about their incompetence. It is never too late to learn. 

Last Friday, we ended our Student Selected Component (SSC) by having oral presentation in university in front of the examiners, and most importantly - in front of my supervisor. It was a day I have long anticipated, I probably secretly hoping to prove him wrong or something. So of course I made sufficient preparation. We rehearsed the presentation for countless times, we even colour coded our outfits. But most importantly, I was all ready to present to everyone what we have done in the past six weeks. Because from the very beginning, I am proud of what my SSC is all about and am really glad that I was given the opportunity to be a part of the team. (Will be posting here about my 6 weeks attachment at Yayasan Chow Kit soon)

The presentation turned out pretty good, the response from the floor was out of my expectation. People were impressed by the findings and how it would benefit the street children. One of the lecturers from Dublin asked if we would like to publish our papers. I mean, what an honour! Publishing papers is the dream of every researcher. To receive such feedback is the best one could ever get.

I wish it was from my supervisor though. He didn't make any comment after our presentation. No dramas like patting on my shoulder saying ''Well done'' or ''Keep up the good work''. But nah it's okay. Maybe my supervisor is just cool like that.

I dip my fist in sugar before I punch my enemies in the face. Sweet, Sweet Revenge.

Life as a medical student #3 Let's go jogging

Picked up my old habit of jogging in the evening today. And it feels so so good. I smiled to strangers. I admired the flowers that people grown outside of their houses. I realised that the family who had a cute rabbit as their pet, was no longer living in there. I have forgotten how beautiful the sunset is.  The sky is so blue, the clouds are so fluffy. Why didn't I think of doing this earlier? When I was all stressed up last semester, why didn't I go jog? I jogged when I was in IC1, like everyday, but not even a single day in IC2. What have I missed out?

Yesterday was a bad day. Got screwed by my supervisor, which, I think he was right. With just passion is not going to pull me through medical school. I am just....not capable enough. Whatever you have in your head, if you don't speak up, if you don't speak to impress, you are just one dumb idiot. But, almost all the time, I have thousands of thoughts running in my head - should I say this? No I shouldn't. People will laugh at me. Is this correct? No it could probably wrong, I better don't say it. My thoughts are scattered. Only by writing, I can sort out my mind and say myself best. Maybe, just maybe. I need to speak up for myself. I am terrified of something, which I have always wanted to avoid. And yesterday, it just exploded. And I could no longer hide it. I wish I could be perfect in everything I do, I never thought that I could be that weak, and stupid, in front of people. 

I would do anything, to get out of this shit.

Had a bit of thinking today when I was jogging. So I was thinking, maybe one day I would thank him for this. What doesn't kill me makes me stronger anyway. I sat on my favourite swing, had some time to myself. I really, really love this. It calms me down. It makes me think. And I don't have to do anything to please anyone.

Because my thoughts are stars I cannot fathom into constellations.

Life as a medical student #2 The lady who inspires me

''What your mind doesn't know, 
your eyes won't see, your ears won't hear, your hands won't feel.''

- Dr Uma Sothinathan

We all look up to strong, independent women. But how do we become one ourselves? There's this one lady - her determination, vision, and strength have always inspired me and is a great example of how we can do anything we set our minds to. Her name is Dr Uma Sothinathan, PU-RCSI Director of Clinical Competency.

I used to dislike her. She is one of the lecturers who emphasises a lot on dress code in university. It really gets on my nerve - it means I have to say goodbye to my skirts and dresses because they are all above knee length! I used to think that she's conservative and demanding. However, not long after I attended her classes and listened to her talks, I realised I was wrong. Proper and decent clothing is a protection to ourselves and also our patients. There's a reason behind everything she does. Deep down, how much she wishes that all of us would make Perdana University proud when we are working in the hospitals in the future. She speaks to us like how a mum speaks to her children. All because she truly cares.

She uses creative methods in delivering quality clinical teaching, with emphasis on reflective practice, mindfulness and shared learning in her students. She made us think - how to be a good doctor? She taught us to be compassionate. She taught us to stop and listen. She taught us to feel. Her humour, her passion in paediatrics, her sparkling eyes when she talks about it. All of these influence my life in ways I am still discovering. 

There's once she made me cry - when she was in-charge of the performance for White Coat Ceremony 2014. It was a group performance. She pointed out my mistake directly, corrected me and said I am not cut out for the stage. She said all these right to my face, I tried so hard not to cry in front of her. I mean, I may not be that talented, but I love stage performance! How could you deny the efforts that I have made to be able to shine on the stage. How could you. I continued to practise, and practise, and practise. She no longer gave any comments, she just sat down at a side and watched. Then when the music stopped, she walked towards me and said, ''You did a very good job. That's the way!'' 

Thank you, for allowing me to grow my own wings. 

Life as a medical student #1 The Introvert

So Monday was the first day in Hospital Kuala Lumpur (HKL). I was excited - the moment I have been looking forward to since the first day I entered medical school! However, just like everything in our lives, there are always disparities between expectation and reality.

I know it all along that I am an introvert. But HKL is constantly so busy that it is difficult not to feel suffocated. The feeling of all those people rubbing against my body and not being able to get to where I want to go was scary. I was uncomfortable and I just wish to escape. Confession: I have agoraphobia. (I wish it gets better after some time) However, the worst part of being an introvert is the over stimulation of brain activity - that I always notice details that others don't.

Here's the story. I was in HKL's cafeteria with my colleagues, wasn't eating anything because I was already exhausted after battling with the inner emotion of me for the whole day. Then I saw this old lady sitting in a wheel chair. Her back was facing me so I couldn't see her face. But I could see her streaks of grey hair and she looked very ill. Her husband and son were beside her, ready to go after finishing their food. The son is around the same age as me, if not, younger. He had a handkerchief with him. He bent down in front of his mum, wiped her mouth gently. Next, he helped his mum to put on her hat, carefully adjusted it, looked into his mum's eyes, and lastly, he smiled. He smiled - and I swear that's the most beautiful and comforting smile I have seen. There was something in his eyes, and it went right through me. My tears immediately welled up in my eyes, which I have no idea why. But I held it back, and I turned my head away.

I went back with a heavy stone pressing on my heart.

I asked my friends if they feel the same after the first day in HKL, and they tell me they don't. This wasn't the first time I am in a hospital, and I am sure there's more to handle in the future. But I guess in different phases of life we feel differently. Not sure what kind of phase I am going through now, but I believe all that I can feel is real. 

All I can feel, is real.

What do you see yourself doing 10 years from now

''What do you see yourself doing 10 years from now?''

I was given this question today, and I immediately went tongue-tied. What do I want to see myself doing when I am 30 years old? The truth is, I can't even provide a good answer if I were given question like ''Why do you want to be a doctor?''. A question that had been asked so frequently during the many interviews that I attended. This normally followed by ''What specialty you are interested in?'', ''Where do you plan to practice?'', etc.

I honestly have no idea to all the questions above. I remember when I was in matrics and was expected to fill in my preferred courses, I put medicine solely because of my passion for Human Biology. Other than this, my future is a blank canvas. When I went to interviews, I heard so many noble stories of what inspire people to want to do medicine. But not for me. I have no stories as such, I only let nature takes its course, I follow what my heart tells me, which leads me to studying medicine today. I have so many friends whom their parents/relatives are doctors. Probably that's the reason they are in a medical school. In comparison, both my parents are very less well-educated. They tell me they are proud of me because I choose to be a doctor, and they live in a belief that doctor is a very noble profession and that I will earn a lot of money out of that. They never told me what I am going to face. But I never blame them for that, as I should be responsible for what I want to pursue and get myself well prepared after all. Just like how people always tell us what we should pursue after: fame, fortune, popularity. But that's not always true, it is our responsibility to determine what we actually want. Only with that discovery will we feel complete. Perhaps, that is the brink of adulthood.

So I have to admit that I have no sufficient exposure to the reality of medicine before I enter medical school, I only knew I was intelligent enough to do medicine. Since I was young, my exam grades is the only aspect in my life that I am confident and proud of. I did well in all of the major exams. I guess all I had was luck. The awareness of that there's so much more to life and medicine than memorizing facts and regurgitating them, really makes me feel like giving up. I am in my third year now - maybe, maybe I can really survive medical school, but what happens after that?

The end point is really not the medical degree. The degree might even be the beginning. People always say medicine is a long and tough journey. Even old people are telling you how hard medicine is. But what they didn't know is that not the extra years we spend in university which makes medicine hard, it's the long lead-in period to becoming a qualified doctor. Let's say if you decide at 18 to be a doctor, you still have at least ten years before you practice independently in your field. Ten years is long. So many things can change in these ten years. Maybe I will slowly lose enthusiasm for medicine. Maybe I get more and more disappointed by things we can't change, the whole medical system in our country. Maybe I no longer able to get the sense of satisfaction from patients - patients pay me, expect me to cure them, then they leave. No respect, no gratitude, no appreciation, nothing. Slowly medicine is evolving to just another profession, doctors have become like everybody else - no satisfaction from the job, no human touch, constantly feeling insecure. I considered myself lucky, because before today, I never thought that I would ever think this way. Main reason being I wasn't taught this way. My lecturers have been giving us a very positive outlook of our future careers, and how much impact we are going to give to the society once we graduate. But now I am not even halfway through medical school, and I am already doubting myself. Most of us went into medicine to help people. We want to practice medicine the right way, but too many forces today are propelling us away from it. Will I become the kind of doctor I despise? Can you believe it, I doubt myself of the decision I once so proud of. The closer I am to my clinical year, the louder the alarm clock in me seems to blare that I should know what I want. The exhaustive commitment that is required in becoming a good doctor, do I have it?

I was told that what we do now has to get us prepared for our careers, for the competition that we going to get when we have so many medical graduates every year. Then I question myself: when my colleagues were busy doing hospital attachments, going to several different conferences, doing research programme or even charity work, what I did in my three months of summer break? I went on a trip to Europe, I had fun, I went to activities unrelated to my field of study. Frankly speaking, I cannot afford to play at all. I have no experience working in an emergency room, in a doctor's office nor any hands-on position with patients. I am already not gifted with a smart brain, yet I did nothing, to attempt to secure my position ten years from now. I am so far behind all the others. What am I doing? Why am I spending time doing things that are not gonna be helpful to me?

If really there must be a reason why I am still holding on to what I am doing, it is because of my family. They never forced me to be a doctor though. However, the exciting look that they have in their eyes when they start telling the others that their daughter is going to be a doctor, telling me what a bright future I have ahead of me after I graduate - makes me stay. The last thing I would want to do is to disappoint them.

Would I choose to enter the medical profession if I were to decide on a career again?

I guess all I have to do is to forget about all the external factors and back to the basics - what are doctors for. I would say the human moments that I am going to share with my patients. As long as I am serving my patients well, no matter which specialty I am in, which hospital I am going to work, they don't matter to me much. The sense of satisfaction that I will get when my patient recovers from illness, the simple happiness that I will get from a thank you from my patient - these are more than enough to keep me going.

Clinical Competency

I despise people who study medicine but think that following dress code is shit.

I started Clinical Competency in this new semester (Junior Cycle 3) and I would like to share with my readers things I have learnt from this module. As a medical student, we are expected to wear decent clothing when we attend our classes. Decent as in no skirts above knee level, no short pants, no open toes shoes, no bangles and watches, and for girls, hair exceed shoulder length must be tied neatly. Why must we do this? You think this is because the lecturers trying to create a fuss? Then you are totally wrong. We wear decent clothing because this is a safety precaution not only to ourselves and also our patients in the future. Doctors are at the highest potential risk for cross infection. Needle stick injuries are so common. How are you going to save someone else's life when you can't even protect yourself well. Imagine you wear open toes shoes and some chemicals just spill on your toes. Imagine you are having a consultation with your patient and while you are sitting down, crossing your legs and your sexy legs attract even more attention than your words. Imagine you are trying to auscultate your patient and your flying long hair is all over your patient's face. Dress codes are set for our convenience. Rules are there for a reason. And of course, when there are rules, they are meant to be followed.

Some private universities in Malaysia never had dress code, medical students just come with t-shirt, hot pants and flip flops. Yes, public universities in Malaysia have dress code, but sadly, it is due to religious reason. However, my university teaches me something. Something that other universities will never teach me - self discipline. Self discipline is so important not only in my future career, and also become a practice in my daily life. We are trained to abide to the dress code, to make us look professional when we start to serve the society, a respect to our profession and also to our patients, and most important of all, our attitudes. You can violate the rules when you graduate. Nobody is going to be there restrict what you want to wear. Attitude determines all. You want to wear mini skirts and shorts when you do medicine? Go away. You just humiliated this noble profession.

No offences.