Ophthalmology MO with not so very good Engrishh

So my friends and I were going through our patient's charts before the rounds as per usual. We were reading through the notes for this baby girl with congenital glaucoma (totally blind in both eyes - poor thing) who was referred to us because she fell off her cot and hit her head (to rule out cerebral concussion / bleed).
The documentation of the event went like this:

"baby alleged fell from bed when no bady there
mother and father in bathroom together at that time
PPK and staff nurse heard sound of the thing fell down
went to bedside when hear baby cry"

Oh my god!!!!
You are an MO for god's sake! Did you learn English from the toilet store? Imagine if this goes to court. What an embarrassment.

Menara Rakyat Merana

Disclaimer: I am not pro-opposition, and neither am I pro-government. I am just pro-common sense!

The most recent thing that makes my blood pressure shoot up is the RM5bil Menara Warisan proposed under the 2011 National Budget. The first thing that came to my mind when I saw it in the papers is: what are they thinking? We are not a rich country, and hence, RM5bil should be spent very carefully, and not on some unnecessary luxury. A poor man shouldn't drive a new Mercedes if he can't even pay his rent.

Why I think the idea is totally ridiculous: KL has enough tall buildings. In fact, the Petronas Twin Towers are probably the most distinctive skyscrapers in the world. They have certainly put Malaysia on the map. People all over the world know about them and immediately think of Malaysia when they see them. In fact they give them their own names e.g. chopsticks. So, why is there a need for another one?

RM5bil is a lot of money. You can do a lot with that.

I feel that they could spend it on improving vocational education in Malaysia, thereby providing people with skills that can improve their standards of living. Vocational education is really important for the scores of people who are not into (or not suited to) academia. In countries like the UK and Germany, it plays a major role in training mechanics, plumbers, builders, carpenters who are then empowered by their skills to venture into business or to gain employment.

They can improve the status of our local universities and hence put us on the map for an even better reason. The level of research could be greatly improved, and other courses such as the arts (music, drama, fashion) could be developed.

They could also improve infrastructure in Sabah and Sarawak by building highways, or rail links, thereby spurring development in these areas and improving our GDP as a result. In fact, even the railway in Semenanjung could do with upgrading. It definitely should not take 12 hours to get to Kelantan from KL by train. They could build a tunnel through the mountains and create excellent road and rail connections between the east and west coast (just like what Switzerland has recently done). Such infrastructure makes the country more attractive for foreign investment. Imagine if you could get to Kota Bharu by train in 2 hours? Or what if you build a high-speed train linking Perlis to Singapore? Imagine if it travels at 250kph? That would allow you to travel to Singapore in 3 hours! Or KL to Singapore in 1.5 hours! Such amazing logistics create limitless business opportunities!

The underprivileged society in Malaysia could certainly do with some help. Social benefits should be improved to emulate systems in the UK and in European countries. Disability allowance and job-seekers allowance should be introduced/improved. At the moment, crime is such a major problem in Malaysia and I believe it's due to an obvious reason: socioeconomic disadvantages. Giving them aid and guidance would be a deterrent from involvement in crime, and could help them move their lives in the right direction.

They could also improve our border protection to avoid illegal immigrants pouring in from all the surrounding countries. This is certainly an issue in Sabah where there are huge numbers of illegals from the Philipines and Indonesia, who contribute to a lot of socioeconomic problems.

Above are the many opportunity costs for the 5bil. I just hope people just do what is right in the end, and finally make a difference.

Cars

The situation in Malaysia really sucks for anyone who loves cars (like me). Foreign cars cost an arm and a leg due to the insanely high tax and even local cars aren't all that cheap, despite how unimpressive they can be.

Let me start with my issues with local cars. My family have had it's fair share of Malaysian cars: an original Proton Saga, a Wira Aeroback, 3 different Perdanas and now a Satria Neo.

They cut corners.

1. The interiors have a very cheap plasticky feel. Some of the parts on the dashboard don't seem to fit perfectly well (there are gaps in some places where 2 pieces of plastic come together, and in other places, the parts stick out slightly).
   
2. Interior room is poorly designed. Take the Satria Neo for instance. It is generally very cramped on the inside, especially for the back passengers where there is very little legroom and headroom. Let me compare this to a Volkswagen Polo that looks tiny, but comfortably fits 3 European-sized adults in the rear.
   
3. They lack refinement. Sound-proofing is poor, resulting in very intrusive wind and engine noise at higher speeds. Some cars (especially Kancils and Kelisas) rattle even at moderately high speeds producing a sensation of unsteadiness and frank danger. The suspension on my Satria Neo is plain bad and even little bumps cause a huge jolt on the inside.
   
4. They don't have adequate safety equipment compared to European standards. The maximum number of airbags is 2, with some only having driver airbags. Options of upgrading to curtain airbags are non-existent. No one can deny that Kancils are just deathtraps.
5. There is very little room for customising your car (unless you go to a shop and get it modified after buying it). Engine options for each model are few and far between (usually 2), manual transmission is not available for all ranges of engines, and diesel models are unheard of. Compare this to buying a car in the UK where you can get overwhelmed by the choice of engines and the endless lists of optional extras.
6. The designs are unoriginal and are carbon copies of other cars. This is no longer true for Proton, because they now design their own cars, which I am very proud of. Congratulations. But to Perodua, Naza etc, they are just producing carbon copies of Japanese models. Take for instance, the MyVi, which is basically a Daihatsu Sirion with a perodua label on it. I personally find that shameful to say the least.
7. Some models are SO outdated. For example, the Perdana (of which production only stopped last year) was released in 1994. This model has been sold for the last 15 years! The old Saga was sold for far too long too (with various facelifts, but essentially, the same car!)
   
8. The cars tend to be very basic and don't really have any inspiring features such as adaptive headlamps, light sensors, rain sensors, parking cameras, built-in navigation systems, electronic user interfaces. Hence to fill space in brochures, they even put "Keyless-entry" as a feature. When I read that the first time, I thought it was keyless ignition. I was about to be impressed, when the salesman told me that it just meant remote-controlled locks/alarms (which have been around since the early 90s!)

I don't understand how our local cars can be of so poor quality when they've had over 20 years of protection from the government to develop. Were they complacent because they felt protected? (and hence, did they not really try very hard to compete?).
I will not accept that there is a lack of talent or expertise. There are thousands of Malaysians that are educated to the highest standards possible. A lot have even qualified with Engineering degrees from the top universities in the UK, US, Germany, France, Japan and Korea. Many of them where given scholarships by the government. I know that many have electrical engineering degrees and probably not many have automotive engineering qualifications. I'm also sure Malaysia does not lack artistic talent for designing cars? There have to be some artists in this country?
What needs to be done

1. Increase competition with foreign cars to put more pressure on local car companies to perform. Reduce the tax on foreign cars but still keep it to the point where they cost a bit more than local cars. This should spur some panic and perhaps knock some competitive spirit in them.
2. Capitalise on Malaysia's talent. Employ these Engineering students who return home and find themselves jobless (and therefore leave the country again!) - JPA should deploy their scholars here. Consult with Malaysians who are involved in the automotive industry abroad. I'm sure if you maximise the utilisation of brains, you'd be able to produce very impressive cars with advanced electronics and great features (such as mentioned above). With them on board, I'm sure you'd be able to design more engines quickly too (petrol, diesel, hybrid).
   
3. Use better quality plastics! Don't use the current ones which give such a scratchy feel! Try using something similar to what BMW or Mercedes use! Use higher quality buttons so they don't feel like they'll fall off after a year.
4. Put more emphasis on safety. Ensure that you provide buyers with the option of having 6 airbags etc.
   
5. Really test out your models before releasing them to tackle problems such as interior space, comfort and refinement. Sound proof your cars well so they will feel more expensive, and hence, more worth the money.
6. Renew your models every 5 years or so. Don't keep selling the same model with a slight facelift here and there for ages.
7. Stop copying foreign car models. I find this disgraceful and defeats the purpose of having a national car. What is the point of having your own brand if you're just selling someone else's product with a different label? Have a nationwide call for talented people who can help design our own models and perhaps get some help from Malaysians working in car industries overseas.

I'd like to see the day when Malaysian cars can compete in an open market with all foreign cars (without the need to tax other cars like mad). And I hope to see that day by 2020 the latest! Nothing is impossible if you do it wholeheartedly!

Driving in Kuala Lumpur

Several words may succinctly describe the experience of driving in KL: appalling, chaotic, stressful, idiotic. Yesterday, I decided to drive to KLCC from Ipoh knowing full well that there was going to be a jam due to the Raya shopping crowd. Rookie error. I was well on my way down Jalan Sultan Ismail (in denial about the jam) when all of a sudden, I realised that the road was closed further down for who knows what. At this point, all hell broke loose.

There was a MASSIVE jam, and there were more lanes in the road than there was supposed to be. NO ONE was giving way (ok I lie, one person in a gold Toyota gave way). No one cared what the bloody traffic light was showing (it was just a slightly interesting ornament by the street that wowed everyone by it's bright colours). I was fucking pissed off because it didn't matter if the traffic light was green for me because imbeciles from the other side were pouring in and congesting the road further. Basically, there were no rules, besides the rules of the jungle (hutan rimba). People were being aggressive and idiotic, hence reducing themselves to baboons, the kind with the red ass. Motorcylcles were EVERYWHERE. They are the most bloody annoying things. They don't stick to any particular lane. They swerve in front of you if they feel like it (and you're forced to make sudden brakes because you don't really feel like killing anyone). And worst still, I had to change lanes in this chaotic situation. It was a complete fucking nightmare.

And about driving in Malaysia in general (as well as today): yellow boxes and zebra crossings: who the hell knows what they are! They are decorations put there so tourists can take pretty pictures. Yellow lines, double lines? Who cares. Just park your bloody car anywhere it fits: on the road, on the pavement, at a roundabout, in front of other parked cars. In fact, just park in the middle of the road if you have to. I'm sure other people will try to avoid it.

This happens because the traffic police have failed miserably to assert their authority, due to rampant corruption and general apathy which has resulted in very little respect from the general public. Malaysians are also generally inconsiderate and reckless when it comes to rules and regulations. They are, in general, not civic-minded like Europeans. Hence, hoping for them to adhere to rules is a lost cause. The way to make it work is to FINE their asses and threaten their licenses with DEMERITS. Fine them for: beating red lights, speeding, parking illegally, not stopping at yellow boxes, not stopping at zebra crossings, tailing ambulances. FINE THEIR ASSES. THREATEN THEIR LICENSES. Fine them consistently, because if you do it half-heartedly, you will confuse them, like how a child becomes screwed up if parents are inconsistent at punishing and rewarding him. Look at Singapore. Without their strict police, they too will drive like apes, like when they've crossed over to Malaysia. But due to the constant fear of being fined, they drive so beautifully. So, dear traffic police, can you please uphold the rules that you are supposed to uphold?
Of course, I can't blame them for being corrupt because they probably don't get paid much at all. They've got to pay the bills and feed their children somehow. So, their pay should be increased! Maybe the same pay as doctors. It's worth it. Pay them well, and they will not be corrupt anymore. And increase their numbers so their presence will be felt on the road and people will know that they're constantly being watched.

The benefits of this

1. People will stop driving like red-assed baboons and more like human beings. Hence less stress on the road
   
2. Fewer accidents on the road, hence fewer deaths
3. No bloody plastic cones all over the place (hospitals, shopping malls, government buildings) to stop people from parking their cars
4. The fines can indirectly contribute to the pay of the traffic police
5. And keep this going for years, and you will finally successfully instil some civic-mindedness

The Mucus is back with a vengeance!

I used to suffer from hayfever all year round in Malaysia!! I remember leading a miserable existence due to constant sniffing and sneezing and due to a constantly blocked nose.
Then of course, I moved to the UK and my problems were gone overnight. But every time I return for a holiday, my problems always start again immediatly after I leave the airport. And of course now, I am constantly sniffing and blowing my nose. And my throat is itchy and I never stop sneezing.

I used to think that this was due to an allergy to dust and cats and dogs. But I was never affected by dust or cats or dogs in the UK. And so I then thought I was allergic to Malaysia. But now, I think it's the grass pollen that's in the air all year round in tropical Malaysia.

I've resorted to wearing this magnetic necklace, which is supposed to cure hayfever. Well pendant, I'm still sneezing!!!
Next step after magnetic pendant: steroid nasal spray

Good luck to me

I have issues

Self confidence was something I never really had. I was always quite an introvert and it was always extremely frustrating to have this brick wall that stops me from expressing myself. I dunno why, but it's just difficult.

I tried to change all this when I went to uni. It was going well in first year and I was still working on it in second year. I made many friends. Went out a lot. Tried to be more outspoken and friendly. But of course, I just had to lose my hair. This was a huge blow to my already low self esteem. It didn't help that it happened so suddenly at the end of my 2nd year. It's such a terrible situation because I keep trying to just move on with life, but keep getting into bouts of severely low mood. It cannot be fixed. I constantly tell myself that there's absolutely nothing I can do about it. But yet, it really affects me. I'm always so self-conscious around other people. I can't stand it when I see their eyes dart to my hair, it makes me blush so much and freeze up. I get so anxious when this happens that I can't really hold a conversation. I've lost so many friends because of this stupid problem because I was just too afraid to face them. Too embarrassed for them to see my hair. And so I hid, and avoided, and now, I feel down so often because of all the friends I lost, who have moved on with their lives and forgotten me. I often have sleepless nights just thinking about this, just wishing that my hair would just grow back and everything will be fine again.

But I must move on. Hence, I shaved my head and oh my god, how liberating that felt! I don't look too bad although of course I can't deny that I would prefer to have hair. But at least, I don't look like a geek anymore and I look more youthful even (because a shaved head looks tonnes better than thinning hair). Now, I vow to cherish all the friends I have and reconnect with the lost ones. I am going to try and accept the way I look, no matter how much an uphill struggle that is at times. I need to be more positive. There are worse things than losing hair. At least I'm alive, healthy and sane (I think).

Self Discovery

Self discovery. What an easy thing to say. If only it was as easy to achieve. Some find it ridiculous. How can someone not know themself? Haven't they known themselves from birth?

Sometimes I find that I don't like the person I am, or the person I'm turning into. All my experiences so far, and the way I handled them have turned me into a bitter person. I'm constantly complaining. Nothing makes me happy. I always feel like I've been wronged in life, and I never count my blessings. Everything around me is wrong. I frequently find myself in a situation where I feel that I'm surrounded by happy people and I'm just a depiction of misery in the middle of it all. This vicious circle has got to stop. What is the point of living if you're not going to be happy?

I feel that I still have a lot to learn in life. I need to satisfy my need for academia more, which I think university is depriving me of (strangely enough). I sometimes feel that I'm stuck in perpetual lethargy and laziness. Well I'm getting out of that. I'm making a pact with myself. I need to improve my value system, which currently, I believe is severely flawed. To do this, I shall do my best to read more books (especially all those clever books that I bought just to make my shelf look better and never actually read beyond a chapter).
I need to get over my fears and anxieties and just put myself out there and get more experience. There's so much in life that I haven't done. I've never climbed a mountain, I've never been deep in the ocean, I've never run a marathon, never just put myself out there, out of my comfort zone, never even danced without a care.

There's a big hurdle I must overcome. My intense self-consciousness. Sometimes all I think about is what other people are thinking about me. This must stop. It is stopping me from even enjoying myself. It causes my tongue to seize when there are more than 5 people in a room. I can't even talk on the phone when there's someone else in earshot. I can't just let go and dance, or even celebrate an achievement. This must change, for it is very unwelcome, and I believe it's a consequence of my obsession of pleasing other people since childhood, even if it stops me from being happy. I must get rid of this obsession of being the good kid.

Well Elias, you've got to change! And you will, because now you've finally had the time to analyse all your wrongs. Good luck and may you find happiness at the end of this journey.

The NEVERENDING Illness!!!!

This is how I woke up today: my throat felt like a cat threw up in it, my right ear ached so much from that stupid pimple just before my ear canal, I was almost deaf in the right ear and I felt completely miserable!
On waking up, I start to try to swallow but it felt like the back of my throat was covered in cat vomit that won't budge. My ear starts to hurt so I think to myself "omg is this an ear infection? did that stupid pimple progress to become an abscess? Is this going to progress to form a brain abscess? Am I going to be brain damaged and deaf?" - once you see cases of such things happening you start to be so paranoid! So I start to stick my finger in my ear to see what the hell's going on in there and I thought I felt a large abscess going into my ear canal and just thought, "fuck". Anyway, I then go over to Dan's room (because I knew Fay was up), and asked her to look into my ear with my otoscope. And she just saw a miserable little pimple, which somewhat reassured me.
Anyway, turns out I was deaf in that ear because my stupid Eustachian tube was blocked with goo (which cleared up)
As I'm typing now, my nose is dripping away like there's no tomorrow.

Here's how I've been in the past MONTH: ILL. I've had a bitch of a cough, and intermittent fever, sneezing, runny nose. And guess what? It was clearing up. It was almost completely gone. But at the last minute, a new bug comes in!!

So it feels like my immune system's being taken out on a test drive by these pesky little morons (viruses). Grrr looks like I'm going to be sick for another few weeks. Thank you pesky bugs!

My role in society

The sacrifice.

I have noticed that over the recent years, I have taken the role of the organiser. The person who is on the ball all the time. The person who herds the stubborn sheep. The person who has to sacrifice his enjoyment for the enjoyment of the mass.

And I deserve some remuneration. I'm the best organiser there is. I started an orchestra last year from SCRATCH. Our first ever rehearsal was a meagre 4 people playing Beethoven's 5th Symphony. And our coming concert will be 47 people playing The Hebrides and Khachaturian's Masquerade. Now that's something. I could've given up at the beginning, and nothing would've happen. Nothing. No one else would be willing to go through the stress and frustration of herding people. But I did it. And I'm satisfied with the results.
In rehearsals, everyone else has a jolly good time, and I really like it that they do. But I have to be on the ball, I need to organise where they sit (because they never know), where their music is, assure everyone that there will be more more musicians to fill in missing parts. And most of all, I find it so irritating when people look at me when the music is hard, or when it's not sounding good. Where were all of you when I asked for help to select music? I did it on my own and with so much planning and thought. Anyway, end of rant number 1. I know I will feel differently after the concert as I would be quite elated.

Rant 2. The flat. I live with a bunch of filthy people. If I didn't live in this flat, I can bet there will be rotting food, dirty dishes, dust and faeces covering every inch of floor and surfaces. It's always up to me, yet again, to be the shepherd. I have to resort to making a rota (which they don't follow). And when I try to enforce it, they glare at me. So in the end, I clean up most of the things. I do the dishes, again and again, and again. And they don't even thank me. I would like out!

The last one is not really a rant. But I do most of the organisation if our group of friends want to go out, eat, movie, concert, ballet, opera etc etc. Which I don't really mind, because I derive enjoyment in the end.

So there. I'm the shepherd. The one who has to sacrifice.

Life goes on!

I PASSED!!! And its great to be back! Now leaving all that crap behind me,

I'm on neurology at The London at the moment and am enjoying every bit of it! Ophthalmology week was great and I'M SO BUYING AN OPHTHALMOSCOPE!!! Oh what fun

Anyway, I'm back on my Music Presidential throne and am working my ass of for it! Can't wait! Despite the usual problems (low on brass, NO OBOE!, no harp) I'm glad to say that things are looking up this year! Many new members signed up at the freshers fair, and a 3rd of them violinists!! and a new cellist and a HORN!!! omg Just incredible, horns are SO rare. But we still don't have trombones...
Anyway, nowadays I'm losing sleep due to excitement! I keep thinking of that first rehearsal that just has to be perfect! First impressions last you see, so i don't want to scare off the new members.

And I just LOVE our choice of repertoire!
-Mussorgsky: Prelude to Khovanshchina
-Khachaturian: Masquerade Suite
-Eric Coates: London Suite

It's gonna be good!

My muddled thoughts

I'm back in London and I'm working my ass out for the resit. The whole thing is such a weird, surreal experience. It seems like all my confidence is out of the window. Nothing I do seems to give me any satisfaction. No matter what I do to improve, there's always something stupid I'd say or do. Why am I so insecure about my abilities? This has never been a problem before.
Just over a month ago, I was a completely different person. The exams did not scare me one bit. (well to be fair to myself I did do well in the written papers, I just managed to fail the OSCEs)

The resits are in about 2 plus weeks and the thought of it freaks me out. I do not want to face it but I will have to to keep my place in this school.

Meanwhile, some complete morons have been trying to fix the boiler without any success in the flat. (for the past 3 days!) How hard could it be? The flats a complete mess.

I am missing the comforts of home at the moment!

MBBS Part 3 Exams

BL 3rd year medics had 2 painful weeks of exams starting the 30th of June. Most people found them horrifying but i thought they were ok, save for the 5 minute OSCEs! I couldn't have screwed up more in them!

Recollection of the OSCEs
Paper Bii (5 minute stations)
Lost of Weight History

• thought i did well in this
• established that the patient has lost weight, has tremors, palpitations, anxiety, irritability and heat intolerance
• has family history of thyroid disease and vitiligo i think
  
• diagnosis: hyperthyroidism due to Graves disease
  

Penicillin Allergy Hx

• patient was annoyed due to reaction post flucloxacillin i think
• established all the symptoms post Abx
• established previous reaction with penicillin
• explained that she's allergic to penicillin and should move on to another antibiotic
• at the end of the station, Dr Epstein asked me: "Did you get the money?" I was so puzzled! What money? So I said "No, I didn't." Then he said, "To buy the double bass?" Then it clicked that he was asking about the orchestra, something completely unrelated to the station! Buat aku panic je

Handwashing station

• what more to say?

COPD history station

• I thought I was doing well and asking about everything there is to ask about sputum (colour, amount, blood, smell)
• but at the end of the 5 minutes, I saw the examiner marking a whole column of 'N's instead of 'A's (with the most bored and annoyed look on her face)
  
• fuck

Blood taking

• went to the station and saw the fake arm, so started saying to the examiner: "I would ask the patient's name and identifiers such as date of birth..." and she stopped me and asked me to talk to the fake arm
• so I did, and it felt weird! Hello Mr Smith, would it be ok for me to stab you and bleed you?
• Didnt get the blood from the Antecubital fossa. bodoh
• Second attempt was panicky but got blood
• Should've passed i thought
  

Oxygen therapy

• man comes in with Status Asthmaticus
• pick and explain the best method of oxygen delivery
• I went for highest flow venturi mask (but i think i should've said non-rebreathing bag)
  

Breast Examination

• saw a woman patient and thought: " wow i didn't expect to have real breasts to examine"
• then after i got consent etc she took of her blouse and was wearing strap on fake breasts!
• the right nipple was missing, but since the instructions said only examine the left breast, I didn't even comment on that (should've said "obvious ulceration to the right nipple!")
• examiner smiled, so i thought it was ok

Diarrhoea History

• young woman with watery non bloody diarrhoea 2 weeks post eating undercooked chicken at a barbecue
• she was worried about cancer! what?
• I completely ruled out cancer and told her she most likely has infective gastroenteritis probably due to Salmonella

Haematuria History

• young man (30 years old) with excrutiatingly painful ureteric colic and haematuria
• from the history i took, i diagnosed nephrolithiasis and told the patient it's common
• he was worried about bone cancer, and i stupidly ruled it out without even giving it much thought. trying to be too clever
• must've failed this one
  

Male catheterisation

• the minute I saw this, I started laughing incredulously: the last time i ever did such a thing was PPD which is bloody months ago!!!!
• stumbled the whole way and the examiner literally told me what to do

Results
-Failed paper B (osces) by one station!! Fuk
-Was such a shock to find out. Like being struck by lightning....

Oh crap- resits
Bye bye summer!