2nd Day of Elective

2day is great too!!!! Reached the hospital at 8.35am, rushed into Dr. Lim's room, thought that we were late, but there was no one inside, lol. The nurse told us the doc usually come at about 9.30am, swt. So we just sat there, then wandered around the hospital to kill time. Finally, Dr. Lim came. Yeah, went inside the room,a old lady came in, complaining about pain from the back down to the front right iliac fossa, and progress down the right leg 3 days ago. Past medical history involves gallbladder operation. There are some cysts in her kidneys(bilateral). The doc said that the pain most like ly not due to back bone pain.A male patient came in, complaining of recurrent swelling and discharge of perianal fistula. Last time he saw Dr. Lim was on 2002, then between 2002-2005, everything is cool, but after that the problem returns. He is a busy person, so he bought cream to apply and it does help to relieve the pain. MRI need to be taken to locate the fistula ulcer of where is it links to, if it is a low fistula, then simple surgery will be done.If it is a long fistula, then more complicated surgery need to be done. We then got to see Colonoscopy.It is like playing a video game, doc's hands need to be agile, haih...I wish I can train my hands more. Midazolam(generic)-Dormicum(brand) was given to the patient before the colonoscopy was done. They found some polyps inside and took it out for biopsy, no tumor was detected.Guess the yellow thingy are what? They are faeces, haha! Besides, that, we got to see the machine for ESWL (Extracorporeal Shock Wave Lithotripsy)-a technique that employs high energy shock waves to disintegrate urinary stones in the body into fine particles so that it may pass spontaneously out of the body through the urine. The procedure was stopped when the X-ray taken showed that the location of the stone is not consistent, so they need to take MRI first to locate it. Side effect after the procedure is usually haematuria 2-3 times a day but will disappear spontaneously after few days. O ya, we got to see Laparoscopic Cholecystectomy on an old women , it is damn cool wei. Imagine watching live to see how the surgeon trying to burn the fats around gallbladder, clip the cystic duct and cystic artery, cut them, twist here and there, operation took over 1 hour, again the surgeon is playing video game again, haha. We got to touch the gallbladder and gallstone. The stones are black, very hard and with irregular surfaces, wow...



Hehe, 2day we also got free lunch, thanks to the Clarithromycin Talk!!! The talk focused mainly on the Immunomodulatory effects of Clarithromycin, almost all the specialist docs were present there, wow...cool!! We followed Dr. Tang (Cardiologist) to visit ICU (Intensive Care Unit). There was a patient who admitted the day before because of acute MI. The doc is good, he taught us how to think and make diagnosis, for them, when the phone call came, said patient came in after badminton,Complaint gripping pain,breatlessness, sweating, low BP, the doc then said OK, hang up the phone then straight away drive to hospital,ECG graph pattern, angiogram picture of the heart vessels were all printed in his head and to no surprise edy, damn cool...He helped the patient to do angioplasty and the blood can then flows through. Time is myocardium!!!! Every seconds count, the more you delay the time, the more heart muscles will damage, that's why time is really very very important in CVS case.How you going to explain in lay man term to the patient if they don't understand? You just use to describe the house (heart) is on fire(damaging in process), can you ask the Bomba to come 2moro (recover the vessels), nope right?? haha...Dr. Lim bombed us with lots of questions(medical and non-medical)--What is dermatome? How many segments of spinal nerves and spinal veterbrae? Where we did our Pre-U course? What we got for our Pre-U course? Is EOS 3 tough? What we got for it? Lol, we didn't answer the last question.


Lesson of the day:

Dr. Lim (General Surgeon) said:

Medical students should learn how to internalise the information and knowledge, not just study for exam. Know the significance of it!!! We cannot forget the knowledge after we have studied. They are all important to save lives!!!!

Typical Malaysian students are afraid to ask, shy. We should talk more, don't be afraid of wrong but dare to ask. Don't let the language difficulties or barriers prevent us from asking! There is no harm but only gains in asking more questions!!!!

English is a very important language especially for overseas students. We must master the language itself. Communication skill and teamwork are vital. without them, no matter how knowledgeable you are as a doctor, you are guaranteed not a good doc and no one will like you.

Acute Coronary Syndrome: Unstable Angina, ST elevation of MI, non ST elevation of MI

Why is surgery only developed after (Year 1820-1840??) in Sarawak---because anesthesia was introduced!!!!Haha,Dr. Chew (Anesthetist) really proud of it!!!


2moro going to see surgery to remove the stone in the ureter in early morning, haha!! Cool cool! 2moro we will be splitted, I will be under Dr. Teo (Physician + partial cardiologist), Natasha will be under Dr. Lau (Haematologist) and Gaik Si will be under Dr. Tang (Cardiologist), wish us luck!!!