I babble, I ramble, and I rattle

I finally made my way back to Shah Alam today, after days of headache sorting out my belongings in Penang, mostly books I’ve collected over the years (including those that I brought back from Dublin) and Tupperware items that I accumulated since my mum forced asked me to join her.

For the past few days, when I was not busy carrying heavy boxes around, I was extremely bored that I actually played Peggle, a game that my brother installed on my laptop many months ago (which I never bothered to play) and managed to finish it. Pathetic, I know.

That was why I was so anxious to return to Shah Alam to the extent that I was not able to sleep last night and therefore was quite sleepy when I started my (lonely) drive back this morning, armed with 3 cans of coffee and a can of Coke.

Just before the Taiping (north) exit, the rain stopped and so did the traffic. Turned out there was a road block ahead.

A police officer with a red flag in one hand and a whistle in the other signaled me to join the few cars parked at the side of the road. Or so I thought.

Another officer (there were at least 7 of them) with a clipboard approached my car and I rolled down the window.

(translated)

Officer : (while checking his list, presumably of vehicle registration numbers) Why did you stop?

Me : (shrugged) I don’t know. (pointing to his colleague) I thought he asked me to?

He continued to flip through the papers on his clipboard. At that time, I was really worried that I would get a speeding ticket because there was a point when I didn’t realise that I was driving at 125km/h (the speed limit was 110 km/h and my regular cruising speed is 110km/h with the occasional 120km/h when I’m overtaking) until I saw cars coming from the opposite direction flashing their lights.

You see… I’m the kind of unlucky person who gets punished the moment I do something wrong. For example, I’ve only parked illegally in Penang for a grand total of ONCE and I get a parking ticket for that. My friends have parked at the exact same place countless times and they have NEVER received any love letter from the city council. EVER.

Officer : Are you moving (house)?

I didn’t even get the chance to answer his question as he immediately continued with his next statement.

Officer : Ok, you can go now.

I was really curious to know what was that all about but he never gave me the chance to ask as he uttered his last statement while walking away from my car. And stood directly behind it. How stupid was that? I had to reverse my car in order to leave that area and of all places, he chose to stand behind my car. Even when I started to reverse, he made no attempt to move. Luckily I had (just) enough space to turn the car and therefore my ever so outrageous imagination of being charged for running down a policeman in front the public and his colleagues remained just that… my imagination.

Just a few kilometres down the road, it was raining cats and dogs. I was really amused on the decided place for the road block. Just like the reason for the road block and whether my car was in their list or I simply misunderstood the officer’s signal, I would never know whether they were really smart (to choose that particular spot) or it was just plain luck that it wasn’t raining in that area.

I was more bored than sleepy during the journey but in a way, I think driving alone is better than having a company as you get to sing to your heart’s content (i.e screaming at the top of your lungs) and yet no one would tell you to stop.

Boredom aside, I was having troubles suppressing the urge to stop and take pictures of the amazing sceneries along the way.

My particular favourite was this one:

Imagine you’re driving between two small green hills, one on your right and the other on your left. It is drizzling. A limestone hill looms right in front of you (the road is curved so don’t worry about driving right into it); the glistening white limestone a stark contrast to the greeneries that managed to flourish on the rocks and the two green hills on either side of you.

On the left of the white-and-green hill, angry looking grey clouds covered the sky but on the right was the clearest and bluest sky that you can find in Malaysia with clusters of the whitest bright clouds (only of the cumulus type) that you can imagine that looked as if they were made of the softest and most luxurious balls of cotton (is there such a thing? The cotton part, I mean).

Hard to imagine such a thing? I know. I’ve never seen anything like it before. That was why I was SO tempted to stop the car to take a picture of that magnificent view but I drove on instead.

In Ipoh, I was greeted by a new toll plaza (hey, I haven’t been back to Shah Alam for months!) and it took me a while to register that particular fact that by the time I thought it would be nice to take a picture of the old plaza with the new one at the background, it was already too late. I snapped some pictures after passing both the plazas anyway.

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The exciting thing (at least to me, the bored driver) was that we get to use the new lanes and the original two lanes became a huge divider from the other side of the traffic.

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I think the last time I came back to Shah Alam was in February this year and that time, they were just starting to chop down the huge shady trees lining the road leading to my house but nothing prepared me for this:

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It looked… BOTAK (literally translated, bald) and very alien.

Last time the road looked similar to this (but already with two lanes for each side of the traffic):

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I don’t know this place anymore. Even the playing fields where we frequented when we were still in school are now gone to make way for new houses/ apartments/ shops. When I was 11, me and my best friend at that time, F (we lost contact since she moved to Sweden (I think it was Sweden) because at that time we didn’t have emails and both of us were simply too lazy to write) would frequently visit this one particular field near my house and climb the trees. Then we would continue our daily activities (telling stories/ jokes, reading, playing) on the trees. We even studied for the end of term/ year exams on the trees. Now on the exact same place where the mighty trees once stood are terrace houses. Sad, isn’t it? Especially when we, even as kids (consider the size ratio factor), thought that the area was too small to build anything on, except maybe a small bungalow.

Anyway, despite the changes in the neighbourhood, our household activities remain the same. Many of my friends have likened my house to a cyber cafe especially during those times when we had three (was it four?) desktops around, two of which were placed almost facing each other.

Now that reminds me of a funny thing that happened between two of my brothers. They were playing Command & Conquer (or something similar) against each other on the two desktops in the family area upstairs. They’ve been playing for more than an hour when my dad went to check what they were up to.

(translated)

Dad: Are you guys playing against each other?

X : Yeah.

Dad : Then how come your army is based in a city but his is in a jungle?

Both brothers : Huh?

They went to look at each other’s monitor.

Both brothers : No wonder I’ve been searching for him for ages but couldn’t find him despite having explored most of the map!

Turned out they loaded different maps and therefore were playing in different places. There was no way that they were going to be able to find each other, regardless of how many hours they’ve played. So much for wanting to play an honest game!

Note : Previously they’ve accused each other for cheating by having peeks at the other person’s screen and that day they made a pact to play honestly.

Tonight wasn’t much different from any other day. My dad was engrossed in uploading the pictures of his recent trip to Saigon and my mum was busy updating her blog (yes, I know her screen shows that a game of Solitaire was in progress but I assure you she was updating her blog; at least before I took this pic) while my brother chatted on his laptop which was connected to the TV so that we could all watch Planet Earth, a documentary series by Sir David Attenborough which he had just finished downloading. My sister, however, was not hooked to any computer. She was busy playing the DS.

Earlier on, my mum sat right next to my dad, both of them were doing something on their laptops. If you think that a person who chats on Yahoo Messenger (YM) with the person who sits next to him (reminds me of my case with my housemate, F. We would spend hours chatting with each other on YM even though she was in the room next to mine) is a bit not right in his head… What about someone who sits next to each other without any barrier whatsoever and yet chats on YM with the webcams on? I thought that was extreme enough but the best was yet to come. My dad asked my mum to do a voice chat (on YM) with him. And I repeat: They were sitting right next to each other.

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Yes, we call our house a cyber cafe. Or is it the other way round? And I love this place to bits.

Note: My mum asked me to cook meals for the family while I’m home and my dad sarcastically remarked that from tomorrow onwards, my blog posts would only about the foods that I cook. We’ll see. In fact, I don’t even see myself cooking anything tomorrow. I would need to recuperate from my jetlag 5 hours of driving first, wouldn’t I?

This would be my last post from Sri York, my home for almost 2.5 years.

Today my housemate went to terminate the phone line and internet services but due to some misunderstanding of our contracts, was only able to settle the phone line. She We thought the free item that we received upon signing up almost 2.5 years ago (yes, THAT long ago. So who can really remember which one was which?) was the modem and the phone was supposed to be on loan. Therefore she only brought the phone with her but not the modem. Turned out it was the other way round. The phone was free but the modem was on loan.

She was told to bring 5 items in order to terminate the internet services.

1. modem
2. charger
3. splitter
4. 2 cables

We had no problems finding the modem and charger despite not having used them for 2 years as another friend just borrowed them from me a few days ago and promised to return them today, which she did. The splitter was still in use and therefore we didn’t even have to search for it. The 2 cables, however, proved to be a problem. I’m not sure if either my friend couldn’t recall what cables were specified; or she was not told specifically which cables… Either way, we have no idea which cables to give them back.

There are several cables in use and a few others just lying around, untouched. Some came from my modem/ router box and the rest either came with the TMnet modem or my housemate’s wireless access set. Identifying which cable belongs to whom became our ‘puzzle of the day’.

She’s going to the TM Point again tomorrow to settle everything. Meanwhile, much to our surprise, the phone line is still working and we can still access the internet. Being the sentimental person I am, I decided to post something tonight (so that I would always be able to look back on my last day of internet access from my Sri York apartment) despite having a huge headache packing and figuring out how to bring my things back to Shah Alam.

Yes, headache. I need to figure things out by Sunday. How I wish getting a small lorry/ truck to transport my belongings back is not so outrageously expensive.

I’ve been busy playing tourist guide for my German friend, Angela for the past few days.

Day 1

Dinner at Padang Kota.

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Shopping in Feringgi.

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Late night people watching at Gurney Drive.

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Day 2

Lunch at a nasi kandar place in town.

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A trip up the Penang Hill.

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View from the station.

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View of town at night.

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Graduation party at Angeline’s place and they had a surprise birthday cake for Angeline.

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3rd day

Lunch near Gurney Drive.

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Visit to Kek Lok Si temple.

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4th day

P. Ramlee’s birth house.

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Kapitan Kling Mosque.

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Little India.

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For more pictures, please visit my GALLERY.

For now, at least.

We went out for dinner together to celebrate Anas’ and Mie’s birthday (both today) and it was a blast despite me having lost my (usual) appetite.

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Surprise! There’s a cake for you! Too bad the candles were blown off before the cake reached the table. They just pretended to blow the candles on this cake for a photo pose. To compensate (for the lack of the usual ‘candle blowing ceremony’), we let them blow the lighter instead… once for each person.

P/s: Sorry, Mie. Didn’t notice you on the right. I was too close to you guys and too lazy to get up from the chair to get a proper shoot.

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Oh, such a romantic couple…

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Hey, what were you guys looking at?

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For more pictures, please visit my GALLERY.

I had TWO externals as my examiners for todays surgery long case. One from Alor Setar Hospital and the other from Sungai Petani. One of them is a Dato’ and Dato’s usually equal to mean examiners. Usually. Not always.

K, a 4th med who’s a friend of mine was assigned the task to be my usher. He escorted me to my patient’s bed and on the way there, he sort of calmed me down by saying that my examiners were really nice. What I had to do was just clerk a detailed history and do a full examination and I should be fine. Ok… That was reassuring.

The moment I saw my patient, an elderly lady dressed in a purple baju kurung I let out an expletive in my head. Don’t tell me she came just for the exam. I wasn’t prepared for a case of I-came-here-for-the-exam. Just as I was introducing myself to her, a doctor popped in to confirm with the patient of her operation scheduled for tomorrow. Heck! Elective admission is just as bad to me.

Just my luck… The lady was not a good historian. She complained of on and off shortness of breath on exertion. When asked further, she said she has thyroid problem incidentally found during a visit to a local clinic due to common fever and sore throat. At one point she said she only get breathless due to the difficulty swallowing and I almost lost my temper there and then. She was a nice lady, really. Tried her best to help me. Too bad I could not appreciate them.

My examiners were two different people who were completely different from one another. One was thin and tall (taller than me) with greying hair whereas the other short (shorter than me) and plump one was black haired with streaks of white. They seemed nice. Well, they WERE nice.

It’s just that they were too strict and thorough in history taking and examination. I wouldn’t mind if I missed anything important in my clerking but I was stopped for very mundane and possibly irrelevant things. When I told them that the patient had no changes in her menses, they insisted on knowing how many pads does she use per day as well as the cycle and period of the menses. Well, I did say there’s no change in menses, didn’t I? Would be make any difference if she uses 3 or 5 pads a day for the past 30 odd years? Unless her cycle has been irregular, then I really couldn’t see the importance of this question. Fortunately, that lovely aunty DID tell me in detail about her menses so I was able to answer the examiners’ questions.

I annoyed them by not ruling out pre-menopausal symptoms (what are those anyway? I mean apart from irritability, moody and hot flushes which I’ve already presented? Besides, her menses are still normal) as a differential diagnosis. Well, to be honest, that differential DID NOT cross my mind at all so I admitted my mistake.

Then I said that the lady had no past medical or surgical history, to which the examiners asked if she had been hospitalised before. I said no (I lied. I didn’t even ask her of previous hospitalisations). The examiners were not satisfied with my answer and turned to the patient to ask her again. Fortunately for me, she said no… Except once when she gave birth to her only son and by then I was already so annoyed with the examiners I butted in, “And it was a normal vaginal delivery with no complications.”

When we came to social history, I don’t know what was wrong with the examiners but they really wanted to make sure that the lady only has ONE son and no daughters at all (the fact which I’ve already presented to them).

They became really frustrated with my differential diagnosis.

Examiner : So what’s your other differentials?

Me : Grave’s disease. (couldn’t think of anything else)

Examiner : What???

Me : Oops, sorry. No, not Grave’s.

Examiner : Why not Grave’s?

Me : Because Grave’s is diffuse.

Examiner : Yes. So what’s your differential now?

Me : …

Examiner : This patient presented with thyrotoxicosis symptoms, right?

Me : Yes…

Examiner : So?

Me : Multinodular goitre with thyrotoxicosis?

Examiner : So what’s your differential now?

Me : …

Examiner : Have you heard of toxic nodular goitre?

Ah, whatever! I was too distraught to pay any attention to that.

Basically we spent too much time on history that we barely had enough time for examination, during which I was further heavily criticised. They even argued between themselves on some term which I was clueless about. They made me check for proptosis (she didn’t have), ophthalmoplegia (none), lid retraction (seriously! What to check? It’s either there or not) and lid lag (also not there).

The time keeper came to inform that we only had 5 minutes left. Great! I’m going to fail this exam! Their words before we went on to physical examination did not help at all. The short one said, “You have one last chance to score marks for this exam. Make sure your examination is perfect.”

Obviously my examination went worse than imperfect.

When we proceeded to the examination of the neck, they wanted me to show them how to check for venous obstruction so I asked the lady to raise up her hands straight up to the air.

Examiner : NO! That’s not how you do it.

Me : …

Examiner : So how do you do this test?

Me : …

Examiner : You have to make sure that the arms are both medial.

Seriously. No one taught us that. I remember being taught that as long as the hands are straight up in the air, the sign will be there if it’s there.

Examiner : So what will you get if there is obstruction?

Me : Plethora on the face.

Examiner : So what do you call the test?

Me : I don’t know.

Examiner : What do you mean you don’t know?

Me : I don’t remember the name.

Examiner A : It starts with an ‘A’.

Examiner B: No, ‘P’.

Examiner A : ‘P’? Not ‘A’?

Examiner B : No. It’s ‘P’.

Examiner A : Oh yeah. It starts with a ‘P’. So what is it?

Me : I don’t know.

Examiner B : Pemberton’s sign.

Me : Oh, yes. Pemberton.

Examiner A : How can you not know the name of the person who discovered the sign?

Me : …

Examiner B : Well, at least she knows the sign.

Examiner A : Ok… ok…

Oh, whatever. I didn’t care anymore. I just wanted to get out of that place as soon as possible.

Examiner : Would you like to do auscultation?

Me : Yes, I would like to auscultate for bruit.

Examiner : What bruit?

Me : (not thinking straight at all) Carotid bruit.

Examiner : What???

Me : Oh, no. Sorry. Thyroid bruit.

I think that was some sort of spinal reflex. I’m so used to repeatedly say “listen for carotid bruit” that I simply blurted it out without thinking.

They weren’t done yet.

Examiner A : Now show me how you do a lymph nodes examination with running commentary.

Me : … (I was totally clueless on the names of the neck lymph nodes but proceeded with the examination anyway)

Examiner A : What’s the lymph node that you can find there?

Me : Pre auricular…

Examiner A : Huh?

Me : Oh, no. Post auricular. (mumble… mumble…)

Examiner B was kindly enough to provide me with the running commentary while I remained quiet.

By the time we were done with lymph nodes, 20 minutes were gone.

Examiner : So how would you like to investigate this patient?

Me : I would like to do an ultrasound scan to confirm if the mass is cystic or solid. Then…

Examiner : (cutting me off) This is a thyroid case!

Me : (with a resigned look) Thyroid function test.

Examiner : What would you expect to find?

Me : Raised T3, T4 and suppressed TSH.

Examiner : Why?

Me : TSH will try to control the levels of T3 and T4 and therefore would inhibit their production…

Examiner : (cutting me off again) What? TSH inhibits T3 and T4?

Me : (bored look) No, sorry. What was I thinking… High levels of T3 and T4 inhibits TSH production.

Examiner : Ok. Thank you.

Me : Thanks.

That was the end of my disastrous surgery long case examination.

By the way, I would like to thank K who had been very helpful to me during the exam. He even mouthed the words ‘multi nodular goitre’ the last time he checked if I needed anything. That didn’t help much as I already had the diagnosis but I really appreciate the help. Surely did boost my confidence. Thanks, dude.

Oh my, I’ve written a lot! And this one is going to be a VERY long one. If you don’t have plenty of time, DON’T read this (yet). Consider yourselves warned.

Yesterday was my medicine clinical exam day which took place in Seberang Jaya Hospital. As usual, I car pooled with my usual partner, Pushpa and her housemate Menaga. Menaga’s session would be the first (i.e at 8.30am) and therefore we had to leave early to be there by 8.10am. Menaga began to worry as we were barely moving on Jalan Masjid Negeri (we left my place at 7.40am) but fortunately the traffic gradually cleared up as we neared the bridge.

Arrived in SJH at 8.10am. We thought we were supposed to report at the clinic but no one was there so we went upstairs to the medical ward. By then it was about 8.20am already. Still, we found no one. Not even Mus & Ijah (also first session) who had arrived earlier than us (they arrived at the hospital when we were still on Jalan Masjid Negeri). Then, we began to worry. What if they’ve been brought to the patients? That would mean that Menaga was VERY late.

We went back to the clinic downstairs and decided to wait there. Others started to arrive and joined us. Out of boredom, someone commented on X’s shoes.

A : Wow, your shoes are SO shiny!

X : Yes. B gave me these.

A : Oh, so nice to have a wife… Hey, Y! Maybe you should get married too. Your shoes are not as shiny as X’s!

Y : (with a solemn tone) My dad gave me these shoes…

Surely had a good laugh. But not before a moment of silence to absorb what Y said.

Then we saw PMC staffs starting to arrive. We weren’t late. They were.

After registering our names, me and Pushpa went to the cafeteria to have a drink while trying to read whatever thing that could still be crammed in at that moment. Andrew came to join us soon after that and Tiff and Zara arrived just after Andrew left for his session.

We reported to Nancy 20 minutes before our turn and handed in our phones. It was surely an amusing sight, seeing her carry around a plastic bag full of handphones of different makes and models.

I was brought in to my patient 5 minutes earlier than scheduled. A cute Chinese male doctor approached me at the corridor (where we were supposed to wait for our turns).

Dr : Nuraini?

Me : Yes, that’s me.

Dr : Ok, come. I’ll bring you to your patient now so that you can have some extra time with him.

Grabbing my bag and following him into the ward. He seemed intent on immediately bringing me to the patient.

Me : Errrmm… Excuse me… Can I put my bag in the quarantine room first?

Dr : Oh? Errmmm… Well, ok. But do not make any contact with anyone inside.

Me : Sure. I won’t even look at them. I promise.

He followed me to the quarantine room, standing at the door to make sure I did not ask my friends what cases did they get. Then he escorted me to the other ward to see my patient.

Dr : Your patient is a very young patient.

Oh, “great”! A paediatric case. Thalassaemia, perhaps? Now, what do I ask for history in thalassaemia cases? Despite having passed my paediatrics posting, I’ve never clerked a thalassaemia case before.

Dr : Ok. This is your patient. Let me know if you need anything, ok?

Me : Ok, thanks.

I introduced myself to the boy and began my questioning.

(translated)

Me : What made you come to the hospital?

Boy : Penat.

I went blank for a while. Penat can mean anything.

Me : You mean shortness of breath?

Boy : Yes.

Cool. That made me 95% sure it was an asthma case and I began asking him questions in detail. He was a very smart 13 year-old who attended a boarding school in Kulim (now I can’t recall the school name) but his parents decided to take him out and send him to a local school since he started having severe asthma 2 months ago. He knew the names of all his medications. He was supposed to be on steroids to control his asthma but his staff nurse mother discouraged the use of steroids and he has not been taking it for 1 month.

I was done clerking within 20 minutes and I didn’t do a full respiratory examination since I did not expect to find anything much except generalised ronchi so I simply listened to the lungs.

A few minutes later, the cute doctor popped in, asking, “Are you still in one piece?”

I couldnt help but laugh, “Yeah, I guess so.”

Then I began to organise my history and re-write them on a different sheet of paper. After all, I had much time to spare.

(translated)

Boy : What are you doing?

Me : Oh, I’m just rearrranging your story in a systematic way and rewriting them so that I wouldn’t get confused when I present your case later.

Boy : Oh? But the abang before you didn’t do that.

Me : Well… Perhaps he didn’t have much time left.

I continued writing while having an idle chat with him… About school, his hobbies, etc.

Me : So how much are they paying you for volunteering yourself for our exam?

Boy : RM20.

Me : Per student?

Boy : Yeah. But it differs between patients. The older they are, the more they get.

Me : …

Boy : Can be RM40, RM50… That uncle over that side is getting RM70 per student and the other uncle at the end of the ward was offered RM100.

Me : Wow!

Boy : (whispered) Don’t tell anyone I said this but I think that uncle is stupid for declining the offer. It’s RM100 per student!

Me : He IS old and sick, isn’t he?

Boy : Well, he can just agree to take ONE student. At least he gets RM100.

Me : (LOL) Ok… But we have to pity him too. Maybe he’s too tired to talk.

Boy : Yeah, I’m tired of talking too. I have to repeat the same thing over and over again.

Me : At least you get some money…

Boy : (grinning) Yeah!

Me : Don’t worry. I’m the last one. No more after this.

Boy : Really??? Yay! (could really see his face lightening up)

I wondered aloud on what else did I miss in my history.

Boy : You know what… The abang before you got scolded by the teachers (referring to the examiners) because of his history.

Me : Oh, really? What about?

Boy : I don’t know. They spoke in English and I couldn’t understand their slang.

Me : …

Boy : Even yesterday was like that. Not my fault. I told them everything already but they didn’t present them to the teachers. Then there was this one fella… He/ She said that I’ve been having asthma since I was 5 years old. That really confused me. My asthma only started 2 months ago.

Me : The one that you’ve been having since 5 years old is your bronchitis (his mother told him he has bronchitis since he was 5), right?

Boy : Right! One kakak yesterday did very well. She could answer all the questions.

Me : Oh, really? What did the they ask her?

Boy : I don’t know. Didn’t understand much. But they did ask on what you would do if a patient with an asthma attack comes to see you.

Just great! I didn’t read anything on asthma! Never expected to get an asthma case.

Every now and then I would ask him questions relating to his medical history when I noticed anything missing in my notes.

Me : How many pillows do you use to sleep?

Boy : I need 2-3 pillows. Otherwise I can’t sleep. But don’t mention this when you present your history. Someone said that in his/ her history and the teachers got really irritated.

Me : Why?

Boy : Not sure. But they were asking him/ her why did he/ she ask about the pillows and they seemed really irritated.

Me : Oh, ok. Why can’t you sleep without 2-3 pillows? Do you get breathless?

Boy : Yes.

I glanced at the nebuliser at his bedside and finally noticed the peak flow meter.

Me : Hey, can you do this for me?

Boy : Yeah, sure.

I didn’t even have to explain to him on how to do it. He already knew it. I asked him to do it twice.

Boy : Thank god you only asked me to do twice.

Me : Why?

Boy : I wouldn’t be able to do it the 3rd time.

Me : Whoa! That bad?

Boy : Yeah.

Me : No wonder your second reading was worse than the first.

Boy : You know… When you present your case later, don’t mention both values, ok? The other person got scolded because of that.

I laughed. Thanks for the tips!

N/B : For those who don’t know… When we do peak flow measurement, we’re supposed to take the best reading.

He looked at my notes and could not contain his amazement.

Boy :You sure do have to ask a lot, don’t you?

Me : Yeah… (sighing heavily)

Boy : If I were you, I’d get very tired doing that.

Me : Well, what to do… I have no choice. Oh, what else did I miss here??? (made some panicky gestures)

Boy : (chuckled) I think the person before you panicked as well. That’s why he almost fainted when he was presenting his history.

Me : Oh, really?

Boy : Yeah. (laughing) Then the teacher told him to sit down and asked whether he has had his breakfast.

The alloted time was almost up and we were talking about something irrelevant to the exam when he blurted out that he gets breathless climbing the stairs.

Me : Why didn’t you tell me this earlier?

Boy : (shrugged and with a mischievous look) Well… The doctor told me not to tell you anything if you didn’t ask.

Fortunately I still had enough time to assess his reduced effort tolerance.

Soon after that, the cute doctor came to ask me, “Are you ready?”

As if I had a choice! The examiners were already with him.

I think it went ok. I fumbled with quite a number of question (told you I didn’t read on asthma at all!) but the examiners ((Dr?) Michael Keane from UCD and Dr Anita (from SJH?)) were kind enough to give me hints. I was asked on the acute management, possible complications, pharmacological therapies (I only remembered beta-agonists and steroids) and assessment of asthmatics in the hospital before deciding to discharge them.

MK : So what other drugs can you give for asthmatic patients?

Me : Errrmmm… Br… Br… What’s the name of that drug… Bromocriptine… No, not that… What is it…

MK : You mean ipratropium bromide?

Me : Ah, yes! Ipratropium bromide.

MK : Ok… What else can you give?

Me : (totally blank already) What else… Errmm…

MK : What about the inflammatory mediators?

Me : I’m sorry? (his voice was soft and I wasn’t sure if I get the question correctly)

MK : What are the inflammatory mediators involved in the disease?

Me : Oh… Interleukins… Leukotrienes..

MK : Yes, leukotrienes. So what other medications can you give for asthmatic patients?

Me : …

MK : Something that opposes the leukotrienes…

Me : Yes… Leukotriene antagonists…

MK : Yes… Can you give me one example of the drug?

Me : C… Errmm.. C…. I’m sorry. I don’t know.

MK : Cromoglycate, yes?

Me : Haaaaa, yes! Cromoglycate!

I was also asked on the side effects of steroids treatments and I went on about Cushing’s and immunological effects.

Dr Anita : What else? Particularly in this boy? Why do you think his parents told him not to take the steroids?

Me : … (mumbling something about the pituitary axis suppression)

Dr Anita : He’s 13 and still growing. What do you think will happen to his growth?

Me : It would be inhibited.

Dr Anita : Yes, short stature. That would be the main concern of many parents.

MK : What if he’s a 70 year old man? What would you be worried about?

Me : Errrmmm… Osteoporosis? (really couldn’t think anymore)

MK : Errrrmm… Well, ok… Steroids can cause osteoporosis… What else?

Me : …

MK : What about their vision?

Me : Loss of vision?

MK : Yes… Why?

Me : …

MK : Do you think they’ll get cataract?

Me : (semi-shouting) Ah, yes… CATARACT! Totally forgot about it.

With that, they concluded my interview. I was very lucky to get such nice examiners.

We went for lunch at the hospital canteen and shared our stories. Andrew was complaining about his patient who could only speak Hokkien and he had a hard time trying to find out his (medical) problem. Frustrated, he decided to examine the patient first to get some idea on what he might have.

No wonder when I was clerking my patient, I heard Prof M (Andrew’s examiner) coming to the cubicle a few times asking, “Andrew, are you ready?”

He then asked Pushpa (her patient was beside his, 2 beds from mine) why did she suddenly speak English with the patient.

Andrew : Your patient can speak English???

Pushpa : Yeah.

Andrew : And they gave me someone who can’t speak English… Can’t speak Malay… And speaks only Hokkien???

All of us laughed.

Andrew : So stressful. I was listening to Pushpa and Zara clerking to their patients in English and I could hardly understand my patient.

Me : (laughed) Yeah, I kept hearing Pushpa’s questions too.

Pushpa : Sorry…

Pushpa told us that the examiners made her examine the patient from the left. Must’ve been really awkward. And she was carrying her stethoscope box (in which she put all her tools stuff for physical examination) when she bumped into Prof M who amusedly asked, “Did you just buy your stethoscope?”

Andrew told us he knelt down to examine his patient’s abdomen because there was no chair and Prof M actually said, “Hey, what are you doing? Its dirty. Stand up. Stand up.”

I told them my patient’s story about someone almost fainted before me and the person admitted that it was him. Andrew added some details to the story (Andrew’s patient was 3 beds from mine and was in the middle of clerking when that person was examined. He heard what was said by the examiners).

One interesting observation during lunch was… many didn’t finish our food, including ME. I was hungry but lost my appetite. I had to struggle to eat that much little.

We went to wait for the afternoon OSCE at the clinic. The time was spent on discussing examinations, particularly for endocrine and neurology cases.

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Just after 1pm, we were asked to leave the clinic (aircond) and wait at the corridor (extremely HOT) because the patients for OSCE were arriving soon.

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Whenever a patient was wheeled into the clinic, we would have a quick peek at them to see if there was any clue on what would be expected from us. My group didn’t get any of the said patients.

By 2pm, my stomach felt so uncomfortable and I became nauseous and light headed. I’ve never been that nervous in my entire life. I was sweating like crazy and the weather was not helping. There were 2 wall fans but unfortunately we could not turn them on. So I went to sit at one corner and take a nap. That really helped.

When we (my group) were finally called in, Prof M said, “Don’t worry. It’s going to be very fast that you don’t have time to worry.” Andrew replied, ” Isn’t that a cause to worry? By not having time?”

I became a parrot at my first station. Thank god Prof Lee didn’t see me doing that. The examiner specifically asked me to check the patient’s pulses, have a look at the neck and listen to the praecordium. I was so surprised by the instruction that I repeated the entire thing to him. Well, I was expecting to be asked to do a full cardiovascular system examination.

The pulses strongly suggested of aortic regurgitation (my FIRST time seeing those signs!) but strangely enough, I thought I heard a systolic murmur which would suggest an aortic stenosis. When asked for diagnosis, I answered aortic regurgitation because of the very obvious signs. Then he asked me what else did I think the patient has. I really went blank at that time. Then I remembered the murmur that I heard and correctly answered aortic stenosis. He congratulated me, shook my hand and let me out. When I left the room, the doctors outside (ushers, timekeeper), including the cute Chinese doctor from the morning session were really puzzled to see me. The time was not yet up (7 minutes for each station).

Doctor A : Eh? Out already?

Me : (making a sad face) Yeah, he kicked me out.

Doctor B : (looking very worried) Why? What happened?

Doctor C : (also with a worried look) Yeah, what happened?

Me : (laughing) Just kidding. We’re done.

Doctor A : Oh, did you get the diagnosis?

Me : Yeah.

We all laughed. Dr C asked me to wait for the bell before moving to the next station.

Second station : Please examine the patient’s lungs from the back.

The patient was already sitting facing the wall (showing me her back) and therefore when I went to greet her and introduce myself, I didn’t really see her face and missed the entire scleroderma thing. After presenting my findings, the examiner asked me to listen to the lungs again. Turned out I missed the coarse crepitation on the right lung base (initially I only heard the one on the left). When asked for differentials, I never mentioned fibrosis because I thought the crepitation fibrosis is usually fine. Did think of it, though, because he kept asking for more differentials. But I never mentioned it. He gave me the answer when the bell finally rang.

3rd station was an abdomen station. I saw the girl’s face and thalassaemia immediately came to mind. I managed to find the liver but span was only 9cm (still within normal limits in adults) so I brushed off my finding that the liver was palpable 2 finger breadths below the costal margin (hence a hepatomegaly). I felt the tip of the spleen but when percussed, it was resonant so I thought it couldn’t be the spleen. I must’ve imagined it. However the Traub’s space was dull.

When asked to present my findings, it wasn’t Prof M holding the marking sheet. It was the cute doctor. Prof M was nowhere to be seen. I don’t know why but I sort of blanked out. I totally forgot that Traub’s space was definitely dull and stupidly said that there’s no splenomegaly. Prof M reappeared when I was in the middle of my presentation. He countered my findings and I panicked. He asked me to examine the patient again but this time he only allowed me to check for one organ. He asked me which one would it be… liver or spleen? I said liver. Then I regretted my decision. I should’ve picked to reexamine the spleen.

Just when the bell rang, he asked me what diagnosis would I consider in that case. I said thalassaemia. He then asked if I would expect to find the spleen. I said yes. Just before I left the station, he said, “Don’t worry too much about this station, ok?”

Yeah, right.

The next station was a neurology station which was weirdly situated at a corridor behind the consultation rooms (you do know that doctors have their own routes to move around in the hospital, right?). The opening statement was, “This patient presented with walking difficulty and his speech is difficult to understand. He has a long history of hypertension. Please examine his upper limbs.”

I was fooled into thinking that the uncle had Parkinson. His left hand looked like as if he had pin-rolling tremor. I thought I couldn’t see it on the right hand because he held it on his hip. Chaon told me today that she noticed that as well and started to comment on it but the examiner brushed it off, saying that he was just playing with his hand. Bad uncle!

Anyway, I had my mind set on Parkinson and tested for bradykinesia. It was positive. I proceeded to check the tone of his upper limbs. No rigidity. Puzzled, I turned to the examiner. I know I looked pathetic. He was trying his best not to laugh at me but at the moment I said there’s no rigidity, he burst out laughing and said, “Well, I wouldn’t expect him to have any rigidity.”

I became more confused than ever. How can Parkinson disease NOT have rigidity?

Then I asked the patient to walk. His gait was stable and looked as if he was shuffling (don’t tell me he made that up as well just to confuse us like what he did with his fingers!) and when I asked him to turn, he turned like someone with Parkinson would do. My mind went blank. What did he have?

Then I thought of cerebellar syndrome. But I couldn’t recall what signs do they have except staccato speech (because I was asking people whether it is word staccato or syllable staccato before the exam started. We ended up asking Prof M and he said he didn’t know. He added that it’s ok for HIM (he’s an endocrinologist) not to know. Arrgh, evil!) so I asked that uncle what did he have for lunch. I couldn’t understand a single thing that he said and the examiner was really really having a good laugh. He said, “Didn’t I tell you that the patient presented with incomprehensible speech?” I would have laughed as well if I was not desperate for a diagnosis. I screwed up with 2 stations already. I had to pass this one.

Think… think… think… What else?

Then I FINALLY remembered what hand signs may be elicited from someone with cerebellar syndrome. They were ALL positive. VERY positively positive. No doubt whatsoever. All the while the examiner was grinning from ear to ear. He seemed amused by my performance.

Examiner : So what would your diagnosis be?

Me : Right cerebellar syndrome.

Examiner : (laughing) Good. So what other signs may be found in a patient with a cerebellar syndrome?

I listed them down. And he asked about further management.

Examiner : What do you think is the cause in this case?

Me : Errmmm… stroke?

Examiner : Ok… cerebellar stroke. What else?

Me : …

Examiner : Remember that he’s Chinese. What else would you consider in his case? (making a drinking gesture)

Me: Oh, alcohol! (half laughing because he actually gave me the answer)

Examiner : Ok. So which one do you think is the more likely cause in this case?

Me :Stroke?

Examiner : Why?

Me : Errmmm… Because he has history of hypertension? (really really couldn’t think of anything else anymore) I don’t know.

Examiner : He has hypertension. What if I tell you he has been having atrial fibrillation?

Me : (starting to grin) Is he on warfarin?

Examiner : (grinning) Yes, he is. Why would that be important?

Me : Because then I would suspect haemorrhagic stroke as a likely cause.

The bell rang.

Examiner : Was that the bell? Ok. You can go now.

Turned out that was just the first bell at 6 minutes. I still had 1 minute left. Ceh! That was the problem having a station at such an isolated place. We couldn’t be sure whether the bell rang because it was rung or simply because someone was carrying it around.

My last station was with the mat saleh examiner who examined me in the morning. It was definitely a spot diagnosis. The fingers were grossly deviated to the ulnar side and there were lovely boutonnierre, swan neck and Z deformities of the fingers. That was my first time seeing a rheumatoid arthritis patient and the signs were so obvious I didn’t have any trouble diagnosing it.

However, I did have problems examining the hand. I didn’t really know what to do. What really frustrated me was that I knew I had to assess the function of the hands but I didn’t know how. Only on my way home did I realise I was supposed to ask her to open the buttons on her blouse (my friends said she wasn’t able to). Damn!

I was asked on the management of the disease. I listed them down.

Examiner : So what kind of drugs do you use to treat this condition?

Me : Errmm… That long named class of agent… Disease… errmmm… alter… errrrmmm… D something…

Examiner : You mean the disease modifying antirheumatic drugs?

Me :Yes! That’s it!

Examiner : So what examples do you know of these drugs?

Me : (remembering the page in a book but not the contents) Errmmm… penicillamine and gold (I know it should be much lower in my list but I couldn’t think of anything else). But not very widely used anymore.

Examiner : Yeah, well… But people still use it even though not as much as before… So what are the side effects of these drugs?

He was so nice to let me off with those answers. Then the bell rang which signified the end of the medicine OSCE and therefore the end of medicine clinical exams.

Many were amused that they saw many things for the first time on the final exam day. I myself have never seen the signs for aortic stenosis and aortic regurgitation (much less both together) before. During the OSCE was also my first time seeing scleroderma and rheumatoid arthritis patients and my first time eliciting cerebellar and extrapyramidal signs. We concluded that 1 day of OSCE taught us much more than 2 weeks (we get 2 weeks for each posting, i.e. cardiovascular, nephrology, neurology/ endocrinology, respiratory/ haematology, infectious disease/ rheumatology) of hospital attachment.

Someone wondered, “These patients had really good signs. Where have they been hiding all this while?”

I laughed, “They’ve always been there at the clinics. Too bad we’re usually too lazy to go.”

Well, for one thing, people expected us to be in the wards and we didn’t have much time allocated for clinics attachments. Secondly, even IF we had clinics attachments, the clinics would be too crowded with patients that our presence would make the congestion even worse and the doctors would be too busy to entertain us anyway. In fact, chances are they’ll get annoyed at us and we wouldn’t like that to happen. Therefore it’s safer to stay away from the clinics. Well, that’s our logic, anyway.

Q shared her OSCE story. She said she saw the scleroderma patient and immediately set her mind to pulmonary fibrosis (which is associated with scleroderma). It didn’t matter what she heard on auscultation (I think she said she didn’t hear anything) but she reported fine crepitations and therefore her diagnosis would be pulmonary fibrosis. The examiner (he’s quite nasty) got pissed off at her because she said the crepitations were fine instead of coarse.

She saw the thalassaemic patient, knew it was thalassaemia from the patient’s look and with the diagnosis in mind, she examined the abdomen. She didn’t feel anything on palpation but presented her findings as hepatosplenomegaly. Hey, cheating!

Apparently, everyone got confused at the neurology station. Everyone (at least everyone I talked to) initiallly thought he had Parkinson. Q, being the smart girl who knows almost everything (she’s our walking reference in the wards ), offered the diagnosis of Parkinson-plus.

Ah well. What was done was done. There’s nothing I could do to change anything. With that in mind, I went home and almost immediately fell asleep only to wake up at midnight to see my housemate doing some online movie quiz and I joined her. Went back to bed at 4am.

This morning, both of us woke up late and had to rush to PMC. The schedule says the viva would start at 9.30am. I arrived in PMC at 9.35am. The list was not yet out.

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Around 10am, we were told that the list will only be released in about 2 hours (how typical) so many went off for breakfast/ lunch/ shopping. The rest decided to spend the time at the library because we needed the aircond.

About half an hour later, phones rang. SMSs came in saying the list was out. Everybody became anxious and left the library together.

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Our dean made an appearance…

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And talked to some of the students.

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My number and my housemate’s were not in the list. But we’re still worried. Not being there doesn’t mean we’ve passed. That just meant we’re not borderline anything. If we passed, we clearly passed. If we failed, we definitely failed. Rumours had it that the dean said 3 people have failed the exams. Me and my housemate could still be one of the three and therefore the suspense remains.

How I envied those who were called for 2H and 1H viva. Not because I want hons (I know I don’t deserve it anyhow and it’s impossible for me to get it with my attitude towards studies) but at least I would know that I’ve passed and can sleep in peace.

Ah, well… Que sera sera.

More pictures at my GALLERY.

This came in the mail yesterday. Thanks, PMC… for rubbing it in. It was bad enough knowing I’m going to fail the exams… And you have to post about graduation now. I need a very long sleep to recover from this…

GRADUATION 2008

The date of the graduation is Sunday 6 July 2008.

Venue : Equatorial Hotel

In the event you are not attending the function please inform Janice. You will then be conferred in absentia.

COLLECTION OF ROBES

Robes will be available for collection from Paulina and Leena on the following dates and times :
Date : 23 & 24 June 2008
Time : 10.00am – 12.00pm

RETURN OF ROBES :

BY 5.45pm on 6 July 2008 at Equatorial Hotel
OR
BY Monday 7 July 2008 at PMC

The cost of renting the robes will be RM50.00. Kindly make the payment with the Finance Department. The charge for non-returned / damaged is RM200.00.

You may collect your final transcript and English translation of the NUI degree after you return the robes.

INVITATIONS

Please confirm and pay for your additional guests. (You don’t pay for the first 2 guests). It is RM60.00 for each additional guest. Pay to Saw Ching in the Finance Dept. All payments should be made by 26 June 2008.

CARDS

When you have paid, you may collect the invitation cards from Nor Hasliza at PMC Reception. One card will be given for the 2 non-paying guests, and one each for the paying guests.

REHEARSAL

There will be a rehearsal on Sunday 6 July 2008 at Equatorial Grand Ballroom starting at 10.00am. It is important that you attend as there is quite a lot of protocol you should be familiar with and to ensure that you know what to do during the conferring.

CONFERRING CEREMONY

You have to be ready for the procession by 2.45pm sharp. The procession will start without you if you are late. Report to the Equatorial Hotel by 2.15pm. Ensure you have enough time to robe. The robing room is at Bayan Room. Staff will be on hand to help you robe.

Seating for your guests will only commence at 2.15pm. Please note that as this is a solemn ceremony, children under 12 years of age will not be allowed into the ballroom during the ceremony.

PHOTOGRAPHY

There will be a professional photographer taking the photo on that day. A set of photo will cost RM60.00 inclusive of postage. The set consists of :
- 2 x 4R (Group without Academics and Self)
- 2 x 8R (Group with Academics and Self)

Pay to Saw Ching, Finance Department and indicate to her, your mailing address and contact number.

ENGLISH TRANSLATION OF NUI DEGREE

English translations of your NUI degree has been pre-ordered from NUI and this will cost €50.00. Kindly make the equivalent payment in RM to The Finance Dept to obtain your copy of the English translation.

HOTEL BOOKINGS

If your guests are interested in staying at the Equatorial Hotel, you can book through the Hotel’s Reservation Dept at 604-643 8111. The room rates applicable for PMC Conferring attendees/guests are as follows;-
Superior RM248.00++
Deluxe RM278.00++ (RM319.70nett)
Please mention that you are booking under PMC Conferring on 6 July 2008 in order to get this rate.

You may also book the rooms at the following hotels;-

B-Suite
Studio Suite : RM125.00 nett per night
Family Suite : RM155.00 nett per night

Tel : 04-646 7777 (9.00 – 5.00pm, Mon – Sat)

Vistana Hotel
2-Bedroom Family Room : RM230++
3-Bedroom Family Room : RM250++

Tel : 04-646 8000

This time around, PMC decided to have the exams in KDU. I wondered why they couldn’t/ didn’t get to use the huge hall at the Caring Society where we had our O&G OSCE exam last year. A few other exams were also done there, though not in the main hall. I prefered that place simply because parking is easy. In fact, I can even walk there.

Well, what can we do? They’ve fixed the venue so KDU it was.

Many of us parked at this parking area near the college. At RM2 per entry, it was not too bad.

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The campus looked very impressive to us who call renovated old bungalows our college.

KDU, Jalan Anson.

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The foyer brings back sweet old memories of my short stint in PRIME College. How can I forget the concourse at PRIME, one of our favourite hang out place? It was known among PRIMErs as the pre-function area because it was right outside the auditorium and hence THE place for any pre, peri and post function activities (e.g. registration, reception, lunch, tea, etc)

It’s much smaller than this but very cosy with its dim lighting and coffee-shop style small round tables and chairs. Many times, Ivy would play the piano while me and Cheryl copied her homework and Man Yin fiddled with her phone. We were the KIASU COLLEGE (our unofficial club) board members the pre-function area was our main office.

KDU foyer.

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The lifts lead directly to the entrance of the exam hall (on the 6th floor) and that area is only big enough to comfortably accommodate about 20 people so we scattered around the college.

First day in KDU… Studying at the cafeteria while waiting for exam to start.

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Second day of exam… we were allowed to wait inside the hall itself… but only at the back.

Their friendship never cease to amaze me.

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Theirs too.

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Some were engaged in intense discussions.

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While some figured a little game wouldn’t hurt.

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And Sani decided to to loosen up the tension and amuse everyone by staging a self molesting scene. He held the other guy’s hands and put them on his breasts chest, pushing him towards the pillar and pretended to struggle to get free. So what do you think? Who molested who?

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My place was the 3rd desk from the back, making it impossible for me to read what were written on the white board.

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I only had ONE shot at this and too bad someone decided to walk into the hall at the exact same moment.

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At the end of the afternoon MCQ paper, many left the hall with a smile. Some were happy that we were done with the writtens while some had their sad smiles on. I, on the other hand, couldn’t stop laughing at the questions and my silly answers.

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We were already on our way home when we suddenly decided to go to Gurney Plaza to unwind. I snapped this picture of the Penang Buddhist Association (the same building that I photographed on Wesak Day) on the way there (yes, it was about to rain at that time).

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After much indecision, we find ourselves at Secret Recipe. We flipped the menu from front to back and back to front so many times I lost count. In the end, we all ordered some ice-cream.

Banana split.

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Chocolate sundae.

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We had a great time and the feel good mood continued until we reached home when we modelled my housemate’s shoes (our shoe sizes are about the same). Half an hour later, we retired to our rooms and I started working on clearing up my hard disk space which has mainly been consumed by pictures. I fell asleep while waiting for the 4th CD to finish burning, woke up at 5am and unable to go back to sleep. Now my head is pounding. I need to sleep. Perhaps some paracetamol would help (don’t worry, I only have about 15 tablets left. Not enough to kill myself ).

For more pictures, please visit my GALLERY.

The second and last day of written exams proved to be a very “nice” final blow. I was neither frustrated or depressed. It was so bad to the extend of ludicrousness that I became exhilarated by the questions.

I screwed the modified essay questions (MEQ) paper in the morning. Then I found the questions in the short answer type (SAT) paper ridiculous. By the time I was to sit for the afternoon multiple choice questions (MCQ) paper, I was already such in a weird state of mind that I burst out LAUGHING when I saw the second question. Seriously. Needless to say, from there onwards, the progress was downhill. Out of the 50 questions, I only knew 8 of the answers. THANK GOD there’s no negative marking so I was free to open fire.

It was really hilarious. I had a few glimpses on the answer sheets of the people sitting around me. Ok, I admit. I was curious whether it was just me or did anyone else find it (almost) impossible to answer the questions. So I decided to have a quick look around.

Rest assured, I did not cheat. I had too much fun shooting that I would stick to them no matter what. Besides, unless you’ve made a pact with your neighbouring friends to openly disclose their answers, you won’t be able to see them. What you can see, though, is the pattern of their answers. Besides, I didn’t look at the OMR answer sheets. The circles are too small and close to each other that I can get a headache by just trying to figure out the pattern, much less to get the exact answers.

However, the second part of the MCQ paper which was the extended matching questions (EMQ) part was different. There were about 10 answer options for each question, labeled with A to whatever alphabet that they need to cover all the options (e.g A-J). For the surgery paper, we were asked to answer these questions in the question booklet but for medicine, they gave us a separate sheet of paper, in which we were supposed to shade the of alphabets of our choice.

That was where the fun part was. The answer sheet looked something like this:

41.	A	B	C	D	E	F	G	I	J	K
42.	A	B	C	D	E	F	G	I	J	K
43.	A	B	C	D	E	F	G	I	J	K
44.	A	B	C	D	E	F	G	I	J	K
45.	A	B	C	D	E	F	G	I	J	K
46.	A	B	C	D	E	F	G	I	J	K
47.	A	B	C	D	E	F	G	I	J	K
48.	A	B	C	D	E	F	G	I	J	K
49.	A	B	C	D	E	F	G	I	J	K
50	A	B	C	D	E	F	G	I	J	K

You see how big the spaces are? It was very easy to see the pattern of the answers on your friends’ sheets. You will not be able to determined whether your intelligent, studious friends answered E or F. You wouldn’t even know whether that answer was for question 45 or 46 but you can see if that answer was followed or preceeded by neighbouring alphabets. You may see stairs-like patterns, arrows, zig-zag, etc. Get what I mean?

So… I very discretely had a look around. I think I managed to get a look at 4 different sheets. None of them had at least a similar pattern, much less the same answers. And all four were completely different from mine. Had a hard time suppressing my laugh. No, no. I wasn’t laughing because I knew all my answers were correct and theirs would definitely wrong. I didn’t know any of the answers. And apparently they didn’t too.

Now… I feel like giving some awards.

The most evil paper: MEQ

Out of the 7 sections, I think I only managed to answer 2 or 3. The “best” thing about the MEQ paper is that it involves a case scenario. The questions come in sections. At any one time, there will be only ONE section on your table.

So, let’s say section 1 starts with how you want to proceed witht he history taking. Towards the end of the given period, they would start distributing section 2 which would be placed faced down on the table. When the time is up, we were required to put section 1 question paper on the floor and proceed with section 2.

Section 2 would then start with the answers to the questions regarding the patient’s history that you’ve (supposedly) written down that you would like to ask in section 1. Now… section 2 asks on the investigations that you would like to do on the patient.

Can you guess what would be written in section 3? Yes. The investigation results.

So you will know whether you’ve answered the previous sections correctly or what you’ve missed in your list of answers. More importantly it gives you an idea on how ridiculous your answers were and how bad the examiner would be laughing them. Get the idea? It drove me mad because it made me feel so stupid.

A summary of the case scenario (spanning 7 sections) that we get during the MEQ was a patient with COPD presented with right sided pneumothorax and was admitted. Chest tube was inserted. During the stay, he developed pneumonia. The chest tube was removed 5 days after insertion before he had a heart attack. That was not the end. The day after the MI, he was diagnosed with haemothorax. Poor guy.

So why do I call this the EVIL paper?

1. They asked us to interprete the arterial blood gases results without providing us the normal values (hey, in real life they DO include normal values in the lab reports!) that I was prepared to hand in a blank paper. I didn’t know the normal values so how would I know whether the values were low, normal or high? Then without knowing what is low or high, how would I be able to come up with a diagnosis? God bless the person who finally asked for the normal values to be provided. Thank you.
2. Then… they gave us a picture of a gram-stained sputum specimen and asked us to identify the pathogen. What?!!! We’re not microbiologists!
3. Which antibiotics to give and to cover what organisms? How would I know? I hate antibiotics! Even if I knew what antibiotics to give, I wouldn’t know what organisms they cover. I thought that’s what pharmacists do?

The most unbelievable paper: SAT

I went blank the moment I saw the first question.

Write briefly on an infectious disease of global/ regional importance to illustrate issues relating to containment and treatment, and how we can overcome them.

The question was not particularly difficult in the sense that I can just ramble and rattle on the related issues. It’s the perfect goreng question. The problem was, I was not prepared for this kind of question. My mind was screaming, “I thought this is a medicine paper? Why is there a public health question?” It really felt like sitting for public health paper again.

Oh, did I mention that this paper lasts for 1.5 hours and there are 4 questions to be answered?

The fourth question was on a patient presenting with bilateral lower limbs weakness and numbness who also had lower back pain. There was something similar in the surgery paper yesterday. Too bad I didn’t go home and read up more about it.

The biggest collection of ridiculous questions in one paper : MCQ

I thought they were written in German. I could read but understood nothing.

Read… read… read… Eh, already the end of the question? What was the scenario again? Read… read… read… Ok… So I think this fellow probably has problem X. Eh, how come problem X is not in the list of answers?

Read… read… read… Oh, easy! This guy has problem Y. Oops, the question did not ask for the diagnosis. Not even how to manage the patient or possible complications. None of those crap. So what is problem Y associated with? In the list of answers were all familiar diseases but none of which I knew was associated to problem Y.

Read… read… read… This disease is associated with the following conditions except… Errrmmm… What disease? I couldn’t even come to the diagnosis!

Read… read… read… How to diagnose alcohol dependence? Eh, isn’t this a psychiatry question? Errmmm… which criteria is used to diagnose this? CAGE or EDWARDS (one is for dependence, the other for abuse)? Errmmm… what’s in CAGE and what’s in EDWARDS anyway? Hmmm…

There was one question on causes of vitiligo. My mind went, “What is vitiligo to start with? I know vertigo… Vitiligo sounds familiar but I don’t even know what it is. So how would I know what can cause it? Oh, wait. One option is alopecia areata. What the heck is that? I know alopecia (immediately thinking of Anas’ head) but alopecia areata…? What is this one? Familial what? Never heard of it. Hmmm… How to answer? Ok… Ok… Steady… SHOOT!”

Anas, after a particularly severe haircut.

P/S: Sorry, Anas.

.

Basically, similar scenes were repeated over and over again for more than one hour.

But the most ridiculous question ever award has to go to this question (rephrased and rearranged according to my memory)

Which one(s) of the following is/are true about pharmacological development:

i) Step I is to test the pharmacological effects on animals

ii) Step II is to test the effects of different doses.

iii) Step III is to release it to the market for trials.

iv) The patent would be free after 5 years.

(There’s one more option but I can’t recall the statement)

I mean, what the…???

Even IF I knew that statement (i) is correct (which I didn’t), I still didn’t know about the rest and answers A-E had different combination of correct statements. I bet even the pharmacists wouldn’t know the answer to this question. Perhaps pharmacologists can help?

Oh, something happened. When the MEQ paper finished, we were asked to put our answers on the table and leave the hall while the invigilators collect the papers and prepare for the next one. 30 minutes break was given to us (between the MEQ and SAT papers).

When I got back to my table (for the SAT paper), imagine my surprise when I saw my MEQ paper still on the table. I wanted to go to the front and hand it in myself but I figured that would raise the suspicion that I took the paper out so instead, I raised up my hand. The invigilator who came to get my paper heaved out a heavy sigh but said nothing.

2 minutes later, Dr C came to my table.

Dr C : 0## (my student number)… Why did you hand in your question paper late?

Me : Huh? I came in and it was still on the table.

Dr C : Are you sure?

Me : Yes.

Dr C : Ok then.

Maybe it was my mistake. I was looking at the normal values sheet while waiting for the permission to leave the hall so when the announcement was made, I put down that paper on top of my question papers. But still they had no excuse for not collecting my paper, right?

A few minutes later, they made an announcement that they lost 3 copies of the normal values sheet. They asked if any of us took the sheet after the previous exam. Then they contradicted their previous statement by saying they collected the sheets after the MEQ exam, then redistributed them just before we went in. That was when they realised the 3 missing copies.

I say that was all bullshit. If they DID collect the normal values sheets, why on earth did I find it on the exact same spot where I left it before? And beneath it was my uncollected MEQ paper? What’s their excuse for that? Can they even come up with a valid one? Good thing they decided not to further press the matter with me.

It’s 6.30pm and sleep still eludes me. My last proper sleep ended at around noon yesterday though after that I did fall asleep again for another 2 hours.

I went to bed at 3am this morning but I couldn’t sleep. Not until just before 7.30am. I was just about to doze off when a friend who stayed over knocked loudly on my door to wake me up.

My mind has been acting weird the entire day. In the morning, it acted as if it was completely devoid of everything. I moved on autopilot; checking my pencil case, making sure I had my ID card with me, getting my purse, phone and keys. Then I waited for my friends to get ready. All the while, not a single emotion registered in my mind. No panic, no anxiousness, no worries… NOTHING.

Only when I entered the KDU hall, I had a moment of panic. Then only did I realise that I didn’t bring my pencil case with me (despite me carrying a bag) and since I put my purse inside the pencil case, I didn’t have my purse as well. That meant I drove the car without my licence. Yes, I panicked for a while but that was not the kind of panic that I would expect myself to feel at that kind of moments. It was lacking in character to say the least.

After the morning paper, I went home hoping to get some sleep. Again it was futile. it was not yet time for me to sleep.

I went back to the KDU hall with the same condition I was in the morning. No emotion whatsoever.

I didn’t even remember that I had my phone in my jeans pocket. It went off about 15 minutes into the first paper (in the afternoon). Fortunately it was just an SMS (therefore short and soft) so no one except those around me heard it. There were no invigilators nearby. Not even behind me. I made sure of that before I took out my phone, turned it off and put it back in the pocket. No one noticed my movements (because when I apologised to the people around me after the exam, they were surprised to find out that it was actually my phone).

Before the second session started, someone saw something related to the questions for the exam paper and started an intense discussion on it. I suspected something was up but I had no motivation to do anything. I didn’t care. Not about the exam, not about anything. Evertyhing seemed artificial. Even my sleepiness felt fake.

I will try to sleep again. Wish me luck.

But before that, allow me to quote Prof Lee during the start of the MCQ paper.

Use the right pencil to shade your answers on the computer sheet. To paraphrase Hamlet, the Prince of Denmark, “2B or not 2B…”