Monday, July 24, 2017

An Elective in Cuba and Peru: The Preparation

Hello! I am currently in Cusco, Peru, starting the 6th week of my elective. I've decided to write this series of blog posts, instead of just my elective report, to allow more space where I can express myself in greater details, and to share my experience to whoever/future medical students who may appreciate this. 

For those of you who are not very medical profession-inclined, a medical elective is something (very fortunate) medical students do towards the end of their 5/6-years of medical school. During the electives weeks, we are allowed to go, literally, anywhere in the world, where there are medical professionals willing to give us supervisions during our practice. The main purpose is for us to see the world, instead of just hiding in our mountain of books and to learn about other health care systems and medical practices around the world. I think it's a particularly important part of opening our minds, especially for the medical students who have been studying and living in their own country for their whole lives. 

Our goals for our elective

The preparation for this medical elective started about 2 years ago when we first started our 4th year. Kevin and I decided to do our electives together and instead of going back to Malaysia or Singapore (where most Malaysians and Singaporeans would prefer to go for their electives), we decided we would like to do something different, something 'once-in-a-lifetime' because after all, when we start working next year, when will we have 2-months long holiday to do whatever we want again? So instead of choosing where we can learn 'proper first world medicine' eg in Australia, UK or US, we tailored our elective so we could experience cultures and healthcare systems which would be wildly different from what we have experienced. And maybe for once, put ourselves out of our comfort zone. As for proper medicine, that can wait... we have at least 40 years of working life ahead! :p 

Where should we go?

'The world is your oyster!' we were told once during our elective preparation session in clinical school. We will have plenty of opportunities in the future to go to places in Asia, US, UK and Australia, whether for medical practice purposes or research purposes. To be able to complete our elective in prestigious universities in the US (eg Harvard, Stanford, Yale, John Hopkins) would be great for our knowledge and CV, however, when we checked the elective prices for those universities, our eyes popped. Is the price worth it? What will we gain from paying that ridiculous amount of 'registration fee'? 

So we decided to park 'US elective' aside. And we were left with mainly Latin America, Africa and the Middle East. I have been hoping to see Machu Picchu and Kevin loved Latin America when he first came here a few years ago. So Latin America it is! 

Peru was the top of our list. But spending 8 weeks in 1 country seems a bit dull to us, so we've decided to choose another country for half of our elective. Our main alternatives were Bolivia and Cuba. And somehow, charmed by the photos of 'Capitolio' and the old American cars of Cuba on google, we've decided to go for Cuba.

I took this. Not from Google. Proud of that. 

Ok, so our touristy interests aside, these are the things you should consider when choosing an elective destination:
  • Safety - in general, and in clinical practice
  • Costs
  • Availability of supervisions in specialty of your choice
  • Language
A good starting point on what to consider for your elective - the MDU's booklet

Contacting our hosts

When we did our research on which hospital to go, we had no idea on which hospital actually caters/welcome elective students. Besides, some hosts were notoriously bad in replying to emails. Fortunately, we found 2 very brilliant, organised and responsive organisations that provide elective packages which met our interests: 
  • For Cuba - Cuba Medical Electives, which has sadly closed now. However, you're encouraged to search for other hospitals in Cuba from Atillo
  • Medics Away - who also provides elective packages to many other countries in the world. 
With their help, we managed to secure places in hospitals of our preferred destinations without much fuss. I will talk more about hospital, accommodation, food and tourist attractions in detail in another post. 

Many people opted to organise their elective independently. While feasible for developed countries and countries which you've already known the hosts, it may be a bit hard to know exactly what is suitable. We've tried another Peruvian elective company, Mundo Verde, before Medics Away. However, after spending 1 year trying to arrange our elective and not getting any response from them 2 months before our elective, we've decided to switch to Medics Away. Fortunately, Medics Away is very very responsive and made arrangements for our whole elective within 1 week's time. 

Language classes

Important when you are trying to understand what your patients are talking about!! 
Most parts of Central and South America speak Spanish. I knew zero (really!) Spanish before year 4. I was fortunate as I was able to take a Beginner's Spanish course, with a slight medical twist, as part of my student selective component (SSC) in my clinical school. After the course, I've decided to learn Spanish on my own by doing grammar books and watching medical Spanish series (Centro Medico). I was nowhere near as good as Kevin, who did 4-5 years of Spanish course, of course. And I knew I will have a hard time following what's going on in the hospitals, but I had to learn! Just imagine, after these 2-months of elective, I will be able to understand a whole new language! 

There are several Central American countries which speak English eg Trinidad and Tobago and Belize. These are popular choices among my peers. Otherwise, you're always welcome to visit Malaysia or Singapore! We speak English and we are quite 'exotic' too! (lol) 

Funding

I shall not dwell much on this as there are plenty of ways to earn your way to your dream elective. From bursaries and grants of Royal Colleges and specialty societies to University Grants, you can easily search for fundings from google. I was fortunate enough to be able to pay my whole elective from my savings and Kevin's college paid for most of his trip. 
I will talk about our specific budget in each country in the other blog posts. 

Flight 

This is a major cost to consider when planning your elective and best booked early. We booked our flight 8 months in advance and managed to spend only approx. £900 per person (London-> Havana-> Cusco -> Lima -> London), with 30kg luggage allowance. 

Vaccination 

This also another major factor/cost to consider. We visited our University's Occupational Health to disucss about this 6 months before our trip as they tend to get really really busy as summer approaches. I spent about £250 getting vaccinations for Rabies and Yellow Fever, and prophylactic tablets for Malaria. The Rabies jabs come in 3-doses and require at least 1 month to complete, and it lasts for 10 years once completed. As for the Yellow Fever vaccination, it supposes to cover your whole life. 



That's it for the advance preparation we had. I will talk about our Ultimate Packing List next! 

Saturday, June 3, 2017

Ethics in Medicine: Termination of Pregnancy

ethics
ˈɛθɪks/
noun
  1. 1.
    moral principles that govern a person's behaviour or the conducting of an activity.



Recently, as part of our 'Ethics and Law' course in clinical school, we have to attend seminars talking about ethically controversial issues. They have been 'bearable', I mean, we attended it as part of a tick-box exercise so we can pass medical school. But the latest 2 sessions have been quite interesting. 

The last 2 sessions were about the Reproductive rights of human and Abortion laws. eg. Should pre-implantation genetic testing be allowed? Is it eugenics? Should IVF be allowed in the NHS on public funds? Who has the right to have unlimited rounds of IVF? Is childlessness an illness that needs to be dealt with by medical professionals? It stirred quite fierce debates among my group. We talked about topics like 'is it absolutely ridiculous that we allow people to terminate unborn babies who have congenital defects?', 'Is any form of contraception or procedures related to human reproductive actually killing a life?' It was definitely very eye-opening, especially the moments when some of my quietest colleagues stood up and spoke strongly for their stance. 

The point of these sessions was not to come to a conclusion. There will never be a conclusion. (That's partly why I dislike these seminars...) If there were a right answer, we wouldn't need to have these debates anymore and things will be done. The point is to just to think about it...

But...I felt very detached and unmotivated to debate about any of these things. I mean...I felt like, it's part of my job, I shouldn't impose my moral judgement on any of my patients. I should do my best to help them from a medical point of view, regardless of what I personally think. With that string of thoughts, I found it pointless to have a debate because...I will do it if that's what my job requires me to do and as long as I am not harming a person. 

'But what is a person?' 
A fetus has no thoughts, no voice and can't say no, even if you try to kill it. Because there isn't a proper definition of 'a person', everyone has a different definition of their own. My view of a person is when the fetus starts having a heartbeat. But that's what I think, not what the patient think. And when in a consultation, what my personal definition is, doesn't matter. Clinically, if the pregnancy is severely harming the person in front of me - a mother, a wife, a woman who is trying very hard to keep her life in one piece and prevent her world from crashing down - I will do my best to relieve that woman's pain. 

'Aren't you a Christian? How can you support something which kills life?' 
I am a Christian, and I try my best to be what my Lord tells me to be in my everyday life. To be loving to everyone, to be kind, to be patient, to be forgiving, to not worry and to fully trust in Him in whatever lies ahead of me. I used to in my mind, judged those people who had a termination, sneered in my mind how heartless these people are. I used to in my mind, judged those parents who chose terminate a pregnancy because there's a serious congenital defect in the unborn baby....until the day I attended the Termination of Pregnancy clinic as part of my O&G attachment. 
I sat in front of these ladies. Every single one of them, feared for their future, scared of what will happen to their body and felt guilty about their past. Even those who had a termination before. Not a single patient was happy when they came into the clinic because 'yay, I can finally get rid of this thing growing inside of me.' 

I chatted to the Consultant who ran the clinic after that session.
'How long have you been doing this?'
'More than a decade.'
'Do you feel bad doing it while all your colleagues shy away from it?'
'Where will these ladies go if I don't do it?'

Sure, as a doctor, I can turn them away under the 'Conscientious Objection' because 'this is killing a life!' But hey, they come to you because you are the only person whom they can turn to, who can help them in a safe manner and who will not judge them. If you judge them as well, they will have nowhere else to go. Perhaps, they will resort to illegal termination or even, suicide. So is that more loving?

Patients have their own stories and their own reasons for having a termination. Doctors have their own stories and their own reasons to object a termination as well. Regardless of what I personally think, I will (hopefully) be their doctor and their colleagues, not their judge.

p/s: If you object TOP, please let me know what would you do to help these ladies if you were in my shoes. 

Wednesday, April 19, 2017

A change of blog name

No more 'the white coat' because...I have never actually worn a white coat as a medical student. The only time I remembered wearing anything close to a white coat was in the dissection room or in the biochemistry lab during my first year. I have been wanting to change that title since I first used it, but couldn't find any particular name which can accurately describe my journey as a medical student (and hopefully a doctor in the near future) and is constantly there - till my clinical years, I found out that, coffee (or 'kopi' in Malay), my dear faithful friend, has been there all these while, through the years. I have no plan to cut this addition of mine yet (for the fear of a migraine I will be rewarded for abandoning a faithful friend).

Besides, my documents, sign-off sheets and books seem to be constantly being stained with coffee. And I always get this disgusted looks from consultants and nurses when they see my documents...

'Can you sign me off for this skill please?' (Before they opened their mouth) 'Oh, don't worry, that's just some coffee stains.' not blood, not faeces, not urine, not what you think it is... Or is it? 

Coffee addiction seems to be the only a socially celebrated acceptable addiction. Well, at least in the clinics and wards. Even if I missed my coffee in the morning, when I am in the hospital, the nurses would always be so kind to offer me a free cup. And I, being a humble, lowest of the low, medical student, feel obliged to accept the offer. 
'Yes please.' followed by a sweet, sweet smile. 

There was once I forgot to drink my morning cuppa before I met up with my Endocrinology project supervisor at 8am. It was the most awkward meeting ever as she, a consultant, a prominent figure in the world of endocrinology, who came to the hospital at 8am to meet me, tried to be friendly and initiated the conversation, but was responded with responses like this throughout the 1-hour meeting. 

'So how's everything?'
Eyes half opened. 'Mmm..ok.'
'Are you ok?'
'Mmm...yea..'

You can imagine how guilty I was after that. Thank God she's still willing to talk to me. 

Coffee stains? No. I am not sloppy. This is what you'll get even if I have 1 spillage for every 1000 cups of coffee I drink. Blame chance. 


Wednesday, September 7, 2016

Oncology Attachment

Hello! I am finally back in Cambridge to start my Year 5! Ok, technically, I have been back since mid-August. A lot has happened, but nothing happened that moved me enough to make me write a blog. Not today! 

Today's my third day in my oncology attachment. I have good friends who's super into oncology and I've talked to them many times on why they wanted to do such a 'depressing' career. I mean, you're dealing with cancer day in day out, it's an uphill battle and most of your patients die very soon. (well, all patients die eventually...still). Why not do O&G? You're dealing with happy patients most of the time, why not right? 

And it's finally my turn to explore this specialty. 

I went to a urology-oncology clinic on the first day, radiotherapy department and the oncology ward (with the palliative care consultant) on the second day. I must say, everyone in oncology is super nice! Way too nice. We, as medical students, are so used to not being acknowledged and ignored in the hospitals and clinics, that when people actually actively teach us and bring us along with them, I feel so 'loved' and grateful. Hehe. 

Today's the third day and I was attached to the early phase (Phase I) clinical trial clinic. I had no idea what doctors actually do in these clinics till I went in. There were 2 consultants, 1 reg and 1 specialist nurse there. 

The nature of the consultations were very different. Instead of the usual consultations where it's patient's health is at the top priority, this consultation serves a very different purpose. It is meant to recruit patients, who have exhausted all other treatment options for their cancer, into clinical trials, in order to test out drugs which has not been tested in human before, but in theory and on animal studies, work. Very often, these drugs do not work and patients suffer devastating consequences and even hasten death. The chances of the drugs actually working is extremely small. 

For the benefit of non-medics/statistician/scientist reading:
  • Phase I: Researchers test a new drug or treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
  • Phase II: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety.
  • Phase III: The drug or treatment is given to large groups of people to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.
  • Phase IV: Studies are done after the drug or treatment has been marketed to gather information on the drug's effect in various populations and any side effects associated with long-term use.
https://www.nlm.nih.gov/services/ctphases.html

These risks were all explained to every single patient clearly and they were given time to think about this clearly. They were not at all pressured to take up the risk and are free to leave the trial any time they like, and enjoy whatever time they have left in this world. This will after all, most likely, to not benefit any of them. It is all for developing the next therapy, for science, for the future generation. 

3 very different gamblers
I saw 3 patients with the docs, 1 who was about to be recruited, 1 who decided to leave the trial and 1 who has successfully undergone the trial and her cancer is stable at the moment. Each of them came with their close family member, carried very different burdens and had very different emotions. 

"You must help me. You will be my hero," the first patient said the moment we stepped into the room. I could see his desperation, his aggressiveness and his determination to beat his cancer. The doc explained to him all the risk, and he claimed that he completely understood the risks and he's very optimistic about the quality of care he has been receiving so far. He was very eager to be in the trials, regardless of the price he needs to pay, at the last few months of his life. 

"I've talked to my wife about it and I want to be selfish for once. Instead of coming to the hospital all the time, I'd rather go home, have my gin and tonic and be with my family," said the second patient. Good, then that's what you'd do. He left and never turn back. 

'I've been doing very well, but I want to drive!' the third patient, who has her cancer controlled by the trial drug for 18 months now. She's one of the rare ones which trial drugs worked. She looked completely healthy and normal, no one would have guess she battled with cancer before, she's currently on the winning side and who knows when will that drug stop working, or she'll live to her 90s-100s. She has been enjoying her normal life, but the only thing is she lost her licence because she has brain metastases. 

It was a very strange experience for me. These are the patients who were given a chance to gamble with their life. If you win, you'll live longer; if you lose, you'll suffer from the side effects and probably die sooner than what your cancer can do to you.  The oncology team try their best to make the patients' priorities their priority too. However, it's still a gamble. It's gamble with a lot to win, and a lot more to lose. 

Clinical-scientist-gamblers?
Normally, clinical practice is a gamble too, but the stakes are never this high. For each procedure/drug/surgery given, there are risk and benefits, but if the risks are higher than the possible benefits, doctors often would not proceed, for the patients' best interest. However, in this case, you know the chances of losing the game is high, yet you still gamble. Yes, all of these are ethical, but it is still a gamble. The only thing is, as a doc, you don't lose much if you lose. You feel sad, guilty, go home and cry, the next day, you come back to work and move on.

And such is a doc's life? I have yet to experience this 'gamble' because as medical students, we are purely observers. I don't know how I'd feel on the day I'm actually on the table, with people's lives as my stake, against fate/life/jack the ripper. Maybe I'll be a risk taker who's ready to advance our medical field, but maybe, I'm just that risk averse and scared that doing a phase I trial will never be my thing. 

Tuesday, July 26, 2016

My year with MMI

MMI stands for Malaysian Medics International 
As stated on the website
MMI, is a student-led organisation founded in 2013. With its rapid expansion and growing successes, MMI is anchored in its three pillars: to connect, to educateand to cultivate. We are dedicated to providing a professional environment for Malaysian medical students to network, keep themselves updated with healthcare issues and develop skills essential for their career. The group also provides information and ad- vice to prospective Malaysians who wish to pursue a medical degree in Malaysia.

My first encounter with this organization was when the founders of the organization organised the 'Medicine in Malaysia' conference. I was a naive second year medical student, unsure about my future after graduation, whether to stay in the UK, come back to Malaysia or to go elsewhere. I joined the conference, learned a whole lot more about the pathways of career development in Malaysia but still clueless about what should I do about my future. However, I was super inspired by the organizing team. I never thought that medics could come together and discuss about important things that will affect each of us as well! I thought, medics just..well..hermit and study. So I interviewed for the VP or Sponsorship officer position. I had no experience in both these position before, but I am willing to learn and give it a try. 1 week later, I got appointed as the first Sponsorship Officer in the first MMI UK branch committee. 


My first year in MMI It sure was fun starting a completely new committee in a foreign country. We had no money, no potential sponsor and no one knew about us. Heck, I don't even know how to be a sponsorship person. I don't think many of us in the 9-persons committee actually know where this organization is heading to, at the beginning too. We just planned activities and hoped things work out. Things worked out not too shabby that year. Considering it was our first year in the UK scene, we had 2 big events and there were actually participants!  That year, I am super grateful for: 


  • The original committee of MMI - for taking me in, even though I had no idea what I was talking about during the interview. 
  • My friend, Livia, from CUMaS, who thought me everything about being a great sponsorship officer and gave me templates of invoices and agreements to start with.
  • A super dedicated MMI UK committee. Though we had no cash AT ALL in the UK, each of us forked out GBP100 from our personal account to make sure our first event, 'The Physiology Challenge', was even possible. And we did it. And the money did came back to our personal account in the end. Albeit later than expected. :p 
  •  An opportunity to learn how to sell something. We made booklets, agreements and went down to London to meet potential sponsors. And Mr Lau from Sunway Medical Centre, was extremely generous and fuss-free. He agreed to sponsor us after a friendly chat. The corporate communication person I liaised with was super patient with correcting the first agreement I sent over too (It was a disaster, don't ask). And they still sponsors us till today. :) 
  • An opportunity to learn that failure isn't something to be afraid off. Many events we made and many sponsors I've approached, did have outcomes as expected. It's hard to accept at first, given that we've put in so much effort to do it, why can't people see it? But we learn from feedbacks, reflections and made ourselves better. 
  • Friends, future colleagues around the world, whom without MMI, I'd never meet. Esp friends in medical schools all around the UK (the gold mine mmmmm :) ) Without MMI, I'd still be hermiting in my Cambridge bubble, without realising how big this world actually is. 
  • An opportunity to pursue something bigger than myself (or my academic results), which leads to my second year in MMI. 
I was nominated (somehow, dk by which silly person from the first comm) to run for the Vice President of MMI UK and Co-chair of the MMI Executive Council at the end of my first year in MMI. I was not sure about this at all because I had no experience in being a president or VP for anything ever since I was born (captain in girls' softball team in high school doesn't count). I was afraid of taking up this responsibility because who am I to lead this organisation with links of thousands of medical students around the world. Who am I to steer this ship and make sure it doesn't sink after just 1 year since it started sailing? My mom encouraged me to give it a try. And I thought, since I am still not sure where my future actually lies, why not? 

Praise God, I was given the chance to take up that opportunity. Though I still had my qualms after the election and almost give up the position, I talked to Zhi Yang in Coffea Coffee and he somehow, managed to convince that I really should take it up. Kevin also asked me to consider this opportunity carefully. So I reluctantly took it up and I prayed real hard about it. I prayed that Lord, since you've given me this opportunity, please use me to glorify your name through this that people may see this organization or at least, see me, and they see your love and your kindness, Lord. Please guide me and look after me, as I embark on this journey and starting my first clinical year.  

The first few months as the VP of MMI UK
The first few months in this position of great responsibility was hard. It was after all, only our second year of existence. People still don't know us enough to let us perform our role to serve as a representative body of Malaysian medical students. Joanna and I had a long discussion to plan for the year in June; Vikki and I had another long discussion to plan for the year. We identified the problems in the year before, restructured the organization, drafted the constitution with our dear Executive Council and recruited a new team in both MMI Malaysia and UK. I was first convinced that I needed to stay and watch something great happening when Joanna and I were interviewing our new committee members in 1Utama's Coffee Bean. They told us so many great plans they have for our new year, plans that I've never even thought about before! These candidates were so inspiring, enthusiastic and ambitious in building this organisation, which belongs to ALL medical students, it made me wonder, who am I to shy away?! I want to be part of this great society too! 

The rest goes down to history. We organised so many events, online campaigns (which involved talking to other international medical students society as well), attended even more events to connect with other students organisations. One thing I realised early on during our office year was our new committee's dynamic was very different from the year before. Maybe because Joanna and I chosen each member of the team on our own, it felt really really great working in the team. It was almost a dream team any organisation could ask for. We did not have meeting very often, but through FB messages and posts, we managed to get things done very efficiently. Thank God really, for such an independent, pro-active team. We would not be able to make MMI UK's events come true while maintaining our grades in medical school, if not because of a our DREAM-TEAMWORK... :) 

Oh, forgot to mention - during this period, I talked to Joanna and Vikki so much that they almost replaced my boyfriend. Just kidding, dear! Now I'm back! :p 

Global connections
I am also super grateful to be able to be the co-chair, which allows me to handle the connection with other branches and try to set up more MMI branches in other countries. A failure I must admit is I have no managed to set up a full-fledge new MMI branch at the end of my term. However, it was not all in vain. Eric from Otago and Edwina from Russia have worked very hard to start events under MMI's names in their respective universities and cities. MMI Otago even had a gathering and mock OSCE session! Through them, I learned that, the same group of people can gather at anytime to do the same thing, but by putting a name and an identity on to the effort, this gathering will be remembered by an entity much greater than that gathering itself. The successors within the same entity, though not knowing the predecessor personally, can then remember, replicate and improve that effort. And I think noble effort such as this should be preserved. Thank you, Eric and Edwina. 


"You are my future colleague?! I fear." 
Another lesson which I learned throughout the year was - to manage people and to manage time. These skills are crucial as a doctor, especially if you wish to move up the ladder in your future career and have a family life, but are never taught in school. Through my journey with MMI, I've learned to find a fine balance between clinical school, MMI, family and friends time and personal time. It wasn't easy, and I still neglected opportunities to catch up with many of my friends!  Besides, I also learned how people behave. There are bound to be people who doesn't work in a team - I call them the politicians, ''talk only, no action'' - and there are people who works very hard. Many times, I got so frustrated and angry over those politicians who gave empty promises that I almost cried. But slowly, I've slowly learned to expect them to be just the way they are. So when they give empty promises, I learned to arrange someone else to do the same job simultaneously. At the end of the day, what do I have to gain to be angry over them? I wish I could tell them in directly in the face about this, but I could not bring myself to - We are all future doctors, future colleagues, if you are not taking your responsibilities seriously at this stage, how could we trust you to be a responsible colleague in the future?   What if, one day, I work in the Day Team, and you work as the night shift doctor, how can I trust you to look after my patient and when I return, my patient will be alive and well? Integrity. 



Managing expectations
The flagship event of MMI is the annual conference/summit. It is, as if, almost an unspoken rule that this event MUST be done, or MMI doesn't exist in the public's eyes (though that's not true, we do many other things to prove we exist too - like spamming your FB newsfeed with random stuff :p) Our super smart organizing committee planned all the details and it looked super great on paper. We even planned to introduce the workshops-circuit (how workshops are commonly run in UK medical schools) to the Malaysia. 

There were many hiccups and obstacles in the process of organizing this MAMMOTH event, or so we thought. We were expecting 1000 participants this year. But as the registration date closes, the number did not rise very much, so we lowered our expectation to 500 (which is almost the scale of previous conference). 1 week before the registration closes, the number was still terribly low. I began to lose hope, half-heartedly managed the ticketing system, let Vikkinesh (my crazy superhuman co-chair) and Joanna handle all my responsibilities, while I prepare for my Year 4 exams. Thank God for them so I could studied. I don't understand - we did all we can to make sure the events' interesting, the ticket price's affordable and the publicity crazy - why do we still not have many participants?! Thank God for Kevin, for helping me manage my expectation when I was so disappointed. 'Then make it a great conference for the 200 participants you have!' he said. Very true, we shall make this an event that impact the participants so much, they would never forget about it and never regret they joined it. I prayed that each of our participants would be able to bring something back with them, some message to bury deep within them at the end of the summit and spur them to be great doctors and leaders of our generation. 

End it with a BANG. 
1 week before the summit, I finished my Year 4 exams, went to Portugal and flew back to Malaysia. The jet lag struggle was real. I could not sleep at night, but during the day, I had to go to Summit venue to help out, because if I don't, the summit will still happen, but I FEEL BAD FOR THE LOGISTICS group for not helping thus far. So I slept for about 2-3 hours every night for a week leading to the Summit. My brain's slow and I was irritable. I lose my temper very easily. I truly apologise if I was being very mean to you, my dear comm. I really, really didn't mean to. And thank God, when the 400 chairs in the hall were arranged and the banners were hung up, the summit felt real. 

When the Malaysian Medical Students Summit weekend came, it happened really fast. It was nuts, the number of things we all had to deal with at any one time. I was riding on the adrenaline rush all the time. I shall not say too much about it now because it was just 2 days ago and I haven't had time to really, thought through it yet. But I must say, without the SEGi medical society and the whole MMI team, this is just impossible. And I am so so so so glad when the delegates said they enjoyed it and learned a lot. It made me feel like 'Sleep-deprived? It's all worth it.' :) I had so many firsts during this summit - my first time wearing a saree, my first time moderating a forum, my first time running a symposium, my first time walking on red carpet with the VIPs (lols), my first time nodding off to the DG when he was talking directly to me in my face (oops) etc...  

I felt asleep the moment I sat on the couch that evening. 
And now...all that's left are the handovers... 






Thursday, May 19, 2016

Worst regional posting you can get?

I have been posted to the worst regional hospital I can get in Cambridge they said. Seniors warned us with all sorts of stuffs before we arrive in the first term.
'Remember to bring your duvet. They have plastic blankets there'
'Remember to bring all the food you can, there's no shops around.'
'Remember to bring...etc'
'Oh ya, there's no wifi in your room.'

Queen Elizabeth's Hospital, King's Lynn

Now that I am on the last day of my posting, I can testify, what they warn us about...are all sadly, very true.

I remember on the first night we arrived in November last year, it was super cold and foggy, and there weren't any soul outside the train station. Everything's dark and quiet in this coastal town. We took a taxi to the hospital and lugged our luggages and duvets around the hospital to get keys to our accommodation, which is right beside the hospital.

When I first entered my room, I thought it was quite good. I mean, it's basic - a bed with a pillow and a plastic duvet, a desk, a desk lamp, a sink and a cupboard. That's it. It's clean at least, I thought. We don't pay for this accommodation because it's covered under our tuition fee. But for the amount of tuition fee, international students pay, I am not sure this is worth the money. But since I am on scholarship and am not paying for this, I guess I have no right to complain. BUT THERE WASNT A CONSISTENT WIFI OMG. The wifi keeps cutting off every 5 minutes and my phone's 3G was burning through very quickly.

Life in this hospital is pretty boring. It's like you're on a camp for 1 month. There's no proper wifi, there's no shop nearby (the closest is Tesco, which is 30 minutes walk away) and you have a very small group of friends from your year. Unlike that in other regional hospitals where you get big group of friends, we only have 6 students from our year, at any point. In summary, you're pretty much isolated. All you can do (if you dont have 3G) is...to read a book/clerk a patient/pester the docs to let you do something.

Library where I spent most my time when there's no wifi in my room
At one point, because of a blunder in the administration, I was not given accommodation for a night, and I had to return to Cambridge with all my luggages. I remember lugging the luggages around town until I had calluses on my hands. I was so furious and boiling that I ranted non-stop for an hour to K (poor man) and I even said, 'Is my tuition fee any less than others that I deserve such placement...'

Found around hospital. I simply can't understand/empathise with smokers.
Fast forward to now...am I happy that it is finally over? Boy, you bet I am. I am counting down the days to get back to civilisation, to my own room, my coffee machine and high-speed internet in my dearest Cambridge. I took one last stroll around the hospital this evening and reflected on the time I had here...it actually was not that bad at all.
The accomodations
A random, one and only turbine in town, right beside the hospital

The art of asking for what you need/want
There were bad times, especially in the beginning, when there was no wifi and I could not understand any medicine or the art of persuading someone to teach you/let you do something. But actually, as the year went on, we got pretty top-notch teaching around here. Yes, we did not have much supervision throughout the year, apart from the last 2 weeks, but we had pretty good teaching sessions. They rarely get cancelled. And when they went on, they are usually very helpful for us. The consultants are usually the ones we will later on shadow in their clinics. They are usually very kind and are very willing to teach if you ask them questions. (If you dont, obviously they will concentrate on their job and ignore your existence.) Although I must say, some may think you are absolutely brainless, especially when I was trying to help them clerk patients during the Junior Doctors' strike days. I remember one consultant being completely appalled at the way I prescribed on the drug chart...'But I was never taught about this before, at all! and I have never seen it done before! Can you teach me how to do it?' Only then he realised I am not a finalist. From that day onwards, he started being kind to me and taught me a lot of things. Slowly, I started to realise that many of the consultants thought we are final years and thus, expected us to be very independent in our learning and to know what to do on the wards. Then only I know the importance of letting the docs know what level am I in whenever I shadow them. The easiest way being acting honestly dumb.
'What is this...?'
'Uh...uh....maybe it's...I don't know.'
'What do you mean you don't know?! Which year are you in?'
'This is my first ever medical rotation. I am in Year 4.'
'Very well...'
Since learning that, I have learned to make my time on the wards more productive. And if I am continuously being ignored for 15 minutes, I learned to just quietly slip away, and Yay, free time!!!, and go back to do some reading, instead of stupidly standing there for no reason.  It's not their fault. They are really super busy, not rude.

I have also learned how to pester the staff nurses to let me do practical skills so I can get them to sign me off. Some of them are super friendly, some of them just can't be bother with another medical student. But as long as you supervise my work and sign me off at the end, I am eternally grateful to you, nurse. :p 

 Simulations
Oh, and I love Wednesdays! It's the day we learn practical skills, with just 3 of us and our very 'fun-loving', enthusiastic trainer will let us do simulations on management of acutely ill patients on SimMan. Apart from that, she also entertains us with a weekly dose of rant about her ex-husband and life on the farm. It's really quite entertaining I must say.

Familiar faces
I guess this is the perk of being in a small hospital. You know every one after you've rotated through all medicine, surgery, pharmacy and A&E. It's nice to walk around the hospital and have doctors and nurses greet each other in the morning. And obviously, you know people from your own year very well. There are only 3 of us, to stare at each other, for a month. We depend on each other to survive, stay sane and eat fish and chips together.

So, honestly, it may be bad, but probably not all bad. Regardless, may all my postings for the rest of my career be an uphill journey from now onwards. Bye bye, King's Lynn!

Thursday, April 28, 2016

Empathy, or the lack thereof.

 In my final term of the year, I am finally in my first ever Medical Rotation. And I started this when the Junior Doctors are on strike. Great. Honestly, it's great, because I get to do most things the juniors do, under the supervision of consultants, who usually don't even acknowledge our existence in the wards. So, it's so great for our education!

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I was in Neurology clinic this morning. My first ever encounter with clinical neuro. It was really strange yet very interesting at the same time. The patients came in with epilepsy, migraine, headaches etc, just like how I read in the textbooks before. However, the strangest part of the whole morning was this consultation...

The patient had been experiencing difficulty walking and blurry vision, twice in 3 years time. Before she came in with her family, the consultant and I had a look at the MRI scan of her brain. 

'Look at those plaques.' It wasn't great.
'Does she has a diagnosis yet?' I asked, 
'No.' Then she walked out to get the patient in. 
I thought, No...this is bad.

The patient came in with her young family, all cheery and happy and agreed for me to be present while the consultation went on. She smiled. I forced myself to smile back. I thought, this is really bad. Does she knows? Is she suspecting? Will she walk out of this room the way she walked in?

The consultant smiled and carried on doing examinations, as if she does not know anything. Everything went on smoothly until the examination ended and everyone was back at the desk. I felt very strange throughout the whole time. I kept asking myself, how would I feel if I were in her shoes? Young family, strange symptoms happening to myself, confused, probably desperate for an answer, nah, I hope it's just something trivial. 

'Remember you had an MRI scan?' the consultant said. 
'Yes, how was it?' she replied. 
'From your history, your examination and your scans...It seems very likely that you have Multiple Sclerosis.' 
The air was cold, dead silent then. Even the baby was not making a sound. 

She started tearing. I grabbed some tissue for her immediately, having observed how the nurse reacted the last time I saw a consultant broke bad news to another patient with breast cancer. The consultation went on with her prognosis and treatment options. The patient went out slightly more composed, but I could see she was very fearful at the end. 

I was not quite sure what to feel. I was constantly battling between 2 different point of view within myself, throughout the consultation:
From the medical point of view, the consultant knew from the beginning what was happening and what will happen. She will get the diagnosis, then she will treat it the best she could and the MS should be under control, given she had RRMS. Job done. At one point, I almost could not understand why is she crying. I thought, don't have to cry, you are not going to die, at least, not that soon. There's a cure, MS is super common, I just saw several patients with MS before you. You will be fine. 
Then I put myself into her shoes: Omg, I am freaking scared, with all the news and things happening to people with MS! Will I shrivel up, stop breathing and die? Will I be wheelchair-bound? What will happen to my baby?! I want to watch him grow! 

I realised how my perspective and state of mind change as I learn more about Medicine. We see so many very very ill people coming in day in and day out, it's just seems normal to be very ill. The same for death - a dead body was pushed pass us on a trolley the other day and we continued to talk about the patient we were about to see as if nothing happened. A life just passed away, for goodness sake....

But...we don't live with those diseases and we have never experienced most of those diseases before, it is very hard to imagine how does it feel like. 




During our Clinical Communication Skills session, we were told to empathise with our patients, whom we have never met before and many with diseases which we never even heard before. I really don't know how medical students like us, 20-something years old, who barely have enough life experience or children of our own, can truly empathise with our patients. We can offer our utmost sympathy, but to empathise?

As for now, to expect us to offer empathy, as it is defined, will take more time, more experience and more deliberate effort to put ourselves in others' shoes in our every day life.