how do you spell that again

am thoroughly enjoying my paediatrics attachment! although honestly I find paediatrics really hard and it feels like a subspecialty in medicine to me.

today in the wards, besides a classical case of childhood nephrotic syndrome, there were no other “simple” cases. there was a langerhans cell histiocytosis patient with chemotherapy completed under remission, admitted for suspected diabetes insipidus. there was a glycogen storage disease type 1 patient. a quadriplegic spastic cerebral palsy patient. yesterday there was a patient with mucopolysaccharidoses @@@@@

when the paeds consultant quizzed me about the lab results for GSD 1, I was just lost for words. i knew nothing else besides that it causes hepatomegaly (the liver was very large. like 6-7 cm below the costal margin) and so my homework today was to look it up and she would further quiz me tomorrow.

and i should prep cerebral palsy too.

Thank God for choosing this path for me! Seriously, despite not knowing 129082357240 things in medicine, there is still this passion to work, work, work! and i will know more tomorrow (although i will forget more too ><)

may all glory go to You. ❤

Love this song by the way. esp the “I am learning how to die” part.

Better Things – JJ Heller

I have a story
That is only mine to tell
I don’t want to make believe
I just need to be myself

I have a mission
That is only mine to fill
Fear may try to blind my eyes
But it can never break my will

There are far far better things ahead
Than what I leave behind
Will you help me find my way

I’m on a journey
I’m losing who I used to be
I am learning how to die
It’s changing every part of me

There are far far better things ahead
Than what I leave behind
Will you help me find my way
[x3]

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the plank

our surgery bedside teaching today was a patient with cancer of the ascending colon.

the patient was a relatively old lady who complained of right lower quadrant pain for two months and anaemic symptoms for 2 years (with no cause found) before she presented to the emergency department a few days ago.

looking back at her history, she already consulted another hospital 2 years back for her anaemia, in which OGD (upper GI tract endoscopy) and colonoscopy was performed with no significant findings, except finding of a small polyp which histology came back later to confirm that it was benign.

the surgical department later referred her to GOPC (general out patient clinic aka family medicine) for follow up her anaemia which did not resolve and remained at a inexplicably low level (around 8g/dL?)

all her past case notes mentioned the low Hb with the comment of ?poor oral intake.

it was during this admission that colonoscopy was repeated, and also a CT scan with contrast was performed. and they found a tumour in the ascending colon, with no locoregional spread and a curative operation was feasible.

As we were taking the patient’s history, all of us got very skeptical as to how a tumour could develop so rapidly in two years that would be totally undetected through colonoscopy, with the anaemic symptoms persisting from the polyp finding up till now.

and honestly, i was being skeptical of what the first hospital did two years ago. Did they miss the diagnosis? missed out some investigations? didn’t take a thorough history from the patient and shrugged off the anaemia as a dietary cause?

During the discussion with our tutor, he mentioned that the colonoscopy performed might not be a “full” one and so the tumour went undetected, or no one could really find the underlying cause and so the patient was referred from surgery to family medicine and then back again.

but at any rate, the patient’s condition underwent thorough investigation and now wasn’t the time to point fingers at anyone for their assumed negligence/incompetency to diagnose the problem throughout the time frame of two years.  and also thank God that the patient’s condition is still curable at this stage although it is a relatively late presentation.

At the end of it, he said, “it’s good of you guys to learn something besides your bookwork. and i have learned something today too.”

i guess for me, not being judgmental is something I have to learn. it was too easy to put the blame on the other hospital for their seemingly incomplete workup, but this would not help the patient any more than create more stress and anger for her and her family to deal with, besides worrying about her upcoming operation. and not to mention lawsuits for the doctors/hospital involved.

Why do you look at the speck of sawdust in your brother’s eye and pay no attention to the plank in your own eye? How can you say to your brother, ‘Let me take the speck out of your eye,’ when all the time there is a plank in your own eye? ~ Matthew 7:3-4

It would do better to serve as a reminder for me, something that we learned earlier on in pre-clinical years…

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tap tap tap tappy

am feeling much better after a few days of rest and more time with God =)

I have day offs every Tuesday; was initially thinking of going back to the hospital to follow rounds/observe OTs/OPDs/clerk cases in the wards but on second thought, sleeping till late + studying in the afternoon seemed to be a more feasible and relaxing choice xd

photo updates of the past two weeks!

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Monsters University exhibition in Causeway Bay. The people here are more interested in watching Monsters than Despicable Me 2, from which what i gather from facebook, is creating a massive McDonald’s happy meal craze back in Malaysia. My friends are lining up in the wee hours of the morning to get their hands on some minions. i mean they are cute but they’re not worth that much trouble imo.

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Yum cha-ed with Amanda and her mom at Times Square!

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Watched a CABG + LIMA operation (coronary artery bypass graft operation using left internal mammary artery as graft) and although the cardiothoracic surgeon ignored us, the anaesthesiologist was nice enough to teach us how to interpret the different views of a TEE (transesophageal echocardiogram) and also tell us how the CABG was done! Basically this operation is for people with severe block of blood vessels supplying to the heart, so the surgeons take another healthy blood vessel from another site and “bypass” the obstructed blood vessel so that the heart still gets blood supply thus preventing heart attack in the patient. This operation involves stopping the heart and channeling blood to an external device where it takes over the function of the heart and lung by oxgenating it and then returning it back to the rest of the body. Its pretty amazing to see a beating heart right in front of your eyes; and then see it stop and all the blood from the body flow out into a machine and then flow back in again.

 

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Our first medic fellowship gathering this semester at Crystal’s house! everyone has a totally different schedule nowadays so we barely see one another; except for my own groupmates. it was fun cooking together (though I must say the sushi from ParknShop was heavenly) and nice listening to everyone share their recent experiences in the wards or over the summer.

 

 

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Am supposed to get back to studying; especially for orthopedics which i practically know nothing about. but the after-rain weather is making me sleepy and lazyyy 😀

welcome to year 4, i guess. =)