…dan kami
hiasi langit yang dekat dengan bintang bintang yang cemerlang dan kami
memeliharanya dengan sebaiknya-baiknya. Demikianlah ketentuan Yang Maha Perkasa
lagi Maha Mengetahui. Surah Al-Fushilat ayat 12

Teringat, dari kecil lagi aku tertanya tanya, apakah
mungkin kita bisa bermain-main di atas bintang yang cantik itu ? Tengkuk
halusku dan tengkuk sederhana tebal abangku  seringkali lenguh tatkala kami sibuk bermain
basikal di halaman sambil sibuk membilang butiran bintang yang berterabur luas.
Lebih sahaja dari 30, aku sudah tidak mampu untuk mengira. Impianku ialah untuk
menaiki roket dan bermain riang di atas

sana

seperti cerita kartun Carebears. Kadang kadang melihat bintang buatku sedih
kerana terasa begitu jauh dan tidak tercapai.

Lewat usia awal remaja pula, pertama kali ku
ternampak bintang yang betul betul menyirna ialah ketika di hutan, sewaktu kem
perkhemahan pandu puteriku. Aku dibesarkan di metropolitan yang penuh dengan
lampu neon dan langit yang tidak begitu terang untuk bintang-bintang menonjol.
Dan pada malam operasi burung hantu itu, aku duduk terbaring di atas rumput
yang segar baunya dan terasa enak sejuk embun di belakangku, bertemankan bunyi
irama cengkerik, terbaring lentang menghadap terus ke arena langit luas ciptaan
yang Maha Esa. Gelap gelita tiada satu cahaya kecuali cahaya bulan dan bintang.
Seperti hendak pecah hatiku yang terasa kembang mekar melihatkan kecantikan bintang
bintang yang tiap satunya bergemerlapan dengan kelipan yang tersendiri, yang
tiap satu bintang itu lain, seakan akan manusia mempunyai personaliti yang tersendiri.

Ada

yang begitu terang dan dekat seperti
boleh di petik manakala ada yang jauh sayup sayup pudar cahaya. Bentuk bentuk
mereka seperti ada suatu kemasyarakatan, ada yang dekat dekat ada yang jauh,
yang mana tentu jika ditunjukkan kepada rakanku yang gemarkan astronomi, sudah
tentu mereka boleh menamakan mengikut zodiac. Kata Puan Zakiah, cikgu geografi ku, bintang malam
adalah petunjuk arah kepada pelayar lautan. Bintang juga berubah mengikut musim
dan sebagainya. Ah banyak betul fakta sains tapi buat waktu ini, aku tidak peduli, aku hanya mahu menghayati
mentah mentah suasana hening malam dengan bintang bintang di langit dengan
sepuas puas penghayatan, bukti yang sangat terang bahawa adanya tuhan, dan
tuhan itu boleh mencipta apa sahaja, dan segala ciptaan tuhan itu sangat indah
dan sempurna. Cukup, tidak perlu sains, hanya menyaksikan kecantikan bintang jiwa
remajaku sudah puas.

 Meniti usia awal kedewasaan, aku
sudah betah berada di langit biru. Alhamdulillah, Allah telah menganugerahkan
rezeki untuk ku berjalan melihat muka buminya yang luas ini. Aku terbang ke

sana

sini merentas benua
dan lautan, dari atas langit itu, aku dapat lihat bentuk muka bumi yang
beraneka dan pelik pelik. Gurun yang berlubang dan berpetak petak, pesisiran
pantai dan teluk di mana dapat ku lihat percamtuman laut dan darat, dan yang
paling menarik bagiku, ialah melihat kepulan kepulan awan yang pelbagai bentuk,
paling pelik bagi ku ialah ketika di bumi Macau, awannya panjang panjang ke
atas persis rambut isteri Homer Simpsons, Marge. Ah, awan, seperti boleh sahaja
aku bermain main atasmu dan mengotakan impian Carebears ku! Kemudian aku di
beri peluang lagi untuk melihat langit yang penuh bintang terang, ketika di satu perkhemahan musim panas di
tepi laut

Rotterdam

,
Belanda. Walaupun jauh di benua yang lain, rupanya sang bintang tetap adil,
cahayanya tetap sama, dan tidak lokek berkongsi kecantikannya dengan manusia di
seluruh bumi, walaupun pada manusia yang angkuh tidak mengimani penciptanya. Di
celah celah butiran cahaya itu, ku mencari bintang bintang yang tersusun
seperti anak panah kerana teringat kata teman baikku dari sekolah menengah,
bintang bintang yang tersusun seperti anak panah itu adalah menunjukkan kearah
kiblat. Lalu aku sujud syukur, merebahkan diriku di bawah pepayung anak panah
cahaya itu. Oh tuhan, betapa kerdilnya diri ini dibandingkan dengan
kebesaranMu.

 Jadi jika ditanya kepadaku, apa yang
paling dirimu kagumi? Akan
kujawab pantas, bintang terang di langit. Jika ditanya lagi mengapa ? Akan
ku cuba untuk menerangkan sebegini ‘Kerana langit yang sehitam baldu apabila
dihiasi dengan kerlipan bintang yang mempesona, akan mendetikkan suatu rasa takjub
di hati, suatu rasa yang tiada wujudnya kata- kata untuk menghuraikan tusukan jiwa
yang dalam itu. Hanya mata yang dapat mengertikannya dan hanya lidah yang mampu
berkata ‘Subhanallah’ Maha Suci engkau ya Allah.

   SCR 2235, 231207

Having reached the milestones of age 23 by the Gregorian calendar, on May 20,2007, 1.01 pm, statistically I’ve completed almost 33% or one third of my expected longer lifespan as a woman. Statistically speaking that is. I could be 98% anytime.
My eldest brother of age 35 (sorry abang, don’t sue for the age privacy ) sent me a birthday card saying ’mudeee lagii’ and all my family n friends wishes me  good prosperity for my upcoming life. That is really sweet of everybody. But seeing all those scrawny drawings of my nieces on the bday card, which was really cute and adorable, made me think of something., that I’m at least 10 times the age of my nieces, whose average age are 2 years old. Wow. I’m that old. That fast.
    I still have vivid memories of my childhood, one was on my the morning of my tenth birthday, it was a school day, so in the car backseat, I pondered about me being a  10 year old, and even that time I feel that 10 is many, like a bunch of sticks used in the mathematics class. And 10 are like a decade. And in that 10 year old head with 2 ribbon ponytails did count that I’ll be like at least 10 years from university life, 14 years from working life, 15 years from marriage and 16 years perhaps from being a mother. Yeah I did think of that and I was really full of curiosity how will my life shaped then. And like a time machine, that 10 year old me was zapped into my current old self, and 13 years later, here I am being able to answer a few questions and held responsibility for how I did spend that statistically 33% of my life.
    If that 10 year old me started to ask what did I learn to manage myself, I can say at least proudly to her, that I learned to cook for myself and do laundries, and do my own bed, iron my own clothes, and decide my own fashion, tie my own shoes and learned how to tie a beautiful ribbon, pay my own bills, do my own shopping and groceries, yes pretty lame stuffs like that, which is so unthinkable for that spoilt 10 year me at that time.
    If she asked was I good, obedient to God and parents? I’ll say yes, I’m trying my best to enflowered my faith from time to time, and managed to do all the compulsory things like praying 5 times a day and fasting in Ramadhan. And I have loved my parents as much. But there were so many things that I regretted doing and also not doing, being I naïve teenager, so if I can advice her one thing, it would be always be wise and keep Allah near to heart always.
    If she started to ask what did I do to contribute to the society, I’ll be shameful then to say to her that I did nothing much yet, and I’ve been pretty selfish with my own leisure. But perhaps I can promise her that soon, I’ll be a compassionate doctor and with the trust I gained, I’ll help the society in whichever ways I can.
    If she started to ask am I satisfied with my life now and if there are things that I want to change, I’ll say that I cannot ask more. Yes if I compared my life to those who are more fortunate, I want to change everything, but it’s the less fortunate that we should be compared to, and seeing the hardships and sufferings in the poor countries, I just can’t ask more..
    And as a farewell bid, I’ll say, ‘ Dear little girl, don’t you worry much, it’ll be an exciting journey to look, feel and touch things, and the experiences that you’ll gained, however bitter and sweet, it’ll priceless, and neither money nor gold can buy those experiences!’

So maybe perhaps, this 23 year old me now, will be visiting a 60 year old me ? I’m sure if I live long enough, that’ll be just a blink of time. And more questions to answer for sure. ☺ 

    I was one of the presenter for yesterday’s junior case competiton event, conducted by biosoc society, and judged by esteemed panels; prof Hill, prof Mcelvaney and Dr. Grogan. After dreading it for almost a week, at last the day came for me to stand in front of the lecture theatre and spill my guts out. It was really like a fear factor thing, to be able to present a case in front of a crowd, i was never good at presenting before, not even in my OSCE or with my consultant, let alone in a competition where a bunch of expectant crowd staring down. But i did it. And it felt good.
    It all started with me blank-minded-ly submitted a short summary of a very interesting case of Graves disease (hyperthyroidism). My case was selected among with other 8 cases. I was terrified then, being my first time of experience and I just can’t imagine how am I going to present it. But the support I received, I was so touched and they get me through it. First the patient herself, Mrs DV, who was so helpful and kindly, consented for her picture to be used in the slides, and she becomes my new friend. There’s so many hikmah lies here, as she’s a revert and she’s looking for someone to help her through and I gladly extend my hand of friendship to help her with any way I can. Then my team’s registrar Dr. Tom King, who initially gave me this case for me and then, helped me out with the presentation. For the concern and time, I just can’t thank him enough. And then to all my dear friends, Fairuz who edited the slides and always giving me a helpful  hand, Huda and Farah who went to support my presentation and always there for me, Wawa who helped me out to choose whether I should wear my pink or black jacket;), Mahirah who helped  my rehearsal and others and to my family who never cease to give me encouragement and motivation, thank you so much.
    When you know that people cares about you, it’s when you feel happy most ☺

This movie is totally unbelievably a good one..it’s been a long time since me and friends been watching an agreeable movie..but this is certainly good..no words can describe it just vacuumed the audience inside to its realm…

Spoiler warning: Plot and/or ending details follow.

An opening prologue tells of Princess Moanna, daughter to the king
of the underworld. The princess became curious about the world above
and fled to the surface, where the brightness of the sun blotted out
her memories. Princess Moanna eventually grew old as a human and died,
causing turmoil in her kingdom. However, the king always believed that
her spirit would one day return, even if reincarnated in the form of another.

The story cuts to post-Civil War Spain in 1944, after Francisco Franco has come into power. Ofelia (Ivana Baquero), a young girl often absorbed in fairy tales, travels with her pregnant mother Carmen (Ariadna Gil) to meet Captain Vidal (Sergi López), Ofelia’s new stepfather and father of Carmen’s unborn child. Vidal, a fascist devotee, suffers from the repercussions of his father’s death as a famed commander in Morrocco,
and takes his feelings out on the Republican rebels he has been
assigned to seek out and eliminate while stationed at a countryside
mill.

On the way, Ofelia discovers a large insect resembling a praying mantis and walking stick bug, and she believes it to be a fairy. The creature follows the family to their new home, where it leads Ofelia to an ancient labyrinth. Before Ofelia can enter the labyrinth, she is stopped by Mercedes (Maribel Verdú), one of Vidal’s maids and a spy for the rebels, who are led by her brother, Pedro.

The faun gives Ofelia the Book of Crossroads, which explains her tasks.

That night, the creature appears in Ofelia’s bedroom, where it
morphs into a fairy and leads Ofelia through the labyrinth into a small
clearing. There, Ofelia meets the faun (Doug Jones),
who recognizes her as the long-lost Princess Moanna and assigns her
three tasks to complete before the full moon to ensure that her
"essence is intact".

The Pale Man awakens and examines his surroundings.

Ofelia completes the first task - retrieving a key from the belly of a giant toad - however, she fears for her mother, whose condition is worsening. The faun gives Ofelia a mandrake root, which instantly begins to cure her mother’s illness. Ofelia then manages to complete the second task - taking an ornate dagger
from the lair of the Pale Man - but not without awakening the creature
and losing two of the faun’s fairies to it. Infuriated by her
disobeying his orders, the faun disappears, claiming that she will
never return to her kingdom or see him again.

Meanwhile, Vidal becomes increasingly vicious in his methods,
torturing a captured Republican and killing a doctor (a Republican
sympathizer) who euthanized
the prisoner (at the prisoner’s request) after the prisoner began to
give Vidal information. Vidal catches Ofelia tending to the mandrake
root, and Carmen, desperate to prove to her daughter that magic is not
real, throws the root into the fireplace. Instantly, she develops
painful contractions and dies giving birth to a son.

Vidal discovers Mercedes is a rebel spy, and he captures her and
Ofelia as they attempt to escape. Ofelia is locked in her bedroom, and
Mercedes is taken to be tortured; however, she frees herself, injures
Vidal and flees into the woods, where Pedro and the rebels rescue her.

The faun returns to Ofelia, claiming that he will give her one more
chance to prove herself. He tells her to take her baby brother into the
labyrinth. Ofelia manages to steal the baby after sedating Vidal;
however, although disoriented, Vidal continues to chase her through the
labyrinth amidst an attack on the mill by the rebels.

Upon her arrival in the clearing, the faun demands that Ofelia spill
her brother’s blood to open the portal to the underworld. Ofelia
refuses to harm her brother, and the faun disappears, accepting her
decision. Vidal finds her, takes the baby and shoots Ofelia. As he
staggers out of the labyrinth, he finds the rebels waiting for him and,
after handing them his son, is killed by Pedro.

As Mercedes enters the labyrinth and mourns over Ofelia’s dead body,
Ofelia is reunited with the king and queen of the underworld. She
learns that by spilling her own blood instead of her brother’s, she has
proven herself to be the true Princess Moanna. The epilogue tells that
Ofelia ruled the kingdom for many centuries, was adored by her people,
and left behind little signs of her life on Earth, visible only to
those who knew where to look.

kudos tu bojol who burned this movie ..

1 - Presenting Complaint of Mrs DV, a 29 year old lady:

Racing of heart, for the past 3 days

2 - History of Presenting Complaint:   
-   
-    The palpitations started from Friday, which was intermittent in duration. She was sleeping when it starts. The palpitations progressed until Monday when it became worse and continuous throughout the day. She had difficulty of breathing too. e She then referred herself to A&E
-    She denied of any ankle swelling, orthopnoea, dyspnoea on exertion, paroxysmal nocturnal dyspnoea or crushing chest pain.
-    She loss 22kg for the past 2 years, she attributed it to being a vegetarian.
-    However she described that she was being hungry all the time, although she didn’t eat much since she becomes increasingly picky with her food.
-    Her bowel habit is regular for the past 2 years except that she had loose stools for the past 3 days, not watery, and there was no blood or mucus.
-    For the past 2 years, she got anxiety attacks over flying and driving. She could not drive now. She would scream hysterically or being agitated although there is no danger. She never experience that before.
-    For the past 2 years, her menstrual cycle was regular but a bit light. She is on contraceptive pill.
-    She preferred to be in warm room but she can wear a light coat over the winter. She can tolerate the cold weather well.
-    She was feeling weak when getting out from the bed and getting into shower.
-    Last week she noticed that her neck was so big.

This is perhaps the most interesting case in my first 6 weeks rotation in Beaumont hospital. A classic presentation of hyperthyroidism, all the facts that I learned from my pathology course becomes so handy especially in history taking from this ever so pleasant lady. It is like a long read story unfolds itself upon my own eyes. I felt an indescribable feeling of fulfillment by making the right diagnoses, just from history and physical exam. I presented the case to Dr. Smith during the ward round, my first case presenting with a consultant. I was so nervous at first, all the feedbacks from my previous presentation flashed back in, but suddenly a sudden urge to just being confident taking over me. It was really a phenomenal experience, just me to inform him on everything and he relied on it. I feel like a real doctor working with him. I did a thorough thyroid physical exam and he was satisfied with all the findings I presented. All in all he was very satisfied with my presentation and I got a good feedback from him. For the first time, I feel so motivated. I learned a really big point today, that I can do it; I can present a case successfully, if I just want to do it. ☺

For the past 6 weeks, all rcsi’s third med students are attached to
clinical teams in Beaumont or Connoly Hospital.. i’ve attached to
infectious disease team, surgical team, and endocrinology team, and
i’ve met with so many senior doctors and patients.. the main essence in
this clinical attachment is to take history from the patients and then
to present it to the senior doctors.. the history taking part is quite
enjoyable for me, as i’m the person who’s like to chit chat
anyway….;) and all the patients are so sweet and nice.. the real
difficult part is too present the case history, ouch that’s so
mysteriously pain in the ass! seriously , i just couldnt understand
why, because in a logical induction, it should be easy since we just
need to report what’s the story.. but in the real world, that nice easy
logic doesnt happen at all..(well maybe sometimes on good days) . i’ve
received numerous comments from multiple senior doctors, hehe.. which
i’m happy to receive too, because i really need to build up my
presenting skills asap, before this coming osce in june.. well dr
shazly said i have the attitude but i’m a big gigly, huhu, and dr david
wants me to be more confident, and dr zubin said dont ask questions
while presenting the case.. i feel so stupid some times, as i think its
unusual to not acquiring the skill in overnight time.. but now i
realize that , it comes with practice and practice..to infinity,
nothing more..i’m improving now,thank god,and a few consultants even
gave me honest grade recently..phew…and then as i google to search
for few good websites for this case presentation, i stumbled upon this
journal, which kinda solved all my 6 weeks mystery.. hehe –> oh
really i’m gigly! is that a bad thing?? really!

Journal of General Internal Medicine

Learning Oral Presentation Skills

A Rhetorical Analysis with Pedagogical and Professional Implications

OBJECTIVE:

Oral
presentation skills are central to physician-physician communication;
however, little is known about how these skills are learned. Rhetoric
is a social science which studies communication in terms of context and
explores the action of language on knowledge, attitudes, and values. It
has not previously been applied to medical discourse. We used
rhetorical principles to qualitatively study how students learn oral
presentation skills and what professional values are communicated in
this process.

DESIGN:

Descriptive study.

SETTING:

Inpatient general medicine service in a university-affiliated public hospital.

PARTICIPANTS:

Twelve third-year medical students during their internal medicine clerkship and 14 teachers.

MEASUREMENTS:

One-hundred
sixty hours of ethnographic observation. including 73 oral
presentations on rounds. Discoursed-based interviews of 8 students and
10 teachers. Data were qualitatively analyzed to uncover recurrent
patterns of communication.

MAIN RESULTS:

Students and teachers
had different perceptions of the purpose of oral presentation, and this
was reflected in performance. Students described and conducted the
presentation as a rule-based, data-storage activity governed by "order"
and "structure." Teachers approached the presentation as a flexible
means of "communication" and a method for "constructing" the details of
a case into a diagnostic or therapeutic plan. Although most teachers
viewed oral presentations rhetorically (sensitive to context), most
feedback that students received was implicit and acontextual, with
little guidance provided for determining relevant content. This led to
dysfunctional generalizations by students, sometimes resulting in worse
communication skills (e.g., comment "be brief" resulted in reading
faster rather than editing) and unintended value acquisition (e.g.,
request for less social history interpreted as social history never
relevant).

CONCLUSIONS:

Students learn oral
presentation by trial and error rather than through teaching of an
explicit rhetorical model. This may delay development of effective
communication skills and result in acquisition of unintended
professional values. Teaching and learning of oral presentation skills
may be improved by emphasizing that context determines content and by
making explicit the tacit rules of presentation

a perfect conclusion!!!

Mind Map: a recommended study technique.. me and my friends use this and we find out that it’s pretty helpful and addictive too! do try!

Tony Buzan suggests using the following foundation structures for Mind Mapping:

1. Start in the centre with an image of the topic, using at least 3 colours.
2. Use images, symbols, codes and dimensions throughout your Mind Map.
3. Select key words and print using upper or lower case letters.
4. Each word/image must be alone and sitting on its own line.
5. The lines must be connected, starting from the central image. The central lines are thicker, organic and flowing, becoming thinner as they radiate out from the centre.
6. Make the lines the same length as the word/image.
7. Use colours – your own code – throughout the Mind Map.
8. Develop your own personal style of Mind Mapping.
9. Use emphasis and show associations in your Mind Map.
10. Keep the Mind Map clear by using radial hierarchy, numerical order or outlines to embrace your branches ^[1].

An idea map is similar to a mind map but does not adhere to the
above guidelines. Rules are constantly broken based on the purpose and
application of the map.

My childhood evolved around fantasy story books, one of the best series is :

The Magic Faraway Tree series is a popular series of children’s books written by Enid Blyton.
The stories revolve around an enchanted wood where a gigantic magic
tree grows, which is discovered by three children living nearby. Every
now-and-then, at the top of the tree, a new magic land appears, which
the children can visit; but they have to leave before the land "moves
on", or they could be stuck in that land when it is replaced by a new
land at the top of the tree.

The Faraway Tree is inhabited by people who include Moonface and The Tinks, the fairy Silky, The Saucepan Man]], Dame Washalot,
Mr. Whatsisname and the Angry Pixie. The lands at the top were
sometimes extremely unpleasant (the Land of Dame Slap) or sometimes
fantastically enjoyable (the Land of Birthdays, the Land of
Take-What-You-Want).

The titles in the series are:

1. The Enchanted Wood (1939)
2. The Magic Faraway Tree (1943)
3. The Folk of the Faraway Tree (1946)
4. Up the Faraway Tree (1951)

This is my second week in a surgical team and already I learn a lot. First from my team, I learn how to have a good bedside manner with the patients, which is basically simple humanism. And then I got the opportunity to be in OT and scrubbed in for Mrs IM’s anterior resection, which was very fulfilling since I had taken history from her before. I learn few surgery techniques such as laparatomy and laparoscopy. And then I follow up Mrs IM post operatively, accompanying her to gastrograffin enema and such, chit chatting with her all the way. I guess the most learning I got is from Mrs IM herself, the patient. She is very brave indeed, enduring this new rocky pathway of life with such patience and acceptance. From her I learned the secret art of healing, of the patients themselves and of us too, the medical personnels. By being aware of our own vulnerability, the crucial part of our humanity is being opened to flawness and only then we are opened to pain and subsequently healing. It is a reciprocal and reflexive process between the wounded and the healer, if we just listen, patient will guide us to heal them.

I got feedbacks from my interns, and sho, which are very motivating. They said I’m very good at history taking and clinical acumen but I need to be more confident in presenting the case and doing physical exams. Thus I hope by paving my way through this intensive clinical attachment, I can get enough practice to build my confidence on a solid ground.

A few bits from my recent case report..

Mrs VC a pleasant 54 years old female electively referred by OPD with altered bowel habit, abdominal pain and progressive faecal incontinence for the past 18 months and significant past surgical history of gastrointestinal system. She had very poor quality of life and also psychologically disturbed which she described as the feeling of being ‘dirty’. Thorough investigations did not yield any definite diagnosis. She had a loop colonostomy done successfully and she is doing well now and had been discharged home. This case shows an excellent example of how surgical intervention improves a person’s life dramatically.

“I will follow that system of regimen, which according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever deleterious and mischievous” says the old Hippocratic oath 425BC, which I just cannot agree more.

This is my first week in the surgical team and I really learned a lot of new things. Besides the theoretical knowledge, I am exposed to a new culture of the ‘surgical values’, which comprises of competency, competency and competency. There is just no place for error in surgery. However there are no clear-cut case and the best way to treat the patients are through integrating knowledge, synergy between team doctors and also learning via time and experiences.

    I interacted with lots of patients and most of them were very pleasant and cooperative. And every patient differs and the art of taking the history is to tailor it accordingly. I hope with the help of the supportive interns, Dr David Mak and Dr Michelle, my skill will improve especially in presenting the case in a more confident way.

cheerios full day in operating theater tomorrow..