Patients : People or Cases?

This month has been overwhelming by school schedules, reading catch-up, and extracurricular activities I have. Last 3 weeks I joined gym and tried to spend 3 times a week having workout session. On one side it has made me feel good about my body, I feel much more healthier and less tiresome, I have better mood, and it is a good way to relieve some stress too (yes, the gym guys are good looking! :p). On the other side, I go home after workout feeling tired and can't stand reading handouts for more than one hour. So I try to do a major catch up on weekends, but then I always use weekends as my excuse to hang out and have fun, so basically I am doing a very slow progress here. I have postponed my plan to take a diving course this month until all the exams are over and it turns out to be the smartest decision I've made so far.

Being so tiresome and sleepy in class make me want to post some tricks (some work, some not) I use to do when I can't stand to sleep during a long class, either it is a morning one or an afternoon one. Still on process on making that post, though. But tonight when I was reading surgery handouts, some case images of oral cancer have disturbed me.

this food has made my day

I love making salads! I can even make 5 reasons why I love salads:
1. You can choose anything you like as the basic ingredients. Name it: fruits, all kind of fruits, almost all kind of vegetables, chicken, turkey, potato, eggs, prawns, tuna, salmon, pistachios, pine nuts, even pasta.

Enjoying medical school to its max

"No matter what you do, this medical training will be a long process. So all we can do is enjoy each second of it." - Robert, a senior of mine and one of the smartest student in my faculty

Three years ago, when I learned about biochemistry, physiology, and biomedicine in med school, I keep on thinking that all I want is finish medical school as fast as possible and get myself to be a real doctor as soon as possible.

Yesterday, I read a very interesting post in Medscape website,which pretty much made me realize on how I actually enjoying this whole process of medical training. This post "Journey or Destination?" had me remember my first three years in medical school, which sometimes I keep on thinking about the goal, good test results, and how it will affect my life as a doctor in the future.

Now I am entering my fourth year, my next semester will be the last semester before clinical rounds, and it will be my last semester having lectures with the whole students in my badge. Rolling my mind back when I had lab classes and medical skill trainings, I start realizing that I am going to miss those whole process.

I remember my first year, still get used to call my lecturers "Doc" instead of "Ma'am" or "Sir", adapting myself in the euphoria of being accepted in med school, caught bad nightmares after doing my first dissection in anatomy class, getting overwhelmed by hundred of Latin words in anatomy and the complexity of human body structure, pretending to be a real doctor by practicing history taking and physical examinations to fake patients...

My second year, studying the difficult schemes of biochemistry, had interesting experiments in human physiology class, seen and tried ECG machine for the first time, paid full attention of roaches, worms, and ticks under the microscope in parasitology class, made the TB sputum preparations in fear of might getting infected, created my very first research proposal and spent nights finishing it, did my first catheterization and NG tube application (which is actually much harder to do it how it seem)...

My third year, did my first phlebotomy (and get my blood sucked by my friends too -- in several attempts), did my first urine, blood, and serum analysis in clinical pathology class, seen the actual tumors and human diseases with my own eyes in pathology anatomy class, finished my research project (about breast cancer) after months of the long process, did my first 5 hour clerkships in neurology, emergency dept, paediatrics, and internal medicine ward, and more exhausting nights of pre-exam nights...

In just three years, I have learned, seen, watched, heard, experienced, felt, dissected, smelled, and done lots of things that I haven't done or even imagined before. I have felt wowed, overwhelmed, jawdropped, amused, excited, upset, desperate, and all of those colorful emotions related with my training. We have been carefully prepared, so we would be the doctors who can face the real patients out there, once we are graduated. This whole medical training program, along with the lecturers, fellow med students, and generous seniors have created an unforgettable experience of a lifetime.

The process of training will be continued even for years after I completed med school, either by formal or informal lessons. As for today, I decided to put more attention on here and now, while keep aiming at my goal.

A lady on my dermatology handouts

This is just random. Related? No?

Almost Unpublished!

This is two dish I made about a month ago, just before the hectic weeks begun. Planned to make pancake anytime soon but the soonest would be after the grand exams though.
I used nearly half the whole pack of cream cheese on the macaroni pizza, and spread generous amount of shreded cheddar cheese on top of it. Combined with lots of sliced sausage, the result is heavenly for cheese and meat lovers like me. Nutmeg, onions, black pepper, and oregano completed the Italian-wanna-be fragrance.

As for the second dish, Spicy Stir Fried Beansprouts, it was literally too spicy for me. Not a major failure but I am pretty thankful its abundant chilli peppers didn't cause any toxic effect.

Some great songs I found today

It's been weeks since my last post. Last 6 weeks I had clerkship rounds, each two weeks in internal med and pediatrics, and the rest is one week each in neurology and psychiatry. Clerkship has been so much fun and interesting but it had opened my eyes that I know almost none about clinical theory. When I faced the real patients, most times I don't have any idea about the diagnosis and the proper therapy. Wearing white coat in the hospital and sometimes being miscalled as "doc" have made me feel ashamed of my lack of knowledge.

Tomorrow will be the last clerkship exam and I was planning to give my best, yet I know I am a bit too exhausted to read some more after a whole day studying. So I decided to watch some music videos and quite excited to discover three music clips of the awesomeness, Beyonce. The recent clip, "Run The World (Girls)" had my jaw dropped. Insanely cool outfits and dance moves.

Second is a soulful song entitled "1+1", again her voice amazingly powerful and so much life inside her words.

The last one is "Flaws and All" which has beautiful lyrics and touchy performance. The lyrics define what I thought about true love, for the you or capital You out there, the love we can get from parent, child, bestfriend, lover, or anyone. I put the lovely lyrics here so you can see why I love this song SO much. =))

Flaws and All
By: Beyonce

I'm a train wreck in the morning
I'm a bitch in the afternoon
Every now and then without warning
I can be really mean towards you
I'm a puzzle yes in deed
Ever complex in every way
And all the pieces aren't even in the box
And yet, you see the picture clear as day.

[Chorus]
I don't know why you love me
And that's why I love you
You catch me when I fall
Accept me flaws and all
And that's why I love you
yes that's why I love you
and that's why I love you

I neglect you when I'm working
When I need attention I tend to nag
I'm a host of imperfection
And you see past all that
I'm a peasant by some standards
But in your eyes I'm a queen
You see potential in all my flaws
and that's exactly what I mean.

[Chorus]
I don't know why you love me
And that's why I love you
You catch me when I fall
Accept me flaws and all
and that's why I love you
yes that's why I love you
and that's why I love you

Beef and More Beef

Actually I made these two dishes around a week ago. Both are made in the same day, with half kilogram of beef I bought from a local market.

Mung Bean Dessert w/ Coconut Sauce

 

I wasn't in mood to study pediatrics this weekend so I decided to make something warm, sweet, and easy. The green bean is sweet with a slight of gingery trace and the coconut milk is a bit savory. Now this snack will be my companion as I open my book! :)

I always like mung bean (or so-they-called here: green bean). Usually I like to keep it handy by boiling them (for 1 hour or so) , add some sugar, and that's it. It is perfect to be enjoyed while it is warm, or after you keep it chilled in the fridge. Today I tried to make a different style of it. I soak the bean for half day (morning to afternoon) while I was revising some pediatrics material. Then on the afternoon I boil it for about 1 hour with some gingers (you can use fresh ones, I use two packs of instant ginger drink this time), and add 1 pandan leaf. Once you see that the beans become twice its actual size and it begins to soften, you can lower down the fire or just lift the pan. add some sugar, stir it up, and leave them to make the coconut sauce.

For the coconut sauce, use coconut milk (I use an instant one) and simmer for about 2 minutes. Mix with some corn flour. Add pandan leaf if you want to add its fragrance to the sauce. Note that you should mix a spoon of corn flour with a room-temperature water first before you heat it. Less water if you like the sauce thicker. Leave until it boils, add a pinch of salt and a bit of sugar,  stir, and lift. Enjoy the sweet mung bean soup with the savory and thick coconut sauce! Yum.
 

a perfect companion as I open my book! :)

Artsy Me

I was re-reading clinical pathology handouts from my 4th semester, and I found these pictures I made during studying and/or being bored at class. Some are pretty fun, some are random, and I even wrote a full lyrics of "I Love the Way You Love Me" by Ronan Keating once I was studying while listening to it.
I guess studying while listening to music would not be an effective learning method for me.

Veggies and Beef Soup

Ah, surely cooking has always healed my mood. I used to have this kind of vegetable soup back when I was home, so I tried to make it myself today. Usually my mom makes it either with chicken pieces or beef, but since I didn't have any fresh meat I use beef sausage instead.

The ingredients:
1 clove of onion, finely chopped
1 tomato, chopped
2 or 3 carrots, peeled and diced
beef sausages, cut
beef stock
about 2 ounces of beans, cut into 2 cm length
salt, pepper, and nutmeg
a small amount of vegetable oil

How to make:
Stir-fry chopped onion until it caramelized and smells good. Add carrots and beans, add beef sausages about 2 minutes later. Pour in the beef stock and set the medium fire until it boils. Once it boils, set the fire to small, add the tomatoes, and simmer. In about 3 minutes, try the carrot and make sure it is already done, but not too mushy. You decide how soft you want them to be. Add salt, pepper, and a sprinkle of nutmeg. Parsley would be good as the garnish and it smells good too. If you want to add chicken or beef meat to the soup, make sure it is pre-boiled and already chopped so you can add it just when you add the sausages in.

Ready to be served, and enjoy!

The Generous Patients

Hari ini hari kedua clerkship di bagian interna dan paru. Hari pertama kemarin hanya dilewati dengan teoritis dan melihat contoh kasus pada pasien nyata, jadi aku sedikit berharap semoga hari ini bisa melakukan pemeriksaan fisik ke pasien, setelah bertahun-tahun hanya belajar ke pasien "bohongan" yaitu kakak kelas atau staff yang berpura-pura jadi pasien. Tentu hasil pemeriksaan yang ditemukan akan beda dengan seandainya yang diperiksa itu pasien sungguhan.

Paginya diawali dengan kuliah singkat tentang anamnesis, lalu kita dibagi menjadi 4 kelompok, masing-masing 3 orang, dan diperbolehkan melakukan anamnesa ke beberapa pasien yang ada di ruang interna wanita. Agak kecewa karena dosen pembimbing kami tidak memperbolehkan kita melakukan pemeriksaan fisik kepada pasien. Alasannya masuk akal sih, pasien sudah terlalu banyak di-"jamah" oleh tenaga medis dan calon tenaga medis yang ada di situ, sebut saja para dm/co-ass, ppds, mahasiswa perawat, perawat, dokter yg bertugas, dsb dsbnya. Terbayang kalau aku yang harus berkali-kali diwawancara tentang penyakitku, ditanya hal-hal yang sama terus, dipegang-pegang dan diliatin padahal sedang mau istirahat dan bosan juga pastinya. Iya juga ya.

Lalu kami ke bangsal interna wanita. Kelompok 1 mendapatkan pasien seorang wanita lanjut usia yang perutnya membesar. Kelompok 2, seorang dengan kaki yang membengkak dan napas pendek-pendek. Kelompok 3, yaitu kelompokku, dengan wanita yang badannya kekuningan, dan kelompok 4 dengan seorang wanita yang (katanya) anemia.

Sebelum memulai anamnesis kelompok, dokter pembombing kami meminta ijin kepada tiap pasien, bahwa kami akan menanya-nanyai mereka, dan apakah mereka keberatan atau tidak. Tiap pasien ternyata setuju dan dengan baik hati mau menjawab pertanyaan kami yang sering kali berbelit-belit, diulang-ulang, bahasanya mbulet, dan mungkin sedikit membingungkan. Yah namanya juga belajar, dan grogi juga sih. Pasien-pasien ini lah yang pasti pahalanya begitu besar kelak, karena kesabaran mereka.

Setelah itu, kami istirahat selama 30 menit lalu lanjut ke bagian paru. Setelah kemarin hanya diceramahi dan kuliah singkat, aku sedikit pesimis dengan materi yang akan aku dapat hari ini. Memang, ruangan tempat kami diberi pengarahan paru itu nyaman sekali, kursinya empuk, adem karena ber-AC pula, tapi dasar namanya rajin (:p) keinginan utk berkeliling dan ke pasien yang beneran masih membara.

Kami akhirnya berlatih pemeriksaan fisik dengan "pasien" seorang karyawan di departemen tersebut yang sudah sedari dulu membantu para clerk di sana -- sejak tahun 1972, katanya. Wow. Bayangkan berapa ratus dokter yang sudah memperoleh ilmu langsung dari sang Bapak, tidak dengan kata-kata saja, tapi dengan tubuhnya sendiri.

Ternyata dokter pembimbing kami harus menghadiri acara lain yang mendadak, jadi kami akan dibimbing oleh seorang dokter pengganti. Dokter pengganti ini sering memberikan pertanyaan, tapi juga tidak bereaksi lebay saat kita menjawab salah, melainkan menjelaskan satu-persatu sampai detail. Dan ternyata kami dibolehkan untuk memeriksa pasien setelah sesi kuis itu! I was so excited!

Kami ke bagian paru, dari pintunya saja sudah tertempel poster tentang keharusan memakai masker bagi yg sakit atau yg akan mengunjungi orang sakit, hand-sanitizer pun lebih mudah dijumpai menempel di tembok-tembok bangsal paru pria ini. Beberapa orang batuk-batuk dengan kerasnya dan banyak yang memakai masker. Pada saat itu di bangsal tersebut ada pasien yang baru saja meninggal dunia. Mungkin karena suasana yang seperti itu, seorang teman kelompokku berkata "rasanya hampir semacam merinding di sini."
Kami dibagi menjadi 2 kelompok, kelompokku akan memeriksa seorang pasien pria yang terlihat kurus dan lemah. Lagi-lagi, aku sangat bersyukur pria ini menyatakan mau diperiksa oleh kami dan berkenan menjawab pertanyaan kami, walaupun itu mungkin tidak nyaman baginya.

Singkat cerita, dari pasien ini aku bisa menemukan sendiri tanda-tanda penyakit yang selama ini cuma bisa kubaca di buku. Fremitus vokal menurun, pengembangan paru tidak simetris, bronchofoni positif, dsbnya.
Tanpa Bapak ini, mungkin semua itu hanya ada di awang-awangku saja sekarang.

Hari ini aku belajar, bahwa bukan dokter dengan jas putih dan tampang pintar yang harus dihormati, melainkan para pasien ini. Mereka yang sering tampil apa adanya, bukan pada saat tercakep/terklimis/tersehat mereka, tapi berkenan memberikan ilmu yang berharga kepada para calon dokter. Ilmu dari mereka lah yang akan membantu para calon tenaga kesehatan untuk mengobati orang-orang sakit berikutnya. Jadi kesembuhan pasien di masa depan bergantung dari kedermawanan para pasien di masa-masa sebelumnya.

By now, I'll proudly say that these patients are my greatest teacher. There will be no greatest way to show my gratitude except by always giving my best to be a good doctor.

Ih, amit-amit deh kalau ntar jadi dokter yang money-oriented. Bisa malu para guruku ini natinya.

Don't Sweat Small Stuff

Overheard the casheer girls' talk in the hospital this afternoon when I was waiting for an appointment with a dentist.

"So what do you think if when the patients want to know which doctor is a reputable one in this hospital, we answer that there is no good doctor here?"

"Yeah, that might be a good idea. Those doctors are nothing without us. Even we look less important for them, it's us who actually play a big role on whether the doctors will have good reputations or not."

"For even if we looks uneducated and less smart than them, they should not underestimate us."


Me, sitting there, so glad to have the chance to heae such honest comments from real people around the doctors. It is so true that we should not underestimate anyone in our life, for every single person have the possibility to affect pur life, either in positive way or in negative one.

I promised myself that very second not to inderesrimate anyone around me, either it is a patient who is not able to pay, a junior coleague, a casheer, even the janitors. Lesson learned. 

My Den

My den is a sea of unread books.







Less than 2 months left to read all of these books. I think I just need to document this as one moment in my med school. My children might want to know this one day. Or it is me as a doctor in the future who will look back at these pictures and may regret on my bad time management and my lack of reading.

For the moment, I think I need a new bookshelf. A big one.

Stir-fried vegetables

This is basically a stir-fried vegetable dish. I used some brocolli, carrots, silk tofu, and fishball in it. Oyster sauce and sesame oil make it tastes good. 15 minutes of preparations, you can always make this kind of this with any vegetables you have left in your fridge. :)

Today's Lunch Box

My lunchbox for today is stir-fried broad Chinese-style noodle. And as usual, it is as simple as any college student would make. First you need to scramble 2 eggs, and separate it. Sautee the garlic until it smells good, add the noodle and beansprouts, stir. Set the fire to medium level. Add chopped fishballs and scrambled eggs, mix them altogether in the wok. Add oyster sauce, salty soy sauce, sweet soy sauce, salt, pepper, and a bit of sesame oil. Mix them all and in just about 3 minutes your noodle is done! Quite easy, you can add prawns, squid, or chicken and you can substitute the broad noodle with any kind of noodle you have in your pantry. Easy and quick, those two words will always be in a college student's cookbook. :)

Singapore, February 2011

"Cadavers; thank them."

Woke up 1 hour late today, as a result I arrived 10 minutes late to the class.
It was neurology. The lecturer turned out to be a silver-haired professor, who -- just like the other neurologist -- is a brilliant person with a "character".

He was a strict person, pointed laser pointer to anyone who talked during the class, especially those who sat on front rows. I guess he is around 70 or so, but still has a good memory about the complicated neurology.

Near before the lecture ended, he gave a short message about how he want us to be. He said that he was a bad student, who usually sat on back rows. He told us to be doctors who have self-confidence but also pay a full respect to the others. We should always call elder patients with "Mr."/Mrs."/"Sir".
He also mentioned that the lecturers, the professors, even the dean are not our teachers. They are just our guide in medical school. The real teachers are our patients who will teach us in the real school: the real life.
"The most honorable teachers are the cadavers. Without them, there would not be any medical students and no medical books would have been written. They are the greatest teachers who still teach us even after they have died. Thank them."

Cheesy Frittata

Just made it 10 seconds ago. Thanks to anyone who invented the brilliant cheese cream.

Fast Food -- a Healthy Choice! :)

So this is the proof that fast food is not always bad. This meal, a super fast one, contains fiber, fat, carbs, and protein. It tastes good too! One different way to enjoy oatmeal: add anything you like in it! I like savoury, so I just put salt, pepper, and crushed chilli pepper into it. Add shreded beef for the protein. Fried shallot and garlic will enrich the flavor.

As for the veggies, I stewed carrots, broccoli, and green bean. Topping is made from peanuts, chilli pepper, garlic, salt and sugar -- crushed altogether.

If you are a busy college student, and you have your own quick and tasty recipe, please do share! :)

Lunchbox

Banana wheat roll--10 minutes preparation! :)

Early Lunch - Late Breakfast

This is a low-budget easy meal that only take less than 15 minutes to prepare. It has the fiber, a bit of carbohydrate, fat, and protein--something that is student-friendly! Well especially for those who don't live with their family. More details on comments. :)

Simply Meal

"Roh Terletak di Mana?"

Hari pertama clerkship, kuliah hari ini adalah Farmasi klinik (tentang obat dan resep), Interna (penyakit dalam), Pediatri (Anak), dan Psikiatri (kedokteran jiwa). Some quotes of the day:

-Psikiatri-
"Roh atau soul itu beda dengan jiwa atau mind. Kalau manusia mati, maka jiwanya akan mati karena jiwa itu ada di otak."

Q: "Jadi roh itu ada di mana?"
A guy who sat behind me: "Melayang-layang."
Me: --"

"Selama ini kita menjudge orang-orang psikopat tanpa tahu sebenarnya psikopat itu apa. Padahal dari 10 orang psikotik hanya 1 orang yang benar-benar schizophrenia."

Q:"Apakah kalian masih menstigma penderita psikosa?"
Some students: "Yaa.."
Q: "Kira-kira kenapa?"
A1: "Tidak tahu..."
Q: "Tidak tahu alasan menstigma atau ketidaktahuan akan psikotik itu sendiri?"
A2: "Karena takut..."

"Di sini adakah yang suka melakukan kegiatan yang berulang-ulang? Atau terlalu sering negative thinking dan emosian? Itu bisa salah satu gejala psikopatologis. Hati-hati karena kumpulan gejala-gejala tersebut bisa menjadi gangguan psikologis."


-Pediatri-
"Virus juga punya hak untuk hidup. Jangan saling membunuh antar makhluk hidup. Jadi kalau dibilang infeksi adalah upaya tubuh membunuh mikroba itu kurang tepat, seharusnya adalah upaya tubuh mempertahankan diri."

"Nyamuk itu juga punya hak rekreasi loh."

"Pemeriksaan fisik itu nggak penting punya stetoskop yang ada mickey mouse-nya. Yang penting adalah pemeriksaan dengan menggunakan otak, bukan hanya menggerayangi pasien saja."


-Interna-
"Mau jadi dokter atau pengusaha?"