23 Years Old

1 Year Older, 1 Year Wiser, Year-old Heart

Today is that time of the year again, the time when I turn biologically 1 year older!

It's funny how it seems that it was just recently that I turned 20, leaving the era of 

being a "teen".  However, here I am 3 years later, 3 years older and it's funny because

back in the States most of my friends are already either working, paying mortgage, married,

independent, etc.  Anyways, it really just serves as random food for thought because

the Asian culture is incomparable to that of the West, moreover studying medicine

just increases that financial dependency factor (among several others).  Yet, though

i'm now 23, it's funny because I still find myself tickled at those lame jokes of

Spongebob Squarepants and feeling as much a kid at heart as I do adult in mind.

Paradoxical indeed, oh well.

23rd Versus 22nd Birthday Celebration

I usually do not promote comparison unless it has contribution to growth or change in

one's thinking for the positive.  The reason for this being is that comparison is usually

done in such negative context it's utterly pointless, but for this paragraph I will shift

from the status quo dogma on "comparison" and compare last years' birthday celebration

with this years' celebration.  2011 has been one of those years filled with countless farewells,

where I had to send off not 1 or 2 but THREE very good friends of mine, not to mention losing

1 in a predicted fashion.  So as expected, this year for my celebration it would be smaller, yet

beautifully quaint in a way that was refreshing - that really lifted my mood up!  You see,

I was really happy with last years' celebration and it was with a good volume of people,

but I never expressed my slight disappointment because a few of my close friendscouldn't

make it that day (all for justifiable reasons).  Yet, for this year with the exception of my

besties overseas I had all of those few and far whom I considered dear to my heart come

down to Seremban and celebrate my turning of 23.  

Just Right! :-)

You see, it was and never was about the quantity of people present - it always boiled 

down to quality and for me the latter was achieved rightly this year around. :-)  But really, 

what the heck is my perception on current birthday celebrations?  Even more relevant, 

what are my expectations and how were they beautifully fulfilled?

Birthday Celebrations - Negative Observations

The expansion which I am going to give below concern negative observations made of simple statements

of what I see and is in no way meant to criticize those that follow this particular behaviour (maybe) nor

does it disregard the possibility for exceptions (eg. mine below, blah, blah, etc.)  I see celebrations done 

out of convenience both temporally and spatially.  It tends to involve random people who may not 

even know the birthday person personally, yet comes out of polite invitation or simply as a social responsibility.  I've seen enough that a birthday celebration is not thrown out of PURE joy and 

genuine desire to see that person feel special for 1 day but out of unspoken obligation due to 

short-term, usually temporarily-bounded close relations with said birthday person.  I've also seen,

halfhearted planning and gifts given for the sake of giving or because of having received a previous gift

for their own birthday in the past.  It is thrown with the underlying purpose for people to have an excuse

to escape from daily responsibilities just for the evening and not done genuinely for the heart of the

person turning a year older.  There is also a tradition of giving secret recipe cakes as if it was a religious offering, as if there were no other cake shops out there that existed.  Yet, this is where it gets a bit personal - what really annoys me is when attendees are exposed for their selfish and in-genuine attempts.  A clear example would be when people back out because of lack of familiarity with others attending celebration or because of awkwardness of particular attendees (after all are you attending for your sake or for the birthday persons')?  For goodness sake, better not to attend "la". 

Birthday Celebrations - My Preferences

Honestly, with the current state of affairs and the majority of my best friends being either overseas or in KL

- I initially had no plans nor expectations of celebrating my birthday in any extravagant fashion.  I was content,

with having dinner (perhaps a slightly higher budget allocated) with my close friends that were in town.

Honestly, that would have made me happy already in comparison to even having 1 of those negative observations involved in my birthday celebration (and so what if it's simple, yet I enjoy it right?)  It's pretty

easy to look at the converse of each of the statements stated above as my preference but to clarify

the slight nuances, I'll proceed to stating them in point-form below:

1.  Small gathering allowing meaningful chat trumps large volume/low quality of attendees

2.  Simple, quiet place to have a meal +/- extra activity (depending on convenience)

3.  VIP = me, VVIP = best/dearest friends

4.  Pointless to have acquaintances or people who only know your birthday through FB

5.  Planning/attending done by those that genuinely willing and without feeling obligated

6.  Surprise or not, matters not

7.  Gift or not, matters not (but if given, sentimental >>> thoughtless gifts)

8.  Cake or not, matters not (I personally dislike cake, I only like the icing but for the sake of

     my friends who do enjoy cake --> this is still tolerable)

9.  I don't believe in birthday wishes (pure semantics and cam-whore moments only)

10.  Double-wishing via SMS and FB (what is the point? Publicized social responsibility?)  

This list is not a check-list en route to the perfect birthday rather different aspects of a single preference of what I expect of my birthday and thus deduction could be made as to why this years' seemingly simple/under-rated birthday celebration eclipsed my expectations in a good way. :) 

"Making a Wish" for the camera

Conclusion

If any reader feels the sting of this post, re-evaluation of your own understanding towards birthday celebrations should be done.  Don't complain to me, I don't care to listen for these are my rants of observations (not hallucinations) made. I thank God for these circumstances which helped to enhance

my own understanding of how I can be happy with a simple, down-to-Earth celebration.  In the end, that's all that really matters out of the celebration right?  This year it was memorable in its own way and i'm grateful.  Special thanks to all my close friends for making that effort, I don't deserve friends like you all. :)  

General Surgery Posting

*peek-a-boo!*

How, I wish an excuse of "hide-n-seek" could be used to excuse my absence for the past 3.5 months.  My poor blog been left to collect dust once again, but i promised myself I will be more hardworking to update my blog as I start Internal Medicine next week!  It's my life that i'm living out now and reflecting on it through my blog helps me consolidate my thoughts in one sense and also let's my dear friends know what's going on in my life.  That's pretty much my motivation to continue on with this, though i'm pretty hooked on Twitter and Facebook right now. :-)

I'm getting Iphone 4S pretty soon, so expect more pics with my posts!  It sure will help spice up my posts as I type out my thoughts, but enough.  Today was the final day of a 7 week posting in General Surgery (Semester 6) and I want to reflect on it.  But first, some basics! (FYI)

General Surgery @ IMU S'ban
The Basic Structural Layout
In IMU Seremban Clinical School, we are given 7 weeks of attachment in three surgical wards at Hospital Tuankku Ja'afar (3A, 3B, 8B).  In Malaysia, general surgery includes: abdominal, thyroid, breast, external genitalia, kidney and peri-anal pathologies.  This was our scope that we had to experience, learn and expected to gain competence in clinical evaluation (Hx/PE) of.  7 weeks is hardly enough time to do abdominal pathologies as there are so many ddx, but through persistent hardcoring; coverage of said topics was marginally possible.  We had experienced senior lecturers (mainly professors of surgeries, eg. head of MRCS Msia, Pres. of Malaysian Surgeon Society), guide us through bed-side teaching, case presentation and task-based learning.  Every effort was made to push us to become independent thinkers and pursuers of skills and theoretical knowledge and I think it was this almost abusive approach that pushed us to learn so much as compared to being spoon fed.  I can see the wisdom behind the structure of the curriculum, because it's aimed at us being able to correlate and appreciate the clinical findings to the background theory so we can come up with possible diagnoses that we can actually defend and explain ourselves to.

Viewing an X-ray, "Sban-style" without an XRAY box. (LOL)
My sr was teaching me about "air under the diaphragm" signifying perforated viscus.

The end-of-posting exam itself was nothing short of intense, roughly an hour was given to us to clerk a patient chosen at random in one of the wards by taking a focused, systematic history + PE.  Then we had a 1on1 viva with the professors who will ask us our possible diagnoses and justification.  Expect to know how to explain deeper than just a 1 off sentence because often we would get fired and penalized for lack of confidence/knowledge of defending said diagnoses.  The examiner would then ask us logical investigations we would want to carry out to confirm diagnoses, and WHY (eg. FBC, RP, Serum Amylase, CT TAP, USG, etc.)  Once again, it's all about justification to the maximum - because they want us to think instead of regurgitate a list of differentials for epigastric pain (which any dumbass could do).  We are then asked how we would manage the patient (eg. fluid resusitation, surgical approach, etc.) and grilled about 5-10 questions which are to gauge the knowledge of our theory that is related to the case.  Oh and it doesn't matter if you get a patient that can't speak Malay, Eng, Chinese...we are expected to find out some way to extract information despite the circumstance as we are expected to be proficient enough to handle those situations just as a houseman would! >.<  In my exam a few days ago, I had to communicate mainly through emblems which was a pain in the ass but necessary lol!

First CSU Session on SUTURING (chicken skin used)
- What you're seeing is a continuous suture (left) and interrupted suture (right) -

My Opinion
Honestly, i was pretty surprised at how much I enjoyed myself in surgery.  I've been actively considering viable options for specialty since the end of phase 1 and i've so far confirmed that the important criteria for me would be: 1.  Flexible time/time for family and church.  2.  something i had interest in (eg. GI, neuro, Nephro) 3. Useful in Malaysian setting (as i plan long term to stay here!).  So how did it fare?

Hospital Kuala Pilah Attachment
(Me, Geena, Wei-yee, Kelvin)

General surgery is way more interesting that I gave it credit for, i've gotta admit.  First thing that I liked was the direct continuity of patient dx --> tx.  Secondary health-care, in general allows you be a part of the whole process from admission (making the diagnosis), interpreting investigations (redefine diagnosis/severity) to actually treating the patient.  The thing, I love about surgery is the fact that more often than not it allows for definitive treatment.  Cholecystitis 2dary to multiplie cholelithiasis?  Ans.  Cholecystectomy.  It is a discipline which allows the surgeon to PHYSICALLY get involved and remove the problem and it is usually more straightforward than what physicians have to face (which is usually more abstract).  It also doesn't just focus on the mental dexterity but also digital dexterity.  The skill of precise JUDGEMENT cannot be emphasized greatly enough during surgeries to ensure appropriate margins in tumour resection or a laparascopic gastric ca staging - it is for DOERS as much as it is for THINKERS.   Another thing, I enjoyed is that it allowed a lot of exposure to GIT (which i really liked!) and renal medicine (which is another interest i am exploring atm).  It is said that surgery is for those that are decisive and confident and this rumour proved true during my observation.  It is honestly challenging enough that it is really enjoyable and at the same time straightforward enough that it really helped me appreciate anatomy more than ever!  Dare I even say, anatomy became more beautiful as i went through surgery... the blood supply, lymph drainage and nerve supply suddenly all made sense!

Surgery Sub-posting Group
(Kelvin, Julaika, Wei-yee, Geena, Me, Jolene)

Overall, i'm so grateful for the numerous nice houseman which I had the chance to befriend.  The lecturers were all capable and fit the bill as role models in most situations - i really have no complain about their competency and teaching.  I felt every so humbled by every experience I had with the patient and grateful for for every single of them who cooperated with me in my learning; especially the 5 patients who i did DRE on.  It is because of these opportunities which will help me later on in life as I work.  However, the major turn off of surgery for me was the LONG hours.  Surgeons are intense, do doubt.  But, i question how well their family situation is at home... it seems pretty hard to have any life when you have to be in the wards by 7AM and leave for home at 7PM.  By the time you reach home, you will just be dead tired and that is not mentioning the fact they are called in the middle of the night a lot of the times.  The hours are definitely volatile to any1 wanting to commit time to family and church and it is that puts me off from this specialty thought i enjoy it so much. :-(  It's still early, let's see how the next 2 years go!

Hospital Port Dickson Attachment

Future Topics
I have been itching to write for quite some time now and here are some of the topics bubbling inside my mind:
-  Family Medicine Posting
-  Seremban Clinical School (The Transition)
-  Clinical School Politics
-  "If one day you woke up, unable to talk/move?" - based on a true story