Remembering Developmental Milestones

Ahh....Its been a while since I last wrote in my blogs.Its not that I don’t have the time… its just that there is a lot of ups and down to take care and somehow I loss interest to talk about it. I guess there are times where silence is better than the words spoken. But long story cut short, basically I was not well during the middle of my 5th year, took too many MC, couldn’t fulfill 80% attendance, therefore barred from taking the exams, so currently waiting to repeat 5th year which will be in early July. Okay! *catch breath*

Let me also take this opportunity to wish, CONGRATULATIONS!!! to my fellow batch mates who had made it safely through the pro-exam and will be doing their housemenship sometime in May. May Allah help them get through that.. :)

For those whose wondering how am I taking all these, well it was a bit difficult at first, but after that, you move on ya know~ hopefully this will make me become stronger and more prepared in facing difficult situations in the future…InsyaAllah...

Okay! Lets get back to business~!

We are going to talk about, Developmental Asessment! Or developmental milestone~! This is one of the major ‘will-forgot-info’ of the medical student life, well for me at least. So lets find a more easier way to remember DA. 

If we talked about presenting DA to our lecturer, we will present according to the four developmental field;

1. Gross motor
2. Fine motor and vision
3. Hearing and speech
4. Social behavior

One child can have gross motor developed at 6 month but socially around 9 month or fine motor and vision at 3 month. Therefore, when we want to remember DA, it would help to remember the developmental stages in one particular area according to age rather than what we usually do which is remembering the stages in all 4 field of a particular age. The end result would pretty much be similar, but somehow I find that remembering according to each field is much faster and esiear to understand compare to remembering according to age. If we remember according to age, most of them will only be simple memorization rather than understanding how the child develops.

Therefore, using the DA guide given to us UKM medical student in our 4th year, the Developmental Milestones 0-2 years by Mary Sheridan, I come up with a table of developmental stages according to each field to ease understanding of developmental milestone. 

Basically I divide all field into 3 levels. Why three? Because 2 is not enough and 4 is just too much. 3 is just nice. If you got a problem with that, that's non of my bizweaaak~

Each level may have 2 to 4 age group. Different field is divided differently. Maybe that will make it more confusing, but who cares, this is for me, if you want to remember your way, make your own. Caphice?!

I don’t have time to explain all, if you want to understand just go through the table. I use common sense. Every level have its specific names, these names are given according to what components in that particular level is best be use to assess the development. For example:

• The Object permanence phase in Gross motor is named in such a way because just by assessing whether the baby have object permanence or not can determine which age they belong to, either 6 month or 9 month. Ain’t that cool?? XD
• The hearing phase in hearing and speech is because in that certain age group, the baby most prominent feature or the feature we can assess is the hearing, other feature are less prominent. Same goes for the early table manners phase in social behaviour. In that particular age, most of the things that can help us identify the age is by assessing the food related thingy mejigger. 

Geddit? So go ahead, if you find it useful, please feel free to copy, paste, share, use, print or whatsoever. I hope I can make things a little easier for anyone~

Thank you for reading! Have a happy peads posting! XD

*note: please click and download for bigger view

Logo Making

I have a thing for making logo,not that i'm good at it.But its kinda fun...:D

How I want to Remember my friends....

The beauty inside

Sorry Nina, I know you told me to just make a synopsis, but I can’t help writing!! You have induce my heart to wriiiittttteeeeeee my heart out….hahaha…. it’s been quite a while I don’t feel like writing up a long essay. But, I promise, the point I want to make, I will highlight it, so for those who hate reading or have tons of other things to read, you can scroll down and go to the bottom of the post, where I summarized what I want to say.

I told Nina today, something I usually told certain people, close people, I told her about what I usually feels after every dinner. Most of the dinner, well actually all of the dinner I went (except for the one….. I shouldn’t say which) I always feel left out. Imagine now, already ‘left out’ after being barred, another dinner for me just to feel left out. Oh man....and I'm the exco some more...? So lets see, why do I feel left out?

REASON 1: Am I not beautiful too??

People coming to dinner always wears their best clothes and make ups. I don’t blame them, I do that too. But not everybody will come to dinners wearing ‘appropriate’ clothes. As Malaysians we all learn to respect each’s other religion. In islam, there is a certain boundaries to what a muslim can wear, doesn’t mean they can’t be beautiful, we can, in any ways, just not the wrong ways. For the non-muslim, they have the right to wear anything they want as beautiful as they want, but…. Being 1 Malaysia, in a place where all races are present isn’t it nicer that we respect each other believes? I’m not asking for every girls to suddenly wear the hijab and the guys wears baju melayu, but at least we wear something that doesn’t ‘offend’ others. I’m quite sure too that other religion also teaches not to wear very ‘revealing’ clothing. Its painful seeing our friends, who we sees going to the ward wearing such modest clothing and just being themselves, but coming to dinners as someone you hardly recognize! On top of that, some with too revealing clothing….its like, “oh this a part of you (body parts) I never seen before! Literally!”. I’m not referring to anyone, since I can’t remember any dinner experiences before, I erased it in my memory long ago. Sorry, but some are just, offensive to the eyes…. For those non-muslims who read this, this does not make me an extremist, I’m just being what a muslim should be.

Tell the believing men to reduce [some] of their vision and guard their private parts. That is purer for them. Indeed, Allah is Acquainted with what they do. And tell the believing women to reduce [some] of their vision and guard their private parts and not expose their adornment except that which [necessarily] appears thereof and to wrap [a portion of] their headcovers over their chests and not expose their adornment except to their husbands, their fathers, their husbands' fathers, their sons, their husbands' sons, their brothers, their brothers' sons, their sisters' sons, their women, that which their right hands possess, or those male attendants having no physical desire, or children who are not yet aware of the private aspects of women. And let them not stamp their feet to make known what they conceal of their adornment. And turn to Allah in repentance, all of you, O believers, that you might succeed. (Source: Holy Quran; Surah An-Nur:30-31)

So as Malaysians, you don’t need to understand this, you can if you want, but at least respect it. So the point is, if there is one time, where we all gather for that very last moments, what do we want to remember about our friends?

• A. Their clothes
• B.Their make-ups
• C. Their body (??!!!)
• D. Their heart

Well, I don’t know about you guys, but I want to remember their heart.  Who says that beautiful is only to the eyes? Well, there are… but those guys are probably big time models and superstars, and we are future doctors, I’m quite sure there is a big difference to that. People can lie about how they look by wearing beautiful clothes and thick make ups, but no one can hide their inner beauty, it just shows… for some reason...

REASON 2: What’s the theme again??

I never follow dinner themes… except for the black and gold something…. Because by chance I have a black and gold jubah, so I just wear it. But honestly, those who really follows themes, I give them the two thumbs up!! Some put so many effort to really go with the flow~ its good really, but I wonder what happen to those expensive clothes we wear especially for our dinner, hmmm…… I don’t think I ever seen anyone wears them to the ward… honestly, I came to a dinner once, wearing something I wear going to the ward…hahaha… And I actually feel a bit proud, because I don’t see anyone who dares to do the same…heheh…I don’t know, maybe there are, but I didn’t see you, sorry..hehe.. so the point is, isn’t it easier if the theme is, well, the theme is just be yourself, release your inner beauty. Drink inner shine a lot… no need make ups, you can still look as cute as Nina Hoklai. (wink!wink!)But of course I wear a bit of make ups too sometimes. (coz I’m not as cute as you):D

REASON 3: Who was it the king and queen again?… but why…..???

Well, I’m quite sure most of the time we judge winners by how awesome they go with the flow~ I remember one of the judges of one of the dinners told me, “I don’t know who to pick….”, FYI, its not because there’s too many candidates, but during that time, everybody seems to be too “malas” to follow themes. But now, since medic student is more rich, such issue will not be raised laa… can follow theme punya la, no hal…. But on what basis do we pick the King and Queens? Just by what they wear? Its okay, it’s a good idea, since people put a lot of effort to look good in every dinner. In that case, so why don’t we make a dinner where inner beauty would be the theme, and the King and Queens would be, the nicest of friends…. The nicest of people…. The one who make a lot of sacrifices for all of us…. The one who sometimes cried for us…. Belanja us....when JPA is not in yet…. Let us sleep in their bed when we have nightmares…(tribute to Nabila who let me sleep beside her on the night i have nightmare during posting at HTI).....you know... those guys…. The one we really want to remember as Kings and Queens… hey this IS the LAST dinner for you guys right? So why not? Make the King and Queen someone who really are the kings and queens of 5^th year medical student… as a way of saying, thank you friend, we will remember you always….

and hey! Why not make a lot of Kings and Queens? Different type of King and Queens for different categories.... and everybody should bring present too...oh oh...and maybe we can make small cute medals, and put there "best friend award" make it as dedications...:DD

I know the idea and conditions I’m asking here seems to be the opposite of what we usually do, but isn’t that the point of the LAST DINNER? One that really LASTS, not just in pictures, but in our hearts… We respect each other’s believes and boundaries, remember our friends for who they are, and give a BIG THANK YOU to someone who deserve it…..(oh, I think I’m gonna cry…TT_TT)

So here’s a proposal for a theme, if you don’t like it, well, I don’t mind, I still have another year to try this out! Haha!

“Release Your Inner Beauty”

Here is the reasons (for those who don’t read the doodles up here)

Inner beauty is not something you can paste with makeup’s and buy with expensive clothes, but you can show by just being a friend, being who you are, and respecting others as 1 Malaysia

It is a theme made to treasure friendship so that we will remember it during those last moments. No need to hassle on what to wear, just whatever makes you feel pretty everyday (you are pretty right?? And handsome too la…)

As a way to say thank you to those friends who really give all out for us for the past 5 years, they will be our Kings and Queen

Let’s not just treasure beauty, but let’s treasure, INNER BEAUTY

How I want to remember my friends:

Pictures of my friends,that they are proud of (if not, they wouldn't put it on facebook!)

 May God bless us all....

"Misi Jubah Merah"

Last Sunday, during the 2^nd Fiqh Perubatan, I met Kak Long, one of our beloved senior who had just fly from Sabah to attend their Graduation ceremony the day before. Honestly, I’ve never seen kak Long in such high spirits before. Its like she have all the energy in the world, I can see the glow of happiness when she talked about the “jubah merah” and the graduation ceremony. Me and my best pal, Hayat took a picture, and I take the chance to ‘test’ the “jubah merah” myself. Its surprisingly comfortable by the way!

I had been reflecting quite a lot on that day. Not only because I get to meet Kak Long, but during Fiqh Perubatan itself, a lot of emotions takes place. If I can, I want the whole world to know about what I’m facing during my final year, and how much it had been affecting my studies. But what I fear the most is the kind of reaction I will get from others that will eventually affect my way of thinking in a negative way. I’m not making sense am I? Well, some things are not meant to be understood. But for once, wearing that “jubah merah” made me forget about all those troubles, and I really felt like ‘my turn’ to wear it for real is really that close. The feel of that heavy red fabric hugging my body feels warm and so welcoming. Will be it be next year for me? and next year is really just a couple of months away.

In my opinion, the happiness one felt during their graduation does not depend on their PNGK or wether they received distinction or what not. It depends on the overall performance of that particular student. How much effort had he or she put in making all of it worth it. And that is something only the person themselves can determined. Success is subjective isn’t? I always told myself that success to me is really that simple, its when I manage to be happy and always giving my best effort to gain the best in the worst of situations. It doesn’t matter how well I perform, as long as I give it my best, to me that is already considered as a success.

Looking at myself right now, thinking about all the ups and downs I went through, I really felt like I had been struggling real hard. Maybe others would beg to differ, and some might even criticize me, but no matter. I was told by my teachers, that “only you know how good you are, and don’t let anyone else let you feel down”. Heck yes! I’ve been doing my best to get myself in a good shape. Sometimes I failed, but I know sooner or later I will stand up anyway and walked in one piece or in pieces. I know that above all, I have to accept myself in order for me to be accepted by others. A good friend once told me, “the only person who will make your life easier is yourself”. How true she was, even though we sometime hope that the people around us will give us all the support we need to succeed, but in the end, all we have is ourselves to decide whether we want to stay on or give up. I felt really lucky being blessed to be on the road of tarbiyyah. The locus of support I’m receiving extends massively. Sometimes I can feel that the whole world is doing their part to help me, and InsyaAllah, only Allah alone will decide for me and His decision is the best decision.

TIPS 8 : Internal Medicine in UKMMC

I was either very lucky or unlucky to have medicine as my first posting. Its been 3 weeks in internal medicine (IM). In my opinion, in IM there is not much variation of the things you need to do, but because medicine itself is a cocktail of all the basic things in medicine, the heaviness lies on the things you need to know, rather than the things you need to get done.The first week is the coffee and lectures week, where there will be lots of coffee to make sure you can stay awake for the long lectures. It might be a little too much to have lectures from 8am-5pm, but some of the lectures really got you thinking of how inadequate your knowledge is. So you will either become motivated to study even harder, or end up getting depressed or a mixture of both (most of the time), but then you need to stand up no matter what to get yourself ready for the real stuff.

My first ward work was at UKMMC. You either start at UKMMC, HKL or HTI. I don’t know about the rest yet, but here’s my very own tips to make sure you can stay, well at least, organized, during IM in UKMMC. Now IM in UKMMC is a lot heavier (from what I heard). It’s a compulsory to be present during ward rounds everyday and to present your case. So even though I say there is not much variation of the things you need to do, but covering the beds and preparing for the ward rounds sometimes takes up half of your life in medicine. Since there will be 4-5 person per ward, one person must cover 6-7 beds. What makes it more heavier is when you ward is very “active” despite being the “active ward” at all. Being in Medical 5, there will be 4-6 new cases every day, that’s right, EVERY DAY, and I don’t know about other ward rounds, our ward rounds will and always start at 9am and ends at 12pm, minimum. Oh yes, the second week is a good week for you to make sure your musculoskeletal system is up to the 3 hours round. So what should you keep in mind during IM? Here’s my tip

For new cases

1. Arrive at the ward at 7am because most new cases came after midnight. You only have 1 hour then to clerk new case and do reviews. At 8.00am till 9.00am you have to attend either lectures, grand ward rounds, CME, or CPC. Right after the lecture finishes, you'll be expected to be ready for the rounds.
2. Clerk the history and present in a way you are trying to arrive to a diagnosis, maybe not necessarily the full history. This is where you sell your stories to the specialist during rounds. Sometimes, there is not much time, so at least try to get the chief complaint and background history right. But come back later to try to get the full history too. Add up investigations and physical examination if you manage to do it in time.
3. If patient could not give history (stroke patients, too tired, refuse, etc), no excuse, clerk the notes (last resort). At least you know your case. Spend time to clerk the case other times if possible.
4. Don’t waste the presence of family members, catch them as soon as you see them, get the history from them too, not the other way around (refuse to take history because don’t want to disturb patients with their family member.)
5. Get involve with the patient’s investigations, especially blood taking and branula. You will have the privileged to take the patient’s blood if he or she is your patient. But don’t get too greedy; make sure your friends get a chance to fill their log books too.

Follow up-ing patients / review patients

What to Review:

About yesterday:

• Had the plan yesterday been carried out?
• What was the result of the recent  investigations or procedures done to the patient? (In pertaining to the patient’s problem)
• Who else had seen the patient yesterday? (Example: in referred cases/ physiotherapy/dietitian)

About today:

• Is the patient well today? Any acute complaints?
• What are the vitals? (BP, HR, RR, T, SpO2, etc..)
• What are the physical findings today? (In pertaining to patient’s problem, eg: lungs clear, no more abdominal pain)
• Is the patient plan for anything today?

1. If possible, came at night to review your patients, at least get to know what happen to the patient yesterday. Usually too many new case to cover the next day, you have to give time for that in the morning. But almost every time, blood result will only be ready in the morning. So if you can come earlier than 7.00 am, you can get everything done quite magnificently good.
2. If you have the time, help the HO to fill in the reviews so that you will not be questioned so much. Oh yes, don't forget to get really friendly with the HO. They gonna help you out quite a lot.
3. To keep your reviews organized, make a table of the patient’s , vitals and important investigations so that you can update and see the trend of the result too. For example:

contoh..

So that’s all I can think of in terms of taking care of the ward and ward rounds. But there are other things to keep in mind during IM, the on calls, procedures to do, procedures to observe, lectures, teachings, oh, and of course the study groups. But basically, those stuff aren’t new, so try to manage time efficiently so that you have adequate time to do all (and I’m not so good at that, so you should ask other people for the tips, hohoho…)So all the best, I’m off to HTI! Chaiyok!

Woman in Medicine

Woman in Medicine, so what's the problem??

courtesy of Nayzak

Being a member of medscape, I, sometimes find some time to read the blogs of medical students or doctors posted in Medscape because most of them are very beneficial. Today, one topic drives my attention, it was "Woman in Medicine, Betrayal or Trust". The post was written by Elizabeth Wiley, a medical student, she was commenting on a published piece from New York Times by a female anaesthesiologist. I find some part of her post quite true. This is part of her post:

A couple of weeks ago, Dr. Karen Sibert, an anesthesiologist, published a piece in the New York Times called "Don't Quit This Day Job." In this op-ed, she argues that "[m]edicine shouldn't be a part-time interest to be set aside if it becomes inconvenient; it deserves to be a life's work." The crux of her piece takes issue with the decision by many female physicians to work less than their male counterparts, whether in the form of extended leave or more permanent part-time work. To Dr. Sibert, such a decision is a betrayal of public trust and misuse of public investment in medical training.

Having just finished my anesthesia rotation as part of general surgery, I have to say that I find it a little shocking that this anesthesologist would make such an argument. Anesthesia is well-known for being a competitive "lifestyle" specialty among medical students and, compared to general surgery, for example, seems to live up to the label in practice as far as I can tell. This is not to say that anesthesologists aren't incredibly important; rather, their work schedules seem to be particularly amenable to "work-life balance" and family life. Dr. Sibert repeatedly references the primary care shortages facing our country, but it's a little difficult to take her seriously given the choice that she made. I wonder -- did she betray society too with her specialty choice? Shouldnt we all be obligated to choose the specialties with the greatest need? Where does the obligation begin and end? But I digress....

As a (relatively) young woman in medicine, I was horrifed to read Dr. Sibert's piece. Her argument is bluntly shortsighted. The culprit in the current physician shortage is not women who go to medical school and dare to start a family. Instead, I'd start with the centuries of oppression and gender discrimination that have created an "advanced, civilized society" in which women are still insidiously expected to assume responsibility for all things domestic. Of course, having made it this far in medical school, I have to admit that women do bear the biological burden of gestation and childbirth. But that's not the genesis of this problem. 

Her post reminded me of what my naqibah always told me. Women and men are different and they are meant for different purposes on earth. Quotting from the holy Quran in surah Al-Imran, verse 36, when Imran's wife had pledged to consecrated whatever that is in her womb for Allah's, but then she give birth to a baby girl, Maryam, she says;

But when she delivered her, she said, "My Lord, I have delivered a female." And Allah was most knowing of what she delivered, "And the male is not like the female. And I have named her Mary, and I seek refuge for her in You and [for] her descendants from Satan, the expelled [from the mercy of Allah ]."

True enough, men and woman are not the same, pshysically and mentally too. The wife serve a larger role in upbringing of a child compare to the father. Even how busy a wife would be, she can never run away from that fact. Being a female doctor, it would be a challenge. Therefore, a reminder to us all, to always keep this at heart. 

To add up to what Elizabeth mentioned, it is not the problem that there are more woman in medicine who dare to start a family,  but to me it is what had become to the world now that woman are assumed to take up the same role as men. There is nothing wrong with female doctors, we need female doctors to treat female patients and in some areas of medicine such as pediatrics and O&G where the female role is predominant. (so to all those men who thinks that female doctors made a bad wife, I wouldn't want you as a husband anyway, good female doctors who understand human and health make the best of mothers and wife, duhhh~~~!) The problem is that, we should be aware of the circumstances. Woman bears a responsibility towards family upbringing and the men would have a larger role as the breadwinner in the family (or pemenang roti as my mother calls it :DD). It is only acceptable that there are difference in the workload and expectations of woman in medicine. 

But to start something as big as changing the whole healthcare organization system require a great deal of public understanding. But just a point for all of us to ponder on, when the time comes for a chance to change, we should give it our full support, that's all I'm saying.

Finally submitted my very own manuscript

Yeay!After all the hard work,I'm just relieved~~~ Our group had to do 4 manuscript. Matun is in-charge of the main manuscript, Prisca, Micheal and me had to create 3 whole new manuscript to submit to 3 different journals. So yup, that's one manuscript per-person! It took quite an enormous deal of time, money, stress, tears, laughter and joy too. So I don't care anymore whether they will accept it or not, what matter most is the experience! :D

Living proof of my submitted manuscript..hehe..