Quack's World

The Cops and Robbers Game

2012-01-17T12:23:00.000+08:00

Salam.

Only 7 days more till the big wedding day. Thoughts come and go about the future - children, house, car, specialty, in-laws, where should I put my PS3 and X-box. However, after seeing this video, I know this is exactly what I'm going to teach my children.

Imagination.

The Base Jumping

2011-12-22T03:09:00.000+08:00

Salam.
Once an outdoor junkie, always an outdoor junkie. All that is needed is the right time and the right amount of dough.

The Surgical Posting

2011-12-18T01:15:00.001+08:00

Salam.

It's been almost 3 weeks since I finished medical posting.

My final assessment went well - I was asked about AEBA management and I went on a verbal diarrhoea, starting from initial management to history-taking, physical examination and investigations to further management. The key to tackling a viva voce is CONFIDENCE. And the finesse to cover up a verbal slip-up.

NEW POSTING

I'm now in surgical posting - a light posting in terms of workload made tedious by impatient bosses and TDS rounds. Plus, me being selected as the next HO leader.

The new blogger feature which fades the background to black when viewing pictures is sweet. Try it!

The common chief complaints are acute abdominal pain, UGIB, LGIB, lumps here and there (on the trunk, neck and head) and MVA (intraabdominal injury, traumatic pneumothorax and cerebral concussion).

So far, this posting can be summed up as half ward, quarter OT/endoscopy and quarter clinic duties.

Must've been one action-packed OT.

I'm currently placed in the female ward - there's less patients compared to the male ward (and less emergency/unstable cases) - but at the same time, I have to cover the periphery wards and night OTs.. which is still not that much work compared to medical posting. Plus, during ON shifts, I get at least 2 hours of nap time (never had that kind of luxury previously).

HO rotation is different for each department. For surgical department, the HO shifts are 3 periphery wards, 3 AM, 3 PM, 3 ON and 3 days off - for a total of 63 hours per week and 1.5 days of rest per week.

Scootering around town reveals many hidden gems.

Medical? 84-90 hours per week.

Am I missing medical posting? Heck no.

GRADUATION

Alhamdulillah, we finally made it to this important point - the point that everyone had been waiting for for a very long time. After all the blind meanderings on an unmarked road, we have finally paved the way for USIM medical faculty.

Terkejut macamane aku boleh dapat gambar awal? Click here.

It's wonderful to know and read about how juniors are inspired to strive harder after seeing our graduation ceremony. Do work harder but at the same time, enjoy student life while you can. Climb mountains, join debates, find a new hobby, get married, whatever.. because the moment you enter housemanship, you're going to put 2 years of life on hold.

SHUTTERBUGGING REJUVENATED

Speaking of hobbies, I've finally picked up my film SLRs after 6 months of abstinence. I missed the shutter sound, the mirror flap, the film advance, the anticipation of the resulting exposures and the mixture of satisfaction and disappointment when I get the developed products.

This is my preciousss.

And then, there's the editing and printing and scrapbooking. What fun!

First roll of film will be uploaded after this; keep up to date!

Here's a HTC Desire shot, edited (converted to monochrome, added grain) to get that film look. Not as satisfying as taking a film shot, but hey, it satisfies the addiction.

Drool like Pavlov's dogs.

Looks like I won't be studying much during this posting either.

The Nostalgia Post

2011-11-08T20:05:00.000+08:00

Salam.

We often neglect the photo-snapping that we do on a daily basis. It's when we move on that we realize how much we value and appreciate such routines - happy or otherwise.

It's nearing the end of our (the first batch) first posting. Some may pass, some may get extended. But most importantly, we will graduate as one complete batch. Can't wait to meet you guys this December :)

Are you ready? It's Nostalgia Overload Time!

And here's the last kicker:

The Games of Life

2011-11-01T20:35:00.001+08:00

Salam.

I'm already 3 months into the medical posting; only 1 more month to go. A lot has happened in that time; so, here's a long post to summarize what I've gone through.

I've covered periphery (which can be translated as long walks along the hospital corridors all day long while getting irritating calls from O&G for medical review before discharge); the CCU/ICU/HDW (where the lucky critically ill patients end up; the unlucky ones get the acute beds in the general ward); the MOPD (sitting down while seeing stable patients is fun!) and more interhospital transfers.

BFMP course - what fun!

TAGGERS

As I enter the second half of the posting, and as the seniors advance to other postings, and as first posters join the Medical Department, I get entrusted into the role of senior medical houseman.

Honestly, I still have a lot to learn - I have yet to master the basics of Internal Medicine and definitely am not qualified to guide - but seeing the way new housemen come into the ward: awkward, disoriented, stressed out, slow - it reminded me of how much I deperately needed guidance when I first arrived. And my seniors helped me. And so, like it or not, I had to teach the freshies. Nasib la kalau dapat silap ilmu - muahaha.

Foggy morning run is a blast in Temerloh.. at least, that's what I've heard.

My seniors said that I picked up fast for a first poster. But that's because I get scolded a lot, by various people. Sure, it's depressing to be called 'mangkuk ayun' in the middle of the night, but it's a blessing in disguise because I learned a lot from such incidents. Also, while it's good to learn from your own mistakes, it's better to learn from other people's mistakes.

MIDPOSTING ASSESSMENT

It's viva assessment by two specialists. They toss you two/three scenarios (emergency or clinic setting) and you answer. Simple.

Anyway I failed the first but passed the second one.

Shocked? I was, when my HOD summoned me to his room to deliver the bad news and ask whether I had personal problems that I would like to share.

I said no.

WORK

I'm getting more adjusted to this lifestyle. Getting scolded has become less frequent as new targets start to appear *insert cheeky smile here*. Work has become relatively less. Reviews has become faster (not as fast as some of my seniors). ABGs much simpler to take nowadays. I've set up femoral lines but have yet to muster the confidence to offer myself for femoral or IJC insertion.

Juniors commented that I was unapproacheable in the first two months. I've got to admit that's true - the stress of working made me focused and less attentive to my surroundings. Also, grumpy-looking. But now I'm able to approach the juniors and chat with them (whenever I get the free time lah).

So, to those who commented that I look happy, yes, I am happy :)

Oh, did I mention that gossiping with the nurses is done on a regular basis? It's fun to hear the antics of the previous HOs, MOs and even the HOD. The one thing I've learned throughout my working experience is: never, never ever mess with the nurses.

MARRIAGE

I'm just 3 months away from getting hitched.

Transferring patients does have its benefits.

I've settled the necessary papers, now it's just to get the clothes done and work to earn a decent, halal salary to fund the whole affair. I'm saving hard, skipping lunch or dinner at times (sometimes it's because I overslept, sometimes it's because I wanted to save money, sometimes it's because I got bored from Temerloh's lack of variety). I've yet to even buy my own home theatre system plus the PS3. Heck, I've yet to repair my RROD-ed Xbox 360.

And oh, since I started working, I haven't played a single game despite having Crysis installed on my gaming laptop. I don't know whether it's because 1) I'm subconsciously trying to fit into my adult shoes, or 2) playing instead of studying makes me feel guilty, or 3) Internal Medicine is so damn tiring.

No gaming craving for now.. until Gears of War 3 and Assassin's Creed 2 Revelations come out for the PC, that is.

MVA

I had a near-death experience a few days ago when I lost control of my vehicle (the family's 17-year-old blue Proton Wira), hit the right divider, turned and crashed into the left divider and subsequently plowed the hilly roadside.

I suffered a cerebral concussion (LOC for a few seconds, I think), minor cuts here and there.. and that was about it.

I was lucky (Mom said that God still has purposes for me) but the Wira wasn't. It suffered severe damage to the engine, frame, and boot. The cost of repairing it was beyond its present value, so we decided to let it go.

It was like losing a friend - a friend of 17 years.

Taken with Yunus' Galaxy S2's native camera.

So long, my friend..

The Kitteh Lifestyle

2011-10-05T18:30:00.000+08:00

Salam.

I miss my cats.

Or is it their leisurely lifestyle that I miss?

*sigh*

The Real-life Medical Syllabus

2011-09-21T00:57:00.000+08:00

Salam.

Today is my 57th day at work.

The wall art reads, "Dr Yusoff was here."

I realized that I haven't been writing about the medical posting itself.

Internal Medicine in the real world is all about medical emergencies. And when we say medical emergencies, there's only two words associated with them - Sarawak handbook.

It's the ultimate guide to medical life, used by MO's and HO's everywhere.

What you find in there is what you'll find out there. From the very dramatic status epilepticus to the very silent hypertensive emergency, every topic is covered and presented well. Plus, the mid-posting and end-posting assessments will cover medical emergencies usually.

Another awesome mini textbook is the Oxford handbook - complete, concise, can fit in the white coat pocket.

If you're tech-savvy, then your smartphone should already have Medscape.

SYLLABUS

ACS (UA, NSTEMI, STEMI), CCF, APO, CVA (ACA, MCA, PCA; SAH, SDH, EDH), AEBA, AECOAD, URTI, CAP, HAP, HCAP, PTB, DM, DKA, HPT, DF, ARF, CKD, CLD, AGE, UTI, RVD - to put it simply, those with abbreviations are encountererd on a daily basis*.

My post-shift jajan binge collection - also encountered on a daily basis.

The main diseases need to be understood thoroughly - from the various presentations to the investigations to the management and progress.

Honestly, it's hard to focus on the subjects of the posting if you're a first poster since you'll be more focused on adjusting to the system and the associated life (or lack thereof).

To overload or not to overload? - that is the question.

The management part is a bit tricky in the beginning, but after a few encounters with the same disease in a variety of presentations, it'll become second nature. Understanding the disease process and pharmacodynamics of the medications will help tremendously, rather than blind memorization of the treatment.

So kids, learn your stuff well while you still have the free time.

Free time well-spent.

It took me around one month to get settled in - even then, I still get scolded at times for reasons associated with lack of comprehension of (and adaptation to) the system.

Holding on to important things in the crucial moments.

As for the compulsory procedures, my logbook is still free of signatures (and my midposting assessment is next Monday, haha). So far, I've done one chest tube insertion and one peritoneal tapping. And oh, countless CPRs (personally managed two resuscitations by myself while the MO is busy somewhere else).

Learning the system, one leaf at a time.

There's a lot to cover in medical posting - and honestly, I don't mind a one-month extension as I can get more medical exposure and training.

*This list is not exhaustive - I can't find an abbreviation for epilepsy, leptospirosis, melioidosis, deliberate self-harm (paraquat, organophosphate, corrosive agent ingestion), alleged snake bite, dehydration, non-compliance. And let's not forget the medical emergencies.

The First Eid As A House Officer

2011-09-05T17:20:00.000+08:00

Salam.

I hope it's not too late to say Eid Mubarak, everyone!

Today, I'm on my ON shift; it starts at 10pm until 10am tomorrow.

So I usually use the free time I have during the day to 'live' a little - I wash my clothes; I buy grocery supplies; I edit the pictures I've snapped and share them with you people; I write this blog; I take a joyride on the scooter, letting the road take me on an uncharted adventure through Kampung Paya Luas behind the hospital; and many other stuff unrelated to Medicine.

RAYA

Initially I didn't plan on getting any Raya leave as I've been taught that sacrifice in the early years of medical profession is a given.

But then, during the departmental Raya meeting, my off day was coincidentally on Raya day 1. So I thought, I might as well get leave on Raya day 2, so I can spend my last Raya as a single person with my family.

Iftar as a single person.

For my department, getting an off day meant working the ON shift the night before. In other words, I was to work on Raya night amidst the happy Takbir and cheerful firework sounds in the night air. Oh, how it'll hurt.

So I informed my parents of my two-day leave and Dad planned to come and fetch me after Raya prayers. I planned to finish my work earlier and leave for prayers earlier (at 9am). I was expecting little work on that night.

Usually as Raya day approaches, the admissions would drop, chronic patients would request for AOR (at-own-risk) discharges, and cases at A&E would request to not be admitted.

But not this year.

Iftar at departmental level.

When I reported for duty, there were more than 10 new admissions that night. What the..!

That's the number of admissions on a normal day until midnight. As it turned out weirdly this year, patients requested to be admitted, not many patients requested for AOR discharge, no deaths and no terminally ill patients. So the ward was choke-full of patients on Raya night.

It's not a problem to clerk new cases, manage them, take blood and present the cases to the MO. Plus, the specialist on-call planned to come the next morning. So, no pressure there too.

The problem was taking the routine morning blood for tests.

BLOOD-TAKING

That early morning, after finishing rounds with the MO (total new cases: 17), I only started to collect blood at 6am. Blood collection by a junior HO in the medical department usually takes 5 hours if done alone.

I take my jajan breaks and pray Subuh when I got bored or pissed off at veins of an IVDU patient.

I favoured the blue needle since it was small and less traumatic to patients, but I found that it was slowing me down if I didn't get the vein on the initial prick. Fatefully, the supply of blue needles on the blood-taking trolley ran out. So, I decided to use the green needle (a slightly bigger caliber needle).

Surprisingly, my work became a lot faster! It was easier to find runaway veins, hit arteries, draw blood, less sample lysis, and since they're rarely used, there's tons of them on the trolley.

But that deciding factor came too late. I finished at..

11am!

So, I missed my Raya prayers.

Dad, who came to fetch me as early as 8am, was forced to wait for me after Raya prayers for 2 hours. I felt horrible for making him wait, but he said that he made use of the spare time learning Arabic via audio CD, so I was a bit relieved.

I slept on the journey back home to Bangi.

My family spent one night and one day in Gopeng, Dad's hometown, visiting relatives, paying respect to those who've passed on and ate a lot of kuih Raya.

I'm sure my younger brothers missed the joyful mood of Raya this year but for me, I enjoyed this little time even more. Somehow, after talking to dozens of strangers, feigning interest in their lives, my communication skills with my relatives have improved.

That, or either I've matured (I don't think it's the latter).

p/s My first pay was spent on duit raya for my brothers and some smaller cousins :)

p/p/s Me - taken yesterday. No weight loss or gain. Macho as ever.

The Ramadhan I'll Miss

2011-08-23T17:58:00.000+08:00

Salam.

It has been a very unnoticeable Ramadhan this year.

Iftar and Tarawih prayers at the hospital lobby last week.

Rushing to review patients, adapting to the system, the core subjects to learn in each discipline - they make you lose track of the progress of this holy month.

Ordered some tarts from the nurses for my post-shift junk food binge.

I miss the gathering of friends for iftar, the spiritual nights of Tarawih and Qiamullail, the peaceful atmosphere. Heck, I miss a lot of things.

I miss my kittehs :(

But that's part of moving on.

One day, you're a medical student being looked up by society; the next, you're a junior doctor,

a low-life, ignorant and inept.

See you guys in late September!

Things get better in the long run. Once you know your way around the system, you'll find your niche.

A mix of paper and paperless work is as confusing as a man with vertigo navigating through KL city blindfolded.

FREE TIME

The shift system allows for more personal time. Some spend it sleeping it off, others spend it with their loved ones.

Me? I like to keep busy with my hobbies. It's one of the things that keep me looking forward to tomorrow.

When I first came to Temerloh, all my favourite activities came to an abrupt stop. It was a stressful and alien time. But after a month learning and adapting to this new phase of life, I found that I can live through this stage without that much negativity. So, one-by-one, I kick-started my hobbies.

I started off with my photography.

It's red in colour because it's hot commodity.

I snapped pictures on my smartphone regularly. I'm always on the lookout for those moving shots of hospital life. Only drawback is the medico-legal aspect of it. None can be revealed too much.

Aside from snapping those pictures, I also look forward to the fun of editing, printing and scrapbooking my photos. You know, for my later years when I'm nostalgic and all.

Nostalgia looking at this picture and exclaiming how much hair I have back then.

For now, you'll have to be satisfied with still life. I'm still not comfortable showing pictures of sick people - especially those in dire conditions or pain.

Until then, here's pictures of dull Temerloh.

Happy Ramadhan, everyone!

The Tagging Experience

2011-08-12T17:52:00.000+08:00

Salam.

It's been a hectic and strenuous two weeks of tagging as a first poster at the Medical Department, HoSHAS. As a tagger, I was required to work double shifts - come in at 7am and check out at 12am (but usually I finish work later than that).

Welcome to HoSHAS quarters, Block E.

The routine begins with morning HO review of patients. On the first day, I was given only one patient to clerk - AEBA secondary to UTI. I was scolded by the MO because I didn't put in any clinical plans - senior HOs were supposed to teach me the works but they were occupied that day.

Then, comes the MO review rounds. These are just refinement of HO management plans. It's during this time that I learn the most. I get to see how the MO's think and argue, and then manage.

The specialist review rounds comes later that morning. Specialist discussions are usually too deep to follow during the initial days of tagging, but slowly I caught on and asked questions.

Medical rounds usually last until lunch, stopped awhile for visiting hours, then continued in the evening.

Hospital Information System (HIS) - berebut laptop dengan nurses untuk buat morning review.

After the rounds, it's time to work the clerical skills - writing discharge notes, calling clinics for appointments, writing referrals, tracing old notes.. stuff that will work itself out by trial-and-error over time. Here's the tricky part - all of these have to be done according to priority, some must be done before the end of the office hours.

Life in the Medical Department is a hectic one, compared to other departments. On an active day, admissions can go up to 25, ballooning up the ward, warranting transfer of old, stable cases to other wards.

My energy drink.

Here's a very brief summary of my tagging life:

On day 2, I was entrusted to cover one cubicle of 4-6 patients.

On day 3, I did CPR on 3 different patients.

On day 5, my post-HD patient developed ACS and died.

On day 8, I was reviewing 8 patients per day. Still slow.

On day 13, I pronounced the death of a patient. "Makcik, pakcik dah takde."

Death consists of five forms to be filled in.

On day 14, my newly diagnosed PTB patient absconded.

TB registry.

GETTING SCOLDED

I've been scolded a few times for my lack of sense of priority but it's an understandable fault - first timers usually don't have the same awareness, sense of urgency or responsibility.

I've been scolded for not reviewing fast enough.

"Tunggul kayu ke? Pegi la clerk new case tu."

I've also been scolded not being aware of the events in the ward, especially the acute beds.

Items to prepare for femoral catheter insertion.

Everyone gets depressed after a scolding, especially if it's not your fault to begin with. But bouncing back is key. And also, saying sorry if you're wrong, saying sorry even if you're right.

Accompanying a patient's transfer to HTAA.

PROCEDURES

Things that were previously awkward to do are now staple.

"Doktor Yusoff, bed 6 cabut branula dia."

"Doktor, bed 18 tak pasang CBD lagi."

"Doktor, anaes call, cakap bed 26 tak repeat ABG lagi."

Gotta memorize what each tube is for by the end of the first week.

What hand hygiene?

But the most routine-disturbing phrase has got to be this:

"Doktor, bed 24 collapse!"

OFF TAG

Alhamdulillah, now that I'm finally off tagging, I have plenty of time to settle my unfinished business e.g. doing the laundry, stocking new supplies of food for sahur, Tarawih prayers, writing this blog, and recreational stuff.

It's a relief but a lot of responsibility at the same time. Some times, the night shift HO will be alone to take care of the whole ward. By merely hoping for the uneventful is wishful thinking; one has to prepare for medical emergencies. That's when you have to decide whether it's necessary to disturb the on-call MO.

If an ACS patient complains of chest pain, you take his vitals, do an ECG stat, give him sublingual GTN, compare the latest ECG with the old ones, review the latest blood investigations, then you decide whether to call the MO or not. If you're not sure, you can just inform him/her while giving her the important info.

That's just ACS. There's SpO2 dropping, hypoglycaemia, hypotension, fitting, etc.

But this level of clinical acumen will only improve by time. Until that time, you'll get scolded over and over again for not being able to prioritize or manage simple events.

Blood culture company giving a talk, then freebies.

Oh, one more thing - night shift HOs have to take blood from the whole ward at 6am in the morning. If one starts at 5am, he/she will probably finish around 7-8am.

So medical students, do come and help, yes?

The 10 Things I Did During The 10-Week Holidays

2011-07-18T21:06:00.000+08:00

Salam.
1. I got engaged!

2. I discovered the wonderful joys of Tutti Frutti.

3. I started a photo book project on my smartphone photos.

4. Oh, and I bought an ukulele and a gaming laptop.

5. Went to Kelantan again for a friend's wedding. Also, pulut mangga.

6. Brought my scooter back home, after six years of rempit-ing in KL. I'm planning on bringing it with me to my new hospital.

7. Went to the Malaysia vs. Taiwan match at Bukit Jalil Stadium.

8. Went to a Personal Professional Development (PPD) camp for the new clinical years juniors at Ulu Sepri BTN Camp, Negeri Sembilan.

9. Went to the 2010 FPSK USIM Academic Workshop at Everly Resort Hotel in Melaka.

10. Watched the kittehs grow.

Off to induction now!

The Turret Opera

2011-07-16T04:32:00.000+08:00

Salam.

Video game sequels rarely top up the hype of their predecessor. One of those rare ones is Portal 2. It's a puzzle FPS game that's riddled with humourous dialogues, an awesome story, improved gameplay and cute memorable characters.

Here's the ending song to the game, sang by the turrets. Oh, spoilers for those who care (and have yet to play the game *gasp!*)

Aaand, of course, on Youtube, there's remixes and covers.

Cara bel, cara mia bella!
Mia bambina, o ciel! [pun: Chell = It. "Ciel" = Sky"]
Che la stima,
Che la stima,
O cara mia, addio!
La mia bambina cara,
perché non passi lontana?
Sì, lontana da Scienza, [personified]
Cara, cara mia bambina?
Ah, mia bella!
Ah, mia cara!
Ah, mia cara!
Ah, mia bambina!
O cara, cara mia...
English:

Darling dear, my darling beauty!
My baby girl, oh Chell! [pun: "oh heavens!"]
That's all
That's all
Oh my darling, goodbye!
My dear baby girl,
why do you not walk far away?
Yes, far away from Science,
My dear, my dear baby girl?
Ah, my beauty!
Ah, my dear!
Ah, my dear!
Ah, my baby girl!
Oh dear, my dear...

And here are the turrets rehearsing earlier on:

The Farewell Dinner 2

2011-07-14T21:06:00.003+08:00

Salam.

Let's continue where we left off.

I mentioned that traditionally the final year students would have to organize their own graduation dinner. Normally it would've been told at the beginning of the year, so that students can manage time between work and studies well; but that wasn't the case for our batch where we were told almost at the end of the final posting. So that messed up our studies quite a bit.

Good news for the subsequent batches, however! At the recent FPSK USIM Academic Workshop 2011 that three of the first batch graduates attended, we suggested that the graduation dinner be organized annually by the MSC. The Dean agreed.

Anyway, here's what I did when after I suicidally volunteered to be the programme head:

1) I formed my committee:

It was easy to choose people skilled enough to work while studying for the finals, but it was not easy trying to convince them. Nevertheless, after seven years of friendship, we know when we have to put aside personal grudges, work together and sacrifice a bit towards a common goal.
Delegated jobs were carried out willingfully and with full cooperation by everyone. It's as simple as asking one to make the brochure, and she'd arrange the contents, select the appropriate artwork and print them out.. all by herself!

2) We selected a good venue:

At first, we viewed the dinner as an annoyance, so we wanted to do it at a cheap but acceptable place. Cincai la. We chose the UKM KRU as our venue. Despite its simpleness, it was a nostalgic place since we had our Tamhidi dinner there. The price was RM50 per head.

But the Dean did not agree to this. He wanted a place of grandeur to properly send us off. He wanted the top university men (plus our former VC) to come and celebrate our graduation.

So, after a bit of grumbling, then searching and suggestions from friends, we chose Seri Pacific Hotel for the dinner. The price for a Chinese dinner was RM110 per head for about 80 attendees. "That's better," the Dean agreed, with a smile on his face.

Another item that the Dean would specifically ask for is the karaoke event. It was either the faculty PA system or the hotel hiring a professional group to set it all up plus bringing all the karaoke songs for RM1000. Due to certain circumstances, we chose the latter.

So roughly, (80 guests x RM110) + RM1000 = RM9800!

3) We collected the fees:

To be honest, I didn't collect anything. AP Dr Shahrir collected RM150 from each of the staff (nobody is willing to pay a quite exorbitant amount, but hey, it's the first batch :P ); and I delegated one student to collect RM100 per student head. The Dean also enforced his authority by demanding payment from some of the stubborn lecturers.

Initially, while collection was in progress, the hotel would ask for some financial deposit in order to safely book the grand ballroom for the event. AP Dr Shahrir was generous enough to use RM3000 of his money for that purpose.

Then, the Dean took over the financial management. He would demand the collected money, pay back what was owed to AP Dr Shahrir, add in a few extra RM for the working staff (IT, photography), add in RM1000 that was generously sponsored by our former VC, and at the end of the dinner, he would pay the hotel using his cheque.

Efficiency comes from experience. So to whoever will be handling this event later, if the Dean argues against something you planned or suggested, he's right and you're wrong.

4) We prepared the shows:

As a staple of every dinner event, there's a slot for a slideshow. Since we didn't have the luxury of time, we made the presentation simple but accompanied by the most important element - sad, sad music. Nothing works the tear glands like nostalgic photos and depressing piano riffs.

Some of us also liked singing, so the karaoke sessions were spread throughout the dinner. Two students (plus one wife) sang nasyeed songs; three students went onstage together to sing a youthful song badly; AP Dr Shahrir crooned a song for his parents; the Dean attempted to sing one of Shahir AF8's song and well, let's just say that he's not that young anymore; Dato Dr Mahmud dedicated a song to the newly weds; and after it was over, some of the students and staff were forced by the Dean to sing onstage as well.

I was forced to sing too.. for the first time ever in my life. The Youtube embed code for the song (not me singing) is not working, so here.

We had a great time during the dinner. Everyone was there to wave us goodbye, even old Tamhidi teachers and preclinical lecturers.

The lesson of the day for me was that as I reached through old contacts in Nilai to get the car plates of the VIPs (for the special ballroom parking), I realized that making a lot of friends here and there does have its long-term benefits. And oh, singing badly at the top off your lungs really pushes all the stress away.

It was an awesome dinner, and those involved were awesome friends.

I tried to salvage what I could from this lowlight smartphone shot.

But despite all the happiness, we must also remember those who didn't make it and help them as best as we can. InsyaAllah we'll see them during the convocation in December!

p/s Because this is already too long a post, I didn't touch upon a lot of important but minor details e.g. dress code.. you know, just in case someone arrives in sandals :P

The Farewell Dinner

2011-06-25T04:59:00.001+08:00

Salam.

The farewell dinner or the graduation dinner is held a few days after the final exams. It's the most memorable of all the dinner functions as you meet old teachers and lecturers, enjoy the company of friends.. before moving on to bigger adventures *sniff*

Seven years whizzed by; it's all a blur now.

Now, don't get shocked when I forewarn you guys that the farewell dinner is traditionally organized by the students themselves.

That's right, during the preparation for the final professional exams, some unlucky students will be organizing the most important dinner function in the history of the batch.

For my batch, that person was me and here, I will share my experience and tips for you (if you were unluckily chosen to be the head of the committee).

Firstly, when the clinical coordinator finally alerts your batch sometime during the final posting regarding the farewell dinner, NOBODY will volunteer to take the helm of the programme. That's because that person's revision for the final professional exam will suffer. In fact, nobody will volunteer to do anything.

Memories are like colours; initially, 256 colours but over time, grayscale.

But then, why the heck did I volunteer?

Here's the thing to consider when finding the head for the programme - the Untouchables.

The top, hardworking ones can't be chosen because they'll be the ones who must ace the exams, get distinction and subsequently get fame for the whole batch.

The bottom-of-the-barrel students can't be selected either because they can't handle the extra stress while struggling for the most important period of their professional life.

The married ones have extra responsibilities (although that should not be an excuse to shirk batch duties). Engagement doesn't count unless you're getting married in a week after the exams.

So, who among you guys will be likely to shoulder this responsibility?

Is there someone in your batch who

has performed quite well academically,
knows how to organize programmes,
is not one of the Untouchables,
doesn't mind doing all the work alone prior to the exams,
doesn't mind the resulting poor performance during the final pro exams (I got a C+, by the way),
is cool or crazy enough to volunteer?

If you are that person, good luck (because your friends will definitely be targeting you to lead after reading this post)!

Karaoke is a must; better find those with good voices and practise now.

Secondly, once you're chosen, you can then 1) form your committee, 2) find a good venue, 3) collect the fees, 4) prepare the shows, and 5) liaise with the Dean.

I'll elaborate in the next post, 'mkay?

p/s More pictures here.

The Android Camera 3: Monochrome

2011-06-21T07:18:00.001+08:00

Salam.

Boredom and uncertainty make me retreat to my hobbies. One of them is editing photos. And then, printing and arranging them in photo albums.

This time, I edited photos that I captured on my HTC Desire. In-phone filters are for kids and hipsters.

Here are 8 out of 150 pictures that I printed out in 3R size, all in monochrome or duotone:

No documentation of medical education is complete without a picture of a skull somewhere.

Enlightened medical student. Literally.

The cat calmly says, "I'm gonna make you pay."

Waiting for turn during the final pro exam.

Only two months gone and I already have the faculty in fuzzy, daguerreotype black and white.

A class with the legend himself - Prof Izham Cheong.

Quick quiz: Find people in this photo.

A parallel world in the reflection.

The images from the smartphone camera are good, but not that great. Plus, some images get cropped rather liberally. That's why I had them printed out in 3R size.

In the end, some of them turned out as expected; some others, better; and the rest, worse.

So tell me, what have you done in your boredom?

The Android Camera 2

2011-06-17T00:44:00.002+08:00

Salam.

Ever since my digital superzoom camera broke down almost a year ago, I found shutterbugging solace via my film cameras and lately, my HTC Desire *applause*

So far, no plans for a new digital camera but I've considered digital toy cameras e.g. Digital Harinezumi, superzooms e.g. the 30x zoom Fujifilm FinePix HS10, and Micro Four Third EVIL (electronic viewfinder, interchangeable lens) cameras e.g. Olympus PEN E-PL2.

Am I ready for a dSLR? I dunno.

Is there a camera suitable for the hospital environment? I dunno either.

In the meantime, here's more pics from my smartphone:

A longing for adventure hindered by an invisible barrier.

Can you guess where this is?

Pictures like this make me feel that my smartphone camera is enough to chronicle my life's small happenings.

Nasi dagang kelantan.

An attempt at smartphone street photography.

I'm gonna miss KL and her flash floods.

The Real Wedding Bells

2011-06-15T01:19:00.000+08:00

Salam.

Most of you have already heard that I'll be getting married by the end of January next year. If not, now you know :D

It was supposed to be hush-hush since I wanted to surprise many people with this good news, unfortunately some unsporting character treated this as his/her own secret and started spreading it around. Also, the Dean made a similar announcement during the monthly faculty meeting ("I would like to make an announcement: This boy is engaged to this girl"). So, it's a secret no more.

Anyways, an end to a single life also means an end to a couple of things:

An end to ogling girls/nurses/female medical students
An end to naughty blog posts
An end to candid photographic sniping of cute girls
An end to my hit Flickr set - Mademoiselle

It is therefore fitting that I end this lonely episode of my life with the appropriate picture - a candid photographic sniping of a specific cute girl:

My dearly betrothed is the one standing, with the peace sign.

The Theory Part of the Final Exam

2011-06-12T16:39:00.001+08:00

Salam.

Ok, this is a long-overdue post.

The theory papers were spread over one whole week. The days are divided according to the format of the questions and more importantly, the disciplines:

Monday - PMP 1: Internal Medicine and O&G

Tuesday - PMP 2: Surgery and Paeds*

Wednesday - Data interpretation/ instruments [20 stations]

Thursday - MCQ 1: Internal Medicine, O&G, Ophthalmology and CH [40 MCQs and 20 OBAs]

Friday - MCQ 2: Surgery, Ortho, Paeds, Psychiatry and ENT [40 MCQs and 20 OBAs]

By the time you reach Year 6, you should already be familiar with the techniques of answering. There's not much difference during the final exam. But don't get too comfortable - the final theory exam is HARD.

PMP:

The most important thing to do on the first day of the exam is to synchronize your watch with the exam hall clock. That way, you can manage answering questions better (focus more on questions that you know the answers, leave the open-ended ones for later), especially during PMP. I missed answering an 8-mark question during the first PMP package because I did not time my watch - it was set 5 minutes later that the starting time.

The style of each discipline's PMP depends on the author of the questions; they are significantly different and you need to anticipate and master them all in order to have a good pass. Take the first 30 seconds to browse through each package before answering; note the number of questions in each package, close/open-ended questions, etc.

As concerned seniors, here's the list of PMP questions (there's no final exam questions from other universities because we care for our juniors more):

Medical:
SLE with lupus nephritis
- Management
Then, she developed PTB
- Xray features
- Management
Then, she developed bacterial meningitis
- Interpret CSF
- Management
Patient wants to get pregnant
- Advice
- investigations
Oops, patient gets pregnant with antiphospholipid syndrome
- Management

O&G:
40 y/o, G1P0, GDM with cephalopelvic disproportion and subfertilty
- MOGTT
- EDD
- Mx
- Delivery method
- Cx of delivery

Surgery:
Acute pancreatitis secondary to gallstone with hypovolemic shock
- Pathophysiology of signs - Grey turner & cullen
- Causes
- Ranson's scoring
- ICU management
- Definitive management - for gallstone in gallbladder and CBD
Admitted again for pancreatic pseudocyst
- Mx
Admitted again for DM and and fat indigestion
Paeds:
Newborn with features of Trisomy 21 (Down's)
- List features
- Abnormalities according to organs
Mom wants to abort at 32 week POA
- View based on Islamic principles
Delivered pre-term at 32w POA.
- APGAR score
- Management of preterm in NICU
Post-op, admitted for jaundice
- Phototherapy
- Indication
- Complication
Then, baby developed intestinal obstruction (vomiting), green meconium at 30hours of life and dehydration
- Hischprung's
- Mx
Down's
- Trisomy 21 karyotyping
- Support group - Kiwanis

DATA INTERPRETATION/OSCE:

Not much can be said about this except that there are 20 stations, covering all disciplines. 10 are listed here:

Medicine - WPW syndrome (ECG), foreign body in oesophagus (CXR), lung collapse in brochogenic cancer (CXR), CVA,
Surgery - Sengstaken-Blakemore tube, sigmoidoscope,
O&G - CTG
Paeds - Childhood obesity (growth chart),
Ortho - Ewing sarcoma, Perthe's disease (limb X-ray).

MCQ & OBA:

160 MCQs (each with 5 answers) and 40 OBAs. A lot to answer.

Quite impossible to cover everything during the 3-week study leave, honestly. You guys better start studying now. Understand the disease processes, make notes, attempt the past year questions.. and oh, make lots of doa.

* Rotation between Paeds, Ortho or Psychiatry PMP yearly.

The Effect Of Studying Medicine

2011-05-28T04:20:00.000+08:00

Salam.

I've been asked by family members and eager parents to give my opinion about sending their child to read Medicine at USIM. I gave them my honest views ~~save for the critical bits about administration and the main campus since I'm not yet free from their hold~~.

But instead of giving them information diarrhoea, I should have made them see this picture:

Seven years did that to me. And the worst has yet to come.

Let's see what I look like in the next seven years.

The Clinical Part of FPSK USIM First Batch's Final Professional Exam (Part One) REPUBLISHED

2011-05-21T20:14:00.000+08:00

Salam.

DISCLAIMER: The Blogger rollback problem caused the first part of my final clinical exam post to be 'temporarily' removed. Luckily I have the older version of it and I've published it for the benefit of my juniors; I will delete this once the old post comes back.

*************************

Yesterday was the clinical part of USIM first batch's final professional exam (I'll update the theory part later). I woke up at 5.30am with a sudden episode tachycardia. I've been having these bouts of palpitations for a few days now.

No, it's not the caffeine intoxication. The Yerkes-Dodson law says that anxiety is good for my performance, but it's suffice to say that I don't like getting jittery while sitting on the toilet or surfing 9gag.

The bus was supposed to arrive at 6.45am for the rush-hour trip to HUKM, but I couldn't sleep anymore after waking up then. It was drizzling lightly that morning but I doubt anybody cared about the weather; what's more important was the TNM staging of breast cancer.

The bus ride was uneventful; we arrived around 7.45am - just nice for the first group of students to skip breakfast and clerk their long case (haha). I was in the third group (long case clerking at 10am), so I chose to eat first. I had low appetite (the tasteless bihun didn't help either) but I figured that I need the glucose for optimal brain function, so I forced fed myself a half-plate of bihun and a drink of teh tarik.

After breakfast and then loitering at the level 1 surau, it was time for my group's turn.

By the way, did I mention that time passed super slowly while one waits for his or her fated encounter? Adding those sudden bouts of tachycardia into the mix makes the waiting game a lot more unbearable.

I definitely don't want to go through this anxiety roller-coaster ride again.

The Long Case:

I was led to a room, occupied by a Malay man in his forties in hospital garb, sitting comfortably on the bed. I introduced myself to him, and as per the best tip given for the long case: I explained to him that this was my final exam and I required his full cooperation during clerking and examination.

I looked at his foot and there was a dressing.

"Encik ade pape masalah perubatan?"

"Ade kencing manis, enam tahun dah."

YES, DIABETIC FOOT ULCER!

Random pic that I got when I googled diabetic foot ulcer. My patient already had his wound surgically debrided.

"Ade pape masalah lain?"

"Takde"

YES, UNCOMPLICATED CASE!

An hour of clerking went smoothly. Time passed by super quickly (look at clock, 1 hour remaining, clerk some more, look up again, waaah! 30 minutes remaining) compared to while I was waiting for my turn. After that, I spent 15 minutes outside the long case presentation room to reorganize my info, plan for investigations and management.

My examiners were 1) my Dean, 2) a HUKM Orthopaedic specialist, and 3) the Psychiatry HOD of Hosp Temerloh.

I presented my case to the lead examiner - the Ortho specialist - while the other two examiners listened on. Well, sort off.. My Dean put his hands on the table and 'nodded approvingly at my answers many times'.

And then, we went to the bedside for presentation of the physical examination. Since it was a case of uncomplicated DFU (no gangrene, cellulitis, osteomyelitis or sepsis), my positive findings were confined to the legs only. Other investigations were done briefly and no surprise, they turned out normal.

In summary, here's what they asked:

What is the management of a DFU at the hospital?
What is the method of wound closure?
What is the insulin regimen during surgery?
What would you like to advice the patient on foot care?
What is the main method of rehabilitation? When is the best time to buy well-fitting shoes?
As a GP, what is your management of a DFU at a clinic?
What are the skin changes in a diabetic leg?
What is the pathophysiology of lipodermatosclerosis?
What is the expected bacteria to be found in the C+S? What is the antibiotic used?
If there is osteomyelitis of the metatarsal bone, what is the management?
What is ABSI? What are the significant values?
Name drugs for DM, HPT and hypercholesterolaemia.

Of course, there were some answers that I could answer well, and some that had to be prompted and guided. No major gaffes except for maybe the description of the wound. I said that there was slough but it turned out that the yellowish creamy substance was actually DuoDerm dressing gel. Dammit, how was I supposed to know?!

It was a 30-minute interview but it felt so fast. After the bell rang and I exited the room, half of the burden that I was carrying was gone. No more tachycardia attacks, no more sweating, just a cool, relaxed walk to the dining room.

The students from the first two groups were already there, sharing experiences and stories. Some had similar straight-forward cases (e.g. DM and HPT in pregnancy, MDD), some got complicated cases (multiple pregnancy via assisted conception, hypothyroidism in pregnancy), and a one or two got rare cases (e.g. brachial plexus injury, varicose vein).

But whatever the performance, everyone was in a generally good mood then.

The PM's 1Cat

2011-05-19T13:24:00.002+08:00

Salam.

This is just a harmless picture of our PM tweeting on his iPad. For coolness sake, I'll just assume that he was playing Dead Space.

Taken from here.

Now, the more important item in this picture is the portrait on the upper left. Yep, that's Him holding a kitteh kinda awkwardly!

Instead of promising millions of RM during election campaigns, our dear leader could've just showed that particular portrait, make a lolcat joke, everyone would go, "Awwwwwww.." and vote for BN. That's ten thousand votes right there.

What - it's not that clear?

Here, I've corrected it in Photoshop:

Captions badly needed.

You're welcome, Internet.

Although the image is quite small, I'm sure we can still put this image to good use.

Now, let's creatively guess the kitteh's name.

The Clinical Part of FPSK USIM First Batch's Final Professional Exam (Part Two)

2011-05-19T04:33:00.003+08:00

Salam.

DISCLAIMER: Blogger is having a problem; Part One was removed.

The Short Case:

Each student has 3 short cases with 3 different examiners. Tip: if one gets an Ortho case for the long case, then he or she will not get the same discipline for the short cases. For me, I could narrow down the scope of my exams to a case from Paediatrics, Medicine, ENT or Ophthalmology. So I focused more on the examination techniques and common short cases of those disciplines.

The first group started at 1.45pm. Like the long case, I was in the third group, scheduled to start waaaay later at 3.15pm. The waiting game started again. The palpitations returned; the peripheries were cold; reflexes were brisk; time slowed down.

It was an emotional torture.

When my name was called, I was 'dying' to meet my examiners. And when I met them - 1) a strict Professor of Paediatrics from CUCMS; 2) a HUKM Professor of Surgery; and 3) an external external Professor of Endocrinology from University of Melbourne - I died a little. I got the same examiners that Bro Zaheer got.

Case No. 1:

"The mother of this 1-day-old neonate asks you whether the baby can be discharged from the hospital or not. Please do a neonatal screening."

OMG! OMG! I didn't really pay attention to neonatal screening during the revision. All I remembered were recollections of my time in the postnatal ward with the beautiful Paeds MO at Ampang Hospital. And dammit, I remember her face more than the flow of examination of a newborn.

Oh well, I progressed this far in medical study to faint now. So I showed the examiners what I knew.

I made sure my examination was systematic - starting at the top (looking for cephalohaematoma, feeling the fontanelles), moved down to the face (looking for syndromic facies), the neck, the chest (looking for nipple discharge), the abdomen (looking for anterior wall defects, inspecting the umbillical cord for signs of infection)..

..when I was stopped by the Paeds examiner.

"What are you doing?"

"I'm palpating the abdomen for organomegaly." I said, as I pinched the abdomen.

"Do it properly!" he said sternly.

Oh shit! Only at that moment, I realized that the mesmerizingly beautiful MO taught me the shortcut method. So, I collected what was left of my composure and palpated the nine regions with two fingers, hoping that it was correct.

Too late for revision; tibai je la.

Then, I removed the diapers and proceeded to inspect 1) the external genitalia, secretly hoping for a girl so that I don't have to prepare for the 'fountain of youth' (looking for normal, not ambiguous external genitalia), and 2) the patency of the anus.

I moved to the limbs to inspect for signs of Down syndrome and signs of labour injuries (e.g. Erb's palsy).

I presented to him my relevant findings and in the end, he asked, "Your diagnosis?"

"It's a normal day 1 female neonate."

"Do you want to allow the mother to take the baby home?"

"Yes."

Case No. 2:

I was led by the harmless-looking Professor of Surgery to an old Chinese gentleman who presented with an irregular mass at the neck.

Since I didn't know the specialty of my examiner then (it's helpful to know because you may then 'guide' the examiner to ask you questions that you can answer) - I suspected that it was either Surgery or ENT - so, I went back to basics.

I started with inspection. There was 1) an irregular mass at the neck, like a skin flap, extending upwards to the right parotid area, and 2) an area of erythema over the neck and upper chest.

I proceeded with palpation. The mass was hard, irregular in shape, irregular surface, nontender and nonmobile. No bruit on auscultation.

I suspected that it was a malignancy. Something was missing from the puzzle but whatever, I presented as usual.

After presentation, the Professor asked me, "There's something else you missed on inspection."

Holy shit, I'm gonna fail.

I looked again at the patient's neck.

Nope, nothing new.

After showing the body language that I had no idea what to look for, the Professor approached the patient and lifted up the flap-like mass a bit, and there it was, staring at me..

..a freaking surgical scar!

I mentally facepalmed myself a few times - that was the second time I messed up.

I gathered back whatever's left of my confidence and proceeded to describe the scar, combine all my findings together plus come up with a provisional diagnosis - cervical metastasis in a case of post-total thyroidectomy for papillary thyroid carcinoma with radiotherapy.

"What else could it be?"

Since I didn't know his specialty, I aimed to cover both aforementioned disciples and said, "Nasopharngeal carcinoma."

"Yes, that's possible. Where do you want to look for it?"

"Fossa of Rosenmuller via posterior rhinoscopy."

Case No. 3:

Final case - a Malay gentleman in his fifties.

The orang puteh took charge and said, "Please examine this man's cardiovascular system".

A CVS exam!

That should be a breeze since it's the first thing you learn during Internal Medicine posting. But it wasn't.

For a complete CVS exam of a normal person, I clocked at 6 minutes. For a patient with findings plus the three staring examiners plus the time limit, I took a.. significantly longer time.

The peripheral examination was so slow that the examiner said, "Never mind, please examine the chest."

One thing that every student must be prepared for is prompting. Usually because we're too slow examining less important stuff, the examiner will ask us to skip ahead to the region with findings.

When this happens, it disturbs our flow of examination.

That's when regular practice and instinct comes into play. If you practice a lot, then you'll focus less on the flow of examination and more on the findings.

For this patient, there was a well-healed sternotomy scar, slightly deviated apex beat, audible S2 click that was best heard at the LSE, and a murmur in the aortic region that I couldn't time properly because of my own tachycardia.

It's a case of prosthetic valve.

Which valve? Couldn't think because of my palpitations. Lupduplupduplupduplupduplupdup!

I messed up a lot during the presentation.

First, I said that there was clubbing of the nails. The examiner immediately interrupted my examination and said, "No, there is no clubbing."

Dammit, I'm definitely gonna fail this.

Second, I said there was raised JVP. The examiner interrupted me again and said, "No, there is no raised JVP."

Fuuuu...!

Then he went on to TEACH me about the pulsations in the neck. Right there, during the final short case. He showed me the surface anatomy of the external and internal jugular veins, and the carotid artery.

That pulsation at the ear? Everyone you met said that that meant raised JVP, but no, during my final exam, I was taught that it can also be pulsation from the carotids.

"Don't make up signs; it's instant fail." Those oft repeated words echoed in my brain. Fail, fail, fail..

So here I was, morale going downhill, asked by the examiner to continue presenting. Of course there was the change in tone, speed and body language after that.

The orang puteh asked me, "Was the murmur systolic or diastolic?"

I hesitated to answer. I could've picked one but I wanted to salvage this case as much as possible.

So I admitted that I wasn't sure.

I did try to ascertain it by timing the murmur with the carotid pulse, but due to the time pressure, I wasn't as able to concentrate.

But he was nice enough to assist me, "Just now, you tried to time the murmur with the carotid pulse but you're not sure of your findings?"

Kriiing! The bell rang and we've yet to get to the diagnosis.

"Never mind. If it were systolic, what do you think is the valvular lesion?" The orang puteh asked as he towered over me.

It was like a loser's whimper when I answered "Aortic stenosis."

"How can you confirm it?"

"Expiration will accentuate the murmur?"

"No, not that. Where else do you auscultate?"

"I'd look for carotid radiation of the murmur."

"Yes, did you find it just now?""No, I didn't b.."

"That's because you auscultated in the posterior triangle. The carotid artery should be auscultated in the anterior triangle."

That was the final facepalm. Mati la aku macam ni.

As the three examiners left the cubicle, the orang puteh said, "Take this opportunity to auscultate his neck." And I did.

There was no carotid radiation.

Finally it was over. I chatted for awhile with the pakcik with the prosthetic valve (about his presentation and management), before silly-walking to the dining hall.

I messed up my short cases but I wasn't that sad.

That's not me.

In fact, I was just glad that it was all over now. The past month had been one crazy emotional tornado that I don't want to experience ever again.

Alhamdulillah.

p/s we'll discuss the theory part later.

The Final Exam Result

2011-05-11T03:08:00.001+08:00

Salam.

Alhamdulillah, I passed my finals!

Click to embiggen.

The announcement ceremony was a very emotional moment. Almost everyone cried - the students, the lecturers, even the IT staff.

Me?

I didn't cry; I shed manly tears.

After seven years of trials and errors, we made it to the end - 28 passes and 1 repeat. The top scorer was a primid at 16 weeks POG who scored B+; the rest were normally distributed among B, B-, C+, C and C-.

I scored a C+ (among the top 5 from below)! To be honest, I was more than satisfied to have passed but the Dean and a few teachers voiced out slight disappointment that I didn't score. I guess I was one of those people who scored during preclinical years but sucked during clinical years.

Oh well, I may have been a C+ graduate, but inferring from what Prof Dr James Best (one of our external external examiner, from University of Melbourne) said, I'm an internationally-tested-and-judged C+ graduate!

Congrats to those who made it. To the one who stayed a bit longer - we'll graduate together!

p/s No one achieved distinction (A or A-); juniors, this is your time to outshine your legendary seniors!

p/p/s I'll disect the exam itself later.

The Last Post Before The Finals (1 Day To Go!)

2011-04-24T03:00:00.000+08:00

Salam.

It's the last day of the study week. Imagine six years of study being tested in only 11 hours and 40 minutes. One word: akathisia.

Like before all major exams, I would like to apologize to all my friends and associate professors for any ill feelings that I've caused:

a) recently, due to my poor leadership or miscommunication;

b) throughout the seven years, due to my actions or words - spoken or written - especially my sarcasm; and

c) due to my passive-aggressive approach to social networking.

Also, I would like to apologize to those I've unintentionally hurt or disappointed with my choices in Life.

I've also forgiven you peeps especially for those silly gossips that reached my ears (gossips that don't reach my tympanic membranes are a non-issue) :P

Maafkan?

The Final Countdown (8 Days To Go)

2011-04-16T22:52:00.000+08:00

Salam.

Are you desperate for a last-minute checklist for the finals? This will help:

How to take a history has always been a mystery,
How to find a JVP,
How to take a pulse.

Asking patients about sex,
Supernature reflex,
Skin bumps, neck lumps,
Now give me a cough (cough)

MMR, BCG, meningitis, DTP,
Bile stones, ucichromes,
Coeliac disease.

Fallot's tetralogy,
Different types of allergy,
Antenatal screening of congenital disease.

Spastic paraplegia,
Syringomyelia,
Measuring Glasgow coma,
Extradural haematoma,
Alzheimer's, Parkinson's
Penetrance of Huntingdon's
HIV, CJD, syphillitic Shanker

It's stuff that you need for finals
Stuff that you need for finals

Thrombocytopenia,
Treating schizophrenia,
Causes of bulimia,
OCD.

Self-harm, suicide,
Side effects of frusemide,
Personality disorder,
SLE.

Multiple sclerosis,
Haemochromatosis,
Paraphemosis,
Endrometriosis,

Salpingitis,
Laryngitis,
Pharyngitis,
Urethritis,
Uveitis,
Retinitis pigmentosa

It's stuff that you need for finals,
Stuff that you need for finals.

Fractured neck of femur,
Causes of oedema,
Aqueous humour,
Different kinds of tumour,

Pneumothorax,
DVT,
Hepatosplenomegaly,
Prostate, kidney, breast and spleen,
Every organ in between

Ehler's-Danlos
Marfan's
Cushing-Conn's
Addison's
Carpal tunnel syndrome
Alopecia,
Dupetryn's

Henoch-Schonlein purpura
Austin-Flint murmur,
VSD, DIC,
SIADH.

Typhoid,
Amyloid,
Osteo, Rheumatoid,
Patient's that are paranoid,
Movements that are athetoid,
Sarcoid, carcinoid,
Cushingoid, Mongoloid,
Pseudopseudopseudopseudohypoparathyroid

Stuff that you need for finals,
It's all stuff that you need for finals.

X-ray, ECG,
Basic cardiology,
Neuro, endo,
ENT, oncology.

All of rheumatology,
Bits of embryology,
A-level chemistry,
Epidemiology.

Haem firm,
Paeds firm,
Psyche, surgery,
Rheumo, ortho,
So much stuff you need to know,
Learning drugs is so much stress,
You memorise the BNF,

Public health, public health,
What the fuck is public health?

Stuff that you need for finals,
It's all stuff that you need for finals,
It's all stuff that you need for finals.

p.s. google 'amateur transplants' for more medical parody songs.

The Marriage (12 Days To Go)

2011-04-13T03:49:00.001+08:00

Salam.

To all dear batchmates who will be getting married after the exams,

Ni belum tambah captions lagi.

Selamat!

The Fullness (17 Days To Go)

2011-04-10T09:46:00.000+08:00

Salam.

Can you guess the common theme in the following pictures taken using the native camera app of my HTC Desire?

Well, he IS anal.

No?

The theme is called...

p.s A week of non-stop studying is taking its toll on my cognitive functions.

The Harassment (16 Days To Go)

2011-04-09T06:18:00.001+08:00

Salam.

Sexual harassment is an important but taboo issue. When we work, it's important to watch what we say and do, especially to cute nurses (and MAs).

That's why we have this educational video, so we can learn all the awkward things that no one is supposed to say in the office.

Smells like vagina in here!

The Preparation (23 Days To Go)

2011-04-01T03:07:00.002+08:00

Salam.

Here's our preparation for the final pro exam.

The above two pics are exposed on Kodak Portra 160VC.

The above two pics are exposed on Fujicolor Superia Xtra 400.

What final exam?

The Last Day of School ( 30 Days To Go)

2011-03-25T19:24:00.001+08:00

Salam.

Today was the last day of school for me. The end-posting exam is next week, followed by an all-out, last-sprint-to-the-finish cramming session for 3 weeks in preparation for the final professional exam.

Going into my studious hermit mode now; don't contact me unless I contact you first.

You know what they say...

The Android Camera (35 Days To Go)

2011-03-21T03:15:00.000+08:00

Salam.

As many of you have known, my old digital camera of two years was busted in a fall due to a simple (but costly) case of I-forgot-it's-on-my-lap-and-stood-up-immediately-itis. After sending it to a camera shop for repairs, I was told that it was unrepairable. Bummer.

Now, it's on my shelf, awaiting sale along with two other busted cameras. I'm keeping my fingers crossed for camera trade-in events (which are quite rare).

In the meantime, I'll be doing my shutterbugging using my film cameras. Currently I have a brick of Fujicolor Superia Xtra 400 (expiry in 2013) and a couple of monochrome rolls awaiting use. So that means I'll be using film for the next two years!

Also, relieving my shutterbugging impatience and hunger for instant results is my HTC Desire camera. While not really a bad-ass in digital photography, the 5-MP camera - equipped with an LED flash and touch focusing - suits my digital needs quite nicely.

But what sealed the deal for me were the apps. The native camera app was decent but with apps that tweak the pics in various ways, it made digital photography using a smartphone a lot more fun!

Here are some of the native camera app pics:

And here are pics captured using the FxCamera app, which provides various lomo filters:

And here are samples using the ActionSnap app, which snaps a number of pics in timed intervals:

And other apps that I don't use regularly:

MultiCamera, which combines multiple pics into one pic.
Camera360, just like FxCamera but with different filters like tilt-shift. Redundant for me.

Of course, traditionalists would frown upon this blasphemy that is the smartphone camera. But this is a normal reaction towards change, since digital photography was not approved as an art medium by film users, and film photography, by painters before that.

So yeah, resistance is futile, old man. It may not be right, but it's getting the job done, so it can't be wrong.

The Fluid Maintainance (37 Days to Go)

2011-03-19T01:50:00.001+08:00

Salam.

The Trio had a few episodes of diarrhoea (?food poisoning) but mine was the worst.

I suppose I was dehydrated at that time. I could've been forced to drink a few glasses of water but no, my father - a concerned dad specialising in anaesthesiology - believed in the modern wonders of rehydration via an intravenous drip infusion. It was also more dramatic.

Eid ul-Fitri, Perak, early 90s.

My playtime activities were severely limited. (I was sad).

Visitors who came to the house queried about the apparatus hanging by the wall and were told nonchalantly by my parents that I suffered from diarrhoea. The whole world then knew that I had rapid bowel movements. (I was embarrassed).

Oh, I was also made to wear a diaper. (I wanted to disappear into a nook).

*************

But now, as I looked back, this was just an episode out of many more episodes of brushes with modern medicine in my life. I would've not voluntarily do Medicine if it were not due to these acts of medical care and love.

And as I stood by - counting the daily fluid maintenance, drip factor and whatnot - as my dad searched for a vein on my little brother's wrist (he had diarrhoea too!), I wondered:

Will I be doing the same things to our children too?

The Context (50 Days To Go)

2011-03-06T03:11:00.006+08:00

Salam.

Context is defined as the circumstances that form the setting for an event, statement, or idea, and in terms of which it can be fully understood.

The best of jokes have context.

But that doesn't that they can be appreciated by everyone. The Malaysian public in general enjoy slapstick jokes; I don't. I guess appreciating jokes (and this extends to making jokes too) is an artform that is a mash-up of one's educational, cultural and social values.

Don't get me wrong. Preferring one kind of joke over another is not a measure of class; it's just a matter of preference.

Also, naughty jokes are the simplest and easiest to make and enjoy. But one has to stay classy or subtle in order not to offend.

Here's a joke with context to test you:

Not guffawing at the end? Read it again. Guffawing at the end? Read it again.

Oh, context.

The Forty Second Roll Of Film (53 Days To Go)

2011-03-03T02:58:00.004+08:00

Salam.

It's been a while since I shot in black and white. Here's some shots of Lucky SHD 100 developed using Ilfotec LC29 in 5:25min at 27 C.

They're warmer compared to the previous rolls. Thoughts?

To escape pre-exam stress, some people find shopping therapeutic; for me, it's this.

The Rheumatology Exposure (57 Days To Go)

2011-02-27T00:28:00.002+08:00

Salam.

During my fourth year (first clinical year), I was never exposed to Rheumatology during my Internal Medicine I posting. I never knew what that word meant, what the diseases involved were, how to examine patients for them or how to manage them.

My first encounter with an SLE patient was during Surgery posting. I never knew what it was and how it was significant. Even then, I focused on her presentation - acute pancreatitis due to steroid medication. I was also puzzled by her eccentric behaviour; little did I know then that patients with vasculitis in the brain may suffer some form of psychiatric disorder.

Anyway, fast forward two years later. A rheumatologist decided to jump ship from a stable Navy battlecruiser that was UKM to USIM, a partially inflated rubber dinghy. All in the name of ambition.

Now, after attending his Rheumatology clinic, rounds, teachings and lectures, I feel like anything could be SLE.

The Spoiled Picture (61 Days To Go)

2011-02-23T01:05:00.005+08:00

Salam.

Film photography is a technically-demanding hipster artform. Everyone involved has to take the proper precautions in order to avoid a mistake since once a error happens, it's irreversible.

If a random picture that you don't give a damn about is damaged, then all is forgiven. But once a picture of a memorable event gets spoiled, you might get hipster sadness.

Here's an example:

Pictured are the three brothers in front of the hometown house in Langgar, Kedah during Eid last year. The orange tint on the right side is called a light leak, a mechanical fault of the camera that hipsters love, a welcomed fallibility that digital can only fake but not fully embody its greater universal meaning*.

But note the traces of developer contaminants and whatnot across the photo. Aaaargh, now that I cannot forgive (some hipster may forgive this f-up)! This is only one photo; imagine if this shit happens to the whole roll.. a roll of memorable shots.. Full-blown major hipster depressive disorder!

So, for those of you who are interested in taking up film photography, be prepared for surprises and heartbreaks!

Of course, in the age of digital manipulation nowadays, mistakes like this can be corrected or at least reduced. But at this current time, let's just say that my photoshopping skills are limited due to... notebook-related technological impediments.

So, anyone wants to help?

* Never mind if you don't get it, it's condescending hipster lingo.
** No, I am not a hipster.
*** This is a film blog I recently joined. Do visit regularly for stunning film photography by young people.

The Final Professional Exam Is Approaching! (67 Days To Go)

2011-02-17T01:59:00.001+08:00

Salam.

The stress of the impending final professional exam is now appreciably building up. Plus the extra chores of the final posting leader means more stress and less focus on the curriculum. Oh, how I long the days when I get to laze around like these fat cats:

But trust these fat cats to find time to laze despite the erratic schedule.

The Rekindled Pastime (70 Days To Go)

2011-02-13T18:18:00.006+08:00

Salam.

I like drawing. In fact, I loved drawing when I was in secondary school. But when I entered medical school almost seven years ago, that hobby slowly died on me.

Medical education shouldn't be a hindrance at all to this particular hobby of mine considering the amount of anatomy, diagrams and various clinical scenarios that I could draw, as shown by the legendary Frank Netter and this girl that I could relate to, but somehow the drawing spirit in me just.. withered away.

Anyway, when I acquired my HTC Desire late last year, I installed this app out of curiosity rather than interest.

QR codes FTW!

It's an app for sketching. Initially I started off doodling simple things like inanimate objects like books and cups; much later, I advanced to drawing portraits during my boredom.

Is anyone surprised if it's a kitteh portrait?

Surprisingly, I haven't lost that amateur touch after all these years. Maybe it's because of all the mangas that I read all the time. Maybe the right hemisphere of the brain still obtains a significant oxygen supply despite the possible atrophy. Who knows?

Anyway, there's also another kind of portraits that I draw.

Question 1:

When does a medical student experience boredom? Hint: it's during those times when we stare at a projected screen in a dimly lit room, listening to senior people talking.

Think about the answer before moving on to the next question.

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Question 2:

Can you recognize these people?

Correct answers win a secret prize!

p.s. Moar info about the app here if you're interested.

The Short Case (89 Days To Go)

2011-01-25T14:02:00.005+08:00

Salam.

In only two days, in one hospital, the whole lot of us (29 med students) were able to finish our ortho/surgical posting clinical exams. It was wonderful getting 6 specialists to examine us; it was fast and not ulcer-inducing. Too bad there were not too many patients on those days.

My experience can be summarized graphically below:

Here's a conundrum to my juniors: if one of us fails the posting, what discipline should they repeat?

The Damn Englishman (90 Days To Go)

2011-01-24T02:00:00.000+08:00

Salam.

Good luck to my friends who'll be taking the Surgery II end-posting exam tomorrow!

Here's a mnemonic to help ease the brain load:

"Some Damn Englishman Called It The Testis."

From superficial to deep,

Skin
Dartos muscle
External spermatic fascia
Cremasteric muscle and fascia
Internal spermatic fascia
Tunica vaginalis
Testis

Or, if you prefer, testicles/balls/nuts/bollocks/nads/crown jewels.

The Other Hospital (92 Days To Go)

2011-01-22T00:55:00.002+08:00

Salam.

The USIM medical programme uses a few hospitals for clinical teaching, they are: Hospital Ampang, Hospital Temerloh, HKL and HUKM (all four for major postings); and Hospital Tampin (for Community Health Posting).

Not much has been said about Hospital Temerloh. More often than not, the students experience hardship and boredom when posted there. Clinically, a few postings were conducted better in Temerloh in terms of teachings and patient variety compared to Ampang; others, not so much.

So, for those wondering about life in Temerloh, here's a brief 3-year glimpse of such a life.

Foggy weather in the morning; hot temperature in the afternoon. Work that hypothalamus, bebeh!

The first time we came here was during Obstetrics posting; we didn't know what to do, so we slept after rounds.

The hospital is in the process of transitioning to 'paperless' status; in the meantime, try to write legibly, 'mkay?

Comfy sofa + quiet environment + air-conditioning = effective recuperation!

Who needs local anaesthesia when you've got Pooh to comfort you?

The 1Malaysia Najib shrine - all that's missing are some candles and incense.

A patient having an early morning epiphany about life and death. And the location of his ward.

Aah, psychiatry. All talk and no walk.

That being said, Temerloh Hospital is a fine place to consider for housemanship - good clinical exposure and training, the presence of students, a two-hour distance from KL, and not forgetting, that other reason as well.

I mean, nurses. Lots of 'em.

The Second Last Posting (96 Days To Go)

2011-01-18T15:33:00.004+08:00

Salam.

Currently the first batch is tumbling through the 8-week Ortho/Surgical posting. Yes, tumbling.

It was originally planned as a 4+4 weeks posting, but on the first day of the posting, the higher-ups held an EGM and turned it into a 2+6 week posting instead (2 weeks of bone medicine, 5 weeks of surgery and 1 week of exams) for accreditation purposes. Just like that.

More importantly, the first day was burned.. Oh yes, we have a lot of experience with this sort of hiccups and needless to say, we got a pretty good vibe about how the posting was going to turn out.

On the bright side, if we mess up, people are not going to blame us. Hahaha!

Initially however, it was smooth-sailing; Mr Burhanuddin Busu came back from UK to teach us bone medicine for a week. After that, back to tumbling our way through.

It was supposed to be a clearly separated posting between orthopaedics and surgery, with a smattering of orthopaedics teachings during the surgical part of the posting. But as much as we plan, Allah is the one to decide. At the end of the posting (at the time of writing), we've had more orthopaedic teachings than surgery teachings.

One thing new about this posting was the frequent trips to HUKM for teachings (usually after office hours and on weekends) because of 1) the lack of variety of cases seen at Ampang Hospital, 2) the teachers were having a hard time finding parking spaces, and 3) we're going to have our exams at HUKM anyway, might as well familiarize ourselves with the place .

The All-Seeing Eye on EVERY FLOOR of HUKM. OMGWTFBBQ!!

And familiarized with HUKM, we did. Nothing exclaims 'standard medical education' like HUKM. With complete facilities, adequate staffing and the patient variety, the medical students have it all at their disposal; given our obvious history of hardshit, we were all very jealous of UKM medical students.

Damn jealous.

But many a times, the Dean assuaged our jealousy by reminding us that we're about 30 years junior to HUKM, so there should be no direct comparison between USIM and other established medical schools.

So, are we destined to be forever subpar?

*ahem* Back to the less upsetting, main topic.

So the ortho teachings were done by this strict, young consultant whose primary motivation was speculated to be monetary. Nothing wrong with trying to provide food on the dinner table; no one can feed his hungry children love, right?

He took us for short cases around the HUKM ortho wards, exposing us to a variety of cases, signs and examination techniques. You know, stuff that we need know but didn't have the opportunity to, given various circumstances. He made the sessions exam-oriented so that we'll be used to pressure during the real exams. It was gruelling to say the least! But enlightening and I daresay enjoyable while they lasted.

Also, coming to USIM is a newly graduated surgeon, Mr Fadel. He is supposed to be incepted into FPSK in February but the Dean wanted him to get to know the pioneer students ASAP, so he's teaching us now; he's taking us for lectures that we've missed during our first surgery posting* promising to take us for short cases next and more importantly, be there for our final revision.

Aaaah, that familiar glimmering hope. Where have you been, friend?

Don't die out now, please..

The 200th Post

2011-01-11T00:30:00.000+08:00

Salam.

It's my 200th post!

Not that great of an achievement if your blog is already two years old. So far I've deviated far off-course from my original intentions i.e. sharing medical knowledge with friends like proper examination tips, mnemonics, important topics to focus on, diseases with issues, etc; so far I've discussed my interest in cats, photography, games and cats (twice mentioned to show quantity); so far I have no intentions of returning back to the course.

Anyway, before we get our brains addled by the Quack's mental dilemma, here are pics of the recent New Year's fireworks celebration in KL!

Taken using the Canon A1 equipping Dad's old fungus-ed 90mm lens, exposed on Fujicolor Superia Xtra 800 (halfway thru the roll already, what to do?).

It was my first time taking pictures of fireworks using a film camera. For those who don't know, fireeworks photography is a technical challenge. It's not about composition anymore; now, it's about controlling light. A digital camera has the advantage of quickly reviewing your pics to finetune the camera settings for the next shot. Not doable with the film camera. It's all back to the basics. And luck.

Before attempting, I went to read a little about camera settings for fireworks photography on some random sites. Some tips were good; the rest, not so much. Plus my reading was a bit rushed since it was about 30min before midnight. At the end of the quick revision, the settings in my head were open wide (f/11), open long (30sec) and tripod.

I was supposed to use a film with ISO100 since it has less grain, perfect for fireworks photography. But since 1) I was halfway through my ISO800 film, and 2) I had no time to carefully remove the current roll and replace it with an ISO100 film, I decided to decrease the aperture by one stop (from f/8 to f/11). And prayed hard that the shots will turn out alright.

I rushed to Block C of our hostel, set up Awe's tripod in about 30sec, and shot away.

And the pictures turned out surprisingly alright!

p.s. By the way, the pictures are entitled, from the first one to the fourth, Excitement, Plateau, Climax and Resolution.

The Consent

2011-01-08T14:46:00.005+08:00

Salam.

If you're a cute girl and the lens of my camera is pointing in your general direction, then yes, I'm taking your picture. I'll take this post and your lack of comment* as implied consent.

*must be approved by me first..muahaha!

The Ramdzan Brothers in 2010

2011-01-07T15:07:00.007+08:00

Salam.

This is a snapshot of us five brothers at various stages of development in late 2010.

All photos taken using my half-frame camera, the Olympus Pen FT exposed on Kodak Portra VC 400 film, composed in Photoshop la, what else.

#1 (with the calico teenage female) is in the final year of medical school.

#2 ( with the yellow mixed breed adult moggie) is in the second last year of the same medical school.

#3 (with the tortured white kitten) is in the final year of aeronautical engineering school.

#4 (with the black adult tabby) is in Form Four.

#5 (with the yellow kitteh) is in Form One.

Dear secret admirers, please right click on the image and select 'Set as Desktop Background'. Thank you! ;P

The Biohazard Drama

2010-12-30T15:02:00.006+08:00

Salam.

Please examine this picture.

Picture tilted for dramatization.

A used cannula lay mysteriously on the floor with blood drops all the way up to level five. What telah happened?

A disoriented patient?

An absconder?

A struggle?

I love the hospital (in a non-workaholic way). There's a story to be told at every hour; a drama on every floor; a show in every ward (most of the time these emotional events occur at the A&E, though).

Every time you're getting bored of the hospital, it shows you something and says, "Oh yeah? How 'bout this?" and then you get intrigued, succumbing to its charms once more.

That sneaky bastard.

Although this excites me (in a non-sexual way), it's sad when our local medical TV shows are limited to crappy dramas with bad medicine. There's so much raw emotions to be tapped and weaved into a beautiful story.

Maybe I should take matters into my own hands and make my own medical drama series. Something for Youtube, free from the pressures of showbiz. Made with a dSLR and a homemade rig.

As a one-fingered salute to Razak Mohaideen for his efforts at uplifting the quality of our local movies.

Now, that's a thought.

Quick, who wants to be my heroine?

p/s Happy new Gregorian year! My Nuffnang ad money is stuck at RM11; I need RM39 more for my first ever check to arrive. Paham-paham je la..

The Broken Heart Pathogenesis

2010-12-22T03:35:00.001+08:00

Salam.

This is 1) a trip down memory lane; 2) a repost in July 2007 from my first blog (which is a collection of crude and immature posts); 3) an idea that I've had in my mind since the prologue; 4) something that I may regret later for sharing with you peeps; and 5) taken from here.

***********************************

A broken heart is neither myocardial infarction nor heartburn. But it’s closer to the former because they’re both of similar pathogenesis.

Broken heart pathogenesis:

1. Things spiral down for a couple; a reduced supply of love to the heart that is unable to meet the heart’s demands (ischaemia: reduced blood supply to the heart).

2. A dumps B for whatever reason. B didn’t expect that; B is hurt. (infarction: myocardium dies due to mainly lack of oxygen)

3. B becomes depressed. (cardiogenic shock: a hemodynamic state in which the heart cannot produce enough cardiac output to supply the body)

4. But B survived; B wants to put A behind him.. or her. (organization: dead myocardium can never regenerate)

5. B swore never to trudge the same path again. (it is replaced by fibrosis, a nonspecific connective tissue - something like a plug to cover the hole)

6. B is back at square one but this time with experience as a guide. (the scarring cannot contract like normal muscle tissue and it’ll only remain as a remnant of the past and a warning for the future)

***********************************

"There is something beautiful about all scars of whatever nature. A scar means the hurt is over, the wound is closed and healed, done with." - Harry Crews

The Final Annual Faculty Dinner

2010-12-19T03:00:00.000+08:00

Salam.

The recent Annual Faculty Dinner was a blast! Held at the De Palma Hotel on a Wednesday night with the theme "1Malaysia", it was filled with awesome shows from both the staff and students. Sadly, the same can't be said about the food.

But was the RM50 for students justified? Yes!

The third batch picture, stolen from here.

Sure, we'd want a decent bang for our buck, but if we focus on food alone, then we're missing the whole point of the function. For this kind of events, we need to focus on a different bang - the memories, the atmosphere, the interaction. Especially when you're in the final year, where you get to meet - for one last time - the wise, old teachers; the hopeful, new trainee lecturers; the loyal staff of the faculty ~~and cute, gullible juniors~~!

Enter the picture-taking sessions. They're the essence of the annual dinner, freezing the point in time for a later moment of nostalgia or hilarity. The batch pictures can also be viewed year by year, so that you can see the transformation of the students from being idealistic and aspired to being cynical and tired.

But all those prim-and-proper poses are boring and hypocritical. Why don't you be yourself? Smile, jump, pose, anything! Or better yet, photobomb.

What is a photobomb? This is Photobomb.

According to urbandictionary.com, as a verb, to photobomb means to drop in a photo unexpectedly or to hop in a picture right before it is taken. As a noun, a photobomb is an otherwise normal photo that has been ruined or spoiled by someone who was not supposed to be in the photograph.

Who better to demonstrate it than the proposer?

Let's start this trend at USIM!

The Posting On Fiqh And Ethics

2010-12-15T14:39:00.017+08:00

Salam.

It's been quite a while since I last updated.

KL from the faculty.

Not much has happened in the last two weeks. Let's see, a posting on Fiqh and Ethics, a visit to Hosp Permai, new smartphone, broke a heart or two.. yep, nothing interesting. Let's talk about the most interesting topic - the posting on Fiqh and Ethics!

The faculty meeting room is our official lecture hall :)

It's a two-week posting, tackling controversial medicoreligiolegal topics like abortion, surrogacy, use of non-halal medicine, euthanasia, etc. It's a laid back posting for the lecturers since we, the students, are the ones who had to 1) research and present the seminars, 2) role-play scenarios like breaking bad news and obtaining consent, and 3) debate like noobs.

Old noob is still a noob.

It was fun not seeing sick people for two weeks. Working in small groups involving the whole batch in a lecture-hall environment brings back episodes of nostalgia. Sleeping, playing games, pestering attentive friends, what fun times!

Hot males (in a sweaty kinda way).

This posting had the potential to shape future Muslim physicians. Making students engage these topics at this early stage of their medical life will certainly affect how they think, work and live later on.

Strong Muslim roots, strong Muslim tree.

You can see it in how current specialists who had early religious intervention frequently relate modern medicine to Allah, get involved in charity work, spend in the way of the Religion and inspire medical students to become great Muslim physicians themselves.

But as always, minor hiccups, different ideals, and old foes bump us along the way and mar the whole experience. That's life, no?

Why can't we have Fiqh questions in the exams? Why aren't we taught how to advice patients on medicoreligious issues? What's the use of the 'I' in USIM?

Anyway, I'm not in the mood for heavy topics - the hot afternoon Sun seeps my zest away always. Here be pics from my new Android baby - the HTC Desire!

Unlike Shutter Island, Hosp Permai in Tampoi, Johor is serene/calm/placid/peaceful/soothing... and oh, gile luas.But high barbed walls serves as an ominous reminder of the dangerous potentials of the residents.

The Emotions In Cat Photography

2010-11-16T00:08:00.003+08:00

Salam.

When I came back home for the week-long end-posting holiday, I was saddened by the news of one of my cats' death (or technically, murder!). Named Nimrun by my younger brothers because his stripes at birth resembled a tiger's, he was the handsome-est cat in the whole bunch.

Sure I was sad but not to the point of feeling low mood, anhedonia or crying. This is the third death of a cat that I was attached to; this may sound pessimistic about life to some of you, but I anticipated that some of the cats would experience early death, so, I lessened my emotional investment in them. It's kinda like an emo barrier that people usually erect after a bad breakup.

Anyways, here are pictures of cats over the Interwebs that I love and inspire me to capture better cat pictures. So yeah, groan all you want; more cat photos coming your way. I'd like to give credit to the original photogs but I'm too lazy to find the original pictures, but you're welcome to use tineye to find them.

One of the things that I aspire to improve is capturing the emotion.

Tone helps.

Bros4life!

Emotions aren't tangible and subjective; quite elusive to burn on film but once captured, a picture becomes very moving despite the broken rules of photography. One way to capture emotions is by candid photography. Easily done by getting your camera ready all the time but not so cheap if using film.

Diptych format helps storytelling.

Cats in Japan FTW!

But then, when you talk about emotions in photography, it's about what the eyes see and how effective you relay what you see or feel to other viewers. Meaning, if you don't want to stalk a cat 24/7 and snap candid pictures but still want to capture emotions, you can do posed photography or set pieces. Just have a disciplined cat to begin with; bear in mind that certain breeds are more photogenic than others.

"Cat size looks appropriate for age but I'd like to confirm this by plotting the growth parameters on a growth chart."

The obvious cat emotions that are frequently captured are playfulness and curiosity. A good example would be the LOLcats. Even without the funny captions, some pictures just speak a thousand words.

Hubungan halal saje, ok?
Curiousity.

Playfulness.

Brotherly lurve.
Epicness (if that's a legit word).

Not just positive emotions, negative emotions can also be captured. Sadness, death, paranoia, whatever satisfies your morbid palate. I suppose that's also why we love drama and soap operas.

Ominous stare from Big Brother.

Lastly, if all else fails, Photoshop!

The Osbournes.

Creepy but funny nonetheless.

I hope this helps you cat fans to improve your cat shots. Happy snapping and have a blessed Eid!

The Posting Where You Release Your Inner Child (No, Not Psychiatry)

2010-11-12T02:45:00.000+08:00

Salam.

Phew! Finally finished the little kids medicine posting exam last Wednesday. Couldn't find a nice time to sit down and bare my mind in the middle of the posting (damn you, Facebook!).

What's new for the urchin postin' round 2, you ask?

First, an old studymate of Dad's who works at the Paediatrics Institute, HKL was kind enough to take us for short cases there on weekends. It was a nice change of setting albeit for a day since we didn't get the chance to go to Temerloh Hospital.

But more importantly, we were exposed to a bit more variety of cases; Ampang Hospital was just about respiratory infections, asthma exacerbations and Down syndromes. CP? Never heard of it at Ampang.

Second, I just realized the keys to examining children! For those who haven't been in Paeds, examination of a child especially those who cannot follow orders (less than 4 years old) is often opportunistic, unsystematic and is almost always useless if the child cries. There are two main keys:

A) General inspection is the most important examination! You don't need your fancy kiddie stethoscope to know when a child is in respiratory distress, hypovolaemic shock or generally ill. The power of observation also useful when an infant is unapproachable or just hates your face.

So, at the start of a short case, take a deep breath and just look.. No need to rush into auscultation of the chest when an examiner says, "Please examine this child's respiratory system".

Please inspect this man.

B) Build rapport with children! Yes, even with the infants! Once, it puzzled me when grizzled, old specialists who make your spine chill with their stares and sarcasm get on so well with the babies. Upon observation, I found out that they always stoop down to the baby's level. Sure, it looked awkwardly funny seeing your grumpy teacher being all fun-loving and whatnot but surprisingly, it works!

Pee-pee boy meets durian ball. Kinky.

So, find your inner kid and channel his/her powers. Me? After realizing that cat calls don't really work, I resorted to bribing children with toys and my charming (some may say perverted but it works) smile. If you abhor children and can't genuinely build rapport, think of building rapport as wearing a mask. Be all cutesy and lovey-dovey in front of the infant but as you turn to face the examiner, go on and be your spiteful self, you jerk.

Cats can treat asthma according to the hygiene theory. Can't do anything about toxoplasmosis or bartonellosis though.

Third, I think those involved can agree with me that it had been a helluva chaotic posting - uncertainties, cancellations of classes, and last minute changes were aplenty. But kudos to the two group leaders for tolerating our crybaby attitudes and incessant bitching. And not forgetting, our bubbly supervisor, Dr Madeehah, for remaining strong against the odds.

~~The first few batches will predictably experience difficulties and hardships as the Faculty struggles in its infancy, but to meet resistance from the inside is just.. suicidal.~~ ~~Just when it seems the future can't get any bleaker, we hear they want to sell the hospital land!~~ I hope by now, everyone knows the source of our problems and frustrations; I'm tired of hearing about fuck-ups, shortsightedness and hypocrisy; and I'm tired of venting them. But I digress.

But I digest.

p/s Inside every cynical person, there is a disappointed idealist. -George Carlin

The Innocence

2010-10-31T01:44:00.000+08:00

Salam.

Some time ago*, the MSC (specifically the preclinical side) organized a 2-week campaign at the faculty entitled 3S: Salam, Senyum, Sapa that preached for friendliness, camaraderie, teamwork, networking and possibly formation of new relationships *ahem*

Merely being a spectator and the occasional moral supporter, it wasn't a new thing for me. for the last two years But to see a programme hitting a right note in terms of objectives, methods, atmosphere and participation was wonderful.

After several months of experiencing the shortage of clinical teachers as well as feeling the academic impact of the university budget cuts and freezes, to go to an event where therein lies innocence, optimism and unadulterated ambitions is like going to a funfair after a bad on-call.

Now I know what it feels to be in the shoes of the Dean - to escape the problems that chronically plagued this infantile faculty. Too bad he wasn't there on that day.

Well, there's also the other reason/motivation why seniors go to faculty events :P

Siapa cepat, dia dapat!

* this post took a long time because I was waiting for the film to be developed.

The Old Laptop

2010-10-21T06:14:00.000+08:00

Salam.

The indications to buy a new laptop:

1. You can't edit pictures in Photoshop or Viveza smoothly,

2. You can't view even decent 720p HD videos without getting choppy graphics every half-second,

3. You can't connect to certain WiFi's,

Look at that time stamp!

4. Your laptop is the heaviest, biggest, most expensive and yet the slowest amongst them all,

5. It BSOD's regularly and predictably,

6. You're using ear phones all the time to compensate for that one busted speaker, and

7. You've replaced major component(s) i.e. mobo, hard disk or battery at least once. I've replaced all three :-/

Despite the seven indications, here I am, writing a blogpost using this colossal machine.

Latest pic. A few weeks ago.

The laptop and I have been through a lot together*; currently lasting SIX years and counting! I think I'll use it until the end of my medical course. Just for the legendary status of "Most Bad-Ass Laptop In USIM".

I ♥ my lappie!

*you know the sound of water droplets hitting a metal surface? that's the sound my laptop made when rainwater leaked in through the hostel roof - and it survived the ordeal with nary a dead pixel. Like I said, BAD-ASS.

The Film Generation

2010-10-16T12:12:00.002+08:00

Salam.

"Color negative film sales have been very stable over the past year. Black-and-white is also doing extremely well. It almost feels that there is a very real resurgence for film. A lot of people that were completely digital are now accepting film again for certain things—or they do like the workflow. And the most exciting thing is to see the younger people adopt film. It’s almost a generational thing. They have not shot film growing up, but once they do get a hold of film in a university, they just seem to fall in love with it."

—Scott DiSabato
U.S. Marketing Manager for Professional Film
Eastman Kodak Co.

Taken from here.

Seeing how we're nearing the end of the first semester and I still had a surplus of the Rakyat's money, I decided to do my part in stimulating the economy by purchasing an SLR from an online collector/seller - the Olympus Pen FT - for RM900.

Jeng jeng jeng!

What's so special about it you ask?

Two words: half-frame SLR, meaning:

1) I get two shots in one 35mm frame,

2) 72 shots in a 36-frame roll of film,

Tosai rawa (in case you're wondering).

3) a different kind of storytelling (when you don't know what side-by-side pictures you get, it's more of a lomo feel than the standard SLR feel),

After an end-posting exam.

4) a 'different' film format (hold the camera horizontally for a portrait shot, and vice versa),

5) twice the hassle in editing (I had to resort to Photoshop instead of Lightroom for more control over the selection mask),

Focusing on hyperactive children has never been harder prior to the invention of autofocus.

6) and most importantly, twice the fun!

♥ ♥ ♥

The Shocking Emergency And Numbing Perioperative Posting

2010-10-10T18:19:00.012+08:00

Salam.

Don't we all love it when two short, sweet but not so simple specialized postings are crammed into a 2-week understaffed mess?

This time, it's time for the Emergency and Anaesthesia Departments of Ampang Hospital to bear the brunt of lack of USIM academicians. That roughly translates into one whole batch of 29 students divided into two groups; one going for one department while the other group, the other department; everything happening in the same hospital, in the same two weeks.

The truth however was not so straightforward - we were further divided into smaller subgroups, rapidly cycling through both postings simultaneously, all looking proper and orderly on paper, but somehow 15 eager students ended up zerg-rushing a clinic room to observe a pre-operative assessment.

But thank God, both departments welcomed us with open arms. I think it was our pathetic, begging looks that pulled it off.

Aspiring quacks.

Let's start with the Emergency posting.

We were already acquainted with the cool, sporting staff of Ampang Hospital from the previous postings. We skipped the topics taught before this e.g. ACS, asthma, seizures, etc; only revising them during our brief stints at the Emergency Department. Instead, we learned special Emergency topics like the triage sorting-and-prioritizing system, disaster management, basic wound, burn and fracture management, basic life support - all new, exciting and simple stuff. Me likeee.

Students trying to resuscitate the baby, a symbol for USIM FPSK - infantile yet rapidly dying off. Where are the adults?!

To make it all go apparently smoother, we had Dr Shahrul Nizam, our own postgrad student, to come and teach us a thing or two. Even though he had his own studies to focus on, even though he was passionate about all things emergency and action, 'twas a shame that he wasn't always around to guide us.

So we had to improvise. Me? I ended up on an uninsured ambulance ride to fetch an MVA patient from a scene. The sight as the ambulance weaved through evening rush hour traffic was unbelievable. The motion sickness, undesirable.

In the end, every one of us had an average of about 2 days of proper Emergency teachings.

Adequate enough to become competent HO's?

Now, for a new posting - the Anaesthesia or Perioperative posting. We were taught by Prof Dr Ariff Osman from IIUM, an old Masters friend of my father. Being the only one whose name he remembers, I had the privilege of being called first to answer questions and do everything. Not that it was a bad thing, but I like to remain in the background, documenting stuff.

Like this :P

Here, we were taught about the defib machine, Hollywood's all-purpose dramatic symbol of life-death struggle.

He was only there for us for 2 days' worth of lectures and practical sessions. Not enough? Sure, but at least he was there. Knowing USIM (experiencing it firsthand), it could have been worse.

For the rest of the two weeks, we were at the hospital, increasing infection rates in the operating rooms and ICUs (intensive care units).

Ooops, wrong hole.

Did I mention the patience, kindness and willingness to teach that the anaesthetists showed us? It could've been one of the inhalation induction agents, but whatever it is, let's hope that USIM doesn't abuse that welcome.

Man, what a bleak one month it has been.

p/s Agfa Vista Plus 400 using Lomo Fisheye2 and Awe's Nikon FG (dunno about the lens)

The Pictures From The 25-Year-Old Camera 2

2010-09-30T04:35:00.008+08:00

Salam.

Since I began dabbling in film photography a year ago, I have finished 28 rolls of film. Mostly spending my JPA money on the ubiquitous Fujicolor Superia brand, I decided recently to try out new films. So I bought a variety of different - and usually more expensive - films online (you can do anything online these days).

Below are the pictures from an Agfa Vista Plus 400, in the familiar order as the previous post.

Starting with a two-wheeled mode of transportation,

followed by a cat,

then, a bokeh-ed portrait of a kitten,

and finally, my youngest bro holding that kitten.

By now, I'm sure you're bored of the pictures but I can't seem to get myself to write anything medical these past two weeks.

p/s like Bro Miqdad and Bro Aw3rz, I can't drift off to slumberland tonight; I wonder why..

The Pictures From The 25-Year-Old Camera

2010-09-22T18:08:00.006+08:00

Salam.

Finally, I received the pictures from the Canon A-1!

I was worried that, due to the age, the metering would go berserk or the lens fogging would affect it considerably but surprisingly, they turned out awesome!

My friends love to say "Pics or it didn't happen" when they hear something unbelievable, so here.

But the shop that I sent the film to did a lame job of developing the roll. Some of the shots suffered greatly from incompetence.

I'd like to show them too if I didn't feel like this mainly medical experience blog turning into a photography blog :P

p/s the film used was Fujicolor Superia Xtra 400.

The Fisheye Portraits

2010-09-18T20:57:00.004+08:00

Salam.

I recently sent 4 rolls of film, exposed using my mata ikan toy camera, to be developed. That's 36 shots in each roll, meaning 4 x 36 = 144 fisheye shots!

Luckily this time around, I've mastered the camera's flimsy exposure functions and most of the pics were properly (or creatively) exposed, some were underexposed but salvageable nonetheless. Plus the shop's scanner picked up most of the shots correctly unlike the last time when it scanned the shots in between two frames (that means ruining two shots at one go).

Below are some of the lomo fisheye goodness! Be sure to check my Flickr account (link in the sidebar) for some pics that I don't upload or hotlink to this blog.

Bro Miqdad with his game face on.

Bro Awe with his I'm-not-in-the-mood face on.

Bro Mongue with his Penjejak Badai face on. Hah, korang tak kenal sape Penjejak Badai?!!1

I suppose this pic qualifies me for a LomoKid title.

And oh, for the NSFW pics, please personally come to my room :P

The New Holiday

2010-09-16T19:30:00.004+08:00

Salam.

Selamat Hari Malaysia, everyone!

The fisheye lens made him look fat. Really.

It's the first time it's celebrated - the day Malaysia was born (that and well, after Singapore was booted out)!

We should be happy for all civil servants.. except medical civil servants because Sickness doesn't give a damn about public holidays.

Dammit, I knew should've read the career guidance pamphlet carefully!

The Fitting Term

2010-09-15T20:22:00.000+08:00

Salam.

If you've done your share of Psychiatry, you'll know that most acute cases are brought in by the police via two special forms: Form P57 and P59. These forms legally allow the police to detain someone deemed loco at first glance and force them to be admitted to the psychiatry ward.

Yeah, the police is that powerful. One wrong move with the Sergeant's daughter and you may end up waking up in the mental ward, drowsily answering questions from an annoying medical student. And let's not go to what'll happen if you mess with the Psychiatrist's daughter. Daily ECT perhaps?

Scary powers, they wield..

But don't worry, abuse of power is all in the past. With the new Mental Health Regulations 2010, in order to limit the powers given to the people responsible for labelling you a madman, admission by the police has to be approved by the Medical Director, usually the head of department (Form 5.. aku ingat lagi beb!).

So, unless you mess with daughters of BOTH the Sergeant and the Psychiatrist, you'll only be observed for 24 hours in the ward.

But one thing that I've noticed is despite the continued legal update on the medical side, the police is still using the same old P57 and P59 forms from the 1950s. Kalau ye nak gune pun borang tu, sekurang-kurangnye tukar la kalimah2 yang dah ketinggalan zaman.

Do you know the term the police used for fits?

Gila babi!

Yes, the term gila babi is very much in use now.

But to be fair to the police, fitting is a rare presenting complaint. Usually patients with seizures end up in the medical ward rather than the psychiatric ward. Plus, relatives usually call the ambulance rather than the police. So, the outdated term is understandably overlooked.

But still, can you imagine one such scenario?

"Tuan Sarjan, ade panggilan kecemasan dari *bla,bla,bla* tentang anaknye yang penah mendapat rawatan kemurungan sedang menggila babi di dapur rumah. "

"Saya kenal mangsa, Prebet! Die budak baik.. rajin makan ubat. Macamane die boleh gila babi balik? Giler babi btol!"

"Tapi, tuan, saya penah mendengar yang mangsa suka memandu kereta laju gila babi. Mungkin itu yang menyebabkan die menggila babi?"

"Prebet, kerja mencari punca mangsa sakit ialah kerja doktor. Kerja kita... MENJAGA KETENTERAMAN AWAM! Ayuh!"

*cue in Gerak Khas theme*

Anyway, my point is there's a more politically correct word to be used - sawan.

But still, one has to wonder how the heck such terms come into existence in the first place.

The Eid Post Without Pics :(

2010-09-13T10:01:00.006+08:00

Salam.

Eid Mubarak everyone!

On the eventful day, I accidentally dropped my Olympus SP570UZ a.k.a skodeng camera on the floor! When I turned it on, it made a funny whirring noise, the LCD screen showed "Zoom Error" and then the camera automatically switched off... Blast!

Luckily I brought my 'backup' cameras - the Canon A-1 and the Lomo Fisheye2 - but sadly both are film cameras so you'll have to wait awhile for the pictures. By then, the Raya hype would've probably died down so what's the point of posting anyway? :(

Anyway, below is the last picture snapped by my 12-year-old bro - overexposed, poorly composed and that stupid barrel distortion! Oh well, it wasn't his fault anyways. So I cropped and 'Lucky-ied' the picture.

Happy Eid from the pre-Masters Ramdzan Boys (and Mr Ramdzan in the background).

Verdict?

The Brotherhood Arts

2010-09-03T00:57:00.000+08:00

Salam.

I like catchy graphics. And when you combine contemporary motifs with Islamic messages, I like them more.

More importantly, you're effectively reaching out to the current generation of teenagers and young adults. Spreadin' da Word in style yo! (okay, that was lame, but you get my point, right?)

Enter the Brotherhood Arts.

Initially starting off as a husband-wife tag team, their business of spreadin' da word in style flourished fast with the use of current technological advances to reach out to the target market. In this day and age, if you're not creative, you're nothing.

And now, with so many stockists around like Russian sleeper agents, you're bound to stumble upon their products while ~~dating at Wangsa Walk~~ out in the city. They're also sought after internationally too; some orders come from as far as Jordan, Australia and Japan.

Among their products are t-shirts, muslimah shirts, badges (most of them intentionally designed to look like our more familiar logos and brands), arm sleeves, bookmarks and even postcards.

Plus for special occasions like Ramadhan, they have a motivational Ramadhan calendar.

Delusion of reference LOL!

Support them today!

The 3 Lessons Of My Elective Posting

2010-09-01T19:50:00.003+08:00

Salam.

After spending 2 weeks in Internal Medicine and 2 weeks in Emergency Medicine, at Queen Elizabeth Hospital in Sabah, I've learned a few valuable lessons.

1. Know your hospital:

This is more than just getting to know the name and location of various facilities at/surrounding the hospital. No, you must get to know the 'environment' of the hospital - how the system works over there, any special features/hot issues in the hospital, statistics, and most importantly, where you can get free Internet access 24/7!

It's quite a unique situation over here at Queen Elizabeth Hospital.

Looming ominously over the other building complexes as you approach the hospital is the Old Tower - a building complex so old (it was officiated by the Queen herself) that it's on the verge of crumbling down. When patients started to hear cracks and random pedestrians get their heads hit by mysteriously falling pebbles, the administration quickly realized that the hallmark building of the hospital was safe no more.

Evacuation of the building complex *removed for fear of unforeseen legal consequences* Apart from being ancient, the wards were cramped and hot - just like an antique pressure cooker.

More importantly, when the hospital was split into parts, the staff had to also be split into parts. And that caused understaffing especially of MO's. And when specialists argue with the admin about this at the end of a CME, you know that the problems are dire.

The wartime wards.

But miraculously, I managed.

2. Build rapport:

Usually medical students tend to hang out in their own flock, even at student conferences which is a shame because we're at a disadvantage of meeting new ~~girls~~ friends, building new networks and finding enough people to support your Facebook cause.

Friendship application form at HQE.

I do this unhealthy habit too; it's easier and more comfortable to hang out with established friends than go out of your safe zone to make new ones. But when you're alone in a new setting (inevitable you become a HO), you gotta lose the I-have-enough-friends mask and show your I'm-friendly-and-fun-please-be-my-friend face. This means befriending the other doctors, the students, the nurses (especially..hehe), the MAs and the admin.

Sure, you can get along fine without a friend, you schizoid weirdo, but life will be exponentially easier when you have people you know around you (read: potential cables in the future). When I was in Sabah, I knew only my two elective friends but they were attached to other departments, and I can't just meet them when I'm lost. So I had to put a friendly face on in order to get through the day without looking like a headless chicken in the boredom barnyard.

The lonely, real world.

This is a point that medical students have to realize: sooner or later, you'll be out of your comfort zone and into the real world, so you have to change any nasty habits now.

3. Try out everything:

This is purely a Quack thing. When you get an elective student's pass, you can go anywhere (provided you can lie plausibly) because not everyone knows where you're supposed to be.

You can gatecrash a dental course on disaster management (all that free food!), saying that you're following the Emergency specialist who's giving the talk. You can pretend you're a HO, attend the HO teachings and when the specialists ask questions like it was an exam, you bolt out. Or if you're bored at the hospital, check out the local scene.. if you're not in the middle of nowhere. Hahaha..

They show this before every CME.

But wherever you are, the most important thing is remember why you said you wanted to become a doctor in the first place - to help people. And help people, you will.

The Fasting Month

2010-08-21T05:00:00.009+08:00

Salam.

I hope it's not too late to welcome Islam's holiest month. It's difficult to update this blog in Temerloh since my laptop BSOD's upon connection to the wifi. I have no idea why.

The Dome of the Rock, or Masjid Qubbat As-Sakhrah, one of the holiest sites in Islam, is seen on the Temple Mount in Jerusalem through festive lights for Ramadan on Tuesday, Aug. 25, 2009.

Anyway, by now, we're about to enter the middle third of Ramadhan.

A Palestinian potter engraves the expression in Arabic "Ramadan Karim" as he puts the final touches to a clay lantern at his workshop in Gaza City on August 17, 2009, ahead of the start of the holy month of Ramadan.

I'm sure after years of fasting, we're all well-adjusted to the hunger pangs during the day. But surprise, surprise, fasting isn't just about abstaining from food and drink.

Muslims attend Friday prayers on the first day of the holy month of Ramadan at a mosque in Beijing, China on August 21, 2009.

It's also about keeping your nafs in check.

Abu Huraira related that the Prophet said: If a person does not avoid false talk and false conduct during Siyam, then Allah does not care if he abstains from food and drink (Bukhari, Muslim).

In other words: see no evil; hear no evil; speak no evil.

That's a tough one, alright :P

A boy sells dates in Amman, Jordan on Saturday August 22 2009.

A taxi driver reaches for a glass of apple juice after sunset in Kabul, Afghanistan on Sunday Aug. 23, 2009.

A Pakistani Muslim arranges food stuff for Iftar, a time to break the fast, on the first day of Ramadan, as a child looks on at a mosque in Karachi, Pakistan on Sunday, Aug. 23, 2009.

Muslims attend prayers on the eve of the first day of the Islamic fasting month of Ramadan at Al Akbar mosque in Surabaya, East Java, Indonesia on August 21, 2009.

Hopefully this good conduct can continue even after the fasting month.

More wonderful pics can be seen here.

For more Quranic verses and Hadith on Ramadhan, go here.