Phileosophie

************************************************ Note: Special thanks to BestPractice for the information in this post. This post has been written by a medical student . This website is a collection of my reflections on life and on medicine. The target audience is technically myself, and perhaps my family. This website includes information on things I am interested in and am learning about. The information here has not been verified and should not be construed as medical advice in any way. If you are sick you should contact a local doctor for advice and management. ************************************************ Cough - it's such an simple thing, and yet, it's always so important to get the simple things right.  The wife of a good friend of mine was recently diagnosed with scleroderma following a long period of dry cough. It had been mistaken for asthma for a long time and I do not know the details about the case but it has made me determined to unders

This is what Time Square looks like right now ! From time to time I check in with my beloved city and today was wondering why it was so empty when I realised it's only about 630AM over there. :-) Hi New York! Hope you'll have an awesome day!

I've been receiving a high number of hits on my post on Brugada Syndrome lately and I'm not sure why. Is there a Brugada conference happening at the moment? This makes me wish I had a more in depth piece of work to offer all of you but in truth all the post said was that I loved cardiology. oh well. After my exams I might try work on something to post up. Anyway, I was at a Thai place today and it really reminded me of this Asian restaurant Duey and I visited when we were up at White Plains. I really miss New York and would love to be back there, though that would mean me leaving Hillsong TV which is a big deal to me. We received our volunteer passes in the mail today and I'm so excited about it. I love the fact that I am going to be a part of conference and am glad I chose to do this despite it being final year in med school. I may never get to do this again.. depending on where I end up next year and knew I would regret it if I didn't volunteer with TV this year

I used to post these photos on Facebook or Twitter but I think I'm going to start putting them up here instead because I don't want to annoy anyone by flooding their feed with food. LoL.. I kinda like my meals looking pretty. This was dinner for tonight - pan fried quail (with spiced & caramelised vinegar), risotto and roasted vegetables. I think the roasted veg is one of the prettiest sides I've ever made! I've been experimenting with these heirloom vegetables for a few weeks and in this meal have used the red radish in both the roasted veg as well as raw and pickled under the quail.

Stanford commencement speech by Cory Booker, Mayor of Newark, New Jersey. Another example of the type of person I would like to become! I think it's sad that at the end of my 6 years of university education I feel that the only thing of value I have received (or will receive) is my medical degree. I wish that I could have been part of a community that I am truly proud of, a community where fond memories of my 'college days' were made and a community that teaches me about the important things in life and not just about how to fix up patients when they are sick. I think this is where education in Australia fails. If I could do it again, I'm not sure if I would come here. As beautiful and stable as this country is, I cannot feel its soul. And I do not feel inspired.

I love how medical researchers tend to name their studies or protocols so that they fit into a memorable acronym. It's just a bit of entertainment I suppose, for what could potentially be quite a dry body of work. Today I was reading up on the use of anti-emetics in children presenting with acute gastroenteritis. Ondansetron is the only type that is acceptable for use in Australia though it is very costly since it is new and still a brand name drug. Other drugs such as metoclopramide have been found to result in unacceptable side effects in children, such as dystonia or tardive dyskinesia. One of the articles I came across ( here ) noted that "patients were discharged... and continued standard oral rehydration at home with the introduction of a bananas, rice, applesauce, and toast (BRAT) diet after the first 24 hours." haha

So Adelaide today has been a little nasty and essentially has said that I won't be entered into their allocation pool because I don't meet the 'Standard' for English requirements. I tried to reason with them and offered to sit for the test but they want it by June 29th and the next possible test date is June 30th. I asked if they would be happy for me to sit for that test and send it in, they just read me the 'Standard' again. Unyielding. I called the Medical Board of Australia and they did the same. I was a little bummed at first - I mean, not getting a job after graduating from med school is unheard of in Australia but you know, I've always said that sometimes God closes unsuitable doors. That's fine. Adelaide was a backup.. an option.. it was another door I was looking at and thinking.. maybe? I'm not saying it was necessarily a stepping stone because sometimes you go somewhere and it changes your direction. You can find your future in places

I was really annoyed, as you can imagine. I don't like stupidity. But I'm fine now. I'll play their game. Dance to their tune. They'll make me jump through hoops - whatever. At the end of my life I would have changed lives. I would have contributed. I would have lived well. That's all I can ask of myself.. and probably more than I would be able to say for any of them.

This was one of the pictures from NEJM's Historical Image Challenge and demonstrates a large thoracic aortic aneurysm compressing the esophagus and causing difficulty in breathing and swallowing. Such aneurysms are due to cardiovascular syphilis, which is a complication of the STI that can occur 15-30 years after initial infection. At some point in the past syphilis was an incurable disease and could result in many wierd and (not so) wonderful complications such as the awful looking busk below. Gummatous syphilis: a tertiary complication of syphilis infections, comprising soft balls of tumour-like inflammation.

I love my At A Glance series... while they are not necessarily comprehensive, they definitely suit the purposes of a medical student and potentially a junior doctor. This series covers almost any condition that you could be tested on in medical school, with each condition spanning two pages, usually one page of text and one page of illustrations. Some topics (eg. cardiology, anatomy, medicine) come complete with multi-colour diagrams and illustrations while others like respiratory and gastro only come in black, white and one other color. I prefer multi-coloured diagrams obviously.. it keeps me entertained while I study. This series is a bit like those picture books we used when we were toddlers learning how to read in that they suit the level we are at, and make for enjoyable study. Note that I do not mean to say this series is too simple - they are in fact the first references I reach for when I need a quick fact-check and this is even when I am studying for major exams. Perfect fo

As it turns out the ACT and Western Australia have pretty much decided to protect their own international medical students in terms of internship allocations, which basically means I have even less of a chance to get a job next year. According to the figures about 6 out of say 150 of us in NSW will get a job - not the best stats in the world. So here's the thing - if I don't get a job as a doctor next year, I'm pretty much offering my services to any legit, suitable organisation that may need a bit more help in 2013. So if anyone who reads this knows of such a group do pass on the message. I'll be graduating with a medical degree and am particularly interested in charitable/aid/humanitarian organisations such as China Cal, A21, Mercy Ships etc. I don't have to be working in a medical capacity since I won't have completed my internship yet but I'd love to be able to help out some place - make the most of my time and make this world a better place. In terms

I don't think I will ever be a plastic surgeon. Not because I like plastics any less but because I cannot let cardiology go. Today I started studying cardiology cases for my exams and came across a segment on Brugada syndrome and the ECG patterns that are typical to this condition. I was surprised to see that this condition was discovered and described as recently as 1992 by a family of Spanish Catalan doctors (the Brugada doctors). I love finding 'new' cardiology information because the problem with being so interested in something is that I sometimes run out of novel 'findings' to keep me interested in the field. Lately I have been reading about microvascular dysfunction (related to womens cardiac conditions) and today Brugada ECGs. I think I could do this forever.

... the relief you get, walking out of the cold in Manhattan - you asked me if I would really miss you Duey and I said I wasn't sure because I wasn't really the type of person to miss someone. I like being honest about these things but you know, I do think about you and wonder how you are... and I do miss hanging out with you and trying to look after you a little bit. I hope you are well. :)

This is Dr. Valentin Fuster, one of the most inspirational persons in the world. I miss Dr. Fuster!

Today's playlist on Elijah Streams was really awesome. This was one of the songs they had on. I go to sleep tonight with my head in the clouds And these dreams alive But it's all a mystery to me, how we're alive and breathing When fear is taking hold and we can't move on And just let go There's more to this than what I know I feel it in my soul There's so much out of our control Your love is deep, your love is high When I was lost and darkness stole the light You pick me up, you take me higher You set me free, you opened up my eyes Tonight, tonight I can't wait to see the sunrise When the light, the light Has brought me back to life And I'll be alright Tonight We walk and then we fall We're just looking for something to matter at all There's every reason to believe It's all in front of you and me This never-ending sky It won't wait too long to pass us by A hopeful desperation's taking hold I feel it i

People have been commenting/asking me recently about why I am so unpeturbed about the internship problem in Australia (we may not be getting jobs) and Phoebe thinks I should just tell them that it's because I'm assured that God has a perfect plan for me.. which is the truth, but I haven't been very good at saying it because I don't think it's generally what people want to hear (ie. Faith-related things). It's true though... I just don't think anyone will believe me anyway! Anyways, when Cecile came over she asked me about it too so I just told her what I told Phoebe and left it at that. Phoebe's Christian so it's easier for me just to tell her these stuff since she gets where I'm comin from.

I had Phoebe over for lunch today - we whipped up a Chinese-Malaysian classic called "Lor Mai Gai". Phoebe who is Japanese-Caucasian will be marrying Chris this December (his parents are/were Malaysian) so the recipe will probably come in handy somewhere down the line! I was quite amused by how excited she was when she saw me eating it at hospital on Monday and when I said I was going to be cooking it over the weekend she nearly went hysterical with excitement and invited herself over. LoL. It was fun. I also whipped up a batch of white chocolate & cranberry butter cupcakes for my cousin. Also had Cecile over for a study session in the evening, which was a good confidence boost because in general I seem to remember all the things I've studied and the session went much better than this morning's sesh with Shing. Shing asked me what I'd do if a patient of mine was unconscious in the recovery bay after a colectomy. All I did was stammer and mumble, and my pre

Humility is definitely something I need to learn. I live in the future and I love talking about tomorrow. I guess I kinda see it as being passionate about my life. You talk about the things you love. At least, I do.. but this bible verse gives me something to think about. Do not boast about tomorrow, for you do not know what a day may bring.  (NIV) Proverbs 27:1

My ED consultant said he was "very impressed" by my work yesterday. Completely made my day! It's embarassing how much the opinions of my bosses mean to me. People sometimes tell me that I shouldn't care so much and that I should just carry on and do what I feel I need to do but when a boss says you're doing well it's like music to your ears. haha Truth be told, it was definitely more challenging of a day than the other days. I generally like 'hiding out' in the sub-acute area where you deal mainly with fractures, abdo pain, fevers etc but yesterday we didn't have that many patients and the consultant needed to evaluate me so he randomly handed me patients off the top of the stack and I ended up with pretty challenging cases from the acute section. The acute section is always more complicated because patients are older with multiple health issues, generally are not too mobile and a bit confused, and they take a pretty long time to get worked up as

One of the most frustrating things for me is when someone (a friend or patient) tells me they want to kill themselves. Coz there is so little we can do, aside from detain them against their will at a psychiatric institute, which is not something you'd do lightly or unless absolutely necessary. It's really frustrating when you're put in that position when you think a life *may* hang in the balance, and even if you spend a significant amount of time counselling them (and I certainly can't do this with every single person who tells me they have suicidal ideation) they tend to just go away and come back and say the same thing next time. And it's not always their fault - some people just want attention but most people have very really psychiatric issues, and psychiatric issues are really hard to get a handle on because it isn't like surgery where you can just cut something or cast something or cover something up. Today someone came in with this problem and it just go

Last weekend Ps Jeffrey Rachmat of Jakarta Praise Community Church came to speak at Hillsong Church in Sydney. I thought the message was really awesome - he spoke about how there had to be seasons of work and seasons of rest. And that while we had a responsibility to do what was possible in the 'day time' we also had to 'sleep' at night to allow God to do the impossible. Ps Rachmat's worship leader, Sidney Mohede (link in the 'Elsewhere' section on the right) co-led worship at church and we sang bits of one of the choruses in Indonesian. I really loved that - it's been three years since I've visited Malaysia and singing in Indonesian (which is similar to Malay) brings back a lot of memories. There are more Indonesian/Malay language praise & worship songs on Sidney's page and you should go check it out!

I haven't been studying much for the past week but I mean, I'm done with surgery and emergency medicine. Have read Paediatrics once and did psychiatry last year. My revision output was slowly grinding to a painful halt because I think I was getting to that point of over-saturation... when there is so little motivation that every new piece of work comes at too high a price. So today I took the day off. After an hour in a surgical tute I went to Centennial Park for a long run. Then I did crunches, then I came home and had a really healthy meal (vegetable soup). Then I slept.. for 5 hours. It was kinda awesome. sleeping I mean. After sleeping I spent the evening eating and watching videos by the Jubilee Project (there is a link in the section called 'Elsewhere' in the navigation bar on the right). It's been a lovely day. Tomorrow I will begin my 508 page review of 'Medicine' topics. I think it will be pretty interesting but for today, I'm rounding off wit