I am going to miss your presence...

Bila ada pertemuan mesti ada perpisahan. And I think I handle separation very badly. I should learn how to say goodbye in a proper manner. And that explains why I have phobia for new things, new situations, new friendships etc, because I can't bear going through the separation that follows..

Today my mood is not in a very good shape. Internet connection was terrible last night, and I woke up so many times (ahh sleepless night) just to check on the connection (urggghhhhh I am such an internet addict!!). Didn't use any alarm clock by the way, it was just the biological alarm ring huu.

And lavender-kun is not in a good shape as well. It hung few times, purely my fault because i overworked it soo much huhu. Welll, i need to finish my part of Obs notes actually (which was assigned to me, so i guess the prob with lavender-kun is not totally mine!). I should be amazed that it didn't blow with a loud bang and nice burnt smell haha.

And I have to admit, I am not keen at all in going back to Kuantan today. If not for the single class that I am going to have tomorrow, I will happily continue my holiday until this Sunday huuu. (Sorry Miyavi, it's not that I don't feel honoured to ride u huu). With all the roller-coaster emotion, at 7.20a.m (I was in the act of bullying Lavender-kun again at that time, reading blogs to blogs), Yasir (who should have departed for school) suddenly bang on the front door vigorously. Ummi opened the door, and Abah had just entered the computer room..


Seriously I didn't know what to do, I just felt like crying. I smsed kakak, asma'.. sedih. Ummi and abah ran out of the door to the accident scene huu ( in front of our house), but I just stayed like a solid rock in front of Lavender-Kun. Kakak called, she cried even worse than me. We just kept quiet on the line huu..

I was phobia to cats, and I had the gut to mildly stroke a cat (mind you I am still dead afraid of kittens until now huu) when I was in primary school i think. I seldom play with tot, and i think i can count how many times I had touched tot, throughout the 3-4 years tot lived with us.. but i still love him deeply, and his actions cheered us all. Everytime we go out, the first thing we would search for when we arrived home was his presence huu! Suka buat aksi menggedik, suka mengiau kuat-kuat bila nak something.. truly we are going to miss all those...

Tot is a cat. Agaknya bagaimana aku bila kehilangan insan2 yang tersayang?..... That explains why I am extremely afraid of meeting..because i can't bear going through separation that follows.. 

we were born into this world and we met our parents, we feel happy but one day we are going to die, and they are going to die..

we were destined to meet and live with our siblings and feel happy about it, but one day each of us is going to die

we are going to get married and feel happy about it but one day death will do us apart.. 

we are going to have babies and feel happy about it but one day either 1 will die first..

adakah best hidup sendiri? you never experience the joy of meeting and you will never experience the gloom of parting. i don't know.. gloom is just not the right word! it is far more terrible and nightmarish than the word 'gloom' could explain... Ya Allah give me strength..


A nostalgic walk

A visit to a long-left (and long-forgotten??) place Matriculation Centre of International Islamic University Malaysia (MCIIUM) yesterday morning It is still MCIIUM to me despite being CenFOS to everybody else :D It has been 3 years since the last time I walked thorugh the much despised main gate (merely because of the strict guards huu). And I am dead sure almost everybody had the experience of 'flying' u know escaping from the 'jail' compound huu. Especially on Tuesday (if I remember it right) when we were allowed to go for an outing 5pm-8pm for the sole reason of paying a visit to the Pasar Malam hehe. As for me, I usually came back from the weekend holiday during that particular period, on Tuesday huu to avoid handing in the outing card. And yup I have experienced receiving a generous amount of fine from Pak Guard due to the same unhealthy activity (Sepandai-pandai tupai melompat, kadang2 jatuh juga. Maybe the tupai has some kind of cerebellar disease which prevents it from estimating perfectly the distance from 1 tree to another tree)

So, back to nostalgic yesterday, It was indeed nostalgic. And i kind of felt happy to be there again. Nothing changed much. KC (Khadijah College) is now painted in brown, kind of nice but i cruelly said to Ummi "Mesti luar je cantik, dlm buruk jugak" hehe. never mind that. Apart than that everything was I think exactly the same as before. Went to SMAWP (I couldn't believe that i still remember the name!), Cenntral Spine, Cafe Jambatan, but my lame Alzheimer brain just couldn't recall th location of Celpad and the Departments! I remember the place but I couldn't tell where is English dept located, or the Sciences etc. I couldn't even recall where did I meet the lecturers before (I mean I used to go to their rooms, put the tutorials outside their room doors... how lame :( )

Itulah matrik IIUM :) I was a student there once upon a time, 


I guess this news is a bit stale..

Huu i forgot to document it here, for the IM exam, everybody passed. Zero failure. Alhamdulillah. Although I am extremely confused.. how could I possibly passed?? Haha maybe IIUM should do some revision on Quality Control of Undergraduates!

Siamese Twin 24 April 2009

The video has been removed for ethical reason :)

Awal pagi 24 April 2009

(The picture has been removed for ethical reason)

this is the anencephaly baby which i have mentioned few days ago..

Last night i manage to watch the delivery of a conjoint twin (kembar siam), attached from the chest up to the umbilicus. The operation theatre was crowded with doctors, nurses and medical students hehe whou wouldn't miss the chance to witness such a rare event.

Tapi kesian mak dia kan... susah nak jaga baby camni



Dr Murad's post-pinch bruise is still there, and the pain is still there.. (Jetul, Hana sungguh memahami apa yang aku rasai huu) but i know it was for our own sake. But i dare to say the horror stories about his classes are so far untrue! 

It is good that we got hurt, we learnt something. Rather than being left in our own wonderful utopia world, we at least got a taste of O&G! :)


Tomorrow would be Postpartum Blue day okay :)

Bismillahirrahmanirrahim. I predict my own collapse in just few immediate minutes! To think that i still have to drive back...... ~sigh~ Whoaa last night was the longest on-call I've had so far. We spent the night in high-risk labour room, finished filling up the labour-observation part in my logbook, witnessed a rare & terrible anencephaly (baby with no skull) labour, listened to Dr Aaron wondering out loud why we were lingering there when we would be having class at 8.30am the next day (today)... but guess what? Today I conducted 2 deliveries! hehe. They are nothing to those who have conducted them, but those two were my firsts, so i feel extremely grateful! alhamdulillah :) A baby boy and a baby girl. and the JMs (Jururawat Masyarakat) were very nice helping me out, but the worst thing was they kept teasing me kena pandai jaga anak sebab nak kawen! huhu. I don't even know how come they know about my wedding. Of course i am not an expert at handling babies because my youngest baby brother is now 16 years old! huhu. i wasn't even allowed to carry him around when he was in his younger days :p as I myself was only 7 years old at that time.

And now what am i doing? Trying to kill my time surfing the internet while waiting for the time to go back and have my beauty sleep :D

So what is it with the topic? The postnatal students (izzati, rodhi and me) have decided to wear blue tomorrow!


There's NO MORE secret about it huh? huuu

For the wikimapia guide, please click here
Coordinates: 3°10'17"N 101°30'51"E
For larger view of the cards below, do not hesitate to click on the pictures k :)

Kenapa banyak sgt kad ni? Because A'thiq suka kad warna hitam tu, my family loves the pink malay one, and of course I love the simple english version (simply because of the rose! hehe)

A new disease

"Awak, nanti kalau awak dah kawen mesti dah takde masa untuk kita. Mesti awak dah tak rapat dengan kita lagi..Nanti awak dah taknak kawan dengan kita sebab selalu sibuk dengan husband je" I am reminded of this usually-true statement from a very very very dear friend, which made me feel sad when she said it...

Is it true? I used to think it's true, and I still think it is true.. based on my experience with married friends.. I don't think they intentionally do that, it's just that to be a wife means to embark on a commitment-loaded journey... and require schedule adjustment according to priority.. perhaps

But I am so determined to change that (of course when I be someone's wife, 1 day insyaAllah....), although I don't (yet) have the slightest confident I am capable of doing it.. 

Because I am afraid I am showing the first vague symptom- blog-update lag huu. I don't write as much as before. But personally I like to read my buddies' blogs on their life experiences, significant achievements, personal perceptions and how they cope being a 'human' and such. truthfully I don't really read blogs containing heavy stuff. Because whenever I want to read on ilmiah stuff, i prefer to read books which explain everything in detail. Oh btw, I despise magazine as well huu.

I learn a lot from others' experiences about 'life' and i try to share my own experience no matter how insignificant it may be, hoping it would be useful though in the least helpful manner. Well you know (this is strictly not for Martians, it's for the Venusians ONLY!!) it is the "I feel sad and when I know you feel sad as well, it makes me feel relieve because i know i'm not alone" thingies hehe.

So back to 'emotional' and 'novel' blogs, through my blog, I find a channel to reach out and connect (to Venusians of course) And when I don't update this, it feels like I am kind of abandoning those who always listen, and always appreciate, always read, always acknowledge my  insignificant existence in this temporary world.

So back to the blog-update lag.. I kinda.... feel guilty because I think I am succumbing to the "Once you get married you are not my friend anymore" disease.. Astaghfirullah, I have promised myself that I will try my best to inject myself with the best vaccine so that I won't get that disease!! 

I think I am not going to update on the Indonesia trips (hopefully the many pictures would make myself remember the nice trip forever :D ) 

Whatever it is, remind me to be perfectly normal whatever happens after this. I think I am straying again.. hmmm..................................

i copied & pasted this hehe

Mama dan Papa sedang menonton TV, seraya mama berkata. “..i letih
la..dah lewat ni, i nak tido lah….”
Mama pun pegi dapur nak tutup tingkap dapur, nanti masuk pulak
lipas…leceh pulak nanti..dah tu, ade pulak rice cooker dalam
sink..rendam lepas makan tadi..basuh jap…
susun pinggan kat rak, lap dapur..terpercik kena sambal masa masak
tadi…check air panas dalam flusk..takut habis pulak nanti malam
nak susu…memang dah kering pun flusk ni, jerang la air…sementara
tunggu air masak, nampak pulak bekas gula dah kosong….salin la
gula…check bubur untuk anak nak hantar ke taska esok..nasib baik ade
lagi…ishh…ni lauk bila ni, semalam…dah beku dah…basuh la
kejap….pegi yard, masukkan baju kotor dalam mesin basuh…penat dah
ni, besok je la basuh…sidai kaian lap je lah…
tik…bunyi air dah masak…salin air dalam flusk…ok settle…

baru teringat tak semayang lagi…on da way nak g bilik, papa tgk tv
lagi…nampak pulak beg anak untuk hantar ke taska…check…baju 2
pasang, towel…towel kecik utk selsama…calamine lotion untuk sapu
4 keping….alamak..telupa pulak masukkan botol…basuh botol jap…ok

ternampak pulak beg g keje…emm..besok nak pakai beg polo coklat lah,
asik2 pakai beg hitam ni je…salin jap barang2 g beg coklat…cek sume
poket beg, takut la tetinggal apa2..leceh pulak..selalunya barang yang
tertinggal tu la yang nak pakai nanti…hishhh sempit la beg ni…hangin
je…nak kena beli ni beg baru…rasenya 25 hb ni Sogo sale nih…mana
flyers tadi ek…ha ni die..ok, catit jap kat yellow sticker, nanti
lupa..ok settle…

Tetiba dengar suara papa…”..u buat apa lagi tu..tadi kata nak
tido..”….”..yelah nak tido la ni..nak smayang jap…”

masuk toilet..buat apa2 yang patut…cuci muka dulu..2 jenis lak
tu…adoi..gosok gigi…smayang…pakai toner…pakai treatment
cream…nak lawa and maintain punya pasal lah ni…
nanti orang kata baru anak satu dah macam anak 4 pulak…huhuhuhu…

bukak almari…emmm…pakai baju hijau ni lah besok…gosok kejap..check
baju papa, baju papa pun kena gosok jugak ni…kat bilik belakang…
la, napa komputer ni tak tutup ni..gelas kopi pun ade lagi, dah bersemut
dah..ishhh …g dapur,
basuh, sambung gosok baju…gantung
elok2…kemaskan baju gantung2…masukkan seluar papa yang dah kotor
dalam tempat kotor…ok settle..

dgr suara papa lagi…”..i dah ngantuk ni..”..dalam pada nak masuk ke
bilik…owh…pokok aku dah nak mati ni ha..lupa dah 3 hari tak
siram…ok, siram jap…check jap pintu ni…sah tak kunci lagi…grill
pun tak kalau tak check ni, senang2 je mat indon masuk rompak
umah aku…bukak lampu luar..

ni mainan ni sepah2…masukkan la dalam bakul mainan budak ni…banyak
nya…sampai bawah meja makan pun ade…adoi….ok dah …

ok dah boleh baring…adoi sakitnya pinggang…cium si comel ni
kejap…selimutkan die…la..napa basah ni…emm, tukar la pempers
ni…tak bagus la brand ni, nanti nak tukar lain la…nanti g Sogo 25 hb
ni beli la skali…ok sayang tido k…kalau boleh jangan la bangun tgh
malam ni eh..tido sampai pagi k…gud nite..sweet

aaahh…sedapnya dapat baring…mana pulak lotion sapu kurus aku
nih…ha, ni dia…sambil sapu lotion kurus,,,setkan alarm…setkan
program kerja besok…pg kul 9.30 ade meeting..
ahh…boring…panas pulak lotion nih..dah la…emm..sedapnya lelapkan
mata…Ya Allah…terima kasih untuk rezekiMU hari ini,…mohon
keberkatan dari mu tuhan…papa pun bangun tutup tv…”…i dah ngantuk
sangat ni…nak tido lah…citer pun tak best malam ni, bola pun
takde…”…selang seminit …dengar suara papa berkeruh…dah agak

So?….apa yang peliknya..??

Anda tahu kenapa wanita hidup lebih lama?…SEBAB ADE BANYAK KERJA NAK
KENA BUAT….tu yang tak boleh nak mati cepat tu…

Hantarkan ke 5 WANITA yang anda rasa hebat…pasti anda disayangi kerana
memahami mereka…well, women understand women better…
foward jugak kat lelaki-lelaki so mereka akan hargai emak, isteri, dan
dengan lebih baik lagi…

Tak kira la wanita berkerjaya atau surirumah…setiap wanita adalah
istemewa dengan cara mereka sendiri…

Kalau lelaki mengakui kebenaran ini….hormat dah hargailah
mereka…untuk keperibadian dan kebolehan mereka untuk berdikari…

apa pendapat anda?


Scary doctros

I never new before that transformable doctor existed but it was proven- Dr Isra' who could change into a crocodile and his wife Dr~ (I can't remember the name) who could change into a snake! We were running like mad, not much different from the Jurassic Park scenes when they had to run for their lives to avoid being eaten by the dinosaurs..we did pretty much the same with regards to Dr Isra' and wife huu~ I saw them transform before my very 2 eyes!! And suddenly I was in the hospital (HTAA). I was being examined by Dr Azarisman on a patient with both renal failure and heart failure except that she had no anasarca. I felt very sleepy during the examination that i actually slept and didn't manage to finish clerking and do the physical examination on her.Everything was very weird!!!.. except when I woke up at 5am, to realize everything was just a dream huu. It made sense then ~sigh~ with today being the last day of my holiday, and Obstetric & Gynaecology Posting starts tomorrow ~sighhhhh~ And yet I still don't know the result of my IM examination. But in my own evaluation and standard, I definitely had a clear fail!.. huu


Abah the gardener

Abah bergembira di rumah kaca taman bunga!

abah teringin nak siram pokok- jadi gardener

muka tersenyum gembira je dapat siram pokok ngeh3

tak puas hati lagi!! cari pokok lain pulak!

pokok mana yang sesuai nih????

haaa siram pokok ni la pulak :D

hmm baru best!! steady je siram pokok

gah! ape tengok2 abah siram pokok?? teringin la tu!

pokok kat depan ni pun perlu siram jugak :)

hati girang :D

cari cari lagi tempat nak siram 

whoaa jangan siram camera woman plak!

aksi aksi yasir busuk!

at the Jakarta airport before departure, trying our best to stuff everything into the bags

huu tidor sandar kat ummi pulak tu, perasan ringan 

kat taman bunga :)

haisyy trying to peek kat newspaper org lain???? so embarassing!

extremely exhausted after half a day walk around taman mini

balinese garden

ni strawberry picking ke? macam gaya pencuri strawberry je...!

eeee mesti ada ulat!! makan tak basuh!

feel my punch! preserved tiger at tangkuban perahu. it died due to air poisoning due to erupted volcano

yasir sengih kerang busuk, ummi tersenyum gembira hehe

this is the giant maze! like heaven, coz it reminded us of SECRET GARDEN!!

balinese garden again, isn't it?

rumah kaca in taman bunga

asma' and yasir with the green bunny :)

kat masjid in Puncak. what a memory 

yasir macam sedih je kena duduk situ haha. taman mini

merenung nasib ke ape nih??

The silly poses haha

yasir tgh pijak babi hutan

ha ape? ape?

urghh tarik bontot dia supaya takleh jalan


1st note on trip to Indonesia

I have just got back from Indon after a 5-day holiday, ALHAMDULILLAH. We were already missing home like mad since the first day haha. Guess I didn't manage to laze around much at home after the final exam (or rather brooding at home :p), that explains it.

So just a little memoir on what we have experienced in Indonesia. As for the start, our flight was delayed for 1 hour on Friday, we were supposed to take off at 8.50pm, but ended departing at 9.50pm. Typical of Air Asia (up-rolling my eyeballs huhu). But no harm, I was expecting myself to be happy every second, it was a holiday after all! I've got loads of time in my pocket (said while i grin broadly exhibitng my imperfect row of teeth :p), except that with every second wasted, I am counting down the number of days left for my holiday!! Gosh 

Anyway, we arrived late, and on our way to the hotel, i saw people sleeping along the road, at the road divider, under flyovers.. sedih dan terkejut... Alhamdulillah Allah memberikan rezqi kepada kami untuk tidak merempat sebegitu, moga kami sentiasa mnejadi orang yang bersyukur..

Yasir, Asma and me shared 1 room and ummi & abah shared another room. felt quite weird becuase the usual designation would be abah and ummi share 1 room, us trio share 1 room, the 2 monsters share 1 room. since umar takde, yasir had to share with us. never mind.

Early the next morning, we went to Taman Mini Indonesia. This parki is kind of a cultural park, where all sorts of cultural (especially the houses/ buildings/ traditional wear) thingies of each part of Indonesia are exhibited/ built in this huge park. We had an exhaustive journey touring the park pheww on feet!! took us half a day, and we only went back after Jum'ah prayer. The thing is, I'm not really into the cultural matters. So instead of enjoying taking pictures with the houses etc, we enjoyed making silly poses with thelife-size  stone animals and people decorating the ground!! what a waste. being around asma' and yasir (the photographer) who also came up with a bucketful of stupid ideas didn't improve the situation much~ 

After that we went to perform our prayer at Masjid Istiqlal- a very big masjid and we ended getting lost in it haha while searching for toilet.. only to discover that the pria and wanita (men & ladies) have to share toilet!!! scary huu

Next we were very eager to go shopping at Tanah Abang. The place labelled as 'ibu ibu girang, bapa bapa suram' haha but it was quite late, (to our surprise the shops close at 5pm!) and almost all the shops had closed by the time we arrived. So it was dead frustrating especially for asma and me! You know we went to indon with almost-empty baggages, with the intention of having a shopping frenzy in indon. the best thing was, we didn't even bring clothes for 3rd, 4th and 5th day haha as we planned to buy clothes and wear them straightaway just to save some space in the bags for more shopping products! Just imagine the frustration when Tanah Abang had closed -sigh-

Tanah abang is quite similar to Pasar Payang, or Pasar Siti Khadijah with the dark and congested alleys selling mostly clothings. Except that it has 2 buildings, and each building stood tall at 10 levels, with the two buildings connected with a skybridge or something like that. So if you think shopping in Kelantan or Terengganu is kind of like heaven compared to other places in Malaysia, then you'll definitely need an asylum after you shop in Tanah Abang. Plus the extra cheap prices!!! Oh my ~~ Bought a maroon-pink Jubah, maroon-pink blouse and few other items.

We had NasiPadang for dinner. then went back to have a good night sleep, ready for the next day's activity..

Continue later k..


A note on examination..

ALHAMDULILLAH I am now reminiscing the examination day, in the quiet ambience of my own bedroom. But if one thinks everything went well yesterday, I have to apologize for delivering such a wrong message- it was worse than worst. That was how I described it to a friend :p

For my long case I THINK I got a Community Acquired Pneumonia case. It sounds simple enough, but the problem was, the patient came in with SHOCK. She was confused, not oriented to time, place and person, incapable of following instructions -SIGH- And I clerked the daughter and granddaughter who had very little knowledge on the illness itself.. -sigh-

A JVP catheter was inserted however on the day of clerking (examination) it was already removed. But she was still not oriented, and worst was it was almost impossible to do Physical Examination on her as she was moving all the time (She was drowsy and kind of.. not agitated, but still she moved all the time, holding my hands and trying to hug me...) On top of that she was lethargic and couldn't ambulate except turning & toss on the bed. 

I presented to Dr Hadzri, and I think I flunked it huu. Thought I had to be re-examined, but my name was not called. It made me wonder whether I had a clear fail huuu. 

Next was short case (SC). Examiner: Dr Ijaz. Pheww~ lega sket. Followed her in ward 8b, walked pass the nurse counter. Nak feel relieved again. Respiratory system? (Because the respiratory wing was located at the back of the ward, next to the nurse counter. Kept praying silently "Ya Allah, please let it be Respiratory system. Please don't ask me to check weird things huu". Aku yang ketakutan dapat patient with haematological malignancy presented with enlarged testes, because I am not well versed neither well prepared to do inguinal hernia examination!!!

Arrived at the bed, a bit upset to see the curtain was drawn around the patient. Dr and me intai dalam curtain, saw Ashraf and Dr Harris doing the SC, Dr Ij decided to find another patient.. ah kecewa tak dapat respi..

Dr lead me downstairs. Ahh a female???? Ketakutan lagi ~sigh~ it's hard to examine a female. Sempat sengih2 kat mimi while we walked pass her and the others near the staircase.

Dr Ij brought me to a young patient (age: 20+), from general exam I can't detect anything except a tinge of jaundice (cuak lagi). I was asked to examine Cardiovascular System! Haa~. For CVS, the problem is not with the technique, but with the interpretation..

So I asked for the patient's permission, pull the curtain, position her (I elaborated on the position haha, siap tengok katil dari tepi nak betul2 tunjuk that I aimed for 45 degrees. Try tarik bantal tinggi sket, suruh kakak tu duduk betul2 sket.. ces memang berlakon tahap melampau hehe) 

Then I moved to the end of the bed for general examination. Took a long time to count the respi rate 

Dr Ijaz: What are you doing so long over there?? (dengan muka yang pelik)

Me: (dengan muka cuak and bersalah) I would like to count the respi rate because the patient appears tachypnoeic....

Dr Ij just nodded in wonder.

Started with periphery. Bersungguh-ungguh I looked for collapsing pulse. Teringat pulak my advise to Hana :Don't ever depend on auscultation! EXTENSIVELY, ELABORATIVELY, SERIOUSLY look for signs in the periphery, so that before you auscultate, you have an idea of what you are going to find. But I myself fails to that in the exam huuu. Apsal la takde orang yang pernah cakap pasal patient ni ada murmur ape2 haisyyyy

Failed to find anything in the hand, I examined the face. takde malar flush tp patient had mild pallor. I denied jaundice although I did think she had TINGE of jaundice.. aiseh ketakutan dah, i have arrived at the neck but no positive signs yet.

examined the neck. Raised JVP. YEAY! Measured it, 5 cm. carotid normal character. tp i thought the patient had corrigan sign. carotid pulsation macam sangat obvius, but i just put that aside. I'll only present it if it agrees with auscultation finding (not to mention that I'm not good at detecting murmur truthfully!!)

examined the chest. waktu ni dah berdebar melampau because i had very few signs in my pocket. No precordial bulge, but obvious precordial pulsation. There was a horizontal scar at the left subcostal area, medial to mid clavicular line measuring 5cm. At that time, I think my own chest would have revealed vigorous precordial pulsation!! Takut yang AMAT AMAT AMAT sangat becuase I thought the scar might due to valvuloplasty. I just don't know what to expect in the auscultation. The clicking sound of prosthetic valve?? aiseh!!! Searched for apex beat. Displaced. 6th intercostal space, anterior axillary line. YEAY! I don't know the character, sorry huu. Parasternal heave! Lega sket. 

Auscultation ni yang memerlukan imagination yang paling tinggi -sigh- Antara dengar dan tak dengar (lebih kepada tak dengar laa huu), she had a systolic murmur. Checked for radiation, tp tak berani plak nak check for carotid radiation just to confirm it was not aortic regurg (i was pretty sure it was not a diastolic murmur). I was confused whether it was tricuspid or mitral. I was sure it was mitral, becuase there was radiation to axilla, but the SCAR confused me. Judging by the scar, i think it should be tricuspid valvuloplasty.. Did some manouvre for inspiratory and expiratory phase.

Examined the leg for pedal edema. Positive up to the knee. Then asked the patient to sit, checked for bibasal crept. ALHAMDULILLAH it was very gross!!! It made me feel confident to claim she is in failure. But sacral edema was absent. By then Dr dah bising2 that I took to long a time. I don't know why, I did everything in a slow motion way huu. 12 minutes! I said I would like to check for hepatosplenomegaly, but she made faces to me. I said never mind, I just presented.

Presentation was not that smooth. Tachypnoeic (i think up to 30bpm, but i was dead afraid to commit to such a severe tachypnoea, i just mentioned 26bpm), pale. JVP raised, pulse (radial and carotid) normal. When I mentioned the scar, she was kepelikan huu. She examined the patient again, ALHAMDULILLAH i didn't bluff about the scar. She asked the patient, and the patient claimed it was present since she was a child huu not a surgical scar!! What a waste to worry in the first place :p Then i said there was a parasternal heave (muka takut je waktu cakap benda ni but when Dr nodded in agreement, I felt relieved). Then murmur haisy..

Me: emm aa emm..

Dr Ij: cepatle. time is running. with your emm oo aaa, u are losing time! cepat sket

Me: emm (lagi) S1 and S2 heard. There was a systolic murmur (tak berani lagi cakap pan systolic murmur). Heard best at... (was reluctant to say) tricuspid area..

Dr Ij: Ha??

Me: No no no! Pan systolic murmur, heard best at mitral area, grade 3, radiating to axilla! (termuntahkan semuanya dengan begitu cuak dan laju. Dr mesti terkejut) 

Dr Ij: (looked satisfied i think....) Yes. During inspiration or expiration?

Me: (meekly answered) i tried to listen but could not appreciate....

Dr Ij: ok, never mind. what else?

Me: pedal edema up to knee. No sacral edema. Bibasal crept present. Tp hepatosplenomegaly could not be elicited.. (continued in muka sedih..) tak sempat....

Dr Ij: You were too slow. Buat cepat sket.

Me: (nodded)

Dr Ij: apex beat kat mane? 

Me: (aiseh, terlupa mention la pulak) 6th intercostal space lateral to midclavicular line

Dr Ij: Yes. Where is it exactly?

Me: Anterior axillary line.

Dr Ij: YES!! is it displaced?

Me: (meekly answered) yes.

Dr Ij: So what's your diagnosis? 

Me: Mitral regurgitation

Dr Ij: with?

Me: with heart failure

Dr Ij: Yes mitral regurg in failure with??

Me: (blank)

Dr Ij: eh look at the precordium. what can you see? Pulsation kan? I can even see it with her clothes on. What more when she took it off!! (Dah start geram?? huu) Can you see it?

Me: Yes. But there was no precordial bulging. Only the pulsation (she initially tried to question my statement 'no precordial bulging')

Dr Ij: yes. td you said parasternal heave. what does it indicate?

Me: Right ventricular hypertophy. 

Dr Ij: Yes, so what is it?

Me: (suddenly i see a light bulb in my head) Pulmonary hypertension.

Dr Ij: YES!! She was finally lega that i could come to the diagnosis with her extensive clues and hints huu) You ni bagi la diagnosis lengkap

Me: Mitral regurg in failure with pulm hypertension

Dr Ij: Ok what can cause MR?

Me: Many differential iagnoses. First is Chronic Rheumatic Heart Disease.

Dr Ij: Ok. (session ended aku masih terpinga-pinga) You took 15 minutes in total. 

Me: (Eh bukan 3rd year dapat 20 minutes ke? 10 minutes for examination and 10minutes for presentation)

After she went away, I talked to the patient, apologizing for whatever inconvenience i have done to her, told her i was having my examination. Asked her what was her chief complain, and she said "batuk berdarah" Aku macam terkejut dengar, so it is true she had pulm hypertension.. Her first presentation. Ver nice lady, her third child is now 2 months old!! Huu. i wonder whether she had cardiomyopathy with severe MR accelerated pulm HPT.. i don't know.. 

So that was it. i leave the rest for Him to decide