The final dance

I still can't exhale a breath of relief.. a hectic period of 5 days awaits me.. I am tired and tired and tired that I said to abang, "Abang, sampai Jordan nanti ayang nak tido je. Nak T.I.D.U.R!!!"

Well I try to take some time to write down my professional exam experience, lest that I forget later. It spanned from 23rd May to 27th May. On the first day we had 2 sets of PMP (Problem Management-something). It is something like PBL. As for the first set (medical), we were given a case of multiple myeloma presented with bone pain, later on developed pulmonary embolism due to immobility (bed ridden), and Cushing syndrome due to prednisolone treatment. Second case was a paediatric case, given a child presented with acute gastroenteritis with dehydration, and later found to have helminthic infestation with anemia. As for the surgical PMP, O&G specialty, we were given a case of pregnancy induced hypertension, complicated by eclampsia, and for the surgery, a case of

In the evening we had OSCE, in which we head to move around from station to station, answering question given in each station. Generally the questions were ok, except for biostatistics of course hehe. I started with REST station hehe (there were 20 question stations and 10 rest stations).

Then for the second day, we had 2 sets of MCQ namely surgical and medical. They were not so ok huuu, but I went out of the exam hall early as I needed to prepare for my clinical exam the next day (Wednesday). It was scheduled at 1.30pm (the 4th group). Well, you just can't imagine the anxiety and palpitation that I had! I was unable to sleep, I was so worried. Abang called me manytimes, telling me that he knew I could do it, he keeps praying for me so I should do well and such haha. Generally I am not a person who worries of exam, but the outcome of my exam this time around has a significant impact on my life.. my main concern was whether I can put an end to the long distance relationship between abang and me.. Living alone without abang really requires me to have extra strength to move on.

At 10am in the morning I became so restless. I put on my best practical outfit to look confident and professional, and at around 11.30 I have arrived in JHC (the hospital campus) where exam took place. Of course I was not allowed to go in, as the morning session were still running. I actually sat in the car crying because I was so damn worried, and I contacted abang and ummi, telling them that I feel so worried huu. At 12pm, I sat at the security guard's pondok kawalan. And I saw many patients (who were called for the exam) reporting in. At around 12.30, the morning session students were released, most of them with a happy smile. Oh how I hope I can come out of the exam hall with a broad smile huuu. Alhamdulillah a friend, Ghaus (if you happen to read this, I really want to say thank you to you) suddenly went to the pondok kawalan and started telling me the cases that they had in the morning. That actually helped me A LOT in calming me down. He said "Examiner baik gila, banyak guide, kes common2 je etc" I was a bit relieved and started to breathe more easily. After performing my zuhr prayer, I entered he JHC building with a bismillah, a strong tawakkal, and a big hope. It is a building which I frequent, which I enter every single day of my clinical student life (except for weekends of course), but on that day, it felt different. Really it felt different.

I was brought to a patient, Bed 4. An Indian elderly gentleman.

"Pakcik, selamat petang, saya maryam, saya periksa ni. Pakcik blh tolong saya? Tolong bagi kerjasama ye"

He smiled. Alhamdulillah, anticipating an easy going patient.

"Pakcik sakit apa?"

"Saya berasa sedih"

Dlm hati" Oh no, a PSY case???????"

"Selain dari rasa sedih, pakcik ada sakit lain tak? Pernah masuk wad tak? Jantung, darah tinggi etc???"

"Tak"

"Pakcik g klinik mana jumpa Dr mana?"

"Klinik kat sini, jumpa Dr Ramli"

"Err~" (Dr Ramli is my psy lecturer :D)

I was a bit worried as I didn't revise on psy AT ALL during the revision week but luckily psy was my last posting so I hope i would be able to recall something back. I remembered my time with Iman Jeffrey (oopsss it should be Dr Iman Jeffrey!) when we made mnemonics to memorize the DSM Criteria for mood disorder. And she told me the melancholic features of MDD is MELAND (I am good at remebering mnemonics but defiitely I can't recall the contents haha), tried to rule out vegetative symptom, symptom of dementia ad anxiety which may end up in depression, general medical condition (esp hypothyroidism) and drug/substance. None. Basically in my opinion this was a case of double depression (the diagnosis that i tried to sell to the examiner later on huuu).

After an hour, I was called to room 4, where I presented to a group of lecturers consisting of Dr Hatta (psy external), Mr Jun (Surgery internal), Dr marzuki (IM internal), Dr Aye Aye (Paed internal) and Dr Dalia (O&G internal). Dr Hatta was the chief examiner for my case of course, it was his specialty. They were very nice, smiling at me.

So I presented

I remembered his first question "Do you know the term for 'loss of pleasure'?" "Anhedonia" Good. It was such a basic question but he still cared to ask, probably just to make me feel confident. And the discussion was about the difference between Major Depression and Dysthymia, why do I need to rule out happy episode (to rule out bipolar), what is the criteria for diagnosing manic, and then personality disorder, mental status examination what I would like to find to support the diagnosis, what are the psychotic features in MDD, investigations that I wanted to do and finally management. He also asked about drug/ substance induce in detail (drug abuse, drug toxicity, drug dependence and specific to alcohol, he was happy when I mentioned about early morning drinking, and he asked me the pathophysio of that. I really should thank my psy lecturers for that ESP Dr Hajee!!! Of course the usual bio-psychosocial and spiritual approach. I said Cognitive Behavioural Therapy, then SSRI and SNRI if presence of melancholic features. He said "Give me 5 names of SSRI drug that you know. I was able to list 3 only huu, and he later asked about each drug, which one is sedative, which one is better in certain types of patient etc. He also asked me about Tricyclic Antidepressant, why I don't want to use it (because of the anticholinergic side effects), on ECT (ask the indications) and finally he asked me something which I have never heard before- Magnetic Scalp stimulation. What I learn from this case, I think he was happy with the presentation because I tried to rule out many differentials in a case of depression :

1. MDD (with/without melancholic, with/without vegetative symptom, with/without psychosis)

2. Bipolar

3. Dysthymia

4. Dementia/ Anxiety disorders

5. Drug

6. General medical condition eg chronic illness, hypothyroidism

Of course I was not able to answer all the questions huhuu, but the important thing is remain calm, and don't hesitate to smile and humbly answer. "I am sorry Dr, I don't know". by the time I finish my long case, I knew that I would be able to get a distinction mark for it, but I have 3 more shortcases to go. When I came out of the presentation room, I saw Dr Ramli, and I felt like telling him, "Dr I got ur patient, and I think I presented well, and I hope that will make you feel happy and proud" haha but I just sat quietly and smiled at him from afar

As for my shortcase, my group of examiners consisted of (Dr Suhaiza (my O&G lecturer who gave Faheem's antenatal care hehe), external paediatrician, external orthopaedic surgeon and Dr Yousuf rathor (my neurology lecturer). I got a case of fibroid (which I think I did well because the discussion was up to management), a HORROR paediatric case which I flunked well of course (boleh plak cakap left lower zone crepitation. Dr: what?? Do you want to examine again? Me: yes... left middle zone crepitation huhuu) In the end I don't know the finding, but I end up saying bronchiectasis & cystic fibrosis becuase the patient had finger clubbing, and then she asked me to elaborate on Cystic Fibrosis. I really should thank abang for teaching me this when I did my elective posting in Jordan! We actually had clerked a case of CF, abang taught me about it and presented it in the bedside teaching hehe. (P/s abang ingat tak kita clerk Nimr?"Cystic Fibrosis in jordan is as common as asthma in malaysia, no wonder they know everything about it huuu. The third case was an orthopaedic case- a foot drop! which was even bizarre. I started to give weird theories to the examiner, buat ntah ape2 mngarut habis. Haihhh.. nak buat camane. I knew it was TERRIBLE when he started asking me the anatomy of nervous system haha. Well when you get a basic question (but hardly anyone can answer), you know you are doomed! By the time I finished my exam, I was even more worried than before huuuu. I was more than sure that I would have to be reexamined on friday due to my disastrous shortcases huhuu. Balik dengan hati yang tak tenang.

I packed all my things, with the intention to go back home if I dont have to be reexamined on Friday. I had another sleepless night and I was so tired but the eyes and the brain just wouldn't shut down. Next evening, at 6pm was the time for the list of reexamination and viva distinction to come out. I waited at home, hoping for wani to check it out for me. Suddenly hana sms me, "Maryam viva distinction!" I was so shocked, I refused to believe,and I was sure there had to be some typing errors, but that's it. A viva, which equals to another sleepless night and palpitation. But I told Ummi and Abang that I have passed alhamdulillah.

The next afternoon at 2pm I went for viva. There were 4 of us, but out of 4, only 1 really got distinction, my beloved Farhanah Ibrahim. Really hana, it feels like yesterday when you approached me and asked "Assalamualaikum, awak tahu tak kat mana tempat exam EAP?" We were actually in the SMAK building, in the first week of MCIIUM (matriculation) in orientation week, we have passed the English Placement Test well and had to do another exam to be eligible to take EAP class.

"Sorry tak tahu, saya pun tengah cari."

"Saya Farhanah"

I nodded and replied "Maryam"

Really hana it feels like yesterday when we did EAP together, when we studied together, when you had that severe sleeping problem and end up sleeping in the examination hall haha till Ummi address you as "Hana yang susah tido malam tu". When we attended programmes and kulliyah together, when we squatted in each others room, and next we moved to Kuantan, cooking in the middle of the night, went to each others room at wee hours in the morning (well both of us are vampires!), being called a pair of twin, when you were there for my wedding, and I went to your place for your engagement. Time do flies fast, and now you are GETTING MARRIED! Alhamdulillah :)

27th May 2011, 5.30pm, the Deputy Dean of academic affair, Dr Shahrin announced "Doctor Maryam al Batul Azizuddin" No, I don't get Distiction, but it is ok :) I stood up in gratitude, I cried and I think of my Abah and Ummi who really deserves this, and I think of my beloved significant other who is waiting for me in Jordan :) Alhamdulillah for His bounty.

Sayonara Kuantan. I straightaway drove back to KL, with my dear Faheem and my SIL, eizati, a journey to kedah awaits us and finally insyaAllah Faheem will be able to meet Daddy! :D