My study experience (3)

Alamak semakin malas plak nak tulis pasal ni, initially plan nak tulis pasal Ameer Faheem's books and education huuu

I guess I should continue on how to study waktu bersalin (which is not useful to anyone I guess haha), and how to study with a baby. Ok, not much on the first part.

Selepas episod yang teruk of nausea and vomiting uring my first posting which was internal medicine, a motivating period during O&G, an extremely tiring period of paeds (I started having nausea & vomiting again in the third trimester, and worst the baby bump was heavy, caused difficulty in breathing, his limbs were sharp poking my abdomen as I had oligohydramnios, I had to do CTG and Doppler US weekly for certain reason bla...bla...bla... ) I can't remember how did I study at that time huuu, but my guess would be, I didn't study much T_T

Next came Surgery. I attended the first fruitless week (the first week is always fruitless haha), then I was admitted in the second week due to premature contraction (Ameer Faheem was 35 weeks old), warded for a week, and at 36th week, I was induced due to Ameer Faheem had IUGR (Intrauterine Growth Restriction) and took maternity leave for 2 weeks. In total I had 3 weeks of holiday hurrah! When I came back, it was in the 5th week!!! Memang terasa bila kawan2 dah pro ttg surgery, and I was crawling to understand simple things huh and to fill up my logbook T_T. Abang had gone back to Jordan, Ummi came with me to Kuantan to take care of Ameer Faheem until my Surgery exam (for 3 weeks). Some lecturers were reluctant to let me sit for the exam as I had more than 20% absence but I was determined to go for it haha. Of course I didn't score well :( but I passed alhamdulillah and I promised myself to do better in the final posting which was psy.

Waktu ni memang mencabar. I left my house at around 7.30am because I breastfed Ameer Faheem before going to the hospital, I came back during lunch time and go out again to attend the afternoon class. Ameer Faheem asyik kencing and berak je sampai bocor pampers huhu, and I don't really sleep throughout the nights sebab dia asyik nak menyusu je. I took that opportunity to read my notes but I was so tired that many times I just didn't know what I was reading. I started giving him formula milk because I was too tired to stay up (many times Ummi would wake up and prepare his milk). Ummi is really a gift from heaven! But I still managed to finish my surgery notes! Tak tahulah macamana sempat buat huhuu. I think making notes to me is as natural as having my meal huuu. You'll find time for it no matter how busy you are!

I drove with Ameer Faheem (only the two of us hehe) to Kuantan to start my Psychiatry posing. This time I knew I had no time to waste. I guess I was truly blessed by Allah to be grouped with Dr Iman in this posting, such a great motivator and a great friend. We always took Psy for granted haha. Every morning, I went out at 6.45am. Ameer Faheem tak mandi ok. I sent him to the hospital nursery, and at 7am, I met either Iman or my best buddy, Zanaridah in the ward. We practice doing shortcases everyday, going to different wards depending on available cases and depending on what I have revised the previous day. Kawan2 kata ada finding best kat Paeds, maka ke ward Paeds la kami pergi. Begitu juga wad lain. I even joined the Internal Medicine ward rounds in the morning! I think starting with IM in the 5th year is an advantage. Because you will get Psy last and you have much time to revise the other postings. At around 9.30am, we walk to the end of the hospital where Psy ward is located (if there is any class at all, otherwise I'll stay in the main building the whole day). Every afternoon we have Psy seminar. After the seminar, usually at round 4am, I will go to Psy ward and find a case (to present the next day) and at around 6pm, I fetched Ameer Faheem from the nursery (which was located just beside Psy ward) and went home. 6-7pm was our rest time. I gave Ameer Faheem his milk, and then both of us will sleep. At 7 I woke up, refreshed myself for maghrib prayer and watched the melayu drama haha. 8pm was the time to start studying again, and making notes (AGAIN???) I studied till around 10 or 11, entertaining Ameer Faheem and changing his diapers in between and putting him to sleep, at 11 I retired to my bed. I woke up again at around 2 to 3 am, to study while chatting with abang.

So you see, I didn't make a timetable which I had to follow, but my life itself was such a routine. And I disciplined myself to follow that routine. Well actually I didn't force myself to follow that routine, but I disciplined myself to achieve my daily aim which indirectly made me follow that routine. I put my study as number one, but in between I fulfilled Ameer Faheem's needs. If you put it the other way round, then the outcome will totally be different! I type while Ameer Faheem was on my lap, I read while breatsfeeding him, I fell asleep when he was sleeping hahaha jeles kot tgk dia best je asek tidur!

As for shortcases, practise practise and practise. I started practising for my shortcase during the last posting, sempat je insyaAllah :D It is never too late I guess haha, but be consistent. There aren't too many systems kan? CVS, respi, abdomen, neuro, ortho (ni memang tak practise sgt pun huuu. my own mistake), O&G, and I recommend for shortcase, bacalah buku NK Chew tu sampai habis, really helpful! Nak khatam ulang2 kali lagi bagus! Do shortcases best in pair, time it (5 minutes), repeat, repeat and repeat. Don't waste time lingering in the ward. Mungkin disebabkan saya ni muka tak malu, I usually go to the ward, IM for example, walk to the last cubicle (respi cubicle), minta izin terus utk examine with a short intro. Tak payahlah nak segan2, jalan kehulu ke hilir without doing nothing, buang masa je. Lepas examine, directly present to your friend, and then straightaway find the bed ticket to know the diagnosis, finding, look at the X ray etc. If anybody inform you that there are patients with good finding, straightaway go to the ward to examine them. Kalau tangguh2 alamatnya patient will be discharged or dia dah malas kena examine setelah ramai sgt org examine haha. Lepas examine, present present and present. Discuss discuss and discuss. While discussing we usually refer to little book of causes (for differentials), oxford handbook for investigation etc and malaysian book for management eg Sarawak handbook, Paeds protocol etc.

Put a target that at least everyday you examine eg 3 patients (examined by you and not you observing your friend!). Many times I like to do long cases straightaway. For example, we go to a patent, then I will tell my friend, "I give you 5 minutes to get a chief complain and get a general idea of what the patient has. Then examine any appropriate system". If you are used to getting chief complaint and know how to exclude each differential for each chief complain, than in long case, takdelah melalut2 tanya patient benda merepek2 :) Go straight to the point.

1 more thing, practise to do a general inspection/ examination of a patient. Zanaridah and me in our third year used to tour the ward, go to each patient and taking turns to just present the general inspection. General inspection really helps you to make certain diagnosis. For example if you see a middle age patient with barrel chest and tracheal tug, you would like to SUSPECT COAD. A young adult, thin, and with certain facies usually has HIV and come with infective endocarditis. Contoh je lah. Most of the time you can 'suspect'. Probably most of us has known that for general inspection we should know what to look for. As for me, I have this 5-sentences template hehe.

1. This is an [elderly/young], [lady, gentleman, boy, girl, baby] who is [lying, sitting in certain position? etc]

2. He is [pink, pale, jaundiced, cyanosed, sallow looking], appears [comfortable, in pain, resp distress?]

3. Nutritional status [obese, cachexic], hydrational staus (controversial, some lecturers dislike), hygiene [unkempt, clean]

4. Syndromic facies, visible deformity (eg arachnodactyly in Marfan, amputation)

5. Attachments [oxygen, TPN, CBD, chest tube or ape2lah]

well I'm going to stop here, will continue later :p