Chest tubes

Accident cases are happening all the time, and serious cases like pneumothorax are not uncommon recently. 

I had just inserted a chest tube last week, and this week another patient came with pneumothorax which requires chest tube insertion.

This patient is referred from a district hospital, sustained multiple jaw-dropping injury like extra-dural hemorrhage, shaft of femur fracture, and bilateral pneumothorax.

The initial Chest X-ray only noted left sided pneumothorax with lung collapsed, chest tube was inserted in the district. 

However, repeated Chest X-ray noted there is expansion of pneumothorax over the right side too, albeit not obvious to the naked eye.

We managed to pick up the findings when we perform eFAST on the patient. The presence of 'lung point' on the right side prompt us to have a closer look on the 2nd Chest X-ray, which if observed closely, a rim of >2cm is present. 

Thus, I inserted the chest tube with Oscar who is the surgical MO oncall. It was quite a good learning process as both of us are still learning and are juniors in procedures like these. 

Take home message: eFAST scan saves life! 

A terrific day

It was the smell of disaster and accidents when the conditional MCO (movement control order) is relaxed, allowing people to travel inter-state. Some may argue that relaxing it may cause a sharp rise in travelling rate and hence, accident rate. However, just like the human body who will undergo illness and injury, people too, may not have good luck all the time.

Lue and I were the only MO (medical officer) working in red zone yesterday. I decided to pen it down as the injury is so devastating and the loss is beyond words. 

Being the junior MO, I was carefully guided by Lue. Thankfully we have a group of diligent team in the zone. We received an ambulance call for an intra-abdominal injury, were being told that few others had died on the scene and they manage to extract only this patient. 

Initial assessment had been done, we thought that there is only injury on the abdomen since it's tender and guarded. However, the Chest X-ray decided to add horror to our day. It was pneumonediastinum (thanks to Lue who is able to spot it) and pneumothorax! 

Chest tube were inserted immediately, albeit we encounter slight difficulty initially, but thankfully Janice came and helped. Ventilator setting has to be low in view of the pneumomediastinum which may be caused by tracheobronchial injury. 

Surgical team came and assess the patient. They requested for CT Abdomen and Pelvis. However, our radiology team noted the extensive subcutaneous emphysema and decided to do a CT Thorax too. True enough, all the other injury you could possible think of is present.

This is just one of the patient for my shift. Not mentioning the other accident patient we attended with Le Fort II fracture (involving inferior orbital wall and maxilla); the one DKA (diabetic ketoacidosis) patient whom we can't find the source of infection; the anterior chest wound patient at the beginning of our shift which pushed to OT straight; the stranded patient in our zone who developed hypotension; the vagabond whom we don't know the cause of his altered mental status; the elderly patient from Hospital Bahagia who had persistent hypoglycemia; and many others.

As a junior MO, I feel the patient does not wait for you. You just have to progress, and improve. Patient will come with the worst possible injury without asking who is the most senior in the Emergency Department. 

In order to strive, sometimes we have to make tough choices although easier ones are available. 

Home Quarantine Day 4-6

Day 4

By the end of Day 3, I got my first swab result, and of course, its negative.

Another day of studying goes.

I tried to relax my mind by watching some movies that I've missed for the past years.

Secret Life of Pets 2.

Greatest Showman (rewatch for the 6th time).

A call to Spy.

I think by the end of Day 4, I already got past my denial stage.

Day 5

We were once again to ask for 2nd swab today.

As I walked past the road of my hospital, I actually never realize that the building is so mesmerizing.

Simple, stable yet provide care for the folks of Ipoh for so many years.

Swab taken at 7.30am by my lovely MO, Dr Chen. 

I like how he can always joke on everything eventhough the situation is like fire burning on yr feet haha.

This time, shit just got real.

We were required to wear the legendary pink wristband, the prisoner band, that forbids us from moving a single inch out from our house.

One of the staff nurse I met that day, told me that his husband is working in the police force, and one of their job is to conduct regular spot checks on us.

True enough, police came knocking on my door in the evening.

I was instructed to lift up my hand to show the pink wristband for them to snap a photo to proof that I am at home.

So this is how it feels when freedom is being taken away....

and yeah, my 2nd swab is negative, of course!

Day 6

I woke up to the voice of my mom urging me to go downstairs, as our dear police officers are here again 'to make sure I'm alright'

Urghhhhhh

I am okay with the way they conduct spot checks but to take photos, its so frustrating.

Maybe its their SOP for doing so.

But its so uncomfortable, especially when some of your neighbours are peeking through the cement wall only to have more question marks on their head as of why police officers will come to my house everyday.

I am so bored.

I was suppose to go for BBQ session in my friend, Fadhirah's house.

It was suppose to be a last gathering among me and my colleagues, but yeah, sometimes life just cheat on you when you are most vulnerable.

It's so thoughtful of them to give me a call. They knew I wouldn't miss this kind of fun gathering especially with colleagues cum friends whom I have been working with for the past 2 years.

I even tried out the trending game, Among Us with my friends.

That is definitely a stress-relieving game indeed.

Home Quarantine Day 1-3

Day 1

So apparently I've come into contact with one of the COVID PCR positive patient while I was working in trauma clinic in Emergency Department.

This comes as a surprise as the patient was not complaining of any respiratory symptoms, but just trauma related complaints. 

I've seen the case with one of my colleague.

On the day when the result is out, I was shocked when my colleague is the first person to notify me.

Subseuently, 2 of my emergency physician contacted me.

I was working in yellow zones that day, having seen total of 6 patients from 3.00-5.00pm, and able to discharged 4 of them.

Yellow zone was busy as usual, but I'm glad we have great souls like Dr Shankar and Dr Iman to tank the zones.

I was asked to immediately go back home.

I clocked out at 5.30pm.

Sat in my car.

No idea what to do.

Later I received a call from occupational health and safety unit. Briefed me about what to do, the need for isolation.

I was so frustrated, angry and sad at the same time.

This means that I am not able to work, my service is abruptly stopped, albeit temporary.

I reached home late at 8.30pm, breaking the news to my mom, who just recovered from the trauma of my dad being hospitalized for secondary dengue infection.

Day 2 

I woke up feeling aimless. 

Although I've longed for a holiday before I'm being sent out to other hospitals, but I've never expected it to be in this way.

Most of my friends were able to see the part of me being granted free MCs..

But the psychological stress is real. This is same like the needle stick injury I got during my first posting as a houseman. You know the result is likely 99% negative but the 1% scares the shit out of you.

I tried to minimize contact with my mom, and advised her not to go out too.

I concentrated on my studies, watching one movie to divert my mind, only to step back to reality after the credits rolled.

Later that night I was again informed to take a COVID swab coming morning.

Day 3

I reached at 7.30am to the COVID container. This is a full container where healthcare workers are able to take swab for patients requiring pre-op assessment and for PUI (persons under investigations).

Usually I am the one who is taking the swab for others.

But today, the feeling is different. I was taken swab by Dr Hariz (my senior MO). 

The feeling of me not being able to serve, but for others to serve me, is devastating, especially when I'm asymptomatic!

I'm also required to fill in a google doc to assess my daily symptoms and temperature.

At noon, I was again received call from psychological unit, to assess my mental wellbeing.

All this has come too sudden.

I still need time to process.

Hopefully during quarantine, I am still able to utilize this time to benefit myself and to serve more in the future.

Do we have control over our lives?

 Do we have control over our lives?

Since we were born, we were guided by streams of culture, sets of rules and social upbringing. The path is clear, we just have to walk on it.

Slight deviation from the path is risky, as we were told to have a path that is clearly defined, but not necessarily refined.

People who deviate from the path can be huge successful, or they may go downstream, unnoticed by the world.

Great things and discoveries can only be done by people who dare to take the first step; as the journey of a thousand miles begin with the first step - Lao Zhi

So ask yourself, what do you really want?

Time?

Money?

Happiness?

or all of them? which we knew its utter impossible.

Or we can have a balance, and only you can determine your own balance.

Thankful

How often do we complaint?

When someone is not doing their job right, or they are slacking, being irresponsible, and the long list goes on.

We always complaint.

Don't get me wrong, complaining is not a bad thing, we all tend to repair our wrongdoings and improve, and we hope people learn too.

But do we thank them when someone is doing a good job?

Think about it.

I think we should all be thankful. To the people around us. Towards what we have.

The above photo is an example of a typical Malaysian 'hospital meal'.

Most of my colleagues will complaint that the taste is awful, or its cold, or its meant only for patient.

THEY ARE ABSOLUTELY RIGHT!

There is no perfect meal in this world, even if there is, it's just for our temporary happiness.

I started to be thankful towards the meal that I have everyday. As I know happiness comes from within, not from external sources.

For it is not the happy people who are thankful.

But the thankful people who are happy.

FRCEM Primary!

It's set!

The pathway to becoming an emergency physician!

To cure, sometimes

To treat, often

To comfort, always

Ivan Tan

22/7/2020

Don't stop

Hey friend, I didn't know so many things happened to you until you told me just now.

It must have been a rough journey for you. If it was me, I don't know if I have the strength to endure it all by myself, alone. But I'm glad you still manage to storm thru all these.

I think the hardest part now is how to continue this windy road ahead.

Well, its really not easy in my opinion. I remembered when I was a first poster, inserted a branula was the most challenging thing for me, especially when the pregnant ladies' vein are large, and I still managed to bunk it.

But I feel the most difficult part is not bunking the vein, its the moment I decided to pick up the branula and poked it into the patient's skin.. that's step 1 for me, and I feel step 1 is always the hardest, no matter what procedures I'm doing.

Of course there are times where I will avoid doing it, as the fear of me bunking it again is so intense. But then I realized, the more I repeat step 1, the more I can progress, physically with skill, or mentally with courage.

Often I have to repeat step 1 for upto three/four times to be able to proceed to step 2, and I tell myself that's ok, because patients come and go, but my skill will build overtime.

Sometimes in ED, we have to use the ultrasound machine to guide us when we encounter difficult branula insertion, and we succeed. But come to think of it, we can succeed is not due to the ultrasound probe, but it's because we ourselves pick up the branula and insert it.

You may have stucked in step 1 now, and have tried few times, but still felt helpless. I'm sure deep inside you, you wanted to do step 1, and many of us are willing to help you to pick up the branula again, but you must insert the branula yourself.

Give yourself time, but not too long.

I'm always available.

A holistic approach

While dealing with specialist, one would usually learn more from the experienced ones.

While there are things that we often miss while dealing with patients, there are also things that is obvious but deliberately missed by us, the healthcare 'professionals'.

In the emergency department, we often tend to give treatment to patients, without explaining much to them, or to their next of kin.

The lesson I have learnt from Dr Chan Pei Fong was a valuable one.

Most of the patients need to pass urine, pass motion and some will feel hungry after more than 6 hours in the ED.

However, we often ignore them while dealing with more vital stuff, forgetting that those are the basic human needs as well.

'Patient will remember you if you take care of those 3 things, and not by how much medication you have administered to them', said Dr Chan.

This is undeniably crucial.

Those are basic human needs.

Also family members are worried too, it is our responsibility to explain to the family members and reassure them!

So yesterday I did the exact same thing, I guided a 80 years old patient to the loo, step by step, slowly.

I looked out for patients without blanket, and asked if they would like to have one, and nicely covered it on their shivering body.

I guess after 2 years of working, there is a need to revive the compassion in me.

There is no excuse to just focus on the 'important' stuff, while ignoring the 'basic' stuff.

It's time to improve!

How is my night?

Last night I was dealing with 2 deaths in red zone ED itself.

As contrary to what others believe that doctors are acclimatized to death, what I can say is, I have seen death in the past 2 years more than most people in their lives, but the scene of family members weeping in front of the cold body lying lifelessly is still not a good sight to me.

There is an old aunty who was involved in a road traffic accident, and sustained multiple extensive intracranial hemorrhage.

Her conscious level started to drop after few hours, and by evening she is already not responding to call.

'Ma, I am back to see you', uttered her son who rushed back from JB to see her one last time.

There was no response from his mother, not even a single sound, except for the constant beating sound of the cardiac monitor.

The woman died 3 hours after being sent to the ward for comfort care.

I wondered how many of us would be saying the exact same words when we are back to see our parents?

Saying it for a thousand times when they are gone does not make up the time loss when they are still around.

Another one was an Indian gentleman who has a wife and 2 children, suffered from heart attack.

We were starting chest compression from the moment he entered the ED door upto the zone itself, as he were already lost his consciousness before arrival.

He did not make it.

Heart rate and pulse oximetry not recordable.
Breath sound and heart sound could not be heard.
cardiac monitoring showed asystole (flat line)
blood pressure unrecordable.
pupils 5mm/5mm fixed and dilated.

As I penned down this routine words which is not something new to me, family members rushed in.

I did not talk to them. As I believe no words can replace a living man.

I was observing from afar, saddened by the harsh fact that we cannot save all lives, and eventually everyone will have to return to their creator.

I do not believe there is any doctors who are good in dealing with death, maybe not from my experience.

Life is temporary. Death is inevitable. 

'I am busy'

'I am busy'

Perhaps the most overused words for me, with such under rated meaning behind it.

When 'I am busy', I am spending 30 minutes taking blood from a difficult patient, with constantly cursing and screaming directly at my face.

When 'I am busy', I am tracing an important CT brain for a patient, as I am worried bout the outcome of the fall from 2 storey height that he had.

When 'I am busy', I am attending an unstable patient, whose blood pressure is constantly low despite giving high noradrenaline support.

Yet there are people who will say words like 'There is no such thing as too busy to reply a message, it just depends on your priority'

While some seem to be offended, it is actually quite true. Priority always comes first. And when you are dealing with humans who have excruciating pain, your priority is to win the deal between you and the grim reaper who wants to suck the life out from your patient.

Thus, the word 'busy' seems to not able to compensate the daily warfare happening in the hospital.

It should be replaced by:

- I was having a back-breaking call last night attending to the non-stop admissions to yellow zone

- I skipped my lunch as my 30 minutes early referral to ICU is more crucial than my rumbling stomach 

- I was late to home 2 hours as the patient decided to vomit blood and life out, right before I stepped out from the hallway

If you have been through what I have been, you will appreciate life and understanding more about suffering.

But fortunately, if you have also not been through what I have been, look around you, you should be grateful =) 

Who is your best friend?

Who is your best friend?

A question that is asked way too frequent.

The older you are, the wiser you become, and so they said, which is partially true.

As I continue to grow in the society, I realized that this question, which I can easily answered if you were to ask me 10 years or 15 years ago, is not an easy question afterall.

I have friend AAA, the friend who is aggresive in learning, believing in focusing on self, who constantly improves oneself. Whenever opportunity strikes, I am humbled to learn together alongside him. This makes him my best friend when I am learning while working.

I also have friend BBB, the friend who believes in work-life balance, the one who will not give extra effort once past her working time, which is not wrong afterall. This makes her my best friend, as she is the one who constantly reminded me of the life after work, that we do not dedicate our lives to just work, and life's too short not to enjoy with your love ones.

Not to mention friend CCC, my best friend when it comes to dealing with my hard times. He may not be physically with me all the time, but he assured me that he will be there whenever I needed advice or help. The one whom I will forget when I'm in my comfort zone, but will only remember when I'm down, and he doesn't mind!

Also friend DDD, the one who is way older than me, who constantly enjoy food all the time. I may not be a food lover, but I can't deny that sometimes a good meal with good companion is all I need after a long day work.

How bout friend EEE, the one whom I seldom meet, although we stayed not far from each other, the one who constantly shared the same beliefs and ideology, who believes in inspiring young people, our juniors, as life is not just about living with ourselves, but to interact with others.

And not forgetting friend FFF, GGG, HHH and so many more, who will only appear at certain times, a certain moment in my life, a certain place which is unpredictable, and at a certain stage of my life..

But one thing is always certain, we not only grow physically older, but our minds grow mentally wiser day by day.

Who is my best friend? This is a question way too easy but too complicated to answer.

FFXIII

Wishes can come true, but not if you just wait for miracles. Miracles are things we make for ourselves, here, and now.

It's easy to lose sight of things in a world as wide as this one, but if you keep going, you're sure to find what you're looking for sooner or later.

When prayers turn to promises, not even fate can stand in our way. We held the light of hope in our hearts, and achieve the impossible.

Now we live on, to greet a new dawn. 

Distribution of Oranges & Love

18 January 2017 - Tzu Chi Melaka have their usual weekly Wednesday visit to Hospital Melaka but this time it was special because we distributed mandarin oranges to patients in the Medical, Palliative and Oncology wards in view of Chinese New Year next week.

We visited with only 1 aim, that is to brighten someone's life up by giving hope and lending ears to those who need it. It is a skill that I need to acquire and practise in order to initiate conversation with patients, especially the non-formal conversation, asking concerns, and try not to go overboard.

In this visit, I have particularly noticed a few things that I have learnt:

1. Patients with chronic illnesses (stroke, cancer) are in despair and sorrow, we can offer them hope by reminding them of the things that the currently have. For example, a stroke patient can still speak fluently (left sided stroke will have impaired speech), or a cancer patient is just tired but free of pain and have good family support. They, just like us, need to be constantly reminded of the things that we have, rather than the things we do not have.

2. Not all patients will listen to me, it depends on the 'channel', if the topic is good, then we can talk for long, but if its not, then its better to move on. No matter how good or how well can I speak, some patients just refuse to listen, this always remind me to be down to earth, we cannot save the whole world.

3. Family members need support too! The best that we can do is to listen actively to their pleas and hardship. I knew it is not easy to take care of an adult especially if they are sick for a long time. Most of the time I can only give suggestions to them, and give them some positive inputs as to remind them of how tough and how filial they are.

To be frank, hospital visit appears to be easy but it actually requires great mental strength and motivation from the volunteers like us. The first person we must motivate is ourselves, once we are in the phase of mindfulness, the road ahead will all be laid out smoothly~ =)

Video and Photos source: Tzu Chi Malaysia youtube https://www.youtube.com/user/tzuchimy

Tzu Chi Clinic with Dr Yap

15 January 2017 - How many of you have seen a person who are well to do in the society, highly respected, and at the same time, treats everyone equally and same? Well, I have the opportunity to knew this man, Dr Yap.

Dr Yap comes to Tzu Chi free clinic on the 3rd Sunday every month with his wife to give free medical consultation services to the poor and needy in Melaka. I am particularly inspired by his attitude in life and his approach to each of his patient, listening attentively, giving respect and building rapport with his patients.

In my lifetime, I have only encountered a few person who treats everyone equally. If you are thinking whether you are the one? Try to think of the people you have seen on the street, the cleaners, the security guards, lecturers, professors, doctors, nurses, bangladeshi workers, the auntie who sells lottery, the uncle who sells tissue and the young Indian boy who sells kacang putih, do you treat them all equally? Yes, I do, and Dr Yap is also one of the people who does it.

Today I have learnt the technique of ultrasound to visualise a uterine fibroid with his guidance. He told medical students like us that it is always a need to treat the patient as a whole, to detect their underlying problem and not just the presenting complaints.

His humble personality and his openness to approach to medical students like us made me feel that there is still hope in the doctor's world. Doctors who are highly educated are not all arrogant and egoistic, he is one of the exception.

I am always grateful that I am exposed to Tzu Chi in Melaka early. The experiences I have gotten so far, made me a stronger person in life.

Visit to Nazarath Home

11 January 2017 - Starting the year of 2017 (Year of the Rooster) with this new post! How time flies~ I started this blog 10 years ago in year 2007 to describe my experience during one of my St. John duties in Stadium Perak. Link below:

http://ivantan5.blogspot.my/2007/08/thr-raaga-concert-duty.html

How much I have grown, physically and mentally 10 years ago compared to now. One thing is for sure, I am becoming better and better day by day. I wonder how will I be 10 years from now? Will I still be able to maintain my current personality to adapt to the challenges in the near future? Only time will tell~ =)

I joined my college student council family to spend my Wednesday evening in Nazarath Home, an old folks home cater to the poor and needy in Klebang Besar, Melaka. I always love participating in events like this, events which keeps me in touch with the people of the neglected society.

There are 43 students, mostly from BDS (Dentistry students) in which some I have knew them earlier (Melissa, Abok), and fortunately, both my groupmates, Izzul and Wei Hoong were there with me too, if not it must be awkward to be with so many people whom I have not known. Oh, Ian was there, a good buddy of mine who carried his guitar and played the carol songs for the people there.

Some people joined because they wanted to bring joy to others, but for me, it works both way. I realised that my communication skills in approaching strangers is improved this time, I am able to initiate a smooth conversation with the people, thanks to my professor, Dr Ng Sin Hui who always demonstrated to me the art of communication in the hospital wards. Thank you Sin Hui (if you're reading).

Visit to homes always makes me grateful, not only for what I have physically, but also constantly reminds me of my peaceful state of mind, undisturbed, unaffected. The people there have different stories and different experiences in life, some speaks for us to listen, while others actually speaks for themselves with us as listeners. I feel that the only way to get in touch with the people is to actually go to them and understand their story, not to comment nor suggest anything. It is through experience that we keep ourselves on our toes all the time~ =)

小明拔牙记

24 November 2016 - It was a usual Thursday afternoon when my class ended early at 3.30 pm. In view of my free time, I went to the dental clinic in my college for a check up on my supernumerary tooth (an extra tooth which grows out of proportion in the oral cavity) for the first time.

Upon arriving, I had a normal check up by the dentist on the ground floor of the clinic, Dr Raeshma. She noticed that one of my molar tooth (wisdom tooth) is slanted and decayed. I was shocked and surprised at the same time, how could my wisdom tooth decayed without any symptoms, I was talked to myself. After that, she referred me to 3rd floor for 'further evaluation', which I thought is great.

However, when I arrived, there are so many dentistry students there, some of them were the ones I knew like Yi Wei, Chopper, Kit Yee, etc. The feeling is strange because I am meeting them as a patient rather than as a friend. Each of them wanted to have a look at my tooth condition, which I happily agreed, because I understand, yes, I understand the feeling of an eager students who wants to learn.

Since my case is just a normal tooth extraction, the dentist there advised me to do it on the same day itself, I agreed. The guy who gave local anesthetic to me is a first timer, with his seniors teaching him how and where to inject the 2% lignocaine. I personally have no problem with it, I don't mind being a subject for learning, as I recalled the situations where I gave my first injections, first cannula, first glucometer, etc, but I can't deny that I was nervous, not because of pain, but simple just nervous, because this is the first time I am actually seeing a dentist for my oral hygiene.

Andy, a year 4 dentistry student started the procedure, with his juniors surrounding me. They were speaking in their dentistry language (bucker tooth, tooth 1-8) and as usual asked me not to be nervous, I finally knew the real feeling of being a patient and surrounded by so many enthusiastic students at once. However, Andy could not extract the tooth out, and had to called for help from Chopper, a final year student. After much effort and swapping of instruments, changing of maneuveres, he could not remove it too.

I was checking my pulse rate at the same time and I had tachycardia because of the long procedures. I thought mine was an easy case, but when they finally asked the doctor for help, I knew something must be wrong with my tooth. After an hour, the lignocaine effect starts to wear off and I can feel mild discomfort, and with much effort, the doctor removed it and it was found that the root of my tooth is bend to 90 degrees, that explains the difficult procedure. The entire procedure took more than an hour, but I knew it was not their fault, as my wisdom is not like the rest, wisdom tooth I meant.

I personally wanted to thank all the dentistry students and dentists in the dental clinic for their hardwork and because of me, they have to work beyond 5 pm. I decided to blog this because the experience in the dental clinic is so new to me, and I am able to really feel what it feels like to be a patient myself. At the same time, I would also like to advise those who are reading this to have a regular dental check up because who knows, you may detect a big problem early! :)

Segamat

23 September 2016 - Going to Segamat, Johor for my 1 week labour posting is definitely an enriching and memorable one~ =)

MMMC (Segamat Campus), actually it's just shop lots~

Days before going to Segamat, I was worried, mainly because of the current comfort zone in Melaka I have been enjoying all these while. I need time to adapt to a new environment (I guess everyone does), and going there for 5 long days means no aircon, no good food, no friends and no comfy bed.

Main entrance to Segamat Hospital

I was driven here not only by car, but also by the positive feedbacks I got from my friends and seniors from the experiences they had in Segamat Hospital. On the first day itself, I examined a placenta with the guidance of Staff Nurse Tay. I can feel the soft and bouncy consistency of the placenta along with its umbilical cord.

Examining the placenta (more like washing vege)

Fortunately, there are 2 other friends from Batch 32 who came for labour posting as well, and they are Wei Ling and Fatin Shahira, so it means we have female chaperons to facilitate in procedures and also for permission to observe some obstetrical procedures, YAY! As males, Yong Jin and I faced many rejections in the O&G postings (in Melaka Hospital!) even to see some basic abdominal ultrasound scans~ =(

The 4 of us sticking together all the time~

First day of posting is on a Sunday, since the official working day for Johor starts on that day. Nevertheless, we stayed until 9 pm to watch the last emergency LSCS (lower segment caesarean section) to sum up our day! Felt so occupied and tired for the day but we have definitely learnt a lot compared to Melaka.

The rest of the days in Segamat were well spent, with the exception of me going back to Melaka for portfolio defense on Tuesday and coming back on the same day ~_~

The dorm view from my bed

For our stay in Segamat, we are granted a dormitory which is actually modified shop lots few minutes away from Segamat Hospital. There are various students from other postings who were staying with us too. The ground floor is the male dormitory whereas the 1st floor is for females. There are also washing machines, clean toilets with functioning heaters for bathing purposes and a study room with aircon for us.

Guess what is my bed number ;)

Frankly speaking, the dormitories are quite stuffed up and it gets warm at night. This condition also favours some blood-sucking visitors to drop by and feed on us, they are none other than the cute cute bloody mosquitoes x_x This reminded me of my time when I was staying in an old hostel room in Tagore hostel, Manipal. I told myself that I have survived that hostel for a year, and now these temporary uncomfortable-ness are just tiny challenges in life~ =)

Dinner at Kampung Cafe

Food in Segamat is good. There are many hawkers centers around and also some nice cafes nearby. The cost of living there is lower as seen by the price of the food. A plate of chicken rice costs RM 4 while in Melaka, it easily costs more than RM 5. For the first 2 days, Yong Jin and I were just roaming around during meal times to explore the unexplored areas LOL. On the 3rd day itself, we had dinner with Wei Ling and her friend, Kah Suen who is in Anaesthesia posting.

Aircon study room, time to take a nap!

Some new friends I have met in Segamat:
1) Wei Ling: With the surname of Lee, she is one of the person from Batch 32 whom I know she exists but I don't know her personally before this. Quiet and shy at first but friendly, approachable, and straight-forward when we get to know her. Laughs a lot. Laugh threshold moderate.

2) Kah Suen: Knew her since first year because of Chin Leong. Can laugh suddenly walao, without any triggering factor or stimulus. Laugh threshold lowest among humanity. But as future doctors, we don't discriminate our patients friends~ jk

3) Fatin: She is a proactive person and a learner. Even with 3 of us as Chinese friends, she doesn't isolate from us much. She even remembered that the first time we met was in Kochi, but as usual, I couldn't recall my first encounter with people that I'm not close with LOL

4) Leon: He is a final year medical student from Monash, based in JB. Serious looking at first but is approachable and helpful at times.

5) Dr Cheong & Dr Woo: Both of them are housemen graduated from MMMC Batch 25. They totally understood the pain of having a portfolio that need to be filled by doctors (if you get what I mean). Dr Cheong is good in his CME presentation, with adequate medical knowledge, he knows what he is presenting and is able to answer questions directed to him. Definitely one of the person I am going to look up to!

6) Hasif: The one who slept beside me (not on the same bed). Super-friendly and is willing to share his experiences and advice to me all the time. He is from the same batch as me but different class.

Oh and did I mention the super cool UD52 O&G specialist I encountered on the first day, Dr Arivendran. With a stylish classical maggi hairstyle, hawaiian shirt, bluetooth headphones on his neck and a croc slipper, he just go for ward rounds as usual with his soothing English accent~

Definitely one of the place I will miss~ 

Experiences in Segamat is one that I have learnt the most in my O&G posting. I managed to get hands on to conduct the 3rd stage of labour (placental delivery), perform a PV examination to look for cervical dilatation and effacement, and many of the practical things I am only able to get from textbooks if I were in Melaka.

Went through ups and downs, thick and thins, thank you guys~ =')

Thank you to all who have guided me this far. I am currently in my room in Melaka, enjoying the chilling aircon and back to my comfort zone~ =)