Shopping in UK

Shopping in UK is never a good idea to spend your leisure time, is not a good shopping spot for the shopaholics either. But i still took some time to shop with my mum when she was here with me for the first month. Some of the items are consider cheap and quite a good bargain to buy it here and some are totally scare you away from buying it after looking at the price.
After spending 8 weeks of life in UK, what have i bought?

1)The most important one, to get my self a mobile and sim card in UK.
£29.99 ( mobile phone costs £19.99 + £10 of credit for my simcard) ~RM189
The phone i got was a simple one, sony ericson W200i with inly 256MB of memory.

2) Londsdale sport shoe. I bought it simply just because my mum was getting my two bros a new pair of shoes, and i wanted too.
£ 10 black leather shoe, consider very cheap liao. ~RM63
Buying sport shoes here is really o smart choice especially for those branded ones like nike or adidas, it is much much cheapier here. do you want me to get one for u???

3) of course i need to get my self a pillow and duvet cover la. i didnt bring it from msia as my luggage was fully packed with other stuff. I bought two here from ASDA ( a very big hypermarket in UK other than tesco), one for spare.
They cost £13.50 for 2sets. ~RM85

4) A pair of beach sandals. i didnt bring any sandal or slipper when i came as my aunt told me that it was very cold and nobody would ever wear sandal out. But i am getting myself one as the weather was turning better as now is the spring season. Spring in wales is just like weather in genting or cameron, very windy and nice.
£0.99, yup it only cost me 99pas i bought from the 99p shop as it is for children but it fits my size nicely. i think most of the asian can try to find their clothes and shoes in the children department if they cant find any in the men or ladies department.

4) A mini shinny bling bling purse for me to store coins. people in Uk use coins more common than notes. and this purse was only £1 but the key chain with the letter "J" was more expensive, it was £2. i bought it from portsmouth when i visited there with my uncle's family. ~RM18.90

5) A nike cap and a pair of gloves. I am not a pinky girl, pink is not my favourite but i bought these pink gloves and cap partly because they are cheap and i need them.
Cap £4.99 and it was made in Vietnam. ~RM31.40 at that time i finally understand why vietnam can produce cheap pirated nike jersey as the manufacturer is there.
Gloves £3.99 ~RM25.13
6) An umbrella that cost £99, i bought it at the same shop i bought the children's beach sandal. ~RM6.23
7) Body moisturizer, a very imporntant things to me as for the first few weeks when i was here, i developed snake scale skin due to the dry weather. as a result, i decided to buy myself some body lotion. i think this is the best and cheapest i can get. it was only £5.00, ~RM31.50


8) I am a bags collector as i like to collect bags. i would always change my bags and bringing different bags since my secondary school. i made up my mind to get a bag in uk as well and i chose this blue bag pack and i really like it a lot as i am bringing it everyday to the hospital. It was £8, ~RM50.4
My parents especially my dad would scold me if he see this post as i am spending money for shopping in UK... But i am spending it wisely after taking into the consideration that i really need them. I think i spent even more on transport fees, bus fares and train tickets. i would need to spend ~£9 per trip from my uncle's house to singleton hospital if my uncle is not working. further more, because of my toothache, i spent another £12 to do a dental check-up and i will have to pay £39 for the dental surgery to extract my tooth as there is abscess in my decayed wisdom tooth.
钱不是万能，没有钱万万不能。I am spending all my money just hoping to get more clinical experience and i think it's really worth it as i am gaining a lot. I shall share it in my next post.

Things that i treasure the most at this moment

Due to limited luggage weight, there's nothing much i could bring over from malaysia. Other than daily necessaries, i purposely brought things that given by my good friends and family. Now, it's my time to share what are the things that i treasure the most.

First and foremost, my coat was given by my dearest papa. It gives me warmth when i m cold. It was very useful when i first came to UK as that time was still late winter early spring. Thanks ya, my dearest dad and happy farther's day.


Next, is my lovely crystal given by my mama. The purple crystal bracelet was said to give you energy of wisdom and the yellow "hu lu" pendant was said to give me energy of good health. My mum is a person who believes in all these feng shui and crystal energies. Thanks ya, mama. I will take care of myself and not to worry too much.


Then, this is my mini jay chou 2008 calender given by jay, my brother. he knew jay chou is my idol, he purposely bought one for me, i was so touched... i pin it in front of my desk so that i can look at my idol everyday. thanks ya, flyoo's boyfriend.

this cutie buddha meditating laptop skin was given by my xiaodee. he bought it as he accidentally scratched my laptop surface. i like this laptop skin because it shows the enlightenment of the buddha, whenever i look at this picture, i feel i was enlightened too.

This picture was taken in th Buddhists camp last year. i had a lot of memorable moments with my dhrama pals. and thanks to the juniors that developed the photo and gave it to me. i miss u guys.... sadhu...
this watch was my 21st birthday present given by my good friends in imu, i really treasure it a lot. by wearing it everyday, makes me feel that this group of friend are spiritually with me. Thanks ya, my good friends...


Lastly, this mini buddha statue was bought in an international Buddhists forum. i place it in front of my desk as well but most importantly the buddha is always in my heart. may the dharma shine in me... sukhihotu...

感人故事

截至5月22日10时，四川汶川大地震已造成51151人遇难，288431人受伤，累计失踪29328人

1) 7天仅吃半张卫生纸
　　5月20日凌晨4点30分，急救车将一名被埋170小时之后获救的村民送达第二军医大学长征医院医疗队实施紧急救治。抢救的专家们当即到位，并组织会诊。 经各项检查结果显示：监护仪、生化等病人的关键指标都相对正常，生命体征平稳；心跳、呼吸正常，血压139/100，偏高；神志清楚，对答准确。
　　记者昨日来到设在安县中学的第二军医大学长征医院野战医疗点，见到了彭国华。他经过军医抢救后，已经脱离了生命危险。他告诉记者：自己能够维持现有状态，是因为一直坚信自己能够活下来。
　　彭国华说，他带进去的一支手电筒、一块电子手表发挥了关键作用。电筒提供照明，一直到他被救出，还有余电；手表一直给他提供准确时间。
　　5月12日下午2时28分左右，他进洞准备放置爆破的炸药，他听到一声闷响，洞口一黑，他知道发生地震了。
　　彭国华说，他在离洞口12米远，80cm×80cm范围的矿井空间中生活，里面一片漆黑。头两天一直躺着。第三天开始喝自己的尿液，一次只喝一点点，他一直坚信会有人来救他。第五天是最艰难的时间，他感觉很饥饿，开始吃身上带的半张卫生纸。当时他的信心有点动摇了，特别是第六天(5月18日)晚上产生一次比较明显的余震，他更加担心因为余震有危险，外面的人停止营救他。但是，他还是没有放弃，强烈的救生意志使他振作。第七天早晨，他终于听到洞口传来挖掘机的声音，再后来，他又听到了弟弟的呼喊。他想答应，但已经没有办法做到。
　　昨日下午，在彭国华的病床前，他的亲人纷纷闻讯赶来看望他。他的妻子文友会亲昵地靠在他的脸旁，给劫后余生的丈夫默默传递温情，这一画面很感人。
　　记者问彭国华有什么感受，他回答说，活着真好！

2) 100小时——“喊”回来的一条生命
“小心他的头！抬起来！用力！注意左边！好！好，出来了！”5月16日下午6时30分，刘德云在被困100小时后，被从废墟中救出。
　　当天下午1时，空降兵驻开封某部队营长孙念安在德阳什邡市红白镇的一处废墟上搜索。他不停地冲着废墟大喊：“有没有人？底下有人吗？”
　　“有。”废墟下传来微弱的回应，孙念安有点不敢相信，“通过对话，我们发现被困住的人思维还很清醒，说自己是来做生意的，已经被困4天了，讲话声音还很清晰。”
　　刘德云被困的五层大楼，地震过后，已不足三层高。救援中，为了确保幸存者的生命得以继续，战士们不断对他喊话：“你要坚持下去！”
　　16日下午4时，战士们辟出一个仅容两人容身的空间，继续向下开进。
　　有战士问刘德云：“能不能看到光？”刘德云回答：“能，我能看到你们。”“营救人员根据他的回答分析出具体位置。由于一个横梁死死压住刘德云的左脚，被压住的左脚已经组织坏死，消防战士对其进行了左脚自脚踝以下截肢。两三分钟后，被困100小时的刘德云重见天日。

3) 手术时突发地震 医生背起病人就跑……
5月12日14时30分，四川省成都市二医院，心内科手术室，一台“心动过速手术”正在紧张进行，患者是73岁的胡俊卿婆婆。突然，室内一片黑暗，监护仪黑屏，“哗啦啦”一声巨响，手术器材散落一地。“地震了！”医生张文勇迅速拔下多根导管，背上婆婆就往楼下跑。
　　此时，整栋住院大楼里面，医护人员们来来回回，背、扶、抬，撤离重症病人。王副院长扯着嗓子喊：“各科室的医生，在天黑之前赶紧抢出病案，医疗不能终止！”内科区、外科区、紧急救援区内一片忙碌，穿着白大褂的医护人员穿梭在各病床之间，输液、缝合、打针、安抚惊魂未定的病人……
　　外科救助区里，35岁的罗大鹏守护着熟睡中的妻子，忧心忡忡：“一个小时前，她为我生了个女儿，这么一折腾，不知道伤口受影响没有？”而他的女儿，正挥舞着粉红的小拳头，好奇地打量焦虑的父亲。小家伙刚到人世，她不知道自己刚才经历了一场如何惊心动魄的“生死大转移”。
　　二医院院办秦主任介绍，地震发生后，该院在院坝中紧急成立了“临时指挥中心”，后勤组负责发电、搭建雨棚、准备急救药品；救援组负责撤离病人，确保病人继续治疗。截至当天15时20分，全院近900名住院病人转移到院坝上的“临时医疗点”， 无一病人在地震中受伤。

Acute toothache

I have been suffering from this gum pain since sunday. the pain was unilateral, right sided, comes and goes. it radiates from the gum near the molar teeth, spread along the muscles of mastication to the temporo-mandibular joint. the aggravating factor might be opening and closing my mouth as i am using my facial mucles. the pain was suddenly very intense on tue evening. i tried to take 600mgm of paracetemol at 7pm to relieve the pain but it didnt work. then, i looked into the mirror, there were no ulcers or redness on the buccal mucosa. it's unlikely to be an oral infection. after discussing it with my friend, according to his expereince, it was likely to be an eruption of my wisdom tooth that causes all the pain. however, i checked on line, the normal age for wisdom tooth to grows would be age18-20. I am too old to have one now.
finally i decided to consult my uncle about it. we both came to a conclusion it was most probably due to the eruption of my wisdom tooth as i havent had one yet. the only advice he could give is to take some pain killer to relieve it and try to see a doctor tomorrow. that night, i took 1200mg of paracetemol and it worked. (the max dose is 2000mg in 24hr)
the next day, i went to see a GP. my first time seeing doctor in foreign country. she was kind and she tried to checked whether was there any abscess. obviously, she couldnt find anything and she asked me to see a dentist. The major difference in seeing a doctor and seeing a dentist is seeing the doctor is free of charge and seeing the dentist is costing money. that was why i didnt go see dentist in the first place and hoping that the doctor would offer some help.
unfortunately, i have to see the dentist. i went to the dental clinic on the same day to make an appoitment. i was told that they charge £30 for an emergency appoitment since i had an acute pain last night. i nearly faint after hearing that figure, as it means it will cost me rm200 just to get an appoitment. the earliest normal check-up appoiment, with no extra charge would be somewhere in end of june. i got no choice but to make an appointment that time on fri morning.
i was still having the pain sometimes in these two days but it was mild. as a result, i went to cancel my appointment. just so happened that they have a slot for normal check up appointment next fri noon. so, i decided to change my appointment to next fri, as the consultation fees for normal check-up vary from £12-£39 depending on what the dentist will do.
i do hope that there would not be other complications or dental problems that cause the pain. i shall wait until i see the dentist...

China mourns as death toll rises

China today began three days of mourning with a nationwide silence at 2.28pm (7.28am BST), precisely one week after the 7.9 magnitude earthquake struck.
It coincided with an announcement that the official death toll had risen to 34,000 and news that 200 rescue workers had been buried by a number of mudslides over the past three days in Sichuan province.
Air raid sirens and horns of vehicles, trains and ships marked the end of the three-minute silence and national flags flew at half-mast across the country and at Chinese embassies worldwide.
All internet entertainment and game sites have been taken offline and users redirected to sites dedicated to commemorating earthquake victims, the Chinese news website sina.com reported.
Beijing Olympic organisers said the torch relay - due to reach Sichuan next month – would be suspended for three days "to express our deep mourning to the victims of the earthquake".
The confirmed death toll from the quake rose to 34,073 and the council - China's cabinet - said 220,109 people were injured.
Officials said the final death toll was expected to top 50,000.Rescue work has been hampered by a series of aftershocks and landslides.
The state news agency, Xinhua, quoting a Sichuan provincial official, said workers had been buried by mudslides while repairing damaged roads.
The official gave no death toll but said three of incidents took place in Yingxiu, close to the epicentre.
Rescue attempts elsewhere were given impetus by the freeing of a handful of survivors.
For further details, please go to http://www.guardian.co.uk/world/2008/may/19/china.chinaearthquake

I find myself very useless as i was worrying of myself these few days. Instead after watching the video about sichuan earthquake that i have just downloaded, i really think that my problem was not a big deal as compared to them.
They had lost their house, most importantly they might have lost their loves one. Children might have lost their parents, becoming the orphans. People who managed to survive may become immobile as a result of severe injuries. Even if they managed to run away from the disaster, they have so much problems in hands. Where to find shelter? Where to find food? Where to find water? Lastly, where to find their family? I do not what i can do to help them at this moment. But i do hope metta radiation would work this time. I sincerely wish them from the bottom of my heart:
May they be well and happy...
May they be free from physical and mental sufferings...
May they be calm and peaceful...
sadhu...

I am on my own

I have been describing myself as a lonely person these few weeks. I think i have to wake up and step forward. Loliness makes me feel weak. I dislike myself in this way, being lazy and so demotivated. the path is tough, i 'll have to struggle to reach my destination. Being alone is a fact, but i can view it positively. I should say: "I am on my own!" It has the same meaning but it gives me more courage. There is no way i could advance if i keep my self alone. But if i make the first move on my own, i believe that i would gain a lot more. I have to unseal myself.
J.J.Tan, open up your mind and your heart. The path is long and I have faith in you.
Today is a good start and keep it up. Jia you!!!

May I be well and happy

May I be free from physical and mental sufferings

May the dharma shine in me...

Sadhu Sadhu Sashu...

Happy Wesak Day

在这条路上，我好像迷失了

第一届超级星光大道冠军得主林宥嘉曾经说过：“当梦想越来越近， 就会容易迷失方向。” 现在， 我终于了解这个意思。 因为，在异国的六十七天里，我的确向着自己的目标， 一步一步地靠近，但也渐渐的遗忘了曾经的坚持。随着日子一天一天的过，懒散的基因漫漫的渗透进身体的每一部分。当初的意志也越来越薄弱了，开始怀疑这条路我选对了吗？
在过去的两年半内，不管考试多么的辛苦，我从来也不曾埋怨。心里的天使逐渐成长，促使我相信自己的选择是对的。这条路虽然难走，但我走定了！然而，一个人离乡背井，傻傻的走着这条路时，对自己的怀疑也越来越多了。身边的每一个人，都是走着这条路的，但原因和背景都大不相同。我开始惭愧了，凭我现在的能力，拿着政府奖学金，是不是在浪费纳税人的钱？心里的魔鬼开始嘲笑自己，高估自己的天分，没看清眼前的事实，往往总是把世界想象得太简单，太美好。这个时候，人类的自然反应就是逃避。我开始不断的自我催眠， 自我放纵， 为自己制造不同的借口，一次又一次的让自己停滞不前。难道身边没有同伴的关系吗？没有人提醒你，没有人鞭策你。回归到原点，只能怪自己的意志力不够坚定。
对这条路提出怀疑并不是不好，可是当你只有一个人的时候，像破了头，也得不到问题的答案。只能选择逃避，肩上的担子越来越重了，感觉再也撑不起来，开始怀疑自己，在何年何月何日，我的信心才能回来呢？一直以来在你身边的人，此刻都远在他乡。亲爱的家人，敬爱的老师，可爱的朋友，都曾是我身后的靠山。如今的我，就像大漠中的沙，散散的，难以凝聚，随波逐流。
我清楚，了解，明白我要坚定，保持清醒，从这团迷雾中找到出路。迷失了并不可怕，只要不放弃，在大漠中，我也能成为一棵屹立不倒，茁壮成长的仙人掌。
明白归明白， 现实是残酷的。我正在寻找正确的方向，我不可能回头了，我要向前，只是我还在徘徊。因为我不够坚定，我需要巩固我的意志，强化自己，才能在迷失的这条路上，把梦想捉住，把自己的天使找回来。
我，要相信，我自己。

Medicine is a business

In my opinion, medicine is always a service, a health care service.
But, nowadays, the drug dealers have made medicine into a business, a potential profitable business. Why would i say so? It was because the drug dealers are so creative in promoting and advertising their company, and also their products. Their would distribute some free gifts that have their company or drug name printed on those items.
Now, i would like to take this opportunity to introduce you the free gifts. Then you would know how creative they are.

1) PEN, the most common fee gift given out by the drug companies. All doctors and nurses need to use pen everyday for writing and recording. So this is the easiest way to promote their products as other health care workers would know when their colleagues are using it.

Types & examples of pen:


(A)the pen is not a normal pen, it is a "bi-cranial" pen as it has two heads. One head functions as ball pen the other head functions as highlight pen. Very smart la, the designer... But blue high lighter is not a very good choice....

(B) this is a yellow high lighter but then the design of the cap is very special. It is a hooked cap. The blue thingy on the cap can be opened and you can hook the pen on your stethoscope.

(C) I know u have heard of 2 in 1 shampoo, but have u seen a 2in 1 pen? The pic shows an orange highlight pen with a space that keeps mini sticky index pads at the end of the pen. Can you see the strip of orange paper? That's the mini sticky... Super creative lei....

2) Sticky note pads- the second most common free gifts. Other than pens, these sticky note pads are widely used in the hospital especially when one needs to leave a message to his colleague on the patient's documents.

3) Can you figure out what is this? It is called a clip dispenser. The white thingy on top are the clips. The transparent holder with blue button is the dispenser. I would never thought that a drug company would spend money to make a clip dispenser as free gift. It doesnt look cheap to me...

4) Last, but not least, in such advanced country, there is no doubt that their free gift would be more high tech.... Look, i got a 1GB pen drive here. Haha. It came with the beautiful box... I think this is the most precious gift i have ever got from the drug company.

I got all these items when i attended the seminar or talk or meeting held in the hospital. the organizer would normally invite one or few drug companies to come and promote their product. they are not only competing in the sales of the drugs but also the creativity in making free gifts. I am impressed with their creativity... Salute...

My first day in Singleton Park

There was a park behind where i stay. A super big park that has several gardens, it's called Singleton Park. I like to spend sometime to jog or walk there. This park has tall trees and green grass. The gardens have pretty and beautiful flowers.


It was so relaxing when u get the chance to stay so close to the nature after a long busy day of learning in the hospital.

The local people would always like to bring their puppies or dogs to the park. Some teenagers would like to ride on their bike and cycle on the path in the park.

On the first week when i was in Swansea university, i have decided to explore this park. i admired my own courage without knowing what place i would go to as i only knew there were a lot of people going in and out through that entrance behind Cefn brynn. i didnt even know it was a park in the first place. out of curiosity, i brought my mobile phone and started my music player and set off to the park.

i followed and walked along the path in the park without knowing the direction, just simply took a junction because i thought i could find my way out by following the way i took in. i reached a point which i could see a big land of greenish lawn. i walked away from the path towards the middle of the lawn. Wow!! for one second i thought i was freed, just like a bird in the sky, walking happily on the lawn with my favorite songs playing from my phone.

all of a sudden, i could feel something push me on my bum. i was shocked and thinking of who would be the one behind me. i dun know any friends yet that dare to crack a joke on me by touching my bum. normally if someone were to push u down, they normally push your shoulder to make u lose your balance, not your bum. i quickly turned and.... i saw a dog. What a relief... at least it's not someone ham sap.

the dog is a golden retriever, according to the owner, it's name was leo. Leo was only 1 year old. but, he was as big as a mature dog, strong enough to jump and push me down. Leo was playful as he kept chasing me when i tried to walk away from him. the owner eventually tied him up since i was so scared that Leo would bite me. after that, i had a nice chat with Leo's owner. she's a midwife working in Singleton hospital as well. We started to talk about the hospital and the doctors that we knew. Apparently she knew my uncle. ( i didnt know he was famous in antenatal department.)

she introduced the park to me and said that it was larger when she was young. but some part of it was developed into housing areas. she recommended the botanical garden which i didnt get a chance to see yet as it closes at 6pm and i normally go for a walk after that time. at the end of our conversation, she showed me the way back to the university.

and now, this park has become my favourite spot for me to "lepak" (a malay word that means wander around) during my leisure time.

周杰伦- 千山万水

作曲：周杰伦 作词：方文山

千山万水 无数黑夜 等一轮明月
梦的边陲 风吹不灭 从不感疲惫

东方无愧 第一是谁 让我们追求完美
我态度坚决 面朝北 平地一声雷

做好准备 这一回 起跑后绝不撤退
痛快一起 努力 的感觉
我们拥有同样的机会

梦想挟带眼泪 咸咸的汗水
你我同个世界 爱从中穿越

梦与希望在飞 我向前去追
有目标就不累 等着我超越

远远抛开一切 过千山万水

Cases in surgical posting

I was too addicted to the korean drama series and taiwanese programme for the past 3weeks and totally neglected my blog. Despite being in the paediatric department this month, I was busy with the research data entry and doing my own private study. Now i would like to present the cases i have seen in my previous posting- the surgical department. To be honest, surgery is not my cup of tea, i have chosen it to be my second posting just because i think i need to go but not that i am interested to go. We have early surgical ward round, normally it ends within an hour, it was boring and less busy as compared to the medical ward. The more exciting part for this posting would be going to the operation theatre.
For the first time i knew i could go to the OT, i was excited. I have been looking forward to see surgical cases, eg: cardiac bypass, thyroidectomy, nephrectomy, colectomy, gasterctomy, appendectomy, cholecystectomy, hysterectomy... however, i knew the surgeon i was attached to was a general surgeon, i woulndt get to see neuro-, cardiac and orthopaedic surgeries. He's Mr JB and he would only deal with surgeries that involve the lower GIT as he other colleagues would cover the other surgeries as they seperate their cases according to the parts in abdominal caivty that they deal with. So basically i have seen loads of lower GIT and pelvic surgeries last month.
The main diffenrence between attachment of medicine and surgery would be you dont normally know what the patients come in for, coz their surgical date was pre-arranged weeks or months ago in the surgical clinic. So the history for the following cases that i am going to present may not be very complete or accurate.
1) A 80y/o men, came in to the theatre for chronic abdominal pain. Abdominal X ray was taken and the colon was noticed to be dilated. Other investigations have done to find out the cause of his colonic dilatation but none was contributory. The surgeon wasn't very keen in doing surgery on him as he was old and might not have good prognosis after that. However, the patient himself insisted to get rid of the pain by removing his colon. So on the 1st may 2008, which was the first day of my surgical posting, i witnessed a total colectomy that took two and a half hour. The normal diameter for colon is approx 5cm and his has gone beyond that, approx 8cm and was really super dilated. The surgeon has made the diagnosis of pseudo-obstruction after looking into his abdominal cavity and removing his dilated colon. he took the picture of it as he said he doesnt normally see this size of colon as according to his experience, he's only seen 2-3 cases per year. there was no organic cause that can explain his dilatation and this gentleman was sent to the ICU after that. However, his pain did subside but he was on a slow recovery. He was admitted to the ward for the whole one month and when i have left to the paeds department on 1st june 2008, he wasnt discharged yet. Coz in between his admission, he developed pnemonia and couldnt eat well after the surgery. I sincerely hope he's getting better although i do not know what happen to him after that.
2) Middle-aged men, who came in for right hemicolectomy as there were two large polpys in his caecum on colonoscopy. After removal of his caecum and rt colon, an ileostomy was formed in his right iliac fossa. A hole was cut across the skin and abdominal muscles, to let the terminal ielum to pass through. The terminal ileum was brought out to the external surface to prevent the enzymes from digesting the skin and an ileostomy bag was stuck onto the skin to collect the faeces. The rt colon that was removed was cut open, and the two polpys were seen, and their size were >2cm. the surgeon thuoght that they were adenomatous polpys and cancerous. it was a right choice to remove it before it was spread to the lymph nodes.
3) 40+y/o M, who came in for a sigmoidectomy as a mass was found in his sigmoid. it was supposed to be a simple surgery but unfortunately the surgeon found an adhesion between the spleen and the colon. He wasnt sure that was the mass extending from the colon or it was just an adhesion as a result of scarring. the spleen was known to be the a very fragile organ in our body and it could rupture very easily. while the surgeon was looking at the spleen to look for any scarring or infarct, somehow... i didnt know how it happen... the spleen was torn, as i didnt dare to question the surgeon. it was happened within a second... blood flew out from the torn spleen and suction was required. the surgeon had no choice but to remove the spleen. on removal of the spleen, an infract was noticed on the parenchyma of the spleen, that might lead to healing, scarring and further adhesion of the scar to the colon. then, the surgeon worked out on his sigmoidectomy. after removal of the sigmoid, a colostomy was formed on his left iliac fossa. as opposed to the ileostomy, colostomy was flat. a hole was cut and the colon was stitched onto the circumference of the hole. similar to the ileostomy, a bag was tuck onto the skin to collect the faeces. before stitching back the midline scar of his abdomen, the surgeon tried to cut a small piece of the normal spleen to implant it onto the omentum. hopefully, the implanted spleen can still carry on with his normal functional reticuloendothelial system. anyways, this patient has to take life long antibiotic as a reslut of splenectomy and anticoagulant to prevent thrombus formartion after the surgery. poor thing....
these are the major cases i have seen and i think it's worthwile to share with my fellow colleagues. the other surgeries are incisional hernia repair, partial spincterectomty/ anal fistula treatment, biopsy of anal intraepithelial neoplasia, laparascopy, laparotomy, stoma repair... i was once very kei poh, went down to the theatre even Mr JB was not around, the nurse was kind and brought me to the other theatre to see mastectomy and axillary lymph nodes excision. that was a bonus to my surgical posting. email me if you are interested in knowing more on other surgeries as this post is already quite long. hope u enjoy reading it.

Cefn Brynn 409

Cefn Brynn is the name of the building, 409 is the room number.
In short, Cefn Brynn 409 is the place i live in swansea.
This is my room. A room of freedom, a room of happiness, a room for dining, a room for studying, a room of sleeping & most importantly a room of myself.

It has 4 walls, 1 ceiling and 1 floor.


Now introducing the 1st piece of wall.
There were bookshelves, a study table, a chair, a fridge and drawers. I put my books on the bookshelves. they were all given by my uncle, i only brought mac cleod. I keep all my food in the drawers. I have a picture of jay chou in front of my desk & another group picture of buddhist camp. regret not bringing my family pics. sigh...

Next wall, the wall of entrance.
The door is opened into the room and i have my personal basin with two water taps. One for hot and one for cold. The drinking water can just be obtained directly from the cold water tap. However , the hot water is not drinkable. Drinkable hot water can be taken from the common kitchen. I can do simple washing & cleaning in my room, eg: wash my face, hands & brush my teeth. And there is a small piece of mirror on top of the basin.

The next wall, i have my wardrobe, a cushion chair which i use to put my clothes and a bed.

The last piece of the wall, it's a big window covered by the blue curtains. I have a radiator, the white thingy on the left of pic and ot's partly covered by my bed, which is functioning only when the weather is cold. My bed (with the pillow & duvet) were pre-arranged at the side of the window.

Dang dang dang dang... this is the view out of my window. The view of swansea university. Where is Singleton hospital? It is on the right side and cant be taken seen from my window. Too bad...

Oops, i miss out the ceiling & the floor. there's a fluorescent light on top & no fan or air-cond in the room. The natural air is the air-cond in this season. I think most people will get a fan when summer is coming. The floor was carpeted and it's nothing special.

So basically this is where i live!!!

What anaesthetists do???

I am attached to the surgical department in may 2008. As a result i get to see how the anaesthetists and surgeons work in the operation theatre once a week. The anaesthetist i met was Dr Suwee. She was so nice and she liked to ask questions. Her favourite questions were "what can go wrong with this procedure?" and "how to make sure this procedure has done correctly?" So i am here to explain what's happening in the anaesthetic room before the patient was sent to the theatre.

I have only seen 2cases of epidural. The anaesthetist would locate spaces in btw T8-T12 vertebrae, and local anaesthetic was injected into the skin. Then a needle was pierced through the skin, then to the supraspinous ligament, then to the infraspinous ligament then finally going through the ligamentum flavum, that's the destination-- epidural space. To make sure the needle is in the correct place, while piercing the needle, saline was injected through a syringe until the needle reaches a point of strong resistance, that is the ligamentum flavum. Once the resistacne towards the injected saline has gone down, it means that the needle has passed through the ligamentum flavum. A tube was inserted followed by the needle and the needle was taken out after that. The anaesthesia was given by injecting through the tube, an extra 1ml has to be injected as there is a dead space in the epidural. The tube was then stuck to the back of the patient and it was left open just in case extra anaesthesia was needed during the operation.

Then is the time to give sedation. Two infusions were given, they were propofol & remifentanil. The infusion rate was increased for abt 1min?? to make the patient asleep. And then it was switched bec to a lower rate to maintain the sedative state. How do u make sure the patient is in deep sleep? first n foremost, it a very straightforward method, by calling the name loudly and wait for response. Next, it;s a very unpleasant way, by pulling the eyelashes gently and wait for response. Normally, if the patient doesnt open his eyes, meaning that he's already in deep sleep. These are the manual method, they do have a monitor to check for the level of consciousness which i dont khow to interpret.

After that, here comes the intubation to maintain the air supply. After the intubation, i was asked to listen to the chest to ensure that the tube has gotten into the trachea, not the oesophagus. The breath sound has to be equal on both sides, and look at the chest movements and look for steam in the tube. If all these are present, u can be pretty sure that the intubation was done correctly. Then, check the patient's ability to breathe on it's own, keep an eye on the SP O2 level on the monitor, basically that's all.

What comes next? Maintenance of blood circulation, checking for blood pressure and heart rate. A mini ultrasound was used to locate right internal jugular vein & carotid artery. This is the most direct way to know the BP. A tube was inserted to the int jugular vein all the way down to assess the right atrial pressure. the tube was left open as well just in case IV infusion or blood transfusion were needed. It's normal to see the patient of 80/60mmHg as the BP was suppressed to prevent uncontrolled bleeding. One litre of saline was given to maintain the blood volume and to prevent the patient goes into hypovolumic shock.

On the other hand, (literally means the other hand as one has the saline infusion, the other hand has another infusion), muscle relaxant was given as an injection. this is to relax the muscle so that the surgeon would easily cut through the muscle layers.

so here comes the favourite question, what can go wrong with these procedures...
1) bleeding as so many needles and tubes piercing through the skin
2) risk of infection as so many foriegn materials were introduced to the body
3) anaphylaxis as there might be allergic reactions to the drugs
4) air embolism as air bubbles might be introduced into the bloodstream

that's all i could remember, i believe there are much more risks in giving anaesthetics. One simple word- Anaesthetic, concludes what i have all mentioned. It sounds simple but it takes about 20-30min to get it done. Do u think that's the end of the job? No, the anaesthetist has to send the patient in the theatre and monitor the cardiac and respiratory function, level of consciousness, amount of analgesia... throughout the whole surgery. In other words, the patient's life is in the anaesthetist's hand. After the surgery, the patient was monitored to recover to his optimum state in terms of cardiac & respi function. So the anaesthetist has to review the patient the next day after surgery to make sure the patient is back to normal.

Now this the end of the story.
To my fellow colleagues, think twice if you really decided to become a anaesthetist.

春天花会开 鸟儿自由自在
我还是在等待 等待我的爱 你快回来~~

Beautiful, colorful and wonderful flowers in
St James Park, London.
Pic taken on 26/4/08.
Super nice weather without putting jacket on.
Temp: 18 degree celcius.

3 interesting cases in general medicine posting

1. In-patient, 60+y/o male complaint of oedema in both legs, on admission both legs were swollen, the diameter was as big as a long ruler ~30cm. this has caused a limitation of mobility in this gentlemen. He has a past medical history of prosthetic femur on the hip. Both femur were replaced 10years ago. LFT, RP, CXR were done to rule out liver failure, renal failure & cardiac failure. the results were normal. Inflammatory markers were tested and the result was negative. what would be the diagnosis if everything looked normal? according to the registrar, this gentlemen rarely walks and he normally sits on the chair and doesnt move much. due to prolonged immobility, the veins were pooled in the legs and caused the leds to be oedematous. Walau A~ there is no underlying organic cause, the swelling legs were just simply because the patient was lazy to move around. therefore, the management is just giving diuretics to loose the extra fluid in the legs. Score of interesting: 8/10, nvr come accross in my life that the admission was due to laziness in moving.

2. Out-patient, 50+y/o, chinese female. ( i remember her the most because she is the only chinese patient i have seen in uk so far) she came to the clinic for follow up of her hepatitis. but she ended up telling stories not related to her hepatitis. it was because on the blood result, she has cleared her hepatitis virus. no viral load was found in the blood. however, she and her spouse had spent nearly 45 min to talk to the registrar and consultant. She was diagnosed with carcinoid sydrome few weeks ago, but it was not in the GIT. It was an incidental finding from a polyp in the bladder. The mass was found in the bladder when she went for ultrasound screening for cervical ca. On operation, the surgeon intended to take biopsy sample of the polyp, but the polyp wall off on its own. As a result, the tissue was sent to the lab and carcinoid cells were found. Initially the specialist thought it would be a benign tumour but nvr thought that it would be carcinoid. Acc to the specialist who was looking after this lady, there were only 8 cases of carcinoid in the bladder in the whole world. it was super rare. This lady had complaint of flushing, lethargic, mood swing and all the while she thought that was pre-menopausal syndrome or her hepatitis flares over the past few months. do u think that's the end of the story after the polyp removal? No!!! The specialist thinks that it would be secondary deposit in th bladder. there might be some primary in elsewhere. Her urine 5HIAA-5 hydroxyindoleacetic acid was monitored for few days after polyp removal to make sure there are no extra neuroendocrine function. She has to go for Ct scan the following to check for any primary carcinoid. I didnt get to know what's the out come after that coz i only seen her once in the clinic.
Score of interesting: 10/10, carcinoid in the bladder lei!!! it was even more rare than male breast cancer!!! It was unbelievable when the patient came to a gastro clinic to tell stories of carcinoid, not in the GIT, but in the bladder.

3. 80+y/o female, admission for pneumonia. blood and sputum was sent to lab for culture and sensitivity. this old lady was a known MRSA(methicillin resistant Staph aureus) patient, all staffs who visited her must wear gloves and gown. this is to prevent the staffs transmit the bacteria to the next patient they are in contact with. her lab results were sent back. she was suffering from sepsis & pneumonia of the same causative agent, it was staph aureus. but not the MRSA one, is the normal commensal staph aureus. the consultant was thinking of any other source of staph aureus infection that predispose to this attack. no dermatology history of staph aureus infection, would it be the bone then? lumbar X ray was taken and no injury seen on the X ray. So... so.. so ... at the moment that the consultant was scratching his head, this lady's medical notes was sent to my hospital from the previous hospital she was admited to. she had subacute infective endocarditis few months back!!! murmurs were heard on examination actually, but this lady was known to have a past medical history of valvular heart disease. her old medical notes have cleared all the doubtd of the source of staph aereus of her sepsis and pneumonia. Immediate treatment was given regardless the cause of infection. she started on antibiotics and her blood test were improving as inflammatory markers went down. but she still looked ill and renal function was deteriorating. very very very sad to say that she was the 1st patient whom i followed throughout in the ward and was not discharged back to home. she passed away the day after the consultant diagnosed her of SIE. Her renal function and cardiac function were compromised even tough she was dong well in recovering from infection.
Score of interesting: 9/10, 1st time not seeing patient in ward round the next day because they have gone to heaven or hell, but not bec to their home.

initially i wanted to write 10 cases. after finish writing the 1st one, i saw the length of my 1 case, i decided to share 5 cases. but after finish writing the 2nd one, i decided to share 3 cases of my posting. not because i am self-fish but i think i m writing too long. i hope u would enjoy reading this la.

猜不透

[title:猜不透] [artist:张韶涵] [album:欧若拉]

作词:王雅君 张耀威 作曲:陈依依

满天的星星在闪烁 点不亮心中的暖和
为什么你不懂我的梦 只是勉强笑了
就像我们凭直觉走 找不到同一个出口
从现在到心痛要多久 还有没有以后
有时 假装沉默是否有点难受
到底期待像什么一眨眼又让心伤透
关于你们手牵手 还是关于你和我
你说你就是在我左右 下一秒却又让我
猜不透

http://www.ffdivcxjr99.cn/data/updata/1143703178.mp3

This is a chinese song that i recently get addicted to it.
It means unable to guess/ unguessable？？
It is always very hard to guess one's mind.
What does he or she think?
It is even harder to understand our own mind.
What do i think?
What do i want?
真是想不透，猜不透。

Launching for my first blog

This is my first blog named Jooney.
I welcome all guest to attend the launching of my first blog in blogspot, the details are as folow:

Time: 1430 (UK time)
Date: 2/5/08 (It's david beckam's birthday)
Venue: Cefn Brynn 409, Singleton Park, Swansea.

It's free of charge and no refreshment is provided.
Thank you for your attention.
Hope you would enjoy reading my blog.