Window shopping in Swansea on 28062008

Sat morning, i spent some time in Swansea before going back to my uncle's house.
From the bus station, i walked to the train station. On the way, saw a lot of shop houses.

British Heart Foundation - it sells shirts, shoes, bags... to raise fund for the BHF.
i like their logo, looks like an ECG wave, but with a heart shape... very special...

99p stores - everything under a pound.
the place where i bought my cheap umbrella and children beach sandal.

sports world - always got sales, they sell sport products eg: jersey, sport shoe...
the place where i bought my sport shoe and nike cap.
those sportsmen and sportswomen will definitely like here. they always have sales from 10-70% off.

Marks & Spencer - it sells trendy, fashion, tops and pants...
but i think only the working ppl can afford to buy things here coz they are quite ex..

Lloyds TSB - My bank. I opened the account in the university branch, not the city centre branch. I have heard stories of difficulty in opening an account as international student. i felt lucky to open it in the university branch as less procedure was needed.

COSTA - the coffee that u can find anywhere in UK
COSTA in UK= starbucks + coffee bean + kopitiam in malaysia
you'll see a costa coffee house in every station of their service centres along the motorway (just like our rehat in the highway)

Thomas Cook - i thought it was a cooking school when i look at the name
actually it was a travel agency

Orange - the phone line company. so far, the ppl i met are orange users in UK.
it's like maxis in msia, but then they sell very cheap phones in package with their sim cards.


Amateur1 on the street- playing some old songs with the guitar

Amateur2 with his dog. Look at the balloons behind him. Wah, i hope i could get one...

Look at this bus/lorry. it belongs to a yogurt company. they set up a tent from this vehicle to promote their products. i think it's very creative to just pull out the tent from the bus/lorry.

Wah~~ hundreds of teddy bears... very cute lei, they were displayed by a teddy shop.


Guess what is this? they are colurful, natural, organic soaps.... Looks very delicious!!!
But they are not edible...


The pigeons on the street is just like seeing sparrows in msia.

The black taxis in uk. I think they look like those cars that carry coffin. Touch wood....

No more pics liao coz my digicam ran out of battery.
But then i went to argos to lok at the furniture. i met an indian old man while flipping thru argo's catalogue. they have two, one thin one thick. the indian man asked me a question.
IM: any bad~~?
JJ: sorry?
IM: got bad~~(pointing onto the new catalogue that i was holding)
JJ: ( i thought he was saying...) not bad? very good?
IM: no... bad-do~~
JJ: oh, this one better? ( i was pointing to the old catalogue and guessing what he meant?)
IM: no~~ no~~ bad.. bad-do~
i totally have no idea on what he was saying, i continue to flip on the catalogue. finally the indian man saw what he wanted and pointed to me. it was a BED....
HE WANTED TO KNOW DOES THE CATALOGUE SHOWS ANY BED.....
super sweat ah... after struggling for so long, i finally knew what he meant.

i came out from argos after clearing my doubt with this indian old man, continue my journey to the train station, took the train back to my uncle's house.

Happy birthday to Tan Jane June

This post was copied from my beloved xiao dee's blog.

Word in red are his writings
and words in black and bold are my writing

Happy Birthday to my beloved sis

happened to be one day...
a pregnant lady suddenly felt that her baby was moving...
but not like how it usually happened..
this time, the baby was trying to make her way out...
to know the world, to see the world after being enclosed in darkness for about 10 months..
but then the lady looked at the calender, it was just 30th june...
the doctor told her that her baby will only be delivered around july..
nonetheless, she got to the hospital...
and, after several tries.. the doctor decided to do the surgery, to 'take' the baby out...
(my mum was telling me that my buttock was at the bottom, unlike normal babies, they have the head at the bottom. the doctor tried to correct my position so that my mum can deliver normally. however, he failed to do so. they had to send my mum to do cesarean section as the amnion was burst.)
yeah, no one knows she was so eager to come out, perhaps in the surgery room instead of normal ward?
(xiao dee, the place to have an opeartion is called the theatre.)
the lady's husband signed the agreement, and without wasting any time, the lady was sent to the surgery room and successfully, the girl was delivered..
on the day of 30th June 1985...
(at 5.30pm in the afternoon, to be exact, my mum was sent to the hospital on 30th june early morning)
and yes, this is the first baby of the lady and her husband...
and due to the fact the baby came out so unexpectedly.. on the last day of june..
the girl was named June...
(good thing i wasnt born in july, i might be named July for that reason. @=@)
Tan Jane June will be the full name for her, following her till now for 23 years already...
(this name is gong to follow me for the rest of my life)

in this 23 years, this baby, has grown into a girl, and now a mature lady that is striving for her dream..
to be a doctor..
(to be more accurate, i want to be a paediatrician)
doing very well for her kindergarten..
(i was struggling in kindergarten as i went to an english kindergarten and was switched to a chinese one when we moved to PD from Klang. I didnt not know how to write Chinese at that time)
enroll in SRJK (C) Chung Hua Port Dickson...
being an excellent and cherry primary student before going to Port Dickson High School.
(the proudest time of my life was in primary3, being the only representative to go for story telling competition in Malay, English and Chinese. partly because nobody from my class would like to go. since then, i have very strong interest in talking and telling stories)
(next, my primary6 life was superb. i represented my school for the state level in a lot of competitions, eg: essay writing, public speaking, drawing competitions... i nearly became the role model student that year. but i was lost to one of my good friend with the score diffirence of 0.4)
Taking the 7A result, the girl went to STPD and make her peak success of her early year, by being the best student during her form2.
Though the 7A1B result of her SPM seemed to be a blocking stone for her future, instead, it has become her stepping stone..
(xiaodee, is PMR result, not SPM. u would nvr know what did i get for B... it was a shame to be i got B for chinese but i nvr retreat and still taking chinese in SPM. felt very sorry to my parents as they took my result for me. i went to a training camp that time)
a driving motivation originated from the dissatisfying result, has opened a bright way for her..
scoring a historical 11A1 1A2 result at STPD for her SPM, she managed to become the ever honourable JPA scholar, and yes, the respectable JPA medicine scholar..
she is on the right track to pursue her dream, becoming a doctor...
(a difficult track though...)

spending 2 years at Intec, getting 3A for her London A-Level and gets into IMU (International Medical University), Bukit Jalil and has always been scoring very well results for her subjects..
notable one includes a 6 A streaks for her semester exam... and only a few B includes in her exams/tests for the time she spent in IMU, clocked at 2.5 years...
(xiao dee, must be humble.. too many people did better than me lei.... i was a little bit shy to admit my achievements... be humble.. be humble...)

and yes, she got a break since last year december...
(super long break until i got poisoned by one million star, hong kong tvb drama, korean drama series and the sleeping bug...)
(i was now cleared from the sleeping poison but then still very addicted to one million star)
but then, she was a great person, has flew to UK to follow her uncle for posting..
to learn on herself, the clinical skills etc. and further discover herself...
she flew to UK during March, and is doing very fine...
(not very fine all the time. got ups and downs. but i guess, that's how life is...)
During September 2008, she will be in Machester...
(xiaodee, another error: Manchester)
studying in the World top30 university - the University of Manchester for her final few years of clinical skill for her Medicine course...

"She is my proud" -- June's mum..
(aka Mrs Tan:你是我的骄傲）
(yes, got grammar error.. should be pride.. but is her mum said in english de, not a translate one, so remain as it is)


and of course, not to forget...
Happy Birthday to Miss Tan Jane June..
(祝我生日快乐)
the girl that is going to spend her 23rd birthday first time outside of Malaysia, first time without us around!
(精神上在一起就够了）
yeah, all the best to you, sis...
you are mama's proud, you are my pride too.. haha..

"when dream is closing, you'll be lost." -- yoga (One Million Star first season winner)

but then, you will find your way back...
(ya, i will find my way back.)

Yes, there were times, Im sure you know
When I bit off more than I could chew
But through it all when there was doubt
I ate it up and spit it out
I faced it all and I stood tall
And did it my way

back on track, to be the ever best sis i could have...

SALUTE!!!
(last but not least, thank you for this special post.
i love it...)

Friday evening in Swansea

Summer break has started and Swansea University is very quiet now.
The canteen was closed since wednesday. I'd been eating sandwich for one week. @=@
The were two mini shops, one was closed for the whole summer break, the other one only open for half day.
It used to be very lively in the campus, but it's very dead now with a very dead weather. ( it has been raining for the whole day...)
But the good thing is the medical students are still around, in my block-Cefn Bryn, consider half lively as they are preparing for exams. I can see them studying in the common room. Quiet and hardworking...

And... and... and... what am i doing in swansea on a friday evening? aren't i suppose to go back to my uncle's house for the weekend? whatever i say next is going to be censored...
*&%$@£¥γŪŊŕŜцуіẃ !!!!
My uncle rang me at around 5pm, i wonder why he rang me so early. Normally he rang me when he finish work and then we will go home together. i picked up his call.
Ch'ng: What time are you coming back home?
JJ: Are you finish working? are you leaving now? where are you now?
Ch'ng: Yes, i am at home now...
( oh shit!!! i forgot to remind him to pick me up)
Ch'ng: i am not working in today...
JJ: why are you not working today?
Ch'ng: i was attending a meeting in XXXXX. you dun know?
(oh shit!!! he didnt tell me that...)
JJ: i cant go home now. i am doing data entry for the research project. it's raining now. i dont think i'll go home today.
Ch'ng: it's safer to go home tomorrow morning. there might be no bus at night.
(yes i know, the last bus to your house leaving at 6.20pm from newport. it takes me 1.15hr to reach newport from swansea by train. and i cant leave by 5.30pm. there's no way for me to go home right now)
JJ: alright, i'll go home tomorrow morning. see you.
(ish..... i normally have a lift by going back with my uncle... i've to spend extra £9 to go home...) that's the end of the conversation and my monologue.

anyway, i wasnt feeling so bad. (what a strange feeling...)
perhaps i wasnt looking forward to go back...
i was planing to go shopping tomorrow.
then i can spend some time in swansea before going back home, provided hat the weather is good.

thank you for your concern

to all my dear friends that sent me email, thank you for your concern.
i am feeling better now, but not back to 100% of my normal optimistic personality, it's on the way heading towards there.
i believe it takes time for me to fully recover, so no hurry.
the outbreak last night was a cumulative effect, long time nvr express any sadness at all.
it just burst out and the effect was as serious as si chuan earthquake. @=@
i just need some time to settle down to re-construct my mind.
i am missing someone that i used to love so much...
i hope she will be back, one day...

i wish someone was there

this is my 5th post of the day. i think i am mad.
i know i wasnt depress. but i just cant control my tears from flowing out.
i just need some attention, especially when my birthday is coming soon.
i wish to be myself, my true self.
i wish to reveal my true personality to my uncle and family...
i wish to reveal my true feelings to my parents...
i wish to contact any of my friends to cry in front of them...
i wish not to pretend i am tough
i wish not to pretend i am quiet
i wish not to pretend i am mature
i wish not to act as other personality
i have emotions...
i have feelings...
i have conflicts in my daily life
there's no one that i could share my problems with...
i do not want anyone to get worry about me...
but i just cant bear it anymore...
i am the only person to share my problems with...
how much do you think i can take...
i am not a superwoman...
i really wish someone was there at that moment...
stupid tears...stupid me...

疯了。哭了。忍了

疯了
花了将近三小时的时间来整理我在小儿科部门的病例。真的快疯了。
突然想到戴佩妮的爱疯了。第一次写到头痛。不过写得很爽，感觉是自己人生中的一个里程碑。
还蛮期待同学们的反应。不过算了，也不是为他们而写。

哭了
上星期不小心的哭了，还哭得蛮久。
不是号啕大哭，默默的哭，向当初看一公升的眼泪那样，眼泪不知不觉就流出来了。
莫名的被人吼了一顿，承受不了，无奈的哭了。
当时真的很讨厌自己。。。
本来我就是非常真性情的人，生气时就大骂，伤心时就大哭，开心时就大笑。
可是，最近，我的演技进步了。
所有的感情都隐藏起来，只因为我寄人篱下。
就算哭，也只能偷偷的哭。
以前非常不明白为什么身边的朋友会把情绪压抑着，因为我都觉得那样非常伤身。
直到现在，我才知道。那样才是成熟的举动。
自己过去的所作所为非常的幼稚。
写着写着，眼泪又不知不觉地流下来。。。
我好怀念幼稚的时光，根本不用演戏。
我好鄙视现在的我，完全跟我的原则背道而行。
原来原则在你没有后援会的时候，是不管用的。
以前不管我如何表态，我总有朋友挺我，撑我，大力的支持我。
现在，我只希望有人让我依靠，哪怕只有一个人也好。。。

忍了
为了我的父母，就算被人破口大骂，我忍下了。
不想让他们失望，不想让他们担心，总装的自己很坚强。。。
又是伪装的自己，我快受不了了，还是忍下来了。
本来就很讨厌表里不一的人，没想到如今我也是其中的一分子。
好像忍住现在的眼泪，可是好难。
难道只有一个人的时候，我好要伪装吗？
忍不住了，真的忍不住了。。。
不听话的眼泪，流下来了。。。

Paeds Attachment Week 4

1) 11y/o boy came in yesterday with the complaint of red itchy urticaric rash, initially on the knee joint and ankle joint, now spreading to the chest, neck and the back. the rash appeared on his right knee and right ankle on the weekend, after playing in the woods. he developed joint pain and swollen knee and ankle the next day, he was referred to the hospital by the GP after that. according to the mum, this boy had taken a course of antibiotic for one week prior to admission. but it was unlikely to be an anaphylatic reaction after completing one week of antibiotic treatment. this boy didnt have any allergic history and his diet was the same as usual. it was unlikely to cause by food as well. patient's mother claimed that the pattern and location of his rash were changing, but was much better after taking piriton(anthistamine). the registra beleived that it might be an allergic reaction caused by a new kitten that was taken home one week ago. as mum was saying that her nose was allergic to the kitten, and therefore she sent the kitten away. but the problem with allergies is it is hard to find out what the allergen is, unless there is a second allergic reaction. and anything common in the 2 reactions that comes in contact with the patient would likely to be the cause. so the only management is avoidance of any possible allergen to prevent it from happening again.
2) 3m/o baby girl came in with vomiting since birth on week1 of my attachment. initially she was sent for ultrasound scan and barium follow through, and the results came back to be normal. they tried on other milk for her as the consultant thought it might be cow's milk intolerance. at the same time, she was given ranitidine because the consultant thought she's reflux as whenever the mum reported her vomit, it was just a little bit of water. she was taking her feed normally after that and was discharged at the end of week2 with the diagnosis of reflux. however, the baby came back on the weekend with the similar complaint. the consultant started to be suspicious as no one had ever witnessed the vomit before, the vomits were all claimed by the mum and the mum was known to have postnatal depression. on week3, mum sent in a pinky urine to the nurse and everyone started to worry of her having haematuria/urinary tract infection. the urine was sent to for microscopy and no red cells was found. the paeds trainee requested them to keep the urine but the microbiology lab refused to do so as they said that the pink colour was most likely due to dye. the urine sample was then sent to the biochemistry lab and they agreed to keep the urine sample for further investigations. however, the next urine specimen was clear and normal. as a result, it was not likely for this baby to have UTI. at the end of week3, her vomit was settled and she was sent back home again. BUT...... she came in again on week4... SWEAT AH!!! with complaint of diarrhoea and vomit. this time the stool sample was sent for culture and the result came back to be positive for Clostridium difficile. Oh My God!!! she finally picked up something more serious than her original sickness due to prolonged admission in the hospital. she's now treated with metronidazole. her father finally appeared in this admission. coz all the while, i only see the grandma and the mummy. i could see that her mum was interacting better as compared to the first admission. the parents now show more concern on the baby. i hope she would get well soon.
3)1y/o boy was sent to another hospital for repair of tetralogy of fallot on my week 1 of admission. the first time i saw him, he was very stable and didnt not show the squatting position as what we learnt from textbook. but when i saw his x ray, it was a "boot-shaped" heart as he had right ventricular hypertrophy. according to the paeds trainee, he was very bluish last time and underweight. they fed him and his weight gone up dramatically. although his weight still abit low for his age but it was within the acceptable range and he was fit for the surgery. he came back on week2 after the surgery with vomiting and diarrhoea. he looked more pinkish and had a midline scar on his chest. the stool was sent to the lab and came beck to be positive for clostridium difficile. he was on conservative treatment to maintain fluid balance but his weight had came down after the surgery. he did not have enough nutrition as he kept vomiting. they tried to feed him through NG tube but his vomiting and diarrhoea havent settle even after taking 5days of metronidazole. the consultant was trying to get hold of the microbiologist and dietatian, as he needs nutrition and gain more weight. let's pray for him...

Paeds Attachment Week 3

1) 17d/o female baby came in on week 1 of my attachment, complaint of persistent vomiting for past 1 week after feeding. the vomitus was non bilious, mainly milk and water. one of the consultant witnessed her projectile vomiting was she vomited onto the pants of the consultant. her blood was alkolotic as a result of the vomiting the other consultant did a test feed(ie palpation after feeding) to look for pyloric stenosis, but no mass was palpated. a palpable pylorus on the right to the umbilicus would indicate a positive test feed. normally, pyloric stenosis is more common in baby boy of 6months with family history. this baby girl wasnt fit with any of the risks. she was then sent to do ultrasound scanning after that but it was negative. a second opinion was taken from another radiologist, a second ultrasound was done to pick up any chances of pyloric stenosis. however, the second scan was again negative. the consultant was trying to work out the cause of her vomiting. they changed the type of milk to feed her and the vomiting seem to be settle down a little bit and the baby was starting to gain her weight. she was sent home at the end of week2 but re-admitted on week3 with the same complaint. her mum was very worried and once again a third ultrasound scan was done. and... finally this time, the radiologist picked up a thicken pylorus of a diameter of 11.7mm and, mucsle thickness of 4.3mm. this girl was then send to the other hopsital for pyloromyotomy.
2) 5y/o young boy, came in over the weekend, with the complaint on 1 day diarrhoea and 4times vomit and 3days of abdominal pain. on examination of the abdomen, there was no guarding, soft & non tender. blood test showed a high CRP of 209 & raised white cell count. this boy was given a conservative management to maintain his fluid balance for the next day. however, there was still persisting suprapubic pain and with a spike of temperature on the second day of admission. the surgeons came in to review him but they thought it was just an acute gastroenteritis as his brother was having diarrhoea and vomiting as well. however, the paeds consultant was not convinced to let him home as his CRP was still 109 with persisting pain when he passed urine. he ordered an abdominal ultrasound scan after seeing him on monday ward round. the ultrasound scan showed a mass close to the bladder in the pelvic area, the radiologist proposed a CT scan for him. and the CT showed an appendicular mass, suspected as an appendicular abscess. the paeds consultant was relieved as they could pick it up although the surgical team had missed it. this boy was then sent to the theatre immediately to drain his abscess and he'd a wash to clean his abdominal cavity to prevent further infection.
3) 8w/o baby girl came in because of neonatal abstinence syndrome as her mum was taking methadone(one type of opiod) during pregnancy. she has been in the hospital since birth but i only seen her the first time in my 3rd week of attachment. to prevent her from having withdrawal syndrome, she was taking regular oromorph(one type of morphine) with reducing dosage over period of time. her mum was found to be HCV positive (i suspect that she got it thru sharing needle) and this baby would have to do a HCV PCR test 3-6months later after the window period. she just had her first immunisation yesterday, it was delayed because of her neonatal abstinence syndrome. on top of that, she has congenital umbilical hernia but it wasnt a problem to her at the moment. the baby has very serious social problems and the parents did not come and visit her throughout her admission. her only guardian was her grandma but her grandma did not visit her very often. her main carers at this moment were the nurses in the ward. the social nurses were trying to get hold of the family members as she has no other reasons to stay in the ward once she is out from her oromorph. the plan now is to make her guardian to come in on friday to look after her 24hr til saturday. and discuss with the nurses on any problems handling this baby on sunday. and the baby can be discharged next mon.

Paeds Attachment Week 2

1) 4 y/o little girl, brought in to the hospital late at night, was sent directly to the high dependency unit as she had high random blood glusoce of 21/22/23 mmol/dL overnight. She was complainig of polydipsa, polyuria and nocturia. she had one episode of projectile vomiting prior to admission. blood gases was done on admission and she was found to be acidotic. glucose and ketones were found in her urine. a diagnosis of diabetic ketoacidosis was made by the night staffs. Insulin and IV fluid were given to try to bring down her blood sugar level and correct her acid-base balance. During the ward round in the morning, the little girl looked very alert but a random blood test was done and her level was still as high as 18mmol/dL. it was still consider diabetic even she just had her breakfast. a diabetic nurse was arranged to see the parents to educate them on insulin injection. however on the second night of admission, her random blood sugar went down to 2mmol/dL. it might be due to insulin over dosage. she was given a chocolate bar at night by a junior doctor and the blood glucose level went high up again. the next morning, when they discussed the case with the consultant, he said that giving chocolate was not a good choice. instead, we shall just monitor the patient. if there's no severe problems caused by the hypoglycaemic level, the correct thing to do is adjust the next dosage of insulin instead of giving glucose. this girl was then discharged from the hospital with an appropriate dosage of insulin injection. but the follow-up system in this country is very good as the diabetic nurse will go to her house to make sure that her mum is able to give her insulin as required.
2) 5y/o girl complaint of intermittent abdominal pain in the morning in the past 1 week. the parents thought that it might be an excuse for their child refused to go to school. however, this girl was in pain this early morning at 5am, pressing on the tummy and squatting down. the parents started to take this seriously as this wasnt the usual time for her to wake up and they knew she was in real pain. they brought her to the hospital and the consultant reviewed her later in the ward round. blood test that was done on admission showed a raised amylase level of 1320 but with CRP<3. style="color: rgb(255, 0, 0);">infective pancreatitis as a result of viral or bacterial infection. she was given a course of antibiotics and pain killer for symptomatic treatment. the pain was subsided on the fifth day after admission and this girl was discharged as she was back to her normal self. however, the consultant would like to review her in his clinic after 2months as he was the paeds gastroenterologist.
3) 21d/o baby girl came in with post feeding apnea. the registra who clerked her witness the episode of her going blue/cyanosed after breast feeding. according to him, it happened just few minutes after he took the histrory and the baby's face just went blue and she was crying. this baby was a preterm, normal spontaneous delivery at 36 weeks of gestational age and with the history of polyhydramnion. her absent of breathing after feeding was thought to be cause by infection. full septic screen was done, which involved the blood test, lumbar puncture/CSF test, urinalysis and chest x ray. none was contributory. the consultant picked up a murmur and she had an echocardiogram done and only 2 branches were found from the aortic arch. it could be normal in some people to have the third branch coming out from any of the two branches. so there wasn't much concern on it as the perfusion on her upper and lower part are normal. a video-fluroscopy was done in the following week to look at the velopharyngeal closure as the consultant suspected she was having tracheo-oesophgeal fistula. the result showed traces of aspiration and the second video fluoroscopy was arranged in 2 weeks time as there wasnt enough evidence to suggest tracheo-oesophgeal fistula. because of her poor feeding, she was put on NG feeding and she was very stable and tolerating very well with her feed. the parents were educated on NG feeding and this baby girl was discharged home with the NG tube as there wasnt any other issues once her feeding was settled. she was still awaiting her second video fluoroscopy.

Paeds Attachment Week 1

1) 11y/0 young boy, had Hx of cerebral palsy with swallowing difficulty, came in to the hospital because of aspirated pneumonia. Because of the cerebral palsy, he had distorted hand joints and severe scoliosis. His right scapula was very close to his pelvis, it was just approximately 5cm apart. His neck was extended. He was looking down all the time when he was watching tv because of his extended neck. On examination, he had crackles on auscultation. He was feeding on NG tube as he had swallowing problem. He had a slower mental development as compared to children of his age. he couldnt talk like a normal 11 y/o child. from the management point of view, he was given a course of antibiotics to treat his pneumonia and the physiotherapist came in everyday to help him to do his physiotherapy. Unfortunately, he died of sudden death on the following week due to sudden cardiac arrest, no signs of bradycardia before he died. I was so shocked when i heard the news. not feeling very sad, am i too cruel? i dun know. as he would suffer more with his on going cerebral palsy if he were to grow up. he had to overcome his physical, mental and psychosocial barrier. i felt sorry for the family. but it might be a good thing for him to be free from the sufferings earlier in his life...
2) 9m/o baby girl, came in with referral of other hospital. She has lots of chronic problems and was referred to our hospital for close monitoring. She has an undiagnosed nerological disorder, leading to bilateral diaphragm paralysis, hypotonia and left sided sensory neuronal deafness. She was suffering from chronic respi failure and bronchiectasis, was needed ventilation fron oxygen. Her main concern would be failure to thrive as she has these chronic and untreatable conditions. On examination, she was breathing with her abdomen. she did not have much expression due to low facial muscles tone. she was underweight on her first two months of life, but she was getting better after having proper amount of feeding in the hospital. she is clinically well apart from her congenital problems, is currently staying in the hospital waiting to be discharged.
3) newborn baby boy, approx few weeks old, preterm baby with normal vaginal delivery. he came in of neonatal epilepsey as he's had epilepsey since birth. according to the parents, he would have 5-6 attacks per day that last for 5-10seconds. he came into the hospital as parents complaint that there were increase in frequency and duration of his attacks. We witnessed one of the episode during the ward round. his lips were smacking and his left arm was just suddenly became stiff and it lasted only few seconds and he was return to his normal state. on examination, he was a floppy baby. his old medical notes showed that he had agenesis of corpus callosum. it might be the cause for the baby to have low muscle tone. he was given phenobarbitone to treat his epilepsy. his frequency, duration & characteristic of epileptic attacks were monitored everyday. his serum phenobarbitone level was checked everyday to ensure his has a good and safe bioavaibility of phenobarbitone in the blood circulation. however, this baby was transferred few days later to another hospital with a paeds neurologist, to have a better care and treatment on his neurological problems.

Adaptations in UK

I have been here for nearly 13 weeks, and i am still trying hard to adapt...
first and foremost, the use of language. my first language is chinese and i was brought up in a chinese-speaking family. as a result, i do not use english as common as chinese. but things are very different here, english becomes the primary language and everyone speaks english. however, the english that speak here is also different from the english i speak in malaysia.
eg: when they say: lovely, cheers... it's equivalent with saying "thank you"
eg: when they say: excuse me, my dear/darling.. it doesnt mean you are their love ones, it just mean the same thing as: "excuse me, miss..."
eg: when they say: here we are/ alright/ okie dokie.. it means "okay"
apart from these, the englishman are very polite and gentlemen. they would always say: "please/sorry/thank you" even for a very small matter.
when they open the door, they would normally wait for you to pass before their turn.
whenever they see you, they'll ask "are you alright?". just like chinese like to ask "have you eaten?"
they like to say :"hi/hello!" regradless whether they know you or not.
i am still in the process of absorbing and adsorbing their way they use this language...
next, is the accent of the english. my aunt, emily is an english who speaks south coast acccent. but the place i am working now is wales. the local people, ie: the nurses and the patients speak english with welsh accent. they speak as if they are singing. but the good thing is most of the consultant do not speak welsh english, that makes me less trouble in listening to them...
next, the food and drinks. I AM VERY SICK OF POTATOES!!! there isnt much choice in terms of food.
breakfast: toast/cereals/yogurt + coffee/tea
(o/s: i wish i have roti canai/chu chiong fun/yau char kuai/nasi lemak +milo/neslo)
lunch: chips/sandwich/cottage pie/pasta + sweets with custard + fruit juice
(o/s: i wish i have fried rice/fried noodle/fried kuey teow/mixed rice/chicken rice + soya/limau ais)
dinner: chips/cheesy pasta/sausage/sandwich/pizza/steak pie/fish fillet + soft drinks
(o/s: i wish i have chinese home-cooked dishes, 3 dishes of fish, meat and vegetables with one oreintal soup + chinese tea)
sigh... those will only appear in my dream...
the culture of drinking alcohol is very strong here as there is a pub in the university. for once, i thought that was a restaurant and i was thinking of trying the food there. at that time, i could see people holding a cup of beer walking out from the door, and i decided not to go there anymore.
next, the weather. i do not have much problems with the weather except for the first few weeks. it was still late winter and early spring. i would have to wear 3 layers of clothes with gloves on whenever i need to go out. at home, i was wearing socks and it was cold when u step on the tiles without wearing socks. the weather is much better now, but occasionally raining and has strong wind. i am staying in 4th floor. whenever the wind blows, the trees wave up and down with the scary noise. i would shut my window pretending nothing happen outside. it would be a very strong resistant if you were walking on the road when the wind is blowing. weather forecast is very important and very reliable in this country as compared to malaysia.
another strange thing is the day time is getting longer towards summer. 4am in the morning, the sky is bright until 10pm at night. i was once woke up at 4.30am, thinking that i was going to be late by looking out of the window, however, it was still very early. it was dark at 8pm in malaysia and normally i was advised not to go out at that time but it would be safe in uk because 8pm is just as bright as 8am.
next, the working hour. they normally work 8hr per day and they hardly work overtime. if u plan to go shopping, u must go early as all the shop houses open until 5.30pm and close after that, the public toilet as well. i couldnt find a toilet once at 6pm as i was waiting for the bus to go home. but the public toilet in the bus station was closed and i'd to hold it until i reached home. sunday is a very good business day in malaysia but in uk, nobody works on sunday. shop houses are closed except for those hypermarket like tesco. do not think that u can go shopping on your off day, as sunday is also their off day.
next, you can see dogs everywhere in uk. but they are not stray dogs.
eg: in the park, along the beach, outside tesco, in the car, on the street....
the englishman treat the dogs like part of their family member. they bring them for jogging, shopping, picnic...
but in malaysia, only a small group of people take good care of their dogs. they treat their dogs like a security guard rather than a family member.
I MISS MALAYSIA SO MUCH. I MISS THE CULTURE. I MISS THE FOOD. I MISS MY FRIENDS. I MISS MY FAMILY.

Audit meeting

Last week, i was told to prepare an audit of hepatitis c treatment as there would be an audit meeting this morning. i have promised dr ch'ng when he first mentioned to me, so he asked to see the specialist nurse that looking after the hep c patients to obtain the relevant data. after talking to the specialist nurse, i knew that she was not in her office on wednesday and i decided to use her computer in her office to do my audit. i went through the patients' details, their hep c genotypes, their response towards treatment... it took me 2hours to sort things out... finally i have completed the audit and i saved a copy into the computer.
however, yesterday, after attending a paediatrics teaching during lunch break. i received a call from dr ch'ng saying that i would have to present the audit that i have done... okie... he asid that this would be a very good training for me. i know his intention and without hesitating, i just said yes. coz it wouldnt be very difficult if i was just going to report on my findings from the audit. i went to his office after that as he would like to do the power point presentation with me. i sat in his office, looking at him opening different folders, different files, cut and paste, and within 1hr. the power point was done. but it was far more than what i was expecting...
the title of my presentation was " management of hepatitis c".. hang on a sec... i ddint know exactly what treatment to use, as far as i am concern, the duration of treatment varies upon individual, the prognosis varies upon individual as well. the only thing i knew was the outcome of the treatment, i knew how many patients was completely cured from hep c as i was the one who did the audit. the power point that he made was full of graph, pie charts, tables, flow charts, and not many of words... of course, he put in the data of my audit. i got two copies of the clinical guidelines from him and i was planning to read through to prepare my speech for my presentation.
last night, i went through the presentation once to get a rough idea on the slides and the flow of it. next i started to prepare my speech by reading through the guidelines and trying to fit the relevant content into my speech. there were 15 slides and i was given 10minutes to talk on it. i came out with my own draft and started to speak in front of my laptop as if i was presenting. my main problems were i couldnt speak fluently, and i wasnt confident in what i was presenting as i wasnt the one who did the power point. i spent 2 hr at night to get it done until i was confident enough with my presentation. i was afraid to let dr ch'ng down as he provided me a very good opportunity.
this morning, i was told that i am the second presenter. i couldnt pay attention to the first presenter at all ( sorry ya, senthil). i was having palpitation and i tought i might have tachycardia as well. i palpated my pulse rate, it was 66bpm, it was normal actually. towards the end of senthil's presentation. i was asked to get to the front to prepare my presentation.
i stood up and clicked on the mouse, looking at the audience (only ~10ppl), started on with introducing myself. next, i moved on to describing a brief history of hep c infection, and methods of diagnosing hep c. then, i went through the needs of treatment, types of treatment, and duration of treatment. finally, here comes my audit, the outcome of the 16weeks therapy on 20patients. ( the conventional way was a 24weeks treatment) From the audit, it has shown that 11patients were completely eradicated the virus from their body, 7 of them still awaiting for the results and 2 of them didnt turn up for blood test after treatment. "...In conclusion, 16weeks treatment was as effective as 24weeks treatment. Thank you." that's the end of my presentation.
phew~ finally it's over. at the end of the audit meeting, i was invited to review the meeting with other presenters. dr ch'ng pointed out my weakness which was lack of knowledge. i knew that by heart as i couldnt answer the questions proposed by a consultant. but the other presenters were praising me that i was doing very well. (+_+) but i knew it wasnt a very outstanding presentation.
thanks to dr ch'ng for giving me this opportunity and preparing the power point for me.
thanks to mdm yeoh, my primary school english teacher who trained me for choral speaking for one year. ( as a result, i get to learn correct pronunciations)
thanks to pn tee who trained me for chinese public speaking in my secondary school. ( as a result, i get to develop my courage and overcome stage fright)
thanks to imu that trained me to do a lot pbls. (this presentation was just like doing another pbl)
thanks to ling min who gave me support and opinions.
thanks to myself that i did not add in manglish which i was so used to it.
bye bye to all the "em..., ~la...., ya...., ~ma..., ~wor...."

不堪回首的记忆

Now that i think of it, i notice that my memories has gotten worst. i could only remember significant moments as i grow older. If you were to ask me what can make me frustrated, it would definitely be my poor memory. I start to forget events, knowledge, people, places that i come across and time that i spent. i could only remember things that i am doing routinely as i am doing it everyday. i could only remember special occasions as they were special. things that i came across only once or twice hardly stay in my mind.
and I HATE THIS... i hate to have partial memory, especially when it comes to studies and medical knowledge. i knew i knew it, but i couldnt retrieve that piece of information from my memory. i would have to spend some time to read again... but then, several weeks later, i face the same issues, and i could only retrieve 50% of what i had input weeks ago...
my golden rules of studying... (1) revising notes (input to the brain) is important for you to pick up and absorb knowledge (2) sit for exams (output from the brain) if you knew where and how to retrieve the information in exams, and then you would know how to retrieve it next time.
unfortunately, i have no exams for the time being. my memories were simply stored in my brain. not organised at all. sigh... i miss the time when i have exmas... am i crazy???
纯姐姐名言：何谓记忆？要记得（INPUT），再回忆（OUTPUT）。有进有出，才记得牢。

十八岁的异想世界

谢谢十八岁的小弟提供以下的文章，有兴趣阅读其部落格者，请游览http://jin-jack.blogspot.com。

一只熊迎面而来。猜一成语。
有备而来！（有BEAR来）

看三級片和看烹任節目有什麼相同的地方呢?
有得睇無得食

在树上唱 RAP 的小鸟。猜一字。
桑（注意！在樹上唱著YO!YO!YO!)

有人晕倒时，哪一首新年歌不能唱？
迎春花。因为 “幸福来 幸福来 大地放光彩”听起来像 “醒不来 醒不来 大厅放棺材”。

By the way, i was touched by your post number 100 (posted on 5/6/8), though i knew what would be the outcome when reading through it. 真的有虅井树的感觉！！！Shall i say i am jealous of your experince even though it's not a good ending. i believe that our suitable partner will appear when the time has come. 有缘千里来相会，小弟，别灰心。Have you ever thought of writing a song for this story?
What did i do when i was 18year-old? Working as a clerk for the first 2 months while waiting spm result...then, started my sixth form for 4months... then, surprisingly got scholarship after appealing... then, started off my medical journey since then in intec.... My parents expected me to be rebellious at that age especially my dad, he said all kids are rebellious at aged 18 as they think they are adults.

有些人的十八岁是叛逆的。
有些人的十八岁是无聊的。
有些人的十八岁是甜蜜的。
有些人的十八岁是平淡的。
有些人的十八岁是孤单的。
有些人的十八岁是精彩的。
我小弟的十八岁是他的蜕变期吧！从一个纯情的男孩蜕变成稳重幽默的男生。期待你破茧成成熟大方男人。
纯姐姐名言：长长长长长长长，行行行行行行行！
要这样念：changzhang changzhang changchang-zhang, hangxing hangxing hanghang-xing.
意思是祝愿你时时刻刻，长长久久的蜕变成长；在不同的行业里，也事事精通样样行！

What's so special about paediatric ward???

This month, i have decided to do my posting in paediatric department. It was very different from medical and surgical ward as there were rules to protect the children. it was different in singleton hospital, but i think generally other hospitals would be the same. What are the major differences???
1) the entrance: the entrance to the ward was locked, you can only enter with the password or the nurse's permission. generally only parents, relatives and health care workers are allowed to the deparment. security wise, they are trying to protect outsiders to get hold from the children. they have 24hr visiting time open to only the parents, unlike other wards that have limited visting hour to the visitors.
2) the bed: neonates, infants, babies and children. they have different size of beds in the ward available for patient of different age. normally they have extra bed of adult size for the parents in case they would like to stay overnight with their kids.
3) the decoration: there were cartoons, pictures and posters pasted or painted on the wall of all rooms, even the patientsi toilet. even the nurses have to wear colorful apron. and medical students like me are not allowed to wear white coat in the ward as this might frighten the kids??? i wonder...
4) the playroom: you definitely wont see this in the medical or surgical ward. it's full of toys, and most imporatantly, they have well-trained nurses to play with kids.
5) specimen bottle: the blood bottles are only half of the size of the normal one. so little and so tiny and i think it's cute when i first look at it... but it was nvr a nice experience to see blood taking from children as they look so misarable when blood was taken from them. needles and canula were smaller. everything was in a mini version even the plaster. the consultant would have the paediatric sthetoscope too, with a mini diaphragm.. so cutie..
6) a full trolley of milk of different fromula: milk for non-breast fed babies that provide similar nutrients with breast milk, milk that special for low brith weight babies, milk for catch-up growth babies when they are undergrowth, milk for cow's milk intolerance.... a wide spectrum of milk formula which i think the nurses would know even better than the doctors
7) the noise: it's not a quiet ward, i would say. babies that are not feeling well, will cry.. babies that were taken blood or doing lumbar puncture or in pain, will cry... babies that are hungry, will cry... babies that scared of stragers/doctors going near, will cry or will scream... next, it's the noise coming from the tv, it's a very important entertainment for the children other than the playroom. the dostors always need to turm down the volume or switch it off during the ward round. it was just annoying sometimes... but i am getting used to it now...
This is my 3rd week in this department. and i think... i think... i love it so much. i used to have very strong interest in paediatric but i just dont dare to step forward and admit it. as i am not a very pateince person, even tough i think i am a caring person. there were a lot of challeges to work as a paediatrician, you need to know how to deal with unwell and sick babies, you need to know how to communicate with desperate parents, you need to know how to treat them...you would end up in big trouble if you fail to manage them properly. there was one big issue happening in malaysia saying that a baby's arm was necrotic and gangrenous due to the faulty practice of a house officer. but then, after spending approx 2weeks time, i have made up my mind, I WANT TO BE A PAEDIATRICIAN!!! this my target, a very long way to go, a lot of skills to master, a lot of guidelines to follow, a lot of knwoledge to learn... but i need to have strong determination to push me to reach my ambition. jia you!!!

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.