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.