Elective Posting: Day 03

Today my ward (ward 18) should be passive ward, i.e. a ward that not going to admit new patient, so it should be less busy, but some how today ward 18 become like an emergency room (ER) in A&E department. There were 6 patients simultaneously collapsed and need resuscitation, but ward 18 don't have so much ventilators, so some patients need to be ventilated manually with Ambu bag. Many patients were intubated. The ward was so busy until specialist also need to help to insert branula/cannula, and doctors from A&E, radiology department, etc need to come to the ward to help up. A specialist came and do round, mainly for GI patients, but the ward so busy that hardly any HO go 'layan' him, and a HO, who is taking care of a particular patient went to listen a talk about dengue (if I know there was a dengue talk I won't stay at that ER-like ward), and that specialist want to see that patient. Anyway...... today is a hectic day for the HOs, MOs, and specialist of that ward. 

Btw, today having lunch with JS and his HO, BFF should join us but for some reasons she didn't. Sadly I heard how that HO described how poor those Russia-graduated HO, not because they are lazy, simply because they didn't learn what need to be learned in Russia, and the different system of medical education in Russia. Anyway, this is the conclusion that I came out:

When we are learning russian, others are learning how to clerk.

When we are reading books, others are reading journals.

When we are writing case histories, others are writing posters.

Anyway again, today I have chance to take venous blood from some patients, and thank God that I managed to take it, though failed few times. Still find chance to insert branula and also taking ABG. But even HO and MO got difficulties in taking ABG. Suddenly I remember again what Paul said to Timothy.

 For God did not give us a spirit of timidity, 

but a spirit of power, of love and of self-discipline.

2 Timothy 1:7

Elective Posting: Day 01

Today came back to this hospital again, the same hospital that I did my 3-days attachment 4 years ago when I was applying for JPA scholarship, and I was waiting with JS at the same place I waited 4 years ago, feel kind of nostalgic. 

Spent quite some time for briefing at the auditorium. One thing that I'll not forget, "Everyone come to this world with many blood, shit and urine."  This reminded me what Paul wrote to Timothy. 

For we brought nothing into the world, and we can take nothing out of it.

1 Timothy 6:7

Later assigned to our own department. Spent quite some time finding the medical department, and register at there, and JS and I were assigned to our own ward. Again we spent some time to find our ward. By the time we reach our own ward, we have already miss the morning round. Saw many HOs at my ward, and they look just like students. Out of my surprise, HOs' handwritting looks like typical students' handwriting >.< . 

In beginning kind of bored. Don't really understand what the HOs and specialists talk about (can't that specialist speaks louder a bit?). Somemore I don't understand what are they writing. In Russia the doctors I can't read their super-cursive cyrilic handwriting. In Malaysia I don't understand doctors' short form. IPR, S/B, TRO, UGIB, c/o, o/e, 3/7, 1/52, LOC, LOA, LOW, WD, TRO, K/C/O, and those superscript-ed "+" and "o" in front of those symptoms and signs, etc etc etc @.@.

After have a lunch at cafeteria with JS (food not very nice, but better than those in Russia), I came back to my ward. Out of my surprise again, I met someone graduated from my university. Though not very close with him and he didn't really know me, but after knowing that I amhis junior, he willingly taught something, how to read their 'files' or case histories, their self-created short forms, what to look for, etc. 

But different HOs gave me different advices. One told me to look through those files because in those files can see the condition of the patient and the plan of management. However another HO told me to go do procedures, like withdraw blood and insert vrenula, because these are the basic things that HO should know and next time no need to worry these procedures and can concentrate on other things which can be only learn when become HO. So what I should do? Hmm......

Anyway, got a chance to draw venous blood, but from a HIV+ patient. Got a chance to insert CBD, but need to leave already, some more is in a female ward. Anyway, I am looking forward into the upcoming CME, and here are some interesting patients that I met today.

* * *

Patient 001 Bed 39

C.C.: Fell down on his forehead. Admitted to hospital by ambulance.

HOPI: On 30/07 patient fell down on his forehead at 11pm, family called ambulance, but only analgesic given. Fell down second time on his forehead at 5am.

Past Hx: Fell down many times last year.
Pneumonia 2 years ago, with cough.
Not oriented since many years.
Taking sedative/anxiolytic for many years (about 10 years).
Difficulty in walking, no able to walk far.
Multiple brain infarct: left posterior, right middle.

Co-morbidity: HPT, on nifedipine, prozasin, atenolol.

O/E: Demented, confused, conscious, cannot walk, want to 'cabut' from hospital.

Dx: Multiple infarct?

Plan: Trace for CT result.
Off anti-HPT drugs.

* * *

Patient 002 Bed ?

Dx: Necrotizing fascitis on left UL.
Co-morbidity: DM, HPT, CRF stage III, TRO psoas abscess
Plan: WD of UL until patient agree.

* * *

Patient 003 Bed ?

HOPI: Admitted on 31/07.
GCS full. Able to lift up LL only after 15sec.

Fever 3/7, LL weakness 2/7

K/C/O: HPT, IHD

O/E: Progressive worsening of GCS and LL weakness.
UL: hypertonia, power 3, biceps jerk ?+, supinator jerk 3+ (brisk), triceps jerk 2+
LL: normal tone, power 2, 0 clonus, knee and ankle jerk ?+, plantar upward, flexion of toe  upon pressure on nail bed

GCS 11/15: E3, V2, M5-6
Open and close eye by command (obey command) - E3, M6
Localizing pain upon sternal pressure - M5
Moaning, no understandable words - V2

Eye examination:
Reactive pupils.
Arcus senilis.
Right INO: left nystagmus, no right adduction when look left.
Fundoscopy: cataract

Lung: left crepts, left consolidation
CXR: left pleural effusion

BUSE: hypokalemia

CT: whiter at left posterior occipital lobe or brainstem (pontine part?) --> bleed/infarct?
*Fresh blood is of higher attenuation, but reduces as Hb breakdown

Plan: Order urgent CT
MRI, MRV, MRA + contrast
look for meningeal or tumor enhancement, to exclude meningoencephalitis (gradual onset of disease with fever)
Maintain BP at 170/120

* * *

Lesson of the day

1. Be initiative, don't expect people to spoon-feed.
2. Protect yourself. Mask, gloves, coat.
3. Is okay to make mistake, but don't let your mistake compromises patient.

P/S: Do feel free to ask any question, either the meaning of those short forms, or the patients, or other things. But I think there are hardly anyone else still follow my blog here >.<

Is Jesus God?

Before we start, I think we all agree that a person called Jesus, existed and walked on this Earth, so the next thing we will asked is, is Jesus God? Since we all agreed that Jesus walked on this Earth before, the next thing we agreed is that Jesus was crucified on the cross. Even historian like Josephus, history of Rome, and muslims agreed this fact (But muslims also said that God changed Jesus with Judas Iscariot, so in the end, Jesus didn't die, Judas die. But of course I don't agree with this fact.), that Jesus was crucified on the cross. So the question is, why was Jesus crucified?

First let's see what Jesus claimed himself to be.

Jesus replied, "If I glorify myself, my glory means nothing. My Father, whom you claim as your God, is the one who glorifies me. Though you do not know him, I know him. If I said I did not, I would be a liar like you, but I do know him and keep his word. Your father Abraham rejoiced at the thought of seeing my day; he saw it and was glad." "You are not yet fifty years old," the Jews said to him, "and you have seen Abraham!" "I tell you the truth," Jesus answered, "before Abraham was born, I AM!" At this, they picked up stones to stone him, but Jesus hid himself, slipping away from the temple grounds. (John 8:54-59)

Jesus claimed that he exists even before Abraham, the father of Abrahamic religions (Christianity, Islam, and Judaism). Not only so, he claimed himself as I AM.  Let's recall the conversation between Moses and God, when God wants to sent Moses to bring the Israelites out from Egypt.

Moses said to God, "Suppose I go to the Israelites and say to them, 'The God of your fathers has sent me to you,' and they ask me, 'What is his name?' Then what shall I tell them?" God said to Moses, "I AM WHO I AM. This is what you are to say to the Israelites: 'I AM has sent me to you.'" (Exodus 3:13-14)

So we should know that the words 'I AM' is of great importance, because it is how God refers himself to be, and that is why the words 'I AM' is used in the famous hymn "Before the throne of God above". 

Behold him there! the risen Lamb,
my perfect, spotless Righteousness,
the great unchangeable I AM,
the King of glory and of grace!

And Jesus refers himself as I AM, indirectly claiming himself as God.

* * *

Let's see what Jesus said when he was charged by the high priest, before the crucifixion.

But Jesus remained silent. The high priest said to him, "I charge you under oath by the living God: Tell us if you are the Christ, the Son of God." "Yes, it is as you say," Jesus replied. "But I say to all of you: In the future you will see the Son of Man sitting at the right hand of the Mighty One and coming on the clouds of heaven."  Then the high priest tore his robes and said, "He has blasphemed! What further need do we have of witnesses? Behold, you have now heard the blasphemy (Matthew 26:63-65).

Jesus claimed that he is the Son of God, and but this the high priests accused him of blasphemy, i.e. the act of claiming for oneself the attributes and rights of God. That's the main reason why the high priest handed him over to the Romans government to be crucified, so is rather contradict for muslims to say Jesus was crucified but he is just a prophet of God.

* * *

Let's see how other people see Jesus as.

But Jesus said to them, "I have shown you many great miracles from the Father. For which of these do you stone me?" "We are not stoning you for any of these," replied the Jews, "but for blasphemy, because you, a mere man, claim to be God." (John 10:32,33)

When Jesus saw their faith, he said, "Friend, your sins are forgiven." The Pharisees and the teachers of the law began thinking to themselves, "Who is this fellow who speaks blasphemy? Who can forgive sins but God alone?" (Luke 5:20,21)

Even the Jews and the Pharisees can also see that Jesus claimed himself as God.

* * *

And how does the prophets see Jesus as? Let's refer to a very popular verse that quoted during Christmas.

For to us a child is born, to us a son is given, and the government will be on his shoulders. And he will be called Wonderful Counselor, Mighty God, Everlasting Father, Prince of Peace. (Isaiah 9:6)

Isaiah wrote this 700 years before Jesus was born as human, and we all know that 'a child' refers to Jesus Christ, and the most important is what he will be called. Isaiah clearly said that he will be called 'Mighty God'.

* * *

How does the disciples looked Jesus as?

In the beginning was the Word, and the Word was with God, and the Word was God. He was with God in the beginning. (John 1:1-2)

We all know that Jesus is the Word of God that came into flesh, and John begins the gospel clarify that Jesus was with God, and Jesus was God.

In our walk with Christ, our faith wavers, so does Thomas, the disciple of Jesus. Famously he was known as "Dubious Thomas", why? Simple because initially he don't believe in the resurrection of Jesus.

So the other disciples told him (Thomas), "We have seen the Lord!" But he (Thomas) said to them, "Unless I see the nail marks in his hands and put my finger where the nails were, and put my hand into his side, I will not believe it." (John 20:25)

Only after Jesus appeared in front of him, and let him touch his scares, Thomas believed the resurrection of Jesus.

Thomas said to him, "My Lord and my God!" Then Jesus told him, "Because you have seen me, you have believed; blessed are those who have not seen and yet have believed." (John 20:28-29)

Thomas called Jesus as 'my God'. Remember in Revelation, when John saw an angel, he was going to worship him, but the angel said to him "Do not do it! I am a fellow servant with you and with your brothers the prophets and of all who keep the words of this book. Worship God!"  (Revelation 22:9). If Jesus was not God, he should correct him and said something like, "I am not God, I am just the messenger from God". Rather we can see that Jesus accepted the worship from Thomas, and teaches us a lesson that 'blessed are those who have not seen and yet have believed.'

* * *

Some might said Jesus is Son of God, but not God. This is rather interesting, let's refer the most famous number, 3:16.

For God so loved the world, that he gave his only begotten Son, that whosoever believeth in him should not perish, but have everlasting life. (KJV John 3:16)

John said Jesus is the only begotten Son of God. A human begets a human, a cat begets a cat. Something begets its own type, never of other type. A human cannot beget a cat, nor a cat can beget a human. So in a same way God beget a person that is of its own type, that is God also. So Jesus is 'the begotten Son of God', simply also means that Jesus is God. (But of course it doesn't mean like God the Father 'gives birth' to God the Son, because each of the person in the Trinity is self-existing, with no beginning and no end, and that's why Jesus is also known as the Alpha and Omega.)

* * *

So we saw how different people: the prophets, the Jews, the Pharisees, the high priests, the disciples, and Jesus himself claimed himself to be. We all know that Jesus is fully human, but Jesus himself claimed more than just fully human, he also claimed that he is also fully God. He never intended to be just known as just 'a good moral teacher' or just 'a messenger of God'. He claimed that he is God.

So this left us three choices:

1. He is a mad man. He is not God, but he thought that he is God.
2. He is a evil man. He is not God, and he consciously knows that he is not God.
3. He is really what he claimed to be, which is God.

The first possibility is out, how can a mad man be a good moral teacher, or a messenger from God? Second possibility is out also, why an evil man will die for other people, and how can an evil man sent by God as prophet? 

Sherlock Holmes said, "When you have eliminated the impossible, whatever remains, however improbable, must be the truth". We have eliminated all the others impossible possibility, so the remaining one, however improbable for us, must be the truth, i.e. Jesus Christ is God.

Some people asked, how is this possible that Trinity is true? How can one God, exist as three persons? I can answered it with the word of Jesus himself 

With man this is impossible, but with God all things are possible. (Matthew 19:26)

If our limited mind can understand the unlimited God, then He is not an unlimited God. But praise be to God that He is who He is, He is the unlimited God, and that's why our limited mind, cannot fully understand the full nature of God. If you still cannot believe in God, if you still cannot believe in Jesus Christ, if you still cannot believe the truth of Trinity, then pray to God and say, "I do believe, help me overcome my unbelief" (Mark 9:27)

 ____________________

Jesus said, "Behold, I am coming soon! My reward is with me,
and I will give to everyone according to what he has done.
I am the Alpha and the Omega, the First and the Last, the Beginning and the End."

Revelation 22:12-13

Isolation 闭关 II

Recently my mood not quite good, and summer examination is coming soon in exactly one month time, would not be posting anything here, unless got something inspiring to share. Also would not be signing in MSN, would like some time of quietness to calm my heart and prepare for examination.

.....

It is time, to cut it off.

....

It is time, to curtail it.

...

It is time, to let it go.

..

It is time, to forget it.

.

.

.

Genesis & Revelation

Just finished the chronological bible studies with Lora after 4 years and 2 months, somehow the original 2 and half years course became so long XD. Anyway we made it and this is something that I learn and I would like to share it here.

In Genesis we have the commencement of Heaven and Earth.

In Revelation - the completion / perfection of Heaven and Earth.

***

In Genesis -the entrance of sin and the curse.

In Revelation - the exit of sin and the curse.

***

 In Genesis -the dawn of Satan and his activities.

In Revelation - the doom of Satan and his activities.

***

In Genesis -the Tree of Life is relinquished.

In Revelation - the Tree of Life is regained.

***

In Genesis -Death makes its entrance.

In Revelation - Death makes its exit.

 

 ____________________

 

Jesus said, "Behold, I am coming soon! My reward is with me,
and I will give to everyone according to what he has done.
I am the Alpha and the Omega, the First and the Last, the Beginning and the End."

Revelation 22:12-13