Step #1: Be a godly man

Today immediately after the Sunday service, I meet with Joshua and went to his church in Cheras. After the sermon there was a choir singing by Jean and other brothers and sisters. After the service we have a lunch at McD. Then we meet up with Wailup, Annie, Chong, and Yiping. We have a great time together and catching up with what happened in our life. 

Glad to see these three couples, not just ordinary couples, but couples that grow together in our Lord Jesus Christ, couples that please God and glorify His name. And the way they being close with each other is so much different from those couples who are not in Christ. I also seen Wailup and Annie's wedding photos. Those photos were taken at Kota Kinabalu by Adam Ong. Maybe next time should find him also, find only I meet a godly partner. 

Btw I quite surprise to hear that Kok Tong is very popular among the sisters in his church at Kedah, even the pastor's wife wanted to introduce her daughter to him. I wonder why this is happening, and Joshua explained, is very simple, a single young man, with talent, works as a doctor, and having a strong and firm spiritual life, so of course many sisters coming after him. After all what Frank says is true, if you want a godly wife, just be a godly man. You can't expect God let an ungodly man to take care a godly woman. 

Seriously I always thought that finding a godly partner is very difficult. Actually it is not difficult, because the difficult part is to be a godly man. Is never easy, in fact it is impossible for everyone, because all have sinned and fall short if the glory of God, but thanks be to our God that He sent His Son to be the atonement of our sins. By His blood we are able to pursuit holiness, to be more Christ-like. Anyway I feel so glad to meet these brothers and sisters again. There are like my family. 

 ____________________

 

"Be holy, because I am holy."
1 Peter 1:16

Elective Posting: Day 10

Today... Nothing much in the morning, the specialists very late only came to do the round ward. I was looking forward to the teaching about insulin therapy, but when my friend and I reached there, the doctor said it is exclusive for HOs only. And there is no CME today because there is only a CME every forenight. Double disappointments.

However today I was given a chance to take ABG again, because initially the HO has some difficulties in inserting the branula and the patient has a bad impression of her. So she asked me to help her take it. Taking ABG is really not easy. Though able to feel the pulse very clearly and the patient is not obese, but somehow I can't insert the needle into the radial artery. The worst thing was that the patient keep making a lot of noise >.<. So the HO asked me to take from femoral artery. I was thinking, are you serious? Femoral artery? Because the risk of having hematoma is much higher.  Anyway I just try and do it because she said is very easy. As she said, the femoral artery is very big and palpable, just that it is deeper. One insertion, and woopa... the bright red arterial blood flow up into the heparinised syringe. Thank God really. Since ABG was taken successfully, the patient also quiet down, but he still complained about the branula on his hand. So I warned him that if he pull it out, the doctor will poke him again. 

Btw, in the afternoon 2 patients passed away. There were some medical staffs carried a metal casing to carry them away. Very sad to see those things happened. 

Last week I was still wondering about asking the patient's family to decide whether to NAR or DNR for the patient. Personally I think that the doctor should do their best in saving patient's life. Today I got my answer about it. The consultant in my ward from gastro explained that the very first principle in medicine is: Patient Autonomy! If patient cannot make the decision due to unconsciousness or confusion or other reasons, it is not the family, who don't have medical knowledge and skills to make consent. Doctor is the one that should make the most suitable choice  for patient according to the situation. We should just counsel the family, let them understand the reason behind the doctor's decision, rather than letting them making the choice. 

What he said is true. How can the family, especially those without medical knowledge can make the decision in how to save patient? But according to the consultant's words, doctors nowadays due to pressure from boss and the family, and they want to save themselves from all the troubles, doctors will ask the family and get their 'consent' when come to making decision, but this is a wrong practice. Suddenly I remember what Peter said. 

Peter and the other apostles replied: 

"We must obey God rather than men!"

Acts 5:29

Sometime instead of doing things according to what other people want, we should do what God commands. 

Elective Posting: Day 09

Today morning I tried to set up a line in a asthmatic patient , but I failed go put the branula on both sides of the hand. The first one failed because I forcefully insert the branula into the vein, so I can't flush the heparin through it. After take out the branula, the HO found out that the branula is bent >.<. For the second one I didn't manage to push the whole branula in, and when I took the branula out there is resistant when taking out, and it bleeds much after the branula was removed. This time the patient was really not happy about it. The third time the HO put the branula, initially there is also resistant when she was tryin to flush the heparin, but after tilting the hand a bit she managed to flush it. Kind of sad because the veins were so prominent and I was given two chances, yet I failed, patient felt very unhappy, and I gave that HO so much troubles. But surprisingly in the afternoon before I left the hospital that HO told me that she need to reinsert the branula because the insertion site of the branula was swollen. I wonder whether I was not skillful enough, or something wrong with the patient's veins? Hmm...... 

Today I also has chance to do PR (per rectum, i.e. digital rectal examination) to palpate the prostate gland, because this patient has liver metastatic disease and prostate cancer need to be rule out by checking serum PSA and doing PR. The HO that taught me to do PR also taught me how to do BFMP (blood film for malarial parasite). A thick blood film and thin blood film need to be done. Today only I knew that this HO graduated from Ukraine. Suddenly felt very...... don't know how to describe it , is like meeting a fellow friend in a foreign country. Anyway glad to meet this HO. 

Those who did practical in medical ward must had follow a round ward with specialist or consultant. But have you seen a grandround ward? Today I saw my gastro consultant came with his MO in the afternoon, but there were many other gastro specialists and MOs came with them. They are known as the 'Gastro Team'. Very surprise to see so many doctors from other department came together to see some patients.  Even the specialists in my ward saw them, raised up their hands a bit, and said, "Hi boss" o_O. I wonder how many does it takes to reach their position. 

I attended the CME of medical department twice, I felt very disappointed. The way they present their case and topic is like...... reading the slide. You don't  need MD or MBBS to read the slide. Even some of my seniors can present better than them. Maybe I think I expected too much from their CME. But their HO teachings are quite good. There is a teaching about insulin treatment tomorrow, I hope medical student can attend also. 

Elective Posting: Day 08

Note: Seriously, I really wonder who still read this blog......

After few days of elective posting at hospital, gained many experiences. By The grace of God I have chances to take more venous blood, set up line or insert branula. There was a time that I need to take venous blood from a 12 years old boy with dengue fever, since need to take blood 3 times per day from dengue patient. But it was difficult to find veins in a small kid, especially after poking his veins so many times. So the HO asked to me to take arterial blood. So again by the mercy of God I have a chance to take arterial blood.

Though the vein difficult to find, but paradoxically the artery is easy to get in children. Though getting more chances to do different procedures after staying at ward 18 for about 1 week, but getting kind of depressed cause can't really answer specialists' questions, and they usually ask us to find the answer in CPG, CPG, CPG, CPG...... CPG simply stands for Clinical Practical Guidelines. They are some guidelines regarding management of patient that set up by Ministry of Health (MOH) of Malaysia. Last time need to read books, now need to read those CPG =_=. Today heard my friend said she felt what we learn in Russia is like...not to say totally useless, but is like not usable in Malaysia hospital. Getting many 5s at there really doesn't mean anything at all, even getting a Red Diploma doesn't mean anything. So how should I move on? Someone said before that our eyes are located in the anterior part of the head, so that we will look forward and not looking backward. Suddenly I remembered what Paul said to the church of Philippi.

Brothers, I do not consider myself yet to have taken hold of it. But one thing I do:

Forgetting what is behind and straining toward what is ahead, 

I press on toward the goal to win the prize 

for which God has called me heavenward in Christ Jesus.

Philippians 3:13-14

Maybe I really need to forget what is behind, and press on toward what is ahead. The past is memorable and valuable, but it can never hinder the future.

Elective Posting: Day 04

Today the ward not so busy. Thank God that I have chances to draw blood from some patients, but still didn't get a chance to insert a branula or take ABG. Yet today I know that there is something more difficult than taking ABG, and HO need to know how to do, that is to set up a central line, mainly to measure the CVP to check the hydration state of the patient. It can be either long line (insert from a peripheral vein) or short line (insert from internal jugular vein). When that HO knows he need to set up a long line, his expression like =_=. He mananged to get helps from few HOs, but after 3 attempts, they still fail. In the afternoon, the MO came to set up a short line, with guidance from other MOs and a specialist. After 3 attempts she also fail, because she keep insert the line into carotid artery. The specialist takes over, but few attempts he managed to insert the short line successfully.

Today I keep hearing doctors mention about this patient is NAR or DNR. NAR is need active resuscitation and DNR is do not resuscitate. But I still don't understand why there is a DNR option for patient. Shouldn't doctors do everything that they could to save the patients.

Today a consultant of ward 18 came again. I assumed that he is a specialist in GI department because he just want to GI patient only. He is a very good doctor, and he is the first doctor that bother me and ask me questions. Other specialists see me like an invisible person or a furniture only. One specialist only talk to me when she is seeing a patient from Myanmar, and she says to me,"You know how to speak Myanmar? Don't know? Why you didn't learn how to speak?" =_=...... Another specialist talks to me because he want me to speak to the patient's family in chinese. =_=...... I am a medical student or a translator?

Anyway, that GI specialist said something quite interesting. He said that everyone in this society has his own responsibility. Doctor can only diagnose the disease and give treatment to the patient. At the end of the day, patient has to take care of himself and compliant to his treatment. Doctor can't do everything. If you try do everything, at the end of the day, you just exhaust youselve only, but patient don't appreciate what doctor did. He keep saying "at the end of the day" many many times. The other day he also said that sometime he feels very lost interest in medicine, not because we can't do anything, in fact the hospital got many advance equipments and the best drugs, but the patient just not compliant to their treatment, and didn't follow up at the clinic. What he said is very true, but suddenly I remember what Paul said to the believers in Thessalonica.

And as for you, brothers, never tire of doing what is right.

2 Thessalonians 3:13

May the daily routine work in the hospital will not make our heart becomes harden and callous. Let us not forget the initial passion that we has when we choose doctor as our profession.