Day 4 (09/07) – My First Pleural Tap

9^th JULY 2009 – THURSDAY

8.00 AM

• I arrived at the medical ward at 8 AM. I waited for a while, then I joined Dr. W for the ward round. I followed her checking on few patients, and we arrived at the patient with pleural effusion.
• Dr. W decided that the patient needed another pleural tap. She asked whether I want to perform the procedure, with her assistance of course, and I agreed.
• Then she went to do some clerking, while I sat on a corner revising the steps for the pleural tap procedure.
• After a while, the nurses came and they set up the equipments. I put up my sterile suit with gloves and mask. Then I set up the drape area for the pleural tap on the patient.
• The area chosen was posterior axillary line on the level of 5^th Intercostals space. First, I clean the area with some iodine, then I swab it with alcohol to prevent contamination.
• After that, I prepared the local anaesthetic lidocaine solution. I inserted the needle all the way in, avoiding the ribs, and started pushing the lidocaine diffusedly.
• Then I waited for a while for the lidocain to take effect. After that, I inserted the pleural needle at the same site. I felt the tip of the needle touched the rib, so I avoided it and went at the upper border of that rib.
• I managed to enter the pleural. I took off the needle cap, and few mililitres of pleural haemorrhagic fluid came out.
• There was only few mililitres of fluid. I pulled out the syringe but there was no fluid.
• Dr. W took place, and tried to retrieve the fluid again, but there was no fluid too.
• We then pulled the needle off, and put dressing on the site of injection. Dr. W decided to order a X-Ray to determine the quantity of the fluid. Perhaps the previous 2 procedures had drained a lot of fluid, that’s why there was not much fluid taken today.
• The procedure ended around 11 AM. I went for a lunch break.

2.30 PM

• I returned to work at 2.30 PM. I attended the emergency department.
• That evening, there were few cases of injuries which required immediate attentions
• One of them, a middle-aged construction worker had an accident at the working site. His 5^th phalanx were dislocated 90 degrees at the level of interphalangeal joint.
• The doctors decided to do closed fixation. Local anaesthetic was injected, and the patient was given enough analgesic. One doctor held the patient, and the other one pulled the affected phalanx. The patient screamed in pain, and a click sound was heard as the dislocated phalanx returned to it’s normal location. The patient felt less pain afterwards. He was then sent to radiology for X-Ray.
• My session at emergency department ended around 4 PM. I then was allowed to be free.

Day 3 (08/07) – Mumps and Stroke

8th JULY 2009

8.00 AM
•    I arrived at the hospital and went straight to the ward. Today, the day began with the pleural tap procedure on the same yesterday’s patient. There still present a lot of fluid in the left pleural cavity, despite yesterday’s draining.
•    I helped Dr. W perform the procedure. This time, the fluid was taken from the posterior side of the patient, at level of 5th Intercostal Space.
•    Like yesterday, the hemorrhagic fluid was drained. Patient informed that she feels a lot better than yesterday.
•    Then, there were new admissions of patient. One patient was a young girl, who collapsed at school. It was believed that the girl collapsed due to dehydration and lack of nutrition. The girl was trying to lose some weight, therefore skipped some meals.
•    Another patient was a middle-aged woman presented with swelling of the left side of face. The swelling was very painful and sensitive to touch. The patient also seems lethargic. Blood count shows an increase in white blood cell, particularly neutrophils. It indicates that there was an infection going on. Swelling of the parotid glands and lymph nodes confirmed the infection. The diagnosed mumps was confirmed later.

10.00 AM
•    I then followed Dr. W and Dr. B to the clinic. At the clinic, I met with Dr. E who was also conducting the consultation.
•    There was a lot of patients with Diabetis Mellitus, and Arterial Hypertension.
•    Dr. B asked me few question regarding the stroke patient in the ward. She asked me about the type of stroke – hemorrhagic and ischaemic stroke.
•    She also asked me about the clinical examination for neurological system, and asked me about reading the CT scan. I told her that I’m not yet having my neurology cycle.
•    The clinic ended around 12.30 PM. I asked the doctors about the evening session, and they said that the ward round may be conducted but will be very late, so I was allowed to be free that evening.

Day 2 (07/07) – The Pleural Tap

7^TH JULY 2009

9.00 AM

• I arrived at the ward. Today, my day began with a ward round, lead by specialist Dr. T.  We checked out each and every patient, and while we stopped at a patient, Dr. T asked me about the patient.
• Among the questions asked by Dr. T were about the classification of Thalassemia, the Glasgow Coma Scale, and about the pleural effusion.
• Then, he also asked me to do the history taking and perform respiratory examination of the patient with pleural effusion.
• The patient, 80 years old lady was admitted with complaint of breathlessness. I did respiratory examination, and general inspection showed that diminishing respiratory movement on left side of the lung. There was also tracheal deviation. Auscultation was done, and there was no breath sound at the left side of lung, below 3^rd intercostal space. Percussion was done, and I heard flatness over lower part of left lung. The initial diagnosis was pleural effusion, and it was confirmed by the x-ray.
• Therefore, the doctors decided to do the pleural tap, as well as biopsy of pleura, to determine the nature of the fluid. Dr. B conducted the pleural tap. Here’s what I watched and learnt from her:

Day 1 (06/07) – Reporting For Duty

8.00 AM

• Today is the day I should be reporting in. I arrived at Hospital  around 8 AM. Since today is Monday, there was staff assembly. Therefore I waited for my appointment with the director hospital, Dr. TGS.

9.00 AM

• Dr. TGS came and meet me. There are 2 other medical students that will be doing the practical with me. They are from Crimea State Medical University, Ukraine. Dr. TGS explained us briefly about the rules and regulation of the hospital. She also reminded us the dress codes, and told us the expectations. We also took the chances to introduce ourselves to her.

10.00 AM

• Dr. TGS assigned me with the Head of Medical Department, Dr. T. He is in charge of the Specialist Clinic of Hospital. Therefore I reported myself to him, introducing myself. He then assigned me with one of the MO in charge, Dr. W. I then joined Dr. W in the clinic.
• In the clinic, I swiftly introduced myself to Dr. W, because the consultation is still ongoing. I placed myself at the corner of the room, listening to the consultation between Dr. W and the patients. Dr. W explained to me about the patients, about her approach etc. Among the patients we have this morning was:

Perubahan

Assalamualaikum

Alhamdulillah, baru semangat sikit nak godek-godek blog baru ini, setelah selamat sampai di bumi Malaysia (dan bebas H1N1!). Hehe.

Kehidupan aku sejak kebelakangan ini, terutamanya ketika exam aritu adalah sangat-sangat stereoraip. Siang tdo malam berjaga, study, study dan study. Membosankan.

Arakian menjadi fitrah manusia apabila dia bosan maka dia akan malas. Haha. Justeru aku ada mengambil tindakan/pendirian ketika musim exam aritu, demi untuk mengekalkan semangat serta mengelak dari putus asa..

Dan antara azam yang aku buat adalah – aku nak beli Macbook!

Macbook?

Mana datang azam nak ber-macbook aku ni ek. Hmm. Tak sure la pulak. I’m not really a fan of Mac (or any Apple product, for that matter). Aku dulu berpendapat, geng2 product Mac/Apple ni “arrogant”. Sebab produk2 diorg ni sangat2 exclusive. Takleh bercampur dengan orang lain. Mac xleh get along with windows, and windows softwares pun xleh get along with mac/apple product.

Tengok contoh, iPod/iPhone. Mesti kena guna iTunes kat windows untuk manage. (dengan beberapa exception lah, seperti plugins, 3rd party softwares etc).

So aku agak sceptic pada awalnya. Mac is for mac users only. Ditambah pula dengan sikap sesetengah pemilik Mac/Apply (sesetengah ye, bukan semua), yang sering berlagak dan menunjuk-nunjuk kelebihan OS masing-masing, seolah MacOS lah OS terbaik di dunia, etc etc.

Out of curiosity, aku berminat lak nak tahu mengenai MacOS nih. Is it really up to that standard? Peluang datang ketika nak settle exam (demi mencari motivasi/semangat), manakala laptop Twinhead lama aku pun da semakin deteriorate. So aku buat keputusan yang sungguh sudden – nak test guna Mac pulak lah.

Ini bukan pengalaman pertama aku dengan MacOS. Aku pernah mencuba-cuba hack install MacOS ke dalam laptop twinhead aku dulu, ketika around 2007 kalau tak silap. Teknik ini dinamakan “hackintosh”, sedangkan masa aku try experiment dulu term hackintosh ni tak wujud lagi pun. Ahaha.

Of course lah, ketika tersebut aku cuma bereksperimen. Banyak masalah yang timbul. Driver tak support la, bunyi tak keluar la, hang la, etc etc. So aku fedup dengan MacOS, lalu aku format balik. Huahuahua.

Then alhamdulillah, recently diberi ilham untuk guna Mac balik. Mungkin sudah terlalu bosan dengan Windows, agaknya. Macam-macam dah aku tau pasal Windows – dari segi troubleshooting, install problem2, softwares2 commercial atau open source, etc etc. Aku tidaklah mempunyai kelayakan formal dalam dealing with windows, tapi pengalaman dan sifat try-n-error yang terbina dalam diri aku banyak mengajar aku.

Secara ringkas, ya, aku bosan dengan windows. Kerenah itu ini, virus itu ini, rosak itu ini. Lalu aku decide nak guna Mac tengok lah.

Pada mulanya, aku bercadang nak buat hackintosh je. Murah pun murah, cadangan asalnya nak cari netbook sebijik, then install hackintosh setup macam iDeneb etc. After all, aku ingat just nak try je.

But then aku terfikir, hijrah/migration ni kena drastik, baru boleh istiqamah. Total change of the environment. Lagipun aku da ada pengalaman deal with hackintosh dulu2, so aku tau banyak problemnya. Last2 aku kata – ah alang2 nak tukar MacOS, baik cari Mac computer terus!

Bajet aku time tu, around rm1500 je. So kalau nk diikutkan, netbook jela yg mampu pun. Tapi setelah beberapa siri permohonan, loan application aku akhirnya diluluskan. Hoho. Loan dari mana? Oh bukan MARA, tapi “FAMA”. =p

So aku survey2 la, ape Mac yang sesuai. Actually ingt nk amik Mac Mini sebab memandangkan aku da ada peripheral (monitor, keyboard, mouse etc), tapi disebabkan aku nk replace laptop aku yg lama tu, so aku kena ganti ngan laptop gak la. Usha2 punya usha, survey2 punya survey, jumpa pun MacBook White yang latest edition, baru distribute early June aritu. Ni basic spec latest MB tu:

* 2.13GHz Intel Core 2 Duo
* 2GB 800MHz DDR2 SDRAM – 2×1GB
* 160GB Serial ATA Drive @ 5400 rpm

Spec-spec lain adalah macam biasa je, graphic card nvidia 256mb, ade bluetooth, air-port wifi, built in camera, microphone, etc. Pendek kata complete lah, cuma takde memory card reader je. Huhu. USB port ada 2 je, tapi aku x kisah sebab aku da ade external USB Hub. Then ade port Firewire. Problem satu, output video dia hanya mini-dvi, so kalau nk output ke monitor atau projector kena beli converter dia pulak. -_-“

Alhamdulillah, aku pun habis semua exam dengan memuaskan, lalu aku pulang ke rumah. Keesokan harinya je aku da ajak parents aku gi usha Macbook nih. Hehe. Kami pegi kat kedai Switch di Sunway Carnivale, Penang. Switch adalah official Apple Store di Malaysia, HQ di Penang. Pendek kata memang kedai khusus untuk semua produk Apple lah, kalau ade problem pape pun boleh carik diorg.

So dah nampak dari jauh Macbook pilihan aku, harga pun mmg fixed RM3699. Try nak mintak student price (less RM200), tapi hanya untuk student universiti2 sekitar kedai tu je (USM, UiTM). Tanpa berlengah lagi, aku rembat jelah. Hehe.

Hmmm…first impression – eh besar gak ek Macbook nih. Aku ingat putih kecik comel macam Twinhead aku dulu tu, rupanya agak gemuk. Dan tebal. Hmmm.. Casing putih kat luar plastik, so masalah cap jari memang akan timbul lah. Tapi takpe, dia ada bagi wiping cloth skali. Kat area keyboard ngan touchpad, material dia lain sket so xde fingerprint.

Then aku pun bukak2 la manual dia, baca2 sket2 dulu kot2 ade pape requirement before first start. Then dia kate xde pape, aku pun on jelah. Kinda impressed!

Starting macam biasa, dia mintak setup user, etc etc. Smooth and clear. Dalam 10 minit je dah boleh access desktop. So aku pun mula2 la godek2 sgale ape yang ada.

Mac is very smooth and easy! Mula2 aku nak try connect internet guna henset aku dulu. As soon as aku on je bluetooth, Macbook pun detect dan pairing. Tak payah install driver paper pun! Setting2 network sket (biaselah, set APN celcom, etc), trus aku dapat connect ke internet! Jauh lebih mudah dari Windows!
Then, nak try guna broadband lak. Lepas je cucuk, macam biasa, dia terus detect dan keluar application dia terus. Xde nak install pape. Within few minutes I’m connected and on line!

Ade member kata, Mac ni untuk orang yang busy. Sekarang aku tahu sebab ape.

Tak perlu buang masa fikir pasal antivirus, spyware, malware, trojan etc etc. Mac is virtually virus-free! Xdelah 100% xde virus, tapi terlalu sikit hingga boleh dikatakan tidak signifikan langsung!
Installation adalah sangat senang! Majority software Mac adalah sangat simple untuk di-install. Semudah copy-paste! Xde susah2 nak cari drive mane location mane, installation wizard etc etc.
Software Mac is built for Mac. Walaupun orang kata software Mac susah nak jumpa, tapi software yang ada adalah sangat-sangat compatible dengan sistem sedia ada. Maksudnya susah nak jumpa keadaan hang la, stuck la, corrupt la etc etc.

Berikut adalah beberapa decision yang aku buat dengan Mac aku:

1. Dulu aku biasa guna Thunderbird untuk uruskan email, sebab email aku banyak so better guna client dari web browser. Thunderbird lak aku kena tambah plugin MyPhoneExplorer untuk sync data email, calendar, address book aku dengan handphone aku.
2. Then bila guna Mac, aku cuma guna built-in software ”Mail“ je. Built-in mail client ni boleh handle sumer akaun2 email aku (even live.com!). Then dia link secara direct dengan software calendar iCal, built-in address book, and finally, dengan software iSync untuk aku synchronize dengan henset aku. Mudah, xde nak kena download pape, plugin pape.
3. Mula2 aku guna web browser Safari yang built in nih. Then aku rasa x brape best ah safari, sebab bagi aku Firefox dah cukup perfect. So aku download la Firefox for Mac, then dilema yang muncul adalah camne nak synchronize profile firefox dari komputer lama aku ke Mac nih. Google2 sket rupa2nya mudah je, just copy-paste! Aku waswas la jugak pada mulanya, tapi lepas copy-paste aku launch firefox mac aku, terkejut jap sebab sebijik sama dengan kat windows aku!
4. Nak main dota. Dota sudah semestinya, baik windows ataupun mac. Aku pk2 jap, camne nak setel ek. Plannya nak download warcraft for mac, tapi cam besar lak saiz (2gb). So aku decide guna virtual desktop, Parallel. Download Parallel (around 100MB), then virtually install XP. Copy-paste je warcraft dari laptop lama aku, terus boleh play! Parallel siap letak icon warcraft lagi kat desktop mac aku. Ahaha. Performance? Macam xde beza langsung berbanding laptop lama aku (cuma skrin jelah, sebab aku skrg ni widescreen, dulu biasa).
5. Banyak lagi lah yang aku rasa mudah je buat kat Mac ni. So far aku xde rasa apa halangan pun nak guna Mac. Apa aku biasa buat kat Windows, semua aku jumpa alternatifnya kat mac, malah ada sesetengah alternatif tersebut even better lagi!

Alhamdulillah, so far 2 hari aku guna Mac, tak de walau sedikit pun rasa takbest atau penyesalan. In fact, rasa bersyukur dan berbaloi walaupun harganya mahal. Harap2nya Macbook aku ni bertahan lama lah.

Anyway, banyak gak idea untuk update blog lepas2 cuti ni. Tapi masa tak mengizinkan. Aku sekarang tengah practical di Hospital Bukit Mertajam. Best giler practical kat sini, compared to kat HSB aku buat tahun lepas. Cuma agak bz lah, banyak homework. Hehe. Anyway, nanti2 lah aku citer pasal practical. Penat, baru balik dari pract, nak rehat dulu. See ya later~ Salam.