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Thursday, October 27, 2016

post-long case medicine

assalamualaikum, bismillah.

alhamdulillah, thummalhamdulillah, 

hari ni ada long/major case medicine, my very first long case untuk final med. dan it is medicine. semua benda lah possible ditanya -.-' konon nak stay up lama sikit, dalam 1230 tu otak aku dah tak boleh absorb dah. huhu. tak ngantuk tapi tak dapat nak tidur, bila tidur mimpi dah macam-macam dah. haiyyaaaa

tiba-tiba dah ada orang kejut, remind aku kena bersiap mandi semua sebelum subuh. (sayang housemates! ;*) tapi in denial dia hanya Allah yang tahu. mandi pun macam 'whyyy, whyy i have to do this.. lol' aku punya turn jumpa patient pukul 730 pagi. Mercy Hospital ni jalan kaki adalah 30 minit. nak naik basikal, tak ada lampu. dan subuh pukul 627 pagi. what do you expect pukul 7 tu langit macam mana? hehehe memang gelap.

around 640 selesai jemaaah subuh. decide naik taxi, taknak gelabah juga. pakcik taxi baik sangat T____T free2 dapat motivasi pagi.

'you'll be okay. you've been ready for this, you just need to keep calm.. (siap gaya tangan)
this would be your last exam (tak adalah last sangat) its worth your time and effort!
have a cup of coffee, keep calm.
you'll be okay. fingercross (siap buat gaya), hopefully. (ni sign 'InsyaAllah' diorang hehe)
best of luck!'

banyak la sebenarnya dia bagi kata-kata semangat. alhamdulillah!

sampai-sampai hospital, gelap la juga. lampu corridor dekat ward tak semua buka lagi. jumpa patient yang diassigned pun, lampu katil dia je buka, lampu bilik belum lagi. bila dah nak habis aku ambil history dan exam, baru nurse datang buka lampu, kejut patient

'good morning!!'

dia buka langsir bed aku. 
'ops! sorry!'

haha issokay, memang awal pun nak ada exam pagi-pagi macamni kan nurse kan? hehe. walaupun aku nervous sangat dan literally shaking depan patient masa ambil history. belum masuk gelabah aku tertinggal BNF atas meja dekat rumah. beria je pinjam from library! sabor jelah. 'ala kulli haal, alhamdulillah it went well.

examiner aku Prof V. One of the respected cardiologist. cardiologist memang jenis busy dan berpagi-pagi kot. dan aku orang kedua, orang pertama turn jumpa patient pukul 715. luls. patient aku history dia agak straight forward; Coronary Artery Disease.

started dengan a bit nervous masa present history :(

'okay so what did you find on examination?'

' on examination, he was lying down comfortable no sign of any distress, not attached to oxygen. Capillary refill is normal, no sign of cyanosis. His heart sound 1st is present with diminished 2nd heart sound. (prof dah start reposition. cuak gak) there is harsh ejection systolic murmur, heard loudest at aortic area; right 2nd intercostal space best heard during expiration with intensity 3/6 and it radiates to the carotid'

'okay..'
'he has good air entry bilaterally in the lung, no added sound'
'okayy.. any other abnormal finding?'
'oh he has some bruises on his tummy..'
'why is that?'
'it's from the heparin injection'
'okay2.. go on'

'your summary?'
'this is Mr M 70 y/o man, non smoker, with very strong family history of heart disease presented to AnE due to sudden chest pain. on examination, he has harsh ejection systolic murmur 3/6 intensity.' 

baru nak cakap impression.

'what diagnosis do you think?'
'the findings are consistent with Coronary Artery Disease'

panjang la pulakkk nak tulis full conversation. lol. pastu kami jumpa patient, dia dengar patient's heart. nervous! takut make up cerita. wallahi that's my first time betul2 menjiwai nak listen to patient's heart. siap tutup mata nak khusyuk dengar lol. hopefully patient tak rasa aku pelik, lama gak duk dengar suara hati jantung dia.

then prof tanya pasal investigation, kalau ECG, particularly nak tengok apa? (Left Ventricular Hypertrophy) , echo? angiogram? sesuai tak buat stress test? indication CABG surgery ? kalau dekat patient, nak tengok apa specifically. aku tak dapat tangkap sangat soalan ni. dia rephrase kalau dekat kaki patient nak tengok apa. ahha! veins for graft. tengok kalau ada vericose vein. Indications for valve replacement? banyak lah juga soalan dia tanya. huhu macam kena drill habis-habisan.

last question he asked;

'what is your differential diagnosis if you hear murmur all over the pericardium?'

(ni memang soalan specific dia pernah tanya masa tutorial! i am grateful i attended the tutorial)

' it could be Aortic stenosis combined with Mitral regurgitation (1), Gallavardin syndrome (2), posterior leaflet syndrome (3), or maybe just purely Aortis stenosis that is very severe (4)' 

alhamdulillah. he gave me distinction for that. alhamdulillah.

'you did very well, you did very well'

All praises to Allah. alhamdulillah. aku sebenarnya dah plan, maybe i should treat myself dengan makan lunch dekat town ke lepas exam (biasalah post exam), tapi last2 decide nak treat myself dengan puasa esok. hoho. sebagai tanda syukur Allah juga izinkan, mudahkan. 

sampai rumah, petang sikit ada Irish 4th year yang attach dengan team prof V mesej. 

'Hey is the Thursday tutorial good? Radiology'

tak perasan mesej dia. 2nd mesej about 15 minutes later..

' I meant to tell you that Prof said you did very well !' 

lol, apakah dia ni, manis mulut, dia ni jugaklah nak tengok template aku punya history taking macammana. sebab ada sekali tu masa present dengan consultant dia kata , your presentation was very good. it wasn't really -..-

panjang lebar aku cakap of course radiology tutorial tu bagus. haha

'i hope prof really meant it. Thanks *E'

'oh he was very impressed haha. must get your cardiology notes off you!! hahaha'

'you just need to attend his tutorial, he already told you the answers for all the questions he asked!'

lol. i really meant it, datanglah semua tutorial, ikutlah semua aktiviti team. no tricks. Memang ada yang rasa tak membantu sangat, baik balik study. tapi pada aku, my personal aim untuk tahun ni memang lah nak score exam, tapi jauh lagi dari tu kot. think about what type of doctor you want to be. aku selalu rasa, semua benda insyaAllah useful je, kalau bukan untuk exam final year, as doctor nanti. yang paling penting be Ihsan. you don't have to justify to someone else pun kalau tak nak pergi tutorial, tak nak ikut team, no one really cares. just be honest to yourself. Allah akan sentiasa akan balas segalanya dengan seadil-adilnya.

dengan ini, minggu ni last week rotation medicine. banyak sangat benda kena improve dan cover huhu. i didn't do well masa 4th med written exam. takut sangat writen exam summer nanti.. tapi insyaAllah mohle kita berusaha. ada masa lagii*biceps* seru semangat..

tadi balik jalan kaki lalu main campus, ada graduation ceremony.

surrounding dia lain macam... tengok orang pakai jubah convo, dengan family semua. bergambar.. happy..

dalam hati..  :

'InsyaAllah Huda, sikit lagi.. sikit lagi.. May 2017 kita convo eh'

:)

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