Tibet [break] Nepal

After about 3.5 weeks of lovely hospital attachments, I rediscovered my love for medicine. or at least I finally saw the whole point of thorough sciences. I promise a detailed post on my attachment as soon as time permits!

I also left for Chengdu and Tibet not long after the attachment came to an end. I truly appreciated the company of a friend of mine from Cambridge and her fiancee from Princeton, especially after all the local delights they introduced me to!

Tibet met my expectations of being truly mystique, with clouds so close they seemed reachable, mountain ranges of marvellous shades laid out like thick layers of curtains, mirror-like, reflective lakes not to mention stunning architecture with the distinct black window frames, red/green ornaments and a tinge of Chinese yellow to everything else.

The food, disappointingly left my entire family travellers' diarrhoea, myself still feeling unwell as I blog despite having returned for about 4 days now. The melting yak butter, fuelling the candlelit temples left me feeling nauseous, and their oil-drenched fried rice/noodles didn't do any good to my GI tract.

As a result, I had to postpone my 6-week stint at Nepal and will only leave for that region of the world this Sunday. Am hoping to feel better by then! In the meantime, I've been keeping myself occupied with fun times at MMHA, whilst recuperating! Met an interesting bloke doing psychology at UTAR and almost met with a car accident, with him in it! I'd be pleasantly surprised if he requested for a lift tomorrow after the nightmare earlier this evening.

Day 1 - A&E

Slightly erratic at the start, but things got better later in the day. With almost zero-experience, the tiniest case admitted sparked my interest and caught me feeling inquisitive. The first case witnessed involved (today's theme: poisoning):

Organophosphate poisoning-malathion, I believe
Ah, chemical warfare. I think the doctor mentioned this was a suicidal attempt (quite obviously), and being cautious of the possibility of chemical aging (I presume the patient had delayed admission), atropine alone solved the problem. He did mention the clear parasympathetic symptoms, bronchorrhea (hypersecretion with excessive ACh), and an exception, sweating (excessive neurotransmitters).

Gastric lavage followed by administration of activated charcoal via nasogastric tube. The following case observed was similar, anti-psychotic poisoning-believed to be lamotrigine.

Major take-home lesson: Methods of dealing with poisoning and observing the common symptoms of these two types belonging to the umbrella theme.

The Bhutanese bloke doing his masters in EM also elaborated on an ECG showing lateral ischaemia, and mentioned other cardiac markers such as CKMB and troponin levels as possible diagnostic tests. He introduced aortic dissection to me and explained the possible appearance of an X-ray scan showing widening of the mediastinum and hints of pleural effusion as well as the plausible obliteration of the aortic knob.

That's hardly anything, but I'm certain there's more to come and that I'll learn more. Hardly did much besides cleaning up some emesis remains and giving the patient a change of clothes.

Voila, so I finally had my law interview yesterday night.

And what can I derive from the 30-ish minute conversation? I can't do law. I should just stick to medicine. =)

For keepsake, this is the brief case we discussed over the interview:

"Z, who is 16, conceives a child as the result of aone-night-stand. She keeps the pregnancy a secret. She wants to give the child up for adoption immediately after birth and therefore contacts the local authority. Neither the father nor her parents know anything about the pregnancy.

Article 8(1) of the European Convention on Human Rights states the following:

Everyone has the right to respect for his private and family life, his home and his correspondence.

In the light of this provision, should the local authority have a duty to identify and inform the father and/or the Z's parents?"

Please read the question carefully. (end)

The interviewer rang 12 minutes after I received the email, and the torment began

Nevertheless, it was great fun. Haven't used my brain that much in so long.

Written test/assessment up soon (apparently it's just an informal exercise). I don't expect it to be any easier than what I faced yesterday.

On a positive note, at least it isn't a scientific essay! I've written an incalculable amount of science-y essays since I embarked on the medical course. At last, something different.

I'm determined to only spend 10 minutes on this.

I've revamped my music playlist and it is this list that has been supporting me through the uphill battle of a certain examination we call Tripos, which makes me wonder really about the effects music exerts in our lives, what with the widely acclaimed Mozart effect, and something I stumbled upon more recently, the Beethoven effect.

To be honest, I don't really understand how music taps into our health; a possibility of establishing synchrony with brainwaves subsequently altering our attention span and ability to concentrate, somewhat similar to how the thalamus and ascending arousal neurotransmitter systems regulate our sleep-wake cycle. If that is true, this is bound to have physiological effects, perhaps observed changes in our breathing and heart rates considering their connections with the autonomic nervous system. But this really is too fuzzy for my liking. Nevertheless, there isn't much to lose by believing in this, bearing in mind the potential placebo effect like how complementary medicine most certainly produces its results.

Having said that, it is also heavily dependent on your choice of music, which then again relies on the different social groups, early exposure and upbringing. Some people find relief in suicidal music, and some in techno. Unfortunately, I fail to understand where they are coming from as I never shared their interest in music of those genres.

And then we come to the popular belief (with fairly solid scientific ground) that Mozart makes your children smart or more intelligent (really, semantics). Putting aside the flaws in assessing one's IQ, and assuming we all subscribe to the Stanford-Binet IQ test, surely researchers have to consider the other existing factors contributing to the results they are obtaining.

Temporarily enhanced spatial-temporal reasoning. hmmm. Perhaps certain pre-existing neurons fire in response to specific frequencies played, and perhaps this corresponds to the region responsible for this momentary spike. Mozart's pieces , if I remember correctly often revolve around a certain frequency range, I wonder if this would explain why a wide range of his pieces, and only his compositions would have triggered the observed response.

I suspect these enhancements may be an artifact-maybe generated from enjoyment arousal. Somewhat like a spillover effect of enjoying your environment? I shouldn't even attempt to challenge this really. Oliver Sacks discovered the association between music and Parkinson's, quoting several examples and citing that even mental rehearsal of a particular piece by patients who are music-enthusiasts creates a temporary effect of being 'released' from Parkinson's. I find that rather interesting, and possibly exploitable. Enhanced performance in the presence of something you enjoy. Projections to the substantia nigra from regions such as the amygdala and orbitofrontal cortex (?, I really am not too sure about this), and efferent connections to the thalamus. And if that's true, what will happen if we play music patients do not appreciate, or children do not enjoy? Will similar results still surface?

An interesting study on epileptics I once read mentioned that besides Mozart's K.448 and Piano Concerto No. 23, only Yanni's Standing in Motion had a similar effect of reduced seizures. Rhythm, tempo and predicatability are possibly the shared factors. I wonder at times if these effects will be produced if Asian contemporary music was used. One has to admit that these are not sufficiently researched upon, and we may be far from realising its potential.

Mozart has certainly received a lot of attention. Beethoven is however easily forgotten, probably because of his temperamental, dramatic style. I am rather ignorant with regards to this effect, but I'm certain it has to do with vibroacoustics, and this will probably come in handy in disabled individuals ie channeling music therapy even to those who are deaf. The proposition that the subtle vibration exuded from Beethoven's composition (especially the celebrated 5th Symphony) can be delivered into and throughout the body, affecting the cells (TOO vague, I know). Disruption of unhealthy cells through resonance? No clue.

Alright, so I spent 20 minutes, and produced trash. That's what I do. It's time to hit the sack and pray I wake up in time to fetch my sawo from the airport. Meanwhile, enjoy the music and my apologies for the K-pop dominance in this updated series.

Really, how important are good values in life when what we have witnessed thus far suggest the dominance of the other extreme? We know for a fact that our education system isn't doing enough, and having experienced (for a measly period of 2 years) a foreign system, I'm not sure if they can claim the prize. My humble opinion is that every education system, regardless of how holistic they label themselves to be, is lacking in something crucial. I'm not sure what, and I doubt many do. After all, none of us were brought up with a truly 'complete' education system.

Oh yes, how did our education system even come into the picture? oh. yes. values. priorities. i think we place unnecessary emphasis on paper qualifications. period.

just sheer superficiality.

i am bored. yes. i can't sit at home and do nothing (which encompasses reading 'introduction to law' and summarising my pfp interview) even for a day. i am officially becoming a couch potato.

i despise the fact that i refresh hermes every 5 seconds, desperately awaiting replies, in which my future depends on (well, it isn't as bad as it sounds-i just need to know if i am allowed to do law in my third year-hence, my future, but only for a year)

but when one spends her time surfing the internet by reading zunar's comics (imustcommendhimonhiscreativity), trying to enhance her intellectual reservoir or at least feel like she's attempting to, discovering the link between sociology, anthropology and law, and questioning why she is doing medicine of all subjects in the world, you should take pity on her.

i think i have become more superficial in my learning. the whole process of rote-rehearse-regurgitate definitely isn't aiding my thought process and this has its ramifications-in my terms (though medically inaccurate), non-pathological-course-dependent-frontal lobe atrophy (completely fictitious).

so i hear of the U.S. Supreme Court extending gun rights; right to keep and bear arms for the purpose of self-defence vs. efforts to reduce role of firearms in American life; Chicago shootings and in the UK, Cumbria-and yet i do not seem to challenge this in a way i think i would have before reading medicine. i should have a stand, but i don't-that's probably because the majority in Malaysia aren't too exposed to our own laws and the society hardly has a role to play in changing law, so why care? we do not question the law since we know nothing about it, and we obey it out of a genuine worry about the consequences of disobedience, what not with our friendly, partial press reporting fates of 'criminals'. a habit of obedience, as Austin calls it, with the ever-present threat of sanctions (in which home has an incalculable collection of, repressive much?). punishable for acts we never knew were crimes to begin with.

then you hear of China-Taiwan bilateral ties (finally!) mostly achieved through new laws-all politically and economically-driven. and i still don't question its flaws, neither am i skeptical of this oh-too-samaritan-like facade.

at the end of it all, i narrow it down to just one thing-i have lost my brain doing medicine for 2 years. maybe not the entire brain-i am sure those required for sensory and motor functions are still intact, and one thing for sure, my hippocampus is probably as large as an elephant or perhaps a London taxi driver's. i've just lost the parts that make me different from an automaton.

hmmm. i should blog on asturias. yes, after i'm done with answering 'how one would assess the benefits of complementary medicine', and also after the Jap vs Paraguay match. asian pride.