Summer!

It's all very exciting now, with graduation only 6 days away, and with social events piling up to the height of a termite nest. Not to mention a spontaneous trip to Spain with my lovely fei po!

To top that, a massive Asian trip, in which I, the self-proclaimed tour guide/organiser am drowning in the rough sea of planning. First up, Borneo, which will involve Mt Kinabalu (obviously), Rungus Longhouses and a trip to the tip of Borneo, and perhaps just some beach activities at the TAR park. Next on the list, Krabi - yes we love our beaches, and thai food + Bangkok, needless to say, a must-visit city. Whilst I recuperate from all that for several days in KL, my two friends will head off to Siem Reap to witness the spectacular Angkor Wat, before the three of us meet again for China.

Planning China = suicide. Almost impossible to plan, but I'm coping. Let's hope it turns out alright! Needless to say, the all-knowing future housemate of mine and her far-too-brilliant fiance have been very helpful in my attempt to sort out our trip to China.

Part of me feels guilty for splurging and also for slacking my summer away-but, I constantly remind myself that it is, afterall, my last long summer. I'd be better off enjoying it to the fullest.

Purpose

Once again, the typical scenario of this blog being revived over summer term. never really do have enough to say since nothing overly interesting deserves to be mentioned.

With a couple of my friends graduating, our conversations are frequently focused on the major take-home values from our 3 years in Cam, and to be honest, they haven't been overly optimistic. it hurts and annoys me to listen to those statements, especially when it highlights how most of them have, in my opinion, completely missed the point of university life. the sheer competitiveness that slowly reveals itself as they share their thoughts on cam reinforces the necessity to analyse and be wary of friends you make. at the same time, i may be unfair to impose my own principles on them, and expecting them to share similar ideals.

Having gone through an asian education system, some friends remain delusional of their main aims in life, still placing tremendous emphasis on academic brilliance with minimal development of emotional intelligence. A friend of mine claims most of her compatriots have become cynical over the three years, but I opine that as a figment of her imagination ie believing is seeing. To me, that judgment is derived from contemplation of one self, and the awareness that she has in fact succumbed to the viciousness of competition.

I won't deny that Cam shatters one's confidence, acknowledging the fact that most students here probably were very established and successful students in the past, but would now have to settle for brutal mediocrity. It is only natural for them to feel so. I then asked, how much more confident would she be if she were to obtain a first class honours, and she replied with great certainty that it was the only thing she ever hoped for in Cam, thus would give her an overwhelming sense of self-satisfaction. Fair enough, you exaltation. I, on the other hand, feel that these successes are too impermanent to cling on to and rejoice, and that even though each success deserves a pat on the back, serious damage can be done when one basks too long in their glory.

I raise these points for several reasons. One, as a reminder to feel grateful for the fact that I lived through the competition and have become stronger, not exactly in a 'survival of the fittest' manner, but rather as an individual that is mentally and emotionally more ready to face what would be a rougher sea when I graduate. Two, as a motivation to pursue my interests and to gain skills outside of the medical field for it draws in a huge amount of satisfaction when I apply this in my career. More importantly, it pleases me to be ensured that I have achieved (so far) my main target in university, and that is to enjoy what I do, and do what I truly enjoy. It reminds me of a very encouraging (and flattering!) comment my teacher once made about me. She claimed to be surprised that I remained optimistic and enthusiastic in a suppressive institution and attributed that to my ability to value the positive and learn from the negative, to my ability to find the silver lining of every cloud.

I intend to keep things this way. But with an added twist. I am keen to revive that building competitive spirit in me and to see the impact I can make by perfecting the necessary skills as a doctor. The past three years have involved a conscious effort to achieve moderation. I want this to change, on several different levels, that I can easily summarise into passion, direction and perseverance.

I have lived my life the way I intended to the past three years, and I hope to accomplish my resolution for the remaining three years.

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.