Evil!

I was writing out of a minor distress due to some short-sighted decision by a certain party. If you can’t take another toxic from me, kindly leave this blog.

Do you know why AJARAN SESAT is evil?

Because once you get in, you can’t get out.

Wait a minute…. Doesn’t that make Islam AJARAN SESAT as well? No..! Islam cordially welcomes you if you’re coming in, but if you’re going out, it’s your loss. Islam has no more business with you. For those who shouts the killing of apostates, they should think back about this. You really want to keep a malignant tumor inside?

But me here is not talking about Islam and apostates. I am talking about some people who really want people to stay loyal by them, when they already know those people want out. They still want to keep that malignant tumor. It doesn’t matter if such person is on individual level or government level.

How sad!

Addendum: It’s good now! Things are still in favor for me alhamdulillah.

Memakan sembelihan ahli kitab – bahagian 1

Please be informed the article below is very long and is not complete. There will be parts 2 and 3 upon request. The article is not mine.

Ahli Kitab adalah satu golongan umat yang berbeza dengan orang-orang yang beriman, iaitu orang Islam, sepertimana yang telah dibezakan oleh al-Qur’an dalam ayat berikut: Wahai orang-orang yang beriman, Jika kamu ta’at akan sesuatu puak dari orang-orang (Yahudi dan Nasrani) yang telah diberikan kitab itu nescaya mereka …… [Maksud surah Ali Imran 03 - 100].

 Ahli Kitab termasuk ke dalam golongan orang bukan Islam, iaitu orang-orang kafir tetapi mereka tidak termasuk ke dalam golongan orang musyrik. [surah al-Baiyinah 98 -02]. Ahli Kitab dari golongan Yahudi dan Nasrani sebenarnya adalah tergolong dalam kategori mereka sendiri, iaitu tidak beriman dan tidak pula musyrik.[surah al-Hajj 22 - 17].

 Walaubagaimanapun kedudukan istimewa kaum Ahli Kitab di sisi Islam hanyalah bagi urusan Duniawi dan tidak pula bagi urusan Ukhrawi.

Terdapat perbezaan pendapat di kalangan ahli-ahli fiqh samada kebolehan hukum-hukum tertentu yang khusus di dalam al-Qur’an itu, seperti halalnya sembelihan mereka dan halalnya pernikahan dengan wanita mereka, adakah ia ditujukan kepada seluruh kaum Ahli Kitab sepanjang zaman ataupun terhad kepada beberapa syarat. Perbezaan ini menyimpul kepada tiga ikatan pendapat iaitu:

1. Kebolehan hukum adalah mutlak bagi semua kaum Ahli Kitab, dahulu, sekarang atau yang akan datang, samada mereka berpegang kepada kitab asal mahupun kepada kitab yang telah diubah suai.
2. Kebolehan hukum hanya bagi kaum Ahli Kitab yang hidup di zaman Nabi sallallahu-alaihi-wasallam dan keturunan zuriat mereka sahaja. Pemeluk-pemeluk baru dari kalangan agama Yahudi dan Nasrani tidak termasuk dalam golongan ini.
3. Kebolehan hukum tidak lagi boleh diterima kerana kebanyakkan kaum Yahudi dan Nasrani masa kini tidak lagi memegang kepada kitab mereka yang asal melainkan ianya telah diubahsuai atau ditukar.

 Huraian Pendapat Pertama

 Dalam satu hadith yang lain Nabi sallallahu-alaihi-wasallam juga telah bersabda: Sesungguhnya Allah Ta’ala telah memfardhukan beberapa fardhu maka janganlah kamu mensia-siakannya. Dan Ia (Allah) telah enetapkan beberapa batas (had) maka janganlah kamu melampauinya. Dan Ia (Allah) telah mengharamkan segala sesuatu (yang perlu diharamkan) maka janganlah kamu mencerobohinya. Dan Ia (Allah) telah mendiamkan segala sesuatu sebagai Rahmat kepada kamu bukan kerana lupa – maka janganlah kamu cuba menyelidikinya.  [Maksud hadith dari Abi Tha'labah radiallahu-anhu, diriwayatkan oleh Imam ad-Daruquthni dan dinilai sebagai hadith hasan oleh Imam an-Nawawi dalam Syarh Matn Arba'in - no:31]

Rumusan yang dapat ditarik dari hujah-hujah yang dikemukakan oleh golongan pertama ini adalah – sembelihan kaum Ahli Kitab, iaitu kaum Yahudi dan Nasrani adalah halal bagi umat Islam tanpa apa-apa syarat atau had kerana Allah Subhanahu waTa’ala telah menurunkan hukum kebolehan ini tanpa meletakkan apa-apa syarat tambahan. Kebolehan ini juga berkuat-kuasa tidak kira samada kaum-kaum tersebut masih berpegang kepada ajaran kitab mereka yang asli ataupun yang telah diubahsuai.

Huraian Pendapat Kedua

Pendapat kedua menyatakan bahawa kebolehan memakan sembelihan kaum Ahli Kitab hanyalah terhad kepada orang-orang Yahudi dan Nasrani yang hidup di zaman Nabi sallallahu-alaihi- wasallam dan keturunan-keturunan mereka sahaja. Ini adalah kerana ayat yang menghalalkan sembelihan Ahli Kitab adalah ia dalam bentuk Kata yang telah berlalu atau Past tense menunjukkan bahawa ia ditujukan kepada umat Yahudi dan Nasrani yang hidup sebelum turunnya ayat tersebut dan bukan ditujukan kepada umat-umat yang akan datang. Oleh itu keberlakuan hukum ini tidak tertakluk kepada umat-umat Yahudi dan Nasrani yang baru memeluk agama itu dan ia juga tidak tertakluk kepada umat-umat Yahudi dan Nasrani yang tidak dapat dikesan nasab keturunan mereka sehingga ke zaman Nabi sallallahu-alaihi-wasallam.

Pendapat ini dianggap lemah kerana tafsiran yang sedemikian itu tidak pernah didengar dari Nabi sallallahu-alaihi-wasallam mahupun para sahabat radiallahu-anhum padahal merekalah orang yang paling mengenali al-Qur’an dan paling mengetahui tujuan ayat-ayatnya. Selain itu sememangnya diketahui bahawa kaum Yahudi dan Nasrani adalah dua kaum wujud sebelum wujudnya Islam dan mereka telah diturunkan kitab Taurat dan Injil sebelum turunnya kitab al-Qur’an. Justeru adalah memadai al-Qur’an mengalamatkan mereka dalam bentuk bahasa yang telah berlalu atau past tense.

 Huraian Pendapat Ketiga

 Pendapat Ketiga menyatakan bahawa hukum kebolehan memakan sembelihan kaum Ahli Kitab tidak lagi berhubung-laku di masa kini kerana kedua-dua kaum tersebut, Yahudi dan Nasrani telah banyak melakukan perubahan serta ubahsuai akan kitab mereka itu sehingga ianya tidak lagi tulen sepertimana yang wujud di zaman Nabi sallallahu-alaihi-wasallam. Selain itu sebahagian besar orang-orang Yahudi dan Nasrani juga kini telah tidak lagi mentaati ajaran kitab mereka samada yang tulen mahupun yang diubahsuai tetapi banyak pula mengikuti hukum-hukum baru yang direkacipta mereka selari dengan peredaran zaman. Dengan hujah-hujah di atas, golongan ini berpendapat bahawa sembelihan kaum Ahli Kitab tidak lagi halal bagi umat Islam masa kini dan bagi yang akan datang.

Ayat yang menghalalkan sembelihan kaum Ahli Kitab bagi umat Islam, iaitu dalam surah al-Maidah 05, ayat ke 5 adalah antara ayat yang terakhir diturunkan sebelum lengkapnya al-Qur’an ini dan sebelum wafatnya Nabi sallallahu-alaihi-wasallam. Ayat ini dijangkakan turun kira-kira 81 hari atau lebih sedikit sebelum wafatnya Nabi sallallahu-alaihi-wasallam dan ia adalah serangkap dengan ayat yang menerangkan tentang kesempurnaan Islam [surah al-Maidah 05 - 03]. Di samping itu surah al-Maidah adalah juga surah terakhir yang diturunkan antara kesemua 114 surah-surah yang terkandung di dalam al-Qur’an.

Hakikat turunnya ayat yang menghalalkan sembelihan Ahli Kitab sebagai salah satu dari ayat-ayat terakhir dalam al-Qur’anul Karim memberikan titik pengkajian yang amat besar lagi berat dalam analisa hukum berkaitan. Ini adalah kerana ayat ini turun setelah turunnya beberapa ayat-ayat yang sedia mengkhabarkan perbuatan kaum Ahli Kitab yang telah mengubah-suai, menukar serta mencampur-aduk ajaran agama mereka.

Apabila turunnya ayat menghalalkan sembelihan Ahli Kitab ini, al-Qur’an sejak awal telahpun mengkhabarkan perbuatan kaum Ahli Kitab tersebut yang mengubah-ubah ayat-ayat dalam kitab mereka. [surah al-Baqarah 02 - 75].

Apabila turunnya ayat menghalalkan sembelihan Ahli Kitab ini, al-Qur’an sejak awal telahpun mengkhabarkan perbuatan kaum Ahli Kitab tersebut yang mencampur-adukkan ajaran mereka serta menyembunyikan kebenaran ayat-ayat kitab mereka. [surah al-Baqarah 02 - 42]

Apabila turunnya ayat menghalalkan sembelihan Ahli Kitab ini, al-Qur’an sejak awal telahpun mengkhabarkan perbuatan kaum Ahli Kitab tersebut yang memilih-milih ajaran agama mereka,sebahagian diambil dan sebahagian ditinggalkan. [surah al-Baqarah 02 - 85]

Apabila turunnya ayat menghalalkan sembelihan Ahli Kitab ini, al-Qur’an sejak awal telahpun mengkhabarkan perbuatan kaum Ahli Kitab yang menjadikan Nabi Isa alaihi-sallam sebagai Tuhan mereka dan pendita-pendita sebagai yang berhak untuk menukar ajaran kitab mereka.  [surah at-Taubah 09 - 31]

Apabila turunnya ayat menghalalkan sembelihan Ahli Kitab ini, al-Qur’an sejak awal telahpun mengkhabarkan perbuatan kaum Ahli Kitab yang menjadikan Nabi Isa alaihi-sallam sebagai anak Allah.  [surah Yunus 10 - 68]

Apabila turunnya ayat menghalalkan sembelihan Ahli Kitab ini, al-Qur’an sejak awal telahpun mengkhabarkan perbuatan kaum Ahli Kitab yang mewujudkan konsep Tuhan Bertiga atau Trinity. [surah Ali Imran 03 - 65]

Himpunan keterangan-keterangan di atas tidak lain menunjukkan bahawa apabila hukum kebolehan memakan hasil sembelihan kaum Ahli Kitab diturunkan, al-Qur’an telahpun dari awal menerang akan perbuatan mereka, kaum Yahudi dan Nasrani itu yang menyeleweng dan menyimpang dari ajaran mereka yang asal. Malah lebih buruk lagi mereka sejak dari awal lagi telahpun melakukan tuduhan syirik yang amat besar terhadap Allah Subhanahu waTa’ala dengan menuduhNya mempunyai anak dan sebagainya. Tetapi perbuatan-perbuatan sebegini oleh kaum Ahli Kitab tersebut tidaklah menjadi penghalang bagi Allah Subhanahu waTa’ala untuk tetap menurunkan hukum menghalalkan sembelihan mereka kepada umat Islam seluruhnya.

Nah ! Jikalau sejak dari dini lagi al-Qur’an telah menghalalkan sembelihan Ahli Kitab untuk umat Islam seluruhnya sekalipun dalam suasana ketika itu kaum-kaum Ahli Kitab telahpun melakukan berbagai-bagai kesalahan, apakah pula bezanya dengan umat-umat Ahli Kitab masa kini ? Sudah tentu tidak ada bezanya. Mereka tetap juga sama sebagaimana generasi mereka yang lalu. Maka dengan itu juga tidak ada sebarang perbezaan bagi keberlakuan hukum-hukum al-Qur’an terhadap mereka, samada masa kini atau masa yang akan datang.

Justeru itu pendapat ketiga ini yang mengatakan bahawa keberlakuan hukum-hukum Islam terhadap kaum Ahli Kitab tidak lagi sah masa kini atas alasan mereka telahpun menyeleweng dari ajaran yang asal tidak dapat diterima. Pendapat ini tidak mempunyai alasan mahupun dalil sokongan yang kukuh melainkan ianya adalah satu sikap yang terlalu berhati-hati sehingga berlawanan pula dengan ketentuan ilmiah agama Islam ini.

Medical residency in the US – how tough is it?

Lately, some people have been asking me about postgraduate residency programs in the US. Most of them are Nizhnians, but there is one from Volgograd as well

Since I’ve wrote about postgraduate studies in Malaysia, Australia, New Zealand, UK etc, might as well I write about the US. Please be reminded that whatever I write here can be wrong, so please verify everything yourself.

1. Some people think passing the qualifying medical examinations for practicing medicine in the US – USMLE or United States Medical Licensing Examination is already enough to get a residency. While USMLE is the core factor for residency in the US, passing the Step 1, Step 2 CK (Clinical Knowledge) and Step 2 CS (Clinical Skills) of USMLE alone is certainly not enough (the points below explain the not-enough part). The application requires med school insignia (what a pain!). Step 3 of USMLE is usually taken during or before the start of residency.
2. Exam accessories – of course you need to choose excellent review books for USMLE revision. You also don’t want to miss excellent USMLE-oriented revision programs such as Kaplan and question banks for your practice (Kaplan, NBME, USMLE World, USMLERX etc). People spend differently on this, ranging from $800 – $5000.
3. USCE or United States Clinical Experience is looked upon quite highly for residency programs to interview their residency candidates. Most programs require a candidate to have at least 2 LORs (Letters of Recommendations) from US physicians. To obtain the LORs, a candidate must take up externship/subinternship/observership program in US hospitals. You need to pay some $$$ for the program. Some clinical and scientific researches give more weight to the IMGs (International Medical Graduates).
4. Getting into the US – this can be quite tough with the pencil-pushing bureaucrats in the US embassy/consulate. IMGs need at least THREE TIMES of travel to the US before starting residency. One for USMLE Step 2 CS exam which is only available in the US, one for USCE, and one for residency interview. More $$$ down the drain!! Visas are pain in the ass; some may get visitors visa B1, for those unfortunate ones, they will decline you the visa. For residency visa, you’ll have to choose H1B (6 years of employment) or J1 (7 years of education). To obtain a H1B visa, an IMG has to be reaaaaaalll good for the program to sponsor such visa. J1 visa requires some letters from ministry of Health of IMG’s home country saying that the IMG will return home after 7 years of training. Many IMGs opt for J1.
5. Application process to a residency program- I haven’t fully understood the whole process, but it’s kinda painful for me tho. With all the pre-match, scrambles, NRMP, ERAS, datelines and timelines, interview processes, final applications, ECFMG certifications and shits like that! Gaaaa that’s too many shits in an IMG’s head.
6. Interviews – IMGs mostly apply a few programs (10-20) for interview. A typical IMG profile is 4-5 years post graduation, have done at least 2 USCEs and have a few LORs in hand (refer above), 85^th percentile and above for USMLE Step 1 and Step 2 CK scores, passed Step 2 CS on first attempt.
7. Specialties - some specialties are definitely no-no for IMGs, such as radiology, ophthalmology, ortho, anesthesia and dermatology. Most IMGs go for Internal Medicine and Family Medicine since American Medical Graduates (AMGs) opt for easier specialties with higher pays to settle their medical school debts. Internal Medicine and Family Medicine residency usually last 3 years. Many IMGs follow with fellowship programs for their subspecialties since the J1 visa is valid for 7 years. So, 3 years of residency + 2-4 years of fellowship = just nice for an IMG to be called a specialist!
8. Competition – no doubt it’s gonna be very competitive. Some programs are real tough they only pick those USMLE scores of 90^th percentile and above for residency interview. Some specialties like neurology, neurosurgery and surgery are much tougher – 97^th – 99^th percentile only. A highly respected surgeon from a foreign country can end up being a family medicine physician in the US. Not that I’m looking down to family medicine, but specialties like surgery is definitely tough for IMGs to get in.

Ok I guess this is the shortest summary down to the bare minimum I can give you. Mind you, my knowledge about residency in the US is not even 10% from what other IMGs know! I was soooo overwhelmed when I saw people discussing residency in the US in some forums available throughout the world wide web.

Anyways, if you’re inspired to work in US because you see how happy those surgeons are in Grey’s Anatomy or how genius Dr. House can diagnose a patient; perhaps you should change your inspiration.

And for those who are inspired by fame, respect and money; you definitely won’t get any of that! What you get is probably long-hours of strenuous working with yelling supervisors, sacrificing your time and being very far from your family and friends, changing who you are and many other negative stuffs.

Perhaps I should just be a nurse…

For more information visit www.usmle.org and www.ecfmg.org.

Tak cukup duit?

Tadi baru shopping kat supermarket beli barang makan. Terlebih bajet lagi… Hayh…. Banyak kali dah jadi macam tu, kadang-kadang teruk sangat sampai mase kat cashier  tu kene buang sket barang supaya cukup-cukup je duit utk bayar. Itupun baru minggu lepas withdraw duit 6000 rubles (RM 840).

Cepat je 6000 rubles tu habis. Bayar hutang orang 1000+ rubles (RM 140+) sebab tak cukup duit beli barang makanan. Dekan Akademi ni cekik darah lagi mintak bayar untuk visa pulak, habis lagi 500 rubles (RM 70). Bayar internet yang super-mahal, bayar ikut megabyte, sebulan nak dekat 2000 rubles (RM 300) habis kat internet saja – sebab banyak download medical lectures yang lebih senang faham dari internet daripada apa yg diorang lecture kat sini.

Tu tak masuk barangan dapur yg makin mahal harganya, sarapan kat kantin hospital, tambang sana sini, buku-buku manual of medicine yg cikgu tulis, bahan-bahan fotostat lagi. Adehla… Boleh je nak mintak mama abah top up sket, tapi, buat apa nak menyusahkan mak bapak dari jauh… Kalo nak susahkan diorang, susahkan diorang mase kat rumah je aaa… Dan bukan semua orang ada mak dan bapak, dan bukan semua mak bapak orang kaya-raya…

Actually dah habis dah duit withdraw 6000 rubles dari minggu lepas tu, itu pun ade jugak berhutang lebih kurang 200 rubles dengan orang lain.

Dulu bila biasiswa naik dari 200USD ke 500USD rasa lega sungguh. Sekarang ni, sejak Rusia dah makin menaikkan harga barang, 500USD memang tak cukup. Tapi yang peliknya, baca berita ni:

More and more medical students sent abroad to study on government scholarships, many costing more than a million ringgit each, are breaking their 10-year bond by refusing to return and serve in public hospitals.

“This is a sore point with us. In 2006, 21 medical students in Britain did not return. Last year, the number was 63. For those studying in Ireland, three students did not come back in 2006 while last year, 27 did not return,” said Human Capital Development division director Datin Madinah Mohamad.

She said these students cost the Government up to RM1.1mil each in funding for the five-year course.

Gahhhh… dan kerajaan masih tambah biasiswa pelajar-pelajar kat UK/Ire! Kalau 63 pelajar perubatan tajaan kerajaan tak pulang ke Malaysia = RM 63+++ juta hilang macam tu je! Sedangkan duit sebanyak tu boleh sponsor hampir 200 lagi pelajar perubatan Rusia, terutamanya yang non-Bumiputra dan persendirian yang mengorbankan banyak wang mak ayah diorang utk belajar kat sini. Duit tu jugak boleh kurangkan beban pelajar-pelajar perubatan Rusia yang merasai bahang kenaikan menggila harga barangan!

Since 2003, 145 students from Britain and 85 from Ireland have not come back. However, only three from Russia, two from Jordan and one from Japan failed to return.

Hanya 3 pelajar perubatan Malaysia di Rusia yang tak pulang (tak boleh dipastikan tajaan kerajaan atau persendirian). Hampir semua pelajar perubatan Malaysia di Rusia akan pulang ke tanah air untuk serve the nation walaupun kebanyakan kami tahu bahawa kami akan dilayan macam taik atau double standard bila sudah mula bekerja.

Yet, the policy still favors the students who lack intention to return home to practice medicine. Government gives them lots of money only to let them drain to the first world countries. Baikla bagi duit tu kat kami, kurangkan sikit kesukaran hidup pelajar perubatan Rusia, Nizhniy Novgorod terutamanya…

Peliknya pelajar tajaan kerajaan di Eropah mendapat biasiswa yang sangat banyak. Walaupun mereka menyewa apartment yang sangat besar di luar kampus, mereka masih ada lebih 50% biasiswa bulanan yang berlebihan! Kat Nizhniy dah semakin tak cukup… Tambah pulak hidup dalam hostel dalam bilik yang sangat kecik untuk share 2-3 orang, dan sewa hostel pulak makin mahal setiap tahun!

Boleh je nak pinjam daripada along-along kat Rusia ni (kononnya diorang lagi friendly daripada along kat Malaysia) atau kerja sambilan kat mana-mana. Tapi rasa hinalah pulak pelajar perubatan yang sepatutnya belajar kena bekerja atau pinjam duit untuk kurangkan beban kewangan….

Apa nak buat kan, dunia memang tak adil. Tapi Allah Maha Adil. Apa-apa yang tak adil kat sini, Allah adilkan di akhirat nanti.

Tapi kenapa saya menulis dengan begitu buruk dan whiny di sini? Kerana saya tahu, Puan Wan Munirah (MARA Officer) akan datang jugak menjenguk blog saya sekali-sekala…. kan kan kan??

Why do you want to be a doctor?

I was doing some blog-hopping and I learnt that there are a lot more NNSMA Malaysian students who blog aside from those listed in my links. The blogs I saw are owned by the 2^nd years and they are real geniuses – they use blogs as a medium to enhance their study quality and productivity, as if I was seeing another emedicine.com, but of course they are sharing the stories of their lives as well. I never knew there are quite a lot of NNSMA students who blog. I am a total noob at blogging myself, started December 2007.

Anyways, there were dusts hitting my face these few days, such minor inconveniences. They affected the pace of my board preparations. I was partially clueless (totally clueless is not me, thank you) of what to do, but somehow I got inspired after some blog-stalking and forumming. Gah, the unpleasant dusts have been wiped out. Whether the dust I have to wipe out is one or two, it doesn’t make visible difference to my eye.

While I keep the inspirations to myself; I will give my beloved blog readers some side dishes I found during my blog-stalking activity. This one is from topher:

Q: “Why do you want to be a doctor?”
A: “I feel like each of us owes something to those most in need. I enjoy helping those that are sick and knowing that I have made a difference in their life.”
F minus!

Q: “Why do you want to be a doctor?”
A: “I used to think it was to help people, and that’s part of it, but if that’s all I wanted to do I’d be a nurse or a tech. I’m a smart person and I work well with stress and prefer it, and if I don’t end up in a field where I am being pushed to the point of a panic attack, then I just don’t want to do it. I am not going to end up as a computer being used as a doorstop. I want to help people, but the best help I can give them is to go get some amazing training, study my ass off, and be a more capable physician. I’m not going to die happy having done anything less than that.”

Oversimplification of leukemia

I was scanning thru some cool hematology lectures, and I saw this cool basic principle for leukemia. Many of you probably have known this already, but the not-so-bright me just discovered this today.

As we all know, the four big leukemias are ALL, AML, CLL and CML. Let’s say you’re working in hematology clinic on leukemia day when all leukemic patients come for check up, guess how do you initially diagnose the type of leukemia in patients? The AGE of the patient.

• 0-14 years old – Acute LymphocyticBLASTIC Leukemia (ALL – seen in pediatric hospitals, most responsive to therapy)
• 15-39 years old – Acute Myelogenous Leukemia (AML – Auer rods)
• 40-60 years old – Chronic Myelogenous Leukemia (CML – Philadelphia chromosome t[9:22] and very low leukocyte alkaline phosphatase LAP score)
• 60 years and older – Chronic Lymphocytic Leukemia (CLL – nontender lymphadenopathy, hepatosplenomegaly, 50% die of infection related to hypogammaglobulinemia)

Of course there are few exceptions to everything, but overall, it’s about the AGE.

Wait a sec, why am I talking about hematology when my current rotation is dermatology? Because dermatology is depressing!!!! I’d rather fry my brain in ОЛЕЙНА cooking oil than in dermatology…

Ngengengenge kidding! Dermatology is cool! I just can’t get enough out of it! In fact it’s the most challenging and high-yield subject in medicine that I really have to keep up with if I want to be a dermatologist.  Some people get high with drugs; I get high with dermatology… ngengengenge

What is your diagnosis (3)?

I finished pediatric cycle today with the zachot (credit test). There were 3 teachers; of course the one who considers me as her favorite student still exists, that insufferable monster who wants to eat me alive. She was glaring at me all the time throughout zachot. She definitely has some unfinished business with me. I was her target from the start!

But then, I am one kind of a stupid person. There was definitely a more lenient and kinder teacher whom I can go answer my pediatric stuffs to, but I chose that woman monster instead! What the hell, right? Since she’s got an unfinished business with me, why not I go give her some closure? And to her I went. Everything went fine, fine and fine from Rheumatic Fever to Hydronephrosis to Case Report.

I can tell that she’s proud of me, although I’m always late for her class (but to think back what’s there to be proud of? It’s just rheumatic fever and hydronephrosis!). Whatever. Got my zachot without ОТРАБОТКА she promised to make me do last week… and she’s got her psychological closure! Ngengengenge!

Ok, enough small talk. I would like to honor a request from a dear boss of mine. He wishes to walk an extra mile as well. Let’s start with Biochemistry:

A 48-year-old divorced man presents with shortness of breath. On questioning, the man admits a 20 year history of extensive alcoholism. A systems review reveal that he experiences tingling and burning sensation in his legs for the past few weeks. Physical examination reveals that he is tachycardic (heart rate 122/min), has rales bilaterally and bilateral pitting edema. He also has decreased sensation in his feet and reduced reflexes in his lower extremities. Chest X-ray shows enlarged cardiac silhouette and bilateral pulmonary congestion. The deficient factor in this condition serves as a cofactor to which enzyme?

•A.      Adenosine Deaminase

•B.      Aldolase B

•C.      Transketolase

•D.      Homogentisate oxidase

•E.       Carnitine Acyltransferase

And here’s Endocrine Physiology:

Growth Hormone (GH) is essential for human growth. Which of the following is a stimulus for GH secretion?

•A.      Hypoglycemia

•B.      Obesity

•C.      Dwarfism

•D.      Pregnancy

•E.       Somatostatin

•F.       Tumor Necrosis Factor (TNF)

And here’s my favorite -Pathology:

A 45 year old woman complains of a blurry vision. She says that her eyes have been very dry and itchy and she is unable to make tears. She also states that she has a dry mouth despite drinking adequate fluids. Physical examination reveals bilateral dry, ulcerated corneas and fissures on the sides of her lips. Her knees are swollen and reddened. When asked about her knees, she says that her knees and wrists tend to be swollen and stiff in the morning. The intern in charge runs for test of autoantibodies, which reveals rheumatoid factor positive and also another autoantibody test is positive. What might the other positive autoantibody test be?

•A.      Anti-Jo-1

•B.      Anti-dsDNA

•C.      Antibody-SS-B (La)

•D.      Antihistone antibodies

•E.       HLA-B27

Okay that’s enough I guess. Whoever answers all the three questions correctly, plus explanations, will get a sushi treat from me. Hehe feeling very spring and generous. You can try answer in comment, or simply thru my YM. Final date? Err… one week, two weeks, tomorrow… what the hell right? I’ll decide later. It’s not like everyone loves to read my blog tho… ngengengenge

P/s: I’ve heard that my blog appears a little skewed (senget)/unreadable or something like that from someone’s computer. Is it true? Need some feedbacks pls.

So you want to be an obstetrician?

 There are some people who love medicine; there are some who loves to cut people. But there are some very rare breeds who love both and can’t get enough of it! Gagagaga! The following are some facts about obstetrics (as a medical specialty) that I heard or read. Some might be true, some are not. Evaluate yourself.

1. The most tensed medical specialty everywhere in the world; it involves antenatal care, medical and surgical natal care, and postnatal care of the mother and the baby. And then there’s clinic!!! That seems to be a lot of work more than a sane person can handle!
2. It is the most sued medical specialty. In the US, 76% OBs have been sued at least once, 57% twice, 42% three times or more. The family expects you to make no mistake; even a little defect beyond your control can come with lawsuit. Many obstetricians have high malpractice insurance premium, differing in different countries.
3. Most bloody, nauseating and complicated specialty, making those in surgical specialties look very mild and tame. That’s what I heard when an obstetrician came to MRSM Taiping to give medical career talk. And I confirmed that myself when I first time watched the delivery of a reluctant-to-push mother. Birth is beautiful? Think again!
4. Most obstetricians are men since most of them are very strong (physically and mentally) to handle bloody surgeries, abortions, miscarriages and other stuffs. But so far that I asked from my peers, only women want to be OBs, no man so far. Maybe I wasn’t asking enough. I just know ONE guy here who has “obstetrician fingers”, and I mistook it for Marfan’s. My OB teacher (a woman) said that a woman who wants to be an OB is a crazy woman! Gagagaga!
5. Myths and Superstitions; there are things like when an OB is trying to do God’s job such as taking away life of a baby (abortion), he/she is cursed and doomed forever. Some OBs have reported to have failed conceiving child of their own. Maybe there’s a psychosomatic correlation I couldn’t fathom. Maybe that’s never true at all.
6. According to a survey, OB is one of the specialties with the least likelihood of physician’s satisfaction. As in previous points, the work is always stressful and demands perfection; for the mother and the baby.

That’s enough, I think, to scare you people from this specialty nyeh nyeh. But if you have the heart of a gold and determination as steel, the abovementioned points would never scare you even an inch away from this very noble specialty!

p/s: Any OBs dropping by, pls forgive my rudeness and don’t kill me when I get posted in your department… Maybe I’d be an OB some day, who knows?

 

The Perfect Surgical Intern

A Perfect Surgery intern/(house officer)

1. Never whines/ complains
2. Is never hungry, thirsty or tired
3. Is always enthusiastic
4. Is never late
5. Makes the intern/resident/chief look good at all times
6. Knows more about his patients than anyone else
7. Loves operation theatres, never wants to leave the hospital
8. Is the first one to arrive at clinic and the last one to leave
9. Reads from a surgery text everyday
10. Is confident but not cocky
11. RUNS for materials, lab values, test results etc before rounds
12. Smiles a lot and has a good sense of humour
13. Always writes the op note without question
14. Loves to do op and can never get enough

And this is the best..
15. Has a steel bladder, a cast-iron stomach, and a heart of gold!

Does such super Intern/HO exist?

[credits to darrenmagic]

Pigeon’s crap

I don’t like reviews, but I’m gonna do it anyway:

1. Series of unfortunate events. Spring makes my sleeping schedule messy; woke up late, waited for buses in so much pain for 20 minutes, took the soviet-style lift in pediatric department which made depressing stops at every floor (thank God not the same as the more depressing ones in Hospital No 13 in Avtozavod). When I arrived at the class, I was 10-15 minutes late and the word ОТРАБОТКА came out from my peds teacher and that hit me like pigeon’s dropping. Urgh! What to do… I was late in 3 of her 4 classes tho, which made me her “favorite” student. If anyone that woman wants to eat, torture or ask pediatric stuffs, it’s gotta be me.
2. We went to the ward to see a 15-years old male patient. Since I am her “favorite” student, I was asked to do the cardiovascular examination and I noticed systolic murmur best heard at Botkin’s point. Everything went well tho. Then there was a pediatric neurology conference and there were two speakers. The first speaker was an energetic young lady talking about Bell’s Palsy and Ramsey-Hunt syndrome. The second one was boring I didn’t pay attention.
3. Then we went for breakfast, enjoying spring air outside, made fun of the teacher and resumed practical class. At the end of class, we saw 2 more patients; one with Juvenile Rheumatoid Arthritis (JRA) and one is a swimmer who has extrasystole but otherwise a healthy teenager. Since I am the favorite student, I had to do some tests at the end of the class *&^%$&*!!!
4. I went to see Ally to get a lifetime’s worth of humanly knowledge. Zillion thanks Ally.
5. I prepared a dialogue for Russian language film project. Original script was in English, sent to Liki to translate using some software and all I got was a ****!! Gagagaga! Not bad translation tho. I just need 5 hours to correct everything. And then Russian language teacher had to correct it again! As mentioned in previous entry, everyone uses either espada’s or shinigami’s names.

Thanks for reading my craps, again.

BLEACH

BLEACH is phoockin’ awesome! At first, I thought I won’t let myself fall into the phantasy world of anime. Phollowing-up anime and manga is too painful… You’ll always want to know what happens next (Yeap, I’m in so much pain right now, waiting for episode -106). And with this turning back the pendulum in BLEACH manga, I am very hesitant to say that I can let go of BLEACH before I graduate med school.

 But why particularly BLEACH? I’d say that BLEACH is very universal. Elderlies, mid age people, youngsters, teenagers, children, men, women, and racial diversity in its characters make BLEACH a very universal popular entertainment to watch. One can find his/her own phavorite character(s) in that anime which is much similar to one’s personality; various people with different histories, different habits, different upbringings, and different lifestyles. The producer of BLEACH is totally a phoockin’ genius!

 Even my class decided to use names of characters from BLEACH for the Russian language film project. There is a Dr. Ulqiorra, Dr. Aizen and a patient named Soi Phong. Of course, I won’t say this film will be in the box office which rocks the philming industry (I wish!).

 Obviously I have nothing much to bring to the table lately, so, just enjoy any crap I write here! I added Fiqhmedic link for those who are interested in medico-islamic issues (blog in bahasa Melayu).

FITNA – is there a need for reaction?

Geert Wilders generalized Muslims as terrorists. Just because a white supremacist/extremist confuses freedom of speech with freedom to flame religious hatred, that doesn’t mean that we Muslims should fall so low to his degrading level till we have to generalize all Hollanders alike. Not all Hollanders are satans. Not all American are satans. Not all Danish are satans. Not all Jewish are satans. Generalizations of certain people have always been wrong.

Boycotting any product is a personal choice, but to overreact to such travesty to prophet Muhammad PBUH (SAW) and Islam is probably not what the prophet wants if he was alive. How many times did the prophet stop Umar al-Khattab from attempting murders to those who belittled the prophet?

If boycotting makes any difference, it makes them poorer by several millions. It doesn’t make any difference with the core of the problem: which is the sheer hatred for Islam. With all globalization going on, with internet and youtube and stuffs like that, it’s gonna be hard to fight against the flow.

Something contemptuous to Islam and Prophet Muhammad like FITNA is simply to be ignored. The more we give attention to it, the more credit we give to its existence. It will grow stronger and stronger, for all we know that 15-minutes film has eaten Muslims alive by a mere simple provocation. Overreaction from Muslims is what Geert Wilders wants.

Such film will grow like mushrooms in years. Nothing we can do to stop it. Let them produce. When certain things are overproduced, the quality drops. In a few coming years, no one will give a damn if they badmouth Islam. These people will simply be dusts blowing with the breeze; they are mildly irritating when they hit your face, then they disappear. They make no significance to the life of the person they hit.

Thus, there’s no need to overreact over some dusts hitting your face.

Here’s a good article by saifulislam on FITNA.

Walking an extra mile

When I was doing my elective in IJN, a senior registrar in cardiothoracic surgery department said the following to me:

 “There are 3 essential things for fresh medical graduates; medical knowledge, clinical skills and work attitude. Fresh graduates have more or less the same medical knowledge. Clinical skills might develop faster in some fresh graduates. Work attitude is what defines the type of doctor you are going to be.”

I wanna elaborate a bit about the above quote, focusing more on MEDICAL KNOWLEDGE.

Let’s question ourselves. Are we sure the medical knowledge we have is ”more or less the same like other fresh graduates“ to be called doctors? Do we cram so hard day and night, suffering sleepless nights and prefer not to waste time to cook, or so much as going to pee? Surprisingly, my friend who studies medicine in Malaysia answers yes to all the questions.

It’s been quite notorious in Malaysia that certain medical graduates of certain regions/countries are discriminated due to lack of basic knowledge. One might say that is so not true; we study very hard and we learn enough, we got great scores all the way thru med school. But when you start practicing, your bosses, nurses and peers start treating you like trash, you’d probably understand what I mean.

There’s a proposal for Qualifying Medical Examination for all medical graduates in Malaysia. If anything, I am totally for it! Why? When your peers of local graduates and mighty countries (UK, Aussie, NZ etc) pass the exam, and you pass the exam too, you’ll know that you’re just as good as them. There is no valid reason for your bosses to discriminate you. But for Malaysia, the implementation of the exam is not so easy due to transparency problems.

So what should we do? Walk an extra mile… There are several highly-recognized board medical examinations around the world. USMLE for the USA, PLAB for the UK and AMC for Australia.

Why should we work our asses off for those exams? What are the benefits of passing those exams?

1. If you ace those exams, you might be able to work and get medical training in the respective countries (probably exception for the UK)
2. These board exams are of the highest standards and qualifications in the world. Passing those exams meaning that you raise your own level of medical knowledge.
3. If you tell your bosses that you have passed those exams, meaning you’re as good as the American graduates (if you take USMLE), or British graduates (if you take PLAB) or Australian graduates (AMC). This will get their confidence in you, and the patients are confident in you and you’re much more confident yourselves to practice medicine.
4. Even if you don’t pass the exams, at least you have worked hard and raised your own standard. There’s nothing to regret about.
5. Mind you, these board exams are not cheap. But if you ever ace these exams, it feels so good and worth it.

How do I know if I need it? Try answering this standard MCQ pathology question for 2^nd year medical students in the USA:

A white, 5-year old thin boy is brought to the physician complaining of recent weight loss accompanied by excessive hunger, thirst and urination. His urine is positive for high levels of glucose and ketones. Which is most likely mechanism and associated findings in this disease?

A.      Autoimmune destruction of the pancreas; association with human leukocyte antigens DR3 and DR4.

B.      Autoimmune inflammation of different locations of gastrointestinal tract in a skip lesion distribution, usually involving terminal ileum; association with human leukocyte antigen B27

C.     Deficiency of brush border enzyme of the intestinal mucosal cells, causing inability to break down all of the normally digested carbohydrates.

D.     Increase in the body’s resistance to insulin associated with body mass index

E.      Strong genetic predisposition; no association with human leukocyte antigen system.

The diagnosis is not hard, but the question requires you to figure out the pathogenesis. So? Did you find it? The answer is there… You just need to choose one… When I asked this in forum for US medical students, they said “Are you kidding me?!” Obviously this one is way too easy for them.

And also try this one (still pathology question for the 2^nd year medical students):

A 56 year old white male is rushed to emergency department with crushing substernal chest pain. He is morbidly obese, sweating profusely, breathing very rapidly and clutching at his chest. The patient is stabilized and seems to be doing well when he suddenly goes into cardiac arrest and dies. Which of the following is the most likely cause of death in this patient?

A.      Fatal arrhythmia

B.      Mural thrombosis

C.     Myocardial failure

D.     Myocardial rupture

E.      Ruptured papillary muscle

I am not going to post answers for both questions. Ask yourselves if you do have adequate medical knowledge, because I certainly don’t. Let’s struggle hard till we ”have more or less the same medical knowledge like other fresh medical graduates” [as quoted by the IJN surgeon].

Of course, medical knowledge alone is not a determinant of a good doctor. You might wanna sharpen your clinical skills in your clinical years of med school, repair those bad-ass attitudes of yours and more studying instead of blogging hehe

Healthcare systems around the world

I watched a documentary about US healthcare system entitled SiCKO, recommended and given by Jatdeng. At first I thought it’s just another crappy documentary until I learnt that this documentary is produced by Michael Moore (the producer of Farenheit 9/11).

This documentary tells about how crappy American healthcare system is; where US falls to number 37 of worldwide healthcare ranking according to World Health Organization WHO, just a point or two ahead of Slovenia and Cuba. Guess who are the winners? France and Italy. Singapore is number 6 (If I get an illness and want a 1^st class treatment, definitely will go there). Malaysia is the 49th and surprisingly even Thailand outranks Malaysia (47th)! Harharhar!!

 Jeng jeng, guess where is Russia in the list???? Scroll down this website and check out for number 130!!

Michael Moore stresses on how evil the insurance companies are in America; how they deny treatment for patients so they can accrue 9-number figure profits, how they make medications and operations very expensive, that an uninsured middle finger reattachment costs 60,000 USD one has to let it go because he can’t afford it. It is as if the insurance companies should write books on patient management instead of turning to clinical medicine bibles.

He also compares US system with Canada, France, UK and Cuba, where healthcare is very very cheap, if not free.

I totally recommend this documentary for those who want to know more about the healthcare systems in different countries. Meanwhile, here is a news about mobile clinic initiated by a doctor in Singapore. Will Malaysia be keen to provide such mobile doctor services?

Zipping around in his Opel Combo mini-van with the words “The HouseCall GP” emblazoned on its side, general practitioner Dr Choo Wei Chieh takes the road less travelled. For medical professionals, that is.

Armed with his mobile arsenal of tools and medicine, the 36-year-old father of two travels all over Singapore making house calls.“

I wanted to do something of my own and differentiate myself rather than open a GP clinic in a neighbourhood,” says Dr Choo, who worked as a stand-in doctor at private clinics and in the accident and emergency (A&E) units of hospitals for a decade before striking out on his own.

The HouseCall GP was started in May 2006, and is a one-man outfit. Dr Choo charges from S$120 (RM176) to S$200 (RM460) between 8am and 10pm, and S$200 (RM460) to S$250 (RM575) after 10pm. The charges are for consultation and exclude medication.

He says his patient count varies, and there are days he does not get a single call. But he remains optimistic: “I foresee a big need for this kind of services because of the growing elderly population.”

Singapore deserves to be in top ten.