M203 Diary

Thursday, December 16, 2004

Announcement: Online Study Group

M2/03ians please try to be online at 10.30pm on Tuesday (21/12/04). Log on to your MSN ok? We'll most probably do CVS or F2 stuff... Discuss discuss, not so stressful mah...

So yupz, the details again.

Date: 21st Dec 2004
Time: 10.30pm
Venue: Cyberspace (MSN)

Thanks Grace, for the suggestion. :)

Ehz, guys, appear ok? Otherwise the group will just be Grace and I


Tuesday, December 14, 2004

Say You Missed Me

Apparently [Sh] did. Hopefully this effort will be sufficient to keep her sated for the rest of the year. I suppose too much time has passed since the last time I contributed, and one is surely overdue, as per contractual obligation. In fact, there are so many things I have to talk about.

Or not. There’s not much to say when it comes to studying for an exam. Actually there was this period when I couldn’t go online at all. Because Mr. Lightning decided to snuff the life out of my ADSL modem. It was a timely opportune event, as I was planning to replace it anyway. Though you can’t imagine how scary it is to see an electrical appliance, which is hooked up to your PC (which is on!), blow up before your very eyes. First it flared from the inside, illuminant. Then it crackled audibly, followed by its lights flickering weakly. Finally, it fell silent. Once I tasted the fumes of fried plastic, I knew she was gone.

Then there was KKB, a field trip of sorts where a small band of us aspiring doctors-to-be venture to a town that likely was built to be an accurate representation of our most sophisticated technology. Ten years ago. This next installment of luxury deprivation really has been the only other highlight of the mostest boringest month yet. Second only to the time when I had to watch Teletubbies to entertain myself during the excessive Sem 1 holidays. It’s times like those that make you wish you had an exam to sit for.

Anyway, let me get back to the story at hand. On the very first day itself, I was assigned to a most challenging patient. Perhaps the worst part was that he wasn’t in any way uncooperative or dangerous. Rather, he was grinning from ear to wax-laden ear! Only it didn’t help that he was incomprehensible. I could swear his first language was Tamil. And his second, Gibberish. But using my powerful gift of assumption and taking the benefit of the doubt, I managed to elicit valuable information. I learned that his name was [name withheld] and I was pretty sure that he could count to seventy-one in English. Here’s what the conversation probably sounded like:

[NW]: {So how do you like my new shoes?}
[ME]: (uh-oh…) Um, yeah, I’m just great. How are you, uncle?
[NW]: *sigh* {You don’t understand me either, do you? It’s okay, I’ll act insane to humor you…}
[ME]: Right, right. So what do you do for a living?
[NW]: Nineteen seventy-one!
[ME]: Um, you were born in 1971?
[NW]: Nineteen seventy-one!
[Me]: O… kay… So where do you live, uncle?
[NW]: Nineteen seventy-one!

The issue I had was that his date of birth was definitely nowhere near 1971 because, by the looks of things, it was probably a year more appropriately related to a time where he had his hip replaced or prostate removed. I stood there clueless for about half a minute or so before I finally said goodbye. But I felt so guilty when he smiled back at me. If he really came in to see me, would I have sent him away simply because I couldn’t understand him? Because I knew not what to make of him or his condition?

What if he was dying? What then?

It is obvious then, as far as my horrid example goes to suggest, that good communication is a valuable skill to be had, at least where it comes down to taking a history. More so perhaps when it comes to the native environment of a government hospital. I’ll keep it in mind when I find time to work on myself. If I ever have time. Certainly, if this is the career I intend to find myself involved with in future, then it has to be soon. But at the same time for similar reasons, definitely not now!

(Another unproductive moment squandered, if only to remain in the memory of others…)

If I had a word to represent my year of 2004, it would be: Fulfillment


Friday, December 10, 2004

New M2/03 Bloggers

I've just added Sarah's and Vasan's blogs to the list of M2/03 blogs. If there's anyone else I missed out, please let me know ok?

One other thing, all M2/03-ians are welcome to use the "M203 Blogger" banner that Elena designed. *points to side bar* See that orange banner? Yeah, that one.


Monday, December 06, 2004


Part I

Do the patients at KKB hospital know that it has been designated a teaching hospital?

Do the women in labour know they will be subject to students staring at their vagina as they give birth? Do the 10-year-old boys know that they will be filmed as their foreskin is snipped off?
Do the patients in the wards know that they will be subject to endless - and I mean, endless - history-takings & physical examinations?

I don't think my patient did.

P, 19, having endured the previous afternoon a barrage of students palpating the thrills at her mitral & pulmonary areas, and listening to her pansystolic Grade 4 murmur from mitral regurgitation, was understandably not keen to have Azri & I take her history the following morning.

We asked what questions we could ask under the guise of chit-chat... I may have not been able to find out how long was her fever before she was admitted to the hospital - she has subacute bacterial endocarditis - but I did manage to build some form of rapport with her.

Enough for her to agree to allow me to examine her.

Without Azri.

After I let her palpate & ausculate my 4 cardiac regions.

Since I wasn't a doctor, I figured it was a pretty fair trade-off for her to examine me in exchange for letting me examine her.
I don't know if what I did was the right thing.
I just know that I've a soft spot when it comes to young patients. She is only 19.

P/S - Will the next bunch who heads to KKB please look in on H? She's a 10-year old patient suffering from asthma in the paediatrics ward. Thanks.

Part II

Having researched & debated endless rounds on schizophrenia, autism, mental healthcare, and yes, even institutionalisation of patients, during the past week for IMU's NHSD - which bore the theme, "A beautiful mind - the mental health enigma" - the irony of watching a movie on the dehumanisation of mental patients in an institution was not lost on me.

During our small-group discussion of the movie, some interesting issues came up:

"The doctor should have gone to see the patients. We only see the patients being brought to the doctor when they do something wrong, or they need serious help."
- Pei Yee

Yep, I also found it stupid that the doctor's idea of "observing & evaluating" McMurphy was to have 1 interview, 1 Q&A session & 1 panel discussion during the entire 4-week duration he was staying there.

"People should have more interaction with the patients outside."
- Theresa

Which brings us to the question, is institutionalisation the answer to patients with mental illness? Some people in the U.K. favour jailtime for dangerous mentally-ill patients, arguing that the conditions in mental institutions are akin to jails, anyway.

Ah, I shall digress for a bit here.

I couldn't help noticing from the outset that the institution depicted in the movie was structurally excellent. The grounds of the Oregon State Hospital were lush, the building was stately, and the staff was nice. At the outset, I said.

Which makes me wonder, if fine institutions such are these are still capable of generating the screw-ups seen in this movie, how must it be like in real-life, real-time institutions, that lack resources, support & funding? Proof that no matter how bad things are, they can always get worse.

Some people in the U.S. favour community-based care, ie. releasing patients into the care of family & friends. The whole idea behind it is to integrate them as much as possible into the fabric of society. I was surprised to find out that Malaysia, famous for hiding its crazies in loony bins with fancy names like "Tanjung Rambutan", actually adopts this form of treatment.

(in a creepy tone) They are among you...

Discriminatory jokes aside, I also noticed that the nurses spoke to the mental patients & the janitors in the exact same tone of voice. It might be helpful to note here that the janitors were all African-Americans. Politically correct term to use in place of niggers. Or even blacks. This movie was, after all, set in the 1960s.

Where does all this lead me?

Basically, this movie is about fear & control.
In fact, nurse Ratched's desire to control is born of fear.
Fear of the mental patients. Fear of becoming one like them.

We see this fear manifesting itself in the barriers she puts up in her interactions with the patients under her care - the glassed-in nurses' station, the "cardinal rule" that no one except nurses are allowed to enter the station, the patronising tone of voice she adopts when talking to the patients. (And the janitors.)
The successful conditioning, or to be exact, the learned helplessness, she instills in the patients in her ward.
And when someone challenges her authority, the primary instinct that overtakes her judgement is not anger, but fear. She bullies people into submission - people like Billy, Cheswick & McMurphy - because she fears what will happen if she loses control over them.

She seeks to establish her superiority, because if you have authority over someone, then there's no reason to fear them. If you're above someone, then you're not like them.

And what's scarier than the thought that there are crazies walking among us, is the thought that sometimes, we too, control because we fear. That sometimes, we too, fear because we control.

"If Billy doesn't feel like talking, why are you pressing him? Why can't we go on to some other business?"

"The business of today is therapy."