Aug 28, 2005

Entrance fee to Penang

Bad news, guys! The entrance fee to our beloved lovely island maybe raised again. Sammy Vee still keeping perfect silence over it.

To all my juniors who currently at Sarawak, busy with the Baktisiswa, I wish you all best of luck and will have lots and lots and lots and lots of fun helping out people there, learning new knowledge and gaining new experience.

Currently, I am in Surgery posting.

Everything in the havoc. The clerk at the department was absent the first day, failed to prepare the timetable for us in second day, and finally gave our exhausted new TL, Suhaiza the timetable on late evening. All our schedule had to be rearranged and for this moment, I am really pissed with that clerk. Acknowledging that feeling, I am now more at peace with myself, shall proceed to attend the Anaest practical class straight after I finished the last sentence here. Yes, here.


Aug 27, 2005

63, retiring?

Rising_sun Luckily, my boring weekend was saved by an interesting movie "Rising Sun". It’s a action-packed thriller. But what makes the movie special is all the incorporation of the jap values. I found one of the saying very interesting:

"they say, if you must resort to violence, you had already lost"

An interesting piece of news about Japan underworld. A new head had been appointed. Guess how old is he? You’re right - he’s 63.

Soothing anaesthesia

Lkp_082505_005Lkp_082505_006 Had several interesting class in my first week of Surgery - learning all the right way to intubate and defibrilate, the right way to assess a person from the anaest point of view, all the physiology and chemistry and learning that we are actually anaerobic beings. All that from the anaest class.

Special thanks to Prof Gracie for the enlightening chat a nd the thunderous claps.

Also thanks to Dr.Siva (taking master in Anaest) for your time and effort in teaching me lots of stuffs in A&E on Friday night, although being unhappy about master students being the kuli in A&E.

Greetings to my most honorable supersenior

From the floor of Friendster’s bulletin:

Word of wisdom from this mamat:

"i dunno what is happening of our batch lately, there r just so many rude words exchanged in the air, flew out of the mouth deliberately….some even
dare to classify a person as not up to the par when come to future dr…he can only mop the floor he said…well who r u to say that…i dont think of u as
a pure candidate of a dr either…niether any of us…but still we move on and pick bits n pieces of wisdom from our lecturers, trying to act like one in
the wards n clinics…but the time will come n watch out for that time….for u have to be responsible for your own words…saying these n that person of not capable of becoming a dr…take a good look of your own self in the mirror!"

Being in a final year, the end of all, and the beginning of all. It is the end of our 5 years course, and the beginning of our working world as a doctor. Being at the end of all, one could not help but review what we had done, what we had achieved, what we have yet to do and what we long to achieve in this 5 years. Just last month, during my birthday, I received a rather heart warming flashback of collection of pictures from my best friend from the first year till now.

In our faculty, the final years were deemed to be superseniors. The taiko of all taiko. The tailo of all tailo.


What are the parameters that determines the super-ness in us?

  • how many exams we had passed with flying colours over the 5 years?
  • how much clinical knowledge/skills we had acquired so far?
  • how many questions from that lecturers that we can actually answer without wrinkling our forehead?
  • how many spot diagnosis that we can make with a blink of an eye?
  • how many prof or doctors who actually recognize/praises you?
  • how many babies we can actually deliver without any perineal tear?
  • how many "interesting case" we had seen per week?
  • how well one can bitch about the incompetence of other clinical colleague?
  • how well one can spin off the whole pathways of cranial nerves?

There’s a chinese saying literally translated as "3 persons walking, surely everyone of them will be the teacher to the other two". I believe everyone is unique in our own way, and we could really learn from one another. Everyone is our teacher.

Through out my life, I’m lucky to meet a few people who were actually better than me. They are deemed better not because they had defeated me, not because they were beyond my league, but simply because they were able to make me as good as they are. They are definitely better.

I beg to differ from "a pure candidate of a dr either…neither any of us…". I believe everyone are a candidate for a doctor, as long as you pass the final MBBS exam with all the reading and knowledge input from the lecturers.

Why do we need education in the first place?

The end and aim of education is the development of character. By the final year, we were all supposed to be florid with all the appropriate values. But from several incidents lately, all the coercion, all the brutality, all the violence of words and action, it can only mean one thing - Patrick Tan had failed. *PPD had failed. *DPHS had failed. UM(Medic) had failed. Not just fail to be a good future doctor, but fail to be a good human being.

Perhaps most of us will be graduating with 1/3 of MBBS(UM) next year.

* in UM, we had 3 strains to follow in order to be a supreme great excellent superb nice interesting good doctor, but all the focus seems to be only for no.1:

  1. basic sciences and clinical knowledge/skill
  2. personal profesional development
  3. doctor, patient, hospital and society

Aug 21, 2005

All the right things

Update so far:

came back from the Buddhist Camp at Mahavihara. Darn tired. Darn amazing. It is a 3 days 2 nights camp organized by Dhamma Study Group of Buddhist Society of UM.

Total participants: 3 persons.

Total overall people benefits from the camp: 20 persons, plus the committee.

Regrets: No first years from my faculty.

The first years in my faculty had been a missing a lot. I mean a lot. After the orientation, most of them felt the relieve, that’s probably beyond their imagination. So much so, like a mother in labour pain, the great relieve after the mother had delivered her baby. I felt this feeling 5 years ago. But after it, all of them is still lost. Lost, lost, lost.

Why? They don’t really see what they were facing. Some may think they see it, just like how I felt when I was in first year. I thought that I had found the path, found the journey, found my direction, found my vision. But only in final year, I realized that at that time, I was lost at that time, so much so, like most of the first years now.

I did mention most because I believe a minority of them is no longer lost.

Some embark on the journey on the excellence of academic…

Some just want to enjoy life…

Some just want to have a life…

Some just live a life…

Some just don’t understand life…

Finding all the right things.

Where can they go? pasar malam? MidValley? Sungei Wang? hospital? specialist center?

Do they see the way? Bus No12? Putra LRT? car?

Do they want to follow the way? or rather be spending time sleeping, comics, etc?

to be continued… (like i said, I am tired…)

Aug 18, 2005

TL, TL, TL, TL!!!!

Last 2 days in ENT posting. Having end of minor posting exam tomorrow. For the moment, just like to laze around, bitching about the meaning of TL.

TL is a word get thrown around often. It meant Team Leader. But for today, TL simply means "**tu lan" (Hokkien) to me. Please forgive me for being such a rude bastard bugger nincompoop idiot moron fellow today. Trust me I could not forgive myself either.

Nominally, TL is supposedly a team leader that everyone depend on for decision and arrangement (and attendance records for sure) for the team, but in reality, functionally, TL is a servant, worst still, a servant without payment or recognition. Traditionally, it would be just strange to say "thank you" to a TL. But often, some decent educated coursemates of mine would say thank you in their own way, either by helping out, or simply commenting what a good arrangement or decision the TL had done.

ENT had been a very enjoyable posting with all the humourous lecturers, except for their frequent postponing of classes. Therefore, in reality, I wasted lots of time waiting for lecturers to return call after I had paged for them. I had no complaint about this. But what made me TL, is my fellow teammates having various suggestions and confirmations that wanted me to be the messenger. I currently need to investigate further to find out whether they are dumb, deaf, blind or just purely tetraplegic - they just could not do something puny by themselves

Messenger "Don’t kill the messenger" does not apply here as I always got shot beautifully in the front, for reconfirming the obvious confirmed tutorial in ENT that I had repeatedly confirm over various sessions of long waiting by the phone for the lecturers, just because my dearest teammate requested it. If it was not confirm, I would had understand my duty, but in this case, I am really really really TL.

I remember another classical incident how a TL can be good servant to all. Everyone were seated nicely for morning tutorial, and the TL had to fumbled around to fix the projector to the PC and the few fellows seated closest to the projector (whom will benefit the most from it) just sit around in their fat/tiny ass, minding their own business. This goes on every morning. I helped him once in while. I could have been more helpful. I admit, most of the time, I am also a lazy bastard bugger nincompoop idiot moron fellow sitting around in my fat ass, minding my own business.

Please forgive me, my ex-TL.

T.E.A.M Together Everyone Achieve More…

Hope that one day, T.E.A.M. could be TL, Everyone Assist More!!!

** generally, it is acceptable in Hokkien language as a relatively vulgar word, which meant "pissed off", and word by word translation meant "penis of the pig". No offense to my Muslim friends.

Aug 15, 2005

a burp to the future

Sky is clear. I repeat. Sky is clear. Sky is clear. But for how long?

Haze had moved to Penang, my beloved hometown. Now, I am worried about my family. Maybe my worries is just too much. Penangites, especially the Chinese should not have any problem with the haze. They probably saved money on the josssticks and all. Well, you see, almost every month, the so-called ardent God-believer would enjoy going into the hazy… no, very hazy environment of a place we called as Chinese Temple (the famous haze factory is Kuan Yin Teng Temple) to pray and ask for lots of stuff, ranging from getting an A in the next exam to asking a good wife/husband for themselves or their sons/daughters. Of course, needless to say, the commonest prayer is

  1. Won the lottery
  2. Good health
  3. Great business

It would be ironic, of course, to hold the jossticks high in the air with all the smokes burning fiercely with dark ugly grey smokes, and pray for the haze to settle, right?

Not just in the chinese temple, annual festival at St.Anne, a church at Bukit Mertajam also had plenty of candles to burn. Of course, there were lots of josssticks lighted up around the place, but not photographed. If you’d been there, you’re know how hazy the place were during the Feast of St.Anne.

Come to think of it. The Penang Island would hazy again few days from now, where there will be lots of burning of candles, jossticks, paper ferrarri, paper Kancil, paper handphone, paper shoe, paper lipstick, paper computer, paper wife, paper husband, paper horse and lots lots lots of hell bank notes for the departed ones in conjunction with the 15th of the 7th lunar month, when the reputed big door to the hell is open wide, and all the burning is for the hell occupants to chow, instead of harming the people of the households.

It is nice to hold this tradition. But then again, with all the haze, you don’t need the door to hell to be open, it is already major HELL.

One thing is for sure. All our government would do for the haze is planning, planning, talking, talking. But they just do not walk the talk. If the haze repeated again, they might just pacify people with "Last year, so damn thick, It will go away in few damn days. Don’t worry" and when it doesn’t - it will be back to the spin doctor’s boring story telling time. Let us just have a good burp to our future.

Burp Still in ENT(ear, nose,throat) posting. Seen lots of people with big cerumen (ear wax) and awesome rhinolith (look up the dicts yourself, don’t be a lazy bum). Turn off, definitely. But all the lecturers and profs there were really cekap and absolutely amazing. They were more like a friend to us.

I still remember the times when I was little, and burping would be something childish and there were challenges in burping - loudest, longest, crankiest and all. This kind of childplay was never a civilized thing to do.

However, today, after learning from the speech therapist of UMMC, I discovered something new. On patient who had their larynx aka voice box removed could not speak, unless they have

  1. a larynx prosthesis
  2. a voice enhancer (put it to the jaw, move mouth exaggeratedly to produce sound)
  3. natural way: BURP your words out loud! (No kidding)

After that class, I would never underestimate a burp. I was wondering whether a belch or flatus would be something useful to mankind. Anyone would care to enlighten me?

Aug 10, 2005

brainy article

Male brain is not all about sex. Female brain is not all about talking & shopping.

Male_brain Brain_femaleHere’s something medical people could drool about. I got it from New York Times today.

The Male Condition

Published: August 8, 2005

Cambridge, England

TWO big scientific debates have attracted a lot of attention over the past year. One concerns the causes of autism, while the other addresses differences in scientific aptitude between the sexes. At the risk of adding fuel to both fires, I submit that these two lines of inquiry have a great deal in common. By studying the differences between male and female brains, we can generate significant insights into the mystery of autism.

So was Lawrence Summers, the president of Harvard, right when he remarked that women were innately less suited than men to be top-level scientists? Judging from current research, he was and he wasn’t. It’s true that scientists have documented psychological and physiological differences between male and female brains. But Mr. Summers was wrong to imply that these differences render any individual woman less capable than any individual man of becoming a top-level scientist.

In fact, the differences that show up in brain research reflect averages, meaning that they emerge only when you study groups of males and females and compare the two groups’ averages on particular psychological tests or physiological measures. The evidence to date tells us nothing about individuals - which means that if you are a woman, there is no evidence to suggest that you could not become a Nobel laureate in your chosen area of scientific inquiry. A good scientist is a good scientist regardless of sex.

Nonetheless, with brain scanning, we can discern physiological differences between the average male and the average female brain. For example, the average man’s cerebrum (the area in the front of the brain concerned with higher thinking) is 9 percent larger than the average woman’s. Similar, though less distinct, overgrowth is found in all the lobes of the male brain. On average, men also have a larger amygdala (an almond shaped structure in the center of the brain involved in processing fear and emotion), and more nerve cells. Quite how these differences in size affect function, if at all, is not yet known.

In women, meanwhile, the connective tissue that allows communication between the two hemispheres of the brain tends to be thicker, perhaps facilitating interchange. This may explain why one study from Yale found that when performing language tasks, women are likely to activate both hemispheres, whereas males (on average) activate only the left hemisphere.

Psychological tests also reveal patterns of sex difference. On average, males finish faster and score higher than females on a test that requires the taker to visualize an object’s appearance after it is rotated in three dimensions. The same is true for map-reading tests, and for embedded-figures tests, which ask subjects to find a component shape hidden within a larger design. Males are over-represented in the top percentiles on college-level math tests and tend to score higher on mechanics tests than females do. Females, on the other hand, average higher scores than males on tests of emotion recognition, social sensitivity and language ability.

Many of these sex differences are seen in adults, which might lead to the conclusion that all they reflect are differences in socialization and experience. But some differences are also seen extremely early in development, which may suggest that biology also plays a role. For example, girls tend to talk earlier than boys, and in the second year of life their vocabularies grow at a faster rate. One-year-old girls also make more eye contact than boys of their age.

In my work I have summarized these differences by saying that males on average have a stronger drive to systemize, and females to empathize. Systemizing involves identifying the laws that govern how a system works. Once you know the laws, you can control the system or predict its behavior. Empathizing, on the other hand, involves recognizing what another person may be feeling or thinking, and responding to those feelings with an appropriate emotion of one’s own.

Our research team in Cambridge administered questionnaires on which men and women could report their level of interest in these two aspects of the world - one involving systems, the other involving other people’s feelings. Three types of people were revealed through our study: one for whom empathy is stronger than systemizing (Type E brains); another for whom systemizing is stronger than empathy (Type S brains); and a third for whom empathy and systemizing are equally strong (Type B brains). As one might predict, more women (44 percent) have Type E brains than men (17 percent), while more men have Type S brains (54 percent) than women (17 percent).

What of Mr. Summers’s other claim, that such sex differences are innate? We know that culture plays a role in the divergence of the sexes, but so does biology. For example, on the first day of life, male and female newborns pay attention to different things. On average, at 24 hours old, more male infants will look at a mechanical mobile suspended above them, whereas more female infants will look at a human face.

It has also been found that the amount of prenatal testosterone, which is produced by the fetus and measurable in the amniotic fluid in which the baby is bathed in the womb, predicts how sociable a child will be. The higher the level of prenatal testosterone, the less eye contact the child will make as a toddler, and the slower the child will develop language. That is connected to the role of fetal testosterone in influencing brain development.

Males obviously produce far more prenatal testosterone than females do, but levels vary considerably even across members of the same sex. In fact, it may not be your sex per se that determines what kind of brain you have, but your prenatal hormone levels. From there it’s a short leap to the intriguing idea that a male can have a typically female brain (if his testosterone levels are low), while a female can have a typically male brain (if her testosterone levels are high). That notion fits with the evidence that girls born with congenital adrenal hyperplasia, who for genetic reasons produce too much testosterone, are more likely to exhibit "tomboy" behavior than girls with more ordinary hormone levels.

What does all this have to do with autism? According to what I have called the "extreme male brain" theory of autism, people with autism simply match an extreme of the male profile, with a particularly intense drive to systemize and an unusually low drive to empathize. When adults with Asperger’s syndrome (a subgroup on the autistic spectrum) took the same questionnaires we gave to non-autistic adults, they exhibited extreme Type S brains. Psychological tests reveal a similar pattern.

And this analysis makes sense. It helps explain the social disability in autism, because empathy difficulties make it harder to make and maintain relationships with others. It also explains the "islets of ability" that people with autism display in subjects like math or music or drawing - all skills that benefit from systemizing.

People with autism often develop obsessions, which may be nothing other than very intense systemizing at work. The child might become obsessed with electrical switches (an electrical system), or train timetables (a temporal system), or spinning objects (a physical system), or the names of deep-sea fish (a natural, taxonomic system). The child with severe autism, who may have additional learning difficulties and little language ability, might express his obsessions by bouncing constantly on a trampoline or spinning around and around, because motion is highly lawful and predictable. Some children with severe autism line objects up for hours on end. What used to be dismissed by clinicians as "purposeless, repetitive behavior" may actually be a sign of a mind that is highly tuned to systemize.

One needs to be extremely careful in advancing a cause for autism, because this field is rife with theories that have collapsed under empirical scrutiny. Nonetheless, my hypothesis is that autism is the genetic result of "assortative mating" between parents who are both strong systemizers. Assortative mating is the term we use when like is attracted to like, and there are four significant reasons to believe it is happening here.

FIRST, both mothers and fathers of children with autism complete the embedded figures test faster than men and women in the general population.

Second, both mothers and fathers of children with autism are more likely to have fathers who are talented systemizers (engineers, for example).

Third, when we look at brain activity with magnetic resonance imaging, males and females on average show different patterns while performing empathizing or systemizing tasks. But both mothers and fathers of children with autism show strong male patterns of brain activity.

Fourth, both mothers and fathers of children with autism score above average on a questionnaire that measures how many autistic traits an individual has. These results suggest a genetic cause of autism, with both parents contributing genes that ultimately relate to a similar kind of mind: one with an affinity for thinking systematically.

In order to fully test this theory, we still need to do a lot of work. The specific genes involved must be identified. It is a theory that may be controversial and perhaps unpopular among those who believe that the cause of autism is largely or totally environmental. But controversy is not a reason not to test it - systematically, as we might say.

Simon Baron-Cohen is the director of the autism research center at Cambridge University and the author of "The Essential Difference: The Truth About the Male and Female Brain."

heaven on earth

_40673298_haze3220 _40673306_petronasap220_1 _40673304_pedestriansafp300 It is heaven on earth… again. Or at least, it look like heaven, but it damn darn feel like hell now. All the thick haze coming down on your face, chewing up your skin, your nasal epithelium, your conjunctiva, your respiratory tract endothelium, your alveolus and all. Life really sucks this few days. Body becoming more lethargic & brain becoming increasingly stupor at one time or another. Luckily, I had my mask on - the nice black one I got from elective in Taiwan. Comes in handy - washed it every night, instead of harvesting on the resources of the hospital i.e. the disposal mask. My room was also hazy to a certain degree, had to steam my room at night, just to keep it less appalling. I boiled water, closed my windows temporarily & let them vaporize. My room did not become heaty surprisingly, instead it was nice & cosy. Kind of turning my room into a croup tent with humidified air.

To tell you the truth, some people could not have been more idiotic. I saw few of the hospital workers actually smoking in the nice little garden behind the hospital in the thick haze that we are having. Perhaps smokers had an illusion that they looks cooler with all the haziness around them while they smoke. They would never guess how much cooler they would look when they had haziness over their lungs in chest X-ray in the near future.

We had this problem every year. But still, there were no preparation by the local authority to tackle this problem, beside reporting the API over the media profusely and declaring holidays. What kind of idiots nincompoops morons pathetic losers professionals are working at the government sectors? No offence to other government servants who are working their ass off to bear the blame together with the idiots nincompoops morons pathetic losers professionals. They can only blame the weather, blame Indonesia, blame our luck, blame our destiny or better they can tell people that this is actually a blessing in disguise. Yes, the blessing is really well-camouflaged. My foot (forgive me, this is one of my stuporous attack). Just look at the pride of our country, KL tower and twin tower above. Our government is just as blur as the view shown above. The pride that we all should be having for our country is to have clean air through out the year, every year and all, not about having the long pacifier and two ‘jagung’ sticking up our capital city.

check out the API at

Aug 6, 2005

a joke or an aftermath?

Complaints were lodged by one of the juniors’ parents in The Star:

++ Their hand phones were kept by the seniors and they were not allowed to contact their parents, family members, and friends. All these so-called orientation programmes go on until 2am or 3am, and they have to get up by am the next day. They have barely three hours of sleep and no time to do daily chores such as washing clothes. My son is not feeling well now and I am worried about his health both physically and mentally, if this continues. ++

I had been in UM medic fac for such a long time and this is the first time I heard about it.

Whose fault it is? Not the juniors, not their parents… ** One perhaps should seek out the first person who threw stones in the glass house, the individual who goes too far, the individual who disregard the ancient rules. **