Breast Examination

Today we learnt to perform breast examination on a real person. It's the first sensitive test I have ever done throughout the medical career, and it turned out to be great!

The day was divided into a few sessions, and there were demonstration from the so-called "clinical teaching associates", experience sharing from breast cancer patients / survivors, history taking ("interview") of someone who presents with a breast lump, and last but not least, hands-on practice on the associate.

As a guy I was supposed to be terribly nervous, shaking and petrified for the day, but I turned out to be okay with the whole thing. The day started with the demonstration where 12 of us stood around a "doctor" and a "patient" who demonstrated the real technique of clinical breast examination. Well, the feeling of seeing real breasts were... Eerm, surreal. But nah, it wasn't "stimulatory" at all if you wonder. :D When you are concerned about the steps and the patient's problem, you kind of put behind the stray thoughts.

So, yeah, we had experience sharing from a breast cancer survivor next. The talk was engaging since it comes from someone who has been through it all. She talked about her diagnosis, her past, and her concerns throughout the disease. Although she removed her breast and has been well for the past five years, the prospect of a recurrence will be looming for the rest of her life. She said she's already made the preparation should things go down that path, and her children even know where to spread her ashes for the funeral. It's a heart-rending story although she managed to put up a positive front throughout the session. You really get to empathize strongly about "count everyday as a blessing".

Next session was a boring, usual interview session. I played a role of a 53-year old patient who's complaining about a lump in my right breast. It's firm, about the size of a marble, and tends to move about when I touch it. What's worse was my mum and my sister both had a breast lump although those were not cancerous. Haha yeah, you get to role-play these kind of things a lot here.

The last session was the real breast examination. Three of us were allocated to a patient, and we took turn examining the breast. It's kind of interesting how all the protocols work: we have to be extremely careful about our language, for example we should say "examine your breast" instead of "feel your breast". Besides, the very important thing was to get a consent from the patient to perform the examination. After some briefing, three of us shyly took our turns at examining the breast. If you would like to know what the examination involves, there are:

1. General observation - the raise your arm, lower your arm, roll your shoulder thingy.
2. Palpation - the doctor uses his fingers to examine all areas of the breasts.
3. Lymph node inspection - the doctor feels for the nodes below the armpit and along the collar bone.

So yeah, that's it. My encounter with breasts. I salute the courage of the volunteers who allowed us to learn so much through sacrificing their privacy. They are heroes.


p/s: And a public health message - if you are a woman, please self-examine your breasts regularly. This is especially important if you have a family history of breast cancer. Ask your doctor about regular breast cancer screening - it really, really saves lives.

Ambulance Without Petrol

It's a national disgrace. [The link is no longer working, but I saved a copy which you can view here]

A woman with severe headache presented to a hospital emergency department, but for 5 hours nobody attended to her. The doctor only saw her when she lapsed into a semi-conscious state. She was transferred to another hospital for CT scan, and the scan revealed a blood clot in her brain (stroke). But the second hospital couldn't perform a surgery, so the woman had to be transferred to another hospital for emergency operation. There was a huge problem.

All the ambulances were out of petrol.

It took them some time before they sorted out the problem and sent her to the destination, but she was pronounced brain dead on arrival.

I am embarrassed.


p/s: By the way I am curious why the husband didn't send the wife with his own car, or at least ask for help. Weird. Regardless, this doesn't detract from the hospital's negligence.

Virus and Bacteria

Virus and bacteria are absolutely different things. Bacteria are little single-cell critters. Virus is just a genetic component plus a protein "cap", and sometimes a oily envelope. Their structure and function are entirely different. Perhaps the only similarity between them is that they both contain species that could cause disease in humans.

But apparently some of the reporters in Australia can't really tell the difference between virus and bacteria.

Link

Eerm. Sometimes I find that the mass media isn't reliable when it comes to scientific information. Recently I have been finding some misconceptions in many newspapers, and some of them actually went on the frontpage. I remember reading things like "egg could stand on its end only during equinox" in Sinchew JitPoh when I was back in Malaysia a few months ago. Probably we could be lenient because it's not meant to be a scientific news after all. However, when it comes to scientific articles, newspapers seem to be born with a knack of giving misinformations. So ya, when the information is passed on from the scientist to the reporter, and from the reporter to the editors, we can basically forget about accuracy.

It's not all that bad, and most of the time the news are pretty accurate. However, slight mistakes do accumulate, and as the ol' trusted source of knowledge, newspaper ought to be more rigorous in their fact-checking. When we have already got urban legends spreading like wildfire online everyday, newspaper editors should try their best to avoid disseminating misinformation.

Death Clock

According to Death Clock, I only have 2,134,917,517 seconds more in my life.

Oops wait, I only have 2,134,917,375 seconds left. Better go back to studies.

Run For The Kids

I am going to Run for the Kids on next Sunday, April 1.

On that day, thousands of Melburnians will join a run for a good cause - we are paying 34 dollars to run for 15 kilometres, and 29 dollars of which will go to Royal Children Hospital in Melbourne.

As anyone close to me could testify, I am not exactly an athletic person. In fact I only enjoy playing "leisure sports" like table tennis, and anything more vigorous than that is not my cup of tea. Sometimes I would go for half-an-hour of jogging, but I thought that's the max I could do. And sometimes at the end of that I would ask myself, "why the heck am I torturing myself like this?"

So when Wee Loon invited me to join the race, I kind of faltered... Could I even walk for 15 km, let alone run? Before I could make a decision, Wee Loon's invitation received a great response from our friends. Many people decided to join, including Xuan Ni, Boon Phiaw, Yong Chin, Freda, Thow Kong, Boon Hoon, Ai Ling (who pulled out later) Ee Syn, Sze Mei etc.

So I decided to join it, as a form of challenge to myself.

We started to have "trainings" at random time throughout the past few weeks. We went to the Princes Park nearby a few times for some evening jogs, and the distance was about 3 kilometres a lap. Three weeks ago we ran to St. Kilda beach, which was 7.7 km from our house. And the last weekend, we ran along Yarra River for exactly 10km!

I clocked about 80 minutes for the St. Kilda run but it was not a good measure because we were significantly slowed by the crowd in the city and the endless traffic lights in Melbourne. For the Yarra River run, I successfully clocked 75 minutes which was equivalent to 8km/h! That was quite a success for me because I remembered that I couldn't even sustain 8.5km/h for long last time... Must be the fresh air there at work.

The Yarra River practice

I am becoming inspired after those runs. In fact I started to enjoy the sense of satisfaction that overwhelms me whenever I achieve a particular target. Yes the journey is always arduous, and the legs are sore afterwards, but at the end of the day it's really quite worth the effort. And I should try to maintain a healthy lifestyle if I were to advise others some time in the future, shouldn't I? :P

Mathematics in Malaysia

It's been a long, long time since I last wrote a real post. You would think that I have been so busy that I don't go online at all; but the fact is, I have been littering my two cents here and there in blogs and forums. I am writing "real" posts all the time - only not in here.

In order to make up for my negligence, I decided to copy one of my ramblings over from others' blogs. This post is about mathematics, something that makes up such a large part of me yet is so rarely mentioned in My Little Moments. As you will see, I wrote quite a big chunk in koln's blog so it's a bit wasteful not to import it here. :P In the following, I modified the text a little bit to make it more coherent and reader-friendly.

Maths and meds are two words that sound so similar yet are drastically different. They are both related to me - one is in the past, one is in the present. As you know, I am doing medicine now. But interestingly, among my current friends, not many people know about my past at all.

My involvement in maths is a matter of the past. There is no point bringing it up today because it isn't quite related to what I am currently doing. Maths belongs to the museum. Besides, my maths has already deteriorated so much after years of disuse, so there's a high risk of embarrassing myself by mentioning the word maths. Today, however, I would like to write about mathematics in Malaysia from the perspective of someone who's been through the whole system. I try to present the picture of Maths education in Malaysia, and bring in some insiders' info in the context of Olympiad competitions.

Since I will mention IMO quite a lot, maybe I should start by a brief introduction. IMO, which stands for International Mathematical Olympiad, is the biggest international mathematical competition for pre-university students. It's organized every year in different countries where contingents from various countries get together and tackle 6 tricky maths questions. For the past ten years or so, Malaysia has been sending a team of 3 - 6 students (that's the max for each country) to the annual competition. Throughout the years, we have struggled with not-so-proud results - out of the possible maximum of 42 marks, our candidates are generally scoring less than 10, and some of our representatives actually scored zeroes. Those who scored zeroes were by no means struggling in maths, mind you, but their performance serves as a grave reminder of how bad our country is faring in this prestigious competition. By doing some analysis, we shall see that Malaysia's poor performance in IMO points to a few inherent weakness in its education system.

First and foremost, there is this undeniable factor of terribly watered-down syllabus of maths in our country. Since the 70s, our education board has been cancelling topics, moving "hard" topics to form 6, and reducing the exam papers to a collection of fixed "question formats". Just grab a maths textbook from your dad and compare it with your current text, and get ready to be amazed by the vast gap between the levels of difficulty. You will begin to respect your dad for going through that ordeal.

But it's not just the syllabus, it's the whole learning culture in exams, especially in maths.. Yes, ask most high-scorers how to answer questions in SPM paper, they will tell you every single step. But the problem is, many people do not understand how to answer a maths question; they just know how to answer a question. By rote learning, by remembering the steps, by familiarising with the syntax and algorithm. People get 80s, 90s and 100 in SPM maths, but the score doesn't really mean that they are good at maths, or they understand maths. They just learnt how to do the few dozens of question formats.

Therefore we get really few ingenious students out of this culture... Let's just ask a question like, "between 3pm to 4pm, when will the hour hand and minute hand coincide"... This question can be solved using SPM maths alone, but it's a "hard question" because it's not "one of the question formats". Ask this question to form 3 students... I think most of them would not be able to solve this problem, despite having learnt algebra which is more than adequate in solving it. By the way this problem was one of the Olympiad bongsu category (form 1 & 2) questions a few years ago.

In China and some other countries, if you look at their maths book from primary schools, you will notice that this kind of "critical thinking" skills are inculcated, taught and tested from a young age. The clock question I asked above could be found in Primary maths text.

Apart from that, there is another major factor of our below-par performance in IMO - inadequate training. In our country, the IMO training is run by a few dedicated professors from UKM maths faculty who organize a few training camps every year. Those who do pretty well in the malaysian olympiad are chosen to those training camps, and in the camps the most outstanding students become the country representatives.

The thing is, the training camps are scattered, and to cover the whole gamut of olympiad type skills would require a more intensive training. I am not saying that the trainers are to be blamed, in fact they did the best they could and dedicated a lot of time and effort into this. However, without intensive trainings like those that we see in national swimmers, for example waking up every morning at 4.30am to swim, you won't get a good outcome like other countries. Yea we could say that the students themselves could be initiated to self-train everyday, but it's a pretty tight situation here.

In China and some other countries, they have special schools and also special intensive trainings where the future representatives study in. It's in that kind of setting where you could get ample training to tackle the olympiad type questions.

It is very inaccurate to say that "the best brain of Malaysia students are worse than the best brain of China". It doesn't work out that way. Shien Jin, one of our very own bronze medalists in IMO said that his colleagues in MIT aren't distinctly super-duper when it comes to intelligence. Of course they are very smart people, but they are not 3 to 4 times smarter than us, as their IMO scores might imply.

So one of the master keys is the training. And that's where we should aim at improving.


[... to be continued]
[Apr 30, 2008: Continued here]

A String of Good News

It's been a special week filled with a string of exciting news.

First, Eric "the maths guy" secured a conditional scholarship from USM to pursue post-grad studies in top universities! For those not in the know, Eric is my friend since day 1 in Keat Hwa Secondary School, a model student and the record holder as a class monitor for 6 consecutive years. To quote from someone in his blog, he naturally exudes an aura of an professor, and his students are amongst the most fortunate people in the world. I was absolutely thrilled when I read his post about the scholarship. Eric is simply fabulous, and I can't congratulate him enough for his feat.

A few days later, I came across a news about four Malaysians who were admitted to MIT this year. At first the news seemed unrelated to me, but upon further reading, I was utterly surprised. Wei Jian, one of my secondary school juniors was one of the admittees! The whole Malaysian education blogosphere was hustling with the excitement over this record-number admittance, and I could say I am one of the happiest soul upon hearing the news. Why?

Because I used to dream of going to MIT last time.

Seeing someone close to me realize my dream gives me some kind of, how should I place it, satisfaction-by-proxy. Wei Jian used to be involved in IMO and maths olympiad competitions together with me, and in an occasion I used to be one of the "tutors" in preparation for the competitions. I would be lying if I said I played a part in his success, because I didn't help out much. And certainly he achieved so much more than me, with three consecutive participations in IMO and now, MIT admittance. It's not that I had any part to play with his achievements, but I do feel genuinely happy and proud of him. I begin to understand why teachers derive such great satisfaction from their job, even it's not exactly similar in my case.

I extend my heartiest congratulations to Eric and Wei Jian. Hope that they make full use of their opportunities in the land of liberty.