4

when i looked back, i realised i've gone thru 4-5 years of tough times. uni years.. are hard but you are taught to live. when i tght back, i noticed change in each step. i'm very different frm hw i was 4 years ago.

i learnt to live. many times, i'd come across things tt are hard for me. things tt cudn't be solved, its heart-breaking. when this happens, i'd tumble for a while.. with support, slowly pick myself up and fight back the feelings. ter's no other way. once it happens, u just gotta let go..

frm tse times, i learnt the most important thing is to love yourself. always remain positive, cont to build urself up despite things tt aren't going ard well for you. always bless the other person in ur heart, despite feelings tt are so unhelpable. coz u knw one day, u guys will be smiling to each other again.. who knws even sitting down, chatting along.

regardless, hw things may be. its always a decision to let go. i've let go many times and i did not regret. i wudn't mourn repetitively coz its useless. i just knw we've to make use of our life, while we still can.. being joyful, being blessed.. bcoz things like tt aren't always there. we have to stand up for ourselves.

you're the 4th influential. you held ur hands on my shoulders just like the 3 others. i've always told myself to keep you as a fren, no matter wt. when i held disappoinment, i decided to let go. i cud never guess hw you are sincere to me, nor cud i understand some of the things u did smetmes. nevertheless, i just want time to heal.. im sure things will be good soon.

i believe one day, we will meet.. to me, this one is a very small problem compared to the last 3. we will meet.. and definitely, we will be in sizzler again :)

- keith

慢歌3

放假生活

在這此天都是玩到很累 的.
放假时候, 唯一一个东西能跟朋友一起享受的是游戏
还有足球.. 搾不多 4am 是我的睡觉錶.. 能够 12pm扒起来已经够好了..
还是觉得缺少精神。

三天前去了溜冰.. 是蛮不错.. 除了跌了几下, 更被冰冻到.. 还是一个好汉.. 其他时间就是.. 暗睡觉, 晚起身.. 就会问问自己.. 现在到底要做甚么.. 真实充满的 slack..

个人生活

坐在咖啡店, 听着音乐, 和喝着美好的 ice mocha.. 其实是蛮享受的. 个人生活.. 有不同的享受.. 也许放假是一个机会.. 不怕时间过的久, 没工作的烦恼, 就这样呆在一边相偎相依.. 有一次在 southbank parklands 的午天, 为着一棵树,就在那边看人看景.. 很轻松的..怀念生活..

人身理由

生 活孤独也好疯狂也好.. 人身意义是哪里表现出来的? 是享受吗.. 爱情? 还是自己? 其实享受是好事.. 但是不必太多.. 相我现在有少少不对劲.. 可能一路来生活都是很认真.. 如果在事业上, 可怕退步一点就很容易退出火线.. 所以现在希望能慢慢站起来.. 回去正确的.. 认真的生活..

朋友

对我来讲, 朋友最重要一点是能够对彼此的尊重.. 在我心里中, 能够当成的朋友是却不多.. 其实对某些人很失望，可是已经放开了.. 没必要对彼此强求。

愿望

其 实一个人生活可不说很差.. 也许孤独可以是一个自由.. 偶尔.. 能够为自己做出某些的表现.. 今年已经进步了.. 生活比去年好.. 不会什么负面去想不快乐的旋律.. 可是工作方面还是要多用功.. 在这里希望为自己也为了家人.. 度过好的生活.. 也作我应该做的东西..

composed- keith
translate- luka

- 28.03.08

blue

blue- is my colour. went for a swim in uq pool and spa.

swimming = my life~

take a shot b4 i cut my hair.

i love my hair~

i.s.

if gigi leung can do it, i can do it! haha.. god...tnx damit tt i had the chance to try my first ice-skating~ i anticipated being a first timer already.. 'd be like falling 1000s of times.. AND its really terrible.. BUT no.. it was great.. HAhaHahA...

i think it was coz i was guided by 3 gorgeous girls aside me, hanging onto them as i drifted along the icy floor. nurul, farah, yil helped me.. w.o. them it wudn't be fun at all. i cud not stabilize myself.. tripped a dozen times.. LOL.. the funniest part is im so willing to go out ter & try all i can.. dropping myself so many times..

p.s. probably u can see hw much i enjoyed by the size of my mandible haha.. brr.. the ice is cold. good shot this one taken when we all tripped.. least i can see life is..not tt bad...least i've a good one this easter. alrite time to go.. gna stay over at damit's to watch two big football matches.. :) cya guys~

-keith

case

74 yr old, low-level hostel resident, female

Bckgrd history

Diabetes mellitus dx 2000

Osteoarthritis of bilateral ankles, knees, hip

Breast Ca dx 2000 treated by mastectomy

Bladder Ca dx 1998 treated by CBG

?IHD allegedly reported by dr, not personally known

PC

Admitted to hospital due to the need for amputation of all phalanges of (L) leg and 2 phalanges of (R) leg, as a consequence of diabetes. After surgery during hospital stay, was investigated to found to have metastatic Ca involving the bone, she isn’t sure which bone (as reported by pt).

Personal feedback

Presentation was generally out of range, here & there. alth i presented throughly in some parts, i missed out some vital parts, but lucky with prompting. I hope the examiners take into account the complexity of the case, but purely unlucky also the disorganisation of my present. (long case- 25%, short case (each)- 25%, consultant assessment- 25%)

Scenario

Qn- wts the presenting complaint? there must be an issue that requires the pt to be admitted, not just purely diabetes. did you ask why she was admitted?

(this is the vital part i’ve missed, mainly focusing on the Bone cancer. I back-up by saying diabetes was the primary reason she attribute her surgery to, definitely this is a very important part of history wch shud be asked but unfortunately i did not)

Qn- what do you think is the issue with her leg that needs to be amputated?

Can be due to diabetes.. an ulcer.. apart from diabetes? she might have an infection like cellulitis does cellulitis require amputation you think? no actually.. it can be treated with antibiotics. Im thinking of the sort of tissue infection wch can eat up your tissues- a necrotising-type. okay do you know the terminology for that one? (i knew i was going the right way but..) sorry i don’t know.

Qn- you said she’s got Bone Ca.why do you think where the source may be from.

A typical metastatic source of bone Ca would be the breast. Alth she had mastectomy, Ca wud have already lurked into the bloodstream & spreaded.

Qn- Can you tell us wt medications she’s on

(i missed this one)

Qn- She’s on thyroxine, do you know why she’s on this?

I actually asked her while reviewing the charts, but she denied any explanation given coz she has already got so many co-morbidities. why do you think she may be on? did she have any thyroidectomy scar on her neck? no, she did not have any scar, i’d examined her neck. the possibilities maybe a thyroid adenoma or diffuse hyperplasia of thyroid gland. besides thyroidectomy, what other reasons you think she wud be on it? i couldn’t think of any.

Qn- the pt may be confused abt her condition. given her real condition is a pathological abdominal lymphadenopathy, how would this affect your approach?

what! so she doesn’t have bone Ca! oh my god.. i did notice a lymphadenopathy in her right inguinal region but did not present coz my notes were all over! And i did not focus on doing the abdominal exam very well.

Ok.. i’d think of lymphoma coz it can affect the abdomen. i did examine the lymph nodes & found to have an enlarged lymph node. ok.. why did you not tell us that you’ve examined the lymph nodes? sorry, i forgot to tell.

In the end, its not so bad. it was a complex case, not clear-cut. i answered some qns relatively well. always kept on backing myself up. my other 2 short cases were:

Pt presenting with fever, jaundice, abdominal pain. generally, i elicited involuntary guarding (rigidity) all over the abdomen. giving generalised peritonitis as one of my reasons, but i basically ruled this one by saying anyone presenting with the triad should be ruled out for acute cholangitis until proven otherwise (i could see the examiner tick)

Examine this pt with tachycardia. apparently on examination, a huge clicking sound even on bedside. no murmur, but thrills over LSE. I gave the answer as a metallic valve replacement. which valve? Given its in the LSE, i’d think its pulmonic valve altgh its a less likely compared to mitral & aortic valves. so which one do you think it is? mitral valve. 50:50.

wish me luck,

keith

let the photos flickr and let these words guide you

let me tell u wts it like to be a blogger- one who maintains.. doesn't mind wasting time on carving words, pics, remns.. just to portray themselves.. on the deepest of occasions. he or she enjoys.. finds meaning in it.. with no exception it'll last each time.. with growing creativity, diversity for the nature of its readers.

let me share wts it like to be melancholic-
one noon, on a drifting vessel overlooking the clear skies, you just wished time doesn't exist. with the breeze blowing past ur face and sceneries of nature unfold along stream, there's an empty seat beside you. the music plays, you just wished to close ur eyes and let it prevail.. her head lying on ur shoulders.. just countlessly dream as long as till the day sets to dusk.

a beautiful trait it is to dream.. smetimes nt knowing why i'd provoke myself to dwell at times.. revisiting places of beauty & memoirs.. did only i coz of questioning? the life of mine.. yet.. after a while, i'd slowly crawl myself out of fantasy and indulge yet again into the realms of reality. just so tt, i'd be putting my life once again to good use.

16.3

sunday- 16.3.08

day- remn
nite- remn

诗

甚么东西是能 让人 感动得?
是 那种再 生活中给了最 美好 的回忆
一种当你想 其时候是永久的意义

today.. i generally tght about ppl.. those touched before.. and worth thinking.. friends whom you'd really knew as frens.. ppl who care.. i miss abi who'd not be coming back this sem.. my most sincere fren in brisbane.. i have less.. but its not the matter.. coz wt matters is you still have one or two..

- keith

march

as of march, 08- i'm leaving this weekend least to break, blog.. wtever u call it. its alwez fun, just had a jog 5km ahead to central, 8km back to uni. the canteen at uni decided to serve 'malaysian' food for the day, ordered chicken tomato, makes me feel like home :) i had an autopsy session at noon, can't describe it, not allowed to.. but its fascinating. you cut bodies u knw, cut tse who just died days ago..

update further on life, its cool. i remembered a year ago, smeone actually posted a meaningful phrase- "what i like abt you is what i like abt myself" with a hehehe.. at the end. wt it means is- she likes herself. 'you' being herself. based on tt, i'm also here to suggest life does rule. so regardless of tngs happening around, life's still cool as ever.

i decided to take a break 2day coz over the next few weeks, we're starting cardio. its gonna be huge.. guess currently for me, 2nd year will be the hardest. stuff is just top-load. but the feeling of enthusiasm in getting to know more keeps me on, tt is hw i survived. besides the whole abt academy, next thing probably wud be house-moving, i had a bit of ordeal on this one.

i actually signed a co-tenancy at dutton park, waiting to move in.. imagine met my new hsemates, and actually went off on a trip for furnitures on the weekend. where this is my first time to IKEA. got a bed, got to knw them, was treated lunch bla.. then.. dilemma came by when my old landlord contacted me, did a few job in securing interest, and i was straight onto signing another year with her. i cud cancel the one at dutton coz its a co-tenancy but it takes a few weeks of rent.

i remembered the day when shallen moved out just weeks ago, my hsemate, you can see her photo down a few posts back. i kept missing her, had to give her a few 1/2-hour calls just to sort things out. she's alwez cheery~ full of life. i also remembered the 1st day i moved into indooroopilly- when i had to leave away frm hurt and influentials- to live life anew. i settled in quite well. hsemates were great. brought myself up frm there.. when a new life was given.
nw i tght back. i cud do another year. its an awesome place. i looked as if i own the biggest room in brisbane. my houselord has always been the kindest to me- after the ordeal, she sent me this- (click here). i thank her for everything. nw its luca, a chinese girl from szechuan. she's also good in nature, it should do.

all in all, life is great. no much no less. just to comment on blogs. cys has one of the most serene blogs she's sculptured abt her feelings to the Lord. i added her earlier last year, thinking i'd at least not be too left out frm christianity. pill has also the best in terms of feelings, but both are quite emotional. i hope one day she'd open her blog again, (waiting yours too pascal! :))

- keith