Monday, November 2, 2009

In search of the best Ipoh hor fun/prawn wonton soup

Lately, my tastebuds have seemed to haven taken a new and profound delight in one of Malaysia's prized dishes: Ipoh hor fun and prawn wonton soup. No doubt, the best Ipoh hor soup still originates from Ipoh but KL does offer a few good eating outlets like Soo Kee and TK Chong coffeshop that serve good imitations of the fragrant and wonderful bowl of soup noodles. What is not comforting about a piping bowl of rich and fragrant stock that has boiled for endless hours using poached tender chicken and prawns on a cold, drizzly aftenoon? Furthermore the savoury broth with a hint of prawn oil is immersed in silky smooth rice noodles, lusciously tender chicken pieces and juicy, fresh prawn wontons. You definitely cannot find a single flaw in this nourishing bowl of soup that is easily digestible and soothing for the stomach making it an ideal choice for children and elderly.

I think what strikes me more about this bowl of soup is the fact that I have grown up loving and accquiring the taste since the tender age of 6 years. I am flooded with an array of childhood memories and I recall the trips I took with my parents on a Sunday afternoon after 1 1/2 hours of Malay tuition (till this day I have yet to master that language) to the famous Soo Kee restaurant which has been awarded as the best Ipoh hor fun in the Klang Valley by the Foodster awards and gorging myself on a bowl of Ipoh hor fun with prawn wontons. I enjoyed slurping up the delicious soup and sometimes grabbing a forkful of steamed chicken pieces drizzled in oyster sauce which is another one of the shop's specialities. I recall the shop's owner barking orders at the workers and frantically attending to the bustling queue of long waiting customers as well as the lady in the corner (probably the owner's wife) who was carefully wrapping each prawn wonton with the right amount of minced meat each with a single, glazed prawn. Or the man in the front counter expertly chopping the chicken pieces on his cutting board and drizzling it with splash of a dark oyster sauce before hollering instructions on who it should be served to. Since the portion they serve is rather small, my parents and I would sometimes hop over the Chinese store next door to buy some good old assorted Chinese snacks such as sak ke mah, chicken and pork floss, dried barbeque meat slices, peanut cookies, rice crispies candies coated in creamy caramel or stack up on bak kut teh or herbal chicken packet soups. Sadly, that shop is no longer available as some food bloggers have pointed that the owner has retired. I've still yet to try Soo Kee's famous Ipoh hor fun prawn wonton soup since returning from Sydney and kind of looking forward for an opportunity to do so.

Another big rival of the Ipoh hor fun business is TK Chong coffeeshop which boasts legendary steamed chicken, 'shiok' ipoh hor fun soup and delectable prawn wontons. My breath was literally taken away when I first had a taste although I was wondering whether they added MSG to enrich the sweet and flavoursome soup and I later found out that a food blogger who is intolerant of MSG dubiously agreed that they do indeed add MSG to their soup. How disappointing...but I doubt this small mishap will prevent me from future visits to the shop. I can assure you that that I will be still be enjoying my Ipoh hor fun/prawn wonton soup when I am 80 years old as its not only a scrumptious bowl enriched with nutrients but with a subtle hint of childhood memories.

Monday, October 26, 2009

Digress and obsess

Feeling the desperate urge to rant out my feelings right now. I'm actually feeling a tinge of fustration because I still have not got a reply back from Dr Philip Jones regarding resitting my O&G term in 2010 plus news about my portfolio examination which I have obtained an 'unsatisfactory' performance in. Its either he hasn't received it yet (quite unlikely as I have been sending out other email to friends which I have gotten prompt replies the next day), can't be bothered to reply back or is still making further arrangements. I know my level of patience is extremely low but then a line that must be drawn when you are waiting ricdiculously long for just one simple, mundane answer/reply. Furthermore, the anxiety and tension starts to pile up and you can't do anything except just fret, digress and obsess about it.

These past few nights as I was heading off to sleep, I couldn't help but wonder if my situation had been reversed and that I had passed the O&G exam and would be back home for at least a year recuperating from a year of intense study. But at least I would have known that its all over and that I just need to prepare myself for internship. Unfortunately, this is not the case and I have to trudge myself back to Sydney for at least another 8 weeks to redo my O&G term and portfolio exam, sit for the dreaded OSCE and VIVA exam that will determine whether or not I can finally pass and achieve my much desired and anticipated MBBS certificate. I honestly don't care even if I don't attend the graduation ceremony in May, so long as they just hand me the certificate in black and white; I'll be happy to take it and pack my bags and leave the country as soon as possible.

So right now, I'm feeling overwhelmed and heavily burdened. The future looks so grim and filled with unexpected and unfortunate events. I don't know even if I can make it this time around and I have already been wounded deeply from my previous two failed attempts so I hardly have much strength, will and determination left. I'll have to try to take it as it is; as the saying goes 'Come what may' and 'If it's meant to be, then its meant to be'. I always thought of myself as highly inadequate and unworthy to be called a medical student and its amazing that I have managed to scrape through 6 years of medicine with the stroke of luck on my side. I don't possess intelligence, confidence, self-respect and awesome communication skills that enables you to pass any interview or oral examination with flying colours. Basically I am not blessed with the qualities of a doctor or maybe I simply don't even have any good virtues/traits/characterisitics. I feel pretty much of a failure all the time and I often beat myself up about it either by lashing it out on others or on myself. These acts of 'repent' often form a vicious cycle and sometimes I start to feel insecure and weird if I do not engage in these acts as they are way to help cleanse me off my 'sins'. I feel like a disappointment to my parents especially who have sacrificed so much for me to have a better education in Sydney, who have used up all their savings and earnings on me in the hopes of me fullfilling my ambition as a doctor and who have dedicated their lives to see me lead a normal, healthy and happy life. And what hurts the most is that I was UNABLE TO FULLFILL ANY OF THESE TASKS....What kind of disrespectful and despicable daughter am I? I don't think I deserve much happiness from now on the fact that I have sunken so low to hit almost rock bottom.

Friday, October 23, 2009

Back home

As things didn't work out as planned, I have migrated back to my beloved home and country, Malaysia, in the hopes that it will bring some comfort in the depths of my despair. I still feel pretty sore about failing my O&G supplementary exam and I carry this wound with me's a constant reminder of why I did not graduate with the rest by the end of this year and telling me that life can be very harsh and unpredictable. Still I am determined to give it one last try before I call it quits so I am going to spend the next 4 months back in KL religiously studying O&G especially those topics I have trouble with and try to gain as much clinical exposure as possible. Also when I get back to Sydney, I will have to redo my O&G term which will be conducted by my supervisor which will hopefully provide me with more background clinical skills knowledge. By then I pray, SINCERELY PRAY AND HOPE that I will be ready to sit for the O&G OSCE and VIVA and finally pass. However, the last incident has taught me that one can never be too sure about passing and even though you think that you have prepared well, the examiner can still fail simply because he holds the power to. It could just be a simple slip of the tongue, your mind freezes up on that day which leaves you unable to recall anything that you've studied, your mannerism that may be irratating to the examiner or basically being very unlucky call lead to impending FAILURE. Anything can happen on that day and its so ricdiculous for the faculty of medicine to pass a student on the basis of just ONE MISERABLE VIVA AND CLINICAL STATION. Does this mean you have profound knowledge and grasp of O&G if you are able to pass just that station which just tests you on a tiny fraction of O&G? Furthermore, you may be extremely lucky and need not even demonstrate your clinical skills though its an OSCE station as it could simply just be a history or counselling station which saves those people (like me) who are clearly lacking and deficient in clinical skills.

At least for now, the tension of the upcoming exam is a lot less since I am back home and the exam is only next year. But this time I am going to prepare myself for failure so that if I do fail once again, I won't feel the torrent of painful emotions that washes over me filled with hurt, disappointment and self-hatred. This year has more or less been an emotional roller coaster ride; filled with many ups and downs, truimphs and tribulations. Altogether, 2009 has not been a lucky year for me in terms of academics, well being and health.

Besides that, I am currently enjoying the comforts of being back home. For now, its a luxury to wake up anytime I want and not procastinate over the daily errands. I also get to try the various food that I have sorely missed as they were unavailable in Sydney and the best part is its a whole lot cheaper and the owners are less fussy and particular especially when the customer requests for extra soup, sauce etc. So far, I've tried some Ipoh hor fun soup from TK Chong and I absolutely love the delicious, enriching, shrimpy stock with bouncy mouth-watering prawn dumplings, steamed chicken also from Thong Kee with its flavourful, smooth and tender meat, springy siew mai filled with succulent lean meat that happens to rival the ones back in Sydney located just opposite my house and tapioca kuih which has been a childhood favourite of mine. And for dinner we had tiny deep fried pomfret fish which you pop into your mouth, hear it go crunch and savour the crispiness and natural taste of fish with bones that are completely edible. No doubt, this should be packed with calcium.

Apart from the good food, mum and I did some window shopping at 1 utama and the curve. These two shopping malls that are located within walking distance from my house brings back a truckload of memories since my high school days. As I was strolling around, I caught glimpse of cafes, restaurants, clothing stores that I often visited after school ended or during the weekends. Of course, there have been some changes but some things remain the same, the malls are still packed with busy and bustling customers, the cinemas are brimming with never-ending queues and there are still clans of school uniformed children bombarding Mcdonalds, Burger King and KFC. I did some grocery shopping at Jusco supermarket and Cold Storage and stacked up my cart with food items are a lot cheaper as compared to the ones in Sydney as well as being welcomed by food advertisers offering free tasting/sampling of their products. All in all, things have hardly changed and that's the way I like it as nothing beats coming back home to be awakened by long lost memories and childhood experiences that touches your soul and brings back a bittersweet nostalgia.

Friday, October 16, 2009

The end of my medicine career

Today has more or less marked the final straw of my medicine career. After failing the supplementary examination for O&G, I'm really contemplating right now on quitting medicine once and for all. I have accepted defeat and have lost all confidence, faith in myself and I strongly believe that history will just repeat itself if I were to resit the second supplementary exam in December which will involve more components of the O&G exam (written, viva and osce). I had previously failed my OSCE component in both the supplementary and mainstream examination which proves that I am clearly lacking in 0&G clinical skills. Or maybe its a stroke of bad luck as the mainstream examination didn't really consist of a clinical O&G station; it was more a history and viva station which I would have surely passed if I had stuck to my ground. And yesterday the examiner told me that my performance in taking a PAP smear and doing a pelvic bimanual examination was unsatisfactory (although I did say the right things). On the other hand, I managed to pass the VIVA station but in the end you are guranteed a 'pass' only if you pass both components.

This O&G OSCE has really been my downfall; the only obstacle preventing me from achieving my MBBS certificate and title as a 'doctor'. It has made a devastating impact on me and I've lost all self-esteem and motivation. I don't think I was meant to be a doctor in the first place as surely God would not have made this exam to be such a barrier. I'm deciding between giving up medicine altogether and return to Malaysia to choose another course or whether I should credit transfer to another university (either in Malaysia or Australia) with the hopes of repeating 6th year medicine. But I am postively sure that if I do decide to repeat the exam in early December and if I were to once again fail it, I will NOT be continuing my studies in UNSW. I never liked Sydney in the first place and these past 3 years has brought a lot of suffering and hardship upon me. Although it can be tolerable at times, I never truly had one fleeting moment when I can declare myself as being content in Sydney and that I had made a right decision to choose UNSW. There has always been a cloud of doubt lingering over my head and I was never free from a set of misfortunes throughout the 3 years in Sydney. Only this time, it has doubled in magnitude. Since arriving in Sydney, I faced the huge problem of trying to adjust to a new country, being away from home, starting in a new university with hardly any close friends around and sharing an apartment with two other medical students (which I have not met before in my life). It was already a bad start of the year. The following year I managed to shift out and settle more comfortably in a single bedroom unit (thanks to mum and dad) but I faced a bigger set of problems mostly consisting of struggling with my own inner demons. I had to fight off dark lurking doubts in my mind, voices that kept telling me that I was not good/worthy enough and a huge torrent of emotions that envelops me in a split second ranging from intense anger, sorrow or fear forcing me to make rash decisions or act in inappropiate ways. These 'bad' cycles often repeats itself and I am left feeling numb and regretful of my foolish actions or words that I could not control during the 'heat' of the moment causing me to despise myself even further. And this year I feel as though all my effort and discipline that I have put in has literally gone down the drain. Maybe I shouldn't blame it all on external forces, I know that a large part is due to my irresponsiblity and that I could have rectified it in the past such as emphasising more on the OSCE component. Or perhaps this is the way I am repaying for my 'sins' or 'bad acts' I have committed in the past.

All I really want right now is to crawl up into a hole and bury myself inside. The pain and disappointment cuts like a knife and it tears me up even more knowing that I will be unable to graduate with the rest in December. I have no desire to speak to any of my friends although I know that they will be supportive and sympathetic. And I have a strong inclination to go back home and to break away from this dreadful place and 'nightmare'. I don't know whether it would be a wise idea to actually go back for a week or two first. It might help calm and soothe me once I am back in the comfort of my own home and in a warm, welcoming and familiar environment.

The only thing right now that is probably making the situation more bearable is the fact that both my parents are around. I know that during hardship and troubled times, it always helps to have family and your loved ones around to offer support and encouragement. This 'failure' has made a devastating impact on me and I don't think I will be able to easily brush aside the matter and sweep myself off the pits of despair. I am unfortunately not very strong-minded who can take failures and defeats lightly and see it in a positive light as a way to learn, grow or mature. Those are the people I truly admire but unfortunately I do not possess such hard-core determination. Even physical pain cannot really justify or rival this inner pain which shatters my heart into a million pieces. I don't know how I can EVER pick myself up from this and try to focus and prepare for the exam in December which will probably be my last attempt in achieving a medicine degree. I believe I have wasted 6years of my life, slaving away in medicine when I could have chosen a much less stressful, demanding and easier course. I'm just not cut out to do medicine and there is no point in reassuring myself that this is just a setback . All I know is that I will decide on Monday whether or not i should try for the final time in december when I meet Dr Phillip Jones who is the Phase 3 course coordinator. And if I were to try again, I do not know whether or not I have anymore inner strength, courage and determination left inside. Either way, I've realised that life can be very cruel, harsh and unfair.

Saturday, October 3, 2009

Over the next few days

The end of the exam is almost approaching. I'm only left with the final portfolio before I can officially say I AM DONE. Luckily, it isn't as stressful as the rest (like what most people say, the worst is over) yet this exam poses a whole new era of challenges. I'm suppose to talk for about 7 minutes on my written portfolio submission which touches on 3 graduate capabilities and then answer the examiner's questions relating to my written submission as well as the remaining 4 capabilities. These graduate capabilities such as patient assessment and management, social and cultrual aspects of health and disease, team work, effective communication etc are used to evaluate your development as a Phase 3 medical student and an upcoming practitioner. Basically we have to cite relevant evidence from past submissions, patient encounters, past clinical exams, assignments, oral case presentations etc to illustrate our learning process during the clinical years and how we can improve in these disciplines. This sort of examination is best suited for those blessed with the ability to express their thoughts clearly (unlike me). There is no right or wrong answer but you have to validate your opinions/thoughts with substantial evidence and attempt to persuade the examiner to believe your side of the story. I suppose its very similar to an interview but in this case you are 'buying the examiner over'. I'm a bit worried about this exam as I am never good with oral case presentations as I get anxious and nervous whenever I speak in front of an audience and I often fumble for the right words to say. I also sometimes find it difficult to translate my thoughts into spoken words as I am much more of an 'written essay' person. Over the next few days I'm cracking my head to try and list out the possible clinical scenarios that I have encountered during my Phase 3 which can be used to address these capabilities.

Despite that, I feel a lot less tense and high-strung as compared to the previous 3 nights ago. I cannot believe that I actually did not sleep a wink the night before the VIVA exam and managed to stay awake for 28 hours. I was very zombified the day after which I thought was a bit unusual as during the 28 hours I didn't exactly feel all that exhausted and I could still muster the energy to drag myself throughout the whole day. I think that sometimes when the body is pushed to extreme limits such as no sleep, no food or too much physical exercise it is able to endure the stressful situation but then eventually collapses the day after when the stressful trigger is gone as all it's fuel and supplies have been depleted. Its not unusual for people to remain alert and active during stressful times but then suffer a 'hang-over' period the few days after. And talking about the exam, it was no doubt very hard but at least I said something which I hoped proved logical to the examiner. I still don't have a good feeling about the exam as there were 2 stations (pharmacology and psychiatry) which I really fumbled and couldn't exactlu arrive at a correct diagnosis. Plus the pharmacology station was a complete killer, I had absolutely no idea which one of the drugs was causing the lady's hyponatremia thus leading to the lady's confusion (delirium) and I tried to distract the examiner by talking about the management of delirum in the attempt to buy some time. It did work for awhile but then my examiner (young Asian lady) was persistent and kept reverting to the drugs that were potentially causing her renal failure, hyponatremia and delirum. First of all, the case was a polypharmacy one (which involves several drugs interacting with one another to cause adverse drug reactions) and I had no idea which were the ones that were contributing to it or the mechanism behind the polypharmacy issue. She even asked me the mechanism of how the drug works and I just stared at her speechless. There's no doubt I probably failed that one; almost all the students in my group were groaning in exasperation over the pharmacology station. It is so unfair that the exam the previous day was so much easier than mine with simple straightforward cases mostly derived from the VIVA list given to us by the faculty of medicine. The complete list that covers medicine, surgery and emergency consists of 125 case scenarios which are supposed to be the building blocks of the VIVA examination. I was so disappointed that only 4 of the cases from that list came out for the exam.

Furthermore, I am doubtful as to whether I passed the remaining 7 stations as after thinking it over, I found that I missed out on a couple of important things that I should have said which makes me feel like kicking myself in the shins. We are given about 5 minutes for each station except pharmacology, o&g, psychiatry and primary care which are 10 minutes and involves only one case presentation so you really need to think fast and immediately say all the vital aspects in the investigation and management of the patient before the buzzer rings. I don't know whether what I have said is enough to give me a pass in that station. And since I did horrendously in my MCQ exam I really need my marks in OSCE and VIVA to be good solid passes (at least a P) so that it would help to bring up my overall grade. Even then, I still stand a high chance of failing the exam altogether which means I have to resit the supplementary exam the following Monday or repeat the whole year (the worst case scenario). Its times like these when I absolutely lose faith and hope in myself and feel very helpless. Its impossible to turn back the hands of time and the future looks so bleak and uncertain. I'm really anticipating the worst for this exam as never in my life have I sat for an exam when I truly and deeply feel that I have failed.

Sunday, September 27, 2009


Avolition is one of the words used spontaneously in psychiatry to descibe a psychological state characterized by general lack of desire, drive, or motivation to pursue meaningful goals. It is commonly seen in patients with schizophrenia, and is one of the four main "negative" symptoms of that disorder. Well I guess in this case it more or less applies to me.

I feel unmotivated to prepare for VIVAs and portfolio. I had my OSCE exam which in my opinion, was a just a margin lower in terms of difficulty in comparison to the MCQ. Time again was a huge limiting factor and I was really fustrated that they didn't tell us beforehand that we NEEDED TO TAKE A 2-3 MINUTE HISTORY before proceeding to physical examination. Plus answer the questions that are thrown at you by the examiner which includes relevant investigations and management and explaining it all to the patient. I mean, this is suppose to be a clinical examination not a VIVA so why include so many aspects into it? We are given only 12 minutes for one station which is already a very short time for you to do the entire examination and come up with your differential diagnosis and present your positive findings to the examiner. Furthermore, there were a few examiners who actually rushed me through the physical exam explaining that it was unneccessary to perform certain steps (probably because you won't find anything significant) which added to the chaos. I know I completely stuffed up the O&G station and I partly blame myself and the examiner. The station was a clear cut 'pre-eclampsia' case which I did IN FACT DERIVE as my provisional diagnosis but due to the examiner who kept questioning me over and over again, I began to feel very doubtful and changed it last minute to a urinary tract infection. I know it sounds so utterly dumb right now but at that time, my mind was racing and the fact that she kept on pestering me made me reconsider other differential diagnosis. As a result, my investigations were defintely wrong. I felt so stupid afterwards. The other stations, I made some mistakes here and there and I am doubtful whether or not my technique was correct (or appeared 'believable') in the examiner's eyes and I am not sure how 'correct' my answers were and whether or not I could have expanded on them or at least delved a bit deeper. And the GP station was like a counselling session, the examiner just sat there observing how well I communicated to the patient so I just went on babbling like some nonsensical fool about everything I could regurgitate about exercise-induced asthma in lay-man's language. Please note, I am not good in explaining things to patients and I tend to have poor communication and rapport building skills i.e patients do not love me. Overall, the exam was just as hard but at the least, I did or tried something (whether or not its correct or not) in front of the examiner. Everyone else found the exam equally hard and DEMANDING due to time constraints and the absolute neccessity to think at lightning speed. I'm really furious at the faculty of medicine for imposing such a difficult exam for the final year students, why not just pass us? We are going to receive further training as interns and in our upcoming professional years so why make this exam seem so much like a barrier exam? I know several good students who crumbled during this exam not because of inadequacy in knowledge or skills or intelligence but because this exam is really pushing them/us to insane limits.

So I feel like its pointless to really try studying for vivas and portfolio. Half of my motivation has disappeared because I really and sincerely feel like I've failed in the exam (FULLSTOP) so it seems hopeless to pursue further or press on. A part of me just wants to give up, there's a part of me who desperately wants to rewind the clock and rectify or amend all the mistakes that I've made during the past two exams and the other part who just wants it to be over so that my mind can just rest in peace. The agony and torment that is building up inside me can be very unbearable at times and its not just affecting me; I know a lot of other people who are shedding tears and complaining how utterly unfair the whole exam is. There already has been numerous complaints about the MCQ exam that Phillip Jones (head of year 6 medicine and exam coordinator) had to reply and email all of us that they will take into account time as a limiting factor and will readjust the passing grade accordingly. They've just created a bigger catastrophe for themsleves if you ask me by creating such an unjustifyingly difficult exam.

One of my friends asked me today whether or not I have 'emotional support'. I guess she is referring to family members (especially parents) who will provide you with encouragement, empathy and basically just to tell you that they will be there for you even if the worse does happen. Just like the passengers on titanic who knew that the ship was inevitably going to sink and that there was nothing they could do to stop or prevent it. Even though they were heading towards their doom, its comforting to have your loved ones there to help make the situation a lot more tolerable and to allievate the pain and suffering.

Thursday, September 24, 2009

As time draws closer, a sense of dread and anxiety is increasing in the pits of my stomach. The pressure to perform well and the absolute neccessity to save myself from the brinks of failure (due to the recent MCQ exam in which I performed horrendously in) is nerve-wrecking. Its an attempt to rectify my mistake and help boost up my overall mark in the examination.

I was never good in clinical examination i.e Physical examination and history taking; in fact they were and still are MY WEAKEST POINT. And don't get me started on neurology, I have absolutely no heads or tails about the matter and the same goes with ECGS and radiology (CT scan/MRI and X rays). Furthermore, i haven't been very keen and optimistic in looking for patients with good signs so that I can recognise them easily which help put me in an advantage in the examination. I have almost nil experience in detecting murmurs, crackles, wheezes which are highly likely to be tested which means I am basically going to fail this exam.