February 28, 2016

My Journey to the West - PART 1

I am writing this on the auspicious day of Aidilfitri 1436. A journey which I shall call it "A journey of my life" took place a couple of weeks ago.

25 JUNE 2015 / 8 RAMADHAN 1436
Departed to KL via Air Asia flight. Arrived in KLIA2 just before buka puasa time. Made my way to the food court, ordered a cold cham drink to accompany a pack of rice with sambal udang (packed by mom) for buka puasa. Made my way to KLIA (via Train) after prayers. Checked in soon after reaching KLIA. Flight Lufthansa KL to Frankfurt ; Frankfurt to Edinburgh. I am going to Europe..huh..I still cant believe this! I checked in luggage & another hand carriage.
Security checking & boarding was uneventful.

The Long Flight
My total travel time was estimated to be 19 hours 10 minutes (including 4 hours layoff time in Frankfurt) Flight left KLIA at 12.45am (instead of 12.05am) and the caucasian pilot sarcastically attributed the delay to a MAS flight leaving before ours.
Lufthansa in-flight service was mediocre...not as good as MAS (before the dissolution of MAS of course). They provided 2 meals. Juices prn basis. and of course aplenty of the "haram beverages". Meal was prepared by MAS (so ditanggung halal la)
It was a unique experience of doing sahur in the sky :)
Arrived in Frankfurt on 26 JUNE @ 7am (local time). German security was stupid I would say...not sure for what reason they wanted to record down the ophtalmoscope I was carrying. Nevertheless nothing eventful. The next flight to Edinburgh also departed slightly delayed by 20 minutes.

Edinburgh - Here I come
Arrived in Edinburgh Airport at around 12.45 noon (local time). It was drizzling & quite cold (though it is summer). Immigration clearance was not a hassle at all. The guy did not even bother to ask for my examination admission letter. He only asked why am I here & wished me the best when I told him I am here for an examination. 
Took a cab and cost me 20.90 pounds!! (paid 20 only). Took me 30 minutes to reach my hostel.."Euro Hostel" The receptionists were friendly but really I had to squeeze my ears to understand their accent. I can only check in at 3pm & it was only 1.30pm. So I wandered around there, looking for the Edinburgh Central Mosque and finally found the masjid at 2.30 and Jumuah prayers were over by then. Made my way back to to Euro Hostel at about 2.45pm.

Accomodation I : Euro Hostel 
Stayed for 4 nights - made booking via booking.com. Paid an average of 25pounds/night. A clean, cozy place offering private room with shared bathroom, shared kitchen (with toaster, fridge & water boiler). Everything was ok except :
1) there was a mice which will freely run in & out of the room
2) usually in the evening for about 1-2 hours, there will be a group of girls making noise at the outside of hotel while having their drinks (loud enough, can be heard on 4th floor - where I was staying
3) No lift

Weather (in Edinburgh)
It was pretty chill & ya I guess I was the only one walking with gloves on in summer. I can't stand the cold even when I am inside my hostel room

Food
I stayed at "the old town" (as they call it), which is only 10 minutes walk away from the Edinburgh Central Mosque. Aplenty of Muslim food restaurants around this mosque. So food was not really an issue; though my meals were mainly breads/canned sardine/ peanut butter I brought from home (to cut cost) I only bought outside food 3x throughout my stay here. they were all either Arab or Indian food. Restaurant I went to : Mosque Kitchen (there were 2 different shops with the same name but definitely they are not owned by the same person; as each of them acclaims to "the only original Mosque Kitchen" on banners). There were few other eateries as well quite near by to each other, but I did not actually enter all the places

Where I went in Edinburgh
I was in Edinburgh for 4 consecutive nights; then in Bishop Auckland for another 2 nights before heading back to Edinburgh on my final night.
My routine in Edinburgh were pretty simple. I'll iftor at 10.30pm; then prayers +/- study and continuous eating until Subuh (2.30am). After Subuh I'll sleep till about 7 or 8. Then wake up & study for a while before I start dreaming in my room. Either noon time or around 5pm I'll get out of my room & walk around. Only on my final day in Edinburgh I met up with Joyce (my PACES training buddy); we took a bus to look around at her exam place (Western General Hosp) & walked around sight seeing, as well as going to the "tourist shopping area" (which is quite near by) Joyce stayed in Tune Hotel (which is a train station away from my place)
Edinburgh Central Mosque - has been my favourite place. I went for night prayers on most of the nights. Tarawih starts at 11.45 and ends at around 1.15am! Imagine 8 rakaat + Witir (3) in 1 1/2 hrs. And guess what, the sof maintaned as how it began! That is something I had never seen in Malaysia. It is so enthralling to see Muslims here! At least 80% will be back to the Mosque 1 hour later for congregatory Subuh prayers.

Off to Bishop Auckland (30 June 2015)
My exam was at a distant town call Bishop Auckland, which is about 2.5 hrs by train (approx 330km) from Edinburgh town. And it is actually in England (which I only knew when I was about to leave the town..hehe). Took "Virgin Train"...that is what the train is called as; from Edinburgh Waverley station (which is 15 minutes walk from my hostel). Left at 6.45am (punctual). Quite a classy train I would say, as the seats were cozy they serve food using the small push cart (just like in flights) err..of course you need to pay for the food. U can buy train tickets online (which offers cheaper price) & print the tickets at the station. Quite convenient. It stopped at several stations (3 I think) and I got off at Darlington, as had to take connecting train heading to Bishop Auckland.
I arrived at Bishop Auckland at 10 past 9. Whew...it was a small quite town with lots of geriartics population (was so apparent the moment I stepped on Bishop Auckland soil) The station was like 5 minutes walk to the hospital (my exam place) Took a bus towards Park Head Country Hotel. Bus driver and senior commuters were very helpful. It is only about 15 minutes to the get to the Hotel
Reached the hotel at 9.45am & the receptionist swiftly checked me in though I was like 4 hours early than the scheduled check-in time. The gave a "suite"...huhu. (No wonder I paid 135pounds for 3 nights!) Weather here was perfect. I can see the sun & no more "Raynauds" for me.

Bishop Auckland is a town in the Durham district (England). A quiet but lively town I would say. I noticed a hypermarket (Morrisons) and the hospital is a district specialist hospital. Nevertheless none of the buildings were more than 2 storeys. Saw a few Chinese and Indian eateries, but did not try any. I "survived" on breads & canned food I brought all the from Malaysia...huhu. No place to cook in this hotel, so I just had to heat up sardines using boiled water.
On my second day I took a bus to the Morrisons and had a peak at the hospital. My stress level has reached max I guess...cant really read anything in peace.

2 July 2015 - 'D' Day

I cant really put into words of how I felt the night before the exam & the morning of the exam. Only Allah knows how I felt. Called home while I waited for the bus to go hospital.
Reached the exam place at about 8am. Exam scheduled to start at 9am. I was the second candidate to reach. There was one Hindustani girl (working in Edinburgh) there even before me. After me came the other 3 (all were Asians except for one girl). There was even a guy from Kelantan who has been working in Glasgow for the past 9 years. The exam co-ordinators were friendly. Approximately 9.30 : the game started!
1) Hx taking : 35 y.o /lady with Cluster Headache. Given hx was quite straight forward & discussion was not too difficult but somehow my mind blanked out when asked about treatment.
2) CNS & CVS. CNS was a 40 something aged chap with LL weakness for many years. Paraparesis with sensory level (likely spastic, but I did not dare to say)as the reflexes...were not hyper, in fact hypo! Gave some differentials. Examiner asked about investigations.
CVS : a middle-aged lady with dual valve replacement.
3) Comm.skill. A total failure. Was given the task of breaking the news to a patient with mesothelioma. Instruction given on paper was that pt attending his appt to know his biopsy result etc. However pt said he has come today as he felt chest pain. His actual appt (to see the consultant) is next week. Did not do enough to satisfy the examiner (who was clearly unhappy); I did not tell the pt that he got this because he used to work in shipyard & he is eligible for Industrial Claim Benefit (though I voluntarily mentioned this during the discussion) Examiner was also unhappy as I said I will arrange an appt to see the oncologist. He wanted me to say that this will be discussed with my consultant.
4) STATION 5 : Partial disaster
1st case : 60 y.o lady wth violaceoes macularpapular confluent rashes on nose, face, forearms, buttocks, knees. (Mind you, it is not Heliotrope or butterfly or DLE rashes. Not psoriatic neither!
Stem was : She has got these rashes for 4/12 - on treatment under skin. Now has come with worsening dyspnoea for 2/12. SPO2 on air : 94%.
O/E : not in failure, Lungs : clear, Not clubbed. SHE HAS ORAL THRUSH. I suspected she is on some immunosuppressant drugs, but she said she can't reveal that to me! I was clueless.
I simply said could pulmonary-vasculitic syndrome, opportunistic infection, Pulmonary HPT. The lady examiner did not appear that happy. (RETROSPECTIVELY : I think she has sarcoidosis with lupus pernio & lung involvement)
2nd case : 60 y.o / lady wth Lt sided headache & partial ptosis of Lt eye for 3/52.
O/E : CN IV, VI intact. only partial ptosis. Pupil : normal size
My dy/dx : Temporal arteritis. The examiner accepted, but asked what else I would think of? I said need TRO CN III lesion (.e.g. compression/ mononeuritis) Do MRI/MRA.
5) Respi & Abdo :
Respi : a lady wth Lt mastectomy scar. Findings: consistent with B/L bronchiectasis. Questions asked: what are your differentials. CXR finding in bronchiectasis. Spirometry findings.
Abdo : a guy wth mid-sternotomy scar, LIF & RIF scar, a weird looking semi-horizontal abdominal scar & B/L BKA! Actually he has got a tranplanted kidney (which I missed out initially: but thank Allah I had 1 minute remaining for examination, thus the examiner offered me to use up the one minute and it was during this 1 minute I found out he has got a transplanted kidney on LIF!)
And he final bell rang... Was a tensed 2 hours of my life.

Honestly I was not happy with my performance. Went back to ParkHead Hotel and just slept till 5pm (though cant really sleep) No mood to explore Durham town (as planned earlier). Checked out at 5 something. Ran down to catch a bus to Durham Railway station (30 minutes away) Reached the station in time. Btw I think I boarded the wrong train (mine was Cross-Country, but I boarded Virgin Train..thinking both are the same)
Reached Edinburgh Waverley Station about an hour before Iftor. Quickly walked to Mosque Kitchen & packed up Kebab for 3 pounds. (Left my luggages at Euro Hostel on the way to Mosque Kitchen)
Iftor at the Masjid. Then had my Kebab after maghrib (It was too much, I had to eat at 3 separate times) Stayed on at the Masjid till the end of tarawih. Then walked back to Euro Hostel, slept for a while at the reception, before going back to Masjid for Subuh. I spent the whole night walking and catching a nap intermittently at the Euro Hostel until about 7am.

3 July 2015 (FINAL day)
My last day in Edinburgh. Walked in & out of gift shos & "kedai 1 pound". Bought some souveniers & some biscuits (sold at 1 pound per box) I was like a zombie as of course literally I did not have  a place to sleep last night. (I paid to stay in ParkHead but decided to leave earlier as I might miss the flight if were to stay there another night)
At about 10am, took airport coach (4.50 pound). Checked-in uneventfully (except that the guard did not allow me to carry a litre of juice in hand carry).
Flight to Frankfurt departed at 1.30pm (ontime)
Lay-off in Frankfurt supposedly only 1 hour, but delayed to two hours. Tried to spend my remaining 4 pounds,but none of the merchants wanted to accept "coin form"
Endured another long-flight & reached Bangkok on time. (My return flight was EDIN to Frankfurt; Frankfurt to Bangkok ; then Bangkok to KL (by MAS) Lufthansa personnel was waiting for me at the arrival gate & swiftly took me to boarding gate.

Finally I am back
Took a bus to Penang & reached late night (almost midnight)

WHAT I LEARNED
1. Sitting for an exam (moreover practical/viva exam) in a foreign land IS NOT EASY. Especially when you are never exposed to their culture/practice. Believe me..i was there and take my words. Be there early (at least a good 4 days earlier than exam date to acclimatize yourself with the weather, environment and to calm your nerves..to certain extent)
2. Plan your trip well (especially accomodation and how are you gonna travel from one city to another (if needed)
3. Survey food places and prices. Bring along some canned food which you could heat up. Saved me a lot. I bought only 3 meals during my 1 week stay. The rest, I relied on food I brought from home (including mom-made nasi with mutton; which stayed afresh even after 26 hours!
4. Experienced Ramadhan in a far away land. I observed fasting for a total of 8 days in Edinburgh. Each day approx. 19 hours of fasting (except the first day; 23 hours as I took safe side by not eating after 4hours into plane) Subhanallah...the 19 hours of fasting was not bad at all. Perhaps fasting in Malaysia could be a little tiring at times; but never in Edinburgh! Perhaps the weather, but I really dont know why.
5. Accomodation - try to go for hostels with separate rooms (shared bathroom is fine); as they provide place to cook and relatively affordable as compared to hotels/apartments.
6. The InterCiy Trains were extraordinary. Frequent travel times. Basically can go anywhere in UK by just boarding the train. Reasonably punctual. Something our KTM must emulate if there is any hope in improving public transportation in Malaysia.

PACES tips:
1. It is still better to sit for PACES in our own place or at leasdt near by places i.e. Brunei. Going UK can be "intimidating", scarry (unless you did undergraduate in UK)
2. Having said that, if the inevitable happens, you still have to go UK; or else you may end up waiting for a place in Malaysia, where as your juniors have started doing sub-speciality training... 9as what happened to me :) I have a colleague (same HO batch; who is a Nephrologist now ;)
3. If you are going UK, do learn how they approach patients. THIS IS EXTREMELY IMPORTANT. It is a bit different than how we do it the Malaysian style. If you have plenty of money, attend a course or two in UK. If not much money (like me), just prescribe the PasTest videos. Learn from the videos. The video is not much of a use if you are attending exam in Malaysia.
4. Books :
- Pacing the PaCES (by PGMES Penang) : for Neurology
- Oxford by Iqbal Mehta : for Clinical topics (read selectively)
- Ryder : for Comm.Skill/ Hx taking and Volume 3 for Station 5
INI CUKUP. Dont read too much

5. Practise daily 1-2 cases. Or else EOD, but make full use of your weekends. Get good training buddies.

6. Attend at least one proper course before you go for the exam (Mock is not really important - but good if u get an opportunity) In my case, I managed to go Batu Pahat as an observer  ( for a short course & Mock exam) and another in Hydrebad (which was quite disappointing!) If you want to go for courses in India, go to a course held at teaching HOSPITALS not at some private clinics...mind you! Nevertheless, the Hydrebad course was good for Comm.skill & History taking (at least something :)

Finally I would like to say that I am grateful to have Joyce (whom I met during my preparatory Course in Hydrebad in May 2015), Chin (my junior in UNIMAS) and Yew YX. These 3 were extremely helpful and I shall help them too when their turn to sit for exams. I go Skype to practise comm.skill, Hx and station 5 - with Joyce. Besides I am also thankful to have some words of wisdom from my sifu, Kantha Rao; whom I emulated by finishing MRCP in 1.5yrs; as well as my colleague, Arvind who took me for a few History sessions.
Last but not least, my training buddies during Masters Part 1 exam - Suba,Rabeah, Salina & Gan. These are the people with whom I " held hand-in-hand" as we polished our clinical skills bit by bit from basics (as it was all rusted back in April 2014; when we were preparing for Part 1 exams)

ALHAMDULILLAH - all praises to ALLAH. I got my results 3 nights before Aidilfitri. I PASSED!

Mohamed Azlam bin Mohamed Micdhadhu
MD (UNIMAS), MRCP (UK)