Valedictory Speech, Full Version

I've just finished my training session for the upcoming convocation with the IIUM Senate Committee. They said that it had good content and a good flow, but was far too long for the 10 minute limit. I'm posting it up, as I feel that the summarized version will never be as good. Note that I've not yet finished it, as the Arabicized stuff wasn't done yet, and the BM needs a lot of corrections. Done in like 2 hours before the training session, haha (!). We doctors do lack time you know (you know the typical doctor excuses).

Assalamualaikum and good afternoon to all.

It is a great pleasure and honor for me to speak in front of an accomplished audience. For today I am speaking not to an ordinary group of graduates; today I am speaking to a group whom can now be called professionals. I must take this opportunity to first thank my parents, my other family members and friends, my teachers of past and present, and as a doctor, my patients. Without all of them, I would not be as successful as I am today, nor selected to speak to address such a special group of graduates. For who I am today is a product of all those I mentioned above.

For you are a special kind of audience. You are an audience of whom standards are not just set by your teachers; the standards of your proficiency of practice is also set by your senior professionals, who have set high standards upon themselves. To graduate as a doctor, an allied health professional, or a lawyer means that there is no question regarding your qualification.

I still remember 7 years ago, when all of us were a group of students who had just finished the SPM examination, and were just about to begin a new phase as students in the Matriculation Center. At that moment many of the faces I saw were a mixture of excitement and anxiousness. We thought that SPM was hard. Would we survive the next 5-7 years of education? An education that is more specialized, yet harder. Nevertheless at the time there was always those moments of youthfulness. Late nights, last-minute studies, and of course the obligatory sleeping in class. This was the same regardless of the course undertaken by the students. Even Medicine.

Now fast forward to the moments right before the graduation. At that time you can also see the same mixture of excitement and anxiousness. But now it was for a different reason: We were preparing for the professional exams. An exam where you are judged not just by your regular teachers; but judged by professionals who are going to see you for the first time, and probably the last time. And this is what I mean to speak to a special group of graduates. You are graduates who are trusted not just by your own lecturers, but also by other professionals who have never met you before; who are convinced by your knowledge and skills the only time they saw you. You have achieved success, surely to be envied by others.

Kejayaan itu adalah sesuatu yang patut diraikan. Ini adalah kerana sesuatu kejayaan akan membawa kepada kejayaan yang seterusnya. Akan tetapi kejayaan kamu pada hari ini adalah hasil campuran pelbagai elemen. Ia bukan sahaja hasil daripada titik peluh usaha tuan-tuan dan puan-puan graduan. Kejayaan kamu pada hari ini juga adalah hasil daripada pengorbanan tenaga dan wang ibu bapa dan ahli keluarga kamu, daripada pengorbanan guru-guru, dorongan dan kerjasama rakan-rakan, sama ada rakan sepelajaran mahupun yang bukan, dan yang penting untuk diingati, para pesakit, pelanggan, dan sejarah atau pengalaman orang lain seperti kes-kes mahkamah yang terdahulu. Oleh itu, adalah penting buat diri saya bagi mengambil kesempatan ini bagi mengucapkan penghargaan terbesar bagi mendiang bapa saya sendiri di atas pentas ini, bagi Allahyharham Prof Madya Ayub bin Mohd Yatim yang meninggal ketika bulan Ramadhan al-Mubarak yang lepas.

It is only fitting to pay tribute to my father, who has given unlimited support in my endeavors to achieve excellence in IIUM. It was a rarity for him to ever say no to giving financial support for my efforts in buying all of However, my late father fell ill during my final year of studies with stroke, making life extremely hard for my family as a whole. He then was afflicted with a heart infection, which required heart surgery - on the day of my final professional exams. And yet my family and I persevered, and I passed my exams which I personally viewed as with flying colors considering the circumstances surrounding the end of my undergraduate life. But 1 month ago, ironically on the first day I was on call, my father passed away due to complications of his illnesses. It instantly had made the hardship of work, and the rigors of studying before that, pale in its emotional stress. The scolding of senior doctors and specialists, and the fatigue of long hours at work, felt tolerable with the death of my father.

The emotional burden of personal family illness, yet with the coincidence of becoming a successful graduate has taught me one thing, something that I wish to impress on you today: your success as a graduate today is to be cherished, but its elements are never to be forgotten. The success you achieve will thus protect you from arrogance, and keep you humbled.

And your humbleness in remembering your roots will keep our parents safe once they leave us, which they will. It is with this humbleness that we will remember to pray for them. To pray that they will be rewarded with Paradise, and saved from Hell. As the prophet once said, “One does not bring but 3 things to the Hereafter: beneficial knowledge, charity, and prayers of a good son.” But before we go further, I would like to remind everyone of a verse in the Qur’an”... I want to create a khalifah on earth...” To fulfill the principles mentioned in the above verse, we muslims must rediscover what it takes to become political and professional leaders. And the effort must be exemplified by none other than the IIUM graduates themselves.

It is important for IIUM graduates to not only be humble as I have mentioned above. IIUM graduates are bred in its system to be more than mere certification holders. We have to, and are educated to, to be more than followers. We have to be leaders. And the leadership displayed by IIUM graduates is not limited to our muslim ummah only, but also to the general public, or in terms of lofty standards befitting an IIUM graduate, leadership of present mankind itself. And better yet, the principles required to lead the ummah in the 21st century are easily derived from the Triple I-CE vision introduced by IIUM, that is internationalization, integration, islamicization and comprehensive excellence. By living the principles above, doctors, allied health professionals, and lawyers from IIUM will not be mere professionals; we will be professionals with leadership, who will unite the muslim populace and lead the world via the various avenues, whether it be academics, practice, or politics.

Internationalization is an important principle to be upheld if we are to achieve our ambition of being khalifah on earth. Muslims in the modern era are now segregated by nationalities and race. In the political sense, muslims are characterized by divisions, infighting, selfishness. And in the professional sense, muslim professionals are slow to not only develop, but to adapt new revised and better standards as regards to our professional development. Instead, we have left it to our Western colleagues, of whom the majority are non-muslim, to develop new ideas, practices, and guidelines which have increased the quality of the work of their profession.

In a different aspect, muslims now still stuck by sometimes questionable traditions. We have refused to see outside of our bubble, thinking that we are superior simply because of our religious faith as being muslim, or by misguided notions that some aspects of culture and tradition have their roots in religion when they are not.

Muslim professionals must be the spearhead of efforts to finally bring muslims to the forefront of the international arena. Muslim doctors, allied health professionals, and even lawyers must learn to be at the forefront of research and development, and to quickly explore new avenues of ideas that may help us improve the standard of healthcare care and legal systems. We should not hesitate to seek knowledge from non-muslims if it means improving ourselves. After all, best practice is best practice. And we must make example of muslim professionals who are among the leaders in their fields, but ply their trade in the western world, and thriving in it.

Muslims professionals from IIUM must also be at the forefront of efforts to educate the general public and modernize its thinking. The muslim professionals should make effort to educate the general public, to teach them than modern development does not have to, and should not lead astray from religious principles. Muslim professionals must teach the public to differentiate culture and religion; the latter is permanent, the former can and must change according to its suitability in modern practice. Muslim professionals from IIUM should be exactly that: excellent professionals, and faithful muslims. We must equal the accomplishments of the various muslim professionals of whom their names we keep on hearing as regards to the Islamic Golden Era.

To become a leader in the modern era, it is not enough to simply be a doctor, an allied health specialist, or a lawyer. The certificate that we have received today, despite of its significance, is not enough to allow us to lead the muslim world and the general ummah as a whole. We must seek out further knowledge, more than the knowledge of our practicing field. And all of this various knowledge needs to be united into one. Muslim professionals from IIUM must live the principle of integration.

A good example of this is seen in medical education. For clinicians of the modern era, it is not enough for them to simply be a highly qualified clinician in practice, or to simply be a Masters holder in a specialist field. Clinicians must now be proficient at research to become leaders of their field, that is to become research clinicians, to search for better practices and develop better technologies. To do so the clinicians must not just deepen the depth of their knowledge; these clinicians now have to broaden the scope of knowledge to the basic sciences of mathematics, the truly basic medical sciences: biology, chemistry and physics. But mastery of these fields is not sufficient; the knowledge must be turned into one, that is integrated.

Integration can also be seen in another light: that is integration of the general ummah. Muslims, exemplified by muslim professionals from IIUM, must be the example of integrating the ummah as a whole. In IIUM, we are blessed with a mixture of muslims originating from various countries. We even have non-muslims studying in this garden of knowledge and virtue. Our experiences and abilities to integrate with various peoples must be extrapolated to leading the muslim professionals and muslim populace as a whole, and then on to becoming political leaders of integration for the general mankind. Muslims professionals from IIUM must be at the forefront of education and goodwill to peoples of other faiths.

Muslim professionals from IIUM must not shun themselves and segregate into their own group. Instead, we must reach out to peoples of other faiths. We should provide service and education to muslims and non-muslims alike. And the responsibility is double-fold for us: to provide as a professional, and to provide as a muslim. During our practice is an excellent opportunity to preach regarding Islam to our clients and patients. And this preaching may not be direct; the character that we portray may sometimes be enough preaching in itself.

Integration and internationalization are interrelated with the next principle of Islamicization. IIUM graduates are ingrained with the principle that all worldly and religious knowledge is interrelated with each other. Secularization is the exact opposite of the what is taught in IIUM. Muslim professionals must change the current practice of their fields to reflect on basic Islamic principles. A good example of this is the field of shariah law, which combines the principles of modern law with basic Islamic rules and regulations into one field, which is already established by lawyers and led by IIUM. Other good examples are the halal food business and Islamic banking. And there are many avenues for muslim health care professionals to contribute to health care. The most obvious of this is medical ethics which I want to talk about.

Medical ethics is currently led by the Western world, based on mostly ethics based on human thinking, which can be wrong. And the western world is itself segmented, with those who believe and those who do not believe in divine concepts. This is where muslims have a great avenue to contribute. This is because Islamic principles of the world and law are based on permanent concepts: the revelation via the Holy Qur’an and teachings based on the Hadith of our beloved prophet Muhammad s.a.w. Because of this, medical ethics based on Islamic teachings would thus have more permanence and acceptance, as basic Islamic principles are true regardless of the passage of time. By improving our practice by integrating fields of professional practice with religious teachings, we will be following in the footsteps of the Golden Era researchers who pursued knowledge of Graeco-Roman origin and related it with Islamic principles to develop new fields of knowledge for which the muslims were the leaders and not mere followers.

To live by the previous 3 principles stated earlier, muslim professionals from IIUM would be living by another principle of IIUM needed to lead the muslim ummah and mankind in general for 21st century and beyond: comprehensive excellence. For to be leaders in an age with increasing populace, increasing political dynamics, increasing numbers of specialized academical and professional fields, and increasing technological advances, there is no other way other than to make effort to be the best: to be the best doctor, the best husband, the best father, the best son, the best neighbor and the best leader. This is because your deficiency in one area may ultimately hinder your role in another. And if you are deficient even slightly in a very competitive era, your leadership role will be taken by another. It sounds hard; no mission ever is easy.

But IIUM has taught you well. You have been taught to become excellent professionals in your field. You have been taught to become excellent muslims, who integrate knowledge of the islamic teachings and modern fields to develop knowledge more than the sum of its parts. You are taught to become one who integrates with the populace and others of your profession. You are taught to become one who seeks to be excellent in all aspects of life. You are a professional, an IIUM graduate.

Now go and make us proud.

Thank you. Assalamualaikum wbt.

For the Juniors

The drama in my life ceases to stop, and at some point or another, you just accept it. An abnormal day is a normal day. Luckily, lifting and recently cooking has kept me sane. After marriage, I have no idea whether life will normal as others'. Yes, I've told her I will keep lifting (but certainly not in a 4-a week schedule, rather a 3/2 a week schedule once work starts and the schedule permits).

Anyways, one of the juniors asked me, what's my secret. After being asked the question, I initially wanted to record myself talking and uploading it as it's easier. But the internet connection sucks balls, so a long lengthy post is what's for offer.

But to understand how I did what I did, you must understand my situation. A background.

I have been active all of my life, physically and in extracurricular activities, though entering UIA made me more sedentary until the discovery of strength training. I was in MSC until 4th year as President. I debated during matric + MEDCY VP and later President too. I once dabbled in program compiling, and for a short while the Mac compiler for the Wesnoth game (recommended), and a bit longer among the moderators (still an MP server moderator). I love learning about other things than medicine. I'll leave school stuff out.

At the same time, I'm a perfectionist. I always wanted to be the best of what I think I can be. This is not the same as being first, in which I compare myself with others. I only compare myself with myself. And so, if I want to invest in something, I'll 1) want to beat all others, 2) once others are beaten, I want to beat myself. 2) comes after 1). This means that even if I was no 1 compared to others, if I didn't reach my standards, it meant that there was still room for improvement.

During the final year, my father suffered from clinically migraine paralysis, radiologically lacunar stroke. A few months afterwards, he suffered a watershed infarct secondary to left ICA thrombosis. He still hasn't recovered from the Broca aphasia and hemiparesis, and now suffered Gram negative infective endocarditis of the aortic valve requiring valve replacement. Radiologically there were new infarcts. He has not yet been discharged, and developed new onset fever with bacteremia. My wedding was supposed to be on this Saturday. It'll have to go on I guess. My mother still has not started working, our general life and finances are in disarray, and other stuff probably with no need of mentioning. The almost constant progress in my lifting keeps me mentally fit, relatively.

I returned home almost every week since the first episode of stroke, whether it was to help out or to prepare for the wedding. My father's op was done at the practically the same time as my clinicals. The initial op planned had a higher risk of dying on the operating table. And added to that, my long case was not revised at all before the exams, and I never saw the case, until the exams.

And my exams were never normal too. My ped's patient had multiple problems. The surgical patient lied, and had a language barrier too. My psy patient ran away. My IM patient was someone I knew 100 percent since admission, with an atypical presentation (bias). My O&G was a "contradictory" presentation. I never saw hemophilia until my Pro.

I'm not going to spend time telling you about the exams exactly, but how to prepare for that. It's how to go through the exams, and call your mother straight away "I passed" before the results came out. Even with my way of life then I told the junior, "I came to the exam not to just pass".

Preparation

It starts now. You need your basics, identify the ones that will last you throughout school, and never forget it.

What you use in BMS will be used in 3rd year, and what you use then will be used in final year. But not all of it. Identify them. Remember them.

Medicine is in some ways about memory. Use it. That means treating information as though you might not read it again. Punish yourself to make sure you never forget important information/values. I survived despite being someone who can't count in his head. If the -7 serial test was the ultimate test, I'd be a permanent Psy patient.

Medicine is about associations, cause and effects, and is not black and white. Cultivate your imagination, be willing to dissect the conditions of patients and relate.

A textbook is thick. A patient's file is thinner. The patient tells more than the file.

You can only read so much with focus. You can listen and discuss much more.

You are only as fast as you can find your information. The internet helps. Knowing how to use it helps even more.

The exams may go the advanced issues, but basics are never ignored.

Mr Hafiz: "You don't need to see any case, you only need to know it."

Timing

Should you go on full throttle very early? Probably not. Even I did not start on "full gear" until the final posting was over. But that's why memory is important.

It's okay to choose whatever method to revise topics, but remember 1 thing: does it help you remember it the next time you have to use it? What we chose was a "always study all postings" method without any particular phases. But early on we stressed more on Ortho.

MCQ's are a student's best friend. But memorizing T/F is rubbish. You should be understanding the spirit behind the questions. I never write T/F on my MCQ's. If you don't know why reread this post. MCQ's always tell you what you don't know. There's more to learn in an MCQ stem than a PMP case.

How to divide time? What we did was to answer MCQ's in the morning, read in the afternoon, discuss and short cases at night. I lifted in the afternoon.

Clerking

Remember: Complaint, course, cause, complications, current status. Start now.

Remember: Patients are not like textbooks. Throw away your scripts. Learn the art of clerking. Start now. With experience, you will learn to pick up what the extras are on a "case-by-case" basis. Some questions you ask patients may make you look silly, and hence are silly to ask.

Patients are people, and hence if they are in distressed, just gather the info you need and move on. No need to do a full cardiac exam on a patient with right sided failure when you just want to appreciate the P2 sound. Others want to examine him/her too. Saves time as well.

Be brave yet respectful. Think of when you will start working as well. I learned to insert cannulas into, um, myself.

You will have to cover wards, not patients. Learn to clerk without writing, and learn to present without reading. Start now.

Ward presentations are different from exam presentations.

Addendum:

Start learning by doing "full" clerking. But learn the shortcuts before the final exam. It might save you. And it's all you'll be doing when working. Clerk to diagnose within 10 minutes of seeing the patient. Dr Haji: "You don't need 30 minutes to diagnose your patient do you?"

Addendum 2:

For ward presentations, remember: presentation, diagnoses, problems, management, current status.

Friends

You are teachers to each other. Be critical of each other. Not to compete, but that's how you cooperate. Teach.

You are as slow as your slowest friend. It's your job to make sure he/she picks up the pace. Teach.

You remember what you teach. Make sure everyone gets a chance to yes, teach. The listener-only friend loses out as he only listens, while the rest loses out in terms of effort.

Sanity

Medicine is not everything. Learn other things. Many other things. I continued to read other stuff even during exams.

Physical health is important. No talk, all action. The fat slob sweating is a lot "healthier" than the skinny nerd.

Have avenues to relieve stress. Endorphins are useful.

Lifting was useful because:

1) The focus needed is more than during exams. A barbell falling on your neck hurts more than the scowl of an examiner. So you train your brain. Exams feel "easy" on the brain.

2) Endorphins.

3) Activity.

Just do something.

Arguments are not useful. Stay away from them, and get them away. Sacrifices, temporary, may be needed during the peri-exam period.

The effort-results curve is sigmoidal. If your aim is to be sane, understand this curve. To be in the middle, aim for 52. Always. Start now. Once comfortable, raise the bar and become crazy like me.

Exam

20 minutes history, 20 minutes PE, 20 minutes everything else. Halve that for your ward time.

Reorganize your thoughts.

Remember your summary, differentials, investigations, management. Start now (in clinical years).

What is the spirit behind the lecturers' questions? Steer them. Be "safe".

The exam is between you, patient and examiner. You can control yourself. Be prepared for the unexpected.

Bismillah before, Alhamdulillah after.

Anything Else?

Go ahead and ask, I'll answer as I can. Preparing for exam only questions of course.

Thoughts, Training (May 16, 2010)

Thoughts (It's been a while):

1) The LPT stretch from Gambang to Kuantan is dangerous in the presence of rain: T-Rex was skidding almost every 3-5 minutes.

2) An interesting quote from Harry Selkow to me:

"The quickest way to get strong is to be the weakest guy in the gym." I've learned to create my own ways to avoid a "jaguh kampung (big fish in a small pond)" mentality. For example, I always look at lift videos in the Internet, not really to humble me, but to motivate me.

MJ used to lie to the media that opponents smack talked with him, and admitted that he lied when he retired, with the intent of firing himself up.

3) An even more interesting quote from Michael Jordan when he was told to emphasize teamwork:

"There's no "I" in team, but there's an "I" in win."

4) People need to have a winning mentality. Standards must be individualized. You don't tell Federer to be grateful whenever he became second best to Nadal; hey at least he got into the finals. You don't tell the same to LeBron James when the Cavs just lost to the Celtics. When your potential is much more, why settle for less?

When I told Umi that I was close to getting a D for O&G, her response was to actually scold me (and my fiancee) for going back every weekend!

5) I've been feeling that I am very lax in preparing for the Professional Exam this Friday. Not spending much time studying, and more relaxing. No pressure for the most part.

This reminds me of SPM, a time in which Abah and I got into a very heated (understatement) argument, and a time in which I was even more hot-headed than I am now. Abah was pressuring me to study while I was home in between papers. I wanted to relax and take my time to read in the middle of a stressful exam period. The trigger was when he kept pestering me to come back after prayers while I was talking with friends. Hm...

6) Speaking of Abah, he and Umi are currently back to the general ward. Atrial fibrillation secondary to CAP. The neurologist said that there's probably new recent stroke(s), although there's no functional signs other than generalized lethargy. I guess the echo tomorrow is for that. Thanks for the wishes from everyone.

7) I'm finding that everyone loves my massaging skills. Maybe I should learn Active Release Technique (ART) or Graston (gasp!).

8) Hm, I can no longer borrow Abah's pants: my thighs have become too big.

9) I don't understand why casual gym goers waste their money with single joint, isolation exercises and getting no visible changes after even 1 year. Unless you can bench 100 kg (I can't), squat 140 kg (not tested yet), or deadlift 140 kg (yes), you have no idea imitating routines of people who spend at least 2 hours every day for 6 days a week with the help of assistance and are already fucking strong in the first place.

Sure, it's your choice, but money and time is precious for those of whom going to the gym isn't no 1 in their lives.

Training:

Since I'll be getting married soon (27 June, Bangi Golf resort - bookmark that date, invites will be sent out when they're ready), I'm going to start fat loss. It's time to dial in the diet 100%. I'm aiming for (generally) normal strength training via 5/3/1 3 days a week, with heavy conditioning on the same days + one. Every other day except 1 day per week will be filled in with general "light" conditioning, probably with Turkish get-ups.

Diet will be carb cycling. Previously I still took carbs on off days. Now it'll be carbs in morning and pre-training only on days with heavy conditioning, and no digestible carbs on off days. The aim is 1-2 kilos a week.

Soon I will also be going back to Bangi, with no lifting partners. At that time I'll have to reduce again my lifting maxes for the bench, which is my weakest lift relatively.

In the mean time, I did have a good deadlift session last week: 131 kg kg for 7 reps.

Thoughts, Training Log Until March 21 2010

I haven't written in a while; not enough time.

Thoughts:

1) Living in the fast lane, stress can either bounce off of you like a slab of concrete, or deliver blast through you, like a slab of concrete. Usually for me it was more of the former, but yesterday it as certainly like the latter, due to multiple stressors finally getting into me.

I need to keep my legendary temper in check: I think I punched the wall almost 10 times yesterday, hard enough to make people notice. The skin at my knuckles aren't hyperpigmented because of hemochromatosis, you know.

2) My aunt got operated for a "ruptured" appendicitis, but the operation was laparoscopic, so it shouldn't have been too bad. Get a good rest Umi Dah.

3) So far I'm finding that I need to do a lot more to get myself ready for Pro, especially now that the date has been pushed forward. And I can't enter the wards to boot. But with the current schedule and stress levels, I'm not sure how I'll manage to fill the hours in. With my current "intellectual abilities" I'm guessing that just 1 hour to study O&G and another to study for Pro consistently every day would suffice. Another would be to study 1 1/2 hours for Pro (which I've not started on my own yet, only group study), and depend 100% on bedside teachings and other "classes" (including on call sessions with 3rd years) to prepare for O&G (which was exactly what I did for internal medicine, and still got me no 2 in the group). We'll see which path I follow, which depends a lot on how well I cope with the stress.

But I want another distinction, for O&G and Pro. I want the money from the MMA award (though I haven't registered as an MMA member. 1K will help out a lot, especially with the internal drama in the family (not just Abah's illness).

4) Speaking of Abah, he has been talking a lot more, which is good. This morning he also started trying to regularly walk without his walking stick. But there's a lot more training required especially regarding his speech, and dealing with his upper limb spasms while doing ROM exercises are very difficult: too soft and you won't be able to extend the elbows & fingers at all, and too hard and Abah will be in pain. But he's laughing more, and interacting better with guests, who are still coming non-stop during the weekends.

Thanks for the support.

5) Next week is Naufal's wedding, the wedding of a person I can truly refer to as a best friend. Congratulations. Hopefully I'll be able to come over, unlike the so many I've missed lately.

6) Some people have it so easy: you'd God damned better be grateful.

Training (writer's block setting in):

The b-ball underground tourney is less than a month away, and what is hopefully going to be a special day is another 3 months away. It's probably time to reel in the diet, get a good more cardio in, and hopefully still increase if not maintain strength while shedding some fat. People don't care how healthy you actually are, just as long as you meet others' interpretations.

Videos are up on my Youtube page. But one thing is for certain: my pullup strength sucks, and I'm very unhappy about it.

Thoughts, Training Log Up to Nov 4, 2009

Thoughts:

I hate being a perfectionist like I am. During times when I want to excel like exams, I stress myself so much that I experience psychosomatic symptoms.

On Monday, I experienced crushing retrosternal pain, centrally located when leaving the hall after PMP. But there was no signs of increased sympathetic activity: no tachycardia, no palpitations, no sweating. I had to sit to relieve myself. Stand up again and walk: return of pain. It only disappeared about an hour while eating (an early) dinner. And of course, there were no symptoms during training.

Today, I experienced some severe claudication in my right leg when going back after the short case exam. And of course, the pulses were palpable, the pain didn't disappear with rest. There was no pallor/congestion or other signs. It only started disappearing during training (almost 9 hours later).

I hope that I get the D, not because I think I deserve it (I don't), but because the wreck it would give me if I don't get it. I like underestimating and overachieving, simply because expectations (whether they are from yourself or others) are a burden. Believe me.

Training:

It's exam week, so no conditioning, partial deload, change from 4 days to two days (today and Monday). We'll push it hard again next week.

Monday:

Deadlifts - Up to 110 kg for 5 reps. All with hook grip. The first time I did my last sets without a mixed grip in a while.

Bench Press - Up to 68 kg for 5 reps.

Front Planks with Salutes - 3 sets of 12.

Today:

Front Squats - Up to 77 kg for 5 reps. Easy.

MP - Up to 43 kg for 5. It was supposed to be 41, but trying to be accurate is probably a waste of effort.

Pallof Press - As usual, up to 3 sets of 6 each side with 29.5 kg cable.

This week, John joined the team (Abe and me). He'll be doing a program similar to mine; more functional leg accessory work compared to Abe (more mass-building). Welcome to hell. I can't wait to coerce him into doing barbell complexes with the barbell rather than the doomstick (the bamboo stick). Lady Gaga people!

Viva for Distinction

This is Part 1 of Surgical Exam series. If I've the mood/energy I'll share my other experiences especially for my clinical exams. My theory paper sucked in my opinion; there were just too many careless mistakes here and there.

Prof Azmi called me for viva for consideration for distinction. He said only if I passed the viva would I be even considered for distinction, with consideration of my other marks. So there's nothing guaranteed yet, people.

It was a roundtable viva, with Prof Azmi, Mr Junaini, Mr Khairussaleh and Mr Yan.

Prof Azmi:
TNM staging of colorectal cancer.
Differences of T2 and T3.
Commonest type of colorectal cancer.
Location of rectal tumor felt on digital rectal examination.
Divisions of the rectum.
Length of the rectum and anal canal
What is meant by the sphincter complex.
Innervation of the sphincter complex
Endoanal manometry.
Actual thing measured by manometry.

Me:
Sphincter complex - Internal, external sphincter, levator ani, puborectalis.
I was not able to answer regarding what is exactly measured during endoanal manometry (internal/external sphincter pressure), only that it's used to measure the pressure.

Mr Junaini:
What is the commonest cancer of the liver?
Commonest origin of secondary metastases to the liver.
Gross morphology of HCC.
Histology of HCC.
Tumor markers of HCC.
Difference between HCC & fibrolamellar liver ca.
Determination of tumor resectability.
Criteria for Child-Pugh.
How many points for A, B, C Child criteria.
T staging of HCC.

Me:
Did not know the answer for gross/histology of HCC. Answered that fibrolamellar tumor hass better prognosis, due to (after he gave a clue) being well differentiated. I could not answer regarding the A, B, C classification for Child-Pugh criteria, nor the T staging for HCC. I did already mention that resectability was based on TNM (especially T and M) staging and the Child-Pugh status of the patient before that.

Mr Khairussaleh:
Adjuvant therapy in breast ca.
New advances in chemotherapy.
(Prof Azmi) Other hormone being targeted by the new advances. The term for these advances in chemotherapy.

Me:
Accidentally answered regarding the neoadjuvant therapy of breast cancer.
Explained regarding the adjuvant modalities - radio/chemo/hormonal therapy. Answered regarding the criteria for all three.
Explained regarding antiangiogenesis agents (e.g. Herceptin)
(After Prof Azmi gave a hint) anti epidermal growth factor.
Targeted therapy.

Mr Yan:
Classification of surgical sutures.
Type of surgical sutures used in intestinal surgery.
Types of abdominal incisions.
Advantages of different abdominal incisions to the patient.

Me:
I didn't know the sutures used in intestinal surgery.
I answered that "horizontal incisions are better, as vertical incisions would lead to more scarring due to not following the I-don't-remember-the-name-line." (Prof Azmi) "The Langer's line".

And that was that. If you want to know how I specifically answered some of the questions I was able to answer, give me a q.

Prof Azmi:
Are you interested in surgery?

Me:
(Couldn't say no and that I wanna be an ED physician now, no?) I haven't made up my decision, Prof.