Tuesday, 23 April 2013

New artwork!: "Mother Breastfeeding Her Baby"

I'm so glad that after a long while, I'm able to produce another artwork!
 
"Mother Breastfeeding Her Baby"
33 x 24.5 cm
Coloured pencils

The subject of mother and child never ceases to interest me. I think it is in part propagated by millions of depictions of the Blessed Virgin holding Child or Infant Jesus. That, and the fact that motherly love is a universal and timeless subject.

I worked on this piece using coloured pencils from various brands. I still have the 36-colour Prismacolor set that I bought back in high school. It's an old set that isn't produced anymore. Then over the years I bought myself 36-colour Faber-Castell watercolour pencils set, and 24-colour Derwent Drawing set of natural colours (the one that looks sort of monochromic, without bright tones). "Mother..." was drawn primarily with Derwent.

I'm not sure whether to classify this art as having mature content. In DeviantART at least, "mature content" refers to "content that may not be suitable for some audiences, such as nudity, excessive violence, blood, and other mature themes. Controversial pieces related to ideologically sensitive materials may also fall under these restrictions." Alright, an exposed female breast *may* fall into "nudity", but the subject of breastfeeding as a whole, I think, is not and should not be downgraded to the level of "nudity, excessive violence, blood, and ideologically sensitive materials". If breastfeeding is an offensive topic, I don't know what isn't.

I'm also uploading this piece to my FB, see if it gets banned :p

What do you think?

 

Saturday, 20 April 2013

Freshly fallen leaves.

There is something unique about the smell of freshly fallen leaves. It is a dark and mysterious scent, earthy and fragrant at the same time---not quite decay or mildew, but not a fresh scent either. I am reminded of the days I spent running in the Gardens. Among ancient trees and cracked bridges I found the meaning of life, and a hidden footpath showed me the journey to eternity.

It is a comfortable smell, but with a hint of adventure.

Then there is something familiar about petrichor. The smell of wet earth after the rain. Like a soft mist raising from the ground, tranquil yet powerful, extending to my nose and to the heavens. I am reminded of a sleepy marketplace at the edge of the town; its people stretching up to a cool morning after last night's storm. They breathe in that scent of new life, from the first drops of the new day. Hands work systematically to arrange soulless fish and shells, and plucked vegetable and roots, to be bargained by mothers and virgins.

It is a homely smell, with a tinge of hope.

 

 

Tidbits about appendicitis

These are the pimp questions regarding appendicitis and related topics that our sweet attendings loved to ask: (no sarcasm there; our surgery attendings were sweet!)

Q: How do you find the appendix when it's not immediately visualized upon opening the abdomen?
A: We trace the taenia coli of the cecum. The three taenia coli will converge at the terminal end of the cecum, which is also the base of the appendix.

Q: What is the mechanism of perforated appendicitis?
A: As the inflamed appendix gets progressively distended and edematous, blood vessels are compressed. Blood flow is compromised, causing ischemia of the appendiceal walls. Prolonged ischemia with bacterial invasion results in a gangrene. This gangrenous area serves as a weak spot on the wall where a perforation can easily occur.

Q: What is the mass that is sometimes found in the location of appendicitis?
A: A palpable mass found in the classic RLQ site is the result of walled-off appendiceal inflammation. Walling off is performed by the omentum, the small bowel, and/or the cecum, as a defense mechanism. The mass is called periappendicular mass, which may consist of a local abscess. Some people call this stage "infiltrative appendicitis".

Q: What is the typical WBC count in appendicitis?
A: In acute uncomplicated appendicitis, there is mild leukocytosis at around 10,000-18,000/ul. A WBC count higher than this suggests perforated appendicitis (it can reach 30,000/ul or more). Vague signs and symptoms with normal WBC count could be due to chronic appendicitis.

Q: What are the meanings of Rovsing's sign, Blumberg's sign, psoas sign, and obturator sign?
A: Rovsing's and Blumberg's signs indicate irritation of the peritoneal wall. Psoas and obturator signs help determine the position of the appendix. If the psoas sign is positive, the appendix is likely retrocecal. If the obturator sign is positive, it is likely located behind the internal obturator muscle.

Q: Why does the pain in appendicitis begin initially at the umbilical or epigastric region, before shifting to the right lower quadrant?
A: The initial referred pain is caused by the common visceral innervation shared by the appendix and some other structures. Sympathetic innervation is by T10, whereas parasympathetic innervation is by vagus nerve (CN X). As the inflammation progresses and starts to irritate the parietal peritoneum, which has somatic innervation, the pain will then shift to the characteristic location at the RLQ.
Points to remember:: 1) the internal organs do not have somatic innervation, and 2) the representation of our internal organs in the brain is very imprecise, unlike the highly accurate somatic sensory homunculus.

Q: Describe the radiographic findings in chronic appendicitis.
A: In radiography with barium enema contrast, chronic appendicitis may appear to have irregular walls, or as a partial-filling defect, or a non-filling defect. Irregular walls are caused by edema in the appendiceal mucosa. A partially-filled appendix suggests the presence of a mass, which may be a periappendiceal abscess compressing the lumen, or other pathology. A non-filling appendix strongly suggests chronic appendicitis; this finding is due to the re-inflammation of the fibrotic appendix.

The fellowship of the unashamed.

I'm a part of the fellowship of the unashamed. I have the Holy Spirit's power. The die has been cast. I have stepped over the line. The decision has been made. I'm a disciple of His and I won't look back, let up, slow down, back away, or be still.

My past is redeemed, my present makes sense, my future is secure. I'm finished and done with low living, sight walking, small planning, smooth knees, colourless dreams, tamed visions, mundane talking, cheap living, and dwarfed goals.

I no longer need preeminence, prosperity, position, promotions, plaudits, or popularity. I don't have to be right, or first, or tops, or recognised, or praised, or rewarded. I live by faith, lean on His presence, walk by patience, lift by prayer, and labour by the Holy Spirit's power.

My face is set, my gait is fast, my goal is heaven. My road may be narrow, my way rough, my companions few, but my Guide is reliable and my mission is clear. I will not be bought, compromised, detoured, lured away, turned back, deluded, or delayed.

I will not flinch in the face of sacrifice or hesitate in the presence of the adversary. I will not negotiate at he table of the enemy, ponder at the pool of popularity, or meander in the maze of mediocrity. I won't give up, shut up, or let up until I have stayed up, stored up, prayed up, paid up, and preached up for the cause of Christ.

I am a disciple of Jesus. I must give until I drop, preach until all know, and work until He comes. And when He does come for His own, He will have no problems recognising me, for my banner will be clear!




These were the words found written a note by an unknown Rwandan man. He was forced by his tribe to renounce his faith or face certain death. He refused to convert, and was killed on the spot.

Thursday, 18 April 2013

7 Quick Takes #2: the eclectic in-between

My life is now in a transitional period from being a medical student to a full-fledged doctor. At this moment, I'm finished with clerkship, but I won't be a registered physician until August, and even that will only be a  temporary status for the purpose of internship! Hopefully, I will have my first real license for independent practice at the end of next year. So don't ask me what I am now, because I'm really not sure... maybe I'm a... quasi-doctor?

Anyway, this period proves to be a great blessing for me. Not only it is a restful time, it is also an eclectic time. Since I'm free from particular routines, I can fill my days with various activities both medical and non-medical-related. Here's some of the highlights so far:

-1-

I got my ACLS certificate! ACLS is very important for us working in the medical field. It is a continuation of the Basic Life Support (BLS); the latter can be performed anywhere and by anyone. ACLS is performed in a hospital setting equipped with medications, a manual defib machine, ECG, advanced airway devices, and more than two helpers.

This ACLS course was the first course that I took that required its participants to pass an exam to be granted a certificate. A couple of my classmates and I passed and I felt like a thousand bucks, to be really honest with you. To this day I'm still grateful to be matched to a very nice and very patient examiner. I promise I will use all the lessons I got from this training to the fullness of good.

License to fix a broken heart.


-2-

My last rotation, forensics, was apparently one that made some lasting memories. There, our group worked with students from two other universities, Universitas Muhammadiyah Jakarta (UMJ) and Universitas Krida Wacana (Ukrida). I'd never met folks from UMJ and Ukrida before, but these groups who happened to join us, were jewels! I made really good relations with some of them. We even held three small gatherings and took lots of pictures! I'm looking forward to seeing what the future holds for these people, because I love them dearly and I pray for the best for them.




-3-

I got my first ever job! Possibly paid too! (possibly) The university hospital is building, from scratch, a searchable database of symptoms and diseases for laypeople, similar to WebMD's Symptom Checker. This website would be the first of its kind in Indonesia. I am SO excited!!! I hope we will begin very soon, paid or not paid!!! =D Details to follow, after we actually start working, hehe.

-4-

I PASSED MY EXIT OSCE!!!!! *beer* *dance* *more beer*

For those of you who don't know, OSCE stands for Objective Structured Clinical Examination. It is basically a performance-based exam that tests you on clinical skills. Candidates are presented with standardised patients (healthy people who act ill) or sometimes mannequins on which they must perform certain procedures. An OSCE consists of several stations, usually around 10, and in each station there is a different task based on a different topic or discipline (for example, the first station is cardiology, the second is pediatrics, etc.).

It goes like this:
1. First bell. You read the instruction taped on the wall outside. Take note of what things you must perform. Only do those things!!
2. Second bell. Get inside the room. Ignore the examiner. Do what you're asked to do.
3. Third bell, some time nearing the end, to inform you how much time remains.
4. Fourth bell. Time is up. Get out, run to the next station, read the instruction. Repeat steps 1 to 4 until finished and you're all blood and tears.

Meanwhile, "exit" OSCE is just my med school's term for the final comprehensive OSCE that, if passed, lets you "exit" the med school, i.e. graduate.

In our exit OSCE, there were 8 stations without rest. The tricky part of this exit OSCE, unlike our past pre-clinical OSCEs, is that: 1) there's a writing component, with questions asking you about your working diagnosis, your differentials, your management plan and/or therapy, and 2) not every tool in the room has to be used; this requires a sharp diagnostic skill to minimise waste of time (and in real practice, money) on unnecessary procedures.

Our stations were gynecology (post-menopausal bleeding), cardiology (congestive heart failure), respiratory (pulmonary embolism), emergency (peritonitis due to perforated appendicitis), ophthalmology (third nerve palsy), neurology (migraine with aura), internal medicine (anemia due to malignancy of the intestines), and breaking bad news (pediatric leukemia). No mannequins, yay!

I definitely messed up at cardio station; I misread the instruction and consequently I did the history taking while really I was only required to perform physical exam, so I had no time to complete the written test. Stupido. But I know I did very well in neuro; it is, after all, one of my favourite specialties.


-5-

Our board exam is approaching deceptively fast! I took up a course (we all did) as well as studying with workbooks and past papers. Lots and LOTS of past papers.

UKDI (or NACE, National Competence Examination, in English) is very similar to USMLE Step 2 CK,
although there are questions about basic medical science, which resembles Step 1


-6-

For the first time in my life, I successfully completed the Divine Mercy Novena. Not sure if I was spiritually eligible for the full indulgence on Divine Mercy Sunday, though. I really hope I was!

During the Novena, I discovered that reciting the 3 PM Prayer (Hour of Mercy Prayer) is very comforting. It takes my mind and my heart away from worldly affairs for a while and back to my little spiritual altar. This spiritual altar is home to my soul. It feels rather like revisiting your family when you have traveled a long long way. I might have to make this prayer a regular :)

-7-

My library of religious reading is expanding! Welcome, Gilbert! I've long been a closeted fan of Chesterton, even though I'd never read his works before. I only came across quotations by him online, and I was immediately hooked by his charming wit. So I finally bought Heretics and Orthodoxy. If you think there are other works by dear Gilbert that I should read, please let me know!

Wednesday, 17 April 2013

Sing with your life!

Since we are still in the Easter season, with themes like rebirth and new life being brought up in readings and homilies, I'd like to share with you all Saint Augustine's Eastertide sermon which he preached to the newly baptised. This is a joyous and hopeful sermon that instructs what to do as Christians who have been born again in the new covenant, in the new life in Christ. Here we go. (Bold mine)

* * *



Sing to the Lord a new song; his praise is in the assembly of the saints. We are urged to sing a new song to the Lord, as new men who have learned a new song. A song is a thing of joy; more profoundly, it is a thing of love. Anyone, therefore, who has learned to love the new life has learned to sing a new song, and the new song reminds us of our new life. The new man, the new song, the new covenant, all belong to the one kingdom of God, and so the new man will sing a new song and will belong to the new covenant.

There is not one who does not love something, but the question is, what to love. The psalms do not tell us not to love, but to choose the object of our love. But how can we choose unless we are first chosen? We cannot love unless someone has loved us first. Listen to the apostle John: We love him, because he first loved us. The source of man’s love for God can only be found in the fact that God loved him first. He has given us himself as the object of our love, and he has also given us its source. What this source is you may learn more clearly from the apostle Paul who tells us: The love of God has been poured into our hearts. This love is not something we generate ourselves; it comes to us through the Holy Spirit who has been given to us (Romans 5:5).

Since we have such an assurance, then, let us love God with the love he has given us. As John tells us more fully: God is love, and whoever dwells in love dwells in God, and God in him. It is not enough to say: Love is from God. Which of us would dare to pronounce the words of Scripture: God is love? He alone could say it who knew what it was to have God dwelling within him. God offers us a short route to the possession of himself. He cries out: Love me and you will have me for you would be unable to love me if you did not possess me already.

My dear brothers and sons, fruit of the true faith and holy seed of heaven, all you who have been born again in Christ and whose life is from above, listen to me; or rather, listen to the Holy Spirit saying through me: Sing to the Lord a new song. Look, you tell me, I am singing. Yes indeed, you are singing; you are singing clearly, I can hear you. But make sure that your life does not contradict your words. Sing with your voices, your hearts, your lips and your lives: Sing to the Lord a new song’.

Now it is your unquestioned desire to sing of him whom you love, but you ask me how to sing his praises. You have heard the words: Sing to the Lord a new song, and you wish to know what praises to sing. The answer is: His praise is in the assembly of the saints; it is in the singers themselves. If you desire to praise him, then live what you express. Live good lives, and you yourselves will be his praise.

Sunday, 14 April 2013

American life according to North Korea (a.k.a. the most extreme and pathetic kind of intellectual sabotage I've ever seen online)

Drinking snow, sitting around on body bags, and eating bird meat until there's no birds in the trees (except for a few which they will eat anyways on Tuesday).

You know, typical American life.


All laughter muffled or else aside, I very much want to know how a North Korean would respond to this video. Will he just believe it straightaway, will he simply take it as the truth? Does he even have a choice?

Monday, 1 April 2013

The Easter Person


Pope John Paul the Great referred to Christians as "the Easter people", but why is that? Why are we Easter people, not Christmas people, for example?

To say that Christians are Easter people because the faith stems from the Resurrection is true, but it needs more explanation. Sure, Christmas and Easter are both the greatest of Christian holidays, but Easter is really bigger (though the popular media doesn't seem to like Easter very much so the emphasis is always on Christmas (besides, Easter is a little too Christian for the mainstream taste (but let's just draw some bunnies and striped eggs to make a cute Easter card))). In fact, Easter is, I daresay, the ultimate Christian holiday. While Christmas is important because it marks the coming of Heaven into Earth, the infinite into the finite, it is in Easter that the relationship of Heaven and Earth is healed, where the finite and the mundane are elevated to the worth of the infinite and the eternal. Christmas is getting acquainted with that new good-looking person; Easter is the holy matrimony.

So how do we live as Easter people? What is the Easter person like? What does it mean to be an Easter person?

The Easter person does not look different from the rest of the worldly world. He is different; the distinguishing features are embraced and integrated within him. He doesn't wear them like clothes, they build him like the cells and tissues in his body.

The Easter person is:

  1. Full of hope. Hope is the prevailing theme of the Paschal mystery. It is a hope that suffering shall end in victory, contrition in forgiveness, faithfulness in salvation, and holy death in eternal life. The Easter person's hope is not merely a wishful thinking, but one that is rooted in and nourished by a deep conviction of the Truth. This hope is unfaltering; it is actually made stronger in the face of adversaries. It is otherworldly and has its own logic. It does not demand the fulfillment of its desires; it feeds only on God's plans and promises, thus it is never in vain. This hope is very much alive and aflame in the Easter person, and in turn makes him...
  2. Full of joy. The Easter person might not be happy and cheerful all the time, but he is joyful all the time. True joy may manifest in outward expressions such as happiness or excitement, but does not require them for existence. Joy is the realization of the hope within. It cherishes in what is True, Good, and Beautiful. It persists believing in the divine providence, in the works of God's hands in every affair. And with joy and hope, the Easter person has all the necessary equipments to be...
  3. Courageous. The Easter person dares the adventures in life. He knows that his God is mighty. He has witnessed God's power; he has seen, with the eyes of faith, what his God can do. His courage is not one that is foolish, but one that is wise: it is calculating, thoughtful, but willing to make the leap when necessary. The Easter person dares the cross, the self-denial, the humiliation, the demand to perfection, not because he is born strong, but because of grace. This kind of courage makes the Easter person...
  4. Free. The secret to the Easter person's freedom lies not in anarchistic behaviours, but---surprise, surprise!---in obedience to God's law. If you are courageous enough to let go of yourselves and obey Him, you will be free from things that are harmful and unessential to the life of your soul; most importantly, you will be free from the slavery of sin. Such is the paradox of Christianity (like you don't know?). And when you are free from the concerns of worldly things, then you are obviously...
  5. Not of this world. The Easter person ultimately looks forward to be resurrected with Christ. The Easter person belongs to God; his home is Heaven. In this world he lives wholeheartedly because he is obedient to the works assigned to him. But he is a foreigner, a sojourner who cannot wait to go home, and is willing to do anything that can get him there.