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Three patients come into the hospital complaining of tummy pains. Here are their stories.

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Robert is in his 70s this year, he has been controlling his HIV well for many years up until recently where it seems he has had a relapse. He looked unkempt and malnourished and it felt like his pains may be from a lack of food. Initially, he says that his tummy pains have been bothering him for years, but when asked to elaborate, he speaks tangentially and paints an inconsistent story that almost hinges on confabulation. When quizzed, he is able to accurately state where he lives and how he got to the hospital; but is unable to state what year it is or do simple mathematics.

His son who moved out last year pointed out that on occasions, Robert was unable to tell family members apart and had started forgetting how to operate his circuit box. Thankfully, when family visited, it still seemed like Robert was coping adequately whilst staying alone.

It seemed like Robert's tummy pains were the least of his concerns now. His agnosia and apraxia are suggestive of a progressive loss of executive function. What was causing this? Is this cognitive impairment causing him to forget to take his medications thus leading to a relapse of his HIV? Or is his relapse of HIV causing him to have this cognitive impairment?

A MRI of his brain revealed a large growth in his frontal lobe. Neurosurgeons are involved, families are called down, radiologists debate the nature of this growth. The path forward seems convoluted now.

Do you put a 70 year old man through invasive brain surgery to find out if his growth is benign, malignant, infectious, or something else altogether? If he does go through surgery, you'd have to plan for the best possible resources to aid in his post operative rehabilitation. If he doesn't, then you'd have to prepare for when he starts declining and be unable to care for himself.

A multidisciplinary discussion was had with Robert's family, and the decision to proceed with surgery was made. In blessed fashion, his surgery was uneventful and his growth was a benign tumour. Robert's road to recovery was not an easy one and ensuring he had sufficient community support was challenging but eventually Robert went home with his loving family.
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Abdul is a 50 year old man who came in after a fall. He seemed well, apart from a few bruises. That was until halfway through the day where he developed a sudden searing pain in his abdomen.His heart rate skyrocketed, blood pressure plunged as he went into shock. Initial efforts at resuscitation bought some time for further investigations to be done.

Blood work revealed a drop in his haemoglobin levels as well as an increased blood clotting time. A CT scan revealed a haematoma at least 1L in volume. Abdul was bleeding into his abdominal wall from acquired haemophilia.

His body was flooded with donated blood and he was promptly started on immunotherapeutics. It was a stormy month for Abdul, where he developed new bleeds that would bring him close to the brink of death every few days. One could only imagine the mental turmoil Abdul experienced each time he experienced a setback. Nonetheless, the medical team stoodfast and stabilised him each time.

One day, his blood work indicated a remission of his haemophilia and Abdul was able to make a recovery.
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James was 83 this year. He had a peculiar gnawing pain in his epigastrium that went to his spine. It had been bothering him for a month, but honestly, it was more of a slight discomfort to James than anything.

If his family gave him a choice, he would have preferred to stay home watching TV and spending time with the grandkids. But his daughter was concerned as James had lost a considerable amount of weight. True enough, James was found to have metastatic pancreatic cancer.

At 83 with a diagnosis of metastatic pancreatic cancer, James' prognosis was grim. He mentions that he has had a fruitful life and was blessed with a loving family. He treasured his independence and valued his quality of life. Was it a surprise when he expressed that he only wanted palliation? It was to his family; his daughters could not understand why their usually healthy father could so easily say no to life.

The family conference was an emotional one. James was able to convince his family of his wishes. The healthcare team worked together to ensure the family had all the available resources to allow James to pass away comfortably at home.
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A long read I know, but here's a few questions.

Did you manage to stick through the entire trilogy? If so - perhaps medicine may be for you?

Which story did you find the most engaging? I myself am not sure yet. Do I enjoy the diagnostic process, the treatment process, or the communication aspect? Can I aspire for holism? I can only hope to have an answer in the next few years.

Get yo K on

Hello.

Welcome back.

Its been a long 2 years.

I'm sure you're all dying from suspense; quivering with excitement 

What could the next post be about?

Years of careful thought, days of grueling trial and error, culminating to this very moment.

Providing you with adequate warm up and good dial back moments whilst ensuring hype not only remains but is built up gradually to an explosive finale 

Ladies and gentlemen, without further ado

I present to you 

Blutackbuddy's karaoke song set list (patent pending)

Set A 

Say you're with a group of people who don't really sing English songs, but they were still exposed to the mainstream ones along the way. This set not only helps you remind them how great English songs are, but also exposes them to the wonders at the fringes of what is mainstream.

What about now - daughtry

Castle on the hill - Ed Sheeran

Come alive - The Greatest Showman

LA devotee - Panic! at the disco 

Holiday - Green day

I don't wanna miss a thing - Aerosmith

Magic - B.o.B

Numb - Linkin park

Counting stars - Onerepublic

Holding out for a hero - Bonnie Tyler

Set B

By the lucks of heaven, you've found a group of friends with girls and guys that are keen to have duets with you. 

But remember, not every song has to be a collaboration, you have to integrate different people into your repertoire of kickass songs 

Quintessentially, remember to read the room. Knowing when to skip to the next song and potentially playing around with its order is key to this playlist

Angels - Robbie Williams

Bop bop baby - Westlife

Every breath you take - The police and Robert Downey Junior

Need you now - Lady Antebellum

Love never felt so good  - Michael Jackson and Justin Timberlake

Two is better than one - Boys like girls and Taylor Swift

20 dollar nosebleed - Fall Out Boy and Brandon Urie/Save rock and roll - Fall Out Boy and Elton John

Wellerman - Nathan Evans* *Disclaimer - untested*

Nothing's gonna stop us now - Starship

You're the one that I want - John Travolta and Olivia Newton-John

Crazy little thing called love - Queen

New divide - Linkin Park

Set C 

Lets say you and the boys have predrank the shit out of that gin and tonic. You guys decide that its a great idea to head to the closest karaoke booth.

By the time you reach there, you're high as shit and ready to spit some lyrics although you know you probably can't.

Remember, the key to quick lyrics are confidence and random articulation; both of which you've already got pat down thanks to that last shot you had.

Airplanes - B.o.b and Haley Williams *controversial - overused*

Billionaire - Bruno Mars and Travie mcCoy

Feel good inc - Gorillaz/ Beggin - Madcon

Dance, dance - Fall out boy

Uptown funk - Bruno Mars and Mark ronson

Fergalicious - Fergie/American boy - Estelle and Kanye West 

Higher - Taio cruz

The sweet escape - Gwen Stefani and Akon 

I gotta feeling - The Black Eyed Peas

Faint - Linkin Park 

Set D

Screw it, todays the day you test the limits of your vocal prowess 

No surprise - Daughtry 

Demons - Imagine Dragons

The house of the rising sun - The Animals/ The temple of the King - Rainbow

Secrets - onerepublic

What a catch, Donnie - Fall out boy

Emperor's new clothes - Panic! at the disco

The great escape - Boys like girls

Stop and stare - Onerepublic

Your man - Josh Turner

Famous Last words - My Chemical Romance

Into the unknown - Panic! at the disco

Alright peeps, that's all for the post. Remember, these aren't set playlists, mix and match the songs but ALWAYS read the room. Now go get your karaoke on.

Of Dragons and Dungeons

Little is known about Warfarin the Changeling, and little does he know about himself as well. Changelings are born as deformed ugly creatures of nature. It is only through their deceit and expansive memory that they are able to assume countless identities and do what they are known for. Aagravon the elusive, was one such changeling who spent years deceiving and fighting his way to the top of criminal orc syndicate. Lawful paladins and knights spent years looking to bring the slippery chieftain to justice but every attempt resulted in slit throats and Aagravon simply manipulating his way out.
Eventually, each victory and escape only served to bolster his arrogance, and Aagravon grew bold in his aspirations. Aspiring to steal the forbidden treasure, he arrived in the village of the Aarakocras alone. His advisories and subordinates were all too cowardly and he had to show them who was boss... Little is known of what transpired in the village that day, but nothing was ever heard of him again. Far away in the plains of the river Esk, a wounded changeling clings on to life. He couldn't remember a face to give him an identity; neither could he recall a memory to even remember his name. All he had was a bow in one hand, and a bracelet in the other.
He looked down at the bracelet and read "Warfarin".

Chicken Soup for the Medical Student's Soul

The following post follows the story of Aaron Tan, a third year medical student sent out into the land of general practice for the first time ever. A foreign and uncharted land, what tales shall Aaron bring back from his maiden voyage into the unknown? Here are his top 5 moments.

5

It was Aaron’s last day of his attachment. Bittersweet with a hint of dreariness for it has been a relatively uneventful day. His supervisor had been entertaining and engaging but the knowledge of impending exams and the lack of variety has taken its toll on his psyche. Things were not looking good for this keen bean. That was until this middle aged lady came in complaining of chest pain, palpitations, presyncope on exertion 1 week ago. She had a similar episode waking her up from her sleep 3 days ago. Initially hesitant to have Aaron sitting in during the consult, she eventually decided to allow it.

Cheerful but facetious at first, Aaron watched in amazement as his supervising doctor skilfully yet subtly coaxed the lady to open up to her. Details regarding the lady’s distresses were eventually shared with the doctor in a tearful manner. Aaron wishes he was more of an approachable character but he understands that it was a privilege to have even been in the room in the first place. He was sent out of the room just as the lady broke down in tears.

4

Brimming with potential and hope for the future, this newlywed couple and their 12 week old baby has come in for a regular check-up. The husband, a hardworking man who works most of the time and good at handling his daughter. The wife, a loving mother who has some difficulty in speaking English. She has been living in this foreign land for a while, away from family, and her closest friend had recently gone home.

The loving mother broke down as she describes her disappointment of not being able to produce enough breastmilk for her daughter. She struggled to find the words to express herself but heart wrenching sobs were all that came through her mouth.

A true conversational gymnast; her doctor weaved through the conversation moving between medical facts, consoling words and light hearted jokes. Tensions and emotions were relieved, and the loving mother smiled for the first time throughout the hour long consult. Impressive.

3

For all weekend, this eager and excited medical student has been hyping himself up. Hours of envisioning, minutes of simulation practice, and seconds of ecstatic excitement. Today was the day. 5 patients booked in, and a friendly doctor. He checked his smile and attire, “I look approachable” he thought to himself.

Things were looking good. The first one he watched and assisted. Prepare the equipment, position the patient, point the light. Insert the speculum and dilate. Sanitize and apply the local anaesthetic. Measure the fundal height to pre-set the device. Insert the device and draw back its sheath. Wait 10 seconds and voilà! Mirena inserted! Trim the strings and check for patient comfort too, of course, let’s not get too far ahead of ourselves.

The medical student was now ready to do an insertion under supervision. 4 more patients to go, and all they had to do was agree to allow him to help out... Rejected, rejected, rejected, and not even allowed to be in the room. Oh well, but at least you got to see one.

2

The hormone cortisol is more commonly known as the stress hormone. It controls metabolism, blood pressure, inflammation, and basically helps get us ready for a fight or flight response. Addison’s disease occurs when an individual’s adrenal glands are unable to produce enough cortisol for the body. Someone with Addison’s disease has to take steroid medications every day to ensure that his body remains balanced.

Stop taking your medications, or develop a bad case of gastroenteritis, and your body stops absorbing the steroid medications it needs. Your body goes into an Addisonian crisis.

Nausea, vomiting, hypotension, hypoglycaemia and an altered mental state. An ambulance was called. Suspense was ringing in the air. Aaron asked for permission to insert a cannula just before the patient is taken into the ambulance. He ran through a mental simulation quickly and started prepping the patient. In the corner of his eyes, he noticed his supervising doctor briefing the nurse on what to do if he missed. Flashback. All was good in the world.

1

It was Aaron’s third day of placement. He had had a good run so far with lots of new experiences and people to meet. To add on to his rapidly growing list of experiences, he was allowed to tag along on an impromptu home visit.

The patient was an old lady under palliative care. She had multiple chronic diseases and has been asking to be allowed to die for a few years now. Aaron was nervous, he was unsure of how to behave in a patient’s house.

He smiled. She was lovely. Sitting up and smiling despite her struggling to breathe. In a soft, wobbly voice she says that she has fallen 3 times since her last home visit 5 days ago, and did not feel like taking her medications today. “Is everything okay?” the doctor asked.

The old lady broke down in tears. Her son and main carer had passed away 3 months ago. “A part of me thought that if I fell, he would come and help me up. He promised that he would be here to take care of me.”

“I know, no mother should ever have to watch their children die. But this is just grief, it’ll get better, you just have to let yourself feel the emotions.”

“It should have been me. If the devil come around to take me this morning, I would have gone with him.”

The old lady looked up at Aaron with her weeping eyes, “You’re going to become a doctor like Laura and help old people like me right?”

Aaron looked back into her eyes and replied, “I want to.”

Social Cicada's guide to the Social Spectrum Vol. 2

"Best publication in recent years! - 5/5 stars" - Rotten Potatoes

"A very well researched and entertainingly written insight into the little known world of social animals" - Manzys Institute for Research

"The most prolific writer of the 21st century!" - Mom

"I want more!" AP
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After selling out worldwide and undergoing multiple reprints, touched by months of adoring fan mail and public interviews, the writer of "The Social Cicada’s guide to the Social Spectrum" is back with his new release - Social Cicada's guide to the Social Spectrum Vol. 2.

Extrapolating from works of the renowned naturalist Charles Darwin, the Social Cicada's guide to the Social Spectrum Vol. 2 recognizes that social animals, like the animals of the natural world, adapt and evolve.

On the Origin of Species introduced the world to the concept of natural selection, whereby species evolve and diversify based on their ability to survive and reproduce. This concept is not lost on the Social Spectrum. The social characteristics of people are constantly being influenced by their need to survive and reproduce. Expose someone to a certain social environment for long enough and eventually, their social characteristics get selected out and they become a whole new animal.

So without further ado. You've asked for it! You've demanded for it! Ladies and Gentlemen, back by popular demand, I present to you - Social Cicada's guide to the Social Spectrum Vol. 2 !

Purchase the full version here for only $9.99
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The Social Deer

Deers live their life quietly in forests fearing that the slightest sound they make may alert the hungry wolves to their presence. In most cases, they fail to realize that the threat of a predator is non-existent. Dangerous predators have all been hunted down by humans, leaving them the potential to roam wild and free, if they choose to do so. The biggest threat to a deer however, is being caught in the headlights of a car. A weird phenomenon it is, when a deer simply freezes in front of an approaching car despite all its natural instincts to move out of the way. Much, like a Social Deer who freezes when being talked to.

The Social Anglerfish

The anglerfish is a deep sea fish that lures its prey via a long glowing growth on its head. This form of predation is much like the favorite activity of the Social Anglerfish - Fishing.

The deep sea is a dark and lonely place. Anglerfishes often find themselves starved for days resulting in them consuming any fish they meet. If you've never seen the surprised eyes of a fish when they realize the friendly glowing orb they've been swimming with, has led them into the gaping mouth of a hungry anglerfish. Try looking at the eyes of someone who has just started talking to an over-eager Social Anglerfish.

The Social Caterpillar

Hemeroplanes triptolemus is an internet famous caterpillar. For purposes of simplicity and classification, it is assumed that all Social Caterpillars are in actuality Social Hemeroplanes triptolemus-es (one can immediately recognize the benefits of this simplification).

"Is it a snake?" you may ask. And that is exactly what this caterpillar wants you to think. Social caterpillars spend their life trying to be something they are not. They think they have to be as cool as snakes to survive in the world. Do they?

At the end of the day, while one or two birds of prey may be warded off by the caterpillar's act, this mimicry doesn't ward off many insects that may attack the caterpillar. Besides, it's exhausting pretending to be snake don't you think?

A common misconception is that the Social Caterpillar would eventually undergo metamorphosis to become a Social Butterfly. Metamorphosis is not evolution. This caterpillar turns into a moth that spends its life chasing after the warm glow of a light bulb.

The Social Mushroom

An important part of the ecosystem, mushrooms grow by absorbing nutrients from material around them.The Social Mushrooms thrives in environments with lots of close-by individuals for them to siphon social energy from. Mushrooms do not undergo photosynthesis, much like a Social Mushroom does not produce his own enthusiasm. However, most mushrooms are either fantastically delicious, or strikingly psychedelic which makes them pretty alright. After all, social mushrooms are pretty fun-guys.

The Social Bacteria

Bacteria come in many shapes and sizes, but they all have one thing in common. They proliferate, they infect, and they are hard to stop. With the advent of antibiotics in the 20th century came the emergence of antibiotic resistance. Nowadays, it has become common for someone to be infected by Methicillin Resistant Staphylococcus aureus, or multi-drug resistant enterococci. 

The Social Bacteria infects whole populations. Let your guard down once on your hand hygiene and the next thing you know, you're being socialized with. The Social Bacteria quickly adapts to each social environment to overcome any resistance that may be posed by clique formations or the classic resting bitch face. 

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Great show

I wanna take a moment to do a shout out. It's not my modus operandi to write such casual off-hand posts but sometimes, you gotta do what you gotta do.

Movies are no longer what they once were. In the current age of show biz, every movie produced is either part of a cinematic universe or a Kevin Hart comedy. To go to a cinema now usually means one of two things:

1. Over-analyzing and detailed concentration in attempts to detect every intricate Easter egg hidden between the lines of a delicately written Marvel movie.

or

2. Dumb humor accentuated by hawt gals.

This wasn't the case when I recently watched The Greatest Showman on New Years eve (which by the way is also a great movie.). The Greatest Showman was an amazing show. It combined inspiring messages with amazing songwriting, acting and storytelling to give me a feeling I haven't felt in a long time.

Believe me, I am a huge fan of the marvel cinematic universe. I enjoy keeping up to date with every TV series and movie and correlating them. However, to enter a movie not expecting much and exit feeling inspired; that's a movie that doesn't come by frequently nowadays.

Every character in the movie was so relatable it was like I was them. The songs were very well written and if you haven't heard them I highly recommend so.

A Million Dreams and Never Enough really resonated with me.

So anyway. Thank you, Hugh Jackman for helping make this show possible ( I saw in an interview that he had been planning for this movie for about 7 years.), and huge props to the great acting by the rest of the cast.

Alright, fangay moment over. Out.

PEP TALK 2018 NEW YEAR NEW SHIT

Mankind. Voracious and insatiable. Impulsive and ruthless. Give him an apple, he'll take the entire plantation. Give him the moon, he'll ask for the universe. Give a man a fish, and he'll come back the next day, to over-saturate the fishing industry and decimate the entire ocean's population.

For as long as there has been light, there has been darkness. (For the following analogy to work, do ignore the fact that darkness existed before light.) And for as long as there was life, there has been greed (not hope). Every plant competes for sunlight, water, space. Every herbivore competes for the tastiest weed. Don't do drugs. And every carnivore fights for more bacon. That is life, always hankering for more.

But one species takes greed to the next level. No longer is competition simply about basic resources like food and water. Men lust for wealth, for knowledge, for technology, fame, power, sex and just about anything their minds can imagine. Millennials lust for stronger WiFi signals and Asian children lust to bring "HONOR TO THY FAMILY".

Greed is good. It makes us want to achieve more. To discover the bizarre and explore the unknown. To recognize our true capabilities and push us even further beyond. To extend our reach to the stars above. Jesse! James! Team Rocket! Blast off at the speed of light!

(It was right there. I couldn't help it... Ok, back to the topic.)

Why do we stop striving for more? Some chalk it down to pure laziness, while others blame their inborn inadequacy. I choose to believe that the mediocrity of the human race lies in what we call, contentment.

We become content with our achievements and accept that we are unable to push for more. How does the saying go again? Human potential is limitless? Or was that stupidity.

As we struggle to improve ourselves, we start looking at our past failures, our aptitude for laziness and complacency, our self worth and insecurities.

It feels good to stop pushing yourself. It feels good to sit back and enjoy what you have achieved in life. And I agree with that once in a while. Contentment is, after all, something that many religions sought after. But in the long run,  that sets a mental barrier that limits what we can achieve. Perhaps it was Man's potential for stupidity that was limitless.

Look I know, almost everyone has heard this chain of thought from someone somewhere at some point of their life. And we all get it, you can do anything you set your mind to. But everyone needs a reminder once in a while. Get self-aware, get motivated, and get going.

Hold up. We're not done here yet. Get going where?

You can't apply pure motivation and effort blindly. Greed and motivation may provide the strength to draw the bow. But, passion. Passion is the target. Fail to realize your true passion and you may shoot someone else's target. Fail to focus on your passion and you may shoot some poor guy in the ass. So ask youself, what is your true passion?

For years, I never really understood passion. Tons of articles on the internet describing passion as some sort of abstract force that people struggle to understand. Articles that I never really understood; articles that I scoffed at for over-complicating something so straightforward. I thought, that my passion was to always challenge myself academically. I thought my passion was to become a doctor.

Well, maybe part of me still feels so. But I no longer think that passion is as simplistic as a single goal. I believe that passion can be generalized into many small aspects of one's life. I believe that it is okay for someone's passion to be shallow and selfish. I believe that passions shift as life changes, but we should never forget past aspirations.

My passions are:
To always challenge myself, to take the paths that will always challenge me the most.
To impress and compete with people that are close to me.
To interact with others and have a positive impact on them.
To be good at the things I do, regardless of how trivial they may be.

I will always want to achieve more. I will always strive to be better. As such, I may always, be inadequate. I may always be insecure of my self-worth. Because I am never at where I want to be. It's exhausting when I'm trying and distressing when I lose focus. But it is what it is.

This is me reminding myself. To keep going, to keep pushing. Because that's what it's always been. Stop lazing around, and start maximizing life.

And for the rest of you. No homo.