NOMENCLATURE

In pathological examination involving malignant tumours (or cancers), the terms well, moderately & poorly differentiated are commonly used to describe the tumour cells. Differentiation means the degree of resemblance of the tumour cells to normal cells.

Our Professor in Pathology, Prof LM, has a unique & interesting way of explaining differentiation to the class:


Well differentiated baby → a baby who looks exactly like one of its parents

Moderately differentiated baby → a baby who looks a little bit like the mother & a little bit like the father

Poorly differentiated baby → a baby who doesn’t look like either parent, but still can make out its race (ie. Malay, Chinese or Indian)

Undifferentiated or anaplastic baby → can’t make out anything, probably from outer space

KKM

My housemate & colleague, who used to work in Penang General Hospital, told me about a Matron at her former hospital, who had to attend meetings after meetings as part of her job as a nursing administrator.

Upon returning to the office (after the many meetings), the Matron was asked by one of her staff about how they went. The Matron jokingly replied, “Well, you know lah. KKM kan Kementerian Kuat Meeting & Kementerian Kuat Makan (referring to the many tea breaks during the meetings).”


* KKM is short for Kementerian Kesihatan Malaysia, for those of you who are not aware of its real meaning :p

COMMUNICATION BREAKDOWN II

I received an sms from my former colleague in Kuching, R, telling about her experience with an elderly patient in the clinic. It reminded me of my own experience with an orang asli patient in Seremban General Hospital many years ago (Tales out of medical school & From memory bank). This is more or less the conversation between R & her patient.


Dr. R: Pak cik makan ubat apa?

Patient: Tak ada makan ubat, doktor

Dr. R: Bila sakit, pak cik tak makan ubat?

Patient: Tak, doktor

Dr. R: Jadi pak cik tahan je lah bila sakit?

Patient: Auk, doktor (Yes, doctor in Sarawakian slang)

Dr. R: Kenapa tak makan ubat?

Patient: Tak ada ubat, doktor

Dr. R: Kalau pak cik tak makan ubat, habis pak cik makan apa?

Patient: (must have thought in his mind why is the doctor asking him a funny question, before coming up with the best logical answer) Makan nasi lah

FAQ

Frequently asked questions (besides the one earlier) by patients & nurses include:

“What’s your weight?”

“Are you below 40 kilo? I think so lah.”

“Are you married?”

“Are you Kadazan?” (for those who know where I come from)

“Are you Iban or Bidayuh?” (for those who think I’m Sarawakian)

“Are you on diet?”

Well, the determination of one’s body physique is an interplay between genetic & environmental factors & I think mine has got to do with the genes. So no, I’m not on a diet. I’m just small-sized & petite by nature. I used to weigh below 40 kilos some years back, but not anymore :)

I'M NOT OKAY

I'm shivering inside the "freezer". Have not been feeling very well over the past few days & it sure doesn't help much to be working in this uncondusive environment. Doctors are also human beings, we are not exempted from falling sick. I have not been doing much today, except for seeing a few patients in the ward. I feel so tired that my eyes just want to close (lethargy induced ptosis). Perhaps I should get toothpicks to keep my eyelids apart. I have come across people who request (or demand to be more precise) for MC for the slightest fever & the slighest aches. But when a doctor falls sick, he or she would still have to continue working & doing oncall duty until he or she is totally debilitated & bed-bound.

HOW OLD ARE YOU DOCTOR?

I have been asked the question “How old are you, doctor?” numerous times, by my patients (most of them Chinese aunties). And every time, I would ask them back, “How old do you think I am?”. It really doesn’t help to be a doctor who looks 10 years younger than her actual age. After Form 5, I did 1 year of A-level before attending medical school for 5 & ½ years. Now it has been 6 years plus since I graduated & started working. So how old does that make me?

Here are some of the responses I got from my patients:

Not very smart Chinese aunty → “You look very young lah, doctor. Must be very smart, graduate so early. I guess…..you are only 21 years old.”

Another not so smart Chinese aunty → “You cannot be more than 24 years old. Wah…..so young become doctor, must be very smart.”

Pretty smart Chinese aunty → “I think you must be around 35, considering the time you spent in medical school & the years of practice. But your face doesn’t look like 35 because you have baby face.”

Also quite smart Chinese aunty → “You look like you are in your early 20’s but I think you are older than that because you spend so many years in university.”

Overtly generous aunty → “Your face look like 18, but I think you are around 20 plus.”


None of them has guessed correctly, but I give credit to the aunty who guessed my age to be 35. I think she has been the closest so far.

PROF WHO?

When I was young (primary school age), I used to read Borneo Post, a Sarawak based paper as my mum (she’s a journalist) was one of its regular contributors then. I often read about the state’s politicians, such as Datuk Amar Sulaiman Daud, Datuk Amar James Wong, Datuk Amar Alfred Jabu & etc. I used to wonder why all these VIPs seem to have similar first names.

I guess that’s excusable (or forgivable) considering I was only 9 or 10. Recently, a friend of mine, L, was at the Radiology Department to look for a certain Professor (in Radiology), who reported the CT scan of her patient. The report stated that the CT films were read by Professor Madya so & so.

L asked a Radiology staff where she could find Professor Madya. Obviously the staff replied, “Which Professor Madya?” since there are so many Professor Madyas in the Department. It took L a while to realise that Madya is not the Professor’s first name, but part of the academic title. Can L be excused (or forgiven), you think?

YOU OKAY?

I frequently hear my nurses (here at UMMC’s Oncology Unit) say “UOK” when they are calling people at other deparments, for example, to trace scan report from Radiology or to get blood investigation result from the lab. And every time, I would be wondering to myself what they mean. Are they being polite & asking how their counterparts at the other departments are doing or UOK actually has some other meaning?

It took me 3 weeks & a half to figure out that UOK stands for “Unit Onkologi Klinikal” – my own department! How shameful, I must admit. By fellow blogger Fibrate’s (It’s a doc’s life – geddit?) definition, I would be considered a “complete lulu”. In fact, I did feel “lulu-fied” when I realised how silly I was. I guess this is probably an example of the Malay saying, “malu bertanya sesat jalan” (though I didn’t actually “sesat jalan” lah) or perhaps, as a “neonate” at UMMC, I have yet to learn all the “jargons” to “gain full entry into the club”.

* Fibrate, sorry for the little violation of your copyright. I’m going to link you soon.

JARGON

I was reading my Manual of Clinical Oncology & came across a little footnote (on one of the pages on cancer terminology) which read, “Jargon is the use of pseudo-words plucked from a “word salad” to make the simple appear arcane, to disguise one’s ignorance of a subject, or to have secret codes that can be used to gain entry into a club.”

The medical profession is often mistaken as a “prestigious club” by many, including medical professionals themselves. Of course, medical professionals are able to speak a “different language”, one which is taught only at medical institutions. It seems reputable to be able to speak this language, but is it so in real life?

Here are 3 examples of conversation (between doctors & patients at my old hospital in Kuching) which illustrate the above meaning of “jargon”. I’m exaggerating a little bit, just so that you get a clearer picture:


Case 1
Patient: (who has breast cancer & not that highly educated) What do I have, doctor?

Doctor: You have Infiltrating Ductal Carcinoma of the breast, where the surgeons have performed total mastectomy & axillary dissection.

Patient: Infiltrating what?

Doctor: Infiltrating ductal carcinoma, which is a cancer, so what you need now is chemotherapy, radiotherapy & possibly hormonal manipulation.

Patient: (confused) …chemo….and…?

Doctor: Yes, chemo. Do you agree for chemo?

Patient: Must I have chemo? What if I don’t want chemo?

Doctor: If you don’t have chemo, you are going to die. Do you want chemo or do you want to die?



Case 2
Patient: (who has breast cancer & highly educated) I have a friend who went for FISH test …

Doctor: (who didn’t really know what the test is all about) So?

Patient: I was just wondering if I should do that same…

Doctor: You’re here today for your chemo, but your total white cell count & neutrophils are low, so we have to delay chemo for a week …

Patient: (got distracted by doctor) Oh? I can’t have chemo today?

Doctor: Yup.

Patient: Why is is so?

Doctor: Well, chemo causes myelosuppression, that’s why your total white cell is low. You can’t do anything about it. Just go home & wait. Come back next week.


Case 3
Doctor: Kenapa bunuh diri?

Patient: (who attempted suicide an hour before, by consuming excessive Paracetamol tablets -- keeping her head down & remaining silent)

Doctor: (lifting patient’s chin in a rough manner) Saya tanya kamu, kenapa bunuh diri?

Patient: (still keeping quiet)

Doctor: (turning to junior doctor & nurse) Do a gastric lavage & take PCM level. If exceed, just give N-acetylcysteine. Follow the “black book”.


* Sorry, this is not exactly something that fits “Laughter the best medicine” though I did laugh when my former nurses told me about them. Maybe it was the way they told me, with the gesture & the imitation of various doctors, but what had transpired is actually a sad thing & certainly a disgrace to the medical profession.