Psychiatry : SCARY

i underestimated psychi.

1st when they said "oh after neurosurgery, its gonna be psychiatry" so i hieved a pretty big sigh and the only thing on my mind about psychi is "i'm gonna die of boredom and sleep during classes"

little did i know.. that there's something quite interesting about psychi. its the part where u actually meet the 'scary' patients!!!!

i believe that, to be a psychiatrist, u have to have insurance for ur face cuz i think u can get punched by your patients. SERIOUSLY.

i even asked the doctors, she said "there was one doctor who was nearly strangled by a patient"

so.. u gotta be extremely professional in handling these kinda patients. and staying calm is up-most important. You need patience too since ur patients will be creating lotta stories that you can use to create a movie with~ like schizo patients tend to have delusions like "doctor, i think my neighbour is trying to kill me using laser beams" or "the president is trying to steal my money under my pillow" that sorta stuff. But u gotta gain the patient's trust or he'll just run away and wont be able to receive the proper treatment!

Usually la kan~ u would wanna sit near the patient, in order to listen what he's saying.. getting to know the patient better.. but in psychi, i try to stay as far as i can but still at range that i can hear what he's saying.. cuz I DONT WANNA GET PUNCHED. or strangled.
seriously scary ok!! yesterday, when we were with one patient, there was another one who came barging into the room and screaming (i dont understand what he said. i heard something like "i have no money")

here's another fascinating fact, when the disturbed patient came in scolding the doctor, she (the doctor) was absolutely CALM. (sumpah aku respect Dr psychi, how could they be like that when they have to deal with psycho patients EVERYDAY!!!!)

The 1st patient that i met, i thought he was a one-of-a-kind, when he mentioned (quite a few times) that he just wants to get MARRIED. but he wasnt the only patient who wanna tie the knot. (we noticed that he kept staring at the females ) keke.
even the patient that we saw yesterday, 39 yr old male, single, was smiling so widely when responding to one of our female doctors that made is all laugh! i guess they just wanna get married! =D (i cant deny that the female doctors there are kinda good-looking~ hik2)

my advice?
stay calm. try to get to know them better. know the difference between fantasy and reality. try not to get punched.

adios!

Its been a while! =)

i lost my inspiration to write, so now i've got it! imma blog my thoughts =)

this is week our 2nd week in neurosurgery. as far as it goes, i kinda enjoy neurosurgery! its more interesting than neurology (honestly i find surgery very exciting!)

so yesterday, my group and I were scheduled to be in the OT in Mansoura University Hospital. We're so lucky i tell u!!!

here's the story. (it might be too complicated for preclinicals to understand this, but i'll try to make it simple to understand)

Last week, we met a patient named Miss XXX age 25. I cant remember her complaint, but she came to the hospital, and mentioned that she was unable to close her eye completely, and we noticed that half of her face is paralyzed. Is 'paralyzed' the right word to describe it? Like when we did the cranial nerve examination, the angle of her mouth dropped, she cant kerutkan her forehead. so my colleague asked her some more questions and she also mentioned that one side of her hearing is not that good.

so we suspected that something's compressing her 7th and 8th cranial nerve.

muscle of the face (like smiling, raising your eyebrow, closing your eyes) are supplied by the 7th nerve (facial nerve)
hearing is supplied by vestibulococchlear nerve (8th nerve)

so now we have to determine whether its an upper motor neuron lesion or lower motor neuron lesion. (UMNL/LMNL)

why? cuz nak tau mana site defect tu~ if UMNL, its somewhere from the origin of the nerve to the brain. if its LMNL, its from the nerve to the muscles supplied by it. you get what i mean? hehe. takpe, tak faham, nanti belajar~ keke


alright, for facial nerve, senang je nak tau its an UMNL or LMNL. if only the lower half of the muscle of the face is affected, then its UMNL. if the whole face is affected, then its LMNL.
So from the examination, we concluded that its a LMNL!!!

Therefore the doctor showed us the MRI of that patient~


nampak tak lesion tu? clue : its whitish in color a.k.a hyperdense~

so the lesion is at the cerebellopontine angle. which explains the 7th and 8th cranial nerve affection.

i was confused at first, why is it LMNL ? then my groupmate explained, he said
"the tumor is arising from the vestibular nerve itself, not from the brain. so that is why its LMNL, not UMNL."

then i recalled our morning lecture, and asked him "is it a Schwannoma??" (nasib baik baru belajar~)

"yes bizzob mariooomaaaa!!" (ok he didnt actually say marioma, its just that they always call me with that name..sounds like a benign tumor ha...)

Schwanomma is a nerve sheath tumor. its a slowly growing tumor of the Schwann cells, surrounding cranial nerve roots (usually the vestibular part of the 8th nerve)

so when it grows big enough, it could compress its adjacent structure, which includes the 7th nerve!

So when we came to the OT yesterday, we were lucky enough to watch the surgery of that patient~ Doctor did an operation, approaching from behind the mastoid process, he opened up the skull, using a HUGE microscope, he elevate the cerebellum to have a good view on the tumor and scrape the tumor shuwayya shuwayya~ in cases of brain tumors, u cant just take the whole thing out or make a safety margin, cuz its the brain for God's sake!! anything you take out, you'll interfere with the brain's function~~~~

the microscope! told u its big!

so tiny. thats why he needs the big microscope.

exposing the cerebellum~

Neurosurgeons need delicate hands and extra patience.. the whole surgery will take 8 hours to complete (thats what he said that day) gila, i didn't wait til it finish of course~ i got class to attend to!! i met the doctor the next day, he finished it in 4 hours @___@

pretty cool case. honestly it took me quite a while to understand the whole case.

kehkeh~ i forgot to mention, there was a fly that accidentally flew in the OT. A man sprayed ridsect in the OT! it was so funny! cant imagine what will happen if the fly mistaken the brain as food and landed on the exposed brain~ kehkehkeh~

hooray to the guy who killed the fly!

well thats the end of this post.
sorry if susah nak faham~ heeee.
i still think neurosurgery is awesome!
til next time!

Lets pray for them =)

Link : http://english.aljazeera.net/news/middleeast/2010/05/2010528431964325.html

Tensions rise over Gaza aid fleet

The UN chief has called for restraint as some 700 activists from around world vow to deliver 10,000 tonnes of humanitarian aid to break the blockade of Gaza.

Israel has cautioned that the Freedom Flotilla would be stopped, if necessary by force.

The nine-ship flotilla is by far the largest fleet of aid to try to reach the coastal Palestinian territory since Israel imposed its siege on it in 2007.

"We strongly urge that all involved act with a sense of care and responsibility and work for a satisfactory resolution," a spokesman for Ban Ki-moon said on Thursday.

He restated UN opposition to the siege of Gaza and the lack of material to meet "basic needs, begin reconstruction, and revive economic life".

After the Israeli army announced a detention centre at Ashdod port for holding the activists, Greta Berlin, one of the flotilla organisers, said: "We have the right to sail from international waters into the waters of Gaza.

"The only illegal presence in the area is Israel."

Berlin said the Freedom Flotilla was on schedule to arrive in the Gaza Strip on Saturday with more than 10,000 tonnes of supplies, including water-filtration units and pre-fabricated homes.

EU call

Israel and Egypt have sealed Gaza off to all but very limited humanitarian aid since Hamas, the Palestinian political faction, took control of the territory in June 2007.

Israel says the Gaza blockade aims to prevent Hamas from acquiring weapons or materials that could be used for military purposes.

For the majority of Gaza's population of 1.5 million people, the result has been impoverished living conditions.

Catherine Ashton, the EU foreign policy chief, issued a statement on Friday, calling for an immediate end to Israel's blockade on Gaza.

"We would like to reiterate the EU's call for an immediate, sustained and unconditional opening of crossings for the flow of humanitarian aid, commercial goods and persons to and from Gaza," she said.

"The continued policy of closure is unacceptable and politically counterproductive.

"The EU remains gravely concerned by the humanitarian situation in Gaza."

'Absolute provocation'

Israel's foreign ministry said it had given warnings to the ambassadors of Cyprus, Greece, Ireland, Sweden and Turkey - from where the ships set sail - that it had "issued warrants that prohibit the entrance of the vessels to Gaza".

The flotilla "is about to break international law", Yossi Gal, the ministry's director general, said.

Gal said that the flotilla was "an absolute provocation" and a "cheap political stunt", as there was no shortage of humanitarian aid in Gaza.

Al Jazeera's Sherine Tadros attended an Israeli army news conference on Wednesday, where journalists were told that there was no humanitarian crisis in Gaza.

She said that the information to back up this claim was both incomplete and out of context: "This tells me what Gaza is getting in terms of supplies but does not compare this to how much Gaza needs to survive."

Israel has vowed to divert the ships to the southern Israeli port of Ashdod.

It has said that Israelis on board would be arrested, Palestinians would be questioned by the Israeli secret service, and foreign nationals deported.

Part of the port has been cordoned off and prepared to deal with the activists, and large tents set up for immigration booths and areas for people to be searched.

Gal suggested the organisers should voluntarily head to Ashdod to unload the supplies so Israel or humanitarian agencies can deliver them to Gaza overland, but the flotilla organisers rejected the offer.

Hanin Zuabi, a member of the Israeli parliament who is on board the flotilla, told Al Jazeera that the activists intend to reach Gaza regardless of plans to stop them.

"If the Israelis try to stop us, this will be a huge diplomatic and political crises for them," Zuabi said.

"We have 50 states participating in this and are sending a very clear message to Israel - the international community is not accepting the siege on Gaza."

Peace laureates aboard

Al Jazeera's Jamal Elshayyal, on board the flotilla, said the activists travelling in the convoy included European parliamentarians, former US diplomats and Nobel peace laureates.

Berlin, the flotilla organiser, said: "This mission is not about delivering humanitarian supplies, it's about breaking Israel's siege on 1.5 million Palestinians."

Fintan Lane, an Irish activist, said that they were determined to break Israel's blockade and will not be intimidated.

"The people of Gaza have a right to access to the outside world and the right to determine their own future," Lane said.

Huwaida Arraf, one of the organisers from the Free Gaza Movement, said: "Israel should not be under any illusion whatsoever that their threats or intimidation will stop us or even that their violence against us will stop us."

PR disaster

Some Israeli officials see the situation as potentially disastrous in terms of public relations.

"We can't win on this one in terms of PR," Yigal Palmor, a foreign ministry spokesman, said.

"If we let them throw egg at us, we appear stupid with egg on our face. If we try to prevent them by force, we appear as brutes."

Hamas officials say that Israel's threats to intercept the flotilla amount to "Zionist piracy".

"The occupation's threat to prevent the Freedom Flotilla from arriving in the besieged Gaza Strip is Zionist piracy and a violation of international law," Ismail Radwan, a senior Hamas leader, said.

"The occupation is concerned about these ships... because they grant legitimacy to engagement with the Palestinian government and confirm that the attempts to isolate Hamas have failed."

Fraser Ruling and Jehovah

these are something i definitely wanna share with my fellow blog readers.

have u guys heard of the Fraser Ruling/Guidelines and also the Jehovah Christians?

yea for u ppl who havent heard of it, 1st i tell u the history of Fraser Ruling/Guidelines.

(reference : Dr. Atia, cuz he told us the story just now.. hehe~ so if the story is wrong, blame him =D)

So its starts with a 14-year old female coming to see her GP. And she said "i'm having unprotected intercourse with my boyfriend. So i want contraceptive pills"

At that time, the law said that, a GP can only prescribe contraceptive pills for 16 years old females only if they have their parents' consent....

So.. the GP said la.. "does ur parents know about this?" she said No.
"i cant give u unless u have ur parents' consent", the GP told her.
She refused la cuz she din want her parents to find out. So she didnt take the contraceptive pills.
and because of patients' confidentiality, he couldn't tell her parents about this.

guess what happened next?
She went back to the GP.

Pregnant.

And the awesome thing is that.. her parents blame it on the GP!!! hahaha! "it's your fault our daughter is pregnant!! why didnt you just subscribe her the pills!". Just great.
yea at 1st i thought its not the GP's fault she's pregnant. She's the one who is sexually active and its her parents fault for not taking good care of her~

ok so they brought this case to court.. jeng3!
And the judge was Lord Fraser~

Judge Fraser asked the GP..
"did u tell her to tell her parents?".."No"
"did u tell her the consequence of being sexuality active and having a baby?".."No"
"did u tell her the side effects of taking contraceptive pills?".. "No"

so can u guys see? its kinda the GP's fault cuz he didn't warn her.

So from this, Fraser Guidelines (for under 16) jadi!
Boleh tengok kat bawah ni..


If you see another point of view, even if you tell her parents, its not gonna prevent her from getting pregnant. Unless u kill ur child.. or.. Lock her in her room~ Or kill the boyfriend.. lalala~

Ok pasal Jehovah pulak~

From wikipedia,
"Jehovah's Witnesses believe that the Bible prohibits ingesting blood and that Christians should therefore not accept blood transfusions or donate or store their own blood for transfusion."

So ada satu case Dr.Atia cerita.. this boy is dying cuz of blood loss (i cant remember whats the disease). So since the parents are Jehovah Witnesses, they refuse the blood transfusion treatment for their boy, yea eventho he's dying. And so they let him die. They said, if the doctors perform the blood transfusion, they will not accept him as their son anymore.

To read more on this, click here
http://en.wikipedia.org/wiki/Jehovah%27s_Witnesses_and_blood_transfusions

What would you do if you're in the doctors' position?

Since baru belajar tadi, in my opinion, i would do the transfusion cuz i wouldn't want my patient to die. Even if they don't wanna accept him, there's always foster care. If the family rejects him, its now the community's responsibility to take care of him =)

Jehovah all around the world, please dont get mad~ its just my opinion =) who am i to judge anyone right?

And that's a rap~

we've just ended our O&G round (us, i meant the semester 8s) and surprisingly, i think i'm gonna miss this round. i totally love the exposure we get from it.
And of all the days, Allah has picked our last day in O&G to give us the ultimate gift, which is to watch live vaginal delivery! ok for some people, they might think "why ultimate gift??? ewwww!!"
its not easy la.. you have to have goodluck =D
if ada case at that time, then ada la.. if takdak.. try another day.. some of my friends had to wait for hours just to wait for the lady in labor to give birth. Alhamdulillah, we didnt even have to wait for more than an hour.. we reached at the delivery room, ada satu case! yay! then 10mins later, the doctor said "get the wheelchair!!"

A respond from a friend who was with me at that time..
"aku taknak bagi bini aku buat normal delivery..aku akan make sure dia buat Caesarean!!!"
the woman was screaming her lungs out at that time.. huhu.. scary mary~

but the girls in my group prefer normal delivery, even after the jaw-dropping experience. haha!

cinca menarik! biar la culture shock pun, u have to at least try watching it =)

oh after that, we went to the gyne ward.. took history from a patient.. did vaginal examination (something that not all medical students get to experience..heeee.. only in Egypt!), speculum examination. During history taking, i realized that, eventho its the last day for me to take history from patient, i still suck at it and i stilllll dont understand the egyptian language : ( (shuwayya shuwayya)
an advice to the preclinical students : please learn ur arabic well before entering the clinical years ok :(

So, itu lah~ habis dah O&G~ sedih? kinda.
what's next? Pediatrics... jeng jeng jeng.... (well exam O&G 1st of course, pray for us!!!!)
I dont know anything about pediatrics, but from the size of the Nelson Textbook of pediatrics, unbelievable ~~~~~~ *hooray*

oh i have paused my cheesecake/choc mousse business, will start again after 9th May insya Allah~ order la lagi kalau nak~

sekian.

Salam.

What's Happening in Palestine?

this is before 1967

and this is today.. Isreal called it a 'NATURAL GROWTH'

What do YOU call it?

Source : http://english.aljazeera.net/news/middleeast/2010/04/201041414395576934.html

Back in Business =)

one of the ways to motivate yourself to study is by keeping yourself busy so that you'll appreciate time~
this is what i believe la~ maybe for some people, one may think that the busier you are, the less time you have for studying~

well at least this gives me a reason to wake up early..haha!

So, these are the menu~

chocolate-covered biscuit-bottom-layered cheesecake~ in addition to that, anyone who wishes to add an extra to the cake are welcome to do so~ (cam kalau nak buah2 ape2 ke~ or jem ke~ ayyi hagah~)

And this year, i've decided to add another cake to the menu~ well actually its not a cake~ its a nice dessert tho~ Chocolate mousse~ compared to cheesecake, this one is not baked and the bottom crust is made out of BOREOS (egyptian version of Oreo...MUCH2 cheaper)!!! So sebab ni still new, i'm gonna offer it at a special price~ nanti2 la aku naikkan harga >:)

so, here's the details on these two~

CHEESECAKE
Topping : chocolate (meleleh ke keras ke, can choose), your choice of fruit, Jem
Bottom crust : Buttered biscuit
Size : 22.7 x 22.7 cm
PRICE : LE 45

CHOCOLATE MOUSSE
Topping : takde~ but kalau nak, boleh request
Bottom crust : biskut Boreo
Size : 22.7 x 22.7 cm
Price : LE 50 [aritu LE 45 kan? haha~ sorry.ada orang cakap the size is besar..so i should resize.. instead, i'll reprice =) ]

Sorry picture tak available.. nak letak pic from internet tapi takut ada orang ada high expectation plak~ @____@

Careful girls =D

Before this, some of my colleagues told me to be 'extra' careful when Egypt starts to heat up~ as in, be careful when summer is approaching.. so i was like "ley ba'a??" (ley ba'a = why la)

so here's the story.
Today after Yah and I went to the gawazat (tempat buat visa?), as usual the 3ammu (pakcik) said "ta3ali bokra" (come tmrow). So we decide to go back to the hospital la~ what for waste time right? baik gi round~ dapat ilmu~

Anyways, On our way (we took a cab of course) to the hospital, as my mind ponder around thinking of life and the amount of sampah by the streets, all of a sudden Yah said "Mir, tengok tu. apsal orang tu bukak baju dia?". Because of my curiosity, i turned my head on the other side of the cab. Its too late for me to regret my actions by that time.... I found myself in a state of confusion at 1st cuz i didnt see anything and i only saw a makcik walking pass by..
as the cab drives closer to the junction of the street, i saw a shirtless old man (age 40-60 maybe~ midlife i assume) doing something weird.. and in just a few seconds, he starts to take of his friggin' pants!!!!!!!

YAH!!! APSAL KAU SURUH AKU TENGOK!! TRAUMA OK!!! TRAUMAAAA!!!!

Alhamdulillah our reflex were quick enough to save our innocent eyes~ (innocent la sangat~ =p ) i only saw his symphysis pubis *thank God*~ BOLEH TAK PAKCIK TAXI TU GELAK JE!!! adoiiiiiiiiiiiiiiii~ i even heard people at the streets screaming "arrghh!!!" sape tak jerit kalau jumpa a naked guy in the middle of the jalan kan???

My provisional diagnosis for this is.. MAYBE he has some kinda brain tumor that's suppressing the part where it controls his rasional actions (Ya Allah, dah tak ingat anatomy otak..), but we cannot neglect the fact that the heat does crazy things to men. Males (Egyptians mostly) tend to be more..urm.. 'active' when the weather is like an oven. its sooo panassss~~ harr!! harr!! (hot! hot!) my friends said case meraba2 ni increase time tengah2 panas nih.. huhuhu~

Juniors especially, kalau tak pernah kena raba dgn arab sebelum ni, try elak by not walking alone kat kawasan yg sunyi/xde orang ramai..

banyak2 la berdoa ye supaya kita sentiasa selamat kat ardhul kinanah ni~

wallahu 3alam~

Abdominal Myomectomy and caput succedaneum

first of all, i wanna congratulate Mansoura Univ Hosp for its brand new clean modernize more sterilized OT! haha~ lawaaaaa sangat! impressive!!!
enough of those compliments. so this post is about abdominal myomectomy and caput sucadeoonoeum~~~ serious til now i donno how to pronounce it properly. adoi.

ok, abd myomectomy means that u make an incision at the lower part of the abdomen, open open.. cut cut. then find the uterus that got lotsa fibroids.. and then just remove the fibroid ONLY. sebelum ni kan total hysterectomy kan, means u buang everything (uterus+ovary+fallopian tube+cervix)
tapi kali ni... patient tu rasa dia nak get pregnant lagi. so since fibroid is a benign tumor, therefore she said she wants to keep her uterus. maka dgn itu Dr pun buat la myomectomy (removal of fibroid).. she's 40 years old btw. i have no idea why she still wanna get pregnant. biarla.. patient's rights~

tada! brand new clean OT! told you.. neat!!!!

ni gambar Dr tengah kopek keluar subserous fibroid from its capsule. Subserous means its protruding outside the uterus. dia ada banyak jenis, intramural (dlm muscle layer), submucous, pedunculated submucous+subserous etc. here's the diagram for types of fibroid. senang faham kot. kalau tak faham, can ask.

kami yang menyibuk~~

so these are the fibroids that have been taken out. Cam tak caye kan ada banyak giler fibroid in one person!! :-s


Ok next is about Caput Succedaneum. it means development of edema under the scalp of a newborn. benda ni normal, tak berlaku kat semua baby, tapi if ada, biarkan je. nanti dia recede sendiri. in about 2 weeks.
If u see in this picture, the newborn's head is not symmetry kan, notice x?? haaa. tu la caput succadaneum~ So no need to panic~ it will subside by itself

Definition of Anaesthesiologist

Do you know the definition of an anaesthesiologist?

"Anaesthesiologists are doctors who keep the patients alive while the surgeons do things that would otherwise kill them"

True or not?

Daddy.

- haha~ go0d one dad =)

p/s : i will post some pictures of abdominal myomectomy soon~ nantikan!

Uterine Fibroids

its been ages since my last post.
been busy with the new semester.
O&G is yet another semester full of new stuff to learn.
this semester, i'm taking an initiative to speak to patients and understand them without the help of our egyptian classmate. chaiyok!!!

ok here's some info about uterine fibroids~
we had the opportunity to observe a total hysterectomy few days ago. Done by Dr Abdel Aziz who was also our doctor incharge for our round that day.
Whats a fibroid? Fibroid is a benign tumor. Uterine fibroid is sooooooooo veryyyyy commonnnnnn in women. some are pretty harmless (30-40% of women are asymptomatic) and only a small chance (0.2%) chance for the fibroid to turn malignant. baca sendiri la pasal details dia. banyak sangat. huhu.

here are some pics!

wanita-wanita Malaysia group 4

The surgeon on the right is Dr. Abdel Aziz. Notice the red lump ? thats the uterine fibroid.

see the stringy part ? thats the fallopian tube.


its looks like a monkey from the back, kan?? the 'head' is called the subserous fibroid. its a type of fibroid that protrudes out of the uterus into the peritoneum.. awesome!!!

Marriage

i find this email i got from my mom quite interesting. haha! enjoy~
thanx for the email mom =)

*1.* *HOW DO YOU DECIDE WHO TO MARRY?** *

-You got to find somebody who likes the same stuff. Like,
if you like sports, she should like it that you like sports,
and she should keep the chips and dip coming.

Alan, age 10 (good plan Alan)

-No person really decides before they grow up who they're
going to marry. God decides it all way before, and you get
to find out later who you're stuck with. -- Kristen, age 10

2._ WHAT IS THE RIGHT AGE TO GET MARRIED?_

Twenty-three is the best age because you know the person
FOREVER by then.
-- Camille, age 10

3. HOW CAN A STRANGER TELL IF 2 PEOPLE ARE MARRIED?

You might have to guess, based on whether they seem to be
yelling at the same kids.
-- Derrick, age 8

4. _WHAT DO YOU THINK YOUR MOM AND DAD HAVE IN COMMON?_

Both don't want any more kids. -- Lori, age 8

5. WHAT DO MOST PEOPLE DO ON A DATE?

-Dates are for having fun, and people should use them to get
to know each other. Even boys have something to say if you
listen long enough. -- Lynnette, age 8 (isn't she a treasure?)

-On the first date, they just tell each other lies and that
usually gets them interested enough to go for a second date.

-- Martin, age 10

6. _WHEN IS IT OKAY TO KISS SOMEONE?_

-When they're rich. -- Pam, age 7

-The law says you have to be eighteen, so I wouldn't want to
mess with that. - - Curt, age 7

-The rule goes like this: If you kiss someone, then you
should marry them and have kids with them. It's the right
thing to do. - - Howard, age 8

7. _IS IT BETTER TO BE SINGLE OR MARRIED?_

It's better for girls to be single but not for boys. Boys need someone to clean up after them. -- Anita, age 9 (bless you child )

8. HOW WOULD THE WORLD BE DIFFERENT IF PEOPLE DIDN'T GET
MARRIED?

There sure would be a lot of kids to explain, wouldn't there?

-- Kelvin, age 8

And the #1 Favorite is ..........

9. _HOW WOULD YOU MAKE A MARRIAGE WORK?_

Tell your wife that she looks pretty, even if she looks like
a dump truck !!!
-- Ricky , age 10

speaking of marriage~ congrats Kak Qila =D i'm very the happy for u!