ANOTHER DAY

Meet Mr.Sumo

2011-06-26T11:25:00.002+08:00

Many joined the Standard Chartered run today, & kudos to those who made it to the finishing line... Well maybe I should make it a point in my 2012 wishlist that I should complete a marathon by the end of the year. Waking up in the morning & reading twitter post of friends with live documentary of their 10km marathon is definitely inspiring, and especially when you are sitting in front of laptop looking at this chubby Mr.Sumo with round cute abdomen, hahh.. yes, I think the only option left is to start exercising!

Don't wanna end up like Mr. Sumo, please...

*knock on wood*

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Location:Jalan Hospital,Sungai Buloh,Malaysia

The red velvet

2011-06-23T00:10:00.001+08:00

Had our dinner at The Daily Grind, Bangsar recently, rated as the best gourmet burger in town (so far) by mr.chordwrecker... I think it is, mmphh, o-kay; maybe I've tasted better home made burgers before (in college days one of my friend's mom once brought home made burgers during weekend for us and I can still remember how it tasted, not even one tiny fat in it and the beef was so soft and fulfilling! and what do you expect, she's a real cook & now owns a full time baking business).. anyway, Afif came back for his summer holiday on same night, I am glad to see he looks pretty much the same, better weigh yourself today dear, so you know how much you've gained before flying back in September! :))

Happy belated birthday, Abah!

*The Daily Grind, Bangsar Village 1, Bangsar.*

- Posted using BlogPress from my iPhone

Look at the bright side

2011-06-18T19:04:00.003+08:00

Living with debilitating illness is surely not an easy thing. And especially if the illness is something that is not curable, but cause sufferings in every way. In those situation, only love, care and attentions are nothing but the precious things that you wish you'd have until your last breath.

I spoke to a patient's wife recently about the condition of her husband. Her husband is one of our patients who was admitted for severe lung infection, and he has been suffering from an illness called Motor Neurone Disease. It is a neurodegenerative disease where with time, the muscle becomes weak and weaker, lost its strength, until it impaired the ability to breath, and to live. When he was told of the disease about many years ago, he was still able to walk, but with weak legs, and after years, the weakness involved his hands, and now, it's his speech and his swallowing ability. One of the sad things about this illness is that it does not affect the brain and how we think, so imagine seeing a lucid and intelligent patient with complete disability to lift up the limbs an having trouble pronouncing words due to slurring of speech, is frustrating.

He refused for tube feeding and he refused for medications. He wanted to be at home with his family, watching TV like usual, and come what may, he wants to be at peace at home.

When I spoke to his wife about this, I was touched listening to her life's experiences. She married him about 3 years before he had this illness, and she stays on with him until today, even when they don't even have any children. She was crying when saying she can't see him suffers with the tubes and she understands that nothing can be done to cure her husband. I was mesmerized by her courage, commitment, loyalty, and most of all understandings to go through all these strife and stress. She is more than ready than the doctors themselves to let him go, in a most comfortable way.

Because if it was me, I know I will try to be strong. But I can't be sure how long I can keep on being strong. I will surely breakdown halfway, and I will surely need help for myself.

Anyway, yeah. I failed my exam by 1 mark. Yes, one mark. And I was so sad. In fact I still am. No matter what people say, I don't think anyone can understands. But I still think I am lucky, for I have what I need the most in life to actually make me happy and complete, (and definitely it is not a qualification paper), and I think I am luckier, when after all these, I know who are my real friends are.

And I should be grateful, as there are many out there who are dealing with more difficult situation and still surviving anyway.

Let's look at the bright side.

*thank you for being there during the ups and downs.

*just a foot note: Allahyarham Dato' Mokhtar Dahari, the famous Malaysian footballer, was one of the unfortunate who died of Motor Neurone Disease. Al Fatihah.

white sachet

2011-04-09T09:04:00.003+08:00

Doing on call every other day for 3 consecutive oncalls has created the zombie in me, as I always have relatively bad on calls compared with other people (why oh why). And being alone in the ward also makes it a damn tiring week. So yesterday I slept with my coffee when I was contemplating whether to drink it to stay up all night for some reading. Well obviously ruminating about the matter when you had to toothpick your eyes open for couple of hours since dinner was a waste.

Anyway I just recall an 'exciting' yet bizarre experience when one of the patient who collapsed in the ward was found to have kept a sachet of 'white powder' inside his penis (yeah this is a medical term and I am not trying to be obscene here if that's what you think, haha). It was found by the house officer when he was trying to insert a catheter for the urine drainage when the patient was already unconscious.

I guess you can brightly guess what's the 'white powder' is.

Sigh, the things people do FOR?

I dunno.

Well anyway exam is another 2 weeks and so here I am trying my best to wake up early to finish all the unfinished business (tonnes of notes to browse before I regret photostating them!)
Let's just hope this becomes perseverance and the tenacity will be sustained!

*oh, and this is the best Yogurt ever. :)

short message

2011-04-08T23:38:00.000+08:00

What happen when you have a wound and you are diabetic, and your sugar is beyond control?

this is what happened after a wound debridement to salvage the patient's limb.

Please, take care of your sugar if you have diabetes.

and please, NO traditional medicine can heal an infected gangrenous wound!

mr. Chordwrecker turns 30

2011-04-02T12:41:00.006+08:00

well at work he is the serious doctor who removes fish bones from the throat and studying to be the expert in the managements of airway of a human being (among other minor/ major head and neck surgeries that can't be simply put into layman's term, hehe),

and at home he still reads naruto, plays the play station, x-box and you can name whatever games on the iPad, and the most recent discovery is that he can still remembers how to sing Postman Pat's official song! hahaha.

Age is just a number.

well in his case, I guess that's true, after all. :)

It was supposed to be a surprise party but I guess I am so bad in keeping it from leaking away, but anyway, thanks guys for making it happened!!

*sending you birthday blessings filled with love and joy*

Masterclass

2011-03-26T22:15:00.001+08:00

Can't wait to study this!! Hehe.
Thank you Fadzlishah!!

*a gift from a friend to me & mr chordwrecker for our birthday. :)

Every other day

2011-03-24T03:45:00.001+08:00

It's almost 4am and I guess I am too tired to sleep. Was oncall on Monday and it was a tiring call, could not sleep on Tuesday as mr chordwrecker had a bad call ( so his phone kept on ringing &he had to go to the hospital three times, such a pity), and it's Wednesday & I am oncall again today & it has been continously busy since the call started!!

Please don't catch a flu :(

Ya Allah give me good calls please, and give me the strength to go through this. Amin.

Cinderella

2011-03-20T14:19:00.003+08:00

sometimes I just wonder why you have to think that the world is like a fairy tale? Please wake up. You are not a goddamn princess ok! and even Cinderella is modest and humble.

And yes, you are so pathetic.

*yes I am in the 'meluat' mode.

Ok mengucap sikit.

The Pearl of the Orient

2011-03-19T12:33:00.004+08:00

So I went to Penang for a short one day Neurology course yesterday. I think I have been to more Neurology courses than any Nephrology courses these past 3 years, so what does that mean? hahaha. Neurology is interesting in getting your diagnosis right, it is something like mathematics where you need to think and put all things together to get only one unifying answer. However I have always thought that the fun in getting the answer is as not as 'fun' treating the conditions. Seeing disabled people without being able to 'cure' them is probably not what will motivate me, but not until yesterday, when a neurologist showed his experiences in treating his patients with movement disorders: he practically almost has cured the disorder using advanced technology (which are very limited in our country). Yup and they were talking about why can't we spend more on creating more expertise on these and the equipments for the people's benefit rather than paying millions for a second bridge in Pulau Pinang.

(o okay, no comment! :/)

and i think i still have long way to consider what I want & should do :)

Anyway we stayed at the Grand Continental Hotel, my advice is: not as GRAND as it claims. Not even close. An expensive but kinda lousy place to stay for the price. Hotel yang agak lama and not properly maintained, aircond tak ada, breakfast biasa je, but charged as high as rm170 per night!

And we almost got conned by a taxi driver who drove us from the hotel to the General Hospital. At first he appeared to be so nice, and welcoming, telling us about Penang, how he never used long route for his customers, talking about the weather and all; and not until we arrived at the hospital he told us his taxi meter broke down and instead of charging us rm6.70 (according to the meter) he said the usual price was actually rm8! I've almost paid him rm8 but I pretended to take down his taxi number and told him I'd want to clarify about his meter with the authority (haha) then he finally said, "tak apa lah, you bayar rm6.70, tapi saya mau cakap ini meter memang betul betul rosak."

yeah, WHATEVER.

the view at Gurney Drive at almost 7pm

I love the yellow crane with the turquoise background

Visit to Penang was completed by having our dinner at Kapitan Garlic+ Cheese Naan & the Tandoori chicken. Slurrpp. A piece of Naan can make you last the whole night. Serious sedap!

こにちわ！

2011-03-16T08:59:00.009+08:00

Have you ever bought anything from the ebay? Well I surf on the internet quite often but it took me years to finally have the courage to do a transaction via internet banking (which I actually later found it, kinda awesome, as there is no need to waste time lining up at the banks and filling too many forms and papers). But buying stuffs from the internet/ ebay is not something I have yet to venture. Listening to so many people's experiences on getting their stuffs delivered to their door after they click that cash button on ebay sounds promising though.

My sister just bought a Canon DSLR Camera from the ebay (from a camera shop in Japan), yeah, she (the camera) survived the recent つなみ (tsunami) apparently and was safely delivered in front of my sister's door 2 days ago. And it was in a good shape, and it's brand new too!

*and she named her あきら (Akira in Japanese)

Mmmph.. maybe worth a try?

*thinking of what to buy as experiment, haha.

anyway this is the world's first photo taken by French scientist Joseph Nicephore Niepce, titled View from the Window at Le Gras (courtesy of National Geographic website)

and this is what our latest technology can do

opps, yeah I forgot to include myself there, haha.

*obviously thinking about my next stop ;)

Tods and Italy sounds appealing kan Bluedaisy kan? :P

Hersheys Bread Butter Pudding

2011-03-14T11:18:00.005+08:00

While encouraging people to count calories for healthy living, I made this sinful chocolate bread pudding last weekend. Realized that the gardenia bread was gonna reach its expiry date soon I just had to make something out of it. The recipe is courtesy from Ms Putu Mayam (who claimed it's the best bread pudding recipe ever), and with the help of Ms Bluedaisy in adjusting the ingredients to what I had at home at that time.

*yeah thanks now I know I can just grind the sugar to turn 'em into caster sugar hehehe and the idea of substituting the sultanas with chocolates since I have plenty of 'em in my coldbox!

So anyway, it takes only 10mins to prepare the ingredients. You will need chocolate bars (in my case I used the Hersheys Nuggets) and about 60g of butter, and about 3/4 cup of caster sugar.

and about 4 cups of milk, white gardenia bread, and there, the Hersheys that has been chopped...

warm the milk inside microwave and pour it onto the bread.. and you will also need to melt the butter inside the microwave for few seconds. Later just mix all the ingredients together, and put it inside an aluminium pan and now it's ready to be pushed into the oven!

Heat the oven about 160 degree celcius, and cook about 30 to 40mins until it turns yellow golden colour.

and wal-lahhh!!

now you are ready to eat 'em!

+yes I need to learn to make them look more presentable next time hahaha

+ serves about 6 people and one slice contain about 500+ calories :), ok I've warned you.

The Final Countdown!

2011-03-03T22:13:00.004+08:00

+pheww almost done with photo editing (takde la edit banyak sgt tapi can't seem to locate the time to do it!),

+now need to fill my oncall claim (since January, itu pun takde masa nak isi, can you imagine! haha!)

+and then the countdown officially begins!

27th April 2011.

Erkk..

lubdup lubdup lubdup

will need more and more chocolates

and I shall miss the care free moments... (for a while!)

Desert is what they think we deserve

2011-02-19T09:19:00.006+08:00

Both photos are taken from the place I work. And to be exact from the place I park my car everyday. Oh I should have taken photos of the lousy parking space, the scenery is probably the worst you could ever imagine. It's like a desert full of cars and if you are unlucky you ll puncture your tires bumping into the hard rocks and sharp woods. Not to mention there's no point washing the car as it will get covered with all the dusts, sometimes, mud, anyway. (when I say desert I really mean DESERT : as in, desolated area with no tar covered road, only ground with rocks and dying grass, and full of puddles during rainy days).

But anyway past few days I have been coming home quite late and I thought the view at night from the lousy parking space, was actually, quite awesome! I think I should go out to KL city at night one of these few days and take more beautiful pictures, for keep! :)

*and maybe I should come earlier (like coming out at 630am!!) to get that very limited proper parking space. mmph.

A letter from your doctor

2011-02-18T22:30:00.000+08:00

A friend posted this on her Facebook page today.

Something worth while reading, and i think it's perfectly written. :)

A letter from your doctor

From:The Sunday Mail (Qld)
May 04, 2008 12:00AM
5 comments

I WORK in a public hospital emergency department, so that means any time you are in my part of the world, you are potentially my patient – you, your family, your friends.

Tomorrow could be the day that a bad thing happens to you and your life is changed forever. That heart attack you knew was coming sooner or later, the crash on the freeway, the toddler found face-down in the swimming pool. Tomorrow, you could be rushed to my hospital – and I'll be doing my best to help you.

But, as your doctor, I have to warn you: things are not good.

I'm a Queenslander born and bred and have worked in public hospitals since 1982. I am a specialist in emergency medicine. My team and I save people's lives for a living. We are good at it, and enjoy it.

We deliver first-class emergency care to Queenslanders and those visiting (yes, tourists, I'm your doctor, too). I've travelled enough to know our state has a fantastic emergency response service and I'm proud to be part of it. Queenslanders expect it and you deserve it. So what isn't good? Put simply, our emergency departments – the place every ambulance rushes to – are already clogged with people. You'll notice that from the time you arrive.

It may be some time before we can find a space for you. Only the sickest people get immediate attention: the ones who can't breathe, the ones who are unconscious.

If that's you tomorrow, I'll see you as soon as you arrive and I'll use my skills and experience to stop you from dying, work out what's wrong with you, give you the immediate treatment you need and then move you on to another doctor who specialises in your kind of problem. You usually don't remember me, but I don't mind. If I smile when I see you in the hospital kiosk next week, it's because I like seeing a good result.

For everyone else, I'm sorry about the wait.

We try to be thorough and that means taking time with every patient. When it is your turn you will get the same treatment. But although year-on-year more people are seen in emergency departments across the country, that's not the only reason we're clogged with patients. A bigger problem is that we can't get people out of the emergency department.

Hospitals (public and private) often have no available inpatient beds, no available intensive-care beds, or no available coronary-care beds. Often, very sick patients stay in my emergency department until a bed somewhere comes up. Sometimes that takes hours or even days. They stay in the beds we need for the people coming through the door. We don't have rubber walls. Somebody has to suffer.

Patients on trolleys are in the corridors, and there they stay until a free bed is found. Sound dangerous? Sure is. I am making life and death decisions in an overcrowded noisy chaotic environment, and it is your life or death I am deciding about. No wonder we're both stressed.

As your doctor, I warn you that when you come to my emergency department tomorrow your experience may not match All Saints with a neat solution after 47 minutes plus ads. I will do the best I can to keep you alive and get you where you need to be. That's all I can do.

Since you are going to be my patient tomorrow, I have requests for some of you:

• TO THE 28-year-old salesman whose car hits a tree after the party tonight: You can't drive better with a few drinks under your belt. And don't take your mate's girlfriend for a spin; after tomorrow, she'll never look the same again.

• TO THE 78-year-old male retired railway worker with chest pain: I know your GP is very familiar with the medicines you take, but I will need to know in a hurry and sometimes it's hard to get through to the GP. Please make a list of your usual drugs and keep it up to date.

• TO THE 42-year-old businessman: Don't tell people you're going to kill yourself if you don't mean it, especially if you're drunk. It will take hours before I can talk sensibly to you and, yes, you do have to stay in my department all that time. And you have to have a blood test. Really.

• TO THE 19-year-old student, nine weeks pregnant and bleeding: We know how upset and worried you are. We'll get you into a bed soon. But mostly, what happens will happen, whether we get you into a bed or not. But we'll still try.

• TO THE 85-year-old retired coalminer and respiratory cripple: We have the technology to pull you back from the brink over and over, but it's like skipping a stone – each skip is shorter and lower than the last and eventually there's not a lot to be gained from skipping again. When a few more days or weeks aren't worth the needles, the tubes, the masks and the whole carry-on, let me know. Say you don't want to do it any more. I will look after you. But don't wait until tomorrow, because by then you'll be on the brink again and too starved of oxygen for me to listen to you. No matter what you say then, I will resuscitate you. You need to tell it to your loved ones now. Then tomorrow, when you tell me you don't want to be resuscitated, that you want comfort measures only, I can check with someone who knows you and I will do my best to follow that wish.

• TO THE 35-year-old female shop manager with recurrent abdominal pain: Please see your GP again before coming to us. Yes, we deal with belly pain, but your GP is well on the way to discovering what is wrong with you. Please persist with him or her. If you come to see us we'll just have to start all over again.

• TO THE 21-year-old male: Don't inject speed. If you act psychotic we will need to treat you, even if you don't want it. Please don't hit us, bite us or spit on us, we are only looking out for your best interests.

• AND finally, to the 53-year-old Queensland Health senior manager: We are drowning down here in the emergency department. I am your doctor, too, and I am tired of waiting for the problem to be fixed.

Quality emergency care is critical for all of us. It's in everyone's best interest to get my department cleared and functioning optimally. I want space, I want staff who can do this job well, and I want time to train them. The situation needs some action now. We are all at risk.

To other doctors: I am your doctor, too. Please help me when I ask you for help with a patient. I'm not doing it to spoil your day. I've got other patients and there's nowhere else to go.

Politicians and powerbrokers: I am your doctor, too. I know you have private medical cover; I know you have a good GP and other specialists who look after you well. But tomorrow it may be you who collapses while walking the dog or it may be you collected by the BMW that lost it on the corner.

No one is going to check for a private health insurance card. They'll bring you to me and I'll be your doctor then. How prepared and capable do you want me to be?

To all of you who are my patients: I am doing the best I can under the circumstances. I can't save everyone. I can't be right every time. I won't be able to get to you as quickly as I would like, and nowhere near as quickly as you would like.

And please be understanding. It's hard enough keeping you alive without being abused while I'm doing it.

The doctor's identity has not been revealed by his request.

Ini station ke berapa?

2011-02-13T22:13:00.004+08:00

and when I was browsing Facebook today on my laptop (it has been ages since I last switched it on!) mr chordwrecker came and asked,

"Ini station ke berapa?"

*Ouch!!!!!

Haha.

Okay okay.

Kena sambung study laaaaaaaaa.... :(

*for the exam there'll be 5 clinical stations where we will be tested on our knowledge, skills, and communication skills.

* it is definitely a lovely lazy Sunday.

*it's a photo of a 35 year old lady's hand with systemic sclerosis that we saw last week: tight, smooth and shiny skin, with presence of palpable nodules (chondrocalcinosis) of the joints. I think she came with difficulty to swallow. CREST Syndrome. Such a pity.

Welcome February

2011-02-03T16:27:00.002+08:00

How would you feel when you thought what you did was right but the results were nothing that you expected?

I THOUGHT I could have thought better.

Sadly not everything can be erased, or reversed.

and in my job that kinda make you feel sucks!

and with that sucky feelings today I actually overdosed myself to sleep, la la la oh what a feeling.

*how I sometimes wish life is just like a doodle*

Anyway, it is already February and it's mama's birthday today.

HAPPY BIRTHDAY MA!

Had nasi lemak breakfast at home in Keramat today after my oncall and stayed playing bejewelled, yeah there's nothing better to do. Tried to influence Ms PutuMayam to jailbreak her iPhone as she's been buying all the games all these while but could not afford to buy the original version of bejewelled blitz! Hehehe! And she has influenced our dad to start playing it too. But of course he complained the screen was too small for him. Well the next thing you know Abah will be buying an iPad for himself, maybe! Haha!

Oh by the way we bought mama a gift and put all your names inside it. (You know who you are :) So later please contact Ms Putu Mayam for details of the price you need to pay, hehee)

Amazing things

2011-02-02T20:39:00.001+08:00

A friend with three kids managed to go through her masters exams and marriage at one go, and still can organize the house without any maid! Are you amazed? Well I am.

A blogger who actually have lost more than 100 pounds in the most healthiest way, just by being disciplined and motivated, really, really, amazes me. Read her blog here and tell me if you are, too. (click here)

A father who has lost his son in a car accident still have the courage to donate the son's organs to welfare of others. I think that decision is amazing.

A guy who sticks to his fiancée despite her being handicapped & wheelchair bound after a road traffic accident is truly an amazing guy. (well if you watch the latest American Idol you might know who am I referring to, some might say he just uses her to get sympathy for the audition, but whatever it is, if he is real, he is really, really, amazing)

Blue sky and stormy weather keeps on alternating these past few days reflects how we should be grateful that we are not caught in deluge or drought like some people in the other part of the world, makes me feel amazed, and thankful for all that I have been granted so far.

What about you?

*the view outside our kitchen balcony when it's almost dawn.

"Living in the moment brings you a sense of reverence for all of life's blessings"

*let's pray for the safety of our Muslim friends and Malaysians in Egypt. Amin*

Rain Rain Go Away

2011-01-30T16:36:00.010+08:00

It was drizzling in the morning and continuous heavy rain towards the evening. A lovely day for hibernating and it was difficult for me to refrain myself from falling asleep. Staying home all day long but surprisingly it was a productive Sunday for me (despite the so not productive weather!).

it is okay to overdose yourself with natural Vitamin C

Nasi Lemak for breakfast definitely saves the perut until evening. Had some problems with the sambal sotong that needed a few alterations before it is finally edible! Haha! But lucky me he ate it all anyway :)

the gloomy weather throughout the day. Can barely see the sky.

Rain Rain Go Away Come Again Another Day.

+ on the other hand, a part of me wish it will rain incessantly causing flood along NKVE so they will have to close the highway. Only until tomorrow. :D

+ I want a Holga!!

Peaceful

2011-01-29T19:13:00.004+08:00

I just need to go to somewhere Peaceful. Beautiful. Neat. Organized. to decongest my stuffed brain!

*in need of great booster after the mock exam today. If only it's as easy as buying it in Bejewelled Blitz. Haha.

*Can't play Bejewelled to de-stress anymore after seeing Mr Chordwrecker's new high score. How on earth did he do 700,000? You gamer freak! Hehehe.

*Probably watching Gossip Girl would be a good idea. =)

Spot what is wrong

2011-01-28T11:27:00.003+08:00

while in the middle of some reading..

*oh please la this is Oxford University Press publisher book. How can they make this kinda confusing mistake!! Should have got it for much discounted price!!

* a boring reading can somehow turn exciting, ha-ha.

So long, Farewell

2010-12-23T14:11:00.002+08:00

Meeting is pleasure,

Parting is pain,

So all the best my friends,

Until we meet again!

*two farewell parties this month for both of my colleaques who are leaving to pursue their training into subspecialty.

Location:Jalan Dr Latif,Kuala Lumpur,Malaysia

Checked

2010-12-19T15:28:00.002+08:00

Did something i wanted to do for quite a long time today!

:: mopped the floor

:: vacuumed the carpets

:: cleaned the kitchen

:: washed all the laundries

:: watched few episodes of grey's anatomy

Phew. It's already Sunday!!

Anyway my Saturday was packed with social activities, apart from obligatory duty to work in the morning. Attended friend's bbq at Lake Edge Puchong, & had a dinner celebrating dearest Sausan's hen's night at Garden Courtyard restaurant before switching for coffees and cathing up after that..

Shall ramble more about it later with more photos!

* Christina Yang quit being a doctor as she could not stand the stress of working and worked as a bartender instead? If she is a real doctor, it is such a waste to the entire profession :p

Paying for the great ambience

O congratulations in advance dearest Sausan Majid!

AOCE 2010

2010-12-02T12:44:00.002+08:00

In the middle of endocrine congress in National University Hospital.. One good thing about helping boss is that you'll be sent for various international courses, and for me, I just need them for the CPD Points and also, the luxury of being away from ward, haha. I love seeing patients but sometimes we just need a break.

Anyway was oncall last night and there was this one guy who swallowed 24 tablets of panadol and 10 tablets of sleeping pills after had a fight with his girlfriend. Well he had no intention to die but did it to attract the girl's attention. Was it worth it? I dunno, you guys need to ask him. Boy, do you know that you could really die with overdose of just panadol? yeah I asked him that, and of course his answer was 'No I didn't'...'

Other cases were nothing unusual. Oh on my last two oncall my colleaque had an old stroke patient who had maggots inside his mouth, only realized by the children when he was half dead and not responsive at home. At the hospital, the maggots were found eroding the hard palate and base of nose, and he came to us just to die as he was already half dead. My point is, the maggots must have been there for months before it can erode the skin and bones.. how the hell you take care of your father at home?! :(

Well anyway, the place for my exam is confirmed next April. Alhamdullillah. So I think I should go back listening to the endocrine lectures :p . Later peeps.

Pssssstt... Endocrine vs Nephrology? Hehe.

Indian Wedding

2010-11-20T12:37:00.005+08:00

Went to attend my first Indian Wedding Ceremony last night at the Kalamandapam Hall in Scott's Road, Bangsar.

It was Punitha's wedding, one of my dearest colleaque in the place I used to work previously : the Psychiatry Department. Me and Punitha were in the same Uni before but we weren't that close back then, probably because we were never in the same class/ blocks. We did housemanship together in HKL too but still we weren't that close either at that time, maybe because we were never in the same posting throughout the one year of housemanship program. But we started our m.o-ship together where we were thrown into the most craziest department (just because we meet almost all crazy people daily there!) : The Psychiatry Department.

Both of us, did not want to be Psychiatrist (though I think Punitha has the talent and the abilities to be one :) ) and so everyday we spent our days in the afternoon (after the long dreaded talking with insane patients) talking about almost everything that girls talk about (haha) and how are we gonna get out of the department, and do the things that we like (or at least, enjoy it better).

Don't get me wrong, psychiatry is not too scary as what I probably have mentioned it earlier, but probably it is just not for me. I am not that patient to talk to someone for a long time listening to their suicidal thoughts and hearing them cry, and at the same time they also talk things that need a special mind to understand (for the initial phase it would be interesting, but to listen to it daily, haha, a no no for me). And if you are unlucky, when they are not in the sane mood, they can ended up spitting on you while talking (purposely!) or when they are in the aggressive manner they might throw chairs in front of your face! And when they are corny they will do almost whatever to get your attention. Eeeii.

*been there done that*

But what to do, most of them are sick people.

Well anyway, it was a beautiful wedding, full of lights and sounds, and for the first time I actually saw in front of my eyes how the bride and groom walk in ties around the nuptial fire with the background of their rituals readings and music (mmg rasa macam drama hindustan! hehe).

* and thanks to Cik Tulang for elaborating how the wedding rituals work after seeing them in National Geography # :)

Congratulations darling Punitha! Happy for you!!

Half Crazy

2010-11-19T10:11:00.001+08:00

I never thought people would be so eager to sit for exam like this. Went to UM today to q for my exam registration (which will be held in next April 2011). Was talking to mr chordwrecker that we should go at 5 am this time since last time when I went at 7am I was already at no 51 yet still could not get a place for the recent October exam ( there were 70+ places at that time)..

Few friends were saying they wanna go at 4 am and initially I was like, okay, nevermind, that's kinda early and I dont think that many would have bangun so early so going at 5am is still okay (come to think of it, 5am is still super early OK?)

But at 330am this morning Mr H called me from UM,
"hey wake up, its already no 18 and people are coming and there are only 45 seats so I think you better come now".."

You know, like,
WHAT IS WRONG WITH THESE PEOPLE?
And they are making me acted 'WRONG' too. So I dragged mr chordwrecker to UM after receiving the call as I just have to get a place this time. Just need to go and finish the exam. Can't afford to spend to sit it in UK too I guess.

So we were there at 415am and I was the lucky no 28. Still could not promise a place since they also consider giving places to those with repeated attempts and almost finishing their 7 years in total of attempts ( we have 7 yrs to finish the exam or we ll just hv to repeat all from scratch again..)

Handed in my form at 915am..
Felt irritated as there was somebody jumping the Q ( But I know God is fair)..
Now it's time to concentrate and hope to get a place, and pass, as I do not want to go through all these s***, ever, again!!
(hopefully!)

Obliviate!

2010-11-19T00:17:00.002+08:00

"Obliviate!"

....and everyone (except me!) forgotten that tomorrow is the Opening Day for the PACES diet 1 2011 registration.

Huh. I wish!!

+ Thumb up for Harry Potter and the deathly hallows. I personally think it was a good movie, compared to the previous ones (probably because I did not read the book for this one this time so I did not have any expectation of what to come next and comparing it with the chapters in the book). Oh Ms Putu Mayam in case when you come back next week you feel like reading it (your book I mean), I'm pleased to let you know that your book is with us here, hehe.

++ I still can't believe it why people want to go and que to send registration form for the exam so early. And because of them, I need to wake up early too, to be one of the kiasus! Urgh. 4 hours of waiting until the office open? Crazy people.

"Avada Kedavra!"

Are you a musician?

2010-11-07T18:43:00.002+08:00

One of my patient who recently died of heart attack in my ward apparently worked as a Musician at Funerals.

Creepy.

Yes, No?

+may he die in peace

c.o.n.g.r.a.t.u.l.a.t.i.o.n.s EJ!

2010-10-31T09:33:00.008+08:00

Early morning yesterday I was awaken by a phone call from my boss Mr B who knew I wasn't doing my weekend morning rounds and was asking me if I can help him doing a test for a lady in the maternity ward with labile blood pressure who is at 24 weeks pregnant. (on a Saturday when I am not working!)

Errr?

I just had to tell him I could not do so as I am attending my best friend's engagement and I need to be there early. Lucky he did not make a big fuss out of it or if not, I would have been late for the ceremony!

Anyway, heaps of congratulations to Ms EJ on her engagement yesterday!

The function was so beautifully held, until at one point I thought it was actually a akad nikahceremony! :P

So she is officially 'booked' now :)

Congratulations again EJ!

The Future

2010-10-27T19:59:00.002+08:00

have you ever thought of your own future generation?

http://www.malaysiakini.com/news/146435

Clarinase and Paracetamol

2010-10-19T19:57:00.007+08:00

It is probably the sick week for everybody as the ward's admission since past few weeks has been like totally, crazy. Can't even find a bed that is empty for more than an hour in my ward since last week. And not just the patients, the doctors and nurses are sick too! (yet still attending to sick patients!). I am down with flu at the moment, and one of my house officers was even more worse, requiring eight hourly intravenous antibiotics and having a cannula on her own hand when she is inserting one for the patients in the ward. One of my nurses was caught with Community Acquired Pneumonia requiring hospitalization.

Is the bug becoming stronger or our immune systems are getting weaker?

Or maybe the weather is getting dirtier?

But anyway we still managed to squeeze ourselves into proper and 'healthier' lunch before being more sick with the never ending work loads back in the hospital!

Someone is trying to please herself after mourning for a lost iPhone hehe

Looks good but to be honest, err, not really!

We only left for about an hour for lunch and when we were back, there were almost 16 admissions to be seen! Pheww. (yet she still can look very excited, haha)

"I feel sorry for the person who can't get genuinely excited about his work. Not only will he never be satisfied, but he will never achieve anything worthwhile."

Walter Chrysler

Sad day

2010-10-12T18:20:00.005+08:00

Dearest bluedaisy lost her handphone in the ward today.

It's not just a handphone, it is iPhone4!

Being one of the first people to que for hours waiting to get the phone on its launching day, ohhhhh, I can imagine how frustrating it could be. :(

Well I have lost my handphone twice in the past,

and I can imagine how irritating, frustrating, debilitating, and disappointing it is.

My first handphone that I lost was my first ever handphone given by my dad, it was the Alcatel 360 with a TMtouch simcard. I lost it inside my own room, and to my own roommate at that time when I was in Uni days. (yeah, in other word my own stupid roommate took my own handphone and still she pretended as if nothing happened!!).

The second time I lost my handphone was in the prayer room in Jaya Jusco Midvalley. Somebody picked pocket my bag in a prayer room (yes, aren't you supposed to pray in prayer room or at least do something good but not stealing?).

Anyway Ms Bluedaisy, stay strong. Pray hard. I know it would be like praying for rain in sahara for your handphone to come back, hehe, but yeah, every cloud has a silver lining. :)

+ so now I only have azila to ping with! :P

Ouch!

2010-10-11T17:45:00.004+08:00

when you least expect something and suddenly they happened...

+ spent the weekend in Kota Bharu to attend our friend's wedding so we awarded ourselves a Monday holiday today

+ good Monday for me, as I am on leave, and I got kinda err, surprise, new toy as a gift today! :P

+ but not a great Monday to wrap things up due to stupid idiot stone that popped onto our car windshield on our way back from One Utama in the afternoon!

ouch!!

double ouch!!

Grumpy mode

2010-10-06T19:49:00.002+08:00

On one hot and sunny afternoon when everyone was busy in the ward full of new admissions... the medical officer of the ward was doing rounds in the ill patient's cubicle to see the progress and updates and was upset to see many blood investigations results were not traced as it was supposed to be, and she started looking around for her house officer who was no where to be found....

Dr. Jenny (medical officer) : Dr. Izzie (another house officer), do you have any idea where is Dr. Estefan (THE house officer)?

Dr. Izzie : errr, I am not sure. But I can call her for you.

So she started dialing on her Blackberry phone and later passed over the phone to Dr.Jenny...

Dr. Jenny: Hi Estefan. May I know where you are now?

Dr. Estefan: errr, I am in the library.

Dr. Jenny: What are you doing in the library? Are you on leave today?

Dr. Estefan: No, I am not on leave. I am in the library studying.

Dr. Jenny: Do you know that our ward is busy today? And why are you not helping the others and yet, stay in the library?

Dr. Estefan: errr, I have clerked one patient and settled that one so now I'm reading something in the library since I have finished all my jobs in the ward. The rest of the new patients are somebody else's turn.

Dr. Jenny: Do you have the blood results for patient so and so, since I can't see any blood results that were supposed to be traced as urgently today? (yet she can say she has finished her job!)

Dr. Estefan: I am coming to the ward right away doctor (in a panicky mode)

Dr. Jenny: (speechless)

And the conversation ended there as she was inside the elevator and the line was cut off.

+ a house officer, as the name implies, are supposed to be inside the HOUSE all the time, and the house in this context is the ward where they are assigned to.

+ They are not supposed to leave the ward unless for short meal break, or for arranging stuffs related to patients, and they are not, not, not supposed to go somewhere like, what? library to study during office hours?? and especially when everybody else were busy in the ward attending to patients.

+ You can go study after work, thank you.

+ you are not going to pass your exit posting exam anyway if you really have attitude problem, selfish, or you do not work as a team, and if you are irresponsible.

* some attitudes can't be changed.

* in a grumpy mood.

Defibrillator for dummies

2010-09-20T22:43:00.004+08:00

Have you ever witnessed someone with cardiac arrest? I'm sure if you have seen one you shall never forget how painful it looks like. The patient will grab his hands on his chest with his face looking upward in agony and later it will turn blue and he will become unresponsive. All these occur within seconds and at that point you know the heart has already stopped/almost stopped. (As in, you can never feel any pulse)

The first time I witnessed such a situation was when I was a house officer (and that was about 4 years ago). I can still remember until today when the poor patient actually was coming back from toilet to his bed on his wheelchair. While transferring himself from the wheelchair, he had the heart attack, which has ended his life, after one hour of our resuscitation.

+ he had a very poor heart to begin with.

Well, anyway, we started to change our ward rotation today, and I have forgotten how busy it is to be in charged of the third class ward. The admissions were over flowing like nobody's business, and during daytime we already had like, almost 30 admissions! And as expected, ill patients came like a bulk after the Hari Raya long holiday.

The long tiring day was started by a patient who collapsed during the clinic session. He was waiting for his turn outside our clinic room when another patient who sat next to him realized he was not responsive and had some jerky movements. The so called blue code was alerted so the whole team including the consultant came down to resuscitate him. It was the first time I was in a 'code-blue-team' where we used the automated external defibrillator (AED) device. It was like a defibrillator for dummies machine, where once it is attached to the patient's body it will recognize whatever the cardiac rhythm and it will say out loud what you need to do following the rhythm.

(I've used the machine during our ACLS/ BLS courses to mannequin before, but never tried it in real life threatening situation as usually during resuscitating real patients, we will use the normal, manual, cardiac defibrillator machine : which is of course, ehem, not for dummies. Hehe. In other ways, you should know what rhythm and what to do following that bla bla bla).

Anyway our patient had a Ventricular Fibrillation on the defibrillator cardiac monitor, and at that point we could hear the dummy said,

" Ventricular Fibrillation.. Defib now"

And there were other things it said like,

"Sinus tachycardia, CPR if no pulse"

I was like, wow. This is cool. While resuscitating should be quite stressful, it turned out to be quite interesting to hear the machine talked and talked. (it felt like we were in ACLS course rather than real situation)

Well in certain countries they apparently have the AED in almost all public areas so if a patient suddenly collapsed, the public (who has been trained for Basic Life Support ie how to do CPR) can perform the AED. And that's why it was created, for the non health care personnel to use in the critical situation.

Wonder when we can be up to that par in our health care system.

We managed to revive his pulse and blood pressure after about 20 to 30mins of resuscitation. Alhamdulillah.

+ventricular fibrillation: the most fatal cardiac rhythm that usually lead to death

+ defibrillator: the act to 'shock' a patient with the electric pads like you always see on TV

+ ACLS : advanced cardiac life support

+ BLS : basic cardiac life support

"dearest patients,

if you feel really unwell, please do not wait for your clinic appointments to tell your doctors how unwell you are. Please, please, go to the emergency departments or the out patient walk-in clinics where they can attend you straight, and not to keep the symptoms until it is already, very, very, late.

Your cooperation is highly appreciated.

Thank you."

Jeans don't lie

2010-09-16T15:48:00.012+08:00

After 9 months of living together we just finished our first 5kg of rice pack last week. The fact that I don’t cook all the time probably be the most important contributing factor (blame it on the busy job as a part time slave to the system :P). But most of the time if I do cook it will be something else as we were trying to avoid eating rice all together , in an attempt to lose those baby pot fats around the belly, ha-ha. Look, we’ve bought a treadmill recently, (oh okay, not that RECENT though, it’s been almost 2 months now I think), but I have been on it for about, what, 4 times? (blame it on the tiredness after working, again! :P).

Anyway one of my passions recently is collecting healthy recipes (so you want a new hobby which won’t cause you any money? Then probably you should also think of this! :P). I started to subscribe to this particular health conscious website many months ago as I found the calorie counting and their balanced nutrition recipes/ facts are amazing. Been wanting to start on their weekly healthy recipes since ages but the usual me always having problems of forgetting what to buy when we go to the hypermarket (make a list, I know, make a list! :P). Anyway there’s this particular article about sugar free substitutes and their role in reducing weight which attracted me to consider having it as the sweetener in our every day morning Milo drink. It’s definitely more pricy than the normal sugar in the market, but I guess if you think in the long run, it is definitely more cost effective rather than spending a lot on insurance coverage for diabetes and its complications in the future, as well as preventing from mental torture and the depression of having the illness!).

+ 1.4 million adults age more than 30 are diabetics in Malaysia http://thestar.com.my/news/story.asp?file=/2010/1/11/nation/20100111140301&sec=nation

+ Oh btw there’s another article about burning calories by doing other things rather than sweat yourself on a treadmill. (and that includes mopping the floor, walking 30mins a day; I walk 15 to 20 mins everyday from the place I park my car to the hospital building where I work so to and fro makes it 30 mins everyday, yes? No? haha. Well at least I feel less guilty now for not running on the treadmill everyday like I thought I would do.

People with apple shapes are more apt to develop diabetes, high blood pressure, heart disease, and certain types of cancer than are those who have pear shapes.
So you would rather be like the apple, or the pear?

(or perhaps non of the above :D ).

Cinta Baru

2010-09-15T00:31:00.005+08:00

Some Malay words just can’t be translated into English words, as it will probably bring different meaning altogether, and vice versa. Or, it will just sound so weird.

Cinta Baru.

hahaha.

:: I absolutely have nothing against Twilight as I actually find the trilogy kinda interesting. It’s just I wish Stephenie Meyer probably could have created a better plot for Bella rather than just being a boring, plain and a very indecisive girl (forever indecisive! But somehow she was the magnet to both the good looking guys in the trilogy (err?! Hahaha).

Its Twilight..
Its the safest time of day for us, the easiest time. but also the saddest in a way.. the end of another day, the return of night. Darkness is predictable, dont you think?

Salam Eid 'Ul Fitr

2010-09-11T21:24:00.005+08:00

Aidilfitri is celebrated in a slight different way for me this year as:

+ I am celebrating it without my darling sisters and brothers as three of them are away in Bangalore, Sheffield and Newcastle (Australia). (and the eldest went to celebrate it with her in laws in Penang). And I would say it is obviously less merrier than the previous years as I miss bullying my sister to iron all our baju raya (and mind you she burnt two bajus in two previous occasions on the very first day of hari raya, haha!) and I miss giving out duit raya to them (haha this one is obviously not true. I am lying :P)

+ I am celebrating it with Mr Chordwrecker’s family as well, and we went to visit my new extended families this year in Klang instead of going back to my own Kampung in Sabak Bernam (like we used to do every time after Hari Raya prayers in Lembah Keramat)

But despite all that, the hari raya routines are pretty much the same.

Managed to convince my dearest Chordwrecker to have the Hari Raya prayers in my parent’s house in Lembah Keramat J , so I will not miss my mom’s usual nasi impit and kuah lodeh with sambal kacang + sotong, and the usual rendang tok. We started cooking quite late that night as we had our last breaking fast outside with my dad’s friends.

Cooking and cleaning started at about 11 mid night, but fortunately all is well and almost done by 3 o’clock in the morning. Had our breakfast the next day before routing to the mosque for the solat raya and later went back home for our usual salam raya and family photos. (But this year, with an additional family member J ).

Happy Eid’ Ul Fitr.

May all the wrongs be forgiven and may more moments to be cherished.

Minal ‘Aidin Wal Faizin.

Almond London

2010-09-09T12:08:00.000+08:00

It’s the last day of Ramadhan and there are still so many people in Kuala Lumpur. Few nights ago few of my friends were planning to go to the ever busy Jalan TAR just to have a feel of the street during the coming festive season, but trip had to be cancelled due to busy road traffic at almost midnight! I guess everyone in KL likes last minute shopping (that includes me as I just got my tudung to match my baju raya today J ).

Anyway I was at the post office today to post raya cookies that I’ve promised to Ms Masquerade, Mr Graeconally and ‘the doctor in the Intensive Care Unit’. Lucky I have not packed the cookies (just went there to find out roughly how much it will cost me) as I have learnt that Pos Malaysia is not sending any food material overseas since August and until further notice!

So guys, I am so sorry you gotta come back here to eat the cookies yourself!

+ takpe la tak rugi pun as it’s not my home made cookies :P

Drive safely

2010-09-08T04:54:00.006+08:00

Recently for some reason there are more hands short cases in the ward. This pakcik actually came in for gastritis to the ward but what his left hand has gone through and caused this lesion appears to be 'interesting' for us sitting for exams (pity for the patient of course :P).

this is a fixed deformity of the fingers

+ i think this is more difficult than before

+ please don't tell me you see fistula here since you are learning renal at the moment (you know who you are :P)

+ the patient actually had an accident many years ago (drive safely to those who are going back Kampung this Aidilfitri!)

* now I got to go and learn how to describe this lesion in one breath!

1Malaysia

2010-09-05T13:36:00.001+08:00

Can somebody do something about this? How insensitive these people are!!!

it's 5 am

2010-09-03T04:49:00.005+08:00

a young chap who is an alcoholic came with chest pain at 3 am.

and apparently he had a cardiac surgery done at the age of 6 and 16yrs old, and has a cardiac pacemaker in situ.

and for some reason his pacemaker is not functioning tonight.

he smells stinks of alcohol,
and he is irritating because he's intoxicated. grrr.
and he made me wide awade until 5am now!

+ dah la ada cardiomyopathy, do you know by being an alcoholic can worsen your heart condition?
+ and do you know that the pacemaker we gave you was not cheap and easy to be given away just like that?

Deformed hands

2010-08-31T22:00:00.004+08:00

tried to capture photos of interesting patients with my HTC phone but obviously the quality of the images is like, totally OUT.

So which phone has best camera features? :P

Secure with the security guards?

2010-08-28T10:05:00.004+08:00

Two hospital security men gunned down after argument

Not surprise at all with the news as many of those security guards in the hospital I work in cannot be trusted.

I have actually witnessed security guards took money from visitors before allowing them to park at the doctor's parking areas many times. Talking about honesty and their jobs to actually secure the reserve parking areas?

And many of the patients who are drug addicts admitted to the wards work as security guards at some school, housing areas, and surprisingly some BANKS. Now talking about how they should be trusted looking after the safety of the area/ community they work in yet who knows what they might do if they are high on drugs at work?

Many years ago when I did locum in a general clinic in Wangsa Maju, a guy came asking me to sign his Medical Check Up to apply as a security guard in IJN. The Medical Check Up form was so simple when they only asked me to check what was his blood pressure, his eyesight, his limbs functions and a bit of his heart and lungs condition. It's just like a tick box at the end of a simple questionnaire when you just have to tick your yes or no findings. But when I look at the guy at first glance, for some reason I had a feeling he is a druggie (haha yes, too many druggies admitted to the wards for food and temporary shelter while having their withdrawal symptoms just make me so good in recognizing them). And my suspicion turned into almost confirmation when I saw that all his veins were collapsed with a lot of needle prick marks on both arms and necks. So I asked him whether he's involved in recreational drug abuse and not to my surprise he said YES. And said he needed the job for money (well I did not want to ask for what).

So if you were in my shoes, would you sign in the medical check up to say if he qualifies for the job?

Good move that in our hospital they have hired Polis Bantuan to replace most of the security guards (well at least, with the title Polis, I really hope they behave like one!)

+ it is difficult not to be skeptical.

+ could not sleep after sahur today so I ended up mopping the floor and only now find myself desperately thirsty! (and it is only 10am!)

AL Fatihah

2010-08-22T21:45:00.008+08:00

One of our colleaque at work passed away yesterday when she was battling to deliver her first child. She had a ruptured placenta and succumbed as a complication of Post Partum Hemorrhage (major bleeding as a consequent of the ruptured placenta).

It was a shocking news indeed to most of us as her death was really unexpected.

I wasn't close to her but I know her as we work in the same hospital and many at times she referred a lot of cases to me so we used to talk whenever we were on calls. But having said that, I know for the fact that she was a very lovely lady, who almost never grumble and always put up an innocent smile no matter how tired she was on a very busy day.

May Allah bless you and your soul.

Al Fatihah.

"It is He Who gives Life and Death; and when He decides upon an affair, He says to it, "Be, " "and it is. " (Surah Al- Mu'min -The Believer(40:68)"

"Nor does anyone know what it is that he will earn tomorrow: Nor does anyone know in what land he is to die. Verily with God is full knowledge and He is acquainted (with all things)" (Surah Luqman:31:34)"

Winter in UK

2010-08-17T20:00:00.003+08:00

Nothing interesting lately. Few updates, but hasn't got the time to write.

did not get a place for my PACES examination in Malaysia this October even though I was among the first 70 candidates who sent in the form on the registration day in UM, maybe it was not my luck, or maybe, I wasn't ready to sit for it in Oct.

so I need to save lotsa. as in. LOTS OF. money to sit for the exam in UK next year insya Allah the earliest in February 2011.

(yeay another holiday abroad :))

So where should I go? London? Edinburgh? or Glasgow?
Oh I Hate Exams!

The panda eyes begins

2010-07-23T19:59:00.005+08:00

Took a day off today to go to UM to pay for my PACES exam. Arrived at 745am and the Q was already very long. The first person in line actually came to Q before 5am, how crazy is that? Well I thought we were kiasu enough as the counter only opens at 9am, but more kiasu-er people were there, obviously. Anyway, we were among the first 50 to send in the form, so most probably we will get our place. (hopefully!)

So it's gonna be the official starting of continuous coffee supply and constant eye bags production!

*and less Facebook!

**I don't know whether I am actually ready

*** 1085 pounds, better be a good investment, Zay!!!

Lymphopenia

2010-07-09T19:55:00.003+08:00

Today, a patient, who is an active intravenous drug addict told me this during my morning rounds.

" Doktor, saya ni drug addict doktor. Tu sebab selama 10 tahun saya amik dadah ni saya tak pernah sakit. Ni baru kali pertama."

WHATTT??

Ada jugak orang boleh fikir macam nih. Proud pulak tu dia drug addict!

Looking at his very low lymphocytes count, I just managed to smile. And not wanting to say anything else.

*low lymphocytes count (lymphopenia) can be due to many things, but of course in active drug addicts you would want to rule out whether they have contacted HIV.

All time favourite

2010-07-04T22:30:00.003+08:00

Gone were the days where I used to have more than 1000 songs in my old computer (before the hard drive suddenly decided to burn!). Now I'm just waiting for my sister in Aussie to come back and update my iPod songs!! (punye lah malas nak buat sendiri! :P)

But this is definitely my all time favourite song.

'Saya Nak Sekolah'

2010-07-01T18:25:00.005+08:00

" Adik sekarang sekolah dkt mana?"

" Saya dah tak sekolah. Kena jaga adik."

"Mak tak boleh jaga adik ke?"

" Mak kena kerja. Ayah sakit, tak boleh kerja. Adik kecik lagi, 4 bulan."

"Tak ada jiran ke yang boleh jaga adik kecik tu masa mak kerja?"

"Tak ada jiran. Semua rumah jauh jauh."

" Saya nak sekolah. Tapi mak kata tak boleh sebab tak ada duit dan mak kena kerja. Dah minta bantuan tapi tak dapat."

Life of a 13 year old girl, born here but both parents are Indonesians who hold Malaysian PR.

Sad but true.

Tax Payers

2010-06-27T18:16:00.007+08:00

So I have subscribed to Pastest PACES online course which costs me 299 pounds. (Let's pray for good internet connections then)

Anyway the videos are okay.

Expensive, but as they say, a good investment (I hope!)

It's a lazy Sunday. Mr Anonymous is on call today but so far his call is good (thanks to the white t-shirt he's wearing all day :p) and he is lazying playing Assassin Creed the whole day.

I am post call so lazying around is definitely not a lame excuse for me hehe (oh it's so good to be post call and not having to do the weekend ward rounds which I hated most). The call last night was 'o-kay' as my pager only beeps only once and that was at 530am today, to see the regular patient who has been in and out hospital almost every other day since the past 6 months (the kinda patient you know everything about him until you can close both eyes while clerking them!). He is a schizophrenic patient (who is also a chronic alcoholic! and unfortunately has heart failure) and always comes with fluid overload as a complication of excessive drinking (part of the schizophrenic psychosis). His family has disowned him to stay by the road side since his 'crazyness' is beyond limitations. Anyway, he wasn't really in a bad condition, was a bit breathless before 40mg of intravenous lasix and later happily singing Kuch Kuch Kota Hei in the Emergency Department while asking us to admit him really fast to the ward so he can have some proper bath! (can you just imagine, sometimes it can be really irritating!). It's like a routine for him to come for a couple dose of diuretics and usually will abscond after 12 hours being in the ward to binge on some alcohol outside and came back again the day after for again, some diuresis and food. (not really surprising, we have so many of this kinda patients in the government hospital, and thanks to you all tax payers hahaha).

Anyway apart from that I was just busy dancing with the defibrillator in the CCU/ CRW attending to all sorts of arrhythmias the whole night!

Must pass this exam so I don't have to wake up at night dancing like this anymore.

Looking forward for a brighter Monday tomorrow!

KITA

2010-06-24T19:53:00.004+08:00

:: watched it yesterday night

:: courtesy of my boss who got a lot of free VVIP seats to be given away

:: but since my first theater was PGL (courtesy to dearest EJ)

:: I thought KITA was, okay aje lah

:: Story of three good friends (Indian Chinese and Malay) and about semangat 1 Malaysia bla bla

:: A bit propaganda

:: but whateheck, free ticket hehe

:: I think the story line was dull

:: maybe if the story line was good and the hero was not Hafiz AF, then maybe, MAYBE, they can get a standing ovation

:: PGL best gila OK!

:: So as expected, balik theater lambat, tido lambat, bangun pun lambat.

:: woke up at almost 7am today to rush to work and reached at 810am (nasib baik tak jammed sgt, had to take two highways!)

:: maybe I need to Bieberize his phone (too!) as I need something irritating to wake me up early in the morning!

Budaya Kerparat

2010-06-20T12:43:00.002+08:00

The department is chairing the hospital's annual 'Budaya Korporat Day' this Tuesday, and I considered myself as unlucky as I was elected as one of the committee members. (just don't find it interesting to do all these administrative jobs). So we already had 3 meetings in the past to prepare for this coming day (and I only attended 1 meeting as during the other two I need to attend to dying patients in the ward). So after those fruitful 3 meetings I was told I am to be the chairperson aka MC for the day.

Crap.

Juruacara Majlis?

Wow. I think the last time I chair a ceremony was like many many years ago back in primary school maybe (haha). And to chair something in the auditorium where all the VIPs will come, and to talk something about Budaya Korporat which me also don't know what's it all about?

^*&@#!

So anyway, the rehearsal is tomorrow and I have not done any script for my aturcara majlis and stuffs, rasa malas gila and malas sebab taktau nak buat cemana. I just don't know how to create all these pantuns anymore. Hehee.

So last Friday I actually joked to the clerk in the office who was the secretary of the committee, telling him I'm too rusted for all these scripts ans stuffs,

and today when I opened my email, to my surprise (and yes, thankful!) I saw and email from him attaching a long file on the script of what I need to say as the chairperson during the day!

(termasuk segala kata kata berhemah and pantun)

Yeay.

So boleh la keluar jalan jalan arini, not having to worry about the scripts anymore! :P

Zillionaire.

2010-06-19T15:04:00.000+08:00

+ online PACES course for 299 pounds

+ PACES exam fees 1085 pounds

+ PACES Penang Course July 2010 RM600

+ SK2 miracle water?

+ apple iPhone 4G?

Food for thought

2010-05-31T23:17:00.007+08:00

Seeing cases non stop from 12 noon until 6am the next day can make you a demoralize person, if, you are not that patient. I swear I was damn tired, as I have not had my proper meals, and too burned out trying to fight my hungry stomach.

The last patient for the day was a middle age lady who came with severe chest infection, and she was intubated for respiratory distress. By the time I saw her she was already intubated so I only managed to speak to her friend, who was the one who sent her in. This lady (the patient) has no contact with her family members and currently staying in a small hut in a Kebun Pisang where there is no electricity supply, in the middle of skyscrapers in a well developed metropolitan city in this country. And she worked as tukang kutip sayur for her chinese employer who sells vegetable at night market. She appeared so unkempt, as if she hasn't bath for many days. She was unwell for many days but no one can bring her earlier as both of them own neither transport nor handphone to call the ambulance.

I was sleepy, yes, but I heard her correctly.

And she did not look like someone who would want to create a soppy story.

I guess while we are enjoying our life being showered with love, money, and pretending to be the rich and famous,

just remember there are people among us living so poor as a church mouse, craving things to eat, and also digging for unconditional love.

Well at least, the long tiring day ended with an inspirational food for thought :)

Gulp~

2010-05-26T18:40:00.005+08:00

When you are in a very difficult conflict, never think that by apologizing will make things much easier. Some people can twist your words and make you sound guilty as ever.

Sigh~

+ today during Journal Read my big boss who just accompanied the PM to the United States apparently told us 'rumours' that John Hopkins Hospital will be opened here as a teaching hospital for the post graduates. Mmmph. Interesting.

++ My dream to open a wedding shop (haha) almost come true when one of my good friends decided to borrow my scarfs that I used for my wedding for her nikah. (Should I rent it to her? :P)

Is the grass greener there?

2010-05-23T14:28:00.008+08:00

Today KH flies to Singapore to start his new journey as a Gastroenterologist registrar in the National University Of Singapore. Met him last Thursday when he claimed he was sad to leave as the place that we're working at the mo is the place that has taught him so many about people and medicine (yes I agree but the fact that you said you were sad to leave, for some reason, I don't believe you haha).

People chose to do their subspecialty after passing their MRCP exams (in this case KH has chosen the Gastroenterology) in Singapore since they want a shorter waiting Q (2 years+ to wait for a place here after passing the Malaysian Masters Programme or The Royal College Membership Exams, but in Singapore you can go as early as 4 months. But of course, more work, and lesser 'life' haha). And some of them has actually requested to go for unpaid or sabatical leave and come back later to serve the government but the government has asked them to resign.

So whose fault if they don't come back after that?

I wish you all the best, friend.

And please don't forget us once you've got your S class Mercedes Benz.

*yeay I got a beautiful fridge magnet from Perth.

** a bit rejuvenated after watching the latest Season 6 Grey's Anatomy yesterday haha.

** MRCP : Member of Royal College of Physician (UK)

Travel and Pastime

2010-05-16T17:46:00.007+08:00

Friend A was on pilot passive call yesterday and he mentioned he was too lazy to fly to Paris since he's been there so many times (whatttt???!!).

And on the other hand, friend B just planned a 4 days trip to Perth in a day (she bought the flight ticket and accommodation 2 days before the trip! It was a adhoc holiday!) as she was too stressed with her houseman (haha) and in need of a getaway from work.

How I wish I was like friend A, travelling around the world is probably nothing anymore, while me here, is dreaming to save a fortune for the expensive pastime!

And Friend B, you are a living proof that anything can be done if we are determined, firm, and of course, if we have a lot of money!

* I hope to get a new fridge magnet from Perth :)

** Wonder how Paris looks like during summer time *hint*

Gratitude

2010-05-14T18:43:00.005+08:00

Ever tried not using your thumb and see what you can do in a day? De Quervain's tenosynovitis, a condition where there's inflammation to the tendon that controls the movement of your thumb adduction. It's very painful if you force to move it, and yeap, trust me, very very painful. It feels like your tendon has twisted and you are forcing it to be back in it's normal position. The tendon will make a 'click' sound and Ouch!

Sakit gila OK.

* need to be on the splint for at least 2 to 6 weeks! :(

* Be grateful of what you have. Been a partial handicap for the past one week is really, no joke and no fun.

Gratitude is riches. Complaint is poverty.

Leave if you must.

2010-05-13T19:40:00.004+08:00

A lot to write lately but just don't have time to put things into words (hehe), anyway, stumbled upon an interesting article about Malaysian doctors in The Star Online Blog recently... Not all are true, but if there's anything to add, I would like to add on how we had to swallow 'verbal abuse' from some of our patients and it is definitely, very, very frustrating. I have always thought I wanted to serve this Government until my pension years (and still going to) but after each time of the 'verbal abuse' and the tiring days but not being appreciated, I've started to think that maybe serving this people is not really worth it. We are also human with feelings and not all of us can be like Mother Teresa.

So my brother and sister, if you think you want to work oversea before you come back, I won't blame you. Go ahead. Hahaha.

* not all nurses are like what being described in the article though

* 2 of my friends are leaving to work in Singapore for almost 8000+ Sing Dollar per month.

WEDNESDAY, MAY 05, 2010

Why we left and why we will continue to leave...

Posted by: MS Mohamad

I read an interesting article today about a few prominent figures addressing their concern over the increasing UKM and UM medical graduates who have left the country to continue their medical practice overseas.

After reading the news for 3 times, I called a very close friend, an MD (UKM) graduate to ask his opinion on how the news might have affected him. He has been working in Singapore for more than a decade as a Consultant Surgeon with a certain sub-specialty

"Why be a slave in your own country, when you are a king in another?" He replied.

Indeed, if anybody would want to find a reason why all of us left, either after housemanship, after being a specialist, or even after sub specializing, and now, even prior to doing housemanship, they need not look at our payslip, or the wealth that we have gained overseas, but only to the Medical System that has been rotting in the ignorance and politic-based stupidity that Malaysia has been well-known for (in the medical field).

I have served the system for nearly 2 decades of my career, waiting for it to improve for so long, and only finding myself in despair, quitting with a 24-hour notice and serving abroad. The system is, in my opinion, keeping doctors, since the beginning of their career as House Officers to the end of it, in the lowermost priority. When I was working there, doctors are so ill-treated, while the nurses and the medical assistants are overpowering us.

I still remember the days when I was doing seeing patients and rounds as an MO, while the staff nurses would mind their own business, having breakfast in the pantry, or having gossip chats at their own leisure. My House Officers would then have to do merely all the labour-work, up to the extent of setting intravenous drips, and serving medications. If I am to expect the nurses, my patients would have been dead, or the work would have been too slowly or incompletely done.

When I was a House Officer, I had to run down 4-5 floors just to review a blood investigation of a dying dengue patient. The ward staff would either be nowhere around, or will say that he is busy (busier than the doctor?) or the answer I got at that time:

"Doktor nak cepat, doktor turun sendirilah, gaji doktor lagi banyak dari saya"

Even when I was a Specialist, the staff nurses had to be called again and again just to make sure the management plan for the patient would be done. I was already used to answers from them:

“I’m busy with something else"

“My shift is already over"

...it was routine for me.

The Medical Assistants were worse. They would hide behind their so-called boss, the Head of Medical Assistant. They feel hiding behind him would make them not under our jurisdiction, that we have no power to instruct them in managing the patient, that they have power to manage own their own. I've seen them giving medications not as we prescribed, performing procedures without our knowledge, as if they are the actual "Doctors". They are in their own world, and we have to do their job, taking blood, labelling samples, and even cleaning gadgets from the procedures that we have done.

Oh, but the ministry loves this group. They even let them run a clinic now, instead of upgrading the clinics already run by doctors. The government feels that the MAs are very important and should never be ill-treated by those big bad doctors. One time when I was a District Hospital Medical Officer, I was conducting a delivery of a baby. An MA insisted that I remove my car which was block-parking his car. I answered through the phone that I was busy.

He came to the labor room and yelled "Semua orang pun sibuk jugak, macamlah doktor seorang yang sibuk!”

It is insulting that an MA or a staff nurse claims that they are BUSY, as busy as a doctor? As a Malaysian Doctor, I have even worked for 72 hours straight. I have experienced working until my 6 month old daughter did not recognize me at the end of the week.

Is that how busy they are? I am very sure that they are so busy, that they can only spend 2 hours at the nearby Mamak stall, or can only leave at 5:10 PM instead of 5, or can only have 1 hour of lunch.

The management staffs are worse. I have to beg and plead so that I can get my on-call claims, of RM25 per 48 hours of work. While sitting in an air-conditioned office, they will at their own leisure, process my call claims so that I will receive them by the next decade.

The state health or Hospital Director would just give another inspirational talk (of bollocks) on team effort and beauty of teamwork.

That is how Malaysian doctors are treated in the government sector: without respect, without dignity and without significance. Why?

It is because we are bound by ethics to try our best to save lives, despite how ill-treated we are. We hardly have time to complaint because we are too busy or tired, and we would rather spend the precious time resting or seeing our loved ones. The burden of trying to save lives is on our shoulders alone. No MAs or Staff nurses would shoulder it with us. They have their own bosses: the Sisters, Matrons, or Head of MAs, which job description is to ensure that the big bad doctors will not ask their underlings to do extra work.

This is how the Malaysian Ministry of Health have treated their doctors. I am very sure that in each and every doctor, there is a slowly-burning patience in serving the Malaysian people, which will eventually fade and cause them to surrender to serving a place that treats them better.

A few colleagues who graduated from UK choose to serve there:

"The pay is more, and we get the respect we deserve"

Another works in Brunei:

“Here the staff nurses respect Malaysian doctors, and they are very co-operative" (He ended up marrying one)

A few are consultants in Singapore (working with me):

"Here we are treated well, we spearhead the management, and every else do their work to the best of their capabilities".

A few even enjoys working in Indonesia:

“The work-load is horrible since there are a lot of patients, but we are well respected by every hospital personnel" (They have migrated there for nearly a decade)

I am sure that people will see doctors as power-hungry individuals who want to be the boss in the hospital. Trust me, after having graduated 6-7 years of medical school, earning a DEGREE, and subsequently MASTERS, and SUBSPECIALITY, you would expect a degree of respect and being considered important. We are trying our best to improve patient's quality of life, or making sure he lives another day. Is it too much to ask from the system that we are important?

I find that Malaysia is the only country that is making doctors' lives miserable and treated like rubbish. It was never about the pay in the first place. It is about the treatment we are getting and the false political-based promises. Do you know that the so-called circular about doctors can have the day off after working 24 hours straight released JULY 2009 is not yet implemented? Do you know that the raise of UD 41 to 44 does not involve every doctor in the government service?

We are waiting for improvement. We have waited a long time when we were working in the system. Somewhere along the line we decided to leave and wait outside the system. Until the system changes, we will continue to work overseas, in countries which are appreciative of us. Trust me, Malaysian-graduate doctors are considered highly skilful and competent in neighbouring countries, and the 15 % brain drain is more significant than you think.

We will return when the system prioritize us and gives us the quality of life we deserve.

If it stays the same, Malaysian Hospitals would end up having Staff nurses and Medical Assistants as "Doctors", and we would have to send patients to Indonesia for an appendicectomy.

Hear our voice. We hardly speak, but will usually fade away from conflict (and fly to another place).

Taiping, M.O.C.K, and Mee Udang

2010-05-04T15:42:00.006+08:00

Taiping:

A quiet but nice town. Love the roads (no traffic!), the food was ok-lah (but Mee Udang Kuala Sepetang was realllly good for the price!), the environment in the Hospital Taiping itself was so welcoming (not like the place I work now where people hardly know each other, and if they know pun, if someone smiles at you it always look like a fake smile covering the tired face). O but I thought the Taiping night safari was rather disappointing. A ride on the train at night just to see the animals sleeping in their cage? Probably not really worth it.

Mock:

A tough one. My assumptions were wrong when I thought it was a 'main-main' kinda exam, (just for the sake of exposure to the system) but it turned out to be like a real one. With the examiners being the real examiners for the real exam, urgh. Memang stress gila. I was stressed I think I twisted my scaphoid bone while doing chest percussion haha. And I failed my abdomen station as I could not diagnose a hypogammaglobunaemia (how common is thatttt??). I think I irritated my examiner as he was trying hard giving me clues but I was just having thought block. And it was my last station, and I was his last candidate for the day. Serve me right. Haha.

Mee Banjir Udang Kuala Sepetang:

Not a fan of mee, or mee udang, but it was yummy. Home cook mee with large, pool of fresh, sweet prawns at RM11 per bowl, was probably the most memorable thing in the whole two days trip!

RM 11 for 10 big prawns!

Today was a fairy tale

2010-05-01T14:02:00.003+08:00

Went to KLCC yesterday to take my almost expired RM75 voucher (after almost 5 months missing Isetan (haha)).. The Isetan layout is totally different now. And everything is more expensive by RM10 eventhough everything is actually on sale. Did not find what I was looking for, ended up buying a white t-shirt on sale for Mr. Chordwrecker since I accidentally made one of his white t-shirt turned into deep yellow! (not my fault ok, blame the dirty water supply :P)

Anyway, it is the Labour Day today. What a bliss to wake up late, had keropok leko for breakfast, and sits in front of the computer (wanting to study but ended chatting with cik tulang on YM). It's the first day in almost 3 weeks straight that I finally got to wake up late and lazying around without having to think of work!

* It's a torturing April. I think I deserve to celebrate the Labour Day today.

* gotta prepare for the mock exam on Monday

*Yeay no work for the next four days!

It feels like a fairy tale! :P

Happy Labour Day!

TRUST NOBODY (do not read this as it contains a lot of medical jargons :P)

2010-04-22T20:53:00.005+08:00

A patient came with recurrent bouts of vomiting for the past 2 weeks. She was jaundiced and tachycardic, otherwise afebrile. Her electrolytes were all hay-wire and she was anaemic with relative lymphopenia. I was scratching my head like HOUSE thinking of what could be her possible diagnosis. Initially I thought could she be pregnant but she denied having any recent sexual intercourse since her divorce 6 years ago. And she told me her last menses was exactly a month ago. So at 3am in the morning when I saw her, I didn't bother to do any Urine Pregnancy Test as she looked quite decent so I trusted her. (somehow!)

But it was to our shocking (and slight disbelieve) when we sent her for urgent ultrasound abdomen today (to look for liver pathology as she's jaundiced) we only found out that she has a pregnant uterus!!!

Kantoi.

Never, ever, trust your patients fully.

And: FIRST INSTINCT IS ALWAYS RIGHT.

1 KM

2010-04-19T21:44:00.005+08:00

It was actually quite late today when we decided to go for a 'jogging' a.k.a evening walk around the hospital area. As we were jogging towards the UiTM Sg Buloh campus this evening, a stranger in his motorcycle stopped us and say,

" Can you turn back? Can you turn back now? This way is dangerous. A lot of foreigners."

" Can you turn back now?"

How scary that can be? He looked like some schizophrenic patients that I know with blunted affect and slight slurred speech (as a side effects of taking anti psychotic) ,but even then, we decided to thank the schizophrenic guy and actually made our way back.

Tak jadi nak jogging 1km! Semangat dah tadi! :P

Optimist. Pessimist. Realist.

2010-04-18T22:17:00.002+08:00

So many things that happened last week has made me ponder a lot lately. Too much thinking until I'm sure my brain cells are shouting for help as they need to rest (hence the 12 hours sleep on Friday night hehe). Anyway, I haven't really replenish my spirit; maybe it's time to buy something new just to make myself good? Hehehe. Believe it or not I've not been to Isetan since the past 5 months (and my vouchers are getting expired!). HELP!! :P

“Be brave. Take risks. Nothing can substitute experience.”

So, which one are you?

Hepatitis B

2010-04-17T15:25:00.003+08:00

everytime nak exam ingat, lepas tu lupa. macamana?

H1N1

2010-04-14T10:52:00.000+08:00

13 TKC students are admitted to the school sickbay and being treated for H1N1. MMph. Should we go for the 1st May reunion back in TKC?

I don’t think I’m going anyway. As I’m praying hard to get a place for the Taiping Hospital Mock Exam.

(tapi tak study pun!!)

I wish I'm a millionaire

2010-04-12T23:25:00.004+08:00

** The TKC_OGA day this year is organizing a hockey friendly match between the old girls and the Kurshians. It has been my dream all year long since I left the school to actually play back the game on the rough and lumpy bumpy field. Unfortunately I only knew the news last minute and unfortunately (again!) I've agreed to change my on call with a friend on that particular hockey match day!!!

Mmph. Frust betul.

** I've missed the boat to register for PACES mock exam in Taiping this May as I was too busy to check online when and where are all these courses gonna be held and by the time I'm ready to check I was too late they've actually closed the registration.
But I bumped into an old friend during the recent NHAM course in Hilton KL last weekend who is going for the course and he actually helped me to get a last minute place and at that moment I was like, "yeay!" and not until today when I called up Taiping Hospital to confirm the place they told me they will need to confirm first. Aiseh.

** A friend is admitted to the ward for Braxton Hicks contraction and I gotta replace her oncall on Thursday. :(

Maybe it's not my week this week.

I'm no angel

2010-04-07T19:36:00.002+08:00

Being on call when you're having fever is really no joke- especially if you are the 'jona' type. I was praying for a quiet night since I wasn't feeling too well with the ever-going runny nose and high grade temperature. But my call was just like the other on calls, or probably worse, with 5 referrals after 12 midnight and I was up and down the fourth floor to ground floor (CCU & The Emergency Dept) the whole night, until 730 am!!! The next day (which was yesterday) I was too zombie to speak, and too burn out to think and to write anything.

Lucky my boss gave me half day off after seeing my face (maybe I really look sick). So I went back yesterday to sleep but was disturbed by 10 miscalls from the hospital from 730 to 930 pm!!!!!

And of course I didn't pick up the phone (sbb malas haha) but was disturbed by another call at 10pm from the Electcom service.

"Selamat malam, ini dr Zaynah ke? Saya dari electcom service, we found out that you did not answer your pager and did not pick up phone calls from the hospital.. Dr oncall kan hari ni?"

SOME PEOPLE CAN BE JUST IGNORANT, or plainly stupid.
I was on call the day before, takkan la I'm oncall the day after jgk? Plus, it wasn't my name in the oncall list! And the electcom people, they know the pager was rosak!
And only after I told her (in a bad mood tone) that I'm not on call then only she realized she wrongly saw the list!!!

Mmph.. siapa tak marah?

Are you using your grey matter, or white matter?

They never stop blaming.

2010-03-28T18:17:00.005+08:00

Too many house officers failed their viva make the bosses angry and look for faults.
Consultants blame the specialists for not teaching the house officers.
Specialists blame the registrar for not doing proper rounds so registrars now have to stay in during their on calls.
Registrars weren't stupid enough to be fooled suggested to consultants that specialists also need to stay in since they are not many reg to take turn to sleep in during oncalls.
So consultants agree that specialists and registrars should stay in, causing them to be angry and blaming the medical officers for not doing their jobs to look after the house officers during their oncalls.
So specialists and registrars came to suggestion that all medical officers should do night rounds every 2 hours in each ward they are covering (mind you one person covers up to 4 wards!).
And only give us so called post call off after 3pm??!!!

WHAT THE *&*(* ??!!!

Tired of being robots.
Maybe I should move on fast.
Or maybe just leave this hospital. Or the service.

Anyway, a trip to Cherating over the weekend to chill around was so much worth it! A great way of Stress- Detox!

I'm ready for on call tomorrow! :P

SSDD

2010-03-20T15:26:00.002+08:00

During my last on call a psycho patient tried to hang himself just outside the bathroom, an old lady at the age of 90 died due to sepsis. A patient with liver disease came with profuse hematemesis, a middle aged man had a heart attack in the general ward, and drug chaser/ abuser collapsed due to pulmonary TB in the hectic ward. I had so much fun during the oncall that I don't think I've recovered until today.
(yet another on call tomorrow!!!)

*hematemesis : vomited out blood

wedding bells

2010-03-12T12:31:00.004+08:00

in the middle of the neurology update course, not much oxygen in here!!
anyway a good friend text me while i'm in the middle of the talk sharing good news she's getting married!!
after all the self conflicts (hehe), i'm happy for you!! :)

Coffee, please

2010-03-11T23:52:00.005+08:00

The weekend is around the corner (yeay!). Looking forward to:

A wedding of a colleaque who was the nicest O+G m.o when I was a house officer :)
coffee with high school friends,
and most importantly; a whole day for sleep payback.

Haven't fully recover from the bad on call on Tuesday. 5 admissions to CCU* in a night plus a patient who just can't stop to have VT** can really make you groggy the next day, and the day after, and the day after that.

+crap forgot that I have to work half day on Saturday!

* coronary care unit

** Ventricular tachycardia ( a form of malignant arrhythmia that if sustain, can lead to cardiac arrest)

Medical School days

2009-07-28T11:19:00.010+08:00

Studying again after completing your primary degree is definitely a challenge, either:

you're too busy at work that you're tired to concentrate;
or you're happy with the money that you don't think it's worth it to spend another few years studying while so many other people can be rich without having to read books;
or it's just another sign of aging that you can't help: your brain just can't absorb things how it used to.

Well I think I chose no 3! Hehe.

Anyway due to my poor concentration ability (to books!), I actually spent some times (to release the stress!) by scanning some of this old photos!

Pantai Malawi: The place that we visited to release the stress (before KB Mall arrives in KB! Hehe)

During study leave before Professional One exam I think...

Photo just before taking our Professional Exam (1) results. Luckily all of us (above) made it.

Wataniah. Part of the compulsary activity during second year. (Those were real M-16 ok!)

This is in Kapit, one of the long houses. (The modern long houses). I also can't remember what is this man trying to do but obviously he's doing a show to welcome us.

A photo with the kids in Kapit.

Haha those were the innocent days! (Tgk muka sorg sorg innocent gila!)

On the boat to visit the long houses in Kapit. Fuhhh.. What an experience.

Ok, gotta go back to books. Exam is tomorrow!! :)

* will definitely scan more photos after the exam yeeeaa...

Not bringing them to your grave

2009-03-22T12:01:00.003+08:00

Sometimes people with title tend to forget that they're not the only one living in this whole world.

They think when they hold some Tan Sri or Puan Sri or Datuk Paduka or whatever title that makes her so great? Those title doesn't give them any ticket to be harsh and arrogant.

Menyampah betul.

Sometimes bila fikir fikir balik, no wonder la some people gets cancer at certain advanced age but the cancer just can't let them die smoothly yet makes them suffer a whole lot. Maybe some people just deserve to be treated like that.

For being so inconsiderate. And not to forget, rude.

Well, you're not bringing those title to your grave anyway. Not even to have them engraved on your tomb stone.

Welcome 2009

2009-01-04T00:25:00.002+08:00

So what did you do to celebrate your 2009?

I was on call and was doing CPR when the firecrackers from KLCC shoot through the skies in the middle of that night.

What a way to start a brand new year. :(

I'm not looking forward for another year as then I just realized I'm not young anymore. Huhu.

Spent half an hour tonight to complete this stack of HOMEWORK. Discharge summaries. Huh. I despise!

Hope it's not too late to wish everyone a happy new year!

Do No Harm

2008-12-09T19:17:00.002+08:00

Treating a patient is not our choice, it is our obligation. But having said that, to treat somebody does not mean to bring them back to life, but to do what is best to minimize harm and at the patient's own comfort and for their long term benefit. Sometimes it's hard to inform the relatives of an ill and dying patient the truth when what they expect was nothing than to bring these people back to life. These people are hopeful with what the doctors can do, but sometimes they also need to understand that we do not play God. We'd do what we can do at our best circumstances as long as it is no harm to the patients. When dealing with a patient who is terminally ill, we opt not to be very aggressive with so many procedures as the outcome will eventually be death. But not everyone can understand this as to some people, death has never appear in their dictionary of life. They refuse to accept the death of their relatives are so imminent not mainly because these people don't deserve to die, but because part of their lives spent with them were mainly filled with full of guilt, anger, revenge, and regrets. And they do not want them to die because they have not got the chance to reverse what went wrong, argh, it's always about the living, not the dying.

I had one patient last week who was dying and you know they will go at any time as the damage is incompatible with life, and nothing you can do to stop that unless she underwent a brain transplant (which is impossible). Yet the relatives strongly requested for us to keep her alive, at least until the next 2 weeks just because one of her son is coming back from USA in 2 weeks time. How can you deal with these kind of explanations? You'd be surprise there are these kinda people in this world.

The living people are always the selfish ones.

A patient who went ill after 30 years on treatment will say,

"aargh 30 years I've been given the wrong treatment!"

instead of saying

"Luckily I was on treatment for the past 30 years, if not I'd have died earlier"

Some people just need to understand that we do not 'blow life' into the soul of our patients. We would try our best, but who die and who survive will eventually be at the hand of the Almighty.

At the end of the day, be it whatever religion; the more closer we are to God, the more easier for us to accept our written journeys.

"Every soul shall have taste of death; In the end to us shall ye be brought back . "

A single dream

2008-11-06T20:56:00.004+08:00

Last week was a healthy week as I actually joined the girls for a run in the lake garden near town. It was a tiring yet fun 4km run, oopss, it was a 4km walk actually. Hehe. There were thousands of people so running could be a bit difficult (memang ramai yg terjatuh langgar orang)..

Well it was the Terry Fox run: named after a young athlete in Canada who suffered from Osteosarcoma of right lower limb (a type of bone cancer) and had that limb amputated yet still go for Marathon in a prosthetic limb to raise fund for cancer research.. Sometimes we just wonder how this kind of people can be so inspired and motivated, and whether they really exist. Haha. Anyway I wasn't really flat after the run, still able to walk through MV with a friend looking for some important gift, not tired until the day I was on call the next day that I felt like fainting at any time! Nasib baik on call not so bad (not so bad pun, the last time my pager beep was at 3 am!)

After so tired of walking

Yup I need to buy a pair of sports shoes I know :)

Cancer is a word, not a sentence.

John Diamond

Not going through my throat

2008-11-02T21:17:00.004+08:00

Weekend moved so fast without realizing tomorrow is another working day. I was on call last Friday and thanks to the one who's in charged of the on call list, I'm on call again tomorrow (crap). Sometimes I do wish I don't have to do on calls (trust me to those doctors to be, it's nothing fun walking around the hospital in the middle of the night while others are having a good night sleep on their dreamland or slumberland or whatever land-mattress for that matter). And the on call food that they served nowadays, is just, inedible!

The merry of Raya Eve

2008-10-03T12:32:00.005+08:00

This year Hari Raya we did not have rendang tuk with chicken, as mama decided to make rendang daging instead. So as usual the night before raya we were busy in the kitchen cooking for the Festive day. I can't understand how people come up with the recipe of making a rendang, so complicated; why would people want to eat them? Hahaha. The process of making the kerisik (grated coconut) is too difficult to analyze, supposed you have to fry them until they become krispy and then kena tumbuk pulak sampai lumat and berminyak (whatthe? hahah).. But our kerisik that night didn't even turn lumat and berminyak even how many hours of banging the mortar and pestle until Izzati decided to surrender the job to me, hahah, and even with utmost diligentness it was still the same so mama decided to leave it as it is. But anyhow the rendang was as good as always anyway. :)

Reminiscing raya during my childhood years, we used to go back to Abah's kampung in Sabak Bernam and during those days my great great grandmother were there to cook the rice in the woven coconut leave casing (ketupat). I remember trying to learn to wove 'em so many times but maybe that time I was too small that I couldn't find it's useful to really know how to do that apart from just eating it; and nowadays we have the most express way of doing it: nstead of rice cooked in a woven coconut leave casing to rice cooked in a plastic cover: easier and faster. ;)

Now don't talk to me about loving mother nature as we only make this once per year :D

The fried grated coconut

Izzati trying hard to make the kerisik

The so called modern ketupat or we'd rather call it Nasi Impit nowadays

It's done! Have a great Aidilfitri everyone!

" Aidilfitri is the day when everyone's striving to seek for forgiveness, forget the dreadful past, be grateful of them, and starting a brand new year and to appreciate it with our loved ones..."

What you don't know can go into your brain

2008-09-20T16:08:00.007+08:00

Neurology is something like mathematics. If you get the correct findings in your clinical examinations, then most likely you gonna get to locate the lesion in the brain or the nervous system correctly. During my on call last week, a young 30 year old lady came at 3am in the morning as she has been having right sided weakness for the past 2 weeks with frequent history of falls. And when she came in she was so confused, with bruises all over her body. Her platelet count was low, yet there was no fever. Her social history was quite interesting in the sense that she's staying with her sister yet she doesn't know what's her job/ who are her friends. Her plain CT brain did not show anything much as to point out to what's the cause. And as she had horner's syndrome with cerebellar signs, we proceeded with the MRI of the brain to see lesion at the level of the brainstem. Just nice on the day of the MRI she deteriorated to almost non responsive to call but only to deep pain.

These are her cuts of the MRI brain and those bright white areas represent abnormal lesions (if you can appreciate below there are ring enhancing lesions scattered throughout the brain matter!)

I've not seen anything as florid like this before and this is classical picture of Cerebral Toxoplasmosis. Toxoplasmosis is an infection caused by an organism ( a protozoa; mainly from cats) that can infect the skin and goes to the blood and reside in the brain). It's not so common to get cerebral toxoplasmosis unless our immune system is compromised. And my gut feeling was right when she came in in the first place. She was tested positive for Human Immunodeficiency Virus.

She was started on the Anti- Toxo regime but the last time I saw her yesterday she wasn't doing well.

So why there are more and more people contacting HIV? Does this show the lack of our public awareness to health? More and more people are so desperate to get jobs and choose the short cut ways to get money instantly by being a crook as they can't meet with the current economy demand? The increase in family crisis that leads to more youngsters into substance abuse? Or just the lack of moral values instilled into the brain of the youth?

"Flowers are the sweetest things God ever made, and forgot to put a soul into. "

Over cooked

2008-09-01T17:51:00.004+08:00

It's the fasting month and I'm going to lose so many kg's again before being able to put on some kilos to prevent the risk of getting premature osteoporosis. Anyway, from sitting on the floor to the study desk and later making myself comfortable with laptop on the bed, my brain is telling me nothing can be absorbed anymore.

The brain became an over-heated-oven after completing 100 questions of cardiology. Pheww. Susah gila, frustrating!

Haha how I wish to eat cupcakes right now ;P

Selamat Berpuasa!

“The month of Ramadan in which was revealed the Qur'an, a guidance for mankind and clear proofs for the guidance and the criterion (between right and wrong).” (Al-Baqarah 2:185)

Anger

2008-08-31T18:40:00.004+08:00

Speak when you are angry, and you will make the 'best' speech you will ever regret.

Independence Day

2008-08-30T16:51:00.003+08:00

The whole of Saturday was wasted as I was figuring out what could be the best and instant remedies for a condition called chronic fatique syndrome. Body aches, headaches, and bloatedness was what I had all day. Couldn't even budge to do anything except for sleeping and lying down as the head was so heavy as if it weigh a 100kg of brain mass (hahah yeah how I wish!)

Anyway, after getting bath and diarrhoea for about 2 times I'm certainly feeling much better now. :D

Blame it on the heavy lunch yesterday! :P

We had a very heavy lunch at The Grand Season Hotel yesterday as to celebrate one of Consultant's last day before being transferred to Hospital Sultanah Aminah JB. (Yup Dr. Sorya, I know you're more than happy to leave, to be your own boss hehehee.. ) The dessert was so delicious and the ice cream was great, and the mussels were just brilliant! I think I'm becoming food fetish now Hahahah. But not that good that after eating so much the brain became so groggy and lazy until today!

The other side of the table. Wow look at Shahnaz, hehe, told ya, it's a heavy lunch..

O it's already the end of August. And it's Merdeka Day tomorrow. The first time ever since working that I got the chance to stay out of Hospital on Merdeka Eve. The previous years I have been so patriotic to stay inside Hospital to work while others enjoying the holiday and the Merdeka Parades hahah. But this year, I've decided to stay at home, even when not being on call, slaving in front of Pastest.Com, trying hard to get that stupid traffic light marks to be on the Green side before sitting for the actual exam! (You gotta be a member of Pastest.Com to get what I actually mean!)

Selamat Hari Merdeka.

*I am still not merdeka yet. :(

Darkness

2008-08-27T11:57:00.004+08:00

"Thousands of candles can be lighted by a single candle, and the life of the candle will not be shortened. Happiness never decreases when being shared."

* I was trying to change the layout into something else sekali semua pun terdelete. Zaty! Where do I find the website for the clock? Hehee.

Have you ever

2008-08-26T13:46:00.006+08:00

Have you ever had so many wishes that you don't know which one should be your priorities?

Have you ever dreamt of so many things yet none of it has actually come true?

Have you ever scribbled wonderful thoughts in your mind yet haven't got the chance to really taste it in real life?

Have you ever doodle so many plans on your desktop yet none of it actually get accomplished?

Haha.

I'm sure you do.

Last few days has been, mundane. Nothing new. Attended Rheumatology workshop in The PJ Hilton 2 weeks ago to bring back free pen supply for the next few months :P

Some parts of the lectures from a Radiologist from the United States.

A token from the SLE Community group after joining as a year member

"Be bold and courageous. When you look back on your life, you'll regret the things you didn't do more than the ones you did,"

A Box of Chocolate

2008-08-14T18:10:00.003+08:00

My oncall this week has been like always, busy, but maybe I've been too long enough now in the rotation that I don't find myself seeing cases too long anymore. Hehee. I had 2 pemphigus patients in 4 days of my on call. (supposed to be 3, but 1 did not eventually turn up from Hospital Ipoh). Pemphigus is a very rare blistering skin condition, so to admit two patients in 4 days I guess just makes the disease looks quite common.

So sad seeing Pemphigus patients. Their skin just peel off easily leaving raw areas that are disfiguring, prone to infection, and of course, pain. And imagine if it affects the whole of your body. They eventually succumb into depression, especially if they are female, and who can actually blame them for that.

Well, to me, it doesn't matter what type of chocolate, I can just swallow all of them (I do eat sweet to dark chocolate :) ). But in life, it's totally different. You just find it's hard to swallow certain things even how many strength you put in to push the things down your throat. There are times when it get stucked half way your esophagus, you can't help but screaming the agony of the pain.

I need chocolates!

Oncall allowances

2008-08-10T19:59:00.003+08:00

Sunday August 10, 2008

Government docs want on-call allowance raised to overtime rate

By DEVID RAJAH and AUDREY EDWARDS

"PETALING JAYA: Government doctors certainly have a lot to complain about, and they’re mostly to do with the much better perks offered by the private sector.

But this time, they are griping about their counterparts who do overtime at government health clinics. And it’s all about a vast discrepancy in the on-call allowance and overtime rate.

Doctors at government hospitals get a RM10 hourly on-call allowance, while those at government health clinics get RM80 for every hour’s overtime.

The hospital doctors say they have to attend to life threatening and emergency cases at casualty units, while the clinic doctors mostly only attend to patients complaining about coughs and colds.

Doctors at government hospitals have to perform on-call duty several times a month, and have called on the Health Ministry to standardise the payment rates.

“The RM10 hourly allowance for on-call doctors is grossly unfair,” said a senior doctor at a government hospital in the Klang Valley.

The doctor revealed that eight to 16 doctors were rostered for on-call duty in most large government hospitals.

”On the other hand, our counterparts at the health clinics are being paid RM80 hourly for treating patients with coughs and flu,” he said.

Other doctors, who spoke on condition of anonymity, said they preferred to serve at government health clinics which have extended operating hours to 9.30pm on weekdays, and from 8am to noon on Saturdays.

“We don’t have to work long hours and the workload is also not that heavy at health clinics,” said one doctor.

A 29-year-old doctor from Malacca said that with the current inflationary pressure, young doctors could hardly survive, especially if they were married with children.

The ministry reviewed the on-call allowance after two decades in 2005.

For weekdays, the on-call allowance was increased from RM75 to RM150 per day (calculated at the compulsory 15 hours of on-call duty which has to be performed daily), while such allowance on weekends was increased from RM113 to RM170.

The ministry started the overtime scheme at 16 government health clinics earlier this year for doctors who volunteered to work from 5pm to 9pm.

This means that a health clinic doctor who volunteers to work the four-hour period will earn RM320, compared with RM150 for a hospital doctor's 15 hours' work.

A specialist doctor cautioned that young doctors may be discouraged from serving in government hospitals if this issue was not resolved.

Health Minister Datuk Liow Tiong Lai explained that “overtime” and “on-call” were different, likening them to an apple and orange situation.

“Being on call is something that all government doctors have to do while working overtime is voluntary. You cannot compare working overtime with being on call,” he clarified.

He said the ministry was not considering raising the on-call rate but pledged to work on improving benefits for doctors to retain more of them in the public sector."

The last statement was :Tettt.. Wrong answer!

Will be oncall again tomorrow :(

And guess what, my oncall claim is not even RM150 per day! (Not even half of that!)

Shalala

2008-08-04T23:14:00.006+08:00

Being me changing the background of my blog so often just shows how bored I am. So sleepy but need to toothpick my eyes open for another 50 pages of what I hate most in Medical School: NeuroAnatomy. Yeah I can never be Derek Shepherd in anyways. :P

Had a long talk on the phone with one of my best buddies during high school tonight. We used to be so close back in high school years, hari hari buat Add Maths sama sama, now she's one of the successful engineer; and I'm not using the Add Maths for anything I do in my daily living :sigh~

Anyway, despite not being able to see each other that frequent, we're able to talk and brag about almost everything, gossip girls, politics, dread things at work, who you despise seeing in office, and your recent weekend getaway activities.

Few weeks back had a few hours with college friends in One Utama Paddington Cakehouse. Enjoying every bits of the talk, even when the food taste lousy as ever (We ordered the wrong menu and it was so so so sweet, and not edible!)

Fahreen menilik nasib...

McD's Coffee is still better (only the 'love' shape of the creamer looks impressive)

Anyway, talking to a bunch of good old friends has always been good. A way to rejuvenate one self. Even when the food sucks. (tapi abis jugak hehee)

"In prosperity our friends know us; in adversity we know our friends"

Palak Paneer

2008-08-03T19:08:00.005+08:00

My sleep has been so good for the past few months. It has always been a good straight at least 5 hours of night sleep, dreamless, not until last night, out of no where I dreamt of the Lady Boss and the Department Meeting and she and her Red Mercedes Benz (haha I have always wonder what car she drives so in the dream it was the E Class Chili Red Mercedes Benz!). Crap. Terus terjaga pukul 9 pagi today and mengeluh it's gonna be Monday tomorrow!

So what's new lately?

1. I'm Yours by Jason Mraz is an awesome song! Downloaded it into my phone and been playing with the MP3 cutter to choose which part is best for the ring tone.

2. Tried the Spice Of India in Midvalley recently; good food. First time eating the Palak Paneer: It's a cottage cheese cooked in butter, cream sauce with fresh blended spinach, well I thought it looked kinda gross macam muntah baby je hahahah but the other party likes it a lot ;P

3. Watched the Journey To The Center Of The Earth at GSC Berjaya today.. Well not that depressing even though at first I thought of watching Brendan Fraser in The Mummy: Tomb of the Dragon Emperor, instead of this one, but it was a good choice though since they said The Mummy sucks anyway.

The whole dish

I told ya it looks like some baby's vomit. Hahaha. But it taste so cheesy.

'Well open up your mind and see like me
Open up your plans and damn you're free
Look into your heart and you'll find love love love'

Why So Serious?

2008-07-27T09:46:00.008+08:00

Weekend is already towards its end, and as usual, the ever dreadful Monday is coming. Tomorrow the Clinical Specialists will have to present their presentations for the National Dermatology Congress in August in front of our Lady Boss. And surely another almost 3 hours of blast and bang before we are going to start our whole week with another frown.

But anyway, I finished another chapter this week and awarded myself to watch the Dark Knights. Well : a very good story line, too many unexpected surprises, and good looking Batman is of course an additional point :), plus the ever annoyed Joker, (the late Heath Ledger should be nominated for Best Actor for Academy Award for making most of us loath him so much during the 3 hours movie!).. It's really worth lining up for almost half an hour for the tickets and ended up hafta go for the Premium one. Haha. I won't say it was a waste as it was really really a 10-thumbs-up-movie. Good work to Christopher Nolan.

My Saturday was well spent indeed with breakfast at The Memory Cafe in Gombak. A cozy place but the food was so so lah! (So to those in Bangalore and Sunway, don't worry too much you guys don't miss a thing hehe). But the Secret Recipe Durian Durian cake was something you should try: I've never liked anything about Durian if it is cooked or being manipulated/ experimented into some Kuihs, jams, Lauk Pauk whatsoever apart from eating it raw, but the cake was something different! As it was a raw durian they put in btwn those soft spongy layers! Yeah how I wish I'd make a good cake one day myself ;)

I'm still thinking what to do today apart from looking at Pastest...
The weather seems so gloomy, baju baju pun belum basuh.
Maybe should go look for kain Baju Kurung for the coming Hari Raya?

But thinking of the balance in my bank after paying all the credit cards, maybe I should put a second thought on that.

Afif with his weird pose haha

The Lime Juice was sweet like honey ok!

How can it was labeled as Best Buy? Haha. Another interesting thing I just discovered: what my new hand phone can do :)

"Life is either a daring adventure or nothing..."

I'm not whining

2008-07-20T09:07:00.004+08:00

Last week was a tiring week as I had a bad 4-days-stretch of on calls. On the first night I had to stay back in the hospital, only to get a nap for one hour, second and third night the nurses kept on buzzing me for some normal blood results until almost 3 am, and the fourth night was rather quiet but it was too late as I've already caught my flu. And during the daytime, a lot of referrals and cases to be reviewed as always.

Luckily, Saturday was a leisure and peaceful day as I was in the house for the whole day, doing practically nothing. Well not really nothing as I managed to finish a 40 pages chapter in the Kumar & Clark, but I have planned to do more than that. But the weather was so cozy makes it to stay awake all the time was impossible!

Working can be so tiring if it is always like this, sometimes being so tired I can't even try to even make a fake smile!

"If someone is too tired to give you a smile, leave one of your own, because no one needs a smile as much as those who have none to give."

Sinful

2008-07-12T11:27:00.002+08:00

In our every day's life, we try not to commit any sins but sometimes it just slipped in no matter however we tried to avoid them. Waking up at 6am after the loud sound of the alarm clock only to snooze it and only woke one hour later for Subuh prayer is an example of sin. Which is avoidable. Gossiping about others in the middle of doing our work at office is another good example of sin. Talking bad about patients to other colleaque is also a simple sin that we doctors do every day. Politicians spreading bad stories about each other (which makes us difficult to believe which are facts and which are tales!) are also very sinful. We lie to save our backs many times is also something sinful.

We know these things are sinful but why do we still do them?

Because sinful things are simply irresistible?
Maybe.

Yeah we had sinful breakfast this morning, very very sinful, but they're simply irresistible. :D

"We are sinful not merely we have eaten of the tree of knowledge, but also because we have not eaten of the tree of life.."

Not a working day

2008-07-11T16:24:00.007+08:00

Another 59 days before I know whether I'm investing for my future, or donating more money to the Royal College of Physician UK. I'm still darn lazy as I was the previous days. Anyway, a bit rejuvenating today as I got a day off to go to the immigration to make my new passport. Yippee I've always wanted to travel the world, at least, this is one step forward in making my dreams come true hahah.

Haven't planned for a real holiday actually.

Anyway, we had good breakfast at McD today while waiting for the passport to be ready. I should say they are quite efficient to have it done in exactly 2 hours as they've promised. And the waiting que wasn't that bad either.

The taste of the strong coffee was enough to make me awake the whole day

"eh ada Kopi tumpah ke?"

Isn't it good to spend every day like this? Chilling at McD, not having to attend clinics in the morning?

I'm done!

Walking back to collect the passport

The tired face waiting for Abah from Friday prayers :P

Well, I did not really take a cab home actually ;D

Darn Lazy

2008-07-10T20:56:00.004+08:00

It's almost a week now that I've been 'blessed' with laziness. Too lazy to think, to read, to work, to shop, to clean the room (yup it's getting into a big store now hahah once Zt is out to Taylor's I cannot have another excuse of blaming her for making it into a store as it is now).. The whole body feels so lethargic and fuel-less.

Maybe I just need a long holiday.

Tired of the traffic jam to work...

And look at my dirty car! Due to darn laziness have not had it washed for almost 3 weeks now!

One of the newsletters for me today..
Maybe I should pamper myself with all these just to rejuvenate the dead lethargic body cells :)

So what shall I plan for this coming weekend?

Too tired to think.

Ongoing Palpitation

2008-06-30T19:22:00.007+08:00

You're gonna have a bad on call if you don't prepare to be on call. Or if you're having continuous palpitation on the whole day that you're on call for no good reason. Like for today, I wasn't prepared to be on call as the forgetful me has wrongly seen the on call roster and thought I'd be on call next week instead of today! And being in Skin Department now, every day is a palpitation day so today I just can't control all my adrenalines from pumping more than the usual 'norm'. So I had like 9 walk in new cases to be reviewed, and 3 referrals to the clinic from the ward, and 2 other ill patients in the Medical ward to be seen as in-patient.

So a total of 14 referrals for a Dermatology on call.

I am so going to win the 'Jonaness Award' if there is any.

And having constant palpitation throughout the day was no good at all. I could not think properly, especially when being bombarded with questions. (as I'm not prepared and being not prepared is always not good for me).. So one of my patients was a HIV patient who was an ex drug abuser, came with 1 month history of itchy skin papules. Initially he had few vesicles but now it's more of excoriations than anything else. All I could see was just excoriation marks with few urticated base.

" So what are your differential diagnoses?", the Dermatologist asked me.

I don't know why I could only think of one thing: Dermatitis Herpetiformis; yeah well it's so rare and it's verrrrry unlikely, and it should be wayyyyy down the list, I know, but I was so having thought block I could not think of anything else.

"Mmpph, okay, accepted. But come on... what are your other differentials?"
"M'am won't like it if you cannot give more differentials..."

He said again, reminding me of our Big Boss, not to any help but to make me more tachycardic. And I added 'scabies' as another answer. And deep fungal infection.
Now it's more likely.

So anyway I got a long lecture of different skin disease that I should know in HIV patients, and I was repeatedly told that I should've known them by now after 2 months in Dermatology. Crap.

"Eosinophilic Folliculitis"
"Acute Retroviral Syndrome Exanthem"

2 new things that I don't think I've read before, or even if I did, I could not remember reading them anymore.

So the patient was diagnosed with Eosinophilic Folliculitis, an idiopathic, extremely itchy, papular follicular eruption, seen in HIV patients, which was exactly what he exhibits on his skin.

Yeah now it's extremely more than just Tinea, Psoriasis and Eczema!

Just some photos when I googled the Net.

Now gotta go get ready for the evening good night rounds to the patients.
Argh I hate on calls!

//Can't wait for Thursday for the on calls to be over.
///O and I need to borrow Zaty's handphone for the next 4 days during my on calls: Poor
Izzati. Maybe the next four days you should play with YM je la eh? :D Thank you! (I'll get my handphone repaired before you start your classes- Don't worry! :P)

Social Stigma

2008-06-18T23:42:00.004+08:00

One of the patients in our Tumour Clinic today came all the way from Sg. Petani to get treatment for his skin condition. He wrote to the Prime Minister Department that he wishes for something to be done to his skin as it is causing him social stigma. He did not ask for much, just to get few huge lumpy bumps removed and leave the small ones as they tend to recur anyway.

Seeing him walking across the room, all of us felt the same thing: Be grateful that your lumpy bumps on your face are those small tiny jerawats as others are suffering even more!

Of course this is not the real patient, this photo is the one I got from google search. But truthfully, it can be much worse than this!

Dreading Monday...

2008-06-15T19:28:00.005+08:00

Psoriasis and Calcipotriol

2008-06-15T15:19:00.003+08:00

The bread and butter in Dermatology. Almost every patients that come to the clinic are suffering from Psoriasis or Eczema.

Psoriasis is a chronic inflammatory, non infectious, skin disorder characterized by salmon-pink plaques bearing large adherent silvery centrally attached scales.

So Calcipotriol is a Vitamin D analoque, exhibits a Vitamin D like effects by competing for the 1,25,OH2D3 (active form of Vitamin D) receptors. It is as potent as the naturally active form of Vitamin D in regulating cell proliferation and cell differentiation, but much less active than the active form of Vitamin D in calcium metabolism.

Calcipotriol induces cell differentiation and supress proliferation of the keratinocytes, with no evidence of cytotoxic effects, thus reversing the abnormal keratinocytes changes in Psoriasis. Therapeautic goal: Normalization of epidermal cell growth. It also inhibit synthesis of Polyamines.

It does not cause hypercalcaemia when used in therapeutic dose. As such, only to be used for mild to moderate Psoriasis affecting less than 40% of skin surface area.

Can't be used on the face - itch and erythema.
Can use up to 100g/week.
Can't use longer than a year at a time.
Monitor serum Calcium/ Renal function 3 monthly in all patients on topical Calcipotriol.
Not recommended in pregnancies : No studies in human but studies in rats shows abnormal skeletal growth.

Side effects:
- photosensitivity reactions
- skin discolouration
- bullous eruption
- skin exfoliation
- contact dermatitis
- hypercalcaemia (rare)

Daivonex cream: 50microgram calcipotriol per g in a smooth, white cream base. Available in tube 30g and 100g.

I'm supposed to read this topic for tomorrow's teaching session but too lazy to make my own paper notes so I thought I'll just post it in the blog :)

Still got another topic to read!

I hate Monday

2008-06-14T13:11:00.001+08:00

As a reward to being able to finish whole chapter of Rheumatology in Clinical Medicine Kumar & Clark today, I made my way to Pavillion at 330pm to catch a movie. Doing Every-Other-Day-Calls in O+G, Shiraz decided to watch something that can make him laugh without the need to use any part of the brain to think about the story line, so we lined up for Kungfu Panda. After about 1 hour, it was to our disappointment that there were no more tickets for the 515pm show. It was 430 at that time, believe it or not we actually beratur again so that it would be just nice to reach the counter again at about 445pm to catch the uncollected reservations. Yeah maybe it was my day that we were lucky enough to eventually get good seats to watch the movie: row no 5 from the back!

So just one step before handing in our tickets, Shiraz got an emergency call that he need to go back immediately.
Haha there goes the Kungfu Panda! We managed to sell the tickets to a Chinese couple who agreed to buy them at no discount rate. (but no one would agree to buy the 1L coke and Popcorn ;) )

So here I am, in front of Pastest, in hoping to complete 100 questions today.

Argh Monday is so near!
Need to read about Calcipotriol and Neotigasone for the Monday morning teaching with the Lady Boss!