Count down to Beijing....6 days

Didn't juggle my time too well today. Though I finished the ward rounds in record time (I call it the Tsunami rounds..don't worry, patient care and welfare were not compromised!), and I did manage to go to the cardiac conference, I was late coming back to the asthma clinic!

I managed to sit through a one half hour talk on obesity in children and adults and it's management. I also managed to sit through 35 minutes of a one hour talk on metabolic syndrome and it's cardiovascular impact (sponsored by GSK). I also managed to browse through all the pharmaceutical booths, meet up with old friends, exchanged greetings and gossips (heh heh) and picked up a few freebies (the pickings are lean this time round....no car up for grabs for instance...heh heh).

What I failed to factor in was the horrible jam near the UM KL gate entrance! It being a Friday and many a pious people were congregating there for their friday prayers. The only bone I want to pick with them is their lack of civic consciousness in parking their cars and also thier callous attitude in jay walking all over the place causing a massive jam! Ugh!

Ok, the steam has been let out. I feel better. The asthma clinic is over. We had just over 40 patients which was more than manageable. I am going to the gym, then wash up, and head for the dinner symposium at KL Hilton (courtesy of Pfizer). And then...I am going home....where my heart is most happy! :-)

And my mind is already dreaming of Beijing! Another 6 days to go......

Time juggle

Didn't sleep well last night. Went for a nice dinner with an old friend followed by an hour of massage at a nearby blind traditional massage centre. The massage was ok, could be better but not too bad. The masseur who used to do it for me has left for home (he was from Sabah) and I had a new guy who did an ok job.

I received a notice from the department yesterday evening telling me that I have to present the proposal of my thesis next Tuesday! That's really short notice! I have, let see, 3 days to prepare it!!! Arrgh! Was suposed to start on it yesterday but the entering of my thesis data collected from yesterday's clinic took too long.

Today the NHAM Annual Scientific Meeting starts officially. I plan to go immediately after rounds and stay till maybe after 1 pm before heading back here to run the asthma clinic and then maybe go again after the clinic depending on what time the clinic ends. It's going to be a long day. Ideally I would prefer to be at the conference full time but I doubt my colleagues in the chest team would take this too kindly...

The weekend is nigh! Yeah! Can't wait to head home and see my family. A week seems like ages.

Another miracle!

I believe in miracles! The clinic I dreaded this morning turned out to be not so bad after all. It's half past 3 now and the clinic is over! Instead of 200 patients, only 173 turned up! And instead of 6 doctors, 9 doctors turned up (though some left early and some came late). And the only complaint I had was from a nice chinese gentleman who complained that he was hungry. He was my thesis recruit number 352 and the last to leave my room.

Suddenly I feel happy. :-)

Gonna go and attend a briefing given by the travel agent for my trip to Beijing next week. I am beginning to feel excited going there!

Cardio clinic day

Another cardio clinic today....and one that I don't look forward to. Why? Because I heard there will be about 200 patients coming today. That's normal you say but considering the fact that today is the pre-congress meeting of the NHAM Annual Scientific Meeting at the Hilton KL (NHAM: National Heart Association of Malaysia) and the fact that most of the cardiologists will be at the meeting (some one conveniently had an 'oversight' and forgot to cancel or cut down the patient load in the clinic); the clinic today will be run by a skeletal team of junior doctors and 2 specialists who will be staying back (God bless their souls!).

Am I mad? Yes, but I am also resigned to the fact that things are not reversible now. Just put on a brave front and plough on. I would expect many angry patients today and equally angry and frustrated doctors and nurses today. I wonder what time the clinic will end. There will be about 5-6 doctors seeing 200 odd patients; each patient takes anything between 5-30 minutes; so, you do the maths....

Another lunch talk

Was just informed that there will be another talk today over lunch. The topic is 'Dengue' and the speaker will be Dr LH Tan, one of our ID physician.

I was going to pop over to my favourite eating place across the hospital. The place is called 'Rumahku' (my house). It's actually a gallery cum cafe. It's been one of my favourite haunt ever since it opened some time middle of last year. I love the quiet ambience, the friendly host, the resonably priced tasty food and most of all, the aromatic divine bru coffee!!!! Looks like it will have to wait till another time.

I wonder if there will be food later at the dengue talk. I hope it won't be a heavy lunch! I am getting tired sucking in my abdomen all the time!!! It's going to give soon at the rate I am eating! :-P

Salmon and Crab

Went for dinner talk last night at the Le Meridien in KL. It was sponsored by GSK and the speaker was Prof Soren Pederson from Denmark, a well known authority in the field of asthma management. He is also a paediatrician. The talk was on 'Asthma Management - What the present holds for the future' (or something like that). I think it was a good talk.

The dinner was very good. Le Meridien's food has always been delicious. They usually serve continental dishes. The menu went like this:

Starters: Bread with butter. All kinds of bread.
Smoked Norwegian salmon on minced crab meat, surrounded by mango salsa and jumaico sauce (whatever that was; but it was tasty!)
A clear soup with mushroom and minced chicken meat inside in a cup. You have to dig up the mushroom using a bread stick coated with parmesan. No spoons available!
More bread with more butter.
The main course was lamb done medium rare with a chunk of cod fish sourrounded by all kinds of I-have-no-idea-what-they-are but all very tasty.
Desert was tiramisu with a strawberry, more funny and tasty sauce; and a tiny cup filled with chilled yellow lliquid (I know it sounds gross...considering the talk was on asthma!) which tasted divine!
This was followed by chunks of chocolate and cheese cake.
And finally coffee and tea.

I skipped all the cheesy materials and coffee and tea. The former gives me one major migraine and the latter, if I took it, would have had me staring at the ceiling with insomnia till next week!

Thank God I hit the gym before the dinner but I doubt the workout I did was enough to burn all the extra calories I put in last night.....feeling loads of guilt now. Sigh.

Long day ahead...it's chest clinic today. No time to hit the gym again. The waist line will just have to expand a bit. Sigh.

Lunch Talk

Just came back from a lunch talk sponsored by Wyeth in the hospital. The title of the talk was 'Prescribing & Education Strategies in an Era of Antibiotic Resistance" by Dr Tan Thean Yen, a Consultant Microbiologist at the Changi General Hospital in Singapore.

The talk started with a buffet lunch outside the lecture hall after which about 30% of those who actually partook of the lunch went in for the talk. While the talk was interesting enough, the data and information presented were not new. A heavy lunch and a darkened ambience in the lecture hall can lull anyone to sleep. Thankfully midway through the talk, some one dropped her very heavy bag with a loud thud on the floor and we were all jolted out of our skins. I suspect the speaker and the bag-dropper acted in cohoot!

I enjoyed the talk. The speaker spoke the same old things in a fresh way. I guess we need to be constantly reminded of good clinical practise and a little revising once in a while is good. I won't bore you with the details of the talk. I did, however, enjoyed the last slide put up by the speaker and I wish to share it here with you. The pic above was badly taken (perhaps because my calories-laden fingers haven't quite woke up from its slumber). I will write it out here....

A Brief History of Medicine

"Doctor, I have an infection..."

2000 BC "Here, eat this root"

1000 AD "That root is heathen, here, say this prayer"

1850 AD "That prayer is superstition, here, drink this potion"

1940 AD "That potion is snake oil, here, take this antibiotic"

20?? AD "That antibiotic is useless, here, eat this root"

Scary isn't it? I think some day we will probably run out of antibiotics to treat infections and the humble microbe WINS!!!

Angels in America - Disc 2

Remember I wrote about this HBO serial earlier? I mentioned that I loved it. I also mentioned that I could not watch the second disc containing the remaining 3 chapters on my notebook. Some time after coming back from Redang (which now seems like a distant memory), I managed to watch the 2nd disc, thanks to my cheap but reliable portable DVD player.

Now that I have watched the entire series, I would like to revise my opinion. My verdict is, if you are going to watch this show, then just stick to the first disc and be left happy and wondering the remainder of the chapters contain. Perhaps there is a reason why the 2nd disc would not play!

I think the story kinda went down hill from chapter 4 onwards. The sight of the angel copulating with the guy with AIDS was little too much for my conservative mind. Never mind that it turned out to be a wet dream. Chapter 5 was a blur. Chapter 6, this guy with AIDS goes to heaven and confronts the multitudes of angels there! Seems that GOD has left his throne a long time ago, leaving His angels the formidable task of running both heaven and earth. And what a mess they have made it. HIV and AIDS made its appearance and people suffered. GOD showed no sign of coming back. The angels were all clueless. And Meryl Streep's Mormon mum character even had a lesbian-like encounter with the same angel. That really grossed me out.

And this guy (I forgot his name) with AIDS was there in heaven cursing God and actually called Him deragatory names...like the 'B' word that rhymes with Custard! To me, that was blasphemous! Never mind that this was a show and the director was probably trying to portray the anger, the hurt, the angst, the frustration of this guy. And yet, you know, even if I am in that guy's shoes, I don't think I can ever come to a point where I will curse God! I remember Job in the Bible, and what a contrast he was to this guy.

The show ended badly. At least for me. One of my friend who has seen it before, said it was all 'artsy-fartsy' and I do agree. The story could have been a lot better. The fate of the Mormon guy who came out as a homosexual was never fully explored. Too many loose ends and it felt rushed at the end. Al Pacino's character died early and never did repented.

I don't think I can ever curse God. You know why? Because for all the hardships that I may have endured or have to endure; for all the seeming injustices that I see around me; all the pain and hurts and sufferings of the world, I know in my heart that God is good. He has always been good and loving. He is not absent in heaven. He knows our sufferings and shares our pain. Some day all these will pass away. Some day all tears will be wiped away, all pain and sufferings shall cease. Till that day comes, I know that my 'God is in His heaven and all is well on earth' (to quote Bertie in the popular 'Ask Jeeves' books).

LOCUM IS NOW LEGAL

The Health Minister dropped a minor bombshell over the weekend. Locum, or moonlighting by doctors, a practise that has been going on for donkey years is finally legal. Almost everyone I know does locum, usually after office hours or during the weekends or on their annual leave. The reasons given by the Health Minister and the DPM on why it's finally allowed were a little hard to stomach. He said it's because:
1. It's hard to 'catch' those doing locum; therefore difficult to enforce the previous ban.
2. It's to prevent government doctors from leaving the service as now they can still work for the government and have some extra income on the side.

They tell me 2 things. First the ministry has no enforcement power at all or they have turned a blind eye to this practise for years and years. Secondly, government doctors have been doing locum for ages and still they are leaving the service by the droves. Obviously somethings other than monetary gains are contributing to this exodus to 'greener pastures'.

The Consumer Association of Penang fired an immediate salvo. Actually I would have been shocked to death if they didn't say a word! They must have a word in for every issue, making them like the proverbial sour grapes. Suddenly they are concerned about 2 things:
1. Patient care might be compromised.
2. Doctors might not be getting enough rest!

Again, I have a bone or two to pick with the above. Like I said, doctors have been moonlighting for years and still worked in the government hospital. And patient after patient has come and gone, treated by the very same doctors! I think our record has been very satisfactory thus far.

The second reason almost had me rolling on the floor laughing hysterically and also bitterly. Suddenly people are concerned that doctors are not getting enough rest!!! What a joke! What a sick joke actually. We have been complaining of the extreme workload and stress, zero family time, zero promotions and zero scope of career expansions (except those lucky ones born with golden/silver or even platinum spoons in their mouth) for donkey years and everyone just kept quiet. And now suddenly when they announced this locum thing, they suddenly became so caring. "Our doctors need to rest, since they work so hard and long hours!" Phoooeeee....! I think amongst all the Group A professionals in the civil service, doctors are the ones who has been constantly treated like dirt. For instance, Group A professionals are entitled to an office; we don't even get a locker!

Truth be told, nothing has changed with the announcement. I think it's even more difficult now since in order to do locum, one has to get the approval of the head of department. I am not sure how many heads out there will be willing to approve it.

Think logically for a moment. Is there anyone out there who relish doing more work, sacrificing time and rest and even family time together to do locum? I really don't think so. The heart of the matter is, none of us like to do locum. So why do it? Because for many of us, it's not a matter of the extra income, it's a matter of life and death and making ends meet at the end of the month and paying that extra 30 sen for petrol! Why? Because the salary that government doctors draw is pittance!

I have been doing locum for as long as I could remember. I don't like doing it but sometimes I have no choice. The extra money helps in paying for this or that bill; or to pay for some thing that always crops up. If I can have my way, surely I'd rather spend time at home doing something more productive than to continue seeing patients beyond my office hour in some clinic somewhere.

Think about this too.....if the government bans locum and enforced it, I think the majority of the clinics in the country will have to close down. The locum doctors are the back-bone of the private clinic business!

So don't judge us. I think the government would do well to study why doctors continue to leave the service and not put the finger on locum practise. There are so many factors compelling doctors to leave. I left in 2000. Ask us why and we will tell you..... Just don't presecute us when we show and tell....

Horrible call

Had a terrible time on call last night. So many ill patients and so many referrals. Things come in hatricks I suppose. I had 3 patients bleeding from all kinds of orifices...tracheostomy site, rectal, massive hemetemesis (vomiting of blood)! Sigh! All are still alive! Thank God!

I was paged repeatedly all night for very mundane stuff which did not need my input. Sigh. But still, being on call is being on call....meaning I have to be available at all times. I accept that.

I have a throbbing headache (left side....the beginning of a very unpleasant migraine), a large tongue ulcer (I hate them but get them all the time) and a very uncooperative pair of eyelids which falls intermittently. Gonna drive home now. Gonna take my family for breakfast. Probably will spend the entire day out with them.

God, give me strength and alertness to drive home safely and to spend time with my family. The most joyous moment about going home is the sight of my smiling wife and my kids hopping up and down at the gate in utter happiness. Only kids can do that. It wouldn't work if an adult hops up and down. People would probably think he/she has lost it. :-)

Have a happy weekend everyone!

PS: I managed to upload all the 'under-the-sea' pics last night. I have also mustered enough courage to post a pic of myself and my friends. It's not everyday that one sees a physician (much less 3 of them!) dressed down....to barest minimum. He he!

Final posting on Redang - Under the Sea!

Sash bought an underwater camera for RM 50 at the hotel. It has 26 shots. Unfortunately we aren't professional camera people and I really didn't expect much from a disposable underwater Kodak camera. So here are the pics (the clearer ones were taken with a digital camera). Frankly I feel the camera did little justice to the wonders and beauty I saw while snorkeling. God's creation is truly truly beautiful/ You gotta see it for yourself to believe it! There were many things that I saw but could not reproduce here because I was not holding the camera. For instance, I saw the giant Maori Eel and also the Giant Garupa fish. The sights were truly awesome!

Posing with one of the beach boy while on our way to the Marine Park.

Zul and I in the sea. Look no life jacket! You can easily float in the sea. I had to lend my life jacket to Hanizam who joined us for the trip (he stayed in the Laguna which only had one trip and he wanted more!)

I believe these are called 'Sergeant Major Fish' because of their stripes

Me feeding the fishes. Once a garupa swam towards me and wanted the bread I was holding. It looked so menacing, I practically gave it the whole loaf!

Some of their bites can be rather painful, especially the larger fishes. Scary...

Sash feeding the fishes....actually it looked like the fishes are feeding on Sash!!!!

Finding Nemo? In the pic below....

This the guy who took a number of the pics for us as he could dive down deeper being an experienced diver cumbeach boy. He was also the one who caught the little clown fish. If you look at his left goggle, you can see a little nemo inside! Don't worry, the nemo survived but may be a little traumatized swimming so close to a human eye ball!!!

Handphone pics

Just got these pics from one of my friends who stayed at the Laguna. They were taken with his handphone. Thought I will just show them here. It's the Laguna resort and it's beach front. Rather impressive when taken from a higher angle. :-)

The under-the-sea pics will just have to wait till I am back next week. Had a horrible call so far. Loads of referrals and very ill patients. Sigh.

2nd last entry on Redang

Having a headache since waking up today. I don't know if it's psychosomatic. I always feel unwell when I am on call! I think it probably is. Tomorrow when I am done with my call duties, I would miraculously recover!

Am trying to upload some more pics here today using one of the pc in the hospital. If u see any pics at all, that means I was successful....


Yes! Managed to upload this one (after like 100 trys over 3 days!). The sign board say 'More More Tea Inn'. I am told that this is the place where they filmed that popular chinese serial called 'Summer Holiday' starring Richie Ren and Sammi Cheng. I vaguely remembered watching one or two episodes of it. I am not really a fan of the two actors (actually I hardly ever watch chinese shows), so I can't really comment. The women trying to put their head onto the mock up board here are obviously having a grand time; though I think they may have a gender crisis issue.

Water is precious on the island. In fact, the water that comes out of the taps are a little salty. The water in the hotel where I stayed was from wells (one of the beach boys told me). In fact, I am told the entire island is closed twice a year,in February and September, mainly to conserve water and because at that time, it would be the peak of monsoon and therefore fewer tourists. This sign found at one of the dive centre nearby is a humourous take on the water situation there! I suppose you can even buy a boyfriend there, or at least hire one! Heh heh!

A row of chalets seen on a nice deserted beach. This pic was taken on the way home, on a speed boat. I think it would be nice to eventually retire to a place like this. Life would be carefree with plenty of sun and fun. But I reckon I would be sick of eating tender coconuts after a while...

The weather reflected our mood when it was time to go home. It was all dark and gloomy; but midway through our journey back to the mainland, the sun broke out between the gloomy clouds. What a sight it was. Things weren't so gloomy any more after that.

One final look at the island paradise that we spent 3 glorious days in. Some day I will go back there again....and it won't be for some conference or for just 3 days. :-)

Some of us didn't even have the energy for a last look and instead drifted off to slumberland. Fun can very tiring...

It would be an unpardonable sin not to stop and buy some dried 'keropok' (crackers) from any of the hundred of stores by the road side. The keropok lekor is a well known delicacy in Terengganu as well as the other 2 states in the East Coast of Malaysia. I think the state economy survived mainly on it! The keropok lekor looks suspiciously like a very dehydrated sea cucumber but is made of fish paste and taste delicious especially when dipped in a special sauce.

Ok, that's about it. The final posting on Redang will be about snorkeling and all the wonders under the sea...

3rd last entry on Redang

Lunch at the Redang Beach Resort was buffet style. You just pile up everything on your plate and woof it down! It was delicious! Real home cook food! Everything is DIY here, so you gotta take your food, and drink and after you are done, you are expected to return the plate and glass to the wash area. Thankfully we didn't have to wash them as well!

There was a commotion near the open air restaurant that night. A bat has evidently planted itself on one of the many coconut trees there and proceeded to eat one of the fruit (must have been a rotten one....I don't see how the blind fellow can crack open a young tender coconut!). The pic is bad I know. I blame it on the darn creature who refused to pose for me!

The building at the far end is Block B where my room was located. The building on the right is the dive centre and on the left is the open air cafe.

Ok, I give up. I have been trying to upload a picture for the past 20 minutes! No luck. Maybe another time....

Gotta get back to my work.

A small miracle

When I found out that there would be 198 patients at the cardio clinic this morning, my heart sank. Last week the clinic finished at 6 pm when there was 205 patients! So, it was a pleasant surprise to realise that when I let 'thesis recruit' number 318 out of my room, there was no more folder waiting!!! Clinic finished at 2.20 pm which is indeed a miracle. I suppose the reason for this is because today all the cardio doctors turned out in full force and so we could finish the lot faster. How I wish every clinic is like this! :-)

Am getting a bit tired of writing about Redang, so I am just going to upload a couple more pics and call it quits. Actually I took about 170 photos and a few video clips!!!

Late!

Woke up late today..again. I swear the alarm clock did not go off. Sigh! Thankfully I managed to reach here at 8 am sharp. My blood was already boiling by the time I reached. KL roads are just full of inconsiderate drivers. VIPs I call them. Very Idiotic People! People who cut in from your left are the worst! Hate them!!!!! AAAAAAAAHHHHHHHHHHHHHHhhhhhhhhhhhhh!

Ok, I feel better already. Cardiac clinic today. Sigh! My patient recruitment for my thesis has reached 305. I plan to call it quits at 400. So the end is not too far away.

Gtg! Ciao!

A Pictorial Guide to Paradise

Like I said earlier, I am tired of writing. Not that I don't like to write. I love to write actually. I find it therapeutic. Better to let out my angst here than to shout at patients or relatives of
patients and get a multi-million ringgit suit right? So, it's going to be just pictures for a while.




We had to wait for our boat to take us to Redang at the jetty.

We boarded our speed boat and dutifully put on our life jacket. Wouln't want to be found floating in the south china sea would we? I am sitting next to Sash.

After 45 minutes of heart thumping, gut wrenching, butt bumping ride on the speed boat, we arrived! The ride was real fun. Totally enjoyed it. None of us threw up or had a heart attack. There was a minor scare though midway when a very nauseated house lizard crept behind one of us along the ledge of the boat. The person (which shall remain unnamed) jumped up and dropped her handphone.....onto the boat. Phew! Thank God it didn't land the other way into the sea! Nearly crushed the poor lizard in the process. I don't think the poor critter vomited but it sure had a strange color!

If you can see the bottom of the a boat floating on the sea, you know it's going to be great!!! I don't think I have seen such clear sea water anywhere else in Malaysia (definitely not in Port Dickson!)

From the jetty it's a 10 minute walk to the Redang Beach Resort. We had to walk across the Laguna Beach Resort (LBR) to get to our hotel next to it. The next 3 pics are of the beach in front of the Laguna. Will show the Laguna hotel building next time (not in my thumb drive la! Darn!)

And then, like entering another world, we reached the beach front of the Redang Beach Hotel. The atmosphere became low key, laid back and lazy. Hammocks greeted us, swaying gently in the tropical breeze...

By the way, the tractor was used to transport our bags. An ingenious way of mass transportation. We, of course had to to walk on the soft white sand. We go snorkeling on those boats you see above.

You can see the Laguna in the distant.

The sign boards can be very confusing for the uninitiated....

I think I will stop here. The wifi is taking forever to upload one lousy pic! Sigh! I just weighed myself just now after the last chest patient has left my room. My weight is now 71.2 kg! Aarrgh! I have gained....200 gm! in Redang. I am going to hit the pool now, haven't swam in ages. Snorkeling doesn't count. Strangely, my pants feel lose, so I am really hoping the extra flab has gone to more desirable spots on my anatomy rather than my 'love handle'.... Chuckle...!

Redang Beach Resort - continued

Some of my colleagues complained about the 'lack' of facilities in this resort. Some of them made arrangements to be 'relocated' to the Laguna next door, a "proper"hotel. Me? I don't really care. I am just thankful that I could be at Redang and also to attend the MEMS.

The RBR grows on you. True, it does lack certain facilities; but I believe the resort was established to cater to a different kind of tourists. The Laguna is more suited for conferences and people with families tagging along. The RBR caters for the more 'adventurous type' and I suppose the younger lot who wouldn't mind roughing out, people who went just for the fun, sun and plenty of snorkeling and partying and only use the room as a place to rest their heads when the merry-making is done.

While the ambience at the Laguna was rather formal, at the RBR, it was rather relaxed, laid back and even bohemian. There's an air of nice lazy slumber. The beach front is dotted liberally with hammocks hanging from every available palm trees. It's just heavenly to lie in one and make it sway a little as you soak in the tropical sun and read a good book (in my case, I was reading Man and Boy by Tony Parsons, of whichI wrote about earlier). Ah, the bliss!

I would have loved to get one of those hammocks hung up in my garden at home but I think there wouldn't be any space left for anything else, since my garden is the size of a toilet.

I think I am done writing. If and when I find a decent wireless connection, I am going to just upload tons of pics and write like 1%. Afterall, a picture tells a thousand words.

3rd day post Redang today. And it's chest clinic day. Ugh! I am slowly assimilating back into the urban jungle, just as slowly as my tan is fading away. Sigh...