In My Father's Footsteps

Happy Birthday Darlene!

2007-04-21T20:58:00.000+08:00

Since the pictures wouldn't 'stick' on Wordpress, I have to publish it here! See how my girl has grown! :-)

Blogging Out

2006-06-21T00:20:00.000+08:00

I have decided to stick with my new blog for now. I won't be writing anything in here for a while. Do drop by my other blog if you are free. It's at http://jimbocyberdoc.wordpress.com

Cheers!

Signing out. Jimbo OUT!

Hallelujah! My blog is FIXED!!!

2006-06-15T16:34:00.000+08:00

Yes! Some kinds souls have offered to fix my blog and they did! In less than an hour. Impressive!

It's so good to see the blog as it used to be.

But now I have a dilemma. Which blog should I continue to use to post my entries? I kinda have grown fond of the new one, though initially it was really tough using it.

What do u think?

Which one, which one?

Winding down

2006-06-15T15:58:00.000+08:00

Work's done for the day. I am waiting for the water to boil so that I can have a cup of expired instant mushroom soup (the expiry day was a few days ago, so I figure it should still be safe to consume) and later drive home. I am off tomorrow, my first leave in about 2 months. Really need the break.

My better half has been sick the past few days. It's like a neverending cycle, first kid no 1 gets it, then kid no 2 gets it from kid no 1 and then mum gets it from kid no 2 and then kid no 1 gets it back from mum….you get the picture. I am just hoping and praying that she will be up for the trip. If not, I am thinking of not going altogether. Better that she get some rest than to make a trip feeling sick all the while.

Some kind souls have offered to repair my old blog. For that to happen, I had to surrender my user name and password. Sigh! I guess it's ok I doubt anything in my old blog can even be remotely considered scandalous. And, I doubt my trusted friend will post anything in a similar vein. (if he does, I swear it's not me!!!!).

Have a pleasant weekend everyone! I'll be back on Monday. :-)

Football and The Metabolic Syndrome

2006-06-15T12:20:00.000+08:00

Found this pic on the net. Everyone is caught up with the World Cup now. I am not really a football fan but once in every 4 years, I get a mild dose of football fever as well.

I suspect the majority of people who watch football don't actually play it! Therein lies the danger. I think if only our occular muscles get exercised during this World Cup season, we are going to see a lot more people with metabolic syndrome! :-)

Fallen Comrade

2006-06-15T10:57:00.000+08:00

He passed away last night, succumbing to the ravages of AIDS and its cohort of opportunistic infections. He fought long and hard and we fought beside him all the way. I feel sad. A very young life prematurely cut short. The healings that could have come from his hands have been denied.

Still, in a way, I am glad that his battle is over. Ironically, he is now free from the suffering wrought through his diseased body. Set free by death. That's ironic.

John 8:7

2006-06-15T08:10:00.000+08:00

A fellow blogger sent me this article by email. It is in reference to the entry I made yesterday (Padan Muka). Have a good read.

Who's guilty?
by John Fischer

Jesus once set a guilty woman free from her accusers by showing that the people who were judging her were just as guilty of sin as she was. "All right, stone her," he said to the religious leaders who were ready with stones in hand to deliver the judgment she indeed deserved. "But let those who have never sinned throw the first stones!" (John 8:7 NLT) This incident shows us something very important about our purpose as followers of Christ. Our job is not to throw judgment upon people but to identify with them. The Pharisees and religious leaders were trying to separate themselves from this sinful woman they had found in the act of committing adultery. By judging her, they were going to be able to feel much better about themselves. Jesus put a stop to their little charade by putting them in the same boat with the woman they were accusing. They were just as guilty.

It is so tempting to think that we are better than other people. We love soap operas and reality shows where everyone's life is so despicable, we can feel better about our own lives. But whenever you start to separate yourself from sinners, you forget that it was your sin that brought you to Christ in the first place. I know this because I'm so good at it.

The Gospel comes best from people who identify with the sins of others, because they have become so familiar with their own sin. It is noted in the account that as the self-righteous leaders were convicted by the presence of sin in their own lives, "they slipped away one by one, beginning with the oldest." (John 8:9 NLT) That makes sense. The oldest would be the ones most aware of their own sinfulness. There comes a time in your life when you can’t fool yourself anymore. There were probably a few young, arrogant idealists who hung on as long as possible, but even they had to finally give in to the truth about their own guilt and drop their stones.

The proliferation of both spoken and unspoken judgment found, sadly, within Christian communities has forced many into the world, unarmed and without a known Christian friend and mutual sinner. Christians are constantly trying to separate themselves from a world that Jesus wants them in. Jesus wants us to see our own sin and not make such a big fuss over everyone else's. Our sin nature is our connection with everyone else who struggles in life, our salvation is our hope, and the Good News of the Gospel is our message.

Anyone can spot a mile away the hypocrisy of proclaiming a gospel about the forgiveness of everyone’s sins but your own.

Dead Tired

2006-06-14T17:20:00.000+08:00

I am post call today. Hardly managed 40 winks last night. I am so tired. Work just got over. I wish I have some extra cash to go for a massage but my hospital has not paid my call allowance and my travel claims for the last 2 months or so. Sigh!

I will just head home, go to the nearby 'pasar malam' (night market) and grab some really unhealthy high cholesterol food of dubious hygiene and have them for dinner before crashing into oblivion on my bed.

It's time for another holiday. This weekend, my better half and I shall fly to an island getaway named after the Eagle.

Moving Out

2006-06-14T12:37:00.000+08:00

I have decided to stick with Wordpress. Am getting used to the complicated way of posting a blog there. I think I won't be posting any more entries in this blog and I will just let it die a natural death.
So friends, feel free to drop by my new blog site at http://jimbocyberdoc.wordpress.com

Cheers!

One For My Kids

2006-06-14T12:25:00.000+08:00

Pooh and friends have a special place in the hearts of my kids. This picture is for them. I miss you fellas so much. :-)

Padan Muka

2006-06-14T08:23:00.000+08:00

Picture these scenarios.

1. A married man visits a CSW and catches the HIV and subsequently passes it to his spouse and the spouse passes it to her newborn child.

2. An intravenous drug abuser shares needles with his fellow addicts and catches the HIV/HBV,HCV. He may be married and passes it to his spouse.

3. A gay man has many ONS with multiple partners and catches the same virus/es.

4. A lady catches the HIV from a blood transfusion many years ago.

What was your feeling when you read the above scenarios? If you are like the majority of the people I know, you would probably be sympathetic to patient no.4 and say 'padan muka' to the rest of them. 'Padan muka' is a malay term spoken to mean "You deserve it or Serve you right".

Sadly, that is the most prevalent attitude, even amongst my most well meaning friends and loved ones. It's even more distressing to find the same attitude in the community whose business is compassion and healing, ie. the medical fraternity. Attitude colours behaviour and if this kind of attitude prevails, how can one expect fair and good care in the hospital?

I have a young man hanging on to dear life by a thread in my ward. He has HIV/AIDS complicated by multiple opportunistic infections. I had a conversation with a nurse last night and she said "Padan muka dia, siapa suruh pergi cari penyakit"! (Serve him right, who asked him to get himself infected?).

A lot of people are interested in ID. But the interest focuses mainly on HOW a person got infected. It's like the papparazzi or something. As soon as they know, they form an opinion regarding the patient, usually a negative opinion.

I make it a point to tell the medical students who follow me on rounds that the How is a lot less important than "What are we going to do for this patient now?". My own personal opinion is that mine is not the job to judge; mine is the work to help and heal (if possible). The how part is between the patient and GOD.

Jesus said "Let him who is without sin cast the first stone".

Winds of Change

2006-06-13T14:04:00.000+08:00

Oh, one who used to be fair and lovely,

How you have changed!

Medicine has corrupted you!

What was once a smile, now I see a sneer,

What was once sincerity, now pretense,

What was once friendship, now enmity,

While you pursue your cause with zeal and compassion,

The same compassion, you have withheld from your peers!

I lament the loss of another friend.

Still, hope springs eternal, that you would realise

The error of your ways,

That things would be as they once were….

I know, I know, my poetry writing skill sucks! I just wanted to get something off my chest. Bear with me. :-P

Still Fiddling Around

2006-06-13T07:50:00.000+08:00

It's terribly frustrating publishing with wordpress. I have written a few entries but it just wouldn't 'take' after I clicked the 'publish' button!

Anyway, here is another try. Attached is a pic which I found in a power point presentation on malaria while reading up on the disease last night. I thought it was rather funny.

I have a man from Myanmar now in my ward who is down with P.vivax malaria. He is doing alright.

I hope the picture will elicit at least a grin if not downright abdominal crunching, rolling on the floor type of hysterics. :-)

Testing

2006-06-12T18:27:00.000+08:00

Just testing if the paragraphs will work...

Sigh!

I really miss my blog, the way it used to be..

I Am MIgrating

2006-06-12T08:43:00.000+08:00

Guys, it's no use. I can't salvage this blog; so I have decided to migrate to another site. Actually, it was whilst in the process of setting up another blog that I fouled up this one. Sigh! My friend (thankfully he is out of the country now or I would have lynched him) suggested that I set up a blog under 'Wordpress' as it gives me more control over my blog.

Anyway, to cut the story short, I am stopping here. My new blog has been set up (but still under renovation). Come over there with me....

Here's the url: http://jimbocyberdoc.wordpress.com

See ya there!

Nope, it didn't work

2006-06-12T07:52:00.000+08:00

Thanks guys for all the suggestions in rectifying my badly damaged blog. I tried changing the templates, several times in fact but it's still the same. And meddling into html is way beyond my league. Sigh!
I'll let you know what I'll be up to next. :-(

2006-06-09T19:31:00.000+08:00

Oops!!

My blog was badly damaged by ..well, me. A few clicks here and there, and I lost everything. It's rather unreadable now. I'm gonna be a little quiet a while. It will probably take, oh, 2 decades to salvage it. Just watch this space ya. :-(

2006-06-09T16:56:00.000+08:00

Something good to end the week with... laughter

Received this in my mailbox this morning. Have a good laugh. :-)

Actual writing on hospital charts

1. The patient refused autopsy.

2. The patient has no previous history of suicides.

3. Patient has left white blood cells at another hospital.

4. Patient's medical history has been remarkably insignificant with only a 40 pound weight gain in the past three days.

5. She has no rigors or shaking chills, but her husband states she was very hot in bed last night.

6. Patient has chest pain if she lies on her left side for over a year.

7. On the second day the knee was better and on the third day it disappeared.

8. The patient is tearful and crying constantly. She also appears to be depressed.

9.The patient has been depressed since she began seeing me in 1993.

10. Discharge status: Alive, but without my permission.

11. Healthy appearing decrepit 69-year old male, mentally alert, but forgetful.

12. Patient had waffles for breakfast and anorexia for lunch.

13. She is numb from her toes down.

14. While in ER, she was examined, x-rated and sent home.

15. The skin was moist and dry.

16. Occasional, constant infrequent headaches.

17. Patient was alert and unresponsive.

18. Rectal examination revealed a normal size thyroid.

19. She stated that she had been constipated for most of her life until she got a divorce.

20. I saw your patient today, who is still under our car for physical therapy.

21. Both breasts are equal and reactive to light and accommodation.

22. Examination of genitalia reveals that he is circus sized.

23. The lab test indicated abnormal lover function.

24. Skin: somewhat pale. but present.

25. The pelvic exam will be done later on the floor.

26. Large brown stool ambulating in the hall.

27. Patient has two teenage children, but no other abnormalities

28. When she fainted, her eyes rolled around the room

29. The patient was in his usual state of good health until his airplane ran out of gas and crashed.

30. Between you and me, we ought to be able to get this lady pregnant.

31. She slipped on the ice and apparently her legs went in separate directions in early December.

32. Patient was seen in consultation by Dr. Smith, who felt we should sit on the abdomen and I agree.

33. The patient was to have a bowel resection. However, he took a job as a stock broker instead.

34. By the time he was admitted, his rapid heart had stopped, and he was feeling better.

I've read it before, in the MMA News, but re-cycled jokes are still just as funny sometimes. :-)

Cheers!!!

SPOT ON, SUE!

2006-06-09T16:39:00.000+08:00

I wrote about a 15 year old boy earlier in my entry 'TYRE-D'. Sue, a reader of this blog, offered a diagnosis of Acute Rheumatic Fever. BloodDoc offered a diagnosis of 'Acute Leukemia'.

I am happy to say that the boy is doing well in the ward and might be discharged tomorrow. His joint pain has all disappeared. The rash, which turned out to be erythema marginatum has also disappeared overnight! Darn! I went so early the next morning with my camera hoping to snap a pic of it but alas, it's gone!

Acute leukemia was one of the differential diagnosis but nothing else was supportive. His ECHO showed trivial MR/TR/AR. His blood cultures are negative so far. His ASOT was markedly elevated.

So, he fulfilled the diagnostic criteria of Acute Rheumatic Fever. Congrats Sue! I will take you out for Starbucks coffee! Just look me up if you are in town. Heh heh! We started him on high dose Aspirin and oral Pen V. He should be well.

It's meeting, diagnosing and treating patients like this that makes it all so worthwhile. It sure beats sitting in a GP clinic treating cough, cold and fever. :-P (don't start ok, I am NOT antagonising GPs here).

The week is drawing to an end and I am so glad it is. It's been a very, very tiring week indeed. After rounds tomorrow, I am heading home. Home, where I am most happy.

2006-06-09T14:31:00.000+08:00

Capote

Warning: Reading further will give the movie plot away.

I managed to watch Capote (on DVD which I bought a million years ago) last night, despite being in a semi-zombie state due to the lack of sleep the night before while being on call. The fact that I could watch the entire movie in that state meant that the story was engaging. And truly it was.

In a gist, it’s a ‘based on a true story’ movie, documenting how the main character, Truman Capote revolutionized the way people wrote books in the 1950s by being the first to write a ‘non-fictional’ book. His work (also his last) documented his interview with the convicted killers of a rural family of 4 in Kansas. The book made Capote the ‘most famous writer in America’.

Capote was a gay writer who set out to write what he intuitively felt would be his greatest piece of writing. I found the way he spoke in the movie nothing less than annoying (perhaps that’s why he was an Oscar for it!). In fact it grates on the nerves!

The movie was engaging because here we see a writer bent on getting his story, by any means, even by deception as he deceived the two convicted killer on death row that he was on their side; that he was trying his best to get them the best attorney to get them off the death sentence. And they believed him, they pinned all their hopes on them.

Yet, to the outside world (unknown to the 2 criminals in jail), Capote was this flamboyant person, full of merry-making and vulgarity. He rubbed shoulders with high society people, fine living and all. He boasted about his upcoming book. He talked constantly about how good his book would be. He chose the title of his book – ‘In Cold Blood’. Hardly the best title if one claimed to be on the side of the killers, at least to them anyway.

But his perfect world and his deceptions collided when, in the process of ‘getting into the mind of the criminal’ he became very attached to one of them (Perry Smith) and came to care for him, even to love him.

In the end, he wrote a book that made him famous, yet paradoxically, his book broke him as he grappled with the immense guilt of his deception. He had to watch Perry hung to death. He lamented that “it was the most horrible thing I have experienced and the image will stay with me forever”.

Capote died not many years later, a broken man addicted to alcohol, never writing another book.

In my opinion, the movie was almost as good as ‘CRASH’. And the actor definitely deserved the Oscar.

2006-06-08T07:57:00.000+08:00

LOVE-HATE Relationship

I received this comment from a pharmacist ( http://www.blogger.com/profile/25632041)yesterday in response yesterday's entry.

From your other post, you seem like quite a broad minded fella. I am a pharmacist. Hhhm, I guess that it doesn't strike you that what we hope to achieve is correct usage of drugs and not a quick way "to save a buck." Oh the times when we screened and found that an antibiotic was started when not warranted. That goes for other drugs. But I am not here to be antagonistic. I wish that I could say, "To hell with the guidelines." That would certainly make life easier for me...and you. Trust me, if I wanted easy, I would not be here. But like you, I have a responsibility to the patients and that responsibility is to ensure that they are getting the correct drug, the correct way. I am sure that there are ways of working together that doesn't leave you and me feeling frustrated at the end of the day.

It seems that whenever I write something that even remotely mention 'pharmacists' or the 'pharmaceutical industry' I could very well expect a response, sometimes diplomatic like the above, right down to angry responses.

Let me just state here that my blog is not meant to be antagonistic. I am penning here my daily angsts and joys working as a physician. If anyone feels slighted by what I wrote, then I offer my sincere apologies.

With reference to my entry yesterday, I suppose some people think that I have a bone to pick with the pharmacists. Perhaps I should have use better words and sentences. My bone of contention was with the hospital and it's rules, not the pharmacists, and not any individuals.
I think that in Malaysia, the relationship between the medical and the pharmacy people is at best a love-hate relationship. There are many issues that both parties fight for which have dragged on for donkey years. You can read it in the media on and off or the MMA News. I don't want to go into that.

That was not how I was educated. I was a medical undergrad in a country where the roles of the pharmacists and doctors were very well delienated. We worked in harmony. Doctors prescribe, pharmacists dispense. There, doctors don't hang on to their 'right to dispense' and likewise, pharmacists do not do what doctors do (you know, diagnose, investigate and prescribe) or tell the doctors what they can or cannot prescribe. Alas, that's not the case here and that is sad indeed.

Anyhow, let me reiterate that I am not here to antagonise anyone nor do I claim to be a 'know-it-all'. Just let me write what I feel here. Comments are welcome. Apologies are offered if anyone is offended. Some may not like what I write. Heck, I find some people's blog totally offensive too.

But I hold on to the adage: "I may not like what you say but I will defend your right to say it". I sincerely hope I will be accorded the same priviledge.

2006-06-07T13:56:00.000+08:00

TYRE-D

I am so dead tired. Spent the entire morning seeing and reviewing patients. The referrals started coming in at 10.30 am. The latest referral was 20 minutes ago just when I finally managed to sit down and was about to sink my teeth into a very rigor-mortised piece of fried chicken thigh, rice liberally moistened by sardine sauce and a few pieces of near-fossilised cucumber. Ugh! The referral was just to "get your permission to start iv Tazocin because the pharmacist insists that an ID physician give the permission first". I happily suggested that they consult the Chest Physician since he also has the power to start Tazocin and the patient has Ventilator-Associated-Pneumonia (VAP).

Over here, everyone has a hand in 'managing' the patients, including the pharmacists who usually haven't a clue as to how critical a patient's condition is but yet has the power to determine what antibiotics should or should not be given and who should prescribe them. It's a lot like the superpowers in the UN with their veto power.

I don't hate them really, they are just part of a huge conspiracy to 'save money'. Of course they have their own good reasons and I am all for using the correct therapy for the correct ailment and to check abuse; but sometimes it gets too ridiculous when people who have not seen the patients themselves have the the power to veto your decision simply because "you are not authorised to give this antibiotic". Sigh!

I have 2 hours to see another 5-6 referrals; gather 4 sets of scans and write a short summary for each of them for the X-ray conference tomorrow and pray that the referrals would stop coming in. :-)

Better get to work.

2006-06-07T07:40:00.000+08:00

Post 666 call and no Omen seen

I have this nagging suspicion that I am put on call on Tuesdays by design. Some one out there is trying to prevent me from watching Desperate Housewives and CSI Miaimi and NY!!! DH comes on at 10 pm over channel 8 on Tuesdays while the two CSIs come on at 9 pm on Astro back to back. I read yesterday's CSI was supposed to be fantastic.

My call wasn't that bad last night, having managed to sleep at least 4-5 hours. That should keep me awake till, oh say, about 10 am this morning before I shall be seized with severe narcolepsy. There is one patient that is on my mind. I shall go see him again later.

He is a 15 year old boy from Terengganu who presented with neck pain, back pain, polyarthralgia, intermittent fever for the last 3 weeks and the sudden appearance of a rash over his back and chest over the last 2 days. There are so many possibilities but the one that nags at me most is, could it be Meningococcal infection?! Gotta take my boss along and see what he says. Also, a mental note to myself, try to get hold of either Rifampicin or Ciprobay!

I've had a horrible day yesterday with 8 referrals, out of which I have seen 6 by 9 pm! I shall see the other 2 today. Yesteday's clinic was awful as it ended way past 2 pm followed by a mortality meeting that went on and on and on. The bed situation was critical last night, having only about 16 beds for the entire night. Thankfully we didn't have to 'close' admission.

I hope today will be better. I hope I can finally see everyone on my 'to-be-reviewed' list today. I hope I can get off on time today. I hope I have enough energy to go to the gym and burn off my lovey-dovey handle. I hope, I hope, I hope :-)

Hope springs eternal.

2006-06-06T07:52:00.000+08:00

THE MALE BRAIN

I google searched 'depressed' yesterday and look what I found! It's a little small so I guess you need to click on it to enlarge the pic. It's rather funny and rather accurate too. :-)

I'd like to think that my own brain is some what different.

Anyone out there who has a female brain version of the above?

It's Tuesday and it's the long (and dreaded) ID clinic day. Am on call today as well. Praying for a good call (ie: some sleep at least tonight).

2006-06-05T18:47:00.000+08:00

Monday Blues

Work just got done and it's almost 7 pm. I am having an acute case of Monday Blues. It's been a long tiring day. I managed to see more than half of the patients on my list this morning which was passed over to me last week. But then, the referrals started pouring in and coupled with the afternoon ID clinic (there were about 20 patients) which were supposed to be run by 5 doctors (on paper at least) was eventually managed by just me and the other specialist; made it a lot worst.

The ID clinic is unlike other clinics because each patient may take anything between half and hour to an hour to settle. Sigh! And I stillhave the other half of patients on my list who haven't been reviewed yet.

It's almost dark outside and I haven't seen another 2 patients referred to me this morning. I think I will see them tomorrow, if I can find the time.

I thought of going to the gym earlier. Sorting out my long pants last night woke me up to the fact that I have been insidiously gaining a nice little love handle. I am NOT going to throw/give away the pants that I now have to inhale deeply to fit in, instead, I shall keep them as a kind of incentive for me to lose the extra fat! Thank GOD my DOCKERS still fit!!!!

But today, gym is out. I am out of ATP. Tomorrow is out of the question too as I am on call (aargh!!), it will have to be this Wednesday (provided that tomorrow's call is good). If not, it will have to be next week... or next month, or never! :-(

Oh God, I am so sedentary....

2006-06-05T08:08:00.000+08:00

A Memorable Patient

I am thinking of writing a series on the topic above, similar to the articles found in the BMJ based on my own experiences. In a decade of service, I have indeed come across quite a few patients that have lodged themselves in my memory for one reason or another. I think it would be nice to write about them.

2006-06-04T11:13:00.000+08:00

Weekend Round - again

Another weekend spent doing round in the ward. This one was a little unexpected as the wife of the MO who was supposed to do the round today went into labour yesterday. So, I had to make the slow (and unwilling) drive back to KL this morning to do the round. There are other more senior specialists in KL but they have...'quote' "decided not to do anymore weekend round" 'unquote'. Sigh....

I wonder when will I get to make that kind of decision.

I think since becoming a physician, even more of my weekends were sacrificed on the altar of work. I have more calls now compared to when I was a MO. I have more rounds to do on weekends than when I was an MO. And of course, more responsiblities. My wife asked me this morning..." I thought u said things will be better, but they aren't".

How do you answer a question like that? How do I tell her that previously I was a senior MO and so can dictate the T&C of my call days, now I am a junior physician and my call days are dictated by others.

I just pray and hope that my family will be patient for another few more months. Things will definitely get better once I am done here. :-)

2006-06-02T16:34:00.000+08:00

TGIF AGAIN!

Work is almost done for the day and I am so ready for the weekend! Had a busy ID clinic this morning followed by an equally busy afternoon reviewing patients in the periphery (I think I only saw 5 % of my patients!) and seeing the new referrals (the last one came in at 4.10pm! Ugh!!!!). I am secretly praying that my pager won't go off in the next 40 minutes or so then I can drive home in peace. :-P

2006-06-02T08:22:00.000+08:00

Burning Fossils

I estimated that my household burns up about RM 600 worth of petrol (or gas as the USA-ites call 'em) per month to keep our 2 cars running. That is a lot of money (and a lot of liquefied fossils!). Though the government promised to lower the cost of petrol if and when the world oil prices come down, I am not too optimistic. I think in my entire life so far, perhaps there was only once that the price of gas actually came down a little; wait a minute, was it the toll rate? I am not sure. Senility creeping in....ugh!

2006-06-02T00:32:00.000+08:00

Terminated My Gym Membership

I know, I know, once upon a time, I was waxing lyrical about how good my gym was. But that was a long time ago; well, 6 months ago actually. Since then I have kinda fallen out of love with that gym. And so, last Friday, I made a decision to give them my one month notice to terminate my membership.

And you know what? They weren't too pleased about it! In fact, the one who attended to me was pretty curt and abrupt.

There are many reasons why I decided to call it quits. Namely:

1. The staff which used to be real friendly are no longer so. The present batch is new and counter service basically is appalling. Souor faces with sour service.

2. I used to be able to get the gym apparels easily; now they tell me they have run out of this or that. Once they said they have no more socks. Another time, they ran out of plastic bags; yet another time, towels and so on and so forth. Some times I am given shirts or pants that can fit 2 or 3 of me, at other times, it's so figure hugging, I was embarrased to wear them!

3. The sauna broke down a few times and no one was bothered to fix it despite complaints being lodged.

4. The showers now spew out icy cold water only to be replaced with boiling hot water after about 5 minutes and there is no way to control it one way or the other.

5. Finding a parking lot there is a major hassle.

6. Frankly I find myself visiting the gym less frequently than I would wish to; mainly due to work commitment. Though RM147 per month isn't very expensive but if I go only twice a month, that would mean each session costs me RM73.50! Now, that's expensive!

7. And finally, I must accept that I can't fight gravity. :-P

I guess it's just back to regular swimming after the end of June. I think I enjoy it more and it's alot cheaper. I just hope the weather willhave improved by then.

2006-06-01T16:30:00.000+08:00

The End and A Beginning

I had to cover the cardiac clinic today, despite the fact that I am now fully interned into the ID unit. It's my fault actually because I personally requested to be in the cardiac clinic one last time this month because at one point 2 weeks ago, I was not really confident that I could reach my target of 500 patients for my thesis by the end of May. (Oh me of little faith!)

And so, today I had to cover the cardiac clinic, all by my own design. I actually enjoyed it, as I did all these while. If not for ID, I would have joined cardio (but then again, most cardiologists I know don't actually have a decent social life out of the work place.....ugh!). I did continue to recruit patients into my thesis (might as well right, since I am there) and so my final tally now is 510 patients! :-)

Today marks the end of my cardio attachment (unless they decide that I must cover some more). It also marks the first day I am in the ID unit. I am put in charge of the 'peripheries' meaning I have to see referrals. To me was passed a list containing the names of all those who were already referred. There were 33 of them! :-P

And I had 3 referrals today (2 of which were totally unnecessary) and so I have 36. I discharged one of them, and so I have 35 patients to review. Arrgh!

Hmm, I wonder if it's still not too late to be a cardiologist? ;-)

2006-06-01T14:30:00.000+08:00

Brickwalled

It's really disheartening to hear from my own fellow colleagues that it's best to keep quiet and carry on with our work because "nothing will change and you will get blacklisted and persecuted if you rock the boat".

Sigh! It's precisely this mentality and culture that I find so irksome and frustrating, not just amongst my colleagues and friends but also, I think, among my fellow Malaysians as a whole. It's because of this apathetic culture that we have bred a host of "small Napoleons" as what was mentioned by our dear PM recently.

So, I have hit a brick wall, but it doesn't mean I am going to stop. :-)

2006-06-01T07:42:00.000+08:00

BE HEALED EFIO!

My DVR-CDRW drive went dysfunctional last night. The last time it happened was last August. The notebook (Twinhead Efio 123A) just did not 'recognise' the drive. The last time I managed to convince the vendor to have it changed but last night, I was dreading the fact that I had to bring the notebook again to the vendor (who were not very friendly....funny isn' it; they were all chummy and everything when they wanted to sell you the product but became totally antagonistic when you want something fixed)!

Being a relatively IT-challenged geek-wannabe (geek is suddenly fashionable....heck, I suddenly realised that I have been fashionable all my life and didn't know it!), I did everything anyone would do...I restarted the notebook, I switched it off and on again, I tried all kinds of CDs and DVDs (genuine and fake ones), I had to restrain myself from giving my notebook a hard knock and nothing worked.

And finally, I did what I usually do when I am at my wit's end. I laid hands on my notebook and I prayed! "In the name of Jesus, behealed, you silly DVD drive!" :-)

And voila!!! The drive suddenly came alive and well again. Was it some circulatory problem suddenly gone right or was it a miracle? I dunno. I am just glad and thankful that it worked! I needed the notebook to be fully functional if I am ever going to finish the thesis.

Now, if only I can get the SPSS to work properly....

2006-05-31T07:45:00.000+08:00

May End

Last day of May today, and it also mean the last day of my rotation in the geriatric ward. And you know what, I think I am going to miss it.. a little bit. I know I have griped about working there a lot but at the same time I recognise that this ward has it's purpose; just like every other discipline in my department.

I don't have the desire or inclination to be a geriatrician but those that are, are doing a wonderful job. In fact, the thing that struck me most when I first transfered into this hospital was the passion and dedication the specialists here have for their work and patients. These I seldom see in the other places that I have worked in.

Tomorrow, I join ID for good. ID is my own passion. I hope and pray that God will help me work with equal passion and dedication in this field that I have chosen as my life career. Amen.

2006-05-30T17:13:00.000+08:00

Culture of Silence

I just came back from attending the monthly department meeting. This monthly meeting is usually a boring affair, mainly to discuss issues as ancient as the Jurassic Park (and as unresolved as well).

Today, it was slightly different. Today I spoke up (rather emphatically I'm afraid). I won't be writing about the issue here. It's not important. What's important is the fact that I personally know very few people who will speak up for what they believe in. Mainly because it will make them unpopular and it may even jeopardize their career should they voice their contra-opinion on issues that their superiors are advocating. I call that cowardice.

I believe in standing for what I believe is right. I believe in speaking up when injustice is done or imposed on others. I do not subscribe to the culture of silence....of keeping quiet, hoping the issue will just blow over; or just swallow your pride and go with the flow, even if it meant more work, more burden, more responsibilities, and therefore even more risks of error and the vicious cycle goes on and on. This has to stop somewhere.

So, today I spoke up. I don't feel proud about it. I am just defending my conviction. I may well have offended some people and I don't feel good about it. Yes, my career may be jeopardized, my 6 more months here not be all that pleasant and my popularity rating may have taken a drastic dip; but I have peace and my conscience is clear.

I doubt that by voicing my stand anything will change but at least I voiced what I believe is in the hearts and minds of the silent majority. I do not subscribe to the culture of silence. Never.

2006-05-30T11:54:00.000+08:00

We're out of Salt Water!

I think it's totally laughable that while we are sending our SMART team to Yogjakarta to help the quake victims (and I think it's a noble cause); on the home front, my hospital (I am told) is running low on Normal Saline Infusion Solution! It seems that the contract with the supplier has expired. Now all my patients are on either Dextrose Saline or Paeds Solution, regardless whether they are diabetics or the fluid regimen is woefully inadequate (for instance, to correct drug induced hyponatreimia). :-(

Someone should be made accountable for this.

2006-05-29T18:26:00.000+08:00

501!!!!

No, not the Levi's label (though I have always dreamed of owning a pair of Levi's....even the fake ones are expensive! Sheesh!).

Drum roll...

Today, I hit my target! Rather unexpected actually. The cardiac clinic just finished and I have reached my target of 500 patients! The one extra was a "What the heck! Just see one more -la" patient.

I feel a sense of great accomplishment and I am a little proud of myself. Heh heh! 6 months of slogging in the cardiac clinic is finally over! Praise the Lord! Inside me, I am just jubilating away! YooooooHoooooooooooooo!

Actually that's only half the work done, albeit the tougher half; now I have to sit down and 'clean up' the data, organise them and finally analyse them and then write about them. Anyhow, half the battle is won and I really, really, really feel good about it.

To reward myself, I shall not go to the gym. I am sipping some hot Milo now, it's pouring cats and dogs outside; I am going to wait till the rain stops, then I shall take a slow drive home and eat home cooked food (mum is in KL!).

Thank you Lord.

2006-05-29T12:55:00.000+08:00

Last Day of School

Driving to work was a breeze this morning. It's every motorist's dream! It's the school holidays, which means traffic is cut by more than half (for the next 2 weeks anyway). My personal dream is that the authorities should relocate all schools out of the city and have special transport to ferry the students to and from the schools. But then again, the parents would not be too pleased right? :-)

Btw, I found the picture above on the net. Looks like bad English isn't just a local problem. I certainly wouldn't want to sit for an anal examination! Ugh!

2006-05-29T08:20:00.000+08:00

Another Bad Sign

Another example of a badly produced question, confusing the students. I mean, do you even notice the arrows (I highlighted it); if you don't then both answers can be correct. Right?

Ok, ok, I confess I am a little miffed over it. Kiasu parents are allowed that. :-P

Anyhow, I am very proud of my girl. Here's her full tally:

Maths : 100/100
English : 99/100
B.Melayu : 93/100
Science : 90/100
Moral : 83/100 (gotta work on this one...)

Well done sweetie! And enjoy our school break! :-)

2006-05-29T08:11:00.000+08:00

Faulty Signs (Science)

My daughter got back her Science paper last week. She scored 90/100. I believe she could have scored better had the teacher taken the trouble to produce better quality pictures.

The teacher probably thought that her students have telepathic powers (ala Jean Grey) that would enable 7 year old kids to decipher what all the arrows in that ink smudge above point to!

A formal complaint lodged with the teacher had her saying that she had pasted a larger similar picture (I am not sure whether by saying it's similar meant it was equally bad?) on the black board and she had in fact, instructed the students to refer to the black board when answering that question. I wonder how big was that picture and how many students (there are 40 of them) could see it clearly (my kid said she couldn't and she wasn't even myopic).

Well, as I was saying, if only she has done a better job in the beginning...

2006-05-26T12:21:00.000+08:00

A Very Long Month

I think the month of May is the longest so far. I wonder when is it going to end!!! It seems like I have been in the geriatric ward for ages! :-P

The patients are generally wonderful and pleasant. It's just that I don't think I am cut out to be a geriatrician (which makes me really respect those who can be one!).

5 more days and counting.....

2006-05-26T07:51:00.000+08:00

Picture For Thesis

It's amazing what you can find on the internet these days. I typed 'viagra' and 'beer' into Google image search and see what popped out! I wonder if I could use it for my thesis cover? Hmm....

Btw, the tagline was "Guys, NEVER mix Viagra with Beer!". Real funny.

2006-05-26T07:21:00.000+08:00

Parent's Day

My church is celebrating Parent's Day this weekend (I declined an invite to the Langkawi Island for a weekend meeting for this....a tinge of regret but I think it's the right move). I am not sure what's the program will be like but there will definitely be 'makan' (food!!!). If anything, my church is big in a few things..FOOD and FELLOWSHIP! :-)

In fact, that's what attracted us to the church in the beginning, the overwhelming sense of love and concern for each other. It's hard to find this in most churches these days.

A kind reader has sent me a song which will be sung by the Sunday School kids in her church. I think it's appropriate to post it here. It's a love song to the Father. Btw, she thinks I am a great dad! Blush blush! So pai-seh la...

Daddy You're My Hero

Father You're the best, my delight
Father You're so sweet
Sweeter than honey on the rocks
Father You're the light in the night
Father You're my strength
and my forever friend

Ch:
Abba Father You're my hero
You're there when I need you
You sent the greatest gift
of love into my life

Daddy You're the best and you're mine
Daddy You're so sweet
Sweeter than anyone I've met
Daddy You're my song in the night
Daddy You're my strength
And my forever friend

Ch:
Daddy Daddy you're my hero
You're there when I need you
You are the greatest gift
I received in my life.......

Song writer: KB Chan

2006-05-25T23:06:00.000+08:00

Dog-tired

It's been a long day. An entire day was spent in the cardiac clinic (preceded by a 'tsunami' round in the ward; because there was no one else to do the specialist round) filled with very impatient and angry patients. Sometimes I wonder why are they are called 'patients' when patience is hardly evident in them!

At 5.10 pm, I left the cardiac clinic, having recruited another 21 patients into my thesis study. I could have recruited more if not because I had to do the round this morning (usually I need not on cardiac clinic days) and the fact that I 'accidentally' saw 2 other patients whom I have already recruited earlier and that ONE particular patient who took up 45 minutes of clinic time telling me how high his sex drive was and that his poor wife could not cope with his needs and that he has to satisfy his itch some where else and that he is planning to marry a second wife soon (he haven't told wifey number one yet!). Tsk! Tsk! Tsk!

I think I could write a book on the stories I heard while recruiting patients. I shall call it 'Desperate Hubbies'.

Locum's over (yeah, need the money for the weekend. The hospital again did not pay my on-call claim!) and I just want to shower, and crash. TGIF tomorrow!!

Good nite! :-)

2006-05-25T07:56:00.000+08:00

I've Been Spammed!

Some lower life forms have been spamming my blog anonymously. It hasn't done much damage yet, except to flood my mailbox (all comments are cc-ed to my email). Sorry guys, I think I will have to change my settings not to allow anonymous comments. I have to do this to prevent my mail box from being overwhelmed.

Btw, X-Men III was awesome (and yes, I did see some celebrities but didn't rub shoulders with them).

X-men III was about 1 million times better than MI-III (maybe it's because I like Hugh Jackman a lot better than old Tom). I definitely recommend all to watch it!

However, as in all sequels, the 1st part was the best followed by the 2nd and so on. Sigh!

2006-05-24T17:00:00.000+08:00

It’s not just about money, Dr Chua

I've been told by my friends that my blog is too wordy. They suggested that I should add more pics. I do agree that a picture speaks a thousand words but sometimes there aren't any pictures to convey what I would like to speak. Here is one of them. Sorry guys. I just had to say my piece. Feel free to skip it but if u have the time, I appreciate a read or two. :-P

Our Health Minister recently announced that specialists willing to return from overseas will be placed on the salary scale of Grade U48, “RM4,000 jump for docs” (The Star, May 22).

Not too long ago (before the Sarawak Election clouded out everything else, including the devastation of the coral reef in Sipadan), doctors working overseas were called all kinds of names for not returning to serve in their own country. They were labeled ungrateful, unpatriotic and mercenaries among other things.

Now it seems the Health Ministry is dangling out a different kind of carrot. “Come back now and we will instantly promote you to Grade U48 (starting scale for Specialists in the civil service); no need to start from scratch anymore.” The starting salary will be RM 7,000 instead of the RM 3,000 odd if they started from scratch (meaning a Medical Officer’s pay).

In addition to this, the minister also warned that in the next few years, it will become more and more difficult for Malaysian doctors to work in Britain as it has to give preference to citizens in the EU. Malaysian doctors would be lumped with others from all over the world.

While the announcement was much welcomed, I wonder how many will actually go for the carrot. I also wonder why it took so long for the Ministry to finally agree to give recognition to these returning specialists when it has been a perpetual grouse for as long as I can remember.

How many will want to come back if by coming back you have to start at MO level, with all your foreign (and well recognized all over the world) qualifications and years of experience ignored? Who will give up a well-paying job overseas to return home to a measly RM 3,000 per month? Being patriotic has nothing to do with it.

I am glad that the Health Ministry is finally doing some thing in the right direction. Still, at the end of the day, I really doubt many will take up the offer. The crux of the matter is, it’s not just about the money.

This July marks the 10th year of my service as a doctor. Though there has been great joy serving in this noble occupation, I have more than my fair share of hardships too. Some of them are listed below:

1. As a House Officer (HO) in the Kuala Lumpur General Hospital (KLGH), I was made to work 7 days a week. If I wanted off on a Sunday, I had to apply for leave. Sundays were considered half day work in the medical department there. Half day here meant you finish your work at 3 or 4 pm!
2. The maximum number of calls I have done in a month as a HO was 18 days! That meant there were days I had to work back to back with no break in between.
3. To add salt to the wound, I was not allowed to claim call allowances more than 8 days per month as I was told by the hospital that they ‘did not have the budget’.
4. My working hours in the medical department was from 5.30 am till 9 pm if I was not on call. And if I were, I had to work from 5.30 am till 9 pm the next day!
5. I have slept on any number of the following: transfer trolley, sofas, patient’s bed, floor, chair and coffee table, simply because hospitals were built with no thought of a resting place for doctors (they still built hospitals this way)
6. I have been denied taking leave even when I got married, because there are ‘not enough doctors around’.
7. My starting pay was RM1690 and the call claim then was RM 20 per 24 hours (which worked out to be 83 sen per hour; by comparison, a 7-eleven worker those days earned RM 3 per hour). 8. Car loans were not extended to HO then (a year after I started work, it was rectified to allow HOs to take car loans from the government).
9. Once we, HOs, were all hauled up on Sunday to carry hospital beds/cupboards/other heavy furniture up and down a lorry because they were opening a new ward somewhere.
10. Food meant for on call HOs were usually eaten up by inconsiderate specialists and MOs who were not even on call. By the time we had time to ear, all that was left was usually white rice and nothing else.
11. As a Medical Officer (MO) in a district hospital, I was moved from one department to another, just to fill up vacancies. My plea for some training in Paediatrics was denied. To this day, I have no training in paediatrics. Instead I was moved from surgery to A&E, back to surgery, to just about any unit that has a lack of doctors. That ended when I wrote a formal letter (and cc to the State Health Department) for placement in Anaesthesia (which I subsequently did for almost 3 years)
12. The most calls I did in a month as an MO was 15 days!
13. I was denied the privilege to write insurance claims for patients as all the claims were monopolized by the Hospital Director then. FYI, an insurance claim can earn us RM 40 per claim.
14. My application to do Masters was rejected twice with no reasons given. When finally succeeded in getting in, they threatened to withdraw the seat because they found out that I was planning to leave the civil service. I finally left the service in 2000.
15. I was asked to pay rent for the house I was occupying in the hospital vicinity as well as paying for water and electricity as well.
16. Getting a house (meant for doctors) in that hospital was near impossible as the Hospital Director then favoured his office staff by allotting all the available houses to his cronies. I finally got mine after a formal letter was written, one and a half years after I moved there.
17. As a MO in Seremban Hospital, I did an entire year of MO calls and never received a sen. All because they ‘did not receive a memo from the ministry authorizing the payment’; all because I was not a government servant then! (I have no such problems in the hospital I work in now). I estimated that they owed me RM 9,000!
18. My working hours then was from 8 am to anytime between 6-8 pm daily.
19. Weekend round was a horror as an MO. My round started at 8 am and usually ended at 8 pm!
20. We had no proper on call rooms to sleep in. The available rooms have faulty locks. Our things get stolen all the time. We didn’t have lockers.
21. MOs were not allocated parking lots. So we had to come real early to get a parking lot of risk driving round and round forever or worse, be slapped with a parking ticket by the ever vigilant policemen when we park along the yellow line.
22. My call claims were never paid on time. Sometimes it would be months before we see any payment.
23. When I transferred here for the MMed program, things were not that much better. Doctors here are also not allocated parking space, they are all assigned to lecturers and professors who sometimes come to work at 11 am! Parking lots are also assigned to clerks and the like. The criteria for allotment were never explained to us.

I am certain that my experience is by no means unique. I am sure everyone in the medical profession has their own horror stories to tell.
I could go on and on of course but what I am trying to say is, “Honorable Health Minister, unless things improve for the doctors working here in Malaysia, dangling bunch of money to lure these specialists back from overseas just isn’t going to cut it.”

Anyway, RM 4000 isn’t worth the trouble, at least not in my books.

2006-05-24T14:30:00.000+08:00

Japanese Tea Garden At the Colmar

Near the Colmar, there is a Japanese Tea Garden. The Colmar Resort provides shuttle buses to the garden as well as to all the other attractions. But my advise is, if you have a car and don't mind driving, it's better to just drive yourself there. Waiting for the shuttle can be very tiresome.

My boy seemed a bit lost here

A Japanese Garden will not be complete without the obligatory koi pond

2006-05-24T14:18:00.000+08:00

Colmar - the story behind it

Some of my friends have written to me and asked me where is this Colmar Tropicale that I wrote about 2 days ago. A very kind reader (and fellow doctor) have given me an interesting link. Please go to http://www.colmar-alsace.com/ to read all about Colmar. Thanks BoodDoc for the link.

2006-05-24T13:49:00.000+08:00

Bizarre Day

Today started strangely. I was up a little later than usual (expected when I am post call) but I still managed to get ready by 6.50 am. And then it happened, the left nose piece of my spectacles fell off. Now, I am practically blind as a bat without my glasses and I went "Oh dear...how to find that tiny piece of plastic?".

I went down on my knees and squinted my high-myopia eyes and lo and behold! There it was! Right at my right foot! And then I went "I will need a miracle to find the even smaller screw" and so I squinted my eyes even more and there it was, next to my other foot! What luck (or miracle!)! Since I didn't have one of those microscopic screw drivers, I had to improvise with a knife. Took me a good 10 minutes to screw that thing in.

The drive to the hospital was ok, considering that I started later than usual. I can't get over the fact that Malaysian drivers would cut queue even at toll booths! I mean, what's the rush?

Ward round was equally bizarre. On top of the usual irritating relatives, one patient decided to stop being responsive! We attended to him immediately. He came in a week ago due to severe urinary tract infection with kidney failure due to urinary retention (prostate problem la). We could not wake him, his BP was unrecordable, his pulse was racing, his bedside sugar was 6 mmol/L (normal). We did manage to stabilise his vitals later. The weird thing was that he had very good strong pulses in the periphery and yet we could not register a blood pressure reading, either manually or using the automated monitor! His ECG, except for tachycardia, was totally normal. Bizarre indeed.

Even more bizarre was an sms that came all the way from Indonesia. It was from Joe, one of my HIV+ patient who had to resign and leave the country when he tested positive on routine check up. First it was just the "apa khabar doc" message which was followed by the real intent in the next sms: "Doc, is it alright for me to have sex if I use a condom?". Apparently he has recently fallen in love with a chinese guy there (yes, you read right) and he (the chinese guy) has been pestering him for sex.

Since international text messages are expensive, I tried to squeeze my reply into one sms (50 sen) using all the abbrrevations I know. Basically I asked him to 'inform his partner and then they decide whether to go ahead". I think that's the best reply I can think up at the time.

And then, just now, I received a call from a nurse I knew when I was working in a district hospital. She called to say 'Hi'. How bizarre indeed. I have great respect for her, having raised her only son alone (her hubby left her for a newer model); now she is nearing retirement and her son is due to graduate from the National University of Singapore in Engineering. I have left that hospital 6 years ago!

The day isn't even half done yet....I wonder what more is in store! :-)

2006-05-24T13:30:00.000+08:00

Oops!

So 'pai seh la' (embarrassing). I got the date wrong! The preview movie is tonight! Thank God I noticed it before I made the trip to 1 Utama! But in a way, it was good as I could get some rest yesterday after the grueling call and I also managed to watch Desperate Housewives! Heh heh!

Will be going with my friend tonight. :-)

2006-05-23T15:52:00.000+08:00

X-Men III

Yes! I am going for the primier tonight at 1-Utama. My friend (I shall not reveal my source) managed to get tickets for the show and has asked me along! :-)

Actually, I am post call today and I had one of the worst call ever...been up most of the night attending to this or that patient. I slept a little just now over lunch and feel a lot better. I am not about to let a bit of sleepiness prevent me from attending such a glamourous event. Heh heh!

Tell you all about it tomorrow...if I am awake enough to get to work!

PS: All I want for Christmas is a pair of Wolverine Claws! :-P

2006-05-22T22:59:00.000+08:00

Rabbit Farm at the Colmar

Think 'rabbit farm' and I believe most of us will think of hypersexed long eared little furry mammals that do nothing but eat and multiply and yes, pass out really stinking rabbit poo. But, sometimes we forget that kids find them really fascinating, as did mine. I think the show 'Wallace & Gromit' did a lot to endear these furry pests to the hearts of kids!

Lining up for the grub

My girl discovered that 'rabbits have teeth'!

My boy discovered that the little furry thing is actually alive!

There is a deer farm nearby too

'Neigh' you say?

2006-05-22T22:55:00.000+08:00

Colmar Tropicale - a pictorial guide

Entrance of the Colmar Tropicale, fronted by the draw bridge and clock tower Pine tree outside the window of our apartment
Each building at the Colmar was unique. Each has a lovely garden at the ground level. This one belonged to the building we stayed in.

'Fuchsia', the building where our apartment was located is at the right.
Lovely quiet walkway
'Azalea', another building next to ours

The walkway leads to the front of the Colmar
The 'Draw Bridge'. The road leads to a double storey underground carpark. The entire Colmar complex was built above the carpark
One of the 2 white swans swimming in the 'moat' under the bridge
There're another pair of black swans on the other side of the moat

I went around the entire complex, keeping to the back lanes. Not a soul in sight!

The entire place was planted with many types of flowers

The swimming pool (the water is heated). There is a big gym next to it and sauna for males and females. Nice clean place
The Viewing Tower located at the far end of the resort. The 3 storey building was easily assessible via stairs and, for the lazier ones, elevators!

Colourful roof tops taken from the Viewing Tower
The Clock Tower at the other end
More roof tops!

Spiralling stairs in the Viewing Tower
'French Street'. The yellow canopy covered the outdoor restaurant of the 'La Blasson'. I had my meals here. Food was so so only, 5 out of 10! Bland bland bland! You can also see the Wishing Well located in the middle of the street. There are many shops selling anything from baked goodies, poultry delicacies, pasta and pizzas and aromatherapy massage.

' Fuchsia', where we stayed in. The buildings were named after flowers (I think!)
Inside the 'Fuschia'

Small canopies on the street sheltering street vendors. At this one you can make a wax cast of your hand/palm/fist, whatever, at a price. The children can also enjoy 'sand art' here
Come on weekends as there are plenty of activities going on like the live dance show, street clowns and magicians
For a price, you can even get your caricature done here
Night view of the Souvenir and Plaster of Paris Cast Shop
The Clock Tower by night
Fountain at the entrance of Colmar
The French Street at night

2006-05-22T18:21:00.000+08:00

Short of Beds

I think the phenomenon of 'bed shortage' is only found in my hospital. Am on call today and after a gruelling double clinics day (geriatric in the morning and cardiac in the afternoon), I am actually not very surprised to know that we are short of beds for the night. Ho hum, same old story over and over again, especially on Mondays.

My hospital has a dubious distinction of being neither here nor there. On the one hand, we can't accept all patients for admission as being practised by the government hospital as "it would be shameful to ask patient to sleep on the floor or make-shift beds"; on the other, closing admission when the beds are all occipied, as practised by private hospitals and some semi-private ones, is unacceptable because "we can't simply turn away patients!". So it's a Catch 22 situation here. We are a 'semi-private' hospital, so we can 'behave' either way. Sigh.

So, here I am, with about 10 beds to last the entire night. Ten miserable beds can be filled within a very short time. Here we practise 'lodging' patients, meaning we try and find some empty beds in wards belonging to other disciplines and 'lodge' the patients there for the night. Unfortunately, as with most Mondays, the wards in all other disciplines are filled as well. That means no patients can be lodged anywhere tonight. We are so, so stuck.....oh dear.

We are going to need a miracle to survive the night! I better get down on my knees and pray now....

2006-05-22T08:09:00.000+08:00

Colmar Tropicale - a French getaway

Took my family to the Colmar Tropicale, a french themed resort, about 60 km away from Kuala Lumpur and located a little over 1500 meters above sea level. The Colmar is part of the Berjaya Group of Hotels and Resorts.

It was a good break. We only stayed for a night. The weather was either pleasantly warm or nicely cool.

Will upload some of the 260 odd pics we took when I have some time.

I think the only grouse we have with the place was the exorbitant cost of everything! Entry to the place (if you are not a guest) was RM16! A doughnut (normally about 80 sen where I come from) costs RM 3.80! My poor family survived on cup noodles! :-P

2006-05-22T08:01:00.000+08:00

Welcome to wherever you are – Bon Jovi

I am not a big fan of Bon Jovi. Their music aren't exactly pleasant to my delicate ears. But once in a while, even they spring a surprise. And this is one of them:

Maybe we’re all different but we’re still the same
We all got the blood of Eden running through our veins
I know sometimes it’s hard for you to see
You’re caught between just who you are and who you want to be
If you feel alone and lost and need a friend
Remember every new beginning is some beginning’s end

Chorus:
Welcome to wherever you are
This is your life, you made it this far
Welcome, you have to believe
That right here, right now
You’re exactly where you are supposed to be
Welcome to wherever you are

When everybody’s in and you’re left out
And you feel you’re drowning in a shadow of a doubt
Everyone’s a miracle in their own way
Just listen to yourself, not what other people say
When it seems you’re lost, alone and feeling down
Remember everybody’s different,
Just take a look around you

Chorus:
Welcome to wherever you are
This is your life, you made it this far
Welcome, you have to believe
That right here, right now
You’re exactly where you are supposed to be

Bridge:
Be who you want to be
Be who you are
Everyone’s a hero
Everyone’s a star
When you want to give up
And your heart’s about to break
Remember that you’re perfect,
God makes no mistakes…

Chorus:
Welcome to wherever you are
This is your life, you made it this far
Welcome, you have to believe
That right here, right now
You’re exactly where you are supposed to be

And I say welcome
I say welcome, welcome.

This song is dedicated to all my friends who went down in their exams last week. Take heart fellas, don't give up, strive harder next time round. We are behind you all the way!

2006-05-19T13:12:00.000+08:00

Back on Track

I had a very fruitful meeting with an expert in statistics yesterday evening regarding the data analysis for my thesis. He was very kind and encouraging.

I am happy to say that a lot of my fears were unfounded and my thesis (which I thought was in jeopardy) is now back on track.

Thank God!

2006-05-19T11:34:00.000+08:00

It's a Sad Day

Not so good news here. FOUR of our colleagues went down. Four out of 9 who sat for the exam.

It's a sad day for everyone...

Congrats to those who cleared. To my friends who went down, don't give up. Keep your chin up and strive harder. We are behind you all the way.

2006-05-19T11:31:00.000+08:00

Hot off the Press!

All the Part 1 candidates passed! (Two who failed are from the out campus group). Congratulations fellas! Very proud of you all.

Stay posted for the Part 2 results!

The honoraries are:

1. Dr. Sufian
2. Dr. Zubin
3. Dr. Ungku Ameen
4. Dr. Haniza
5. Dr. Rizah
6. Dr. Haree
7. Dr. Cheong KL

CONGRATULATIONS!

2006-05-19T11:17:00.000+08:00

Hour of Reckoning

It's 11.15 am now, all the Masters candidates have congregated at the department for a meeting with the head of department. Their results will be announced any time now. It's the hour of reckoning. Rumour has it that some didn't make the cut. Just who did and who didn't?

Watch this space....

2006-05-18T14:03:00.000+08:00

Palpable Tension

It's the exam week this week. I have friends attempting in just about every exam that is going on. The MMed Part 1 got over yesterday and the Part 2 will finish today. The Family Medicine Part 1 was finished yesterday as well. My friend and fellow trainee, CW, passed his Paediatrics Part 2 (way to go man! So happy for you!). I told him from now on, my kid's health will be his responsibility!

The MMed results (Part 1 and 2) will be released tomorrow. Even as I write this, my juniors are sitting for the short cases (in Part 2). I met a few of them just now, some were happy with their performances so far, others were a little downhearted. I can understand their trepidations. I have been there before. It's a horrible feeling; the uncertainty, the tension and stress can be overwhelming.

There is indeed a palpable tension in the air. By this time tomorrow, the stress would have been forgotten; let's just hope there will be a happy end to it.

2006-05-18T12:03:00.000+08:00

Memory Loss

I think our Memory Clinic has got to be the most poorly attended clinic in my department, which is rather ironic and funny at the same time as the clinic is meant to help elderly folks with memory loss. Last week, only one patient came for the clinic. I wonder how many will turn up today? The patients simply forget to turn up! :-)

2006-05-18T08:38:00.000+08:00

Blogspot problem

I just realised that my blog (and others I have viewed) does not have a 'forward' or 'back' button; meaning, once I am done reading one page, there is no where for me to click to read the page before or after the current page! Anyone out there (who is wiser, not necessary older) can help me with this?

It's the cardiac clinic day today. The clinic is actually cancelled (because it's the exam week here and most cardiologists are on leave - which is strange as I thought all leaves are 'frozen'). But, there will be patients who did not receive the cancellation notice and those who come today as a 'walk-in' patient. I am hoping to be able to recruit a few of them for my thesis.

Will be meeting the statistician this evening after work. Sigh! Looks like I can kiss going to the gym after work goodbye. I need to trash out a few important issues with him. The way I look at it, my thesis has many flaws!!!

My sore throat is still there (though I have sucking lozenges like crazy) and I have a few oral ulcers (ouch! I get it all the time and they are SO painful!).

The weekend draws nigh, really looking forward to it....we are going to a little French getaway!

2006-05-18T08:15:00.000+08:00

More on CARDIAC CRIPPLE

I received this response from Pat regarding my article on 'Cardiac Cripple' posted on 2nd May 2006. I thought I will post the comment here so that everyone will know what it is and from where the term originated. We learn new things everyday, even though the new stuff we learn may be ancient. :-)

Jimbo:

FYI: the term "cardiac cripple" wasn't just coined by some smart alec. It has its roots in a 1927 paper by a Canadian cardiologist, and describes a real and sad phenomenon. (If you search for the quote "cardiac cripple" on Google or PubMed, you'll get a link to the full text of the article.) These are people who are physically okay after a diagnosis of heart disease but who worry so much about every little palpitation or increased heart rate that they become home bound, or even bed bound.

Cheers,
Pat Skerrett
Editor,
Harvard Heart Letter

2006-05-17T15:27:00.000+08:00

The Gatal Specialist

Something hilarious happened yesterday during the geriatric ward rounds. One of our elderly male patient (he is 80+) registered a drop in his Hemoglobin count on routine blood investigation. We wanted to know if he was passing blood out through his intestine and the fastest way to do it was to do a rectal digital examination.

So we popped the question at him, "Uncle, can we examine your back?"; to which he replied "Sure, do anything you want. After all you all are the experts".

My specialist was a little miffed that she is now known (at least to this patient) to be an expert in rectal examination! Anyhow, she put on a pair of surgical gloves while we positioned the patient.

The rectal examination isn't exactly a very pleasant experience (at least for most people I know). And so he 'oohed and aahed' in pain during the quick procedure. Thankfully there was no evidence of a bleed in the intestine.

While my specialist walked off to dispose the gloves and wash up, the patient turned to us and said one single word: "Gatal"!!! :-) My specialist walked in just as he mentioned that word! She didn't know whether to laugh or to feel insulted. One moment she was an expert in the rectum, the next she was labelled 'gatal'!!

The word 'gatal' is a malay word which can be taken to mean just an 'itch' or it may be used to insinuate that a person is horny or even lustful. It was truly hilarious!

On the other hand we do have some really gatal patients. Opposite the patient above was another man (we sent him home this morning). When my House Officer (a lady) was inserting the urinary catheter into his penis a while ago (to allow continuous drainage as well as for monitoring the urine output); he remarked during the procedure that it was "sungguh sedap" (so pleasurable)!!! Now that is one gatal fellow! Little wonder he has 11 children! :-)

2006-05-17T14:15:00.000+08:00

TOO LATE

I wish I saw this cartoon before I bought my MPV last year. Sigh!

2006-05-17T13:56:00.000+08:00

Postprandial Somnolence

I am feeling it. The sheer fatigue and sleepiness that have become all too familiar after every on call duty. I just had a good lunch at Rumahku and now am sitting down to do a quick check on my emails (mostly junk). I can hardly keep my eyes open.

I think I will have to give up going to the gym after work later. The gloomy weather outside also rule out any chance of getting a quick swim (unless I want to be struck by lightning). In fact I am seriously contemplating giving up my gym membership altogether seeing how infrequently I actually go there. I am not seeing any result either....my morphology is still the same! :-P

I spent 2 hours with the medical students just now. They didn't come for rounds last night because:
1. 2 of them went to watch MI-III (so Mr Cruise won)
2. 1 of them slept early
3. 1 of them mumbled something incomprehensible
4. 1 of them didn't know there was rounds!

NONE of them watched Desperate Housewives! Ugh!

My throat hurt a little now; yours would too if you taught continuosly for 2 hours.

I just want to go home and sleep. :-)

2006-05-17T08:13:00.000+08:00

Post Call and non the worst off

Had a relatively good sleep last night while on call. Slept at 1 am after reviewing the last patient. He suddenly developed typical left sided chest pain which lasted a few minutes. By the time I got to him, he was well again but his ECG showed significant changes. I treated him as unstable angina till further review.

Was paged at 3 am by the MO downstairs regarding 2 patients. One was another geriatric patient who was promptly dumped in the A&E by the family and hence, again, we have no idea what she has! From her Xray she appear to have pneumonia or maybe even an abscess. Doesn't it make your blood boil that people can be so heartless? I mean how can you just leave your loved ones (assuming they are loved) in the ER and scoot off?!

The other was a referral from the psychiatrist. The patient was a 31 year old guy who was depressed and wanted to jump off a building to kill himself. The referral was for an incidental finding of a high white cell count and a slightly elevated paracetamol level. We didn't take over the patient as my MO could not find a source of infection nor any evidence of infection (note: a high white cell count does not necessary always mean an infection) and anyone who has just taken even just 2 tablets of panadol would have an elevated PCM level.

Thereafter it was sweet sleep till 7 am this morning. I don't feel very tired, maybe later, after lunch perhaps. I have 5 medical students to teach at 10 am. Btw, they didn't show up last night for the rounds. I did ask them to choose between watching Desperate Housewives or the rounds. Obviously they love Bree, Gab, Lynette, Susan and all the hunky guys in the show more. No-lah I think they were probably busy clerking the 4 patients I assigned to them yesterday.

It's the middle of the week! Am looking forward to the end of the week. Planning to take my little nest for a weekend getaway somewhere in the mountains.

2006-05-16T18:45:00.000+08:00

ON CALL...again

Bad start to a good day....2 elderly (all of them are elderly in my ward) passed away this morning while we were doing the rounds. One of them was admitted by me from the clinic yesterday. She was 95. a frail chinese woman who has been bed-bound for the last 6 months and developed a very bad and smelly bed sore. Her children brought her from one GP to another.

Altogether she had 1 month of Augmentin, then another 2 weeks of Amoxillin and the bed sore was applied with Fucidin Cream for over 2 months! Not once did anyone attempt to clean her sore or deslough her. When I saw her yesterday, she was skin and bones, barely conscious and in pain. What really touched me were her 2 children who accompanied her. They were also very old (above 60).

When I requested for her to be placed on the bed to be examined, these 2 elderly people gently carried their mum onto the bed, huffing and puffing away. Their mum was in a bad state. I decided to admit her for nursing of the bed sore. It was badly infected and very smelly. You can even see her pelvic bone!

And less than 24 hours later, she breathed her last. Her son was by her side. She went away silently. Her son didn't make a big fuss. I guess he expected it. He said it was better that she went. She has suffered long enough. And indeed she had.

What really bugged me was the suboptimal care that she was given. I think the doctors failed her and ultimately took her life or at least hastened her death.

The rounds was over by 11.45 pm. It was made very unpleasant by the many intrusive relatives. The afternoon was more of the same. Relatives that dump their elderly folks in the A&E leaving us without a clue as to what is wrong with the patient; relatives who turn up 10 days after the patient has been admitted and demanding to know everything about the patient; relatives who hang around the patient even when requested (politely) to leave....the list goes on and on. Sigh!

So why is it a good day? Here are the reasons:
1. some of my patients are actually getting better! Miraculously!
2. I got some wedding flowers this morning from the office clerk. I couldn't go for her nephew's wedding over the weekend (because i had to work u see); so I send a gift. Now I got flowers in return. I wonder if I should eat the eggs that came with it.
3. I got a cheque for my travel claims. Not much but at least I won't starve till the next salary
4. I am taking a bunch of medical students for rounds later. I so like to teach. It's a great priviledge to teach. Each medical student is a potential consultant in the future. Plus, it makes me feel a little like Dr HOUSE. Heh heh!

So, I do feel good. I pray it will stay this way. Amen

2006-05-16T12:50:00.000+08:00

GRAFITTI

I find toilet graffiti fascinating. Ok, before you label me a pervert, let me qualify my statement. I I admit that much of the graffiti that adorn the walls/ceiling/toilet cistern/door of the public toilets in Malaysia are pretty distasteful, ranging from works of unknown porn artists to open slander and phones numbers either soliciting services or offering them. I must say they make for an interesting read, especially when you have 'big business' to do but forgot the newspaper or magazine. Ladies, don't gloat; I heard it's just as bad in the ladies.

But, sometimes you come across a gem or two; like the one in the picture which I recently found scribbled behind the door of the toilet in our postgraduate department. It speaks volume doesn't it?

It tells me 2 things:

1. There is a very frustrated and hygiene conscious guy (it's the male toilet) who probably encountered an unflushed toilet complete with organic waste product more than once in that toilet.

2. There are one or more guys (postgrad fellas mind you) who can't be bothered to clean up after they are done. Or, he doesn't close the toilet door when he does his business (I mean, you can't see the message if the door's not closed right?)

I use that toilet all the time and I can tell you that the message has fallen on deaf ears. I can't begin to tell you how many times I had to clean up after some idiot who thinks the world owes him a favour by flushing for him after he is done. (I hope he gets hemorrhoids or something)

Frankly, we are not known for our excellent habits in the toilet department. Walk into any public toilet and you will know what I mean. But for this to happen in a prestigious (or assumed to be) institution of higher learning and in the postgrad department is well...sad.

If we who are educated behave like this, what hope is there for those who are less fortunate?

PS: I don't think any mother would want to clean up her child's waste products, particularly if the child is a postgrad student! Shame on us.

2006-05-16T07:52:00.000+08:00

CRASH

I managed to finally watch 'CRASH' last week (after lugging the DVD in my bag for the last month or so). This show won the Oscar this year, upstaging the favourite 'Brokeback Mountain'. I don't think CRASH was shown in Malaysia (if it did, I missed it); as with Brokeback.

I figure that the censorship board, or the Information Minister (again) think that Malaysian brains are too juvenile to see shows like these (or live parliamentary proceedings for that matter).

I loved the show. Watching it was a gut wrenching experience. I was led through an emotional roller coaster ride as I watched the story unfold. The plot was simple; 24 hours in the lives of various people in the post 9/11 LA.

We have the white DA (who was more concerned about his image than his wife) and his bigot wife; a Persian family; a Latino family; a black detective with a white partner/girlfriend/lover; a black family; a pair of black car-jackers; a chinese human-trafficker; a white cop (rookie) who struggled with his convictions about race relations and a black (who didn't think he is one) movie producer and his colored wife. In a span of 24 hours, their lives collided.

I saw racism, prejudices and sheer hatred as I watched the movie. Juxtaposed in between were moments of grace and even a miracle! (of some sort anyway). The climax had to be the scene depicted in the picture here (you want to know...go see the show).

I came away having a mixed feeling in my heart. My whole soul screamed out "No! No! No!" as I watched one scene of misunderstanding, hatred, prejudice after another; but deep within I knew that it was real, so real. It's not hard to imagine the same thing happening in our so called 'multi-ethnic society living in complete harmony'.

In fact, despite all the media hype and lovely jingle about how nice and loving we are and how we can 'Boleh' (Can Do) in everything; there are some things that we just 'tak boleh' (can't). Race relation is a very fragile thing. I fear that, looking at the present scenario, very soon life will imitate art and not the other way round.

In my books, this movie deserved all the accolades it received. Brokeback was like Looney-tunes compared to this show.

2006-05-15T17:40:00.000+08:00

Teacher’s Day – A Tribute to My Teachers

May 16th, Teacher’s Day. I don’t think I can be where I am today without my teachers.
So, on this special day I would like to remember them and thank them for all that they have done for me. Who knows, maybe some of them might stumble upon my blog and realize that their labour of love had not been in vain. I owe them so much.

And the honoraries are…. (drum roll)

Mrs Foong, my kindergarten teacher, a no nonsense Chinese lady with a hair-do that made her stood at least another half foot taller, complete with butterfly shaped glasses. Very, very scary if she held a cane!

Pn Zainal, my class teacher for standard 1 and 3. She was a Chinese who converted to Islam by marriage. She taught Art those days. I was her pet actually. ;-) She frequently called me out of the classroom to help her in all kinds of art and craft projects, be it the school play decoration or art competition. I looked forward to it as it meant fun rather than sitting in the boring classroom.

Pn Nathan, my class teacher for standard 6. A tyrant at the beginning of the year but she became our friend by year end. She taught us English. I still remember the time she punished us by making us squat under the desk or squat under the black board for the entire period as she carried on teaching, oblivious to the fact that her poor (but mischievous) pupils were having severe lower limb cramps. By year end we were frequent visitors to her home where we had great fun and tea. Her son became our good pal.

Mrs Boo, my English Teacher from Form 3-5. Another irritable lady! It would be unwise to be in her bad books. Luckily, I was her pet! She made a tremendous impact on my reading habit. Happy were the days when I was at her house for tea and she would introduce me to her favorite authors, showing off to me her vast collection of books in her library. She would get me to read the books and tell her what I think of them. I don’t think we can find teachers like her anymore. She taught me English by example.

Ms Lee, my geography teacher in Form 4 and 5. When this lady tells you about the demography of a place anywhere in the world, you’d better believe her as she HAS been there!!! She gets very animated and excited when she tells you about some place she has been before (which was just about everywhere….oh well, when you are single….); and so the usually dull subject of Geography became alive when she taught! She planted the seed of curiosity in me.

Ms Lim, my ‘Kertas Am’ (General Paper) teacher in Form 5 and 6. She was petite, soft spoken and spoke malay so fluently you could easily mistake her for one. Ironically, she was the one who taught me to be a little cynical; not to look at the world with sugar coated eyes. I still remember her words to me: ‘Find your niche in this world, if you don’t, some day there will be not one inch for you or your race to stand in this country'. She was by no means a racist. What she said was true and I still believe it.

Mrs Ong, my Mathematic and Additional Mathematics teacher from Form 4 to 6. She was the one who literally turned my life around. Towards the end of Form 5, when the trial exam was drawing near, she literally pulled me aside and told me to get my act together. I was scoring borderline fail those days in maths. Maybe she saw something in me that I could not see in myself. Maybe she knew I could do better. After her private ‘lecture’, I poured in 101% effort into maths and changed from a mediocre student to one of the top students. I never looked back since. She taught me excellence required hard work.

Mrs Seong, my Biology teacher in Form 6. She knew that I was weak in my science subjects but still accepted me into her class (thank God, otherwise, I can kiss Medicine goodbye). Happy were the times when we would be at her home playing UNO or SNAP or Monopoly or anything! She taught us there was life outside of the classroom.

Ms Khoo, our music teacher. Grave would be the life of anyone who mistakenly addressed her as ‘Mrs’ Khoo!!! She whipped a bunch of us into a formidable choir group. Our greatest achievement was performing at the Kuantan Stadium during one of the MSSM meet. Her house was the ‘lepak’ (hangout) place for us, even after we left school. A lovely wooden bungalow surrounded by a lush green garden. She taught us that education does not only mean books.

Dr Wan Zurinah, my supervisor and mentor in the final year of my BSc (Hons) program. Tall and willowy, energetic and full of ideas, she was a great encouragement to me especially the times when my experiments did not yield the desired results. My thesis got an ‘A’. :-)

Prof Dato’ Lam Sai Kit, short in stature but powerful in influence. He was a tough taskmaster as I worked as a Research Assistant and Masters Student under him. He introduced me to the wonderful world of genetics and bugs. When I chose to end my postgraduate study prematurely and pursue a career in Medicine, he did not stop me but instead encouraged me. Throughout my undergrad days in Medicine, he would send news or cards and later, emails. I know I have a good friend in him.

Dr Ingrid Kautner, my bubbly supervisor from Poland when I was doing research in UM. It was a joy working with and under her guidance. She introduced me to the classics when she gave me a book titled 'The Castle' by Kafka. Took me forever to read it. She deemed the stuff I was reading prior to that unsuitable for a scientist! She taught me perseverance and not to give up, no matter how bad things were.

Dr Susan Benjamin, my physiology lecturer in India. She walked with such grace. If you can imagine those private tutors in the Victorian Era, she would fit the bill nicely. She was a walking physiology book! Physiology was interesting when she taught it. She taught us that Medicine can be graceful.

Dr Benjamin Joseph, hubby of Dr Susan and Orthopedic Surgeon extraordinaire. He made me beam with pride when he patted me on the back during an orthopedic ward round after I explained to postgraduate students the entire process of fixing biopsy tissue into wax and subsequent slide preparation. (He didn’t know that I had first hand knowledge of such things). He taught me the power of affirmation.

Dr Anjali Rao, my biochemistry teacher. The most vivid memory that I have of her was that of her pacing up and down the lecture hall, dressed in her saree (with perspiration evident under the arms), furiously wiping the perspiration from her brow with the tiny hanky in her hand as she taught biochemisty in the hot Indian summer. To me, that’s dedication and passion.

Dr Lavanya Rao, my O&G lecturer. She was a petite lady who was a firebrand. She taught, she scolded, she threatened, she yelled, she shouted, she screamed and she pestered; and she got some O&G stuff into our thick resistant brains! She taught us that the most unpleasant subject can be learnt.

Dr Chandrashekar, my ophthalmology lecturer who taught me the power of imagination. I remember him telling us as he showed us a slide, “Can you see the microaneurysms in the fundus? Can you? Can you? You can’t? If you can’t see, then just imagine them!!!”. And then miraculously, all I could see were microaneurysms everywhere!!! Enough said.

Dr Sharmini, my Community Medicine lecturer, also wife of Dr Chandrasekhar. I love Community Medicine because of her! Actually I can’t remember much of my community medicine stuff when she taught. It was a pleasure just watching her. Such beauty and grace! Not a hint of perspiration even in the hottest Indian summer! And yes, I did get a gold medal in Community Medicine. :-)

Dr Jim Mathew, my close friend, brother and fellow church member and, a postgraduate student in Medicine when I was in India. He taught me to love medicine, taking the trouble to have me around the hospital in the night just to show me this or that patient; or he would be coaching me on the finer art of medicine in an empty room some where in the hospital. Thanks buddy.

Dr Suhas Bhat, a young lecturer in Medicine. He was the heart-throb then, girls would faint in his presence. He had good looks and beautiful hazel eyes. I owe him lots for the long hours he spent with me in the district hospital where we were posted together, going through one ECG after another ECG with me, helping me to understand that the wavy jagged lines on paper actually meant something! He helped me want to be a physician.

I could go on and on. I just want to say “thank you” to them for all that they have done in my life. My prayer is that I might in turn, make a difference in another person’s life just as they did in mine. Happy Teacher’s Day!

2006-05-15T13:48:00.000+08:00

SWEET LITTLE FOUL MOUTHED LADY

I remember a 90 something sweet looking lady who was admitted in my ward 2 weeks ago for a UTI (urinary tract infection). Of course she had a lot of other comorbidities like hypertension and some cognitive impairment.

When you look at her, you would be amazed at the angelic smile that seemed to be perpetually fixed upon her face. I guess when you lose all your teeth, the face kinda reassign itself into an angelic smile.

So every morning, I was greeted by an angelic smiling grandma, who just nodded at my questions, or perhaps mumbled a few words; always with that smile.

All was smiley and well, until last Thursday. That morning I found it hard to wake her. She was more drowsy than usual. When the nurses tried to wake and feed her, she flew into a rage.

From her angelic mouth, came forth the foulest of chinese adjectives! She was cursing the nurses with words that describe everything from their ancestors (3rd and 4th generation, in the past and the future) and every vile description of the female genitalia in the chinese language!

I was quite taken aback actually by the stream of profanities. A quick check with a bedside blood sugar monitor revealed a reading of 2.1 mmol/L (normal above 4 mmol/L).

She had hypoglycemia. Her blood sugar was low enough to turn a nice sweet elderly lady into a venomous foul-mouthed, porridge bowl throwing, spoon flinging, pillows flying, screaming and kicking grandma!

Moral of the story?
1. Don't judge a lady by her smile. I am sure she didn't suddenly acquire her vocab armament during the hypo episode. She must have been pretty conversant in it when she was much younger. I have an aunt who can shoot off profanities without so much as a blink. One of those Mae West personality.

2. Don't ever, ever go hypoglycemic if you got something to hide!!!

If you think she was bad, wait till you talk to her children.....

2006-05-15T13:10:00.000+08:00

Post Geriatric Clinic, Pre Cardiac Clinic

I am in the in-between period where one clinic has just ended and another is about to start. It's kinda like the lull before the storm. I am feeling so sleepy; haven't really caught up with the lack of sleep from the last on call; and I am on call again tomorrow!!! AAARgh!!!!

I did, however, managed to recruit ONE patient in the geriatric clinic just now. So, now I need another 45 more patients to call it a day. I am meeting a statistician this Thursday to trash out a few problems with my data (I suspect it's going to be more than a few problems...ugh!).

It's the exam week this week, both the MMed Part 1 and 2. I can't believe it was only 6 months ago that I underwent this 'hell' (forgive the expression but I am sure none of the candidates will disagree). Yesterday night, I shot off a few sms-es to all my friends who are taking the exam this week. Some replied saying they are so exhausted and panicky. It's only natural, I have been there before. It's one of th worst time of my life.

All the best to you all, everyone sitting for the exam this week. Stay cool, get plenty of rest and go ace it! :-)

Cardiac clinic in 50 minutes. Think I will get a shut-eye.

2006-05-15T07:45:00.000+08:00

I don't mean to brag but..

Certificate for standing first in English Spelling

Johan! (First) in Mathematics

Sweetie, daddy is really very proud of you!

2006-05-15T07:42:00.000+08:00

TRAINS

I believe that all boys, regardless of how old they are, should have a train set at some point in their lives. It's a man thing. :-)

2006-05-14T08:00:00.000+08:00

Happy Mother’s Day

Today is Mother’s Day and I am not at home.

Why? Because I have been asked to work today.
Why? Because there is no one else to do the rounds.
Why? Because the people in charge of the ward are all away at courses and the Medical Officers will be sitting for their Part 1 exam tomorrow.
And so, I have to do the rounds today…for the 3rd day in a row.

Naturally I am not happy.
Naturally I would want to be home, celebrating this wonderful day with my family.
I’d rather be in church, where the men will make a show of appreciation for their spouses. I’ve paid RM 10 to the Men’s Fellowship’s Coffer and I have no idea what they got the wives!
I got my wife something shiny and golden. Heh heh! (I doubt RM10 can buy anything substantial…, better to have Plan B, just in case!)

Yes, I am not happy.
But my happiness has nothing to do with it..
I choose to do the rounds this weekend; simply because there is no one else to do it. It would not be fair to ask the MOs to do the rounds (if I were sitting for my exam the next day, the last thing I want to do is to do the rounds, especially in the geriatric ward!). Also, it wouldn’t be fair for the 30 odd geriatric patients staying in the hospital on this wonderful day if no doctor comes to see them.

SO….
On this wonderful day, I want to wish my Mum, my MIL and my darling wife, “HAPPY MOTHER’S DAY!”. Love you all HEAPS!!!You’re the BEST!

Now, if they make me work on Father’s Day…..Grrrrrrr.

2006-05-13T10:13:00.000+08:00

One For The Road

2006-05-13T10:01:00.000+08:00

Post-call Fatigue

I am so tired. Didn't get much sleep last night while on call. Woke up with a heavy head and heavier eyelids. Managed to trudge through the geriatric ward rounds and finished it in a record time of 1 hour 40 minutes. (No patient care was compromised). Thank God there weren't any new admissions to the ward last night and so rounds went a lot faster. Plus the fact I have a HO who writes as fast as I could talk...that helped a lot! Thanks Ganesha!

I am going to take a slow drive back to my hometown. Tonight we will be celebrating my parent's and my MIL's birthday at a restaurant. I just hope I can keep my eyes open! :-)

Tomorrow I gotta get back to KL again to again do the ward rounds. Will have to miss church and Mother's Day celebration as well. Any of you young fellas out there still want to be a doctor? Better think again. :-)

Cheers! May I reach home safely today.

2006-05-12T17:49:00.000+08:00

On Call Blues

It's a public holiday today and I am on call. Sigh. It's terrible being on call on a holiday. Not only because I am stuck within the confines of the vicinity of the hospital, the day seems to drag on forever and ever. It's almost 6 pm now, and there's another 14 more hours before my on call duty is over. Did I mention I have to do the rounds tomorrow?

The day started badly. Right on the dot at 8am, I got a page! It was from a House Officer from the Orthopaedic Department (see, my claim has been justified....read my article on 'Sheer Arrogance'). On the other end of the line was a very terrified sounding HO trying to refer a patient to me. Poor fella. He must have been pee-ing in his pants.

I confess I was not very kind to him. First he gave me the wrong patient's name (which resulted in me looking for the referred patient in the entire ortho ward later); then he mumbled and fumbled through the entire referral. I was not told the patient's age, or her background. He took a long time to read the patient's meds and actually asked me why the patient is on such and such a medication! I had to literally dig the reason for the referral out of him.

The reason for the referral? Uncontrolled hypertension. The patient was admitted yesterday morning for an elective surgery on her right knee on Monday. She is a known case of hypertension, post-thyroidectomy hypothyroidism on L-thyroxine and also a case of Exogenous Cushing on replacement therapy with hydrocortisone. She has been on a single anti-hypertensive agent for the last 3 months. (I got this history myself, not from the HO).

They noted that her BP was high yesterday and decided to refer to the medical lecturer on call. The point is, the patient was admitted yesterday morning and the decision to make a referral was also done then; why is it that the referral was only done today, on a public holiday, leaving the patient with high BP overnight? Things like these makes my blood boil. And the next morning (ie: today) they make the poor HO make the referral! I am sure at 8 am in the morning, there are more senior doctors around in the ward and yet none of them have even the slightest courtesy to call and make a decent referral. And these are the people who demanded arrogantly that only our consultants can refer to their consultants! (see my article 'Sheer Arrogance' on 5/5/2006)

The HO asked if I would like to see the patient then (read: immediately). I answered "No". I said I was busy in the ward (one of my patient took a turn for the worst) and I asked him to tell his MOs to start something first. The reply was typical and anticipated. He said "That's the problem, they don't know what to start"!!!

I told him to tell them to "figure it out". After all, it wasn't exactly 'rocket science' and all of us have been through medical school and we were taught basically the same things. Starting a anti-hypertensive agent need very little gray cells.

By the time I was free to see the patient, her BP was already well controlled. Some one actually 'figured it out'! If only they would bother to read her old appointment card, they will realise that she was also on Amlodipine which she hasn't been taking for the last 3 months simply because the last doctor who saw her 'forgot' to prescribe it to her. Sigh! A totally unnecessary referral.

Ward round thereafter was horrible, what with the one patient going steadily down hill and a constant stream of relatives that disrupted the smooth running of the rounds.

I tried to sleep a little after lunch (power nap mah) but was repeated paged by the medical MO running the emergency room downstairs (poor lady). She has one complicated patient after another.

I just hope the evening will be better. There's another guy with a heart attack to review, and another woman who just came in with high fever and confusion. I have a bad feeling about this.

It's 6.10 pm, another 13 hours and 50 minutes to go...

2006-05-11T23:00:00.000+08:00

Times are bad

This new sign was pasted on the wall of the postgrad room that I use, right above the printer. It seems from 1st June onwards, we have to buy our own printer toner. It will not be provided anymore by the Postgraduate Secretariat. The said printer is a HP Laserjet 1300.

I guess it has to come to this. Sigh!

I probably will have to buy one in order to print my thesis later. These toners are expensive. I just hope that we won't be asked to bring our own printers next time!

The real winner in this scenario, of course, is Hewlett-Packard. :-(

2006-05-11T16:44:00.000+08:00

Thesis Update

The Cardiac clinic was pure madness today. 232 patients! Our highest record for this year. Some people aren't doing their jobs controlling the number of patients. By noon, temper was already flaring.

I didn't leave my room except twice when I had to go for a PU (pass urine) break. Lunch was kindly sponsored by a drug company (thanks fellas) which was delivered into our rooms.

Alas, out of the 200 odd patients, I only managed to recruit 19 patients today. The total now is 454 patients, another 46 to go.

It's raining dogs and cats outside. I wonder when will this horrible weather let up. I long to swim in the hot sun again.

Ok, gtg for locum. Tomorrow I am on call. Ugh!

2006-05-11T07:55:00.000+08:00

Alcoholic Nanny?

Was surprised/shocked to see an opened can of Guiness Stout (8% alcohol, mostly malt) in my toilet last night when I reached home. Initially I thought it belonged to the nanny that my brother hired to take care of the new baby. Not a very good idea to have a drunk nanny right?

It turned out that it was my sister-in-law's idea! Apparently her side of the family has this tradition where if the baby develops heat/nappy rash, the baby is bathe in Guiness Stout! She asked if I have heard of this practice before and frankly, I have not. I suppose the logic behind this that the alcohol in the Guiness Stout acts as some kind of astringent upon the rashes. I don't know what the malt does though.

Personally, I'd rather use calomine lotion. Works just as well and the baby smells great! :-)

2006-05-10T17:06:00.000+08:00

Addiction

Ripped this off my friend's blog (http://sbanboy.blogspot.com). Thought it was real funny. And no...I am definitely NOT addicted to the toilet bowl!!! :-)

Work's done for the day. It's pouring a menagerie outside. My bones are lazy. I am wondering should I brave the rain, traffic jam, flash floods, lightnings, falling trees, dysfunctional traffic lights...blah blah blah (I hope I don't come across as procrastinating!) to go and work out at the gym! :-P

Should I? Shoud I?

2006-05-10T11:49:00.000+08:00

Varicose Veins

Rounds just got over...miraculously because it's not even noon yet! My legs are killing me. The soles hurt, the calves hurt, the thighs hurt....ouch ouch ouch!

My patient, the one who stayed >90 days, suddenly passed away last night. I was just saying hi to him yesterday afternoon and now he is no more. Very sudden, very disconcerting.

Most of the patients are well. And...not so many obtrusive relatives around today, so rounds went pretty smoothly. Thank God. Sometimes I wish the relatives realise that we do need our space to do our work, to think and to plan the next step. Some just wait at the bed and before you can say 'hi' to the patient, they would have thrown some 101 questions at you. Being concerned is one thing, but being a pain is another. They probably think we are psychics....able to diagnose without examining the patient and we heal by telepathy or something.

I think I might just develop varicose veins on my legs by the end of this month when I am done with geriatrics. Thank God I had my hemorrhoids out a long time ago....

Lunch, here I come!

2006-05-10T07:53:00.000+08:00

AFFIRMATION

Whenever I take a long drive (ie: home or coming back to KL), I would pop my favourite CD into the player. It's the 'Best of Savage Garden' compilation. I know, I know, they are defunct, but their songs, particularly the lyrics are very meaningful. One of my favourite is 'Affirmation'. Not only does it have a nice beat (I usually play it full blasts!! A good way to keep awake!).

Here's the lyrics:

I believe the sun should never set upon an argument
I believe we place our happiness in other people's hands
I believe that junk food tastes so good because it's bad for you
I believe your parents did the best job they knew how to do
I believe that beauty magazines promote low self esteem
I believe I'm loved when I'm completely by myself alone

Chorus:
I believe in Karma what you give is what you get returned
I believe you can't appreciate real love until you've been burned
I believe the grass is no more greener on the other side
I believe you don't know what you've got until you say goodbye

I believe you can't control or choose your sexuality
I believe the trust is more important than monogamy
I believe your most attractive features are your heart and soul
I believe that family is worth more than money or gold
I believe the struggle for financial freedom is unfair
I believe the only ones who disagree are millionaires

I believe forgiveness is the key to your unhappiness
I believe that wedded bliss negates the need to be undressed
I believe that God does not endorse TV evangelists
I believe in love surviving death into eternity

Now isn't that beautiful? Whoever wrote the lyrics is a genius.
What do I think? Well. I believe 99% of the above.... :-)

2006-05-09T16:45:00.000+08:00

NOT DONE YET

For some reasons, I could not sleep last night. I was tossing and turning the entire time. It's hard for me to fall asleep, more so last night. I was thinking to myself, did I eat or drink something that could have caused the insomnia? I can't sleep if I take coffee or tea or even just coca cola! But no, I didn't. And I even went for a swim earlier after work (so unfit that at the end of 10 laps, I was ready to be ventilated); so by logic, I should have slept like a baby. But I didn't.

I think I finally slept at around 2 am.....only to be woken up at 2.30 am when the fan stopped. I got up and was instantly hit by a foul smell in my room. It was dark but I could see that mine was the only house to have the blackout (it doesn't take a genius really). As I stumbled in the darkness, I reached for the torch light on the bedside table and switched it on.

Lo and behold, it was like holding a light saber (I do so like one of those!!!). Why? Because my room was filled with smoke, very foul smelling smoke that was escaping from the burnt out motor of my stand fan! A nice long light beam made from smoke and the light of my torch.

My first thought was to rush out and check whether the house was on fire. It wasn't. I could almost see the headline "Doctor burnt to death buck naked while asleep (yes, I sleep with only channel 5 on) along with the entire household....due to faulty fan, no foul play suspected!".

Thank God everything was fine. My little niece was asleep peacefully next door with the nanny. I don't think anyone knew what happened. After I got the power back on, and got rid of the offending fan, I sat down and thought for a while.

Yeah, I could have died! Maybe suffocated to death, or even made into human toast. The foul smell was still evident in my room as I slowly drifted off to sleep.

I knew why I couldn't sleep last night. Had I fallen asleep earlier, I would have been in dream land and probably not woken up so quickly by the blackout and the smoke. Bad things could have happened.

As I drifted off to sleep, I knew in my heart that a miracle has happened. And most of all, I knew that God isn't done with me yet here on earth. And that is comforting indeed.

2006-05-09T09:01:00.000+08:00

Maths Whiz

My wife called me yesterday to tell me that our daughter brought home another trophy, this time for standing first in mathematics! I was like, WOW!!!!

I am so proud of her. Her daddy was never good in maths, well, at least until form 5 when my maths teacher pulled me aside 2 months before the SPM and told me that I will probably spend the rest of my life in the lower end of the economic spectrum unless I did something about my appalling mathematics knowledge. That kinda woke me up. Even turned me around, from then on, I was pretty good in mathematics....add maths included! :-)

I am so proud of you sweetie (have I said this just now?)!!!! Way to go! Well done!

PS: I am a bit worried about her Bahasa Melayu though. You would too if your kid describes a leaf as 'seketul daun' !!!!! Oh dear....

2006-05-08T17:43:00.000+08:00

'Clinic-itis'

I think I have been infected with a very severe case of 'clinic-itis'. That's a condition you get when you sit in the medical clinic the whole day, day in and day out.

I was running the geriatric clinic this morning (total 54 patients) and left it at about 1.45 pm (there were 3 more patients waiting to be seen) and made my way to the cardiac clinic. At the entrance I was waylaid by drug reps from Novartis. A new guy (who is the manager..spots a right earring, very metrosexual) wanted to interview me on how to improve their services. I gave some statements (I can't remember what). Next I was held up by the Pfizer team, who informed me that the material I needed for my thesis will be arriving next week (whoopie!); and finally the other Pfizer team (in charge of antibiotics) waylaid me and gave me the update on their antibiotic and also a box of salmon sushi from Sushi King. Finally I broke free...

Nearly choked on wasabi sauce when I gobbled down the raw fish and started the clinic. The wasabi sure cleared up my sinuses!

The clinic is still running (total 135 patients). But I left because there are no more subjects to be recruited (ie: no more male patients).

Total tally today: 435 patients. Another 65 more to go! Praise the Lord!

I want to go for a swim now (miraculously no rain today!). It will be my first swim in almost 2 months. Mum made 'tenggiri' fish stuffed with chilli for dinner. My parents are here to see my new niece (btw, I stay with my brother and commute back to my hometown to see my family only on weekends). So, I am really looking forward to dinner! Yummy!

:-)

2006-05-08T08:01:00.000+08:00

To weiwei

weiwei, a reader of my blog has requested for the contact of Rev Christopher Chia who recently preached at my church's family camp. Since, she did not leave a contact email or number, so here it is. You can get his details at www.arpc.net. It's Rev Chia's church's website. :-)

2006-05-08T07:45:00.000+08:00

OSIM Tongue Twisters

I've had a lovely weekend. Saturday saw us eating our favourite 'wan tan mee' for breakfast at our favourite shop. Next we spent half a day at Jaya Jusco, mainly to buy my MIL a birthday gift (we settled on a Sanyo CD/CDRW player). Met one of my former patient there who works as a security personnel. He gently reminded me that next week is 'Mother's Day'!!! Aargh!

I totally forgot about it. I had secretly (for many years...just didn't have the cash!) wanted to get my wife a Corelle dining set. She has had her eyes on a set ever since I married her. This time, Jusco had an offer for the dining set. Alas, she didn't like the design of the dining ware. Actually, I didn't like it all that much either. How come only 'not so nice' designs are always on offer? Hmm....

So, it's back to the drawing board...gotta wrack my brain on what to get her. 6 more days to think about it.

In the lobby, we were 'caught' by the DJ promoting OSIM massage equipments. He was a young energetic and hairy guy! Initially we were just asked to answer some really simple questions (does not need IQ more than 50) and we were rewarded with little Osim pens as gifts. Next, we were 'caught' again to play a game. This time there were 5 of us and we have to repeat, in turn, a series of tongue twisters in 30 seconds.

I really can't remember the entire sequence of the tongue twister. Something like "Shape up, slim down, tone up...something something, Zap, Zap, OSIM, U-Zap!"

The first lady (a malay lady) managed '8'. The second fumbled and tumbled to just '5'. My wife was next and she managed '8' repetitions. My turn was next. Happy to say I scored '10'! The guy next to me managed '9' (that too, but substituting 'zap' with 'zip'...it was hilarious). My reward? A digital thermometer, now given to my brother and wife. All in all, it was fun. It's also the first time we actually did something like this in public. A spot of glamour there. Heh heh!

I've had a lovely weekend indeed.

It's back to work today. My 'anger' on Friday has disappeared. Many in church who read my blog shared my sentiments. Time to forget the past and move on.

Long day today...geriatric clinic followed by cardiac clinic in the afternoon. :-)

2006-05-05T16:56:00.000+08:00

Sheer Arrogance

I just have to get this off my chest before I go off for the weekend. We referred a patient (who is the mother of a consultant here) to the orthopaedic department for what we thought might be a hip fracture. We sent a referral letter to the orthopaedic consultant on call. By tradition, usually a Medical Officer will write the referral and sign his name on behalf of the referring consultant (hence, the 'BO' in the picture which in malay meant 'bagi pihak' or on behalf of ).

In fact, only the medical department do this. Other departments usually just ask the house officer to call us when they refer a patient and much of the time, the referring house officer hasn't the faintest idea what the patient has and what the referral was for! And what do we do? We keep our cool and see the patient anyhow. The patient matters, protocol is secondary.

The referral letter was returned to us today. On it was scribbled rudely "CONSULTANT TO CONSULTANT ONLY. BP not acceptable". The patient was not seen.

To me this smacks of sheer arrogance. To Prof C, I have this to say, "please do not be such an arrogant person. Please do not let your pride or ego cloud your judgement and compromise patient care. What if it had been your own mother who needed the referral? Think about this".

You know, this was a referral for another Prof's mother who is 93 years old! I wonder how many other elderly mothers out there who have no prominent or influential sons are being deprived of care simply because a person has too inflated an ego to care.

In the same vein, Mawi's (our local singing sensation) dad was admitted to IJN (National Heart Institute) for some cardiac problem recently. This was much publicised by the media. Just how many fathers of unknown sons out there are admitted daily for cardiac problems and not a word would have been mentioned.

We must stop being egocentric hypocrites....

Have a restful weekend everyone. :-)

2006-05-05T13:39:00.000+08:00

Bed time story

I remembered a time not too long ago when my wife and I would take turns putting our then 2-3 year old girl to sleep. It usually starts with getting her to lie down on her bed and snuggling next to her. Next, she would break into a string of choruses, ranging from 'Twinkle2 little star' to some sunday school songs or some silly Barney songs she picked up from the purple dinosaur. Often I would take turns singing with her. The songs would be accompanied by actions. It was fun.

Of course I would read her the bed time story. She would choose the book and I will read it, usually in an as animated fashion as possible; complete with sound effects of various cars, animals, etc etc. Her books then were not so thick (she has now finished all the books on 'Narnia' on her own) and usually we are done in a few minutes.

Next, we would get on our knees and pray. Her prayers were simple: "Father God, please grant daddy, mummy and me a good night rest. Please take care of Ah Kung and Ah Ma (maternal side of the grandparents) and help Kung2 and Po2 to know Christ (my parents), Amen". Short and sweet. Mine would be more elaborate stretching from asking for blessings to settling the home/car loan etc etc (just kidding about the last part).

And then she would lie down again. I would get up to switch off the lights and we will say out "ooohs and ahhhhs" as we gazed up to the ceiling where I have stuck maybe a hundred 'glow in the dark' stars of all shapes and sizes. We would stare till the stars began to fade and she would say "stars going to sleep now". I would hug her, and give her a little peck on the forehead and say "Good night sweetie, I love you". She would give me a hug and a kiss in return. The little ritual would end with the phrase "Good night, sleep tight, don't let the bed bugs bite, I love you!".

It's been a while since I last did that. Some how in the course of the years, this little ritual got lost. Now I see her only on weekends (when I am not on call); most times I am too tired to put her to bed. And when I could, it was hurried. Prayers were said (if said at all) in a few short sentences. The hugs are still there, the kiss too though now she is now less inclined to give me a kiss. The singing has long stopped. The stars are fewer now (we moved her to another room and we didn't stick so many start on the ceiling).

I miss those days. I think I have paid a very heavy price with this Masters program. We all have. Now she is all grown up. She no longer thinks her daddy is superman or Einstein. Some of her behaviour is starting to worry us. MMed has taken their daddy away.

Lord, I just hope it's not too late when I am done with this course. My son is now 2+ and I still have not done with him what I did with his sister. Sigh!

I don't want to be the big bad wolf....

2006-05-05T13:06:00.000+08:00

Hemo-hyperthermia

Rounds actually finished a little earlier today....15 minutes earlier than the usual 12.30pm or so. But it has been a stressful round all in all. It's not because the patients were particularly ill, it's because of the relatives that really got onto our nerves. Sigh! A whole bunch of 'glutalgia majora maximuses'. Arrgh!!!

I don't even want to talk about it. But I have to say that I have great respect for all Geriatricians. You know, you will seldom find such annoying relatives in any other medical wards except the geriatric ward. My boss says it's because of guilt. The all empowering force within each of them (because they haven't been doing much for thier parents when they were much younger) which is now let loose in full force onto the medical staff taking care of their beloved. I think Geriatricians are great people, being able to take this abuse day in and day out. I would have gone insane or done something homicidal.

The patients are mostly very gentle folks. Some of them have such gentle demeanour. There is one chinese lady with a perpetual smile on her face. :-)

Not so the relatives.

5 more hours to the end of the day, 26 days more to the end of the month....and I am counting.

Btw, the title of this article was coined 5 minutes ago as I munched on some over cooked kangkung with rice and a very rigor-mortised fried mackarel. It means 'blood boiling'.

2006-05-05T07:51:00.000+08:00

TGIF!!!!

I woke up this morning, feeling like I am 80++ ( I wonder if working in the geriatric ward has this kind of effect?). I ache all over, have this pounding headache on the right side of my head, the muscles in my neck and back are taut and painful, I feel nauseous...generally my body is screaming for an MC!!!! If I am a woman, I'd probably diagnose myself with either PMS or early pregnancy. Alas, I am not. I think I am going to be sick.

Yesterday was another e-prescribing horror at the cardiac clinic. The computer hanged for 2 hours! I had one patient sitting next to me, waiting patiently (at first) for me to fiddle with the stupid computer for eternity. We made small talk...lots of it. By the end of the fiasco, I know him like my own blood brother! The fiasco was ended by the sudden appearance of the 'Charlie's Angels' (4 beautiful young malay girls from the IT department) who burst into my room, and declared that I have to go back to old school prescribing until they can sort of the problem. Sigh!

Yesterday was a good day....my thesis now has 425 recruits. Another 75 to go. Hallelujah!

It rained as I rushed to locum (ah, probably that's why I feel sick now la, I got caught in the rain) after the cardiac clinic. Locum was the usual ho hum, except for 2 patient...

The first was a young Indian chap, very good looking (spots ear rings on both ears) and apparently, he just got married last month. As with any newly weds, they were 'doing it' regularly, probably overdoing it. He's got all kind of blisters and bruises on his, you know, wee-wee and he got worried. I took a look and the lesions didn't look alarming. My conjecture was that he has been rather 'rough' (poor wife). My advice? "Go slow brother, take your time....blah blah blah, you know, the whole birds and the bees stuff). He wanted a blood test and I asked him to go do a HSV serology just in case. Still, I told him not to doubt his spouses' fidelity.

The second memorable patient was a lady who is a lecturer in a certain institution of higher education (that got bumped off the top 100 list). She was so scantily dressed (ala Eva Longoria, mind you). Her complaint? She was alarmed that spots have appeared all over her arms. Actually I counted 7 spots. Apparently one of her colleague has got similar spots and has become 'worst'. Apparently, another doctor told her colleague (a guy) that it was due to some exotic 'worm' that is not found in Malaysia and the 'worm' has laid eggs all over his body causing the offending lesion!

I am like, "What hocus pocus?"!!! Anyway, our Eva Longoria was convinced that she was totally infested with the eggs of this exotic worm. The eggs are hatching out of her skin....arrgh!!!!

I told her that it's unlikely to be due to a worm. She looked at me as I spoke sanskrit! You can tell she was unconvinced. So, I told her that it's probably best to visit the same doctor who treated her worm infested colleague since he has diagnosed him with such an exotic diagnosis. She said to me "You are the doctor, you should tell me what these spots are!".

I looked at her and said "We doctors don't profess to know everything. If I don't know something, I tell my patient so, rather than cook up a cock and bull story like exotic worms". You could almost see Eva here smoking at the ears.

Finally I told her that the lesions are probably some kind of 'septic spots' (well, they do look like them!). She wanted antibiotics and I gave her some. She seemed happy after that, convinced that the medications will eradicate all the 'worms' in her body. Sigh! I can't believe a lecturer can be so ignorant.

Long day ahead, more rounds in the merry old ward. But TGIF!!!!

2006-05-04T08:07:00.000+08:00

E-prescribing chaos

My hospital embarked on an ambitious project yesterday...e-prescribing. Basically what we used to do on paper (ie: write out prescriptions with our barely legible handwriting), we now do by typing into the computer and the prescription is sent electronically to the pharmacy. The idea is that by the time the patient takes the slow stroll to the pharmacy, the smiling pharmacist would be waiting for him with his medications all done. Beauooooo..tifulll!

Sounds good....on paper (pun intended) that is. We were given some form of 'training' prior to this. I went for such a course last week and it was totally useless. Our teacher wasn't even sure of the system himself and I couldn't hear what he was mumbling about though I was sitting about 6 feet from him. :-( We were given our passwords and told to go e-prescribe! Goody!

So, yesterday's clinic was chaotic! Many of us (I won't name names) did not go for the useless course and had to be given impromptu teaching in the clinic! And the system used was so archaic....for instance you cannot cut and paste. Meaning, if the patient has 12 kinds of medications, you have to type out every single one of them! That translates into time wasted and longer patient waiting time. And there is no automatic log out time, meaning if some one is using the patiet's info some where else and forgot to log out, there is no way you can access his info and prescribe. I had such a patient yesterday. He had to wait for more than half an hour while the IT fellas go hunting every for the culprit who forgot to log out.

And most of us doctors aren't all that nifty when it comes to typing, many of us type with one finger (after locating the appropriate key!!!). More time wasted. And the fonts used by the system was so small, I had difficulty reading it! I suspect by the time I leave this hospital at the end the year, I probably will need a change of eyewear. Sigh.

All these in an effort to make the hospital 'paperless'. I have serious doubt about how this system is going to make life easier. What's the point? After all, most hospitals I have been to have been paperless from time immemorial... all the toilets have no toilet paper and all the wash basins have no paper towels. We have indeed been very good at 'conserving' trees.

This new effort won't make any difference.

2006-05-03T17:33:00.000+08:00

Telling Bad News

I feel sad. I had the unpleasant task of telling a relatively young woman who is strickened with lung cancer that her chemotherapy (the 4th line...meaning she has already tried almost everything available) has failed her. Her husband was beside her. I could see the defeat in her eyes as I told her the bad news. What little hope she still harboured has been taken away. She put on a brave front, as did her husband. Now they will venture into the unknown, unproven and uncharted territory of traditional/alternative therapy. Modern medicine has failed them.

It is at such time that I feel so helpless. WWJD? Once again, we are faced with our own mortality.

WWJD indeed....

It's raining dogs and cats outside. I just want to go to the gym, sit in the sauna (after burning 200KJ on the threadmill) and not think about it for a while.

WWJD indeed?....

2006-05-03T07:53:00.000+08:00

Mission Impossible 3 - the verdict

The show lasted 2 hours and 10 minutes (by which time my bladder was at its maximum capacity of 700 cc). There was nothing glamourous about the premiere (read: no freebies) except that we were scanned at the entrance and asked to deposit our precious handphones at the counter. They said this was to prevent illegal taping of the show. I wonder how much of the show I can get onto my 64MB MMC card! :-)

So here's the verdict:

1. Explosion and the 'wow' factor: 10/10 (I swear I am a little auditory-challenged now after all the pyrotechnics)

2. Character development: 5/10 (I still wonder who is who)

3. Story line: 6/10 (It was actually much less convoluted than MI:II which I took a while to digest; and oh, there were no doves flying slow-mo since this is not a John Woo movie)

4. Tom Cruise emoting: 1/10! (Aiyo it was so painful to see him emote any 'emotion')

5. Grey cells utilising factor: 0.5/10 (I did say this is a no brainer)

Overall, I would give it a 7/10 (if only to see glimpses of the Vatican City, and Shanghai). And I wish Lawrence Fishbourne would consider dental braces.

Not looking forward to today's work.... geriatric ward rounds (which I predict will last forever) followed by the chest clinic this afternoon (I pray it will end by 6 pm!). But I do look forward to the evening! Little Cheryl (my new niece) will be discharged today and I will get to cuddle her when I get home! Thank you all for praying. She is well enough to go home! Praise the Lord!

2006-05-02T18:05:00.000+08:00

Cardiac Cripple

I first heard of this term last week at the cardiac clinic when one of my patient's wife asked me "Doc, do you know what is a cardiac cripple?". (Btw, I hate to be called 'doc').

I was stunned for a while...mainly because I had no idea what she was talking about! Apparently some alec out there who has nothing better to do has coined another 'useful' term..much like 'metrosexual' or 'vital sexual' or even 'ubersexual'. How did this one pass me by?!!!

Thankfully, she saved me from further embarrassment by answering her own question (she was one of those who asks rhetoric questions, you know, the type that ask questions when they already know the answers).

Apparently a 'cardiac cripple' is a person who becomes incapacitated after a cardiac event. Like her husband for instance. He is only 45 but he suffered a heart attack some time last year. He didn't smoke or drink. He was totally without any risk factors but he still had a heart attack (I blame it on his fellow smoking colleagues...murderers!!!!). An angiogram revealed a single vessel disease which was promptly stented without complications.

So, in all sense of the word, he is 'well'. In fact, he did not have any more chest pains since then. But he was so traumatised by the whole thing that he could not return to what he used to do anymore. He is now anxious all the time, wondering when he will have another attack; wondering whether his stented vessel will block up again; he doesn't exercise anymore fearing that it might 'aggravate his heart'; he has zero sex life now (wife very unhappy); he doesn't work; he eats only "healthy food" (read: tasteless bland organic material passed as food); he doesn't do anything except sit at home and.... breathe!

That is a cardiac cripple. A person with no physical deformity but behaved as if he has one, all because he was so traumatised by the cardiac event, he never fully recovered from it. He came face to face with mortality and came away a shell of his former self.

At the church camp, I was 'cornered' by a fellow church member who, in my opinion, is another cardiac cripple. Whenever he sees me, he will ask me how long will his cardiac bypass last! He had a bypass last year and now he is constantly worried when his bypass will give out on him. I told him a bypass can lasts 8 to 10 or even 15 years, depending on many factors. This time he challenged me as some other doctors have told him a bypass can last 20 years! I could strangle that doctor!

I confess I was a little miffed. At best I can only give an intellectual estimate (or guestimate) based on statistics. I can't ever tell him his bypass will last 9 year, 3 months, 5 days and approximately 23.4 seconds! That's God's department, not mine.

There are 2 issues here... one, we doctors have failed to address the psychological impact of a cardiac event on a patient. We just assume that once the blocked vessel is reopened or stented, all is well. We fail to see that some patients become psychological cripples.

The second issue is this... I think it's better to spend the remainder one's life being productive and putting one's life in order (before God and men) than to sit and vegetate and wait for the bypass to give way or for the next heart attack to occur.

Death is a certainty, but the hereafter is a even surer certainty. Are we ready?

2006-05-02T17:25:00.000+08:00

Mission Impossible 3

Yup! I am going for the movie tonight. It's the premiere night for the show. A friend has very kindly let me have his tickets because he couldn't make it. Will be going with my colleague. I am not really a fan of the series nor Tom Cruise (it's hard to like some one who eats his daughter's placenta...heh heh) but going for a premiere must certainly be a little glamourous huh? Too bad I have to miss Desperate Housewives on TV tonight! But thank God for the VCR!!!

The last movie I saw, if I am not mistaken, was the third part of the Lord of the Rings....yup, it was that long ago. Sigh!

I watched 'The Constant Gardener' last night while ironing my clothes. Very good movie, I think. Very thought provoking. For MI:III I doubt I need to bring my brains with me into the theatre...

Hmmm..I wonder what I should wear. Heh heh! Just kidding.