Happy Birthday Darlene!

Cool Slideshows

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

Blogging Out

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!!!

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

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

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

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

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

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

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

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

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

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

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

Just testing if the paragraphs will work...

Sigh!



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

I Am MIgrating

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

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. :-(

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. :-(

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!

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.

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.

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.

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.

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.

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).