Time Waits For No One

Year 2009 just zoomed by. I was taken by surprise. Without a sign, Spring turns summer, then autumn and now its winter. December in just a flicker of candlelight. Looking back to my resolution made in 2008, I was shocked that I achieve few, if not none.

For one, I did reunite with old friends. We had good time going up Mount Kinabalu. We had nice foods. We chat till dawn. The old company is still close together. I really appreciate these old dogs. They coloured my life.

Regrettable, my weighty issue still not settled. Maybe I did nothing about it. Guess this is gonna be my 2010 resolution.

While I didn’t joined or affiliate with any organization, this is due to the fact that I was not ready, I can’t meet up with people’s expectation while not having adequate skills and knowledge. I always love to help people.

Another wish that was fulfilled, that is I got my first dSLR. Its a Nikon D40. It might not be the very best one, but it served the purpose well. I am still learning on how to use it, though. Right now, it churns out pretty good pictures. I just love it.

My hope for year 2010:

1. Enjoy my work and doing what I know best. I am going to finish housemanship soon. Hopefully I can get to do what I want then.
2. Health, not only me, but my father, mother, and everyone.
3. Love. I wish that I can bring the relationship to another level
4. Travel. The next destination is China/Taiwan. And if possible the States.
5. Weight loss

Tragedy

“You made me.

Yet you left me.

This is where I am. In this cold room. All the time. Why? Because you made me.”

This is what a child felt. Two years old. And five months in the ward. Not a single soul came to claim him. Nobody visited him. No family members fed him. Day in and day out, he was kept in the ward. Waiting for placement in special welfare home.

According to the officer, paperwork takes 3 months to half a year. Placement is subject to availability. So we wait…

It started when the child was brought to us by a referral from district hospital. A child from aborigines in Pahang came down with odd symptoms. He kept on have repeating bouts of cough post feeding, fever and was unwell. On top of that, the child lacks facial expression. At two years old, he is still unable to vocalize, nor responds to his parents. There is a problem with his swallowing mechanism. The secretions pools everytime. He can’t swallow. He can’t cough. The is paralysis to his facial muscles due to defect in the cranial nerves. He gets bouts of aspiration leading to pneumonia. Feeding tube were made.

The parents is of the lower socio-economy group. Apart from this child, they need to take care of more kids. They need to work. They need to feed a family of 10. Staying in hospital is out of question. Taking care of a special need child is totally impossible. Bringing the child for follow up is a no-no. There is only one road. Disowning him.

Fate is a strange thing. Some are lucky, some don’t. I guess this is survival of the fittest.

In One Breath

Hundreds of steps under my feet, but I have to just go on. I can’t stop and will not stop, until I reached my destination. There may be missing steps, and potholes along the way. Sometimes, the railings were missing, but it can’t stop me. I am determined this time, and I will reach to the top!

There Is Always Hope

When you come to a crossroad, no signs leading to your destination, and you are lost. The road you took seems new and unfamiliar. Don’t despair. There is always hope. Just hold on. Eventually you will reach your destination.

At the dead of the night, you can’t see where you go, and you lost your way. You can’t figure out the path. Don’t be afraid. The daylight is just around the corner. At the break of the dawn, everything will be crystal clear.

This journey is full of challenges, and the reward is waiting for those who is persistent and determined. Just hope, and always hope for the best.

Wish you success, my dearest.

July: The Haunting

In Chinese culture, July (in Lunar Calendar) marks an important date. It is the date people speaks in hushed tone. It is the period of the month where we avoids going to travel and out-station. It is the month where undertakers' business is blooming. It is also known as the 'Hungry Ghost' month.

In my personal experience, I had seen more mortality case than usual. My days during on call usually blessed with less case and I am yet to see many mortalities during this rotation.

The first case happened during the first day of July. The sky was drizzling lazily. Yet what we were dealing in the resuscitation room is all but cold. There were a deadly accidents involving 2 cars and few motorcycles. Two victims is already dead. Another two were intubated when I was called upon from my fever zone. There was this guy, young guy in early 20's. He had gas trapped between the layers of his lung. My service was needed to insert a chest tube. After the procedur, patient started going down hill. Blood pressure dropped followed with respiratory arrest. Shortly, cardiac arrest ensues. Resuscitation was done. About an hour later, we had no choice but to pronouce his death. As for one of the intubated patient, she did not make it after the emergency operation to evacuate the blood clot in the cranium. So a total mortality of 4 cases.

A week had passed. During my shift in the resus room, There were one ambulance call, despatched to pick up a patient who involved in accident. 'Ting, Ting Ting'. The bell rang three times, The the patient was pushed in in troly, face covered with blood, and the medical asistant was bagging the patient. We sprang to life. Seeing this patient, she was not spontaneously breathing. Pulse was also absent from palpation and the cardiac monitor. Everyone was playing their role. I started the CPR. She was intubated and given fluids and blood, but she didn't make it. Another soul was taken.

Then, three days ago, another patient fallen for heart attack before my shift started.

Just be careful, people. Its is July now.

Unmasked!

It is funny to watch people in panic nowadays. In the height of H1N1, you can see the reaction of human beings. There are few things that caught my attention, though.

First, does the people know what’s the purpose of wearing a mask? It is to prevent the spread of disease to other people, not really prevent from contracting the disease. Unless you are speaking of N95 or N100 respirator. One day, I saw a couple waiting beside me for the traffic light, Both of them wore mask even when they were in car! You gotta look at their face, they were so proud wearing mask in the car! How on earth… Maybe that makes them a Mask Rider.

Then came along people that wear mask, just enough to cover the mouth only. The nostrils were staring at me. When they start talking, they just pull their mask even lower, to show me their mouth. I would say: “Hey there! Wait a second. Put back your mask!” They indeed wore mask, but only to cover the neck only. These are the ‘Neck Masker’.

Maybe it is a market hype, or latest fashion trends. Some patient wear a weird mask, or shall I say, a fancy mask? I have seen one that was black in colour, come with side gills and a pretty red linings. It might look trendy, and fashionable in a way, but I can’t say it confers protections against the miniscule virus particles. The side gill is indeed holes that is perforated, that permeates the passage of air in and out, way too large for a filter actions.

Mask is indeed an important object in term of self protection. Wear it correctly, it become a protection. Wear it wrongly, it might become a nuisance. Your choice.

G.I. Hoe: Rise of the VIPER

Lately, there are too much of workplace politics, to my likings. I am not a political person per se, but things do come to your face when you least expect it.

First, My MO forms two battalions, one called themselves as the ‘Shift Workers Union Team’. The SWUT army consist of those who work in shifts, not confined to the usual 8 to 5 and those who need to do night shifts. Its members is about 10 persons. The other side is also known as the ‘Office Hour Liaison’ (OHL). OHL has smaller number of people. In fact they have only 3 members to speak of. However, don’t judge the OHL by sheer number, as all the member are high ranking officers. The battle line between the SWUT and OHL is clearly drawn. OHL accused the SWUT for working less hours and not allowing them to take their day off. SWUT blame the OHL for not doing any oncall at all despite the number of MO is minimal. If you think the SWUT and OHL is like cats and dogs from the start, you are wrong.

Going back to history, They were not like this. They were loving each other, complementing others work. They OHL wouldn’t mind helping out night duty. The SWUT wouldn’t mind the extra calls and all those weekend shifts. It was due to a OHL chief that is able to find harmony between the 2 teams. The peace was not forever. With time, the chief promoted to other post and came the new leader of OHL. Within the week of taking the throne, she had made new rules and changes that favours OHL. She blame SWUT for not working enough. She pushed the SWUTs to work extra. Many SWUTs that can’t take the new ruling resigned. There are also some SWUTs that stay on and put up a good fight with this OHL.

Out of nowhere, came a swarm of General Infantry (G.I.), sent by the Higher OrdEr (G.I. Hoe). These are G.I. Hoe. When all else fails, they don’t. They can work 24/7. When the Order call, they can work without food or rest. They know no fear. They have the tolerance of getting 60 rounds of automatic machineguns per second to their head without breakdown (I mean the scolding).

So the new chief of OHL saw an opportunity, and she snapped it! The swarming of G.I Hoe is seen as the solution for the uprising battle between the SWUT and OHL. Then she fully utilized the G.I.’s and put them is many calls and rotations that they don’t belong to, for example in the fever screening zone. Everyday, she do rounds in resus and green zone and shunt away all G.I. to this fever screening zone despite no patient in the fever zone! With these, she can shut some of the SWUT’s mouth and the OHL especially her do not need to be on call at night at all. What a brilliant solution! Pity the G.I. Hoe, working day and night in the fever zone. They are supposed to learn something in the resus and green, but all they get is only seeing the fever cases…

One day, the VIPER (Very Important Person in Emergency Room) will rise, and the chief shall fall. I am longing for the day to come…

Birthday Blues

Dear Mom,

It is your birthday today. I did not bring you any present. I am sorry. I just want to wish you happy birthday. Deep down in my heart, I wish you enjoy every moments you lived now. Your life journeys marked heavily on your face. Each line is a passing of a past that turns into nothing but memory. Each dots speaks for itself for a legend that you make.

There are few things that I regretted in this life. I am sorry for not spending more time with you. Its all the work, stress, love, and sidelines that keep us apart. I know you are lonely. The vast amount of time that you spent on the couch crunching away the stupid Taiwan Hokkien TV series is to filled the emptiness of this house, more of the emptiness of your heart. The nonsense that you joined, to give back life to the ex drug addicts, says it all. I know. I can see it in your eyes.

I am sorry that I behave like a jerk. I raised my voice to you. I turn a deaf ear to you. I shut myself from you. I lied to you. I am trying to shake loose this connection. All because one day, I am ready to fly. I will be going away, sooner or later. You stories ends here, but my life starts from here. There is endless possibilities out there. I will be back, as the new me.

Don’t cry, mama. Your agenda is not my agenda; your life is not my life; to you is good but to me, maybe it’s bad. Alas! we are two different people. I read from a book once: you know your child only as much as when both of you are connected via the umbilical cord. After the cord is cut, the child is a person by himself. You don’t know what he thinks, why he behave like this. You have to admit, the child is a totally new person, and you will not understand him/her fully. 

I don’t want to break your heart, mama. Sorry for all the things that I did, things that I ought to do but I didn’t. Sorry for the big gap in between us. Sorry for the words that I said but didn’t mean it, and the words that I should have said but didn’t. I still love you the same. Till then.

 

With love,

Son

The Pan(dem)ic Flu

At the time of this writings, the author is suffering one of the worst post call syndrome in his whole career.

I am recovering from one of my worse call ever. Since the escalation of H1N1 cases on top of new mortality reported on daily basis, my emergency department had faced its hardest time. On the usual daily basis, I am seeing about 100 cases per night shift. Yesterday alone, there is a whooping jump to 380 cases! The card stretched 3 times than our table can accommodate and the waiting time is up to 4 hours. If you take a walk outside my clinic, you might think you had walked into Puduraya or Bazaar Ramadhan. There are seas of people, with all seats occupied and the ‘standing’ seat also taken. People lying on the floor, on the trolley, on wheelchair, in toilet and into the open road outside. During the past 20 years of its service, this is the worst ever ever faced by Emergency department. We had declared a state of ‘disaster’, and channeled doctors, nurses and paramedics from all over hospital to come to aid.

It is safe to say 99% of the case came to hospital for sole reason: to ascertain whether they contracted H1N1.

People are in panic. They fear of H1N1. They want to be sure that what they are having is not this strain. I can’t blame them. The propaganda for this disease is very extensive. I will take time to explain to them and make some facts right. I hope it would help the people who read this article. Yes, it’s you.

While it is true that the Director General (DG) of Health said we should not be less vigilance on this disease, there is a general rule of the thumb that one should adhere before coming to hospital:

1. Please COME to hospital/health facilities if you failed self treatment after 3 days. AH1N1 is a new strain of Influenza virus. Means there is no herd immunity. Means it can and will spread like wild fire. But flu is always self-limiting, that is to say it will resolve within few days of onset. We take a rule of 3 days. So to say, if you are having underlying risk factors such as obesity, pregnancy, underlying heart of lung disease, or any condition that renders your immunity less than ordinary people, you are welcomed to see us earlier.
2. Take adequate water and rest. Yes, it is important but often overlooked steps. Take vitamin C. Take 2 large bottles (3L) of water unless you are told not to. Don’t take too much of carbonated isotonic drink if you are having vomiting as the gas will make you bloat and nauseous.
3. Bring your medications to follow up. It will definitely help us a lot if you can remember what medication you took, but most of the people will describe to me “the white pill” “small yellow tablets”. This is like describing Adam Lambert by telling me he wear a blue jeans.
4. The Throat Swab. I know this is a very controversial issue. Majority of the referral cases from private healthcare to us request us for a throat swab for confirmatory test. This is also a confusing issue. At the early part of the disease, the government requires all patient that came from affected area to be screened from AH1N1 by doing the throat swabs. With time, the disease burden increases to a level that National Lab unable to cope with the amount of throat swabs analysis with the escalating amount of patient. New circulars are out by the minute to limit the screening to high risk patients i.e. pregnant mother, heart disease patient or with other co-morbids. In outbreak cases, for example in a closed compound like a school facility, only a random sample of 10 throat swabs will be taken. So you understand why we as the staff of Emergency department do not take anymore throat swabs; this responsibility is passed to Medical Department specialist and medical officer to decide which cases are severe enough for a confirmatory test. In shorts the throat swabs is a limited test now and NOT done for mild flu cases.
5. Help us to help you. This is my personal opinion. We are seeing at least a 400% to 500% increase in patient a day. My clinic usual closed with 100 patients during a night shift; but in this hard times, the numbers jumped to 400 patients at night time only. The number of doctors are very limited at night, and we are recruiting ‘cold’ department Medical Officers to aid in seeing patients but still average waiting time increase to 4 hours. It does help a lot if the patients behave less hostiles towards the doctors. It is a testing times. No one like it either. Tolerance is the key.
6. Please adhere to home quarantine order. I have few cases in hand that came to us. She was supposed to be in home quarantine as the school closed for a week. Out of her sympathy, she went to visit a sick friend and got fever instead. At this time, the cinema, shopping complexes is full of youngsters that feel that home quarantine is nothing but a scam. Home quarantine is meant for reducing the disease spreading rate. As a general rule, any viral fever should settles within 7 days and by separating the affected and unaffecting, we are hoping to limit its spread till it dies down. There is always a reason for things to be done.

This is both a testing time for us, the healthcare provider and the people out there. H1N1 is hard to control. But we still have to do something. The number of cases is increasing and the mortality increase. However, the rate of mortality remains fairly low. There is no reason to panic. Mostly recovers from H1N1 as a self limiting viral flu. At the same time, we should take precautions as listed in ministry of health guidelines, cheerful and above all: constant vigilance.

Same Mistakes

Unable to sleep yesterday. Was pondering over things that happens lately. Not sure I had done my best. Worse still, did I do something wrong?

At times, you did your best, but things just don’t go your way. Then, all of a sudden, someone kind enough would point to you, saying “hey, You made a mistake. Buckle up!”. I don’t hate them, but thanked them. They make me learned my mistake. After all, we are human.

I did save life. That is what I mean to be, but the mistakes always come and knock your door, disturb your inner peace, making ripples in what supposed to be a calm lake. There are things that you are so sure the minute before, turn out to be opposite. The outcome that you anticipated, turn out to be no more than a waste of time. The effort, the sweat, and the name, all go down to drain!

I can’t help but realized, Is this what they mean by the difference of working life and student life? What makes the difference? Is it responsibility? Is it remorse? I don’t know. Honestly.

What I know is I will fight on! Come what may. I welcome every challenge. 

Small Tip on Preventing A(H1N1) Flu!

The uprising of the A(H1N1) flu to become pandemic flu is indeed a worrying thing. The number of people affected is increasing exponentially with new cases detected every hour. On top of that, the virus is capable of local transmission is not going to do any good to curb this problem. Amidst the commotions, there are panicky people who makes the situation worst by spreading some untrue fact regarding the disease. I am going to straighten some facts here.

Eating raw or rare meat can spread the illness

I heard this statement over a well-known radio station. While it is true that the origin of H1N1 is from pork, but it is an influenza virus, which means it need to spread through airborne and nasal droplets. It is in no way at all a chunk of meat able to spread the disease. It needs the respiratory system to produce the aerosolized viral particle to spread.

Avoid crowded public place

This is a very important steps to curb the spread of disease. As you frequent the crowded place, the chances of getting the illness will be higher. But one place that people often forget is the Hospital itself. While it is true that when you are ill, you go to hospital, but a trend that I observed lately that the non urgent case also in the waiting room of my clinic. The hospital should be classified as the highest risk of all public place as the confirmed  case or suspected case of H1N1 case will go through our screening centre. Yet parents also bring the little ones with cases like scabies or impetigo at the depth of the night to seek for help, all this which can be done in the daylight in out-patient department. The worst case of all that I had seen was a man who is perfectly well, came to me 2 days ago, says that his subordinate had been in contact with a possible case of H1N1. Apparently the subordinate had attended a lecture given by an American. I asked whether the American had got any fever symptoms. He said no. So I discharged him within 30 seconds.

Wearing a Mask while You Travel

I saw a few photos cutout from local daily, saw a couple from Germany went down from Batu Caves with a mask on each. While the virus has escalade to Level 6 which is a pandemic, there are still people that ignores the WHO advice regarding travelling. All the mask do is to prevent you from spreading the illness from other people and a little bit of protection from the outside to inside. This is absurd. I have seen cases from Pulau Tioman, Caucasian on their way travelling in Malaysia, and bring along the disease. People, listen up! Stop unnecessary travelling and the disease will be better curbed.

The Homeless Nest

One fine evening, I took my camera out for a shooting. And I found this empty nest. I vaguely remember there were a robin with 2 chicks some 3 weeks ago. Guess they grown up already and left the nest for a better life.

Back to real life, my sister is leaving the hometown for good, for the future. What she left to is an empty nest. Grandpa used to be dependent of her. When she is gone, this old man will be lonely. Yet, true to the sayings, old man are stubborn. I just simply can’t  him to stay with us (me and mother) for he has things that he can’t leave behind. But most of all, he is afraid of change. Any trip to unfamiliar place will pose a treat to the stability.

Soon, there will be the ‘Empty Nest Syndrome”… 

Reflection: Surgery

It had been a tough 4 months in Surgical internship. I had made it! I had made it to the end. With all the bad remarks regarding the department staff, the rotation itself and all the no-nonsense attitude in the posting, I am surprised myself for being able to go through it.

First, the department head gave a lot of pressure to us. He is treating us all like an army recruit. “You may do this with written permission; You are not authorized to do that; You must submit your form by 0800 on every 2nd of the month and bla..bla..” Working hours was from 7 am till 8 pm. Gosh! I had so little time for myself, my girlfriend and my family. All devoted to the ward and the sick bay. His style can be described in one word…unpredictable.

Next, the ward staff are bunch of back-stabbing monster. They will do anything to sell you out for the sake of their own good in front of the Big Boss. I had it once. The Sister of the ward once file an invalid complaint against us, saying that the House officer were not doing their job for discharging patient. It never occur before because discharge is our level 1 priority when doing the ward work. I was in rage when the boss came to tell us that we need to have schedule for the HO to do discharge. All for the sake of Sisters…

Yet I find a lot of fun in doing surgical stuff. All those logics in managing patient, decision-making and the thrill of hands-on is so nice. I like the feeling of holding the scalpel, carving the lines, and remove, repair, and remodeling the disease parts. It feels so real, so myself.

Now, the time is gone… I am already into my next rotation. Emergency department. Now it is a better time for me.

A Selfless Act

This case happened during my on call...

It was midnight. Rainy nights. And he is just another typical boy. Young and bright boy, and just finished school, waiting to go to college. Let's just called him Ali. Ali was riding his bike down the street. He just finished work and was rushing to go home. The watch on his wrist shows 25 minutes past eleven. The street was quite deserted, only few cars cruising down the road. Like him, they are going home too.

Out of no where, this cyclist dart across the road. Spinal reflex kicks into his action. His right hand jam into the brake, and his left hand quickly steer to the left to avoid the imminent crash. Alas, the wet road does no help. In no time a all, his bike skidded and he was dragged along. It just won't stop. With a loud 'crack', he hit head on into the road divider. The last thing he ever saw is the flash of street lights. Then he went into unconscious state.

I attended him in casualty department. His Glassgow Coma Score was merely 6/15. CT scan done, There were extensive skull bone fracture with massive intracranial bleed. A ring to the neurosurgeon on call realized my worst fear, his condition is beyond the help of modern science.

This piece of news was broken to the Ali parents. Naturally, they were in the state of devastation. I wasn't expecting anything less than this. Having raised this child, seeing him rocking the cradle, to his first word to his first graduation, there is more than just memory. There were life, joy and there were pain. There is no grieve worst than a white-haired sending away the black-haired, as the chinese saying goes.

"I wish to give away the organs of my child to the needful person." The mother said to me.

"What?" I replied. This was not what I would expect in a typical parent in such situation.

"I don't want him to die like this. I want him to be remembered as someone brave. And I want his spirit to live on in people that need it the most." The mother added.

I was taken back of her decision. It seldom happen in this country, what more in this small hospital. Her generosity to donate organ is genuine and pure from the heart.

A couple of phone calls and paper work later, the organ harvest team arrived from Kuala Lumpur by plane with all sorts of equipments. Finally, he was lay to rest at 1 am the next day. Physically, he is no longer here but his spirits and organs lives on in the other people.

Bravo to such a selfless act. Only wish that there were more people that wiling to take such steps to help the people in need. Anyway, death is just a path that everyone has to walk down alone. Why we need to carry all the organs that will eventually rot or cremated along while it can help people like those haemodialysis dependent or external cardiac machine and give them another ray of hope? Time to think, people...

My Love

If you ask me, I never regret taking this road, although it may be a hard sometimes, lonely sometimes. The transition between a lone ranger to this state now needs a lot of change. I don't know, but I feel the person I used to know six months ago is no longer the same anymore.

It always amaze me, how your hand fit in mine. My hand feels cold and clammy, its yours that warm me. It felt just nice.

Oh my love

The Brain Drainer

It is always glad to know that you are on the safe side. After passing my assessment, finished with my presentations, all I have now is 30 days of smooth sailing journey ahead (I hoped!) to reach the next rotation. Apart from the long duration in the ward, Surgical rotation is never a bad posting to stay on. The work load is not too many, the patients are easier to handle and not too many medicolegal stuff to start with.

We get to do neurosurgery rotation as a minor posting here. It was fun handling the 'higher function' of human. Day in and day out, we deal with 'brain drain' craniectomy/craniotomy - for those patients that has blood clots in their skull. I have 2 patients: one is a 14 year old boy from Felda Selancar (somewhere in Muadzam Shah) while riding a motor bike, ram into the back of a school bus, and rendered him unconscious. He was not wearing helmet for one, and at this age, he is definitely with no licence. On arival to my hospital, CT brain of his shows a massive extradural blood clots, and was open up. After fourteen days post operation, his conscious level still not improved. Repeat CT brain hold the key to this mystery. During the accident, there were brief episodes of hypoxia. Now the essential centre of the brain has infacted, which may includes the conscious centre. He might be in a vegetative states, if he survived.

Then, there is another boy, a young and vibrant 17 years old Malay boy from a village in Kemaman, riding bikes to refill petrol in nearby petrol kiosk. Again, he is not wearing helmet, and was hit from sideway by another motorcyclist from sideway. After the accident, his conscious level dropped, significant to warrant a CT brain, and further admission to Intensive care unit. I assisted the evacuation of blood clots. Currently, he is still recuperating in ICU post operation. At least he is recovering well.

The similarity in this 2 patients is both of them are young adults that has bright future ahead. Yet, both failed to adhere to simple measures such as wearing a safety helmet. One might recover, the other might be in coma forever.

Neurosurgery is one of the highest mortality department. You don't open up a patient, he dies, You open up, either he dies on table, dies post op or dies later. Either way, outcome is not so bright in my settings. That's why I dont quite into neurosurgery.

A Quiet Afternoon with Myself

For a long time, I have not seen daylight. Working schedule that makes me goes to work at 6 am and back at 8 pm makes me an indoor person. After a long on call, I am back with myself in this quiet afternoon with no one but myself.

Life is soon to be back at the square one. The one and the only is leaving soon to out station for duty. Nothing that I can do to hold her back. Its the government's order. Without realizing, my life has been so much dependent on her. Everything seems to be evolving around the both of us. 'We' has replaced the 'I'. I always look forward for more time to spend with her. Albeit, time is short.

Now, there is no better place than here, inside me. Inside my heart. Dwelling with the memories. Swimming in the sea of futures. How I wish all this happens earlier! How I wish time is longer!

I just want to be with me now.

Flowing Gently

It's ever so soft, caressing every rock and sand;
yet it is strong, carving ways as it goes.
It gives life to whatever we are now.
Let's save water

The Dead End

Do you ever wonder, the road in front is not the path that you ever want to walk ever more?

It is exceptionally lonely now, when you are alone walking down this wrong path. Can I ever turn back? I am not sure how. I am being pushed my the rush of people to the destination that I do not know where. Could it be that the destination is still the same, but it is me that changed?

Maybe its a dead end of the road. Or it is the cliff that I need to embrace myself to jump in. Then I can discover the new horizon

A Letter

Dear friend,

I know it is hard what you have been through. You are a tough man. You can make it through.

The joy of sharing a cuppa coffee, the good time of holding hands walking down the park, and the thought of someone is there for you when you are down may be gone. And you said the efforts for all these years may go into the drain. You feel sad, angry, and felt cheated, but it is still not the end of the world.

I say it a chapter in life that everyone must go through. Its like a book. Growing is a chapter. Falling in love is a chapter. Having children, career are chapters itself. We can't predict every chapter in the book has a happy ending. There are ups and downs in the stories that make it an exciting one. In the end, it is the whole story that matters. We are writing a book, not just dwell in a chapters.

You said the wound still hurts. It hurts when it matters. I say give it time. Let time heals. In the end, you will thank her for making who you are now. At least you are loved. It is never a waste. It makes you grow. Looking back, now you are full of experience than before.

As a friend, when I say I will be there for you when you are down is a total BS. But my ear will be. Always be. You must be strong. This storm must be weathered. Given enough time, you can walk out of this dips in life.

Twenty Nine Days

It not right to feel for the patient you are treating. It is almost wrong when you are emotional connected to a patient that you are treating. They says it affect your judgment and the clinical acumens. Despite all the teaching saying so, I still made the mistake.

Dasuki was a very unfortunate boy. At the age of twenty, almost all of his fellow at the peak of their life. Everyone venturing into working, busy with marriage, but this poor boy was bed bound. Not only he had to depend on his father for the simplest chores as to personal sanitation, he had become the increasing financial burden of the family for his medical need and disabilities.

After a freak accident one day where he lost control of his motorbike and skidded, his life changed. The motorbike hit a sand dune and he was thrown forward and landed head on. On arrival to hospital, doctors pronounced that he had a spinal segment T8 and T9 fracture, which translated into paraplegia for the rest of his life. He lost feeling of both lower limbs. Anything below umbilicus feels numb. Both legs were heavy and felt disconnected o the torso. Passing urine and bowel habit became automatic event, and he has no control whatsoever towards it.

Studying the family dynamic, he is the youngest of eleven siblings. As if to add salt to the wound, his mother is a stroke-surviving patient with hemiplegia as well. Father earn a meager pay by doing plantation work in small scale. He has a sister he used to mention quite a lot. This sister is closest to him, bathing him, feeding him at regular interval. But what to do, his sister has to get on with life. She need to work. She need to take care of her family. After her marriage six months ago, she had moved away from Kuantan to Johor Bharu following the husband.

He came to us with prolonged bed bound, 12 months after the accident. Instead of a young and vibrant boy, we saw a nutritionally-deprived boy, dirty and unkempt. The bed sore already formed over huge area over sacral, the heel and even elbow. A sigmoid colostomy had been made to accommodates faeces passed through anterior abdominal wall. This could prevent soiling of faeces and the sores.

At the last 11 days of his life, we have to open him up, to find the bowel is a mess with adhesion and perforation. Everything necessary had been done. After the operation, he was going down hill. On the other hand, we are giving stronger antibiotic and nutrional support for him.

The day before he is intubated, I was talking to him. There were very few visitior for Dasuki. The father seldom came as to take care the other needy one at home. We talked about many things. All I want is to set a long term goal for him, to make him ambulate by wheel chair. At least he is less dependent if he can whelled to the toilet or to reach for things. He said that he missed his sister, and asked me to called up the sister. He wanted to see her badly. On top of that, he says living has no meaning for him anymore. I just kept quiet as did not respond.

The defence finally breached on the last 3 days. His lung and heart had gave up on this battle. We intubated him and put him on inotropes. Blood pressure on few instances were unrecordable. Most of the time, it was lowish. We rang up the father, told him that his son was not doing well. Soon after that, the relatives, family members came.

The last word he said to me was I am tired.

On his last day, his sister came to see him. After twenty nine days of long winding battle, he finally passed away, fulfilled his last wish. Rest in peace, Dasuki.

How to Avoid The Fear of Change

Have you seen lately that more and more people start to fret about the posting they are going into? Some said they are going to the worst posting, some says they are going through hell. All mean the same. We don't enjoy our posting, or the rotation is not meant for human.

Most of us prefer to dwell in the latter one. Blaming other people is always easier than working out our self conflict. Yes, we work extra long hours, sometimes up to 36 hour non-stop. We seldom get adequate rest, most of us came to work with 'panda' eyes. Most of all, we get all the work, plus the scoldings as well. Isn't that what we have expected? Is that what we have signed up for? Why regret now?

People loves to tell stories, and most of the time, the stories aren't what it is. Sad to day, we chose to believe the stories. People might tell us, how bad it is to go into this posting, how bad the superior is, how hard it is to work extra hours, all sorts of things. These are stories anyway. Stories that will bring us down and demotivate us. We cannot predict what will happen in future, nor we can change the past. Its now that's most important. We lived out each seconds like its the last. We work like one at a time. There is no problem that cannot be solved. We choose to write our own stories, not dwell in theirs.

Be a non-conformist. Do not live by others' shadow. You are the best, and no one else. Just be who you are, not dictated by the stories.

Reflections: Obstetric and Gynaecology

The end is near. I can see the light at the end of the tunnel now, but what lurks ahead might be total darkness to me. The once happy go lucky, couldn't-care-less person I used to be now underwent changes. Every words I said, everything I did now carries weight, and I have to be responsible to it.
Four months of delivering babies, supposed to be the happiest moment in life. Why I didn't feel the joy? Was I not passionate with my job? I think not. Come to think about it, I think it was due to the medicolegal stuffs that daunt every doctors. How could you be happy if you wake up everyday waiting for phone calls that one day will bring you down, tear your reputation, take away your hard-earned pay and ruined your medical profession. With these thoughts, how could you be happy?
Speaking of hardship, I am already anticipated long work hours ahead, scowling from boss, friends that's take advantage. Its already a norm. What I need is excitement, excitement that brings fire and passion in this job, to get me through.
On the light side, I've someone to share with me the ups and down through the hardship. I've count my blessings. Thanks to the one, that make my life better and more complete. For now, I just want to go home.

Solar Eclipse

On 26th January 2009, we citizens of Malaysia evidenced the event of partial eclipse. It began at about 4.30pm and last to about 6. Without a good lens, its pretty difficult to capture the image of the sun. However, the UV filters of my cam (or I believe so) able to create the reflection, which inverts the eclipse and produce the double image. The reflections is in the yellow bracket.

Kids: Gift from Heaven

Innocent. Which correctly describes the nature of the kids. They would not lie. They cannot lie. They express their feelings through their eyes. The eyes would tell a thousand words.

Playful. It's their nature. They learn through play and they play to learn. From play, they learn to share, they learn to fight for themselves. Most of all, they learn the skills for survival.


Some live a happy lives, some, carry the heavy weight on their shoulder. They mind are like sponge. They see, they absorb and they change.


Strangely enough, simple things like balloons will make their day. Their soul is as clean as a piece of white sheet. Only time will make a mark on this clean sheet.

On Call Blues

Today, I am on call again. On a straight EOD calls for three days in a row! Since I go on call for quite sometime, I had seen many types of people lingering around me:

Some, albeit rare, are the hardworking type, working beyond the time limit set, working beyond their boundaries, never feel tired and always ahead of other colleague. They help you to take blood for the patient, arange for caesarian section, buy you dinner, talk to you and tidy up the mess. So far I have seen only 1 out of 25 housemen.

Some always watch the clock, punch card ready since 4.30 pm, eager as ever to go home. As the clock strikes 5, they will transform from little filthy mice into a handsome stalion. With a magical "pop", they will vanished into thin air, like never existed. Any new cases that pops in at 5.00:29 will be considered cases for the on call people. Haha. What do they care about other people?

Some people feels like chips more (T). Now you see it, now you don't! They are mentally and spiritually be with you during your on call, but not physically. When you need them the most, they will say:" Hey ya, I need to go and pray, can you sort of cover me for a while?" Then they are gone. After prayer, they will text you again, saying that they will go and take a bath, and then go for dinner, and then spa, and then meet the uncle's best man durinmg high school... then only they will be back on call.

No matter what type of people you are, please respect you job. When you are dealing with live, they deserved nothing second best. Do the right thing and do it right.