Crawl...Walk...Fall...Walk Again

A baby learn to walk is no easy feat. It will start with a small steps, small and uneasy steps. The gait is waddling, the toes are in-curling. There will be numerous falls and bumps. Numerous bruises on forehead, scratches over limbs and endless cries. Given enough time and practice, small steps become big steps, uneasy become steady, then there is no more falling down, Walking become the second nature.

Isn't it the same with life? House officers learn from experience, numerous failures, many ups and downs, to become a safe doctor, and a better person?

New ruling created by the day to help these 'underpriviledged' group of people. First come the rule of house officers not allowed to follow in ambulance. Then came the shift work system to cut back the working time to 60 hours. Now there are hospitals that won't allow them to clerk case and examine patients! Looking at all these rules, it follows after certain events.

First, there were an incident of a house officer in Melaka Hospital involved in road traffic accidents while transporting patients. While we cannot predict the future, shit does happens to anyone. I witnessed a case of a staff nurse sustained a fracture of the radius bone while transporting a pregnant mother to general hospital for delivery because the new ambulance driver hit on a wild boar and the ambulance go turtle. Do we bar the nurses from sending patient? Certainly not! While I cannot say the ambulance is the safest ride home, even a fully registered doctors like us cannot prevent any untoward things to occur.

Then, house officers complaining of long working hours in the hospital. Hospital basically become the second home. There is no social life, love life or party life next to working. Then came the shift work implementations. Initially was full of glitches, but thing smoothed out in the end. The draw back is the oncall claims was with held. Then complaints starts again become there is not enough money to cover the car installment and side expenses, so another 600 bucks given on top of the shift work. What they didn't realized that without the adequate exposure, there is simply a disaster in the making. Not only more officers will be extended for the lack of skills and knowledge, they will be less equipped when sent to places that has no senior people to back up. The situation is similar in most of the government hospitals.

Are we doing them any good? Ask yourself, in years to come, will you want to go to any government doctors when you fall sick? If the answer is no, then please review the system again. For me, to be a great person, one have to fall many times, then when he stand up one day, he will be standing up tall. The scar is to mark how resilient you are, and prove to the world that you are not a weak doctor! 

Your Friendly Neighbourhood

I was going through my copy of 2010 ACLS guidelines. Something strikes me...

This is only happening to the Chinese patients. I never see it occur else where.

Whenever a person falls very ill (or collapse), we as a natural instinct will start our resuscitation effort. Secure airway, Bag-valve mask, Initiating chest compression. Orders will fired across the poor chap. Adrenaline, IV access, Oxygen...


Then a head will poke inside the curtain. "How is the condition of this patient?" He ask. Seriously, I am not joking! He is the familiar face around the hospital when you work long enough. And he is not even related to the patient or the relatives!

I will usually ignore him.

Resuscitative effort carried on, Nurses getting grumpy, junior doctors getting fatigue, and I am also exhausted. Finally I terminate the resuscitation. Break the bad news. Family cries. Some howling, Some fainted. But he will snake around to me and ask, "What is the time of death?"

The man is an undertaker. Its his business to care for the afterlife, and its a good business, where every 'customer' average from RM 3000 onwards. Beneath what we see, there are few companies doing this and  these people are fighting with each other to get more customer. There are eyes and ears in the hospital looking for potentials, and last time I heard, they are the attendants and the nurses. Tips can go up as high as RM 200 (more than an on call pay for a doctor).

What I hope is that they respect the person that we are resuscitating, as well as the family. The privacy of the patient should not be breached. One should never be a busy body around the resuscitation. You may be the obstacle for the process. On top of that, they are harassing the family members with the 'packages' and the promotions of the day. Often, critical periods like this are usually the last moment a family can spent with their loved ones and prepared mentally for the worst.

Its a good business, but please do it with some sense of responsibility.

From Bad to Worse

Medicine is a highly regarded field. The stakes are high. The demand is always overwhelming. When they tell you there is surplus of doctors, they are actually talking BS, at least in Malaysian context. This created a demand for youngsters to go into medical field. Many parent send their children to medical schools, be it local or abroad, self sponsored or scholar shipped. Many graduated. Some are knowledgeable and willing to endure the workloads. Handful are not very intelligent, but able to carry out the job. Yet a small portion are neither having the marble nor the right attitude for the task awaits.

Sometimes, I encountered a few special cases that worth mention:

The Troll

This type of people are born with a very thick skull bone. They cannot follow orders. If I give them plans of management, they will not give me results. If there are 10 plans, probably 1 or 2 were carried out. Sometimes poor time management are to be blamed.

The Escapism

These people usually less equipped. When given the task beyond their capability, they are at lost. They would not know what to do. The solution is to run away from the trouble. There are also a mixture of laziness in these people. They refused to learn up new knowledge and skills, despite how much I try to guide them.

The Fierce

Conflict of ideas are common when you are dealing with matters. Some when confronted, will over react and snapped back immediately. They take every comment as a negative thing. Some forgets their position as a junior staff. Some just forget how to respect other people. Some don't have manners.

The Fart-and-go

At times, I met some junior doctors that always looking at their watch whenever they do round with me. When given a job to do, they do it half-heartedly. The case summaries needed to be summarize again. The referral letter most of the time are plain useless. In the end, the ministry decided that these people are not up to the task of doing these things and the medical officers have to take over.


Despite all this, now they are cutting down the working hours for junior officers to 60 hours. I sincerely hope these doctors can absorb the needed knowledge or skills. It is also my duty to guide the young doctors so to make them a better person. Well, I will always teach whoever that wanted to learn.

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.

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…

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. 

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...

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.

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.

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.

收拾心情

最近发生太多不如意的事了。

刚认识的女友，却得了病需要动手术。需要开刀的时候， 身为男友的我， 却不在她身旁，真是遗憾。 但是手术很成功，她安然无恙。心中的大石也就可以放下了。

有人说，一段感情，若没有经过风吹雨打，就经不起时间的考验，我不信！为什么不可以让一切平淡，只有快乐，没有烦恼？难道没有挫折，就不会成长？没有跌倒，就学不会爬起来吗？

工作上也到了一段瓶颈，每天重复做一样的工，面对同样让人气愤的上司下属，每天都要面对工作上的政治。唯有等待下班时跟女友约会，家人用餐，让自己松弛心情。要等待加薪，还有好远；要等待换岗，都要多两个月。

自己开始遗忘最初的理想和梦想了。这些都是属于学生年代的东西，现在面对的是事实。嗨... 难得充实的利用六天的假期，现在还是收拾心情，明天又开工啰！

The Depth of Death

Death has been a topic which people discussed with a hush voice. It is a word that you shouldn't use during festive season as people will scowl at you. Yet I had written a handful of blogs regarding death.

The fundamental rule: Everyone must go through death at least once. Some people had escaped death, coming back to tell tales about near dying experience. Which brings to the fundamental rule No 2: You can delay death, to the extend of prolonging death, but you can't totally avoid death. Patient with brain death can be hooked on the ventilator machine. The can breath. They have heart beat. But once without the mechanical support, he or she is very vulnerable.

I don't like death. It brings tears to people, it breaks the heart. But I faced with death, day in and out. No matter what you do, you just can't avoid death. If you face death like a journey that one must endure, then death may come with less pain.

One good friend of my parents were diagnosed with advance breast cancer about a year ago, competed surgery and chemotherapy. About 2 weeks back, she had a fall one day at home and was brought to the a private hospital. CT scan of brain were done, showing multiple metastasis to the brain. Nothing curative were able to be done at that moment. Family members were desperate, seeking for second opinion, asking for miracle to happen. Everyone seems to know the diagnosis except the patient herself. She was kept from the truth, fearing that the truth will burden her already troubled mind. They brought her to hospital, asking doctors to do further active management for her.

I believe this is not the first case. Most of us face death with fear, only few have courage to stand up. More often than not, we often omit how the patient feel with regards to her own body. If you are the patient, lying on the death bed, will you don't want to know what is wrong with you? Will you like the truth to be buried with you to the grave? Most of the time, the patient is not blind, death or dump to be not able to guess what is wrong with her own body. Yet, she has no right towards her own body when it comes to death? What if the patient wish to meet certain people, to forgive some relatives and to repay some old dept before she dies, wouldn't she feel regretted for not able to do so? If she wish to donate her organs to benefit many, we would have selfishly denies her to do so. Death is not as simple as close your eyes. There are many legal matters involved. For example, bank accounts, saving bonds and funds that needs to be transfered to some one else. These things, although small, will be a big hassle for those who live on.

Please, do not deny the patient from the truth. It hurts me every time I faced with this situation. When you come to make decision for other people, always put yourself in other people's shoe. Do you want to be treated that way? If the answer is no, please don't do it on other people. You have absolutely no rights over other people.

Making Heaven Out of Hell

Lately, I had been having conflicts with my new department. Being accused for the things that I didn't do, senior officer talking bad behind us, colleague that is very calculative and no team work spirits and many more. All these had been burdening me quite a lot lately, to the extend of almost feeling depressed.

Yesterday, I had a revelation...

I was walking down the alleyway towards the cafeteria. Suddenly a thought stuck me... I was making my own living hell. Why not make a heaven out of it?

Now, I am working in one of the wards. My senior officer in the ward is what a common people would call 'bitch'. She was the kind of people that likes to gossip. She has a couple of horrible gossips partner, that not only tell nothing but lies, but also love to wreak havoc. What makes the matter worse is she is also likes to report to the big boss regarding small matters, and exaggerates things. Her mood swing is as fast as the F1 racing machines.

Lately, I had been called to an inquiry, no less thanks to her. She had been telling lies behind the big boss. Glad the things I did was acceptable under standard medical practice, I was spared from getting a punishment.

How can I clear up this mess?

First, make truce with her, my senior officer. I said to myself, why would my mood be affected by someone that is so less important to me? She can curse, talk bad, laugh about me, but she can't control the way I feel. Follow her order, my day will be fine. Against her, she makes the hell out of me. So you tell me, which way I should go?

Being nice to people doesn't always equals to people being nice to you. There are people who takes advantage on other people. I notice of late, there are colleague that fits into the criteria above.

She came late to work. She doesn't want to clerk cases. She does not want to present to a consultant during rounds. She does not like to wake up during night call. In the end, who needs to cover her? Me. Who needs to clerk case? Me. Who needs to present cases? Me. All me, and me and just me. Naturally, I was up in smoke. How is it justified that who of us get paid but only one get to work?

And again, why should I be not happy for some other people's problem? If she doesn't like to learn, it is her problem. If she doesn't want to work, it is her problem. The more I work, the more I gain, in terms of knowledge, experience and improves on my patient relationship. At least, I know the hard-earned money I get at the end of the month are worthy.

Working is fun, only if you can make heaven out of the living hell.

The Unexpected Death

I think, almost every mother bearing a child came to my clinic would expect to bring back a child when they were discharged. No one, absolutely no one expects the others.

Today, I faced with a difficult situation.

8.27AM, an expecting mother came to my clinic because she is feeling pain at the lower abdomen and the contraction was getting stronger. After a quick examination by my fellow friend, she was already in the advance stage of labour. So we pushed her to labour room.

I was the most senior house officer at that time. My friend was a tagging house officer since she just joined the department. After a while, the medical student rushed out for my assistance. She looked scare. So without wasting any time, I rushed to the labour room.

The atmosphere was cold. Nobody speaks. Everyone looked at the newly delivered flesh laying motionless on the green sheet. His body, swollen up twice his size. His face plethoric and the skin peeled of like plastic cover, exposing the red flesh. The umbilical cord was snapped into half. It was an awful sight.

The mother looked at me, half expecting the outcome of the labour. "How was my baby, Doctor Goh?"

"Did you go and check you baby well being lately?" I asked.

"I felt the quickening lessen throughout this week, but there was contractions. People said contraction was due to the baby moving..." She said.

Then came the hardest moment in my career, breaking bad news.

"Madam, I am sorry to say that you newborn is a stillbirth. He must have died quite sometime in your uterus. I am really sorry..."

Then she cried. I did not try to console her. This was grief which she must go through, so Elizabeth Kubler Ross said.

I offered her the opportunity to see the child. She could not bear the sight of a dead child. Must have been a great loss to her, her family and her love life. And I had to break the news to the husband as well, which he accepted quite well.

I am not good with death counseling. There is still a long way to go.

My Teacher, Then My Patient, Then My Teacher Again

Nothing touched me so much compared to this.

One fine day, my brother rang me up, told me that a patient had handed a note to him mistakenly, (as we share same surname). It was a small piece or parchment, apparent scribbled in a hurry. Each and every words were misaligned. After reading the note, there was a warmness spreading from the heart. Thus my tiredness bubbles. At least I know there is love in this world.

Read on for the content of the note:


Sometimes, a word of gratitude is more valuable than expensive gifts. His gratitude lights up the healing heart of mine.

Working is fun, all along.

Reflections: Medical Posting

Four months had passed, just in a blink of eye.

I had completed my first rotation in Medicine posting. It seems like yesterday, a fresh grad, half trembling, half confused, make his steps into this biggest hospital in the biggest state of Peninsular. Countless of sleepless night, exhaustions beyond words, pressure from superiors, ragging from peers, finally, yes finally I reached the end of the steps.

I learned a lot. Stuffs that I don't learn throughout schooling years. Stuff like interpersonal relationship, teamwork, overtime, and overwork. Not that I am not expecting all this to come, but the culture shock it gave to me. If I wasn't strong enough, I would have been a total failure. I would not be considered bragging when I said I am excelling in Medical posting. Most of the supervisors gave me an approving nod. (some even going to the stage to extend me so to help them out with work) I think to summarize it all, hardworking and honesty are the values that everyone values.


Next, I am going into Obstetric and Gynaecology. Hope I still have the passion to go on. I just love this job.