The Days of The Blue Skies Are Gone

I had an exacerbation of asthma yesterday, not because I am a smoker, but all thanks to the recent haze. The friendly neighbour country began their yearly rituals of burning forest to make way for plantation. The results is the smoke that makes the road looks like in Genting highlands and the lungs congested. Despite many meeting and consensus made between our country and theirs, yet the old habit sticks. A month ago it was a beautiful sky in KL, but now its just haze.

I wonder all the effects of open burning and forest clearing on the wildlife such as the Sumatran tigers and rhinos? Are they being barbequed as well?

Hopefully someone please remind them again that we are suffocating here because of their doing.

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! 

The Dog-faced and The Dog-breathed

Someone to hold your hand

Last night, another kid try to take his life.

He is the dog-faced. We (the semi-alert on-call doctors) are the dog-breathed.

He is an 18 years-old. He had met his hurdle in life, and I am sure this might not be his first. There is always a mixed feelings when examination results were released. Yesterday was SPM results announcement. He is unhappy with his results. And he took a total of 50+ tablets, containing a mixture of paracetamol, loratadine, cinnarizine, and maxolon. The mother found him 4 hours later, in severe abdominal pain, but luckily he is not intoxicated.

I could remember how elated my feelings were when I get hold on to the results slip. It wasn't because my results were that good, just seeing that what I had worked for bring fruits and what I prayed for were answered. It is a relief that is beyond words. It is a feeling of putting down a stone from the inside your heart. But soon after that, another stone will starts to grow and the cycle repeats again...

There are many ways we can choose to handle the critical situation. He might had flung his examinations, but there is always a way to go about it. He can ask for help. He can talk to his friends or parents or his teachers. He can share it out. He can get self-help, or learn to forget. Is there something wrong with our society's support system that makes it difficult for young adults like him to get help?

I try to talk to him, to peel into his self defense. Unsuccessful. He choose to keep it a secret. Or he is too shy and regretted to what he did. All his vitals were stable and blood parameter were luckily normal. IV's were pumped in to rehydrate him. He survived, at least for another day.

If we try to see our problem from different perspective, or just stand back and looking at the problems again, the matter might just shrunk and disappeared after all. There is always a way to every situation and there is always something good behind things that seems so bad. For example, you fall sick, very very badly and recovered from it, you will develop immunity and become stronger.

For me, the best way to overcome a problem is with a song. Singing put away all your stress. It is as good as any tranquilizer. And there is just the perfect song for all troubles. "Let It Be" by The Beatles. My all-time favorites.

The Voice of a Nanyang Chinese

Malaysians

Often, i came across teachers who made headlines by provoking the students in class,
usually involves racial issues. "Kamu orang Cina balik ke negara China!" means you
Chinese go back to your home country, China. This is really regrettable, especially when
nation unity involving multi-racial and diverse cultural background is at stake.

Truely, majority of Chinese were immigrants during the rise of industrial age during late
19th and early 20th century, to fulfill the job vacancy such as miners, traders and manual
labours. Those jobs were regarded as unfavorable by the indigenous then. The influx of
Chinese and Indian were fueled by the ambition of our previous colonial rulers to gain
their foothold, making profits and the race to conquer South East Asia. Many of our
grandparents were from China, or their parents originated there. Many travelled south in
search of better future and hoping that one day will bring the hard-earned cash to feed the
hungry ones in China.

This trend took a major turn during the World War II, when the rising if the Communist
party, taking over the whole China. The motherland become a place of desolate. Many
Nanyang Chinese had forgone the idea of going back, had choose Malaya and Singapore
as their new settlement. They married and lay roots here since then.

What about those Chinese who migrates early (around 1500 a.d) during the time of the
rise of Malacca as the entreport? They had long been part of the society and blended in.
This is what you see in the Baba and Nyonya culture, distinctively in Malacca. Are they
considered as the indigenous people?

My story is about how my rgrandparents came about. My paternal side grandfather
originated from China, came to Malaysia as manual worker, to built houses. My
grandmother borne in Malaysia. Her father came from China, settled here early. My
maternal side is complicated. My grandfather is a mixture of Thai and Chinese. My
maternal grandmother is borne in Malaysia. Siamese people roamed the northern part
of Malaysia, blended in to the local people. It was used to be Thailand territory, until the
Britons made a deal with the King of Thailand, and the 4 northern states became part of
the Malaya. So can he (my maternal grandfather) be considered as the indigenous people,
or the most important question, can I be considered as indigenous?

It doesn't matter anymore. The newer generation already regards Malaysia as their home
land. They never get to know what happens in China or India that much now, all they care
is about the land they set foot on. Like me, I had never been to China yet, and my root is
deep in Malaysia. If you ask me to go back to China, I will be like an Indonesian coming to
Malaysia. This puzzle piece don't fit anymore.

This is what 1Malaysia means to me.

Thirty and Wasted

This is a true story. 

This is a story of a boy. He is 30 years old, and paralyzed. A freak accident 6 years ago took away not only his limbs and his freedom, but also his dreams and his life. A boy that has plenty of future, ended up lying on bed more than 20 hours a day.

We pass urine without even break a sweat. He needs to self catheterized. "Or else I will have retained urine." He said. Passing motion is a automatic response. Moving around means a lot of work transferring himself to wheelchair and back, involving many helps and energy-consuming. He and caretakers resorted to the simple way out, that is not moving at all. He has a loving wife, staying beside him, answering to whatever his needs are and tend all his errands. Whenever he is admitted, she will stay beside him, like a shadow.

But he is not always a good boy, to start with. He has issues. He can't get over the fact that his life has changed. He did drugs. And he had complications from it. The heart fails as we witnessed that he has worsening oedema all over his body. He is breathless at rest. He is tired all the time. And he makes his wife suffers. The newly gained weight caused him more disability. As a result, there were multiple pressure sores over the buttock and the prominence of the hips. And it sure smells bad too.

With good medications and nursing care, we bring him out of the disaster.  His failure symptoms resolving. His infections under control. Proper rehabilitation goes a long way to restore his function and self esteem. Last I saw him, there is a shine in his eyes that were absent previously. The smile that he and his wife gave us tells us a lot.

This is not only Malaysian dilemma, I believe it is rampant all over the world. Illicit drug is a very serious problem, both in term of healthcare burden and social aspects. Most of the drugsters are of the young and so call productive group. The country lose out the brilliant assets when these people getting high in some dark alleys. They are prone for blood-borne illness, as well as creating sense of insecurities in the neighbourhood. Many ended up in correctional facilities or prison, some even to the hang rope. 

I don't despise these people. I felt sorry for them. I will try to help them, if it is within my ability. I don't deny that many treat them as a nuisance, a self-inflicted illness, 'high risk' for infection transmission case, and difficult vascular access case. But I sincerely hope it will change. It start from within your. Please...

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.

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...

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

Insider Vs Outsider

"Chinese are the immigrant, squatters"

I can't believe I am still hearing such a low mentality statements being made.

Despite being independent for more than half a decade, the fundamental mentality is still stopping at British colonial times. As a Malaysian Chinese, we had rooted here for such a long time that we have little or no memory that we originates from China. I am born as a 'Malaysian'.I do not have a place in China for me. My mainland is here, Malaysia.

Despite all the moves to recognize every entity as 'Malaysian', there are people who still can't get over the overwhelming feeling of their own race being the greater one. Understandable. When we are equal, lost are the special privileges, unfairness, and foul play. Having a divided race entity is important in this context.

We may be independent at the outside, but inside, there is still a long way to go.

Hospital Is My Second Home Programme

Most of us would try as hard as possible not to step into the hospital, to have nothing related to it. Hospital is synonym to sick, death, dirty, and all sorts of infections. Admission to hospital is suffering.

Yet, some will find all ways to get admitted to the hospital. I have seen quite some diagnosis such as " Poor oral intake and patient requested admission". Those 'patient requested admission population' are generally from the low socioeconomy status group, prisoners, intravenous drug users, and those with very poor family support group.

The first one, Ah Tat is his name. Every time we discharged him, he will return to our door steps on the third day without fail. Every time with the same complaint. He was not able to control fluid intake, subsequently taxed the ailing heart, ended up with heart failure symptoms. Despite giving the best medications, he did not want to take because he believed taking too much medications will do him more harm. So if I am on call and he is admitted, I do not need to clerk him, simply give him some advice and a nice bed. That's all.

The second case, 77 years old elderly, initially having acute renal failure, requiring dialysis. But the children strongly believe dialysis will do more harm than good. By going against doctors advice, the patient was going downhill. Currently, her kidneys is damaged beyond repair. But her will to live is strong. She had multiple episode of severe ulcers bleed, the next day I come, she is still alive. The daughter refused to take back the mother because apparently no brothers and sisters will take the responsibility to take care of the mother in the care towards the end and there were no maid at home. The best option is to let the staff nurse to take the responsibility of the children to take care of the mother. So until now, we still can't discharge her.

The third case, a 30+ guy, actively injecting drugs, despite went in and out institution, still unable to stop this habit. He would come in every other week for worsening abdominal distention. His liver was already cirrosed, because of viral hepatitis. When he was in the second home, he wreaked havocs. The staff nurses loathed him because he stole their ketchup. However, he has passed away unfortunately due to severe liver failure.

Hospital is not only the place for the sick. It is also the place for the unwanted, the lonely, the leftover, the unemployed, and those who wanted free food with some hospitality. My hospital door is always open (because there is no door!). Welcome to our second home.

This is Where I Called Home

Let me introduce myself to you guys. My name is Muthu. I am eight. Eldest of the five siblings. All are boys, the youngest is 1 year old. I never attended to any formal school until now. My parents never send me to one. I am staying in a hut as you can see with a blown off roof after the last thunderstorm and a door that barely close. There were no windows.

I introduce my mom first as she is the person that I see the most everyday. My father seldom at home. He loves alcohol more than our family. My mother is currently expecting another baby. Heard that it is a girl this time. I seldom see my dad. He is never at home. I don't know what he is. Only thing I know when he is back is mother will get hit and we all siblings we got beaten up for no reason at all. Since he has this new found girlfriend, he came home less and less. I knew my mother cried a lot for him.

Since I am not attending any school, I had plenty of time. I like playing around with friends. Though they always have some shiny new toys I could only hoped for. So I found a way to make money. I asked from people. Sometimes, on 'luckier' day, I could earn myself a can of coke. 'Bad' days can be really terrible. Anyway, I don't enjoy reading. I can't read anyway. Although I hate it, I have to take care of my younger siblings for my mother sake.

Life is tough. I never want all this responsibility of grown man. I wanted to play, I wanted to go to school like the other boys, to see the world. Above all, I wanted a home that is warm, a father that provides, mother that heal all the wounds, and everyone around table to enjoy a nice dinner. Not this and definitely not what I had now! I am so longed for a change in my life and fate.

To see this broken family really breaks my heart. They were a defunct family living off the main road from Kuantan to Gambang. They were the poorest of the poor among the area. The house they lived is no living condition. Torn down roof, no rooms, poor sanitation, with food and faeces lying around. Anyway, it is a shelter provided by some kind people. They were like a roadkill from the economic highway.

Father does not has a permanent job and mother is a housewife. Most of the income were spent on the drinking behaviour. Moreover, the father is abusive at times and his beating never spared the younger child as well. Education for the young one never seems important. The health condition were terrible. Almost all of them having head lice manifestation with the second youngest child having scabies infection as well. I have no doubt that the other siblings will have the same infection. All of them seems malnourished and looks small for their age. The mother, though pregnant, never attended the routine maternity clinic check-up for the young one inside.

People around had been trying to help them, with monetary support from governmental agency, non-governmental organisation and people with a heart of a Buddha. People donated food and clothing to fulfil only the basic necessities but they were far from enough. They need better homes, and most important, education to promise a brighter future for the younger generations. With the help of people who cares, this family will be relocated to the foster home to ensure proper living condition and schooling for the child. There is still hope if everyone only lend their helping hand.