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...