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...

MM Kills the Doctors

No. It is not Marilyn Monroe. And it is certainly not your M&M sweets (although some might argue that the high sugar content will cause harm). No, I am not talking about multiple myeloma either.

Its maternal mortality.

Just mention this term among your colleague, it will certainly bring chills to their spine. Some had nightmares of going through the painstaking process of being interrogated. Months of sleepless nights, loss of appetites, anhedonia, and suffers in term of performance at work. Some even loss their money and worse case scenario, losing jobs. 

I want to share a personal experience of my recent encounter with MM:

Mdm Z was a 24 years old expecting mother. She enjoys good health previously. She had a loving husband, and a caring family. This was her first pregnancy, and she had lots of hope for it. The first trimester of pregnancy passed through like a breeze.

During her second trimester, she had fever for a week. To cut short the stories, she was found to have infective endocarditis of the native valve. She was told of the problem and treatment commenced. As she was pregnant, many drugs were contraindicated, so the choice of antibiotics were limited. After about a week, she developed heart failure, probably because the infections cause valvular insufficiency. However, as of many Malaysian, they have predominating mindsets that alternative medicines works, and refused the trial-proven therapy. So the family brought a Shaman at midnight to her cubicle (without our prior consent), chanting spells for 2 hours, spraying water all over (nevertheless, causing massive rain inside ward and disturbed the other patients). You know what, the fetus died the next day!

Couple of days later, she delivered. Treatment was continued (and many 'I told you so, yet you don't want to listen'). Finally she was discharged well after weeks of antibiotics and planned for operative management in near future. Just a week after discharge,  patient condition deteriorated at home yet family refused to bring her to hospital. When we rang up to follow up her condition, that's when we knew she had met her maker.

Who's at fault?

Sooner or later, there will be inquiries regarding this maternal mortality case. We have to attend countless of meeting, fired with many questions and waste many time in between.

MM also created a culture of defensive medicine where managing team will priorities the non-emergent case over others to save themselves from this MM inquiries hassle. What do you think?

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.

Be Thankful!

Be thankful...

That you are still breathing, as some people never wake up from their sleep.

That both of your parents are still in good health, as time is short.

That your partner still loving you, as love is not an eternal thing.

That your friend still cares for you, as friendship can fade with time.

That you still have a job, even your boss is mad.

That you have a roof over your head, even though it is a simple house.

That you have a means of transport, as some people has to walk miles instead.

That you have food on the plate, as many children died of famish everyday.

Have Passion!

This is the first and the last post for 2011.

In life, we encountered many difficult situation. Many deadlines. Jobs that seems endless. Bosses that keep giving pressure. Ends doesn't seems to meet each other. This is my life now. We tried to do all at once but 24 hours a day doesn't just seems enough.

But one thing that keeps me going on and on, it is the passion for this job. The hard work you do for the job you love will pay you in the end. Passion bring on the fire, the motivation to move you on. You will do it tirelessly. Don't be afraid to try something new. If we try, we will either succeed or learn new experience. If we choose to stay put, nothing is done.

I have seen many of my junior doctors who chose this profession other than the passion itself. They bring sad faces to work. Poor attitude. Lack of professionalism. At the end of the day, they bring regrets and sufferings home. The cycle repeats itself. If there is no passion, soon they will burnt out. Better to reconsider other options than stuck in a job that will dread you for life!

Life is short. It is meant to be enjoyed to the fullest, ain't it?


Happy new year, folks.

Growing Up!

Finally, I can say I had reached a stage of equilibrium. Stage of maturity. Full grown.

Now, as I wrote this blog, I am being promoted as officer in a small town's hospital. As a matter of fact, I am being in charge of the casualty. With it, its safe to say that my job has come to a stable pace. I enjoyed more privilege than before. There are staffs that I have to take care and work together. People will look up to you for decision making. Your decision finally will affect the patient's life. I am not afraid. I believe I have enough of 'juice' to run the casualty. It's the skills that I need to honed up.

Before this, if I have any doubt, there is always someone senior to guide me through. But now, I am fully in charge of my own decision and the decision of others under my care. This is the process of growing up, and growing out of my shell.

I am enjoying my life, now, at least. Every moment of it.