Friday, January 26, 2007

I wish I wish...

I wish I had a magic wand that could fulfill all my wants without limitations.

As I go through my simple life, I see so many wrongdoings and faults around me that if I spend my time thinking about it, seriously, I would get so depressed and lose my appetite (buleh ker....hehehe).

But occasionally, these so called 'wrongdoings' may sometimes be perceived as human nature, or behaviour and I don't want to come across as being judgemental.

I have so many opinions in me, yet I fear from speaking out because I realise how 'jahil' I am and I don't want to speak out of ignorance.

Tapi, if you are faced with an aged mother who goes around carrying her disabled child, who tells you that she has gone twice to a local KK but been asked to leave as the doctor is too busy to write her a short letter on her child's condition so that she could apply for financial help, and then travels 30 kms to the district hospital in hope of getting someone to help her....what would go through your mind?

What do you tell her when you wish you could help her and write her that letter yet there are 50 patients waiting to be seen and they have been waiting since the clinic opened and that was 3 hours ago?

I want to be angry but to whom do I direct my anger? To the M&HO at the KK who was probably unaware of her in the first place? or to the KK staff who could spare time to help some bigshot see the M&HO regardless of how many patients there are waiting yet could not spare one minute to assist this helpless nobody? Am I angry to the government who seems to ignore the plights of the poor - the gap between the rich and the poor seems so far away nowadays. Am I angry for my fellow doctors who choose to work overseas therefore contributing towards the lack of medical officers here? I am outraged, I want to blame everyone yet in reality there isn't really anyone to blame.

While I was in charge of the Paeds ward a few years back, I had a case of a child with CP (cerebral palsy). She was 9 I think, I can't remember. Her parents are in KL, from what I gathered, working in 'kilangs' and they have left this child to the grandmother. and this grandmother, a frail makcik, weighing probably at about 40 kilos, actually CARRIES her grandchild to appointments and physio and god knows what else at home. Even when they are waiting in the waiting area, she was carrying her. Her muscles are too limp and she can't even sit stright in a wheelchair. and how long are waiting times in a typical govt hospital?

Makcik tells me she travels 40 kms everytime her grandchild has a specialist's appointment, with a 'kereta sewa' that sometimes comes to rm20 one way. and Pakcik is suffering from stroke at home, mostly bed bound. So tell me, who do I get angry with? Especially when it is this Makcik who suffers through her hardships.

I try to help once in a while but there is only so much I can do as one person.

I wish I wish.....

p/s: Do you know what 'kuaci's (sunflower seeds) are called in the Kelantan dialect? I learnt this from my niece Asilah Husna not long ago and I thought aptly described what they are.

Butir ralik.

Ralik means leka, as if in a trance. and do observe people who enjoy eating kuacis. Note their almost trance like action of putting one seed after another into the mouth, extracting its crunchy insides.

Interesting isn't it...? :)

Sunday, January 21, 2007


There's nothing more pleasant than discovering I've got a long weekend ahead of me with no on calls!

Came back to work on a relaxing Thursday and discovered among others that in view of Maal Hijrah on Saturday, Sunday has been proclaimed a public holiday! Yippeeee!

Kelantan and Terengganu have been having their govt officers in a muddle before this. Sekejap cuti, sekejap tak cuti. In one instance, Kelantan cuti tapi Terengganu tak cuti. So I'm not sure whether this will be a permanent thing or not.

Wanted to go for a family trip with Abg's family but they weren't very enthusiastic plus SIL had her classes this weekend. So ended up doing basically NOTHING - which, isn't really bad you know.....:)

Plus, suddenly developed a case of the sniffles on Saturday. Pergi K*B M*ll pun takde mood. This morning managed to do some tidying up and vacuuming. Abg did lunch, what a sweetheart.

I'm on call Wednesday. Booo.....

Friday, January 19, 2007

A well earned break

After the chaos that is my OPD in HTM, boy was I glad for my holiday. I usually try to go back to KL once every three months. Abg doesn't get to query/complain because I spend the rest of the year with his family. Fair la kan...hehehe.

We (my sisters and I) decided that we must must MUST go for a family trip this time round. I said I'd pay for accommodations, and sendiri2 bayar duit minyak and duit tol. So, sis number 2 said she'd pay for dinner at a Medan Ikan Bakar. Originally wanted to go to Melaka but sis number 2 already went so she was not keen. After lingering on Bagan Lalang (no suitable place to stay) and Kuala Selangor (Tok Mama does not want to ride on rickety boats at Maghrib time regardless of how beautiful the kelip2 looks), we later decided on Lumut. I came across *Lumut Valley Condo Resort* - RM148 for a studio deluxe, RM268 for a 3 bedroom apartment - good deal what? - among the advantages of holidaying during off peak seasons.

Stopped at Teluk Intan for lunch. Gu*lam Ras*ul is so famous there...! it's like THE nasi kandar place to be and I saw at least three different branches of it roundabout Lu*mut/Te*luk In*tan.

We reached Lumut about 4 and after checking in and checking out each other's rooms, Hannah immediately wanted to go to the swimming pool. What is it with kiddies and water, huh? The moment they see any amount of water in a container, they develop this uncontrollable urge to jump in and splash around. Hannah was so excited, she insisted on wearing her goggles in the car. Kiut sangat.

By the by, her mummy has enrolled her in a kindy called Kri*sta. Very nice location, very nice headmistress. I think they have branches all over. After classes in the morning, they also have daycare. Nice lah, siap ada uniform lagi. Hannah has been taught to say "My name is Hannah" whenever she is asked the appropriate question. But then, she has also developed this knack of saying "Oh mak kau" at no particular time of day; I'm worried her babah will say her aunts are becoming a bad influence on her.....hehehe. Janji bukan kitorg yang ajar tau......

Lumut's a nice place. Very well developed. Clean. It's small, yes but only because most ppl just use Lumut as a stopover on the way to Pangkor. Excited sgt sampai lupa nak ambik gambar. Later that evening, Abg and I went to Tel*uk Ba*tik to survey for dinner. The beach itself is average, but just before you reach the beachfront itself is a sign towards Medan Ikan Bakar (apatah - tak ingat). We chose and ordered food and told them to prepare it for half eight. So, kot bila nak makan karang, takde la nak tunggu sejam baru dapat food. Preparation is the utmost when you are travelling with 9 other adults, ok...:)

Ramai jugak org kat Medan Ikan Bakar tu later that night. Nearly full and they had quite a lot of tables. Luckily our tables by the water had been reserved and food came not 5 mins later. Perfect. Taste wise, hmmm, not that great lah. I've had better tapi boleh la....

The next day off we went at nearly 8 to get a ferry to Pangkor. Biasa lah, tourist spots macam nie byk lah ulat2 berkeliaran, insisting that their ferry is the best option around. Since going to Langkawi last year, I've learnt my lesson and not grab the first thing that comes hovering near my face. If there are no better options about, I can always get back to him, huh?

We were loitering around at about quarter to 8 and this ulat approached sis number 2, insisting that the next ferry was only at quarter past. He is offering RM10 perhead (return ticket). I said no, I want to check out other options. Ye lah, we're not really pressed for time ke apa, kan..kalau betul dah takde ferry, nanti kiotrg dtg la beli tiket you. Tapi as we walked towards the jetty, he loitered with us, siap buat small talk with Tok Papa. and Lo and behold, an 8 am ferry is waiting and we paid only for 8 adults (we got 2 FOC), so ended up only paying RM8 per head.

I sound calculating, kan....? but it's not the money, it's the principles, people! :)

Pangkor was marvellous!!!!!!!!!!!!

A sea of pink vans waited as we unboarded the ferry (journey took 25mins). Take note, these are the only means of travelling. It fits 12 adults so just nice lah untuk the Sukeri clan nih. They offered us RM60 for a 2 hour trip and they will bring you to 4 sights - 2 tourist spots, a kilang ikan and the beach.

Next time I go, I'll just get a 'taxi' to Teluk Nipah. Snorkeling there is highly recommended and you don't even have to know how to swim! I saw a family of makciks siap dgn tudung labuh ngan baju kurung lagi okeyyyy......sense of adventure sungguh.

Hannah had fun destroying the sand castles her mak long made (apa la punya anak sedara) while her mummmy and babah went snorkeling. Nasib baik baby Hariz slept soundly all the while his mummy went. I told Hannah mummy gi kerja cabut gigi kat tgh laut...hehehe....

At noon, we trudged back to the apartments with big bags off fish products and made our way back to KL. Reality sank in as we got caught in the Sungai Buluh traffic crawl. Ahhh, nothing like a traffic jam to jolt you to your senses, huh....

All in all, a fun and mostly hassle-free family outing. Where next people????

Sunday, January 07, 2007

Birthday Girl

Nama saya Wan Nadiah Hannah.
Hari ini, harijadi saya yang ketiga.
Saya sangat happy sebab Mummy dan Babah belikan saya Barbie Beautiful Bride dan Prince Derek yang ada 12 pasang kasut.

Saya ada seorg adik. Nama dia Wan Nazmi Hariz. Dia saaaaangat gemuk sebab tiap2 hari dia minum baaaanyak susu.

Tok Mama dan Tok Papa pun ada belikan saya pressie. Mak Long saya tinggal di Kelantan. Mak Long kata dia akan balik minggu ini. Saya takut dengan Pak Long sebab dia ada janggut. Babah takde janggut. Mak Long suka belikan saya hadiah tapi kadang2 Mak Long suka marah saya sebab dia kata saya cepat nangis. Tapi saya tau Mak Long sebenarnya sayangkan saya.

Mummy kata Mak Long nak bawak Tok Mama, Tok Papa, Mak Teh, Mak Su, Pak Uda dan Pak Su, Hannah, Mummy, Babah dan baby Hariz pergi jalan-jalan. Mak Long, Hannah nak pergi tempat yang ada swimming pool!

Saturday, January 06, 2007

Post Call Post Mortem

Future MOs at district hospitals sekalian.......bahawasanya, kes-kes APO dan yang sewaktu dgnnya will almost always turn up in the wee hours of the morning. Seriously.

APO (acute pulmonary oedema) is a condition when there is a sudden onset of chest pains associated with shortness of breath due to fluids in the lungs. Your patient will definitely not be able to lie flat - if he/she is forced to do so, he/she will complain of feeling 'lemas'. They get very restless and to a fresh MO on her first on call at the district hospital, can be very scary. Ye lah, previously, masa korang housemen, most likely case APO nie MO korang yang settle kat casualty. By the time korang tgk kat wad, makcik or pakcik tu dah stable.

My on call last night (speaking of which, on calls on back to back weekends are sgt meletihkan la. Hari tu on call raya haji-the following weekend, on call lagi..) wasn't too bad in terms of patients coming to the casualty. Well, not in the first half of the day anyway. Patients were basically non existant apart from a barrage of jaundiced babies which, most, thankfully could be discharged. However, the previous night a male patient with fever and low blood pressure was admitted. His BP only picked up after commencement of dopamine. The staff nurse in ward kept calling me with one problem after another. I think, though, it's just a ploy to get me to refer him so that they won't have to be bothered with his once every 15-minutes BP monitoring...hahaha.

First his BP was shooting up and down. Adjust dopamine pun payah nak stabilise. Then he developed vomiting and abdominal discomfort with some difficulty in breathing. Finally, he stopped producing urine after 12 noon. Waaa, manyak tension oo. Then I had the unfortunate luck of having the most annoying night staff who kept pestering me to refer the patient. Weh, aku doctor ke mu doctor....that was what I wished I could say to her.

On top of that, the casualty started to become busy. There was a PV bleeding, two MVAs (motor vehicle accidents) - one of which claimed and cried when he was unable to move his legs, tapi tetiba kecoh and menjerit mintak seluar jeans dia balik. One kid got knocked down by a motorbike, NOT by the aforementioned though, hahaha. A stroke case got in and an acute abdomen who had come several times the night before. and ON TOP OF ALL THAT, my male ward has become full. Aiyo, where to put patients lah?

Luckily, a former colleague in Machang was also on call. I gave him a quick call and asked if I could 'borrow' a bed or two if needed. Nasib baik boleh. So one of the MVAs was shipped to Machang, his friend was referred to HRPZ II and the stroke to Pasir Mas. The PV bleeding got admitted, as with the child with the closed fracture. The acute abdomen was a clear cut case of intestinal obstruction but refused to be referred. Letih la. If I keep him, his condition might deteriorate. Honestly, ikut hati memang tak nak simpan la cases like these. Tapi what to do, if patients refuse to go, there is nothing you can do.

Labour room kept receiving cases, thankfully, nothing serious that needs urgent attention.

About midnight, just when I thought I could finally go and clerk my labour room cases, masuk la this 88-year-old lady. TYPICAL presentation of APO. Tambah2 lagi, already has a history of previous admission for APO. According to son, though premorbidly quite active, very difficult to persuade to take medications.

I started the initial medication, put her on bladder catheterisation and called the medical MO on call. Suara macam letih aje. Nasib baik dia tak ckp banyak, terima terus kes tu.

By now, it's already past 1 am. Makcik looked increasingly distressed. My second on call was away somewhere else which would take an hour to get here. What to do, what to do?

Future doctors, if you're on passive call, please la don't be so irresponsible as to be so far away from the hospital. It beats the purpose of putting you on passive call in the first place.

Makcik's oxygen level dropped to 80. She looked near collapse. I contemplated intubating her. Tapi karang takde ventilator, susah plak aku. I gave her another shot of frusemide, put her on high flow oxygen and decided to escort the case myself. A quick call to my senior MO who lives nearby and I was off.

Surprisingly, makcik survived the 45 min journey. Siap bleh sengih2 kat aku lagi. "Mujur selamak sa-pa, deh? (Mujur selamat sampai, kan?)" Ye makcik, mujur..... Her condition made a complete turnaround. Must be that roller coaster-like ride on the ambulance.

Balik ke HTM at three, sembahyang isya and collapsed. Slept till 5 am and trudged to casualty to look at this IHD case. He came in at half two tapi apparently was stable. He was sleeping soundly on the stretcher. Kalau aku tau, aku tidur sikit lagi. Hehehe.

Penutup of my oncall was a BID (brought in dead) case. 57 years old, background history of heart problem and had earlier complained of shortness of breath. Apparently, became still about 10 mins away from the hospital. Sedih la tgk anak dia. Tak sangka la mak dia dah meninggal. Apa nak buat.

and BTW, the guy with hypotension and no urine? Referred him at 8 am. My morning nurses must have been jumping for joy as he left.