The early years..

A forum message got me reminiscing about my early years as a 'kuli batak' houseman.

To tell you the truth, I seriously don't know how I managed to get through med school. I'm not sounding arrogant and truth be said, I almost DIDN'T. Failed my second year, I think and had to redo some of the modules. By my final days in med school, I was thinking in much disbelief that I, the know-nothing, most lazy final year student was going to be let out unto the real world and managing real patients.

Now, isn't THAT scary.

Coming back to Malaysia to work was an easy decision. Choosing WHERE to work was another story. I wanted to be near Abg; Ma wanted me to remain in the same state. I pondered upon the idea and discarded it instantly. Being away from home all this while: MRSM Kuantan, Walthamstow Hall and Belfast, I wasn't sure if I could adjust to being at home, if you get my drift.

Thankfully, HKB wasn't a popular choice among the final year graduates, so I got in rather easily. Ma actually drove from KL, just to get me there on my first day.

I was told to report to the Medical Department. Hah, little did I know what a life changing experience Medical Department HKB was going to be! :) Early next morning, I went to Ward 4 (Male Medical), all scared and excited at the same time. Met Roshaini who was busy zooming up and down the aisles, taking vials after vials of blood. To say I was overwhelmed on my first day is an understatement.

To give a better picture of how overwhelmed and so-thrown-and-floundering-in-the-deep-end I was, I'll let you in on a secret, something I never told anyone.....when my MO told me to review a CVA case, I actually went up to a nurse and asked her what REVIEW meant!
I had no idea what BHTs were and when my nurse wanted me to write medications, I was looking at her face as if she was speaking to me in Swahili.....


Gelak la.....I definitely snicker to myself whenever my mind returns to that fateful day...:)


I can laugh now but I definitely wasn't laughing then. It got so hectic and so mad that I didn't have time to be sorry for myself. Patients were lying on foldaway beds in the middle of the ward; some days, even right to the doors. Visiting time was like making your way through people at an exhibition or something. I lost 10kg in my first week (and unfortunately gained much much more during the next 2 years, haha) and on some days, only survived on drinking cold plain water in the pantry's fridge.

I remember being shouted at by MOs-particularly by pissed off Radiology MOs who just couldn't be bothered to get off their asses in their comfy homes to do an urgent CT scan at 11pm at night. Referring cases to other departments was another chore that I didn't look forward to. Maybe I sounded too much like a houseman who didn't have a clue what she was doing, haha....they could smell the fear! :)

A typical day would start at about seven (HOs had to come in early to complete the morning bloodtakings, you see); MOs would start their rounds at about eight and then Specialists would come by at about half nine. Rounds are usually done by ten or so when a fresh round of blood investigations have now been ordered, sometimes making your early efforts obsolete. While you struggle with the morning instructions, new patients would be wheeled in and you'd be the person responsible for 'clerking' them. All these new cases would have to be informed to the MO in charge and at the same time, discharges (patients going home) have to be completed.

Some specialists do afternoon rounds as well and if you're lucky, maybe get to trudge along home by six. Some housemen even come in later to finish discharge summaries and what nots.

The Obs&Gyn posting was another matter; definitely eye-opening. EOD (every other day) on calls! How on earth did I manage to survive a full month of EOD calls?! :)

I do think, though, that the best decision I made was to postpone getting married till after I completed my housemanship. I don't think I would've made a good wife when I was either on call, OR too stuporous to even eat...! Having Abg for support definitely helped, as well as having gila-gila fellow housemen.....:)

Seriously lah....if you have relatives who think doctors are glamorous, and want to shove your kids into med school, think again. Semangat kena kuat, telinga kena tebal and muka kena selamba. Kena marah tu perkara biasa, and I strongly believe that whatever/whomever doesn't kill you, will only make you stronger and a better person.

On a less morose note, :)....congratulations and a Yippe-dee-yay tu Dr. M who is now a proud father of two! MDQ no.2 rolled out all pink and nice on the 27th February, 1952H (hours, bukan Hijrah..hehe).

Update

Arrived at work rather early this morning, all with the best intentions of doing my job well, and not be mad at any of my patients.

The staff nurse who accompanied the PPH case was buying her nasi pagi (nasi with 'kro-peh' - siap ada kaki ayam terjulur keluar via the opening of the package) and beckoned at me excitedly as I approached the very busy gerai.

Apparently, my patient required 10 pints of blood transfusion during the weekend as her Hb dropped to 3.5 on arrival. She had also gone into DIVC and had to be given two courses of DIVC regime. She is, last heard, stable and hopefully will be well enough to undergo an EUA (examination under anaesthesia) later today. According to my staff nurse, understandably the O&G people in HRPZII has kicked up a fuss as to why this has happened. They have asked for her delivery charts and reports. I hope it will turn out okay for the patient. At 27, a hysterectomy would be so devastating.

Had a 'date' with Abg in KB in the afternoon; lunch was nasi at the local mamak eatery. Abg's nasi putih with 2 medium sized sotong goreng and a piece of tenggiri goreng and some pak choy (pak choy in Mamak?) cost him RM9.80!!!! Seriously, RM10 nowadays have less value than it used to.

We went to KB Mall to get his glasses and browsed at Guardian.

I've always loved going through toiletries and such; while I was in UK, I would spend HOURS in Boots, going through aisle after aisle of beauty products and make-up and picture frames and CDs and what nots. They have this really cool loyalty card-reward system that for each pound you spend, you get a point (and occasionally they would have offers of, say, 5oo points if you buy the promotional syampoo or deodorant etc) and if you collect enough points, you could use these points to buy stuff! Example, if you had 500 points, this would be equivalent to 5 pounds and so on.

Now, why can't we have something like that?

Yes, I still keep my Boots card even after all these years....sentimental or what...

Five minutes of eternity...

Normal finding in an on call room: Owner-less toothbrushes....

There ends my last call of the month. Perhaps, no more PH calls for at least 4 weeks. Working for 24 hours straight is seriously inhumane, I tell you. Even when there are no cases, you can't sleep. Not properly anyway. At least, I wouldn't call 'tidur ayam' proper sleep. You keep waking up wondering if the phone had rang and you were too tired to hear it.

I am writing all these down, perhaps as a documentation of what had happened during my calls. Maybe for when something does decide to crop up later, y'know, as things usually do.

Labour room started busy early that day. Thin meconium liquor in a 43 y.o. gravida 5 I think. Eventually delivered rather uncomplicatedly but alas, her baby showed rather strong features of a Down Syndrome. It was left to me to inform her of her baby's condition, since he was to be admitted for observation anyway.

I was prepared for shock, I was prepared for unconditional acceptance - but I was not prepared for downright rejection. Was I being naive? Had I taken a mother's love for granted? She was shocked, alright but she was so shocked to the extent of refusing to hold her baby. Apart from his physical features, he was totally fine. But later, he developed hypoglycaemia and despite feeding, still required infusion of dextrose. I went to check on him later that night and he seems to be doing okay, despite the minor hiccup of a blocked intravenous access that had me in near tears.....frust, occccayyyy, kalau tak jumpa urat nie tau...:) in the end found one on the foot. Phew!

Then, a case of fall from height arrived. Ada apa tah kat tangki air kat rumah dia, that she had to check for herself....complaining of pain at the back but could move her legs okay. Xray showed a wedge fracture of the L2. Last I checked, she still didn't exhibit any neurological deficits, so I hope she'll be okay, at least until Mr S checks her out tomorrow.

Then I had two MVAs - siblings who both sustained fracture of the right femur. I don't know about other people, but I seriously have issues with underaged people who ride bikes as if they were racing in a GP. Serious. They are the worst in tiny, bendy kampung roads which only allow one car at a time. Seriously la, if they were to fall and the bike were to fall on them, serious tak larat nak angkat okay. and it's ALWAYS the car driver's fault. Tak percaya, gi tanya mana2 victim MVA yg bawak motor. I've never heard one admitting that it's their fault.

My weird case of the day came in form of a 19 y.o. chinese girl who, from what I gathered, had initially complaint of stiffness of the jaw, which progressed to numbness/cramps of both hands, SOB (shortness of breath) and then suddenly fainted. Her concerned mother and sister immediately came to the nearest hospital. Mother and sister claimed little sis had no medical problems, not on any medication apart from panadol for her gum pains but denied any possibility of overdosing. This had never happened before and there was no history of fall or family disagreement.

Her BP was normal, her oxygen sats were perfect and her blood sugar normal. There was no neck stiffness, no jerky movements, and her CNS were normal. I was totally stumped. There were no signs of infection, ECG was normal, her serum Calcium was normal and so was her renal funtion.

I rubbed on her sternum till my knuckles hurt and there was no response. Serious! and I rubbed extra hard some more but still nothing. Hish, kabar ke dok mek nih? She opened her eyes for a while but did not seem to register anything. I honestly admitted to her mother that I have no clue to what was wrong with her daughter and since she wanted her child to be admitted to a private hospital, she wanted us to send her.

We managed to send her eventually but I got temporarily pissed with a certain MA on call who was supposed to escort her. I clearly stated that he didn't need an attendant; he was supposed to come here and whoosh, go off. Tapi, on hearing that an attendant was not called, he PURPOSELY delayed leaving by, I dunno, pretending to check on resus kits and what nots until his 'best friend' magically turned up without any of us calling him. Why why why???? If he insisted on having a helper, he should have approached me or the other MAs on duty. If he sounded reasonable, I would have agreed. Nie tak, kau biar patient ngn mak dia yg already so flustered on the ambulance, pestering my driver who didn't know squat.

Then I had a young male with a history of rather uneventful asthma who suddenly had a bad episode of SOB and wheeze. He took about three hours of stabilisation before I could transfer him to ward. Seriously, I thought he was going to collapse on me. Young male with no history of ventilation before - major caution needed. This morning, I dropped by to check on him and he was fine.

Tapi, was my call ever going to be uneventful? Nooooo....of course it just had to end with a bang. and a Big Bang it was. Young mother of three, delivered 13 days ago came in with symptoms of shock. Pale as sheet and complaining of dizziness. BP registered at 77/33 with a heart rate of 80-90. Admitted to having PV bleeding since 7 pm the night before (she turned up at casualty at 5 am); lochia before this was already decreasing in amount and she denied history of fall, sexual intercourse (at 13 days post delivery? Ada ke?) or massage. Blood was literally pooling underneath her clothes. After pushing in fluids, BP picked up to 90/40. Vaginal examination revealed more and more and MORE blood. Abdomen had a mass of about 16 weeks pregnancy (when there shouldn't be at 2 weeks post delivery - uterus should have been impalpable) and scan revealed a bulky uterus. What was in there? A retained placenta?

Blood was ordered for transfusion in progress and I alerted the Gynae MO on call that I'm sending this patient. Now I need an escort. MO 2nd call was on call the night before and had OPD duty this morning. It was already half 6 in the morning. If I went, the ambulance could leave straight away. I know I had done all I could in my setting. She needs to get to HRPZ asap. Plus, MO 2nd call lived about 45 minutes away. Dilemma and decisions. On call money doesn't pay enough for dilemmas like these.

The ambulance journey took only half an hour, zooming through the morning mist which is occurring quite often nowadays, but it felt like ages. Five minutes were set between each BP readings and those five minutes felt like an eternity.

The patient still wasn't out of the woods when I left her. Her BP was still on the low and dangerous side. I prayed for her well being as I passed her case to the Casualty MO (all fresh and wangi and possibly wondering what she did to deserve a bad case of PPH so early in the shift..:))

Tied up all my loose ends, checked up on the patients I admitted last night and drove home. Ate my nasi pagi in silence and went to bed. Pukul 3 baru bangun balik. Which means, pasar malam dinner....hehe.

On a more cheerful note, Hooorayyy for sis who officially became a salary receiving staff with KKM last week. May you turn up for work with joy in your heart and always be at your table and not having never endings 'minum2' - dpt gaji jgn lupa belanja...hehe...

I'm IT.....

sebab dah kena tag dah la kan....so I'm it la....

Thanks Mafeitz for tagging me....tagging nie usually means shadowing in our line of work. For instance, kalau ada budak hingusan baru masuk kerja, he or she's supposed to tag for a few days just to get a picture of what the job entails. Usually up to 8 pm la, but of course, nothing exciting happens before 8 in the job so....

Well, I digress....

I'm supposed to list 6 weird things about me...


1. I must have my books lined up according to height. and if possible, according to length as well. But height gets priority, for instance, if i get a book which is shorter than the one to the left of it, and it juts out, usually, the height wins. I'll most probably just find another shelf for it. or buy books which are roughly the same length (length, from the spine to the edges of the pages).


2. I'm a sucker for Hindi movies.

I know.....! Weird, right? It must be embedded in my subconscious or something, maybe Ma watched a lot of Hindi movies while carrying me. When I was younger, Hindi movies were something else, weren't they? Bobby, Sangam, Qurbani, Dosti Dushmani, Chandni, Amar Akbar Anthony - these were what I watched and remembered, apart from the sing-a-long Disney movies. At MRSM, I was in the TV room at 2 pm on a Friday (the boys would be out for Friday prayers and the girls were either doing laundry or sleeping) with Kak Safilah, religiously watching Hindi movies even when I had to be content with Govinda. (No offense, Govinda fans)

Heck, just to illustrate how weird I am about Hindi movies; I even went to Coliseum Jln TAR ALONE just to watch Khal Nayak, ok???

Till now, Hindi movies still get me. Even when they feature ridiculously impossible stunts or death defying heroes and illogical plots. It's just something about the haunting melody of the sitar and wonderfully thick manes on the heroines I guess.


3. I ate a couple of lizard's eggs once when I was younger. I actually thought they were sweets.


4. I hate seeing hair in the kitchen. I mean, on table tops or in the sink - not on top of people's heads where they belong, of course.


5. I wake up earlier in the morning during the holidays then when I'm working. I'm a morning person, so usually waking up isn't a chore but during working days, I seriously struggle to get up and shower tapi come weekends or holidays, tak payah alarm pun bleh bangun pukul enam. I'm like the kid who wakes up super early and goes into his parent's room and bug them. In this case, Abg gets poked and bugged to get up and entertain me.


6. I seriously LUUURRRRVE onions. Yellow, red, big, small, uncooked, cooked - but I stop short at biting into them like Shrek did in the first movie. and to think that Ma used to have to force me to eat them when I was younger.


I'm tagging -

Yaya, RedBeanBun, Zetty, Zaiti, DBI and SuperWomanWannabe - all among my must read blogs.

Rules of the game: Each player of this game starts out by telling 6 weird things about themselves on their own blog, as well as state the rules clearly. At the end, you will need to choose 6 people to be tagged and list out their names. After you do that, leave them a comment on their blogs letting them know you tagged them.

Tag, you're it!

I love....

...four-day weekends! Especially the ones when I'm not on call. If I am, then the day before the call is ruined, as well as the day after, coz usually I'm just too knackered to do anything.

I must be the only person in Kelantan who would drive alllll the way to Kuantan to catch a movie. Seriously.

Three hours and a half journey, 300+kms...all for two plus hours of Ghostrider.

Well, actually, it didn't really matter what film it was. I just wanted to get myself into a cinema, and my other choices were a film where Eddie Murphy plays multiple characters and something with Erra Fazira.

I love making road trips like these. It gives me a chance to just lay back and catch up on stuff with Abg. Get away from that bangun pagi-mandi-gi kerja-balik kerja-masak-makan and go tidur routine.


View finder misted sebab baru keluar dari air conditioned room


View from our room

We checked into Gr*and Contin*ental Ku*antan, a stone's throw away from the MegaMall. Had lunch and Abg went off for Friday prayes. Movie was at 3.10pm tapi the hall was full, ok? Where did all these people come from? and it wasn't school holidays or anything. Maybe I'm NOT the only person who drives from Kelantan to Pahang for a movie, huh?


MegaMall is the building on the right.

Abg didn't fall asleep, so I guess that said something about the movie. On the way out, I saw this middle aged makcik - wa, makcik tgk Ghostrider, okay. and some people had kids of about 6-8 years of age. Okay la movie tu graded U but do you think a kid of 7 would actually appreciate a film like Ghostrider?

The next morning started with a leisurely buffet breakfast - 4.0 for variety; they had porridge, pancake, chicken sausage, baked beans, nasi goreng cina, nasi lemak and meehun plus the egg station and bread section and about 3.5 for taste - the sambal ikan bilis was nice. I still think MS Garden serves the best breakfast though.

and before we headed home, a short stop at Giant for our shopping. There are a few things that I keep a tab on with regards to prices. Kuaci Chacheer and Shokubutsu shower gel. Pacific KB sells the 300grammer kuaci for rm5.30 and it was only rm3.88 in Giant. I used to get rm5.99-rm6.50 for a packet of shokubutsu but lately I've been forced to buy them at RRP of rm8.50. At Giant they were selling it for rm14.28 for two and you get a cute soap dispenser. So guess who ended up with three cute soap dispensers that she now does not know where to put....hehe.



Anyone want one?

Come in pairs...

I've always noticed that my cases - on call or in the OPD - always usually come in pairs. Not the usual hum drum HPT, DM type 2 cases, 'sakit urat' or demam selsema routine; but the out of the ordinary, once in a while cases.

Like for instance, one morning in OPD, I had two cases of per vaginal bleeding. I had other examples too, but I can't remember them now....

But anyway, my call last night started quite busy after five. A family brought their mother who had been unconscious since 10 am okay? I understand la korang takde kenaikan and all, but 7 hours? Seriously?

She was breathing alright but was as if in a deep trance. Her arms were making random movements but she didn't respond to my calls. She DID however respond to me rubbing my knuckles on her sternum (the bit of bone in the middle of your chest. Cuba try tekan situ - sakit woo). When a case of unconsciousness like this comes into your A&E, if you're lucky, it's a case of hypoglycaemia (low blood sugar), kalau kurang sikit itu nasib baik, it's a case of haemorrhagic stroke and if you're really unlucky, it's something else.

I wasn't feeling very lucky that night, so of course, her blood sugar was normal. Her oxygen saturation and blood pressure remained stable. I was sure it's a haemorrhagic stroke but must have something to back my story up, yeah? Nanti susah aa MO Neurosurgical in USM nak terima...:) Then, after checking her pupils for the second time, I noticed that the right one is oval in shape. When I reported this to the MO on call, he accepted my case and off she went to HUSM.

As I was having my dinner and Maghrib prayers, I wondered if there would be a 'twin' of the earlier case. and I was not disappointed. At about 8, came in this case of a 71 y.o. male who apparently overdosed on his schizophrenia medication. After vomiting once and had some loose stool, became unconscious. He was actually snoring like a baby when he arrived. His pupils were pin point. Besar sikit je dari saiz noktah at the end of this sentence. Off he went to HRPZII. Selamat.

The rest were MVAs, fevers and the run of the mill epigastric pains.

Woken up at three for a bronchopneumonia. Mother actually surprised I admitted the 3 year old. What...? You come at three in the morning, must be something serious kan? Of course need admission la! :)

Laid my head for a split second (or so it felt) and it was already half five. A case of G4P0+3 (means currently pregnant for the fourth time, yet no live deliveries. +3 means three abortions) at 31 weeks complaining of having contraction pains. She had cervical circlage done (meaning stitches were made in her cervix to keep her baby inside) but I guess that isn't working. My prayers went with her as she boarded the ambulance. I'm not sure I would be as strong if I were in her shoes.

Along the way...

Hannah enjoying her cream of mushroom soup at S*hakey's Pizza after we 'abducted' her from kindy. Her teacher was telling telling us that once she was telling them about cows and Hannah went to her and asked 'Teacher, kenapa cow ada tetek?'. Macam manaaa nak jawab tu?



View from our room at E*quatorial Melaka during our road trip to the south of Malaysia last year.



Something I wish to see in the future, with one of our own. Buat masa sekarang, takde rezeki lagi la kot.



Hannah in a contemplative mood while Mak Long, Pak Long, Mummy and Babah were having lunch at Orie*ntal Restaurant, K*ota B*haru.



One of those increasingly rare moments when we could get away as a family. Taken at Pang*kor Island.

Korunnnnnnkkkkkk!!!!!!!!!????????????

So anyway, yeah......i'm on leave and all.....after siapkan kerja2 yang menempek2 including my very long overdue SKT (thank you Kak Nor for entertaining this procrastinator)....I logged on to my blog and somehow today decided to update my beta blogger to the brand spanking new Google account.

and guess what I found????????

Twenty two messages (well, satu tu tak kira sebab spam)!!!!!!!!! Where have they all been all this time? Kena sembunyi ngan virus ke?

So anyway.....my silver lining today is, I ACTUALLY HAVE READERS!! *lol* Can that be considered a silver lining?

So all those people leaving comments for me, wow...thanks! Waaa, rasa macam Mawi dapat award Bintang Paling Popular la plak.....

So, (berapa kali 'So' daaaa), I hope I got this glitch sorted out and keep leaving comments!

p/s: i think i know why lah - me thinks me's supposed to click at 'moderate comments'? Hmm?

One Year Old

Thirty one I am today.

Boo.

Very bad past two days, but I will not dwell on it. Suffice to say I hate some staff nurses who are so kiasu that they would actually do something unethical like alter their reports (which aren't that useful anyway - sikit-sikit: pesakit dalam keadaan lemah tapi stabil. Ubatan diberi. Bla bla blaaaaa....) so that they will be free from blame.

BUT, it's my birthday today. Not that I'm glad I'm older yet no thinner than last year. Well, at least, not heavier, yeah? Hehe.

Abg got me a gorgeous gold locket for our anniversary cum birthday present. I actually first laid my eyes on it about a month ago while I was getting my niece Hannah her first gold locket. P*h K*ong just launched their latest range of lockets which are shaped like mini heart shaped 'cages' and in some of these 'cages' are semi precious stones. The one I particularly fell in love with had two blood red biji sagas in them. One side's yellow gold and the other's white gold so you get to wear it with either necklace. Cool, eh?



But at that time I thought it was a bit too pricey so I longingly left it in the hands of the sales assistant. I never spoke about it after that. So, when it appeared in the box that Abg gave me, imagine my surprise. Yes Abg, you exceeded my expectations....next year, must do better, yes....? Heehee. I love you Abg. I love you and all your jiggly bits....:)

Two down, two to go...

Bad on call last night.

and when I say bad, I meant, death happened.

and it's bad because it was preventable.

How could I have not remembered that I ordered a repeat ECG and then forgotten to review it? Why didn't my staff nurses remind me that I ordered a repeat ECG and that I was supposed to see it?

Bengang and terkilan.

The thing is, I HAD gone to the ward for a quick round at 8 pm before attending to cases at the casualty. I spent half an hour there reviewing my unstable angina cases and not one of the staff said to me, Doc, you ordered a repeat ECG, would you like to take a look?

Aaaarrrghhhhhhhhh!!!!!!

Multiple bleuuurghs...

I just couldn't go to work today. I woke up so depressed and then in turn made Abg depressed. I seriously had chest pains thinking about turning up for work today. I know what I'm doing is bad. Keji ya amat. But I just could not do it. I know if I did, I'd be grumpy to my patients and end up not feeling too good about myself.

I haven't felt good about myself in a long time.

First, I thought moving back into a hospital environment would help. It did, for a while. But my ugly dragon reared its head again and started to cause misery for the people around me. I have lost interest in life, in my home - no longer indulging in my hobbies. Anhedonia, I think is what it's called. I'm sleeping more yet the more I sleep, the more tired I get. I've even started to lose my appetite, and THAT is not good. Food tastes crap (but then that's because I'm cooking, kot) and tears are incessantly welling up.

*SIIIIIIIIIIIIIIGGGGGGGGGGHHHHHHHHHHHHHHHHHH*

Where is a silver lining when I need one...?

A special dedication.

WHEN I SAW YOU - Mariah Carey

Soft heavenly eyes gazed into me
Transcending space and time
And I was rendered still
There were no words for me to find at all
As I stood there beside myself
I could see you and no-one else

When I saw you
When I saw you
I could not breathe
I fell so deep
When I saw you
When I saw you
I'd never be
I'd never be the same

Only once in a lifetime love rushes in
Changing you with the tide
And dawn's ribbon of light
Bursts through the dark
Wakening you inside
And I thought it was all untrue
Until there, all at once, I knew

When I saw you
When I saw you
I could not breathe
I fell so deep
When I saw you
When I saw you
I'd never be
I'd never be the same

With no beginning
And without an end
You are the one for me
And it's evident
And your eyes told me so
Your eyes let me know


Happy Birthday Abg.

With oceans of love,
Your wife.