Jumping all over topic

The best oncalls are the ones where no matter how busy you are during the day, you still get uninterrupted sleep later on the night. Even a mere three hours should be okay to get you going the rest of the day.

It was one of those days when you had a whole bunch of stable patients, but they came with weird complaints. Luckily for me, I could always clerk them in for observation. Should nothing is wrong with them in the first place, the MO in charge can always discharge them.

It's just a few minutes after 7 and already the A&E is starting to get patients. It's usually MVA patients this early. I hope that at least the patient's conscious, unlike the ex YB who yesterday was involved in a head on collision.

You can tell how important a patient is in the hierarchy of the society by the size of the crowd that is hanging about the hospital. The last time we had a VIP, a crowd the size of a small kampung (including all four wives, apparently) came to see him.

My sister is getting married this August. Weddings have become really expensive nowadays, don't you think? Maybe it's time we stepped out of the box and do away with wasteful habits such as fancy invitation cards and do a Maya Karin. You do realise that most of them end up in rubbish bins?

The other thing is the door gifts. Remember a few years back when everyone started using those pearly-multisheened ceramic egg holders? Too ugly to use to decorate but too 'sayang' to throw away? When I first got married and moved into Abg's house, I was soooo itching to get rid of them. They were just gathering dust in the old cabinet anyway.

I think a good doorgift should be useful, and if not, at least recyclable. Ma used to save every bunga telur she got whenever she went for weddings and 'cukur jambul's and 'maulud nabi's, that after a while she would have a HUGE bunch of non matching ones displayed right by the phone.

What she did was, when it was time for her to host a maulud of her own, clean up every single one and use them as doorgifts. Jimat, right? and they actually looked nice on the bunga pahar stand, despite being missmatched and all.

I think the problem with our society is that we are too scared of 'losing face' and wanting to please everyone else, BUT ourselves. Relatives are the worst. Especially when it comes to weddings. Everyone wants to give their idea on how much 'hantaran' money the bride should get, where the wedding should be held, how big the event should be and beware should you just brush off any ideas, or you would find yourself being given the cold shoulder come next family gathering.

Talking about recycling, after that three day conference in KK, I've now ended up with about 4-6 bags and a tonne of leaflets. I've decided that from now on, the bags will be coming with us on shopping trips so that we don't end up with plastic bags. The bags that they were giving away at the various booths were the cloth type, and rather sturdy too. We had a trial run at the recent pasar tani, and the bag I had easily carried 4 small papayas, three bags of onions, a bunch of long beans and a few other stuff. One makcik was really impressed when we insisted, no plastic bag please. Besides, they were more comfortable to carry and were less painful on the fingers.

Good eh? I think Ma would be proud. She's always tried to make us reuse things when we were younger, though at that time it was called being frugal rather than recycling.

Now, if only I can locate a paper recycling centre in KB......

Oncall nonsensical ramblings

I've just returned from two trips and I think I need another holiday to wind down from them. It used to be that I could travel on overnight third class trains and still be excited for a weekend trip but I'm beginning to accept that I am no longer that sprightly young thing.

I used to reminisce about my backpacking trip to India and Nepal and often wondered if I could do the same thing nowadays.

I think I know the answer and the answer is I probably can but I will probably end up hating it and can't wait to go home.

and it isn't just holidays, but oncalls too. I remember that we used to do compulsory EOD (every other day) on calls during our O&G attachment and postcall, I still found time and energy to meet Abg.

Get me to do EOD calls now and I'll be bedridden after a week!

Seriously.

Am I getting old?

Shall I..?

Shall I write about pakcik in bed 15 who started to have difficulty breathing suddenly at about half seven last night? He who deteriorated and became so blue that we had to intubate (and re intubate) and for whom I spent 3 hours looking for a bed and ventilator for?

or shall I write about sleeping at half three, after eating my cold rice and waking up at half four and then five and then half five to check on the patient with low blood pressure and was told about another supposedly stable patient who became breathless and restless?

or shall I write about the fact that a bunch of us were supposed to sit for an exam this morning and with only 2 hours of sleep, I am in no shape to be answering questions?

Shall I also write about my oncall partner who also only went to sleep at three, and then woken up to resuscitate another patient in the ward and then called to attend another case of shortness of breath at casualty?

Shall I write then about this son whose father passed away unnoticed in the midst of the chaos that is the male medical ward, whose puzzled face when I told him that his father had passed away is still etched in my mind? I hate it when it gets too hectic that I've become such a nasty MO to my staff nurses who are already overworked, that a death is just another number in the statistics that I forget about the grief and the loss.

Shall I write about this particular staff nurse who totally ignored my orders to push the emergency trolley when the above patient stopped breathing - simply because her shift had finished? I was so shocked at her (non) reaction yet too busy to attend to the case that it is only now that I am overwhelmed by my anger.

These are the things that five years of medical school can never teach you and whether it makes you into a better person or otherwise is totally up to you.

Why I sometimes hate my job...

It is 1 am and I am just sitting down to eat my dinner. It's mee hoon, so that's a good thing. It's only been three days since my jaunt in Java but it already seems to be in a distant past. Almost like I dreamt it all. Reality sure can give you a hard slap on the face.

But, good thing is, three days, one on call and one PTK exam later, I will be off to KK for the MOA Conference. I've already looked at the programme and made plans during the times that I can skive off. I wonder if boss will notice me missing.

Abg will be joining me on Friday and we'll only be flying home on Sunday so that gives us about 24 hours to go pearl and 'ikan bilis' shopping. I remember having good memories of KK so I hope this trip won't spoil it. I'm already salivating over the mee hun sup ayam in Sinsuran that we had the last time we were there.

Anyway, we had a patient who was complaining that we were late in attending to his son who had bleeding from the nose. He had come this morning and since the bleeding subsided some, I allowed him home and told him to come again should the problem recur.

When he turned up at about 10 thirty just now, all the beds were full. Basically all the lethargic pakciks have run out of 'ok' power (ok - Kelantanese for persevere) and have decided that they will turn up at the casualty that day. One relative of my staff had had bilateral lower limb weakness for 2 weeks and was just now insisting on being admitted. I had just pronounced the death of a 4 year old with malignancy and was still tying up loose ends but then proceeded to deal with the case of the bleeding nose.

Just as we had registered the case to be admitted, then comes the 'oh i am so pandai and so mighty don't you dare play play with me' father who started to boss my staff around telling her that she's doing things wrong.

Suddenly he came puffing and huffing wanting to bring his son to HRPZ II. Apparently we are all idiots here in HTM. Well, good riddance and good luck mister!

Seriously lah...? How obtuse and how selfish and ridiculous can you be? A mother had just lost her 4 year old daughter to cancer and a pakcik is lying on the stretcher fighting for each breath and a kid just broke his thigh because of his stupid parent who couldn't be bothered to strap him with the seat belt (but that's another story) - get some perspective la.

It is people like this that make me hate my job sometimes. Thank god they are far and few between.

Roasted chicken wings, here I come....

Did I not say so..?

I wonder what has kept Abg. He's usually not late. I've just been lazing around surrounded by my kids. Che'Tam looks lethargic. Friends are humoured by the fact that I use medical terms to describe my cats' condition.

Anyway, I fed Che'Tam her deworming medication during the weekend. She hasn't been herself since. She seems to devour my KFC chicken though, so I hope that means that she's not that bad.

Unlike how her master is feeling.

Last night's call was not that bad, considering. A bad call is when more than 2 patients collapse on you. One is acceptable. Two is still not bad but more than 2 means that you really need to 'mandi bunga', as we like to joke.

There was a relative who brought his wife who complaint that she was dizzy. He had just arrived as I left to shower, leaving the casualty to my partner that night. As I turned up about an hour later, he was just leaving. He turned to us, and said in an unusually loud voice, "THANK YOU DOCTOR. HAVE A PLEASANT NIGHT" - it was said in a way that clearly indicated that he meant otherwise.

I've long learnt, in Kelantan, if a malay speaks English with you, he/she is trying to say "I'm educated you know, don't mess with me like you mess with the kampung folk". Urgh. Stupid. What have we become; learn Mandarin to get a job, learn English to intimidate people.

According to my colleague, he had sat at the counter and was babbling away while she was clerking her cases. She wasn't in her friendliest mood as the cases were many and waiting. Was that why Mr Moustache was so sarcastic? You think by loading your sarcasm on us, it will help us improve our service? I don't think so!

Anyway, we ended up resuscitating a patient at about 1am. Despite our efforts for the next couple of hours, he was still hanging on by a thread. He was too ill to be transferred and we both knew that he was there because of the medications that we were pumping into him. Bleurgh. Regardless of how ill or how bad premorbidly my patients are, I still feel bad when they expire. Definitely one for the mortality meeting.

Ah well. Shall deal with it once I return from my long awaited holiday.

Who to blame?

Talking about the news, I'm sure the whole doctor community is abuzz with a politician who apparently had caught two doctors in HKL 'napping'.

and news from the grapevine is, the 20 patients were actually just 8 cases, the rest being relatives and the two doctors were not even on duty! But of course, these are the things that doesn't end up on front pages of newspapers.

I feel sorry for us lot, sometimes. We work way beyond our exhaustion sometimes; returning home way past dusk - just to make sure operations are done or that patients are escorted safely - but most times, things are just out of our control.

Take last Sunday, and I hope I don't get into trouble for this. We had three elective and one emergency case waiting to be done. I had gone for morning rounds with boss and proceeded to OT as usually he expects us to prepare the patient before (if he needs to) he comes in and does the operation.

Lo and behold, the anaesth MO informs me that the airconditioning in the OT had tripped during the night and the temperature of the OT had gone into the 30s. So, I waited and waited and after two hours, the aircond went on to trip two more times and the OT temp never came down below 22.

and this is the OT that had just been completed at the end of last year. Yes, I am talking about a 4-month-old OT and already it has been piling a bunch of incident reporting with regards to the airconditioning, the air pressure and what nots. Not to mention the door which is now coming off the wall, the broken hinges and the OT entrance which is like a mini waterfall come rain.

We ended up cancelling the cases and only managed to squeeze in one emergency case. But patients don't see the goings on behind closed doors, all they knew was that they had to fast for three days and STILL no sign of the op being done.

It is frustrating when your patient is upset and you know it isn't your fault. But who do you blame?

Not only do you have to deal with things that are occuring internally, you also have to deal with external stuff, like the expectations and attitudes of your patients. When I worked at the Outpatients Department (OPD), I had a girl who kicked my door just because I refused to give her an MC. She didn't have any complaints, all she came for was some allergy medication and she informed me that her boss had told her to get an MC. It is sad, but I know a lot of my colleagues give in just because we don't have time to deal with silly things like this.

Sometimes when I hang out at the OPD and perform routine medical examinations (RME) on students about to fly off for their degree in medicine, I jokingly ask them whether they know what they are getting themselves into. They smile with the youthful confidence that only the young (and ignorant? Hahaha) possess and I wish them luck.

In dire need of a holiday

April has been a hectic month. There was a period where I was at the hospital everyday for 13 continuous days with absolutely no weekend break.

Thus, it is of no surprise how much I am so looking forward to my holiday in Java. Of course, knowing me, planning the travel itself gives me a buzz. All Abg said was, you plan everything and just give me the itinerary so I know what is happening.

The hospital was in the news recently. A former patient of ours had gone to see a reporter and moaned about the bad treatment he got from an MO of the ward where he was recently admitted. Now, since the article did not mention the name of the MO, everyone who had seen the patient is now required to write a report, including yours truly.

Hmph. Macam la aku takde kerja lain.

I know think hope the person he meant wasn't me because he came to our table to say hello this morning. I couldn't bear to look at his face and be courteous. As much as I wasn't really chummy with the person whom the patient complained about, there is a sense of loyalty towards a work colleague and I am sure this is all just a misunderstanding.

Anyway, while I was chatting with my boss, I remarked on the fact that when I was studying in Belfast, the wards' notice boards were always full of thank you cards and every other day the nurses would get gifts of chocs and cakes and flowers. Perhaps it is part of their upbringing, being constantly reminded to watch their Ps and Qs and the practice of writing thank you notes after receiving gifts for birthdays and Christmases.

At bus stops, people would form a queue based on the order they arrived and they would get on the bus in the same manner. I wonder what people thought of our custom of jostling and elbowing our way in. Cars would stop to let you cross the street and men would hold the doors open for you. Till now, I still find myself holding doors open for the person behind me to come through.

So much for Adat Ketimuran, huh.

Anyway, I digress. I just had my last call of the month last night and it was pretty laidback considering the MO the night before could only sleep at 4 and the casualty had been kept busy till the end of the night shift. It's been a pretty good run the whole month so I am now anticipating a highly jonah oncall, which in the past, had always turned up just before a holiday.

This is how I feel when I am postcall....

p/s: My Che'Put sleeping under the coffee table.

Road Rager me

On the way to work, there are two stretches of 'lorong memotong's. One in the Tok Bok area and the other just a few kilometres ahead, where Yamud's house is.

I was driving to work this morning when I reached the first one with a dark coloured Iswara driving ahead of me. There were no cars in front nor the left of him. I had long gone past flashing my lights to idiots like these because I think their cars have probably been manufactured with steering wheels which could not maneouvre to the left, so I took the left lane and over took him.

At the next 'lorong memotong', I was following a black Naza Citra rather closely on the right lane. We were overtaking a kancil when the idiot took the left lane and wanted to squeeze in between the Citra and my car. I honked at him and instead of pulling back, he persisted on taking my lane. So I honked long and hard, glanced at him and showed him the finger.


Seriously.

Thinking about it now, I am not proud of what I did. It was very unladylike, (well, what's so lady like about me, doing Ortho and all that) and very rude.

I can still remember his face before I sped forwards, then proceeded to overtake the Citra and went on my way leaving Mr Idiot behind.

You think just because you lit your indicator lights that you can simply squeeze your car in meh? Just now you were dilly dallying taking your sweet time and now you suddenly decided that you're in a hurry?

If there is one thing I don't get about drivers here are their love for the right hand lane. Bawak la 40km sejam pun terhegeh2 kat lane kanan. Tak paham aku.

The definition of 'jonah'....

...is after admitting two nonagenarians, one of whom is now on double inotropes, at 4 am is still admitting patients with low blood pressure, and with an Acute Pulmonary Oedema case waiting at the casualty because now there are no more beds in the acute cubicle in the ward.

but I suppose, that doesn't beat escorting cases to HRPZ II five (yes, 5) times on a 24 hour shift.

I've been back to KL during the extended weekend. Sometimes, returning to the west coast is like going on holiday in a another country. Cars are faster, the people are more wound up, houses and shopping areas bigger. I ended up coming back home a day earlier than planned, much to the chagrin of Ma, because I involved my cats in it.

By the way, Verver is now missing for a week. I was on call and Abg had let them out for the evening and she never returned. I'm convinced she has been hit by a car or motorbike and has gone to die somewhere else. The lack of closure is making me uneasy. Sad as it is, I'd rather see the body and know rather than left wondering.

Anyway, I'm up attending to the case of the nonagenarian with cardiogenic shock and also sepsis. Man, of all the things to end up with at 92. It has been sort of a "Hari Warga Emas Sedunia" today. I had gone to HRPZ earlier today escorting a case of peritonitis. She was 81 and had just returned from a family holiday in Penang. Her blood pressure wasn't great when I left her in the care of the Surgical MO.

I'm not sure whether it's a good idea staying up, hoping that the three hour-sleep I got from midnight is going to be enough, but it is Thursday today and I'm always hopeful on a Thursday.

The definition of unstable....

...is an 81 year old lady who is on triple inotropes (medication to bring up your blood pressure) of which all three are already on maximum dose, yet the blood pressure remains below 100 and whose Ryle's tube (tube from the stomach coming out through the nose or mouth) is pouring out dark brownish material.

Hmmm.

KNOWING.....

how bad the film would be, I wouldn't have wasted three hours of my time and ticket money to watch the movie.

If I had known the film had aliens in it, I wouldn't even have glanced at it. I think ET was it. Other alien films just couldn't measure up to ET. Much less aliens who have wings and spaceships which resembled the castle from "The Never Ending Story".

If I sound disjointed, it's because I'm blogging in the dark.

You know.....

....you are addicted to the internet when you start snarling due to the inability to log on since 5 pm Thursday, despite calling 100 on the phone line to get to the technical support and nearly biting the head off of the guy who answered your call.

and not minding forking out RM250 to get a new modem because after calling 100, and checking your account and the other PC in the house, you are now convinced that the modem is broken.

but hey, at least the house is now wireless!

I was doing my grocery shopping yesterday at the local big chain store when I saw this:



The other boxes next to this said Mar 09. Something tells me these are not selling very well. I guess for most Kelantanese, nothing beats a hot plate of nasi berlauk.

The kittens are doing well. The black one can already walk without stumbling and have been seen trying to be playful with the sibling.



This one has colurings similar to a Siamese. I think she'll probably have blue eyes too. This one is so fat I could just squish her!

Well lookee here...

'Kucing De ('e' as in THE)' is a female cat who actually belongs to Abg's aunt who lives 2 houses away. She has been our cat since she discovered the abundant food source here. Abg wanted to get rid of her since she's been doing her business in the house but I never had the heart. She has been quite useful the last time when I brought home two small kittens, she nursed them like they were her own.

Anyway, kucing De became pregnant with the stray Tom cat who, yes you guessed it, became a regular here. We were anxious when she started to roam around the house looking for hidey holes to give birth.

About two weeks ago, I was talking to Ma on the phone and kucing De just sauntered along with blood all over her backside. I frantically looked around but couldn't find her litter when suddenly I heard mewing from underneath the steps of the front door and the only way to access that area is by crawling under the house via the side.

Abg called his 'anak sepupu' and we paid him RM10 to get the kitten.



Anyway, to cut a long story short, the next day, Abg found the rest of her litter in the boot of the abandoned car in the house next door. They've been in the cold and mummy-less the whole night!

Unsurprisingly, two of the kittens died the next day.

So, the other two have since thrived well and have opened their eyes. The little white one has been having on off abscesses on the limbs and currently have a huge on on her left front foot.



The black one, however, I have discovered, have 24 toes!

Cats usually have 5 toes on their front legs and only 4 toes each on the hind leg, which come to 18, right?


Pic not so clear here but isn't that a cute face?


Count 'em!

Friday morning laugh

You know those quizzes that you take in order for you to know what type of colour you are, whether you're a right or left brained person etc?

This was what I got for "What kind of a doctor are you?"

Hahahahaha. I'm sure at least one specialist in my hospital will disagree. Hahahaha.

Me time now

I don't worry very much.

Unless when I am about to be oncall, then I worry whether there will be cases which I cannot handle, or I worry if my temper is going to be too short or whether a patient is going to die because of my mistake.

But, apart from that, I don't worry very much.

Which is perhaps why I am in this situation right now.

Maybe doctors mislead themselves that they are invincible; just because they are in the health business, then by logic, that they are healthy.

I know I am not. I could do with more exercise, for one thing and less junkfood postcall (it is always postcall, like a mini party for one for me everytime).

When I had my miscarriage last year, the O&G consultant who managed my case noted that there is a small mass near my uterus. He had told me to come again for a repeat scan but of course lah, I was too busy, had other obligations, can always get another date bla bla.

I tried late last year but my specialist had an emergency operation he had to attend and I told myself I would reschedule.

and I can hear my family members whom I know are reading this, saying, why don't you just see the specialist at the hospital where you're working? No need to set appointment what? Yes yes, I know I don't actually have a good excuse.

But anyway, me thinks me must get a specialist's opinion soon. I've been having this lower abdomen discomfort for the past couple of months. On top of that, for the past fortnight, I've been having this really bad lower back pain. Last night, I could barely get myself into the car. Fortunately I had some ketoprofen patch, which at least guaranteed me a continuous night's sleep, otherwise I'd be woken up in the middle of the night due to the pain.

So, I've told myself that I will get xrays done next week at least and arrange for an ultrasound scan soon.

It's time for some me time now.

Kalau Suami, Jika Suami

I came across this in a forum and thought I'd put this up here.

KALAU SUAMI.....

Kalau suami mula berahsia..
Itu tandanya dia tak setia

Kalau suami meninggi suara
Itu tandanya dia dah ada mak we

Kalau suami mengaku bujang tua
Itu tandanya dia nak ngurat anak dara

Kalau suami selera tak ada
Itu tandanya dia nak pasang dua

Kalau suami lambat balik aje
Itu tandanya dia dah syok kat setiausaha

Kalau suami tidur di ruang tamu
Itu tandanya dia dah jemu

Kalau suami malam jumaat buat tak tahu
Itu tandanya tak lama lagi hidupmu bermadu

Kalau suami garang macam singa
Itu tandanya hati dia dah tak cinta

Kalau suami asyik komplen aje
Itu tandanya dia dah tak suka

Kalau suami mula sepak terajang ke muka
Itu tandanya dia nak memberimu title JANDA..

JIKA SUAMI...

Jika suami sayangkan isteri
Dapat gaji semua diberi

Jika suami sayangkan isteri
Kerja rumah rela dikongsi

Jika suami sayangkan isteri
Kereta diberi suami naik LRT

Jika suami sayangkan isteri
Duit poket diberi setiap hari

Jika suami sayangkan isteri
SMS dikirim tanda rindu dihati

Jika suami sayangkan isteri
Kongsi masalah nasihat dikasi

Jika suami sayangkan isteri
Diberi ciuman setiap pagi

Jika suami sayangkan isteri
I love U, I miss U katanya setiap hari

Jika suami sayangkan isteri
Isteri gemuk, dikatakan seksi

Jika suami sayangkan isteri
Sakit sikit selongkar laci ubat dicari

Jika suami sayangkan isteri
Kemana sahaja dibawa pergi

Jika suami sayangkan isteri
Sentiasa jujur perihal diri

Jika suami sayangkan isteri
Status berkahwin bangga sekali

Jika suami sayangkan isteri
Cintanya suci hingga ke mati

PESANAN KEPADA ISTERI2 :
Adakah suami2 kita tergolong dlm kategori JIKA SUAMI atau KALAU SUAMI ?
JIKA SUAMI ... lebih banyak dari KALAU SUAMI maka bersyukurlah kerana rumahtangga anda umpama SYURGA.
TETAPI ....
KALAU SUAMI.... lebih banyak dari JIKA SUAMI... maka berhati-hatilah. .. wahai kaum isteri jangan sampai rumahtangga mu umpama NERAKA.

Malisa loves Twilight

I had seen this book at the bookshops a few months before the movie was released. After Buffy and Angel, I thought, oh no not another one of those forbidden love between human and vampire rehash?! So, I dismissed it as another teen fantasy romance of which I am sure I am too mature and too old for.

Somehow, during one of my trips back home, I went out with my two brothers and we decided to watch this film.

and this so called mature, happily married, makcik mulut-laser-tak-hengat joined the bandwagon of I love Edward Cullen fan club.

Seriously.

Perhaps it was because I had absolutely no expectations towards the movie that I ended up with such a reaction. I remember while the credits were rolling and people were making their way out of the cinema, this girl sitting behind us shouted 'What a waste of ten dollars!' and I was thinking what? Did you not see the same Edward Cullen I did??!!

So I decided to get the book and see what the fuss was all about. I recall reading somewhere a book critic had labelled Meyer's book as self indulgent and I thought, surely something that bad can't have stayed on the NYT's best seller's list for so long.

Firstly, I didn't like Bella. To me she lacked personality. She has brought this gorgeous, Adonis like creature to his knees and I just can't see why apart from her smelling nice.

Secondly, you know this is total fantasy when Edward Cullen is protrayed as how he is. There is this line that he says in the book, when Bella asks him whether he finds her attractive in 'that' way and Edward says "I may be a monster but I am a man." A man who spends half of his time in anguish about his new found love and the other half TALKING about his feelings. Uh-huh. Someone build a robot of Edward Cullen and MAN (as in the gender) may actually cease to exist.

There is nothing as salivating as knowing that a man is in so much pain over wanting you; that the smell of your hair can easily tip him off the edge. I guess that was the winning formula the writer adhered to and hey, it worked.

Still, despite snippets of incredulousity, it was a good enough book for me to while away the time.

Oncall post

It's half two in the morning and yes I am oncall.

It has been one of those very very long day which started with one of our patients who was involved in a motor vehicle accident two days ago having altered level of consciousness. As a result, I had to endure a half hour of nauseating drive in the ambulance. Eurgh. Seriously, one would think the government could spend some extra money on really good suspensions on their ambulance. or build better roads.

Now my partner has gone off to escort a case of placenta previa type III who decided that it will start to bleed right at the moment I came into the ward to review a case of PV bleeding. It's just one of those days.