IT'S A DOC'S LIFE (geddit?)

Just Keep Knocking

2007-06-28T19:02:00.000+08:00

Sorry folks. Got feedback that the link to my new blog isn't working. Checked it again and again...and it seems to be working fine. Gee, how long does it take for a new domain name to "propagate" through the Internet?

Moved!

2007-06-25T22:39:00.000+08:00

It's A Doc's Life has moved.

If I'm on your blogroll, kindly update my link !

Gate Crasher

2007-06-21T18:20:00.000+08:00

I will be gate-crashing an intensive care conference in Kuala Lumpur tomorrow.

A physician in the midst of anaesthesiologists and intensivists. I hope I won't be singled out for my ineptitude in all things ventilator-related.

Blogging shall resume in 3 days' time.

Innovative Patient

2007-06-20T23:35:00.000+08:00

Spotted in my ward : One lady's fierce determination to ensure that her IV cannula stay firmly in place.

Her request to have her plaster reinforced must have fallen on deaf ears.

Shameful.

Very Irritating Person?

2007-06-18T22:06:00.000+08:00

V.I.P.

What it means to me :

patient with acute myocardial infarction - needs my immediate attention and antifibrinolytic therapy STAT. Time is myocardium
patient with respiratory failure - needs my immediate attention and early anaesthetic assessment for consideration of assisted ventilation
patient with upper gastrointestinal bleed - needs my immediate attention and judicious fluid resuscitation while we arrange for means to stop the hemorrhage
patient with a sudden deterioration in GCS - needs my immediate attention and assessment for need for airway protection while measures are underway to determine its cause
patient with cardiac arrest - you know what he/she needs

What it doesn't mean to me :

high-ranking government officer who walked in (or chauffeured in, whatever) with fever for 3 days, but stable
relative of some MP who has mild abdominal discomfort
some Datin with moderately high BP but asymptomatic
resident orthopedic surgeon's neighbour who has diarrhoea

Can't we just do our job? Your order of importance is dictated by the nature of your medical condition, not your status. Don't pry me away from a patient who deserves my attention more just because you are an "important" person who happens to have a trivial medical problem.

Did I just commit professional suicide? Maybe. Not that I have any political aspiration anyway.

I took an oath to be fair and just to my patients, and I intend to honour it.

Everyday Hero #2

2007-06-16T15:29:00.000+08:00

I cannot possibly do for one and not the other.

This is beginning to appear contrived, but I really do have something to say about the first man in my life.

I have a cool dad. Not cool in the fashionable, hip, tech-savvy sense, but cool in the way he raises his children. He's conservative, yes, but not in a you're-not-wearing-that-out sort of way. I remember a childhood peppered with humour, lots of story-telling, and even more books. He hurt more when I grazed my knees, cooked us horribly bland food when we had acute gastroenteritis, ferried us to various school meets, sports outings and tuition classes, and remained very supportive of our choices in life. He's dependable, reliable and kind.

Some say we came out of the same mould. So dad, I'm proud be your girl. Hope you're proud of me too .

Happy Father's Day!

(This time I'm posting at the right time.)

*Image courtesy of www.donnabellas.com

R.I.P.

2007-06-15T15:28:00.000+08:00

Sucky, sucky, sucky.

3 mortalities. Thought by now I should be accustomed to deaths, but yesterday's just felt particularly sucky.

Man in his 60s, single, survived by a brother. COD : Advanced colon carcinoma. Did he even have his chance at a meaningful life?

Man in his 30s, mentally-challenged, welfare home resident. COD : Diabetic ketoacidosis and septicemic shock. Survived by no one. I stared at his I.C. and felt depressed that his demise probably meant nothing to anybody.

Man in his 50s, heavy smoker, survived by one son. COD : Acute myocardial infarction with cardiogenic shock. Another boy has just become newly orphaned.

As for me, I was worn out, physically and emotionally.

And the curtain closes on a chapter in my professional life.

*COD = cause of death

August 2002 And Everything After

2007-06-14T12:03:00.000+08:00

14 June 2007.

I am on call today. It's my last call as a medical officer, since I started in August 2002. For many nights in the last 5 years I have had to spend nights alone in the hospital (mostly awake), walked along empty deserted corridors and entered spooky elevators in ungodly hours of the day, had uninspiring (to put it kindly) on-call meals provided by the kitchen, dragged myself out of bed to attend to patients who had a knack of "collapsing" the moment you fell asleep, and braved temperatures of Artic proportion in the very, very cold emergency unit in Sarawak General Hospital.

It's a lonely business, what we do. When the world is sleeping, you are up, thrust into a position to make life and death decisions. There have been s****y calls, when bad outcomes transpire despite all that you do; there have also been rewarding moments, when your action makes a difference (with a little divine intervention).

I shall miss escorting patients in the short journey from casualty to CCU most, where I would surmount all my strength and push open the CCU doors to allow the trolley through - a moment time and time again I would liken to Aragon pushing open the door in Edoras in his return from near-death (Return Of The King). A little fantasy-diversion wouldn't hurt!

And my on-call attire...my trusty black top from Isetan I had worn on most of my calls, is starting to fray. Even the backpack I carry to store my personal effects has a small tear near the strap. It's time they retired, having served me well over the years.

Strange, somehow I don't feel like I'm moving forward to a better phase. Now s**t begins!

Blackout!

2007-06-13T20:54:00.000+08:00

What a night!

The lights went out on me last night. It wasn't personal. I heard the whole of Seremban had a power outage too.

And lives were disrupted, plans foiled. Hair left semi-dry, recipe for frizz. Laundry pile gaining critical altitude, deferred yet another trip to the washing machine. Navigation around the house aided by the faint glow from my mobile phone screen, with a high risk of rolling down the stairs and sustaining a head injury (and we wouldn't have been able to find the car keys to take me to the hospital). Blog not updated...at risk of losing its readership?

So what's a man and a woman to do?

I played Quadra Pop - a pathetic underwater theme Tetris rip-off which is strangely addictive - on my mobile phone, while hubby fell promptly asleep beside me.

Yes, many a generation have been conceived in darkness, but it simply had no amorous effect on 2 very tired people!

Unclear On The Concept

2007-06-11T15:20:00.000+08:00

Some patients can be so unbelievably clueless. Some examples :

Man walks in, sits down, says HI and then asks, "Doc, what's my BP today?" Wait, I haven't checked!
Woman, told that she's just been diagnosed to have diabetes mellitus from her blood test, exclaims incredulously, "You didn't even check my urine! How do you know for sure?" (Can I propose that the misnomer kencing manis be banned?)
Man, told that he has renal impairment, asks, "Which one? The left or right kidney?"
Woman, a hypertensive on treatment, pleased that her blood pressure has returned to normal, asks hopefully, "So am I cured? Can I stop my medications?"

A former consultant of mine was of the conviction that no one should ever be admitted for hypoglycemia. If ever, he was adamant that it was the medical practitioner's fault. I remember an exchange during a grand ward round when we were house officers in the medical ward.

Consultant : Why is this lady here?
HO : Hypoglycemia.
Consultant : You are not answering my question. Why is this lady here?

We were dumbstruck, but really, his point was that no patient would develop hypoglycemia if we took the trouble to educate our patients.

HO : We have counselled her on multiple occasions, but she just doesn't understand.
Consultant : You don't need a high IQ to comprehend these instructions, just common sense. And she can't be so stupid.
(Turned to patient) Makcik, apa itu Proton Saga?
Patient : Tak tahu lah!

This has now been immortalised in our memories as the "Proton Saga Story". The point is, patient education is extremely important, but on many occasions, all your advice and instructions fall on deaf ears or get deflected by a thick cranium.

Well, we do try anyway.

Newly Added : Blogroll

2007-06-10T12:44:00.000+08:00

Technology is a beautiful thing (yes, the geek in me has spoken!). Over the last few weeks I have reconnected with some people from my past, with a little help from blogging.

YLTan aka DocPerineum (it's obvious what he does, doesn't it?) is a former colleague from the Land of The Hornbill; he also lived in the room across from ours in the HO quarters. He is a budding photographer when not dealing with matters of the nether regions.

Dr Flora maintains a witty blog that tells of funny patients and even funnier medical personnel in Sarawak General Hospital, hence it's no surprise her blog is called Laughter, The Best Medicine. We have never actually worked together in the same department, but have braved heights, leeches, the open sea and endless boring lectures in our induction course.

Medic Fang was a classmate in medical school. Known for spouting the best straight-faced one-liners, he continues this tradition in Medic Diary, with his funny insight into matters both medical and non-medical (like movies!). He was actually part of my husband's group of Heroes Of Might And Magic ~~fanatics~~ fans - they had marathon sessions lasting well into the wee hours of the morning, and called themselves by nicknames.

I have hence added a blogroll - of blogs by people I know and those that I ~~stalk~~ visit often. Now, when do you think a class mate from secondary school will drop by and say HI?

Organised Chaos

2007-06-09T12:48:00.000+08:00

This is a copycat act following a rash of posts featuring doctors' worktops/desks in the MMR.

This is where I spend most of my waking hours at home - where I have toiled for my membership exam, spent countless hours in the quest to better my own Bejeweled scores, edited scores of photos, and blogged. Most of the time with my husband next to me playing real-time strategy games.

There's a Pfizer year planner for 2006 (!), stacks of review articles yet to be read, a notebook that's perpetually glued to the table top, some water bottles that have been there for weeks, my MRCP scroll still in its case, a dummy Symbicort turbuhaler and a handy DIY stationery organiser from IKEA (where "miscellaneous" objects go).

It's messy but functional. That's why it's called organised chaos.

LULU II

2007-06-08T07:48:00.000+08:00

This is another LULU moment.

We bought tickets to see Shrek 3 and to our surprise the movie projected on the screen was Pirates of The Carribean 3, which we had already seen! The guy at the ticket counter must have been day dreaming - we asked for Shrek, but he sold us tickets for Pirates instead. Our fault too for not checking the tickets before leaving the counter.

Oh well, we didn't mind sitting through another 3 hours of swashbuckling action. When the credits rolled, people streamed out of the cinema while my husband and I stayed behind, knowing that there's extra footage midway through the credits, having missed it the first time. We felt so smug!

Then again, who's the bigger lulu? Probably us!

Painful

2007-06-07T23:49:00.000+08:00

What a day.

I sat for a "competency assessment" (otherwise known as the PTK) today, which in spite of what it's called, does little to measure my ability as a physician. It is however a prerequisite to a promotion and pay rise, and so we poor civil servants have little choice but to force-feed our brains with facts that are irrelevant in our practice.

And so for the past 3 nights I had been grudgingly poring through information I know will slip through my brain once it's been regurgitated in the exam hall. It's called cramming, which is disdainful. I must say though it's one of the least stressful exams I have ever had to prepare for, which leads me to the conclusion that life is indeed blissful when one has absolutely no expectation (you might call it ignorance).

I am glad it's over, but I'm left nursing a migraine and an extremely sore right upper limb (from 5 hours and a half of furious writing). I need analgesia.

The hazards of exams...study, anyone?

Little Kathmandu II

2007-06-05T20:08:00.000+08:00

I ran the tuberculosis contact screening clinic today. A woman brought in a van-load of Nepalis, all of whom had the misfortune of having shared a hostel room with a co-worker infected with tuberculosis.

Hah! Another outbreak of Nepalis!

There were altogether 11 of them. My job was simple - take a targeted history and perform a quick examination, and review the chest x-ray and sputum results. These smart guys took the opportunity to complain about their headaches, body aches, skin rashes and constipation! Pretty soon I felt like I was running a polyclinic. By the fourth patient, I had to tell them that I was just a "TB doctor"! Health care should not be this compartmentalized, but I had tonnes of other patients to see.

Sigh. I hate to turn patients away, especially these gentle Nepalis.

A Step Forward

2007-06-04T20:22:00.000+08:00

After umpteenth months, the powers that be have decided that I am "ready" to assume specialist responsibilities.

It's life as usual, except for a certain awkwardness in doing ward rounds with people who were once your colleagues of same rank (and with whom you sometimes b***h about some specialists over lunch). What is really wonderful though is the fact that my signature carries a great deal more weight now. Imagine, I can now prescribe amlodipine for my mother-in-law without having to beg for a specialist's signature!

Some genius told me, "Membership has its privileges".

I couldn't agree more!

Welcome Back!

2007-06-04T13:34:00.000+08:00

Hubby's back in the hospital for his final 2 years of postgraduate surgical training.

It's surreal. Not having to drive myself to work. Constantly feeling for the car key in my pocket and not finding it there, and feeling a few ounces lighter. Having a consistent lunch buddy. Being able to go have lunch outside, then leaving it to him to deal with the stress of finding a car park space later.

Welcome back. You have been missed, by me and the staff alike.

The Transformers

2007-06-03T11:33:00.000+08:00

My brothers and I loved Transformers (probably under heavy influence of a cousin whom my second brother worshipped). I think the appeal lies in the humanisation of the bots, and how good versus evil is played out. That good always triumphs, against great odds.

I saw the first animated movie. When Optimus Prime "died", we fought back tears.

Perceptor: I fear the wounds are... fatal.

Daniel: [long pause] Prime, you can't die.

Optimus Prime: Do not grieve. Soon I shall be one with the matrix.

Hot Rod: Prime.

Optimus Prime: Ultra Magnus, it is to you, old friend, I shall pass the matrix of leadership as it was passed to me.

Ultra Magnus: But Prime, I'm - I'm just a soldier. I - I'm not worthy.

Optimus Prime: Nor was I. But one day, an Autobot shall rise from our ranks, and use the power of the matrix to light our darkest hour.
[opens his chest to reveal the matrix. Removes it and begins to hand it over to Ultra Magnus]

Optimus Prime: Until that day, till all are one.
[Matrix starts to fall to the ground. Hot Rod catches it, gives it to Ultra Magnus. Ultra Magnus inserts it inside. Prime dies]

And when the Autobots seemed to be headed for a certain doom, Rodimus Prime saved the day.

Rodimus Prime: This is the end of the road, Galvatron.
[throws Galvatron through Unicron's hull and opens the Matrix]

Rodimus Prime: Now light our darkest hour!

The place blew up. And the soundtrack played. What a moment!

Michael Bay, please don't disappoint us.

Flushed Away

2007-06-01T21:04:00.000+08:00

Spotted in one of the cleanest and least known, least frequented (explains the "clean") wash rooms in the hospital.

Well-placed message, but do you see what I see? Is it what I think it is?

*The sign says don't forget to flush

I Wonder

2007-06-01T13:33:00.000+08:00

I've had some memorable patients in my days in Kuching. I sometimes wonder if they are still around, whether they won their battles....or had succumbed.

M was a young lady who had never smoked a cigarette in her life. At age 32 years, she was diagnosed to have stage IV lung carcinoma. One of the first chest drain insertions I performed was on her, which she bravely tolerated. Her husband brought me fresh tiger prawns from the village - I think they lived in my freezer for months. She was lost to follow-up subsequently. I wonder if her last weeks or months were good.

J was another young lady diagnosed to have multiple sclerosis. It was heart-wrenching to watch her disability progress. Each time her ward stay became longer; soon it felt like she'd never left the ward at all. My colleague and I chipped in to buy her an AM/FM radio to ease the boredom of being confined to her bed 24-7. It broke my heart when her young son came to visit and took the radio home with him. I wonder if you're in a better place now, J.

Mr B had bronchial asthma, initially cared for by a GP who put him on years of long-term oral corticosteroids. His asthma control was atrocious. He was a regular at the emergency department - on most of my on-call days he was certainly there. I wonder if he is still steroid-dependant?

Finally, an adolescent with Type I diabetes mellitus, who had recurrent episodes of diabetic ketoacidosis. His presentation was classic - he'd walk in, looking a little dehydrated, breathing a little rapidly, and he'd say, "Doc, I think I have DKA"! A blood gas analysis always confirmed his acidotic state. He'd survived each one. I wonder if he'd run out of "luck" some day.

I wonder if I'd still see some of these folks when I return to Kuching.

LULU!

2007-05-31T14:26:00.000+08:00

We love this word. We don't know its origin, or how it crept into our vocabulary.

lulu (n.)
one who has been duped / easily duped

Several examples to illustrate its meaning :

Scenario 1
I was at McD trying to get some take away dinner. There were 3 counters, only one of which was operational. I went to an empty one, but no one was manning it, and no one intended to (there were idle staff members milling around, looking busy). As soon as I joined the queue, a staff opened another counter and immediately served a lady who had just walked in. I swear she saw me come first. I felt like a lulu.

Scenario 2
I caught POTC : At World's End last week. Felt rather pleased I could get tickets. Enjoyed the movie, though the ending was less than ideal. Cleverly surmised that a 4th movie was definitely on the cards, as there were loose ends and no closure. Capt Jack Sparrow lost his Black Pearl? Will was separated from Elizabeth? Learned today however that there was a "second" ending, which came up after the credits. Yes, you guessed it. I felt lulu-fied.

Scenario 3
This is a frequent occurrence at Baskin Robbins - being short-changed. For instance, the bill says RM 22.06. If you pay RM 22.10 you won't get any change back. They won't accept RM 22.00 either, because you're 6 cents short. They think we are lulus.

Get it?

You Are In My Way

2007-05-30T11:35:00.000+08:00

Two words : Selfish + Inconsiderate

This car belongs to my neighbour, and it's parked outside everyday. Of course, my portion of the driveway is trespassed and sometimes I have difficulty reversing my car out of the porch. That's all right, Mr Neighbour. Your action is perfectly understandable, given that you don't want to block your own driveway so that your family members will find it a breeze to drive in and out everyday.

Motivation note to self : Make tonnes of money so that someday I can afford to be a hermit holed-up in some posh one-elevator-to-one-unit condo.

Round And Round We Go

2007-05-29T21:42:00.000+08:00

Life is an endless series of rounds.

This downward spiral (pardon the pun) is detrimental to members of my team. Here's how :

my FEET hurt - even Clarks and Hush Puppies can't save me

my THROAT hurts - from repetitive case presentations

my HOUSE OFFICER hurts - from scribbling what is essentially the same information over and over in the patient's notes

my PATIENT hurts - how many times does an abdomen need to be palpated?

my NURSE hurts - HO says to turn off the oxygen, MO says to put it back, specialist says to change to oral antibiotic and remove IV cannula, consultant says to continue with IV. Huh?

the ENVIRONMENT hurts - God knows how many trees we can save by cutting down on paper use, which can be achieved through minimising entries in patient's notes. If it's going to be a seen by aka S/B entry ending with a continue same treatment aka CST entry, why bother duplicating it?

I don't know a better way to do it, but multiple ward rounds are counterproductive.

Everybody Hurts. Maybe REM was really singing about us.

Home Alone

2007-05-28T21:49:00.000+08:00

I am home alone.

Hubby's been doing back-to-back calls. He is the one man in a one-man unit - no surgeon, no fellow trainee. And all this in a teaching hospital! The higher authorities want the show to go on. Comply, or risk being kicked out from the programme. Hardly a choice.

And so one man has to pack his clothes and move into the hospital. Watch TV with the nurses, eat out alone, send dirty laundry to his parents' house (nearer) and get bitten by bugs that occupy his call room bed.

And somewhere, about 90 km away, his wife comes home to an empty house everyday, finding no one to listen to her b***h about the horrible things that happened at work. She too has to dine alone, and is running out of meal ideas. Having now to drive herself in search for food, she sticks to familiar places (mainly along the route from home to hospital and back!) - she's been lost in this town on more than 1 occasion. She's fine otherwise. Laptop + Internet connection + DSLR + car that takes me places - man = FINE. Of course, Laptop + Internet connection + DSLR + car that takes me places + man = PERFECT!

A typical homemade dinner

Can't believe 1 month is nearly up. I will soon be home alone...no more.

Bragging Ladies

2007-05-26T17:21:00.000+08:00

During a ward round with my consultant, she pointed out an old lady whom she knows personally. This lady speaks proudly of her children to anyone who would listen; both have successful careers in UK and Australia respectively. Yet, she is alone in her twilight years. No one visits her in the ward. I was instantly reminded of a Petronas Chinese New Year TV ad, which I loved.

I look forward to these gems by Yasmin Ahmad every year.

Not A Playground

2007-05-24T14:02:00.000+08:00

There's a presence in our hospital corridors or wards I strongly feel we can do without.

It is that of children's laughter, merry-making, play.

I remember the times when my mother was admitted to a government hospital. My dad would leave my brother and I at the hospital playground while he went up to the ward to see my mum. I used to think that cruel and not very child-friendly, but this rule was not made without good reason.

I'm not Scrooge, but I don't like the sight of children in my ward. We see toddlers lying on hospital beds, kids crawling under the beds or chasing after one another while their parents look on with adoration. There's a potential hazard at every corner waiting to befall these little ones - trolleys and drip stands they could knock into or over or dirty slippery floors they could slip on. There's also an unseen danger - nosocomial bugs they could pick up. If we have to allow children into the wards, more supervision is required.

Kids will be kids, but the hospital is not a playground.

Not My Fault

2007-05-23T23:10:00.000+08:00

How do you apologise for something that's no fault of yours?

Over the years I have had to put on a brave smile to endure hostility, anger and disappointment hissed at me from disgruntled patients. Drip finished, still not replaced. Drugs administered late. BP not checked but charted. Urine bag on the verge of bursting and not emptied. Bed too high. Bed too low. Ward too hot. My MRCP training dictates that I have to be impartial, objective, calm and empathic. And so I have always been impartial, objective, calm and empathic. I always apologise on my nurses' behalf, on the hospital's behalf, and heck, on the Health Ministry's behalf! All this while the patients, sensing a diplomacy they mistake to be guilt or fear, intensify their tirades against all the wrongs that have been committed against them.

We have nursing sisters who should be overseeing such things. Today a patient of mine complained incessantly about poor nursing practices that had befallen her (she being a former nurse herself). I asked my ward sister to join our "discussion" (mostly one-way sonar traffic with the patient doing all the talking and us listening) hoping that she could come up with some solutions.

She spent the whole morning grumbling about how she always had to apologise for things she didn't do! Hmm.

These days, I take diplomacy a bit further. I take the patient's side. Ever so subtly I nudge them towards making a formal complaint. Let the hospital director hear about our shortcomings. Maybe then things will improve.

We always have to learn the hard way, don't we?

Hair Woes

2007-05-21T21:33:00.000+08:00

I'm a low-maintenance woman.

I couldn't sustain a high-maintenance existence even if I wanted to. I hold an unglamorous job, and while I maintain that style AND substance will get you far, I'd look out of place all dolled-up. Not in the hospital anyway. My only indulgence? Trips to the hair salon.

Of late, these trips have become somewhat stressful, and not unlike a visit to the hospital. Here's how :

THE WAIT
Sure, some salons entertain walk-ins; the hot shot ones by appointment only. There's no numbering system, no irritating ding-dongs indicating your number is up. But you wait, nonetheless.

NO CONTINUITY OF CARE
Then, the person you trust with your hair is not always available. He may be on leave, or held up with another patient...I mean customer. Darn, but he knows my hair history. Are you sure the junior MO...I mean stylist, is competent? Which hair design institute did he graduate from anyway?

MORE THAN YOU BARGAIN FOR
I come for a wash-and-cut, but I always end up with a new diagnosis that requires further treatment. Hair too frizzy. Scalp too greasy. Colour fading. Excessive hair loss. Each time there's a new - expensive - product to be purchased to avoid further complications. If my hairstylist conducts a spot-check of my bathroom he'd conclude that I'm a customer who practises polyhairproduct-y but who has compliance problems (bottles and bottles of unfinished hair products).

THE DEFAULTER
My stylist expects to see me more frequently than I can afford (both temporally and financially). He says, see you in 6 weeks for a trim and I don't turn up unless my bad-hair days become more intense, more frequent and occur even when I'm not post-call. I'm a bad customer, but I have no time.

Phew, lucky for me I'm not into facials, manicures or pedicures.

The Wedding

2007-05-19T14:54:00.000+08:00

I'm attending the wedding of a long-time friend today.

I'm looking forward to it despite being day 2 post-call - stressed-out skin, less than sensational hair, a pair of tired-looking eyes and some insect bites on distal extremities which I could in no way cover up (Insect bites? Probably from bugs that co-inhabit the bed in my on-call room).

I'm looking forward to it because I'd be meeting up with people I grew up with, way way back in the pre-Blogger, pre-YouTube, pre-Friendster era. It's nice to see what varied lifestyles we have each pursued. It's even nicer to celebrate our similarities, that we can still pick up where we left off and laugh at the same silly things.

Mostly though, I'm looking forward to it because hubby and I could pretend that we are celebrating our other wedding anniversary (which falls on the same day) in a swanky hotel on another person's expense. Mwa ha ha ha!

Now, how do I assimilate a DSLR into my look without looking like an overdressed photographer on the job or a pretencious wanna-be photographer?

*Other wedding anniversary : when we threw a dinner reception to celebrate our marriage which had taken place earlier

What's In A Name?

2007-05-18T13:40:00.000+08:00

Took the lead from Jimbo and decided to check out a name-bestowing site. Wow, I can have a monster or sexy or cyborg name!

Get Your Cyborg Name

Get Your Sexy Name

Get Your Monster Name

It's silly but fun. Harmless and surprisingly delightful on a post-call day!

Food For Thought

2007-05-16T13:30:00.000+08:00

TODAY'S SPECIAL

hors d'oeu-vre

Bread and butter

soup du jour

Cauliflower soup

entree

Pizza Pie with Swiss Cheese

Grilled Salmon with Anchovy Sauce

dessert

Strawberry Ice Cream

Coffee or Tea

What a doctor/pathologist may envision instead :

Anchovy sauce pus of a liver abscess

Pizza pie (?new fusion food) appearance in CMV retinitis

Strawberry cervix of trichomoniasis

Cauliflower-like growth of a laryngeal papillary squamous cell carcinoma

Bread and butter appearance of fibrinous pericarditis (you'd have to drop the bread on the floor to leave that kind of texture!)

Swiss cheese appearance of emphysematous lung

We see food in everything.

Thin...and Loving It!

2007-05-15T10:28:00.000+08:00

I have a positive body image. Well, some parts may be entirely delusional, but if I like myself with conviction - false belief or otherwise - that's a good thing. I learnt from a tender age not to take things at face value. Looks-aren't-everything was my mantra because, well, I was more brainy than I was pretty. Smacks of sore loser-ism, I know. I'd just rather call it positive body image. After all, my husband (then boyfriend) saw beyond my pimples and orthodontic contraptions, and he always thinks himself lucky to have me! (All husbands think that of their wives, I reckon.)

So why did it bother me so when more than 3 people I met over the weekend commented, similarly, that I had become thinner? Well, thin is supposedly good. I've been thin all my life. But now I'm thinner! Those remarks did not have a complimentary ring to them; they were more you-poor-thin-thing-what-happened-to-you kind of remarks. Do you know what's disturbing? The fact that I was sufficiently bothered!

I weighed myself that very night. I hadn't done that in a very long time. I just wasn't weight-conscious (remember, I have a positive body image). I discovered that I hadn't gained a single ounce since the fifth form! Boon or bane? I feel healthy. I eat heartily. I am clinically euthyroid. My body mass index is well within the normal range for Asians. Why was I bothered at all?

(Chant) Positive body image...positive body image...

I guess I allowed myself a moment of frivolity there. There are a lot of people out there whose obesity is no choice of their own, or underweight persons who are that way because of medical reasons. Me? I should just be glad that there are labels that carry my size, or a seat that fits my rear, or food that I can eat without ever having to count every calorie. The next time someone calls me thin, I'll thank him for the compliment!

Fashion Tips for MRCPians-to-be

2007-05-14T13:47:00.000+08:00

You are what you wear.

Why do you think we're made to wear white coats anyway? A robe doesn't a good doctor maketh, but until one opens his mouth or touches the patient, he can fool anybody into thinking that he is competent. Because he wears the white coat and looks the part. Also, added bonus if he wears the tie too!

So how do you look the part going for exam (specifically MRCP UK)? Admit it, it's relevant and pertinent. And don't judge me because I spent time fretting over what to wear on my exam day. I had worked hard, and I wasn't about to let a less favourable first impression cloud the judgement of my examiners.

Concern #1 : Hair
Bun? Too severe. Ponytail? Too girly. Long and loose? Too unkempt. I ended up pony-tailed. A friend of mine took it a step further - she got her hair done in a salon just hours before the exam. Well, she passed!

Concern #2 : Top
All right, we all agree that the powersuit is the safest bet. Very professional. I was undecided on the shirt. Pink? Again, too girly. Blue? Probably. I finally opted for a white Victorian-style blouse with some lace trimmings. Feminine, but subtle.

Concern #3 : Bottom
This was the tough one. Skirt or the pants? In the end, the skirt for me.

Concern #4 : Shoes
Flatties? Pumps? Heeled-pumps. Needed to look taller lest they think I look too juvenile to become a physician.

Concern #5 : Brain
The most important fashion accessory. I operate on many modes - sharp, confident and pleasant, or slow, sluggish and stammering, or high-strung and fidgety. I think I wore my brain well that day, when it mattered the most.

So there, I was what I wore on my exam day. I was definitely assessed based on my skills as well as my appearance. Don't call me shallow. I am of substance, but I do not think style and substance have to be mutually exclusive.

*Even the Singaporeans put emphasis on appearance. There's a section in Look and Proceed - a useful clinical skills book written by Singaporean doctors - that teaches you how to stand when you face the examiner, where to "hang" your steths when idle etc. Like, seriously.

Old Is Gold

2007-05-11T15:16:00.000+08:00

People say I'm good with old people.

I'm more surprised than flattered. Who, me? I'm hopeless with old people. I can't remember the components of a mini mental state examination, and so I can't perform one without reference. I don't deal with age-related complaints very well - the aches and pains, constipation, poor vision, the forgetfulness. To make up for my lack of experience in geriatrics, I inject an extra dose of kindness in my approach.

How do you not feel compelled to be 10x nicer to the pakcik in shabby clothes with a backpack and an umbrella who had travelled in a bus from another district just to see you in the clinic? Or to a polite octogenarian with a walking stick who drove himself to the hospital but had to take a RM2 cab ride from the car park (about 2 hills and a mortuary away) because it was too far for him to walk? I think we owe it to these elderly folks to spend more than the customary 5 minutes to take a BP and ask close-ended questions. Find out how they came, who they live with, what they used to do, what they do now.

Have a heart, people. We'll all be droopy and saggy and wrinkled one day too.

This Is What I Think...

2007-05-09T20:55:00.000+08:00

"Good course...compulsory for anyone even thinking of attempting PACES!"
Dr VMA, Tunku X Hospital

"Intensive...it whipped me into shape; so crucial just weeks before the real exam"
Dr FBC, University Hospital

"The best course available locally...book early to avoid disappointment!"
Dr ABG, Oh Pee Dee Clinic

Very cheesy comments, reminiscent of those gosh-it's-so-good kind of remarks you'd find in the inside covers of paperbacks.

You see, I have been asked to submit a comment on last year's PACES preparatory course organised by the country's premier private medical university for use in their promotional flyers for this year's event (since I was a participant...and passed!) I presume they want only good comments, but the first thought that sprang to mind was, it's not cheap! Well, the PASTEST courses in UK cost much more, but I hear they are really good. The price has escalated this year for the prep course in Singapore, but then NUS brings in good tutors from UK. A few years back, they had Dr Praveen Kumar (the Kumar of Kumar and Clark)!

So what of the local course? I can't really compare, this being the one and only prep course I've ever attended, but we have our share of prominent local clinicians who are actual MRCP PACES examiners. Can't say much for the cases though, but then again the patients were mostly from my hospital so it didn't feel like we were seeing fresh cases. What was important to me though was the opportunity to size up the competition - people you would be up against on exam day.

But guess what? I walked out of the exam ward grinning and shaking my head in disbelief. I had for my skin station a gentleman with pachydermaperiostitis, which I took the trouble to read up after coming across this big word in PACES MRCP. And it's free.

Seriously.

Little Kathmandu

2007-05-07T23:07:00.000+08:00

There's an outbreak in my ward.

An outbreak of err...Nepalis!

I had a field day on my call last Saturday receiving one Nepali after another. Poor guys. To leave your home country for the promise of wealth and a better life in bolehland is one thing, but to get bitten by the evil Aedes aegypti and end up in a third world health institution where nobody understands a word you say, is surely something else.

Some spoke a smattering of English, and some, remarkably, Malay. Then there were some who spoke neither, but somehow history taking was accomplished with the help of wild gesturing. I say wild because - trust me - there is no genteel way of communicating the meaning of vomiting, bleeding or diarrhoea. The only word I know to utter in Nepali (or Hindi, I think) is namaste, but I usually spare them the agony. I mean, there's only so much nee hao mas or apa khabars you can stomach from gwai lohs who visit our country, so I won't do the same to these poor Nepali souls.

None of them pulled a bleeding, plasma leakage or shock stunt on me that night (despite the fact that my very considerate boss Jimbo turned up in a RED shirt!). I hope they get well and get out of the hospital soon. And that they will return to their beautiful country Nepal when they have made enough money, where there's little chance of falling ill with dengue fever.

*bolehland = Malaysia, where nothing is impossible
Aedes aegypti = the mosquito vector that carries the dengue virus
namaste = ?hello and good day in Hindi
nee hao ma = how are you in Mandarin
apa khabar = how are you in Malay
gwai loh = cantonese slang for "white man"

Shattered Glass

2007-05-06T22:19:00.000+08:00

Did you catch this in your Sunday paper?

"KLANG : A couple had the shock of their lives when the windshield of the car they were travelling in shattered into thousands of pieces.

Mr and Mrs K were on their way back to Seremban. The incident took place at 2 pm, just as the car was approaching a flyover several kilometers away from the Kota Kemuning toll plaza. The otherwise pleasant journey was ruined by a loud crashing sound, followed almost instantaneously by cracks that formed radially from the point of impact. They did not know what hit them.

Mrs K was furious. Although there was no eyewitness to attest to her claim, she was certain a stone had been thrown in their direction. "We were not trailing any big trucks carrying debris or rocks so it could not have been a stray pebble that hit us. There must be someone on that fly over intentionally hurling an object at us. What scums! Don't they know that lives could be lost? We could have lost control of the car; the glass shards could have injured us. What kind of sick people are we raising?" Mr K was also visibly upset. He had lost his prized collection of car stickers accumulated from the different places he had worked in.

Car stickers beyond salvage

Traffic was not disrupted. The said flying missile had not been discovered, but police have yet to rule out any foul play. No KESAS official could be reached for comment."

That sort of summed up my weekend. A damaged car, no Spidey ticket, and pathetic broadband service.

An Everyday Hero

2007-05-02T09:40:00.000+08:00

*This fine piece of art work is the property of Gustav Klimt

I could submit a heart-warming story of her to the newspapers, for a shot at the attractive prizes at stake. But you know what? It won't win.

She has no superpowers. She is not perfect. She has bad days. She has quite a temper. She doesn't drive. She raised us with a lot of help from her husband. She never walked through fire or parted oceans. See? I have no mother-overcoming-adversaries kind of tales to share.

So mum, you'll have to settle for a blog spot instead.

You are to us in ways that other people will never understand. Simply put, there's only one of you in this whole wide world. And for that, you're our HERO.

Happy Mother's Day!

*This is a tribute from the daughter who never inherited your infectious-laugh gene, and never found out what day in May Mother's Day falls on. Nonetheless, I hope I've made you proud with... ahem...the good job you did with me!

One Day Blog Silence

2007-04-30T13:23:00.000+08:00

Top 10 Books

2007-04-29T14:41:00.000+08:00

5 out of 10...ain't so bad.

The Malaysia top 10 favourite books (fiction) list was revealed today in The Sunday Star. I am slightly dismayed to learn that I have only read 5 of these shortlisted books, and I consider myself an avid reader.

Actually, I was an avid reader. Call me a geek/nerd/bookworm, but as a child - when the Internet was a concept you heard about in shows like Beyond 2000 - my idea of fun was being left alone with a good book. A book a day, I lapped it all up with glee. I even started my own library - my books were catalogued using serial numbers and all had a "date due slip" pasted onto the last page - except that there was no patron. I enjoyed the trips I took with dad to various book fairs/exhibition/warehouse sales around KL, when we'd take a bus down from our hometown of Klang instead of drive. Those express bus trips (aka direct trip), windows down and wind beating on my face, with me struggling to keep my eyes open, will forever live on in my mind as one of those classic father-daughter moments. We'd return home after a tiring and fruitful day, pleased as Punch, with our individual loot. Mum would roll her eyes (all done with affection) in a way that said, like father like daughter. And of course, I once fantasised that I would meet the guy of my dreams in a bookstore!

Over the years I read less and less fiction. My reading list consisted of medical text and journals, guidelines and papers, all very boring stuff, I must say. The occasional fiction I read, I read during air travels, books I purchased at the airport bookstore and never quite got around to finishing when I got home. My last book? Amy Tan's The Opposite of Fate (which doesn't really count as fiction). Status? Unfinished.

I didn't take part in the poll, but my top choice echoes that of the Malaysian public. The Lord of The Rings rules them all!

Mr JRR Tolkien

The Right To Know

2007-04-27T22:59:00.000+08:00

It upsets me to learn that some fellow doctors do not bother revealing the origin of low molecular weight heparin (LMWH) to their patients. It upsets me even more that they think that those who do, shouldn't!

On what grounds? Look, I know most of us have the genuine intention to treat our patients to the best of our abilities. Therefore, my opponents think that withholding a minor detail such as that above is done in the patient's best interest - a so-called therapeutic advantage. They argue that most Muslim patients who were told of LMWH's porcine origin ended up declining its use. They are after all offering the best treatment there is (in the case of acute coronary syndrome - ACS).

But still I ask, on what grounds? If you're a Muslim, don't you want to know if your treatment is halal? If there is no better alternative, the origin or religious legitimacy of a particular therapy does not preclude its use. I usually make it a point to counsel a Muslim patient before I administer LMWH. Yes, it's porcine in origin. Yes, it's the best treatment available (for ACS). Yes, there is an alternative, albeit an inferior one. Yes, in my professional opinion, you should receive this form of heparin. And yes, the final decision is yours.

In the end, if you are mentally competent, able to comprehend and retain this information, the final decision is yours. It's your right, the right to self-determination. In my limited experience, most of my Muslim patients have no objection to using LMWH, since it is undoubtedly the one thing that can save their lives when they present with ACS.

We'd like to think that doctors know best (and want the best for their patients), but let's not also forget that ultimately it is the patient's right to decide what they really want. Autonomy still rules.

My Cup Of Tea

2007-04-24T22:57:00.000+08:00

An old love affair has been rekindled.

Ah, the joys of drinking tea...rediscovered.

Growing up in a household virtually devoid of caffeine (bar the occasional root beer, cola or Sarsi during festivities), I didn't begin to drink tea regularly till I was much older. Tea quickly became my new favourite beverage. I love both its taste and after taste; I like it thick and black, slightly bitter, and hot. Of course, I also like what it does to my spirits - one cup and I'm living up to my potential. I could do a million things, I write better, I articulate better. That, as we very well know, is caffeine-driven!

I have tried a variety of tea brands, and so far Tazo has been a sentimental favourite. I remember my first days in Sarawak General Hospital, when my husband and I were housed temporarily in one of the empty rooms in the specialist clinic complex while waiting for the actual quarters to be vacated. Those were such cold days in every sense of the word. The air-conditioning was on 24-7, and I would be reduced to a cyanosed, shivering mess trying to get an express shower at midnight after returning from my "tagging" duty. My only material comfort was my Tazo tea. For that I think I have Wyeth to thank. To promote their antibiotic Tazocin, they gave away Tazo tea bags with their drug papers. What a clever marketing gimmick! My darling hubby had collected an impressive 6-8 sachets from his colleagues because he knew I loved tea. I was wary and slightly confused at first ("you sure this tea doesn't contain any Tazobactam?"), but Tazo had me at first sip.

Over the years I had come into contact with some mediocre tea; you know, those shamelessly watered down, diluted imposters. And the lure of coffee was strong. Even if coffee proved too strong for me initially - giving me palpitations, headaches, and insomnias - I soon crossed over to the dark side. Pretty soon I was downing something like 3 cups a day (which is to be considered massive given my small frame), and I realised I was more dehydrated, edgy, and thoroughly exhausted at the end of the day. One of my resolutions for the year had been to cut down on my coffee intake. First quarter review : partially successful. Will work harder on that.

So how did I rediscover tea? I was at a conference recently and expecting to be fed the usual inferior quality brown beverages passing off as tea/coffee during the multiple tea breaks. But this particular hotel of the many many 5-star hotels I know had this charming little booth where tea bags were displayed and we could have our own pick. Fine tea all, measured in bag per cup, not in parts tea per million. My cup of tea, precisely. So there I was, one tea break after another, trying a different flavour each time, quietly but rapturously sipping my tea in the corner. Ah, the simple pleasures.

For now, I'm sticking with tea. The perfect cuppa? Tazo Awake, an English Breakfast blend, of course.

*Tazo says it best : Before the advent of Tazo Awake, most of humanity lived in a kind of dazed, dreamlike state where nothing much got accomplished on a regular basis. This made organising things like the Internet pretty much unthinkable.
Tazo is available at Starbucks.

Steve Versus Bill

2007-04-21T16:44:00.000+08:00

Poser of the century : PPC or Palm? Canon or Nikon? Mac or PC?

While I have sworn allegiance to Canon, and would switch to a Mac in my next upgrade, I still don't own a PDA because I cannot decide which to get.

Anyway, here's a hilarious Steve VS Bill cartoon I found in You Tube. (Note : Bill has the green lightsaber, but why is he the good guy?)

Drug Wars

2007-04-20T14:20:00.000+08:00

It's war between the drug cartels (small fry need not apply). Drug pushers are sent out to the streets to ply their trade, and we're caught in the cross-fire. No, I've not migrated to some drug-lord infested South American nation. I simply work in a hospital.

The hospital, or for the matter any health institution is fertile ground for drug-pushing. I don't mean that in a bad way. Pharmaceuticals is a multi-million dollar industry, and understandably it's break-neck competitive. The prescribing policy of a hospital could mean a windfall for a particular company and bust for another. New drugs and old ones given new indications are pushed into our faces all the time. So how does one choose?

Life just keeps getting more and more complicated. Choices, choices, choices! From skin care to hair care to brand of cereal or fresh milk, I am swamped with choices. Consumer products are petty matters. With drugs, my choices can have a huge impact on patients' lives and health economics. So how do I choose?

All drugs being more or less equal in terms of efficacy, tolerability and cost, do I choose based on

the strength of evidence of drug trials
my consultant's prescribing preference
the likeability of the pharma rep
the agreeable appearance of the pharma rep
the support from pharma company (i.e. sponsorship for CMEs, conferences, department, research grants)?

All of the above for me, to a certain extent, with the exception of the physical attributes of the salesperson (there are more comely young lasses than lads in the pharma industry anyway, so not very interested). Our prescribing practice usually mirrors that of our specialists and consultants in the early years, with some fine tuning along the way as we mature into experienced practitioners. Ultimately, most of us prescribe within the confines of consensus guidelines where they exist, and where cost is not prohibitive.

In the meantime, we enjoy the attention. Sales blitz is the latest marketing ploy, where reps sometimes dress and give out lunch packs or snacks according to theme. My favourite so far? Sushi packs, as sushi=fish and fish="mascot" for one 3rd generation cephalosporin. The most desperate? Secret Recipe cakes for energy to last you 24 hours, to remind us of a certain ARB's "24-hour protection".

We are not complaining.

*CME : continuous medical education; ARB : angiotensin receptor blocker

Disclaimer : Opinions expressed are entirely the author's and may not reflect the truth of the situation, and certainly do not represent the views of the doctors practising medicine in Malaysia.

Roma Fan

2007-04-20T00:05:00.000+08:00

This is old news, I know. That Manchester United trashed Roma 7-1 like ages ago. Yawn.

Anyway, just thought I'd share this because I find it amusing.

Spotted in my ward the day after the breathtaking match :

The caption should read : Roma fan keeps flag (towel) flying. Poor thing. I bet she didn't even know her team had lost!

I Know Who You Are

2007-04-19T17:25:00.000+08:00

The realm of cyberspace isn't that vast after all.

Ever since I started blogging, I have spotted some bloggers with profiles matching people I know. Being the sleuth wanna-be that I am, I was spot-on each time!

All right, Jimbo sniffed me out first but I still had to figure out who he was - which I did. Small world, eh? It turned out that we work in the same hospital. And so does Two Woods.

Blooddoc was quite easy. A Malaysian hematologist working in Germany? I know one. Pictures of his adorable girl posted in his other blog Travelogue-Southern Germany confirmed his identity. A fine physician/hematologist I had the privilege to work with some years ago.

YYYap of The Tent was obviously the easy one, complete with name and all. We were products of the same medical school.

My latest revelation? Cytusm! Every alphabet of his moniker stands for something; when the realization hit me his name made perfect sense. If I were to follow suit, I'd be called something like cylusm. Doesn't sound very nice. Anyway, it's great to reconnect with another senior from university in the blogsphere.

So if you think I sound like someone you know from school, college or work, please establish connection. I am looking forward to hearing from you!

Toilets That Kill

2007-04-17T21:28:00.000+08:00

This is nothing like the high funda toilet that fellow blogger Jimbo raved about in his blog. This is a third-rate, third-world toilet - or what's left of it - in the third-class ward that I work in. The cistern came crashing down one fine day. My patient somehow had the foresight to pull the flush handle only after she had stepped out of the cubicle, hence she escaped what could have turned out to be a horrific freak accident. No where is safe anymore, is there?

A Less-Than-Regal Dinner

2007-04-16T22:28:00.000+08:00

I had been invited to attend a dinner cum talk (in conjunction with the recent National Heart Association meeting) on a fine Saturday evening. The speaker was a professor of cardiology from France and the venue was the rather exclusive Carcosa Seri Negara.

I simply couldn't pass up this opportunity.

Me, I like fine things. Carcosa promises just that - grand colonial mansions, lush sweeping lawns, dainty tea cups, gleaming silverware and exquisite china. Not my typical weekend. You could tell I was psyched. (Incidentally E&O Hotel is one of my favourite hotels, Smokehouse in Jalan Mayang KL is my favourite fine restaurant - I love structures with a distinct colonial influence.)

We arrived to find the place in a less than pristine state. Well, maybe the lighting wasn't flattering, but was it not peeling paint here and a water stain on the wall there? I didn't get a chance to explore the place, as we were quickly whisked-off to the function room where the talk promptly began. No matter. I was too embarassed to take out my bulky DSLR camera - stuffed somewhat pathetically in my bag - to begin snapping away anyway. Like, hello! Have never been to Carcosa ah? Actually, no!

Dinner took place in Gulai House, supposedly well-known for its local specialties. I'm no food critic, but after years of eating out I'm inclined to think that I have developed discerning taste receptors. The food, to say the least, was disappointing! After a decent starter of satay skewered in lemongrass stalks and a somewhat salty prawn and spinach soup, things went downhill. Of notable mention were the prawns - they were close to decomposition! My boisterous company made no attempt to disguise their disgust. And again, I was too embarassed to whip out my monster of a camera to take some shots of the so-called food (which would have made good blog material). Like, hello! Have never eaten fancy food ah? Suffice to say, we did not stay back for dessert!

The Gulai House

I admit some of us behaved like ungrateful guests. Well, I appreciate being invited. I most certainly won't come here to dine on my own. At least I can now blog about my Carcosa experience! Then again, surely the food can be better? Especially since it's so pricey!

Top 5 M.C. Movies

2007-04-06T22:15:00.000+08:00

5 "comfort" movies for them M.C. days (in no particular order):

Spirited Away
A classic by Hayao Miyazaki. A movie for "10-year-olds and those who used to be 10-year-olds". The kid in me always loves a fairy tale. Perfect distraction from any physical discomfort.

Love Actually
The movie tells us that "love is actually everywhere". Makes you feel all warm and fuzzy inside. Kinda like chicken soup, good for a sick soul (and body).

Shrek
Not the greatest fairy tale never told...I'd say one of the greatest EVER told.

Austin Powers 1,2,3
Oh, groovy baby! Cliched as it may sound, laughter is sometimes better than medicine.

LOTR

No reason needed!

I have watched one of these movies everytime I was on MC. Therapeutic value - proven!

*M.C. = medical certificate

Foodis horribilis!

2007-04-06T14:33:00.000+08:00

This may be a problem peculiar to my hospital, but I'm inclined to think that most hospitals are afflicted.

The affliction? Bad food. Or in the case of my hospital, bad AND expensive food!

We demand better food. It's a pretty basic human right after all - the right to decent food. Especially if you are paying for it. I am not a picky eater. I'm an omnivore, I don't practise food taboos and I have no reservations paying more for palatable meals. But walk into the establishment thinly disguised as the "hospital cafeteria" and you will empathise with me. I suffer from anorexia of sudden onset everytime I walk into this joint. It's the usual "cafe fare" - measley portions of meat, boiled veggies drained of colour (and whatever vitamins they contain) and overfried fish that cost a fortune. A simple meal consisting of a chicken drumstick and 2 pieces of tofu (and half a portion rice) can set you back something like RM4.58. The odd 58 cents? Government tax. Like I said, I'll willingly pay for real food but this, I'll do so grudgingly.

Of course, there's always the option of eating out. Except when you have rounds that go on till 1 pm and clinics that start at 2pm sharp, eating out remains a luxury. Besides, once you vacate your parking bay at lunch time, do not expect to find an empty slot when you come back that is not at least 3 slopes, 2 blocks and 1 mortuary away from the main building (coming soon in my blog : car park woes in my hospital)!

I remember a time not too long ago in the land of the hornbill far, far away. There was a coffee shop located just outside the hospital that served decent food - red-wine mee sua (rice vermicelli), claypot tom yam noodles, fried noodles in tomato sauce, laksa Sarawak etc. We always looked forward to lunch. Now, lunch feels like a drag. I'm not expecting gourmet lunches, but is it too much to be asking for better food?

I want this for lunch!

You know, I could go on a hunger strike, but the canteen operator will have his tender renewed year in and year out anyway. I think I'll have to start packing lunches to work.

Ridiculous blog title, you say? That's because I'm hungry - I skipped lunch today!

"Where Doctors Go Wrong"

2007-04-04T13:22:00.000+08:00

A thought-provoking article my former cardiology boss shared with some of us. It was in the March 15 issue of TIME magazine. We're all guilty of these "sins" at one time or another, aren't we?

Where Doctors Go Wrong

By Christine Gorman

The patient was an 8-year-old California girl with severe headaches. Her parents, who were both struggling to adjust to new high-pressure jobs, took her to top neurologists and pediatricians. The child's symptoms, the doctors concluded, were a response to stress at home, along with perhaps a sinus condition. But four or five months later, it became clear that she had a brain tumor and needed surgery. When her doctors looked back at early scans of her brain, they were aghast to see the shadow of a tumor they had previously overlooked.

For Harvard hematologist Jerome Groopman, who is a friend of the child's parents, the missed diagnosis was more than just a cautionary tale. It was the start of an investigative journey. "People talk about technical errors in medicine, but no one talks about thinking errors," he explains in an interview. "I realized I had no framework for understanding these kinds of problems."

For the next three years--in addition to seeing patients and doing research, plus his gig as a staff writer for the New Yorker--Groopman began to intensively examine how doctors think and how they get sidetracked from the truth. He learned that about 80% of medical mistakes are the result of predictable mental traps, or cognitive errors, that bedevil all human beings. Only 20% are due to technical mishaps--mixed-up test results or hard-to-decipher handwriting--that typically loom larger in patients' minds and on television shows.

The result of Groopman's journey is How Doctors Think (Houghton Mifflin; 307 pages), an engagingly written book that is must reading for every physician who cares for patients and every patient who wishes to get the best care. Groopman says patients can prompt broader, sharper and less prejudiced thinking by asking doctors open-ended questions and learning to identify some of their common thinking mistakes:

ERROR 1: I RECOGNIZE THE TYPE

Doctors, like most of us, are often led astray by stereotypes that are based on someone's appearance, emotional state or circumstances. Thus a homeless man's disorientation might be quickly attributed to alcoholism when the real culprit is diabetes.
Groopman describes this kind of "attribution error" in the case of a nervous young woman who kept losing weight even when prescribed a high-calorie diet. Her doctors, convinced that she was lying about her food intake, suspected anorexia or bulimia, but her problem, diagnosed after years of ill health, turned out to be celiac disease--an allergy to wheat. Had the patient been male or older or less anxious, the doctors might have got it right in the first place.

ERROR 2: I JUST SAW A CASE LIKE THIS

"We all tend to be influenced by the last experience we had or something that made a deep impression on us," Groopman says. So if it's January, your doctor has just seen 14 patients with the flu and you show up with muscle aches and a fever, he or she is more likely to say you have the flu--which is fine unless it's really meningitis or a reaction to a tetanus shot that you forgot to mention.

The best defense--besides giving as complete a history as you can--is to be alert and ready to ask questions anytime a doctor says, "There's a lot of this going around."

ERROR 3: I'VE GOT TO DO SOMETHING

Physicians typically prefer to act even when in doubt about the nature of the problem. And yet this kind of "commission bias" can lead to all sorts of new problems if the treatment turns out to be incorrect.

"Don't just do something. Stand there," one of Groopman's mentors told him years ago when he was uncertain of a diagnosis. This buys a doctor time to think--which is especially important when trying to ensure that something hasn't been overlooked.

ERROR 4: I HATE (OR LOVE) THIS PATIENT

Groopman cautions that emotions are more of an issue than most physicians like to admit. Doctors who are particularly fond of a patient have been known to miss the diagnosis of a life-threatening cancer because they just didn't want it to be true. But negative emotions can be just as blinding, sometimes stopping a doctor from going the extra mile. "If you sense that your doctor is irritated with you, that he or she doesn't like you," says Groopman, "then it's time to get a new doctor." Studies show that most patients are pretty accurate in describing their doctors' feelings toward them.

Groopman's book makes abundantly clear that despite all the electronic databases that are being used to improve health care, a lot of medicine still comes down to a doctor or two puzzling out what might be wrong with your body. Experience, common assumptions and human nature can guide them or lead them astray. By asking a few questions--especially if you think your doctor isn't asking enough of them--you can raise the odds that your physician won't get detoured from the truth.

Told You It's A Dog's Life

2007-03-29T22:46:00.000+08:00

These days, I'm walking around my workplace with a perpetual p***ed look on my face.

It's not my good face, nor my real face. It's just a face that has contorted into being as an unfortunate (by)product of my circumstances.

You see, I've had a lousy week. I've had to deal with mounting non-clinical tasks when the ward deserves more of my time. I've had to put up with incompetent house officers and rude patients. But what really takes the cake is my neighbour's inconsideration - I returned home today to see his car partially blocking my gate but leaving his own unobstructed, allowing me little space to drive into my porch.

Of course, I deal with my problems in ways I feel are non-offensive. I turn on the car stereo really loud, I ventilate to my husband and colleagues, I seek comfort food, I walk around with a p***ed look on my face but making it clear that it is NOT you I am p***ed off with, and I go shopping (I bought 3 pairs of shoes this week). You see, everybody has bad days. Deal with them! Don't take them out on another person, especially if she's your daughter's doctor. In my duty as a doctor, I am bound by ethics and code of conduct. But in no instance assume that because as you raise your voice I try harder to be diplomatic you are in a position to bully me. It is my job to try to understand the reasons behind your hostility, and to provide you with the correct information to clear any misconception, but I will not tolerate any rudeness from my patients. I stand unwavered in my principle - that I am a human being first, and a doctor second. (I later learnt that he has 3 daughters who have thalassemia; maybe he has more bad days than anyone else, but there's still no excuse for abusive behaviour.)

I'm glad the weekend is here.

I'll get my real face back, the one I think my patients like. I promise.

A Convenient Political Documentary?

2007-03-29T22:15:00.000+08:00

"The scientists are virtually screaming from the rooftops now. The debate is over! There's no longer any debate in the scientific community about this. But the political systems around the world have held this at arm's length because it's an inconvenient truth, because once they accept it the moral imperative to do something is inescapable" - Mr Al Gore, in An Inconvenient Truth.

I have a deep seated mistrust for politicians, and this documentary for all we know may simply be a political platform for Mr Gore to launch his comeback (then I've been had!). Frankly, I never knew about his passionate crusade against global warming and related environmental issues - which apparently was the case, as the film showed - until now. To me at least, his claim to fame was the infamous "potatoe" faux pas and his near-victory 2 presidential elections ago. But go see it anyway; it's well-made, he's witty, the theme song by Melissa Etheridge rocks and the facts are presented in a global-warming-for-dummies style even the most scientifically-challenged can comprehend. After all, at the end of the day, whether this issue is politised or otherwise, it remains a real one.

Well, there's no other place like home.

Pirates!

2007-03-23T21:06:00.000+08:00

Over a cholesterol-laden lunch today, we (fellow blogger Ji mbo and other colleagues) talked about the piracy of intellectual property. All of us are guilty of this unlawful activity at one time or another. When I worked in Kuching, my "loot" was impressive - French and Spanish films otherwise not showing in a cinema near you, Japanese animation, preciousss box sets of LOTR and Futurama and tonnes and tonnes of audio CDs. Look, I'm not proud of this. When the authorities started to clamp down on piracy, I stopped going to my favourite haunt for weeks. I would picture myself being caught on film fleeing the scene when officers raid the premises, which would then be shown on national TV. My patients would see me and exclaim, "Itu doktor!" Scary thought, powerful enough to suppress my need for more cheap discs.

I sort of stopped buying when I came back to this part of Malaysia. Somehow it just didn't feel right anymore. If you buy pirated VCD/DVDs, you're dealing with criminals and funding their activities - haven't you seen the TV ads? The guys in the ads were so disgustingly sleazy and loathsome, I totally buy it.

I promise, Borat and The Holiday would be my last discs...well, all right, maybe the complete season one of Heroes, Transformers and Shrek 3 too!

House Trouble

2007-03-21T12:17:00.000+08:00

We're in trouble with the law.

This concerns a recent house purchase in the town I work in. We thought it a good buy - more built-up space for a fraction of the price you'd have to fork out for a similar property in say, Klang Valley, it's reasonably near my workplace, and it's very near Jaya Jusco (grocery shopping made very easy). The finishing was no where near top quality, but heck, it's cheap. The ceiling and bathrooms leaked, but well, the developer sent some guys over, though not promptly, to fix things. We got a government housing loan, making full use of the low interest rate. We expressed concern that government applications usually take time, that there might be a delay in servicing the loans. We were assured by the developer that they would not charge interest for that kind of delay, since it's "usually the case with government loans; we don't take action one". We were fooled.

First, a letter from the developer demanding a penalty for the late payment by the housing board. Huh? A check with the housing board and land office revealed that the first payment had indeed been on time, the second and subsequent ones delayed because the developer had a revamp in the board of directors and the company had a change in name. Our sales and purchase agreement had clearly stated that in the event of any procedural delay on the part of the developer, the house buyer should not be held liable. Negotiations with the developer did not work out, and lo and behold, we have now been summoned to court!

Legal matters, we're laymen. We saw an attorney who is a friend of a friend; he offered us sound advice and thought we have a case. The second lawyer we saw was the chap who handled our S&P agreement, whom we expect to be of greater assistance but instead had more sympathy for the developer. It turned out that he's the legal representative for the developer! Talk about conflict of interest. As he blah-blah-ed about the inefficiency of government agencies and the plight of the developer - painted as the victim here - I couldn't help with but mentally picture him as a bad, bad wolf...in a sheep's clothing.

As a matter of principle, we would not settle out of court. Why pay for something that's no fault of ours? On the other hand, this could drag on. We could ill-afford time off work to attend court or legal fees that could end up a bigger sum than our penalty.

Moral of the story :

Buy property from REPUTABLE developers who'd rather safe-guard their reputation than pursue a measly couple of grands from their buyers. Companies not originally in the property business but later "diversified", give them a wide berth.
Always get a second opinion. Not everybody is forthcoming with the right information, intentionally or otherwise. You know, doctors can get sued for economy with truth.
It's always good to have a lawyer in the family.

What Do You Want To Be When You Grow Up?

2007-03-18T21:17:00.000+08:00

Growing up, I have had a few vocational aspirations. I remember wanting to a corporate high-flyer (in my 4-year-old brain, powersuit = success), then a fashion designer (in my 8-year-old brain, portfolio bags = artist chic), then a writer/author/journalist (in my 13-year-old brain, proficiency in written English = good stories), then a graphic designer (in my 14-year-old brain, good marks in Arts = creativity) and most recently, a doctor (in my 17-year-old brain, hard, punishing life = living life to the fullest). It stopped there because by then I had made decisions that did not allow me any more luxury of flexibility. I had committed.

I am now at a point in my life where I need to make another big professional decision. What shall I be? Should I turn my back now on hospital-based medicine, and opt for a subspecialty that could afford me the luxury of a 9-to-5 5-day week so that I could indulge in other non-medical related interests? Or should I heed the occasional whisper of my inner voice that reminds me that acute medicine is really why I set out to become a doctor in the first place? Seriously, I don't know. Yes, I must envy the girl who supposedly obtained THE MOST As in the recent SPM exams, obviously because she got MORE As than me and made the news, but mostly because at that tender age, she already has a firm idea of what she wants to be. Not just a doctor...but a cardiologist! Wow, so specific. If you recall, my list of ambitions is a mess of non-specifics. Corporate high-flyer - banking? Investment? Retail? Fashion designer - Pour elle? Pour homme? Haute couture? Ready-to-wear? Writer - magazine? Fiction? Journalist - print? Broadcast? Graphic designer - design what, girl? And of course, most recently, doctor -what doctor? Cardiologist? Endocrinologist? Palliative care physician?

Seriously, I don't know. Maybe that's why I did not "score" that many an As - my goals were not specific enough!

Never Too Old

2007-03-13T22:20:00.000+08:00

Confession : There's a child lurking inside my 31-year-old body (no, I'm not pregnant). Which explains why most of my favourite movies happen to be animation features, or why I'm totally smitten with this ages-18-months-to-5-years piece of toy.

Remember Furby, one of the earlier interactive toys to hit the market? I own one. Since med school. Mine's a mixture of glorious white and brown fur, with eyelids that bat and ears that wiggle. He sings, coos, plays hide and seek, acts bored and best of all, says "Furby loves you!" It was like a pet I never had. Well, Furby's in storage now but I have room for Elmo! So red. So funny!

I so need an Elmo right now (I'm on call tomorrow).

On-call "Locum" - Any Takers?

2007-03-10T22:42:00.000+08:00

Anyone wants to take over my call duty? With 3 of my colleagues recently taken off the medical officer pool to begin specialist duties, there're at least 32 extra calls to be had by the rest of us. Of course, I'm not terribly excited about this. At my age, my body (and soul!) doesn't take to exhaustion so kindly anymore. I suffer from pre-call depression, finding myself unable to have any fun the night before my on-call day lest I be punished for my good times with endless admissions and a night long of cardiac arrests and multiple other emergencies. I suffer from on-call lethargy, finding great difficulty even climbing out of bed to begin what could be the longest day (and night) of my life, as well as on-call anorexia, partly somatic, but mostly understandable given the inferior standards of the on-call meals provided. I also suffer on-call acute irrationalism, but this mainly concerns my superstitious behaviour (and not clinical judgement) - I abstain from wearing any bright, cheery colours; my on-call attire has remained consistent in my years of service. Only the gloomiest and most dull colours for me, thank you. I have even made my on-call house-officers change their shirts - what audacity, turning up in my wards in red and its family of hues! Finally, I suffer from post-call migraine, dehydration and bad-hair/skin. I also don't smile at patients that much and most certainly would not be in the mood to make small talk with them (I usually do).

So, anyone interested to take over some of my calls? It's after all RM 150 per on-call and an extra RM 20 on weekends (sarcasm very much intended).

Bananas Go Hungry!

2007-03-07T22:43:00.000+08:00

I'm feeling the full brunt of illiteracy in this little town I work and (temporarily) live in. I can't order food, because I can't read the menu! You might think that these things happen when I walk into posh, snobbish French establishments. But really, sometimes all I want is a bowl of prawn mee or chee cheong fun! Most food courts in Seremban carry signs only in Chinese, so most of the time it's intelligent guesswork and relying on visual cues. We're not stupid - if a stall has chickens on display then it's obvious what it is, but when things aren't so straight forward we boldly ask.

Me : What do you have?

Stall owner : These (pointing at the menu card)

Me : Hmm...(staring hard at the characters, trying to make some meaning out of it...fan (rice)...thung (soup)...)

At this juncture my husband valiantly stepped in with his usual "trick".

Hubby : So what would you recommend?

Stall owner : This is good, this also good (running his finger down the list)

We ended up ordering from a hawker next door who's obviously selling char kuey tiow!

Today we had dinner at a new eatery in town. To our horror the menu was entirely in Chinese (with the exception of the beverage section where Guinness, Anchor and Carlsberg were printed as they were - how do you say them in Chinese anyway?). And there was not a single pictorial clue!

Waiter : So what would you like to have?

Hubby : So what would you recommend?

We went with all of the waiter's suggestions!

I am not proud of myself. I'm sorry I didn't want to attend Mandarin classes in school. I remember my Mandarin teacher had to bribe me and some friends of mine with stamps to get us to attend his classes. We made off with some neat stamps from his collection, but I still can't read well enough to order from a menu in Chinese.

What bananas we are. We are so not proud of ourselves.

Someone's gotta work!

2007-02-19T22:28:00.000+08:00

When we were house-officers, due to the overwhelming number of Chinese colleagues in our department, my husband and I were not able to take leave. Both of us were on-call on new year's eve and by 4 pm I was the only doctor left in the ward. I had never felt so alone in my life! I was an ocean away from home, and for the first time in my life missing the reunion dinner with my family. But my MOs had other ideas. One bought us chocolate cakes from Hilton, one delivered a 5-course meal (befitting a reunion dinner) from Sarawak Club and another got us a whole roast chicken! And so the 3 of us (me, hubby and our MO on-call) had the closest thing to a reunion dinner while on duty, in the nurses' pantry! During that moment, we were indeed "family" - bonded by the common pain of missing our real families, yet deeply obligated to care for our patients, festivities or not. That night, as expected, admissions were few - I think there were only 2 after dinner; for fast AF and hypoglycemia. At 12 midnight, I stood by the windows on the 6th floor, and joined by my patients, stared in awe as the night sky exploded in a myriad of colours. Well, I guess I never could have witnessed it from this vantage point if I were some place else. I knew that in the other ward, my husband was sharing the same spectacular sight. Since then we have experienced several Christmases in the hospital and enjoyed the carolling and fireworks.

To our Chinese co-workers holding the fort during this holiday season, thank you. May you have fond memories of your experience, like I did.

Happy Valentine's Day!

2007-02-14T22:27:00.000+08:00

Dear hubby,

You're a lucky man. Your wife has a romantic spot, but oh, how she hates love commercialised. That's why she has never given you the cold treatment or throw a fit when you fail to give her flowers on every single Valentine's Day we've been through. I mean, 15 ringgit for a stalk of rose? (Or does it cost more now? Gee, I guess I'm out of touch). I'd think you foolish to fall for this kind of exploitation. And baby, diamonds are so politically incorrect. Who'd want to be adorned with these blood-tainted rocks? Who'd want to indirectly fill the coffers of terrorists so that more lives could be lost? (Yes, thank Blood Diamond - perhaps it's not all fiction after all). But you caught me totally unaware when you dragged me into a luxury (for us, anyway!) watch store - the intimidating sort with a glass door and snooty sales assistants - and got me one fine specimen! It cost you more than a month's salary, but remember this :

Watch : RM xxxx
Dinner for 2 : RM xxx
The look of joy on your loved one's face (that's me, of course) : PRICELESS

I guess I'm a lucky woman too. No, not because of that watch, but because I have you. Happy Valentine's Day.

Love,
Wife

Shit Happens!

2007-02-12T18:44:00.000+08:00

On my list of top 5 most dreaded bedside procedure : peritoneal catheter insertion. I think a lot is left to chance when, despite all the precautions we take, some mesenteric vessel or bowel might be sitting right where you intend to stab with a trocar with "gentle force", but force nonetheless, waiting to be perforated. Yes, it's a blind procedure, and I hate being in the "dark"! Is there no better way? Induction of a false ascites isn't necessarily trauma-proof either. I recall an incident sometime last year when my house officer informed me that, on withdrawing the 16G cannula after infusing adequate amounts of fluid into the peritoneal cavity, she had noticed the tip to be faecal-soiled. True enough, after staring at it for a good minute, I finally decided it was faecal material after all. I complimented my HO for her keen eye (it was a tiny speck!) and good sense not to have proceeded with the procedure, but informing me instead. In a place where someone is always to blame for something bad that happens, I told myself that night that I would stand up for this girl if anyone were to start finger-pointing. She had performed the procedure correctly; the patient was unfortunately a victim of a recognized complication of peritoneal dialysis. A former consultant of mine in Kuching once asked me, "So (my name), how many of the stab PDs you did that were complicated by bowel perforation/vascular injury?". Then, having been in service for 3 years, and having performed quite a number of such a procedure, I said none, feeling rather pleased with myself for the clean sheet. He said, "Then you haven't done enough!" and went on with his collection of horror stories associated with PD gone awry during his younger days. No, he's not condoning this practice of unwittingly rupturing guts and tearing vessels, but simply to state a point - even when you have taken all precautions, shit (pardon the pun) sometimes happens. If it hasn't happened to you yet, you're either very fortunate or not doing enough PDs. Since then I have caused 1 case of jejunal perforation; my patient however survived the laparotomy and went home well, if only with an unsightly abdominal scar. Needless to say, I was upset. With that I guess I had done enough. These days, I'm lucky to be able to delegate this task to my HOs trained to do PD. I look forward to the day when stab PD will no longer be mentioned in standard medical text, except perhaps under the section "A History of Renal Support"!

07.07.07

2007-02-04T14:48:00.000+08:00

Have you cast your vote? The competition for the New 7 Wonders of The World is on and you can vote online for your 7 favourite heritage sites (out of a shortlisted 21). At time of writing The Great Wall of China is leading the race...wonder if it has anything to do with China being the most populous nation. Malaysia, a young nation relatively, is not represented but please exercise your right. An event of such monumental scale transcends race, nationality and borders. Be a part of this historic, global event. Every citizen on this planet has a right to vote. I've done my bit - and I can proudly declare to my kids years on that I had a part in selecting our new world wonders. My choice? Why, Angkor Wat, Taj Mahal, Machu Picchu, the Pyramids of Giza, the Great Wall of China, Acropolis and Coliseum, of course! The final 7 will be announced in Lisbon on 7 July 2007.

Beatocello!

2007-02-02T21:23:00.000+08:00

Let me present to you Dr Beat Richner and his cello...otherwise known as Beatocello! He sings, plays the cello, cracks a joke or two, and talks passionately about his work in Cambodia. On a recent trip to Siem Reap, I had the opportunity to attend his concert and meet him in person. Dr Richner is a Swiss paediatrician who helped set up several non-profit hospitals in Siem Reap and Phnom Penh offering free medical treatment to sick children
(www.beatocello.com/Assets/richner_history.html). The operating costs of these institutions are funded by donations alone. In between his cello solos, we were shown videos depicting the sad state of healthcare in Cambodia. Picture this : mothers ambubagging their own children for there was no ventilator, children getting infected with HIV-tainted blood as there was no facility for donor blood screening, the still widespread use of chloramphenicol as a first-line drug for the lack of a better but more expensive option. His point is, why is it that standards deemed unacceptable in the developed world still apply to poorer countries? Aren't these children worthy too, simply because they come from a less-privileged background? Well, he is a remarkable man, and the locals speak highly of him. Wished there were more individuals like him around.

Beatocello plays every Saturday at 7.15pm at the Jayavarman VII Hospital auditorium. If you happen to be in Siem Reap, take a break from the temples and go experience Beatocello. It might be life-changing.

Laughter The Best Medicine?

2007-01-17T22:29:00.000+08:00

My hospital has recently introduced a weekly program whereby staff from every department put up a show...for the patients! Missed the inaugural concert today, but caught a junior MO lurking around in a deserted part of the hospital after the show ended. Couldn't resist this photo opportunity.

I wonder if the patients mind being hauled to the auditorium for a show they did not ask for. I was asked to sign a "certificate of fitness" for a patient to attend - fit i.e. not on oxygen supplement, not on an intravenous drip, not incontinent, not oozing secretions from any body parts etc. You get the picture.

Anyway, it was a good effort. I mean, bumping into a clown lifted my spirits today! I just shudder to think what my department will come up with when it's our turn to entertain. I can't sing and I can't dance, so I'll probably offer myself as the "official photographer"! Watch this space for more photos.

Dare To Fail

2007-01-08T23:28:00.000+08:00

Still on the subject of exams, do you know that I sat for 3 mock exams before going for the real one? Surely this smacks of a certain degree of kiasu-ism, but it's nothing like that. I truly needed all the practice I could get. I wasn't comfortable displaying my clinical skills (or lack of them) in the full view of a disapproving audience. With some years of experience behind me I liked to think that my competence and skills are reasonable. Suddenly you have to sit for possibly the most stressful exam in your adult life (for me, that is) and you find yourself in a position to be judged and criticised. In my mind I could almost hear a senior colleague snigger, "you mean she's going for exams?" while I struggle to pick up the right murmur, determine if there's really a spleen or differentiate coarse crackles from fine ones! So there, the greatest hurdle for me was swallowing my pride - it's all right to look stupid if I can learn from my mistakes. The mocks were essential. The first I paid for. Dato Kew said that if we found it useful we should tell our friends about it! Well, it was useful for me. Watch out for the IMU-PACES prep course this September.

Participants of the 2006 IMU-PACES Preparatory Course

The second took place in my hospital. The third, in Kuching - I got to attend by virtue of having been one of them. Thanks, you guys in the medical department of SGH! And oh, I did not pass a single one, but what's more exciting was that my marks improved with each attempt. I thought that was the perfect run up to the actual event. I was so psyched by then I took to presenting mock findings in front of the mirror, in my suit - and I thought I made a handsome candidate too! Now I look forward to helping to organise a mock exam for the next batch of candidates from my hospital who are going for PACES, simply because I want to do my bit in return.

Happy 2007!

2006-12-31T11:19:00.000+08:00

Resolutions are made to be broken, yet we make them anyway, year after year. I don't remember now what I intended to set right or make better in 2006, but it was a year of milestones for me. Here's what I mean :

I ditched black tea for coffee, then upped my caffeine quotient from 1 to 2 cups a day
I purchased a new car, then rediscovered my ability to drive one (yes, in that order)
I moved into new house - our first property
I passed a crucial clinical examination, but not before failing 3 mocks earlier
I got myself a DSLR - gift from hubby

So was it a good year? Not the best year of my life, but good enough. In 2007, I hope for a more laidback lifestyle, more holidays, more photo outings, less caffeine, and perhaps, a baby!

HAPPY NEW YEAR!

How Malaysian Are You?

2006-12-08T20:08:00.000+08:00

Is there a way to measure how Malaysian one is? It is a matter I never gave much thought to until recently. For me, I am about as Malaysian as any Timah, Danapackiam and Hock Seng. Or heck, as any Gurdev Singh, Timothy anak Boniface or Ignatius Anthony. Yes, I am Chinese, but being Chinese AND Malaysian isn't mutually exclusive. I am Chinese because it is in my genetic makeup. It means that I have a predisposition to certain medical conditions associated with this race. It means that I have less melanin in my skin, that I burn more easily in the sun compared to my other fellow Malaysians. It means that someday I will probably visit the country my ancestors came from, and try to feel a spiritual connection with that place. It means that I will celebrate an age-old tradition associated with ang-pows and firecrackers and all things red and that my mother will chide me if I wash my hair on the first day of that said celebration. It means that I am expected to know how to speak in a tongue that is the tongue spoken by my mother and father and their mothers and fathers. And well, I think it also means that I am more likely to have slanty eyes and stick-straight hair (you pretty Chinese lasses and lads out there may beg to differ). And so, being Chinese, does that make me any less Malaysian? I was born and bred here. I never knew any another country other than this to which I belong to. I learnt to write in Bahasa Melayu and English way before I could write in Chinese. I went to a national school, where I fought with, befriended and played football with Kai Sian, Nurizam, Vengadesh and Yan Ni - and they were just as they were, friends with tan variation because their genetic makeup dictated it (unless you were Michael Jackson). I cheered for our team in the SEA/Asia/Olympic Games, whichever country they were up against. I pay my taxes; I serve my people - my patients have consisted of Malays, Chinese, Indians, Punjabis, Ibans, Bidayuhs, Melanaus and various other "minority" races, and in this context race only mattered in predicting what kind of illnesses they were more likely to get. I speak fluent Malay, English and a handful of Chinese dialects, and a smattering of Indian and Iban which is extremely helpful in my work. No big deal, I agree. Most of you are like me - there isn't really any need to declare how Malaysian you are, because we already are! So don't confuse me by telling me that I am a "minority" race, that I was blessed to be granted the right to live in this land that was not the birthplace of my ancestors. Like I said, I know of no other country to which I belong. Recognize that we all have differences, just as there is heterogeneity within a family or a racially homogenous group, but please, don't make such a big deal out of it. I am as Chinese as I am Malaysian. That's how Malaysian I am.

*some names have not been changed

I PASSED!

2006-12-08T13:58:00.000+08:00

Professional milestone : I passed my PACES! Yes, it's no big deal - thousands of people pass each year. What's another physician? Well, I did work hard (no movie for a month!) and therefore I think it's blog-worthy! I realise that this is only an entry rather than an exit exam. I also realise that this is the beginning of more challenges to come; passing is by no means a right to exemption from hard work or continued learning. But allow me to be shallow just this once - passing is great for numerous reasons having nothing to do with career advancement. Passing, for me, means

I can go to the cinema every week and not feel guilty (I'm a movie buff)
I can spend the money I have set aside for a second go at the exam should I not make it the first time eg. vacation, DSLR and lenses, more shoes, more bags
I can pack up Baliga's 200 Short Cases for good
I can spend my weekends away from home
I can go to the library after rounds to look up journals of interest rather than hunt for short cases and beg for people to take me for these cases
I can start my own blog
I can start a family!

Of course, I will strive to be as good a physician as I can be. To my consultants, specialists, medical officers and colleagues past and present, thank you for your hand in moulding me into the doctor that I am today. Once, I aspired to be you. Today I am a step closer to that goal.

I've Been Hugged!

2006-11-26T15:51:00.000+08:00

I am a physical person. Beyond the contact required for a proper and thorough physical examination, I like to put my hand on my patient's shoulder, or hold another's hand - to reassure, to console, to convince. But a hug? A patient of mine took me completely by surprise one day. She was a frail elderly Indian lady who spoke little Malay. As I helped her sit up on her bed, she put her hands behind my head and hoisted herself up, then brought her head to mine, held it there, forehead to forehead for all of 5 seconds while making gleeful sounds! When she finally let go of my head I just stood there and gave my house officer a stunned look. Her daughter then added that it was her way of saying that she liked me! How cute. Once, when I was a house officer, I treated a lady for hypoglycemia. When she regained full consciousness she sat up in bed and hugged me, expressing her gratitude with a dramatic "thank you doctor, you saved my life!". Maybe she was still delirious from the effect of hypoglycemia. In a more sombre situation, a young man, full of grief, just lunged forward and hugged me after I broke the news that his mother would not survive despite all that we had done. Moments like these serve to remind us that above and beyond our ability to wield a scalpel or accurately diagnose and treat an illness, there is something else that is powerfully therapeutic - for patient and doctor alike. Like a hug!

The Most Difficult Thing

2006-11-25T22:16:00.000+08:00

What is the most difficult thing you have ever done? In my world, I am not required to be a genius; yet one skill had eluded me for most of my adult life. In that aspect I should be considered a moron, for this was a task a former boss of mine used to describe as something "even attendants and cleaners in the hospital can do" but which I could not (I mean no disrespect - I appreciate what the hospital support staff do). I have been a Mensa member since my teens; I perform medical procedures; I am a Bejeweled hi-scorer but I COULD NOT DRIVE A CAR! I had in my possession a valid driving licence which was practically useless. I did not think I could reverse a car out of the driveway even if there was an emergency. So what went wrong? I passed my driving test (though it took 2 attempts), zipping through PJ at lunch hour in a Proton Iswara. After obtaining my licence my dad would take me driving around the neighbourhood, outings that sent him into panic mode and which forever cemented the belief that I could not drive a car. Truth be told, driving terrified me. I did not feel in control - I could not shift the gear while looking at the road, and if I looked at the stick shift during shift change the car veered off its path. It was just so difficult for me! Somehow, somewhere there must be neurotransmission dysfunction. Psychomotor dissociation. Uncoupling of intention and execution. After that I never wanted to try again. It did not help that I always had someone to drive me around; first my father, then my husband. Dream car? Never had one. Petrol price up again? Not affected directly. Beneath this blissful ignorance was a sense of failure. My wings were clipped; I was pathetically dependant. Today I am driving again; I have been driving for the last 5 months. Let just say circumstances dictated that I drive or crawl to work. So I got myself a new car - my first car! I will always still be a psychomotor retard, but haven't you people heard of the wonderful invention called automatic transmission? I took intensive refresher lessons (my "instructor" was none other than my husband who was as hysterical as my father; fortunately our marriage survived my driving) and on the 1st of June 2006 I made my solo trip to work...intact! Pure relief spilled from every pore in my body and I called my husband at work just to announce that I had made it (something in the spirit of look-ma-I-am-walking)! I know this is trivial to many of you but this is a BIG deal to me. It is no more the act of operating a vehicle than it is one of overcoming your doubts and fear. Today I am driving, secure in the knowledge that in an emergency I am able to send someone to the hospital. Today I am driving; who knows what I can do tomorrow? This is how powerful it is, this lesson that things are difficult only if you believe them to be. My sister also took up driving again this year, many years after obtaining her licence. She put it succinctly - emancipating. 2006 is a good year indeed for the women in my family.

The Best Place To Call Home

2006-11-24T23:41:00.000+08:00

According to the Malaysian Urban Indicators Network, which measures the sustainability of development in towns and cities, North and South Kuching emerged as the second and third best city to live in respectively (NST, November 5, 2006). Hooray! My excitement isn't without reason, although I am not from Sarawak. I have lived 4 significant years of my life in Kuching. I loved the city and its people, and the lack of traffic congestion and garbage littering the roads. I appreciated its simplicity and unhurried pace, and the fact that I felt safe on the street. All right, I must admit that I did find the cat statues in town somewhat kitschy. Check out this picture.

My husband and I had to move back to the Klang Valley about a year ago for his postgraduate training. Someday I will return...or maybe relocate to Malacca, which by the way, came out tops in the evaluation. Chicken rice balls washed down with cendol ais? I can live with that!