Sep 28, 2005

Dodgy disturbing thoughts

posted by a mamat:

have u guys read the star newspaper report on Spiderdog
asians learning to spend their weekends n
reducing the working hours…well i just dont feel
part of this new sensation or watever u wanna call
it as we the future drs have to work for hours n ppl
still think that its acceptable…just bcos the senior
drs have gone through the phase n some still do
it…n say that its a pride n a responsibilty…well we Spidermouse_1
have responsibility not only to pts but to ourselves,
family n happiness…without those will I b able to
sit my ass thru these 5 yrs of medicine?…how can
something b normal what its not…we r lying 2
ourselves…the truth is plain 2 see..theres only so
much u can do in a day 4 pts…sigh

define normal, please.

is it normal as in what the majority of public is going through is considered as normal?

normal 9 to 5 job and continue the normal day by entertaining our children and helping our ladies with the normal dinner or so, or had a normal evening of minor sport games?

I hope someone out there could enlighten me. We had so many medical schools all around malaysia producing so many medical doctors, yet we had insufficient doctors to attend to patient. I heard postulation/speculation that many doctors (pardon me) after they had their title (having the government supporting their study so far), they went into other non-clinical - insurance, politics, health admin and most could not handle the stress in the line of duty and decided to be housewives.

Could this be the reason why doctors still shouldering a large burden in the line of duty?

"theres only so much u can do in a day 4 pts"

Maybe being more in the medical field, one had forgotten that at the end of the day, we are also human. There will be a day, or maybe two day, or maybe more, when we will be in the hospital bed, being severely ill and hopeless. Then, would you be hoping that the doctor could have done more for you?

One maybe dreading long hours of on-call, blood taking, writing the consultant’s words without thinking, tracing results, reviewing old notes, preparing IV drugs, retracting and stitching up at OT, and listening to patients grumble about difficulty in breathing after they had smoked a few puff but at the end of the day, we are not the one with CA of head of pancreas.

Doctor is not god, and should not be playing god, but please reminded that

Me_as_spidey "with great powers, come great responsibilities"

If you can’t handle the responsibilities, you can always strip away your powers and lead a normal life. Not that you’re being bitten by a radioactive spider, right?

P/S anyway, mamat, you always have the SLAB to shorten your "suffering", right?

Skinned alive by THI HAnnibal

Finished my surgery posting with an unforgettable long case, with the cheeky uro specialist, Thi Ha. Yep, he is the same guy that told us about "no pride in having a long ***** "

Sing Yee had obstructive jaundice

Helmi had upper GI bleed

Nadia had colorectal ca

Images_3 I had MALIGNANT MELANOMA. Oh gosh! I just briefly flipped through this topic in the morning - totally zielsch nil zero recollection about it.

the whole session was not depressing or pressure mounted, but felt like answering SAT (short answer test) in long case.

Dr. Thi Ha asked me about:

  • types of melanoma? beats me. benign and malignant?
  • what is subungual melanoma? i bullshitted about darkened skin or melanoma under nail bed, causing eversion of nail, deformed nail, may cause gangrene at the finger tip if circulation was affected. He laughed and told me only the first part is enough.
  • complication of TPN? knew the drill
  • types of radiotherapy? got the common types covered - PO, external beam, brachytherapy… missed out on IV for sarcoma
  • non-neoplastic diseases for radiotherapy? i knew Grave’s nia. then he reminded me of Gamma Knife for trigeminal neuralgia, epilepsy, AVM…
  • tumor lysis syndrome? knew about it, but could not answer completely
  • many many other question which knocked me down flat, really flat.

though, I learnt plenty of stuff from him

the most depressing thing is I am the last person to present my case.

Waiting there for hours and hours and hours and hours…

Sep 27, 2005

Banner, anyone?


Click Here!

A time to die

BMJ is currently discussing about the issue of euthanasia.

"there are signs that a majority of UK doctors now favour legalisation of physician assisted suicide with stringent safeguards"

This is very much depressing, and I particularly support this chap below

Eugene B Wu,
Interventional fellow, cardiovascular division
Brigham and Women’s Hospital, ppb-1, 75 Francis Street, Boston, MA 02215, USA

"The position the BMA has taken on euthanasia troubles me deeply. Truth is not determined by head counting, right is not determined by votes, and good is not determined by law. Ethics cannot and should not be determined by popularity. The turning of the tide of opinion about euthanasia does not make euthanasia right. Democracy may be a good way to select a president to run a country, but it is not a good way to do ethics. Slavery, eugenetics, female genital mutilation, ethnic cleansing, and infanticide have all be democratically deemed as good in other cultures and in history. To suggest that just because many people agree with euthanasia and therefore we should legalize it is simply bad ethics.

Those who say that "They wouldn’t let a dog die like my old dad died", may be failing to genuinely appreciate the gross difference in the value of life between his old dad and his old dog. The value of human life is not determined by votes, nor by law. Philosophically, assuming all men are created equal, then, the value of human life is at least as great as the value of my life. Therefore, I am at no liberty to take another man’s life and also at no liberty to take my own life. Since my life is valued higher than my autonomy. In fact, this should come as no surprise to practicing clinicians as many of us have persuaded, argued, and limited our patient’s autonomy for beneficience. From the simple persuasion to stop smoking after a coronary stent to a desperate warning against further alcohol in liver disease, we put their benefit above their autonomy. If we are willing to so discard their autonomy for modest benefits, how much more should we be willing to do so for life?

Historically, doctors have stood out against the crowd on many issues. Even today, doctors in Africa recommend chastity to prevent HIV. Our stand for clean water, vaccination, healthy diet, tobacco use and alcohol use stand against the majority trend of our societies. Our recommendation is more passionate and more urgent than the manufacturer’s "smoking is a cause for lung cancer" label on the packages of their products. When did we, as a profession, lose our guts to stand up for what is right?

As an ageing physician, I unwisely yearn for the days when medicine was a professional vocation, when patient’s trusted their doctors, when legal threats did not impact our decisions. There are many reasons for the degeneration of our profession and the lost of trust of the public. Perhaps one of them, is that we are becoming like the public, for we no longer stand upon ethics, but upon opinions.

Let us not change our position on what is right based upon votes. "

Are becoming more like public? I had to have a closer look at my fellow members of my fraternity…

Something new, there’s an interesting findings about higher risk of neh neh cancer in the left-handers char boh.


The college administrators yet again pulled out a no-brainer stunt of spot-checking us for electrical appliances and prohibited items.

Several signs that they were idiot moron nincompoop blockhead dimwit donkey dumbbell imbecile jackass jerk meathead nitwit pinhead typical low life:

  • Last spot-check, they have it the night before our exam at 1am. they don’t even introduce themselves and force their way through into the room with the spare key in their hand.
  • Current spot-check, they even brought guys to go around ladies’ hostel. Just a soft-spoken "spot check" and within seconds, they opened the door to the room with the spare key. One of my coursemates were changing her attire at that time. Ain’t this all just insane? Why don’t the pengeTUA-TUA give us a spare key to her house?
  • They confiscated electrical items, but surprisingly, they left the cigarette packs alone.


Typical reply "Jika tak suka tinggal kolej ini, boleh tinggal lain tempat."

Sep 25, 2005

Onae mai wa?

Found a japanese name for myself:

松尾 Matsuo (tail of a pine tree) 明 Akira (bright)

song wei ming

The website is pretty cool, to put my mind off, especially after getting some darn unexpected question about complication of total parenteral nutrition in my end of posting paper exam just now. Luckily, Helmi discussed it a bit just before we entered the exam hall just now. Should have discuss it in greater length.

Here’s what I found about Matsuo Akira.

You can go here for the name generator site.

You can also get a name for your penis. I took the liberty and generate a name for the **** of my friend by the pseudonym Shawn Haririe

It’s called "Hannibal the Perky Spaghetti Strand"

Major events

Deeply shakened by the demise of my PC monitor that I forgotten to update about 2 major events in Medic Fac lately.


Well, that’s what left on the big board behind the stage on the same night this program ended. It is actually the Mass CPR program, last tuesday, organized by UMMC Emergency Department. The main person behind this is Dr. Ali. It was held at our dining hall, all first years and final years is in the program.

In the morning, the final years had to practice and fine tune our CPR skills till we were darn tired, and as Dr. Ali defined it "You had to practice till you sweat in your underpants"

1st response: *EWWWWW!!!*

2nd response: *wouldn’t that predispose us to anal fistula, fissure, etc*

After lunch, we had a short on-stage sketch with dance, which I had practiced them rather haphazardly, but I followed the "veteran" dancer - Norliadi well, and managed to get through the dance without creating too much of attention or humiliation on my behalf. The sketch is actually based upon Akademi Fantasia, and I am the only chinese participant there. I was there because most of my groupmates in Surgery was there - Shawin (tall, dark and buttless main actor), Aishah (gypsy lady), Nadia (perky girl). Racism apart, beside me, I don’t think others would be interested to join us.

Lkp_092005_006At first, I was rather negative about the whole sketch revolving MAINLY around the dance, which is rather difficult to choreograph and seems meaningless to the whole CPR program. But, it turned out to be a "blockbuster" as mentioned by Dr. Ali.

My friends actually found that the dance is the main attraction point, something different from the previous years, where it only involved amok shouting, and non-sensical shrieking, and people collapsing everywhere without any obvious entertainment value.

Everyone, especially the juniors, had a good laugh at me for dancing, not because I was funny up on stage, just because they never would expect me to be dancing so well (ahem…) on stage. Ok, maybe I should say, dancing just ok.

My buddy, Tracie, jokingly asked me after the CPR program: "Have you ever seen a dancing pig before?".

"No, I haven’t seen you dance before, even if you do, I don’t want to see it" was my reply.

Lkp_092005_002My partner for the program was Choo Wei, and my trainee were Shi Peng and Aik Kheng. Well-trained. Actually we were quite strict during the teaching. He He. Pretend to be strict only.


last saturday, at Dewan Jemerlang, UM medic faculty, officiated by Tun Dr. Mahathir, MPPSR "malaysian physician for peace and social responsibility" headed by Dr. Ronald McCoy, with one of the committee members being my beloved medicine tutor when I was in Klang, Dr. Raveendran.

I guess I had to agree with this mamat. If without the presence of Tun, the attendance of such event would be like the attendance for out PPD class - sinisterly low. Some of my friends actually were so desperate to take picture with him that they made him the background.

P1020083 It is the first time I meet Tun up close - he’s really larger than life. And he made good speech about the ‘primitive’ world we are living in. He’s right. Killing one person, you are labelled a murderer, but killing a few hundred millions of people (ie in Iraq) is alright.

Beside the speech by Tun, there’s 2 striking things I love about this event:

  • The food: mushroom egg tart rocks!!
  • The vision of Dr. Ronald Roy: "We have got rid of human sacrifice, slavery and apartheid. How did we do it?" he asked.

I realized that there are "impossibles" that we can just accept them to make our life easier, or these "impossibles" are something that we can really strive to make it possible and make life more wonderful for everyone in the generations to come(sounds like an old man d), by every simple effort that we can, or at least by having the faith in it.

For more about MPPSR, go here and here and here.

Sep 22, 2005

BPH: Men’s inevitable enemy

Had urology clinical skills session with Dr. Thi Ha, and followed on by an observation of an insertion of the bladder catheter with the rigid steel introducer into a complicated case of post-op BPH. He failed to get in after several attempts and he found the main problem - the introducer is not long enough. It was a very painful experience for the patient.

(Far from the patient) He commented, "Student, you see, there’s really no pride in having a long *****." and he cheekily smiled.

All the guy urologist kept telling the patient as well that "their time will come". And I realized, my time would come, too, if I live long enough.

Apparently, BPH is an almost universal phenomenon in men as they age, beginning at 45 years old and continuing until, by age 70, 90% of men have an enlarged prostate.

So, calling all men alive out there, who still do not realize this fact, you better be forewarned. Here’s an interesting place and here where you can get information about BPH and it’s integrated relieving factor from music therapy to herbs to color therapy.

Dog_flu_1 By the way, here’s an interesting new flu - DOG FLU.. how do they got it? being horsy with some horses perhaps.. read more here in New York Times.

HELP: Monitor Black-Out

My computer monitor just don’t live long enough to see me finish my medical school. Here’s the history:

4years/LG monitor 15"/white housing

with chief complaint of generalized blurring of pictures into black and white stripes

  • first episode, no past history of mechanical or electronical problem
  • gradual in onset
  • intermittent, usually 3-5minutes
  • progressively becoming worse
  • initially relieved by moderate tapping of the monitor over the lateral left
  • but symptoms came back, I had to remove the cover and push gently a panel behind to make it better
  • insidiously, 3 days ago, the screen had blueish discoloration followed on by greenish discoloration, not relieved by the previous method
  • then, it became black over the screen, but the whole circuit is still running, because i tested it with a test pen.

Any computer expert with a solution?

Anyone out there near PJ with a spare computer monitor viable for loan (just for 6 months more to go) or anyone with a reliable second hand monitor for sale?

P.S. Idio_syn, the vids in the pc, I can’t extract what I can’t see. apology for tht delay. The vids is of bad resolution anyway.

Sep 21, 2005

Pissed to death

Doing surgery now, exam next week. Very pissed by my assessing lecturer - for various reasons, alpha to zeta, the below conversation being only one of the mild irritation. Maybe he’ll stumble upon my blog and see this, and decided that’ll be the end of my career as a future medicine man. Like I give a **** (star?fork?damn?). Bottomline, I had no bad comment for him here, because the whole world around me is choking with worse comments for him. For him, his reputation is so low that one had to start digging. Come to think of it, I really sympathize him. Poor thing, going through life without anyone telling him the hard cold truth that could make him a better man. I hope after I had graduated from UM, I could send him something to tell him FRANKLY his mistakes. Hopefully, it could reform him, unless at that time, he is still stiff as a prick.

I told my groupmate "He is actually a very good example to all of us. A very good EXAMPLE that is bad to follow."

Him: "why are you late?"

Me: "got mild diarrhoe" (i sincerely do have one episode)

Him: " do you want me to colonoscope you?"

Me: (silent) ………….

(thinking in my mind "next time, when you had diarrhoe, let me have the honour,dr")

This message goes out to all my friends and people who are junior to me, if I am a prick, please tell me straight to my face, or in a more Asian way, send me a note or memo. I would like to take this opportunity to thank all my friends who reminded me of my mistakes over the years.