Aug 30, 2010

obstuesday | to jab or not to jab?

This is a clinical scenario (or you can call it predicament) that a fellow O&G enthusiast brought up in her facebook status.

"28 yo G2P1 @ 31w, GDM with BSP 6.3/4.1/4.2/4.3
is it wise to start insulatard based on fasting dxt only?"
(the proper formal long version would be: a 28 years old lady Gravida 2 Para 1 at 31weeks gestation, with gestational diabetes mellitus coming in with blood sugar profile of fasting 6.3mmol/L, prelunch 4.1mmol/L, predinner 4.2mmol/L, prebed 4.3mmol/L, is it wise to start insulatard (insulin) based on fasting blood sugar only?)

Along the comments, there were some suggestions on starting oral hypoglycaemics and referrals to the medical team.

My answer to her was:
Acceptable level of fasting BSP is 5.3-5.7, i hold the threshold of 5.6
at the level of 6.3, authenticity of the BSP must be questioned thoroughly (her diet and how BSP was taken)

As the protocol suggest and the normalcy of all postmeal BSP, diet control with the proper referral to the dietician should be the first move before an abnormal repeat which indicates a stronger indication for the commencement of insulin therapy after counselling of the patient regarding the indications, benefits and risks (mainly iatrogenic hypoglycaemia) of it.

Having said that, jumping the gun to insulin without trial of diet control may be warranted if there are past supporting evidence for poor glycaemic control ie. first pregnancy was shrouded with GDM on high dose insulin, first child which is macrosomic or with abnormalities associated with high gestational glycaemia, or a grossly deranged MGTT results or ultrasonic evidence of fetal abnormalities associated with poor glycaemic control in this pregnancy (of which these details was not given)

Although insulin is the gold standard for good glycaemic control, in selected patients, which have poor social support,resistance to hospitalization for insulin, morbid fear of needles/pain related to it, or just refusal (or poor country with insufficient budget for insulin - this is input from Ainy Nor), OHA can be considered only if the administration properly guided by consultation with a MaternalFetal Consultant.

referral to medical or the endocrine team is reserved only for patients with poorly controlled BSP with high dose of insulin or patients with volatile glycaemic control with bouts of life-threatening hypoglycaemias.

(short) refer dietician, repeat 2weeks, if fasting BSP >5.6, start insulin after counsel patient.
to jab or not to jab?
think thrice before jab.

P.S. Happy Merdeka to all. I'm on call. Haiz.

Aug 29, 2010

medical monday | the muscle of AVF

I was discussing with my colleague that after having the diabetes, hypertension and stroke combo (not me), the worse would be to be down with renal failure, especially end-stage.

She mentioned not only the long term repeated financially-draining dialysis, it is difficult to look for a good surgeon to make a good arteriovenous fistula.

I couldn't have agreed more. With so much of AVFs failing and creation of the new one, probably will make the whole arm looks 'muscular'.

IMG 0253 590x442 Funtabulously Frivolous Friday Five 026

Do you know?

Compression of AVF can cause bradycardia.
It is called the Nicoladoni sign.

A slowing of the heart rate (bradycardia) in response to (manual) compression of an arteriovenous fistula

A circulatory phenomenon observed in angioma racemosum of the extremities.Compression of an arteriovenous fistula causes bradycardia…if there is a significant circulation through the fistula.The phenomenon was first described by Nicoladoni in 1875, then by Israel in 1877 and Branham in 1890, and subsequently rediscovered by Wigdorowitsch in 1915.

misc sun | tutup aurat | takes two

And for her insensitivity and ignorance, YB apologized.

What about the people below?

Ini juga gambar Rosmah Isteri Najib yang dibanggakan oleh
penyokong UMNO/BN.. juga memperlihatkan aurat didalam Masjid.

Ini gambar lama.. Puteri UMNO sedang
membaca Al-Quran sambil mendedahkan aurat

P.S. 1Malaysia? From outside we're all similar, just that deep down inside, probably level of hypocrisy a bit different.

misc sunday | Penang ping pong kakis?

Really missed the lunch hour ping pong session in SP.

Will the ping pong kakis in the island, please stand up.

Aug 27, 2010

solemn saturday | nuzul al-quran

Yesterday was a public holiday in my state, which I found out a few days earlier.

There are so many public holidays in this country, that it is rather difficult to keep a tab of significance on them.

Public holiday is not just a rest day, it is a day of significance where something is to be rejoice for, for one community or another. Yet for some people (most people) especially people who worked madly throughout the week, it is a truly well-deserved rest day.

Yesterday was Nuzul Al-Quran.

In the history of Islam, Nuzul AlQuran marked the revelation of the first verse of the Holy Quran to Prophet Muhammad (PBUH) on the 17th day of the month of Ramadhan ( or 6th August 610) in the Cave of Hira in the Mountain of Light. Immediately on that day, the Quran was shared with His friends and family. The Quran was revealed in stages in a period of about 23 years.

The word Nuzul meant transcend from top to below.

AlQuran needs no further explanation is the holy Book of Islam.

No, don't get me wrong. I'm not embracing Islam. I'm just want to have a slightly deeper understanding on the Main Religion of my country and the religion of my fellow friends and colleagues.

In Buddhism, there's no grand main Holy book.

But there are many, many, many Holy books, which can fill the whole section of a library. And that is the truth, not to be misunderstood as bragging.

Going back to history, after Enlightenment, all the Lord Buddha teachings went by sayings and words of mouth without any literature note down.

His first discourse was at the deer park of Sarnath, India to five monks on Dhammacakkappavattana Sutta (can u read it in one breath?).

His first few line of address was:

"There are these two extremes that are not to be indulged in by one who has gone forth. Which two? That which is devoted to sensual pleasure with reference to sensual objects: base, vulgar, common, ignoble, unprofitable; and that which is devoted to self-affliction: painful, ignoble, unprofitable. Avoiding both of these extremes, the middle way realized by the Tathagata — producing vision, producing knowledge — leads to calm, to direct knowledge, to self-awakening, to Unbinding." (in short, do not go into the extremes)

And He further explained the 4 noble truths and 8 fold path.

And further teachings of Gautama was massively recollected after He attained Nibbana (physically passing away, spiritually free from circle of rebirth - is just a simple way to put it).
The recollection of His teachings of 300 plus occasions over fourty-five years were put into words into Dhammapada.

Dhammpada text on a pal leaf
This Dhammapada palm leaf manuscript (44.5 * 6.5 cm) in Sinhalese characters, of which the first and last pages are shown, is believed to be the oldest extant copy of the scripture. Photo: Courtesy of K. D. Paranavitana, Assistant Archivist, Department of National Archives, Colombo, Sri Lanka.
Therefore, when a Buddhist being stumped by the question "So, what is your holy Book?"
The answer is
Not Dhammapada
Not Dhammacakkappavattana Sutta

"We don't have a holy Book, we have a holy Library of them."

P.S. Happy berpuasa to all my Muslim friends and families!

Aug 26, 2010

film friday | SALT overrated


A few months before this faithful show went up the big screen, I had a short glimpse of the promo clips in the TV section of Tesco Utara Sungai Petani while taking little Aedan for a stroll.

Both Aedan and me stopped to watch this action-packed clips. I resisted the urge to complete watching as I knew Aedan is too young to be exposed to too much of violence.

I was thinking, this probably gonna be the movie of the year, and I just couldn't wait to feast on it visually.

The name of the show 'Salt' does leave a lot to be curious about.

But when I really sit down and watch it, I am like 'Duh!'.

Angelina Jolie at event of Salt
Bye, bye, lousy movie which left me injured

Few reasons that I couldn't really put myself into kissing this show are:
  1. Mature audience don't appreciate superhero in a form of a lady, no matter how cool you may look at one time or other. That's why 'Heroes' and 'Smallville' are appealling to many.
    We appreciate some vulnerability like her portrayal in 'Wanted'.

    Come on lar.
    First, she 'macqyvered' the bomb for escaping, then she 'chow yun fatted' the killing of the masses of security force/spies (both Americans/Russians) and finally 'jasonbourne-ed' the scaling down the elevator shaft without a single dirt on her clothes. Perhaps that small scene will be perfect for some detergent's advertisement.

    Even if she was being injured, she was like shouting out with her cool look 'Is that the best that you can do?'

  2. The whole plot was like a bigger scheme of the Hong Kong hit 'Infernal Affairs' with the police-criminal combo switched with American-Russian, and A.Jolie was the Andy Lau, who decided to be with the American, despite of her Russian root.
  3. Heavily-spiced with action, makes one wonder - where has the beauty gone? No portrayal of AJolie's sexy side, except for the initial torture scene in underwear tainted with bloods and torture. Calling the emotional part (pathetic glimpse of A.Jolie's cartoonic interaction with his on screen spidey hubby) super-amateurish would be praising it.
Angelina Jolie at event of Salt
Arrested for not being in a better movie.

P.S. This movie is simply pale against the hit 'Inception'. Almost a pathological pallor with hemoglobin of 6 g%.

Aug 25, 2010

tanahair thursday | meritocracy racist?

Tun M made an interesting entry, calling all meritocrats as racist as other racist's organization like Malay NGOs and Perkasa.

His reasoning was

And the slogan "Malaysian Malaysia" continued to figure in Malaysian politics, evolving into a new catchword, "Meritocracy". If "Malaysian Malaysia" conjures equality between races, "Meritocracy" implies something stronger. It implies dominance by the race with the greatest merit in every field; in education, in business and in all fields of human endeavour

Counting down to our Independence Day and Malaysia Day, if you actually read the papers, mainstream or otherwise, you'll realize that the word 'racist', or words of racial-chauvinism surfaced one after another.

Someone warned us all about the fast-ticking racial time bomb.

I suppose I should be worried. But then again, when too much is being said, being mentioned, being banged down our eardrums, it will become trivialized and probably in due time, transcend into a joke.

Maybe by Merdeka, I will probably be sitting beside another fella Malaysian with different quantity of melanin and I will question his racist's status.
"Of course, I'm racist. Who isn't nowadays? Haha."

Plus, if the government is serious about weeding out racists, they should probably enter a few lines in their jobs application forms.
Tick if you
[ ] a racist
[ ] occassional racist (when I can gain political mileage)
[ ] like to write racist's stuff
[ ] talk racist's stuff
[ ] discuss about racist's stuff
[ ] not a racist, unless required so
Something that I don't really understand, or just that people are just too blind to realize that we want the best for the country and being the best ain't restricted to a certain race.

It is certainly rather insulting and disappointing when someone works so hard, day and night only to have his/her celebration of success being called off by others as something he/she got from the national crutch.

Perhaps the crutch is relevant back then, where peaceful contentment can be created without creating something of the 1998 Indonesian racial meltdown.
The question facing us today is whether or not that path has run its course, and its time for us as a nation to change our tack. Are we ready to rid ourselves of our training wheels?

In summary, let's us all together make a bigger pie, so that everyone can have a larger slice. Rather than keeping up with a small pie.
Even having the biggest portion couldn't have fill up a small corner of the stomach.

Meritocracy is racist, afterall. It involved the all the superior Malays, Chinese, Indians, all Malaysian races and all mixed race creating a bigger pie to keep everyone full and satisfied.

- Burp -

The simplest thing to do this Merdeka 2010 - to stand up and be counted.

If this country is to have any future as a true nation, the time has come for those who believe in the ideals of equality, ideals which were held by the political founding fathers of the country as well as the traditional Rulers of that time, to stand up and be counted.

To not be cowed by the bigots and to say that this is our country and it stands on noble humanitarian ideals, not opportunistic racialist thinking.


Can the politicians stop monkeying around?

P.S. Just realize I haven't taste a pie for so long. Any recommendations?

Aug 23, 2010

Begging for a work change?

Malaysia seems to have become a haven for foreign beggars who can reap up to RM8,000 a month from donations by kind locals, said MCA Public Services and Com­plaints Department chief Datuk Michael Chong.

He said these beggars are believed to have entered the country with the aid of syndicates by abusing their social visit passes.

Besides begging at night markets or preying on customers at coffee shops, their tactics have taken a more desperate turn, with some seen pestering motorists waiting at traffic lights.

Okay, what are my thoughts. Well.
  1. A beggar in Malaysia earns more than me, almost double.
  2. The beggar surely going to help PKR's 2020 target for minimal household income.
  3. Who the fark are those pathetic, loser, dumb, moronic 'kind locals'?
  4. Is 'pestering motorists at traffic lights' a traffic offense?
Surely, I shunned most of the beggars, not because they are stinking degrading lowlife who hogs up the roadsides and alleys, but because they had a choice to make a difference in life and they chose not to do it.

There are plenty of centers around Malaysia who can help them make a living and not take the easy way out, yet they chose to harp on naive sympathy and stupidity of others.

The most unforgettable fictional beggar that I remember would be the action Hero Beggar Sou, which led the Beggars' gang.

While the funniest portrayal of beggar would be by Stephen Chow in the movie 'Tong Pak Fu Dim Chao Heong' where he begged for a simple moment of lust amidst his pathetic polygamous married life.

Given my little experience of living in Malaysia, I had seen and known of several types of beggar.
  1. OKU beggar
    Thinks they are too god-damned to do any work to earn a living. And thus, the begging. And worst of all, they used their obvious handicap to maximize the sympathy.

    OKU beggars can be divided into primary and secondary OKU. Primaries are those born with congenital defects, while the secondaries are handicap due to some unfortunate accidents or illnesses. The secondaries can further subdivided further into (I guess you're getting much more confuse right now) 'fated' and 'self-inflicted'. 'Fated' are those who drove at 80km/h on the highway and knocked down by others, causing loss of limb. While the 'self-inflicted' are those who drove dangerously on road and loss their limbs to motor vehicle accidents, or those who had to undergo amputation secondary to peripheral vascular disease secondary to smoking.

    The 'self-inflicted secondary OKU' beggars are the coolest beggar around. They can be seen begging with one hand and puffing away a pricey cigarette on the other hand, lacking only a sun shade to complete the picture.

    Anyway, they should probably look at this talented OKU for inspiration.

  2. Depressive, lonely beggar
    This kind of beggar is someone who had gone cuckoo and lost the will to do anything. All they need is food and water, which some begging will help get them. But what they really need is a caring movement to counsel and bring them back to 'life'.

  3. Lazy beggar
    Similar to the type 2 beggar, but just absence of psychopathology with abundance of ill-willed intelligence.

  4. Seasonal beggar
    They come out only during celebrative season, which was almost a fortnightly affair given the massive variety of celebrations in our 1Malaysia community.

    Some seasonal beggars even try to deceive themselves that they are not begging as they offer a parking lot for you by flashing you with torchlight as if catching 'khalwat', when that parking lot was already being paid up in full by income taxes.

  5. Rich beggar
    This type of beggar can further be subclassed into those who 'count their blessings' and 'count their beggings'.

    Those who 'count their blessings' are those maded their appearance very obvious, who came out during joyous celebrative day and lined up well on their places of worship. They beg because all their prayers were answered.

    Those who 'count their beggings' are those who are less obvious, and not easily detected by the naked eye. Most of them had jobs, great ones. And still, affordable to buy a RM1million house, they still beg for a bigger rate of discount.

Aug 22, 2010

malaysian great sex opera

got it from here. kinda makes you stop wondering why there's so many baby-dumping cases.

Sodomy circus turns into a sex opera!

By Martin Jalleh

It seems that for the past few days the Attorney General (AG)’s Chambers have become somewhat like a boiler room after being hit by one steamy story after another. The AG, Gani Patail, has been going bonkers, berserk and ballistic, as a result of an unexpected hard blow below the belt by Raja Petra Kamarudin (RPK).

The famous whistleblower, lid-blower and blogger had dropped a bombshell by alleging that the AG has been bonking the head of one of his divisions.Such news blew many away but RPK said their sexploits were nothing new. Many in the AG’s Chambers have chosen to turn a blind eye to their boss’ bonking.

The AG and partner have allegedly saved the nation’s taxpayers money, as they would blissfully bunk, bonk and bond in the same hotel room during their frequent trips abroad.

We should not be bogged down by who is bonking whom, but when such basic or base instincts are allegedly displayed by the nation’s top legal officer it becomes the rakyat’s business!

This is especially so when the AG has been bonking from high moral ground of his Office whilst trying hard to banish Anwar Ibrahim into political oblivion with a bull-loaded sodomy charge.

Bonking Binge

The sex opera began with RPK alleging that the prosecution’s star witness in Anwar's Sodomy II trial, Mohd Saiful Bukhar, was bonking Farah Azlina Latif, a deputy public prosecutor (DPP) involved in the case.

Was RPK bluffing? The AG begged not to comment but instead bundled Farah off to another division. Saiful and Farah bound themselves in silence, though Saiful could not stop babbling about the truth finally prevailing (and it really did!)

Anwar lodged a police report alleging that the “bonkers” had breached the law, especially the OSA. Karpal Singh, Anwar's lead lawyer, said the couple, if innocent, should be bold enough to verify what they have been accused of. The Court was duty bound to allow him to question them in Court.

Karpal also blasted the AG’s Chambers: "Never before in the history of the country or in the Commonwealth has a DPP had an affair with the star witness". The brave legal tiger forgot for a moment that he was in Bolehland, where everything is beyond human comprehension!

The AG betrayed himself when he passed the baby on to Solicitor-General (SG) II Mohd Yusof Zainal Abiden, who told the court that the prosecution was totally blur on the bonking. He accused Anwar of making “bare allegations” and insisted there was no miscarriage of justice!

Karpal countered that Anwar had “bare facts” and “hard evidence” that the two had bared and bonked. He urged the Court not to go soft on the prosecution. The naked truth they could stand no more -- is that their absolute lack of integrity has been exposed and credibility stripped to the very core!

The SG who was in the best position to respond to Anwar’s affidavit seeking the dismissal of the case, or require Saiful and Farah to file an affidavit, bewildered everyone by passing the buck to his subordinate DPP Hanafiah Zakaria and Investigating Officer (IO) Supt Jude Pereira.

As expected, the Court, which has been perceived by the general public as subserviently doing the bidding of the political masters, bowed and bent backwards, much to the pleasure of those in the AG’s Chambers.

Judge Zaibidin Diah found Anwar’s allegations of the Saiful-Farah’s sexual affair to be true but he ruled that the relationship did not compromise the case. He based this solely on the affidavits of the DPP and the IO. He rejected Anwar's application to strike out the sodomy charge.

We are asked by the Court to believe that Farah, a qualified lawyer, chosen to be on the high-powered prosecution team, to assist in such a high-profile case, was merely a note-taker and beyond reasonable doubt was not privy to crucial information on the case!

Further, surely the learned judge knows that great empires have fallen when forbidden secrets were released by a lover during pulsating and passionate bonking moments and pillow talk. From the charge sheet and on to the bed sheet surely much would have been spilled!

As for DPP Hanafiah, Karpal told the Court that the DPP’s very own credibility was in question, alleging that the latter had had a second marriage in Thailand, and had tried to “legalise his marriage in Kota Bahru” and is therefore “guilty of committing an offence under the Syariah law”!

The IO had said that all investigation papers were strictly under his control. But who can trust the police nowadays? Even the Kota Kinabalu Sessions Court had described Jude Pereira’s boss, IGP Musa Hassan, “an incredible witness whose evidence is not to be believed”!

Monsters & Masterminds

The rakyat’s heart goes out to Janna Syariza, the fiancée of Saiful. Once when referring to the sodomy case, she had very bravely declared that she will stand by her man through the “monstrous battle that is looming ahead”, not realising that a “monster” was standing next to her.

RPK has also alleged in a blog posting “Just when you thought it is safe to go into the water”, that Saiful is also bonking Khairil Annas Jusoh, an aide of Najib. The man had proudly posed with the sodomy accuser outside the PM’s office when the latter went there “to apply for a scholarship”!

RPK revealed that after a one-month marriage, an on learning about the affair, Khairil’s wife left him and “divorce is certainly on the cards”. Will Janna Syariza, the fiancée of Saiful, be able to stomach and survive this third “storm”? She can be assured of the sympathies of many Malaysians.

One cannot but feel also for the fiancé of Farah who according to the Malaysian Chronicle is the assistant head of the prosecution unit in a northern state. They were engaged last year. Their marriage was due to take place on July 9.

A day before the marriage was due to be solemnized she asked for a cancellation, leaving her fiancé who had already sent out all the invitation cards stunned and heartbroken. Farah must have realized that she had gone too far!

Before we could even recover from the revelations of the shocking sex scandals of those who allow themselves to be used by the masterminds to destroy Anwar politically, RPK serves yet another sex sizzler and it involves the Attorney General himself!

Gani Patail must not remain silent. He must speak up and reveal whether it is just a spin (just like when almost everyone first thought that the Saiful-Farah sex liaison was one?). Not only his credibility and integrity is at stake, but also that of the Office of the Attorney General...and even the government!

Strangely enough the country’s self-appointed moralists and religious authorities have also been very silent on the sex fest that has taken place. There have been no screams or shouts of zina or khalwat or interviews and investigations to be conducted. Perhaps they have all grown up?

If such secret sex trysts are really going on amongst those in the Chambers of the AG what would be left of the public’s trust!

(19 Aug, 2010)

paternity leave

not as rosy as everyone thinks.

Aug 19, 2010

All hail princess Genevieve!!

Thanks Dr Joy for the instinctive decision and the uneventful operative delivery
Thanks to Najahah for the adequate fundal pressure and good assisting
Thanks to Koh & Ng for the pre/intra/post op anaesthetic care
Thanks to all nurses who made this a great moment
Thanks to all relevant parties for the re-opening the Maternity OT
Thanks to Dr Kuna's great team which made all things possible

4.28kg Genevieve. Delivered at lunch hour.
In the arms of her mummy. All cosy and nice.

Thanks to everyone for the well-wishes.

Aug 18, 2010

Limp, phew, luckily it's the leg

I wasn't the brightest futsaller around.
Probably would be the worst around in an average crowd.
Yet, I still join the game for the sheer love for a decent exercise that won't bonk me down with boredom like jogging etc.

Warmed up for few minutes. Something that I don't usually do.

Then, I went all out. Hopefully to sweat it all out.

As the ball lobbed across the field, I turned around swiftly and WHAAM!

I could felt as if Thor whipped a bolt onto my bottom end of my Achilles' tendon. It felt like a strong kick by the strongest defender on the field.

The ball felt pathetically away from my reach, and probably my teammates was thinking bout how pathetic I am.

I turned around. No one was there. For a split second, I don't believe that ghosts are that much into futsal. But then again, I could be wrong.

I tried to take few steps but can't.

The pain persisted. Numb from mid-calf downwards. I had pulled my calf, and I had to limp away.

Inflammed achilles tendon

It dawned on me.

It wasn't the futsal-loving ghost or demon of the 7th lunar month, but instead it was aging and the excess weight gain that creep up on me and decided to give me a nice WHACK on the Achilles' tendon.

Now its rest. wait. avoid heavy legwork.

Get a better shoe. Longer and proper warm-up before any exercise.

is this the naked truth?

Aug 16, 2010

Found: my life's aspiration!!

Written by Adrian Tan, author of The Teenage Textbook (1988), was the guest-of-honour at a recent NTU convocation ceremony. This was his speech to the graduating class of 2008.

I must say thank you to the faculty and staff of the Wee Kim Wee School of Communication and Information for inviting me to give your convocation address. It’s a wonderful honour and a privilege for me to speak here for ten minutes without fear of contradiction, defamation or retaliation. I say this as a Singaporean and more so as a husband.

My wife is a wonderful person and perfect in every way except one. She is the editor of a magazine. She corrects people for a living. She has honed her expert skills over a quarter of a century, mostly by practising at home during conversations between her and me.

On the other hand, I am a litigator. Essentially, I spend my day telling people how wrong they are. I make my living being disagreeable.

Nevertheless, there is perfect harmony in our matrimonial home. That is because when an editor and a litigator have an argument, the one who triumphs is always the wife.

And so I want to start by giving one piece of advice to the men: when you’ve already won her heart, you don’t need to win every argument.

Marriage is considered one milestone of life. Some of you may already be married. Some of you may never be married. Some of you will be married. Some of you will enjoy the experience so much, you will be married many, many times. Good for you.

The next big milestone in your life is today: your graduation. The end of education. You’re done learning.

You’ve probably been told the big lie that “Learning is a lifelong process” and that therefore you will continue studying and taking masters’ degrees and doctorates and professorships and so on. You know the sort of people who tell you that? Teachers. Don’t you think there is some measure of conflict of interest? They are in the business of learning, after all. Where would they be without you? They need you to be repeat customers.

The good news is that they’re wrong.

The bad news is that you don’t need further education because your entire life is over. It is gone. That may come as a shock to some of you. You’re in your teens or early twenties. People may tell you that you will live to be 70, 80, 90 years old. That is your life expectancy.

I love that term: life expectancy. We all understand the term to mean the average life span of a group of people. But I’m here to talk about a bigger idea, which is what you expect from your life.

You may be very happy to know that Singapore is currently ranked as the country with the third highest life expectancy. We are behind Andorra and Japan, and tied with San Marino. It seems quite clear why people in those countries, and ours, live so long. We share one thing in common: our football teams are all hopeless. There’s very little danger of any of our citizens having their pulses raised by watching us play in the World Cup. Spectators are more likely to be lulled into a gentle and restful nap.

Singaporeans have a life expectancy of 81.8 years. Singapore men live to an average of 79.21 years, while Singapore women live more than five years longer, probably to take into account the additional time they need to spend in the bathroom.

So here you are, in your twenties, thinking that you’ll have another 40 years to go. Four decades in which to live long and prosper.

Bad news. Read the papers. There are people dropping dead when they’re 50, 40, 30 years old. Or quite possibly just after finishing their convocation. They would be very disappointed that they didn’t meet their life expectancy.

I’m here to tell you this. Forget about your life expectancy.

After all, it’s calculated based on an average. And you never, ever want to expect being average.

Revisit those expectations. You might be looking forward to working, falling in love, marrying, raising a family. You are told that, as graduates, you should expect to find a job paying so much, where your hours are so much, where your responsibilities are so much.

That is what is expected of you. And if you live up to it, it will be an awful waste.

If you expect that, you will be limiting yourself. You will be living your life according to boundaries set by average people. I have nothing against average people. But no one should aspire to be them. And you don’t need years of education by the best minds in Singapore to prepare you to be average.

What you should prepare for is mess. Life’s a mess. You are not entitled to expect anything from it. Life is not fair. Everything does not balance out in the end. Life happens, and you have no control over it. Good and bad things happen to you day by day, hour by hour, moment by moment. Your degree is a poor armour against fate.

Don’t expect anything. Erase all life expectancies. Just live. Your life is over as of today. At this point in time, you have grown as tall as you will ever be, you are physically the fittest you will ever be in your entire life and you are probably looking the best that you will ever look. This is as good as it gets. It is all downhill from here. Or up. No one knows.

What does this mean for you? It is good that your life is over.

Since your life is over, you are free. Let me tell you the many wonderful things that you can do when you are free.

The most important is this: do not work.

Work is anything that you are compelled to do. By its very nature, it is undesirable.

Work kills. The Japanese have a term “Karoshi”, which means death from overwork. That’s the most dramatic form of how work can kill. But it can also kill you in more subtle ways. If you work, then day by day, bit by bit, your soul is chipped away, disintegrating until there’s nothing left. A rock has been ground into sand and dust.

There’s a common misconception that work is necessary. You will meet people working at miserable jobs. They tell you they are “making a living”. No, they’re not. They’re dying, frittering away their fast-extinguishing lives doing things which are, at best, meaningless and, at worst, harmful.

People will tell you that work ennobles you, that work lends you a certain dignity. Work makes you free. The slogan “Arbeit macht frei” was placed at the entrances to a number of Nazi concentration camps. Utter nonsense.

Do not waste the vast majority of your life doing something you hate so that you can spend the small remainder sliver of your life in modest comfort. You may never reach that end anyway.

Resist the temptation to get a job. Instead, play. Find something you enjoy doing. Do it. Over and over again. You will become good at it for two reasons: you like it, and you do it often. Soon, that will have value in itself.

I like arguing, and I love language. So, I became a litigator. I enjoy it and I would do it for free. If I didn’t do that, I would’ve been in some other type of work that still involved writing fiction – probably a sports journalist.

So what should you do? You will find your own niche. I don’t imagine you will need to look very hard. By this time in your life, you will have a very good idea of what you will want to do. In fact, I’ll go further and say the ideal situation would be that you will not be able to stop yourself pursuing your passions. By this time you should know what your obsessions are. If you enjoy showing off your knowledge and feeling superior, you might become a teacher.

Find that pursuit that will energise you, consume you, become an obsession. Each day, you must rise with a restless enthusiasm. If you don’t, you are working.

Most of you will end up in activities which involve communication. To those of you I have a second message: be wary of the truth. I’m not asking you to speak it, or write it, for there are times when it is dangerous or impossible to do those things. The truth has a great capacity to offend and injure, and you will find that the closer you are to someone, the more care you must take to disguise or even conceal the truth. Often, there is great virtue in being evasive, or equivocating. There is also great skill. Any child can blurt out the truth, without thought to the consequences. It takes great maturity to appreciate the value of silence.

In order to be wary of the truth, you must first know it. That requires great frankness to yourself. Never fool the person in the mirror.

I have told you that your life is over, that you should not work, and that you should avoid telling the truth. I now say this to you: be hated.

It’s not as easy as it sounds. Do you know anyone who hates you? Yet every great figure who has contributed to the human race has been hated, not just by one person, but often by a great many. That hatred is so strong it has caused those great figures to be shunned, abused, murdered and in one famous instance, nailed to a cross.

One does not have to be evil to be hated. In fact, it’s often the case that one is hated precisely because one is trying to do right by one’s own convictions. It is far too easy to be liked, one merely has to be accommodating and hold no strong convictions. Then one will gravitate towards the centre and settle into the average. That cannot be your role. There are a great many bad people in the world, and if you are not offending them, you must be bad yourself. Popularity is a sure sign that you are doing something wrong.

The other side of the coin is this: fall in love.

I didn’t say “be loved”. That requires too much compromise. If one changes one’s looks, personality and values, one can be loved by anyone.

Rather, I exhort you to love another human being. It may seem odd for me to tell you this. You may expect it to happen naturally, without deliberation. That is false. Modern society is anti-love. We’ve taken a microscope to everyone to bring out their flaws and shortcomings. It far easier to find a reason not to love someone, than otherwise. Rejection requires only one reason. Love requires complete acceptance. It is hard work – the only kind of work that I find palatable.

Loving someone has great benefits. There is admiration, learning, attraction and something which, for the want of a better word, we call happiness. In loving someone, we become inspired to better ourselves in every way. We learn the truth worthlessness of material things. We celebrate being human. Loving is good for the soul.

Loving someone is therefore very important, and it is also important to choose the right person. Despite popular culture, love doesn’t happen by chance, at first sight, across a crowded dance floor. It grows slowly, sinking roots first before branching and blossoming. It is not a silly weed, but a mighty tree that weathers every storm.
You will find, that when you have someone to love, that the face is less important than the brain, and the body is less important than the heart.

You will also find that it is no great tragedy if your love is not reciprocated. You are not doing it to be loved back. Its value is to inspire you.

Finally, you will find that there is no half-measure when it comes to loving someone. You either don’t, or you do with every cell in your body, completely and utterly, without reservation or apology. It consumes you, and you are reborn, all the better for it.

Don’t work. Avoid telling the truth. Be hated. Love someone.

Aug 14, 2010

jokes apart II

Laughing Frog
I was told a joke by a staff nurse yesterday.
"There is not enough house officers"

Ice Cream
I asked another junior doctors simple math and he 'aced' it.
"Today is 13th. Tomorrow is her (the patient's) due date, which is 40weeks"
"So what her current gestation?"
"39weeks and 5days"
"Are you sure?"
After 10 seconds of 'bursting inside laughing' pause.
"Would you like to correct yourself?"
"It's 39weeks and 5days"

Yoga Grandma
Epic black humor.
And the consultants/specialists/senior doctors had to stretch themselves trying to educate them when what they really need is to re-sit their UPSR exam.

Oh, wait, they may not be able to do it soon when More-He-Didn't abolish this exam.

Who are we to change the world anyway?
The whole Heal Ministry is a joke.

The senior doctors are all stretched out, multitasking and multifunctional, and by the end of the day, even the functional will become dysfunctional and subsequently non-functional.

Resources planning are just as fkup as their human resource management, probably because the package of side-income (under the table moolahs) determine the course of it.

One of my fellow new-found friend struggling in Central Malaysia had this thoughts.
It is a chronic problem, 2 district hospitals with OT facilitites, big wards and air conditioned like a chalet more than a hospital. No pakar, no specialty MOs... there were 8 staff nurses in LR and 1 MO in charge, only one patient in labor with OS 7 cm , they ask to me to help have a look and then decide whether to send to my hospital or not? All non functioning hospitals and staff

then they plan to build another 60 acres maternity and child health hospital in the state, really close to the 2 district hospitals... and in my GH where we are totally swamped with work, we only have 3 functioning specialists, and on paper ample of MOs, but only a handful really doing work, Some just MIA and no action taken, while we run courses, run calls, watch over the juniors, train our junior MOs
At the end of the day, dengue, AIDS, pneumonia, intractable cancer, postpartum haemorrhage and even intracranial bleed are not really our main gruesome enemies.

It is stupidity, inefficiency and greed.

Aug 13, 2010

Potong saga 2

From my niece's fb status:


" Kami sudah merima awak, jadi , awak jagan buat apa apa lagi " " Sebagai contoh, saya ada sebuah kereta SAGA, kalau kamu naik, kereta itu adalah hak milik siapa? masihlah kepunyaan saya lagi kan!? "
"Saya CUMA BERGURAU sahaja "
" CINA balik CHINA? Oh, kerana Negara Cina adalah sebuah Negara yang baik "
" Cina pergi Foon Yew jagan belajar di sini ? oh~ Sebab Cina banyak kaya mah"

From SMK STARP's headmistress
I don't mean to politicized but someone should be civilized.

We can't blame these aunties, I guess. Bapa borek anak rintik.

Well, politicians said them to gain political mileage, and poorly-evolved civilians got warped into their dirty propaganda, forgetting the fact that the great ancient elders that once got to the Peninsular was from somewhere in Indonesia.

Our independence and nation-building is the effort of every Malaysians.

For her information, someone replied to her.
to SMK STARP's headmistress : ya , kamu ada SAGA "baru " , bawah bumi 5% interest cover , barulah kamu ada saga "baru" , cina tiada bumi protection , pun chin cai gunakan BMW .... haha , apa sah nak naik kau punya " potong saga " ? haha

Gelato Di Nuvola

Aug 12, 2010


A bullet is not kacang puteh. What is so darn hard to investigate the source?
It is just a matter of WANTING to do it.

Aug 11, 2010

hanging by a pulse

between fluctuating hemoglobin of 4 to 9,
volatile hematocrits of 15 to 33,
bullish INR from 5 to 1.3
and the repeated relaps with packs
I hope she pulls through

Aug 10, 2010

few days from home

3 back to back call.

today, penny into my pocket. pennies...

made me ponder.
geneva declaration. everyone equal.
health-based or complaint-based?

kept my silence, the show must go on...

glad to have aedan back into my arms again.