Dec 27, 2010

busy monday

tired. just tired. and but still wants to rant bout it.

starting with a helping out a junior colleague with a intractable bleeding lower segment leading to a PPH, despite of so many of multiple figure of 8 sutures applied. Could have been knitting a sweater on the whole incision site.

Alternating running up and down with specialist, Dr. S, attending to another fetal bradycardia at labor room, leading to ventouse and subsequent shoulder dystocia.

As I sat down to document the storm that I thought was passing, a house officer sheepishly said: I think someone in triage with a cord prolapse.

Rushed to triage only to find speculum findings of bulging membrane. Per abdomen fetal at oblique lie. I let the house officer to have the privilege of doing the vaginal examination to confirm any cord presentation.

His reply: Something beady. plastic. funny, non-pulsatile
My super-duper-soft reply: Then, you should take further history from the husband.

I confirmed it to be hand presentation with os 6cm. Sent her off for the usual C.

Rested a while during case presentation, followed by calls from triage with a row of patients suspicious of having pre-eclampsia.

Did a brief labor room round and found out a fifth-posting house officer having done medical does not know what to look for in peripheral blood film and does not know what TIBC stands for. Reason being: I forgot.

Perhaps the 2 yearly housemanship should be a loop, keep repeating until one really remembers and then they go off the tangent.

The night time was well-filled up for a farewell for 2 specialists, one junior and one senior.

Dec 23, 2010

Christmas here again!!!

Santa has been stung by recent vehement criticism claiming that he is a bad role model for children and should be considered a ‘public health pariah’.

In order to rescue Christmas, Santa Claus has made a number of pledges to improve the health of the public by serving as better role model:

  • Santa Claus will no longer smoke a pipe or any other form of tobacco.
  • After every 10 km Santa will give his reindeer a rest, and pull his sleigh all by himself for the next 1 km (unfortunately, some presents may arrive late).
  • Santa will no longer appear in any marketing campaigns targeting children, particularly those involving junk food and soft drinks.
  • Santa will no longer drink the copious cans of beer left for him on Christmas Eve. Instead, Santa will now have a share of the carrots left for his Reindeer. He also requests that beer no longer be left out, so that neither he nor his reindeer will be tempted to imbibe, and so that neither he nor they can be accused of drinking and driving.
  • Santa will now wear a helmet and safety harness when driving his sleigh, on rooftops and when abseiling down chimneys.
  • In the interests of stemming the spread of infectious diseases, children will no longer be able to physically touch Santa, sit on his lap, nor kiss him in shopping centers.
  • Santa will undertake an UCEM-sanctioned diet and exercise regimen (details to be released early in the New Year) with the intention of making significant inroads into his considerable girth.
And suddenly Santa bit the dust.

santa tombstone The Death of Santa Claus

So, while Santa’s exact mechanism of death is not yet known, it is clear that the writing was well and truly on the wall. May he rest in peace. However, the show must go on and auditions for a new Santa Claus have already begun.

Those hoping for a fit and healthy new Santa may be disappointed:

santa smoking The Death of Santa Claus

And lastly, just one day before X'mas, Santa comes back alive, again!! However, with his renewed physical vigour and increased leisure time may have some unintended consequences:

santa flashing Santa lives... again!

Last year, I wrote briefly about Santa. Never knew this year, the whole Santa saga becomes much more theatrical than before.

Something about Xmas really strike me deeply, probably due to few reasons. My high school education was in a missionary school. Few of my friends were stout Christians. The annual jovial celebrations of Xmas. My first airflight many, many, many, many years ago with my family was going to Singapore for Xmas. And my first short outstation vacation with my dearest was to celebrate Xmas as well.

Back in my uni years, someone actually commented to me that I looked like a Christian. I never knew Christians have a specific facial features. Anyway, I am Buddhist celebrating Xmas, because I still believe Christianity has and always will bring goodness to everyone.
And Buddhist rejoices in everything good. Kusalasa upasampada ('Do Good' in Pali).

Last year December, back in my previous hospy, as I walked past the non-sterile room of the clinic, I could see a Christmas tree about the height up to my ankle sitting lonely at the secluded corner. By itself, the tree appeared to be rather jovial despite being dumped into a barely noticeable quiet place. I was curious and found out that the tree was fully sponsored by my specialist, Dr J, placing it in the outside corner of the clinic. All set to brighten up the waiting area, just to have it removed after few hours by the hospy's administrative people for reasons that neither can comprehend. I could remember vividly how Dr. J sat down on the couch during her on call and shared her disappointment over it.

This year round, I have pleasant surprises cropping up all over the place in my current hospy. I could see Xmas trees and presents at its feet in the Labor Room itself.

Another one near the entrance. And many more within the hospital compound.

Not that Xmas tree is a good proxy to the whole spirit of Xmas. Xmas tree is an adopted pagan practice.

But still, to have them set up spontaneously in spite being post-accreditation, is something worth more than 2 thumbs up.

For everyone, have yourself a merry blessed Christmas!!

P.S. My christmas wish: Let it snow! Let i snow!

P.S. Something obgy: Which syndrome characterized by the association of polycystic ovaries and the abnormal functioning of the urinary valve? [Reference]

Dec 16, 2010

I loooove hospital accreditation...

After my working hours being bowled over by helping out in the November's conference and the subsequent on-call marathon, my nightmare seemed to continue with the preparation for hospital accreditation, only to have fallen in love with accreditation.

Firstly, one must understand what is accreditation.

is a process in which certification of competency, authority, or credibility is presented.
the word itself roots from
  • ac- var. of ad- before c and qu: accede; acquire.
  • crēdere to believe, confide, entrust, give credit
Therefore, it is clear that accreditation is a process to acquire confidence, with or without the presence real substance. By substance, I mean competency, authority and credibility, of course.

I learnt about few colleagues of mine (within and out of department) who are forming an underground extraordinary league with strong anti-accreditation sentiments.

Oh, come on! There's so many things in it that we can fall in love with.

Let me list them down for future references.
  1. Fiction-writing

    Yes, it allow us to rake up some fictional stories about the minutes of meeting that we had over the last few months, plus the virtual attendance sheets of a few teaching sessions. Those masterpieces probably put Dan Brown to shame. Way to go, Dr Adahuys and Dr. Deys.

  2. Theaterical

    Better than 'Beauty and the Beast' or 'Phantom of the Opera'. All the staffs went around with their perfect mannerism and hardworking stints. The best was seeing the Sister of the ward pushing the patient for C-Section. So much of grace and poise, just lacking of the background classical music to complete the scene.

  3. Exercise


    A lot of stuffs were being moved. Into the stores. Out of the stores. Above the stores. Around the stores. Somewhere near the stores. Lots of housekeeping exercises for everyone.

    To my knowledge, the best exercise was the exercise to remove few beds from the ward to ensure good bed-to-bed distance for the 3days of accreditation and to have them moved back after it. Just think of it, how much of cardio work out that would be. Not to mentioned how much calories will be burnt from those exercises.
    Secondly, lots of legwork from 'running away from the surveyors'.

  4. Dress up

    Black bear

    Definitely a Kodak moment for everyone. Donning the white coats, most of us, if not all, looks at least 10 years younger. No kidding. One of my specialist actually look like a house officer, or a lab technician. Talk about role-playing.

  5. Wall papers

    Suddenly, the boring walls became alive again with lots of life-saving poster about what-to-dos in the event of emerging Godzillas or attack by the killer King Kong. In addition, the organization charts were revived with lots of vibrant personal photos.

All the fiction-writing, theaterical, exercises, dressing up, wall papers and the whole shebangs of creativity...

Now, don't you simply loooooooooooooooooooooovvvvvvveeeeeeeeeeee accreditation?
No wonder the Ministry are spending so much of moolahs on it...

Dec 11, 2010

the scandalous HOgate

The Star today, in this beautiful Sunday morning, decided to pull the plug on the HOgate (house-officergate) with a series of exposure of the reality which probably end up making those whining letters from the house officers or their parents about 'how' busy and overworked they are, sounds like babies' cry.


The list of articles were:

Ministries order five-year moratorium on medical courses
Cleaning house
The parent trap
We should not be faulted, say housemen

Reading through them, I could not help but to point out how inappropriate for the Paper to stressed the low quality of grads from Russia, Ukraine, Indonesia or India, because through my little years with these junior doctors, I had seen more than a handful of house officers graduated from those countries having more knowledge, initiative and participation than those from local unis.

Although the aim of "meet the national target to have a doctor to population ratio of 1:600 by 2015 and 1:400 by 2020 with the present capacity" was being blamed for the present glut, I simply believe there are more scandals yet to be revealed.

If the reporters are inquisitive enough, perhaps their investigations will put more scandals to light.

If those oversea medical schools were substandard from the beginning, how do they pass recognition from our esteemed board of higher learning? How much were involved?

Local private medical schools are piggy banks held by political parties and figures. Their number and quality of lecturers are just a small fraction from what they supposed to provide in black and white. Something rather fishy brewing in the House of Hippocrates.

The principle in life is rather simple.

When something go wrong as a whole, it will involve power, money or both.


I wouldn't be suprise if the 5-years moratorium probably is just another stop-gap or smokescreen for further witch-hunt.

As for now, the house officers, the senior practitioners, the elders of the fraternity and the general public just gotta swallow the bitter pills of current predicament.

Chiptune Commando

Having said that, kudos to the elders for keeping the momentum forward in bringing in light into this HOgate.

Dec 10, 2010

of triplets and bandl's ring

today is a good day to rejoice.

been pretty tied up for the past 1 week, having to be on call 5 days in a week.
Saturday, Sunday, Tuesday, Thursday and Friday (Yesterday).

Some days were busier than the others as required to cover for my junior colleagues who are still at their infancy of training. Tired as it was, I was glad to help out, because all I could think about is how slow, stupid and pathetic I was when I first started my journey.

I could remember vividly what my senior specialist told me.

"Pilo, you came in at a wrong time."

I do not wish to indulge further in the details of how my initial training would have been better.

I was called upon twice on Thursday.

First, it was my colleague's suspicion of an abnormal uterus and did not dare to proceed further. In a C-section for fetal distress, to stop and pause when the uterine field of lower segment is wide enough to deliver the baby is probably frowned upon. Nevertheless, to proceed when you're not in control is definitely worse. I applauded his wise decision to go back to the first rule of primum non nocere.

I scrubbed in subsequently and noted the thick plastering adhesion between the anterior wall of upper segment of uterus and the anterior abdominal wall. I copped a feel of the gravid uterus from the sides and ruled out any fibroid or didelphy. The clear deepening line between the upper and lower segment was smiling at me. The thought of Bandl's ring struck me. All done in a few quick seconds before I knife in and got the little one out. That little fellow sang a lovely tune as I passed him over to the maternity nurse - pure rock and roll.
(credit: airahospital)

Bandl's ring is a constriction located at the junction of the thinned lower uterine segment and the thick retracted upper uterine segment that is associated with obstructed labor.

Later that night, after midnight, my phone rang.

"Triplets in labor, os 5cm, sending over to General Hospital as ventilators there." (Of course, this is the summarized version)

"OK" (Not a summarized reply)

I was heading towards the Operating Room and my phone went blasting again.

"Now, already 8cm, Paeds agreed to be done in Maternity Hospital."

After a few unintentional driving drifts (I made up this part), I was there in the Maternity OR.

The cool anaest MO, JY was there smiling, probably a bit pissed not being able to chill in the middle of the night. Just probably.

2 warmers were on standby with nurses busy preparing.

Paeds team stepped in subsequently in large numbers - which is a wise thing to do.

As JY was pushing in the magic potion to wipe out the contraction pain and numb out the lower part of the body.

My mind was racing through what would be different in this C-Section.

First, delivery of the babies must be pre-planned based on their positions. I reconfirmed. It was cephalic, breech and breech. Mainly the most important thing is to keep the sufficient pool of liquor, go in, manouvre and grab them out. The only way I can screw up is to have an impacted triplet in tranverse lie - which is minutely possible.

Second, anticipatory bleeding from uterine atony secondary to the accomodation distension for the triplets.


At that time, my game plan was set.

I went in vigilantly, managed to entered the uterine cavity with the amniotic membrane intact. My hands felt the buttock of the 2nd triplet at the opening and slid down further to scoop up the deeply engaged head of the 1st triplet with slight difficulty.

A cartoon thought flashed through my mind. The 2nd and 3rd triplets were trying very hard to kick the 1st triplet out.

Once the 1st exited, subsequent deliveries of the 2nd and 3rd weren't shrouded with much difficulties as I was able to hold on their respective ankles before rupturing their respective amnion membrane.

The uterine muscle clamped down well with the continuous infusion of the love potion.
No crimson tide for tonight, thank God.
(credit: carrie)

My first triplets delivery. Ecstatic. For the right reason.


Dec 7, 2010

knight's gambit

drhsu applauded the move as killing monkey to warn other monkeys or chicken.

personally, i think it is a gambit and probably general election is pretty near.

of course, it is a normal process, putting up a smokescreen that the Almighty is sugar, spice and everything nice.

Dec 2, 2010

could not really put a finger to it...

The difference between your ring and index fingers

Can your health, wealth and even sexuality be seen in the difference between your ring and index fingers?

A study in the British Journal of Cancer appears to show that men whose ring fingers are longer than their index fingers are more likely to develop prostate cancer. If you're a man, chances are you've already checked your fingers and found cause for alarm. Don't worry too much: the majority of men have a longer ring finger.

In addition to being disheartened, you probably also found checking your fingers for length a bit familiar: in the last 10 years, "digit ratio" has been alleged to predict many different traits, risks, advantages and deficiencies. What else might your fingers tell you?

That you're a man Digit ratio is to some extent sexually dimorphic – men tend to have longer ring fingers, women more or less equal ring and index fingers – and is thought to be an indicator of one's level of exposure to testosterone in the womb. But variation is even wider across different ethnic groups. As digit ratio researcher Dr John Manning puts it, "There's more difference between a Pole and a Finn than a man and a woman."

Your fertility In his 2002 book Digit Ratio: Pointer to Fertility, Behaviour and Health, Manning found that men with longer ring fingers tended to be more fertile. It's the other way round for women.

Your risk of a heart attack Testosterone is believed to protect against heart attacks, and a 2001 study showed a lower risk of early heart attacks in men with the smallest index-to-ring finger ratios.

How rich you'll be Two years ago, Cambridge researchers found that City traders with longer ring fingers made more money than their short ring-fingered colleagues. They're also thought to be more aggressive, and more likely to take risks.

Whether or not you're a lesbian A California study looking at the fingers of 720 men and women from San Francisco showed that lesbian women tended to have the more masculine (long ring, short index) finger arrangement.

How bad a driver you are A 2005 German study (involving only 40 volunteers) showed that men scored higher on spatial skills (the "bad driving" part was a leap of imagination on the part of the media) but that women with longer ring fingers did better than those whose ring fingers were equal to, or shorter than, their index fingers.

After reading the news piece above, I was thinking.

Dang, i got a shorter ring finger.
But then again, there were never a local study on it, all were done by the Germans, British, Americans, mainly the orang putehs.

Anyway, all my fingers are short, but not stubby. That's the biggest reason why I found it difficult to take up piano or guitar beyond the basic key. Kinda frustrating initially, but just like everything in life, you either accept it or change it. Since it should be excruciatingly painful to change it, I accept it.

Lastly, talking about fingers, reminds me of something about fingers.

Do u know y God created gaps between fingers?

So that someone who is very special to you comes and fills these gaps by holding your hand forever.

Wifey, thanks for filling these gaps with your warm tender loving hand.

Happy Anniversary, dearest.