A brand new year?

Or just a continuum of time...

GOOD BYE 2011!!

Hellooooo 2012!!

2012年寫給自己的話：
1.再難也要堅持。To persevere in difficult times
2.再好也要淡泊。To be indifferent in good times
3.再差也要自信。To have confidence even when I'm weak
4.再多也要節省。To save even with abundance
5.再冷也要熱情。To be warm even in the coldest moment

slope of QR

I was being kept going. And finally today, I am on the slope of QR.
I will be mentally prepared for any drop to S wave.
I learnt not to overestimate happiness, joy and ecstasy.

Today, there's just too many things to be happy about,
new rotation next year
good rating by superiors
but mostly Thank God It's Friday!!

a splendid X'mas gift!

It maybe 3 days after X'mas
He maybe not of the same physique as Santa
not even the same religion
He maybe looking down on the list,
not the same naughty or nice list

But today, he had given us the most beautiful gift of all.

Deep down in our hearts (or at least, my heart): Thank you!

P.S. a returning gift of gratitude is within contemplation.

A Desaru Xmas...

Santarina Genevieve


Little footsteps on the beach..

public hypocrisy

A week ago, I read the following letter to The Star (the paper, not the celestial unit) titled "Housemen need the hours"

I AM a house officer in my first posting in the Orthopaedics Department of Hospital Sg Buloh. I strongly disagree with the ruling to cut down on the working hours of house officers to 60 a week and to be given two days off a week.

The housemanship programme is a training programme. Freshly recruited house officers are mostly, let’s face it, incompetent.

Two months into the programme and I still find there are a lot of things I need to learn, including even the basics.

How can we benefit from reduced working hours? It is laughable to think that with less training, one can be a better doctor.

Let’s not forget that doctors of the previous generations all survived a much more intense training programme. If they could do it, why can’t we?

And to have our parents fight for us? We, who are in our 20s? A shameful act, indeed.

We need the training. We need the scoldings and the discipline. We need to become doctors, not killers. We need much more than 60 hours a week, believe me.

Let me postulate this situation for you, the public: You have heard stories of incompetent doctors making horrible mistakes.

Imagine doctors of the future who would have had even lesser training than these incompetent doctors.

Imagine yourself needing a medical procedure and you can only turn to glorified butchers and shamans, instead of surgeons and doctors.

Just imagine.

Dr JOHAN ARIFF JUHARI,

Sg Buloh.

Dear Johan,

Although your letter had struck a few good chords with most MOs and specialists who had read it, I agreed to some parts of it, and other parts of it, it believe it is just pure hypocrisy. A hypocrite house officer trumps any lazy house officer, anytime.

I fully agree that house officers need more hours and more training. Plus, house officers who still have not wean off from their breastfeeds after graduated from medical school are truly shocking, too.

I am also shocked that at 2 months into programme, you have not grasp on your basics.

Although the system had restricted your working hours to 60hours, it does not mean that you can’t extend own time in the hospital at your own leisure.

The hospital is open twenty four seven and I don’t think any consultant, specialists or MOs will keep you out of the ward or operating theater if you offer to come back. Plus, outside your working hours, you can also do more reading about the basic sciences about the disease of patients or learn up more about thing that you’re lacking in.

The point is Dr. Johan, you’re a slacker and your letter further proves you’re a hypocrite slacker.

Nowadays, I been doing more and more house officers work, because people like you, Dr Johan, who do not have initiative to learn how to do it and chose to be pampered in learning.

Few years back, whenever I finishing C-Section at subcutaneous layer, I would release the assisting the house officer to go and type in the postop note in the computerized system. I would tell them the basic essential details and the rest is more or less the same. And I would double-check for the less bright ones. The bright ones will have the wisdom to do it correctly and responsibly. To write a post op note is not rocket science. I believe any 3^rd year medical student can do it, because it is straightforward, repeated and basic.

These days, I had seen the worst of the worst. Few days back, a house officer just sat there idle and told me she did not get the personal password to the system yet, because she is in her first posting. Some of her first posting friends already got their own passwords, why couldn’t she get one? And she already in the department for 1 month plus. Why can’t she call any of her other 30 or 40 fellow house officers for the temporary passwords? Why can’t she come back to OT to ask me my password instead of sitting idle, wasting all our time?

The recurrent time-wasting phenomenon recurred again after 2 days. Another house officer opened the surgical note template and told me he does not know what to write because the computer system had been down when he was tagging 1 week ago, so he had not learn it, but the system already recovered for a week. For the record, he is a house officer in the 2^nd posting. The computer system already back to normal for 1 week, why can’t he take the initiative after his compulsory 60hours to learn up? His other fellow house officers in their first posting can already prepare post op notes even for the 2 different complicated elective gynaeoncology operations, and being in 2^nd posting, he can’t even prepare post op notes for a simple C-Section?

In conclusion, Dr. Johan, like the 2 house officers quoted above, you’re a slacker because in spite of knowing you can do more than the compulsory 60hours but you didn’t. If you didn’t know that you can, then categorically you should be classified as retarded.

I apologize for being mean, because the one thing that medical fraternity could not tolerate more than glorified butchers and shamans are glorified hypocrite butchers and shamans.

Kindly refrain from blaming the system for your own incompetence.

xoxo,

Pilocarpine

means you're constipated

Ho Ho Ho.. Merry X'mas!!

Here's an obgy quiz related indirectly to christmas:
what syndrome is characterized by the association of polycystic ovaries and incomplete emptying of the bladder associated with abnormal electromyographic activity?
Answer: here and here.

P.S. typical nerdy Xmas posting. haha. merry xmas, everyone!!

idiopathic lens error

one moment, I was happily snapping photos of the lectures and the next moment, my lens wouldn't retract back. no trauma, no assault, no nothing. just like that. it got stuck, like my camera caught priapism without any foreplay.

i brought it to the service center and they came up with the repair price of one third of the cost of the whole camera. devastated, but i have to give in. no camera for x'mas, hope by chinese new year, it'll be ready and durable.

d election experimentation

election is round the corner.

that's what everyone was saying before november, but it didn't fall through, probably because the sentiment of anti-government was strong and it wouldn't be the smartest thing to call for an election.

But government been throwing out goodies and somehow in someway or the other, the sweet loving smell of cash may in some way or other, be enticing a whole lot of people in loving our present government.
there's this RM500 for the poor.
there's flash salary hike in the new SBPA scheme for government servant.
they are trying very hard to subconsciously plant the thought 'if the government changed, all this maybe out of the window' in everyone.

They also put up the facade of hypocrisy by displaying the false sense of justice by punishing an exposed minion in this game of politics.

And lastly, a friend of mine in the printing business exposed a secret to me. The Printers already all standby with the blue print of the campaign prints, waiting for that 'green light' to make millions of copies.

many people predicted it could be in march, but personally i felt it will be straight after chinese new year.

Will there be a change of central government? Personally, I don't think so.

But warfare for several state's governments may weave exciting and interesting tale.

Below is an experiment by an economics professor. Have a good read and share your thoughts.

An economics professor at a local college made a statement that he had never failed a single student before, but had recently failed an entire class. That class had insisted that Obama's socialism worked and that no one would be poor and no one would be rich, a great equalizer.
The professor then said, "OK, we will have an experiment in this class on Obama's plan". All grades will be averaged and everyone will receive the same grade so no one will fail and no one will receive an A.... (substituting grades for dollars - something closer to home and more readily understood by all).
After the first test, the grades were averaged and everyone got a B. The students who studied hard were upset and the students who studied little were happy. As the second test rolled around, the students who studied little had studied even less and the ones who studied hard decided they wanted a free ride too so they studied little..
The second test average was a D! No one was happy. When the 3rd test rolled around, the average was an F. As the tests proceeded, the scores never increased as bickering, blame and name-calling all resulted in hard feelings and no one would study for the benefit of anyone else. To their great surprise, ALL FAILED and the professor told them that socialism would also ultimately fail because when the reward is great, the effort to succeed is great, but when government takes all the reward away, no one will try or want to succeed. It could not be any simpler than that.
Remember, there IS a test coming up. The 2012 elections.

These are possibly the 5 best sentences you'll ever read and all applicable to this experiment:
1. You cannot legislate the poor into prosperity by legislating the wealthy out of prosperity.
2. What one person receives without working for, another person must work for without receiving.
3. The government cannot give to anybody anything that the government does not first take from somebody else.
4. You cannot multiply wealth by dividing it!
5. When half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for, that is the beginning of the end of any nation.

brief moment in the air

life experiences, work cultures differences and a whole different world of life... does make me think what I was hoping for...

and finally I know what I had always been hoping for...

monday-friday near-far complex

Insults | Denied

One day Buddha was walking through a village. A very angry and rude young man came up and began insulting him.. "You have no right teaching others," he shouted. "You are as stupid as everyone else. You are nothing but a fake."

Buddha was not upset by these insults. Instead he asked the young man "Tell me, if you buy a gift for someone, and that person does not take it, to whom does the gift belong?"

The man was surprised to be asked such a strange question and answered, "It would belong to me, because I bought the gift."

The Buddha smiled and said, "That is correct. And it is exactly the same with your anger. If you become angry with me and I do not get insulted, then the anger falls back on you. You are then the only one who becomes unhappy, not me. All you have done is hurt yourself."

"If you want to stop hurting yourself, you must get rid of your anger and become loving instead. When you hate others, you yourself become unhappy. But when you love others, everyone is
happy."

Bottomline: stop insulting yourself.

almost heaven...

almost... almost...

birds 'n' bees...

Value has a value only if its value is valued

30 seconds speech by Bryan Dyson: Former CEO of Coca-cola

Imagine life as a game in which you are juggling some five balls in air. They are Work, Family, Health, Friends and Spirit and you're keeping all of these in the air.

You will soon understand that Work is a rubber ball. If you drop it, it will bounce back. But the other four Balls - Family, Health, Friends and Spirit - are made of glass. If you drop one of these; they will be irrevocably scuffed, marked, nicked, damaged or even shattered. They will never be the same. You must understand that and strive for it.

Work efficiently during office hours and leave on time. Give the required time to your family, friends and have proper rest.

Value has a value only if its value is valued

I was again and again and again enlightened by this short speech.

genevieve's body parts

"In three words I can sum up everything I've learned about life: it goes on."
— Robert Frost

genevieve's development milestone has been rather weird so far. at 15months, she able to walk independently, yet her speech just barely able to go over 'papa', 'mama' and 'nennen' (milk).

funnier thing was few months back, no matter how much I tried to teach her to greet me 'papa', she wouldn't say it and just echoed back with 'mama'.

But now, it is completely different. Whenever asked to greet 'mama', she would first sheepishly smile and cry out loud 'papa'.

then she started to learn about various parts of the body.

when asked about...

the eyes, she would cover her right eye with her hand
the nose, she would blow out air from the nose as hard as possible
the mouth, her index finger would point to the angle of her mouth
the hair, she would rub her hair

the ear, she would grab her ear
the hand, she would shake her whole arm
the leg, she would be wobble her leg in the sitting position

just recently, she learnt about beard when I had a few weeks of look with a goatee and beard.
whenever asked about beard, she would rub her chin

recently, as we went through the whole ritual of going through the body parts with genevieve, she was busy strolling in circles.

as we asked about the leg, she pinched the baby fat over the upper third of her right thigh with her right hand and trying to shake her right leg in the standing position.

in her annoying state of not being able to fully demonstrate, life goes on.

she appeared truly comical and we all burst into laughters.

Bolehland’s Bunch of No-Nos

Najib has no balls

Muhyiddin has no brains

Hishammuddin has no integrity.

Rais Yatim has no sense

Zahid has no defence

Nazri has no consistency.

Palanivel has no merit

Yen Yen has no explanation

Peter Chin has no energy.

Shafie Apdal has no clout

Noh Omar has no answers

Mohamed Yakcop has no transparency.

Shahrizat has no “beef”

Kong Cho Ha has no backbone

Liow Tiong Lai has no sincerity.

Ismail Sabri has no price controls

Ahmad Shabery has no medals

Idris Jala has no sagacity.

Ongkili has no innovation
Douglas Uggah has no enthusiasm

Shaziman has no accountability.

Tsu Koon has no leadership

Dompok has no support

Subramaniam has no empathy.

Rosmah has no self-control

Ezam has no real issues

Khairy has no decency.

MIC has no voice

MCA has no choice

Gerakan has no stability.

Judiciary has no honour

Police has no independence

AG has no impartiality.

MACC has no results

MCMC has no logic

EC has no credibility.

Parliament has no vibrancy

Speaker has no fairness

Civil service has no quality.

Himpun has no relevance

Jais has no evidence

Perkasa has no respectability.

Utusan Malaysia has no ethics

Umno’s papers have no limits

MSM have no objectivity.

Umno has no shame

It has made no changes

It has no morals and honesty.

BN has no future

A coalition of no principles

The government has no dignity.

Bolehland will have no money

The country will have no hope

A pariah nation – Asia’s tragedy!

Say “NO!” to Umno

Say “NO!” to BN

Say “NO MORE!”

Martin Jalleh, 31 Oct 2011

gloomy truth bout Bolehland's medicine

After reading the following article, being inside the inner circle, I felt a compelling urge to share it out with everyone, since not everyone have access to Malaysiakini. The content of the article, everything, if not mostly, is the honest cold truth about our current medical landscape, which had turned from the graceful underwater coral beauty of Sipadan to the barren dry wasteland and disease-infested dumpsite of Kuala Lumpur. The writer seeked to warn everyone about the storm coming, I believe we are already in the middle of it. Some are already being beaten up, tattered and shattered by the storm.

To be honest, I hope this article goes viral and to be read by every citizen of Malaysia. I know that is not going to happen for several reasons, mainly because some are still being marginalized from proper education, some are still reluctant to learn up English and fall back in comfort in their own mother tongue, and mostly just don't care.

Kindly read it and share it out to everyone.

'Storm is coming' for our medical profession

Keruah Usit 11:51AM Nov 15, 2011

There has been a recent rash of angry letters and articles in the press, detailing the incompetence and lackadaisical attitude of many of the new generation of junior doctors, known as interns or house officers.

Most writers are contemptuous about the majority of the 7,000 new doctors entering the ranks of the medical profession every year.

Some letters, on the other hand, are written by house officers or their families, complaining of long working hours and harsh treatment by specialists.

It is obvious that feelings are running high. Traditionally, most Malaysian doctors do not write in much to the press. Doctors rank among the most conservative citizens in the country.

Even when the profession was faced with the torture of 106 prisoners of conscience in Operation Lalang in 1987, most doctors remained silent.

But in recent months, like other urban, educated and Internet-savvy Malaysians, many doctors have been changing tack.

Senior doctors took a concerted stand in July against the tear gas and water cannon used in a police assault on Bersih 2.0 protesters sheltering in the grounds of Tung Shin Hospital.

Following the arbitrary arrest and imprisonment of Dr Michael Jeyakumar Devaraj (left), one of the Emergency Ordinance Six (EO6), a large group ofPerak doctorsworking in public hospitals looked squarely into the camera, and called for Dr Jeyakumar to be freed.

The Malaysian Medical Association (MMA), the professional body representing over half of all registered doctors, also criticised the detention without trial.

This mutiny by middle-class Malaysians augmented the efforts of Parti Sosialis Malaysia (PSM), PAS, PKR and DAP, as well as civil society groups like Suaram, Aliran, the Bar Council and religious groups, in pressing the Home Ministry to release the detainees.

Vocal debate over ‘substandard’ interns

Some concerned doctors are now warning of future disaster in our health care, caused by substandard new interns.

“The storm is coming... Commercialisation of medical education will soon affect all of us. The glut of doctors is getting worse and many of them are being under-trained,” wrote Dr Pagalavan Letchumanan, a consultant rheumatologist and prolific blogger on crucial issues in health care.

Prominent doctors argue that profit-seeking degree factories in Russia, Ukraine, Romania, Egypt and Indonesia, as well as local medical schools with low teaching standards and inadequate lecturers, have condemned thousands of house officers to a hollow career they are not qualified for, and ill equipped to cope with.

The number of medical schools in Malaysia is 35, a staggering number for a population of 28 million. This is twice the corresponding ratio for the United Kingdom, with 33 medical schools for a population of some 62 million.

Of these 35 local institutions, 18 in the public and private sectors have already passed out house officers. Another 17 medical colleges will produce graduates between 2012 and 2017. Understaffing in local institutions is endemic.

The government claims the new doctors are needed to improve the ratio of doctors to patients from the current 1:1000 to 1:400, a level typical of developed nations, by 2020.

The Health Ministry has reneged on last December’s promise of a moratorium on new medical courses.

Several senior government doctors, requesting anonymity, blame political patronage by ministry officials, in this lucrative business of producing doctors, for the huge excess of house officers.

Greed, they claim, has been the prime mover behind the proliferation of officially recognised, but substandard, medical degrees from deficient medical schools, both inside and outside the country.

But many of these same senior doctors in the public service fail to report the poor performance of some of their new interns to the Malaysian Medical Council (MMC), the licensing body.

Some supervisors dread the paperwork involved in blocking the inept doctors from being registered. Others are simply reluctant to rock the boat.

These established doctors clearly lack the mettle of more vocal colleagues, like the current MMA president, Dr Mary Cardosa, who spoke up for Tung Shin patients, and for Dr Jeyakumar.


‘Pampered and reluctant’

Several specialists tasked with training the new doctors say many of these interns are pampered, reluctant members of the profession, cosseted by unrealistic, well-to-do parents.

Firsthand accounts by these specialists indicate the average quality of interns has plummeted, even though there has been a surge in quantity.

One surgeon said he received a telephone call late one night from the angry father of an intern. The father complained bitterly that the surgeon had ticked off his daughter for a mistake, earlier that day.

The surgeon asked to postpone the conversation until the next morning, explaining he was on his way to the operating theatre, but the father kept up his barrage of verbal abuse.

A specialist in Sabah recounted an episode of a house officer going absent without leave for several days. When challenged, the young doctor claimed he had been admitted to a private hospital for a “heart attack”. A check with the private hospital confirmed it had never heard of him.

“Some house officers just don’t know the basics,” one exasperated consultant told Malaysiakini. “I was trying to teach two house officers, both of whom had been working for a year.

“I was soon reduced to asking the most basic questions. Even then, they couldn’t tell me the normal range for the heart rate. One guessed ‘60 to 80'.

“Even Wikipedia has the correct answer. They couldn’t tell me what a normal blood pressure was either.”

Another specialist added, “Some of these house officers did not make the grade to enter reputable universities for a good reason. Their parents shouldn’t have forced them to become doctors, they’re simply not interested.”

There are, undeniably, a number of bright, dedicated potential doctors in the ranks of the new house officers. But the lack of motivation among many of the interns is plain to see.

One government specialist tried an age-old trick to elicit some empathy for a patient who had been treated badly by an obdurate house officer, by asking him: “How would you feel if this were your own mother, lying here in this bed?”

The specialist was taken aback by the young doctor’s reply.

“My mother wouldn’t be in this bed. She’d be in Singapore if she fell sick.”

---

KERUAH USIT is a human rights activist - ‘anak Sarawak, bangsa Malaysia’. This weekly column is an effort to provide a voice for marginalised Malaysians. Keruah Usit can be contacted at keruah_usit@yahoo.com

unforgettable intro

Got a phone call from someone...

Hi, Are you Dr.Pilo? I'm calling from ABC. I think we need to admit this patient to your ward.

Yes, I'm Dr. Pilo. Oh, I'm sorry, I had specifically discussed this patient with my Specialist-On Call and we do not see this admission to be a warranted one. May I know who I am speaking to?

Dr.Pilo, I am Dr X, Medical Officer from Y Department, 2nd year Master Student in Y of Uni of Z, I am telling you're the primary team and this patient have to be admitted to your ward.

(Gosh, wow, a Master Student... ) Like I said, I can't allow that to happen. My specialist do not see this admission as warranted.

No, you see this patient came here with this problem... bla bla bla.. bla bla bla... it's a gynae problem... bla bla bla... (Wow. a speech. Awesome)

... the rest of the discussion was a boring one and finally it was up-levelled to the specialist level.

Kinda bowled me over when some people believes in the prestige of being a trainee or Master student, including their status being higher or more solid than others...

As for me, for now, I appreciate the grace and solidarity that invisibility has to offer.

the patients at the back

it's been amazing, knowing many survivors of gynaecological cancers.

most of them will be admitted and be placed at the 2nd half of the ward, therefore, aptly being addressed as 'the patients at the back'. Their place at the back doesn't mean less attention given to them, but instead the other half of the ward is the more slow-paced, peaceful area with a simple fun, loving group of people.

but in few months time, slowly, i had grown used to calling them by their first names.

to see them go through the emotional rollercoaster of fear, anxiety, sad, depressed, grumpy, irritable, hope, joy and relief.

when a whole row of patients can share the some laughter over a few simple jokes, i knew i done more than treating them.

when a patient can share their fear and joy, i can see there is really more to life.
much much more.

their survival over their own emotional turbulence trumps their survival over the disease.

the following video had done a marvelous job in capturing that exact emotional rollercoaster in something that we take for granted everyday.

The Princess from Disposable Film Festival on Vimeo.

A film by Adonis Pulatus – amazing emotional, real-life roller-coaster of time-lapse photography

random short chat

halfway through the department's weekly presentation, my colleague noted the fetal scan parameters was a bit funny.

"Hey, Pilo, comparing the 2 scans, you see after the few days, the AC (abdominal circumference) of the baby became smaller. You saw that or not?"

"Yes. Probably the baby farted."

(=,=")