gynae statement of the year

genevieve's baby steps

Found this somewhere in fb...

Teens: you have all the time and energy, but no money.
Workers: You have all the energy and money, but no time.
Oldies: You have all the time and money, but no energy.

Lesson: Enjoy life and all the things you have at the moment because you can't have everything all at once.

The above is profoundly true, but i believe the lesson is lame and perhaps, a bit too gay.

Here's what i think the lesson should be.

Now, all you need is to find ways to have money when you're a teen (probably by doing some part time jobs), to have more time when you're a workers (probably choose a more flexible work) and to have more energy when you're getting old (probably by staying healthy when you're younger and stop breeding by then).

As for now, I think I need to think of more strategies to increase my 'time', so that I can have everything all at once at a perfect balance.

After a busy day at work, breathlessly working, taking care of the whole gynaecological subsection of the departmental service, it really make me wonder. The discrepancy between the real and allocated manpower served only as a deception, deceiving themselves of the fairness, justice and equality that were never there at any point of time. Sleeping better at night doesn't mean that hurricane is not hitting that other part of neighbourhood.

Anyway, I guessed i had busier days. Many years ago, I was so busy that I missed my son's first few independent steps. I only can see them re-played in a poorly-recorded video using my wife's handphone. It was a consolation of a bliss for a father. Now, even closing my eyes, I can imagine that short vids clip from start to end, every details and sound.

Nevertheless, after a busy day at work, I felt rejuvenated, watching my daughter's first few independent steps. Slow and slightly limping, but she was walking steadily for 5 steps before hugging me at the end, and followed by loud applause by everyone at home.

Now, I can proudly say: I was there. Live action!

I believe I will need more 'time' in life to be present for all those great moments in all the people dearest to me.

Find Malaysia

Hartal! First independence Initiative!

Every year on this date, I wish to remind my fellow Malaysian ...

Today is 20th of October, the real first nationwide initiative to fight for our national independence, unknown to many, most Malaysians.

The initiative is a peaceful demonstration called 'Hartal'.

You can find out more by watching the short film by Fahmi Reza named '10 Tahun Sebelum Merdeka'. I compiled the all 4 youtube parts below.

I decided also to pimp the great top 10 below by Fahmi Reza.

PopMuda Post 1: Top 10 Myths Pasal Merdeka

31 Ogos datang lagi! Masa aku buat research untuk filem ’10 Tahun Sebelum Merdeka’ & ‘Revolusi ‘48’ aku jumpa banyak fakta menarik pasal sejarah perjuangan kemerdekaan negara kita. Jadi today sempena hari merdeka, aku nak kongsi my top ten favourite myths pasal kemerdekaan 31 Ogos 1957 yang masih banyak bikin kita confuse.

#10. Lagu “Tanggal 31” dicipta oleh Sudirman

Sudirman only covered lagu Ahmad C.B. from the 60’s & changed one line from the lyrics. Kalau tak percaya, listen to this!

Tanggal 31 Original version oleh Ahmad CB
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Tanggal 31 Cover version oleh Sudirman
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#9. Kita ada “Social Contract” masa merdeka

Where got? Idea kontrak ‘bukan-Melayu dapat citizenship in exchange for hak istimewa orang Melayu’ mula surface in the 80’s. “Ketuanan Melayu” also the same.
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#8. Malaysia sebuah “negara Islam” sejak merdeka

Sebenarnya Malaysia negara sekular dengan Islam sebagai official religion, bukan Islamic-state!
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#7. Malaysia bebas 100% dari penjajahan British masa merdeka

Until 1970’s British controlled over 60% kekayaan ekonomi negara dan British military terus stay kat Malaysia sampai 1971!
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#6. UMNO-MCA-MIC mulakan kerjasama politik antara kaum untuk merdeka

Putera-AMCJA dah start much earlier in 1946. Tengok filem ‘10 Tahun Sebelum Merdeka’ kalau tak percaya.
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#5. Mamat yang design bendera Malaysia tak ciplak bendera US

Sure or not? :)
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#4. Perjuangan gerila komunis masa darurat bukan untuk kemerdekaan

In 1948, gerila komunis & non-communists lancar revolusi angkat senjata untuk halau penjajah British dari Malaya. Tengok filem ‘Revolusi ‘48’ kalau tak percaya.
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#3. Tugu Negara simbol perjuangan kemerdekaan Malaysia

Kita berjuang untuk kemerdekaan dari komunis atau dari British? Masa kecik, tugu ni buat aku confuse.
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#2. UMNO pengasas perjuangan kemerdekaan

Before UMNO (est. 1946), Parti Kebangsaan Melayu Malaya (est. 1945) fought for merdeka oredi. Before PKMM, Kesatuan Malaya Merdeka (est. 1938) fought for merdeka oredi. Before KMM, Communist Party of Malaya (est. 1930) fought for merdeka oredi.
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#1. Malaysia mencapai kemerdekaan tanpa pertumpahan darah

Inilah bapak segala merdeka myths, ditulis dalam semua buku teks, reinforced setiap tahun sejak merdeka. Realitinya, ribuan gerila anti-British terkorban dalam anti-colonial war of independence melawan British. Ribuan askar Melayu terkorban dalam perang penjajah melawan komunis. Ribuan rakyat juga terkorban kat tengah-tengah…
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Dedicated to the heroic fighters in the cause of liberty, justice and equality. Selamat Hari Merdeka.

x Fahmi Reza

gutter politics at its nadir

"Mungkin dia roboh Kampung Buah Pala sebab nak ganti dengan Kampung Buah Dada"
to be honest, some people in this world should just eat shit and die.

"Penang chief minister’s son had assaulted a 16-year-old schoolmate and tried to escape punishment by using his father’s name."
"A girl photograph was used to level accusations of sexual harassment against Lim Guan Eng’s son has been identified as 21-year-old chess Grandmaster Anya Sun Corke, who represents England in chess, has no ties with Penang and has never been a classmate of Lim’s son"
to be honest, some party should just do the same thing as aforementioned as well.

to be honest, politics is really not dirty, something else is, and their script to repair its badly dented image has become so predictable and pathetic.

It does not take much to decipher the dangerous direction it has taken to stay in control.

Here's Martin Salleh's brief discourse on their totally expected pathetic dangerous direction...

• Destroy the greatest danger to Umno – Anwar Ibrahim, by launching a relentless and slanderous attack on him with a second sham sodomy trial, sex videos and the help of spin doctors.

• Damage the credibility and integrity of Pakatan Rakyat (PR) leaders with ceaseless calumnies of wrongdoing and downplaying the successes of the PR states… till the coalition disintegrates.

• Discredit the coalition with the help of deserters, detractors and disgruntled leaders of PR parties with them spewing out their stale and silly exposé.

• Demonise, denigrate, defame, disparage, even denounce as traitors those who dissent against or criticize Umno and the government and those who dare to march for genuine political reform.

• Distract the nation from the failures of the Umno-dominated government and the damning evidence that the country is going to the dogs and we have become a perfect “sham democracy”.

• Divert the people’s attention from the Umnoputras bleeding the country dry. Deceive the nation with Najib’s publicity stunts and populist slogans. Distort the truth about the economy.

• Divide and rule this country along racial and religious lines and provide Umno’s newspapers the licence to publish unsubstantiated and wild allegations aimed at fomenting distrust and discord.

• Drag in the King and the royalty as pawns in their dirty political game. (Umno and Najib have made use of the palace to push and protect their agenda and vested interests.)

locum funnies

i blame the recession for making me slaves for extra bucks, but never knew I was entertained in the process.

incident 1.
Lady A: i think i'm pregnant.
Me: Oh.. when is your last period?
A: June. And I been having morning sickness and early morning vomiting
M: So, you come just to test you're pregnant?
A: Yes
M: Okay. (did a bit of examination, uterus just palpable) Here's go check your urine.
She came back with UPT test positive.
M: Okay, confirmed you're pregnant.
A: Yep, I checked myself the urine test yesterday, it was positive. I just want to confirm.
M: (?!?!?) Okay, quickly get go and make the 'buku merah' and get a scan. Here don't have scan.You want something for the morning sickness?
A: Actually, morning sickness and vomiting all gone already.
M: Oh (?!?!) okay, see you. just give you some folic acid.

incident 2.
Guy A: I have severe headache, cough, fever, runny nose and sorethroat. Really terrible.
Me: OK, how long?
A: 4days already, getting worse, even with medication from another clinic.
M: What was the medications given?
A: Some, cough and cold meds, no antibiotics.
M: Sure no antibiotics?
A: Yes (confirmed with acknowledgement from his wife beside him)
M: Ok. let me check (proceed to standard 'URTI, TRO Dengue fever' package examination)
A: So, how?
M: Because it's already so long, starting you on antibiotics. If you smoke, must stop for awhile.
A: why stop? Smoking should make us stronger.
M: (!?!?!) (smirked and giggled) You serious ar?
A: Oh, ok.. So you see, I already lost some time being sick 4 days, is there anything that can give me so I recover within 1 day?
M: (!?!?!) Nothing, your recovery depends on your body fighting it. And smoking will only weaken your body.
A: So, you sure, I can't smoke to get better.
M: (?!?!?) Err.. absolutely.

the Jumper

Darn, I still got some many things waiting for me to do, but still, my mind just favors writing here. Perhaps it is a misplaced priority, but then again, this is my interest and a place that I can find solace from the wild wild world of mental brutality paced upon anger, paranoia, hypocrisy and everything that nice and sweet but stings like hell.

Another relationship crisis was aborted yesterday, thanks to a Consultant who willing to address the issue and sit in to listen. Basically, not being a ‘jumper’.

Yes, For today, I would like to coin the term ‘jumper’, reserved for the privileged few who simply loved to jump to conclusions and triumph on assumption.

To point one finger at others, four fingers folded back stare blankly at my own face. Yes, I must admit I am also an occasional ‘Jumper’, but with aging and experience, I jumped less, much less, probably due to the fact, that I had been a jumpee in many occasions. A ‘jumpee’ would be someone who was victimized with the resultant lost of image and reputation or simply being emotionally brutalized as a result of the jumping by the jumper.

I ceased to continue with my own literal fantasy of jumpology, and let’s jump (no pun intended) into my real story for this week.

Here’s the thing.

As the person-in-charge of the ward, my ward specialist appreciates if all minor surgical procedures pre-planned for the day can be booked before our 7.40am passover at the other side of the hospy. This is mainly so because the passover will end around 8.15am and follow by ward round ending at the region of 10 to 11am. Probably if with the early morning OT vacancy, three to four cases could have been done and with it, those four patients could be discharged home by evening plus it would not have overspill to the on call period or worse, brought forward till middle of the night. To me, that sounds sensible and efficient.

It was not my first time booking. If not mistaken, I had done it for few weeks already.

Yet, on that very special day, I was rejected and was politely asked to book only after 8am where the medical officer in charge of the day can receive. I explained my predicament, politely explaining my situation. She explained hers mainly being her colleagues do not like if she did not do the cases she accepted. I simply had to agree that our differences held us at an unlikely impasse. We ended up vocalizing in a less polite tone without raising any volume. She gave in finally because it would be weird for her to reject, because on call is like 7 Eleven – it supposed to be open 24 hours. Nevertheless, I was not happy about the mood on which those cases were accepted. Let’s just call me a schmaltzy communicator. I would be glad we can work together, par on par, for the patient, rather than anyone of us being more superior to the other.

As expected, the vacancy was filled up with the first out of four cases that I had booked.

After changing to Papa smurf, I entered the operation theater main lounge. Short of stepping further to see my patient in the lobby, I was invited into the Anaest’s relaxation room by the cool Anaest Consultant Dr. L. Yes, the coolest people usually have name starting with ‘L’. OK, I digress.

“Pilo, I heard you were naughty this morning.” Cynically suggestive.

“ Hmmn.. morning… naughty.. hmmn..” I smirked sheepishly trying to complement the merry atmosphere that the consultant trying to build before starting a serious discussion.

She was being a minor jumper in the beginning, telling tales that the on call duties on my side are usually sleeping call and her minion grieved possibly due to sleep-deprived duty till 4am.

I kept my silence briefly, knowing that her perception was grossly misplaced in the yesteryears when gynaecology calls were so called ‘chill’ call.

Unknown to many, on top of our main core of gynaecology work, our duties been quadrupled due to the esteemed growth of patients of the gynaeonco subsection with multiple geriatrics trivials and the whole shebangs of medical complexities at the palliative state, not to mention the groundwork preparation or complications arised before, during and after their respective chemotherapy, radiotherapy or brachytherapy. I shall not dwell into the pre and post-operative care of patients who underwent the long-paragraph-named gynaeoncological ops. I remembered once I completed my night round at 1am plus.

And, then, there were the informal ‘EPAU’ (early pregnancy assessment unit) consultations with a free flow of miscarriages in their diverse degree of bleeding with the various degree of intelligence of those early preggies to come in the middle of the night, ie 3-4am when the bleeding was few days back. My theory is they probably had a long and detailed discussion with their respective husbands over a cup of teh tarik during their supper in their favorite mamak stall and then decided to seek treatment.

And not uncommon, there will also be sexual assault cases coming in with the police escort to be seen immediately. I fully understand the reason being this unfortunate cohort coming in at such ungodly hours – mainly to avoid the busybody crowd of fellow patients or their family members who usually builds up in the light of the day. Lastly, commuting between the main buildings of the hospital to the maternity side 4 blocks away to help out our junior colleagues over the obstetric side in the event of grave emergencies are not rare instances that usually comes with palpitations. Furthermore, the next morning, we do not go back at 8am in the morning. We used to be going back after 5pm or more depending on the completion of wardwork, until recently by grace of our superiors, we were granted rest after the sun on top of our head.

And that was 3 paragraphs of silence, for I believe my colleagues in Anaest worked just as hard, if not, harder. ‘Harder’ simply translate to ‘better’ as the fiercest fire mould the finest sword. Secretly, I am really glad the training got tougher, as long as it is sensibly tougher.

The rest of the conversation shall be kept from public, but the result was an agreed middle ground where both of us can find comfort in - sort of fine-tuning of the small matters which seems to have the potential to grow out of proportions.

For that brief moment of level-headed civilized discussion, she earned my respect for not being a major Jumper.

I texted my Anaest colleague whom I had the verbal-duel this morning, apologizing and sort our differences.

For the time being, I simply wish not to be involved in anymore misunderstandings.

fri funny | epic fairytale

really epic fairytale from Melissa.

and this is the epic truth

Young doctors mollycoddled - with MCQ

Here's the modified MCQ-plus version to this awesome honest letter about current medical predicament.

Young doctors mollycoddled

I REFER to “Overworked housemen” (Letters, Oct 5) and other grouses that increasingly make their way into our media by Generation Y housemen. As a specialist in a government hospital in Selangor, I feel that instead of silence that may be misconstrued as guilt, there is a need to reply.

We are now at a crossroads in our health system. The high standards that were maintained through the years have fallen by the wayside. This is especially evident from the constant complaints of the younger generation, although the system and the government are bending over backwards to accommodate them. The reasons:

-- An overload of new housemen/doctors – 500 a year in 1998 and 7,500 in 2011, with the number estimated to rise to 10,000 in coming years.

also known as

A. house officers boom

B. house officers avalanche

C. tsunami of house officers

D. future cheap medical labour

E. etc (insert suggestions here)

-- Too many medical schools in the country – 42 at the last count, with some having very low standards. Indonesia with a population of about 300 million has half the number. How did these colleges come to be recognised?

A. political-affiliation. MIC - AIMST, MCA-UTAR med school, Melaka Manipal - ??
B. the 5 years moratorium are just bull-talking (reference)
C. lots of under-table monetary gains for recognition
D. all of the above

-- Too many medical schools recognised overseas, with the standards, especially of Russian ones, being extremely low.

-- So we are now inundated with housemen to train, wherein 60% are of very low standard – meaning not even fit to pass the finals in a medical school exam, let alone to treat patients.

-- We, the specialists, are forced to retrain and even reteach these incompetents.

-- There are only so many times you can give advice to a person who doesn’t listen – sometimes when a patient’s life is at stake, voices have to be raised! Don’t you agree?

A. Agree

B. Disagree

C. Agree, but that would spoil one's perfect civilized image of gentle-mannered doctor

D. Disagree, raising voices increase risk of laryngitis, contribute to noise pollution and create a hostile working environment. the preferred method is to write a 100 pages letter to Ministry of Health and Malaysia Medical Council about that person's incompetency, either as a one time thing or in separate occasions.

E. Don't know. (typical Malaysian apathetic answer)

-- Increasingly, our politicians get involved when some VIP’s son or daughter who can’t cope, just wants to float through. Many specialists have been given letters of warning, when all they were doing was enforcing appropriate disciplinary action in respect of housemen who had gone AWOL.

Appropriate response to letters of warning:

A. Ignore the letters.

B. Make paper planes out of them.

C. Send a reply letter and cc to the politicians of the opposition parties

D. write a 100 pages explanation letter to Ministry of Health and Malaysia Medical Council about that person's AWOL, either as a one time thing or in separate occasions.

E. All of the above

-- The number of litigation cases against the Health Ministry due to housemen is at an all-time high.

-- The shift system was opposed by all senior faculty in the ministry, vis a vis all senior specialists, but it was forced on us. Who is going to monitor all these housemen under the shift system – the specialists?

A. The specialists.

B. The medical officers.

C. The administrators.

D. Good GPS trackers gadget and tag all house officers at the nape of their neck with electronic chips.

-- When these housemen become medical officers and specialists, are they also going to go on shift?

A. Definitely.

B. Surely.

C. Of course.

D. Is this really a question? Sounds more like common sense.

-- We have better things to do than mollycoddle a tsunami of sub-standard doctors. If we are not careful, there will be a great exodus of specialists from the public health system in the next few years.

All you see in government hospital nowadays are the poor and the illegals – everyone else has an insurance card! So to the powers that be, wake up and smell the coffee.

S.A.
via email

** For serious reading of extended articles on the matter, kindly read: Can you smell the impending disaster?.

tis piggy went to library

i used to be tempted to buy lots of books for my lil Aedan, mainly to broaden his literature horizon. nevertheless, i found most of the books border on recurring themes and usually most books will end their existence as the space occupying objects. Buying a whole shelf of them will only make me broke and it is an extravagant spending that I can really do without.

Not so distant from home, I found the State Public Library for Children. The membership fee is almost non-existent at the rate of RM1 per child per year. There are also Children Playroom membership fee at RM12 per child per year. But, I did not sign up for the Playroom, because to play in a library would have defeat the purpose of being in a library.



Aedan read few simple pictorial books there that day together with me. Most of the awesome books he fell in love with was in the reference section and not viable for the borrowing back home.

Together with him, we loan 3 books for two weeks.

And here's Aedan taking the oath of never to mess a book.

winning isn't everything

someone once said:
when you're already won her heart,
there's really no need to win every arguments...

Following my heart and intuition

It had been 5 long years since I first came into medical workforce as the greenhead house officer. Thanks to my buddy K for reminding me that. Clinical work is a different world from the medical school. One is like the sky and another is like the sewer below the North-South highway.

There were ups and downs, but the 2 major downs were the most memorable. Nevertheless, my previous downs were transient, the second one longer than the first. But, my hardwork persists and I have a lots of guardian angels in my life to be grateful to.

As for this time, I guess there are not enough angels in the whole wide world to change the prejudice, misunderstanding and misperception. What crime have I committed in the first place?

First time as an MD, I could not control myself and few tears welled up during an open heart discussion with my boss. I guess that's what people really do when they have been too strong for far too long.

I am just an honest person earning an honest salary to support my home. I never knew something so simple can be so complicated. I just have to do what I need to do. I can't do much more than that.

In a way, putting things into a positive perspective, I should be glad that life had choosen something so painful, so sharp and so blatantly damaging to mould a greater strength and patience in me.

Nietsche once said, that which does not kill you, will only make you stronger.

The lessons of strength are never meant to be learnt in classroom, but in the 'downs' that I experience as life goes on, holding on to my truest conscience.

I found solace in the words of a legendary Buddhist of whom his passing today had shaken the world.

His short discourse on Death had greatly captured the truth about anicca and anatta of which had slowly becoming foreign to me due to my lack of perseverance in pursuing the dhamma

No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life’s change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true.
Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma — which is living with the results of other people’s thinking. Don’t let the noise of others’ opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.

~ Steve Jobs 1955-2011

Steve Jobs is right.

Never be trapped by dogma.

Have the courage to follow your heart and intuition.

This entry seconds as the tribute to the great legend Steve Jobs, but primarily it's about my everyday physical and emotional struggle as the grossly and morbidly misunderstood trainee.

human touch

today, the clinic ended early, but a few of us was still wondering around because of an auntie, 5 years short of being an octogenerian. she was a strong lady, independent and came to our clinic by herself having being referred by the concerned primary care doctor for the disturbing vaginal discharge.

if it wasn't for the house officer's simple nature of being thorough and his profound human touch, we would have missed a pulsatile mass on abdominal examination. a quick sonography revealed a possible major vessels aneurysm. aneurysm is a dilated area of a vessels, thinned out and if not being carefully gently attended to, it will just burst like the blown-up bubble gum.

reflecting on our mediocre knowledge on such a condition, we decided to refer to our surgical colleagues. the referral and getting the transport to ship this lady over took us almost more than fourty-five minutes despite the working phone lines and the modern tech readily available. that's another enigma for bedtime story for another day.

the time-consuming ordeal did eat into our lunch hours, but we're glad to be part of it.

it is always right and definitely true, in spite of modern improvement to our life, the most powerful and essential is the human touch and the human-centric usage of our technology.

pimped from here.

even if you'd have only few more minutes to spare, the following vid is worth watching as a timely reminder of the most powerful tool in medicine.