Merry Xmas from Caffeinated Snowman

Hint: I'm oncall =)

Christmas spirit?

 

I thought Christmas is coming soon and I should be hearing a list of christmas songs.

 

But instead, all I hear whole day and night is

KARAKU, TADADADA, YENE, TADADADADA (with drums + ETC)!

 

Kind of annoying when I am trying hard to sleep postcall. 

JB street art

Legoland meets JPO meets Criminal meets Police Officer meets Corruption.






meets how people seem to disappear in Malaysia without any traces...

Maternity in troubled times

Emily Ortega, 21, gives birth to baby girl Bea Joy, after being in labor for five hours at an improvised clinic at Tacloban Airport in Tacloban city, central Philippines.

Read more: How to Help the Philippines' Typhoon Haiyan Victims, Survivors | TIME.com http://world.time.com/2013/11/10/how-to-help-typhoon-victims/#ixzz2kRFBc0hC


This is the moment when we should all close our eyes and imagine no matter how effing busy and tired or devastated we are at our current state, we must still rejoice for we are still alive and having probably a little heaven of world at home.

Dangerous leaks...

 

Happiness is within

Life is a series of pulls back and forth.
You want to do one thing but you are bound to do something else.
Something hurts you yet you know it shouldnt.
You take certain things for granted,
even when you know you should never take anything for granted.
A tension of opposites, like a pull on a rubber band,
and most of us live somewhere in the middle.
-Mitch Albom, Tuesdays with Morrie

Time and again

“Try to imagine a life without timekeeping. You probably can’t. You know the month, the year, the day of the week. There is a clock on your wall or the dashboard of your car. You have a schedule, a calendar, a time for dinner or a movie. Yet all around you, timekeeping is ignored. Birds are not late. A dog does not check its watch. Deer do not fret over passing birthdays. Man alone measures time. Man alone chimes the hour. And, because of this, man alone suffers a paralyzing fear that no other creature endures. A fear of time running out.”
― Mitch Albom, The Time Keeper

 

Time keeping. Do we really able to keep time?

Time and again, I felt time had failed me.
Time went too fast.
Time went off too furiously.
I do not know whether time are really worth keeping.
Maybe for once, I should really let time runs wild.
Let time falls apart and maybe it will consider stopping for me.
Nah! What nonsense am I babbling about?



I have all the time in my life.
The auntie at the bed fifteen have all the time in her life.
She did not threw it away.
She used it despite the knowing fear looming from every of her meeting with us.
Yet, her time is not for keep.
She let her time went freely from time to time.
And I do not know the reason or the compulsion brewing in me,
I had used up my time so that she maybe, probably, possibly have more time

When someone gives you their time,

they are giving you a portion of their life that they will never get back.

It’s one of the most precious gifts you can receive.

Don’t waste it

I wish her well. Always.


 

 

Girl vs Guy: Reality Bites!!

curi from here

Psychology of being sick

No male(s) during delivery, please?

I was being asked multiple times to comment on the issue stated above for some obvious reasons.



Being in this country with Islam as our national religion is kind of an unique experience because in this Bolehland, the religion is practised slightly differently from the original teaching for reasons beyond the understanding of even the brightest Muslim scholars.
Read: Islam in Malaysia: Perceptions & Facts. 


Neither am I an expert in Islamic studies nor a woman.

But I am a husband and also a medical person.

Personally, in life, everything is about prioritization.

You can't live without prioritization.
If you don't prioritize, you'll end up doing things that's not urgent,
and leaving things that is important unattended.

Let's put religion aside.


What's the priority?

As for me, the priority is simple.

Health and safety trumps privacy.

If possible, even as non-Muslims, it is the hope of every men that their wife's privacy will be protected from other men (except for swingers and naturalists), unless there is an issue of safety or possibility of better/more superior treatment that can be only managed by the more experienced male medical person.

The writer of the letter clearly understand this but he has a slightly different threshold as he only consider treatment by the male expert after complication arises.

As a medical person, medical practice is moving away from paternalistic medicine and constantly, if not always, is taking into account of the patient's wishes.

Taking into account of patient's wishes do not mean it is for the doctor to tleave the patient to blindly follow a suicidal path.

The medical person should try his/her best to give the best counselling based on latest evidence and possible worse case scenario to the patient together with the patient's family members/closest next of kin.

And if certain examination or treatment are being rejected, the second best or follow up should be considered for the patient.

In the West, namely, UK, focus is on the respecting the women's wish(es) and consent, including doing intimate examination.

It is done only if it is completely necessary and with formal consent in a comfortable room.

Here, sometimes, intimate examination is being done, for completion sake or not following protocol. It is something that we must look into.

But, most of the time, the women are extremely compliant because they value health and safety more than privacy. (the subservient value of Asian women, maybe)

In medicine, we must try our best to cater to women's wishes and needs.


For instance, for women with Jehovah's witness as their religion, they are never keen for blood transfusion, and in UK, as a solution or as the second best, they are being referred to medical centres with Cell-Saver if they are of high risk of bleeding.

Another instances would be for elderly ladies planned for removal of womb for benign condition.
If she is ardent on conserving the ovaries - why not?
Recently, a Prof asked us guys, how would you feel if I want to do a bilateral orchidectomy for you.

Thus, if in the hospital, if the woman's wish is to follow her religion strongly,
and the hospital can provide the appropriate female medical person, why not?



But the woman and her partner should be fully counselled (warned) regarding the downside of having such preference - mainly delay and in rare instances, deadly complications associated with delay.

As MOfrust puts it succinctly:

I personally feel, the letter should be rewritten in a different manner. Instead of MELARANG, it should be "meminta supaya kakitangang wanita yang mengendalikan kes isteri saya". Either that or add a clause at the end of the letter: 

I will take full responsibility of any morbidity that will happen in the event of any delay in treatment of my wife as a result of me not allowing any male staff to attend to my wife despite being informed on the inadequate female staff....signed and dated by husband.

For most people in the medical line, we always classify those patients as fussy patients who are better off going to private because they can get whatever they want at a higher price.

Often, I felt it is a wrong mindset.
It is just like some idiots who tell off some Malaysians,
if you don't like our education, or our government, or our healthcare, or our food, you can migrate to other country, or balik to the original country of our ancestors.

In the public healthcare, the cost of healthcare is almost the same.
The public paid taxes - some pay more, some pay less.
And allocations are being made for healthcare.
Meaning, the people paid for the services at the public healthcare facilities through their taxes, not just their RM1 only.



Thus, the women and their respective husbands can make their wishes crystal clear, but they must accept the shortcomings and difficulties faced by the medical staffs of public hospital.

Prioritization of healthcare should be done to cater to all the women in the wards, and not just fully allocating a female doctor for the patient who requested female doctors only.

And at that some juncture, they must decide - RELIGION or HEALTH/SAFETY takes precedent...

Don't be surprise that for some, religion may comes first. Read: Qurban

In our neighbouring country - Brunei, only female obstetricians and gynaecologists are accepted into service.

Did you know that?

Below are commentary for intimate health examination by the opposite gender, from the Islamic perspective.

Pada diri wanita ada ciri-ciri atau kriteria yang spesifik dan itu tidak dimiliki oleh lelaki, begitu pula sebaliknya. Apabila salah satu pihak meninggalkan kriteria yang telah ditetapkan Allah bererti ia telah meninggalkan fitrah dan merosak kudrat insaniah. Ada beberapa ketentuan dalam syariat Allah sehubungan kriteria yang dimiliki oleh wanita, oleh sebab itu berpegang teguhlah dengan syariat tersebut dan jangan perkenankan lelaki campur tangan dalam urusan dalaman jika tidak ingin dirugikan ataupun kehidupan fizikal dan kejiwaan wanita akan rosak.
Secara syariat, wanita muslimah hendaklah menjaga dirinya dan auratnya dari dilihat orang lain, kerana jika perkara ini terjadi pasti akan menimbulkan fitnah. Secara fitrah baik lelaki ataupun wanita yang bukan muhrim bersentuhan pasti akan menimbulkan berahi dan getaran jiwa yang akan mendatangkan tekanan syahwat baik banyak mahupun sedikit. Inilah namanya nafsu yang pasti ada pada diri seorang lelaki ataupun wanita yang normal.
Wanita mengandung ketika mengadakan pemeriksaan bulanan dengan doktor lelaki bukanlah tergolong dalam keadaan darurat, kerana ketika itu wanita tersebut bukan dalam keadaan sakit. Jika ia bukan dalam keadaan darurat sudah tentu hukumnya berdosa ketika seorang doktor lelaki menyentuh bahagian-bahagian tertentu tubuh wanita tersebut. Kedudukan darurat dalam Islam adalah jika sesuatu keadaan itu tidak ada pilihan lain, maka secara terpaksa atau harus kita melaksanakan sesuatu yang pada dasarnya bertentangan dengan ketetapan Allah. Umpamanya, memakan daging khinzir hukumnya haram, namun ketika dalam keadaan tidak ada sedikitpun makanan melainkan daging itu sahaja, sedangkan kita dalam keadaan kelaparan yang boleh membawa maut, maka hukumnya menjadi harus memakan daging tersebut sekadar mengelakkan dari mati.
Begitu juga halnya dalam masalah pemeriksaan bulanan, ia bukanlah dalam keadaan darurat, sebab masih ada cara lain atau alternatif lain untuk mencari doktor wanita ataupun bidan yang beragama Islam. Apatah lagi di negara kita sekarang ini mudah didapati doktor wanita, bahkan di hospital dan klinik kerajaan pun kebanyakan yang memeriksa wanita hamil terdiri dari doktor atau bidan wanita. Mengapa kita mesti mencari doktor lelaki jika hanya sekadar menginginkan kepakaran mereka disaat mengadakan pemeriksaan bulanan. Bahkan doktor wanita yang pakar sakit puan pun telah ramai di negara ini. Maka tidak timbullah istilah ‘darurat’ ketika mengadakan pemeriksaan bulanan dengan doktor lelaki bagi wanita hamil. Kecualilah ketika akan melahirkan, di mana wanita yang akan melahirkan tersebut memerlukan pembedahan dan perhatian yang serius dari ramai pihak. Maka ketika ini barulah boleh dipakai istilah darurat tersebut, kerana wanita yang ingin melahirkan itu tidak terfikir masalah lain, melainkan ingin selamat melahirkan anaknya.
Ditinjau dari aspek psikologi pun proses pemeriksaan bulanan yang dilakukan wanita hamil dengan doktor lelaki ini akan menimbulkan kesan yang jauh dan negatif dalam hubungan kekeluargaan. Bayangkan saja bagi seorang wanita yang selama ini hanya disentuh oleh suaminya, tentu akan merasa suatu getaran ketika lelaki lain menyentuhi tubuhnya. rasa kelainan dan getaran inilah yang membenihkan suatu keinginan tertentu kepada yang lain selain suaminya, lebih-lebih lagi ketika mereka menghadapi masalah atau krisis rumahtangga. Perkara ini sepintas lalu nampaknya macam perkara biasa dan sederhana, namun dalam jangka masa panjang, kesannya sangat membahayakan minda dan jiwa isteri tadi serta suaminya juga. Dalam hal ini bagi doktor lelaki mungkin tidak merasakan apa-apa perasaan terhadap pesakitnya, disebabkan terlalu ramai pesakit yang dirawatnya setiap hari dan ini menjadikannya lali dengan keadaan tersebut. Namun bagi seorang wanita yang normal dan sihat, getaran di jantungnya pasti akan terasa dan getaran inilah yang dinamakan syahwat.
Jika perkara ini terjadi bukanlah bererti setiap wanita yang hamil itu tidak baik atau wanita yang rendah moralnya, malah perkara ini membuktikan kenormalan wanita tersebut. Dalam hal ini kebijaksanaan suami sangat dituntut untuk melaksanakan tuntutan Islam agar isterinya mengadakan pemeriksaan bulanan dengan doktor wanita Islam sahaja.
Saya ingin membawa contoh yang sama dalam diri seorang lelaki. Bagaimanakah rasanya perasaan seorang lelaki jika bahagian tertentu tubuhnya disentuh oleh doktor wanita dengan nada bahasa yang lemah-lembut dan baik. Sebagai seorang lelaki yang normal, pasti dia akan merasakan getaran di jantungnya, kecualilah jika ketika itu ia betul-betul sakit (dalam keadaan darurat), sehingga tidak ada yang lain difikirkannya melainkan kesembuhan dari sakitnya itu. Begitu juga halnya dengan doktor wanita yang menyentuh pesakit lelaki mungkin merasa lali dengan situasi tersebut disebabkan profesi dan tanggungjawabnya sebagai seorang doktor.
Fahamilah tentang kaedah batas-batas aurat bagi seorang wanita atau lelaki yang bukan muhrim. Jika perkara ini tidak diberi perhatian secara serius, lama kelamaan akan runtuhlah sendi institusi rumahtangga keluarga muslim. Seandainya seluruh umat Islam tidak mengambil berat tentang perkara ini, bukan saja institusi rumahtangga malah negara pun akan runtuh kerana kejatuhan nilai moral dan agama dalam kehidupan bangsa. Peliharalah diri dan keluarga kita agar kehidupan bahagia di dunia dan di akhirat serta terhindar dari seksa api neraka. Wallahu A’lam…
Wassalam.
http://www.ukhwah.com/

Beautiful to love the ordinary...

Anyone can love a rose

























but it takes a great deal to love a leaf. 


It's ordinary to love the beautiful


but it's beautiful to love the ordinary

"Anyone can love a rose, 

but it takes a great deal to love a leaf.  

it's ordinary to love the beautiful, 

but it's beautiful to love the ordinary."

Unorthodox breastfeeding position

From the Daughter of the Sun. the Newspiece.

Reminds me of the time at the age of 2years plus,
when my Dearest wife asked my little Genevieve whether she still want breast milk.
Little Genevieve requested: Can you pour them out?

(=,=")

...

The falling star

Morning round started with the specialist who came in early.

The lady in front of us was pale and obviously in slight distress, mildly gasping.

As the medical officers and specialists quickly did a run-through examination on the unfortunate lady in almost plain white, I ran and took a branula trying to secure a running line into the vein.

And the house officer, oblivious to all the emergency steps we're doing still in her own world, standing on the foot of the bed.

She wrote "S/B (seen by) Dr XXX (the name of the specialist)" and below written "Case and progress noted".

She didn't budge a single inch from her place of writing. Possibly was doing some kind of exorcism or external healing from writing on the medical case notes while her superiors all busy fluid resuscitating the lady.

Such is the quality of future doctors the whole innocent world are up against. Sadly.

A brief review of the case note revealed that she was being operated the night before for bilateral large endometrioma and currently suffering from hypovolemic shock possibly due to the underestimation of blood loss from the operation the night before.

Unfortunately, she was seen by the gynae medical officer on call but was not being fully assessed or scanned.
She was referred on table by the Surgical team after the glaring perineal findings came into the light (the laparoscope light).

Something that is very dishonorable about this whole incident is the lack of professionalism in the initial assessment.

The unfortunate lady would have been diagnosed correctly if she was being assessed with massive apathy because the bilateral endometrioma was as big as two ostriches' eggs.

She would have undergone an elective operation after good pain control and exclusion of the minute risk of malignancy.

Under a better controlled elective setting, it would possibly end up with reduced blood loss and dismiss the need for transfusion.

It would be less taxing on the on call team and the on call team can focus on other more dire emergency during the on call.

The gynae medical officer, Mr B was reprimanded only with a few words - I know you have brain, but you're purely lazy.

If this was the first time, then maybe it could have happened by chance, but it isn't unfortunately.

Mr B is a foreign student under training with our Master training programme.
They do not have salary as they paid for this programme.
Thus, his concept is that since the local students from Ministry of Health are being paid, therefore we should work harder than him.
And fair enough, our superiors (not all) conformed to the similar thinking, which I beg to differ.

We are paid salary but we're also being tied up for 5 years working for the government after we graduated.
Technically, we are also paying for the programme, similar to them.

Secondly, in an esteemed centre of training, I do not comprehend how can we let certain standards slide away just like that.

He is always missing from the wards and clinics.
What happens to the maximum 2 weeks of leave of absence for every 6 months of training?
If it was more than 2 weeks, isn't it a person need to be extended in his/her training?
Why lady trainees has to be on their toes and return within 2 weeks post delivery to assure non-extension of the Master training, yet some people just go missing more than 2 weeks without substantiated evidence of their absence?

There was just no team work in him.
He even can tell his teammate that he is not coming for ward round because he was invited the other day.
Do you actually need to be invited to ward rounds?
What kind of specialist are we breeding in this centre of excellence?

When there was shared and scheduled operation theatre hours, he refused to enter operation theatre.
And he boasted on how he could do a certain surgery by himself with supervision of lecturer, but end up his intraabdominal drain got stuck and required a relaparotomy.
Maybe it's just a rare unfortunate occurence, or perhaps it is due to lack of experience in assisting.

My eyes welled up with tears during ward round that day, knowing the clinical circumstances leading to the emergency endometrioma removal.
How could such a appalling and disgusting performance be accepted in the institution?
Even if he is a smart student, he is an excellent protege, he is possibly the exam top scorer, is that how we should accept the birth of a specialist who lacks professionalism and proper attitude for life and patient?

The saddest of all, his infamous role model for delinquency is well known by all the lecturers and Consultants but yet there are no formal response to such a shameful attitude, only table talk about him over meal time.

This inaction will only breed more to follow in his footsteps.

It is really unforgiving for this institution to allow such a candidate to be honored with the recognition of a specialist at the end of program without any correction of his current appalling attitude.

Is our institution still ardent to be stars of the sky or are we letting ourselves reduced to a falling star?

The fitting things for fits

Calm Sunday morning.

Thought of waking up  - naturally.

Naturally basically means sleep till late late, but kids are already jumpy and going all over the bed like baboons in the zoo.

My wife and I craved for the beef noodle near the old town.

We forced ourselves up and got dressed up for that awesome morning meal.

By the time we were there with my 2 little angels, the whole place was packed with people from all walks of life.

That shop was hidden away into small alley and without any signboard of the shop's name.

Frankly-speaking, it doesn't need a name.
Everyone seems to know this place.

As we sat down and began to order, the dried a.k.a. gravy version, mee and koay teow had already finished... at 845am.

Only left were the noodles with soup version.

Still a good enjoyable dish.

The next table was filled with a group of youngster, possibly in their early 20's.
A few of them started to light up a ciggie each.

It annoyed me a lot as my kids were there exposed to those toxic fumes.

Intermittently, I stared at them, the few who lighted up, giving them my infamous crazy eyes stare.

Luckily the nicotinic aroma did not travel to my table as the fan was directing the wind away from my table.

Out of sudden, a sudden crash was heard.

The soup of a youngster who sat just behind me were splashed all over the place.

My initial thought was they were playfully fighting or playing, but as I turned over, I could see above my shoulder, a young man was basically fitting on his chair.

All of his friends, in their stylish half-blonde and semi-redhead hairstyle, were stunned and tried to hold him down and tight as if their strength will stop him from shaking.

I quickly ordered my wife to bring my children to the other side of the table.


With the help of his friend, a plump guy with less clothing or hairstyle sense but more senses in everything else, we brought him down to the floor slowly and put him in left lateral position.

All his other friends just stood there, indulging in their own anxiety, puffing away more ciggies and basically blowing those smokes to their fitting friend and to my face.



I asked them to go away and provide more air for his friend and the plump friend (let just call him fatso) was suddenly on the phone.

While holding the phone, Fatso pinched on the fitting friend's nose and obliterating it, as I was holding his cheek turning him left lateral.

I was shocked, surprised and practically speechless.

Fatso revealed he was talking to the fitting friend's mother and that was fitting boy's mom's order.

I quickly slapped that hand off the nose as I saw the lips slowly turning cyanosed.

At that point, I had to declare my identity as doctor and I know what to do.

The fit aborted spontaneously but he was still drowsy and breathing in deeply.
The blueish discoloration of the lips went into a crimson shade of relief.

I asked for help to fan the fitting guy and someone volunteered to do it with the newspapers folded into two.

On and off, there will be people, mostly looks like those who survived Japanese occupation, coming over my ears and trying to convince me to shove a spoon into his mouth or do something to prevent him from biting his own tongue.



One actually suggested putting in a finger.
I smiled at them, although, I could not tell you how much I wish to laugh out frantically and suggest to them to volunteer their fingers.

I explained that it is important not to put as if foreign body broken off it may cause choking.
I also explained turning to side will prevent the tongue from falling back and block the airway.

Fatso continued to talk to the mom, telling the mom, I was pressing on the fitting man's neck.

"Helloooo.... This is cheek and not neck lah."

Anxiety-induced visual illusion.

"Please call for ambulance." I ordered.

Fatso asked me "Mister, do you have the phone number of ambulance?"



My mind was yelling "WTF!" but my words was exactly "Call 999 and ask for hospital".

I was not sure if it was education failure or community failure or just purely another anxiety-induced morbid panic, even as a young chap when my legs were short and my shorts were small, I always knew 999 was for police, firemen and ambulance.

The ambulance couldn't come because they don't know where were we.
Really couldn't blame them, this place was pretty hidden away from the main streets.

That person slowly regained consciousness and I asked him if he knew who he was.

I asked Fatso what was the fitting boy's name. "Yxx Hxx"

As if in a deep slumber, he answered "I am Suai Ker Xing (Handsome Xing)." and fell back to sleep.

All his friends quickly brought him into their "sport car", modified version of our local car and they sped off to the nearest hospital.

It's been quite long time since I last seen any fits.

The last fit that I encountered was the 5 seconds eclampsia that spontaneously relieved, too fast for my eyes. This was like 5 years ago.


Wifey was impressed and sort of figure out I am not just another lame fanny doctor.

It was an eye-opener to my kids and they are still trying to digest what exactly was happening.

All my cute daughter told me was "That uncle is sick."

As a whole, I think my medical and public health colleagues still have a lot of grounds to cover as even the epileptic's mother do not know how to administer the correct first aid (WTF, pinch nose and obstruct nasal airway) and the general public as a whole in the misperceptions in attending to person with seizure.

Here's a good read about seizure treatment.