pīlōkär´pēn’s

bring it ON!

2012-01-27T09:18:00.000-08:00

surgical small talk

2012-01-24T03:27:00.000-08:00

There are many reasons for any medical practitioner to fall in love with the practice of surgery. Subconsciously, the short period of time when you have the patient’s internal organs on your finger tips – it is almost god-like. This could just be the main raison d'être for anyone to fall in love with surgery. Conversely, the fear of screwing up with all those bloody live human organs on your hands is partly the reason why others fell out of love with surgery.

The other small, tiny perk of surgery is that little small talk while one operates. Rarely, the patient would be awake to hold a conversation with you, ie conscious brain surgery or when patient only on local or regional anaesthesia.

Here’s a small talk that I recently had, while assisting, inspired by the Chinese New Year song heard from the radio in OT.

Surgeon: So, the next year is Dragon Year, right?

Me: Yup. This year is Rabbit.

S: So fast came back to Dragon, I used to remember that the millennium was Dragon year.

M: Yup, luckily it’s Dragon, and not Dog,Rat or Rabbit. Like this year Rabbit, a lot of people bought rabbits, mainly for good luck, and then do not properly take care of the animals.

S: Hmmn. That’s bad. Good that it’s Dragon. They can’t buy Dragon, right?

M: Yup, they don’t exist to be bought.

S: How about other years?

M: There are Cow, Tiger, Snake, Horse… I doubt anyone would keep Cow or Horse.

S: So, what do they do during Tiger Year? They go for tiger show?

(Taken aback. Almost speechless. 2 minutes of pause)

M: Haha, no, they go to touch Tiger in open zoo or some temple in Thailand.

And that was the last surgery that I had taken part in before the year of the Dragon.

Happy Chinese New Year!!! Hope everyone have high-flying, wonderful Dragon year!!

1support TAK NAK 1care

2012-01-17T03:11:00.000-08:00

daily cardio exercise

2012-01-17T02:34:00.000-08:00

quite elated that i have this exercise almost everyday...

and i am sincerely glad my friends are doing this exercise along with me...

SBPA?

2012-01-07T08:47:00.000-08:00

holiday: boon or bane?

2012-01-06T02:39:00.000-08:00

It is rather not surprising that one third of our days of year are being spent on leave. Yet, out of this holiday, I believe strongly that I will probably be on call on 2/3 of it and actually on leave on the other 1/3 out of those holiday.

Thus, my actual holiday is 1/9 (1/3 X 1/3) of the whole year. Bad deal, right?

Dr Ng brought up the issue of how destructive holidays can be.

Although, I totally agreed with the disastrous standpoint of having an emergency public holiday, I do not stand with him on the fatality of fixed, scheduled holiday.

The main reason for me to be skeptical is that what he had proposed, what everyone projected, what theoretical logic suggested, may not be the evidence-based conclusion that one should simply adopt without seeing a validated figures.

The actual fact that western countries with 4 seasons have more holidays but better healthcare outcome endpoints than Malaysia appear to antagonize the 'hazardous over-holiday' theory. Of course, there are abundance of other confounding factors to be taken into consideration.

Holiday being synonym to the absence of formal clinic and elective operation list may lead to unintended procrastination in treating the patients.

Nevertheless, the positive implications of holiday to public health should not be discounted. Of course, by continuing to read further, please be reminded that those implications are also theoretical reasoning, without supportive evidence-based figure.

Holiday can reduce psychological or psychiatric morbidity as everyone take a break from work, except for doctors who have to 'hold the fort' while others go for holiday.

Holiday opens up more time for family bonding moments, healthy sporting adventures and mind-relaxing retreats. Festive holiday also pushed everyone to start to tidy and clean our residence more aggresively, leading to more hygienic and organized, less accident-prone home.

On the downside, too much time out of work may lead to overindulgence in bad habits like heavy drinking, heavy eating, heavy gambling, heavy driving and heavy everything. The drinking part leads to more liver diseases, the eating part leads to hypercholesterolemia, obesity and diabetes, the gambling part lead to poverty, the driving part lead to motor vehicle accidents. Contrary to belief, festive seasons can be very stressful for some. Some people depressed looking at the big hole in their wallet after spending for festive preparation. Some people stressed up looking at the potential being questioned about their persistent failure to find a life partner, recent disastrous family disharmony or recent sudden descent in their career climb.

Well, I wouldn't conclude whether holiday is good or bad, but possibly the government of Malaysia could take a year and cut down half of the holiday (probably the State holidays) and study its actual health implications based on several key representative endpoints.

Either that or declare more holidays!!!

happy birthday, dad!

2012-01-04T06:48:00.000-08:00

happy birthday, dad.

you'd done a whole more than protecting your balls.

i love you so much!!

A brand new year?

2011-12-31T17:41:00.000-08:00

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

2011-12-28T07:37:00.001-08:00

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!

2011-12-28T07:00:00.000-08:00

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...

2011-12-27T08:04:00.000-08:00

Santarina Genevieve

Little footsteps on the beach..

public hypocrisy

2011-12-26T02:14:00.000-08:00

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

2011-12-25T08:51:00.000-08:00

Ho Ho Ho.. Merry X'mas!!

2011-12-24T08:45:00.000-08:00

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

2011-12-23T20:49:00.000-08:00

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

2011-12-23T20:17:00.000-08:00

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

2011-12-21T02:17:00.000-08:00

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

2011-12-18T20:27:00.000-08:00

Insults | Denied

2011-12-08T02:19:00.000-08:00

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...

2011-12-08T02:02:00.000-08:00

almost... almost...

birds 'n' bees...

2011-11-25T21:16:00.000-08:00

Value has a value only if its value is valued

2011-11-23T07:04:00.000-08:00

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

2011-11-22T04:26:00.000-08:00

"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

2011-11-20T04:07:00.000-08:00

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

2011-11-15T06:59:00.000-08:00

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

2011-11-14T02:03:00.000-08:00

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

2011-11-12T00:53:00.000-08:00

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

2011-11-09T02:44:00.000-08:00

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."

(=,=")

amused by a muse

2011-11-08T03:58:00.000-08:00

amused by a referral...

- Dr. Pilo, I would like to refer you a patient. She's a Gravida 3 Para 1 coming in with giddiness and nausea...

- (Too lazy to correct the Gravida-Para discrepancy) could it be morning sickness? how many weeks is she?

- Her last menses is in July, and 2 months ago, her UPT was positive, and 1 month ago, her UPT also positive, however...

- However...

- Yes, however, today, her UPT also positive. And she's having some per vaginal spotting.

- (I held my big bang of laughter under control) OK, send up for assessment.

Then released... BWAHAHAHHAHAHAHA...
I laughed privately, though.
That's a lot of endorphin through out my body.
Failed to express my gratitude, though.

* UPT - urine pregnancy test

a befuddled halloween

2011-11-05T08:24:00.000-07:00

It is extremely difficult to say that sexual preference other than heterosexual being unnatural, because if they are unnatural, why have they existed naturally?

nope, i didn't celebrate Halloween.
I was at the east coast of peninsular instead celebrating my incumbency in clinical research.

2 major news got my attention: the major uproar against the sexuality independence, while there is the unmatched volume of national objection against Halloween or the horror of astronomic wastage as noted in the A-G report.

In actual fact, Halloween is the night of honouring the dead and to teach the young ones about death and mortality, being the eve to All Saint's Day - a day honouring all the Saints. It is pretty much a Christian affair, though some people would argue that special day to be slightly shrouded with some essence of paganism.

As far as I know, some Muslims throughout the country had been soaking wet in the fun of Halloween, celebrating it as if it is their annual costume party.

Indeed, the focus has always been on putting up scary make-up and clothing the out-of-the-world costume, especially when people do not even care to find out the origin of the practice.

Nevertheless, by its own misconception, it had never bring any harm.

As for the major backlashes against Merdeka Seksualiti, I stand at the neutral position, neither support or reject.

It is extremely difficult to say that sexual preference other than heterosexual being unnatural, because if they are unnatural, why have they existed naturally?

There's no technology, gene alteration or recombination, or any man-made disruption to their creation. They are always there since the beginning of times, just that the community acceptance for such honest declaration of their affinity equal to complete 'death sentence' hostility during olden times. Even their own battle with such evolution of their sexuality became suicidal.

In my line of work, rarely, there will be unfortunate ladies with problem of intersexuality or genetically-male females. Nature made them. God made them. And yet, nature and God also created the religion, their holy scriptures and their followers in condemning them.

Befuddling indeed, right?

Let's get back to Halloween, then.

Well, O&G-related costume can be pretty scary at times. Below are my collections (of photos) so far.

Vagina man. A strong person who can really take a good pounding.
Refer to the previous post.

Pad with Menses. Pukability score of 99%

... with tampon nunchuks. Pukability score reduced to 90%

Crowning with congenital hirsutism. Rare instances of shock during the end of second stage.

Uterine rupture with abdominal injury. Highly likely post motor vehicle accident

- comes in handy when women with 1 previous Classical section scar refusing Caesarean Section

Anyone brave enough to sport such any of those awesome, obnoxiously offending costume above?

gynae statement of the year

2011-10-25T03:31:00.000-07:00

genevieve's baby steps

2011-10-23T07:32:00.001-07:00

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

2011-10-21T21:20:00.000-07:00

Hartal! First independence Initiative!

2011-10-19T06:43:00.000-07:00

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
.

Tanggal 31 Cover version oleh Sudirman
.

#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.
.

#8. Malaysia sebuah “negara Islam” sejak merdeka

Sebenarnya Malaysia negara sekular dengan Islam sebagai official religion, bukan Islamic-state!
.

#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!
.

#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.
.

#5. Mamat yang design bendera Malaysia tak ciplak bendera US

Sure or not? :)
.

#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.
.

#3. Tugu Negara simbol perjuangan kemerdekaan Malaysia

Kita berjuang untuk kemerdekaan dari komunis atau dari British? Masa kecik, tugu ni buat aku confuse.
.

#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.
.

#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…
.

Dedicated to the heroic fighters in the cause of liberty, justice and equality. Selamat Hari Merdeka.

x Fahmi Reza

gutter politics at its nadir

2011-10-19T05:11:00.000-07:00

"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

2011-10-16T21:19:00.000-07:00

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

2011-10-14T22:25:00.000-07:00

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

2011-10-14T04:02:00.000-07:00

really epic fairytale from Melissa.

and this is the epic truth

Young doctors mollycoddled - with MCQ

2011-10-13T02:44:00.000-07:00

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

2011-10-12T01:24:00.000-07:00

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

2011-10-09T21:48:00.000-07:00

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

Following my heart and intuition

2011-10-06T02:56:00.000-07:00

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

2011-10-03T03:38:00.000-07:00

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.

my boss's sms

2011-09-28T12:56:00.000-07:00

an unidentified person messaged my boss, telling him I was being substandard without further explanation how that person came to that conclusion. it is a good thing that my boss did not jump to conclusion and enquired further.

once a while, i think when you're being too nice, too soft and too blardy polite to people, people get the better of you. for once, i think if they really wished to make such an implicating comment on people, they should at least have the bollocks to write in a formal complaint letter with the full details of the incident to me or my department. If it was my mistake, I am glad to submit myself to an apology. I am human after all. And human, not always, but at times, do make mistake.

But to came up with such a slanderous text message to my boss without really understanding the full nature of the situation, to a certain degree, it does surmount to defamation as it pull down my reputation inappropriately. And to that, I reserved my rights to sue you later. If you think I am just joking blankly in the cyberspace, wait till you get a lawsuit letter from my lawyer friend.

Never underestimate the implication of a text message with a registered phone number.

he's right...

2011-09-26T03:48:00.001-07:00

deadly dilligence

2011-09-23T04:38:00.000-07:00

Lesson from this piece of news:
1. Don't work too hard. Nobody notices anyway (as suggested)
2. The cleaner may be the only one who really notice you.
3. Always have someone that will nudge or irritate you everyday
4. Reading too much of medical textbooks is hazardous to your heart.
5. You can be low profile, but not TOO low profile.

epic geographic confusion

2011-09-20T03:16:00.000-07:00

my colleague mentioned this today: "I am sometimes confused about geography. I used to think that Alor Star is in Kedah."

and everyone burst out laughing...

因为有了因为

2011-09-19T07:08:00.000-07:00

因为有了因为，

所以有了所以，

既然已成既然，

何必再说何必。

seeerrrrdappppp...

2011-09-17T18:36:00.000-07:00

heard one real life joke today...

someone ordering food in the in house cafetaria near the ward...
cafe boss: nak makan ape? (wanna eat what?)
dr t: nasi goreng. (fried rice)
c: nasi goreng ape? nasi goreng kampung?cina?pedas?ikan masin? (what type of fried rice?)
dr t: nak nasi goreng Sedap Sikit. (want the type that's more tasty)

reminds me of an eatery at JB that goes by the name Kedai MKTS... with small words beneath in brackets... 'makanan kami tentu sedap'...

fine line. the sequel

2011-09-16T08:18:00.000-07:00

not so long ago, I wrote about the fine line and came up with a quote.

there's a fine line between dedication and obsession.
dedication is when you're crazy in your passion,
obsession is when you're driving everyone crazy in your passion.

my junior colleague, T21 (who is stalking this blog) praised me for having the balls to write about one of our dedicated superior.

first of all, it didn't cross my mind that it could have been misinterpreted, because most of my rantings are my personal reflections.

buddhism has taught me that no one can bother us except ourselves. from the beginning, there is never an 'I' to begin with.

anyway, to be honest, i need to eat the humble pie and confess that I was the obsessed one few weeks ago. probably more of being possessed.

i was obsessed with my struggle in preparing for my exam, struggling with the remainder of my time after my work commitment which includes clinical groundwork, sudden presentation at state level, urgent preparation for maternal mortality and etc.

i neglected my daughter at some point of time. i knew she was having upper respiratory tract infection, did initial check up and provided the medicine to my wife. But her conditions persisted for more than 4 days and she was suddenly turn listless. i had to rush back from work. she was weak and tired from all the vomiting induced by her cough. her lungs had some fine creps and chest x-ray was with some minute haziness. luckily, Dr.C, the paeds consultant sacrificed little time she had (being busy with clinical work and managing house officers) assessed her and reassured wifey and me. thank to our lucky stars, a good dose of 2nd line antibiotics did the job well and all our crazy worries subsided. it was impeccable timing for Genevieve to recover for the day she turned one.

at some point of time, i also raised my voice (a bit) in public at wifey for her time at the market was taking up my time for library. at the end, i felt like punching myself with a clenched fist. i felt like a total crap, a jerk and a psycho (is there a single word that meant those three combined?)

from now on, i allow myself to be dedicated, but not obsessed with my passion and anything else.

Medical Depression 2.0

2011-09-11T03:49:00.000-07:00

Warning: For junior doctors or medical students in Malaysia (or planning to flood the Malaysia healthcare system), by continuing to read further, it may cause clinical depression. (Either that, or it's still not too late to go into the 'kacang puteh' business, which earns as much with good quality of life)

Few days ago, Palmdoc wrote the following:

A little bird has told us that MITI wishes to accelerate the liberalization of Health services in Malaysia. Originally, the date for full liberalization was 2015 but now they want to bring it forward to 2012.

Opening up our borders in the field of healthcare has its pros and cons.
Whatever they are, in the era of globalization, it is inevitable.

The question is, will 2012 be too early?

Is everyone (from the MMC, National Specialists Register, Professional bodies) prepared?

Heck we don’t even have the necessary legislation in place yet as far as compulsory CME and compulsory enforcement of the NSR goes.

While big businesses may be smacking their lips at the opportunity to make money in Malaysia, everyone should be genuinely concerned about whether or not
- medical standards can be maintained
- liberalization affects healthcare in the areas which are needed e.g. rural vs urban

If you chose to skip reading above because of all the seriousness in between, inside and outside of those words in the previous paragraph, I seriously suggest it should re-read again.

It is a very depressing piece of news or rumor. That is the reason why I chose today's date to release it. Hopefully, it will remain a rumor but then again, hope is never the strongest word in English. 'Hope' can bring a candidate to presidency but never to allow the presidency to sit in comfort.

Maintenance of medical standards at our current system has been made more difficult partially because of the avalanche of new medical grads (which I aptly appointed this as medical depression 1.0), partially because the ignorance of certain powerful quarters to acknowledge and rectify it and partially due to the fact that most of us rather sit here and blog about it because if we don't.

With all due respect, I belong to the 3rd group. My Chinese horoscope, at some point, defined me.

If you have ample time for reading more about globalization of Malaysian healthcare and can stand reading through 80 slides of presentation without too much of fatigue, heavy-headed or other symptoms of information-overload, I reckon you should run through the following presentation by Dr. DQ. downloadable here, as well.

Medical Globalization by Dr David Quek

View more presentations from pilocarpine.

Liberalization of health service will bring more bane than boon with our current standards of 'check and balance'. The current and future junior doctors will find themselves drowning in the tsunami of doctors from outstation with medical liberalization while competing among the massive number of the peers.

And the big question will be...

with the end of the world, at least we won't be having Medical Depression 3.0

best shit about life! (seriously)

2011-09-07T07:53:00.000-07:00

got this from the Keyboard Man...

FIVE RULES TO REMEMBER IN LIFE:

1. Money cannot buy happiness but it's more comfortable to cry in a Mercedes than on a bicycle.
2. Forgive your enemy but remember the bastard's name.
3. Help someone when they are in trouble and they will remember you when they're in trouble again.
4. Many people are alive only because it's illegal to shoot them.
5. Alcohol does not solve any problems, but then again, neither does milk

leaning towards lina

2011-08-25T03:58:00.000-07:00

snippets from operating theater

there's this white board in every theater that had to be stated the vital main details of op and the team members involved. If not mistaken, it was being known as the white board of SSSL (Safe Surgery Saves Lives), mainly saving the patients by avoiding cutting the wrong patients and saving the surgeon's livelihood, too.

I didn't know what was going through the mind of my house officer as she wrote there in the board...

"Anaesthetist: Lina Teoh"

And the anaesthetist-in-charge with rather similar name stood there, eyes fixed on that part of the board, stunned for 20 seconds minimum. Behind the face mask, I couldn't tell whether she was smiling, dropping her jaw or just smirking.

But I had to turn around and held my bursting laughter, suppressing them into simple heavy breathing.

I asked the house officer. "Hey, do you know who is Lina Teoh?"

"I think so. Miss Malaysia, right?"

"Then... "

"Oh, not her ah? OK, I go re-write it."

Laughing behind my mask, "There is no one in this whole hospital named Lina Teoh."

"Hey, don't laugh lar. Anyway, she's prettier than Lina Teoh?"

"Yeah, good way to cover your silliness."

That really made my day. Really.

fine line

2011-08-21T18:31:00.000-07:00

there's always a fine line... it is an agonizing thing because being a fine line, people often crossed it carelessly, blaming the physical width (or the lack of width), rather than the people's own eyesight or perhaps insight on the existence of this fine line.

i dunno why, i dunno how, but suddenly i thought of the following quote.

there's a fine line between dedication and obsession.
dedication is when you're crazy in your passion,
obsession is when you're driving everyone crazy in your passion.

perhaps it's time to re-draw a wider, thicker line or maybe let it be a whole lane, just so others can see the divides better.

a word bout primary prevention

2011-08-20T17:45:00.000-07:00

when i read this newspiece:

Ambulances will be stationed at accident-prone spots along the highways during the coming Hari Raya festive season.
Health Minister Datuk Seri Liow Tiong Lai said that this would ensure that injured motorists received medical aid quickly.

He said that when accidents happened, it took a long time for ambulances and medical aid to reach the victims, and this delay sometimes contributed to fatalities.

i was pondering, have we thrown primary prevention out of our syllabus, or rather out of our logic.

it isn't difficult to understand primary prevention.

it is like if you don't want a flu, you don't kiss a person with flu.

if you don't want diabetics, you start losing weight and forgo fatty diets.

if you don't want AIDS, start capping yourself and avoid promiscuity.

if you don't want lousy politicians, you should vote correctly.

anyway, instead of wasting medical resources, in those accident-prone areas, possibly it would be better if you place traffic police officers 1 km before and after the areas or put up mock cameras, improve the lighting and the road condition of those areas.

why repair an injury when you can prevent one?

bad fall day

2011-08-20T17:26:00.000-07:00

it was few days back.

a house officer left the plastic chair and switched to other more comfy chair.

i need to use the phone and thus, sat down on the white plastic chair.

suddenly the motion of me sitting down on the flat of the chair got extended into a slide down to the floor.

everyone looked in awe.

i stood up immediately, looking at the bent hind left leg of the chair.

everyone asked if I was ok.

once I reassured others of my good health and absence of injury, possibly due to my impact-reducing big butts with good suspension, everyone started to rake out small burst of laughter.

"Haih, sekarang kerusi pun 'tertekan'"(with reference to the recent Harian Metro letter)

Then the big bang of laughters exploded all around.

P.S. Great people talk about ideas, average people talk about things, small people talk about other people.

Piloism: Great small people talk about ideas for other people.... So stop talking about asking me to lose weight. =P

bad hair day

2011-08-18T05:30:00.000-07:00

snippets of the day

i didn't use hair gel today postcall, because i left it at home. not on purpose, of course.
without hair gel, my hair looked pimpy. blondish brown up front with smooth gradient to black at the back. people was thinking, how do i dye my hair during on call. well, i didn't. it was dyed like err... 2 months back.

and just today, during a tutorial with the med students...

me: so any questions for me before we proceed to 3rd stage of labor?
- silence -

me: how about you? (looking at a slightly plump chinese fella, ms)
ms (med student): dr.pilo, you dyed your hair?

- silence - (same duration, but different feeling - sort of gay type of silence)

me: err.. ya ya.. diy dye.. bought from watson.
ms: really? wow, you can work in hair saloon d.

- silence - (totally speechless)
me: no, i think i will keep my dayjob. ok, enough of craps, let us proceed to ... bla.. bla..

black humor of the day

2011-08-05T06:50:00.000-07:00

a farmer forced the chicken to lay more and more eggs, so as to produce similar number eggs as other farm with more chickens.
one day, that chicken chickened out (no puns intended) and ran away to a better farm with more chickens.

and the farmer asked all his neighbours: why that chicken ran away?

after awhile, a farmer kept beating up one of his chicken and stop feeding it, knowing it'll be the perfect slaughterpiece for the upcoming festive season, as all other chickens started to grow up.

one day, that chicken expired before its time.

and the farmer asked all his neighbours: why the chicken die?

tanahair thurs | MMA rejects Lynas

2011-08-04T00:09:00.000-07:00

Malaysians are not guinea pigs. Period.

Here's the MMA's stand on Lynas (or rather rejection of it) based on inconclusive safety profile.

MMA Statement on Lynas

View more documents from palmdoc

If the government choose to ignore, this will be a valid document to be used in the court of law, be it local or international, for indefinite compensation.

Have some conscience.

wedgynesday | male contraception

2011-08-03T05:03:00.000-07:00

the issue of contraception has never been this hot ever.
it is now gaining more attention, more eyes, more ears, and basically more senses for the same reason that it should have been long time ago.

no, not for these reasons.

contraception in Malaysia failed to see light, and the uptake is barely up to 50% mainly because of our outstanding sociocultural make-up (wow, it does sound very positive by the way i put it), the lack of accurate formal sex education and abundance overloading of skewed sex education (thanks to our malaysia's policy of increasing internet access without increasing the population's maturity).

the spotlight on contraception went hand in hand with the sudden task of millenium development goal 5 (MDG5) to reduce maternal mortality by 2015 slapped onto the unprepared cheeks of the O&G fraternity. the MDG 5 was there since few years ago, but we only knew about it now. Something like the Malaysian's hitam kuning was supposed to aim to win World Cup by 2015, but only knew about it last year. Although the results of those matches was devastating, but who could really blame them, right? they were exhausted after against Chelsea and Arsenal, Singapore had a constellation of players 100% Singaporean but from somewhere else (I used to think they're good in logic) and Lion vs Tiger lar dei, which is the king of jungle lar. We should change to Malaysian mammoth or elephant or dinosaur or zookeeper. Yes, malaysian are good in making excuses - that's our niche, and so be it.

Oops, i digressed.

Anyway, ideally, a great knowledgeable and sarcastic consultant from Ipoh gave us 'great' solution to reach MDG5 in the special debate session during one of our course lately, with all pics and logos.
1 outlaw pregnancy
2 impregnate the guys (nothing mentioned about reducing paternal mortality, right?)
3 fake the stats

so, what can a real man do with the above 3 suggestions.
number two is impossible mainly because it ain't physiological and babies can't exactly go through our external urethral meatus, right?
number three is also impossible we don't fake something. we fake everything - that would be too obvious. (ever heard bout the one liner about women can fake an orgasm, but men can fake the whole relationship?)
number one is possible, provided we sketch out a good antenatal care and safe delivery for the pregnant women in jail and get the guys in too for pregnancy and labor support. that will probably increased our male doula population as well.

anyway, as the world evolves, progresses, changes or whatever you want to say about the world, gender equality fast becoming an issue. it shouldn't be an issue simply because equality is equality, there's no need to look at gender, race and whatever.

and so, male should now go forth and be responsible and be more contraceptive.

here's an update on male contraception, pimped from here (nytimes). have a good read.

Steve Owens had always left birth control to his wife, who took the pill. After all, male methods were vasectomy, which he did not want, and condoms, which he described as: “Well, condoms are condoms.”

Then Mr. Owens volunteered to test potential methods that lowered his sperm count so much that “I was not viably able to produce a child,” he said. His count rebounded weeks after stopping each method, and he fathered a daughter between research studies.

“I would definitely do some kind of long-term male contraceptive,” said Mr. Owens, a 39-year-old school social worker from Seattle.

Male contraceptives are attracting growing interest from scientists, who believe they hold promise for being safe, effective and, also important, reversible.

“We have a number of irons in the fire,” said Diana L. Blithe, program director for contraceptive development for the National Institute of Child Health and Human Development. “I think men actually do want to do this.”

While male contraception has been studied before, no method met the stringent safety and effectiveness criteria that female methods do. It was also unclear whether men would use them.

Now, scientific advances are producing approaches that could pass muster. Prompted by women’s organizations, global health groups and surveys indicating that men are receptive, federal agencies are financing research. Some methods will be presented at an October conference sponsored by the Bill and Melinda Gates Foundation.

“Male contraception is a critical area,” said Jenny Sorensen, a foundation spokeswoman. “It doesn’t make sense to not include everyone in the discussion.”

The most studied approach in the United States uses testosterone and progestin hormones, which send the body signals to stop producing sperm. While effective and safe for most men, they have not worked for everyone, and questions about side effects remain.

So scientists are also testing other ways of interrupting sperm production, maturation or mobility.

One potential male birth control pill, gamendazole, derived from an anticancer drug, interrupts sperm maturation so “you’re making nonfunctional sperm,” said Gregory S. Kopf, associate vice chancellor for research administration at the University of Kansas Medical Center. The center has begun discussions with the Food and Drug Administration about the drug, already tested in rats and monkeys.

Dr. John K. Amory, a reproductive scientist at the University of Washington, is studying a drug that was developed for worm infections and was later tried on men because it caused infertility. Using rabbits, Dr. Amory said, he discovered the drug blocks production of retinoic acid, important for sperm production.

Unfortunately, the drug acts like one for curbing alcoholism, so drinking when taking it makes people sick. Dr. Amory is working to make it cocktail-compatible.

“The joke,” he said, “is if it weren’t for alcohol, no one would need contraception.”

Debra J. Wolgemuth, a geneticist at the Columbia University Medical Center, is testing in mice another drug that inhibits retinoic acid without alcohol interactions. Bristol-Meyers Squibb developed it for skin diseases, but found it was “a testicular toxin.”

At Harvard, Dr. David Clapham, a neurobiologist, discovered that sperm tails contain calcium ion channels, with electrically charged atoms “turbo-charging the sperm” to reach eggs, he said. He is developing a drug to disable the channel.

“You just turn off the motor, rather than alter the people in a car,” he explained.

Elaine Lissner, director of the Male Contraception Information Project, formed a foundation to develop other approaches. One, “reversible inhibition of sperm under guidance,” or Risug, involves injecting gel into the scrotum to inactivate sperm. Another involves briefly heating the testes with ultrasound, which can halt sperm production for months, she said.

“I can imagine a world where you take your car in every six months to get your oil changed and go next door and get your ultrasound for 50 bucks,” she said.

American scientists will remain skeptical unless research shows Risug is reversible, or ultrasound effective.

There are also two drugs, an antihypertensive and an antipsychotic, each found to keep men from ejaculating during orgasm. The drugs would need modifications not to affect hypertension or mood.

Of course, women may have to trust that their partners are using birth control, as men do now. But at least one method, hormone implants, visibly bulge from a man’s bicep. “Guys like it because they can show it off,” Dr. Amory said. “Proof that the male is contracepting.”

Pharmaceutical companies have not yet embraced any method, waiting for something as effective as female methods and risk-free enough to give to healthy men.

Hormones — in implants, injections, gels or pills — while perhaps not ultimately preferable because of questions about long-term effects, might gain approval first. Currently, they work for about 95 percent of men; why others are unresponsive is unclear. With progestin, the brain signals the testes to stop producing testosterone, arresting sperm production. Resupplying limited testosterone restores libido and muscle mass.

(Chinese studies found that testosterone without progestin inhibits sperm production. But for reasons that are unclear, testosterone-only methods are less effective in non-Asians.)

Hormones can also adversely affect the heart, cholesterol levels, skin and mood, as can birth control for women. Recently, reports of depression prompted the World Health Organization to stop a large trial it co-sponsored with Conrad, a Virginia nonprofit group, said Douglas Colvard, Conrad’s deputy director for programs. Results on safety, sperm counts and pregnancy will be analyzed in case different doses or formulations might work better, he said.

Other studies are testing synthetic testosterone and delivery methods bypassing the liver, to lower potential prostate risks.

Michal Lehmann, 39, a Seattle landscape designer, said he experienced minimal side effects with implants and gels, besides acne and, possibly, more frequent sexual thoughts. He and his wife have since had two children, want no more and, since she stopped the pill, would like “a better option than just condoms,” he said.

Mr. Owens disliked testosterone gel, which was applied to his shoulders and required that his wife and daughter not touch him for hours to prevent exposure. “I don’t personally like rubbing things on me,” he said.
He believes it also made him overreact to frustrations. “I don’t want to call them rages, because I’m a really mellow guy,” he said. “But I would go from zero to 60. Initially it was like, why am I acting like this?”

He did, however, like the progestin implant, which caused no side effects. Although it “kind of was a disappointment” that the accompanying testosterone shots did not help him win amateur bicycle races, he said, the implant made him “the talk of the party.”

Men’s reactions, he said, ranged from “ ‘I would do something like that’ to ‘Dude, you’re crazy. How do you know if your sperm count will return? Is there shrinkage in any area, or malfunctioning?’ ”

But “women were just totally excited,” he said. “If I were single, I probably would have been able to use that as a dating thing.”

misc sun | weaning off facebook

2011-07-31T01:26:00.000-07:00

Source

I will be weaning off facebook for this month.

no, not because of the fasting month...

wishing all my Muslim relatives, friends, colleagues, acquaintances, patients, enemies and passerbys - have a holy month of fasting, may you be stronger following the blessings of your Mighty God.

wishing all my Chinese relatives, friends, colleagues, acquaintances, patients, enemies and passerbys - have a good, safe Hungry Ghost month. may you rejoice that the passing does not bring sorrow but bring remembrance. Plus, a grim reminder that life is uncertain but death is.

wishing my department will have new medical officers and not those invisible ones, especially not during Hungry Ghost month.

meet the pengarah

2011-07-30T05:12:00.000-07:00

a real un-doctored pics posted up by a cool colleague in anaest dept

it's almost 2 months since the sting of the medical shortage. the poison now ran so deep, so dissipated, so profoundly rooted that maybe what ever comes in these few months to come, everything will never be the same again.

the statistics of graduate trainees coming in been obnoxiously devastating. in 3 years, it had dropped from 2 to -1. no one came while one left with reasons being openly obvious to everyone except to those who chose not to believe it, continued with their impervious hallucination or just simply accepted as fated by god or any higher beings.

new bloods were injected into the fellowship, but morals, interest, enthusiasm continued to wane. they were being deceived into a short voluntary charity service, only to be found themselves stuck in their self-proclaimed hell. the plot thickened, especially when contradictory decisions reared its ugliest head. they found themselves gasping for the air of escape.

while the rest got more weary, wasted and worn, as we're all expected to be totipotent and multipotent. at times, i was being put in a position with antithetic and conflicting crossfires.

as suggested by the most experienced, we placed ourselves in a very shallow, desperate and pathetic position, pleading for our sanity, health and life to the one person that could be our savior.

as the dialogue went past the long list of manpower with the imaginary names without a contributory soul being crossed out one after another, there were sighs all around, as well as the look of complete surprise.

"well, i really, really didn't know. there were complaints from specialists from this and that department of shortage, but there aren't any so far from your department. as i look out this window, to the maternity hospital below, i always thought you all a happy family there."

promises were flying on the air as the conversation exasperated into extravagance, ridiculing our current predicament as the calm before the storm of medical officer glut.

"in times to come, there will be so many of you, that you'll will come to beg me to stop sending anymore to the department."

my mind only able to retain this two profound statements, for several reasons mainly because they gave a clear picture of things now and beyond.

as for now, it's all que sera sera. a painful sorrowful song, nonetheless...

random thoughts

2011-07-29T08:32:00.000-07:00

手指指 finger-pointing

2011-07-26T02:48:00.000-07:00

手指指... 不能确定是否是好还是坏...
finger-pointing... not sure whether this is good or bad...

如果我秃头，你应该知道为什么...
if i go bald, you should know why...

the Lawliet position

2011-07-25T02:16:00.000-07:00

today's random thought

somehow i find myself concentrating more and absorbing greatly when i read in this position.
nah, it's the furniture lacking of proper ergonomics. either that or i'm going cuckoo.
i chose to believe in the former, possibly in denial.

WTF of week: Ibrahim Ali Award

2011-07-23T18:43:00.000-07:00

pimp this article from Sinchew.

The UiTM is going to give away the Ibrahim Ali Awards to its students.

It is yet to be known whether the awards will eventually get handed out, but just in case they are awarded, I doubt what would happen to the recipients.

I have imagined the following scenario:

In 2012, Ibrahim Ali Award recipient Encik Abu visits a multinational corporation for an interview after his graduation.

"Hi! May I know how you performed at UiTM?"

"Yes. I was awarded the university's Ibrahim Ali Award that came with a trophy and RM5,000 cash prize which I received from the hands of Encik Ibrahim Ali himself."

"Sounds good. But can I know what the award is all about?"

"The award is given to a highly principled student who would defend the rights of his own ethnic group, just like Ibrahim Ali."

"Wonderful. This Encik Ibrahim Ali must be a great man then."

"Most definitely. I would say he is unprecedented and his achievements are hard to duplicate."

"Excellent! Can you tell me how great this man is?"

"He used to oppose the BN government, but is now more supportive of the BN regime than even the most loyal BN members.

"He used to love Anwar Ibrahim, but has grown to hate Anwar more than anyone else.

"He used to run under Umno, Semangat 46 and PAS in elections, but later betrayed all these parties, elected or otherwise.

"He said the Malays were entitled to at least 60% of the country's wealth given the fact that the Malays made up 60% of the national population.

"He said the Christians were trying to take over Malaysia.

"He said his tolerance for the Chinese had been stretched to a limit.

"He also said women were to take the blame for their husbands' infidelity.

"He said he would send 15,000 people to the street to counter Bersih but only 30 turned up in the end, he himself absent on his wife's advice.

"During an interview with CNN, neither the anchor nor the audience could understand his English. A CNN record indeed!"

"Give me a break! Ibrahim Ali is such a stupendous person. I have yet to see anyone like him having recruited people all across the world."

"Ibrahim Ali is to Malaysia what Apple's Steve Jobs is to America."

"Sure, I can imagine that."

"So, looks like I will be in your distinguished company's payroll soon."

"Well, I believe you, a recipient of Ibrahim Ali Award, have the style of Ibrahim Ali. Unfortunately, we are a multinational corporation doing global business, not a warring organisation nor a circus.

"I would nevertheless suggest that you apply to al-Qaeda, the Taleban or Cirque du Soleil. Good luck, young man!"

touched

2011-07-22T08:47:00.000-07:00

Dearest 与孩子一起制作的爱心生日卡

acute uterine inversion

2011-07-21T07:41:00.000-07:00

presented in conjunction with the presentation on our dept's recent experience with this rare but life-threatening obstetrics emergency.

here's an update

Acute uterine inversion

'Tung Shin Drs, live not in fear' by Willing Shaking-Spear

2011-07-18T05:48:00.000-07:00

Shall we fear when Truth becomes inconvenient?
Or shall we fear to speak when untruth surrounds us?
Shall we fear the law which is to protect all?
Or shall we fear to act and let lawlessness rule?

Shall we fear to change for it is uncomfortable?
Or shall we not join the forces that make change possible?
Today, fear bridles your love for peace.
Your yearning for freedom is but a dream.

You fear to walk, less your life be snatched.
The street you once loved is now your fear.
You fear to complain for it puts you in a spot.
You fear to stop wrongs for it shows you weak.

You fear the law for it protects not all.
Your fear the halls of justice and the shadows behind the wall.
Eventually, the fear you fear consumes you all. Leaves your body empty of spirit and soul.
You become nothing but a falling leaf,

To be swept away into darkness like a rotting heap
Of broken men without hope or love,
Grovelling for crumbs from the master's table.
You fear other voices,

Because it tells the truth.
You fear the truth for it foretells your lies.
You fear to speak without a spin.
Your tolerance for truth has just gone thin.

Power you use to suppress the truth.
The cells of history have many good men.
Who one day will appear to unlock the secrets,
That you so tenderly keep from the streets.

Doctors fear not when you are right.
Speak the truth and bring on the light.
Fear not the fear, where darkness hides.
You heal sometimes but never shall harm.

To comfort always those in need.
What gives you the strength is that you are right.
Join hands together for the fight.
For better care and patient's rights.

This poem is dedicated to the 11 doctors at Tung Shin Hospital who have come forward to speak the truth about the July 9 incident.

doctors and stains...

2011-07-17T04:46:00.000-07:00

You recognize a surgeon or an ob-gyn because he has blood on his shoes, a urologist because he has urine on his, and an anesthetist because on his you see spots of spilled coffee.
—Bernard Cristalli

I guess we stained ourselves regularly, some more regular than others.
Anyway, perhaps a bit contrary to what generally perceived by the medical fraternity, i think the anesthetic team in my hospy is just pure awesome in some way or another, especially the ones who are on call with me during this weekend.

at a point, between managing the ill patient in ICU and strolling that same patient in for procedure, the anaesthetic team reminded us about getting our midday consumption.

whether or not we ate in to their suggestion yesterday is of complete irrelevance. nevertheless, the importance of food and fluid intake, in quantity and quality, can and will determine the quality of our work and generally our health in the long term time frame. that's a fact, not a fantasy.

regularly, it is common to see anaesthetic specialist coming into the OT to chase their medical officers out for the food consumptions. At times, when there is lack of variety in satisfying their palates, they will organize something from outside.

reminds me of the time when i was in my last posting as house officer, when i started the 'tabung hypo' for the male medical ward of kenanga 7. i bought a huge packets of sweets and put it into a large jar. And anyone, which is too busy to catch a meal can take one of the sweets of their likings for hypoglycaemic prevention. it was there for sometime until someone took it out, possibly due to its lack of relevance since now there is 6 to 7 house officers, compared to my time, when it was maximum... yes, maximum 2 house officers per ward. Now, possibly they need 'tabung kurang berat' stuffed with metformin tabs, sibutramine tabs, high fibre drinks or skipping ropes.

often it is not the lack of food that is killing the the medical practitioner slowly, it is the lack of fluid and hydration, causing dehydration.

contemporarize

2011-07-13T22:26:00.000-07:00

it is always essential to keep up with the trends.
a lot of things can be fun if we put our heart into it and break the conventional pattern without losing the core of the principle.

i am someone that hope, aspire and perspire to do so, although, there will be a lot resistance, a lot of pondering minds, a lot of wondering thoughts, i believe the conception and achievement of the vision is more important the ways that dictate its path to it.

traditional postnatal services?

2011-07-12T03:04:00.000-07:00

i had mixed feelings when i read about this in The Star...

KOTA BARU: The first traditional and complementary postnatal service for mothers has been set up at a rural clinic here.

The service at Jalan Bayam provides postnatal massage as well as sauna and herbal treatment.

State health deputy director (Public Health) Dr Wan Mansor Hamzah said the centre was the first in the country that enabled mothers to obtain traditional treatment right after giving birth.

The setting up of the service at the clinic cost less than RM3,000 and packages are expected to cost around RM60.

To be honest, totally, postnatal service in Malaysia is probably the best, if not, up to standard of health care of a first world country, although, the third-world-mindset citizen who received such a privileged service wouldn't think so.

I did not comment the above from a medical doctor's perspective, but as a husband to my wife who received good postnatal service. The community nurse rode a RX5 and came to my rented house and did the necessary check up with her simple postnatal check up kit. All done within less than 30mins and she started her journey to other postnatal mothers' home.
Ladies are being spared off the painful walk with the perineal trauma to the clinics. Even the privates do not provide such service. But then, they are lacking in giving contraceptive advices.

Let me critically appraised the postnatal complementary service of massage, sauna and herbal treatment.

As it is complementary, the role of such service is not recommended by professional bodies, neither within or outside of country. Recommendation for postnatal care as recommended by NICE, UK is clearly summarized here.
Therefore, there are no clear evidence of benefits, but preliminary reports from reviews of such traditional services, shows that it will relax down and slim down the mothers.
The relaxation may be beneficial in improving maternal health, preventing postnatal depression. Slimming down the ladies will offer positive results in reducing maternal obesity and the well-fretful metabolic syndrome.
One of the downside of these traditional treatment is the unknown effect towards the practice and physiology of breastfeeding.
Secondly, financially channelling the cost of public health allocation to this unrecognized service will take away the necessary focus on some part of the postnatal care that is still very lacking such as contraception initiative.
The current contraception take-up rate in Malaysia is hovering around 30%, which is a very disappointing low rate. As the community failure of taking up adequate contraception, the public health postulated it was all due to our socio-cultural of being thankful for all God's gift, even if the gift means 12 kids, one year apart, nightmare adhesions after 4 C-Sections and a life-saving hysterectomy because of atony. Ever consider the invention of contraception as the God's gift?
Thirdly, the lack of transparency in selecting which traditional practitioners for the complimentary treatment concession is another questionable income flow within the public health expenditure.
Lastly, lacking of audit and control of the practice of this treatment may have detrimental effects. For instance, abdominal massage for patient post C-Section may induce uterine rupture. Wrongly given advice on putting traditional paste on the episiotomy wound to make it hasten healing may caused wound infection leading to wound breakdown.

My sentiment really is when you're complimenting, supporting and approving non-evidence-based traditional practice, you offended the main practice of medicine.

At the very least, do your best in your primary duty, before embarking on additional stuff.
It is vital that focus and re-focus on contraception be stressed, to prevent more unplanned, unwanted pregnancy, and in a way, reduce maternal mortality as being advocated in our Millennium Development Goal 5.

BERSIH 2.0 vids and pics

2011-07-09T21:21:00.000-07:00

everyone is invited... including balisan...

main video!

minister said "we have erection every 5years"

janji kosong nak sediakan stadium

BERSIH 2.0 melbourne

BERSIH 2.0 london

hospital diBERSIHkan oleh polis

BERSIH parody

Some people have to get the service of 'rent-a-pakistani'

In Pictures: Protests suppressed in Malaysia

Police fired tear-gas and arrested hundreds of protesters in Kuala Lumpur who were calling for electoral reforms.

Al Jazeera staff Last Modified: 09 Jul 2011 13:39

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More than 20,000 people demonstrated for electoral reforms across Kuala Lumpur, the Malaysian capital, on Saturday in a rare protest that was declared illegal by police. The protest was called for by opposition groups, including the Coalition for Free and Fair Elections, Bersih (Clean). Police fired tear-gas and water cannons at demonstrators and arrested more than 1,400 people, including top opposition leaders, according to protest organisers. The activists' demands include an overhaul of voter registration lists, tougher measures to curb fraud and fairer opportunities for opposition politicians to campaign in government-linked media. Malaysia's next general election is planned due in 2013.

1) With Kuala Lumpur under police lockdown since the morning, protesters tried to gather and seek refuge inside a railway station before being led outside by police where many were detained and put into police vans. [Saeed Khan/AFP]

2) Protesters display the yellow shirts of the Coalition for Free and Fair Elections, or Bersih (Clean}, during a rally calling for electoral reforms in Kuala Lumpur [Ahmad Yusni/EPA]

3) Riot police stand making a cordon in front of Malaysia's iconic twin towers before demonstrators gather [Saeed Khan/AFP]

4) A Bersih supporter shouts at police during clashes in downtown Kuala Lumpur [Shahir Omar/Reuters]

5) Police use a water cannon to spray Bersih supporters in downtown Kuala Lumpur [Samsul Said/Reuters]

6) A Bersih supporter throws a water bottle at a police water-cannon truck [Mohd Rasfan/AFP]

7) Police face off against thousands of Bersih supporters [Saeed Khan/AFP]

8) A Bersih supporter holds the Malaysian flag in front of a police water cannon [Damir Sagolj/Reuters])

9) Police in riot gear march under heavy rain toward protesters calling for electoral reforms [Saeed Khan/AFP

10) Police face off against thousands of protesters in a scene shrouded by tear gas [Saeed Khan/AFP]

11) A Bersih supporter is detained by police during protests in downtown Kuala Lumpur [Damir Sagolj/Reuters]

12) A Bersih supporter is detained by police during protests in downtown Kuala Lumpur [Saedd Khan/AFP]

13) Bersih supporters are detained by police during protests in downtown Kuala Lumpur [Damir Sagolj/Reuters]

14) Malaysian opposition leader Anwar Ibrahim (C) is surrounded by supporters, one of whom is injured, after a protest in Kuala Lumpur calling for electoral reforms [AFP]

15) Bersih supporters chant slogans during a protest calling for electoral reforms in downtown Kuala Lumpur [Damir Sagolj/Reuters]

analogy of a critically-ill patient

2011-07-09T18:06:00.000-07:00

many would have argued, with their facts and numbers, justifications and qualifications, experiences and exposures, belief and principles that the core of management of a department is completely different from management of a patient.

but, i beg to differ. i beg from a lowly position that i held, without any power, respect or jurisdiction. management of patient is a life and death affair, but management of department is just about life and death of the corporate body - no blood, no gore, no people dying. But if that people in the department is involved in management of patients, by compounding factors, there's more gore, more blood and more... I will stop the list here

here's the analogy...

beep... beep... beep...
the machine of the ICU beeping to the heart rate of the ill mother, who had labored for many hours and managed to survived a postpartum haemorrhage. On the verge of going into the nightmare of disseminated intravascular coagulopathy, her condition continues to slide.

2 obstetricians stood by her. maybe more. both agreed - the patient need blood. the blood bank was contacted earlier. very very much earlier. the blood bank agreed to supply 4 pints of whole blood. whether or not the promised quantity is sufficient is still questionable, but to the very least, it will alleviate the condition, possibly to a great extend.

1 obstetrician waited patiently, while the patient continued to filled up her drainage tubes with small crimson tide. he called back to blood bank and "on the way" was the standard reply, even after few hours. he continued to wait - patiently, in spite of news that the assigned blood was channeled to other patients, for reasons only known to the blood bank who couldn't really comprehend the clinical side of matters.

another obstetrician, at a slightly lower hierarchal position, suggested that someone should go to the blood bank to get those essential life-saving human products. his polite recommendation seemed to have fallen into deaf ears. as patient deteriorated further, his motion escalated into a stern proposition. he was seen as impatient, harsh, pushy, less civilized from the approach, though his intention was noble, timely and appropriate.

the remaining hemoglobins of the patient is fighting their best war in keeping the patient alive. the patient wished she could stand up and march to the blood bank to keep herself alive.
the patient hopes and trusts that she's in the good hand of obstetricians.
and the only thing that she needed badly is still "on the way".

on the way...
on the way...
on the way...

and soon, the patient will be on the way to heaven...

no, this is neither an open assault on the blood bankers, the obstetricians or the intensivists, but a grim reminder of the negative repercussion of the refined gentle courteous practice of a manager.

expectant management must be used with extreme caution and extreme flexibility and fluidity in managing development in the case scenario, or else, be prepared to bear the extreme liability due to delay in responding to the arised complications.

GCP | grievious coma-inducing program

2011-07-07T04:52:00.000-07:00

no, for real, it's good clinical practice.
but for 'real' real - it is really a grievious coma-inducing program.

this is the first time, in the history of mankind (I mean, mine), that in the middle of the course, I felt like going to the bathroom to bang my head on the wall. yes, for real.

being in the Master training program doesn't exclude you from being uninitiated and waiting for the sky to pour down guidance for you.

since the first day of orientation of the program, we were all being told - to start the research early, start the research early and start the research early.

No, I am not whining, but serious, it was told in the same exact language (if not, words) so many times over the orientation, mainly because our Profs were afraid that we'll be barred from the Finals, not because of our lack of white and gray matters, but rather our affinity towards procrastination in putting in sound research work and print outs. Nevertheless, neither my internal nor external supervisor breath a tune about asking me to get the GCP certification - which is the compulsory document to have before starting any medical research.

Let me rephrase that, before starting any LEGAL medical research.

within the context of starting off my compulsory research, my sincere gratitude to Dr. T, my senior and mentor, who given me sound advice on getting the GCP.

GCP by itself, good clinical practice, can be a pretty amazing misnomer, because halfway through, a participant commented that the course should be renamed as good practice in research, because he was duped (by himself) to believe that this is a course about good CLINICAL practice.

this is where i would like to remind everyone not to undermine the power of literacy, and reading everything and not just the headlines. Anyway, that chap looks like he has tonnes of money to splash around as well as a lifetime to just hang around and be amused.

Anyway, the name GCP sticks, because it's the standardization of term used all over the world. Just like balisan, the name remains, no matter how it much it had evolved to a crooked wavy line.

In a brief, GCP mainly governs all the essential ethics to protect the human subjects in a medical research, with concern on the validity of the study. It is a regulation and a law by indirect jurisdiction, mainly by enforcement by the drug authority. No doubt it is an important program, essential to the bone prior to starting any medical research, but i think to have everyone to attend to pseudo-law crash course for 2 and 1/2 days and participate in the exam is really pushing the limit of boredom. I was pretty suicidal after the second day. Apart from the content, the organizer really did their best to perk things up and their effort is just praiseworthy with multiple thumbs-ups - all the group game, card game and etc.

Frankly, they would have save us a lot of money, save them a lot of time, save everyone a lot of trouble if they make it just purely exam with focus-driven questions and we revise those essential GCP protocol online prior to the exam.

I presented my study proposal twice. Once in my department, the second time in today assessment at the Uni. I was brutally attack verbally from head to toe on the proposal of research and I am glad, not in the masochistic way.

Because their machine-gun verbal assaults on my proposal is a boost to my study. It is like a company hiring a hacker to hack into their own system, to create a better security system. But in this case, all my consultants, profs and specialists did it voluntarily (or it was within their SKT) and I was totally awed and gratified. I am sure there are more imperfections.

As a matter of fact, most Profs sigh, lament, groan, roar, whine or simply sulk whenever they found out that the trainees shilly shally on the research.
However, they failed to understand the spirit of a research.

The research is being developed and run with enthusiasm, either for altruistic, knowledge or monetary gain.

Drug companies do research to create new drugs to earn bigger bucks.
Space exploration corporation do research to get to the moon to take a look at the wreck of Ark, the ship of Sentinel Prime and to gain the technology of advanced alien race.
Many bioequivalence tests to get similar actions from the drug without breaking the wallets of the people.

So, what's our driving desire to do a research?
To do something simple (and not weird), get it over with, so that can sit for Final exam.

Now, the perspective is clear. We can choose to fake our enthusiasm, or fake our study.
But by the law and regulation, only the former choice is GCP-compliant

the degree of yellow-phobia

2011-07-06T21:17:00.000-07:00

so scared till asking for help?

pimped from here.

US Navy stealth ship is headed for Malaysia

US Navy stealth ship is headed for Malaysia

The Sea Shadow's End
By Twenty Mike Mike
Mon, June 20, 2011, 11:10 am PDT

U.S. Navy's Sea Shadow. The stealth ship, which served as an inspiration for the supervillain's supervessel in the James Bond movie "Tomorrow Never Dies," is set to serve the Royal Malaysian Navy.

These vessels are designed for a variety of different missions, including escort, patrols, reconnaissance, and front-line combat duty.

HEAVY MISSILE LAUNCHERS : To back up the heavy lasers the Sea Shadow's are also armed with twenty heavy missile launcher tubes that launch ICBM-like missiles at enemy ships. The missile tubes resemble torpedo launchers and are mounted alongside the hidden main laser cannons on each side of the ship. The launchers contain long-range nuclear or reflex missiles and are usually used only during assaults and heavy combat.

death of Dr.Death

2011-07-06T06:44:00.002-07:00

life is uncertain, but death is.

though what Dr. Death had done may or may not be within the accepted social or professional norms, but his ideal belief and the trend line that follows, maybe something the medical fraternity is looking for. for better or worse.

Here's why Dr. Jack Kevorkian probably had a profoundly correct message:

This was a time when the American medical enterprise was very afraid to use opiates to treat pain in cancer and other terminally ill patients, concerned that they would addict, or would be accused of addicting, their desperate patients. And doctors and nurses practiced the notion that human life should be preserved and extended at any cost in suffering or money.

It took the Debbie case, the Kevorkian extreme actions, and yet other trailblazers who saw life and death through a different prism to move our society, ever so slowly, towards realizing that death is not the enemy; the enemies are premature death, disease, disability, pain, human suffering.
Death is normal. Every American deserves to have a death with dignity and as free from pain as possible, as can now happen with much hospice care.

Strange though he was, Jack Kevorkian helped us as a society to move a little closer to that ideal.
Let’s keep that trend line.

seriously?

2011-07-04T06:01:00.000-07:00

The Health Minister said: Housemen need to practise their specialties at district level as there is a lack of specialists in district hospitals

= housemen to fill specialists' shoes?

Aedan's first movie (in the theatre)

2011-07-04T05:50:00.001-07:00

first movie with my kid!

aedan's wearing yellow without any reference to the recent CLEAN movement

the only legal photography inside the movie theater, in the twinseat.

the movie - awesome
the company - more awesome than the movie.

P.S. twinseat also called as couple seat is generally a misnomer, because most of them were filled up with families of three (like yours truly), and even five.