MOG Clinical Little Book

Got bugged by Zizi. 

Here's my little book on MOG Clinical, painstakenly compiled. 

All the best to my battlemates (past, present and future)!!

Addendum: Please email me at obgylowkp@doctor.com if need the little book in pdf form.

A little "pick-me-up" book

Managed to steal a little time from my busy schedule pre and during gazettement to compile a little "pick-me-up" book. 

Hopefully, those who are struggling right now, will know that they are never alone in this journey.

Download it HERE 

Permanent link to the book is at the right of this page, named "Struggling With Failures".

Gaining back some comfort

Good experience in elective operation theatre today. 

The Prof who operated was awesome. 

The operation was like a piece of cake to her, even though the patient's BMI is over 50. 

And finally, I gained back confidence and comfort in assisting in a gynaeoncology operation. 

All my previous experience with such operation really psyched/depressed me out and end up with massive pooling of venous blood in my lower limbs. 

There were laughters through out the operation. 

Here's a few bits and pieces. 

As we're struggling down the tunnel of adipose and omentum, Zeppellining down to the vagina, the long length of cervix seemed to annoy us. 

And at last, we clamped the cervix for the last time and breached into vagina... 

"Ini Kalilah!"

LOL. 

Another time, the house officer was having a tough time holding the retractor. Instead of getting sounded or being given red card, Prof adjusted the retractor for her and said "Come, let me Ubah this retractor for you.".

LOL.

Who let the dogs out? Who! Who! Who!

Rotation continued. Now in a new environment.
Nice view from the window.

Almost a penthouse.

Here's the thing - the new hospy is different from my previous hospy. (Kinda obvious, duh!)

No, what I meant to say is that - the new hospy is not under Ministry of Health and I am still considered a staff of the Ministry of Health.

So, my status in this hospital is not a staff of the hospital but rather a student of the hospital, although all the 'students' worked their asses off (doesn't mean we lose weight on our hind end), every 'students' from Ministry of Health don't have a carpark or other benefits because we're not deserve to have it.

Kind of make sense, though.

Like how Balisan has always make sense in prospering us for 50years, while continue secretly superprospering their own cronies and deprive rakyat of our own well-deserved wealth of the country.

Beside the 'students' privileges, they are charging the patients at a price range between a full private and a full public hospital's rate.

Anyway, here's the thing.
A patient made a huge fuss at the nursing counter.

She was standing there, hawkeyed on everyone working and writing behind the nursing counter.

She commented on how early the Professor already declared her safe to be discharge and the delay we had caused.

We were all halfway doing ward rounds.

She refused to follow the correct protocol to go down and collect the number for her medication to sort out the total fee.

She patronized the meagrely-paid clerk to call up the pharmacy to ask for cost and declare a number for her personally.

The clerk fumbled and could not get a proper response from the pharmacy because the pharmacy required the medication slips to check various costing.

She barked at the clerk and barked for the ward Sister.

The ward Sister helped to sort out the medication part including going down to pharmacy for her to get the number and costing.

Then, when everything added up, the Sister passed her the bill with a checklist of all medical services she acquired during her one night stay, without costing.

Costing usually will be calculated when paying at the payment counter at the lobby.

Again, she barked at the Sister insisting on wanting the full amount in dollars and cents because last time when she was admitted, she was told 1K but when the charges sent to her house, it was 2K.

The Sister kind of felt lost and turned to me.

I was busy sorting out logistics to post a patient up for diagnostic laparoscopy for suspected ectopic pregnancy.

For those who don't understand what is ectopic pregnancy, it is pregnancy outside of womb, usually in the tube and if ruptured, the patient may die. Yes, die

Apparently, the hospital was in semi-chaos since last Friday
(I can't reveal why because if I did, the private wing of this hospy may just hire a gunman (or more) to snipe me down. Yes, I am serious)

Sister: Dr.Pilo, macam mana? (how?)
Pilo: Just follow protocol.

Then the barking started again. She stood firmly at the counter edge.

What follow protocol? Can't you just sort out this simple things for me.
What is your name?
Hi, I'm Dr Pilo. I can write my full name and give my phone number to you if you want to. But now, I am busy. But, you must follow hospital's protocol.

She was shocked to see that I did not sport the sad-puppy look together with the clerk and the ward Sister.
She walked away.

I continued to call this and that and this and that and this and that (repeat like forever).
Still, the solution to the logistics problem remained elusive.

She quietly settled the bill with the billing counter and came up.

She composed herself and came back for 2nd round of battle, barking again in human words.

Sigh. I hate to be involved in pathetic debate.

Most of time, I will win, but I will feel extremely sad because the other party will be greatly depressed by then. (bad kamma for me)

Thus, I chose to be as 'nice' and 'relevant' as possible.

Italics The Patient

Bold Pilo

Underline Pilo's thought

Since you're so happy in giving me your name and phone number. Give me then.
Okay, here's is it (I wrote down my full name and phone number). I am busy right now because there's an emergency I need to sort out. If there is anything that I can help with, within hospital protocol, I will help you, but not now.

Let me tell you you are an arrogant doctor. Very arrogant.
Dear Madam, out of 10 of my patients, 10 of them would disagree with you. 
This IS arrogance, fyi

Hey, is it really so hard and difficult to do extra to help one sick ill patient out of your 10 patients?
Dear Madam, I am helping all as much as I can.
You should just tag with me and see how for yourself how much MORE extra I had done for my patients. Sick, ill and barking, what a paradox

Is this what you called service? Is this what you called service?
Dear Madam, I am doing job, to prioritize my duties and responsibilities and work within protocol.
Thank God she did not repeat the 'Service' word for 9 times like the 'Listen' fiasco.
Service? Service? You think I'm a 'duck' mer? (insert vulgarities here)

I want to see Matron.
Dear Madam, here's the Sister, she will sort out for you.

She continued to talk to the Sister rudely and wrote up a complaint letter.

I intended to inform my Head of Department because in my old hospy this kind of stuff is kinda big, because God-knows-why even if we're not wrong or involve in any illegal activities.

But the Sister told me: Nah, it's pretty common here. Just wait for the complaint letter and explain.

Common.

I wonder who or what have been constantly providing the fertile ground for the breeding of this ungrateful, demanding and unreasonable patient's culture.

Sad, but annoyingly true.

Hands tapped by Prof - TWICE!!

All alone guarding the fort - the whole full board recognizing the full labor ward.

My wardmates left to attend teaching and presenting for our monthly Census. 

Out of the flash, Prof appeared.
I presented the whole ward of patients by referring to the maternity board.

Alerted by a staff nurse after noted a suspicious fetal tracing, we made our way to that patient. 

The fetal tracing was indeed suspicious, bordering on pathological. 

A quick review revealed the mother had indeed entered 2nd stage of labor. 

I scrubbed up and attempted to guard the perineal with my right hand as the baby's head is crowning.

Prof tapped my hand. 
PAAAKKK!!

"Hands poised!" he said. 

I removed my hand. 

The lady kept bearing down and the baby's head kept coming down. 

I moved my hand back to the similar place, stuck tightly with the perineal body.

My Prof tapped me again - TWICE!!

PAAAAKKK!!!

"Hands poised, young man" he exalted, again.

Therefore, first time in my working history (was not that long to begin with), I stood at the end of the bed, overlooking the delivery of a baby without any perineal guarding.

And her perineal only have a short second degree tear.

Tiu. It was sublime. For that moment in time.

Was it luck? Was it a coincidence?
Is 'hands poised' another fancy English term by Prof T?

I decided to look it up academically (basically just googled it - lah).

I don't even know wtf is the meaning of poised.

Here's what I got from Reducing Genital Tract Trauma at Birth 

 The first was a study from Great Britain that assessed the role of hand maneuvers for the actual birth in a large, randomized controlled trial.^[4] In this study (called the HOOP trial, for "hands on or poised"), some 5,471 women were randomized to either "hands on" (one hand flexing the baby's head and the other hand guarding the perineum) or "hands poised" (both hands off, but ready to apply light pressure to the advancing head in the case of rapid expulsion) at delivery of the baby. Both approaches are taught in British midwifery education programs for management of birth, and both are practiced in the United Kingdom. 

Midwife compliance with the experimental allocation was 84% overall, 95% in the "hands on" group and 70% with "hands poised." After each birth, trauma to all sites in the genital tract was systematically assessed and recorded by the attending midwife. This was the first large clinical study to provide a detailed and complete picture of the total array of genital tract trauma sustained by women having normal, spontaneous vaginal births. 

Results of the HOOP trial showed that trauma is indeed a very common experience of low-risk childbearing women: 68% had major or minor trauma to the perineum, 61% had vaginal lacerations, and 11% had episiotomies. The trauma profiles of women in the "hands on" versus "hands poised" groups were virtually identical (recall that the techniques were used at expulsion of the baby, and not earlier in the labor). However, marginally fewer women in the "hands on" group reported perineal pain at the 10th postpartum day (31% versus 34% for the "hands poised" group). 

This represents a 3% absolute difference (95% confidence interval, 0.5% to 5.0%; statistically significant because the confidence interval for the risk difference does not overlap 0). While this difference is small, it is of interest to U.S. midwives because "hands on" for management of the actual delivery is the practice norm in this country.

And all this time, for the people, mostly HOs or nurses who conducted the delivery, ending with obstetric anal sphincter injury, the superiors would just screw them up nicely for not guarding the perineal properly and send them to some classes.

When all they need is to stand up (after reading this post) and reply "Hands poised".

P.S. it appear like I am rather stupid, not knowing all this all this time. 

Practical usage of "Listen! X3" ?

Post call yesterday.

Almost to passover time in the morning.

Not much of a difference as I was in-charge of labor room anyway.

My colleague and senior MO, Dr J stepped into the labor room.

First thing she heard was the loud echo and volume of a hollering mother in labour.

It was so loud that I was surprised there wasn't any crowd forming outside of the room.

"ARRGGHH!! ARRRGHH!! ARRGGHH!!!"

J was trying to communicate with the mother, not knowing much about her background.

 "Madam, LISTEN! LISTEN! LISTEN!!"

"ARRGGHH!! ARRRGHH!! ARRGGHH!!!" continued.

"Err.. J, she's not from Malaysia, and neither speaks English or Malay."

"ARRGGHH!! ARRRGHH!! ARRGGHH!!!" continued.

"Oh, luckily, I didn't say let me speak, let me speak..."

(=,=")

When woman in labor, there's this peculiar moment when temporary partial deafness sets in, where they don't hear whatever that you trying to tell them.

My dearest described during short early phase of active labor, she only able to hear monosyllables word and couldn't care much about whether we're scolding or encouraging her.

The language of pain is indeed very deafening.

Close monitoring

Consultant: Why do you want to keep this patient in High Dependency Unit?
Me: She requires close monitoring as she is a high risk patient.
Consultant: Come, take off your shoes and lie down on the bed beside the patient. Now, you can closely monitor her.

(=,=")

Reminds me of my first boss, Dr K.

Dr K saw the plan in the case note, nicely written "Strict Pad Chart"
Dr K: So, what is strict pad chart? Do you use a microscope to see the Pad, Pilo?

(=,=")

P.S. Bring back good memories..

Princess's antenatal check up

Cloudy day on the last antenatal clinic day of the week

I glanced at the mother's name and prepared myself.

An African couple came in.

They were fluent in English. Thank God.

Full check-up and everything explained to the couple.

Couple reassured and delighted.

All smiles.

As they were at the door, my curiosity taken over and exchanged few words with the hubby.

Just wondering, I notice there's a "Princess" in your wife's name.

Yes, I am actually the Prince. (sport a sheepish smirk) 

Wow. So that makes me the royal physician.

Sort of. (more of a smile)

Alright, see you.

Perhaps they were just pulling my legs. But who knows.

Pain of inertia

Trolled by pain. Sigh!

I was in a sombre mood and pain score of 10 having to make the move - a change in my workplace.

It was an anticipated move, yet life changes in more than 360 degrees and my expenditures rises to the similar figure in percentage.

After 3 weeks here, absorbing whatever comes along the way, I am lucky not to be sucked into the black hole of unhealthy working environment.


Black hole: Look pretty much like main interest in my line of work,doesn't it?

My fellow batchmate summarized it beautifully as

"It's freaking tiring like that, mentally and physically. Blaming game is one, defensive medicine is another, hierarchy system is another killer. Basically before getting the apple(credentials ) one has to get raped by everyone" 

Or perhaps my time have not come yet.

Still have not properly understand the natural history of such pathological phenomenon.

Yet, I should consider myself really effing lucky to start of my posting with such nice and dynamic team, especially the 3 senior colleagues who are always there for us, the 3 newbies, including me.

Dr S is informative and resourceful.
Dr N is funny and dynamic.
Dr Z is disciplined, pushy and things always get done - quick.

Lecturers are good teachers and sets fine examples to follow.

It is always nice to be in the junior pool again. Relief.

Horror stories had caught my ears. It isn't nice if one is caught with senior colleague who is lacking of the sense of teamwork.

My fellow Master batchmate was forced to the point of using the four letter work with the -ing suffix.
Four letter word would have been bad enough, but in continuous tense, it is definitely worse.

Now my pain score had gone down to 6-7.

P.S. the free usage of FB and blog in the hospy helps in reducing the pain score even further.

Crimson tide

The 'best' thing about the new hospy that I am working right now is all deliveries to be conducted by doctors.

All deliveries to be conducted by medical officers or house officers under medical officers supervision.

It does bring back good memories of the time when I first conducted my first delivery, which is in the same hospy but different labor room.

Now, the labor room is new and so-called advanced.

Computerized partogram. Data through computer. CTG centralized view.

Maybe it's inertia.
Maybe it's adjustment disorder.

The installed system has less pros and more cons.

Browsing through the computerized data takes a lifetime and the previous records still need to be traced manually on paper technology.

Although one may argue the invincibility and economics in intrapartum care records as its prime and sole raison d'etre, I beg to differ.

Files can be corrupted, hacked, stolen, altered and destroyed with good computer programming skills.

Plus, the poor record-keeping using the not-so-user-friendly system will work against the medical institution.

Feedbacks from Prof J on the review of the documentation can be summarized in one word - Rubbish.

When I had complicated third stage and documented in length in the 'remarks' column, the senior nurse partly 'censored' my entry because when printed out, it doesn't look 'nice'.

Lack of triaging also renders serious conditions do not get immediate attention.

When a preggie lady came with per vaginal bleeding, as I am busy, I instantly ask a loitering house officer to attend to the lady for brief history.

The house officer just ignored me and walked away.
When I confronted him, the nurse in charge backed him up, telling me about how the whole system works. Patients to be registered by the clerk. Then, reviewed and vital signs be taken by the nurse, before the lady can be clerked.

Probably there is a reason why a lady came with massive abruptio but was seen only after 15mins later.

All victims of technology, or rather victims of common sense deficiency.

Updates...

Reviewing a post delivery patient.

Medical Officer: Houseman, please update the baby.
Houseman: update the baby?(scratching head)
Specialist: Yeah, update the baby about the mother.

Sarcasm of the day.

A melody that I will complete

restecpe. yup. dat's how Ali G would have spelled respect.

Respect is a very simple thing.
It has nothing to with money or status.
It has nothing to do with a great amount of time or sacrifice.
It has something to do with being sincere and open.

I may not have fate with that person for a long period of time.
May have seen that person 3-4 times.
But from that person, I had received the great motivation from that person.

That person have given me a simple mindtrack and mindset that I must project myself to be.

That person's ultimate victory has allow me to respect that person's rightful success.

That person also kept reminding me who is the person behind what he had achieved today.

Incidentally, I bumped into that person during dinner tonight and was re-motivated again.

And a song came into my mind.

Listen,
To the song here in my heart
A melody I start but can't complete
Listen, to the sound from deep within
It's only beginning
To find release
Oh,
The time has come
For my dreams to be heard
They will not be pushed aside and turned
Into your own
All cause you won't
Listen....
[Chorus:]
Listen,
I am alone at a crossroads
I'm not at home, in my own home
And I've tried and tried
To say what's on my mind
You should have known
Oh,
Now I'm done believing you
You don't know what I'm feeling
I'm more than what you made of me
I followed the voice you gave to me
But now I gotta find my own..
You should have listened
There is someone here inside
Someone I'd thought had died
So long ago
Oh I'm screaming out, for my dreams to be heard
They will not be pushed aside or worked
Into your own
All cause you won't
Listen...
[Chorus]
I don't know where I belong
But I'll be moving on
If you don't....
If you won't....
LISTEN!!!...
To the song here in my heart
A melody I've started
But I will complete
Oh,
Now I'm done believing you
You don't know what I'm feeling
I'm more than what you've made of me
I followed the voice you think you gave to me
But now I gotta find my own..
My own...

Culinary of vaginal discharge

Ewww....

Here's a rough guide on vaginal discharge when you see such colors on the 'nasi'...

Clear and Milky

 

The normal colors of vaginal discharge are clear or milky. It depends what time of the month your body is going through. Most women will experience both clear and milky colored vaginal discharge in a given month. These changes are nothing to worry about.

Cottage Cheesy White
White, cottage cheesy vaginal discharge can be a sign of a yeast infection. Yeast infections are simply an extra abundance of the yeast fungus. This condition is extremely common in women who are pregnant, have diabetes, or are on any type of antibiotics.

Grey Vaginal Discharge
Another condition of the vagina is bacterial vaginosis. This is detected by a gray vaginal discharge, itching, and a fishy smell. It is nothing to be worried about because it can easily be treated by taking antibiotics. Usually this is in the form of a pill.

Green or Yellow
A sign of a more serious condition called Trichomoniasis is a green or yellow vaginal discharge. This is also accompanied by a nasty odor. This disease can be caught from a sexual partner without using a condom. Unfortunately, women can have this condition for quite a while without knowing. Many times, a characteristic of the vaginal discharge associated with Trichomoniasis is a bubbly quality.
 

Examining exam

Frankly-speaking, I was feeling rather quesy having to be included to plan the long case exam for the medical students.

Gathering, persuading, calling and confirming patients for long case exam, then making sure the students and patients at the right place at the right time is really sucking the energy out of me.


Of course, everyone in the team worked very hard as well and made it an exciting and good experience.

Still couldn't get over the 'bad' joke of asking one of my colleague going in as a patient with primary amenorrhea. I am sure there will be quite a lot to be discussed given her physical appearance. My bad.

There were two nerve-wrecking moments. Firstly, when the airconditioner in one of the examiner's room not starting and we had to take over another dept's house officers' on call room as a substitute. Of course, with blessing of the other dept's Consultant. Yet, something puzzled me. I always thought house officers are all running shift system right now.

Secondly, it was the major black out for a good 10mins. Basically, no electricity in the entire building. Sunshine substituted the artificial light that went off. The room temperature remained cool, heavily upon the residue air-conditioned air of the close room. Presentation to examiner and clerking of patients continued in the semi-dark condition.

Reminds me of the time when I had to perform C-Section in the dark when the lights went out in the Maternity theatre. No emergency lightings. So much for developing country and first world facilities.

I am pretty sure Bryan Mills won't be holding up Marko of Tropoja here. No constant continuous electrical current.

I wasn't in the room when the examiners drilled and grilled the students. Thus, no exam bloopers to brag about.

Yet there was an awkward moment when a student was clerking a patient.

Med student (MS): Hi, can you take the BP? (She was speaking to the house officer who is co-invigilating the exam)
House officer (HO): (Bring the sphygmomanometer to the MS) Here.
MS: Can you take the BP?
HO: (Stunned and speechless for 10secs) Err... No.
MS: (Took the sphygmomanometer and appeared lost for a while)

I told the HO. Perhaps you should have asked the MS: How much?

I am not surprise at all that this incident happening because I used to have referrals from house officers in their sixth posting, meaning 4 months away to being medical officers, telling me:

"The BP is 163/95. I swear I took it manually with the BP set"
"Pardon, what is the BP?"
"THE BP is ONE SIX THREE over NINETY-FIVE"
"And that's a manual BP?"
"Of course."
"Well, you see manual BP only shows even number."
"But it is really 163/95 manual. Really. So how, admit or not?"
"Admit, then." I put down the phone and whispered to myself "Admit to re-check BP."

Partially impartial

Frankly, in perfect contrast to public perception, we do not treat all patient equally.

Reason being, some patients are more important the others, due to several factors ie.

1. Age. Young patients have greater life span ahead of them compared the old patients, therefore, they get prioritized. If there were a single ventilator for both patients with similar severity of disease, it will go to the younger patient because they have 'better prognosis' and the older one will be considered as 'waiting for his/her time' to come. No one really takes into account how much the older patient had contributed to the society in their youth.

2. Status/Royalty-link. YBs, VIPs, Sultans and family members, political figures will trigger the red carpet treatment. Some even coined the term 'social' ward rounds when ward rounds felt like a cocktail party where the high society people mingle.



3. Preggie. If you're pregnant or even just delivered few weeks ago, you're in the radar, you'll get prioritized. Preggie or pregnant ladies is being given priority is not because the noble value of upholding the sanctity of conception, pregnancy or the 'two lives in one body', but because people just wanted to save their asses from potentially being screwed in maternal mortality meeting which will be held at district level up to national level.



4. Complaint freaks. Surprisingly, our system do not allow us to be objectively providing treatment effectively and equally. Most of times, we reduce ourselves to lap dogs for anyone who threatened to complain. Sad, but true. Personally, I just do not give a d*mn and I will personally help him/her to write the complaint if needed to if they insist to make a fool out of themselves and their parents who fail to educate them.



Sadly (and pathetic), our system do not allow objectivity in treatment of preggie simply because they are preggie.

An unfortunate lady, delivered vaginally uneventfully a week ago, slipped and fell. Suffered loss of consciousness and possible symptoms of cerebral concussion. Ambulance call. She was shipped to the maternity hospital, instead of going to the General hospital, a separate building across the street with imaging facilities and the Surgical team. Time wasted further to bring that mother out of the ambulance to the triage for assessment and referral, plus putting back her to ambulance and send her over to General hospital. If needed, Gynae team is available in General Hospital.

The utterly appalling scene repeats itself again with another mother.

Delivered well 5 days ago. Slippery floor. Fell and hit her back. Couldn't walk. Sent to Maternity Hospital.

I think anyone with IQ of 70-100 without any medical knowledge would have known the mother with back ache do not need an OB consult.

The main reason she was being sent to Maternity Hospital is simply because of the General policy of Ambulance Call: If pregnant or near after delivery, all patients MUST be sent to Maternity Hospital.

Thus, can't really blame the people for fulfilling their faithful duty of 'saya yang menurut perintah'.

Perhaps such policy should be reviewed urgently before the delay actually kill someone.

I have no doubt that it will one fine day.

Killer Lifts!!

The lift in C Block of my hospy nearly dislocated my Specialist's shoulder as he walk in to the lift and the door came in closing even with me pressing on the '< >' button.

Even as I pressed the usually middle bar of the door of the lift, it does not stop it.


It came closing and unstoppable.

Security guards had already alerted the supposedly 'On Call' technician, but the lifts continue to have their killer edge up till the night time.

Instead of closing/barring usage of the killer lifts, the security guards just went around reminding everyone who is using the lifts.

A staff nurse told me, once upon a time (not fairy tale, mind you), someone actually got her fingers fractured because banged by the lift's door.

Freakishly dangerous. I was imagining a scene from Final Destination.

Grateful for the services

One of the best thing about this profession is the moment that few milliseconds or more our heart totally melt down patients who came in being ill or mashed up like a potato  and now went home walking like a professional footballer

as they took their steps heading to the exit they express their gratitude to you... But one took it further and present a personalized trophy/award... You're awesome, Siow Jin!

Jumping the gun again, mate?

Some people believes that I am an authoritorian bordering on sadistic whenever I asked them to write explanation letter about certain irregular activities in the ward.

And often people mistaken explanation letter as apology letter. Explaination letter is to truthfully explain what had happened and to decide whether somethings are out of hands and out of basic human capabilities. My mind hungers for the pathogenecity of things.

I am not a perfect being and at times, I did jump to conclusion, but I tried my best not to jump the gun. Thus, an explanation letter helps a lot, unless your confession is indeed a misdeed, then it would be polite for an apology to follow.

Again, there it was, out of the blue, some people insidiously attaching me with something that I was totally not guilty of.

For starter, I did not ask someone to passover on my behalf and I passover to another person myself. The proof of my communication is registered in my phone and the proof of another acceptance of my communication is also evidently kept.

I just asked that someone to call up when the patient had reached that place therefore reducing time wastage if another person is being called in prematurely.

Would have got all this truth if one would be wise enough to ask me and maybe the other junior personnel, the 3 staff nurses and the other medical officer from another department who is in the scenario.

If the issue is about another matter, relating to vital omission of certain intraoperative procedure. Then, it is another ball game altogether, because its failure is a failure of a whole system and a whole unfortunate chain of events.

Antenatally did the person in-charge of proposing and finalizing such procedure make the adequate arrangement to ascertain the fulfillment of procedure?

Did the person who posted up the operation conveyed the 'extra-ordinary' to the person who supposed to do the operation?


Did the surgeon read and understand about the patient before the operation?

How can that person who had taken part in the antenatal hospital admission review and finally end up being the surgeon do not know the need for the procedure?

Did the surgeon fail to listen to what the staff nurses who noticed the peculiarity and reminded the surgeon?

Finally, did I really took some time off to shake my bollocks or contributing to the department by organizing and chairing the whole event with involvement of several departments including the attendance of the big shot from State Health Department even though I was sharing half of the on call burden of my other colleague the night before?

Lots of questions unanswered and perhaps presumedly being answered based on assumptions.

About passing over does bring back very vivid livid memories of how I was being screwed, mentally stomped to the ground and diminuted to less than a tagging medical officer when I was being accused of failure to  pass over a pending emergency procedure to the on call superior. I did inform the office hour's superior and offered to pass over to the on call's superior but was being told it will be done superior to superior.

Nobody came to my defense, no apology for the false accusation.

Nothing beats the stench of superiority and the holier-than-thou attitude.

Double standards will eat in, one fine day.

Buddhism has a name for it - it is called kamma.

I am just doing my part to send out a gentle reminder.

During my school days, I was being taught a useful two-liners.

Never assume because ASS/U/ME, because when you assumed you are making an ass out of you and me. 

Perception of impossibility

Alice: This is impossible.
Mad Hatter: Only if you believe it is.

I rushed to General Operation theatre for 2 pending procedure.

A call from the nursing counter for me.

It was a referral from one of the primary care department of my hospy.

She had to start her conversation by sighing and tell me this:

"Dr Pilo, hi, I need to refer a case to you. It is impossible to reach you."

My reply: "I'm in OT. No line"

What I was thinking of replying her was

"How can I make it possible for you?

Well, you see, there is 3 problems with your statement.
Firstly, if you're already talking to me, how would you consider it to be impossible.

Secondly, unless I purchase the telecommunication company, I do not foresee any connectivity through my handphone in the future whenever I am in OT or A&E department. Pager system never had worked for the department ever. Even a Red Alert looks like Pink Alert.

Thirdly, if you're thinking that I am avoiding you or I am sitting idle at Starbucks Cafe far far far away from hospy, I think you're thinking way ahead of yourself. I don't even avoid my ex.

Get a hold of yourself.

Today is not my first day receiving referrals from your department.

Everyone knew, if you had called the ward, you would have known EXACTLY where I am, which is not Timbuktu."

Case noted.

Almost Van Dyke!

Having facial hair, even for man, can get a lot of various response as well, as opposed to women having facial hair.

The pharmaceutical drug rep was wondering whether I am post call.

The nurses thought I was trying to change my image. I told them it is because of high androgen.

My deareast couldn't stand having a porcupine in bed every night. She should try to embrace it.

My daughter like the ticklish feeling whenever I brushed my chin on hers.
My son, don't. (Failed the Gay Test. Good)

And one of my ex-house officer (a guy) sms me: u looked so man with your moustache!!Hehehe.
My reply to him: Walao, so previously I looked like a woman?

The real reason behind my 'almost Van Dyke' look is that I just want more sensation and feel whenever I rub my chin in deep thoughts.

Sorry for keeping everyone guessing.

Here's a PHD in Facial Hair.



Created by: Online PhD