Earthquaking

2 days ago.

Public holiday.

New Agong's Day.

It was a lazy day that I decided to be diligent. 
Sort of dumb and inappropriate, I think.
I should be sleeping soundly after 3 hours of almost non-stop badminton in the morning.

It was more exhausting than usual, thanks to a few friends who 'let go of airplane' last minute.

I was sorting out my drawers which is piling up with a few mountains of important documents.
Fan was blowing behind me. Not oscillating as I was alone in the room.

After 2 hours of digging through the stacks, I suddenly felt my chair swayed slightly to the left and right.
Michael Buble's song came into mind.

It feels like earthquake, it shakes like earthquake, it spins like earthquake.
But can't really say that it's definitely an earthquake.

I went out of the room, on my feet. The spinning was less, but the 'vertigo' persisted.

I was wondering whether it was my wife on hoola hoops upstairs.
I asked her when she came down. She was on hoola hoops.

Then the phone rang.
It was my uncle.
In a way, he was doubting himself, too and wanted our confirmation of the moving earth.

Next, it was my colleague's text, stating how awesome it was to be earthquaking!

Last bit of confirmation I needed was to go into FB and all the reel of updates came through.

Not just real serious updates, but also dumb ones.
Like how suicidal people can be.
Holding up camera and waiting at the seaside to catch a glimpse of tsunami.

There's another fella who bragged that he was crossing the bridge like a Boss.
Maybe it's a substitute for bungee-jumping or sky-diving. Maybe.

The tsunami alert was lifted soon after the predicted aqua armageddon of 9pm.
Nevertheless, it was a night of full of thoughts about what's next if it really happened.

Nothing good can be expected from a high waves of fluids, even if it's beer (named as 1814 beer-nami)

I got myself away from this disaster, but landed myself in another, the day after.

FML. FML. (yes, double) and now still picking up the pieces.

拿BOOK出来了

830pm TV8

Grandma   : "孙悟空"还有做吗？
Aedan     : 没有了... 孙悟空拿BOOK出来了...
Grandma   : (=,=")

When man menstruates...

One of good difference between men and women is menopause, because men-no-pause.
Men will go on forever and ever and ever.
Of course, on extremely rare occasion, obligates the recognition of the contribution of sildenafil.

Beyond imagination but true.

What about menstruation?
Can men menstruate?
Not technically menstruating.
Nevertheless it is possible to have a medical consultation of primary amenorrhea for boys!
It's the failure for the boys to start male-menstruating or rather called as "manstruation"
The lack of manstrual cycle in the boys causes anxiety and doubts in the parents.
In those places, the extraordinary is the norm. 
But real men do not menstruate.
The business drive for sanitary pads for boys is in actual fact the parasite infection of urinary tract or intestines by Schistosoma haematobium.

Also cleverly known as Schistosomiasis.

In some tropical peoples that work in wet places such as rice fields, most boys pick up Schistosoma, and start the bleeding, about puberty when they start working in the rice fields, and uneducated locals think that it is normal and refer to it as the male equivalent of female menstruation, and call it by their native language word for "menstruation".^[1]

In at least one case, it was reported that a boy in an affected area started work in a factory instead of the rice fields, and so did not pick up Schistosoma, and did not develop the bleeding, and his father took him to a doctor asking for investigation of primary amenorrhoea.

Source: Wikipedia. 

It is not a serious illness, but it will simply make one weaker primarily down with anemia (lack of oxygen carrying agents in blood cells).

Secondly, it will pathetically present with slight shrinkage of penis (dafuq!) and rare symptoms such as yellowish discharge from the penis, excitedness when least expected (This could be potentially positive), and an undescribable odd feeling (potential orgasm?)

This is to be distinguished from genuine menstruation in an anatomically intersex human who has a functioning menstruating womb but external sexual organs which are on the male side of ambiguous in form, or the menstruation experienced by trans men.
Source: Wikipedia.

Schistosoma haematobium's life cycle below.



P.S. It's not cool for men to have menses.
Men's 'bird' never ever require extra pair of 'wings'. 

P.S. Too bad for men. Men can't conveniently go for MC with primary dysmenorrhea.

What Freshly Grad Doctor Should Know...

It is awesome but at the same time, perfect sympathy for new doctors who just recently confirmed their pass in the Final.
Congrats (cynically) to my dear buddy CL.
I hopefully you will grow well in the midst of the houseman glut.

From me, frankly, I am not  wise enough to provide good valuable advice.
Nevertheless, I'm cool enough (self-proclaimed) to give short and snappy tips.
I asked of you to make 4 promises:
1. Never to give up
2. Grow in the world of medicine at your own comfortable pace
3. Never neglect your family/life-partner
3. Be a bitch/bastard only if it's absolutely necessary

Perhaps a good read, it's something that I pimped over from Dr. Edwin Leap. 

Raising doctors, beta version.

This lecture was recently delivered to the weekly student convocation at Erskine College. I’ve already posted a link to a story about it, but this is the text I used.
It is in thinking of my children that I decided what to say to you today. You see, at least two of my children have said to me that they would like to become physicians. Now, that may change. They’re still young. They may yet become dancers, musicians, craftsmen or many other things. But if they choose to follow my path, I have some things to teach them. And so, since many of you are young enough to be my children, and since some of you may also desire to become medical doctors, I will share some advice with you.
It occurred to me once that medicine is not like it used to be. I cannot allow my children to follow me around and learn as my apprentices as they might have in centuries past. And when they are in school, medicine will have changed far too much for me to be their teacher in the science of it all. But I can be their teacher in the art. Because, cliché as it sounds, and no matter how much we become absorbed in scientific evidence, medicine is an art. Anyone who tells you otherwise has not practiced enough, or has forgotten what it was like to practice.
So, I give you the Beta version of ‘Raising doctors.’ But it might also be called ‘Raising wise, compassionate adults.’ Because the traits I want to inculcate into my four little interns are traits we all need in large quantities, if we are to navigate the world for good.
So, what would I tell my children? What advice can I give you from years in the emergency room? Rules of thumb and a few stories.

First, about humanity.

I Humans are good. I have seen old couples love one another to the very end. An aged couple once touched me…she had hemangiomas all over her face, and he was kind as any old man I ever met. They loved each other so, and he kept talking. ‘Would you shut up! Ask him the time, he’ll tell you how to build a clock!’ But they so loved each other! I have seen grandparents tenderly raising the children their own sons and daughters abandoned. I have talked with parents of adult addicts, struggling to do their best for them. I have seen young parents lose infants and mourn in ways you could not imagine. I have been amazed that the scary, tattooed man in leather was all tears and kindness, no matter how he may have looked on the outside. I have met men and women who could have been on disability, but who worked on despite their frailty. I know physicians who give their all, at all hours of the day and night. Humans are capable of enormous love and compassion.

II And here’s the hard truth. Humans are wicked. Just last year I saw a man who had severely beaten a child. And he himself had been beaten in jail. Just last year, I saw a child beaten by his mother’s boyfriend. Every day, someone lies to me to receive prescription drugs. In fact, prescription drug abuse is a massive problem in America today, as people take pills and even sell the pills prescribed to them; all while getting state and federal assistance. Men and women routinely cheat on their spouses, become addicted to alcohol, drugs and pornography, and drive their vehicles illegally and while intoxicated. Humans lie, cheat, steal and do everything else imaginable to lower our expectations. And some of the worst wear expensive suits and speak perfect English. Do not be deceived by externals.
Love humans, but beware. They are, to paraphrase Pascal, ‘glorious and wretched.’

Kenneth embodied both. An old drunk, a mean drunk, a murderer who had served time in prison, he routinely came to the ER, as you might guess, drunk. He often threatened to kill us. He could have. He would often leave us, angry, and say ‘I’m going to get my shotgun and come back and kill you!’ I guess he just went home and fell asleep. He was loud and profane. Who knows how he ended up that way? But, in the midst of his anger, all we had to say was ‘Kenneth, there’s a baby in the next room, please be quiet!’ And he would apologize and weep. He could, and did, recite Shakespeare.

Money
I Medicine, work in general, is not only about money. Money cannot make you happy; money cannot provide the meaning you so desperately require in order to press on toward the goal to which you were called. Many of the least happy physicians I know make lots of money. Money compels many bad decisions, and many moral perils, in which men and women make bad decisions because of the lure of cash. The news is full of their stories. Bernie Madoff comes to mind. His money purchased jail-time.

II But money is not evil; the love of money is the root of evil. If you do your job well, you will deserve to be paid well. Compensation is appropriate, and the lack of fair compensation for work will kill a work ethic and productivity quicker than my children can start a brush fire. Never be ashamed of your skills, or of the desire to be paid for them. And always remember that money is payment for pieces of your life, which you carve out for the purpose of supporting yourself and your family. You need the money, and your employer needs your skill. They key is to have something someone needs, and to be willing to do what others don’t want to do, in places they don’t want to go. I have a great job in Seneca, because lots of people want to practice in LA.

Death

I Death is universal. It is the constant perspective of medicine: this realization that the grim reaper stands by our sides at all times. You are young. May God give you many long decades of life. But in the end, we will all exit the earth. I have seen a bunch of death and participated in quite a few deaths…I mean, as a doctor. I have watched aged men and women die slowly, holding hands. I’ve struggled in cardiac arrests, trying to save life. I have seen infants who died in their sleep. And I have seen young people, in the prime of life, die tragically from accidents, or from cancers that they never expected. We can delay it; so live healthy lives and don’t take unnecessary risks. But in the end, it gets us all. The death rate remains the same, my partner says: One per customer. It’s a useful cure for guilt to realize that no one avoids it forever.
I learned this most poignantly the night my partner was driving home and ran his car into a horse. He was killed, but before he died I had to help care for him, and face his family. Death even comes to doctors!

II Because this is so, life is precious. Moments are precious. Do not waste them. Use them in genuine pleasure, use them in love, use them to produce and create and leave behind a legacy of wonder. Television is not a productive use of your life; frankly, though I do it myself, neither is Facebook, Twitter, constant web-surfing or X-Box. (Though I someday hope to beat my children at HALO…if you don’t have ODST, go and try it!)

Someone once said, ‘as though one could kill time without wounding eternity.’ I have tried to live by that rule. And so, I struggle to use every minute well. A life in which death is certain should inspire you to fill up every breathing moment with something good. I hope to stand before God, exhausted because I was still moving forward when I died.

Broken

I Everyone is broken. Everyone is broken. Everyone is broken. Do I need to say it again? As Philo of Alexandria said two thousand years ago, ‘Be kind, for everyone you meet is fighting a great battle.’ I have known so many people. The woman crying for her recently deceased husband. They angry young man going blind, bitter because he would never see his daughter with his earthly eyes. The brother of a man stabbed to death who punched the wall next to me. The woman constantly abused by her boyfriend, who just wanted a kind word. The man always afraid and paralyzed by anxiety. The woman who has come to our ER some 2000 times, literally, in the 16 years of my practice, because she is lonely within her marriage and just wants someone to talk with, in a place clean and bright. If you would be great, be kind. And show the broken that they are worthwhile.

II Everyone is worth fixing. No one is garbage. We might use the term ‘trailer trash,’ but it’s incorrect. No one is trash. Some are evil, some are deceitful, some are just bad. But inside each is a human soul of some potential, created in the image of God. Be careful not to judge too quickly. Be careful to show kindness. Remember that the drunk may have been ignored or abused by his parents. Remember that the addict may have been raped as a child. Remember that the angry may have lost his children to tragedy. Remember that the rude driver may just have learned that he lost his job, or his wife, or that his sister has cancer. Remember that we all have pain. And remember this:

Worth:

I Humans matter because they have intrinsic worth. This is a kind of grace; that we have worth not because of what we do, or who we are, but because we are! This is why I always took care of Larry no matter how drunk or crazy he was. See, in addition to being a drunk Larry was addicted, heart and soul, to pain pills. Once, stoned out of his brain and with a blood alcohol of 400, he said, ‘I have to go doc, and babysit my nephews!’ ‘What? Are you crazy?’ I said.
He was in the ER constantly. Something always hurt. I checked him, and decided if it seemed legitimate or not. Over and over again he visited, as he slowly, surely dissolved his own liver and finally died. Did he deserve it, from a human, utilitarian standpoint? No. But from a heavenly one, he did. And I never regretted it. Not even the times he told me ‘my brother stole my Lortab! Momma’s in the truck, you can go ask her!’ In the end, I came to really like him. I miss him, to this day.

II Humans have worth, so you have worth. Do not be used or abused by anyone. You are as entitled to happiness and safety as anyone else. I always wondered why that woman left the ER one night after caring for her sick, but very annoying mother, and then put gun to her head. I wonder if she felt she was worthwhile. I’m afraid she didn’t. But she was. She was infinitely valuable. Never doubt that you are an amazing creation, who has just scratched the surface of your potential, temporal and eternal.

Truth

I The truth is powerful. Do not neglect it out of convenience, even kindness; for it is a false kindness. I once 
confronted a patient and told her that she was a narcotic addict, that she needed to get help and get a job. She wasn’t happy with what I said. But about a year later she saw me, stopped me and thanked me for telling her the painful truth. She beat the drugs and had a job! I could have lied to her as she lied to herself. But that would have been crueler than anything I could have done!
II The truth requires gentility. ‘Am I going to die?’ people ask. Sometimes, the answer is yes. But the answer I give is, ‘We’ll do our best to keep you from dying!’ Sometimes, all anyone needs is a little bit of hope. Use the truth carefully when you give bad news; couch it in love and possibility.

Love

I Love your people fearlessly and recklessly. Give your time to those you love lavishly. Time is your most precious resource. Spoil your family, your siblings, your parents, your lovers, your spouses. Spoil them with time. A man who lost a teenage child to a car wreck, said to me ‘spoil them while you have them!’ Truer words were never spoken.

II Do not be deceived by any love that causes you to be or feel diminished. Love that is good enlarges you, so beware of anything less. Remember that, in the name of love, men use women and women use men. I see the results of their lies in abuse, in sexually transmitted diseases, in violence. Love is the most abused word on the planet. Guard your hearts, as the Bible says.

Family

I Family is paramount. Have one. And when you have one, fight to keep it. Children whose families are shattered struggle. They feel uncertain and alone in a frightening world. Sometimes, the parents of single mothers or fathers do ridiculous things, like taking the baby for a stroll at 1 am, or subjecting them to the violence of boyfriends and girlfriends. These children from chaotic homes look at me, even at age 2 or 3, and seem to say (with their eyes), ‘please take me home and put me to bed…these people I live with are nuts!’ Marriages that break up leave both parties divided, lonely, financially devastated and depressed.

II Do not be tricked. Crazy people make for difficult families. And by crazy, I mean out of control, dangerous, dramatic, unstable individuals. I’m not talking mental illness; I’m talking crazy. You all know someone who is crazy, don’t you?

Drama

I You are all young and passionate; those are wonderful traits. But avoid unnecessary drama. I see drama all the time. Try to remember that for most of the working, struggling world, drama is exhausting. I work in a Level I Drama Center, with a D. Couples fight, scream, call each other rude names, leave lewd messages, get divorced, shatter the quiet nights, take overdoses and talk about suicide, pretend to pass out and feign illnesses, only to get angry when I believe them and try to put them in the hospital. And that’s just the staff! Drama, manufactured drama, drama created out of boredom, is a distraction from unhappiness and often the evidence of a mind lacking creativity and purpose; or the appropriate fatigue of hard work. Live lives of meaning and purpose and you’ll have little time for drama.

Calling

I Calling is paramount. Find that thing that moves you. Frederich Buechner said: ‘Your true calling is the place where your deep gladness meets the world’s deep need.’ Let me say that again……
You have gifts of love and opportunity. So find the things you do best and use them for the good of the world. But don’t be surprised if your calling changes with the years, even your profession!
I began as a journalism student, became a physician, then became a writer once more. Who knows what will come next? I’ve been blessed to care for sick and dying people. And to write words that encouraged people, or made them laugh. These are great gifts; the gifts of following my calling. So, I urge you to work with all your hearts at what you love, and be open to what you will come to love next. Your skills and interests will change with the years, and so must your calling and work.

II Calling may have nothing to do with your job; your job may merely exist to support your calling. Your calling may be something you desire deeply; or something you have not yet even discovered. Be patient, but be persistent.

A few closing thoughts:

Finally, and more practically:
Avoid drunk people with chainsaws.
Do not look for dates in the emergency room waiting area.
NEVER keep a rattlesnake for a pet.
Take as few medications as possible. Especially for pain.
No one is attractive when they vomit after drinking too much.
Police officers have no sense of humor after 11 PM. They don’t even laugh at donut jokes!
Dogs do not enjoy being kissed on the mouth by intoxicated loud, aggressive individuals.
Hit the dog, hit the deer, but do not hit the oncoming vehicle.
If your friends want to ‘make a bomb,’ get the phone and prepare to call 911. Stay back a safe distance. Follow the donut rule.
Your parents were correct: nothing good happens after midnight. I’ve seen the aftermath.
Be wise in all you do.
Be compassionate.
Learn to love well.
Doctor or not, you’ll make the world better by loving. 
I dub you my interns; go forth and treat the world well!
Now, have a great day, and please try to stay out of the emergency room. It’s really not that interesting if you’re a patient!
God guide and bless each of you, today and always!

Edwin

ACLS | Awesome Class in Life Saving

Went to ACLS (Advanced Cardiac Life Support) recently.
Have been wanting to update myself since ages ago.
Never seem to have the opportunity to do it.

Dr.L, the main pillar being it, had been 'harassing' me.
In the most civilized way.
I gave in finally.
It was for my own good.
More so, for the good of the patients under my care.

Not that I am the perfect clinician, unscarred by mistakes.
Yet, I do my best.
I am sure no one with the sane mind would declare themself error-free.
Yet, some chose to cast the first stone.

It is truly indefensible when a recent mortality was shrouded with mystery.
A mystery that its final stage, there was just lack of ACLS megacode resuscitation.
'Lack of facility' may be sent up the centrestage for ridicule and blame.
Yet, truth remains that humans should be responsible for the non-living objects.


In the course, Dr.L at a very particular moment, shared a harsh sentiment.
She was rejecting the instinctive explosives of scoldings during any resuscitation.
"You have to be calm and steady during resuscitation
Go over your megacode
Give clear instruction
Do not shout or scold if something went wrong,
Or someone gave you wrong instrument.
It falls back at you to put in a system to make sure everything being checked.
Everyone being trained.
You just waste time scolding.
And the relatives who hear you loud and clear won't be happy,too"
One can't really disagree with that logic.

As for the true lethal pathology that set to kill is largely unpredictable.
Nevertheless, the true survival rate in UK is 80% in 2010.
(Ref: GTG56 Maternal Collapse from www.rcog.org.uk.
Knight M, Tuffnell D, Brocklehurst P, Spark P, Kurinczuk JJ; UK
Obstetric Surveillance System. Obstet Gynecol 2010;115:910–7.)

Dr. L did remind everyone not to be overzealous and be more accepting.
If he or she is meant to die, they'll die, no matter how appropriate and timely your action is.
If he or she is meant to survive, they'll survive. But that doesn't mean you just let her/him die, ok?!?
The most important thing is that you being able to do the right thing and do your best.

Back to this ACLS course and exam.
Yup, again, I am in the guinea pig cohort.
This is the first time ACLS is shortening its 3-days course to 2 days.
Everything came hard and came fast. Like the chest compression.

The foreign ECG became familiar again.
And out of good luck or serendipity, I scored full in the ECG part.
Perhaps I underestimated my residual knowledge from my awesome undergrad Cardio Sifu, Dr Halmey.
Still in the ECG test, I had to chose 'sinus rhythm' after excluding all other ECG abnormalities.


Had an excellent tutor and partner in the Airway station.
Learning was a breeze.


Prep before advanced airway - intubation.
codename: MALES (right to left)


The distractor at the Airway station. It's called Laryngeal Tube. It resembles.. err... never mind.


MegaCode Exam with my colleagues, Dr.C and Dr. H. Sporting the 'LGE smile'.


The examiner was the awesome biker Dr.L.

Passing the short course was not my primary aim.
But still I'm glad I did it together with most of the participants.
This cohort set the record for having a high passing rate.
For those who didn't make it, it's TCA 2 months - May
Confirmed joining are at least 2 Consultants and a specialist my dearest Dept.

And it's "Staying Alive" all over again...

Franchised slides for the whole crash course is attached below.

Airway lecture06122011

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Rhythm recognitionskillstation06122011

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Drugs inresus06122011

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Defib skillstation22122011edited

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Put italltogether06122011

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Ethical issues06122011

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P.S. Dear A, no, I'm so not going to share the lame 'rigor mortis' joke.