Life

Life should be cherished every day as we live through every moment of it. If that is so, why does my heart feels empty, like a small empty glass lying sideway in an old abandoned cottage near a beautiful lake.

Why can't I feel the taste of possible happiness out there.

It's eating my mortal body slowly and with every moment pass I can feel my soul fading away into a state of permanent oblivion.

But it's hard when things do not go the way we had imagined it. Is this all there is to it? Could I brace myself to this feeling every single morning I wake up to for the next 30 to 40 years of my remaining life. If I could live that long anyway.

Life. Pity.

Warm fuzzy weekend

After so many hours inside the hospital OT having to deal with its sub-zero arse-freezing temperature (okay i exaggerate a bit).

It's good to have the whole weekend off..away from it all and not having to do weekend on-call.

Hurrah! (repeat twice and fade away...)












It's good to be out there enjoying the nice warm saturday morning while listening to ma MP3 songs...

... oh Norah and U2 was there all the way!

.... and convincing mr tastebuds to sample thatt sweeet juicy pancake for breakkie paid-off well....

....and later the not too-heavy Thai Express luncheon

...oh have mercy on ma duodenum

...followed by light reading at one's favourite bookshop-cum-browse for free for as long as you want...

... and not having to buy anything!

(Phew! Spoiled by a burst of afternoon rain-storm)

Hmmm sunday wasn't that bad either --

apart from finding out that the RM4 kuew teow Penang Mari of TTDI could beat this seafood kuew-teow any given sunday

Heheh!






As for the weekend feast finale the japanese cuisine was a delish except for this funny looking appetiser which was

.....well taste funny ;)

By the end of the weekend..

I went home and curled down on my sofa and dozed off

like this fellah..

felt thousand kilos heavier...

Ah love the cholesterol!

"Somebody please wake me up on monday! -- Groowwwl"

A young heart -- part 2

..... "We got pulse!" I was breathless while looking at the rebirth of his heart's sinus rhythm on the cardiac monitor.

I threw a glance at the other patients knowing well they were all stable, but as usual there would be at least one patient who isn't doing well and that night it was this young man.

"Hmm doc what else could we do? We've done almost everything that is possible" Yasmin, a senior nurse who's been working in ICU for 10 years look concern.

"Pray" I replied.

"...and while we do that, we increase the noradrenaline to 2 mcg/kg/min! We're not gonna give up on this boy" I reached for the perfusor machine and pump it up and making sure the nebuliser is giving continous salbutamol

I went quietly to the waiting room and sat down next to his mother explaining to her what had just happened.

"Please doctor help my son, please don't let him die...he's the only one I got left" she sobbed heavily. She looked fragile and helpless. That was when I knew that the parents had divorced a year ago.

******

"Doc he arrested again!!" Yasmin shouted while starting CPR. It was 12am.

I grabbed the adrenaline and atropine syringes and injected 1 mg each via the central line. I replaced Yasmin as the 48 year-old woman became exhausted. CPR is a physically demanding procedure. Imagine having to exert yourself pressing on a human chest 100 times per minute.

As I glanced at the cardiac monitor suddenly showed irregular ventricular rhythm.

"HE'S IN V-FIB!! We stopping CPR... step aside!" I charged the biphasic defibrilator machine to 200J, and placed the 2 paddles on his chest.

"CLLEEARRR!!" his body convulsed as the current shocked his body and soul.

We got him back. Sinus rhythm established. However our relief is short-lived. Between 3am to 6am he arrested another 5 times.

"Come on buddy don't you give up on me...COME ON!" I heard my inner voice shouted at him as I pressed down on his chest.

I look down on his face and I could feel his not with me anymore. The young man beneath me look different from the 1st day he was admitted. His pale face looked serene and peaceful. As though as his soul has found its solace. I opened his eyelids and his pupils were fixed and dilated.

And that was it, that was our final battle. His young heart didn't want to respond to our effort.

The young man passed away at 6.30am Thursday 19th. After I pronouced the time of death, I went to the devastated mother and held her hands.

"I'm sorry auntie, we're unable to save him... your son had just passed away" She cried softly. I took her to see her boy and upon seeing his lifeless body the old lady fainted on the floor and we had to carry her to a bed.

I looked outside through the large frameless ICU windows. Fresh sunrise threw its first bright light over the green hills marking another dawnbreak, deep down my heart told me that it was a terrible way to start a new day.

I sighed.

A young heart

19 year old
asthma attack

Ordinary monday morning albeit a cold one. A young man collapsed in a busy ER shortly after arrival at the counter complaining of breathing diffulty. A scruffy looking young MO on his way out after his night shift jumped into action. The intubation was smooth, however that hospital had just ran out of its last ICU bed to a 49 year old attempted suicide.

A prompt referral landed the unfortunate lad into our ICU.

The first 24 hour was an uneventful predictable recovery. Then the trouble began. At midnight he popped out his lungs resulted in bilateral pneumothorax, chest tubes were inserted.

Then his kidneys decided to shut down, most likely pre-renal failure, resulting in serious metabolic derangement. His acidosis creeping up so badly the nephrology team had to dialyse him preventing from further blood toxicity that can kill him.

36 hour later his heart slowed down, hence the first CPR. We revived him.
From then onward his condition spiralling down by the minutes.

"He has multiorgan failure, I'm afraid his condition is now more critical than before" My boss explained the situation, carefully selecting his words, to the boy's parents.

The mother cried hysterically. The father had a lost look on his face, speechless.

The night before my on-call duty, my friend had to CPR the poor chap 4 times. He survived.

"He's on 4 inotropes now.. but looks like the heart is giving up slowly, BP was labile all the way. The asthma also showed no signs of fading away, the bronchospasm is quite resistant and getting more frequent despite our IV salbutamol, ketamine, MgSO4 and the isoflurane.. good luck bro" Johan was less cheerful during the pass over, he didn't get any sleep last night. The dark spots around his eyes tell it all.

"Yeah.. well I gonna need that" I knew right away, it's not going to be a quiet night.

The phone in my on call room rang exactly at 8pm.

"He arrested!" a nurse sound alarmed.

"Start CPR! I'm coming" less than a minute later I found myself on top of him, compressing his chest, pumping blood into his circulation. I palpated his corotid artery searching for sign of life...

(....to be cont)

Baby boy

No matter how bad is the 'on call' sometime all of that sleepless night wouldn't matter in the end when u know you did something good that day... something right to another human being. To make the patient feel that this life is worth living and all those sentimental hallmark moments.

This late 30's chinese lady had been married for 12 years, and all those years had been trying and waiting to have a child. In the process she had 3 miscarriages and 1 ectopic pregnancy. To make things worse, this current pregnancy has been compounded with several challenges including oligohydramnios.

Since it was a 'precious pregnancy baby' -- bcoz she might not have another good shot at this, the OBGY team decided to go for caesarean section.

Half an hour later a 3.7kg heathy baby boy was delivered. We showed her the baby, let she kissed him and bond for the very first time...

... but of all the circumstances surrounding this case, what lingers in my mind long after the operation had over is the tearful joy streaming down her face.

Holy crap!

It was a bloody on-call from 6pm onward. The surgical team really got their hands tight with the nearly 4 hour-op emergency laparatomy on a 21 year old lass with perforated viscus (aka a hole in the gut).

After the op she was in pain, so i gave her a device called PCAM (Patient controlled analgesia Morphine) which means she has a little button which she can choose to press if she's in pain. and that device will give her a pre-determined dose of morphine.. yeah baby that's freakin' M.O.R.PH.IN.E !! (Heheh to all those druggy abuse out there ..Hah! eat your heart out, cruel world ain't) .

Not to mention the irrudicble hernia which TRO (to rule out) obstruction, he was in severe pain... so they had to went in and fix it.

Surgeon A : Hey isn't dat the spleen?
Surgeon B : Hmm maybe, I sorta miss the lecture
Surgeon C : Shoit! I didn't know we need to know that one.
Anaesthetist : (humming the Twillight zone theme)

Idiot box

Huh! TV got the best time of our life. That's why they use to call the 7pm - 9pm slot as the prime time. But not anymore now with ASTRO, all the good stuff would go on and on till 12am..

...talk about CSI: Ulam Bator anyone?

Most people would be glued to the idiot box, no more quality time with their kids, spouse. I bet gone are the days where families would sit together having nice quiet dinner or play scrabble. Instead they all would be sitting in front of the telly and come back for refill during commercial breaks. Talk about afundeeek AF on saturday nite ho ho ho!

The 3 selling sought-after genre: medical, cop and legal/lawyer shows.

How on earth they got all the juicy stuff they serve us on medic shows these days - there have stop making shows like St Elsewhere, ER and Chicago Hope.. (well the latter didn't quite make the cut). Oh no no, these days u gotta put a lotta s.e.x in your show to sell it.

**HOUSE: the medic-cum-CSI type This super-smart pill-popping tempang fella with freaky bad bed-side manner is able to diagnose baffling medical problems and save lives every single episode without failing.

If only this happen in real life he would get dozens of CNY limau mandarin and Datok-ship every year. Anyway i dig his style... cool! Just finished the 3rd season DVD boxset hahaha!

Dr. Cameron: Do you have any idea what it feels like to have a six-foot long hose shoved into your large intestine?

House: No, but I now have a much greater respect for whichever basketball player you dated in college.

**GREY'S ANATOMY: Chicago Hope meets Melrose Place. You can't get any more cheesy title than this man. At first it sounds like a bad porn title for one of the greatest work in classic anatomy textbook: GRAY'S ANATOMY.

I bet the producers saw the book and change the protagonist name from Orphelia to Grey. Oh wadahel seems like in this show; everyone got the chance to screw almost everybody etc etc.

McDreamy: Uh! Nice dress (hey can i see you tonight?)

Grey: Oh dont talk to me, you bastard! (he loves me, he loves me not, he......)

********
SCRUBS: Oh snap! I love this show... at least the first season though.

Fragile

Her small frame sat quietly outside the lobby, all alone. The words "hospital's property" printed on the back of the wheelchair. I stood there watching if someone gonna pick her up, moments passed... nothing. Not a single soul came for her.

She would probably have no one in this world, maybe her beloved husband died many years ago. Her children may have abandoned her in the elderly home. This person is real and has a name, she could be someone important in her prime days. I wonder what was she liked 40 years ago.

Has her dreams, hope and aspiration came true?

Bedroom window

Last night, as I browsed through my old CDs collection I came across an album entitled Boys & Girls 1 + 1 = 3 (a local indie compilation album produced by Positive Tones label in 1997).

There's this particular song Bedroom Window which I usually listen to when I'm in despair...
... I suppose my current situation suits the occasion. As I put the CD into the stereo and listening to it -- I can't help but feeling like I just opened an antique priceless bottle of wine.

So here it goes one more for the road.

**BEDROOM WINDOM**

all alone in my room
sittin in the afternoon
all i heard is a sad sad
listen to what they say
from the room window door
ordinary day...4x

little by little that she wants it all about you
if you find me i'm over, over you

lying down on my bed
as the day seem so sad
wishing on the sunshine
come and take me now
from the room window door

ordinary day...4x
little by little that she wants it all about you

if you find me i'm over, over you (2X)
little by little that she wants it all about you

if you find me i'm over, over you (2X)

Artist: NICE STUPID PLAYGROUND

Post mortem

Thank God there were neither fatal accidents nor casualties that day.

Hallmark Astro got it wrong after all eh?

Sometime there is no drama in real life.

Which is good no?

Imagine the heartache to the families and fans worldwide...

...like the day we lost Aryton Senna in the fatal Formula 1 crash in 1994 at San Marino Grand Prix At Imola.

He had just turned 34.

He is remembered as a man

who cared for the safety of his fellow racers.

In 1992 in Belgium when during Friday free practice Erik Comas had crashed heavily on the back straight, other drivers drove past the wreckage at high speed.

However Senna jumped out of his car and while endangering his own life, sprinting down the track to the wrecked car to reach inside and hit the electrics kill switch, to prevent a possible fire.

THE FATAL CRASH

On the burning afternoon of May 1st, 1994. In lap 7, from the onboard camera of Michael Schumacher's Benetton, Senna's car was seen to break traction twice at the rear, go off the track at Tamburello corner and strike an unprotected concrete barrier.

At 310 km/h, he manged to slow the car down to 218 km/h in less than two seconds before hitting the wall.

After the crash, he remained motionless in the cockpit. Then his head was seen to move to one side slightly causing false hopes to be raised. A long time seemed to pass before medical units came to his rescue, with fire marshals having arrived at the car and unable to touch Senna before qualified medical personnel arrived.

During this time a miscom at the pit stop caused a Larrousse F1 car piloted by Erik Comas (the same racer he saved 2 years ago) left the pit lane to rejoin the now red flagged Grand Prix.

Frantic waving by the marshalls at Senna's crash site prevented the Larousse from risking a collision with the medical helicopter that had landed on the track.

Professor Sidney Watkins, a world-renowned neurosurgeon, head of the Formula 1 on-track medical team, who performed an on site tracheostomy (Disclaimer: This procedure could be dangerous if performed by an untrained personnel) on Ayrton Senna, reported:

“He looked serene. I raised his eyelids and it was clear from his pupils that he had a massive brain injury. We lifted him from the cockpit and laid him on the ground. As we did, he sighed and, although I am totally agnostic, I felt his soul departed at that moment".

Later, officials found a bloodsoaked Austrian flag. A victory flag that he was going to raise in honour of Austrian Roland atzenberger, who had died on that track the day before.

After his death it was discovered that he had donated millions of dollars of his personal fortune (estimated at $400 million at the time of his death) to children's charities, a fact that during his life he had kept secret.

Aryton Senna, 1960 - 1994

Four months prior to his death, he said:

"If I ever happen to have an accident that eventually costs me my life, I hope it is in one go. I would not like to be in a wheelchair. I would not like to be in a hospital suffering from whatever injury it was. If I'm going to live, I want to live fully. Very intensely, because I am an intense person. It would ruin my life if I had to live partially."

Laughing - still d best medicine

There was this book I read years ago when I was still a pimple-face medstudent, called HOUSE OF GOD (by Dr Samuel Shem M.D)

I don't fancy the title that much but the content itself is worth reading if you're into comedy like SCRUBS (perhaps the adult-rated version.. yeah steamy sexual encounter with hot nurses chap 2.. boo hoo hoo). It's sorta like autobiography, the author's own struggle surviving his 1st year internship.

A lot of my colleagues said it was a poke in the eye for med profession while laughing silly at their own asses. Tons of funny anecdotal experience of what happen 'behind the scene' in hospitals, stuff that would make patients have sleepless nightmare if only they knew 'Ssshhhh!'.

And yes... the infamous '10 Laws of the House of God' :

1. GOMERS** DON’T DIE (young patients do instead).
2. GOMERS GO TO GROUND.
3. THE PATIENT IS THE ONE WITH THE DISEASE.
4. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
5. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A 14 GAUGE NEEDLE AND A GOOD STRONG ARM.
6. THEY CAN ALWAYS HURT YOU MORE.
7. IF YOU DON’T TAKE A TEMPERATURE, YOU CAN’T FIND A FEVER.
8. SHOW ME A MEDICAL RESIDENT WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
9. IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE.
10. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

Plus some of its infamous acronyms....!

**GOMERS (Get Out of My Emergency Room): Applied to patients who are frequently admitted with complicated but uninspiring and incurable conditions.

LOL in NAD (Little Old Lady in No Apparent Distress): An elderly patient who admitted following a minor fall or illness, would be better served by staying at home with good social support, rather than being admitted into a hospital with all the iatrogenic risks of modern medicine. Another way of saying a 'NAD' (No Abnormality Detected) used to record normal physical findings.

VSD (Venticular Septal Defect -- a hole in the heart): or a Very Short Dick! - Nah I made this one up!!! :>

-- --- ---- Well folks! Grab it at your nearest friendly book store - the author promised me 0.005% (statistically significant) profit for every unit sold.. Noootttt! ----- -----

Arrkkhh! I'm on call again tomorrow and Yippiee! Will be leaving the next day for F1 medical cover stint -- Hmmm will be back on the 9th "sigh" until then, safe driving everyone.