Thank you for smoking

Malaysian public and mass media have forever blasted our public hospital/clinic/A & E waiting hour. Accusing doctors for incompetency and what not. Even though it's true that long consultation takes place. However they are unavoidable since communication breakdown happen not just between 2 lovers but also between patient and doctor.

For me mostly the challenge stems out from the difficulties in taking medical history. As the old medical axiom says: "99% of diagnosis comes from accurate history".

What I could easily achieved in 10 mins in overseas, takes twice as long in Malaysia. Here is some of my personal favourite.

Q: Pakcik dah bape lama ade darah tinggi?

A: Dah lamaa, sejak anak pakcik yang sulung tu lahir.
- Yup, great as if i know his eldest son personally, please be more specific uncle.

****

Q: Makcik bawak tak ubat, boleh saya tengok?

A: Nah (She emptied an old expired multivitamin bottle onto the bed - at least 5 different types of drug mixed together came out)

- Those unlabelled medications really speed up our consultation time.
****

Q: Okay, saya rase masalah jantung ni okay, kite jumpe 6 bulan lagi.

A: Hmm okay, tapi boleh tak tengok telinga pakcik jap.. macam ade lendir keluar, dah 6 bulan.

- The habit of showing 10 different types of medical problems in one clinic visit

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Q: Your heart attack is related to your smoking habit.

A: But doc I have quit.

Q: Oh okay.. Since when?

A: Yesterday.

- Buddy that doesn't count

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Q: So you had an abdominal surgery done it Selayang Hospital a year ago , exactly what did they do?

A: Hmm i dunno, they never told me... Hmm why don't you check your record?

- If someone cuts open your tummy, please pay attention on things he/she removes.

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Q: You'd been admitted 5 times into Ampang Hospital before, why did you come here this time?

A: I like to try new hospital, it might be better here.

- Argghh 'doctor shopping' isn't a good idea. Your '2 volume' medical record is not here.

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Q: Asoo, kenapa datang hospital, apa sakit?

A: Aaa.. sebab... aaa tatau cakap melayu.

Q: Anak mana, biar saya cakap dengan die.

A: Dia balik rumah.


****
Q: So how can i help you?

A: I got breast lump here - since 2 years ago.

Q: Great! you've come to the right place. Here in A & E, we give priority to chronic breast lump.

The hunter became the hunted

First came the abdominal pain.. then the purging! The man laid with eyes wide open the whole night literally restless on his queen size bed. Every single joints and bones within him felt twisted and burned to ashes. Not to mention the hourly visit of chills & rigor which clamp down his muscles while making his mind seem cease to exist.

Thinking it was just a viral food poisoning he stayed at home the morning after, tried to shake it off with oral hydration salts and lot of water. Which was an error in judgement because by afternoon his condition deteriorated which left him with no choice but to drag himself out and drive all the way to the hospital.

Upon arrival at the emergency dept, a newbie triage medical assistant made a 'diagnosis of probable dengue fever' hence advised him to go someplace else for blood checking. He proceeded by ticking the 'normal' checklist box without examining the patient. However the triage machine detected a rapid pulse rate of 120/min with a low BP of 100/60 whereas it should be 120/80.

The patient was then put in an observation ward with 1.5 litres IV drip went in over 5 hours, however the repeat BP later was even lower at 80/40. Then the man started adjusting the IV drips himself made it running faster.

At 9pm the senior doctor 'on call' came down to the A & E and started 1 pint gelafundin fast and having assessed it lack of response he finally said...

"Frapp, we gotta admit you upstairs".

So there i was, admitted into my own ward.. and put in the very bed where I did resuscitation on another patient about a month ago. Things started to feel different after I got my first dose of IV antibiotics called rocephin. The recurrent chills & rigor decided to shy away for good. Six days later , I was discharged home...with a different perspective on life in ward as a patient.

To all staffs & my friends, thank you for everything.

***
The CSI folks in the lab finally found the culprit from my sample... an uncommon 'Gram -ve bacilli' from the vibrionacea family named called P. shigelloides. I hope they burned in my gut.

The enemy within

One fine day, your GP tells you that your persistent cough with blood may indicate you have lung cancer. And a second opinion from Dr Dunhill Marlboro concurred with it. So your GP refers you to the most respected respiratory unit in the Klang Valley (which I happen to work with currently ehem ehem).

The task is now how do we look for it? Let's assume your respiratory physician works for the CIA, and your cancer's name is Osama.

Chest xray:

The CIA can use satellites to take aerial photograph of Afghanistan (your lungs) hoping to see some shadows that resemble Osama. With some luck they may see some suspicious looking shadows wearing turban holding machine guns (lung nodules/lesion). Which may be Osama (harmful malignant nodule) or it could be just innocent small kids with toy gun (harmless benign nodule). To confirm it we need to extract that bugger out for confirmation. We need to biopsy it!


Biopsy via bronchoscope:

What they need now is to grab some of the lesion. Imagine your airways is like a network of caves. Now, if the lesion sits near the big airways a favourite option is to do insert a fexible endoscope via your nostrils/mouth into the airways and biopsy that lesion (send some agents into the caves and grab Osama to be sent to Guantanamo Bay for interogation. Trust me - doing the bronchoscope is really look like one is exploring a cave network.




CT scan-guided biopsy:

Boy! The CIA didn't realise that Osama doesn't play hoola hoop near the cave opening to be captured. He is hiding deep underneath the ground. So forget the caves onslaught. The CIA now has to drill the ground and send a covert team to kidnap Osama guided by special satellite image (CT scan).



Pleuroscopy:

Or if there is pleural effusion AKA 'abnormal fluid collection in the pleural cavity'. We can puncture the side of your chest and insert a flexible scope into the pleural cavity and suck the fluid out and biospy your pleural wall from inside... hmm something like the CIA can examine a river next to the cave plus some take some soil sample, hoping to find Osama's waste in the river which means he's there all along.

Oh all right that is a crap anology! So i'm gonna skip it and you guys just have to wait for Discovery channel.

Disclaimer:

The above anology is just for fun. If the CIA happen to read my blog. I'm neither working for Osama nor that I know where he is.

PS: Btw the CIA/Bush and Co. are bunch of moron who wouldn't know it even if Osama sleep in the White house over Thanksgiving.