Kidney-licking good!

New unit rotation kicks in with December. The amount of workload is pretty much heavier compared to the previous haematology posting. When everyday feels like monday.

In nephrology we often deal with patients whom have multiple maladies ranging from hypertension, diabetes to auto-immune disease such as lupus, Ig A nephropathy bla bla bla. where all the above can lead to renal failure.

As a wise man once said "a broken heart needs no tomorrow.." well I'll be darned if a failing kidneys don't need no saviour. In severe infection, the kidneys are one of the first organ to go. It constant need of a steady flow of blood supply prove to be its Achilles tendon. With a sustain drop in blood pressure that comes with infection or a failing heart, kidneys will soon to learn its place in the cycle of the food chain.

If no action is taken, urine will build up inside causing fluid overload drowning the lungs and heart. Toxin will be released into the bloodstream poisoning all organ from liver to brain. A slow, painful but a sure ticket to the mortuary room... called it senandung malam express.

A dialysis machine is designed to replace a kidney's function in filtering and removing all the body waste product and excess fluid that Pak Cik Johnny Depp cannot pee out from his bladder. An expensive form of therapy. A person on haemodialysis would spent a 4-hour session a day for 3 days in a week. Hence a RM200/session can easily cost RM2000 per month. Oh yeah, that is for the rest of his wonderful life.

"RM2000 per month for kidneys

RM5000 - 8000 for putting a stent in blocked heart vessels.

... for more time to spend with your loved one - PRICELESS"

PS: Psttt all the traditional medication out there (from atok akar kayu to medical hall ginseng has the potential of poisoning your lovely kidneys too!)

Staying alive

Boy, it has been a while since I had a bad on call like last Friday. It was the '5th call' which put me in charge of all the warded patients. That means 5 wards x 28 patients per ward = 140 patients. Plus another 6 patients in the high dependency care (HDW).

An on-call officially begins at 1700 till 0800 the next day. So at 5pm all doctors from all the 5 wards would call me up and pass over ill cases that need to be reviewed that night. My average usually is around 3 - 4 cases. However that night I got 11 cases to review plus 2 new admissions from ICU and paediatric into the HDW. Yehaa.. come what come may!

At 1900, I came across Julia, a junior doc graduated from UK still in mid 20's, full of energy and zest in life. With her shoulder length brown hair tied up into pony tail mean that she's ready for some action. However she looked flushed and out of breath, apparently on her way to attend a collapsed patient. We both ran to the scene and a pool of nurses had already started CPR.

I took over as the team leader and coordinated the resus effort. Julia rattled out the patient's medical problems from the file, as I bagged and intubated the chap. A 65 year old man with a history of chronic pulmonary embolism suddenly collapsed without any prior warning. We resuscitated him for 1 hour giving him the whole shebang.

At 2200 as I was munching on some cold karipaps, I received another code blue from Julia. A lady of 68 year old with a diagnosis of a possible cancer just collapsed. I met up with her and we went over the same routine and sang the chorus with a bunch of different nurses.

0100: Had a quick shower and speed-gossip with nurses while having long overdue dinner. Nasi ayam goreng with air tembikai.

0200: Dozed off however interrupted by Julia every 30 min for opinion.

0430: Woken up by Julia to see a 74 year old man with Type 1 respiratory failure due to right upper lobe lung collapse secondary to possible TB. Already put on high flow mask earlier, so I called up a buddy in anaesthesia dept for CPAP support.

0600: Helped another MO to do a lumbar puncture in an altered-behaviour aggressive young patient possibly due to meningoencephalitis. He still put up a good fight despite 10mg of Midazolam and pinned down to the bed by me.

0800: Passed over to the Saturday on call fella, and rushed home for a dose of sunshine.

1000: Sipping a cold mochalicious ice blended in a gondola while staring at the blue clouds in lala land.

At the end of every bad on-call lies a nice perfect day off. The trick is to stay alive and age gracefully.

"Do we really talk to our patients?"

****
Sometimes patient needs someone who can listen to their problem and read between the lines:

Doktor bertauliah: Sakit ape makcik?

Makcik: Sakit dada makcik ni bertambah teruk sejak anak makcik meninggal dunia 2 minggu lepas...

Doktor bertauliah: (memotong)... kalau macam tu sakit dada ni bukan real, cumer emotional-related jer makcik.. ambik ubat ni.. (bla bla macam bagus)

--> If only the doctor listens carefully, he would identify that the chest pain is only 'a cry for help'. And he could explore the miserable feeling of this old lady, looking for symptoms of major depression hence a prompt referral to a psychiatrist.

On another note, I still notice few of my colleagues unselectively use bombastic words and medical jargon when explaining the nature of a disease and its treatment to patients and still expects the old pakcik from Ulu Yam to remember his illness.

No wonder this phrase is kinda popular in follow-up clinics.. "hmm entah le, pakcik nitak tau pakcik sakit ape, ade doktor to bagitau dulu, tapi panjang sangat"...

... and surely with that kinda answer he will get a smirk or sarcastic reply from the doctor.

A glass of emotion

Haematology rotation is full of drama. More than any other discipline out there. In the past 2 months I've seen a lot of human emotions expressed be it jubilant, sadness and even tense. I befriended quite a few of them too. In a way it reminds me of paediatric haematology when I first started out 5 years ago.

Case 1: M is a your typical 20-year old next-door-girl, diagnosed with Hodgkin's lymphoma in 2006. She only had the 1st chemotherapy cycle when apparently the only one who knew about her illness was her father died of heart attack not long after. Since no one else knew about the nature of her cancer, she missed the follow-up and the rest of the treatment until she was seen again by me in 2007. These days whenever I saw her. I'd say "Hi M, stay cool" and she would giggled and laughed. She completed her final chemotherapy cycle last week and in pretty good shape.


Case 2: Z is a 42 year-old widow with 4 kids has acute myeloid leukaemia (AML)which is resistant to all chemo regime we tried, currently battling severe infection complicated with hyperviscosity syndrome. She's still holding on even though her blood pressure can be labile at times. She looked at me from behind her 'high flow oxygen mask' with a fatigue look on her face, thanking the team for trying our best. Deep inside, I tried holding back my tears.







Case 3: Few weeks ago I spent a lot of time tried to re-convince a woman that her mother who has Chronic myelocytic leukaemia (CML) need to be started on Imatinib which can work wonder in CML. Instead she & her siblings opted for her mom to be on 'pil minyak kuda'. The daughter look annoyed when I showed her blood results from other patients who responded to the treatment.

What amazed me is that this woman is a university graduate working with government. When I asked makcik, she said "entahla nak, makcik ikut mana yang molek jer".. though I knew she wanted that Imatinib.

Two days later, the daughter called me up -finally agreed to my suggestion. That alone kept me happy for the rest of the week. However one thing I realise now, is that "Common sense is neither thought in University courses nor it comes with paper degree"

CSI Bukit Bintang: Pilot

There was a mixture of excitement and sombre mood in the air. The street was dirty with little humidity to be shared around tonight. The crowd was restless, few security guards were trying their best to hold back some curious onlookers.

The object of affection was a scrawny-looking young malay lad who laid unconscious in front of Sg Wang with his skull half-cracked open. I tried to walk away with my shopping goodies, but my conscious told me to stay put and be a good boy.


So I introduce myself to the guards and they allowed me to pass through. For a split second I felt like Horatio Caine of the CSI Miami (minus the sunnies and a quippy one-liner... errr and hot babes wearing bikinis in the crowd) walking in a slow-mo approaching a crime scene.


This unfortunate chap was attacked by some bikers armed with Grade A helmets. So yeah he was totally knocked out with a Glascow Coma Scale of 8/15 (google it lor), a rapid non-alcohol breathing with relatively strong pulse.


The thing with ambulatory medicine (or pre-hospital care) is we aren't equip with all the standard gadgets in an emergency room. No gloves, IV Drip or Oxygen mask to play around. So my 'street magic' healing process was pretty farking useless. Feeling naked and helpless all I could do was putting him into lateral recovery position so the poor sod didn't aspirate his semi-digested lemang into his lungs.

In a classic M. Night Shyamalan's twisted ending the loud wailing siren vehicle finally arrived and TA-DAA!! The hospital ambulance came in a form of a van from the Jabatan Pertahanan Awam. Well don't get me wrong, I was thrilled they came. But the way those JPA boys carried the victim was a bit too rough.. err please handle the neck with care boys.

For goodness sake, whatever happen to our national health revamped that took place few years ago. I'm sure with couple of million pumped into buying Mercedes-branded ambulance. Maybe Anwar could use this piece of ass - ops! I meant information for his next election.

Cheerio!

Mentor

A wise man once said that a great teacher does not teach but to inspire others. This is exactly how I feel toward this man who has inspired many generations of doctors in this hospital.

He is an internationally renowned physician who has dedicated his life to mankind through his clinical work and research.

Although I didn't have a direct opportunity to be his student, but many of my teachers were once thought by him. So one way or another I feel indebted to him.

The bad news is he is currently unwell, the old enemy that he fought and defeated has returned and want a rematch, which I believe he will not give in or give up that easily. With Aidilfitri is around the corner, things would be even more challenging for him and the family.

Be strong now Prof, now more than ever.

We are with all the way.

alone@aidilfitri.com

Happydoc is a newbie in our hospital, having just joined the masters programme last June, he was considered a junior. His stylish hair, boyish look and nice taste in the clothing department reminds me of the once locally famous 4u2C group.

But oh boy! I was totally wrong about him, after knowing him later did only I realised that he has strong experience in internal medicine having gone through all the major postings in GHKL.

So superdoc has helped me a lot during my rough period in these last few months. Perhaps he's one of the few good soul out there whom willingly want to befriend a crooked chap like me.




On another note, I must say this would be a lonely Aidilfitri for yours truly. I thought I could be happy again this Raya... but i guess that my wish would just have to wait this time... which may be forever. I finally realised that in life.. it's not what we want that matters. And above all the ironies in this world one thing stays true -- sometimes we can't always get what we want.

I have to live with that now.

Lastly but surely not the least Selamat Hari Raya to all my readers
... may all your wishes come true.

Listen to your heart

Once upon a saturday morning...

A 70 year old man presented with neck pain which aggravated by movement. Which of coz is your typical 'atok tua dengan sakit tengkuk' scenario. A young doc at the A&E however noted something is amiss. His pulse rate only register at 26 per minute!



An ECG revealed a second degree heart block - Mobitz type II which could progress rapidly to 3rd degree or complete heart block which is your Grim Reaper's recipe for dinner.

The heart is likened to a pumping machine which in a normal mortal pumps out about 5 litre / minute of blood into the circulation. It however needs an electrical supply to coordinate its pumping activity. Right now his heart's electrical wiring is fucked up big time.

The A&E doc paged the cardiology unit MO on call aka 'me in sleepy mode' to further manage this case. On further questioning he admitted to been having giddiness for the past 2 days. After consultation with the registrar & cardiologist on call, we decided to perform an urgent transvenous temporary pacemaker (TPM).

Under local anaesthesia we pierced the right internal jugular vein (a big vein at the neck) and push the pacing wire into the heart.

One hour later with the TPM on board we set the heart rate at 60 beats/minute. This should buy some time until the 'fellowship of the heart' reconvene on Monday morning to decide the next best course of action.



My only concern that night was what if the old man suddenly 'mengigau' at 2am in the morning and pulled out the pacing wire that hanging down from his neck !

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

****
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

****
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.

****
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.

****
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 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.

Let's nuke the bastard

There is no certainty in life, you make plans and hope for the best.

At 40 years old, you could either be married or stay single... with a bit of luck you might live long and dance the funky chicken at your 70th birthday party.

Or you could also be diagnosed with cancer at the tender age 30 years old. I've seen lot of fatalities to these malady. It knows neither mercy nor boundary. Any of the human organs is a potential target, from prostate to ovaries... from brain to bone marrow. In most cases you can't cure them.


Sure we can kill the sonoffa with chemo or radiotherapy but not without caveat emptor. Take chemo for instant we have reliable cocktail on our shelf. But the side effect can be nasty to the other healthy living cells. Not to mention the nausea and puking your guts out. In the end the cancer cells might return and haunt us back like Stallone in Rambo 4 (he should know when to quit).

Performing pleural biopsy on a patient with pleural effusion, suspected to have lung cancer.

This unlucky pakcik smoked 1 pack per day for 15
years.

Cut that sucker out you say. Sure if it is Stage 1 NSCLC (non-small cell lung cancer)... why not? But what if we diagnosed Ahmad's cancer a bit too late. Think of it like PS2 game - Stage 4 is a more difficult level where surgical resection is rendered useless because your Damansara cancer has taken the LRT to Port Klang and married a second wife there. What did you say?? That LRT route doesn't exist? Oh sue me then and later take it to Ong Tee Keat.

Not to mention the issue of 'no-fly zone' or no man's land where if Muthu's cancer cells have an office on the 52nd floor of Petronas tower. The surgeon surely can't take it out without chopping away the first 50 floors. Hint: Most brainstem gliomas are deemed inoperable due to its close proximity with certain vital part of the brain required by Muthu to breath, shit or copulate.

I would not be far wrong in that to own your own cancer cells are likened to the top 3 real estate pearls:

1. Location


2. Location
   
3. Location.

Think again

There are number of the do's and don't that you should adhere to when you visiting your relatives in hospital.

In random orders:

1. Do not shake doctor's / nurses' hands

They spend their waking hours (sleeping hours too) touching patients from head to toes and yeah including sticking their right index finger into anus (patient's not their own) checking for bleeding or enlarged prostate.

Often enough, patients have all kind of germ and nasty bug, some would be resistant to even powerful antibiotic - among the popular ones are MRSA and ESBL. Being tired mortals & all, these doctors sometime forgot to wash their hands.

2. Using the utensils in canteen

You would probably don't mind sharing the utensils with the general public at restaurants. Think again when ill patients find out that ward meals aren't that tasty and they decide to visit the hospital canteen. Some of them even have oral candidiasis (fungal infection inside the mouth). Ooh yes the kitchen staff really clean those forks & spoons thoroughly like you do at home.

3. Don't stand near mobile Xray

Frequent enough we call mobile xrays to ward if patients are too ill (boley blah xray). You will see hospital staff move away from the xray machine, at least 6 meters away, even hiding in the next room. I suggest you do the same. Coz you don't want to be exposed unnecessarily to the radioactive ray.

4. Bring regular medications

If you send your love ones to hospital for treatment. Please la bring their medications as well. Our records are usually not available after office hours. The last thing we want is for you to describe them " alaa dokteerr ubat yang panjang warna coklat tuuuu".

5. Bring previous letters/appointment/previous discharge summaries.
E'nuf said.

Losing a friend

I first met him when he got admitted last November. A 35 year old man hailed from Terengganu. In many respect, he was one tough man inside. Never had I came across a person with a long list of medical problems. He had asthma, diabetes, burnt out-acromegaly, AIHA with evans syndrome, cardiomyopathy, hypothyroidism and left leg filariasis (untut). He was even allergic to penicillin which once nearly killed him.

He was single and being morbidly obese with those list of illness. Perhaps it was hard for him to meet up a girl for a meaningful relationship, although he was a gentle, good man with a chirpy character.

That November he was admitted for severe left leg cellulitis which compounded the filariasis. We became good friends after a while, he addressed me just by my name - no more doctor which didn't bother me at all. It took him 1.5 month to get well enough to be discharged back to Terengganu.

Two weeks ago while I was on call. A nurse told me a new patient just got admitted. She said "He's big doc... very big and there is something about his left leg which doesn't look right". I knew right away my friend had come back.

He looked like he had lost a couple of pound. Flabby arms and shrunken face. He was ill. This time none of his pre-existing diseases could explain his current problem. He had fever, breathlessness, weight loss for the past 1 month. Over the few days we treated him for congestive cardiac failure secondary to pneumonia.

The full blood picture however showed presence of blast cell (immature blood cells produced too early by damaged bone marrows). We immediately knew he had leaukaemia.

It was me who had to do the first bone marrow aspiration and considering his weight of 110kg, the task was not easy. It hurt me to see him in pain during that procedure despite the 100mg of IV pethidine and the 10mg midazolam which didn't sedate him either. We then proceeded with chemotherapy after identifying which type of leaukaemia we're dealing with.

He fought his last days with courage and patience. Never had I see him broke down in fear, one time he asked me why was he being so unlucky. I replied perhaps God was testing him.

I last saw him one morning in the high dependency ward. He looked tired, lost all his hair from the side effects of chemotherapy. His lips were swollen and bruised and he could barely speak which required him to communicate with pen and paper. I held his hand and tried to comfort him. He knew his time would come soon, so I stayed beside him for a while.

The next morning when I went to see him again. His bed was empty. A crisp clean sheet covered the bed. It took a while for me to realise that he had gone forever.

Rest well my friend, you had fought a good battle.

D-Day

Masters Part I exam had put me out of action for few weeks. Got 1 week of study break from the department and made full use of it. Until i heard that our counterpart whom study outcampus got 2 weeks up to 1 month of study break. Wadahek?!

Since we're banned from entering our own wards, in case we might hear any soalan bocor or potential cases used for exams. I decided to hit the mothership of hospital --> GHKL itself to look out for interesting cases.

Lotsa patients over there man. It's like world war II ward. However i must admit that the GHKL library was stunning.

Not forgetting to mention disovering some nice spots at the national library. I must say the crowd there was enough to make 'kempen baca buku' proud. Amazing setting on the 4th floor.

Anyway just had my exam from Monday to Wednesday this week, a combo of MCQ, essays, problem solvings and practical exam where we were given 4 cases with 7 mins each to diagnose the disease solely based on body physical inspection without asking any questions.

And finally the exam result was announced this evening. Phew the suspense was so nerve-wrecking that i might as well declared a state of temporary insanity.

Thank God - I made it through.

Now that the Part I exam is done and over with shall i be a notty boy for the next 2 years or start head strong for Part II exam @ June 2010.

Ergh MRCP anyone?

(MRCP = Membership of Royal College of Physician, UK post grad medicine)

Hope

The old man called out her name. Yet he received no reply. The woman he married to for the past 40 years lied silently while her lungs were connected to a a breathing machine. He stood steadfast beside her for hours... waiting for some kind of miracle that she will return back to him as it was before.

She suffered from severe cardiac failure secondary to heart attack in front of him 2 days ago. With all the strength left in his frail frame, he carried her collapsed body out to their front yard and drove her to hospital.

***

I wish miracle would happen more often these days especially to those good people. For all we know it could have taken the last bus to Santa Fe. Andy Dufresne once said "Hope is a good thing, and no good thing ever dies".

As ironic as it is... I agree with the first part.

Andá a joderte

Last week a patient of a Caribbean origin landed in our ward with a blood disorder (which country shall not be named coz apart from dr - patient confidentiality, his country also has long range nuclear ballistic capability).


During the course of his treatment he had multiple visits from his country's ambassador. Which shows how genuine their concern over their fellow countrymen' wellbeing.


Maybe it just me, but i felt that with the ambassador's daily visit, things got speed up a little - with a bone marrow aspiration done in less than 24 hour. Which I must confess I haven't seen that happen with the other ordinary Malaysian patients (malu... malu).


This guy however know zilch of English coz they were once conquered by Spanish. Luckily their embassy could provide us with a translator.


Which was hilarious at times coz me being a highly imaginative person felt like being in a RTM 4pm Spanish telenovela with my name tag says Dr Drake Ramore...

...uttering "Te quiero con todo mi corazon"

(with dramatic facial expression).

Patient in bed 6

The old man waited for his children to pick him up from the ward, they had promised him yesterday. It's already half past 6pm and yet there were still no signs of them... and he waited.

At that time he reminded me of my own dad...

Step one you say we need to talk

He walks you say sit down it's just a talk

He smiles politely back at you

You stare politely right on through

Some sort of window to your right
As he goes left and you stay right

Between the lines of fear and blame

You begin to wonder why you came

Where did I go wrong, I lost a friend

Somewhere along in the bitterness

And I would have stayed up with you all night

Had I known how to save a life

Let him know that you know best
Cause after all you do know best
Try to slip past his defense
Without granting innocence
Lay down a list of what is wrong
The things you've told him all along
And pray to God he hears you

Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night

Had I known how to save a life

Lost soul

"1 mississippi 2 mississippi 3 mississippi..."

I'm looking down on a 26 year old chinese lady whose heart just arrested 30 minutes ago on a Chinese New Year morning.

She got admitted via the A&E the night before with breathlessness, diagnosis of pneumonia was made and she was treated accordingly.

Her breathing became more laboured in the wee small hour of the following morning and the high flow mask device just couldn't cope up with her deteriorating lung function.

" 20 mississippi 21 mississippi.. i need more adrenaline!..." a sense of agony & frustration fills my voice..

She was supposed to attend the CNY's reunion family dinner that night...Alas, she ended up collapsed and intubated, it can't get any more tragic than this.

"Let's call it... time of death 0900." Our futile resuscitation attempt lasted almost an hour.

A message to my dear future young doctors out there... learn your arterial blood gas good. As the frontliners in our public hospital settings you will be doing on calls at night --- and trust me that between 2 and 6am in the morning what you know could save or lose your patients' lives. 'nough said.

memory lane

Just under 3 weeks ago the HOD announced that our exam had to be brought forward from May to March.

So all the sorry-looking 1st year scrambled their sorry little arses to the hospital library day & night. Pushing the study gear from neutral to gear 5. We sweat it out every minutes of our precious remaining time.

This afternoon the exam has been postponed back to the original date in May.Whattt!! Stop messing with my my mind and hormones or I'll end up ovulating - who knows?

Anyway, besides that we just finished our intensive/revision course in UH.

Being there brings back all the nice memory I had during my housemanship. Some of the specialists still recognise me though - hopefully in a good way.

All corners and corridors have its own memory and they whispered to my ears as I walked through them.

"Hey look!! that's the bed where i performed my first intubation and CPR.. Hooray!"

"Wait a minute, i think i went out with that nurse 4 years ago... quick hide!"



I dropped by at the oncology paediatric ward to see if my old patients are still there, but as i suspected... well... (sigh).

All was good, except for the revised exam dates! Coz now I have to hit the break pedal.

The fact that the library there was hot & stuffy doesn't help either. Just great.

dammit... stay with me

"So how are you today auntie?" I smiled at her.

"Okay, feeling much better, thank you for everything" She looked much better than before.

This makcik Odah (not her real name of coz but it sounds like a good 60's name) from Rembau, N9, was admitted for mild acidosis due to pneumonia. She's recovering well and was planned for home discharge soon.

As I was reviewing the next patient, I heard the nurse's voices....

"makcik... makcik bangun makcik...!!"

I turned and look at Makcik Odah. Her face was pale and and was staring at ceiling unresponsive - a face which I personally called - deathface.

AIYAAAA!!! GET THE CRASH CART NOWWW!

Her breath was shallow with a thready pulse. I haven't done resus for quite some time since I honourably discharged from anaesthesia - so my mind was a bit slow. Anyhow I quickly push a Guidel's airway into her mouth and bagged her while the houseofficer jumped on the bed following my instruction on a proper cardiac compression.

The cardiac monitor showed runs of VT (a bizzare looking heart rhythm).

Adrenaline & atropine went it. In the background her daughter was crying and blaming the nurse for giving her a drug which might gave her a drug reaction.

True enough, the nurse gave her an IV drug right before she collapsed.

However there's no obvious rash on her, and the lungs were clear. I proceeded with intubation, and the larynx and vocal cord was not inflammed or oedematous. All the signs that pointed out towards no allergic reaction.

We got a sinus rhythm in 3 minutes with good blood pressure.

I called up the ICU for ventilation backup and explained to the family that it wasn't the drug/antibiotic that caused it, she had a sudden coronary event which caused her to collapse.

That was about 3 weeks ago and by the time I'm writing this - she's already backed in Rembau chilling out with her grandkids.

Thank God that she make it through that ordeal coz the circumstances surrounding it is your homecook recipe for disaster. Let's face it if you don't know what you are doing you gonna end up making a terrible chicken curry.

When everything else fails, always have a solid documentation if in any case you have to make a stand in a courtroom.

*****

Speaking of courtroom, the current Linggam fiasco is a big joke on our country's judiaciary system.

WEAK LEADER. POLITICAL CORRUPTION. NURIN. HINDRAF, SYALINIE.

Whatever happen to Malaysia that we all knew when we're growing up.