"Do we really talk to our patients?"

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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"

Bill and Ted misadventure

Last Friday me and Happydoc went down to Melaka for a conference entitled "Managing cardiovascular risk". Both the event and the accommodation were at Renaissance Hotel which was cool since it's a 5 star hotel so supposedly "all the good stuff in life" could come in its package.

The thing I love about waking up in a hotel for a conference is because at that moment of time it feels like I'm doing something else for living such as preparing for a huge boardroom meeting. Taking a hot shower while listening to a British chap on BBC news on the telly. Neatly pressed suit and a crisp white shirt readily hanged and me taking my own sweet time sipping that cup of hot strong coffee while watching Melaka folks minding their own business.

However to my surprise the so called 5 star hotel didn't come with a free Wifi or broadband. They instead charged a whooping $21/hour or $52 for the whole day. What a rip-off, we could even get a Wifi for a $10 coffee at sbuck. And all I need was to check a few important emails or perhaps any offline message which would take no longer than 10 mins.

After the event we decided to rush back to KL. Funny thing happened as we were approaching Linggi exit when all of sudden Happydoc's sweetheart started to moan and making weird noises. We stopped at the roadside and discovered that the cambelt was totally stretched out thin and bits of it shredded into pieces. Then the battery went flat and we got stuck for nearly 1 hour. It was so ironic that I end up laughing my arse off every 10 mins which didn't amused Happydoc at all.

Luckily PLUS men answered our SOS and jumpstart the battery. Trying not to push our luck with a worn out cambelt we continued at 50km/hr and reached KL by 1am - that's almost 4 hours from Melaka to KL. Tiring.. yes but I reckon that me and my buddy had some good quiet time by the roadside that night.

Moral of the story is "it's not the distance of a journey that counts but whom you share it with what really matters".

Sunshine

England is forever known for its bad weather. No surprise there since fish & chips is considered as the greatest invention the country has to offer to the world. I guess there isn't much you could expect for from the land where Tun Lancelot lost the holy grail to the Lady of the Lake and the last worldcup was won 42 years ago.

However a recent report from the NOrthern SHeffIeld Weather CenTer (NO SHIT) has observed a bizarre weather phenomenon in the city of London where the sunlight activity has increased by 25% since last September making the sunshine brighter than ever since the last 100 years.

Even more mysterious is that by using advance binary system, NO SHIT postulates that this amazing sunshine trend will moves along the equatorial line and hit Kuala Lumpur by October next year.

I am looking forward for it.

Hopefully the weather change will brighten our day.

... and I'm certain these flowers would agree with me.

Happy ending

A friend of mine introduces me to a Brit singer called Adele... a google in the youtube lead me to this charming song, check it out: Chasing pavements.



Which brings me to a theory that every story/life deserves a happy ending. Life is too short to be painted with melancholic colour. Many of us give up too soon on the idea that 'happily ever after' can be applied outside Walt Disney's movies. Well hang on there! I ain't talking about prince charming with his white donkey either. That would be the joke of the week.

I'm talking about living this life in its simplicity. No complication. Let all the hatred by-gone. No friends with hidden agenda, no colleagues-turned Lex Luthor. Again that doesn't mean that MPPJ will stop charging our annual cukai pintu. The Federal highway potholes are still gonna be there forever.

The change must come from within us. I wanna be a better person. I realise the only thing that I can change is me. Not my hospital's insane parking lot system. Not Pak Lah's weak governance or the fact that Obama is gonna kick McCain's arse back to Arizona.

But it has to be within my own capacity since the only legitimate jurisdiction that I have is myself. And the wind of change is here.. it's blowing.

They are 4 sides to every interaction that we have with another person:

1. the side that we both know



2. our side that they don't know



3. their side that we don't know



4. a side that both party doesn't realise

These factors are so dynamic that it could change rapidly within a conversation, hence I suggest that

CSI: Bad to the bone

The chilly air greeted us in creepy manner that morning. Happydoc had just moved out his car from the front porch when I noticed a strange looking white object which was hidden underneath his car now staring back at me.

I took a few brave steps closer, and suddenly I felt a shiver came down my spine like a bolt of lightning on a broad daylight.

"Meromaaanngg buluu pakcik"

We examined it carefully and it looked like a piece of human mandible (jaw bone) cut in half. Unlikely to be from dogs, because the canine tooth was not sharp and long enough.

"Perhaps a stray dog dug it from a shallow grave and dumped it here" Happydoc thought loudly.

"Hmm it could easily came from a young adult of between 14 - 17 years of age old... (dramatic pause)... possibly asian female" I summed up the final diagnosis.

Suddenly I felt the the spirit of Hardy Boy's enters my body (err in Happydoc case - maybe Nancy Drew's). Dang! what are we gonna do now?? After some serious consideration we came up with 3 options:

1. If this is a human bone - we need to send it to the police, they may come and turned Happydoc's house into a homocide crime scene. What would the nice 20's something-girl next door think?

2. Show it to our forensic colleagues at the hospital for confirmation - then if yes.. send it to the police.

3. Throw it into the neigbour's compound and it now became their business. Muahaha!

Finally we decided if this really belonged to a human victim. Then the owner deserve a justice and a proper burial. So we handed the bone to the nearest police station and surprise! surprise! Those folks were unsure but promised to confirm it with their experts.

The very next day I called them up for answer.. and creepy enough they said it belonged to a certain mammals of a yet undetermined origin...

"Who are you... who? who? who?"