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.

Silent night

Whatever it is... I hate insomnia. Coz time stood still at midnight tonight.

Countless trains of thought passed through my cerebral tracts in a repeat slow motion.. I hope they will derail and stop bothering me. They even keep me pondering at the possibility of whether the sun will ever rise up again the next morning.

Tonight I learn not to put up my hopes too high... coz If I fall I'd probably be too screwed up to get up again.

Then the only logical thing to do is to learn how to fall. Wouldn't that be practical.

"Yes yes.. my dear pink panda - time for your bedtime story... yes don't worry Captain Kangaroo is gonna be fine"

"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"

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.