The Master (program) and 'civil' servants

Come October every year, a substantial number of Malaysian doctors would compete to get into the Masters program which enable them to become a specialist. Another 4 years of their life will be devoted to exams, lectures, on top of daily clinical works @ hospitals (hey that's ok!)

However, the fustrating bit is the shenanigans we all have to face in order to apply for it.

Imagine all these paperworks and what not:
* u have to get sah lantikan, then sah jawatan (for whatever those mean actually)
* at least 3 years of service
* decide on the kwsp/pension options
* pass the 3-week 'induction' course
* security clearance (some have to filled this twice, since the first one gone missing) - a conspiracy that N.korea agents might infiltrate as under cover docs?
* etc etc

And if you wanna have those papers processed within 1 - 2 month instead of 1 year, one gotta climb the putrajaya stairs around 5-6x, 50x phone calls which may sounds like "Maaf encik, belum siap" or my favourite "..nanti saya passkan awak ke pegawai lain".

I seriously pity those docs who lives outside selangor or worse still @ sabah/sarawak.

Huhu don't forget that this special October - we only have 3 weeks due to the double festive season.. yeayy!

The clock in the OT is ticking my friend!
Shoits - i'm on call again this weekend

"Dr atas panggilan"

Some hospitals still have "dr atas panggilan' stamped in front of on-call rooms. Yes-sirree your classic BI -> BM translation.

Yaiks! I never like being on call on weekends, it only means 1 thing: you're the only medical officer from your dept whom they will call should there be any emergency arise. The OT (operating theatre) of course is only open for emergency cases i.e appendicitis etc

Today i got 4 cases waiting in OT. That should keep me on my toes for d next 6 - 7 hours. Hopefully the ICU patients would be kind enough not to drop their blood pressure. Well another 24 hours to go before my shift/call is over. Then I'll hit the highway with my 'road-trip CDs'.

My kampung is waiting.. i hope the ocean is as blue as i remember it.
Selamat Hari Raya everyone!

Breaking bad news

He had just turned 42. I could imagine him woke up that morning as usual. Maybe had sahur with his kids or kissed his wife on his way to work. It should have been another routine day.


Who would have guess that by 7pm he would be lying unconscious in a resus room with a group of strangers pressing on his chest.

The chest pain started around 6pm with no provoking factors. Crushing in nature and "it feeels like an impending doom". The ECG showed that the heart had been deprived of its birth right --> oxygen & blood supply and that caused the excruciating pain.

Without further warning his heart rhythm went berserk: supraventricular tachy (SVT), and caused the blood pressure crashed to 70/40. We need to stabilise his heart fast. I was called by Chan, the medical MO 'on call' to assist him in doing just that.

He's a moderate size guy, not the morbidly obese type, but a smoker. He's obviously anxious while his breathing was rapid and shallow. He's definity lost lots of CO2 and his ABG might shows an alkalotic picture.

I held his wrist feeling for pulse.

"Darn it, this guy is pale and sweaty, and the BP is way too low" I told Chan.

Maybe he knew that already. He didn't looked up, eyes still looking at the ECG in his hands obviously muttering about s'thing.

I told the patient what we're going to do, and 5 mins later I put him to sleep by using intravenous drugs while Chan connected 2 paddles to his chest.

"CHARGE to 100. Everybody clear!"

ZAPP!!

The machine delivers 100J of energy into the man's heart. The patient jolted while we held our breath.


We manage to arrest the SVT, but his heart suddenly went into 'heart block'. A nightmare. Within 1 minute the rate slowed down to 30 beats/min and changed to pulseless VTach. He went into cardiac arrest. Another type of battle had begun. Cycles of defibs, CPR and drugs were given plus intubation, but there was no respond at all.

One hour later his pupils were fixed & dilated. His hands were as cold as ice. No spontaneous breathing. Nothing.

"Time of death 20:05"

As i walked away to the counter i saw Chan talking to the wife. She bursted into tears in the arms of a relative. I saw his kids. Three of them ranging from 4 - 9 years old standing in a corner. The eldest seem to understand something bad had just happen to their dad. While the youngest looked unfazed by the whole commotion. I feel sorry for them, especially with Raya coming. They have now become anak yatim.

I wish there is a proper teaching in medschools on how to break bad news. Most of us learn it along the way by watching seniors. Then you sorta develop your own way of doing it. You definitely come across lot of styles, some bad examples too.

A useful method is to emphatize with the relative, to be aware that there is a lot of sadness and confusion going on. One has to be precise/clear and avoid using vague terms. I'd seen families who were still unaware of the death even after being told that the patient had passed away.

"Take a deep breath, choose your words carefully and don't rush it" my senior once told me.

Easier said than done.

A note to a friend

What a week, my streamyx let me down again.. called up the centre. After 10 painstaking troubleshoot steps, the techy told me he could only send peeps down to my place after 2 working days... dat could mean this wednesday (or longer if i still live in Malaysia).

Truth is, i dunno when the streamyx @ my home will be up & running again. So this is to let you know what is happening here on the eastern front

Prologue

Hi folks!

This is my 'amateurish' attempt in connecting to the www society.
Sort of an xperiment to see how deep does this rabbit hole goes.

Getting to know strangers... ...

interesting people we don't usually interact with in our daily life.

"Life is full of opportunities, seize them we will"

taken on airbus (Beijing to KL May 2005)