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.

Sentimental value

1. I recently realise that I can track all those songs that I grew up listening to, at youtube. Such a sentimental moment as there are certain songs that define certain period of ourlife. Like those ads on radio - songs that were popular on the airwave during your first falling in love or first ever break-up. Check out the bad ass hair style of Bad English back in the 80's. Rockk kapak satuu kurang manis!


2. I noticed of a late that I'm doing a lotta self-talk (dlm hati le.. nanti kene cap kuda terbang pulak). Which I haven't done so for many years since I left medschool. Apart from human interaction at the hospital - I've been spending a lot of time alone with my thinking cap on and a glass of frappucino in my hand.

3. On another note, I came across a book penned down by a US surgeon named Atul Gawande practicing at the famous 'Brigham and Women's Hospital @ Boston' - entitled COMPLICATION. Which made me realise what was written there mimic 95% of my own experience when I was a junior doc with fresh pimples on my face.

Especially the 1st chapter on performing 'central line' which means piercing the neck with a 14-gauge metal needle (that's a hugeee one) into the biggest vein that run a course near the top of our lungs, in order to insert a flexible plastic tube which have to be positioned exactly at the outskirt of the heart.

That of course brings about to some potential complication such as puncturing the lung or hitting a big neck arteries called the carotid. Boy if that happen - someone gonna yell "We got a spurterrr!"

Smileeee. U just got cannulated big time!

"Medicine is an incomplete science with an ever changing frontier practiced by fallible beings on another fellow men.
To withold treatment would do unjustice to the suffering and preventable death.

But certain treatment process in itself is filled with certain mishap and unforeseen side effect that could cause another type of harm to the human body. Which if happen... we got sued. So God help us all"

- drfrappucino

The darkest hour

Oh, why you look so sad?

Tears are in your eyes

Come on and come to me now

Dont be ashamed to cry

Let me see you through

cause Ive seen the dark side too

When the night falls on you

You dont know what to do

Nothing you confess

Could make me love you less

Ill stand by youIll stand by you

Wont let nobody hurt you

Ill stand by you

So if youre mad, get mad

Dont hold it all inside

Come on and talk to me now

Hey, what you got to hide?

I get angry too

Well Im a lot like you

When youre standing at the crossroads

And dont know which path to choose

Let me come along cause even if youre wrong

Ill stand by you

Ill stand by you

Wont let nobody hurt youIll stand by you

Take me in, into your darkest hour

And Ill never desert youIll stand by you

And when...

When the night falls on you, baby

Youre feeling all alone

You wont be on your own

Ill stand by you

Ill stand by you

Un-kodak moment

You ever came across an absolute embarrasing moment resulting in an utter silence like 'malaikat lalu'? These two happened today:

Awkward moment 1
A female waitress slipped and nearly fell while serving drinks to a family with 4 young kids ranging from 2 to 15 years old. She yelped out loudly 'B**** mako' - loud enuf to be heard by everyone in the restaurant. RATING: 5 seconds of silence.

"Hey buddy, that's just a car-key... Hang on i wonder if it has tuna flavour on it - curious... curious"

Awkward moment 2
I was about to leave a surau when a blind man asked if I'd seen his water bottle. I saw one next to a wall and while walking to get it, I accidently asked him for a confirmation"yang hijau ni ke pakcik?".
I felt like 'can someone please get me a rope'.

Dang!

This ain't a love song

Where does this road would lead me to?

I have made a decision on this part of my life which may not have a turning point. I may not live that long...

...but for whatever that left of it, I think it's time to pick up the broken pieces and move on. This is as real as it gets in this life.

As I reflect on this journey that I've made so far, there are definitely few things which I am not so proud of... and this would probably top the list.

Would you ever forgive me?

This ain't a love song.

I should have seen it coming when the roses died
Should have seen the end of summer in your eyes
I should have listened when you said good night
You really meant good bye

Baby, I thought you and me would stand the test of time
Like we got away with the perfect crime but
We were just a legend in my mind
I guess that I was blind

Remember those nights dancing at the masquerade
The clowns wore smiles that wouldn't fade
You and I were the renegades, some things never change

It made me so mad cause I wanted it bad for us baby
Now it's so sad that whatever we had, aint worth saving
If the love that I got for you is gone
If the river I've cried ain't that long
Then Im wrong, yes I'm wrong, this ain't a love song

If the pain that I'm feeling so strong
Is the reason that I'm holding on
Then Im wrong, yeah I'm wrong - this ain't a love song

I cried and I cried
There were nights that I died for you baby
I tried and I tried to deny that your love drove me crazy

If the pain that Im feeling so strong
Is the reason that Im holding on
Then Im wrong, yeah Im wrong - this aint a love song
Yes, Im wrong, yeah, Im wrong - this aint a love song

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.