Monday, April 04, 2016

#Throwback Diagnosis2 ke Mesir - Part 1

It was planned a few months in advance. When Anwar and Ben received the invitation, we were elated. AF, Aizzat, Azah and Ben met the representative in November when she came back for the PAT in PWTC. It was to discuss about the programme. Projek Nusa Bangsa. Totally bombastic!
However, being practical, never that i thought they would invite all of us to go. I would reckon that perhaps just 3-4 of us would do - all expenses paid! I was surprised when it was informed that all of us were invited and its on them! Wah.. I do know that Overseas UMNO Club is funded well but to sponsor 7 of us? It was surreal and i never thought it would be as such! Apa lagi, Why not right? 
All of us then applied for leave and planned for the trip. I had to look for locum cover during my absence. The list was getting busier and it would be catastrophic to just leave without cover for that week. SOmehow it was rezeki that the month of October in my place increased. Usually February is a slow month for private hospitals. 
Unfortunately FL had issues with this pregnancy. Initially we timed it well so that she could be on board the plane. However, it was not meant to be. Bukan rezeki. For her own safety she had to stay back. Kudos to Ben for helping out to get appointment in IJN after a palpitating (literally) episode in UKM during her call.
Honestly we did not know what to expect. I was in Cairo in 2014 but because of the mission tension, I did not visit Cairo much eventhough we were persuaded to do so. It did not feel right. This time around, i did a bit ofreading so that i know what to look for  during this trip. Of course, the main objective of the trip was to meet up with future doctors and inspire them. Apparently, D2 is a big hit with the students around Egypt and therefore justification to the club of our invitation.
We had to take an early morning flight from KLIA. Everyone was excited. Shahnaz (Din's wife) took leave tofollow her husband. She later became a big asset to the team during this visit. We were excited and really looked forward to be in Egypt. 

The arrival of Apokalips

Launched 29 MArch 2016 - MPH PIBF Putrajaya.



A lot has happened since my last "real" posting late January. I've been a complete slacker after a promising January for blog postings. Somehow after the death of arwah, I had a thought block. There was no desire to share or blog anything that has been happening. Seriously. Tak bernafsu langsung nak tulis apa-apa. Searching for what i really want again i guess after seeing the end of a loved one in this world, awaiting to board the permanent destination. 
There is a lot to share of what has been happening this past few months. I was in Egypt with the Diagnosis2 gang as we were invited by KULN Mansoura. It was nice to travel again with friends and at the same time, sharing about our lives with future doctors. I will blog down a post on that later. It was fun to travel: Cairo-Mansoura-Alexandria nad a definite memorable trip!  
Its April now and suddenly I am in the mood to blog again. Perhaps the 2 things which has been bugging me, the launch of Diagnosis Apokalips and my solo effort: coming out soon end of this month during PABKL Insha Allah. Sorted editing it and hopefully it'll be fulfiling to the potential readers. 
I was sick after the Egypt trip. It was the week after returning. A bout of bad viral fever ( not Dengue or anything that can be detected) but it was a miserable 2.5 weeks. I've recently recovered and Alhamdulillah. I was worried if my mysterious illness in 2011 had made a comeback. Alhamdulillah, perhaps a reminder for me as well to be on my toes on my health. Sayang that i had to miss Powerman and NKVE run which i have registered for. Takpelah, ada runs lain to do Insha Allah. 
Work is getting more hectic. We have hit the 100 case per month target. Somehow, in February when in all other centres the cases declined (the usual trend) Ours went up. Last month was busier and i guess Insha Allah, can only be better.

Monday, February 15, 2016

Testing one's iman

It has been a sad end of the month. Azad's wife deteriorated and finally found her peace on the 30th of January. Azad was in fact actively dicsussing in the whatsapp group towards Maghrib that day. He suddenly disappeared and came back, telling that his wife had passed away.
The diagnosis was perhaps in late October and her deterioration was so swift that within 4 months she left for the hereafter. Thats how fast lung cancer stage 4 can deteriorate. 
I guess that must have been the reason why I stopped blogging for a while. Totally had nothing to blog about. Perhaps the significance of being in front of a PC and writing something did not bring me peace. Nor was the novel i was writing in full speed, halted at chapter 14 at the moment.
Azad is like a brother to me, we have known each other long enough. Our wives were cousins thus the link to our blood relations at the moment. When he is sad, i feel sad. I know how heartbroken he is at the moment as that is who he is. He may be macho and look tought, but he is the sweetest person that i've ever known in my life.
What triggered me to restart my blog maybe because of a FB entry we wrote today. It brought tears to my eyes because when you do something for the person your dear most, you dont think. you just do. 

I wrote this for Azad the day after the burial. I could not sleep and i just had to write it down. It is how i express myself i guess.

makna cinta teragung,
adalah cinta dengan penciptanya,
cinta yang bertunjangkan ketauhidan ilahi,
cinta yang berteraskan iman dan ihsan.
kelmarin ramai yang menjadi saksi,
bagaimana cinta dua manusia yang berpaksikan ya rabb,
berkekalan mekar selama-lamanya,

La yukallifullahu nafsan illa wus'aha,
Allah tidak akan menguji hambanya dengan sesuatu yang hambanya tidak mampu,
Allah menguji cintamu kepadanya,
Allah menguji kasihmu atas keesaannya,
Allah menguji ketaatanmu sejujur-jujurnya.

Tidak pernah aku melihat keikhlasan cinta,
Sebagaimana yang engkau zahirkan,
Manakan aku mampu lahirkan,
Daya usaha yang engkau korbankan,
tak pernah muncul keluh rungutan,
tak pernah wujud tanda sesalan.
kudrat luar biasa yang kau kumpulkan,
walaupun seringkali hati bagai diluluh-luluh,
menerima seadanya berita cerita derita,
duka nestapa yang datang bertimpa-timpa,
engkau redhakan jua dalam keterpaksaan.

Dari mana kau ambil kekuatan,
untuk merenung lau mata pemberi 5 zuriatmu.
mengharungi hari-hari terakhir bersama kekasih hatimu,
menatang jasad yang lemah dan tak mampu,
Yang kau tetap cintakan hanya kerana DIA.

Mungkinkah aku dapat menjejaki langkahmu,
Begitu mulia tanpa dipaksa,
cinta suci hanya milik isterimu,
cinta abadi yang pasti kepada Allah,
bisakah aku menjadi sepertimu,
Imam yang berpesan akan kalimah thayyibah,
tatkala sakaratulmaut menjelma,
Imam yang mendoakan kesejahteraan barzah,
apabila nyawa terpisah dari jasad,
Imama yang menyembahyangkan jenazah,
usai sempurna urusan,
Imam yang memeluk ampuh serapat-rapatnya,
membaringkan sekujur tubuh jasad berkafan,
di liang kekal tempat persemadian,

tanggungjawabmu menjadi khalifah,
ketika akad penghalal mudahcara,
ikrar membimbing pendampingmu ke Jannah,
bagai terlaksana sudah,
seiring tanda-tanda khusnul khaatimah yang mulia,
dikala kau redha mengizinkan pemergiannya,
tenang senyumannya nyata,
yakin untuk bertemu dengan penciptanya.

Thursday, January 21, 2016

Shah Alam 21k night run

After the talk during the day, guess what i did that night? haha

I DID NOT PRACTICE AT ALL FOR THIS RUN. And i registered post hajj aritu kononnya motivation la to start running again. Haha My mileage before this run was probably only 6km per week itupun tak tentu!
I've totally lost my fitness and slowly trying to regain it back. I had second thoughts about not coming for this run but its the new year, so i have to change something! Haha so belasah je la. Lets see how far i can go. I sort of "retired" last year and hence i can say that i've not run competetively for almost a year! I registered for few but chickened out at the very last minute because i did not have the motivation. 2016 lain sket aa.. 
 Puncak Event became the main organizer for this run. ALhamdulillah, bisnes Deeno and Pak Am maju jaya as they are organizing more races now. Doing really well insha Allah and I will supportthem in any way that i can. Termasukla join the race hehe 
 The running route was phenomenal. It was superly humid but that is not my excuse for doing a very slow time. Obviously, i did not train for this run so it was a disaster. If it was 10km i would have been not too bad. But 21km?/ haha memang gila lah. But then again, 10km is of not so much challenge. The pain of reaching the finishing line is something i've missed for at least one year. Ada umph lari 21km! But definitely not 42km hahaha yang itu kalau tak train memang cari nahas! 
 I ran for 10km and after that a leisurely walk for the next 11 km hahaha seriously! Felt good at the beginning thinking eh.. macam boleh je ikut pace. But reaching 8km i knew it was my delusion haha time tu pun kaki cam nak cramp! hahaha So better slow down as if i injure myself tak habis the route, lagilah buat malu! 
Managed to reach the finish line in one piece. NO obvious injury but at times twitches je lah. Alhamdulillah, yang penting tak injured. I do need to buck up for my project this year! Especially to get back my fitness. It made such a difference when you are fit! I do hope to find time in between my busy days to run insha Allah. 

Monday, January 18, 2016

UPM Fiqh Medic talk 16/1 #DIAgnosis2

I came early to the event. It was not difficult to drive from Shah Alam to Serdang. The UPM medical department is just beside Serdang Hospital. The students who received me did not know who I was. It was okay ..takpela.. haha  Im not as famous as Ben or Anwarlah kan. haha 
Our slot was due at 11am as the third slot. We were his sideshows.  I was keen to listen to the talk of the earlier slots. It was about Medic fiqh by Ustaz Fauwaz Fadzil Noor. Alhamdulillah, I was not disappointed. He was a good speaker and I am lucky to have his book with me. A souvenir signed by Ustaz Fauwaz himself. He is the son of Allahyarham Ustaz Fadzil Noor (past president of PAS). I am sure he will follow his dad's footsteps.
 He dazzled the crowd with his persona and jokes. The mood was elated after his session. I said oh no.. we have to keep the momentum going. Me and Azah were due to speak about Depression among medical students. Honestly, if we were not careful it can be a very dry topic for a forum. We had to step up! 
 I wasi n my Maharaja Lawak mode haha I am lucky it sort of click otherwise it could have been a disaster! I must apologize to the moderator as she was the person whom i picked for the crowd's entertainment.We broke the ice and the crowd was certainly concentrating on our event.
I started of by defining definition and the data which depicts that in general 1/3 of medical students anywhere in the world facing this problem. 
Azah was at her usual best - "mini" Prof Muhaya; a true inspiration and role model to the medical students. 
It was an enjoyable session and I thank the organizing committee for inviting us. Of course, my hunch was my name will not be the first in their minds to invite but Insha Allah, I will always give my best to share and hopefully the crowd benefited. :) 

Wednesday, January 13, 2016

Jom meh dengar

This year the Diagnosis team will try to engage the public more besides our incoming write ups. Insha Allah, sharing is caring.
A spin off from our earlier engagement with CUCMS. Insha Allah, semoga bermanafaat. 

Monday, January 11, 2016

Can/t intubate Can't ventilate - Sux magic.

(This is a very technical post - mind the terms but I want to keep this as an entry) 

After a long lapse of this possibility, we had this episode recently. This was something all anaesthetist feared and the nightmare happened.
This patient had a BMI of just 30 however the airway was suspect from the beginning. His mouth opening was small, a Malampati 4 and he had a thick short neck. However, it was not we have not encountered such patients before so the case was to proceed as planned. I was there to help up my colleague and this meant we had 2 consultants standing by. 
The issue about difficult airway is IF YOU LOSE THE AIRWAY. This means the inability to oxygenate the patient and that can be catastrophic. If one can continue to oxygenate, then the attempt for laryngoscopy and intubation can theoretically be as long as possible. 
At the same time, patient was suspected of having an acute abdomen which means the risk as gastric content regurgitation to be high! So it was a catch 22 situation. 
Traditionally RSI (rapid sequence induction) will be the gold standard to secure such airways. The arrival of sugammaddex (direct reversal of Rocuronium) has changed the airway management to a certain extent, however traditionally one would still use suxamethonium as the mainstay for safety. Especially in a centre where one might not have the full equipment for back up. 
True enough, this patient had a very anterior position of the vocal cord despite a satisfactory tube on the C blade of CMAC. The view on the Long blade was 3B at least and no way of manipulating to get it a 2 or 1. It was difficult to negotiate the tube to be placed in the trachea. 
As i've mentioned before, we had BIG issues trying to bag mask the patient when the saturation dropped, and by the 3rd attempt it was almost impossible to mask ventilate the patient. He desaturated badly and in my mind i was already thinking of attempting a direct invasive airway.
And the magic came.. sux effect came to and end and the patient breathed spontaneously. And this spontaneous breathing was the thing that kept him alive. His saturation picked up straight away without the muscle relaxation. 
It was a sigh of relief.. ultimately safe this time around. Thank god for suxamethonium property of being a depolarizing muscle relaxant! 
We woke up this patient as how the protocol would recommend us to do so. We explained to him what had happened. The next step was supposed to be awake fibreoptic intubation - unfortunately we did not have that facility. Thus we had to transfer the patient to our sister hospital so that this case can be managed accordingly. 
It wasa heart stopping moment, i have not had this type of situation for quite some time. It tested our ability to think as based per protocol. It made both of us reflect on the importance of having plans B and C all ready when disaster strikes.