Tuesday, October 14, 2014

Its coming.. surely.. #DIAgnosis2


To be brave enough to venture; replacing Dr Aaron.. :)

Quite a number of people asked me, why did i leave UiTM? I have always been known to be a strong staunch supporter of the instituition. Therefore, my move this time had surprised many though it was not something unexpected. To them i looked like i was prepared to end my career with UiTM. I even had a phone call by a colleague of mine in USM Dr Rhendra just before he left for Hajj asking me, am i seriously moving? haha

Honestly, i myself thought i would end my career in UiTM. I was under the pension scheme and that was an early evidence of what i wanted in life. Our plans may change and Allah's will change too. I had a change of heart in the sense of i had to make the step. It was now or never because this is just about the time for me to make my decision.
Some might argue my future in UiTM was bright as i was seen to be one of those who was assumed to be interested in taking over the faculty leadership in the future. I can say this maybe true but we do have our priorities in life. What we would want to achieve can be different and the satisfaction factor differs from one to another. I could have persevered to be a professor or even the dean, but i know somehow that was never my goal. I do love to teach as it is in my blood. However, going private does not mean  i have to stop teaching as there are numerous available pathways of part time teaching.
Private practice is hard work as the wagers earned depends on how many patients we see everyday, in my case how many case I do. I did cover for locums now and then during my tenure in UiTM and it was an introduction of what private practice is about. It was not easy as most of the time we are alone in making our decisions. We have to be really sure what we do is the best of practice because suing a doctor or another is not uncommon. Sure it can be lucrative as charges per day can reach up to RM10K if we do the right type of cases. (on a good day provided no complicated cases during the day).The stress is different, public and private practice.
In private practice, independence is the word.Especially in Anaesthesia. You do things all by yourself and your skills will do the rest.Honestly it is all MOs daily work in the government setting. The cases that you see and do. Nothing to shout about in terms of complexity mostly.  I guess that's the reason why certain institution would want at least 5 years experience as a specialist before being allowed to join private hospitals. 
Insha Allah, from time to time perhaps i can reflect on private vs public practice in my coming entries. It would certainly be interesting to note the differences of attitude and work ethics being on the "dark" side. Being a doctor is noble to many and some may doubt of private practice doctors role in the medical world. I am sure we have our part in ensuring the best of care to patients but in a different viewpoint. 

Kilimanjaro Part 5: Summit attack.. Stella point-Uhuru peak MERDEKA DE KILIMANJARO!!

During dinner time, everybody was not in the best mood. It was drizzling and that made the temperature drop. It was cold. We were all tired. The dinner was not very encouraging as the soup and potato was not to everybody's liking. Enock and Deeno lead the briefing, telling us about the 17 hours journey we were about to embark in the next few hours. 4800m to 5900m!! That is a very demanding height for our condition. The AMS symptoms were beginning to bug few of the team members. The initial plan was to have our 4 hours rest, and the team to start moving up at midnight. When Seri suddenly puked everything out of her guide, 
Deeno then said,"OK Enock.. since I am the team leader, we move at 4am!"
 At 3am we were all up. To say that everybody was enthusiastic is an understatement hahaha People were sick but very determined to reach the peak. Everybody knew it was the beginning of the dream. Going against nature is the toughest to cope as i know most of us do have the basic fitness requirement. What was with us was the snow and rain, despite being too cold to sleep, it made the path to be less dusty and slippery. Off we went at the early hours of the morning. 
 We were moving slowly.. too slow but necessary. The cold weather increases our oxygen demand and at 4800m above sea level, there ain't much of it. We had to mentally reduce our oxygen cell requirement and continue. Failing this is not the answer but at the same time, we were reminded to throw our ego away if we are too tired to think. AMS was evident in the sense of it made us very sleepy. Most of us keep asking if it was possible to take a short nap before moving. 
 The sun rise view was majestic and subhanallah. Despite huffing and puffing we were reminded of how great Allah's creation can be. To really saviour the view was not possible as we were physiologically challenged. We kept on moving and by 8 am our groups were divided into 2. I was with the front pack and we moved on. Not that we were any faster but we stopped for rest less. 
Abang Ayob made his legendary move when we passed us and stormed away with his walking stick! I was dead worried at that time because i knew what happened the last time around. I was concerned if he had HACE which would make his judgement unreliable. Unfortunately i myself was too tired to follow his step and i prayed that he will be OK. 
 We did pass Abang Ayob on his way down. He arrived at Stella Point quite early but unfortunately was without any food or water. He decided to descend as he was not sure whether he could survive the trip alone to Uhuru. What made my heart sunk was when he said we were 2 hours away from Stella point! Hahaha and i thought at 10 am we were near our destination. We persevered though.. 
 Alhamdulillah, at 1pm we were on Stella Point and it wa such a relief! I was tired myself as i was unable to follow the steps of Joshua and the gang. However i was not left too far behind. I knew i can reach the peak but not at the pace they were going. Kicok then motivated us to keep moving as we have to reach Uhuru. Joshua (our guide) intially was not encouraging but after seeing how we springed to life while taking pictures, he changed his mind. We could see Uhuru peak and its wall which looked quite far away. With some amount of sneakers and kurma, I then slowly walked to reach my destination. Memang nak muntah dah dengan sneakers.. hahaha 
 THe journey to Uhuru peak took longer than what i thought it would be. My legs were tired , i was breathless with every step that i take. Having the thought that the trek was flat was bullshit haha it was ascending.. and ascending.. and still the peak was nowhere to be seen.. hahaha I saw Tokki sitting down and having his rest and urged me to go on first.. The view was however damn cool. It was amazing though as i could witness the enormous glasier on one side of Kilimanjaro. Simply superb. Subhanallah..
 Alhamdulillah...at about 130pm 31 August 2014, I have summited Kilimanjaro! The highest peak in Africa!! I felt amazing and thankful that we managed to summit. The team was exhausted but alhamdulillah we did it together. Deeno and the rest of the team came after and we passed them on our way down. Everybody looked superbly exhausted with few appearing like hallucinating all the way. The guides were certainly inspirational as they urged my colleagues for them to continue as it was just a bit more of a distance. 
Guvu Kama Simba.. Strong like a lion.. 

Kilimanjaro Part 4 : Shira camp-baranco camp - baranco wall - Barafu camp

The departure from Shira camp was memorable. After the morning briefing before we were about to leave, Joshua and his crew sang the magic "Jambo Bwana" song. It was lively as everybody participated and danced to the rhythm of the song. We were not fully fit but we were jumping around with the guides and porters! The sun was shining bright and the weather was cold and crisp but we did not bother that! And began was the journey to Baranco camp. The journey from Shira (3766m) was to Barranco (3983m) but we will go above 4000m before descending as this was appropriate for our acclimatization. 
The journey was tough as again it was high and low with the sun shining bright without any cloud filter. I was walking with Azad and Mtey the guide. Of course, the scenery was legendary but knowing that we were still far away was not a sounding factor. Azad was dehydrated from yeterday's travel and to control his AMS symptoms, we needed to really move Pole Pole. 
We were supposed to climb up to Laya Tower (4600m) but because the pace was not as how we wanted it to be, we bypassed it to go to Baranco camp. The junction was already above 4000m so Deeno as the team leader decided that the team was good enough to acclimatize without going to Lava. The walk to Baranco camp was never ending as Mtey keep saying," Yes Azad.. another hour to go... the camp is just there.." And for hours we walked without the slightest sight of the camp! It startedto snow as well and made the journey cold and wet! Something you would rather not have during this period of fatigue.
We reached the camp at 6pm and it was such a relief! What i was keen on was the scenery as this camp was hidden in between the valleys at near 4000m above sea level. Simply breath taking. Kilimanjaro peak was certainly our background. Looking at the majestic peak of Africa, some of us were doubting whether we can achieve it in the next few days. 

The trek to Barafu camp the next morning had its unique challenges. The first was to climb the vertical Barranco wall. It was not technical but we did not have that much room to walk. the pathway was small and we were lucky that it did not rain the night before. The view was amazing and i wouldn/t know if i want to repeat it again as we ascend to 4800m above sea level. Barafu camp would be the base camp before we summit. Few of the team members were superly exhausted. I had to give Abie his daily Arcoxia dose for him to survive everyday. It is amazing to see how he recovers overnight and fit and well to begin the next day's climb. 
 Midway climb, we arrived at Karanga Hut which where we planned to have our lunch. Everything was set when suddenly the rain hit us hard. It was heavy that the ground was flooded! Imagine flood at 4000m above sea level! hahaha And of course, there would be snow and that was what greeted us till we arrived in Barafu. It was becoming colder as we went.At this point, I have moved with the front group.. namely Kicok, Mawi, Azman, Kak K and Tokki who i guess were the fittest amongst us. 
 We arrived in Barafu at about 4pm. It was cold.. so cold that i was shivering like mad eventhough i was wrapped in Azad's sleeping bag.(my bag has yet to arrive). I did not have a carry mat with me and i guess.. NOW I KNOW.. why you bloody need the carry mat! The ground especially the hard stone surfaces were really cold up to one's shivering spine! Down jacket is definitely the best to be used! Most of the team members arrive quite late in the evening and i can see how exhausted they were. And imagine.. we were supposed to start our summit at midnight with some rest in between...

Wednesday, October 08, 2014

SMKTTDI Qurban 1434

I guess once you have kids who are growing up, you wanna show  and teach them everything that you know off. Especially the exposure about life and the community. I believe nowadays, kids tend to be indoors and indulge with the digital world rather than being out there. Its a shame that modern technology has changed this. Of course, the sense of security has alerted a lot of families to keep their children indoors.
Since i took part in the school qurban, i brought the four of them to my alma matter for the qurban. Every year without fail, Ustaz Ahamd will organize a big scale qurban for the kids in school to experience it. It can be fun but at the same time dangerous. And it is this that i hope to let my children experience. 

                                           KARESMA
Im sure the elder 3 would have found the exposure interesting as they tried to get close to the process each time a new cow was selected. KARESMA's was bulky and it showed how wild it can be! hahaha The element of danger and the teamwork showed by the Qurban team was amazing. Together, putting the big cow down and then perform the qurban was amazing. Our cow even rose and went to another part of the field after everyone thought it had died! hahaha 
 I wish i was exposed to this when i was younger. I do hope the children will appreciate this activity and for them to ponder when they grow up.

Eidul Adha with the family

Both of our families are in KL, so far there has never been a time this was an issue. I could go to both in the same day, its just that perhaps it has been a while since we last slept in TTDI.
We spent the raya night in DJ, and i guess ita the kids that make such festivities alive. Having all 5 growing up together can be fun and stressful at times. Their antiques will certainly blow you away and you would forgive them easily.Ayman was around so i guess he would himself appreciate the presence of 5 young kids running around here and there. I can't imagine when he is old enough to play with the rest
 In the afternoon, we were off to TTDI as it was promised that way. The menu was BBQ raya and a cake was prepared to celebrate Doya, Mutee and Mikochi. It was fun to have them around and i could not understand why Mutee was not there. He has finished his studies and i thought we should be seeing the more of him. 
 It was a simple affair but meaningful. I did not have my raya celebrations this year and what transpired this time around was enough for me. Insha Allah, with more rayas to come, the kids will grow and appreciate the gatherings as how i missed the mass gatherings we had in Muar when i was younger. 

Wednesday, October 01, 2014

The last week in CTC

The title sounds so dramatic.. poyo haha
Its not easy to let go of your baby. Something you have worked hard for and built it from scratch. Setting up the department was a task i took galantly with the vision during my Masters day. It was a clear vision of how i want it to be. Alhamdulillah, I've managed to do it the way i want with all the things that i like to use.Training the support staff in achieving the standard you would like it to be is a satisfaction. Its been more than 4 years since i passed and 20 months since i came back from Perth.
This week is in fact a horrendous week because I am doing the call for the whole week till Raya. There are some issues regarding the anaesthetist available, thus why not just do this once.At least, i can say i've done this and on the very last week.Somehow, by chance it was arranged that we have a full week of cardiothoracic cases! 5 open heart surgeries planned for this week alone, the most ever! However, looking at one of their absence, its going to be 4 straight CABGs.
Yesterdays 2 on pump CABG was a whammer. It was the first time we had it back to back and i guess this will be the way CTC is in the future. I was alone handling the 2 cases but of course not an issue for me. I take pride in my job and i enjoyed it! Having nurses and technicians who were trained to know how i want it to be was a satisfaction.You wished that you do not have to do this, but unfortunately you have to do what you have to do. We finished at 9pm, but it was a glimpse of how things would be in the future here. I am glad though as i've contributed to this cause directly.
 It was just after Subuh that i extubated my 2 patients simultaneously.Of course it was a scary bit to my nurses when i ordered it but it was justifiable. And to see that happeningat 6am in the morning is just wonderful and made me sit down and ponder how i am going to miss this set up. A dream where people wanna do but maybe never had the chance to do so.. Creating histories and stories.
 
 Today was an off pump case which challenged me to the core. Somehow i am more excited when it is off pump because its a test of my understanding of the heart's anatomy and clinical physiology and using what i have to manipulate it. I know i will miss this part in doing CABG as it is almost orgasmic when you are able to maintain the pressure especially the Circumflex graft which can be really posterior. Exposing the site is the ultimate challenge to stabilize as it can just go bonkers. Lifting the heart and putting it almost upside down can be exciting to nerds like me hahaha and of course, to many anaesthetists a heartache!!!
Its obvious isn't it? I am starting to get withdrawals.. hahaha But insha Allah, new place, new setting, new hope and new experience to share.

Monday, September 29, 2014

A small do for Kili team at Kak Shams

I have not finish my Kili posts on this blog and we had our second meet up yesterday. The first was a simple lunch at Kak Sham's restaurant sometime last week and yesterday was the big BBQ do! haha Either I'm too slow or the gatherings are done too fast! It was a great excuse for meet up so that we could all copy the pics we took during the trip. I have yet to go through the 23 Gigabytes worth of pictures and videos. Itwill be interesting!
The fun continues and Insha Allah, we will climb more mountains together.

P/S a bit cuak with my new job next week :P

Friday, September 26, 2014

Kilimanjaro Part 3: Machame gate - machame camp - shira camp

We woke up early that day. Me and Azad were room mates since Abu Dhabi. Thep acking was done quite simple and Enock inspected our stuff the night before. I never knew he importance of a carry mat until this trip! haha When everybody was ready, we were off from Moshi to Machame gate.
Machame gate is one of the few other routes people trek to Kilimanjaro. Deeno chose this route as it was the one he had used before. Seeing the programme i was a bit anxious and worried, as the demand to elevate in the number of days would predispose us to AMS. And AMS is bad! 
When we arrived at the Machame gate we saw a lot of locals waiting outside the gate. Apparently because of the ebola virus, the number of groups that cancelled their kilimanjaro trip was significant! Being peak season, it would be more than ten group at one time. There were few other groups as well but i guess our group was the biggest! 18 of us andthe ratio of guide;porter;trekker ratio is usually 3-1! And seeing our big entourage of people was amazing! Gila ramai! 
 What i reckon made this trek interesting is how we can experience different kind of forest as we ascend. Machame gate was about 1800m from sea level and being near to the equator, the rain forest is almost similar to ours in Malaysia. It was a familiar sight on the first day. The only difference would be the our weather's unpredictability of rain! Alhamdulillah we were dry but the first day work was far! Really far.. haha We started quite late as the assortment of guides and our stuffs took some time as it was near lunch time that we were off. In fact we took lunch before moving! 
We arrived at Machame camp (2834m) when it was dark. I could not really appreciate the landscape but what was obvious is the temperature! And what impressed me was the dinner tent we had! wahh.. the standard that they maintain is exactly like the expedition trips we see on TV. All our supplies were carried by the porters employed and they certainly prepared our dinner like kings. The table was complete and it starts of with soup before the main course and dinner. The chefs introduced themselves and certainly they know how to entertain us! What makes this trip good was the arrangement for halal meat for our meals.
 The vegetation for our trek to Shira(3749m) was bonsai like. Slowly the trees become shorter and we were more bare to the direct UV light. It was much steeper to Shira as compared to Machame. But the Machame way certainly took a bit sap of energy out of few  team members.I was walking with Azad and together we had one of our guides with us, Mtey. He was certainly knowledgable and friendly as he gave information about what to expect along the trek. He even introduced us to the vegetations of Kilimanjaro as we walk.
Arriving at Shira was a relief as we arrived late afternoon. It was cold and we had to wear our down jacket to be comfy. Abang Ayob went for the short walk looking at the famous shira caves. None of us had the energy to do so hahaha and we ended up in our tents til dinner time. I brought an SPO2 machine with me and it was interesting to look at the SpO2 levels of the participants. 90% looked good and i guess thats why Deeno chose us to try on this 6 days to the peak trip.