Saturday, February 28, 2015

Sometimes we have to be more than what we are

Having being told of one having a terminal illness can be a nightmare. Its the sudden news of a diagnosis which brings death to the front. The one reason why some of us can be obsessive in going for medical checks often is the big letter C. A taboo to be spoken about but a definite prognosis beckons. Being in the medical field, it is often a situation where you don't really want to be involved in. Unfortunately for some of us, breaking this news becomes a responsibility. 
I will come across these patients in different stages. Most often, the point where surgical intervention is needed, either in emergency situations or after electively discovered. Honestly i cannot imagine being in their shoes, having being told, yup.. you have the big C. 
I sat down and talked to one of my patients the other day. Even though i was there for pre op assessment, i spent more time being a doctor rather than as anaesthetist. The unfortunate diagnosis was confirmed just few days back and it is a big one. I am sure he is still in shock, I could see in his eyes the tears but he holds it back as we talk. His family is in shock with the wife not really accepting it well. The psycho social aspect in this matter is very important; as the mental health should also be reviewed. Its important, as fighting cancer can be a mind blowing journey with full of uncertainties. 
Yup, it was just a short discussion of what it is all about. I encourage him to read about what he has, so that when he meets up with the oncologist, he and his family will be ready for questions rather than listening and absorbing. That is the usual practice in asian community. As the one managing them, we should explain that the treatment for cancer is a journey which needs a lot of strength and courage, full family support an istiqamah. Yang penting usaha bukan semata-mata berserah sahaja. And whatever the result will be, we redha. 
It was something i felt i had to do, the chat. As i believe as doctors, we are still human. Being humane and providing empathy is something that we should all do. I am not sure whether i did help but i do really hope i did especially for the stage which he is at, at the moment. 
My prayers for his oncoming journey. 

Friday, February 27, 2015

You're 8 today Qaisya!

Happy birthday to my 1st daughter Qaisya!! Many happy returns!
The little girl who is growing slowly but surely, the one with a distinct personality which amazes me how great Allah Almighty is.
She can be grumpy and self centered, but she is smart and intelligent.
She knows what she wants and what she can achieve.
Insha Allah, my dear.. you will be what you want to be :) 

Thursday, February 26, 2015

Revision and revelation

I've been attending the general hajj course organized by Tabung Haji in Kelana Jaya mosque every Sunday morning. I try to attend despite sometimes being oncall. In private, your oncall is unlike in the government as patients are not as many and over the weekend unless it is super rgent that you have to rush to do the cases.
Honestly, i was reluctant to join the course as it was all revision knowledge for 14 weeks. What is to learn in that very long period? Setakat rukun and wajib haji, larangan ihram etc.. not that difficult to digest..no? Revision of subjects during my secondary school which should not be that difficult to be reread. I was tops 5 year in a row for agama in secondary school.
Or was I? 
I was wrong. 
How could i assume as such when we talk about knowledge of ibadah.
Indeed, attending is a revelation.A revelation of mind and soul. Something i did not expect. It is about its feel. And a similar feeling indeed during my Gaza mission journey the other day.
I learn new things every time. May not be academic per say, but that is the gem and gold about hajj. As i look back the journey of hajj began when i agreed to perform it by Tabung Haji.
Indeed, it is an invitation from god.
A new meaning to life, a turn over to renew my vows with him.
Insha Allah, my azam to become a better person and understand the true meaning of hajj. 

Wednesday, February 25, 2015

The equinox is here again

After the rainy season spell, guess what.. the heat is back! It has been a warm week so far and one can notice it via the scorching hot sun everyday. My career would put me in OT the whole day so I am not affected directly, but coming back home and feeling it to be warm is real!  The threat of drought may be sooner than expected. Such irony, when at one time we were overflowed with water and now, we are getting less of it. The 2014 drought comes back into mind, oh such unpredictable weather nowadays.
The KKM has come out with these posters. I reckon it is a very good conscientious effort! To warn the public about the dangers of heat stroke. Ironically, at the moment i am finalising an article with Prof YK Chan regarding heat stroke. But it is more academic rather than for public reading.
So guys.. stay safe. Do not underestimate the dangers of heat stroke.

A new year of the goat in zoo negara

Belated Gong Xi Fa Chai ! We celebrated the chinese new year in a holiday manner. We did not go anywhere fancy but decided to go to Zoo Negara. It has been a while since i last step in Zoo Negara. It would be nice for the kids as this is the right time and age to bring them there. Besides, the youngest 2 has yet to be brought to this wonderful zoo of ours in Ulu Klang.
We were off early in the morning and parking was plentiful. It is much more expensive now to enter zoo negara especially if one plans to see the two pandas Ling Ling and Xing Xing who arrived mid last year to our zoo. However, i thought that it is more reasonable than a miserly rate because it does cost a lot to maintain a zoo. Overseas zoo prices can be atrocious and i dont see why we should not charge more. However, it should be complemented with satisfaction and good service. 
 Of course, the main attraction this time is Xing Xing and Ling Ling. We waited for the 1130 slot because it is during this time the pandas will be fed. Pandas can be really sensitive and it proved so during our visit. Xing Xing was happily munching his bamboo shoots when Laikha decided to shriek! hahaha and guess what, the panda ran for cover and looked terrified. Remaining still amongst the stones of the artificial river hahaha We were told to be quiet from the start and quite unfortunate to witness what they mentioned were true :( 
 The animal show they had in the afternoon was not too bad. Compared to the zoo many years ago we have improved. The 2 seals were the main stars of the show without a doubt. It was nice to see how the coliseum were full packed with families waiting for the show. This is where i reckon the zoo can improve on with better animal shows. I am confident that we will match the other international zoos in the future. 
Thumbs up to the current management of zoo negara. I was here last probably about 6-7 years ago and i can see a lot of improvement to our zoo. The 2 pandas must have changed the fortune and attention to zoo negara, nevertheless we should love our zoo as a whole. The animals i must say is a far contrast from how they were many years ago. The look sharper and healthier! Seriously! I always remember our zoo animals looking unhealthy and not well kempt. The animals are much better looked after now i guess :) 

Tuesday, February 17, 2015

You think you can manage the airway ?

Airway management is core for an anaesthetist's practice. Nowadays, Emergency Physicians are expected to be competent at it too despite the reduced importance in the ALS or ACLS guidelines. It goes back to ABC, A=airway. When A is compromised one can in a way forget the others as the mishandling of A will go a looonngg way!

During my MOship, only when one is comfortable with managing straight forward airways, one would be allowed to be oncall. And this would be certified via peers working with one, never self assessment or presumption. This is the one subject where theoretical knowledge without the hands on experience would be useless. One can be really good at reckoning which is which and how to handle things in theory, but when it comes tho practice; its the years of experience will count for any mishaps or possible issues. There is no time to think, its just the output needed on managing the basic principles. 
More so if it is the paediatrics population. How time is of essence. Many anaesthetist would frown upon paediatrics cases when they are posted up. Its the fear of problems that can come and handling paediatrics especially the smaller ones can be really delicate. Its not just a small person but its a totally different population and universe! 
I have evolved from the first day i was asked to intubate electively. I did make numerous attempts in resuscitation during my medical days, but those were when we gung hoed and just shoved the laryngoscope in! It was later in anaesthesia i do really understand which views we were looking for and of course with supervision. One of the first few persons who taught me how to intubate was Tok Man, who later became our senior MO in Sungai Buloh. He did not pursue his post graduate studies but his experience was abundant that he trained from the start a specialist like me. 
Its easy to say relax and take your time when you were in the midst of completing the task. Preoxygenation is important as it gives us the time to take a step back and figure why things happen when you do not get to intubate the first time around. It must have been fun for my MOs and specialists then seeing me jittery and jumpy in managing the airway whilst observing me. The same fun i had when i was training my HOs and MOs to intubate! haha 
"Bang.. tak boleh intubate ni.." Young healthy ASA 1 with features as easy intubation. 
"Abis tu?"
"Abis tu.. camana ni bang.. tolonglah.."
"Boleh bag kan?"
"Boleh.. boleh.. try intubate 2 kali ni tak dapat?" 
"Pandai-pandailah kau.." and he left the room for coffee..

Haha similar story? :) 

Monday, February 16, 2015

UIA Meet & Greet #DIAgnosis2

Again, another last minute request. I was oncall but it was possible for me to appear in UIA last Saturday. Most of other team members were either oncall or had events on that day at that very hour. It is a bit quiet in my place this week, so i guess it was possible for me to be away for 1-2 hours during lunch time.

It was my first time in UIA Gombak. Utterly magnificent. I guess those studying in UIA must be really proud of their organized campus. Truly how a university campus should be.
Diagnosis2 was again  being promoted by Deen's print, one of the booths in a hot selling seminar, "Sebelum Aku Bernikah" by Hilal Asyraf and gang. Walawei.. haha bahaya kalau amik gambar kat conference cam ni, wifey dodgy tengok hahaha  
It was just me and Dr Din. Alhamdulillah, eventhought it was just for an hour, we could see how D2 can be hot selling.. habis tu time kitaorg kat sana. It was nice to know that our readers were not just medics, in fact the public! Not just students, those who are currently professionals too. ALhamdulillah :) 
 Thanks bro Din.. for being there with me. And of course to the other team members with their full support always! 

Friday, February 13, 2015

A proud father MDQ1 first MSSS

Yup..the competition day came after 2.5 weeks of last minute training. It was on Wednesday 11 February 2015. Dzaeffran has been on intensive training for the past 2 weeks. Intensive I must say and something that he was determined to do. He looked forward for every training session and will do his best in every session. I may not be a proper trainer, but on those days where i supervised the regime, he was ever willing to do and never tried to cut corners. (which was unusual for him haha) He was determined as well. 
His best time before the big was circa 1:12-1:15 for 50m freestyle. Slow for podium standing but definitely a marked improvement from the first time 50m he had which was 1:35. His improvement was superb and it was fun to see him getting better everyday. His plunge dive got better as well and come competition day he was up and ready for it. I must thank teacher Dory Salmiah who has been training him ever since. She used to be a well known competition trainer long time ago, evidenced by all the people that know her when we were in Pusat Akuatik Shah Alam.
His event was at noon and i waited from morning for it. He did not show any jitters, typical of him haha simply supressed on the adrenaline rush. 
Honestly, when i brought him to the reporting room, i started crying (not meraung2 la.. haha) felt sebak because proud to see him taking part. He was up for it and who would have thought, the small baby i saw in distress immediately after delivery is here on the big stage. The flashback of that particular moment came rushing to my mind. I guess its because i was the one who saw exactly what happened afterthe delivery. How he was breathless for breath.. how i could see the tachycardia.. his heart beating so fast that i could see it visibly. And his tone on being floppy then.. very-very floppy.. I did paediatrics during my housemanship and flashes of the problematic babies came into mind straight away. I was ready to face any predicament then. I was just praying to Allah to let what is best for him.
And from the moment he was on the start platform till the time he touched the pad, tears were flowing and there was no way i could control it. Even if he'd come last in his heat, it would not change how i was so proud of him. And he did well.. almost getting 1st in a mere milisecond losing to the second spot. Allahu akbar.. Subhanallah.. it was a very touching moment. 
Alhamdulillah, he did a 1:02.98. Of course far off from the 34s of the one who won the event, nevertheless, it was great to see him did his best. I did not expect him to go that fast but he did. With the adrenaline rush, he swam all his might. Subhanallah. my boy.. and to see him do that is such a satisfaction for me.
Insha Allah, next year he will come back strong and the challenge is on MSSS :)