Dear baby..

cute.. 

Assalamualaikum baby ,

How are you in there ? Hopefully the amnion around you are keeping you warm and comfortable. I know you've been keeping yourself busy , stretching yourself by rolling , turning and kickin umi's tummy. I am happy to see how you've been a good fetus by making umi smile everytime you wake up.

Baby sayang ,

Umi and I have been waiting for you in patience. Though the initial stages were stormy and critical , we are glad that with Allah's grace ; you managed to defy the earlier barriers. Umi shed into tears everytime she bled during the first 3 months. Alhamdulillah , you manage to hold on and praise to Allah the Al-Mighty.

Baby manja ,

Its nearing 32 weeks now ; almost 8 months since you decide to hold on to umi's endometrium . Your growth had been excellent , and we were always greeted with the "don't worry" smile when seeing Uncle Baskaran , or Uncle Patrick. ( Umi's Obstetrician ). I am getting anxious by day , praying that everything will turn out alright. Abang Mikhail's experience last year certainly caused a lot of trauma to Umi and me. Hopefully he is happy up there and will remember us especially in padang mahsyar for his "syafaat".

Babyku ,

UMi is very excited to receive you. Look !! She;s filling up that little corner in our room with your things ; MACAM MACAM ADA ! haks.. As long as Umi is happy , i am too. I know however , deep inside , she's so so worried . I can't do anythingh about that really , Umi being umi !!! but lets pray together kay baby..

I'll write to you again later kay sayang..

your father..

p/s glad you enjoyed the FA cup finals !!


banyak giller.. 

THE LAST SUPPER

team Kam Cheng 

We had our last badminton game last night. Damn..it was good. LAst because ramadhan is approaching and i suppose most of kam cheng members are keen to respect and benefit from the holy month of ramadhan. hahahaha..Well , i reckon that is the main point , tarawikh.. iftar with family etc. Anyway , the session will resume in December , so i hope. I've been missing the fun for the past 3 weeks !! Everybody performed and MAINTAINED their composure last night.. haks..

Zaini ( the tallest ; standing behind ) was generous enough to sponsor our team t-shirts !! ( He's the t-shirt towkay ! successful businessman !! ) haks.. it was funny after the game when we all changed for the pic. It was hillarious !! MAcam betul2 team MAlaysia !! hakss..

The game was one reason , the MAKAN after the game was the other excuse for all of us to be there last night !! haks.. THE LAST SUPPER.. YUps.. the kuew teow , nasi lemak panas.. and MILO KAW... haks.. yup.. i had my tummy full !!!MBBUUAAAHH..
However , i don't really reckon that this is our LAST SUPPER.. hehehe.. Who knows , more to come in ramadhan itself..


the big supper.. 

p/s KAraoke sempena Ramadhan on tak this sunday gang ?? hahahaha

Once upon a time..

match begins..  


the dinner..  


half time show.. 


hardcore fans.. 


31 weeks pregnant..and climbed up 8 flight of stairs ... haks.. footie baby..  


A satisfied fan.. 

tribute to SELANGOR.. the champions..

Champione' 

I was there..
when Bambang curled in a delightful freekick ..

I was there..
when Eli Aboi thumped in a drive elegantly through the arms of Hamsani..

I was there..
when Fuentes lobbed in a simple ball into the goalmouth..

And i was there ..
when Bambang dived and headed the ball in to complete the rout..

I was there..
When Selangor won the FA Cup 2005..

p/s tah apesal tah Hello... i cannot download my pics..

Footie fan's passion

the official wear..ready..  

Yes.. its 3 days to the FA CUP finals and i'm really hyped up about it !! Football excites me , the stadium atmosphere has always been electrifying .. Its just wonderful to be in a ..nope not one..two Cup finals !!! YOu may wonder what is so great about Malaysian football ? Yes.. i know our game is way below the standards of EPL , La Liga or The Scudeta , but if you're a footie fan from the old Selangor days.. you'll know what the feeling is all about..


the elusive ticket 

Went to get the tickets in the afternoon. Being post call , of course i was tired but i need to do it today as i don't think i can manage it tomorrow or Friday. We went to Shah Alam stadium after slugging through One Utama - The great Jusco Sale !! My god.. i've never seen so many people in Jusco with everybody shopping like crazy !! Wished i brought my camera then so i can show you how bad it was !!! Wifey bought few things for the baby.. and Dil called me..

" Lal.. Selangor !! " haks.. terus berkobar-kobar !!! hahahaha..


World Cup 98.. Marseille  

I've always enjoyed live entertainment. I consider being in the stadium while the game is being played ; MENGUJAKAN. Even though the comfort of home television would be the most logical choice , true football fans would prefer being in the stadium.And i can tell you , it's worth it.. especially when your team ends up as the winner !!!

MY experience in europe was exhilarating ; The World CUp being the mother of all football experience !! Though Malaysian fans will never be as creative and fanatic as the Dutch fans ; we have our own unique way of cheering..and chanting..

"Man...onnn.... man.. onnn....pass laaaaaa.... "
as if the player can hear your instruction.

" refereee.. kayu !! referee kayu !!!! "
when referees make questionable decisions

" Phhheeewwwiiiiittt... fuuiiiyyyoooo.. "
when girls in numbers decide to walk along the aisle during interval..


Anfield.. reds champs forever..  

Seven..seven..

Finals !!!  

hahahaha !! Yes.. the red giants are in two finals .. FA CUP which is this Saturday.. and the prestigous MALAYSIA CUP.. Next Saturday !! Wow.. I am definitely going for both !! So Dil , Fiqar.. macamana ?? Others are invited too..lets rock the stadium !!! MBBUUAAAHH...

Anyway , Nor tag la pulak and she knew i cannot resist this tag / meme thingy !! hahahahaha... Ok..

Seven things you plan to do before you die:

1. Bungee jump in NZ - the place to do it.
2. pilgrimage to Makkah/Madinah/ Jurasalem.
3. Be back in Manchester - Rusholme Kebab..hmm..
4. Apologize to those i have hurt in the past.
5. Anfield VIP box in match against Man United.
6. K2 / Everest. wahh.. ni dream ni azad..
7. open a mosque.

Seven things I could do:

1. Sleep during the day.
2. Sleep at night.
3. do PROMUDAGRAFT with more enthusiasm
4. play regular footie week in week out
5. go to the gym for work out
6. get a new car
7. help wifey more often

Seven celebrity crushes:

1. Demi Moore
2. Pamela Anderson ..hahaha..
3. Brad Pitt..that gay huh..
4. Feminin
5. Ella
6. Lara Croft
7. Tommy of Rugrats

Seven often repeated words:

1. Allah..
2. Mak Aii..
3. CIBXX
4. Shit
5. NOOO..
6. MBuuahh.
7. Scoupie miaw..

Seven physical traits I look for in the opposite sex:

1. Straight hair
2. fair
3. more than average boobs.. hahahah. just being honest..
4. pleasant smile
5. pro-active
6. sepet
7. environment friendly..

Seven tags go to:

1. Azad - because he's the chief
2. Fiqar - everybody'll want to know
3. Amirul - somethin extra to do in ukraine
4. Izreen - she\ll not be able to resist this
5. Lolyta - silent blog reader..
6. Najmiah - a brit's point of view
7. Dil - my main man..

P/s Salam Nisf Syaaban.. semoga berdoa untuk kesejahteraan buku baru..

ALONE..

I'm in the OAS room now. Obviously i am on call. Sapa la nak gi hospital tak pasal2 kan ? haks... When its not busy , it can be a bit lonely at times. I am the only anaes in this vicinity. The OnG fellas are always busy so can't really lepak with them.

So far , my luck has been good. Only 3 caesareans so far. Only 4 epidurals so far. The labour room still not at its full swing. Time to relax i suppose.

Well , hopefully everything goes well tonight. I'm still tired from Thursday's call. Not in the mood to do call actually.

Puuuuhhh...

Glory days are here again!!

Full house Shah Alam Stadium 

I was one of the 65,000 crowd who flocked Shah Alam stadium last night. It was a sight yearned by many for years . Large group of men singing , chanting and dancing . Celebrating the game.. the big game... Selangor's fan really had their treat after a long lapse. I've been to the stadium with my fellow fanatic supporters time and time again ; usually we'd go back in frustration. But the feeling last night was certainly something new..

MALAYSIA CUP SEMI FINAL. SELANGOR VS TERENGGANU

I really love big games when the supporters will come all out to support. Not just young men , but families with their wife and young ones ; a family outing. Eventhough it was a Wednesday night , nobody really bothered. I was quite surprised initially as the traffic jam caused was really a bummer. We were stuck for about half an hour on the road ; driving 4 kilometers at a snail's pace. mE , dIL , Fiqar and wifey were late for the game !! It was already 30 minutes into the game when we stepped in. It was annoying at first , being late and all. However , when i opened the Kelisa's door - the sound of supporters cheering , the echo made by the massive crowd , all the despair feeling disappeared.


Hardcore fans 

GOAL !!! Everybody was shouting and immediately we knew.. it was Selangor's goal !! We wnet in to have a look on the score board. Damn... 1-1. Which means that Terengganu had scored earlier. Quickly we took the stairs ( pity to wifey who was panting away ) and sat on the third tier. Good view to watch a good game !! Anyway , that was the only tier which was quite empty. The first 2 tiers were full , people were actually standing up to cheer our beloved Selangor team.


happy supporters 

The second half started slow. The game however was played very openly mannered. Both teams were attacking each other and it was nerve wrecking to see Selangor's defense making silly mistakes which nearly resulted goal for the opponent. Bambang and Elli , the two indonesian imports were certainly at a different class from the rest of the field. Thats how Selangor gained good stadium support this year ; the working-class foreigners in Malaysia !!! Khalid as usual was the one to jeer. I do pity him at times but unfortunately he is just pathetic !!

And when the corner kick was taken , everybody knew it was goal bound and walah.. We were 2-1 up !! We were all jumping for joy like small kids !!! Wifey was just smiling and shaking his head seeing 3 20 ++ year olds acting like < 6 !! hahahahaha... ANd of course , when Bambang wrapped it up in the dying minutes , The celebration was complete !!! It is the euphoria that all supporters have been waiting for for years...


kick baby kick 

I hope that my baby felt the stadium atmosphere.Goo exposure though at a very young age !! hahahaha.. Overall ; It was a good game..and a good outing! It was the first time , the three of us watching a Selangor match , and Selangor won !!! Viva RED GIANTS !!

Jonah at its best..

Masya Allah !!!!! Subhanallah !!

The call yesterday was sooooo busy !! I was stuck in the OT for 24 hours ! I know the calls can be busy but waah , i was so knackered come morning and can hardly drive back home. What made it worse was the seniors ; ( Masters students Year 1 & 2 ) are away for their intensive pre-exam course for two weeks !! Therefore , the one on call will have to deal with all the electives as well as emergencies ; to top it up the epidurals as well in the labour room.

However , i was unable to do any epidurals yesterday. I just did not have the time. My apologies to the ladies who delivered yesterday in upmost pain. The Maternity Hospital in HKL is the biggest of its kind in Malaysia. Imagine , having only one anaesthetist to handle all the cases through out the night. I was one of the unlucky ones lah.. On Friday , i was able to take short naps in between , but yesterday.. Muahahahaha.. too intense.. too intense.. cases kept coming like Pipe BOCOR..


Unique aquarium in sentosa

Yesterday , there were 20 emergency LSCS done throughout the 24 hours. I managed 13 of that !! Eventhough it was just giving spinal/epidural anaesthesia , it becomes more of a challenge because of the blood losses that occur intra-op ; very operator dependant !!! The other 7 cases was managed by my colleague who i had to SOS ; 2 OTs were opened 3 times , and from 1am onwards - it was running simultaneously. I dunno why they had so many fetal distresses ; with bad CTGs yesterday ; hence the urgency of OP and having to call Ismail ( my senior ) to help out. I'd query any funny management in the labour room at that time.

I had one interesting case at about 2am. A multigravid lady with multiple problems ( PIH , GDM , I previous scar , macrosomic baby ) who was scheduled for Elective Casear ; in labour. Apparently , she had this really painful abdomen , and haematuria ( blood in urine ) . The OnG fellas pushed for urgent Casear for ? Uterine Rupture . Alamak... i said.. called boss and he sent Ismail to help out as at the same time we had one Thick Meconium Stained Liquor mother as well. I had no choice but to intubate the patient.

It was a nerve wrecking moment. The lady was 99 kilos and mak aih.. GEMUK GILLER , short neck.. thick chest wall.. I really had the table high to intubate. Alhamdulillah , it was ok.. luckily it was sort of impending rupture of the previous scar , not bleeding profusely just oozing. Managed to extubate the patient well without her desaturating. HAks.. the only event in that Op was after intubating and bagging - was ok.. good bilateral chest expansion and the machine showed the tube was in.. but when i converted to the ventilator ; SUDDENLY THE VENTILATOR malfunctioned !!!! ee eee leeehhh... i was pissed off as i had to bag the patient for 20 minutes before the MA came and sorted out the problem !! Tu la pasal , in Maternity they rarely use the GA ventilator . I DID CHECK IT BEFORE STARTING.. but it just decided to fail on me.. mentang2 la not a difficult intubation.

Ismail was unlucky next door . It was a bad case that ended up with HYSTERECTOMY. 40 year old Gravida 4 who came in with fetal bradycardia. The Op ended ok , stable but post op.. during VE , Blood just poured out like nobody's business. Shakti was unlucky as he came to visit me , but ended up helping Ismail to resuscitate the lady. The whole OnG team was there to sort out the case.. giller critical.Intermittently i went to Ismail's OT to help out on other matters like getting the blood for transfusion. After i finished my case at about 6.40 am , i went into Ismail's OT to help him. Imagine ; She lost like 10 L of blood intra-op. Managed to replace it and transfused 2 DIVC cycle. She was then sent to ICU for post op management. Giller massive transfusion ; will have to check on her tomorrow.

Dr Satber ( My Consultant ) came into our OT at 8am this morning. She was smiling and laughing at me seeing the mess in the OT with blood everywhere. The drapes were dirty and it was total post chaotic OT. I just smiled .. haks.. She was a bit worried if i "had" it with maternity posting. But funnily.. The endorphines were at its max .. WAA CAKAAAAP LUUU....

MiNd Block..

After having the "trauma" on Thursday , I came to work on Friday feeling a little bit edgy on facing my on-call. heks.. The OAS ( Obstetric Analgesia Service ) nurses are very experienced and friendly.They are good teachers as well ; it was good to have them around during the day .

Howdy! 
We did our review rounds in the morning and obviously my concern was for my patient yesterday. Pheww.. How glad can i be seeing her breastfeeding her baby. She was actually sitting up and not in pain. When i asked her what happened yesterday , she said she can't remember. She said that after she lied down everything went blank. Syukur everything turned out ok.

SOmehow , after caesarean section , patients are doing well post Op. According to the OAS nurse , after we introduced MOrphine during spinal and epidural anaesthesia for caesarean , patients seemed to recover fast. Gone were the days when patients are immobile in bed for days because of pain. Nowadays , we practice giving 0.2mg Morphine in the subarachnoid solution or 4mg of Morphine bolus in epidurals before pulling out the catheter. There were even patients already walking to the toilet 6 hours post op !! Amazing.. a totally different picture from my houseman days in the obstetric wards..


our lovely set.. 

And guess what... I made a DURAL PUNCTURE for my first epidural patient !! Damn !! Her physique was alright but dunno somehow , i just could not locate the space. So i pushed..and pushed.. and suddenly a gush of CSF came out.. macam PIPE beb.. HAks !! We had to abandon her after my senior tried too and somehow just could not thread the catheter. I said.. Alamak...ahh... how lah macam ni in starting the call..

But Alhamdulillah , my call was alright on Friday. We had only 13 emergency caesareans to do the whole day. ( The record is 30 ooh.. ) It was intermittent and i did have my short naps in between. Only like 2 fetal distress ; the rest was the usual poor progress / 2dary Arrest. So ok lah !! no catastrophies.. Even the hysterectomy they had to do for one lady in the evening was stable. I managed to get the fluids right so she was alright post op.. even though emotionally she was very upset when told during the OP ; the surgeons had to take off her one and only reproductive organ. INserted 12 epidurals that day.. haks.. 2 at 3 am in the morning !! apa la.. tapi nak buat camana... dah job specs..

Nearly..

spinal.. 

Obstetrics analgesia is very unpredictable. One has to be ready to deal with any possible complication. Damn.. things always happen when you least expect it to happen. You just have to be on your toes.. day in ..day out.. I am glad that the Consultant in charge ; Dr Satber is very helpful and ever willing to teach. SHe;d always be around when you call her for help !! HAd my first call on Tuesday night ; it was cold however.

Its true what my seniors told me about this posting. It maybe routine but you just cannot be too sure of everything. I've been doing like an average of 10 epidurals per day. haks.. giller banyak.. I was slow initially , but by the end of the day.. you sort of just poke and walah.. tak ler susah sangat.. hehehehe.. Hmmm.. can't wait to insert epidurals in private.. RM1000 woo per service..

Anyway , something happened today when i did a breech in labour case. A chinese lady , in her mid 30's , 3rd child with i previous LSCS scar . She was about 75 kg and a height of 170cm. Fairly tall for asian ; she had a large frame anyway. Did my spinal , it was easy ; no blood aspirated , inserted it slowly and the amount of drugs used was the normal routine dose. She was fairly happy when she was unable to move her legs.. and i was passing over to my afternoon shift colleague.

This lady suddenly snored.. but it sounded more like a stridor. I thought she was sleeping but we were not able to wake her up. Its like when one hass been given Midazolam - totally knocked off. We managed to wake her up..but she was confused. I was unable to communicate with her ; compared to before she was under.

Damn ..i said.. she became more restless. Funnily , her saturation was good 95- 100 at that time , and the bP NEVER dropped. However she was acting awkwardly , nobody was able to understand what she was saying. During this commotion , i called boss to ask for her opinion. She was a bit on the obese side with a FAT and SHORT neck. haks.. then , suddenly her saturation DROPPED. She was refusing the mask.. haks.. Apa laga.. intubaTE SAJALAH... My colleague gave the necessary IV drugs.. and i managed to intubate her.. syukur alhamdulillah it was not that difficult...

Her saturation picked up - the LSCS went on and the baby was delivered with a good ApGAr Score.. Boss came in later ; she was actually on her way back home but returned after receiving my call. Thanx boss !!! We manage to extubate her in the end..Alhamdulillah she was alright.

In retrospective , Dr Satber said most likely what happened wasa manifestation of a high block from the spinal anaesthesia. Although she agreed with me of the atypical presentation , the most likely reaosn would be that. She was worried of Amniotic embolism , but she picked up and was ok intra-Operatively. hakss.. Gila high spinal macam tu.. I was soCUAK you know !! But it was a good experience , coz i have a rough idea how bad it can be when you least expect it. She was tall !! But i did not consider her tummy was "tall" as well and this might have caused some compression ; hence the high block !!!

Anywya , i'm glad that the patient is ok. but my god.. my adrenaline was sky high !! sakit jantung ahh.. Can;t imagine when i';m realy alone in the middle of the night. SHit..it's tomorrow... haks...

Preferred characteristics of anaesthetists BMJ 2004

A good doctor—the characteristics of a good doctor as outlined by the General Medical Council are found in good anaesthetists
Calm under pressure—anaesthesia can be 99% boredom and 1% terror. You must act clearly and decisively under testing conditions
Dexterity—nimble fingers are not only the territory of neurosurgeons—ask a paediatric anaesthetist!
A good team worker—often the anaesthetist is team leader in theatre
Academic—sound understanding of physiology, pathology, and pharmacology is essential
Communicative—surprising as most patients are asleep! But good communicative skills are necessary through the pre- and postoperative periods
Methodical—anaesthesia is procedural and repetitive, so attention to detail is paramount

Happy Birthday..

Happy Birthday Muti n Doya..  

To my dearest brother.. n sister.. ,

Happy 24th Birthday ..Muti.. @ Mukhreizal Mamat

Happy 18th Birthday ... Doya... @ Eidura Syefeira Mamat

Abang @ eay-lalle