Happy Anaesthesia Day !

It was Anaesthesia day last week 16/10 and i decided to celebrate it with my staff. We did not have full house as people were still on Aidiladha holidays otherwise we would have had a grand celebration! Having a small family, we are happy to support each other and i guess i wanna have a good working environment.
I have always dreamt of having the ideal workplace and everybody would want to contribute to the best of their ability.. whenever.

 I took the liberty to order a special fondant cake from an old friend of mine. This is her core business now and I was confident of her creativity to produce what i want. And.. wow.. it was amazing! Everybody loved the cake and hesitated to cut the open up hahaha

Adik's wedding weekend

It was the last wedding for my Mother in law. Since its a girl's wedding obviously it will be more elaborate. My MIL is a simple person so organizing for such an event is not too much of a hassle. We've all decided to the the nikah at our place in Bukit Jelutong! It was a suggestion i had all along because our venue is much more convenient for people to come. The DJ house is a total congestion nighmare and I'm glad we made the right decision. Although the wedding event was a bit early for us (haha) but it was an experience organizing it at your own backyard.

 The reception was done in Dewan Gemilang FELDA in Kelana Jaya. It was a simple place for a maximum of perhaps 500 pax.I do respect Qayyum for his willingness to perform on the stage despite being prompt quite late.I felt really proud seeing him doing the silat pulut which the steps he managed to memorize it in 2 days. It was not long but to have a young person up there was good enough for us. I am indeed very proud of my kids; Qaisya and Marissa did not have any issues being the flower gals :)

Thank you team for a good outing. The organization was superb and i will certainly miss the boys session of putting the signs up the night before :)

My short Singapore trip

I was last in Singapore in 2011 whilst attending the World SIVA conference.I was back again a few weeks ago for ASCA and this time around, i saw a different Singapore. I guess its because of my lodging, having to fork out my own money i decided to become a miser haha Well, its me alone so whats wrong in being in a backpackers hostel like accommodation?
I looked through trip advisor, booking.com and there was this place which was cheap and at the same time highly recommended. I thought why not as the location is superbly in Boat Quay; the heart of the nightlife in Singapore. Besides being only 5 minutes away from an MRT station why not?
I saw the pictures in their website, 5 footway.inn but of course being sceptical i reckon it will not be as how they hae potrayed it. To my surprise I was totally WRONG! It was how it is advertised and my my.. Cool gilerr!! haha I shared my room with two other visitors whom I've never met before. My next bed bunk mate was from India who came over to Singapore for a conference as well.

                                                  i slept up there

The breakfast terrace view was superbly excellent as the magnificient Marina Bay Sands hotel became the main landmark. At night, live music was just down below and i enjoyed my sip of coffee (free.. haha courtesy of 5footway.inn) and my laptop with the free wifi provided.. Wow, it was simply amazing to be at this place :)

Going around in Singapore is easy when you are travelling alone, the public transport is convenient and having been to few countries with such facilities it was never a problem for me to go where i wanted to go. Of course the Wifi service is not as good as ours in Malaysia (as it is not free!) but I manage to meet up with Hilman and his dad for a hearty meal of murtabak Singapore! Perggh.. memang kenyang tak ingat!

                                                      Murtabak Singapore medium.. ??

                                            Pak Basri the amazing man from Singapore

I took the opportunity too to meet up with Shah who is a Consultant in Alexandria Hospital. The cool thing about where he worked is the mosque is just behind his hospital and I managed to perform Jumaat prayers here. In Singapore it is not convenient to pray Jumaat and Shah is very lucky! I then met up with Rudy and Norlina( my colleague from Manchester to IMU) . They brought me to the famous sup tulang merah.. and wooo behold... Sedap gille! hahaha

ASCA 2013 Singapore

I was in Singapore recently attending the Asian Society of Cardiac Anaesthesiologists. I registered for it quite some time back after browsing through the net. What got me interested was the programme and of course the orgnaizer being Prof Hwang, I was sure it would be really good.

                                              the cool thumbdrive on ur tag

Indeed the programme was good and i was glad i made decision to fork out my own money for the trip. Sometimes you cannot rely on sponsors when your main objective is your quest for knowledge! Of course, i tw ould have been better if people were racing for me to do it but i guess my aim would be to be invited as a speaker :) Then you do not really need to beg and wait for such offers as everything is settled by the organizing committee.

It was an eye opener for me meeting up with fellow cardiac anaesthetists from Asia. I was taken aback when both the authors of my TEE book was in the congress as speakers! The venue was excellent too ; held in Academia a building dedicated for academic excellence and the facilities for the small congress we had was just superb. Kudos to Prof Hwang who i guess in his way single handedly doing things that he wants to do:)

p/s I will always remember Prof Hwang for his remarks during my viva.. "Are a an ED physician or an anaesthetist?" hahahaha

My SCMKL 42KM 2013

Yes.. Another chapter of me testing the limit of what I can do.. My 3rd official marathon which is the 42km! And of course, as usual.. the unstructured and incomplete & suboptimal training for the event! I guess I will never find real time to practice for the 42km and as how addictive it can be, I somehow don't mind to cause suffering to myself! hahaha Well, I may not have achieved the goal of fully running a marathon but i do still can finish it.. By hook or by crook :)

After Perth City to Surf last year, this is the next marathon that i have decided to join. I guess if it was during its original date, the run might have been different. Then I was just back from EBC and perhaps had achieved my best physical fitness ever. But the postponement certainly changed a lot of my conditioning.

 Coming to the event day, I was having doubts whether i should go on. Honestly, the training was in shambles and I was never the man i was when i ventured on Perth's City to Surf. Being me, tawakkal Alallah je la.. haha Why not kan..why not? The bitter experience of 2010 is still in my mind but that adventure had taught me a lot to prepare and protect myself.It proved to be helpful during City to Surf.. and for this run:

1) Anti blister cream
2) Instant Pain reliever (got myself a spray on)
3) Nutrition for the run
4) Rocktape
5) Compression top & bottom

I was up early. At 2.30am I woke up on my own. Of course, after a good carbo loading the night before, I had to let it all out to facilitate my run. I remembered when i did my first half marathon.. haha I spent sometime in the toilet immediately after the start :)

I parked next to Masjid Negara as the road to Bukit Aman parking was closed as early as 320am. There were not that many cars then so i had a good spot:) I felt a bit jittery and the morning was pretty humid. There were already a sea of runners waiting and everybody seemed to be excited to be part of this big running event of Malaysia.

The marathon flag off started on time at 0430. It was a good crowd but i did notice that there was no gush of wind. Hmm.. it is the start of a very warm day! My pace was good but i was a bit careful not to push myself too hard inthe early stages. This is Malaysia and the weather is different. I remembered the suffering I had during the Kuantan Century Ride!

I thought i did well till about KM15 when i felt a bit burnt out.. literally! It was so hot and i just felt very tired and fatigued! I started to walk and run and walk again at this stage and I thought oh my.. this will be a long day!

 Half way along the run, honestly i felt like quitting. Seriously! I was burnt out and somehow the mojo was not there. I can;t explain why! I was feeling weak and helpless. And i sort of decided at km22 I will stop. And I did. took a breather.. and tried doing a selfie pic haha Then somebody asked if i wanted a picture there and of course i replied Yes! Somehow the breather at this cooled me down. At the water station there i slowly took few drinks and munched my chewies ( i thought this was better than the gel.. which after sometime can be a bIt revolting!) Somehow, I regained my strength and determination, and I told myself.. I cannot stop what i have started. I guess, this was a reflection of our lives.. At times, we may wanna just give up or change directions. However, if we have a goal.. then we have to go all out and persevere.

 Of course, the journey from the Cheras Badminton Stadium to Segambut was not easy. It was getting hot when the early morning sun rose.From KM22 onwards, i was moving on fine. Though i walk in between mostly because of the twitches I felt. I did not push myself too much as I do really want to finish my 42km in one piece!

 After KM30, The rejuvenation was obvious. I did not feel the pain and fatigue that I had before. In fact, i felt stronger to continue and I was sure that I can do it. I did listen to my body when my small runs somehow caused some muscle pulling here and there.The water stations were really good as I don't think I was in a state of dehydration at all during this whole run! Subhanallah.. it was SOOO HOT! I felt like a running coal and at every station with a sponge i will literally bathe to cool myself down. It was AMAZINGLY SUPER HOT!!!

 At KM37 I met Shuk again, whom went passed me at about KM15. He was not in a good condition and with my spray on, he felt a bit better. The cramps were getting on him and he was struggling. Seeing the time, I know I may not achieve my PB. This is the first time i can actually finish my 42km with a friend and i thought, Why not escort him all the way to the finish line? I am sure my presence lifted his spirit and both of us slowly paced to the finish line!
It was an overwhelming finish when i reached the Finish line. It may not be as estatic as the first time.. I can still remember how i felt when i saw the finishing podium then.. and again this time around I was proud to have finished it again.. haha because of what i felt at KM22, It was such a good feeling to persevere and complete what you have started.

My gun time was 5 hours and 52 minutes. Way beyond my best time I did last year. However, i am not dissapointed because despite my appauling training, i manage to finish it under 6 hours. It is a definite improvement from the 7 hours I did in 2010 hahaha Alhamdulillah, I completed this run without much morbidity.. though a bit fatigued but not injured. I am thankful for that :) 

And now.. I will have Putrajaya Night Marathon next.. I am Insya Allah sure, I'll clock a better time:)

The learning continues as we are up to 15!

It has been an interesting journey. Whatever that I've seen, done and learnt before did not really prepare me on being the clinician taking full responsibility of the patient's management. There is never a straight forward case, something and somehow things will happen and pushes you to the limit to apply the knowledge that you have obtained.

Having your own patients do not mean that you cannot refer to your friends elsewhere for opinion but having to make decisions there and then poses the ultimate challenge of to do or not to do. Its not about you having the balls to proceed or not but to make an informed decision for a better outcome can be really unpredictable.

Being in the theatre poses a challenge but managing them post operatively can be tricky. I am glad i have had full ICU training in Sg Buloh therefore there are lots of bits and pieces that i can match together for a better outcome. From Sepsis to managing nutrition, from haemodynamics support to ventilation I was challenged in a way i never thought that i would come to someday.

Of course, I am still a long way from being a "House" (from House MD). The learning before was compartmentalised but managing real patients is a multi holistic approach. Seriously! Its not just a jargon but having to manage all the problems at the same time can be overwhelming. Having experienced staff and a good team is essential to the success of such a programme.

I wish i can be of more descriptive as how I've done it before. However being in my setting at the moment, especially at the beginning of our mitosis; it is against ethics and can be medico-legal if I am to discuss or reveal the specifics of each surgery and procedure done.

I am looking forward for more adventures as it matures my ability to troubleshoot and manage as we go. Nothing beats experience and Insya Allah, slowly I am gaining it.

This week 16,17 and 18! Allahu Akbar!

Successful event thanks to the great team

As I've blogged earlier, my thanks to the team who made it al successful that it turned out not too bad! It was a lot of effort and enthusiasm. I really do appreciate the wilingness of all the staff to make it a success.

                                                                  Kudos team!!

Simple life.. not so simple as it should.

I try not to make my blog as my emotional bashings but throughout the years (it has been 9 years in fact!) at times I just have to blurp it out. It has only been indirect and to those who knows me may understand wy at those junctures i just have to blog out a few words. Its a venting space but I try very much not too be to specific on the topic.

A healthy mind is needed to be productive and unhealthy ones can lead one to misery. That is the root of happiness. If one is unable to free one's mind from hatred and envy, one will not be able to feel what happiness is all about. 

I used to be bogged down by this fact but i have liberated myself years ago. What is the point of being unhappy thinking about other's misery? I suffered then and it made me suffocate. Keeping a clear mind is really important and we get to be focused on what we do. Seriously, I'm not bothered anymore of what people can do to me and perhaps it is just my nature to be so. It gives me the peace of mind and Alhamdulillah, I'm sure that Allah is kind to me on that.

Treat people how you want people to treat you.. and important concept. However, it is not grasped by those who reckons that whatever they do should be recognized and respected. Respect should never be asked as  it can only be earned. How is it earned? By the way we deal with things daily and the respect will come with it.

Honestly, i yearn for simplicity.. the simple life. Being simple on everything that we do, I maybe a high achiever with many aspirations but nowadays, i envy those having simple lives.On Sundays when I have the time to do so or when i am not working, I love being in Shah Alam Stadium bazaar. I would sit down and observe the simple life that people has. What the community is all about, the lower middle class society. Simple life, simple hopes simple needs.. And unfortunately, I don't have that.

A simple life.

Hari Malaysia 2013

16 September today.. Selamat Hari Malaysia! Since 2011, the gov had introduced the day today as a public holiday. Interestingly, it was a question I asked when i was younger, the eager beaver learning history of why was 16 September not celebrated but only 31st of August.History is interesting but a bore to many. I love history because of the story it tells and about the humble beginnings of many things.

History would also compass of how things can go right and showed retrosepctively how it went wrong that leads to the downfall. I have always wondered that did not these leaders realize the obvious wrongs they were doing then? Throughout dynasties, empires including our own Malay Empire fell due to the same causes. By history it is obvious what brings people apart instead of together. Again and again it is being repeated which brings to my own conclusion about history.

The saying goes that we learn from history. I reckon for a hard crude fact We've never learnt from history! In fact, despite knowing all the does and donts, We tent to repeat history again and again. There will always be the struggle to start off with, then the peak and then the downfall. Interestingly, all empires and civilization fell because of the same reasons. It may not be similar but the principles are the same.

Malaysia by convention is 50 years old, Independence has been 56 years last August. As a country, we have moved up a rank and different from what we started off from. We seemed to have a direction and objective, rooted with the eastern culture and mentality we have grown. As a nation, we are still very young and the basis of how we want our nation to be seemed to be rocked and shackled. It is not being helped by the openness of our media as the information which is unvetted is easily available online 24 hours. The biggest sin of rumours and wildfire stories are easily flamed through this media nowadays and it is not easy to know which is really true.

Being idealistic does not mean it can be translated into reality. Being in Malaysia, there are so many taboos to crossover. As a nation, our maturity is still questioned whether we can really apply the idealistic nature of humanity in our society. We can never run from our eastern values and it is apparent in our past civilizations. It is easy to be swayed by western ideas of liberalisation but at the same time we have to be wary of their cunning nature. History has shown that fact of how manipulative they can be; and in this time it will not be the physical nature but perhaps the indirect influence of our thinking and ideas.

Hahaha.. as you can see i can ramble and ramble without stop. I have always been a keen thinker on this issues and perhaps now I should be more vocal to put my ideas through.

Selamat Hari Malaysia Malaysiaku..:)

One Friday 13th: Essentials of HO

It was such a hectic day.. I was jugging two things at one time. My patients in CTC and at the same time ensuring the Essentials of HO being organized well. It was not easy but i guess the flow of planning that made it work.This was an official College of Physician's ,Academy of Medicine Malaysia programme and no way can I muck this up.

I am blessed to be surrounded by efficient colleagues and fellow doctors who did what they were asked to do.I was a bit gung-ho when i changed the whole programme of how the afternoon session should be done. I suppose it is because i have a bit of attachment with regards to HO training and I do have my own ideas how they should be exposed. Coming from Simulation background; as I have always wished that I was trained in such during my undergraduate days. In fact, i believe it should be a big component in the Master of Anaesthesia programme.

As my head was totally filled in with the happenings, it is unfortunate that i did not have the time to snap pics to show the event. One of my trainees managed to recogize this and took the initiative to take the event pictures! Hopefully i have it available by next week so that i can share it with you.

I have to thank my ED colleagues; Izzat, Julina , Amin and their 2 trainees for their support. They have been really helpful since we started Simulation based training 3 years ago. Of course, to Nadia, Azman (who came and helped my O2 station at the very last minute!) the awesome trio.. Fairuz, Naim and Azizah (my future co-workers) who handled the logistics efficiently and made everything work during the day. I was worried if the flow or things that can go wrong on that day. Handing an OSCE like session is very labour intensive and needs a lot of coordination. It was not easy but Ahamdulillah, i do appreciate my team members.

Thank you! Thank you!

Exponential progress, CTS rolling forward

Alhamdulillah, we are at no 13. Who would have thought our team are capable of going on strong as such. We are not aiming to be a service centre like IJN, but we are progressing well towards being a cardiac centre.It has been an interesting few weeks now and the trend is we are getting busier. I guess it is a good thing for CTC as now we can see how by starting Open Heart surgeries we have managed to tickle and activate other departments to move forward.

 One of our patients had a delayed recovery. It was certainly a challenge to us the anaesthetist managing an ICU case. It was in fact the first proper ICU managed case. From an eventful cardiac surgery, we thought we were OK after 2 days but suddenly he developed an abdominal pathology which we were thinking of the worst about. Luckily it was not one of the common complications and managing the patient holisticly became a true challenge for us. We needed to reintubate the patient twice and both times the whole team had a challenging time to decide and consider options.

At a certain point, I did feel like doing a "House"-like queries on looking for the cause of insults. The patient did went into multiple organ failure but in terms of grading, it did not go to the severe spectrum.It was really a good case to reflect upon and review how we have managed it.It was really interesting and made me learn more than i thought I've known. Partly, the training I had with Shanti in Sungai Buloh really helped to bring the patient from its brink. I guess it is time for me to grow as well and make calculated clinical decisions to scenarios which was uncommon to us.

The whole team had our Aidilfitri do in a different manner. We started with prayers and of course, the awaited makan. Honestly, this is the place I want to be at the moment. To have a team which works cohesively at the moment is enlightening. I can see its potential to grow and it can only be better. There were glitches along the way which could have been very detrimental. However, Alhamdulillah; we manage to control the hitches with care.

To infinti and beyond :)

Life Long Leaning - Lessons I;'ve Learnt

Norizal whatssapped me while I was doing the CABG the other other, but i was not able to answer him. Nor did i know what it was for. He then called me up coaxing me to give a motivation talk to the new batch of MBBS UiTM. I told him about my issues : I have 5 kids to take care off on Saturday morning but he reassured that it can be handled.
Yup.. it had been quite some time since I last did a motivational session with young medical students.It used to be a routine for me since my medical school days and even after that. It was my forte before and of course, I would be more than happy to contribute.
I was honoured to be given the first ever slot for these students in UiTM. haha It was overwhelming but at the same time, I had to ensure the talk would not be too boring or typical of an academic staff. (As usual, I always try to be different..) I spent the night looking through my old pics; as i am sure visual stimuli would make people to be more interested with my talk.
I can see myself in their shoes.. All of them do not really know what they are into :) Everybody will say they really want to do medicine but soon reality will hit them. To carry the responsibility of becoming a future doctor demands a lot of their effort and time. The shocking thing later to them will be when they start working.. It will totally be another chapter and challenge. I do hope that our medical school will train them to be resilient and strong to face what is to come. The scenario and setting will be different but the gist of it i feel will remain the same.