Gigi dah nak tumbuh

araa - ra - ree... 

Main lidah la pulak...

November rain

oncall delicasies 

It's a very wet month so far.Rain kept coming everyday - spells lasting from an hour to 3 hours. Sometimes its the descriptive cats and dogs , sometimes just a sudden gush which resolved in a glance.It made me gave up to clean my car as it will become dirty again after work.

My calls this month had kept me away from my routine Tuesday nite badminton. Therefore , my health seems deteriorating and I can sense my panting after walking up the stairs to the departments office.My aim to have my weight nearing the normal BMi looks impossible as my meals frequency had increase. Its a tradition in the Anaes department to have inter case coffee breaks , as well as the early morning breakfast , lunch etc... Hahaha.. you see what i mean. And how can i resist ?

Wifey and I are currently busy looking for the best deal in terms of financing our home. We just booked a link house in the Bukit Jelutong area and it is a headache thinking about the money we are going to "invest". I had a torrid time trying to understand the jargons with house buying and it is a dilemna to think of which financing scheme to take. Each has its pros and cons. At the end of the day, can you afford it will be the ultimate question.

On top of that , I get to go back to the OT after my coffee break to see wonders in medicine... ( apart from the new HOs and nurses ... )

inverted uterus 

Party bash for the young one

favourite toy 

Dzaeffran's birthday was celebrated in modesty last Friday. Initially , wifey and I were not that keen to do one as wifey is busy with her project and studies. We had a change of heart at the very last moment when we reckon that it should be an event that dzaeffran should have . However I don't think he understood the significance last night.

The party was of small scale , the main menu being KFC and Kajang sate ; something easy to buy at the very last minute. It was a night where we did not put dzaeffran to sleep early and made sure he had a long afternoon nap. It was only for Dzaeffran's close family and Alhamdulillah the turnout was good. As usual Mama and Papa had some other VIP obligation that was more important than Dzaeffran's first birthday celebration.


yeah !!! 

I would like to thank Dzaeffran's PakLong who took a lot of effort to organize this small party. He ordered the ice cream cake and cup cakes which was wonderful ! He then single handedly supplied the balloons !! Dzaeffran had a lot of fun chasing after the bouncy balloons !! It was very memorable singing the birthday song for him as we sang it 3 times !! haks.. Dzaef was stunned and kept looking to everybody around him wondering why is everybody making this funny sound simultaneously !

I enjoyed the food and it was a bit funny that wifey took the honour to open dzaeffran's presents . Thank you everyone for making it a memorable event.

presents.. 


auntie elly special 


family picture 

Nice touch

Ice cream birthday cake  

Thank you very much Pak Long !!


specially made cup cakes  

HAPPY 1ST BIRTHDAY MDQ

HAPPY BIRTHDAY 

16 /11 /05 ... the birth that changed my life 360o...

Tradition in caesareans

holding strong 

There is this one thing i really don't understand why nobody bothered to improvise the "STRING" during caesaran section.( refer to pic ) I believe the practive must have originated since Caesar was delivered .

Basically after the outer abdomen is incised , the upper skin and subcutaneous tissue segment will be clipped and a string will be tied around the handle. Then the string will be thrown to the unsterile site ( which where the anaesthetist will be ) and we will TIE it "tightly" to the table. The idea is for the upper cut segment be pulled tight so that the surgeon will have a good view of the uterus etc.

However ,in Seremban , HKL , Selayang and now in UMMC ; its all the same !! Ikut suka hati tarik perut orang and looks so unprofessional. I'm not sure about the private sector but I bet its just the same thing !! Why nobody improvised ? Cost would be the main factor i reckon. I mean that piece of string may cost few cents and imagine a traction mechanical device that would cost thousands. There are cases as well where the baby's face will be brushed onto the clippers and causing abrasions . That will depend on the surgeon's vigilance and awareness though.

But still.. heyy.. it looks terrible. Especially when patients under spinal who's only anaesthetised half her body ask...

" Doctor.. tali apa ni ? "
" Mmm.. ni nak tarik perut sikit so senang nak potong and keluarkan baby.. "
" Macam tali kasut jerr... "

Haks.. Hmmm.. looks like a good invention idea for "Mafeitz's Pull" !!!!

He'll be one tomorrow !!!

first ferrari 

I can't believe it. He'll turn 1 tomorrow. How time flies my little dzaeffran.

little men 

big robot !! 

Angina tu Tun...

Tun M was admitted to IJN early this morning after complaining of chest pain in the wee hours of the morning. The latest news on him is that he is well and had a minor heart attack.IJN consultants has yet to organize a press conference tii date in explaining Tun's condition and progress.

Being symptom free since his bypass in 1988 , having chest pains now is a worry. I suspect he may need surgical intervention in the near future but being 81 , I am not sure whether the risk is worth taking. Maybe he needs to cool down and not moving around so much as if he is still in his 30's ; that is if Tun wants to prolong his life expectancy.

The timing of this ailment is also interesting as the UMNO General assembly is next week. Recent controversies of Tun vs Pak Lah had made the public anxious to see the proceedings this year. Tun has always been regarded as a Malaysian hero and his recent spat tarnished that perception ; he is perceived as Mr Villain number 1 in UMNO. Many speculations and rumours had surfaced regarding what he may do in this coming assembly.

UMNO politics runs a strong tradition of :
a) respecting the elders
b) forgive and forget

With his condition now , strategies need to be improvised by his detractors . Going against the Malay tradition , culture and way of life can be detrimental. The Malays are emotional and sensitive .Strong issues can be forgotten and in fact forgiven with sentiments and life events such as this.Remember DSAI ? Tun looks invinsible for now if he continues his critique role while from in the IJN but it can backfire instantaneously. But Tun is smart and sharp.. Lets just wait and see what happens next week.

Semoga Tuhan panjangkan umur..

Ad hoc call

door 

I was happily having trouble with my first elective caesarean section patient when Susheela came in and told me that Aktar's ( who is on call ) wife is in labour.That means either one of us will have to do the call yesterday.Susheela had just came back fro 2 days MC for a bad flu ; which means that I am the sole candidate ! haks.. Kelam kabut jugak as i had to go back home and take my things.

The call was mild ; just the normal routine "kelam-kabut"ness of the OnG side to do caesareans. I don't mind doing OnG calls because I enjoy it. I don't mind putting epidurals in the middle of the night unlike few of my colleagues. Somehow , you became the patient's saviour in relieving their pain.It's worth the effort to see them smile and happily nursing their baby. It is very rewarding when they thank me during removal of the catheter after the delivery.Its not what I yearn but I believe as a doctor you've done your job to help them. Alhamdulillah , my epidurals proceeded to vaginal delivery on not the OT table.

by the way , after a lengthy complaint ; the management have repaired the toilet ! Apparently the air con is working as well but it smells la pulak !haks.. The fan was adequate for me and I slept in that room last night ; only to be awaken up by the pager at 4 am !

me : Dr. Mafeitz anaes here.. anybody paiged me ?

houseofficer : mmmm... kejap yee... **yelling ** ada sesapa paige anaes ke ?

background : PAeds... Paeds...

houseofficer : Alamak doctor.. sorry..salah paige lerr...

me : eee.eee..leeeehhhhhhh....

the room 

Something you'd always remember

Winter Sonata 

*translation*

You Jin : I love you...
I love you since the first time i saw you..
I will always love you..
Is it wrong for me to do so ?

Jun Sang : "speechless..."

Trying to get into the right gear

my study area - check out the pin ups !! 

It had been quite some time since I sat down and study. Well don't think i've dedicated my time to do so since i ended medical school. After the punishing 6 years of my life why should i do so right ? haks..It was such a liberation after graduation because I don't have to mug the lot any more. True enough , "thinking" doctors is what every medical institution aims for ; but without hardcore knowledge - no point thinking then doing rubbish. ( the main difference between us in the medical fraternity with politics)

I've been in the post graduate programme for the past 5 months now and I am still procrastinating to start reading up. My major Part 1 will be next November ; thus the more reason why my mind refuses to get my brain working. I have my aptitude in January which is not counted at all but still.. hello !! Wake up boy !! Enough of the honeymoon...

I am not the type who can sit hours on the table ; mugging things in. I like action and that is why I am in anaesthesia. Unfortunately , I have to be the MASTER in Physiology and Pharmacology before I can declare myself a competent anaesthetist ! Mak aii.. so many things to grasp ..

Being in the maternity posting these 2 months should give me enough room to study as the elective Caesarean list is not as heavy as the OT list. By 12 noon it is over and I'm back at home. I've been handling the cases alone for the past 2 days as my senior colleague had to take emergency leave for her child's sake undergoing surgery for torsion of testes.

I have to discipline myself to sit on that table and study...

and not engaging on my PS2 playing Winning Eleven.......

goaall.. 

can we stop it ??

one step for mankind 

Dzaeff has taken his few first steps and he is certainly enjoying it !! haks.. I watch with wonder how he discovers his ability . Trial and error with each fall ; looking for recognition everytime he succeeds. Its fun to see them grow ; and to see them having a "bit" of you..

partners in crime 

maternity period

tvroom 

Did my first obstetrics call in UMMC last night. Alhamdulillah , it was a cold call as I only had 3 Caesareans and 3 epidurals to do in the last 24 hours. I was ready for a busy call as those on call last week had a torrid time. It is not as bad as how my previous posted colleagues described . Maybe I am a bit biased as I was initially trained in Maternity Hospital , HKL.Anyway , the number of beds here is far less than the sardine packed wards we have there. It makes me wonder whether the house officers here are trained well enough to face the real world. We need competent doctors and not slackers who would prefer to sleep off the night than treating patients. That is the path we have pledged to thread on !

The one negative thing about this obs call is our on call room near the labour room. Absolute 3rd class ;air cond is out.. the linens unchanged , smelly room ; basically crap maintainence. What makes it worse now is the toilet is spoilt and there was no effort by the labour room management to fix it. Mana boleh ?? I ended up sleeping in the common room ( tv room ) on the couch which was not that comfortable .

The day started off alarmingly potential "jonah" day by having a cord prolapse case.Having the OnG team to go panic did not help at all. As they transfered the patient to the OT bed , they managed to dislodge my IV access which was vital for me to proceed in the first place. Calmness should be the main skill to attain here to ensure smooth operation. The lady was obese and regional anaesthesia was not a choice ! I manage to intubate her eventhough i could not view her vocal cords properly.. Alhamdulillah the baby was well and I did not have much problem with my intraoperative anaesthesia.

Then it cooled down - my epidurals were successful as all my patients delivered vaginally. Ok lah tu for my first call in this posting !!

sleepy head 

The on call routine

UM OT technology 

Did my first call post ray period yesterday. I had to miss the all awaited badminton session last night! aarrgghh.. and looks like November and December will tax me heavily with 8 calls per month !! Back to the old HKL routine then.

We had and all men team yesterday and we scheduled plans to have our lunch and dinner outside - hoping that I was able to visit the badminton gang in RASTA late last night. Unfortunately , we were not able to do so due to the hectic emergency OTs with complicated cases. My 2 SMO ( Senior MOs) had to be in the OT all the time as well and neither rested well as how it had always been.

MY 2 orthopaedics cases which was suppose to be a straight forward simple procedures became chaotic due to excessive bleeding. My 82 year old ITP with a platelet of 32,000 bled 1 liter during his below knee amputation as the surgeon accidentally snapped on a major vessel.THis old man's heart was strong and we managed to extubated him. My 20 year old boy bled a lot eventhough it was just a debridement. The thing was , I did not manage to catch up initially because my trusted IV access "caputted" at the wrong time. He went hypovolaemic and was very restless as I only gave him spinal anaesthesia. It went on to about 3 hours as the block was wearing off but i suppose communication is the key and managed to calm him down.

One nearly amputated forearm case came in for reimplatation at 6pm and that spoiled our OT arrangements. It took one OT 8 hours up to 2 am to settle and i hope the reimplantated arm worked. I had one lady with a really bad heart condition up for OP and she was in the waiting area from 5pm and I only managed to check on her at 12am in the morning ! As usual , as anaesthetists we were informed that the patient is allright but upon seeing ; I discovered that she had 3 vessels disease with almost all 80% blocked and she failed her stenting 2 months ago !! Her ECG was SCARY !! And doing her at 12 midnight ?? haks.. I was cursing myself because we cannot postpone her after the long wait ?? Luckily her I&D was superficial and my femoral block was good enough.. with again "REASSURANCE" strategy.. ( + a bit of midazolam.. morphine.. fentanyl... hahahahaha.. ) I wouldn't want a GCS 15 arrest on table would I ??

scalp and skull opened up with the brain swelling really bad-from my camera phone  

We had one neurosurgery emergency as well for an 85 year old man with bad lungs at 10pm. He had craniectomy done 1 week ago for his intracranial bleeding and unfortunately now infected ; with his CSF leaking obviously when you carry his head up.It was like a leaky pipe. Initially we thought that the debridement would only be superficial thus inserting LMA so that he spontaneously breath.Thinking that we will not to further his dependency on the ventilator machine. Lepas tu surgeon buat lawak pulak .. and opened up his skull !!(picture above) Hakss.. It got me and my SMO praying really hard that things would not go wrong ! Gile punya kerja but we pulled it off.. and I suppose , I can say now how it is possible to do neuro cases wihout paralysing your patient fully ! haks.. please do not try it aahh..

Slept at 4am ; wanted to watch the Liverpool game but I fell asleep instantly after throwing myself on the TV room couch.