2008 Greeting

Did you happen to watch Pak Lah's New Year speech ? I didn't really watch it though but it was the only thing on TV and I wasn't paying attention. However , I do have "sharp" ears and I don't know whether he uttered it by mistake or simply reading the text without thinking..
"Syabas kepada angkasawan kita yang telah menjejakkan kaki di ISS pada bulan FEBRUARI 2007...

HELLO ???? FEBRUARY ??? Hmmm....
Salam Tahun Baru 2008 ...

Hello uncle..

Hepatic encephalopathy patient ; Intubated for airway protection 3 days back because his conscious level decreased markedly. Apparently , according to the medical team , his GCS improved ; and I was asked to review so that he can be extubated ; if possible immediately.

" Uncle apa khabar ? "
He was looking at me.. smiled and nodded with the endotracheal tube still intact.
" Uncle mau tube keluar hari ni... ? "
Still looking at me , smiled and nodded.
" Uncle boleh batuk ? "
still again.. looking at me ; smiled and nodded.Hmmmm...
" Uncle , ini saya pakai baju biru ka ? " I was wearing my red baju melayu.
Again.. the same response... nodded and smiled.
" Uncle , sekarang boleh balik rumah.. ? "
He smiled and nodded. I stopped asking , and moved to the side.

Haks.. he was still looking at the place where I was standing.. pause and smiled and nod !
I guess ; he's not ready yet .... :)

Always about something..

What to do ? do to what ?
Its only you or one of me ,
is it yes or is it not...

Searching for light
Or is it not shining anymore..
Auscultating for heart
or is it not beating irregularly ..
Looking for solace
or is it deep in to stay...

*ICU delirium*

I'm not as young as I thought I am

I am so tired... drained.. exhausted... having being oncall continuously during the raya weekend. I used to be all psyched up physically and mentally while doing my ICU calls but I guess when you have too much of it ; you get jaded and so knackered. Being independent is very prominent as a UM trainee .At the same time to know when to consult your superior as decisions are based on knowledge and experience.
I just wanna sleep for now...

Smile and smile again !

Gambling the fun

We were hoping Dzaeffran's lesion would clear off so that we could attend Azman's ( Edrus's) birthday. It was not so convincing ; and we decided not to attend to avoid spreading chicken pox epidemic ! We all had fun the other day going to the zoo ; spontaneously , we decided to bring both Qaisya and Dzaeff to " Kota Keriangan" Genting !!!!
Of course , this time around it is not about us but about the kids ! Gone were the days i would valiantly thread on my adrenaline and scream my lungs out. Now , its about wait..and wait..and wait... hahahaha.. but I am not complaining ! Seeing both of them enjoying themselves is indeed rewarding ; and watching them adapting to the different ambient temperature was cute to make me smile before I go to sleep ..:)

Sejuk.... intermittently though..

Jumbo trip

It has always been his dream to drive the family

classic Ferris

With the sponsor

One for the album !

Its a zoo day after all

After a lapse of more than 25 years , I returned to Zoo Negara today ; with my offsprings this time. I've always remembered the smell as it is the one thing i really can't stand . It still smells the same though !! hahahahaha It was a fun outing with Dzaeffran running around liberally ; as happy as he can be. To hear him naming the animals as he sees them was a delight ! Now he knows that the characters in his favourite book at home is indeed real ; alive and kicking !

a must standard protocol pic

Trunk call anybody ?

eat me

E = mc2

Don't be sad.. :)

I don't wanna go home...

Though nothing compared to Singapore zoo , it was an enjoyable trip and now i understand why it is so much fun to bring children to the zoo.

Standing still

"Dr.. patient brady... "
" Oh... ok... " I rushed towards bed 13A as I was on the other end of ICU.

His family were reading yasiin around him as how I've instructed them earlier in view of the poor boy's prognosis. Quitely i tapped his father's shoulder.
" Anak pokcik dah nazak sangat sekarang ni.. Pokcik bisik syahadah ye... " I said in the most gentle manner. His heart rate was getting slower by the second and his pulse was very weak.
"Ready for CPR... " I instructed my nurses.

The unfortunate 24 year old man , who collapsed in a nearby Health clinic 13 days back , had almost all his small bowel resected as it was dead - gangrenous upon arrival in our hospital . He then remained septic but it was a bit funny that he never recovered fully - when we woke him up ; almost always restless ; potraying severe pain . He never tolerated his feeds from Day 1 ; and yesterday he went into Septic shock. Through differential of opinions amongst the carers since the first op ; he visited the theatre again yesterday . BY then , he has already developed multi organ failure and needed quadraple inotropic support. The Op findings matched with what we suspected earlier.

When I escorted him back from the OT ; I knew the night would be a nightmare. He arrested on the table and a short CPR was done ; luckily his eyes were still reactive then. On arrival to his room ; he just bled from everywhere - and seeing fresh blood coming out from his ETT ;was a sign that his deterioration is irreversible.

" Adrenaline shoot fast..... continue CPR... my saturation... my pulse please... "
Being the standard protocol of CPR ; the ICU nurses were used to the routine and it was good everybody knew their role. But the patient was going nowhere as he was not responding.
I looked around at 130am yesterday , in the tense activity , knowing sakaratul maut and izrael taking their turns . His "roh" taken away , leaving the body lifeless. All that happening in a split second , without any of us in this dimension realizing it.
Lailahaillallah... Lailahaillallah....
Pulse ? none felt..
BP ? no tracing..
SPO2 ? unreadable..
pupils ? both 5mm.. fixed dilated.
Any spontaneous breathing ? No trigger... no chest rise..
ECG ? straight line... asystole....

Time of death ? 142 am.

Dream on..

Something i don't think I will be able to do ( one day... ) tapi macam nak... hahahaha

Dealing with izrael

We had two mortalities ( deaths )last week in our ICU . Both , during my call ! Therefore , being the MO on call on that day , I was to fill in lots of documents ; which if I don't do it fast ; will pile up as days goes by. Paper work is something i'm not keen on and it would be really sad if hospital management revolves around it rather than total patient care.
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We had another death today ; and it was in a way a blessing considering she's been in ICU since late October. It will be tough for the parents to accept as she is only 21 but the agonising suffering for the past 2 months was worst. As an intensive care unit , our job is mainly to stabilize , get everything under control ( infection , effusion , renal function etc.. ) and reverse the morbidity .However , it becomes tricky when pre morbid factors are taken into consideration ; and it becomes an ethical dilemna when the patient comes with a known disease with an unlikely good prognosis to start with. It is true , that as carers we have to give our optimal attention and treatment . In our current setting ,it becomes a challenge as resources itself limits one's point of management.

I must say , it is a challenge to make decisions that would decide life or death. A consultant or the person in charge must be brave ; backed by knowledge on every decision. It is the superiority of experience which holds the edge ; but without a firm personality it means nothing. Stamping down one's feet is very crucial because resources are limited and should be aimed for those who will benefit ; not for the sake of academia.

I will hold that responsibility one day , and I am still learning. My decisions will be questioned by god in the hereafter , and will i be able to justify my actions ?

Intensivist dilemna

I am back in ICU , few would dread , few wouldn't mind , few can't wait for the chance. As for me , I am OK lah with the ICU rotation because :
1) you don't have to do pre-med.
2) you are not confined to one theatre for the day
3) If you are not on call , departure from work is predictable.
4) you get to polish your line insertion procedure skills.
5) You get to go to the wards and A&E

Not that i enjoy it so much but it is not that bad. It is one of the subspecialities in Anaesthesia and not many people are fond of it. Few that i knew are really cool and you know they were born to do it. I guess experience would contribute a huge bulk of current decision makings. Its not easy to decide on who should be admitted , who should not. The tough part being to withdraw support ; having to consider patient , family and resources factors. Its a big responsibility.
We are under a different Prof now as the Consultant of ICU. Her management is certainly different from the previous Prof I worked with during my first year. Both have different style of management that are controversial at times ; especially with the doctrine in HKL. I'm here to learn and I guess by being under different heads will ascertain my decision making in the future. These individuals are qualified Intensivists and having Fellowship recognition from overseas anaesthesia body must surely mean something !!

Chicken pox period

During my exams , Qaisya had her chicken pox. Obviously , his elder brother would follow suit and yesterday the pustules were all over his body ..
Kesian tengok dia tergaruk-garuk... hahahahaha

Life goes on

Post exams , I certainly felt a bit loss. For the past 6 months ; my main concern was passing the exams and it was just about physio and pharmaco mugging , again and again without fail. Though at times it became a bore but the show had to go on. I suffered from a bit of "withdrawal" for the past 1 week , coming back home and felt like I did not know what else to do. TV or movie did not interest me . I felt the night was too long !
Work resumed and being on call as the CRASH person on Friday woke me up from my long slumber. I realized that a lot of my judgement on that day was rusty and clouded. ( macam Star Wars la pulak ! ). Being the person to be relied on became a challenge and I was a bit slow to do my usual thing. Felt really really karat - and i realized ..oh no.. i have to buck up as I am going to be in UMMC ICU for the next three months !!
Lessons I learnt from my Friday call :
1) Make your own differential diagnosis. Do not rely on the physician/ surgeon 's opinion.
2) Play it safe ; do not be too confident especially regarding airways.
3) sharpen the setting up of lines skill.
4) Consider A-Z and never take short cuts !

We just had to follow the trend..

Did you happen to watch team Malaysia in action today ? ( Hockey Champions Trophy in bukit jalil). And we just had to follow the current trend of wearing sleeveless jerseys !!! Hahahaha.. metrosexual look !
I'll post the pic later. Tomorrow's edition is not out yet ; thus no pictures available.

We look so ugly ..with the yellow and black stripes. Sleeveless... haaaarrk..what a sight !

Meeting old friends

Just came back from Uptown ; I;ve or we've ( the unofficial kamcheng badminton club ) been regulars at Sallehs since we started playing badminton in a nearby hall. I guess the 222 "mat salleh" will be disappointed with our absence for the past few months. We were the mentekedarah customers.. the best available ! Uptown is much nearer for a glass of teh tarik.. ( yeah right.. we usually end up eating mixed grill ; steak , chicken chop and lamb on "pirate" sauce dish !! ) after a hard fought game !

It was a good turn out last week as the "US" trip gang having a mini reunion with Badak. Man..it had been quite some time since Izzat , Kamal and me seeing him ! He came all the way down from Ampang and that was sweet ! Hai was there too and the whole gang certainly had lots to catch up ! Including Dil , Mafiz , Edrin and Zaini.. we were so loud ( macam tak biasa ) .. and I went back home like 3.30am ! The call next day was bad and a killer ; not to exclude the results anxiety which came out that day !

We were the culprits again today , making lots of noise with corny jokes ; laughing out loud like drunkards! Azad came about ; having his "last" outing before he is off to Mekah for Haj next week. It was fun reminiscing old times ; esp after the influx of old pictures of ourselves in facebook this past few weeks. It was also an occasion to celebrate me passing my Part 1 and Kamal , who just passed his PACES ! Alhamdulillah !
But of course ; learning my lesson from last week , we took off at midnight because I can't bare doing my call with my mind half dead !

Clean up..

during the exam period.. in fact 4-5 months towards it !

A major clean up.. fuuh..berhabuk !!

Jerry McGuire

It was one of those moments , a sudden massive flood of words in my mind ( not that I am schizophrenic !! ) . Remember Jerry McGuire when he suddenly sat down and wrote his Mission Statement ? I dunno what got into me the other night.. and today.. in Utusan Malaysia "

Sistem Latihan Doktor perlu dirombak drastik .

What was i thinking about ? It had been quite some time though since i last wrote in Malay !! :)

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Update 12.30pm : wahh.. it was so difficult to get your hands on the hard copy of Utusan. Being in SS2 where the dominants are not Malays ; I had to shop hop before it could be found.. Dahlah terceruk !! Hahaha.. jakun betul..


Sunday 25/11/07 .. Its out in the STAR as well !!

Reorganize houseofficership

Primary Part 1 Master Anaesthesiology

It was a very jittery day. I was on call after a three weeks - some may consider it cruel considering the emotional turmoil one is having. My mind was everywhere and it showed so much when i induced my first patient for the day ! I did not reject to the roster maker earlier , perhaps at that time too numb to even think about passing yesterday ; results day.

Alhamdulillah. I passed. I passed ? yup..i passed. My specialist informed me earlier in the morning secretly before the official results were posted in the department. I am so thankful to god for his graciousness ; I felt so overwhelmed yesterday. Lost my voice , not because i shouted or screamed my lungs out so much ( hehehehe ) ; but i guess it was due to the tremendous stress for the whole of last week.
Not everybody made it though , and that is the sad part. I felt sad for my colleagues who were unlucky ; to the extent few may not being able to continue the course. I am devastated because i know that these people are excellent doctors , a rare breed that is very dedicated to their patients.

1957 Hati Malaya

Being a history buff , it will be a sin for me not to watch this movie. What prevented me from doing so was my preparation for the exam I have just taken. I was tempted then to just go and watch it but i promised myself it will be the first thing I do after I'm done with the cruncher.
As expected , I was lucky that it was still being shown in GSC MidValley - the nearest for me to go. IN One Utama , the show was scheduled for 645pm screening ; which i felt very unappropriate.
As how our previous historical movies , Hati Malaya was a failure in box office. So far , they've just managed to collect RM400 K after 3 weeks screening. This has always been the trend for such genre ; where attracting the mass is a huge challenge ; an almost impossible one . Zombi Kampung Pisang grossed more than a million after 2 weeks ! And I guess , most Malaysian movie goers are more interested in seeing Nana Tanjung or Orang Minyak rather than appreciating our past.
The movie was good ; full of facts which makes it cool as we appreciate the historical characters in action. The potrayal of Onn and Tunku was excellent , considering their amateur status. I certainly enjoyed Tunku's laid back personality with his Kedah accent ; and the actor really played him as how we read him in his biographies. Shuhaimi was certainly careful with details ; from Tunku's "boy" serving his favourite roti bakar to H.S. Lees trademark mufflers . A memorable scene from the movie for me was when the UMNO leaders post Dato Onn's resignation , attending Tunku's bbq ; Tunku wearing baju melayu with an apron on as the chief cook !

It had its sentimental value and one could not hide the chills and passion when they shouted Hidup Melayu , Daulat Tuanku and Merdeka !

p/s However , I cannot deny the fact that Maya Karin was sooooooooo attractive in the movie !! hahahahaha

How in the hell did I end up in the Nadal-Gasquet match ?

It was by chance really! After picking up my son from his TASKA i decided to visit a friend of mine who's back from UK for the holidays. His house was very nearby so i dropped in. He did actually called me up through his house phone earlier but I thought it was the TASKA calling me ( not that i was late! ).
And he popped the question ..
" Kau free tak malam ni ? " ohh.. i thought there was some kenduri or some religious function.
"OK kot , wife pun takde ni. dia pergi Induksi," I said.
" Kau nak tengok Nadal tak ? " "What !! Kau ada ticket extra ke ? " "Adalah ! takkan aku nak ajak kau !! " Hahahahahahahaha...

And there I was , In Malawati stadium watching the exhibition game between the two World tennis stars. Nadal was as big as how we see him on TV. ( Azalina certainly got to watch his muscular figure as how she was keen for - as reported by TV3 news the night before ! ) .It was an entertaining match apart from the cheezy emceeing by the none other Mahathir Lokman. Thanks man ! Certainly a good way to celebrate me finishing my exams !

Physio viva

Had my viva today at 12.30 pm , just before lunch time. I was dead hungry while waiting for my turn but at the same time , my heart was pounding wild. Exams are really bad for your heart you know !!
I was in stream B. I had Prof M.James from South Africa , Prof Choy ( UKM ) Prof YKChan (UM) as my examiners.Prof YK was the silent observer and i'm not sure whether did i make a fool out of myself in that room today!

1.Prof James broke the ice by asking me to explain the fight or flight mechanism , local blood flow , circulatory regulation etc. Hahaha.. a real "talking through experience" thingy ! I dunno whether it was me or him confused ourselves.
2. He asked about how vaporisers work.. And shit.. Never touched that page before ; so i tried to talk my way but hahaha.. it was so obvious the vacuum in my knowledge of this.
3.Prof Choy then asked me about GFR , Starling forces equation , Why GFR , How does it autoregulate , how to measure GFR and about Renal blood flow.
4. CO2 transport , Haldane effect , buffer why and what which i managed to round it off just before lunch.

PEEEEERRRRRRRGGGGGHHHHHHHHHH.... I was so glad when it was over and Dil called me just in time ; as we then spent the afternoon with Mafiz and Rizuan in redbox..
P/s madah berhelah made my voice dissapear !! ... Ziana Zain wannabe..

Pharmaco viva today

It was at 11 am today ; i was scheduled to be the first of the second batch.
I came at 1030am ; having my heartbeat racing like mad.

I was on table B ; Alex Sia ( Singapore ) Prof Marzida ( UM ) Prof Jaafar(UKM) were my examiners.hmmmm... Sitting in the waiting room was no different as I was getting nuts... "rabbish rahli.sadri... etc" uttered like nobody's business..

went into the room ; OK.... Alex Sia introduced himself and off we go ; with something simple he said.. hahahaha

1. Lets talk about opioids. Show me the Plasma concentration vs time graph of fentanyl..
Then we started talking about effect side , compartments , elimination , comparing with alfentanil and of course remifentanil..
2. What local anaesthetics do you use in practice . and we went on to the properties what makes it different from one another. mode of action ; frequency dependent action , and the stereoisomerism which the way i answered made him a bit uncomfortable !! hahaha
3. Gave me a table with numbers and asking what statistical test would be appropriate.

Prof Marzida was next. Her questions were fairly ok for me to blubber out..
1. Diuretics and mode of action.
2. Desflurane watchouts.
3.Renal toxicity with inhalational agents.
4. Obstetric drugs..

and tiiiiinnngg...
Waahh.. 20 minutes hell was not as fast as how i wanted it to be ! I'm still having palpitations now ..and of course , the reason for me to blog this out as I am just gonig bonkers for my physio viva tomorrow... Urrggghhh...

Dzaeffran's birthday..

I'm in the midst of my exams and it is my boy's 2nd birthday today !!!
Sorry dzaeff , walid can't organize a birthday cake for you because of walid's pressing exam. However , I did bought you a present earlier this week...

And you certainly enjoyed the gift after I had blown out all my lungs for you ( excluding residual volume of course) ... Hahaha..
Happy 2nd birthday yea... :) I'll make it up to you..

Yup.. Here we go..

Been dreading this moment.. since.. i can't remember when.
Its my part 1 tomorrow.
Physio and Pharmaco.
Its not easy to pass.. dunno whether I've done enough.
But hey.. you'll never be ready if you ask me !
Here we goo... Bismillah...

feeling like spraying yourself ?

Or wrong placements..

Lets run away !!

3 days and counting.. dup..dap..dup..dap..

DiGi phone home..

Despite the warning . despite the threat ,
despite the heavy rain , despite the blockage attempt ...
people came , people marched , people were brave.

Vena , Vedi , Vici and Carpe diem became the theme..


I must congratulate the police force for their control of the situation and did not over react. The objective of handing the memorandum to Tuanku was achieved in a bloodless manner. There were few casualties though ( but all 245 released !! ) , but being in a mass of at least 40,000 ( from net sources ) ; it is not significant statistically. Even the 40,000 number is nothing because if you compare the number of the votes gained by the opposition in the 2004 elections against the top 9 fellas in MIC ; it summed up to more than 120,000! Baru 9 Parliamentary.. ( Why MIC lah ? well.. its Deepavali period isn't it ? ) thus , the organizer's target of 100 k was realistic to begin with.
Its the IT era , information is limitless ; compare and contrast reports from both sides. Everybody is free to express their concern and what happened on the 10th of November 2007 showed how the cyberworld and blogs are tools of matter. ( Wait a minute , i thought somebody said it was only for dim wits ?? :) ) Humans are naturally anti-establishment ; we should use that as our strength rather than denying it.

At the end of the day , you wonder who'll benefit the most ?

Susukan kera, anak tersadai
Ayam menang kampung tergadai

cool pic of MAYA TzM.. "ciplak kejaps ekss.."

Symbol of supremacy ?

UMNO Annual assembly is going on and you cannot espace from the keris Panca Warisan controversy. It'll be its third year in running of kissing and waving the keris ; a definite issue maker of its symbolic representation in the eve of General Elections. Things are certainly getting out of control with Uncle Sam issuing a directive to its party members but then retract it few hours later yesterday. Quo Vadis ?

Though , i still view our Gen X and Y will continue congregating the mamak stalls come weekend , in harmony and unity ; observing the race for post-millenium supremacy !!

Manifestation

The exam is next week and I'm on my last few days of sucking up the details of my physio and pharmac. Though at times i do get distracted with facebook , its a good tension releaser ! The exams will be tough and of course i don't think anybody feels they are ready to take it.

This time around , i reckon i am in control of my emotions induced by the stress ; but my body is definitely showing the psycho-somatic effects. I'm getting altered bowel habits , a "certain" past occurance came back, my appetite suppressed ; but the most obvious is the "butterfly malar rashes" on my cheeks ! Takkan SLE ( systemic lupus erythematous )kot ? Is my body manifesting a hidden chronic autoimmune state ? Its more common in females rather than males though.. hmmmm...

Tu fikir kemudianlah. Lets concentrate on the immediate task in hand.

OGKL Aidilfitri open house 2007

10 years ago...

the WTC was still "twinning" majestically..

The blackpool trip was where it all began..

and I wonder who's chained to who after ten years ?? :)