Sometimes

I have learnt silence from the talkative, toleration from the intolerant, and kindness from the unkind; yet strange, I am ungrateful to these teachers.

Kahlil Gibran

Learning from the past

I'm an avid fan of Malaysian biographies and autobiographies. It is fun and interesting reading for me. Some would find this weird but I just love them. I can hardly go through my physiology and pharmacology but I can religiously go through page by page in one night on these type of books. Going through the lives of our forefathers gave me the insight of how their mind works and most importantly ethics of integrity.

The latest book that i bought and managed to finish it within 24 hours would be the Tun Dr Ismail story ; the reluctant politician. I've always been intrigued by the mystery of being the "Prime Minister" who never was. He was remembered fondly by the elder politicians as an example on what people politics is all about. I was brought up in Taman Tun Dr Ismail , studied in SM Taman Tun Dr Ismail but i never knew who he really was - except as the Deputy Prime MInister who died in office and the first to be buried as a national hero.

Tun was a shrewd no nonsense leader - very nationalistic but fair at the same time. He was seen as pro malay but at the same time realizes the need for unification of races to achieve a true Malaysia. He was liberal in his daily practice ( as how most malay leaders in that era ) that i doubt the book will be translated to malay as many "religious" issues may be questioned. The current crop of university's student leadership that sways towards "real- islam" will definitely question personal habits of gambling and drinking and not focusing on his true contribution towards what we have today.

His contribution was immense - justified by Tunku and Tun Razak's trust on him. He was always viewed as the "third" man of the country after those two figures. Many feared him for his straightforwardness and respected him for his principles. I've been told by his grand nephew how his family continued the tradition on being firm with one's principal - a legacy of famous doctors in Malaysia ( Tan Sri Yahya Awang , TAn Sri Abu Bakar etc ) who stayed in the service till their retirement in order to fulfill "serve the country above self" policy.

Tun was reluctant on being the typical politician - taking all the advantage at helm ( logically who wouldn't ? ). He was a true nationalist and i believe that our history books should highlight him more than what is available in the syllabus at the moment.

I've been tagged : Confessions

LAma tak buat kerja camni. Thanx shah for tagging.

6 weird things you don't know about me:

1. I will always ask wifey everytime after dressing up , do i look fat? My BMi is on the overweight side but somehow my mind keeps denying that fact !!

2. I love listening to X-JApan's songs ( Japanese rock band). I don't understand a word but I listen to it everyday to work in the morning.

3. I still have my eyes caught in action with "amoi-looking" girls... ( kalau wifey baca ni sure... What do you mean abang ?? HAhahahaha !! )

4. I can eat KFC anytime. breakfast , lunch , dinner , supper - continuously. Certainly my favourite dish without fail in any occasion.

5. The only game I've ever played on my PS2 is the Pro Evolution / Winning Eleven series. I have > 50 games of various titles but for the past 3 years.. I've only played the footie game without fail.

6. I still have a favourite bantal ... :)

The rule of the game:
In this game, each person who is tagged starts out by telling 6 weird things about themselves on their own blog, as well as state the rules clearly. At the end, you will need to choose 6 people to be tagged and list out their names. After that, leave them a comment on their blogs letting them know you tagged them and get them to read your blog.

So here are my victims who are among some of my favourite bloggers.

Dil : The main man... dato'...
Nor: Real time blogger..
Suriana : an old friend up in the east coast confusion..
Ee Van : a macho friend who's done the marathon before..
drfrappucino : a colleague somewhere in the valley
KJ : I'll be surprised if there is a reply !! hahahaha..

Hope all you guys will keep this chain going ! One for the boar new year... oink..oink..

Holiday dilemma

Its the first day of the Chinese Lunar calendar - the year of the boar promises good outcome for those who work for it. To my chinese friends ; a very happy new year and may the year brings you prosperity !!!

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Obviously , I am on call today. It'll be my last call for the month as I've requested to finish it by this week. It had been a busy 2 and a half week. My mind is a bit tired ; drained by "thinking" while doing my ICU call. Wifey is 37++ weeks now which means that the baby may come out any time now. Dzaeff was delivered spontaneously at 38 weeks therefore I;m predicting my second to be around in the very near future. We haven't decided on any name for her as yet - thanks to wifey's "fickle"ness - not to be helped by her busy working hours and on call. Her department is not as kind as mine - She's still doing calls till term and if she takes the whole 2 months maternity leave ; she would be extended for another year !! A bit cruel i reckon considering us doctors having to work like a dog day by day.

My ICU is still full - I'm stuck with certain patients who are not going anywhere.True enough we are giving full support to ascertain stabilization ; unfortunately things have to move fast as sepsis with multiresistant bugs are just waiting to strike. Tracheostomy for few patients are delayed due to the long holiday. We don't do percutaneous traceheostomy here in UMMC - which certainly slows down all plans and further management.

Managing ICU during a public holiday alone is a challenge. I am sure my colleagues all over the country would agree with the statement. If things are Ok it is OK - but when "drama"s happen all at the same time - it is very frightening as one has to make decisions swiftly. No matter how one calls for help , but life is at stake. Decisions made at that split second will determine whether the patients continue living or die. Sometimes , we wonder , are we just prolonging death or saving lives ?

Talking to patient's relatives is a big challenge. It is not an easy job and I have to do it everyday. Keeping them updated is one thing - informing deterioration is another. Helping families to cope with such critical illness at times can be disheartening. Discussing with families who cannot accept their family member dying is a skill which I am certainly hoping to gain. When things go wrong - denial is difficult to encounter. I believe that strong communication will help to ease the acceptance - but I mean if you are in their shoes - would you be rational as you think you might be ?

Waahh.. philosophical ! I'm thinking too much eih ? Well , its time for my maghrib prayers and night rounds will continue..

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Bed 1 : Day 32 - iatrogenic perforated CBD. abdomen still distended - ileus . Unable to wean off to CPAP because of diaphragm splinting !! Now having gross haematuria !!!

Bed 2 : Day 5 - form 2 boy MVA - hit and run with subdural and subarachnoid bleed with conservative management. splenectomy done and i just extubated him this morning.Not really awake.

Bed 3 : Day 6 - fit foreigner paralysed neck downwards ; C5-C6 fracture corrected. Trachy delayed till Wednesday - no relatives around. very depressed.

Bed 4 : Day 22 - young lady with stage 4 SLE. Needs continous dialysis - lungs not looking good. Just spoke to the family regarding tracheostomy.

Bed 5 : Day 7 - an elderly who recuperated from Perforated Gastric ulcer but now in spesis - nosocomial pneumonia in a chronic COAD patient.

Bed 6 : Day 1 - readmitted to ICU for BIPAP. An elderly lady with a chronic urology problem - pain causes her tachypnoea ; currently comfortable on BIPAP but if the main problem is not adressed - we are not going anywhere.

Bed 7 : Day 38 - a middle aged lady who underwent a simple operation which went wrong .. MAJOR ! Not doing well in every department.

Bed 8 : Day 14 - A middle aged man with ESRF on continuous dialysis , IHD recurrent APO - not doing well at all. reintubated x3 last night.

Bed 9 : Day 10 - an elderly lady whose primary teams were fighting over the proper diagnosis. Still in sepsis with acidosis - not looking good. CVVHD stopped because not going anywhere.

Bed 10 : Day 5 - a referred case from a private setting. Bad pneumonia on a chronic restrictive lung disease - Post tracheostomy looks convincing as She's more awake now. Unfortunately , all breaths are mandatory and none of her own effort despite full GCS !!

Bed 11 : Day 2 - a depressed mother who just lost her child two weeks ago - went overdose with her medication. Not awake yet.

Fuiyooo.. mcm buat round online pulak...

Generations

The young and old..


in between - always in denial...

Kinkin'

I had a full ICU last night. It was managable however - no major disasters , and somehow this week - We had a geriatric ICU on board. Most of our patients are above 70 years of age ! How it came to that , I am not sure - but the person on call during the weekend certainly filled it agely !!

I was called by Cardiac ICU near midnight , telling me they were not able to insert their suction catheter through the endotracheal tube. I went down to have a look because there must be something mechanical that should be corrected easily.

The patient was 1 16 year old girl who just had her op earlier - debulking of nurofibroma. She has this disease called neurofibromatosis
Currently , she has this large tumour encroaching her left lung - effectively she is breathing on only one side of the lung. The surgeons initially wanted to resect most of it but they only managed to take out 10% of the initial 90% planned.

She was on a flexo-metallic tube which is very mobile and flexible. I reckon my colleagues used this in view of her distorted airway - She also had severe kyphoscoliosis which was corrected but still , the trachea was deviated because of the mass.

Hmmmm... i tried it myself and i could not pass through even the smallest catheter through the tube. I looked at the ventilator and it did not show any sign of blockage. It is of common knowledge that flexometallic tubes can be very" flexible" that if the patient bites on it , it will be disfigured.

Called my lecturer and Senior MO on call to have a look. They were quite worried as well , as her physique looks challenging for intubation. Of course , the first thought was to railroad a new tube but unfortunately we were not able to track through either using the bougie or Cook's catheter. Called Prof M up to ask her how was the intubation condition and convincingly she said it was not difficult - Cormack Lehane 1 but of course one has to manipulate one's tube.

We sedated her with propofol and then had a look with the laryngoscope. The cords were visible and we just did it ! Exchanged it tube for tube. And luckily , it was alright. Success !! Hahaha.. Indra laughed at me when i brought the WHOLE DIFFICULT INTUBATION trolley into Cardiac ICU. Well.. better be ready then scrambling in panic isn't it ??


the kinked site..

I left my heart..

I;ve been disturbed by the itch...
Not the 7 year itch !!!!
but the back to nature and outdoor itch.

It was only last week that I tortured my self ,
the pain is still felt ,
but the endorphin euphoria remains..
and the urge for more is increasing...

Trans Titiwangsa perhaps ?? the G7 dream is definitely on for now...

*G7 - 7 highest peak in Malaysia - all above 7000 feet.


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Me , wifey , Mal , Azad and Yanti went to the former Mimaland - Gombak area this morning. We left Dzaeffran at home because of Mak's objection. Apparently , Mal recently bought a land there and invited us to visit . Well , it is still "hutan" but Mal is trying to clear the land slowly. The pathway to the place was bad and I did not expect such access !! Imagine - My Perdana tortured and scratched ! Arrgghh.. I was cursing and cursing as we followed the road which used to be the pathway for logging lorries.

Initially wifey had to stay in the car as we had to climb quite a distance - 200m away . Being nearly term is definitely not suitable for such activities ! Luckily , one of Mal's "neighbour" there had a 4 Terrano so he was kind enough to pick wifey up. Pak Rodzi brought us to his piece of land and he certainly made it comfortable for him !

It was good to be back among the greens. I certainly felt the endorphin rush as we walked through the woods this morning. Hmmm.. looks like I'll be looking for similar activities to fulfill my addiction !

Things you don't normally see

They call it the cu-cu train...

I was appauled to find this happening in my ICU ! Menjatuhkan maruah !!!

Sendiri mau ingat

I survived the weekend ! It was tiring but definitely worthwhile climbing Pine Tree Hill ( 4,771" ) and Twin Peak in Frasers Hill. Kudos to OGKL for organizing a very enjoyable and SANTAI event for us. By mantics ; it is indeed stupid to spend one's weekend outdoors - being cold and wet off from the potato couch comfort zone. And somehow , doing this is actually a satisfaction of what one really wants from life..



Azad picked me up early Saturday morning to join other OGKL participants in Teratai Dayabumi. In a typical Malaysian time , we started off late ! haks.. We were supposed to be off from KL by 9 am but unfortunately we only moved out of the restaurant at 11 am !! However , it was an opportunity for me to know most of the other 23 members joining this trip ; in the very true spirit of OGKL ukhwah.I felt a bit "amateurish" when comparing my backpack to their haversack. Malu weeihh.. I managed to buy my first hiking stick though - which proved to be very useful during this trip.




We arrived in Frasers Hill at 1pm - and surprisingly it was very cold up there ! The fog was so thick that we can barely see the road during our journey to the starting point.To make it worse , it was drizzling and the temperature was low. I cannot recall Fraser's Hill being cold and windy. Unfortunately , that was the weather for us to start our journey to the highest peak in that area.

The journey to Pine Tree Hills on the map was 5 km , sounds short eih ? haks.. Obviously not. Seeing the organizers being so laid back , I would have thought the track there would be easy and within 2 hours since we only started walking at 3pm. I was SOOO WRONG ! It was wet and very slippery. I fell a few times walking through the thick forest. The climb was not easy as we had to cross 4 other lower hills before arriving on top of Pine Tree Hill ! It took us 5 hours for the gruelling 5 km track. We arrived there at about 6.30 pm.




It was so cold and windy when we arrived that the leader of the trip - decided we should camp there instead of Twin Peak which was just about 1 kilometer away. I was freezing and a friend recorded the temperature to be about 12oC. I did not expect the weather to be so cold hence my pathetic thin clothes. I noticed most of the other climbers brought thin clothings too , so I was not alone in this issue !! I only had one long sleeve t-shirt with my windbreaker.. and I suffered that night !

Pine Tree Hill was certainly not suitable for big group campings - and we had to break the basic rule in camping. Camping on a bare area - on top of the hill ! haks.. literally , we were sleeping on top of the peak which was very-very freezing especially when the wind blows. We did attempt to start a fire - it was difficult at first because most of the woods were wet. Azad was very skillful that he managed to start the small campfire for the team to gather around - keeping oneself warm !

It was so breezy that everytime the wind blew we became unstable ! I can't imagine if it rained heavily that night . Something funny happened to us as well ; the area on top of the peak was not that great - thus when we set our tent it was quite slopy. There were 4 of us in that tent - very small space i can tell you ! However when we woke up at about 5 am , our tent moved more than a meter away from where we set it up ! Luckily there were small trees blocking the movement otherwise we could have just fallen off the cliff ! Scary isn't it !!


We woke up in the morning feeling tired - but we had to continue our journey to reach the Twin peak ! The trip was definitely less challenging and we arrived there at about 10 am in the morning ! It was so satisfying to be up there on top of the world... Looking how vast the Titiwangsa higher ground were. Beautiful view and very soothing. I was so proud to be up there - having to survive the challenging trail. Thank you OGKL..

more pictures in : http://picasaweb.google.com/mafeitz

Achievement