My mental visualisation

**All pics from OGKL n Apips.

Honestly , I am damn too excited thinking about my trip next week. I am trying to not visualise the pain and agony of climbing !! hahahaha but visualising the beauty and atmosphere when I am on top..Insya Allah...

Top of Tambuyokon..

The mornin view of Kinabalu from Trusmadi..

Yang ni future la.. coming soon..project Titiwangsa 2009..:)

pre SMO call..

received 2 phone calls this pm..

1) 3 year old with brainstem tumour for open biopsy tomorrow..
2) an elderly for thoracotomy ;

Wahh... memang menuju ke arah kejonahan ni... hahaha

Doctor in spotlight

With the recent revelation of the initial medical notes from PUSRAWI ( the most famous case in Malaysia at the moment) ; it is interesting to know that the doctor in charge is nowhere to be found.I would like to take the opportunity to comment on few issues relating to this.
Ethically it is wrong to reveal such information to the public.All patient-doctor documentation are exclusive and revealing it in the mass media betrays the professionalism conduct. I believe it was beyond PUSRAWIs knowledge ; it must have been one of their admin / clerking staff there who thought it was their right to blow the trumpet.
Nobody knows what was the outcome of Saiful's report in HKL. It was treated as highly top secret and those involved that day were summoned to zip their mouth and not to release any statements. With this revelation , the conspiracy theory believers are more convinced and this adds value to DSAI's side compared to the police and the current government. No matter what HKL's findings will be , this report has swung everybody's opinion.
What would be the next tactic then ?
1) The doctor's credibility questioned .
2) PUSRAWI will deny it as false document.
3) HKL doctors will reveal their findings in a major press conference.

I'd just like to touch on the first step. The doctor's credibility and integrity will be questioned. I did my check in MMC's registry . ( CHeck Mohd Osman Hamid ) . Wow.. it seems that this doctor has been practicing in Malaysia since 1993 ; having his APC ( annual practicing Certificate ) updated. ( He was in UM till 2007 !! ) I thought that this would be the evidence for Tan Sri Ismail Merican to question Dr Osman .However eventhough he is a foreigner ; he followed our rules obediently and is a certified doctor recognized by MMC. His professionalism cannot be questioned at all at this moment ! He may attack him individually but hey.. it'll just be a shot at our own face because he is legally certified by us !But then again , MMC may loose his file and the internet entry may be deleted., MMC buiding in Putrajaya terbakar ke tomorrow... hence no record !! ( true story : i had the experience with my file .. ) So i have saved the data about his APCs today and if it is not available the next time around then hmmm... very fishy.
So what next ? the plot thickens...

Dup dap.. dup dap..

Manyak suspen woo.... one week today and I'm off for 2008's conquest..

Duathlon rookie..

I managed to complete MUDS in UM ! Thank you MALAKOFF !! It was my first ever action in multidisciplinary sport . This was my first ever competitive biking . I guess , in the true spirit of being an IRONMAN one day , this is indeed a small step towards a brighter future.. ( Obama style of oratory.. hahaha ) Azad , Ruslan and the TALISMAN gang was there early. I managed to bump into Sharil ( AKA Cip ) on Friday during registration. It was good to meet up with your former mates and to know that we still do these crazy things to push ourselves ! Azman was also there with his friends and the usual fit athletes suspects ; who i've seen them in several runs this year.

The usual suspects.. plus Sharil ..
The 3.5 km run then 14.5km biking and another 3.5km run course in UM was excellent. I had no problems with the run but the biking.. my god.. the hill as we begin biking was a killer ! Mencanak habis !! hahahaha.. And having to go three rounds with that obstacle in mind was a challenge for a rookie like me. Luckily I did try the trail 2 days before and I've set my mind about what I was to face. It is not about the effort because i know I can stand and recollect my breaths ; but whether my thighs could sustain the strain and not cramp.
We started off at 9 just in front of UM's Pusat Sukan. Those who were going for the medals really ran their lungs out. It was tempting to try and follow them but my experience in previous runs made me just to focus on my own run ! I just wanna finish unscathed and that is enough !
After the 2 rounds around Rimba ilmu , it was then time for the bike. When i arrived at the biking station , most of the bikes were already gone and it was not difficult to spot my orange bike!
BUKIT CINTA was a killer. i had my maximum gear on when climbing the steep hill. Mak aaii... it was just pure determination that pushed me to arrive at the top. Each time i thought of ..hmm.. next round i will just push my bike up ; maybe its faster. Somehow , i managed to convince myself that i can still push myself.. and Alhamdulillah , i did not touch the ground while cycling up the hill on those 3 rounds ! PUAS HATI !!! The downhill post hill climbing was really good because it was pure cruising at top speed ! Never mind the fit ladies who passed me during the hill climb though it was "that ego" which spurred me to stay put on my bike !!!
The run after the biking felt a bit funny. Oh yeah , i forgot to mention ; I bought new cycling tights which had paddings ; as it was important because of the trauma i had during my practice run. It can be really painful on your bicycle seat for more than 1 hour ! Back to the story.. it felt a bit funny after the biking ; lari mcm ORANG KENGKANG !! Hahahaha.. Glad nobody took any pics of me like that because it can really look silly !!
And YES !! finished the race without any serious injury ! Of course , towards the end i did feel a bit of pull here and there but i manage to control it and let it settle down. YES !! PUAS HATI... and it felt really good when you cross the finish line !
Of course , there was no way i could get myself in the top 10 but i am glad i did the thingy. Never mind being oncall straight away after the race.. HAHAHAHA Memang kerja gila ! I was a bit knackered in the OT after that but it was worth it bro... really worth it ! My thousand thanx to the organizers... :)

in the transition station before the race with my T bolt

berjaya kita berjaya !!

The PROTON T Bolt team..

Ultra team.. hahaha janji sampai !!

Azman... you rock bro !!

A simple celebration

Wifey has been on pM shift last week ; thus making me the sole person in charge after picking up the kids from TASKA. She would come home knackered and of course she was not keen for night outing especially after 10 pm! ( and with 2 kids tagging along )
Her birthday was last week and initially i planned to bring everybody out for dinner , but throughout the week i found that it may be impossible to coax her to go out after a day's work. I bought card which had both Dzaeff and Qaisya's hand print on it ! Dzaeff was so excited to give it the his mum when she arrived home.
However as soon as i brought out the cake with candles on , both the kids who were waiting in front of the door just went beserk ! Dzaeff dropped the card and rushed towards me... more interested to see what i was bringing !! Hahahaha
Happy birthday ja... no berapa.. hehehe.. takleh la cerita dalam blog..

August.. the month before ramadhan

First half of August will be a very hectic month for me .On top of having to do the SMO call , i have lots of social activities up my sleeves and i guess by the time ramadhan comes I am all ready for solace.

Aug 2 : Elly's wedding.
Aug 3 : Dzaef and Qaisya's sports day !
Aug 5 - Aug 12 : Trusmadi Tambuyokon , Sabah climb.
Aug 16 : Mat ( Dil's bro ) wedding.. I'm the MC
Aug 17 : Edzwan's side reception.

Talk about being hyper... hahahah
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I've confirmed my participation for the Duathlon Univ challenge this weekend . Seeing Azad's triumph in his maiden sprint triathlon certainly made me to strive for it in the future. Swimming is my problem and I am trying to sort the training for that so that i can qualify myself to be a part of the "elites" .hahahaha
This will be my first try in cycling ; the distance is moderate and i guess is suitable for a rookie like me. I don't have a proper road bike but i do have the MTB to ride on !! Hahahaha Lets see how i perform on that day.. I am registered under the university category ; taking advantage of my "student" status here in UM. Maybe I'll be the "oldest" student to be in the race.. watch out !! HAHAHAHA ( you only have to pay RM20 )
The best thing is.. after finishing the race I have to rush off to the OT because I am on call !!

a step for mankind

Due to the small number of final year trainees , the department has roped the third years to do the SMO ( Senior MO ) call. Its a tough job considering that you are the one in charge of the on call emergency list. Of course , you are being watched over by the Lecturer cum Specialist on call and of course the Consultant. But then again , its your call and your decision to make! One can become unpopular when deciding.. and of course , when you get this teeny weeny child who's fragile and GULP.. haa.. nak challenge sangat !! Hahahaha
Last month , Lip Yang and Hady did us the honour to kick it off and guess what, I'm on this month !! And I'll be "officiating" by doing the 1st call of next month ? More exciting and exhilarating ? I don't think so. Its more of more responsibilities and decisions to make . But as how we are trained here... BELASAH JE...
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I have to wake up now ! Enough of this honeymoon business! Hahaha.. but then again , I'm still in third year therefore i have another whole year to look forward to before really sitting down and study. However , i have this sudden surge of interest in taking a foreign exam and STILL thinking hard whether should i attempt it ?? hehehe

Its not easy..

I was just about to begin my session with the Neuro ICU nurses , when my phone rang. The Sister in charge was keen for me to give a talk or two regarding ICU topics to her nurses. I have no problem sharing what i know , so it was not something i don't like to do !!
Anyway back to the story ; my Neurosurgery colleague asked for my help from the CT scan room. Apparently the little boy could not sit still and was very agitated. What do you expect from a 3 year old going through the CT scanner ? My colleague has given enough midazolam and he didn't know what to do next.
Of course , ketamine is the next best choice but only anaesthetists can have access and administer it. I had to abandon my "class" for a while and went down to give a hand.
To my surprise , both the parents were my counterparts from other departments and i know them well. And only that, it triggered me ; we had discussed the young boy's brain CT scan in the ward. There is a big mass in the brain discovered ; and it was only the day before that this fact was known. Masya Allah.. I was a bit stunned because the picture is not convincing ! But i continued to smile and calm their little precious one down with my "magic" drug..
Honestly , i cannot imagine being in their shoes. Having your child growing well , no problems or whatsoever. Suddenly , presented with a short history which seemed like what any other normal child would. Wham.. a smack in the head when imaging investigation showed your child having a brain tumour. I had a bad experience with a previous child ( a doctor's son too ) with a similar pattern and it did not produce a happy ending.
My prayers for your child and hopefully any intervention in the future would be in the best interest of the child.. Insya Allah..

I witnessed history on tv9

History was made today with the debate between the current government's representative against the opposing arm ( more over the Opposition head ! ) . It was telecast live and the whole Malaysia was watching. To those who rarely switch on to tv9 , tonite was the nite ! Ratings went up the roof woo..following the angkasawan trail ! Too bad we only had cheap commercials during the intermission !
I have to agree with Rockybru's comments. I thought that the debate was a step forward. It was the american style ; certainly looked fair and its the issues we should assess.It was up to the speakers to open our minds in dissecting the arguments. Both speakers did not go overboard or emotional ( kalau Ibrahim Ali vs Karpal Singh habis dah... ) and tried as much as possible to be factual . However , politicians will always be politicians and we cannot expect them to speak as academicians in economics. DSAI certainly had the advantage because of his flair on stage in experience , but Shabery Chik manage to brush it off and equally confident to rebut. Although at times he was merely attacking DSAI , his efforts were commendable. I did find DSAI startled a bit in the beginning , don't think he is nervous with the crowd but i reckon more of trying to be factual rather than his usual rhetorical style. But of course, we are still in the stonehenge age of politics ; it was obvious in the way both parties argued which just cannot run from the " wtf are you talking about ?? " hahahaha
We should continue this trend and i urge the youth division from both sides to actively organize such debates. Its the way forward to become more mature ; and self conduct - control is the key factor which I still reckon a bit dodgy when we speak along racial lines. Don't think we are ready for that yet though...

No sore thumbs anymore eih..

Being at home..

I do have the option to send them to my mum's place whenever wifey is oncall. It can be tedious managing them alone. They'll be running around and you have to feed them. More so to bath them and the most yucky thing.. to clean them when they decide to bomb it hard ! I tell you , both my children's "offerings" can be really smelly ! It stinks the whole house that you have to put away the dirty diapers out of the house !! I am not complaining though as both of them are well and healthy ; colic free since birth.. Alhamdulillah..
However nowadays I prefer to have them with me. My care may not be as detail as wifey but I can manage both of them. They make the house alive and its fun to just see what they do together as well as when they are alone. Dzaef is an Ultraman fanatic that when wifey is not home , he will coax me to play on the Ultraman playstation game ! Not that he can operate it but he had fun just watching me killing the monsters.. ( Hahaha.. bapaknya yg nak main sebenarnya.. ). Qaisya can be really sweet especially when she smiles. She never fakes her feelings and I guess that is how she will be when she gets older. MY two angels..

smart and ready for nite out..

Can be playful together..

This is the best part of them all... :)

My first ever poster..

I felt really proud to see my poster on the display board in the National Intensive Care Conference. It was held in Shangri La hotel from Friday to Sunday. The issue i brought upon maybe of no interest to the organizers but I was thankful it was accepted.This is my first ever submission and being a part of the poster presentation was an honour. There was a competition but obviously I was not the winner ; however I felt happy anyway seeing it up there.
The ICU conference was a good one and the turnout was excellent.Intensivist , doctors and nurses from all around Malaysia swarmed KL and at times ; food was not enough ! A nightmare to the hotel management !! Hahahaha I was surprised to see almost full attendance from the first to the last day. I met quite a number of old acquantainces ; and for staff nurses to remember me and me not remembering them brought a lot of awkward moments !! hahahaha..
The updates presented was certainly useful and I must say , I enjoyed it very much. It is refreshing and inspiring to attend conferences such as this i suppose.

OFFICIALLY FUNCTIONAL !!

I am proud to say that on the 9th of July 2008 , the trauma OT of UMMC is fully functional ! Ranjit and I were the first anaesthetists to solemnize the theatre !!! Prof Lucy had very strict criterias to kick off and obviously , our first ever case done in this OT was appendicectomy. The drawback was however , ( no wonder our Health DG is pissed off regarding resources allocation ) the first patient was a foreigner !! Hahahaha

patient transfer..
it was however not without a glitch. Off all the days the construction outside trauma OT decided to disrupt a power cable the day before. The air conditioning was not functioning with the OT humidity 90% ! It was all wet and i nearly slipped when entering the OT. OT lights just went off and waaahh it almost looked as if we had to postpone again. The 02 gas outlets and the scavenging pump were rectified after failure on our first two days there. And at 11.15 am , we called our first patient from the green zone.
Out of enthusiasm , we had 3 doctors performing the appendicectomy and I inserted the temperature probe with TOF monitoring for the patient.. a slight overkill but hey.. i nearly used the new fibreoptic scope for intubation ! ( nak test alat la tu... )
I do hope that the trauma OT will serve its ultimate function after this trial period ; for really urgent traumas.. and of course , to the benefit of efficient time management for the patients.

Surgeon and Anaesthetist... towards multilateralism..

Continuous learning

They called me the "chosen one"... hahaha..

I am no Mourinho but Prof Lucy specifically chose me to help her start the Trauma Centre OT( Operating Theatre ) . She is my supervisor anyway so I complied . However , I was keen as well to be a part of the pioneering team of the so called "new-OT".The OT has been there since the inception of the TRAUMA CENTRE but the usage never took off. There were so many reasons for the OT not to run , from technical glitches to manpower issues. I never thought I would see the OT running in my short stay in UMMC but hey.. we are actually progressing !!
Surgeons and Anaesthetists are always thought as the main personnels in OT , NB the Surgeons will always regard themselves as THE MOST IMPORTANT PERSON IN OT... hahahaha However , one must not disregard the nurses and supporting staff as the backbone and soul of operations. It was only until these few days that I realized that the main person who is legally responsible for patient's safety in OT is the Aanesthetist. No wonder Prof was a bit obsessive and compulsive while running through the OT protocols.


There were so many things to consider ; and while doing this i finally understood why the first few chapters in any Anaesthesia textbook important ! I guess its only when you do the things yourself , you find the significance and relevance. Otherwise , how do you find the topic : Medical gas supply , OT machine , Electrical safety etc as topics that you can read without going to sleep?
I certainly renewed my knowledge about the physical aspect of OT while following the technicians and engineers exploring places where no Anaesthetist has gone before !
We've done all our checks , our drills and Prof managed to "force" me to understand my Aestiva 5 machine inside out. ( good for my Part 2 ). And tomorrow will be the day we will start our GA cases in this satellite OT.

Siemen's I run for....

I did not plan to run in the Siemen's run today but my Neuro house officer , who is a keen runner herself had a spare number tag. Well , since I don't have anything specific to do ; APA LAGA ?? Hahaha.. The race started at 730 am but i initially thought it was at 7. I actually knew this but it slipped off my mind this morning! So there I was , dah lah sorang2 tunggu kat depan Dataran Merdeka pagi buta AHAD. Hahahaa
I managed to pin my number on my shirt 5 minutes before the run start . The crowd was good in fact better than last week's participants. The usual suspects were there ; though I don't really know them personally ! The hardcore fellas are now in Kenyir for the gruelsome triathlon. I had a good spell of run ; did not push myself too hard and fairly comfortable on the recognizable route from Dataran to Bukit Tunku , Mahameru and Jalan Tunku Abdul Rahman. I guess the gang should consider to join Siemen's next year !

early morning..

before the start


sob..sob.. glamour sorang-sorang..

Instant reaction..

I dunno whether he was a watermelon lover before or inspired by the "tabloid-like" study yesterday.. hahaha

p/s melloonnn..mmm...

Pintu Belakang..

The whole Malaysia is talking about the back-door scandal ; whether it is true or not , it is currently the issue to discuss and debate. Well , life goes on for everyone but the turmoil is certainly not looking good for the country. However , i only see one party benefiting from this saga' and Malaysia beware...
It is July now and I am doing my Neuro ICU posting ; i guess the Neuro posting is not as heavy as others and I guess i should use this time to study and do my research project. I managed to print my poster for next week's ICU conference in UiTM Shah Alam. Its cool to see it printed in front of your eyes and I am very pleased with the results !

dekat sama tinggi la !

I saw my young patient during my rounds with the MRI above which I did the Op earlier. Alhamdulillah he is recovering well after the tumour was excised. I guess , changing one's life after a heavy duty high risk surgery is worth it after all.

And today , we did a brachial plexus block for an unlucky foreigner who had his hand nearly amputated. It looked scary as it was dangling as we performed the procedure. Hoepfully , the reimplantation is successful .