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.