Disaster Drill KPJ-evo

I am the chairman of the Disaster committee in my hospital. We had our first annual Disaster Drill last week. It was an exercise to test our hospital protocol and readiness if such event happens. Rawang is an industrial area and would be of risk for disasters to happen. Therefore, even as a private hospital, we are to be ready at least in terms of preparation in case something happens.

                                                   moulage and make up

                                                   macam zombie

                                                    caught radiology by surprise

                                                    Qayyum in ED

It was something that everybody was excited to participate. We planned it well 1 month in advance. The actors (staff members) were ever motivated and gave their full cooperation. Sporting habis! I brought Qayyum to join in the fun. The moulage was extraordinary! Kudos to the staff members! Memang dedicated :) 

We ended our session in the afternoon after a debriefing. It was a good learning experience. Insha Allah for the better! 

Selangor Misi 33!! Red Giants rule!

#throwback 

Selangor marched into the finals of Malaysia Cup as a surprise package. As loyal fans, how could we not attend the match.. dahlah duduk Shah Alam kan? Besides that, we are season ticket holders :) (which we only use like 3 times? haha) Anyway, Shah took the initiative to buy the tickets online and Walah! the ultras are here to celebrate! Yes!! My first ever Malaysia Cup final! Ive always been to the stadium but never to a Selangor Malaysia CUp final.. the last was in 2005, but i could not attend then. So now is the time! 

With our previous experiences in Shah Alam stadium, we decided to park far away from the designated parking as the traffic after the match can be a nightmare if we were to park next to the stadium. Honestly, for a Cup final we were too casual and by the time we got into the stadium, there were no seats left! Aduss... I was thinking, maybe i have to stand all the way to watch this match. Shah then brought us to this place.. which was cool.. as we literally watched the game from the roof of the stadium! Haha.. 

 The atmosphere was as ever electrifying.I love being in a stadium full of passionate supporters. Cool habis. We were there. It was a question though why was the Kedah supporters who looked like dominating the stadium seats.. hmmm.. 

 We were there when Hazwan scored the first goal in the first few minutes. We were there when Hazman scored another in the second half. The Selangor supporters were singing and dancing. The team played really well. Puas hati tengok.. effort from each player. The antiques of Di Guelme.. Andik and the rest of the team. Not to be forgotten, Kedah's keeper haha  

And when the final whistle blew, we were there... were there.. to witness Selangor's 33rd Piala Malaysia.. Kudos Red Giants! Kudos Selangor!

Another year coming to an end

I have not done justice to this blog. I guess since the day our maid called and decided not to return from her holidays it has been a haphazard life. Wifey became very stressed that she had changed the definition of stress Haha I was busy myself with work as suddenly there was a surge of cases. Its the end of the year and lots of people are trying to maximize their benefits. I had a run of midnight epidurals and caesarean sections; uncommon in my hospital so far but i guess that is how life is. Kalau tiap-tiap hari macam tu, then hmm.. kena relook at my life goals! haha 

Its the 30th today and in two days time, according to the Gregorian calendar we will be moving on to the next cycle of life. 2015 was certainly the year where I recalculated my life goals especially with the hajj trip. The last 2 months became an eye opener to the meaning of life. Seeing wifey's cousin in battle with cancer at a young age is overwhelming. I cannot imagine the things that she has to go through, and of course her dear Hubby, Azad my good friend. I honestly don't know if i am to be in his shoes, to be doing what he has done so far. The sacrifice, the pain.. masha Allah. I may have encountered patients with a similar state and condition, but as now it is happening close to me; it feels surreal that i maybe able to think what should be done, whether I can really do it if I am the one. 

What will it be in 2016? For whatever it is, Allah has already have everything in plan.

#DIAgnosis2 in CUCMS - The Giving Hands

Talk to the hand.. tengok poster rasa macam tu.. haha

Alhamdulillah, the 3 of us were invited to be panelists to this session last night. We were invited by the student body who were raising funds for their humanitarian trip to Laos next year. I have always enjoyed such forums and talks especially towards the future healthcarers of Malaysia.

It was my first time in CUCMS premises and I was very impressed with the set up. I have been following the university's progress through the years because of Prof Latif. A very inspiring person I had met when I was 18 years old. He changed my perception on the true meaning of a complete and holistic doctor. We were young, far away in a foreign land and it was him who impressed me the most. High academic achiever and at the same time inspiring us the Islamic way. This was back in 1994-1996! He did then mention of his vision of having his own medical school with its own unique teaching philosophy. Alhamdulillah, I was at his premises yesterday witnessing his vision. Insha Allah, maybe with DIAgnosis, we can create something similar.  

The format was simple, and we only had two real questions to talk about. And 10 minutes for each of us flew just like that. I nearly forgot how i would always enjoy myself on the stage talking.. talking.. haha What i reckon have changed in my way of presentation would be how relax i can be on the stage, thus cracking jokes here and there as how I would do during my teaching days in UiTM. 

Azah was as inspiring as ever, cool and calm and the idol. Dato Rahim mentioned that she was like Prof Muhaya! hehe Indeed she was, talking in the mannerism of an elder sister inspiring her siblings. Ben was as usual the charming guy.. the darlig of the crowd! Haha Well, nak buat macamana as he is indeed very famous on twitterland with 40k followers ! mak aii.. and nampak sangat la when 1 girl actually stood up during Q&A,,, " Im here because of Dr Beni..." and i could swear seeing in her eyes: waiting to say I love you Dr Beni! hahaha but this is Malaysia kan.. so malu sikit aa.. 

 We had the special appearance of Muadz, a contemporary nasyid singer who sang for us really well! I am impressed with him and who knows in the future we might collaborate? :)

Alhamdulillah, I was glad to be involved in the programme. Thank you to the organizer and thank you to teamdiagnosis for making it happen :) 

Mati adalah motivasi hidup terbaik

I've been watching Sayap Jibril on tv. I reckon more lesson learnt as compared to the monotonous tanah kubur. Though i must admit that the popular Tok Adi is one my current favourite characters on TV. Of course, the element of logical condition of Ustaz Rayhan can be questioned, but for dakwah entertainment purposes there are other things which is more important. 

The other thing that attracted me is the soundtrack. When it is from Ungu, you would know the depth of their song's quality. When i went through the lyrics, wah.. too powerful! certainly something to ponder. I've been pondering about death these few days. Its never ours to decide when and how. I've been toying around with the idea of What if it was me kind of thing. Am i ready? Am I prepared?

Saat tibe nafas di ujung hela
Mata tinggi tak sanggup bicara
Mulut terkunci tanpa suara
Bila tiba saat berganti dunia 
Alam yang sangat jauh berbeda
Siapkah kita menjawab semua
Pertanyaan

Bila nafas akhir terhenti sudah
Jantung hatipun tak berdaya
Hanya menangis tanpa suara
Mati tak bisa untuk kau hindari
Tak mungkin bisa untuk engkau lari
Ajalmu pasti menghampiri
Mati tinggal menunggu saat nanti
Kemana kita bisa lari
Kita pastikan mengalami mati

Mati tak bisa untuk kau hindari
Tak mungkin bisa engkau lari
Ajalmu pasti menghampiri
Mati tinggal menunggu saat nanti
Kemana kita bisa lari
Kita pastikan mengalami
Mati

Alfatihah to Shahril Hamzah

I received the news through our SMTTDI chat group. An ex schoolmate of mine Shahril passed away due to a freak motorbike accident in Pajam early morning. It was his last ride. I have not met Shahril since leaving school. Perhaps just facebook and the whatsapp group where he was a non active participant.

Since I was in TTDI on Sunday, i made a point to be present during his funeral. My mum's place and SUngai Penchala is too near. He was a lovely guy as long as i can remember. He was part of the Gunung Tahan expedition team in 1992 and a very useful member. He has always been courteous and i will always remember him for his akhlak.
As the Ketua Murid, i took him into the prefectorial board in form 5 as he was fit to be one. Its just unfortunate that the school had some sort of bias towards those coming from Sungai Penchala. He was chosen based on his merits and Alhamdulillah, he was doing well in life. 

 He left 4 children and it was heartbreaking to see them yesterday night. The jenazah arrived from Seremban hospital at about 630pm and he was buried after the maghrib prayers. It was a shock to the family as he was at his best of health. Shahril was a superbike enthusiast and it was just unfortunate that he decided on a solo ride to Tanjung Malim yesterday. Daud (another ex SMTTDI) colleague was his usual companion and in his bike team. It was a sad moment when his uncle lead the jenazah prayers with his father and siblings on the first saf. 

I saw a few familiar faces yesterday, Im sure they were my juniors in SMTTDI. I met Afezan, a close family friend of Shahril and my former schoolmate too. We caught up and i guess thats how I will meet my old friends; either weddings or funerals. 

ALfatihah for arwah Shahril and may he be blessed amongst the solehins. 

School holidays and achievements thus far

Again.. the hectic schedule of running around with work and activities for the children had made me neglected my blog this last 2 weeks. Honestly, i totally have forgotten about continuing to write about my hajj journey!! Haha 

Its the end of the year and kids were at their busiest schedule. From Marissa's end of year concert to Qayyum and Qaisya's Hari Anugerah. I try as much not to miss their thingy in the midst of my hectic oncall. 

 Qayyum surprised all of us with his achievement in SRA. At first when he came back and told me that he was 2nd in class, i was very sceptical. I could only attend Qaisya's report card day and not his. Ustaz had to call to inform that it was true that he will be getting his prize on Hari Anuegerah. Haha That is as bad as it can get. Alhamdulillah, it was his rezeki. I guess the drill we did during the haze "holidays" improved his grades. As proud as I can be, i thought it was good for his motivation. This was his first time unlike Qaisya and I am sure it will spur him on to achieve better things in the future. 

 I missed Qaisya's SKBJ hari penyampaian hadiah though due to work. It was not possible to take short notice leave and we had a busy list that day. I must thank my auntie, AUntie Nor who volunteered to be at the school to celebrate Qaisya's first place in class! Kudos! 

 Last weekend, both Qayyum and Qaisya took part in the SKBJ close chess competition. It is a yearly thingy for the club - in seeing how much those coming for the weekly chess club had progressed. It was Qaisya's first tournament and I was interested to see how she would cope and fare in a more competetive environment. She got 3rd and hence the medal and I am beginning to sense her longing to win things. Haha I'm just not sure how would she cope with dissapointments later :) 

My Hajj journey Part 3

The flight to KLIA to Jeddah took 9 hours, I've not been in a flight that long for quite sometime and probably realized that fact when it was announced by the captain. I am with Tabung Haji's Topaz package and with me were about 30 couples. We only knew one couple at first, Yuzaini from Petronas as we were once facilitators for Projek Tekad more than 10 years ago! We met them earlier during the Kursus Intensif package in KL few weeks before departure. Its nice however to be in a group where you do not really know other people as it gives you the chance to obtain more friends and contacts from all ages.

Our flight were shared by a few other Malaysian package groups. Most significantly, a group which was invited personally by King Salman - the chief of Malaysian Police Tan Sri Khalid  and Dr Maza, Perlis Mufti was in that group too. It was with this group that I met Fadzil - an acquaintance from my Perth days! We managed to catch up a bit, its good to meet up old friends in this journey of ibadah. 

We were in our ihram and slowly building the momentum towards niat in miqat which means having to confirm our intention at the place designated for us to do so. This would be one of the pillars of hajj. It is haram to enter Makkah if not to worship him ie either umrah or hajj as planned. Since our flight was from Malaysia our miqat was Qarnul Manazil. Obviously being high up in the sky we would not know but we were informed by the flight authorities to confirm our intentions when we passed the area. And from there on, we are bounded to the 13 don'ts of ihram. Bismillah. 

I guess it was the niat to ibadah that made me uncharacteristicly not taking as many pictures during this earlier part of the journey as I would have if travelling elsewhere.I was more comfortable after masyair and did take my chance to snap typical jemaah pics! haha The talbiah was recited again and again. My heart went racing as this is it. I am on my way to Makkah. I am on way to the holy land. The last i was there was when i was 16. A lot have changed i guess based on the stories which were told to us by fellow Hajj who went on previous years, 

This is a journey where we were advised to be patient all the time. A lot of test will be encountered and one has to be true to one's intention. Being a "pendosa tegar", i was a bit worried if I am to be facing multiple dugaans haha But i guess this is the time to be tested. It was talbiah, zikr, talbiah zikr on my lips and in my heart. 

Allahumma yassir Wa la Tu'assir.

Our arrival in Jeddah was on time and surprisingly the immigration wait was not too bad. It was not too long and made easy with the efficient movement by the authorities. 2-3 hours waiting was not too bad as compared to the experience of 8-14 hours by previous jemaahs. We arrived at 9pm and by 12am we were on our bus to Jeddah.

The true heat of Saudi was felt when we went out of the airport to the bus station area. Our Tabung Haji Travel CEO, Dato Yasmin was there to receive us and with her staff, making our journey experience as comfortable as it can be. Honestly, in my mind i was ready for any worst scenario.. as I've always been ready in my past travels. This time around it was different because my mind was then focused on my task ahead. The palpitation was getting more obvious as we were approaching makkah.

My Hajj Journey Part 2

To tell you the truth, I don't really have that much of pictures to share. Somehow along the trip, it did not trigger me to snap pics here and there as how i would usually do. Brought my selfie stick but almost did not use it as i felt wrong doing that.
 My initial plan was to do a video log of what I do everyday from arrival till departure. It was not doable because once you are there, it did not become a priority. What was more important was the submission to Allah. And that feeling is totally unexplainable. I reckon to those who have gone through this journey may understand what i mean. As how i began to understand the magical wonders of hajj in this trip as it went.

1 Zulhijjah 1436 - 10 days before wukuf; the date of my flight from Kl to Jeddah. We were scheduled to fly on the commercial flight instead of a chartered flight. It was via Saudi airlines thus our departure point was from KLIA instead of Kelana Jaya. Thus we were known as SV 12 as compared to the standard Tabung Haji fellas of KT (I had a hard time to describe to our fellow jemaah in Mekah when we met haha) 

In terms of experience, we missed the crowd, the atmosphere in Kelana Jaya that is knwon to be very festive  and the police escort to KLIA. What we appreciated was it was possible for the kids to see us till the boarding gate. If the check in was in Kelana Jaya, we don't think it was suitable to bring the kids to the crowded area. Alhamdulillah. Anyway, it was a small affair, both of our parents and siblings came to the house before we left. 

                                   classic picture - must find my grandpas pic posing as such.

 After putting on the ihram it felt different. My mind was focused towards what I will be going through. The last few months was about consolidating my knowledge about hajj. Eventhough i learnt about it in school. it was different pondering on the knowledge as it was the ibadah i was going to perform. Papa recited the doa for us.

 And at that moment when my eldest son recited the azan before our departure, it hit me. Labbaikallahummalabbaik.. Labbaikkalasharikalakalabbaik...

 Felt proud of Qayyum as he has been trained to stand up to his role on this day that he will remember for the rest of his life. I saw the tears in his eyes which translated to his quiet cry while in the MPV to KLIA. 

 Kids were as usual jovial. Perhaps only the elder 3 understood what was going on as we were leaving them for a month. Perhaps their previous experience sending and picking me up at the airport gave them a bit of comfort of not feeling the temporary loss. 

"See you in October Ummi.." Qaisya yelled as we were proceeding to the immigration counter. Typical of her personality; few days before the departure, Qayyum n Marissa would be sobbing and crying while going to sleep. Qaisya went" Why is everybody crying?" haha typical. 

We did not feel too sad leaving them ( as for me mmg takde perasaan la.. haha I've left them too many times) because i guess our minds were directed towards the bigger task at mind. For Allah to accept our humble ibadah. 

My Hajj journey Part 1

After all the kursus haji that we have attended, it was the real thing now. Honestly, despite people giving lots of advice, Ustaz and his teachings, we still did not know what to expect. Ihram, Mashair.. etc.. Ya Allah, every night was filled with what ifs. 

We held a small kenduri doa selamat a few days before we left for Hajj. It was 2 days after the crane tragedy happened in Makkah. Everybody was shocked with what had happened and figured that this year would be a challenging one. This was our first ever kenduri event at the house. It was a good one as we managed to invite the neighbours around us. Those who did not make it came earlier or later to meet us personally wishing us mabrur for the trip. Alhamdulillah, we were glad that the weather was convenient for all our guests.  

Dr Anwar had earlier agreed to lead the Maghrib prayers and Yassin recitation with doa at the end of it. Thank you bro! I really do appreciate it. His recitation of the quran was wonderful. Luckily i managed to get our own PA system for the event. And guess where i bought it? Rawang! Where you can find anything at a cheaper price! haha  

Alhamdulillah we had a good crowd with closest family and friends came to pray du'a for me and wifey. I am grateful of the attendance at at times was worried if the food we catered was enough!It was a very busy night as everyone who came had something to tell us. Most of the relatives shared their own experience and gave us handful tips. Thats why this event was different from any other event that we have organized before. We had more close conversations with the guest compared to if it was raya/birthday or gathering. 

 Alhamdulillah, the night ended well and we were very pleased that everything went as planned. Now the palpitation will be of waiting for the day we were scheduled to depart for Jeddah. 

Labbaikallahummalabaik... 

CIkgu garang

My children is getting bigger and wifey can't really manage the elder ones as how she would like to. Especially during the exam week as too often i will hear her shout and scream..(haha, stress) during the revision. So this time around I've decided to take over that role. Anyway, wifey was occupied with her ill cousin that I had to step in anyway. 

It was supposed to be only during the exam week but the haze messed the arrangement. In the end they had to take exams for both sekolah kebangsaan and sekolah agama in the same week. Usually it will be one week after another.

Kids will be kids. Their ability to absorb and handle everything at the same time is better than adults. So we proceed for the 2 weeks full revision with me mentoring. It had been quite sometime since i last did this. I have always enjoyed teaching and i will have my own unique technique. When i got angy then i realized, ooo patut pun wifey stress haha Anyway, with rotan on one hand it did help as the children were always more afraid of me because of my action first talk later. Haha Managed to discipline them for that 2 weeks with the worksheets I've asked them to do. We went over it after and Insha Allah, i guess the children somehow appreciate it. As by the 2nd week they were ready asking what they were supposed to do on that day. 

I guess its not easy for the teachers in school to handle these kids. Especially if the kids had varying abilities. 40 students in 1 class can be too much for the teacher to really concentrate on everybody. However, i do believe that a good teacher would try his or her best to sort the kids to the best of their ability. Indeed a very noble profession. 

This week we are waiting for their results, I must say Qaisya's has been encouraging as how she has been. For Qayyum, i do hope that there will be some improvement to his grades as the mid year exams showed us how bad his understanding was with what is being taught ( or was it even done?). Insha Allah, the super drilling i gave them last week would help and i guess towards his UPSR or whatever they may call it then. 

To live and to die

It has indeed been a busy week at work for me. It was also a crucial week for a close friend as the the diagnosis was confirmed. The big C. The unwanted C. The vicious C. When it smacks at somebody close to you, one would realize how fragile one is in knowing what the future holds. It is never ours to know or predict and the acceptance of such qada and qadar can be easy to be uttered, yet hard to be realized. 

It is common to hear sermons demanding to make death as one's ultimate motivation. It is the best motivation but in the midst of our daily lives sometimes it becomes the thing one wants to avoid to hear. Having a young family, young children with life thought to be ready full ahead is disrupted. Insha Allah, it is a blessing. The chance of actually knowing one's life expectancy. You and me, we will never know when it can be. As for me, perhaps after blogging this entry, i might just slip and have hard fall causing a massive intracranial bleed which can take my life instantly. That is much scarier to think about. Life is just to short to not be satisfied with. Carpe Diem.

Insha Allah, i pray to god for what is best. Of course, despite being at Stage IV it does not mean one should just let it be. A certain effort is needed to not cheat death but to realize how powerful Allah's will is.

One year after hijrah

It has been a year after i made the move. Alhamdulillah, it has been a fulfilling journey so far. The many things I thought it was not possible to do if one is in the private, I did it. It is possible to take leave and do charity work and of course, the journey of hajj. I guess it was my rezeki as the hospital I am now is relatively new. Therefore, the workload would not be as intense as established private sector. Despite that, the remuneration I made is sufficient and I am happy with what i am earning now. I have an understanding colleague and a healthy atmosphere with my surgical colleagues. What more do one wants kan? 

Is there any regrets? NOPE.. Insha Allah it will never be that way in fact a move forward with the hijrah. Honestly, it was never in my long term plan to join the private sector. I was a loyal servant especially to UiTM as I see great things that my faculty and University can achieve. I have always been a strong supporter and as much as possible, brought the UiTM tag with me wherever I go around the country. People knew me as the Dr from UiTM. I recruited a number of doctors and jurses to join the university. I had dreams to grow with Faculty of Medicine UiTM. We started the Cardiothoracic services and that is the highlight of my job with UiTM. A small new faculty and department but we did wonders to be able to do open heart surgeries in our humble centre, CTC. I learnt the off pump technique from a very distinguished surgeon, and i owe him the wisdom of clinical and maturity. 

So why did i leave? Soalan cepumas!! Tak puas hati dengan gaji? Problem dengan admin? Dizalimi roster? Haha Maybe few of the typical reasons of why doctors from the government decide to go private practice.Insha Allah, none of that is my reason in fact i wish i did not have to leave if it was possible. I enjoy the chaos and the rifts of emergencies that occur in government hospitals. Memang best despite when at that moment in time, we just had to do what we had to do. The environment in UiTM is condusive. Politics? well.. mana2 pun politics as that is part and parcel of life. One has to be cunning to realize one's potential. Of course, teaching the students. I miss that the most. To see the innocent young at their enthusiastic idealistic stage being nurtured into becoming complete doctors for ummah. Its a joy to see their faces as you share your knowledge with them and I do hope i would have the chance to contribute like that again in the future. 

SO what was my reason? Its our teaching hospital. The delay and frustration of the dream project for hopefuls like me really would be my reason. When i joined the faculty back in 2005, we had this vision of a medical city. An idea which inspired many others to have similar visions. I have always looked forward to the dream and motivated myself on it during my post graduate studies. It was not meant to be but we were promised our own teaching hospital circa 2015. I was really looking forward to that. Psyched my team on the dream to form our own department and unique hospital. 

Unfortunately, the project got delayed many times and the timeline moved with it. Early 2014, in a discussion with the new faculty management I found out that the project status was as how it was earlier planned. I was shocked and that made me rethink of my goals and aims.  Of course there were meetings, seminars , "FINAL" meeting etc but unfortunately it never got off to whatever reason. The VC announced regarding our teaching hospital in 2010, but as it stands now,. nothing conclusive on this project. 

My unfulfilled journey in the GAZA mission later in 2014 changed a lot of my beliefs and perception. I saw with my own eyes how weak the ummah is and how we are all gullible to the powerhouse. We can all just complain but can do nothing at all. We do not have the means to help the Gazans really. The only thing that they need and really plead if we wanna really help is to fund them. How can we fund them if we do not have the means? 

And i made my decision to part from UiTM despite my love for the institution. I still believe that the faculty and university will thrive. Perhaps not in my time and my rezeki. It will come and i guess i am the person who won't wait for things to happen. I try to make things happen! 

And here I am.. a year after. Insha Allah, prayers for better years to come in fulfilling my duties.

And I am 39

A belated birthday post for me! Alhamdulillah, I turned 39 last Saturday. The 24th of October. There was not so much of celebration this year, i guess because I was oncall. It was a nice feeling to have friends from all over wishing you from all social media platforms. Nowadays you don't really receive the old school birthday cards anymore, even from your closest family members! 

It was a cool Saturday. I spent my time mostly at home. Tutoring (more of drilling!) haha my elder 2 kids on their coming exam this week. The hospital  did not have any case though and all day i was reflecting on my life so far, of what has happened, what I am now and what my future will be...

Significantly, I am one year short before turning 40. Life begins at 40 they say. I read in an unnamed whatsapp message about the significance of the age 40 for man. And i was astonished with the fact of a verse in the Quran, Al Ahqaaf 15.. 

"We enjoined the human being to honor his parents. His mother bore him arduously, gave birth to him arduously, and took intimate care of him for thirty months. When he reaches maturity, and reaches the age of forty, he should say, "My Lord, direct me to appreciate the blessings You have bestowed upon me and upon my parents, and to do the righteous works that please You. Let my children be righteous as well. I have repented to You; I am a submitter." 46:15

Subhanallah. It is being mentioned about the Quran how significant age 40 is. AN age of maturity: the prime of life. The best of times for Allah's creation. 

And it was this fact that became the theme during my recent hajj. Of how, a reflection of what i have achieved so far and an evaluation of whether my so called achievements are tallied to the ultimate aim as the servant of Allah. 

I have never been a perfect servant. Perhaps maybe committing sins more than the supposed deeds. Masha Allah. 

I pray to Allah that he will keep me in the right path, the path of the righteous. And I pray really hard , that this realization i have before turning 40 would be constant and perhaps towards the penultimate goalof any muslim. Insha Allah. 

I'm back

The journey of my lifetime. Alhamdulillah, I'm back home now after a long absence on the blogging scene. I went to Makkah on the 12th of September and came back on the 13th of October. One month of my direct dedication to Allah and it was a wonderful experience.I will share with you guys in my coming postings. It was not possible somehow though to blog it in realtime. I guess, I was more keen to be in direct communication with god than with mankind.I twas my only opportunity which should not be wasted in the holy land. 

Am I a changed person/man now? Only time will tell. As the challenge now would be to maintain my istiqamah :) Pray that it'll be easy for me though i know that it will be a challenge!! 

Perjuangan Ultras Malaya #ultrasmalaya

 The mass media is playing the blame game on the Ultras for their brave act in Stadium Shah Alam the other night. I would have been in the stadium if not for an emergency case that came up last minute despite planning to attend the calling by Ultras for true fans to show their strut. I am disappointed with the media who are trying their best to show the so called EVIL amongst this batch of Malaysia supporters. I am sure the ultras bashing is being orchestrated by the powers up there: obviously the one funding them .. periuk nasi maah..

All Malaysia football fans were angry, dismayed by the poor performance of the team in the last few games. Of course the pinnacle was the 10-0 drubbing by UAE. Everybody knows the root of the problem which have been breeding for years; and being let to rut. It is unfortunate for Dollah Salleh to inherit the title of the WORST MALAYSIAN COACH ever with our heavy defeats to Oman, Palestin with 6-0 each and the UAE tragedy.

ULTRAS did what they had to do. There was no other way or SALURAN to use as it has been exhausted and not being taken seriously by the authorities.

Perhaps it was over the top, but HOW ELSE BRO? How else to make the whole nation realize how bad the situation is at the moment.

The media is trying to brainwash the public of how embarrassing to have the ULTRAS around.. but HONESTLY, I AM MORE EMBARRASSED with our LOST to PALESTIN.. C/mon.. PALESTIN? A turmoiled country and we lost to them. 10-0? WAAAHH.. Memang standard SAN-MARINO..ANDORRA.

ARE WE THAT BAD? WHAT HAPPENED?

I am a keen Malaysia football fan and as much as possible will try to be at our team games despite their mediocrity at times, even though the games were played with only a scarce number of fans. You can check out my previous entries about Malaysia team and i will continue to support despite us being in the lowest pit of quality at the moment. 

Ultras Malaya has brought a new dimension to the supporting crowd of the national team. It used to be very boring and only full of swearing by the crowd. At times everybody would cheer and sing to the tune of Inilah Barisan kita. But since it has the word Barisan, few are not too happy to sing and clap with it anymore... haha

Ultras would chant.. and sing..and dance for the whole game. Before and especially after the game. They will continue giving their support and I've NEVER seen them jeered the National team players during the game. The crowd used to boo certain players from the likes of Zainal Abidin Hassan to Khalid Jamlus. The worst was when KJ brought MYTEAM to play Malaysia. That was a purely CIRCUS game! Perhaps KJ had the same sentiment against the FAM admins as he was the Deputy President then. He must have realized something had to be changed and organized the circus. That was the saddest moment when our players in the traditional national colours were booed by the crowd and only a handful of us cheered the National team. Imagine if ultras were around then..

Ultras best moment? The electrifying legendary moment of AFF 2014 finals in Bukit Jalil. They did the parade and made the whole stadium in awe with their support and chants. Whoever was present in the SSBJ would witness to the best of support in our lifetime. It certainly made the players fired up for the game and despite losing, NEVER did the ultras bowed away from supporting till the very end. 

AND THE MEDIA ARE PERSECUTING THEM TO THE GUILLOTINE? 

KAMONLAH MEDIA.. Jangan makan suap!! Where is your integrity? 

To the ULTRAS, Please continue to show your support to Harimau Malaya. You've made the difference to all national team suppporters out there. Sapa yang banyak komen tu confirm not those who goes to the stadium..Wannabees who only support the national team when we are winning which defines them as not true supporter.

Selamanya HARIMAU MALAYA.

Its coming soon

Its getting nearer, my flight to Makkah. It is coming soon. Every night i get palpitations, don't really know why. Its the journey. The journey of my lifetime. Am i ready for it? I don't know. I can only pray that things are made easy for my ibadah. 

Its the 5th pillar of Islam, and every muslim who have fulfilled the earlier four is summoned to complete the five. Ideally, all four should be at its maximum before one submits oneself to realize one's iqrar of Islam. However, i guess the calling, the calling to his holy land. 

Reciting the talbiyah, can be very emotional when one recites it..Somehow..

Labbayka Allāhumma Labbayk. Labbayk Lā Sharīka Laka Labbayk. Inna l-Ḥamda, Wa n-Niʻmata, Laka wal Mulk, Lā Sharīka Lak.

In Arabic: لَبَّيْكَ اللَّهُمَّ لَبَّيْكَ، لَبَّيْكَ لاَ شَرِيْكَ لَكَ لَبَّيْكَ، إِنَّ الْحَمْدَ وَالنِّعْمَةَ لَكَ وَالْمُلْكَ لاَشَرِيْكَ لَكَ

Here I am at Thy service O Lord, here I am. Here I am at Thy service and Thou hast no partners. Thine alone is All Praise and All Bounty, and Thine alone is The Sovereignty. Thou hast no partners."

Semoga dipermudahkan.

When a fellow colleague reflects.. All reflexes maintained constantly :)

Reading this entry from an anaesthesiologist in Canada made me smile. If it was a facebook entry i would have just clicked the button SHARE. I am relatively new to anaesthesia as compared to him but i could relate to what he had written. The practice may change with technology and time but the sharpness of mind and practice of an anaesthesiologist is maintained through generations. 

Its true that with technology, the fundamentals of anaesthesia care may not well be emphasized - more so to consider giving anaesthesia when there is no electricity remains foreign to the young. In my earliest training, I was mentored by few really senior ( as in now RIP..) anaesthetist. I can still remember how they emphasized on ME as being THE BEST PATIENT MONITOR at all times. This remain as my mantra to my trainees.. 

Credit to bleeding heart. Excellent entry! 

Reflections on a quarter century

25 years ago today or maybe it was yesterday I gave my first anaesthetic as a specialist.  I remember it was an oral surgery list.  I also remember my first patient was a Pediatric patient and I remember thinking how it was a good thing I hadn't looked carefully at the list the night before because I might not have slept well knowing I was doing a kid first.  Fortunately that child and the two other patients I did that day did well.

The child I would have induced with Halothane before starting an IV, giving a muscle relaxant (probably vecuronium) and intubating after which I would have maintained him with N2O, oxygen and halothane.

The two adults I would have used Alfentanyl, thiopental to induce and either succinylcholine or vecuronium to intimate.  I would have maintained with nitrous and oxygen and either isoflurane or enflurane.  Because the surgeon may have wanted induced hypotension, I may have used curare as my muscle relaxant.  Morphine would have been given for analgesia and I probably gave droperidol as an antiemetic.  Interesting how many of the drugs I used then are either no longer available or have fallen out of favour.

My machine would have been a Boyle machine.  No electronics, no software, driven by compressed gas and just as safe or safer than the $100K behemoth I use today.  To switch fron the bag to the ventilator, you manually disconnected the bag and connected the ventilator hose, remembering to close the APL valve.

The anesthetic circuit was the Bain circuit, with its necessary high gas flows which meant you went thru at least 1 bottle of isoflurane a day.  The circle circuit which had fallen out of fashion was just coming back into fashion.  Circuits were changed every case but there was no filtering.

Monitoring was with EKG, NIBP, pulse oximetry, and  ETCO2.  The latter two had only recently been mandated as standard.  There was no expired gas monitors.  Most of us figured that by dialling in a certain percent, we got a certain end tidal gas concentration.  Pulse oximetry had not been mandated in recovery yet.  Our recovery had one or two pulse oximeters which they put on whoever they figured needed it the most.

A significant number of patients were admitted the night before surgery which meant seeing them the night before after your list  and coming in Sunday evening.  At our hospital then, the person on call saw all the pre-ops which meant 10-20 patients on Sunday evening on top of doing emergency cases and I remember rounding at 2300 some nights. (When people complain about the pre  assessment clinic I remind them of this, but so few people remember having to do this that it doesn't work any more.)

Cholecystectomies, appendectomies, and hernias were still done open.  The laparoscopic cholie appeared early in my career ( initially three hours of farting around followed by an open cholie), the others later.

Over time things changed.  Propofol was introduced early on.  At first pharmacy refused to supply, then rationed it; I got into the habit of mixing it with Pentothal, I called this mixture President's Choice propofol.

Muscle relaxants came and went, rocuronium came and stayed, less so cisatracurium and pipicuronium. Curare disappeared soon after I started.  Pancuronium hung on until recently.  Atracurium and vecuronium, introduced while I was a resident are gone.

Sevoflurane and desflurane appeared in the mid to late 1990s.  I still don't think they are much better than halothane and isoflurane which have also disappeared from use.  So has enflurane.

The laryngeal mask airway was introduced early in my career.  Who remembers mask anaesthesia?  That was how we did short cases like D+C s and cystoscopies, holding the mask with one hand, and writing up the chart with the other.  Some of our older colleagues even did longer cases and had elaborate set ups with the black mask strap and tongue depressors to free up their hands.  (Periodically a resident comes across the mask holder and asks me what it was for).  The LMA has mostly supplanted the ETT in many of the cases I used to intubate although I am still a lot more conservative that some.

When I started well over half of Caesarian Sections were done under general.  Now GA is reserved for special exceptions and dire emergencies.  Some commentators are now saying we don't do enough GAs. Unfortunately in my time the section rate has increased from 15-20% to 30%.

My malpractice premiums were $9000 (14,600 in 2015 dollars) that first year.  I currently paid $8600.  I would like to think that this is because we are all better anaesthesiologists but I credit the pulse oximeter for most of this.

One constant in my career has been the drive to cut costs.  For the past 25 years, the mantra has been that health care costs are spiralling out of control.  With that logic they should now be consuming 200-300% of the total provincial budget or GDP however you want to express it.

One major change in anaesthesia and in medicine in general has been the increase in obesity.  On my fellowship oral exam, I remember being given a case of a morbidly obese lady presenting for a D+C.  I see at least one such lady every time I do the Gyne list.

Two things I thought were inevitable when I started have not come to pass.  Today as I have for the past 25 years, I charted on a paper chart.  Lots of places have an EMR; in my chronic pain practices I use an EMR at some but not all sites, but if you offer me good odds that I will not be exclusively charting electronically before I retire I will take them.  Secondly I am still billing exclusively fee for service.  I gave this 5 years maybe, when I started.  I will take the same odds that I will be billing fee for service until I retire.

Since my first day I have moved cities once and lived in 3 very different neighbourhoods in my current city.  I have fathered a second child, and watched 2 boys grow up.  I have gone thru 4 dogs.  I became an accidental chronic pain specialist.  After working unhappily at the C of E I now enjoy my life at my medium size Catholic Hospital.  I have gone into and survived administration.

When my wife learned I was blogging on this, she asked if I was nostalgic or whether I was happy with the way things had changed.

I am nostalgia for the way I felt during the first few weeks in practice when everything was a novelty, and you realized that after 4 years of training, you had made the right decision and you were competent at it.  You never get that feeling back.  I feel nostalgic for some of the people I first worked with who helped me out.  I also feel nostalgic for the little town in Atlantic Canada where I first worked for 2 years before I went to the Centre of Excellence.  I don't know how many times in the first few months, I wanted to call them and ask for my job back.  All in all I still think that the move was for the better.

Have things gotten better?

I do like the short acting drugs we have now although they are not always a short acting as we would like them to be and sometimes because we don't respect them we get into trouble.  Like the recent article in Anesthesiology suggesting that a significant number of patients still get discharged incompletely reversed from their intermediate muscle relaxant.  Pancuronium and curare we knew lasted a long time, so we used them sparingly.  If the surgeon complained about bucking while he was closing, we didn't give another dose.  It may be a good thing that patients are more awake post-op, however I wonder how whether the recovery room nurses appreciate the awake, anxious, painful patients we now drop off as opposed to the sleepy ones we used to.  No matter what anaesthetic you use, discharge is driven by things like policy, availability of porters and when the patient's ride shows up on time.  When I recently had a colonoscopy with sedation, I liked being able to walk out 15 minutes after the end of the procedure (I told my wife, "I've driven in worse shape then this.")

The greatest advance in anaesthesia is the pulse oximeter.  The ETCO2 is also a useful monitor and one I am glad to have.

With the medical system in constant crisis, I often wonder whether we are worse off.  I sometimes think that we are like the frog in the pot of water that is slowly being heated, and don't realize that we are being boiled alive because it is so gradual.

I like history and one of the advantages of growing old is to look back on how things have changed (and how things have not changed) ; how dogma becomes heresy and how heresy becomes dogma.

Looking forward to the next 25 years.