Sometimes we have to be more than what we are

Having being told of one having a terminal illness can be a nightmare. Its the sudden news of a diagnosis which brings death to the front. The one reason why some of us can be obsessive in going for medical checks often is the big letter C. A taboo to be spoken about but a definite prognosis beckons. Being in the medical field, it is often a situation where you don't really want to be involved in. Unfortunately for some of us, breaking this news becomes a responsibility. 

I will come across these patients in different stages. Most often, the point where surgical intervention is needed, either in emergency situations or after electively discovered. Honestly i cannot imagine being in their shoes, having being told, yup.. you have the big C. 

I sat down and talked to one of my patients the other day. Even though i was there for pre op assessment, i spent more time being a doctor rather than as anaesthetist. The unfortunate diagnosis was confirmed just few days back and it is a big one. I am sure he is still in shock, I could see in his eyes the tears but he holds it back as we talk. His family is in shock with the wife not really accepting it well. The psycho social aspect in this matter is very important; as the mental health should also be reviewed. Its important, as fighting cancer can be a mind blowing journey with full of uncertainties. 

Yup, it was just a short discussion of what it is all about. I encourage him to read about what he has, so that when he meets up with the oncologist, he and his family will be ready for questions rather than listening and absorbing. That is the usual practice in asian community. As the one managing them, we should explain that the treatment for cancer is a journey which needs a lot of strength and courage, full family support an istiqamah. Yang penting usaha bukan semata-mata berserah sahaja. And whatever the result will be, we redha. 

It was something i felt i had to do, the chat. As i believe as doctors, we are still human. Being humane and providing empathy is something that we should all do. I am not sure whether i did help but i do really hope i did especially for the stage which he is at, at the moment. 

My prayers for his oncoming journey. 

You're 8 today Qaisya!

Happy birthday to my 1st daughter Qaisya!! Many happy returns!
The little girl who is growing slowly but surely, the one with a distinct personality which amazes me how great Allah Almighty is.
She can be grumpy and self centered, but she is smart and intelligent.
She knows what she wants and what she can achieve.
Insha Allah, my dear.. you will be what you want to be :) 

Revision and revelation

I've been attending the general hajj course organized by Tabung Haji in Kelana Jaya mosque every Sunday morning. I try to attend despite sometimes being oncall. In private, your oncall is unlike in the government as patients are not as many and over the weekend unless it is super rgent that you have to rush to do the cases.

Honestly, i was reluctant to join the course as it was all revision knowledge for 14 weeks. What is to learn in that very long period? Setakat rukun and wajib haji, larangan ihram etc.. not that difficult to digest..no? Revision of subjects during my secondary school which should not be that difficult to be reread. I was tops 5 year in a row for agama in secondary school.

Or was I? 

I was wrong. 

How could i assume as such when we talk about knowledge of ibadah.

Indeed, attending is a revelation.A revelation of mind and soul. Something i did not expect. It is about its feel. And a similar feeling indeed during my Gaza mission journey the other day.

I learn new things every time. May not be academic per say, but that is the gem and gold about hajj. As i look back the journey of hajj began when i agreed to perform it by Tabung Haji.

Indeed, it is an invitation from god.

A new meaning to life, a turn over to renew my vows with him.

Insha Allah, my azam to become a better person and understand the true meaning of hajj. 

The equinox is here again

After the rainy season spell, guess what.. the heat is back! It has been a warm week so far and one can notice it via the scorching hot sun everyday. My career would put me in OT the whole day so I am not affected directly, but coming back home and feeling it to be warm is real!  The threat of drought may be sooner than expected. Such irony, when at one time we were overflowed with water and now, we are getting less of it. The 2014 drought comes back into mind, oh such unpredictable weather nowadays.

The KKM has come out with these posters. I reckon it is a very good conscientious effort! To warn the public about the dangers of heat stroke. Ironically, at the moment i am finalising an article with Prof YK Chan regarding heat stroke. But it is more academic rather than for public reading.

So guys.. stay safe. Do not underestimate the dangers of heat stroke.

A new year of the goat in zoo negara

Belated Gong Xi Fa Chai ! We celebrated the chinese new year in a holiday manner. We did not go anywhere fancy but decided to go to Zoo Negara. It has been a while since i last step in Zoo Negara. It would be nice for the kids as this is the right time and age to bring them there. Besides, the youngest 2 has yet to be brought to this wonderful zoo of ours in Ulu Klang.

We were off early in the morning and parking was plentiful. It is much more expensive now to enter zoo negara especially if one plans to see the two pandas Ling Ling and Xing Xing who arrived mid last year to our zoo. However, i thought that it is more reasonable than a miserly rate because it does cost a lot to maintain a zoo. Overseas zoo prices can be atrocious and i dont see why we should not charge more. However, it should be complemented with satisfaction and good service. 

 Of course, the main attraction this time is Xing Xing and Ling Ling. We waited for the 1130 slot because it is during this time the pandas will be fed. Pandas can be really sensitive and it proved so during our visit. Xing Xing was happily munching his bamboo shoots when Laikha decided to shriek! hahaha and guess what, the panda ran for cover and looked terrified. Remaining still amongst the stones of the artificial river hahaha We were told to be quiet from the start and quite unfortunate to witness what they mentioned were true :( 

 The animal show they had in the afternoon was not too bad. Compared to the zoo many years ago we have improved. The 2 seals were the main stars of the show without a doubt. It was nice to see how the coliseum were full packed with families waiting for the show. This is where i reckon the zoo can improve on with better animal shows. I am confident that we will match the other international zoos in the future. 

Thumbs up to the current management of zoo negara. I was here last probably about 6-7 years ago and i can see a lot of improvement to our zoo. The 2 pandas must have changed the fortune and attention to zoo negara, nevertheless we should love our zoo as a whole. The animals i must say is a far contrast from how they were many years ago. The look sharper and healthier! Seriously! I always remember our zoo animals looking unhealthy and not well kempt. The animals are much better looked after now i guess :) 

You think you can manage the airway ?

Airway management is core for an anaesthetist's practice. Nowadays, Emergency Physicians are expected to be competent at it too despite the reduced importance in the ALS or ACLS guidelines. It goes back to ABC, A=airway. When A is compromised one can in a way forget the others as the mishandling of A will go a looonngg way!

During my MOship, only when one is comfortable with managing straight forward airways, one would be allowed to be oncall. And this would be certified via peers working with one, never self assessment or presumption. This is the one subject where theoretical knowledge without the hands on experience would be useless. One can be really good at reckoning which is which and how to handle things in theory, but when it comes tho practice; its the years of experience will count for any mishaps or possible issues. There is no time to think, its just the output needed on managing the basic principles. 

More so if it is the paediatrics population. How time is of essence. Many anaesthetist would frown upon paediatrics cases when they are posted up. Its the fear of problems that can come and handling paediatrics especially the smaller ones can be really delicate. Its not just a small person but its a totally different population and universe! 

I have evolved from the first day i was asked to intubate electively. I did make numerous attempts in resuscitation during my medical days, but those were when we gung hoed and just shoved the laryngoscope in! It was later in anaesthesia i do really understand which views we were looking for and of course with supervision. One of the first few persons who taught me how to intubate was Tok Man, who later became our senior MO in Sungai Buloh. He did not pursue his post graduate studies but his experience was abundant that he trained from the start a specialist like me. 

Its easy to say relax and take your time when you were in the midst of completing the task. Preoxygenation is important as it gives us the time to take a step back and figure why things happen when you do not get to intubate the first time around. It must have been fun for my MOs and specialists then seeing me jittery and jumpy in managing the airway whilst observing me. The same fun i had when i was training my HOs and MOs to intubate! haha 

"Bang.. tak boleh intubate ni.." Young healthy ASA 1 with features as easy intubation. 

"Abis tu?"

"Abis tu.. camana ni bang.. tolonglah.."

"Boleh bag kan?"

"Boleh.. boleh.. try intubate 2 kali ni tak dapat?" 

"Pandai-pandailah kau.." and he left the room for coffee..

Haha similar story? :) 

UIA Meet & Greet #DIAgnosis2

Again, another last minute request. I was oncall but it was possible for me to appear in UIA last Saturday. Most of other team members were either oncall or had events on that day at that very hour. It is a bit quiet in my place this week, so i guess it was possible for me to be away for 1-2 hours during lunch time.

It was my first time in UIA Gombak. Utterly magnificent. I guess those studying in UIA must be really proud of their organized campus. Truly how a university campus should be.

Diagnosis2 was again  being promoted by Deen's print, one of the booths in a hot selling seminar, "Sebelum Aku Bernikah" by Hilal Asyraf and gang. Walawei.. haha bahaya kalau amik gambar kat conference cam ni, wifey dodgy tengok hahaha  

It was just me and Dr Din. Alhamdulillah, eventhought it was just for an hour, we could see how D2 can be hot selling.. habis tu time kitaorg kat sana. It was nice to know that our readers were not just medics, in fact the public! Not just students, those who are currently professionals too. ALhamdulillah :) 

 Thanks bro Din.. for being there with me. And of course to the other team members with their full support always! 

A proud father MDQ1 first MSSS

Yup..the competition day came after 2.5 weeks of last minute training. It was on Wednesday 11 February 2015. Dzaeffran has been on intensive training for the past 2 weeks. Intensive I must say and something that he was determined to do. He looked forward for every training session and will do his best in every session. I may not be a proper trainer, but on those days where i supervised the regime, he was ever willing to do and never tried to cut corners. (which was unusual for him haha) He was determined as well. 

His best time before the big was circa 1:12-1:15 for 50m freestyle. Slow for podium standing but definitely a marked improvement from the first time 50m he had which was 1:35. His improvement was superb and it was fun to see him getting better everyday. His plunge dive got better as well and come competition day he was up and ready for it. I must thank teacher Dory Salmiah who has been training him ever since. She used to be a well known competition trainer long time ago, evidenced by all the people that know her when we were in Pusat Akuatik Shah Alam.

His event was at noon and i waited from morning for it. He did not show any jitters, typical of him haha simply supressed on the adrenaline rush. 

Honestly, when i brought him to the reporting room, i started crying (not meraung2 la.. haha) felt sebak because proud to see him taking part. He was up for it and who would have thought, the small baby i saw in distress immediately after delivery is here on the big stage. The flashback of that particular moment came rushing to my mind. I guess its because i was the one who saw exactly what happened afterthe delivery. How he was breathless for breath.. how i could see the tachycardia.. his heart beating so fast that i could see it visibly. And his tone on being floppy then.. very-very floppy.. I did paediatrics during my housemanship and flashes of the problematic babies came into mind straight away. I was ready to face any predicament then. I was just praying to Allah to let what is best for him.

And from the moment he was on the start platform till the time he touched the pad, tears were flowing and there was no way i could control it. Even if he'd come last in his heat, it would not change how i was so proud of him. And he did well.. almost getting 1st in a mere milisecond losing to the second spot. Allahu akbar.. Subhanallah.. it was a very touching moment. 

Alhamdulillah, he did a 1:02.98. Of course far off from the 34s of the one who won the event, nevertheless, it was great to see him did his best. I did not expect him to go that fast but he did. With the adrenaline rush, he swam all his might. Subhanallah. my boy.. and to see him do that is such a satisfaction for me.

Insha Allah, next year he will come back strong and the challenge is on MSSS :) 

1st meet & greet in #PestabukuSelangor2015 for #Diagnosis2

It was rezeki that we managed to collaborate with Deen Prints to sell Diagnosis2 in Pesta Buku Selangor. It was never in our earlier plan but is definitely a good platform to publicize the book. Of course, with every book fair, authors will come and have a signing session right? 

I was oncall on that day and before 12pm I was praying hard that I will not be called. Alhamdulillah, the coast was clear and there I was with the kids to do my first ever book signing. AF and FL could not attend because of their commitment to work. Honestly, it s not easy to get all us 7 at one sitting! 

The event started at 12pm. As usual, I am the early bird and i could see people were waiting around the N21 booth. Of course, the star attraction expected would be AF, FL and our latest star, Ben. @heart_kl. Me? Aku hanya insan biasa that even Ammar, Deen Prints CEO did not realize who I am when i arrived haha I am that invisible :) hehe 

Shortly, Ben arrived and I must tabik Din for coming from all the way from Temerloh to make the event merrier! Azah and Aizzat arrived later and we were on full swing sigining and talking to our readers. Azah was definitely a hit with the sisters and i guess she must be a role model to them. Honestly, I cant imagine if AF and FL were here.. sure kecoh tak ingat haha kena upah RELA standby.

It was a different experience for me. There was a que to start off with and instantly subhanallah, memang macam dah jadi celebrity! hahaha But of course, that is never the intention.

 Alhamdulillah, it was good to see people keen and interested in our book. Of course the main bulk were the Gen Y and Z generation but there were few from the elder generation who lined up to have our signatures on the book. Thank you sir!! 

Alhamdulillah, the event went well and there was no commotion or FRU needed to be on standby. Well, definitely not for me but i am worried for Ben as we go to bigger book fairs! Haha Nanti jadi sejarah lak, first time author mobbed by fans :P

Insha Allah, God willing our next meet and greet will be at the MPH bookfair in March.

Marissa's birthday gift - the day i nearly failed her

Last Sunday was Marissa's 6th birthday. It coincides with my arwah FIL who I've never met. It was meant to be a busy day as everything was scheduled ; tight. Wifey registered for a course and would take her the whole day. I had my usual weekly Hajj class which i try very much not to miss. The revelations you get is beautiful. I cannot really describe it in words. It was also my oncall day and usually Sundays would be a breeze unless something comes up. Public holiday charge can be a nuisance if its not super emergency. And this was also the day for team Diagnosis2's meet and greet session in Pesta Buku Selangor 2015. A very cramp day! 

When I arrived home, i was surprised to see Marissa in her Anna's (frozen) gown.

"Marissa nak pergi mana?" i asked.

"Hari ni kan birthday Marissa! "she said happily.

I was taken aback. Wow.. she is really expecting something special to happen today. Of all the MDQs, she is the one who can be pretty sensitive and manja at times. I thought to myself, ok today we'll have a treat for you.

"Nanti kita gi Toys r Us for your present ok?" i said. A promise. She nodded and as usual went on playing with her siblings.

And we went to proceed with my Diagnosis2 event. I had to let them be on their own in that 2 hours because i was occupied at the booth. Luckily qayyum is around to bring them all around the bookfair. Meeting yahanana (the puppet characters like Sesame  street) was a bonus! I can only give them money and they certainly walloped the RM50 i gave them! Thats why one should always supervise one own's children habits.. haha

And when we were done, she asked me," Walid.. bila nak pergi toys ur us?".

I told her we'll go after the swimming session with cikgu that evening. Competition is getting hearer therefore cikgu ensures qayyum to train every day.

"MArissa nak pakai baju ni jugak after swimming.." she told me. I thought oklah. As long as she is happy.

When the phone rang from the hospital just after maghrib prayers, my heart sank. There was an emergency case that i needed to attend and we were just about to go to toys r us and perhaps a celebration dinner after that. 

"Walid.. jom," she said.

I looked at her again and again. Ya Allah, i cannot disappoint her now! At that moment, after  the delay from the morning. I had tears in my eyes. I was divided. What should i do then?

I totally cannot disappoint her. I don't want to be the father that disappoints his daughter. The common tv shows you watch when parents become too occupied with their work and neglecting the attention needed. I must fulfill what i promised her that day. Told the OT that I'll be running a bit late (the notice was a miscommunication as well and the emergency was the one that could wait..)

Of course, it was a rush.. we went to toys r us in Empire. We were literally running! Once we were in i told her choose what you want! Price was not a factor for me.. 

She chose her pinky my little pony which was very costly (gulping) haha and ya allah.. after that, i had the cashier to wrap the present. Here was the most testing part.. sloooowww gile la pulak nak balut and i had to rush.. haha Sabar je lah..

To see that smile on her face was fulfilling.She was indeed very happy, smiling all the way. I explained to them i had to go to the hospital. They understood i think. But i knew at least, i did not leave my daughter broken hearted with empty promises. They enjoyed the day out, and alhamdulillah, i managed to end it with the present that she wants.

Happy birthday Marissa Daania Qystiena. MDQ3

Hopefully one day, you'll read this entry and know how much i love you.

Learning from your patients Part 1

"You learn more from your patients than from the books,".

So i was told when i was a medical student; at that time it was difficult to confirm that. Sceptical.Macamana lak kalau tak baca buku boleh jawab soalan dak? Memang tak logic. 

But mind you, if the statement comes from a senior wise consultant, not one but most of them.. then the wise truth is in that sentence. 

The true lesson on becoming a doctor/medical personnel is never during that long journey to pass the exams. It is totally different. Langit dan bumi. 5 years of med school is honeymoon and none of what we do during this time would really prepare us for the life afterwards. One can imagine with the stories being shared by seniors, lecturers, specialist in the ward but none can come close to when one expererience it. 

Being academically able is just a prerequisite and not a must. But if one is not academically able, then one will struggle more because of the amount which is being needed to be digested. I cannot imagine how i managed to overcome the 5 years of having the 20 odd books facts in your mind. Subhanallah. Only he knows what is best for us. 

The basic knowledge yes is important. The "basic" requirement to have that at the back of your mind. Once you step into the housemanship period. Yup, this is where the reality will show up. When one realizes and perhaps ponder, Betul ke buat medic ni? Berbaloi ke? 

Housemanship is the most important and critical period. Everything will be tested here. Knowledge. Attitude. Resilience. Adaptability. Most important of all, your intention aka NIAT is tested to the max. Kata ikhlas kan.. buktikan!! 

Skills? this you start developing it at this time. Of course, it depends on where you are and who you are working with. The trust by your seniors is the thing we sort after. the more you do, the more you are better at it. 

And true.. the more you are at work, the more you realize you learn. The issues in medical management is not about which page, but who it was and what happened to the person. The book is just a reference point to understand. Nothing is 100% textbook, there is always a twist or a small print of signs and symptoms that was presented. 

The different levels that you achieve, you realize you learn more from the patients. Not just about their disease and how to handle it, but the holistic nature of management. 

Its about treating the person and not just the disease. 

Macam jargon.. but its true.

#Diagnosis2 in Pesta Buku Selangor

I don't think this was in our earlier plan. To have it marketed in Pesta Buku Selangor which started last Thursday. Insha Allah the fair will be till 8 Feb which is this coming Sunday. Because of our geographical demographics, as it was not properly planned it is difficult to get all of us to be there. Insha Allah, we are trying to work things out for a book signing session on the last day of the fair. 

Thank you to Deen Prints for selling Diagnosis2 on your premises. Majalah Jom is not bad to those who have never seen it. Wifey is keen on it after having a glance at it a few days ago. This was independent as she did not know about our collaboration. Not easy to get her attention you know! hahaha I've browsed the copies wifey had and I must say, impressive publication! All the best Majalah Jom!! 

Those reading this blog who are keen to get your #Diagnosis2 copy, please visit Booth 21 in Pesta Buku Selangor, Shah Alam COnvention Centre! 

Weekend intensive swim

Usually on weekends wifey will be bringing the kids for swim class with teacher Dory. A regular saturday afternoon stint which started from Qayyum when he was 2 and until now the full MDQs entourage including Dzulaikha. Unfortunately last weekend, wifey was keen to attend  a few courses that it took the whole weekend from dusk til dawn! I was available however as this weekend was booked for no call. 

Qayyum will be entering the under 10 MSSS 50m freestyle. I registered him through the school because i thought they will do the regionals/

 MSSD first before the real thing. This is his first competitive swimming and he is not used to 50m straight! Takmau la malu kan last.. so kenalah training sket.. haha  It had been an intensive week for him as he goes to the pool everyday. Drilled by teacher Dory. And this weekend, teacher Dory is not available as well. 

Since I am available, i became the takde tauliah coach to follow the drills which was organized by teacher Dory. haha Mmg takde tauliah but i could see that the regime is for obtaining stamina. 

I'm not expecting him to win anything but i want him to experience the feeling of competition. Having those butterflies in the stomach and try one's best to perform. I want him to feel and go through that. The exposure is important as this will be what life is about. Being amongst the many and thriving to do well. I prefer the life lessons for them as a preparation to face the real life. 

#Diagnosis2 on Resensi RTM1 30 January 2015

The invite came a few weeks ago. However it was cancelled because of the ongoing coverage of Banjir in Kelantan. Few days back we were asked to reconfirm our participation. Initially I was not in the panel because i thought i was working on that Saturday morning. Since i was not rostered, my earlier intention was to follow both Ben and Azah and ended up sitting up there with them. Hahaha Thats the reason why i did not really inform anybody about me appearing on TV because it was never in the plan! 

 This experience was different was it was really LIVE. Awani interview was recorded but nothing was edited therefore it mimicked a "live" interview. The Awani experience was valuable because this time around i was more ready to answer. Kudos to Azah for being the person that she should be when on live. Ben as usual, the cool cucumber and me.. hm.. i look big in TV! haha 

Sayed Munawwar was in his usual style and persona. The main "wawancara" man for RTM at the moment. I am sure if you browse the talk shows or main issues discuss in RTM, you would see him taking the lead. I guess, his future will not be limited here as i foresee him as a front runner for the media circle chiefs in the future. Even now, he is the CEO of kotabuku, a GLC. 

It was a humbling experience. My regret was for not having the whole Diagnosis2 family to be on tv. It would have been a fun experience and exposure to all of us. I believe AF and Aizzat should take the limelight more than us for this project. They are the prime movers for Diagnosis2. Insha Allah, we will create a phenomenon!