Korea Anaesthesia 23

I had the honour to be invited to Korea Anaesthesia this year. It was held in Seoul and yes, it was my first time to the country. I was lucky in a way because the invitation was via MSA and as per our MOU wirh KSA, we were invited as speakers and chairs for their big conference. I was glad i took up the opportunity as for 23/24, I am not in the exco anymore!

Of course my topic was RA and I was in a session with experts from the region. It was an overwhelming experience and I do thank KSA for their kindness. 

Looking back at the video taken of my talk, I certainly must slow down on chill a bit. My passion for my talks never change haha Asyik mcm debate la pulak.

The dinners organized were amazing. In the Gala Dinner we had an orchestra actually playing.For the presidential dinner, it was in Aston House (for K-drama lovers tempat ni mmg no 1!)

     Faculty members

  

               Fellow speakers of the track

      Two super heavy weights in the RA world

     Pick with KSA president and the jacket souvenir

Not sure if ill get the opportunity again but Korea Anaesthesia is certainly one of the best conference I have attended before😊

The year 22-23 gone report

Ok here goes.

Whats new in my life currently? I'll just list down what happened over this period. But if you are a detailed reader of this blog, you'll realize how in have post before over the years; I expressed issues regarding some unhappiness that I've felt - and of course it was something that we cope along with life.

1. I am divorced with my ex-wife for the obvious reasons of prolonged shiqaq.

2. I am married to my wife now.

3. I have a new baby. 6th! (A miracle really) 

4. Qayyum is done with his SPM. Alhamdulillah with Excellent results! 

5. MDQ1-5 embraced the separation better than what I expected.

6. Trying to cope with the arrangements and my busy like hell work.

Haha.. senang buat summary. All this was very PnC and I did not really share with even my close friends. The separation and divorce did not really come as a surprise but the marriage yes.. because my parents did not even know about it until when the time I did tell them haha gile scorpio. Lejen stuff..

There are many insights I would like to share but I have to be fair as well so the story does not seem biased. Honestly, though me and my ex-wife is not aligned anymore, I truly appreciated the times we were together. It was real and I have no regrets as I consider it as how my life went. 

Those who are blessed and lucky may have their marriage a lifetime. Unfortunately mine was not. But I am blessed that I have found another partner who has her own attractive criterias which fits me. I am thankful she embraced my my kids and vice versa. And as how i call it a miracle my new baby 1 because my wife is not that young but Allah is great.

                                                               Introducing Eusoff

                                                             Introducing my wife Eka

                                                            My full family picture

The education initiative: Intensive care for non intensivist in Covid ICU

It was supposed to be a small affair. Perhaps only a virtual talk to the new HPKK MOs who are coming in droves to open up more critical beds in HPKK. SOmehow, it became a viral thingy where it was up in even my mum's Whatsapp group? (Like what?? )

I must congratulate this lot for their initiative and perhaps the most congested zoom session we ever had. The youtube live viewers were consistently more than 1.5k in the 8 hours of streaming? Bayangkan.

I had to wake up early as 5 am  here is 830am in Malaysia. Keranamu Malaysia and luckily there were no cases during that time.

Alhamdulillah, Glad that I was involved in this sharing session and hopefully it would bring benefit and some guidance to the newbies (yang terpaksa) on the job.

A month since I've been away

Its almost a month that I am out of the country. Surprisingly it did not feel that long. Surprisingly I am fairly comfortable with where I am. Away from the typical hustle bustle of normal life but in a fairly demanding job to ensure that the medical services go well and without hiccups.

Surviving the first month without severe reprecussion is good enough I reckon but it is something to be expected. There were few dodgy ones but Alhamdulillah it was managed accordingly and patient was well.

After one month my relationship with the guys here has been well. It is fun to have them as colleagues and they do really look up to me for guidance. They are good enough to run the centre and I am sure they will continue to excel and flourish. Its interesting to see how they have progressed based on the progress report that I have been briefed from previous expats in a space of 4 years. 

The overall condition in the country can be a bit dodgy looking at daily updates on FB, twitter and mainstream news. Somehow whatever happens, this area that I am at maybe the last to be fought over and I am waiting patiently what will be the outcome.

How about myself? I believe it is such a rebreather for me to reset and reflecting back on my life. I have certainly not spoken Malay for a month now (maybe short ones on the phone) but otherwise it is interesting how English becomes the bridging language between the European expats, local Nationals and myself. Such a unifying language in the current context.

Ramadhan 1442

Its 10 days in Ramadhan 1442. 1/3 done and 20 more days to go. That is how fast time flies. 2020 and 2021 seemed to be a nightmare for the whole world. A lot of plans and doables are halted. We are not as free as how we used to be. Imagine how easy it was to sosialize, go out, go abroad and we can freely plan what we want to do with our lives.

Alhamdulillah, I have been blessed to still have a job to go to; enjoying my daily routine even though at times it can be demanding and mind boggling. Being in a tertiary private hospital is not as easy as it sounds. More so with the current Covid19 patients that we receive daily. Its a challenge to manage them and a challenge for the family too. It is not covered by any health insurance hence they have to fork out cash to pay for the treatment. Being in ICU is not cheap daily and imagine having to stay for at least a week. It can cost up to RM 200K for the whole stay. I am lucky to have a very good team and the communication is good between us. 

Everybody is hoping for Covid19 to go away so that they can relive back their live. Unfortunately I dont think it will. Covid19 has changed our lives forever. Things will never be the same again. In a way, I am glad that I've managed to maximize my travels around the world. Perhaps I can only tell my grandchildren how I was able to roam around freely without the current "normal" restrictions. There was a time we can plan and just do it without much thinking or planning. 

Allah is great, Allah knows better.

Raya Covid19 2020 OT celebration

Better late than never! It was celebrated on a lower key but nevertheless good food and spirit saves the day😊

The new norm: Webinars

A new thing that i discovered during this pandemic is webinars. I dont think we will be able to attend conferences in the near future because of its social gathering; the latest SOP allowing up to 250 for meetings/seminars/conferences.
I attended few of these webinars which can be interesting. I was given the opportunity by this new company teying to penetrate Malaysia to deliver educational talks online globally. The nervousness i felt last night was the same as how presenting at an international seminar. I enjoyed the session anyway😊
I guess for now, this is the only way to spread knowledge from home!

Covid fellowship tales 3

We have yet to win the war

We have yet to win the war.
#Kitamestimenang #Frontliners #Sentiasabersediaberkhidmat #Hipnotis

Ended my Covid19 “fellowship” in Sungai Buloh ICU. There were few of us from the private sector who answered DG’s Hisham Abdullah SOS call for help to combat Covid19 with KKM. The projection then was we were heading for an overwhelming surge of cases in mid April.

Thank you to Hasbe Zuraina Abu Bakar (CA Setapak) and Intensivists Aliza (PPUKM) and Kamal Basyar (KPJ Rawang) for coming in together in such short notice. There were other KKM Anaesthetists too from around the country who came over to join the team in HSB.

It was a very fulfilling April. It was great to be amongst old acquantainces and new generation colleagues (my previous HOs and MOs are now specialists😊 sudah tua lor...) ; the last line of defence in ICU. I really admire the dedication and hardwork that was put in by all of them. It was a good refresher to remind myself why I decided to join the anaesthesia and intensive care fraternity many years ago. Alhamdulillah, the expected surge was dampened but it was not an easy task to manage something unknown.

My kudos to the HOD of Anaesthesia & Intensive Care Shaiful Zaman for his leadership and meticulous planning of manpower to ensure that the care given at the national centre of Covid19 to be the best that any centre can offer. If we were stretched, 100 ICU beds were ready to be activated. My hats off to Intensivists: Lee CK Chew Kiok and Eng Kar Seng  (Ismail from HKL in early April) for their astuteness and dedication which lay people may not realize their contribution. A very stressful responsibility as the whole country was watching us.

To the department’s Anaesthetists and Medical Officers, thank you for your hospitality and I had a great time working together in a very dynamic youthful group. It made me feel young again to be there with you guys. Hahaha last but not least the pillars of the system, ICU nurses and MAs who without them the ICU will collapse. Their sacrifice are legendary and unmatchable whilst looking after the sickest of the sick. I’ve learnt a lot from all of you.

The 2nd wave came and we prepared ourselves for the worst. Alhamdulillah, the graph did not peak as how it was projected.

The early morning handovers were legendary as we went through the progress of each case in detail. Plans of extubation and discharges brought smiles but reintubation and deteriorations were perplexed upon as we were looking for positive solutions. Practicing social distancing was a challenge but that is the new norm that all of us have to endure. Im not too sure if I’d miss the donnings and doffings; Ive never felt so clean in my life having multiple showers daily! At times it was mind boggling handling the complex cases but thats our line of work. Being the person to update the next of kin everyday can be an emotional roller coaster ride. We only aim to care to the best of our ability.

We have yet to win the war against Covid19. The battle is ongoing. Lets all do our bit from wherever we are.

P/S Labour day has always been a public holiday but there will be an oncall team covering actively the hospitals all over the world.

HSA Acute pain workshop 2019

 I've always enjoyed being in the teaching role. Hence when there is any invitation to teach i will try my best to come for it. I must say i do miss having students and trainees to share my knowledge with. In the private practice its just you and your peers ; maybe opportunities to co manage certain complex cases but its different to teaching somebody younger and raw.

 I was invited to give a short talk with regards to acute pain with the HSA pain department. Initially the arrangement was i was to speak for industry but the arrangement collapsed due to recent government strict restrictions. However it was not an issue for me to sepnd an hour or two to talk to the current backbones of Johor main hospital. 

Thank you Dr Nita for the opportunity. 

Dying blogging

People dont read blogs as much as it was at its peak. Since facebook, twitter and instagram came into the picture, blogs are slowly diminishing. I have to concur to this because i dont browse through blogs anymore. Most blogs that i read are inactive now. Who would have thought, this blog thingy would be somehow ancient after 10 years. I was at my peak of blogging then circa 2008-2010  :) But i guess that is how life is.

People tend to browse facebook and twitter more because less writing to read? Haha the truth is people's focus and attention is less with facebook and twitter. As one can see the language used in fb postings are short ; the long winded ones will be skipped anyway. If you are looking for followers, then fb and twitter would be the instrument. Blogging is a different ball game. 

My own blog entry has been pathetic the last 2 years so I am guilty as well to let this trend continue. I can give all the reason to justify myself but the truth was i sort of lost interest in blogging :) Simple, straight to the point. Blog is something personal - diary like. Its nice to share thoughts and ideas in this medium. 

I am lucky my blog is still around; remember geocities? I do hope that blogspot will be around for the next 10 years. As a back up i should copy and store it somewhere. Looking back at what i wrote then, kelakar juga ( haha puji diri). I guess the blog serves as a virtual diary that can be read by many; that will diminish unless being search upon. 

If there are still readers of my blog and in particular this entry, thank you. Thank you for keeping the blogosphere alive. And if we can keep the momentum going, do not be surprise if there is another wave of blogging happy bloggers and readers who will make it popular again! 

Hope and despair

Scenario 1

Patient just woke up from her anaesthesia in recovery . The first thing that she did was looking at her previous stoma*  site. The operation planned was to rejoin the previously parted bowel due to an unexpected growth that caused sepsis.

*It is an artificial opening that allows faeces or urine either from the intestine or from the urinary tract to pass.The stoma is created of an end of the intestine, which is brought to the surface of your abdomen to form the stoma (opening)

"Eh, belum buat operation ke?" She asked. She was still dazy due to the anaesthetic effect.

The stoma was the cause of her depression. She was still young of child bearing age and was looking forward for this day. Gone will be the days when she does not have to see her stoma bag full with her faeces. She became withdrawn after the surgery because she felt embarrassed to the society. She felt herself dirty carrying the faeces back all over.

"Bila nak buat operation?" she asked again. Tears were slowly flowing.

Its tough to break the news to her for the failure of the intent operation today.

Scenario 2 

"Biopsi akan diambil terus dan di hantar ke makmal. Kami akan  dapat result dari pathologist dalam masa setengah jam. 

Kalau result negatif, kita akan buat lobectomy.

Kalau result positif, kita akan tutup"

The patient with her husband nodded. It must have been the umteenth time somebody is explaining the objective of the surgery today. I did see on the notes ; my surgeon and my respiratory physician detailed extensively the consent explanation.

That morning, the whole family waited outside the OT. With hope for a miracle. Based on the CT scan and PET scan, it did not look promising. Her father was in his wheelchair, her two children brought their toys to play with knowing how boring it can be waiting. Her husband was full of hope, requesting my nurse to keep the "yasin" in the pillow throughout the surgery.

We did not proceed with the surgery after receiving the call from the pathologist. 

***************************

Handling the family and patient's emotion is not easy. In my profession, I would be one of the first to witness the hope and expectations as soon as the bad news come around. Its an everyday story everywhere.

Seeing this all make me wonder how we should be thankful for whatever we have at the moment. The moment the crisis steps in, its a roller coaster ride. Its easy to think how we do not have enough but if we step back and look around us, we would be surprise how lucky we are to have what we already have. Its so easy to see our own misfortunes but when we compare, what we thought was bad is not as how people dealing with worst scenarios have to deal with. 

Arrogance, self mindedness is something i would pray to god to not me fall into the trap of declaring as such. That is why I appreciate my work, it reminds me a lot how lucky i am. 

Aneurysm Sonata

ANEURYSM SONATA

The path of hope,

Lies in thy little fingers,

Cautiously swaggering,

Loops and twirl,

Perfection sought neither,

Never say never,

As night reaches dawn.

Angio suite

00:01 30 December 2018

Our Nurses day do in OT

It was not really planned but the nurses were excited to celebrate it. We were quite busy that day therefore the gap that we had we had a small makan-makan and cake cutting! The creativity came fast flowing and we had excellent simple decorations within hours. I must say that the OT staff are a very talented lot. They work hard and when its time to play, they know when to play hard! 

Of course i would not bring my selfie stick to work. So we had to improvise, the concept is important so the best tool would be the drip stand. Haha! It was way heavy but the product, EXCELLENT!! 

 Thank you staff for all your efforts throughout my stay here.I can be a nuisance at times and i do ask for your apologies for my wrong doings. I can be an a*****e at times with my temper and perfection! Haha I've seen comments about how i acted and eprhaps it is good for me to have come across it. I am not perfect and i need feedback to make myself better. Lagi=lagi dah Haji ni..Haha 

Insha Allah, to better care for our patients. 

Happy Nurses Day 2016!

A special shout out to the backbone of medical services! 

Thank you for being there!

Thank you for caring for the patient!

Thank you for being reliable colleagues!

Thank you for all the sacrifices!

Thank you for being my teacher!

Can/t intubate Can't ventilate - Sux magic.

(This is a very technical post - mind the terms but I want to keep this as an entry) 

After a long lapse of this possibility, we had this episode recently. This was something all anaesthetist feared and the nightmare happened.

This patient had a BMI of just 30 however the airway was suspect from the beginning. His mouth opening was small, a Malampati 4 and he had a thick short neck. However, it was not we have not encountered such patients before so the case was to proceed as planned. I was there to help up my colleague and this meant we had 2 consultants standing by. 

The issue about difficult airway is IF YOU LOSE THE AIRWAY. This means the inability to oxygenate the patient and that can be catastrophic. If one can continue to oxygenate, then the attempt for laryngoscopy and intubation can theoretically be as long as possible. 

At the same time, patient was suspected of having an acute abdomen which means the risk as gastric content regurgitation to be high! So it was a catch 22 situation. 

Traditionally RSI (rapid sequence induction) will be the gold standard to secure such airways. The arrival of sugammaddex (direct reversal of Rocuronium) has changed the airway management to a certain extent, however traditionally one would still use suxamethonium as the mainstay for safety. Especially in a centre where one might not have the full equipment for back up. 

True enough, this patient had a very anterior position of the vocal cord despite a satisfactory tube on the C blade of CMAC. The view on the Long blade was 3B at least and no way of manipulating to get it a 2 or 1. It was difficult to negotiate the tube to be placed in the trachea. 

As i've mentioned before, we had BIG issues trying to bag mask the patient when the saturation dropped, and by the 3rd attempt it was almost impossible to mask ventilate the patient. He desaturated badly and in my mind i was already thinking of attempting a direct invasive airway.

And the magic came.. sux effect came to and end and the patient breathed spontaneously. And this spontaneous breathing was the thing that kept him alive. His saturation picked up straight away without the muscle relaxation. 

It was a sigh of relief.. ultimately safe this time around. Thank god for suxamethonium property of being a depolarizing muscle relaxant! 

We woke up this patient as how the protocol would recommend us to do so. We explained to him what had happened. The next step was supposed to be awake fibreoptic intubation - unfortunately we did not have that facility. Thus we had to transfer the patient to our sister hospital so that this case can be managed accordingly. 

It wasa heart stopping moment, i have not had this type of situation for quite some time. It tested our ability to think as based per protocol. It made both of us reflect on the importance of having plans B and C all ready when disaster strikes.

Alhamdulillah..

Kais pagi makan pagi

 The best peribahasa for my current job and position.
Kais pagi makan pagi,
Kais petang makan petang,

p/s check out my scrubs cap.. haha fanatic..