Kicking off Cardiac Anaesthesia services.. my specialty !

One of the things that I have left my legacy in all the places that I have worked would be the setting up of the cardiothoracic anaesthesia services. It started with UiTM and the Department as well as the CTC services have strived really well. 10 years now. It was in 2013 when we kicked it off. Then the next when I was in Medini - another milestone for the hospital to start doing open heart surgeries in 2017. Now in Sunway Velocity , we have kicked it off in September. One of the reason I was brought to Velcoity was to set it up.

Initially there was a hiccup because the resident CT surgeon decided to leave after I joined last year. It was quite unfortunate because I did not even met him to talk about the setup and to do our first case. Hence, the search for CT surgeon began. It was not an easy task because most are already afliated to other hospitals. The younger ones were perhaps too green to lure into private practice. Then it was by Allah's grace that somehow Prof Zamrin (who was my former surgeon general in UiTM) was looking for place of practice as he would be retiring in the coming few years. And by stroke of fate whilst having my junior in UiTM to do locum in Velocity we got reconnected. And the rest is history! It was the "underground" team in 2013 - perfusionist and Anaesthetist at it again! 

                                                  planning is key to success 

Alhamdulillah, we have been going on strong with total 5 open heart surgeries and 5 Thoracic surgeries done since late September. And having your former teacher to do it with all over again is such a satisfaction. Sacrificing time for this can be demanding but at the end of the day, seeing this partucular service running well is very satisfying.

                                                           the team of CTC SMCV

                                                             Index patient happy post op

                                                   All CTC team with Index patient

New place.. new adventure

😉

Sekali sekala dihargai

Rare occasion when an anaesthetist is celebrated by the patient. Of course smiles all over, such a warm feeling :) It was a year ago the baby was delivered via caesarean and Alhamdulillah, all is good :)

The cool online workshop we had SIGRA

It was a project where SIGRA approached the industry to have it done. It was the first ever done in Malaysia and preparing for it was not easy. It was the pinnacle to showcase how in private we do blocks too and its a skill which is needed in private practice.

Alhamdulillah it went well with the excellent support of AV which transmitted us live during that weekend. Luckily we managed to get a last minute patient to show instead of the pre recorded version that we did as Plan B.

Certainly enjoyed the stint and looking forward to future online live workshops :)

5th Mission Cambodia - Siem Reap 25-27 October 2019

Insha Allah our istiqamah and it has been ongoing strong. This time we took a location faraway from Phnom Penh as the GA machine is not working at the moment if we plan for surgeries. hence the mission this time is much more relaxed with only circumcisions to be done. I brought with me Syafiq my long time accompliced in Perth and it was a good reunion for our craziness. hahaha It is such fun to have him around as he is one creative person who is very intelligent and wise. 

 We had our programmes in two different places. One was right in the mid smack of Siem Reap CBD and the other at least 7 hours journey by bus. This was the biggest contingent ever with another NGO (besides Muslim Care) Dana Kita with Tauke Baloon Nasron to be amongst us. A group of students from SAS volunteered as well to be in the group. (for obvious YDP reasons hahaha)

 This time around it was 180 plus kids - i got to do a few. There was a different contrasting population that we served - town vs kampung and it was obvious. The town one, it was a war with sounds of agony going around from the first second! The kampung- we get to see small kids but brave and resilient! I guess the upbringing certainly affects a child's strength and mentality. I had one kid who was sucking his lollipop while i did my local anaesthesia and I chose him as my subject for sunat hahahaha

Alhamdulillah, the event went well. There is always lots to learn from each programme with different participants. I enjoy this a lot and really happy to continue this again and again. 

AOSRA-PM Kochi,Japan 2019 Part 1

When Abbvie asked me whether I was interested to go to this conference, I wasn't sure what I should reply. I've not planned this but i knew a number of my SIGRA members are because they were invited to talk at that conference. Thats why I decided ok lets do this. This was the first place where i did not research anything about it before hand despite this will be my first time in Japan.

So there I was on my way to Japan for the first time. I decided to take the Changi-Haneda route as i thought it would be more convenient especially when coming back. Mahal sikit je la to hire transport from JB to Changi.

Nak buat cerita, the flight was at 1am so i decided to come into Singapore at 9. Guess what? No not the traffic, it was pristine at that time. The van that drove me in had some sort of record with the police and ICA! hahaha Kena la tahan kejap! Apparently the owner before had a record of hitting somebody on the road last year. So kena la jadi cam wanted for awhile. I did not press my panic button but was quite worried if I miss the flight! haha Such an experience to have.

The flight to Haneda was 7 hours. I was on board Japan Airlines. It was comfortable but my seat was a bit warm i thought. Arrived in Haneda Tokyo and transit there for my flight to Kochi later that day. That was my first introduction to Japan:) Everything was fast and instructions were clear. I had my first go at their toilet in the airport - the fully automated seat warming toilet hehehe Such a wonderful experience and very clean indeed! 

The flight to Kochi was a bit later in the afternoon. MAti kutu jugakla duduk airport haha It was very convenient to have free wifi all around as well as charger ports. Had my first pure japanese sushi for lunch! It was an effort to look for what kind of sushi I was taking hahaha 

RA Masterclass in Ayer Keroh

Oklah i thought. Melaka is not too far. Teett.. wrong! The traffic was horrendous on Saturday and i spent 3 hours on the highway before reaching the Hospital.

Thank god i was on time. Pak Dan and Amir was already there and was about to begin the hands on. This was our second programme after January in Johor. RA workshop for those in private. This time it was in Pantai Ayer Keroh ; another Pantai Sister hospital.

I've always enjoyed teaching hence i was not hesitant to participate when asked by Abbvie. Its good to share the knowledge with others and the session was short and sweet. Thank you for everybody's time. I then rushed back to Iskandar as I will be oncall that Sunday.

As much as i want to

As much as you want to ramble on the internet, you know you can't do it freely. For many reasons. A thin line between exploring your thoughts and revealing things which should be private in nature. Its easy to say that one should reach out, let out, let go.. but the reality is sometimes you just have to savour it all.

Its not something new but i guess it had rammed to the maximum tolerance of how one can cope. Its not easy to not being able to share freely as how one wishes. But yeah, no wonder orang jadi gila Hahaha

I've never felt sad as I am at the moment. I have my moments of being down in several occasions but this time around it really hits me hard. I am in fact amazed how much it can affect one. I've read about it, i've seen people talking how it can be and now when it happens to me I do really understand why and how bad it is to have such feeling.

As you can see this is being half here half there. Howlah to solve this issue? 

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Watched a Singaporean 2008 movie called Leap Years last night. Thought it was sweet but what i like most were the quotes within the movie. 

In three words i can sum up everything I've learnt: life goes on  - Robert Frost

And it made me wonder. True enough Mr Frost. Life goes on regardless thinking otherwise. The world do not revolve around us but just continue without our presence. 

Experience is simply the name we give our mistakes - Oscar Wilde

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. 

Dinners in Puteri harbour

Last week i had a back to back dinner in the same place! Haha Its in Fraser's place, a new hotel and resort situated in Puteri Harbour. The theme coincidentally was related to each other so i did not have any issues wearing the same thing twice! Haha

Its definitely something staffs would look forward to each year when celebrating such events. Its an important tool in companies and societies; as it will create the feeling of commitment and loyalty. Loyalty is important to nurture in a company but it must be with reason.

I enjoyed the night out and good fun to see people being happy celebrating with each other :)

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

Historical March 2017 - Tale of two specialties

Alhamdulillah, March has been very kind to us. We have crossed boundaries and leaps towards our brand namesake. I am very happy to have been involved in these two milestones that we have achieved here in Medini. Bearing the name Gleneagles, this is what we can comfortably fulfill our potential. It is not an easy feat but I guess when we do it for patient's sake, god will help us achieve it ho help more people. 

Honestly, I am blessed to have dedicated and enthusiastic people to work with. I know what they want to achieve therefore that is my role as the team player. I may not bear the glorious end as the surgeon in charge, but as the anaesthetist who ensures what feels impossible to be a reality

Awake Craniotomy

When i was approached by my neurosurgeon about the possibility of doing it, I told myself Why not? By principle it is a simple thing to do. Its the precaution and anticipation that will make a difference whether it becomes successful or you have to abandon the initial plan.

The challenge for me was for the awake-awake-awake procedure! Wow, thats an uphill task but of course not impossible.

Important VIP points:

1. Patient must be counselled properly and understand every detail of the procedure. They must be fully motivated for this procedure.
2.Regional anaesthesia skill for the scalp block. This must be superly perfect.
3.If patient throws a fit during the procedure, there must be a solid plan for airway protection.

I did my research by lookingthrough the literature and case reports written by colleagues in Malaysia. MOst of them were more comfortable with sleep-awake-sleep method so i suppose what I was going to do is pioneer "ish". I was lucky as the surgeon adopted a position which was convenient for possible problems if it arises.

Alhamdulillah, the good teamwork with had made this procedure successful with good outcome.

CABG

This was the marker of a tertiary hospital. It has always been its KPI since the start and after 1 year and 3 months, i present to you CABG.

The preparation was immense. 80% of my OT staff had never seen one before. We had a thorough preparation from the nurses to the PCAs. What i value most was their eagerness to learn and cross that boundary. My surgeons are both renowned in CTS and certainly the 2 Cardiothoracic surgeons that you want to work with.

When the day came it was goosebumps all over. I started UiTM's first and now its Gleneagles Medini. The profile of our first patient honestly may not be the typical first case you want to operate on. But then again, with cardiologists being more daring than before, one cannot expect CABG cases now without a challenge.

Alhammdulillah again, it went smooth and well.

And till date,  we have done 3.

Logs

HAd an interesting chat with an old friend yesterday. We discussed the importance of keeping a journal for future reference. Hence, blog. A very important pieces of writings that will be preserved forever. (Unless bankcrupt la)

I will cherish this picture forever, taken before the opening ceremony of the Annual Scientific Congress Malaysian Society of Anaesthesiologists and College of Anaesthesiologists Malaysia 2017 in Berjaya Waterfront, Johor Bahru.

Getting prepared for the big day

We are getting prepared for our big day. Our first open heart surgery very-very soon. This i suppose will be the landmark of how my current centre will be. We have currently doing great things with the neuro team and now the cardiac team is set to go.

 The OT staff themselves are excited but at the same time having palpitations. Its not something trivial as the preparation must be perfect. This reminds me of the time when we prepared for our first case in UiTM. It was nerve wrecking preparing for the day. Its not just the equipment and number of staff, it is also the mindset of the whole team. One thing for sure is once this gets started, there will be no turning back! 

Its not just the OT, but the ICU staffs are gearing up themselves for the start. They've been working hard these past few months because of the neuro cases we have been handling. I must say they did really well to cope with all that. Now another frontier is beckoning. 

Alhamdulillah, i must say the team we have is a good one. Both surgeon's are of recommended reputation. I have an experienced perfusionist and at the same time, enthusiastic nurses who are ready for any challenge any day! 

Lets do it!! Bismillah..