The scare..

sick 

It was a havoc and tiring week for me and wifey. Me coping with work and wifey with one month to her exams. We never thought that Dzaeffran would not recover from his flu which started last weekend. Being doctors; we assumed that his URTI was viral in origin , thus self limiting and with good supportive treatment , he would be ok in no time. Unfortunately, our assumption was wrong.

It became difficult to control his fever as his temperature spiked to 39-40 C especially at 2 am in the morning. Our vigorous tepid sponging did help to reduce his temperature but somehow he did not get better. On Monday evening , wifey thought she heard Dzaeff wheezing thus brought him to a nearby paediatrician. There was no nebulizers needed then but his cough was getting worse. Come Wednesday morning, he started to refuse feeds and that was not a good sign.He was breathing fast and we can sense his discomfort. His temperature spiked despite numerous suppositories of diclofenac and paracetemol.


admission 


24G IV line 

Mak called on Wednesday morning saying that he looked really ill and very very warm. I told her to bring baby Dzaeff to Selayang. Wifey freaked out knowing that Dzaeffran was really ill. I guess her pregnancy trauma hit her hard. I asked a friend of mine in paediatrics to examine Dzaeffran and she suggested admission.Thank you Anis !! His chest x ray looked fine but his lung findings were a bit worrying.

He was started on IV Cefuroxime and was on full drip maintainence as he still refused feeds even breast milk.He did not look dehydrated but certainly toxaemic. I was worried if his temperature remained high that he'd have fits. Alhamdulillah , with the treatment he received the temperature was controlled. His cough however became worse. His auscultation findings were terrible that he needed 4 hourly nebulizers.On top of that he needed nasal prong oxygen to help with his oxygenation. I never thought his chest recessions were serious enough for such intervention !! It was a trying time for wifey as her mind was a bit off ; having to prepare for her main exam in 4 weeks time !!


Nebulizer 

Dzaeffran's initial blood investigation showed his white blood cells to be within the normal range. Aaah.. a simple RSV pneumonia we thought . However , his C Reactive Protein was sky high at 11 ( normal < 0.8 ) and the specialist was very suspicious. To our surprise , his blood grew streptococci pneumonie which means that he REALLY HAD BACTERIAL PNEUMONIA !!! Haks.. well , this can happen to anybody oo and that includes us eventhough both of us are doctors !!

Alhamdulillah , Dzaeffran recovery was swift. His usual smile came back and he became more active each day.Wifey was certainly the very glad with the progress and it showed with her enthusiasm to continue studying while in the hospital.

smirkin 

Dzaeff is still in the hospital. He needs to complete 7 days of intravenous antibiotics to ensure his recovery. I had to re insert his IV access today as the old one on his left hand was swollen . haks.. Dah jadik anaes , kena pandai pasang line ahh...( though i had palpitations while inserting ! ) It was indeed a very stressful week and i hope he will be discharged as planned on wednesday..

New rotation

the procedure 

Started my ICU posting in Selayang today. I was preparing myself for a busy month as ICU posting was the most demanding area of anaesthesia during my HKL days. Post call , I'm usually knackered and my off day will be spent on bed. Selayang has less ICU bed but we are practising the "open" system where the primary team will have the say in the management of the patient.So maybe not as busy as HKL lor..

My first day in Selayang ICU was very mild. There was nothing much to manage as yet.. being a new day with mostly having old patientsaround. After rounds , Dr Suresh ( our cool Intensivist ) offered us to do tracheostomy on a particular patient. As i've never done it before , i volunteered myself .In HKL , it was only the consultants and specialists doing it. So why not ?

It was quite scary really. Imagine , poking somebody's throat and inserting a device for the patient to breathe.This 28 year old man , who developed really bad bleedingintracranial haemorrhage ; and the neurosurgeons had opted to treat him conservatively. He did not recover neurologically ; which means that he remained stone with the ET tube in him.Sort of vegetated . We don't think he will progress from what his current condition is. Therefore , the indication for tracheostomy.

Dr Suresh guided me well and i managed to do it without totally traumatising the patient !! Of course , we had to make the patient relaxed and paralyzed first before doing all this .After dissecting the area i poked my patient with a needle to get a free flow air gushing out from my syringe. Dr Suresh viewed through the fibreoptic scope from inside to ensure that i don't poke through to the oesophagus !! Then, I had to use brute force to insert my "rhino" ; a dilator before inserting my trachy. haks.. Nasib baik tak pecah tekak noo.. heks..

Not bad for my first day in ICU. Looking forward in doing more procedures !! haks..

Who's who..

classico.. 

I reckon Mafiz is the only person who retained his body weight 10 years after these pictures were taken.

What happened ah to us ? haks... I never thought i have my current physique esp my current trousers size. haks !!


good old days..  

Down..

hello..hello...  

Baby Dzaeff is down with flu during the weekend. Slowly recovering to his old smiling self ! Walid loves you ok..

Similarity

the mum 

Went through old pictures recently. To our surprise , there was similarity of wifey's baby pic with baby dzaeff !!

Oh no !! I cannot imagine a male version of wifey in dzaeffran !! haks..


the son..  

Latest Sensation

durr.. 

Congrats to Miss Durratun Nasihin for her 4 silver medal feat in the recent concluded Melbourne Commonwealth Games. If not because of the World class Canadian , she would have swept the golds easily !! haks.. Anybody know how i can have her autograph ? or perhaps phone number so i can guide her for good SPM results later this year !!! haks..

Anyway , Kudos to Malaysia for achieving their target of 7 gold medals .Badminton was the usual suspect for our gold , but 4 ? that was remarkable !! Lawn bowl will definitely be Malaysia's next frontier to achieve gold in olympics and of course.. i would like to congratulate our hockey team ! Eventhough it was only bronze but it meant a lot to the whole of Malaysia ! I loved their current gameplay. Certainly full of passion and desire with mostly the young lads out there !! Keep it up !!

P/S Malaysia Boleh !! Proud to be a tiger..

Kisah Benar

ok.. 

Its confirmed ! I'm goin to UM soon. Got the letter today. Registration will be on the 31st of May.haks.. I'm gonna be a student again. A new chapter in life huh.. haks.. Now.. i can register to be a :true" member of GPMS ! haks..

In the midst of all this , i managed to finish a book i bought today. I'm just a keen history buff and i could not resist to buy this book. I do recommend those who has similar interest to read through. Only for histroy keenos ah.. kalau tak minat sejarah ; then it'll be boring !!

Title : Ousted ! by Patrick Keith.

It is a well written account of events that lead to Singapore's seperation from Malaysia. I liked the way Keith describe the histroy ; seeing it in 3 different perspectives ; Tunku's , Lee Kuan Yew's and the rest of them. So many things revealed and certainly had me glued to during my locum today ! haks.. The author is currently in Australia therefore explaining his frankness on writing everything that happened then. It was interesting to learn about these facts ; how the racial rot that existed for so long. I suppose , we have not learn anything from the past , as things that happened then as it was written , is still pertinent . Suspiciousness and championing own races are still a strong de-facto in our local politics.

Our politics never really grew. It is still divided and polarised as how it was many years ago.I guess we like to keep it that way. In the midst of debates urging national unity ; it is quite a paradox with what is being practised. Lee Kuan Yew tried to champion his concept of a true Malaysia but obviously , it was his realpolitic to gain support. The way he manipulated Tunku to merge as Malaysia was just a ploy for his greed of power !! haks.. Thats politics ; only a handful are pure nationalist ; like Dato' Onn who was unfortunate not to succeed in having an "ideal" idea of governance.

Job Satisfaction

circle of life 

Job satisfaction is something ideal which is difficult to achieve especially during the early years. We try to do our job properly but not everybody are enjoying what they do. At the end of the day , it's the pay-cheque that counts. Its about what produces the magic papers that guarantees life. Especially nowadays when money is everything.

I am not quite sure whether i achieved this nirvana on Sunday morning , but i felt good , really good keeping my patient alive. In the midst of chaos , he pulled through but the prognosis.. It did not look good. He is still on the ventilator in ICU ; fighting it so much that we had to sedate him .

This pakcik underwent a laparotomy early Sunday morning , at 2 am. He was my last case for the night. A 65 year old Pakcik , with Diabetes and Hypertension ; history of abdominal pain with sign and symptoms of intestinal obstruction for 3 days. His sugar control was haywire ; most likely due to peritonitis with an unknown cause.

We saw him in the recovery area before hte surgey to assess him . He looked troubled , difficulty in taking long breathes due to his distended abdomen. His SPO2 was at its best 82%. Otherwise , he was very alert and calm ; reciting quranic verses. A short history taking revealed he was a very active person ; moving around like either yours or my grandparents.

The laparotomy went well early in the operation. His airway was easy so i gave Halina to intubate him. His saturation picked up to 98% after pre oxygenation but it quicky went back down after artificial ventilation is given.Haemodynamically he was stable ; after fluid resuscitation he was fairly stable. Unfortunately , the surgeons were unable to find the source of 800ml of pus collected ; the whole bowel was out but his oxygenation is still poor. His PEEP was already 10 but his oxygenation remained 78 - 82%.

2 hours into the Op his BP started to decrease. Called my Consultant to inform him about the likelihood of this patient not to be extubated post Op. His BP went crashing all of a sudden , with his heart rate following suite. I tried to do something but i didn't know what was wrong with the patient ! I panicked !! Gave him Atropine , but it did not help at all. I was in the midst of preparing Noradrenaline when my Consultant came in ; and i saw the panic look in his eyes !!

His heart rate was going down.. 65... 50... 43... 35... Shit !! Bp was low.. 50 / 30 mmHg. Dr HAshim gave adrenaline , but he did not respond. Surgeons stopped the Op . A moment of standstill beckoned. I was preparing for the worse.. the patient was going !I told the nurses to prepare adrenaline and atropine for CPR .Syringes and needles were flying around with drug ampoules all over the floor. Another bout of adrenaline was given... and his heart rate picked up. Adrenaline and Noradrenaline inotropes were started .. and his BP picked up. He was a fighter. Maybe it was not his time to go as yet. Boss quickly inserted the triple lumen and the surgeons managed to complete the Op. Unfortunately, his bowels were markedly distended so they did not really close his abdomen.

I was glad that we manage to save his life then. I felt really good but seeing his poor saturation with a distended abdomen ; it did not look good at all. But somehow , i felt satisfied because somehow i know that he is not ready to go yet.

Kudos for the gold

the new game 

My call was very calm yesterday as 1 only had to do 1 LSCS after office hours at about 4 am in the morning.

I managed to catch our national heroes in lawn bowl late afternoon on tv . Haks.. I was so excited by the game ; it was as if watching footie ! haks.. A bit funny though as the game is very mild in nature and it was great to see our team trashing the Australians on thier home groud for the gold .Who would have thought we could snatch the gold under their nose. Caya la !! Malaysia Boleh !!

I never understood the game till yesterday . It looked fun and mimicked the simple games i used to play with marbles during my childhood. Apparently , there is another game called PETANQUE which was much more similar !!! and people do compete in the olympic games !!

What say you Kamcheng gang ? Maybe we should change our weekly badminton session to play this new game? Who knows amongst us , a pearl waiting to shine in lawn bowl ?? Bule represent Malaysia in the future !! Amacam ?

My first ever Anaesthesia conference...

the meeting 

It was a good meeting. This was my first opportunity attending such an event. It was useful and something i look forward to go to next year! It was casual as there was no such thing as compulsory attendance. I realize tham Most of the anaesthetist came to meet old friends and enjoy themselves. The activities arranged were family oriented and i saw the kids enjoying it. Too bad wifey is a bit busy studying thus her non presence in this conference.

It started on Thursday with the airway workshop. We were exposed to updates as well as hands on with our "toys". It was cool meddling with airway gadgets ; trying the fibreoptic intubation , multiple ridiculous looking laryngoscopes etc. Shakti was with me only for this event as he had to work the next day.. so half the fun dissapeared!


post dinner with the selayang contingent .. somehow males are the not the dominant species in this specialty  

On Friday , the biggie began. My word , there were like 700 of us whom bout 450+ were anaesthetists. Mak ai.. banyak gile orang !! Who's who in Malaysia's anaesthesia field were there. Met lots of people from around the country who basically runs the Malaysia's hospital operating theatres. The staff nurses from HKL still recognized me ! haks.. it was kewl meeting back with them and obviously everybody commented on my weight.. hmm..

The speakers were good and certainly inspired me more to do anaesthesia.WHo's who in the journals were around and it was certainly nice seeing them !! I enjoyed the talk by Dato Hassan ; IJN's anaesthetist who showed us his video on regional anaesthesia during CABG ( Coronary Artery Bypass Graft ).Imagine , being awake while your chest ripped out and your heart repaired !! Scary isn't it ! Really really kewl visuals !! And the scientific paper presentation competition. Certainly something i would like to consider in the future !!

Managed to squeze in time in between to visit Mak Long and En . En's wife is due anytime and i wish them the best.. Insya Allah..


booth 

Away

I'll be away in Melaka till the weekend. I am attending the Annual Anaesthesia Conference with all my colleagues from all around Malaysia. It should be interesting.

Hope thati get to snap good pictures for this blog !!

Photos for memory

Grand-Dad's minime 


maktuk dearest 


with nenek 


pijak tanah 

fotong la.. fotong lah..

I received a shock when i arrived in TTDI yesterday morning. I had a bad call the night before and slept for a bit only at 6am !!Cases went on and on with the bummer bad laparotomy that needed ICU admission midnight , and had to settle really emergency orthopaedics cases early in the morning. I was really knackered and lucky enough not to overslept ! I arranged my alarm to be tirggered at 7am , instead i woke up on my own at about 7.45 am.The marhaban was to start at 10am.


Sani's piece 

"Besarnya ! " i said. Mama told me she wanted to do the berendoi thingy with a traditional cradle. Having been to few of these events myself , i could imagine her vision. But .. as you can see , somehow Sani ( the person who's famous for pelamin's in TTDI ) installed this huge "buai" and caught me by surprise !! Thank you Elly ( my sis ) for sponsoring the "buai". Oh my god.. it was beautiful and certainly the aura of grandiosity was there.Apparently it was used in one of the royalty's event.. Merasa jadik anak raja la Dzaeffran semalam !!!


Marhaban 

The event started on time. I was lucky to have Fiqar's mum to lead and Megat's mum to be one of the "vocalists" as well. Some sort of Kamcheng's fellowship bond demonstrated here. Thank you to both aunties for making the event a memorable one. Dzaeffran certainly enjoyed the event. He awed everybody with his cute kopiah when he went down to take his place. I dunno whether this is an indication of him being a very sociable person in the future.. but he never did make a noise during the event. He even went to sleep during the berendoi !! He did not ran amok after he was woken up for the "jejak tanah" adat. heks... As if he had never touch the ground.


potong jambul 

Dzaeffran was lucky as Maktuk from Muar came for this event. This was her first time seeig Dzaeffran and her first time out of Muar after a bad pneumonia last week. She was admitted for 5 days and Alhgamdulillah recovered well. She was keen to be here yesterday and we stayed over in TTDI last night to be with Dzaeff's beloved moyang.


di endoi 

Alhamdulillah it went well. Thank you for those who managed to drop by.. especially during this busy school holidays. Lan Tipah made a surprise appearance ! Thanx Lan for coming..

Kings of awful strikers

mourning.. 

I bet today ,all liverpool fans would be depressed and not motivated to work. We were banking on them to bounce back and defend the title in Paris come May. Unfortunately , it was not meant to be. The mighty Liverpool fell in disgrace at their own backyard.

I cannot believe I actually watched the game from 0330 to 0550 just now - and currently I am waiting for Subuh prayers. I changed my shift with a fellow colleague in order to watch what i suspected to be our last Champions League game for the season.. and i was right ! I dunno what time i'll wake up but i will be in my OT at 2pm !!

The strikers / forwards are just not scoring goal.. why ? because they are s**t crap. A very simple reason.. haks.. Morientes sucks , Crouch is pure "crouch" , Cisse makes me puke , Garcia ..haks.. takyah cakap la , Kewell is dead , Fowler just not there yet.. damn..i can';t stop rambling. Me and Dil had the discussion last night and boy.. he shares my sentiment. Its the curse of Liverpool you see.. Only pure "scousers" are successful.You can be good elsewhere , but when you come to Liverpool , you'll be rotten real bad. God help us..

One thing i noticed during the game , how it confirmed the Kop ( Liverpool's supporters ) are truly legendary. I could here the crowd singing our anthem , near to the end of the game , eventhough knowing that the European Cup is not ours this year . They were singing all their might with full of passion and pride."Youll Never Walk Alone" was simply demonstrated here. I guess the players themselves must have felt the guilt so much to dissapoint the Kop today. Respect giller.. True fans , loving their club no matter what.

Its definitely not our culture here in Malaysia ; e.g. Selangor or be it the Malaysia team fans. If we were down 1 - 0 at 70 minutes the crowd will be jeering , swearing and throwing things towards our own players ; creating the negative aura and mentality. SOO KIASU... And by 80th minute , everybody will be going off the stadium which till today i cannot understand.I will stay at the stadium whether we win or lose.. because thats how you watch a footie game !!! And when the team is not performing like Selangor in the current Super League ; nobody comes to the stadium. But when the team is in the finals , then everybody would gush and rush ; claiming to be hardcore supporters. APA HAL ???

I do hope that Rafa will consider drastic changes to the team come next season.haks.. Kalau tak lama-lama.. kena jalan sorang2..

p/s Banking on Lyon to go all the way to win Champions League !! Go Gerarld Houllier !!

Invitation

Invitation cards in process 

I reckon it would be easier to do it this way. But only to the faithful followers of this blog lar.. which i don't think there are that many and i reckon i know most of you .My mother had made simple invitation cards but due to my busy nature of job , it is quite difficult to get hold of you guys..

Anyway , if you don't already know.. You are all invited to :

Baby Dzaeff's POTONG JAMBUL ceremony !!

Venue : 147 , Jalan Athinahapan TTDI
Date : 11 March 2006
Time : 12 - 3 pm
Itenary : Makan !!! haks..

Well , most of the itenary will be in the morning ; marhaban / zanji / etc from 10am. It will be led by Fiqar's mum's zanji group. It will be an all women's affair . My baby is already 3.5 months old but it's my mother's hajat you see ; Ye la.. cucu sulung !! haks..

So , if you happen to be around TTDI area this Saturday , do hop in to my parent's place for lunch !!!

P/S this is jemputan ikhlas !!!