Thursday, July 31, 2008

HO, MO and Specialist

Case 1

Specialist: "HDL and LDL stands for?"
HO: "High-density lipoprotein and Low-density lipoprotein."
MO: "Highly-desirable lipid and life-destroying lipid."
Specialist looked at MO, "Not're right."

Case 2

Specialist: "What's idiopathic?"
HO: "Means no cause is found."
MO: "It's a diagnosis of exclusion, after you've ruled out every other causes."
Specialist: "Right, so if you simply use this diagnosis, it means you are an idiotic doc treating a pathetic patient. Hence the word idiopathic."
HO & MO: "......"

Case 3

Child's coughing vigorously.
HO: "Is that barking cough?"
MO: "OMG what did you just say? You can't even differentiate how barking cough is like? You should go back to your school and learn again. Barking cough is such a basic knowledge, and don't make me laugh by saying that is it OKAY."

Specialist passed by..."Did you all hear that? It's a TYPICAL barking cough. One should never miss that ya. Very typical."

HO looked at MO, MO looked at ceiling.

(Note!: In this case, I wasn't the MO k. Just to clarify lolz)

Case 4

HO: "This patient presented with SOB..."
Specialist: "I hate ppl using short forms. What is SOB?"
HO: "Shortness of breath..."
Specialist: "But it can mean son of bitch also right? Why you so bad saying ppl got SOB?"

Thursday, July 24, 2008

My Fav Song..and It's M'sian Product!

Well, I could be outdated..but who cares. The song i'm putting now, is one I really like, and have been addicted to it for reaaaally quite sometimes. First time when I heard it, i really thought it's from some Taiwanese singers. (No offense to M'sian singers, but this really sound different..i mean, much better actually hehe)

Until I found out it's a song called "一起飞" by Henley 许俾文 with 陈威全. I guess they're some "Superstar" winners..ha pls correct me if i'm wrong, and pls forgive me for bit of losing touch with the current entertainment field status (i'm getting old...)

Anyway, just wanna share the song and hope you'll like it too!=)

Tuesday, July 22, 2008

What Exactly is Housemanship?

Lately, the new batch of housemen does not seem to be happy. Apparently some housemen (yes, THE new batch) are very unsatisfied with their jobs. Ya they have been making noises, but lately they're making more. Most of them made complaints about long-hours work, too much workload, always got to miss meals, always get scolded, work stress is depressing etc. And one of the HO's parent (apparently the over-protective type) even personally called the hospital director, complaining that the "36 hours on call" is unacceptable and it made her son "stress till constipated for 1 week (she can't possibly be serious)" and she requested on "less call, regular meal time, and can go off work on time" for her son.

This is just not so right.
I'm just wondering, do they ever know what exactly is housemanship? What was their expectations before they start working, or even before they chose to study medicine? Did they think it's gonna be easy?

First of all, housemanship is a training. A TRAINING. Not honeymoon or whatsoever. It's never easy. You'll do everything under supervision, and your knowledge, attitude, responsibility and endurability etc is tested, before you can be fully registered as a practising medical officer.

The "on-call" is 36-hour working and it's been there for ages and already like setting a "trademark" for doctors' work. Yes, it's tiring, for sure but I can assure you that this is the one of the most vital parts of your learning. Let me just quote my good friend, Steve's saying: "Being on call is clinically, physically, psychologically, socially, spiritually, and technically challenging. So, Bravo! to all doctors who had endured housemanship."

I can honestly tell that I learnt the most from calls. It's the time you learn to (or forced to because you're alone on the night) be independent handling and managing the patients. And talking about long hours, have you heard of back-to-back call? Meaning 2 calls in a row? What about a stretch 3-calls? And, the ultimate, 4 calls?

The shown punch card is of my worst month in surgical posting when the housemen were in awful shortage, and we had to do stretch calls. Note that those are active calls, so go figure how many hours of working was that. But I DID NOT complain. Nor did my mom.
(To all the respectful seniors, i'm not trying to show off at all. Just to put as an example. I'm sure there are some of you who had even worse time than it)

So the conclusion is, pls stop complaining. Housemanship year is crazy/mad/whatever-you-call-it but every medical officer has gone through it. If you think this is unacceptable, pls re-evaluate yourself before you have doubt on this working system.

And a piece of advice to all concern and over-protective parents: It's time to let your child go and learn. There's bit of suffer for him/her, but it's all for his/her own good.

I can bet with you, if housemanship has turned into a relaxed, goyang-kaki 9 to 5 job, in the end of the day, you'll most probably call the hospital director again and say,

"I want to complain! How come my son/daughter is now a fully registered doc but he/she doesn't seem to know anything one?
Did you all train him/her properly or not?"
Related post:

Sunday, July 20, 2008

Miracle (2)

"An Indian man has survived an operation to remove a 1.5-metre (five-foot) long iron bar that stabbed right through his chest, reports said Friday, calling it a medical miracle.

The rod was lying on a construction site when the taxi Supratim Dutta was travelling in smashed into it on Saturday.The bar crashed through the car's bonnet and dashboard before hitting the 23-year-old, who was sitting in the car's front passenger seat, The Times of India said. It measured 10 centimetres by 10 centimetres (four inches by four inches).

The man remained conscious and called family and friends from his mobile phone while he waited at the scene for an hour before being taken to hospital, the newspaper reported.

"I was shocked to see him. He was on the stretcher holding the iron angle. Groaning in pain, he kept asking people to move aside so that the angle (of the rod) wasn't disturbed," Tej Prakash, one of the first doctors to see Dutta, was quoted by the paper as saying."

- news from Indian man survives after iron rod pierces chest

Another miracle!

Related post:
Miracle (1)

A Beautiful (or Colourful?) Mind

Tell me what would you do if you were me.
Busy day. Admissions non-stop. Then I saw this patient (the unlucky me).

20 years old. Student nurse.

"Doctor, i noticed something funny with my stools. Over the past one week i've been passing darkish stool..but not really like malenic you know? More like dark BLUE..with some mucous..i'm not sure whether it's mixed with some tissue debris? And that day i also saw something orange colour..looks like the Vit C tablet that i took? Not fully digested..why like that ah?"

"Any blood?"

"Blood..yaya..that day after a difficult strain..i saw a few drops of bright red blood.."

"So isit black or red? I'm sure you know how malenic stool looks like..isit like that?"

"Hmm it looks like black but not really black..sometimes i even got green stool! *giggles*"

*Slightly nauseated* "Any abdominal pain?"

"Oh ya..i have left hypochondriac pain..but tak tentu one, sometimes like needle-pricking sensation, sometimes like spasm..then when the pain comes, i feel headache also, then giddy and feel like vomiting, but just mild one la.."

"Pain is localized?"

"Hmm..*hand make a 360 degrees round over the abdomen x2*, sometimes the whole abdomen also feel uncomfortable..ohya then my bowel habit, it's altered i think.."

"Like how?"

"Used to be twice a day, but now 3 times a day. I'm not sure if it's bcoz i'm eating more?*giggles*"

....this is just the 1st half of the history. Honestly, in a mad busy day, but you're stuck in seeing a patient like this, you'd really feel like killing yourself.

Noticed that she has already given more than 10 symptoms?
Basically the summary of the history is,

Non-specific abdominal pain with Rainbow-coloured stool. (Yup, a new medical term.)

Someone pls give me the diagnosis. (Or is that the diagnosis?)

Thursday, July 17, 2008

Combination of Durian and Alcohol Kills or Not?

It's durian season the popular myth about whether durian mixed with alcohol kills, is kinda brought up for discussion again.
I read it from MMR's Durian and alcohol - the death mix myth, then I just further did a little bit of research about it. Just to show some extracts:

"In 1981, J. R. Croft wrote in his Bombacaceae: In Handbooks of the Flora of Papua New Guinea that a feeling of morbidity often follows the consumption of alcohol too soon after eating durian. Several medical investigations on the validity of this belief have been conducted with varying conclusions." - Wikipedia (notice that it mentioned morbidity..what about mortality?)

Then I found a more scientific explanation:

"...The presence of harmaline in durian kernels as well as in the fruit pulp has been confirmed. It will, in conjunction with alcohol, induce hypertensive periods, whereby the blood pressure is raised to absurd high levels, sometimes even reaching life-threatening values of 300. Durian is also a source for tyramine. In absence of alcohol tyramine is converted in the gastro-intestinal tract swiftly to the corresponding N-oxide, but this conversion is greatly inhibited by harmaline in the presence of alcohol. Thus, the tyramine level in the blood reaches unacceptable high levels, eventually leading to a stroke." (Hmm hypertensive crisis causing hemorrhagic stroke leading to sudden death..quite convincing..)

Then some mythbuster's experience:

"I thought I was a goner. I felt my head spinning, and it was hard for me to breathe. The pain on my chest was unbearable..Alcohol and durian can generate so much heat if taken. If both are taken at the same time, the human body would not be able to stand the heat."

It happened before?

"..A middle aged man in Batu Niah was recently found dead on the floor of his room by friends. He was covered with foams of mixed saliva and blood in his mouth. Friends found that Panggau, in his 50's had been drinking four bottles of branded liquor and ate some durians in his room." - Winedragon (In fact there were also a few cases in M'sia..ppl found to have unexplained sudden death after consuming the lethal combination)

So were there any scentific studies done or not?

"Some scientific studies have actually been conducted to investigate the validity of this belief. Despite the important contributions to our knowledge of durians and human/animal physiology provided by these experiments, some flaws are evident. Most of them were lacking a control treatment in which animals were fed an equivalent mass of some food item other than durian. Thus, any effects on alcohol absorption might be due to the presence of food in the stomach, and not durian per se. At this point, it is fair to say that consumption of durians with alcohol has not been shown to be harmful." - Singapore Science Center

Any Malaysian mythbuster tried it?
Yes, they even had a durian party with alcohol. Timothy didn't take the risk actually, so he's still fine.

What about his friends then? Hope they're fine, too.

Wednesday, July 16, 2008

Mad Referrals (2)

Mad referrals are back! Recently i saw these two:

(I think i can put the whole content here because it's very "simplified")

"Dear doctor,
Thank you for seeing this 14 year-old girl, who's previously well,
currently unwell.
Kindly do the needful."

Look at this. Fantastic isn't it. Patient's problem is perfectly summarized. I just feel like replying to him, "Dear doc, thanks for your referral. I think, hmm, if patient comes to see me, you think I dunno she's unwell??! Next time you can just omit your referral letter thank you."

I saw a 29 year-old gentleman in casualty. Had a short chatting while i opened the referral letter. I almost fell from the chair when i saw the diagnosis: "Imp: Acute myocardial infarction (AMI)"

You know why I was so surprised? Because, from the chatting, he told me that after he saw the GP, he rode his motorbike, went home and took a shower, then rode motorbike again and came.

First thing, 29 year old is quite unlikely to have heart attack. (I then checked the ECG stat, it was just a high take-off in only one chest lead, and the clinical picture was more suggestive of costochondritis.)

The problem is, when you think that someone has a MI, it's an EMERGENCY, no doubt. Your reaction won't be like, "Hey, I think you're having heart attack..faster take your bike and go to hospital ok?"
"Can I go back home and take a bath first ah?"
"Hmm..can la but after your bath, faster take your bike and go to hospital ok?"

Make no sense isn't it. MI patient should never drive, and there should never be any delay in getting treatment. Time loss=muscle loss, remember. But of corz, luckily this was not really a MI patient, if not the GP is gonna be in deep, deeeep trouble.

Related post:
Mad Referrals (1)

Tuesday, July 15, 2008

Pachelbel's Canon (Canon in D)

Read a post in shinyin's blog which she was playing her piano. I think she did a very fine performance.

I'm sure everyone's familiar with the song?
Pachelbel's Canon (also known as Canon in D major), is the most famous piece of music by Johann Pachelbel. It was written in or around 1680, during the Baroque period, as a piece of chamber music for three violins and basso continuo, but has since been arranged for a wide variety of ensembles. (i'm not that good with history, this piece of info is from Wikipedia lol)

This music has been played with various instruments, and all are widely acceptable. I just wanna share a few clips:

A version with electric guitar. This guy is amazing. I've seen this clip on youtube few years back, and now it has already got over 40 millions view. Very very nice.

Legend in the making. Sungha Jung, a Korean boy who's extraordinarily talented.

And this is the last clip that I wanna share. Not about Canon but, is he not amazing? He just showed us that with strong determination, nothing's impossible!

A superhero in real life.

Monday, July 14, 2008

Interesting Chest Xray (3)

This is a Xray of a 60 year-old lady who presented with severe breathlessness. It's pretty straightforward, think a 4th/5th year medical student should be able to describe it. It's basically a massive pleural effusion of left lung with mediastinal shift. But what I wanna show here is the marked trachea deviation, and if you look closely, even the carina can be seen!

Related posts:
Interesting Chest Xray (2)
Interesting Chest Xray (1)

Sunday, July 13, 2008

Couple Jokes

Let's have some light moments. Saw these somewhere.

Wife: "Dear, we have married for so many years."
Husband: "Ya..."
Wife: "Tell me, which part of me you like the most? Is it my beautiful face or my gorgeous body?"
Husband: "...I think I like your sense of humour."

In an art gallery.
Wife: "I think the portraits are overall excellent."
Husband: "Ya..."
Wife: "But there was one I saw just now was simply terrible, the worst of all."
Husband: "...I think you were walking past a mirror."

A lady loves to sing loudly at home.
But whenever she sings, her husband will walk out to the balcony.
Wife asked, "Why must you stand there when I sing?"
Husband: "I have to. I want to let our neighbours see me, so that they won't think that i'm physically abusing you or something."
Wife: "......."

Thursday, July 10, 2008

Welcome to the Mad House

This is what happened when supposingly 3 ppl doing the shift, but one went to do the post-mortem and one went to attend some courses. Left a poor doc in the department, running like a mad dog.

"Doctor, patient's BP high la..260/120mmHg. Complained of vision blurring."

"Doctor, patient complained of chest pain la..ECG looks not good."

"Doctor! Patient's fitting! Fitting!"

"Doctor, I think you should see this first..per vaginal bleeding..still actively bleeding la.."

"Doctor, patient's collapsing..BP's down to 60/30mmHg! Wanna start inotropes?"

"Doctor, MVA case, severe head injury."

"Doctor, call for you from district clinic to consult."

"Doctor, the green zone patient said she's waiting for quite long already..she said if she go back later during lunch time the traffic very jammed one.."

"Doctor, patient's fitting again! Fitting!"

"Doctor, just to let you know, later got third-degree burn patient coming. Got THREE."

"Doctor, the uncle very tachypneic la..SPO2 85%, on high-flow oxygen already.."

"Doctor, can you see me first ah, I'm a hospital staff la. I feel veerrrry pening today. Can you write me a MC ah? Now can ah? Now ya.."

"Doctor, patient collapsed! Quick!"










"Doctor are you ok? Are you ok?!"




"Help! Everyone help! Doctor's collapsed!! Quick!"

The end.

P/s: Of corz, the last part didn't happen. Docs are not allowed to collapse during work, no matter how tired, as one of the work rules.
Enjoy the mad house.

Wednesday, July 09, 2008

Must It be Private Hospital?

My emotion is quite affected by one incident today.
A man brought in by ambulance, 40 year-old Chinese, alleged MVA (motor-vehicle accident) - car vs lorry, sustained a bleeding forehead wound. GCS on arrival was 8, with unequal pupils, showing that head injury with intracranial bleeding is likely. We stabilized him, then I called up surgical team and spoke to radiologist to arrange for an urgent CT brain.

Everything was quick and smooth. He was ready for a scan then an emergency op if needed. But then suddenly the family came and said, "No need for the scan! We are bringing him to Hosp X (a private hosp in Penang). My friend told me there's a very good neurosurgeon there."
Penang? We explained to them that this would cause unnecessary delay in management, which is highly unwanted in such case. And surgeons, we also have plenty here.

"Nonono! We are bringing him there. I called there already..they said they can send their ambulance to here now."
" But how long is it gonna take?"
"They said around 30 min will do."

Rounds of explanation were given by us and the surgical team on the possible risks and complications of such decision, but in the end they insisted and signed the "At own risk" discharge. By hospital's policy, this is something like you're refusing hosp's treatment despite advice, and of course, you're fully responsible for your action.

Everything was settled at around 11am. Patient was electively intubated to protect the airway, I guess this is the last thing that we could do good for him.

30min passed.
1 hour.
2 hours. (At this time the family was calling the ambulance, they said on the way..)

And guess what, the ambulance finally arrived, at 2pm!!
3 freaking hours.
If every second is a golden second for a head injury patient, please do the calculation that how much time was wasted and how much that we could have done for him, if only they allowed us to, which they didn't.
Invariably, the outcome and prognosis is gonna be less favorable.

Is private always a better place? What made them so sure? That they could risk their closest family's life just because they thought so?
They thought they have made a good decision for him. They thought.

Tell me why.

Tuesday, July 08, 2008


"A 70-year-old from Muzaffarnagar, India, became the world’s oldest woman to give birth after she delivered twins Friday. Omkari Panwar, the wife of a retired farmer, delivered the twins — a boy and girl — via Caesarean section.
Panwar, who has two adult daughters and five grandchildren, underwent in-vitro fertility treatment so she could produce a male heir.

Her husband, Charan Singh Panwar, 77, mortgaged his land, sold his buffalos, spent his life savings and took out a credit card loan to finance the treatment.
“At last we have a son and heir,” he said. “We prayed to God, went to saints and visited religious places to pray for an heir."
“We kept no stone unturned and God has rewarded us. The treatment cost me a fortune but the birth of a son makes it all worthwhile. I can die a happy man and a proud father.”"

- Pic and news extracted from FoxNews

Miracle does happen.

Wednesday, July 02, 2008

You Made Us Proud

A record was made.

For the first time in the history of Malaysian advertising, a Malaysian television commercial, directed by Yasmin, was awarded a Gold Lion at the Cannes Advertising Festival, 2008. The commercial was entitled "Tan Hong Ming In Love" and i'm sure everyone is familiar with it.

Another commercial in the same campaign, "Race", was given the Bronze Lion in the same category.

I'm truly so proud of her.

Her ads are always inspiring. Very simple messages, but delivered in her unique storytelling way, never fails to touch everyone's heart. Look at the recent news in the country, and look back on the ads, don't you think that if we're all "colourblind", isn't that everything will be so different now?

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