Induksi ROCKS!

I'm back from my 2-week Induksi course! I think I really enjoyed it alot..and it ended too fast la as the whole group were just getting very close and the course has come to an end dy. Nevertheless, i think it's very good memory=)

This was the first day when we reached the terminal jetty to take ferry to go Pangkor.

My group! We were divided into groups and given some group tasks to carry out. My group consists of me, Tan from Hosp Parit Buntar, Lim from Hosp Ipoh, Jamuna from Hosp Teluk Intan, pharmacist Ling and 2 staff nurses.


Evening time is for free activities. We usually go for cycling, or walking at the beach side. There is one "jambatan gantung" which the road to get in there was so narrow, full of weed and occasionally you'd hear the sound of wild boar around.

We also went for island-hopping. Had great fun on that day.


No this is not a Titanic-scene. Hehe. Some of the group members went for snorkeling.

The water was not crystal-clear but, still a lot of things can be seen la.

Then came the performing night. Each group was presenting e.g sketch, melodrama, singing, dancing etc.

After all the group performances there was one 20-minute session of "Persembahan Istimewa" - my magic!=) It's mainly close-up card magic to the VIP table. I was performing to our state health director, Dato Dr Haji Ahmad Razin, gosh you can imagine how nervous i was! The guy in red is En Harris, our fantastic facililator of the induksi.




I performed my favourite card routine with a few new effects. I'm glad that he enjoyed the show very much! After the show he was still asking, "How did you do it? Was it real magic? Very impressive! Are you a witch doctor?" Ha the last one was funny lol.

My group after given certificate of the course and the big hamper that we won. It was really a great night!

And finally, the group picture on the last day before the final exam.

The 2 weeks were really fast..probably because it's too much fun ha. Really enjoyed it and very glad to know a lot of people who are the health personnel working in this state, next time the referrals will be much easier already ha. Induksi fun fun fun!=)

Induksi 1st Half

It's day 6 of Induksi course now. Still has got 8 days to go, hmm..can i have more? hehe..okla afterall it's actually an enjoyable course, staying in sea-side hotel, in a beautiful island, 6 meals a day without fail, what's more should we complain. The moto from our group leader: "Happy, stylish & successful". The unofficial one is, "Together, we learn and gain weight". Hehe.

It's good to get to know a lot of health personnel from various places in state: docs, dentists, pharmacist, nurses and other healthcare workers from general/ district hospitals or clinics.
Some of the funny things that happened here:

#1 On the first day we were separated into groups and had our 1st group task. A scenario was given: While heading to the induksi course, if your boat has got some problems and you're left alone in an island, name 3 objects that you want for survival and why.

Most of the groups chose drinkin water/ knife/ rope etc and will include fire for SOS use, except one group which chose neither fire nor any other communicating tools in the list. When asked how they're gonna get out of the island, Ben gave a classic answer,

"Oh I'm not worried about that. Once i'm not reporting myself back to duty within 2 days, i'm sure my head of department will frantically search over the whole planet to locate me and send me back to work!"

#2 The other day somehow we were chatting about what was the weirdest referral we've seen. I told them about my experience, but Tan (MO from Parit Buntar) told us his champion experience: he was once referred from a GP clinic a 70 year-old woman, with the diagnosis of acute urinary retention secondary to Benign Prostatic Hypertrophy!! Absolutely unbelievable. LOL.

Guess that's all for now..will post up the pics when i'm back!=)

Good Read

Found a good read about housemen. According to the author, the house-officers are classified to few types: the "Don't know", "Don't know, don't care", "Don’t Know, Don’t Care, Bullshit Non-stop" and the "Know Something, Can’t Do Anything" type.

Very interesting read indeed. And I really agree that HOs make up an extremely important portion in our healthcare system, and hence their qualities inevitably reflect how good/bad our healthcare system is.

Having been inspired by the article, I think i have encountered a few more types of HOs:

The "Chipsmore" Houseman
The typical "Now you see, now you don't" HO. One of the most hatest type of all. If you happen to work with them, you'll find yourself developing refractory hematemesis soon. They'll disappear anytime during working hours, and be totally uncontactable. You'll practically get mad especially if you're left alone in ward handling every single thing helplessly.
After variable duration they'll reappear, giving all sorts of ridiculous excuses:
"Oh you called? Phone no battery la..no i wanted to call you back one..but credit JUST finished.."
"Oh i went back to take shower la..sorry forgot to tell you.." (take shower..for freakin 3 hours?! during the time that you're on call somemore? Can't you see how busy the ward is?)

The "Forever-EL" Houseman
EL stands for emergency leave. Supposed to be for unanticipated emergency, but is frequently misused for various purposes. I have met one HO who's taking EL "regularly", using similar reasons every time - to attend relative's funeral. It's either his aunt, uncle, cousin, or grandparents, a total of 4 ELs in about a month time. If not his close friend revealed that all those were lies, we almost wanted to investigate why the mortality rate is so high in his family in that month.

The "Don't know, don't care, Dangerous" Houseman
I'm really concern about this. I think ultimately nobody can know everything, but one thing has to be sure: You are a SAFE doctor. Code of ethics no.1: Do good, do NO harm to patients. If you're not sure of something, pls spend some efforts to ask/ find out before you "empirically" do it. I've seen one HO attending a patient just transferred back from ICU, who developed SOB again in ward. No one can believe what she wrote in the plan:
"Noted patient breathless...SPO2 76%...some examination findings..
Plan: Nasal prong oxygen. KIV discharge today."

I can understand that new HOs can be quite helpless sometimes especially in handling the cases which he/she is not confident about. But once you're not sure, pls ask. Do not put patient's health at risk just to save your pride. No one will scold a HO for asking.

At the end of the day, what we're looking for is not how smart you are, but how safe you are as a doctor. And your attitude, instead of just knowledge, will certainly determine how far can you go in your career.

Little Updates..before I go

The 6-month JMOship is coming to an end soon. I'm having my last 4 weeks in paediatric department, and after that, I shall be posted to ANYWHERE in this state. It's pretty unpredicable, though you're allowed to fill in a form with your preference, the rule is simple: You just can't get what you want. Some say this is a form of training by government to us. Looking at some of my batchmates:

Congratulations to Dhanendra, one of my good friends, who has made his way to the paediatric residency in Bronx Lebanon Hospital, New York. All the best bro, i'll see you there one day.

A big welcome to Steven my batchmate, who has just joined Hospital Taiping O&G Department as a new MO. As far as i know he actually applied for paediatrics. I heard he's already taking prophylactic Prozac now...no i'm just kidding=)

And Steve is now a Anaes MO in Hospital Serdang..JK's a Urology MO in HKL...

Where will my next destination be?


P/s: I'll be going for Induksi Course in Pangkor Island from tmr onwards, for 2 weeks. Should be enjoyable i guess. See you then=)

I Love Stephen Chow

It's difficult to describe how much I like stephen chow and his movies. Probably the following few points can help:
1. He's the only actor/director that i have FULL collection of the movies, and i even bought his books. Though he never really writes one, but those published collaboratively by his fans are good enough.
2. If someone tells me he doesn't like Stephen chow's movies, no i won't get angry. But I feel so sorry for him that he's missing some best things in life.
3. I would say he's one of the most important persons in sculpturing my personality over years and teaches me (indirectly) on how to view the uncertainties/obstacles in life etc.
4. I can't recall how many times i've repeatedly watched his movies, and still enjoy as much as i first watched them.
5. And many many more...

"If Hong Kong has a Charlie Chaplin, he's it." - TIME 2003 on Asian Heroes

Two of the youtube vids i found that well summarize his work:



I quite like the comment nearing the end, "Stephen chow's movies are original, constructive and unique. Simple remarks such as just good or bad, can never judge him."

.

I love Stephen Chow. I'm proud of saying it. =)

Nice Vids by IMU Juniors

It's been quite long since I last visited my uni, IMU campus in KL. By the time i left i think it was just started the 2-phases expanding project, i guess now it should be under phase 2. From the newsletter i got to know that now it's providing dentistry course, dietetics & nutrition etc, plus quite a number of posgraduate courses.

I came across a few vids posted on youtube, by my juniors, and some are really interesting.



The ball song done by Jing's batch. A basic summary of life in IMU..in a very funny way=)



A orientation vid done by M205. Gosh it's really brilliant. How much i miss my orientation week now..it's the craziest week in your entire uni's life, but definitely something very memorable.



Another vid by one of the super juniors. I think it's for a vid competition or something. Damn creative la, lyrics very smooth..good job indeed!=)


Makes me really miss my IMU's days la.

Sign Language Miracle

That day in clinic, came a young couple, age in early 20's, came for urine pregnancy test.

Me: Your wife..(looking at her kinda strange name)

Guy: My girlfriend actually..ya she's a Thai.

Me: I see..hmm may i know when's her first day of last menstrual period (LMP)?

Guy: (frowned) This is difficult..

Me: Difficult? (i thought difficult to remember)

Guy: Err hard to ask la..we actually have some difficulties in communicating one..i can try la..

Then he took the calendar on my table, showed to the girl, pointed down there (not very down la), then pointed at some red colour stuff. The girl figured it out, then use her fingers to show the date.
The further history taking was conducted in similar way, which was mostly transformed into sign languages and "translated" back to me.

Finally the urine pregnancy was done. Positive.
I initially thought the guy would be quite worried, but he said,

"Positive? Expected la..i know this time i can't escape already one. But doc, dun worry, I'll sure marry her one. Althought i didn't study that much, i know how to be a responsible father. Thanks!"

The couple then left happily and i'm glad for them too.
But one thing i'm just wondering, with mainly sign languages and they could also come to that stage..hmm..how ah?

Simply amazing. Ha.

銀行家與漁夫的故事

Read this somewhere..a very meaningful story=)

........ 話說這位投資銀行家在墨西哥某海灣度假，看見一個年輕的漁夫在碼頭釣魚，手到拿來，不到半句鐘時間便釣了十多條肥大的活魚，塞滿整個水桶。
漁夫收桿離開，投資銀行家語帶不解問道：「為什麼不多呆一會兒，可以釣更多的魚？」漁夫回道賣掉這些魚已經夠換來好幾天的家用，等需要時再釣吧。投資銀行家好奇，問漁夫除了釣魚，是怎麼過日子。漁夫答道：「我釣魚的時間不多，沒錢用時才到碼頭或出海捕魚。白天我和我的孩子們玩、睡午覺，下午和太太漫步、溫馨溫馨，晚上和朋友們喝酒吃飯、唱歌跳舞玩結他，一直玩到深夜。我們平時睡覺很晚的。」

投資銀行家於是教訓他：「你太不思進取了。你應該花多點時間去釣魚，多釣多賣多賺，然後買一隻大漁船，釣更多的魚。」漁夫不明所以：「之後呢？」投資銀行家續道：「之後賺了錢便換更大、更多的船，把船租出去，再把你村內的漁民組織起來，變成為你賺錢的船隊。到那個時候，你就不需要自己出海，你可以自己開一個魚食加工廠，做自己牌子的魚肉罐頭，自己生產、推銷。」

漁夫更加不解瞪大雙眼問：「那我豈不是很忙碌？我豈不是沒有時間陪伴家人，不能晚晚和朋友吃喝玩樂？」投資銀行家安慰他：「我是投資銀行家，我可以幫你，把這個業務做大做強，然後安排公司在紐約交易所上市，到時你便是千萬富翁了。」漁夫聽罷有點興奮：「這要用多長時間？」投資銀行家回應：「如無意外的話，只需10至20年時間。」漁夫心裏冷了半截，續問：「公司上市後又如何？」

今次是投資銀行家有點興奮了，他回道：「公司上市後你可以退休，搬到一個美麗的小漁村去生活，白天和你的孩子們玩，中午睡個午覺，下午和你的太太一起溫馨溫馨，晚上你的朋友們喝酒唱歌跳舞玩結他，一直玩到深夜！逍遙快活，多麼寫意。」

漁夫冷然回應：「哦，我現在不就是這樣生活嗎？我為什麼要等10至20年？」 .............

Neonatal Jaundice..no need phototherapy?

Neonatal jaundice is commonly seen due to a few reasons such as fall in hemoglobin concentration, shorter red cell lifespan and less efficient hepatic bilirubin metabolism in newborn. The fearful complication of jaundice, kernicterus, which occurs as a result of bilirubin neurotoxicity, can lead to catastrophic damage and death. Infants who survive may develop cerebral palsy, learning difficulties and sensorineural deafness. For management, phototherapy is the most widely used, which the blue light converts unconjugated bilirubin by photodegradation into a harmless water-soluble pigment, and excreted in urine.

But sadly, there're still parents who would refuse treatment, and on the other hand, opt for traditional medicine. Here's an example that i saw today:
Baby day 2 of life, clinically jaundiced, serum bilirubin taken was 14mg/dl. (photo level for D2 is 12, SB>20 is considered severe NNJ; SB>25 will require exchange transfusion).

I explained to the parents about the condition and that baby requires phototherapy.

Father: NO, I dun think he needs it.

Me: But your baby is jaundiced..

Mother: You know why he's yellow? He's just after bathing la, looks pale abit, then you thought he looks more yellowish lo.

Me: We checked his blood, the bilirubin level is high, 14mg/dl.

Father: 14 is not a problem! My mom can treat it.

Me: How? Your mom is a..?

Father: My mom is a "kampung midwife". She said just give some "susu kambing", then the jaundice will be fine.

Me: "susu kambing"? It shouldn't be given to newborns..

Father: No problem la..my mom has tested many babies before..they all became okay what..

Me: If you're lucky, the jaundice is a physiological one, yes it'll come down by itself..but what if it's not? Are you aware of the complications of severe jaundice if untreated? (i told him about the kernicterus etc)

Father (impatient): Doc, i'm making this clear. I DUWAN phototherapy. I want traditional way. I won't let my baby admitted. We are bringing him back. End of story ok?

Subsequently my specialist also came and gave another round of counselling but the parents still insisted. In the end they signed the "At own risk" discharge and brought the baby back.

How sad isn't it? My nurse told me that she saw this kinda parents before, which the most severe one was, they brought back the baby few days later, with SB of 80mg/dl. EIGHTY!! The baby is kernicteric, but surprisingly looks pink, in fact more to reddish as he was bathed with some kinda "mandi-daun" which has colouring effects that make the baby looks pink, making the parents think that the jaundice has "resolved".

Do the parents really have the right to decide this, i mean refuse treatment for the baby? It's so unfair for the baby!

But who will suffer the most in the end?