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 bad..you'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?"
MO's ROTFLOL.

Beijing 2008 Olympic Games

Beijing 08 Olympic Games are finally around the corner. Just to share two related songs:



This MV is really tears-stimulating..so touching! I think Andy Lau can be considered the best role model in HK entertainment industry..his forever positive image, very very hardworking, always humble, and never stop contributing to the society. Salute him.

And I like one part of the lyrics:

Everyone is No. 1
只要你凡事不问能不能
用一口气交换你一生
要迎接未来 不必等
Everyone is No. 1
成功的秘诀在你肯不肯
流最热的汗用最真的心
第一名属于每个人

So true!



Theme song for Beijing Olympics. Nice and warm rhythm. I only have a few points to say:

1. Everyone's gesture is kinda too similar. The choreographer should be more creative!;)

2. I'm really wondering why Jay Chou is not included. Is it because Jolin is there? lol

3. How come 张娜拉 is there one? Korean invited guest?

3. LeeHom has the best look. 周笔畅 has the best voice. Eason is the best overall. Hehe ok i know i'm a bit biased.

有勇气就会有奇迹! 北京加油！中国加油！

The Story of Poor Doc

This is a story about the A&E poor doc again.

Busy day as usual. Admissions piling up, Red and Yellow zones are full, Green zone patients' faces are turning green for waiting too long. The poor doc was trying his best to see patient asap, and totally no time to rest (hands are getting cramp)/ take glucose to prevent hypoglycemia/ go bathroom (impending bladder rupture).

Incident one:

Suddenly a patient was brought in by a man, shouting "Any doc here?! Pls come and help! Pls!" The way he shouted was exactly as dramatic as in some HK series. I went to have a look, it's a MVA patient, with nose bleed and blood-stained shirt. So I directed them into dressing room, then i performed a quick primary survey, basically he's having possible nasal bone fracture and no other injury. So i asked my medical assistant to clean him up, then send him for a Xray. Then of course, i went back to my seat and continued seeing patients.

Then the dramatic fella came. In front of all patients, he shouted at me, "Hey doc, i need to ask you, my friend is BLEEDING inside, i can't understand how come you can still sit here? Shouldn't you be attending him? What are you waiting for?!"

(Da*n it! I've already attended him la! Is that the way you should speak to me? You watched too much HK series is it???!)
Having suppressed all that, I said, "I've seen him. Someone's doing dressing for him now, and then he'll be sent for Xray."

Then he went and checked, kinda satisfied and became quiet. Arrrggh.


Incident two:

In the middle of seeing patients and writing tickets, suddenly another uncle just came and sat down, and started to present his own complaints.

I stopped him, "Uncle, was your name called already?"

Pt: "Not yet, but i'm passing blood-stained urine la."

"I know, but you should wait for your turn." (Showed him that he has got 4 patients before his turn)

*Turned angry like The Hulk* "What? Do i still need to follow turn at this time? Hey, i'm passing BLOOD in my urine, is it not an emergency? You know how to judge or not? Ok fine, if you don't wanna see me this old man, just let me bleed until fainted outside!"

(For your info, hematuria is indeed not that of an emergency, as compared to chest pain, sepsis, painful obstructive jaundice and heart failure etc, that I was seeing before his turn. Why patient just fails to understand that, and thinking that i'm neglecting him?)

Again, having suppressed all that, i just told him, "Ok uncle, I apologize for that. Please lie down there and i'll attend you shortly."

The poor doc just has to swallow back the blood that he almost vomitted out.

Life's not easy in A&E!


Related post:
Welcome to the Mad House
A Taste of A&E

Best of Russell Peters

I think beside Stephen Chow, the only person who never fails to make me laughing out my tears is Russell Peters, the world's comedy superstar. I used to think he's the Canadian version of Stephen.

Russell Peters' comedy focuses largely around his Indian upbringing and racial stereotypes, as he often parodies his parents and South Asian culture. Much of his material explores the cultural divides between many different ethnicities and upbringings in a way that includes many impressions. Beside the clip he's talking on Italian and sign language, here are two more of his best:



The stereotype of Chinese. I have to say it's quite true..and the way he imitates chinese accent is just super hilarious.



His theory on "you should beat your kids" by sharing how he's treated by his father. This is a must-see! And the quote "somebody's gonna get a hurt real bad" has become his signature!;)

And he does have a blog too, though infrequently updated. I just hope he'll come to M'sia one day..can't wait to see his live show!=)

Psychotic Attack!

What an incident today.

Just 10 min before I finished my shift, one man suddenly walked in and asked me, "Dr, I have cough and some mouth ulcers. Can give me medication?"

Noticed that he just came without registering himself, I said, "Can, but please register at the counter first?"

You won't believe what then happened. He suddenly "mengamuk" (in psychiatric, it means going mad, or you can imagine he's like turning into THE HULK like that), walking out and started to shout, "I have the license to kill! I have the license to kill!"

I was like "wth? License to kill?" Then the staff nurses came and told me, he's actually a psychiatric patient, who would on and off came to get medication, and would easily get provoked if his request not permitted. (I was like, DUH, she should have told me earlier LA...)

Then the next thing was, a loud "PRANG!" sound from the entrance there..we knew something wrong happened..we went out and saw this.

The man just broke the glass! But fortunately no one was hurt..yet.

Terrible isn't it? Psychiatric patient (the aggressive type) can really be a time bomb, you never know when he's turning into The Hulk.

Gosh I just pray he won't come back and look for me again tomorrow, or ever. I probably need to get myself some armor or something. ^^

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!=)

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:

Will you study medicine?

Types of Houseman

New blood in work

Anniversary

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 shit. (Yup, a new medical term.)


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

Courses & Courses

Let me see..this month is really a rewarding month! Up to now i've been sent for 4 courses in this month alone..ever since I joined emergency department.

2nd July - Short course in Pre-hospital Care, a joint workshop by Emergency and Traumatology department Hosp Ipoh & Taiping

8th July - Course in Triage Guidelines

14th July - Medical-based Emergency care Update, by Medical Dept Hosp Teluk Intan

19th July - Nephrology Update..just came back from it!

All the courses are very beneficial, I think the "absorption rate" is generally higher than you read by yourself.

Hope more are coming! ;)

Jones Criteria

MO: Medical officer; HO: House officer

MO: "Tell me about this case."

HO: "This is a 10 year-old boy, presented with migratory joint pain and fever. ESR is raised. ASOT positive."

MO: "So your impression is?"

HO: "This is suggestive of acute rheumatic fever, as the Robert Jones criteria are fulfilled."

MO: "Robert WHO?"

HO: (confidently)" Robert Jones. It's the criteria to diagnose rheumatic fever." (Then gave me a look as if how come I do not know about it)

MO: "Are you really really sure?"

HO: (becoming hesitant) "....Ya...i think i read it somewhere before..."

MO: "You sure it's not Duckett Jones?"

HO: (flushed) "Oh..yayaya..oh i'm very sorry..."

MO: "I don't care, I'll post this joke in my blog." (OKla I didn't say this=p)

Jones criteria was proposed by Dr.T. Duckett Jones. But usually we'll just call it Jones Criteria.
Please don't simply change his name to Robert or something else.

Luckily he didn't say Indiana Jones. He'll be the joker of the century man.

What is Casulo?

Imagine this thing arrived at your doorstep. What you think it is?
Take a look at the tutorial on how to use it.



Casulo, the "Mobile Living Furniture" is a collaborative project of the two German designers Marcel Krings and Sebastian Mühlhäuser.

Cool isn't it. I respect creative people who brings constructive ideas to the world. Brilliant job!

Sign Language?

I think I don't have to say much. Let the clip tells the story.



Oops. 1:22. Something shouldn't be seen was seen.

So when asked about why was there the "palm hitting a clenched fist" gesture in Dewan Rakyat,
Answers: "It was a different gesture. Everyone has different perception. Yes I did it but it's not what it means."

Well, maybe we all misunderstood him.
It might not be an universal hand signal. It could be a friendly gesture in some other places? We never know.

Remind me of how Russell Peters gave a super funny show on "hand gesture":



I still can't help but laughing out loud whenever I see this. Don't simply try that gesture in Italy! Ha.


Related post:
Dear Mr President

Combination of Durian and Alcohol Kills or Not?

It's durian season again..so 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.

Mad Referrals (2)

Mad referrals are back! Recently i saw these two:

#1
(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."

#2
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)

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.

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!


P/s: If you wanna see a Xray of a child who swallowed a padlock, see here. Shawn, did you follow-up on how it's finally taken out?=)


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

Couple Jokes

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

#1
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."

#2
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."

#3
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: "......."

Public Health Education

I was surfing the net and went into a forum and looked around. It's a local famous forum with more than 100,000 registered users. Most of the topics are technical stuff-related, so I have not much choices but clicked into the "Health & Fitness" area and see what's inside. To my surprise, after a quick look on the discussion, I was horrified by the contents, and get almost arrhythmic.

The topic titles are fine. It seems that someone posts the medical question, and the forum members (with no medical background) will try to help and answer it. It ends up..all types of misleading infos crossing the forum! Something like blind leading the blind. Let me show you some examples:

#1: Question: Will I still have menses after I get pregnant? Coz some say yes, some say no. I'm confused.
Answer: The period cycle will still come for a while eventhough you are pregnant. But the flow won't be so heavy as compared to normal cycles.

Gosh. WRONG! Menstuation will definitely STOP once you're pregnant. All mothers-going-to-be, pls take note here: ANY vaginal bleeding after you're pregnant, is ABNORMAL. Meaning, if you're pregnant, and one day you have bleeding like having menses, pls go to doctor immediately. PV bleeding in early pregnancy can be either miscarriage, ectopic pregnancy or molar pregnancy.

#2: OCP (Oral contraceptive pill) is a treatment for acne.

This is not entirely true. Layperson might take the wrong message and start on OCP just for the acne. Yes OCP can reduce acne but it's just an extra-contraceptive benefit of it, instead of being a treatment.

#3: Question: What should I do if I would like to be screened for cervical cancer?
Answer: You can go get a CA 125 blood test, as it is a tumour marker to detect cervical Ca.

This.is.not.true.at.all! Tumour marker is rarely sufficiently specific to be of diagnostic value, and CA 125 is used for purpose like monitor the course of illness (e.g. ovarian Ca, it's never cervical Ca) and the effectiveness of treatment.
For cervical cancer, Pap smear is still the best screening test.

These are just a few examples that I spotted. I think I'll spend sometimes to go through other topics and "intervene" if needed.

I think I just have the responsibility to educate. It's good that they have the initiatives to ask, but they must be taught the right facts!

Analysis of Nuffnangers

I've observed nuffnangers for quite some time. I think if you wanna know about what does a person like, you need to know his/her personality, and vice versa. Meaning if you wanna know one's personality, you can somehow know it from observing what he/she likes.

I spent some time looking at innint posts, which had climbed the popular rank. Surprisingly they have kinda similar features. The categories are not many, namely:

1. Money-related posts. These can easily climb to the top. Posts about "How I earn from Nuffnang", "How to draw crazy traffic", "See my cheque/ uniques", "Oh I get paid again" etc, never fail to draw Nuffnangers' curiousity.

2. Gossips! Posts like Dawn vs XiaXue vs DawnWayang, most of the nuffnangers are pretty concern about them.

3. S*x-related topics. I'm sorry but this is kinda true. Don't you see posts with subtle titles like "first time", "Got nude pic here", "couple caught having s*x" will sure go up to top 10. Human nature, I understand.

4. Flaming. Don't like someone? Or think someone's a copycat? Put a little flame. You'll see big fire after a while. With lots of readership followed.
(Err, this is not advised of course)

Then what about posts regarding world news, health, culture, art...? They hardly get nangs. They do get a few but..rarely seen high in the list.

So what does it mean?
You gotta help me to analyze Nuffnangers.

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!"

"Doctor!"

"Doctor?"

.

.

.

.

.

.

"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.

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.

Miracle

"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.

Dear Mr. President

Just to share a great song..although this has been released for about 1 year, when i now listen back to it, I still find it very meaningful. Here it goes: (turn on your speaker!)

Dear Mr. President
Come take a walk with me
Let's pretend we're just two people and
You're not better than me
I'd like to ask you some questions if we can speak honestly

What do you feel when you see all the homeless on the street
Who do you pray for at night before you go to sleep
What do you feel when you look in the mirror
Are you proud

*How do you sleep while the rest of us cry
How do you dream when a mother has no chance to say goodbye
How do you walk with your head held high
Can you even look me in the eye*
And tell me why

Dear Mr. President
Were you a lonely boy
Are you a lonely boy, Are you a lonely boy
How can you say
No child is left behind
We're not dumb and we're not blind
They're all sitting in your cells
While you pave the road to hell

What kind of father would take his own daughter's rights away
And what kind of father might hate his own daughter if she were gay
I can only imagine what the first lady has to say
You've come a long way from whiskey and cocaine

Repeat *
Let me tell you bout hard work
Minimum wage with a baby on the way
Let me tell you bout hard work
Rebuilding your house after the bombs took them away
Let me tell you bout hard work
Building a bed out of a cardboard box
Let me tell you bout hard work, Hard work, Hard work
You don't know nothing bout hard work, Hard work, Hard work Oh

How do you sleep at night
How do you walk with your head held high
Dear Mr. President
You'd never take a walk with me
Would you

I just get deep heartache when I read the newspapers now.
- To all self-centered, egoistic and hypocritical leaders,
We're not dumb and we're not blind
What do you feel when you look in the mirror
Ask yourselves
Are you proud


Update:
Take some time to watch the music video. I almost cried while watching it. Reminds me of the feeling when I watched the movie "World Trade Center".
Natural disasters are unavoidable, but some disasters, are created by human, ourselves. Sad isn't it.

Deadly Rivalry

Did you watch the movie "The Prestige"? It's a really great movie. The tagline can quite summarize the story - "A friendship that became a rivalry. A rivalry that turned deadly."

This is somehow related to what i'm going to talk about. Hmm although i'm just an insignificant so-called blogger, and i'm never into bloggers' conflicts (you flame me, I flame him, all of us then get some extra readership), i really have something to say about Xiaxue vs Dawn Yang. I got to know this first from KennySia, then I read how it get started, then Dawn's reply. Oh and the "hate site" too.

First of all, just to make a note that i have not been a reader for both of them, and the following are just some of my personal, neutral opinions. (pls dun flame me if you dun like it)

If from medical and psychological point of view, i think we need to understand a few terms:

Delusion - defined as a fixed false belief that is firmly held despite incontrovertible proof to the contrary.
Denial - Avoidance of awareness of painful reality.
Fixation - Partially remaining at a more childish level of development.

I think, everything (probably) starts with jealousy.
Extreme jealousy.
That turned into long period of denial, then formed delusions:
For examples: (examples only)

1. Why she looks so pretty? NO. This must be plastic surgery.
2. Why her body is so much better than mine? NO. It MUST be plastic surgery.
3. She gets almost everything that I want! NO..!
etc etc.

The delusion can go so extreme, to the extent of one even thinks that, Dawn would go at all cost to copy another person by undergoing plastic surgery, and copy whatever she likes/ her styles and all..

WOW. I'm more than amazed to read that. THIS CAN HAPPEN IN MOVIE LA..but in real life, I think it's more likely to happen in someone's delusions.

And not to mention the hate site. Full of nothing but accusations and intentional personal insults. I think it merely exposed more and more jealousy, denials and delusions.

"A friendship that became a rivalry. A rivalry that turned deadly."

Ohya..I was talking about a movie rite. Remember to watch it. Or maybe you're already watching it, happening in real life.

-peace-

New Members Join Taiping IMU Gang

(Pic from my convo mag, shot by Shawn)

Just wanna say a big welcome to Dr. Teh KY (2nd right), my batch's Gold Medalist and his wife, Karen, who have reported duty to Taiping Hosp on Friday, joining surgical and emergency department, respectively. Karen is gonna work with me!

(Steven is still in O&G, as happy as shown in the pic)

Gonna have a gathering dinner later today!


Update:
The dinner is fantastic! We had such a good chat and catch up for 2 hours plus. Thanks to Jo An who organized it!;)

A Taste of A&E

3 days passed. But I felt it's much longer. A quick conclusion: Emergency medicine is..hectic but interesting! Some adaptations need to be made are now working is by shifts, hence slightly less working hours but the sleep-wake cycles need to be adjusted. Otherwise, hmm althought one shift is 7-10 hours, it's not easy at all. Basically the flow of patients will be continous, with various severity, and everything has just got to be quick and precise, especially the decision-making part.

You never know what combination of cases might just come in. What happened on my first day was while managing a 90 year-old lady alleged fall with active bleeding lacerated head wound, one DKA complicated with acute renal failure due to severe dehydration came in, soon followed by one acute myocardial infarct, then another anaphylactic shock with BP 70/30mmHg. Plus loads of green cases waiting with limited patience, having low threshold to throw a complaint if they "think" they have waited a bit too long.

But of course I know this is how emergency medicine should be like. Expected it but probably just need to adapt to it better. Another thing is the cases in A&E are very "raw", patients sent in with blood-soaked clothes, in coma, or fitting, or in agonizing pain. The whole scene is very chaotic. It's vastly different from what you see when you receive case in ward - which they are already stabilized and "cleaned up". I think now i can appreciate better what SK posted when he worked here.

Ok..last but not least, the "case of the day" would be a 14 year-old boy I saw yesterday, with the chief complaint written "genital area hit by book". I was like "Huh? wth?" Then I spoke to him and asked him why and how it happened. He said,
"I have no idea. I was singing in the class, but i think one girl didn't like it and she threw a thick hard book to my private site which hit on my ****(the most sensitive and painful part), i felt so painful and then fainted."

Hmm. My sympathy to him.
But what happened to our girls nowadays? No comment ha. Actually dun dare to comment, hmm to avoid any book-induced trauma.

Boys, don't simply sing in the class!

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?