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Thursday, November 17th, 2005
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7:34 am - Stemlife...
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Fancy keeping the cord blood of your baby for future use?
Malaysia has finally set up it own stem cell bank...with more newer discoveries, stemcells are being use more widely to treat more diseases...
Their team came to selayang hosp yesterday to give us an insight of what has been going on lately about stem cell research...
You can get more information from their website
www.stemlife.com
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| Wednesday, November 2nd, 2005
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10:13 pm - Slowly getting the feel of Surgery...
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Trying it increase my own personal experience...lots have been happening, most of it during on-call times...
Just when you thought that there will be less patients during the festive periods...I seem to find that there is mroe than ever, all sorts stuffs are coming through the ED...from children eating screws to pt's who have been operated a few times and still did not solve the presenting complaint of the patient.
Knowing how to make referrals is essential (as a HO, MO or even a consultant!). There was a referral made to me while I was on-call on Saturday. She gave such a long past medical history until she forgot to tell me the presenting complaint. I was already strugling in ED trying to settle all my cases. Imagine, I was actually half way aspirating a gentlemen who had a gluteal abscess when the nurse shouted from across the room to tell me there is a phone call for me. I had to abandoned the procedure to answer the call, then getting back to the gentleman later. I take phone calls pretty seriously since they can't call me while I am in the ED (Pathetically, there is no network for maxis in the emeregncy department). And Selayang is too poor to provide us with Pagers...only a few people have them...In the end, I asked the MO, what do you want me to do after telling me this whole long story. She replied 'Take over the patient', I went like huh? Itsn't it a bit early for to take over patients at 4.30pm! I guess she forgot to look at the clock prior to making the Referral and keep insisting that I take over her patient. I had already asked for the vitals and form my own evaluation, the patient is pretty stable and I can see her later. The referring MO was insistant, and asked me to see the patient immediately...I nearly wanted to give her a piece of my mind, but then again, I told myself, can't blame her if she can't make a good referral...some people just don't have what it takes...if the MO had said it a little nicer, I would have considered seeing the patient earlier...the earliest I went to see the patient was around 7.00pm, after clearing up my cases in ED...
What a busy call night...going on-call again tomorrow...
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| Wednesday, October 26th, 2005
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5:13 pm - Grand ward rounds...
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It's Wednesday again! It's grand ward rounds day..at the surgical dept...My boss wouldn be inspecting the wards, giving continuous and effortless teaching to the entire team of almost 30 people...Almost everyone will get some soft of bashing...but I must say, for once, he was in a very good mood today...I actually learned something! (just kidding, I learn something everyone he does his GRAND ROUNDS)
Post call...going to rest...it was a really Good night...and I actually had long periods of sleep. However, I couldn't sleep well as I had constant thoughts of my phone ringing...
Holidays coming real soon...but I'm working through that period to cover my Malay colleagues who will celebrating Hari Raya...
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| Sunday, October 23rd, 2005
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12:11 pm - Post call...
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My first on-call on my own...well, maybe not that alone since I have people tagging with me today...so it ain't too bad...had 8 admission of all sorts...PGU, Appendicitis, Acute pancreatitis, Colonic cancers, Burns, UGIB etc... Even had a Extradural bleed which I had to refer to HKL...paged the MO three times before he responded to my call...really hate referring cases. Everyone is taking their own sweet time to respond...
Manage to even get a couple hours of sleep!!! Whooopie...
Time to rest for the Sunday...tomorrow back to work.
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| Thursday, October 13th, 2005
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3:03 pm - I'm droooooling again...check out palm's latest toy...
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Palm T| X
Possibality my new PDA? Hmm...someone would be nice enough to give this to me for my next Christmas Present! Both Bluetooth and Wifi for a reasonable price fo rm 1288 (from the official malaysian site). Probably can get i cheaper at Low Yatt...
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| Thursday, October 6th, 2005
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4:56 pm - Post call...
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Whoooooopie....it was a good tagging call...admissions were kept to a minimal. Even if there was more...there wouldn't be a place to put them. We were trying to keep admissions to as few as possible; and we have to mobilize beds like crazy in the hospital...to even accomodate to a few admissions.
I had a 24 year old guy who came in presenting with an acute abdomen. He was so cool, even keepping his sunglasses on while in yellow zone of the ED. When I attended to him, I asked him, "You have some photophobia or the lights are just so bright that u need to keep them on?" Only then i realised a black eye and he was trying to hide it...It was an alleged assault case and he was kicked and stabbed in the abdomen. The best part was, He waited 3 days before coming to the hospital. My surgeon nearly freaked out when I told her about the case. CXR showed air under the diaphragm...he was sent to OT immediately for laparotomy...as expected, there was bowel perforation..the best part was, the gut was very CLEAN! (My surgeon thinks that he has not been eating for the past 3 days also...what a bowel prep!)
I had a patient the other day who pulled out his own urinary catheter...yeah, he pulled out his own urinary catheter when the baloon was still inflated. I don't know what got into him...the urology team had to do a cystoscopy the following morning to take what's left of the tube out...I have a pic of the catheter that snapped (those interested to know, please email me)
Remember the patient which I talked about earlier about having Diffuse Axonal Injury...He turned out better than expected...and had already been discharged home...Looks like the cerebral protection helped him and the forces favoured his side...he should be recovering speedily....
Taking a break now...wuah, what a feeling...!
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| Tuesday, October 4th, 2005
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8:27 pm - Life as a medical officer...
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Wuah..this is certainly a big transition if my life...
I was promoted by my peers to a MO on the 1st of October...and I started tagging on Sunday in preparation to do calls on my own in about 2 weeks time. Life is really different now...just want to share some experiences with the people who read my blog...
Being an MO, comes with more responsibalities...this time you are the FIRST line...you need to screen which are the patients you need to admit, which you can discharge, and which are life threatening and which are not. Your senses need to be sharper than ever...HO's will now call you when something goes wrong, and even consult on how to handle things at certain situations...and you can't really go like ' Emmm, i don't know '. This is the sole reason who one would have been tortured like crazy during housemanship...so that you really learn.
I went to ward this morning, and I was going to see a few patients and the HO suddenly popped up and started presenting the case. Wah, that was really a weird feeling...and I also began to ask questions pertaining to the patient...it's really a HUGE responsibalitiy, everything you say will be taken down by the houseofficer...
I was a houseofficer...i knew how it felt like to be one...
I was also covering clinics today, so before long I was seeing patients from 9.00am until 3.30pm! Patient just kept coming in and out...I was also covering the procedure room and I got a few chances to do procedures (form simple suturing to biopsies). It was really cool since I am doing something different from the usuals...and I'm enjoying it so far. When clinic finished, I went for lunch and then back to the ward to follow rounds. Rounds had already started, and nobody asks when did you come from, or where did you go to...(they seem to know...). I just blended into the rounds and said what I knew about certain patients...
Tomorrow another tagging call...
I have not opened a book for a long time...now I really NEED to OPEN a book to learn things...
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| Tuesday, September 27th, 2005
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8:49 pm - Another day in KKB
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Spent another day at a district hospital...have to get up early and
travel 50km to reach there...Roads condition are not too bad...though you'll pass through S-curves, straight roads, very sharp corners...no wonder so many people get. involved in accidents on this road
Today covered Obstetirc ward for them...I think they give me lighter duty
since I'm more junior...my specialist from Selayang came to do
specialist clinic, so I was also helping him see cases after doing a
quick ward round and discharges in my ward. After coming back from
clinic, alreayd have 5 new admissions...wah liao...I though this
place going to be easy...but since they admit those with os 2-3
cm...so, just let them wait in ward auntil they deliver
Only 1 delivery from 9am to 5pm...I should have delivered the
baby...since I haven't done one in ages. Spent almost my whole day doing paper work, signing here and there...
I had one of the cheapest food found in Selangor state...A plate of Wan Tan Mee (moderate sized) + fried wantan, and char siew + a homemade barley ice = RM3.00 only! What a deal!!!
Otherwise it was a good day...I might actually like district life,
since its not life threatening and everything seems to be slower...just need to stat alert to pick up urgent cases...
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| Monday, September 26th, 2005
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10:11 pm - Diffuse axonal injury...
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a word which I have not heard or speak for a long period of time...almost always used as a diagnosis of exclusion, since you'll probably need to take brain cell samples and look it under the microscope before you confirm the diagnosis...
A young boy came in after a very bad ' Hit and Run' Accident in the ward....he was brought in by ambulance and had to be intubated upon arrival at ED for poor GCS. CT brain was normal, and there wasn't much reason to beleive that there is any other course to the deterioration of the GCS...His initial trauma must have been really extensive...
His parents were initially very cool and didn't say much. I guess there didn't know the severity of the problem and even asked me if the son is going to be concious soon...I spoent quite a lenghty time to explain to them regarding his current situation and plan, and that we don't really know the extent of the brain injury until time tells us...
I guess reality really hit them hard this time...I only hope the best for the patient...
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| Thursday, September 22nd, 2005
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10:51 pm - Surgery going by fast...
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Wuah...surgery is travelling faster than I thought...I'm already in my 3rd week...
Taking a day off tomorrow, for Choon Yan's graduation...
I have finally conqured my fear of setting Short central lines...after not doing so for almost a year, I finally found the guts to do one on my own, of course under the guidance of my more experienced MO's...the feeling is good...though I must say the patient is not feeling well either. She passed away the next day...and this time, there is no PNEUMOTHORAX!
I had a patient who came in for suspected lung injury with 3 and 4th rib fractures.
I was listening to his lungs one day and suddenly found out that air entry of both lungs seemed reduced and informed by specialist, he was amazed, and decided to have a listen for himself. Using my stethoscope, he said "There is either something really wrong with my ears or there is something wrong with this stethoscope". One of my other surgeons who was also following rounds took my stethoscope and had a look at it; " Sure there is something wrong with the stethoscope, I can't even see through this hole - it's filled with ear WAX!" Man...now I know why it sounds weird at times...
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| Saturday, September 17th, 2005
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7:34 am - Surgery ar...!
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Can't really say I like ot hat eit at the moment...
I'm doing three calls this week...and its taking a good chunk out of me...it's been really tiring. The past 2 calls have been busy, not giving me much time for rest. I guess. Surgery is busier that I thought it would be. Though I must say that the work that I am suppose to do now is not that different from what I have been doing for the past yearl Probably I'm just sick of housemanship work...time to move on, time to think laterally, make decisions rather than just picking up the phone to ask for answers all the time...
I can't imagine which is more stressful in the end of the day, to make decisions or just carry them out...I will find out pretty soon next month...
I went back to Paeds ward yesterday...it was a nice feeling to see all the kids again...and my previous consultant + specialist welcomed me with open arms...
Choon Yan has been busy for the past few days....settling a few family issues of her own. It has never been easy to try to get a life when you're working that hard...With so many calls this month, I have seen her less this week...
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| Friday, September 9th, 2005
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6:12 pm - Reporting from Surgery...
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Ergh...I'm not sure whether I am suppose to be having a time of my life and crying out in pain...The first week of surgery has not been the way I had expected it to be...
I had seen my boss on Monday and reported to him and his PA. After a quick 5 minute introduction, I proceed to my own ward in 4A, starting with female surgery.
I have to be an HO for a month before they promote me to an surgical MO...*Sigh*
My first impression of that place was not bad...since everyone was pretty slumber around here...not until I bumped into this particular MO (to be most exact, a master surgical student) who started bragging around, showing her 'acts' ..and even being extremely rude to me! It was as almost she was treating me like a THING rather than a human being. The best part was, her knowledge is something that still needs to be tested...for the time being, my impression will be ' Empty Vessels Make the Most Noise!'
Never had I been treated soo rudely among my own colleagues...well, I also wouldn't know who has been poking my back also lah...
Tagging was bad on the first night...I only went home at 12am+, took a bath, rested, ate...and slept by 1am+. I was already up by 6am...geez, and had to head off to work...it sucked man...
Yesterday I was in OT...boy, was that fun...well, I spent most of the day standing and assisting my surgeons...I had a thyroidectomy case in the morning..it lasted 5 hours after we didn't know where she was bleeding from and had to be transfered to ICU post op for observation after she had lost 5 litres of BLOOD! Next, I saw my BREAST surgeon perform...it's almost like an art for her...it took her 2 and a half hours to perform that mastectomy...layer by layer, inch my inch...the last one I assisted as a med student, took less than 2 hours! I must admit, her artwork was skillful and there was minimal bleeding! The only I admire about her was her OT eyewear (to protect her eyes). It's like one of those cool ones you get in the market, except that this is transparent and its designed to protect you in OT!
Starting on-calls on monday...
I need to fo extra rounds on Sunday...man, this is boring...or just perhaps I'm getting lazy...
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| Sunday, September 4th, 2005
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8:44 am - Resting at home...
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The past few days have been great...
It gave me much time to reflect on what I have been doing for the past few months...
I am also having a good rest after a long paeds posting...just loafing around, spending time with Choon Yan, planning our future, surfing the net, listening to songs...settling all my bills...
Wow, the months have really passed by fast and now I'm thinking of what I want to further specialise myself...I already have a few things in mind, but I would like to keep it to myself until the time is right for me to reveal it out...
To all IMU people who reads my site...please register yourself at the IMU Alumini
IMU Alumini
It looks a bit unfashioned at the moment, but progress is being made to bring it back to style...The association members are trying to get people to inject new life into it, and ex IMU/current students are encouraged to participate in it.
It's a sunday...i'm just loafing around, will probably grab a quick breakfast and some exercise before going back to my usual routines...
Looking forward to Surgery tomorrow...
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| Thursday, September 1st, 2005
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5:03 pm - The end of Paediatrics for me...
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There goes another posting...I did my last call on Merdeka Day at NICU...the place where I first started when I first joined paediatrics...
In total, i have spent 2 months in NICU and 2 months at General paediatrics, giving me pretty much all the exposure I need to handle basic paediatric problems. I also spent a few days in clinic and day care...
Confidence in setting IV lines for paediatric patient have really improved since ocmpleting this posting...it's an important skill that I hope I won't loose since I'm heading now to Surgery, and off and on, I will see paediatric surgical cases which I need to manage...
The whole Paediatric team at Selayang has been wonderful, from the boss all the way until the attendents...many thanks to them for giving me much teaching and exposure to the world of paediatrics...
Oh, how could I forget my Kuala Kubu Bahru experience...something I will remember for a long time to come...thanks to the people who 'looked' up to me to do this job...
I'm heading of to Surgery next...
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| Saturday, May 28th, 2005
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10:08 pm - Food is everywhere...
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Today was pretty much an eating day...
Went for CME this morning, they gave a talk on Rhabdomyolysis...from an anaesthetist...interesting topic though I never though it was interesting topic during my undergraduate days...as usual, after talks, there is always food...that time I was already soo hungry (no breatfast), so i ended up gobbling to my hearts content...
Today we also celebrated my HOD's birthday...we had organised a mini party for her (with cakes and stuffs) and it turned out pretty well...again, there were lots and lots of food...yum yum...Paeds is a pretty happening department and everyone is pretty close to each other...
Feeling so tired now, though I did next to nothing in the afternoon...might as well sleep early then...
Cheers...
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| Friday, May 27th, 2005
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6:08 pm - It's back in the ambulance...
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Went to IJN today...this time I accompanied a 10 day of life baby with a cardiac problem for a clinic review with the experts there...the baby had to be admited for observation after they found a coartation of the aorta! Wuah, in my view, this is so rare, and the only finding that might have given this away were weak peripheral pulses (of course, its finally diagnosed with the echocardiography)...not to mention that this baby also has a VSD, PDA and a mildly dialated heart...the baby would get occasional cyanotic spells and desaturations...
Good news for all House-officers and Medical Officers...there is a claim increament which starts from 1st June...rm100 per night for HO's and rm 150 for MO's. Weekend rates are rm110 for HO's and rm 170 for MO's...Perhaps now, I can afford to get a car of my own! The only problem is when we will get the claims to our bank accounts...the last claim I have recieved until now is only up to January! We hope something can be done about that...
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| Monday, May 23rd, 2005
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9:37 am - Working with pathetically pathetic people...
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I wonder if there is such a sentence which I just said...
Anyhow...was on call on Saturday...which was a pretty all-right, considering the fact that I had already anticipate it to be busy...
The most important thing when you're working, no matter where you are...have workmates who are reliable...and I must admit, being post-call yesterday and having to screen about 50 babies in 4 wards...is no joke...already half the mind is asleep, you can't expect it to function to the optimum...my current department has allocation for an extra house-officer who comes and help out with rounds and all the other micellaneous issues...and asking a small favour from this guy...is really a total waste of my time...not to mention that he had already recieved specific instructions from the medical officer to help me out with the screening...so, I pretty much finished everything by around 4pm...
I'm much waiting for my old team to come back to Paeds, so we can start having good fun again...
When you have realiable workmates, the whole flow is so much better and more could be achieved...
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| Saturday, May 14th, 2005
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2:56 pm - Logging from NICU
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Cool...my second call...hope it's far better than my first call...yeap, my first call was really bad...though I only had 4 admissions...in already intubated babies in NICU were giving me and my MO a really hard time...but I'm glad I survived though the day, and ended up going out with Choon Yan and only slept around 1am!
NICU is cool so far...people here are really friendly and we have a team of dedicated consultants around...devoting their time for a great subspeciality that takes more than just effort to perform your best...it's all about how much time you spend with the patients and family too...and not to mention, this field is really for people who have plenty of patience and dedication...
Let's hope tonight's a good night...
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| Tuesday, May 10th, 2005
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6:31 am - Posting early in the morning...
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I'm currently at Grand seasons Hotel in KL checking out the wifi service here...
good...not bad...its covered by 'time' here...
Chilling out for a while here before going back into the war zone...
Yesterday, i set my first paeds IV line successfully in 1 prick! Wuah...a personal achievement...
Today is going to be a long day...
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| Saturday, May 7th, 2005
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10:36 pm - Welcome to Paediatrics...
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Ho Ho Ho...finally got into paeds on thursday..and I was posted to the NICU (Neonatal intensive care unit), yeap...that's pretty much equivilant to the ICU for adults...just that all the babies here are very very small...and premature...
Selayang itself is a specialist centre for Neonatology and the pretty high tech on their facilities...the team here is fantastic...
As for me, coping in such a place is always difficult...the past few days have been difficult...not sure what is going on all the time, having difficult in taking blood for neonates...its a totally different experience compared to adults...everything all of a sudden is small! Most of the babies here are pretty ill too and require very close monitoring...
Have been feeling depressed for the past few days...as I'm really lost and can't really help out much..hope things will improve as the days go by...have been pricking babies vigorously to get their bloods...and failure rates are high (getting it on the first try!)
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