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BECAUSE HE NEVER LEAVE US ALONE...

Assalamualaikum and good day to all,

I assume people who read this inactive blog of mine are probably those who do not know me that much or do not even know me at all since I have changed the website address for some stupid reasons. 

A lot has happened in my life and today I got this hunch I am hoping a good one, to have an entry posted in my blog, and for whatever reason, He The Almighty has brought me to read my previous entry  which reminds me of how (probably) innocent I was, and how my life before was full of purpose, and how I was very convinced that everything is preordained and happen as it should. For a moment, I realised my purpose of life has probably changed for the past one or two years, and I pray that Allah will never leave me alone without anything to hold on to.

I also realise that probably blogging is the best way to let go all of my sadness so I can move on, and writing up is probably my way of coping up with things and make me a better person. Despite the depressive one year I have gone through (which I will probably tell later to let go all of these unnecessary and wasteful thought); despite the consistent crying in the morning and before going to bed which has been reducing although the eyes have never been deprived of tears; despite the persistent denial and strong hope that things would go back to normal after all the sufferings - I am very lucky, I honestly think I have a very good insight of what is going on, only that I am still in denial and am consciously trying to live my own life NOT being me. Everything has changed. And today, I want to go back to be me that I miss. 

Why suffer for such stupid reason when you know He is always by your side, all these while, all the time??? 

I have wasted one year in which that last one month within it was fulfilled with this incredible feeling full of hope and love. Then  I wasted another one year crying over it, denying, being such a stupid person who rejected every new opportunities and every what is supposed to be enjoyable moment with my family because of one guy I should have not trusted in the first place.

I am moving on. Today. No more procrastination and pampering myself with unrealistic hope and wish. I still have a purpose of life, of course. And hope is always there because He has never left me alone. Wish me the best!

THE DWELLING

This is one motivational video I need to replay many times to keep me going. Replaying because the motivation just doesnt last very long, how weak I am.

It is already June 2013. Things have gone wild and unexpected. Remembering how life was planned ahead last year, today witnesses how very broken my heart still is. Despite knowing and having all the very good insight about how this is only His test, I still chose to dwell my past. I am fully aware that it is not something I should do, but when it comes to feelings, you just feel helpless and hopeless. Whoever is reading this, please pray for my strength, because a sincere untold prayer plays a role... I really need the strength and I do not seriously want to succumb to all this sadness, it is killing me, and I am no more myself!!! Verily, we can plan, but He is the Greatest Planner of all, may all go back to normal, in fact better than before.

*I hope the next time I read this post again, I will have already realised how stupid I am now for dwelling on what I shouldn't have.

FOR LADIES WITH BROKEN HEARTS

So when he lets you go, he's just not that into you. The only explanation you have to repeat everyday. It's hard, but the most hurtful part is the betrayal, thereafter trying to trust people again. And you need to avoid killing yourself, stat or in silence.

Yes, yesterday is history. Memories, please go away.

THE FAITH

Sometimes
Things do not happen the way we wish they would
You get upset
Your heart is broken
And truly
It is very hard to mend

You try to find the strength to move on
Days, weeks, months
Hopefully to get over it before years pass by
You wonder if it will ever heal
The broken heart

And a saying quotes
If you want Him to mend your broken heart
You have to give every pieces to Him
A trust, what you have to give Him
Convinced that He knows everything
And there is a greater plan for you, soon
The faith is what it's called

Have faith
Have faith
Have faith

Everyday you try to convince yourself
To put all the trust in Him
Sometimes it feels bad
When it feels so hard to believe
Even when you repeatedly saying it
Consciously or not
Can your broken heart be as numb
As it is not the way it used to be
And certainly not something you want it to change into

Ya Allah
Show us the way
Lead us to the right path
Let us have faith in You

Because sometimes
We have to stop worrying
Stop wondering and stop doubting
Have faith that things will work out
Maybe not how we planned
But just how it's meant to be

LIFE IS A DRAMA

There is this urge to write something today but I absolutely have no idea exactly what to write. But to my conscience, with nothing I could, and I usually always end up with a lot of things to say (ie write). So we will see...

I looked at my blog address and thought I'd changed the address to avoid using my full name as its address. Thought I should be more private about myself, although I may tell everything I chose to share in here. Hmmm maybe I should delete all the photos with me in it in here too (maybe, if I have the time and most importantly the urge).

I was watching the latest Malay movie 'Aku Terima Nikahnya' a few days back - finally a Malay movie with contents as compared to endemics of stupid comedy movies that I think were trying too hard to be funny that made them not hilarious at all, rather irritating. Nevertheless I have to sadly admit that Malaysian stars are now too daring and I have no idea how they can act as good muslims but perform sinful acts in real life at the same time. I do condemn the acts, but I wont comment much about the them, I might have been worse than anybody else.

Anyway, back to its content. It was a story about a newly married couple, Johan and Alisa. Johan then had an accident which had caused him selective amnesia, that he could not remember getting married to Alisa neither his feelings for her. To my view, Alisa had been very patient trying to win back her husband's love. Initially I was a bit mad at Johan, probably because of female preference. She was damn right guys play around with sweet words and can totally shut down in the end. But eventually I have to say, it is not his fault that he cannot remember. It is just so amazing how Allah can withdraw back whatever feelings He has already implanted in one's heart. I have so many thoughts and theories to share when I watched it, but right now I just can't put them in words.

Anyway. Sometimes when you watch a movie, you thought it is too full of drama that never happen in real life. But it does. You never thought it will until it happen in your life, or lives of someone close to you. Life is full of drama. Try to recall any sad things in the past and see what happened at certain time, certain place. It is like the flashback scenes in the movies. Then you see how dramatic your life is.

THE FIVE STAGES OF GRIEF

As a (former) medical student, I used to learn about the stages of grief. It was in the study guide as part of our professional development. The purpose is so that we doctors will be able to be as empathic as possible with patients or relatives who are in their stages of grief. 

Those patients who have just been told that they are suspected to have appendicitis which will be cured after an appendicectomy, a simple daily most common surgical procedure, or those patients who have just been diagnosed with a stage 4 malignancy with only few months to live. Those parents who were told that their children have just died following motor vehicle accidents, or those wives whose husbands just presented with heart attacks and that CPR is ongoing, then asked if CPR should be continued for another 30 minutes or otherwise stopped if no signs of life present soon enough. Let it be benign nor malignant, let alone the patients themselves or their relatives. All of them will eventually face these stages of grief.

What we sometimes overlook is how this teaching actually applies to many other situations that may occur to anyone, any day. Sad things happen everyday. Unpredictable things happen everyday. Sometimes they occur in your lives, some other days they befall upon me, and some other days they happen in some other people's lives. So everyday there must be certain someone who is at these different stages of grief. 

The five different stages of grief. Denial, anger, bargaining. The first three stages that may bring you so many unanswered questions; that you would do many impossible ridiculous things you would regret later on just to have these questions answered. 

Then there is depression. When you would ridiculously torture your own selves for something you should not, be it either you have no appetite for food causing you loss of weight despite busy occupying yourselves with baking new recipes just to get rid of those memories that brought you to your grief; or be it you have no energy to smile that your colleagues would query and whisper among them why have you become someone different; or be it you cannot sleep, only you are so lucky to know some medications that have their sedative effects then wrongly use them to help you sleep rather than for their own indications; but even with this abuse you would still have interrupted sleeps that is most definitely unhealthy; or worse, at this point of grief some people with no faith would just succumb to ending their own lives a a shortcut to end the misery and pain they were going through. And this is where I think the challenge is for the psychiatrists - to differentiate whether the depression is pathological and needs treatment, or whether it is just a physiological stage of grief which is completely normal and needs only time to heal, hence treating this with medications would only cause a disaster and is inappropriately necessary.

And then, comes the final stage. Acceptance. Only if you handle the depression well enough to come to this stage. And you will never know how long to go until you come to this stage. 

I used to read a really wise book entitled Don't Be Sad, or rather known with its arabic title, La Tahzan; which also has its Indonesian translation - Jangan Bersedih. I used to read it halfway through, never did I finish it, had you known me, you would know I like to read, but I always stop halfway through. I know it definitely is not a good thing, but reading it the second time at time, I will try to finish it and hopefully not only to finish reading it, but also will be able to take in and hold firmly all the advice close to my heart.

I am no where near to the middle pages, I cannot promise that I will finish reading the whole book cover to cover (it's an old habit that is hard to change of course, and promise is not something you should play with), but I can promise that reading the first few chapters would have given those in grief (or not) soothing words of wisdom and hope. Hope that should only be leaned to Him, as to Him alone do we all return. The words that bring you closer to Him, that hopefully will lead you to be able to deal with the griefs or tests in the best possible way.

Every word written is so true. Reading too much into the past is a waste of the present. Sometimes, you want answer for things that happened, but maybe not knowing the answers is the only way you can live better, you never know, but He knows. Enough with all the ridiculous things you have done in the past; denying, being angry, bargaining. Former days are gone and done with, and you benefit nothing by carrying out an autopsy over them, by turning back the wheels of history. 

Depression brings you to idleness and idleness would furthermore brings you to depression - as nicely written in the book; When you find yourself to be idle, prepare for depression and despair, because idleness allows your mind to wander in the past, the present and the future, with all their difficulties. Idleness is an expert thief and your mind is its victim.  It says ' Get up now and say a prayer or read a book; praise your Lord, study, write, organise ... and loads more, so that you can put and end to your inactivaty.' Tossing and turning around your bed, thinking too much about the past would bring nothing other than torments. ...and hence the writing after one year of silence =)

And these are my favourite quotes from the book so far: 

"The pen has dried, the pages have been lifted: all events that shall come to pass have already been written. Whatever has befallen you was not meant to escape you, and whatever has escaped you was not meant to befall you."

As a weak human being going through difficulties, those awful feeling will always haunt you and put you in sorrow and trouble, and studies have extract out this common stages of grief which should be a normal reaction towards letting go. As those who believe, we will never completely feel at ease until we firmly believe that Allah has preordained all matters. It is the 6th pillar of faith anyway. Easier said than done of course, and once in a while even if you agree and are comforted by the preordainment, those things that happen to you will always haunt you because it is your past. Just wish that it will not haunt you too much and be thankful that your life is much better than some other people.

So yes, every day some certain people are at grief. Sad things happen every day. Unpredictable things happen every day. But good things also happen every day. And unpredictable things can happen in good ways. Grief is a normal process, just pray that it will not take too long to destroy you  apart. 

I pray that my faith, our faith will always lead us to the betterment. No, I pray that we always have faith, as once we have the true faith and we believe, this will always lead to betterment =) So my friends, (and a very sincere advice to my own self of course), HAVE FAITH because He is The All-knowing.

HATING YOUR LIFE?

I have just finished updating another week's shift rota and my eyelids are so heavy already. It was a tiring AM shift especially at the beginning. Enough to say that I and my lovely MO oncall today had to standby at OT for a triplet emergency delivery - not to mention that there is a DIL patient in NICU, also another one with PPHN on HFOV. But still, I'd prefer neonates than general paediatrics.

The picture above was posted by a friend in my facebook - it is a wise reminder for me at time because I am so not looking forward to be responsible for HO in my department - but it's a duty I cannot run away from and I think it is failing me - I have never been a good leader, I suppose. God, help me. I should have been more grateful.

THE SHIFT SYSTEM: PRO AND CONS

About a month ago, the head of HO in my hospital asked me to send him opinions from paeds HOs regarding the HO shift system. These were the feedbacks I managed to gather from the team, at time with the assumption that the shift system planned for implementation is a similar one to the one used in A&E posting:

PRO:

1. Enough rest in between work

More energetic housemen and presumably less mistake. Hence, shift system is probably good with departments with expectedly non stop works, and with not much of continuation of care which need brief passing over– for example, in casualty and labour room, but not in wards where continuation of care is essential

2. No oncall allowance for housemen (*definite cons for housemen though)

A huge reduction in the money spent on the health sector by government – good as money can be spent on other healthcare needs, for example hypoallegenic gloves (as part of right and welfare of the employees with sensitive skin) or to get better equipments for treating patients

3. Working time not adhered to regular office hours might be beneficial

Ability to run any errands that need being done during office hours eg going to the bank

CONS:

1. Number of housemen in each department is labile and not fixed (due to possibility of extension)

Not enough numbers to be divided into shift hence difficulties in coordinating the shift duties

2. Limitations which makes hectic morning shift – and might lead to major dissatisfaction if shifts are not properly assigned

Morning shift will be particularly busy – with the specialist ward round, blood takings needed being done during office hours, attending clinics. Surgical based posting with elective surgeries in the morning makes it rather difficult to organise the shift system. Few housemen might be left in ward, leaving jobs passed over to the next shift, but unlikely to be done on the same day if those jobs are limited by office hours only – hence the unnecessary delay

3. Less teaching

Teaching done during office hours, some might miss the teaching

4. The pass-over tradition which in itself is time consuming and might not work well in all departments especially in ward

Those who are less responsible will become more complacent, passing over the jobs to the hardworking/more responsible ones.Either the hardworking ones will continue to suffer or a viscious circle to happen where jobs might be passed over on and on before being noticed, which might compromise the patients’ care. Also, jobs might be missed if passing over sessions are not properly conducted so, effective hand over session is very important, and a clear guideline is required. Having said that, a proper pass over can be very time consuming, hence more time spent for passing over, less work done in time, less care and time for patient

5. No oncall allowance for housemen

This is probably not too bad, providing the working hours is much less than the current oncall system. However, it is of no guarantees, and the working hours might end up with mere minute difference. These extra hours should be entitled to some compensation too

6. No more weekends or public holidays

Difficulties in arrangement of holidays as everyday is a working day, hence ending up with less rest throughout the month even if there will probably be enough rest in between shift. Cumulatively, working shifts might be more tiring

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In conclusion at that time, consensus I think was NO, DO NOT implement it until we are all ready. Or at least that was the consensus among me and my colleagues in the same hospital.

Good grief. I can still picture myself standing up in front of all housemen and DG in my earlier days of working, asking about whether or not the shift system is soon going to be implemented. And why on earth did I ever have the nerve to ask that question?

And now having been in the system for around 10 days, I can see the pitfalls here and there which I will try to conclude in another entry after having a post mortem with other colleagues of the department. Enough to say, I need daily motivation to go to work now....

THE NEW LAYOUT

Today marks a one month away to completing housemanship. Loads of experience gained, with happy and sad times, with encouraging and upsetting moments, together with old and new friends. I am still in Paediatrics department, and since I am too busy with making the shift timetable for the housemen, this leaves me with headache. I just created a blog for the HO in my department to put up updated timetables which I am really sick with - I will comment about it later - and after creating a new blog, I made a change to mine as well.

So TARAAAAA...here is the new layout. It looks weird, but sometimes change can be good. I need to accustom myself to new changes all the time anyway. I am sorry that there were previous posts that will come out without previous comments, or with white font colour which won't appear upon your eyes because to change it all will take me ages.

A few more things in mind before I keep myself busy next week for another rota:
1. Summary of my thought on shift system so far
2. Nice write up on HIS system - can I go on with petition?
3. Viva!!

Too much but too short and I still have not decided yet of my field of interest, huh

HILARIOUSLY IRRITATING

I was reading this one article that I accidentally found upon googling for articles on the yet to implement shift system for all housemen in Malaysia. Hilariously irritable. I repeat, irritable.

No offence to the nurses, my near 2 years experience have exposed me those who are unexpectedly of cannot-make-it calibre, as what the blogger named it. Go on, have a read:

DOCTOR, DOCTOR! by Home of the Manx (I think the blogger is a psychiatrist)

The head nurse of my main ward was slightly upset when I told her my opinion that some nurses of certain wards are of cannot-make-it calibre. But it’s true. The ones in my main ward are generally OK despite being relative greenhorns. They have an acceptable average level of intelligence, integrity and diligence, with an outstanding one here and there. On the other hand, some staff in other wards really make me want to bang my head against the wall. I tell myself that there is no point in sacrificing my noggin like that. If I used their heads to smack the wall instead, the building would crumble.

Example.

(Phone rings)

Me: Hello.

Nurse: Hello, Dr. Katie. This is staff from Long-Stay Ward Pee-A-Lot. Do you think you could come and conduct an urgent multidisciplinary ward round with the medical officer, nursing staff and pharmacist? This afternoon?

Me: (thinks: that would be the equivalent of chartering an emergency jet plane to buy groceries for tonight’s dinner) Huh? Why?

Nurse: We want to convert all the patients on Valiant tablets to Valiant syrup.

Me: Huh? Why?

Nurse: Because we had one patient who nearly choked on a Valiant tablet.

Me: Oh? When? No one told me.

Nurse: Last year, before this ward came under you…

Me: (moment of disorientation – this is late July, right?) Okayyyy…

Nurse: … so there was an enquiry, and now we have to think of ways to prevent further near-choking incidents, so I thought we should change his Valiant tablets to syrup form. Then I thought we should also convert everybody on Valiant tablets to syrup. That’s fifteen patients. That’s why we need you to do a multidisciplinary round for everyone to institute the changes.

Me: Whoa, wait wait. This patient who nearly choked – was he only on Valiant tablets?

Nurse: No, he’s also on Fluent tablets, Hallucinate tablets, Chlorophyll tablets, Di…

Me: Uhhh… so you’re telling me that putting him on Valiant syrup plus ten other tablets will prevent him from choking on tablets?

Nurse: Well, it was Valiant that he nearly choked on.

Me: And the other fourteen patients? I suppose they’re on lots of other meds too? For which there is no syrup form?

Nurse: Yeah…

Me: So how does converting them to Valiant syrup make sense?

Nurse: Well, true, it doesn’t… but there was an enquiry. We have to do something!

Me: (sighs) OK, fine. If there HAS to be a change, I have no objection to this one patient being converted to syrup form. Leave the other patients alone. No multidisciplinary round. Just get the medical officer to convert the Valiant to syrup form at the same dose.

Then came the clincher.

Nurse: But Dr. Katie, Valiant syrup is very expensive, you know. Are you sure you want this patient to be on syrup instead of tablets?

Good grief. No amount of bonus is gonna compensate me for the brain cells that died during this conversation.

My very shallow experience so far has enlightened me of how unbelievable nurses could be and of how much the nurses' works has shifted to become part of the junior doctors' jobs, because we (junior doctors) have apparently become the glut.

One example of mine:

One hectic night in a surgical based ward, a patient was having a problem to pass out urine post op (which is not uncommon) and another patient who has low GCS due to intracranial haemorrhage ran amok in ward. Not to mention there were another few cases who I had not yet fully clerked after seeing them shortly with my MO - at least the diagnoses and plans were already there. I was left alone in ward as another HO oncall in the ward had long gone into the OT to assist the surgeries.

Before handling the latter patient, I have requested the nurses who were chatting at the counter (and was probably finishing off their very important report which copied every plans by doctors) to prepare the catheter set for the former patient.

After the amok patient been taken care of, I upsettingly found that the set were not ready yet. To make it quick, I prepared it myself and pushed the trolley to the patient's bed myself, passing through the nurses who were too busy chatting or probably gossiping. Then I had to pull the at least 2 screens to secure the patient to his own privacy - there were no curtains in the ward you see.

And to make it worse, it was a male ward and I was completely aware that I was much in need of a chaperone for those kinds of procedures - but like that ever happened in this hospital anyway. Surprisingly in Malaysia or maybe just in this hospital where the chaperone appears in every single introductory papers to be signed off by new doctors entering a new ward, having a chaperone practically were made compulsory only if you are a male doctor having intimate procedure done on a female patient. Other than that, it is definitely not widely practised here.

So I shouted out that I needed a chaperone, in which later on as expected, nobody came to chaperone - let alone if I asked them to assist me. Again to make it quick, I just proceeded with the procedure but it was not as easy as expected. I needed a smaller sized catheter and hence shouted for another help.

Me (shouting): Akak, tolong bowok cbd size 12 se (nurse, can I have a size 12 catheter please?)

After twice or thrice shout out, a nurse came with the wanted catheter and she placed it on the trolley next to me who were all sterile.

Me: Thanks... (before I could finish off with asking for another favour to open the catheter packing up into the sterile set, off she went to the other two nurses at counter)

SPEECHLESS. That was all I remember. I was completely speechless! Hello, it was a only a common sense for you to open it up, d*** you.

Luckily my MO (who was quite new in this hospital at time) passed by and he nicely helped with the favour I was about to ask and chaperoned me until I finished off my procedure, asking during that while 'what are the nurses doing leaving you alone here?'

Exactly. So what do they do? Obviously we need more doctors to compensate for those jobs that previously not done by doctors. So why complain of the glut?

Anyway, having said that, there are some nurses who I love so much and I think these are the nurses that achieve the same standard as those in the UK. If there are awards I can give to the best nurses, I will definitely pass them to these two nurses I have met in my career so far - 1st one in renal male ward who would call you to clerk a new patient who needed a peritoneal dialysis at 3am in the morning and by the time you reach the ward, everything has already been prepared, and when you were doing the procedure she was closed to you so you do not have to shout to ask for favours (I know nurses have tasks to do too, not that I always wanted her to be on my side even though that is what u get in the UK), and when you finished off the procedure she would take care of the other sets after you thrown away the sharps as she knew your phone just cannot go silence for a while and there were other patients you need to see and take care of.

And another one I met in ortho ward who would call you to clerk a case and by the time you need sedation and analgesic for a close manual reduction, he said it was already prepared as he already anticipated it. Prepared as in already diluted, mind you.

Seriously, thinking about these two particular nurses made me want to cry, thanking God for still making them exist in my current world. How I wish things are different, but who am I to change things?

OF WIZARDRY AND ITS WELFARE

It was one fine day where everything ran smoothly. But it was Monday, the day all the young wizards were gathered at a new building called the Cedric Hall to learn more about magic. A female young wizard had finished off all the works required in the main magical infirmary that morning. Off she went to the dining hall with another female wizard to fill her stomach up then to a room to commit herself to God, the One she believes in, before going to the lessons of magics.

The sign on the heavy, bulky door reads ‘staff room’. They very rarely went there before but it was one of the nice rooms in the hall for a prayer.

Suddenly the head of the fairies named Bathilda looked at them in a suspicious way, asking “which department are you in?”

“The art of human carpentry”, the young wizard gave her a short and honest answer.

“There is a room just outside here if you would like to do your prayer, you know”, said Bathilda, pointing towards a general room, probably at the back of the room they were in, where anyone with the same beliefs who came to the magical infirmary would perform their prayers there, as the main means of submitting themselves to God.

Of course, the young wizard already knew where the room was. And, of course she understood what Bathilda was trying to hint them both.

“But this one is more comfortable. It has the restroom inside here, you see”, again, the young wizard tried to reason herself. ‘After all, we are still staffs, are we not?’, she whispered.

“Even when we were treating the humans with potions out there, we still go to the outdoor restrooms”, replied Bathilda with a mean look, and as she was on her way out of that so labelled as ‘staff’ room, she took out her wand for a jinx to switch off the room cooler, making the room warmer than it had already been – that was after Bathilda started talking.

Speechless, the young wizard was reminded of Hogwarts. She used to study magics in Hogwarts before being awarded to become a wizard. In Hogwarts, things were very different. The welfare of the wizards in Beauxbatons, her birth country was comparatively horrible.

In Hogwarts, let alone the young wizards, even the students who were not considered staffs were being treated nicely. Tea was pouring endlessly in their cups during the hand-overs, a session where the switching team of wizards, witches and fairies gained information about the humans retained in the infirmary, their illnesses and the potions that worked well for them. Again, let alone the young wizards, those students of magics – mind you, who were not the staffs – were given a small cupboard where they can use a unique enchantments to lock up their valuables so they were not lost to the abusing power of black magic. And these students of magics were entitled to use the big, huge staff room that was equipped with a magical entertainment box that enabled them to watch news from all over the world, nice and comfortable seating and many more.

The young wizard never had these advantages of being a staff in Beauxbatons. At least, that small cupboards for wizards would do, coz all fairies had them, but not the wizards. And they even had them placed in wizard's rooms. What more can you say of a wizard being chased out of a staff room (which I supposed was meant for any staff) when a fairy could have their belongings in the WIZARDS' room?

Even though there were not many people who shared the same belief in Hogwarts, most of the people there would respect the young wizard when she had to excuse herself to a room – any room – so that she can perform her prayer wholeheartedly. Some of them kindly showed the way to the nearest quiet room where any believer from different religions were welcomed to perform their prayers. If there were no quiet room, the fairies, and sometimes the head of fairies would put an unlock charm to a locked room for her so she can submit herself wholely to God without any distraction. And these people did not share the same belief in the same God as she did.As Bathilda did.

And rumours say that the Beauxbatonians who used to study magics in Hogwarts not coming back to to serve their own people because of the higher rewards they gained in lthe atter. Nonsense! Well, it was true indeed that they gained extra galleons there – but that was only the benefits of staying in Hogwarts, not the reason. The young wizard can clearly see now that welfare might be one of the issues.

Not that she wanted the endless cups of tea or coffee, no. Not that she was so arrogant, being a wizard, who supposedly by hierarchy was higher up than the fairies, wanting to be respected too much like she had been a staff for long and knew everything about magic already. No, not that. (But sometimes even those higher up in hierarchy, the witches were outruled by the fairies in the infirmary, let alone the level 2, 3 or young wizards). On the other hand, of course those fairies were mostly more experienced and hence, the same respect that the wizards deserved for should be given to them too, no. So in the end, it was not a question of who should be respected by whom, but a matter of respecting each other even if you were just a house elves who served diets to the humans.

The young wizard was helpless and hopeless. She could create a parchment of complaints to King Arthur or Lancelot or even the witches - she might, but this might well get back to her as witches sometimes like to compare the way the were being treated when they once were the young wizards – those times where she assumed the welfare were never thought for or fought off. Time has evolved and people are more educated about their rights and it was never fair for people to let you being treated as they were before. If this still occured, then why use the apparation, the latest means of transportation, and not the old conventional broomstick?

As for Bathilda, the young wizard thanked her for finally triggered her to do something about the welfare of the wizards. A parchment of news would do, maybe? It might be the time to start fighting for the right. And hey, wizards are staff too, they do work for the infirmary!

*original idea taken from OF WITCHCRAFT AND WIZARDRY

THE LAST HOLIDAY

Considering the quite regular basis of blogging I did over the first month in casualty, it seems like ages that I have not been updating anything on the blog. I have been quite sick - no, really sick with keyboards I guess, I wish there are devices which detect whatever I say verbally and turn them into the soft copy. No doubt there will be, in years if not too soon. The computerised system at the hospital is killing me, especially when there are way too many patients to be served. Now that we are moving forward to the second phase, I wonder if my eyes can endure looking at the computer screen too much. I hope it is the best for all.

Kinabalu Mountain; 16 December 2010 [Credits to Faizal]

I spent half of my holidays for this rotation climbing up Kinabalu, too much stories behind it that I refuse to type in, enough to share that I still have bilateral subcuticular haematomas on both my big toes, they are still black after one month coming down from there. Today, is my last day off in casualty that I am entitled to. Will be finishing off my rotation at casualty by 11th of February, provided I pass my viva of course. And the thickest logbook of all... Great, now these sound dreadful.

Three months being here, I have to say it is the best posting of all, despite the same moaning of unfairness and insatisfaction, it is a nice posting indeed. I still hate green zone as much as I used to at the beginning of the rotation, and I still love reds. Adrenaline rush...

Honestly, I do not mind staying at casualty for another 8months to complete my housemanship, swapping it with orthopaedic and paediatrics posting which coming up. New posting means new environment, new staff and superiors you need to be dealing with and get used to, new knowledge (which is good) and new everything. If only there is a way for me not to do the other two postings...

TRIBUTE: THE LOSS OF A FIGHTER

I was totally shocked upon hearing the news of the death of a good friend, Mas Afzal Masaruddin. Not that I was one of the closest person to him, but him and my other good friends; we surely are bonded by one tie that is strong enough to say that yes, indeed we are good friends who walk the same path.

I first met him at KMYS, the college where I did my A Level. We were never in the same groups but I remember going for the bronze award of D.O.E which involved climbing up to Cameron Highland. He was one of those few who joined - he was so nice he carried my 10kg rucksack when I was too tired to push my body up with the heavy rucksack on (which made it probably more than 20kg total of rucksacks he was carrying).

I was despatched to Newcastle whereas he went to Sheffield. I met him every now and then back in the UK. He was constantly giving good words, inviting people to what he believes in, Islam. He was then diagnosed to have Hodgkin's Lymphoma - but I was not that close to him, to personally say how sorry I was to hear his condition.

Yet, he was a true fighter. He never failed to amaze me. Having been diagnosed with such cancer, with bouts of coughing and side effects of chemotherapy that he had to succumbed to, he still passed his final year medicine and graduated as a doctor. The last time I read his blog was quite a few months ago, then I never really heard of him and how he was doing again.... until today. I feel ashamed and speechless, to have been so busy with my own life and nonsense worries, when he was fighting endlessly in his own world - and never did I try to contact him.

Truly, he was indeed a fighter. He fought to the end. My deepest condolences to all close to him. His presence once will be remembered. May all his doings bring him to the Paradise.

Innalillahi wa inna ilaihi raji'un.
Al-Fatihah.

DOCTORING THE DOCTOR

I was planning for at least a decent day off during the 'week off' for raya haji, but due to shortage of H.O. that was not made possible. But my wish was finally granted, after I got this horrible self diagnosed AGE (acute gastroenteritis).

I actually went to hospital for my morning shift on Friday, only to find out that I was too dizzy to stand up (I even get my brother to send me to the hospital), probably due to the loss of fluid via vomiting and diarrhoea. I hesitated before decided to finally take the two days of MC that the Big Boss offered me. My hydration was actually fair (a very bias judgement I have to say, as I was assessing myself), so I refused IV drip in the first place, but after two bouts of vomiting I succumbed to the correct decision of having a cannula inside my vein - and it did feel painful when the Hartmann solution ran through the small pink cannula into my left radial vein (is there?) to compensate for my loss.

Diarrhoea became worse when I got home that I literally did nothing just because I was incapable of doing things or to think, because I was too tired and dizzy running from bed to toilet, and vice versa. The next morning I woke up, pulse rate was still tachycardic, but I was feeling much better - then only I could think up straight - I was probably already in second stage of hypovolaemic shock. I called my friend, and let her brought me in anohter couple of IV drips. Today I feel much better, and ready for works, and surely in a much more empathic mode.

*Left - modified IV drip stand at home; Right - adik Aqil my doctor*

The Big Boss asked me why did I refuse admission, which I didn't because on Friday morning there was exactly no indication for admission (Friday night's condition was a good enough inditation though) - but so true, the worse patients to serve are the staff, simply because we know how it works.

I might as well sign an A.O.R anyway should I require admission, why should I be warded when the rest of the family is at home? Still the granted two days off at home was not that meaningful because all I did was sleeping and sleeping, all day long. And I miss a day out with friends who came around from Kelantan, as well as a friend's wedding. The least bit that made it worth it was that I managed to read almost five chapters of Harry Potter and The Deathly Hallows after feeling a bit better, after completing those IVD and tolerating orally.

The sad thing is, I am left with only 6 days off for another 3months in this posting, and that is only if it is permitted. Yes, for us H.O, MC is deducted. Counted in. Exactly why we bother so much about getting ones. Explains the reason why we still work despite having a one week suffering of unresolved fever, seeing those who came with a few hours fever without taking antipyretics.

The good thing is, now it reminds me how bad an IV line could torture your nerves, I will try to be more empathy as I used to once upon a time when I was a medical student.

EID MUBARAK

THE BIG BOSS

Some people missing in action in working time, is not a peculiar subject for me anymore. People coming in late for the ward rounds in the morning, or go back so early and leave the burden of the ward works to the others, also sounds so familiar. I can go on and put in complaints, and the list will be endless. Including things about my own self, like how I feel how slow I can be at times. But complaining alone won't achieve anything. Feedback like those in today's handovers is more likely to cause improvements, complaints won't.

I like my Big Boss, he is so far the most responsible H.O.D. I have met. He has this weird 'flight of ideas' speech when we were presenting cases or during the handover sessions, but he is very thoughtful and he does take good care of the staffs and the department; about things that should be in its right place. No one is allowed to come late. Which is good. I dislike punctuality too, even though I have always been rushing to work - but to my defense, that is only so that I arrive on time. I can list up ten reasons how coming in late for ward rounds will cause your punctual colleague to suffer. Of course, there are exceptions to being a few minutes late, but if it is a habit, it is something that hardly changes.

Back to the Big Boss. He knows what is going on in the department. Absconded staffs, nonfunctioning computer system that delay things, absconded patients, issues with other departments...etc. People who were missing in action and those staffs who weren't helpful were also warned today, so hopefully things will get easier and quicker for me. I love those nurses who were so helpful and not just bossing around, scolding doctors (read: housemen) because they have to do jobs. I love the former I would bake cakes for them. If I have the time and energy =)

Anyway, feedbacks like these, discussed in today's handovers are more likely to cause improvements, complaints won't. When I said feedback, I mean complaints made to and done by people who are able to do the changes for the better, and not just merely complaint to friends, who are at the lowest position like yours.

Attempt to get help from the supervisor was to no avail the last time, and even when we ran out of the lab forms yesterday, nothing very helpful was done about it. If the Big Boss is not in his current position right now, I wonder if adrenaline will always be enough in the emergency department.

Malaysia and good feedback system, is still a long way to go. The last time I put in suggestion in a suggestion box, a few weeks (or months) later, the box was gone. When my medical boss lodged an incident reporting to improve some systems, which I seconded, he got an incident reporting attack as if he was doing that out of arrogance.

Reminds me to how Newcastle University library answers NICELY to all the suggestions sent, oh how good the system is.

Same goes with the politics. But not going into that topic tonight, too tired I need some good sleep right now. And the conclusion is I like my Big Boss. Taraa...

OF ALL THE FEELING

I feel I lack that feel that I used to have
I don't exactly know how to describe it
Maybe one day I will be able to
But for now
It is just upsetting
I want my old self back
And the gratitude I used to show
I miss my old life
This working life is just.... not working
As how I wanted it to be
As how I imagined it to be
The soul feels empty
That surely needs a refill
And all traced back to the One

THE GREEN FEVER

I was working at green zone this morning, and most of the cases I have seen today were those with fever. Here goes some conversations:


SCENE 1

Me: Bakpe mari?
Patient: Demam doktor
Me: Bile start demam?
Patient: Bangun tidur tadi
Me: (glancing at the watch which showed 1030am) Ooo...baru 4jam laa lebih kurang?
Patient: Lebih kurang gitu aa
Me: Amik panadol doh ke?
Patient: Dok pon. Buleh ke gitu?
Me: ????


SCENE 2

Me: Mokcik, bakpe mari hari ni?
Patient: Demam doktor
Me: Ooo, berape hari doh?
Patient: Lima hari doh
Me: Lagi ade masalah lain ke?
Patient: Ade...batuk-batuk doktor
Me: Ooo, berape lame doh batuk?
Patient: Lame doh doktor
Me: Ye la, berape lame?
Patient: Lame sangat doh doktor
Me: Mokcik, (again, with all the patience) lame tu, berapa lame? Seminggu, sebulan, setahun?
Patient: (sengih) Lame doh, mokcik dok pindoh rumoh anok mokcik lagi mase tuh
Me: ?????? (and how on earth would she expect me to know when did she move to other house?)


SCENE 3

Me: Bakpe mari hari ni?
Patient: Rase pening aa doktor. Hawe2 nok demam ade gok. Tadi daroh saye tinggi
Me: Ooo...kad takdok lagi ni, doktahu lok tekanan daroh awok berape (assuming it was the BP he was talking about). Saya panggil je dulu sebab takut ramai lok beratur kekgi. Berape tekanan daroh awok td?
Patient: 146 gitu aa
Me: Hok atas ke bowoh?
Patient: Hok mule2
Me: Ooo dokla tinggi sangat
Patient: Tapi memang tinggi tadi doktor!
Me: Dakpe, kekgi sapa kad kite tengok

(after noted his diastolic BP was more than 90 for four times, and him having symptoms of hypertension with a high haematocrite and viral illness symptoms, he was advised for admission)

Me: Awok kene masuk ward ni, tekanan daroh memang tinggi, apstu kite takut denggi jugok
Patient: Hah? Dok payoh la doktor, saya rehat kat rumoh je laa. Doktor wi ubat je ke saya
Me: Doh awok siap kelabu mate lagi, tu tanda2 tekanan daroh tinggi. Dohla mude lagi dapat doh. Kene cek betul2 ni. Lagi daroh awok dok comel sgt, takut denggi. Ade due sebab doh ni saye nok suruh awok masuk ward
Patient: Dok payoh laa doktor. Bagi ubat je laa
Me: ??? (tadi die jugok yg beriye kate tekanan daroh tinggi, pening dok berenti)
Lucky he finally took the advice for admission, if not I myself would go hypertensive.


SCENE 4

Me: Ye dik, bakpe mari ari ni?
Patient: Sakit perut doktor
Me: Sakit kat mane...bla2
Patient: Sakit kat beloh ni...bla2
Me: Ade demam dok?
Patient: Semalam rase macam ye, tapi tadi misi kat depan tu kate saye takdok demam pon
Me: Tuh hok die cek, die dokleh rase awok demam ke dok. Awok sendiri rasa hawe2 demam dok, dik?
Patient: Doktau laa saye. Takdok la kot
Me: (susoh nguh ikut ke misi pulok doh)


How I wish history taking can be much easier...

THE CUTE TOM

This is not the exact reason why I am giving my thought to having an iPhone, more specific the iphone 4. Should I, or should I not?

But seriously, the Talking Tom is so cute and funny it made me laugh.

ps: I practically did part of a chest tube insertion today, I was only assisting, but did actually managed to put a finger on top of somebody's parietal pleura. How exciting is that? Just joking =) At least next time I will have to do it on my own, I have some ideas about it.