Sunday, November 28, 2010

on the go

mobile blogging is awesome!

Tuesday, November 23, 2010

Cuti

Blog ini akan bercuti selama sebulan.

Satu; sebab aku pun bercuti semester.

Dua; sebab aku akan masuk ke pedalaman Pahang sepanjang cuti ini.

Kawasannya adalah antara Lebuhraya Karak dan Jengka.

Dapat kerja sambilan sebagai wire-man dengan Telekom Bhd. Spesifikasi kerja adalah untuk memasang electronic jumper di pencawang-pencawang. Sebahagian besarnya adalah di kawasan tanah tinggi dan hutan belantara.

Balik ni kena pergi short-course selama 3 hari dan boleh kerja minggu depan. Mungkin kerja selama sebulan. Jadi sebulan jugalah aku duduk dalam hutan.

Aku rancang, selain daripada barang-barang keperluan ikhtiar-hidup, nak bawa 5 buah buku

  1. Al-Quran
  2. The Muqaddimah, Ibn Khaldun
  3. Personal View: An Anthology, British Medical Journal
  4. Intellectuals in Developing Society, Syed Hussein Alatas
  5. Naratif Ogonshoto, Dr. Anwar Ridhwan

Dan juga beberapa buah buku catitan kosong. Manalah tahu, untuk conteng-conteng ke.




Sekali-sekala, mungkin kerana lelah berjumpa orang, teringin juga untuk bersendirian.

I'm very excited!

Sunday, November 21, 2010

OSCE

These were the cases that came out during my Objective Structured Clinical Exams (OSCE) last week.

Day 1, Morning Session

  1. Smoking in Pregnancy - Obstetric (Women's Health)
  2. Meningitis - Paediatric (Children's Health)
  3. Dementia of Alzheimers - Psychiatry
  4. Hypertension - General Practice

Day 1, Afternoon Session

  1. Endometritis - Obstetric
  2. Simple Reflux in Infants - Paediatric
  3. Bipolar Mood Disorder - Psychiatry
  4. Erectile Dysfunction - General Practice

Day 2, Morning Session

  1. First Trimester Miscarriage - Gynaecology
  2. Acute Epiglottitis - Paediatric
  3. Drug-induced Psychosis - Psychiatry
  4. Hepatitis B - General Practice
Day 2, Afternoon Session
  1. Contraception Method - Gynaecology
  2. Child Abuse/Neglect - Paediatric
  3. Schizophrenia/Schizophreniform - Psychiatry
  4. Domestic Violence - General Practice

****

Day 1, Morning Session

The morning session was quite okay except for the meningitis case. The child, 1 year of age, presented with unresolving fever and drowsiness. What was running through my mind was it could be either underlying urinary tract infection or infection/septicaemia. Little that I suspect that it could be meningitis, because the admission physical examination and the preliminary investigation provide little clue for the signs of meningism.

Apparently, candidates were expected to make a diagnosis of meningitis and refer the kid to a tertiary hospital for lumbar puncture. The sign that you 're on the right track is you get a phone call from the receiving doctor requesting for summary of information and treatment plan. I, of course, on the other hand, didn't get the phone call. =(

The rest were quite straightforward. For Obstetric, I had to counsel a heavy smoker and intelligent young lady regarding the risk and complications of smoking in pregnancy. For Psychiatry, I had to take some history and perform a mini mental state examination in an elderly, delirious old man who had just lost his spouse.

For General Practice, I think I did quite well. The hypertensive patient was smiling and he understood my explanation.



Day 1, Afternoon Session

The patient for endometritis was quite emotional, blaming the doctor for her post-delivery fever and abdominal ache. I had to take history, list out the possible diagnoses and explain them to the lady.

For paediatric, I had to manage a case of continuous non-bile stained vomitting in an infant. It was a simple reflux disease and I had to rule-out the common surgical and congenital defects condition in the baby. The bipolar case was a give-away because it came out during our mock-test; the full diagnosis was Bipolar Mood Disorder Type 1 currently in Depressed Phase. Take history and manage the case.

The erectile dysfunction case was funny. I can't help myself but to grin and chuckle all the way through the consultation, because the patient too was smiling and being "goofy" all the time. He was a middle age successful businesman presented with distressing 'night' life and was really eager on getting the viagra from me.


***


Day 2, Morning Session

Ah, it was good! The cases were not as perplexing as Day 1, but each case needs a holistic, detailed and carefully designed management plan, none-the-less.

The examiner for Hepatitis B was no other than the Dean himself, Dato' Dr. Khalid. I had the 'oh crap!' kind of feeling when I first saw him in the exam room, but after a while, he was smiling to me and appeared to be satisfied with my treatment plan, so I guess it was okay. The patient was a Vietnamese migrant who was just had the mandatory annual medical checkup and was found to be positive for Hepatitis B.

For the gynaecology case, I had to manage a missed miscarriage. A young lady had her scan and the ultrasound revealed a singleton, normal growth-correspond-to-date foetus but, unfortunately, the heart beat was nowhere to be seen. I had to break the bad news to her and explain both the medical and surgical procedure of abortion. She was indeed very sad, perhaps because it was her first pregnancy.

The Psychiatry case was tricky. A teenage girl was brought to the hospital by a family member after she came home from a girl's night-out party. She was found to be confused and talking nonsense. The family suspected that she was drunk but afraid that she might actually did some drugs. I can't talk to the girl because she was too confused to talk and seemed 'wild' (heheh) so i had to plan my questions carefully to the relative. Not much insight can be gained from the relative because one; she hardly sees her around, two; the girl was quite secretive about her activities and stuff all this while. She was indeed seemed to be overdosed and high, and I had to resort to urine toxicology to screen for drugs and admit her to the ward.




Day 2, Afternoon Session

By this time, my brain was just too tired to think but I forced it to work extra-mile. I had to go all out this time. One last shot!

I had to counsel a mild intellectually disabled young lady regarding the options of contraception. She insisted on getting the pill, but I felt that the injectible hormones would be of a superior advantage for her since she was quite dependent on others, even in keeping her own hygiene.

The domestic violence case was quite interesting. I had to play some tarik tali (tug-of-war) game with the patient. She tried with all her might to conceal on what was happening at home, but the physical evidence was just too obvious. Multiple bruises of different sizes and colour, history of fractured wrist and insomnia were more than enough to raise the suspicion of abuse.

Initially she denied any conflicts in the family, but later she succumbed to her emotion and threw out a whole host of physical and emotional abuse from her husband. The problem is, or was, she innocently believed that her husband will change, some time soon.

Yeah, right.

I had to 'enlighten' her about the cycle of violence and begged her to realize that this thing will happen again and again, no matter how many times he said sorry or tried to make up with his sweet voice and nice gifts. He had many other risk factor like alcoholism, stressful job, unhealthy lifestyle etc., and exactly like a ticking time-bomb; he just wait for the right(or wrong) time to explode.

I think she accepted it.

The rest of the day was flowing smoothly and nicely. Alhamdulillah.



***





Overall, I'm quite satisfied with the OSCE. I hope that everything will turn out to be okay at the end of the day.

May the mistakes that I've done during the exam will always be a reminder for me and may the success be a reinforcement for me to keep my face up, back straight and walk tall through the upcoming life as a doctor.

I want to help people. Really.

Usaha, Doa, Tawakkal. Insha-Allah.

Saturday, November 20, 2010

Bucephalus

Sejak akhir-akhir ini, Bucephalus agak 'kemalasan'.

Tersengguk-sengguk, terutama sekali pada waktu pagi, lepas bangun tidur.

Selain itu:
  • kadang-kadang meter RPM (revolution per minute) agak lari dari senggatannya secara tiba-tiba.
  • pendikit (throttle) minyak tidak begitu responsif
  • prestasi kuasa terjahan (torque) yang kurang optimum
  • bunyi enjin yang agak 'beralun' ketika tidak bergerak (idle)
Dari simptom-simptom yang ada, diagnosisnya adalah impending fuel pump failure.

Seperti tertera pada nama, fungsi pump itu adalah untuk mengepam minyak dari tangki minyak ke enjin.

Biasanya, tangki minyak untuk kereta ada di belakang (for a reason). Dan pump itu ada dekat-dekat dengan tangki minyak.

Ringkasnya, jika pump ini gagal berfungsi, minyak tidak dipam ke enjin, enjin berhenti berfungsi.

Jika kenderaan anda mengalami gejala-gejala seperti ini, eloklah kiranya anda bersegera mendapatkan khidmat nasihat dari mekanik yang anda percayai.

Jangka hayat pump ini bergantung kepada cara pemanduan. Tapi, secara kasar, pump ini sepatutnya mampu bertahan dalam jangka masa tiga hingga ke lima tahun. Sekiranya terbukti pump ini mengalami tanda-tanda akan rosak semasa pemeriksaan, moleklah jika ianya ditukar.

Anda pasti tidak mahu keadaan di mana enjin anda mati tiba-tiba di tengah jalan, samada di tengah-tengah traffic jam mahupun di tengah-tengah rimba banat.

Satu, upah tow truck mahal, yang kedua dan yang lebih penting; keselamatan anda dan poket anda.








Oh ya, Bucephalus itu nama kereta aku.

Monday, November 15, 2010

Kitalah manusia itu

Sesungguhnya manusia diciptakan bersifat keluh-kesah lagi kikir.

Apabila ia ditimpa kesusahan ia berkeluh-kesah,

dan apabila ia mendapat kebaikan ia amat kikir,

kecuali orang-orang yang mengerjakan solat,

yang mereka itu tetap mengerjakan solatnya,

Al Ma'arij : 19 -23



Kita manusia yang mana?

Saturday, November 13, 2010

because I care

We know accurately when we know little;
with knowledge, doubt increases - Goethe

It all stems out from a link to a blog sent by a friend of mine several weeks ago. The blog is owned by a lady from the metropolitan city of Kuala Lumpur. She wrote anything about her experience, and for this time, her birth-giving experience.

She was in the later weeks of her pregnancy and the delivery was imminent. Like many other ladies, she hopes - or rather demands - a comfortable and rewarding experience while giving birth. This is a perfectly fine and reasonable thing to ask for.

To me, the only thing that could answer her call is a good obstetric care by the healthcare providers.

But it didn't happen in her case.

Her pregnancy was complicated by a condition known as pre-eclampsia. It is essentially a pregnancy-induced hypertension with protein leaking out from the body. Though it is common, it is a very serious thing and quite different from the hypertension in a non-pregnant state.

What makes it so bad is the complications. To name a few, they can range from as mild as nausea and headache, to the life-threatening convulsion and bursting liver, which will eventually and surely leads to - if not enough attention given and appropriate intervention done - the gruesome maternal death.

She shared the prejudice of all Malaysian ladies - and that also includes my mother - that the service in the government hospital is very, very bad. At times it could be unimaginably horrifying experience, especially with the junior doctors.

And her prejudice was proven to be true. She was admitted early for monitoring and possible option of early induction of labour. This is standard procedure throughout the country. But what is substandard here is the service that she got from the healthcare professionals, namely the doctors and nurses.

The main issue was the lack of communication between doctor and patient. Apparently from her rantings and complaints, it appears that she didn't have a clue about what's going to happen to her and it is only natural for her to think that all the investigations done and the long days of so-called monitoring was purposeless and a complete waste of time.

Obviously no one have sat with her and discussed about, say, the risk of premature delivery, what is the ideal time to induce the labour, what meds can be taken to lower her blood pressure down, does her condition warrants an operational delivery i.e. caesarean section and so on.

And things went from bad to worse when she heard the mismanagement by the junior doctors from other patients in the ward. All the bad things like horrible post-delivery wound repair (the episiotomy), the scoldings and barkings from nurses and doctors etc. have haunted her thoughts and emotions, and much to the detrimental of her anxiety and eventually her pre-eclamptic state.

Perhaps due to these things, she made up her mind to pack her things up and off she go to the private sector for 'better' care.

I'm happy to found that she got what she wants and finally gave birth to a lovely and healthy baby boy last week.

May Allah bless her life with happiness and soleh and taqwa children.



End of story. Now's my turn to talk.

I have to admit that these things happens. And before any house-officer (the juniormost doctor's rank in the hospital - sometimes lower than the janitor) kill me, I will be the first to acknowledge that it is not easy to work long shifts and under loads of heavy pressure . Accidents do, or rather prone to happen.

But it is not an excuse. Never.

To me, obstetric is a very specialised branch of healthcare. What makes it so special is that the stakes are high. Not only it involve a lot of people, the emotion runs deep in everyone who is at stake. It is not a surprise to note that this little department of the hospital 'scores' the highest number of lawsuits and complaints each consecutive year. Never fail I tell you.

Therefore, obviously, the demands of passionate and skilfull personnel from the medical fraternity is overwhelmingly high here. He or she must have sheer amount of interest when it comes to the care of pregnant ladies. Only passionate doctor, I think, will consciously and subconsciously try to avoid any mistake and negligence at anypoint of time, no matter how tired he or she is.

Previously, under the house-officer training scheme, obstetric and gynaecology was not among one of those 'statutory' rotations. Due to the alarmingly high number of incompetent young doctors (they said), it is felt that the training is not enough and the solution is to lengthen the training program from one year to two years.

That, I whole-heartedly concur.

But, and here's the big but, I cannot agree with the addition of mandatory obstetric and gynaecology rotation into the program.

If they say the fundamental concepts of basic medicine is consensusly lacking amongst the fresh graduates nowadays, wouldn't it be more logical and rational if we lengthen the medicine and surgical rotation instead of adding more specialised rotations?

Because, you see, from what I could gather from my experience with the house-officers, not many of them have the interest in the obstetric fields. Some of them are even depressed and in despair.

The common thought among them is "just get it over".

And if this sort of thinking occur, I'm afraid that it can only spell disaster to the quality of job given and also the public trust to the medical profession.

Like, how can a depressed and uninterested doctor who was just being demoralised by the scolds and shouts from a consultant can take care of a lady who is just about to bear down a baby at 3 am in the morning?

The chance for a comfortable care by the doctor is, at this moment, almost close to none.

I felt sorry for both.

Maybe people will shout at us from afar, that we should stop complaining. If you want to be a doctor, this is what you should expect.

I agree. But my point being that we should not force people to do obstetric care. It wouldn't make sense. And it would definitely serve no justice for both parties.

My final verdict is simple ; the rotation should be opened only for those who are genuinely interested in it.

I have seen women giving birth in various conditions, some are happy while others, or rather most of them, are crying in agonizing pain. You wouldn't want this to happen to you, your wife and etc.

I have spoken for, I believe, the good of our healthcare.

I ask Allah S.W.T for His guidance.


"...Thee do we worship, and Thine aid we seek. Show us the straight way; The way of those on whom Thou hast bestowed Thy Grace, those whose (portion) is not wrath, and who go not astray."

Al- Fatihah : 5 - 7

Wednesday, November 10, 2010

Buaya dicuri !

Selipar Crocs aku yang dibeli raya aidilfitri lepas telah dikebas dengan jayanya selepas selesai solat 'asr di surau kampung X tadi.

Keluar-keluar surau, tengok dah tak ada.



Nak kata orang lain terambil, tak juga, sebab tak ramai pun pergi solat di surau tadi. Jadi kebarangkalian tersilap ambil tipis.

Tapi tak mengapa, aku balik dengan senyuman, bahkan ketawa.

Bukan kerana kebangangan pencuri itu yang hanya mengebas Crocs pasar malam aku.

Tidak.

Tapi kerana kesempatan berkenalan dengan seorang brother yang sungguh baik hati memberi pinjam seliparnya.

Kerana kesempatan berkenalan dengan jemaah-jemaah surau dan tok imam yang lain ketika kecoh-kecoh di depan tangga.

Kerana memberikan aku 'lebih' sebab untuk sabar dan berdoa. Ya Tuhan, terangkanlah hatiku menjawab exams esok. Berikanlah aku kejayaan.

Sesungguhnya doa orang yang teraniaya makbul. Makbulkanlah doaku.


Wahai pencuri,

Terima kaseyyyy!

doa.hamba.hina

Dan Tuhanmu berfirman: “Berdoalah kepada-Ku, niscaya akan Kuperkenankan bagimu. Sesungguhnya orang-orang yang menyombongkan diri dari menyembah-Ku akan masuk neraka Jahannam dalam keadaan hina dina”.

Al-Mu’min, 40: 60



Dan apabila hamba-hamba-Ku bertanya kepadamu tentang Aku, maka (jawablah), bahawasanya Aku adalah dekat. Aku mengabulkan permohonan orang yang berdoa apabila ia memohon kepada-Ku, maka hendaklah mereka itu memenuhi (segala perintah-Ku) dan hendaklah mereka beriman kepada-Ku, agar mereka selalu berada dalam kebenaran.

Al-Baqarah, 2: 186




Ya Tuhan, kepadaMu aku berserah.

Monday, November 08, 2010

Karipap dah mahal

Tahun depan, ramai sahabatku dari medical fraternity akan memulakan kerjaya. Antara immediate concern golongan ini adalah pembelian aset yang, pada mereka, asas dan fundamental dalam pembentukan keluarga.

Seperti rumah, kereta, perabot dan sebagainya.

Pasti, dalam suasana ekonomi yang makin tidak menentu, keluhan utama adalah harga barang semakin mahal, gaji tak naik-naik. Ditambah pula dengan pelan ekonomi baru yang nampaknya sangat tidak popular dikalangan kelas pertengahan, ramai yang merasakan bahawa kebajikan golongan ini seperti tidak dipedulikan lagi. Agaknya, mungkin hati pelancong asing dan penggemar pakaian dalam lebih diutamakan.

Kita tinggalkan sebentar perkara ini.

Kemerosotan nilai semasa mata wang dollar Amerika Syarikat, menurut Pengurus Kanan Kumpulan TA Investment Bhd., Alsetdek Al Haj Ali, sepatutnya membawa kepada kenaikan nilai mata wang kita.

Dengan kata lain, nilai ringgit sepatutnya naik, secara relatif.

Hal yang sama berlaku pada dolar Australia, yang hingga ke saat aku menulis, nilainya telah melepasi dolar AS.

1 AUD = 1.01223 USD

1 MYR = 0.323645 USD

Jadi, 1 MYR = 0.319757 AUD

Kesan susulan dari kenaikan nilai mata wang adalah meningkatnya kuasa membeli, atau purchasing power.

Ringkasnya, jika purchasing power meningkat, kita sepatutnya boleh membeli lebih banyak barang dengan nilai RM1 sekarang berbanding dulu.

Tapi, semua warga negara Malaysia yang waras tahu, bahawa hal ini tidak berlaku.

Bahkan yang ironilah telah berlaku. Makin hari, makin mahal harga barang.

Karipap di kafeteria hospital pun dah makin mahal. Dulu seringgit empat biji, sekarang tiga biji.

Diagnosis Alsetdek Al Haj Ali kepada punca keadaan ini adalah pincangnya perancangan model ekonomi negara.

Hingga ke saat ini, Malaysia menggunakan harga barangan kawalan dalam indeks inflasi untuk menentukan kestabilan ekonomi negara.

Sepatutnya, menurut Alsetdek, kita gunakan purchasing power. Rasionalnya mudah.

Kerana ianya lebih jitu dalam mencerminkan situasi ekonomi rakyat.

Barangan kawalan adalah seperti tepung, gula, beras dan sebagainya. Betul, ianya barang asas, tapi bagaimana pula dengan barangan rumah yang lain seperti sabun, syampu dan sebagainya?

Untuk hidup di bandar besar seperti Kuala Lumpur (dan Sitiawan), dengan pendapatan purata isi rumah RM 3 000, kita hanya hidup dengan nyawa-nyawa ikan.

Takkan hendak beli tepung, beras dan gula sahaja?

Dan, bukankah jika harga barangan lain semakin mahal, ia akan lambat laun memakan ruang bajet untuk barangan asas juga?

Kalau tumpuan dan usaha diarahkan untuk meningkatkan purchasing power, kesannya akan dirasai dengan lebih menyeluruh.

I think it make sense.

Saranan beliau adalah supaya Malaysia mengadaptasi model ekonomi kebanyakan negara maju.

Contoh, barang yang selalu dibeli, seboleh-bolehnya, direndahkan harga. Turn-over rate yang tinggi akan mampu menanggung kos pengeluaran akhirnya.

Aku rasa saranan beliau wajar dipertimbangkan.

Sebab karipap, kalau dah mahal, mesti tak sedap.







Entah mana datang rasa pahit itu.

Sunday, November 07, 2010

scribblings

Untuk pengetahuan mereka yang tinggal di bulan selama dua tiga tahun kebelakangan ini, udara politik dan sosial di Malaysia berada dalam keadaan yang paling tidak menentu sejak bermulanya millenium yang baru.

Mungkin aku tidak mahir menganalisis, tapi padaku, tidak ada pihak yang nampaknya seperti mungkin menang atau pasti kalah dalam pilihanraya akan datang. Buat masa sekarang.

Seperti lazimnya, banyak pihak cuba menawarkan perubahan untuk kebaikan.

Dan dikit demi dikit, perubahan telah, sedang dan akan berlaku.

Namun, sekalipun 'perubahan' yang diuar-uarkan telah berlaku, ia tetap tidak bererti jika ianya hanya untuk menutup batang tubuh yang lama.

Biar banyak manapun daun gugur, bau busuk bangkai gajah tetap dapat dihidu juga akhirnya. Itupun jika hidungnya sharp.

Mungkin kerana itu banyak antara belia telah berenang dari tanah mainstream ke pulau indie. Dan mungkin juga ada yang tenggelam terus.

Kerana itu, band-band indie seperti badan bukan kerajaan mula mencetus fenomena. Gerakan-gerakan badan bukan kerajaan mendapat sambutan hangat dan, arguably, antara yang dominan dan berpengaruh dikalangan belia dan mahasiswa.

Sekiranya kita extrapolate graf yang ada sekarang, rasanya puak yang inilah yang beroleh mandat dan punya bargaining power nanti.

Aku percaya, antara sebab yang memungkinkan band-band ini untuk terus meraih sokongan dan menikmati kuasa adalah modus operandinya yang berorientasikan penanaman idea.

Bukannya berpaksikan lanjutan-lanjutan 'budaya' yang ritualistik dan sampah.

Kenapa idea? Jelas, idea adalah air-borne virus. Idea akan memungkin tindakan, tindakan akan memungkinkan perubahan.

Barangkali lebih kurang seperti teori domino

Apa yang aku khuatirkan adalah idea mungkin tidak mampu untuk menentukan, secara keseluruhan, arah tindakan.

Kita boleh menanam benih pokok, tapi tidak mungkin untuk kita jangka arah mana pucuknya, dahannya, rantingnya akan tumbuh.

Mungkin di sini peri pentingnya peranan disiplin dan juga consistency.

Harap-harapnya, idea mampu menjadikan kita lebih terbuka, rasional dan progresif. Dan tidak menjadikan kita - dan ini yang paling aku risaukan - lebih tertutup, emosional dan regresif.

Manusia yang begitu (merujuk yang akhir) biasanya manusia yang curiga terhadap sekeliling.

Prejudis kepada mereka yang tak segolong.

Was-was kepada segala keasingan.

Syak-wasangka biasanya membawa kepada persecution, persecution biasanya berakhir dengan kehancuran.

Mohon dijauhkan Tuhan.

Selamat belajar dan bekerja.

Friday, November 05, 2010

mereka kejam

Lepas solat jumaat nanti, rumah akan jadi kosong. Hampir kosong.

Rakan-rakan rumah sewa semua akan pergi panjat gunung.

Aku tak boleh ikut. Tak dibenarkan. Sebab ada exam.






Ala...