Simple pleasure

The sky was of clear light blue with different shades.

The rain had just stopped.

I can smell the scent of fresh wet grass.

The slippers I wore made squishy sound as I made my way across the garden.

I found some whites flowers lying on the grass.

I stopped, as I enjoyed the simple pleasure given in this life.

Miracles & love

Whatever happened in the past, I believe everything happens for a reason.

So few fundamentals need to be covered before we walk into 2010. Although hope can be cruel at times, I believe that we should never give up on our hope.

Never give up on those who in need of our service, although all that is left are miracles. For every disease has its cure, and human knowledge are the rate-limiting factor. But there is no real bound to what human spirit can achieve. In the face of our greatest adversary that can only we acknowledge our weaknesses and overcome them.

If you ask me what do I know about love. Well, I know for certain now that you can't create or fake it. Although recently I was wounded by its departure, but that is mostly due to my own naivety, and perhaps somewhat self-inflicted. I'm sure she's out there somewhere. I just haven't found her yet.

I'm looking forward for 2010. There will be lot of major changes in this life. Although, one thing will never change though, is that I always be a man of certain characters... an idealist and a dreamer.

With all of those in mind, it is time to make our very own miracles.

Good luck folks!

... and good bye.

***

"It's late at night and I can't sleep
Missing you just runs too deep
Oh I can't breathe thinking of your smile
Oh God I wish I could make you see

Cuz I know this flame isn't dying
So nothing can stop me from trying
Baby you know that
Maybe it's time for miracles

Cuz I ain't giving up on love"

***

Meet Mr McClane

If I were to have a housemate.

He would be as cool as this chap here.

... and I would call him John McClane.

Smart, cool and tough.

"Ms Katherine eat your heart out" :D

My way

At times, you will feel a certain connection to songs that sort of reflect how you feel at a certain point of your life. As the 2009 curtain nearly closing upon us. These are the few phrases that feel close to home.

Regrets I've had a few
But then again too few to mention
I did what I had to do
And saw it through without exemption

I planned each charted course
Each careful step along the byway
And more, much more than this
I did it my way

I've loved, I've laughed and cried
I've had my fill, my share of losing
And now as tears subside
I find it all so amusing

For what is a man what has he got
If not himself then he has not
To say the things he truly feels
And not the words of one who kneels
The record shows I took the blows
And did it my way

Yes it was my way

****

I had taken few course of action this year, and followed my instincts. Although the result was not quite as I wanted it to be, but it gave satisfaction knowing that I had given it my best shot. So I won't regret it many years down the line by asking myself "What if I have done it?"

Uncle Newton was right on the spot with his 3rd law, that to every single action there is an equal amount of energy but in the opposite direction.

Good. Now I've got to at least admit it, that the ending of 2009 is ain't that super. However, on the plus side, I've learned some useful stuff on how to deal with my own issues and others especially when it comes to the opposite sex. I am a much wiser man I hope.

The world is round, and it can only be fair that all things would get their own share of joy and pain. But it is time to put some everlasting smile on that face.

I double dare you 2010, bring it on!!

Somewhere wonderful

Came home to a dark quiet space.

Turned on the fan at maximum speed.

The light can wait.

I dropped everything that I had in my hand onto the black coffee table and found myself curled up on the sofa... and slowly closed my eyes.

Some people believe that at the end of one's life you would see all your past events flash quickly right in front of you, it feels like watching your own movie running at high speed.

I experienced that earlier this evening. All the memories flashed right before my eyes as we had some serious talk about how this relationship had come to an end.

****

One particular image caught my breath as I tried to contain my feelings.

"I don't care anymore... " I uttered those words accidentally out loud as I lost my way somewhere inside her eyes. She looked puzzled and we laughed our heart out.

That was the best time of my life.

Ain't a reality show

It has been a truly revealing sub-plot for yours truly these last few days. Whereby, I realised for the first time where my "character" now stands in this soap opera-like real life drama, similar to those once shown at 2am on TV2.

The question is what could possibly happen to your character when it has been downgraded from a main role into a supportive role. Could they kill off off your character like Dr Drake Ramoray? Wait, I think we all what's the answer to that question.

In the end, well people's priority change as they seem fit. So this is not a blaming game. And who am I to argue with people's wish.

Run my mind tells me, save your feelings. Fragility doesn't pay, and it definitely won't save your arse one day when you fall. Everyone has a little bit of self preservation ego, I think I've suppressed mine long enough. Well some actors would quit the show. Better quit then be killed right?

It is time to wake up and smell the fresh scent of roasted-coffee and perhaps the fresh carbon monoxide in the Klang Valley's air. I suppose if the reality is too good to be true, then you're right, it usually is not the truth.

Although the damage has been done, I just have to come up with some kind of backup plan.

Like the old man in Ward 2 once told me "Don't worry young man, you just improvise and get on with your life."

I think I've repeated this statement before. It is Deja Vu all over again.

Happy at last

There are so many things in this life that we take for granted, may it be our health, our secured financial status, well not to say that we're rich. Enough to say that we would not go hungry at night or have to starve ourselves because we can't afford to have food on our plates.

Ah yes! Of course the more money we have the better, which to some of us that would be a never ending quest. What is more important in the future is to have more time for myself.


So at this current state of life and as far as happiness is concern. I think I'm pretty much a happy guy now.

Although I'm yet to settle down with a girl and have my a family of my own. At least I have a decent job which I enjoy doing day in & out. Parents for which I'm sure loves me (Gee I do hope so). Good friends that I can share stuff with and to rely on during good times and at time of needs.



It would be a great tragedy in life if one looks back at one's journey and weep like a wounded soul. I have a good feeling that 30 years down the line, I could look back at all this and have a good laugh at myself and yes again that's good enough for me.

Yes, you always have choices in this life.

I choose to be happy with what I have now.

a febrile affair

Falling sick again.

The last 2 days were nothing but a roller-coaster of moderate grade fever, and I can't seem to shake off the febrile mode. Surviving with 6 hourly PCM. Hopefully it's nothing. Coz i can't afford to fall ill or worse admitted again.

Deep inside i fear it may in fact be dengue, especially with its rising incidence in KL in the past 2 weeks. That plus the fact that these eyeballs felt 'pressured' whenever I closed them, with the occasional arthralgia. Devoid of flu-like symptoms makes me pretty much sure about this self-diagnosis. Even worse I'm gonna be oncall tomorrow in the emergency dept.

I wish the fever would leave me alone. Otherwise I would be treating a legion of ill people while my own platelet is plunging by the hour.

Damn I hate those freaking mosquitoes.

Ho Liao !

To survive one of the bloodiest on call was one of the superb feeling to any of us out there. You feel like you did your job and earn a restful post call day.

Last night was one of those when the phone call just wouldn't stop ringing till morning. It ended at 7am with the final call from the ER docs wanted to get an opinion on an elderly lady who was brought in very ill.

The ECG of interest finally landed in my hands, and true enough we made the right decision at the very crucial point not to thrombolyse the patient.

When the on call ended, I dragged my sleepy body up to the canteen and have a jolly good breakfast with my mates who just arrived with fresh clothes and smiley faces and I on the other hand could have won the "smelliest haggard-looking ogre" award of the year.

I knew

Trust is important.

Between a surgeon and her patient. Before she makes the first incision.

Between husband and wife. Before the akad niqah.

Between lovers. Before the first kiss.

When that trust is broken nothing could fix it, not even a single stitch on a pus-ridden open surgical wound nor the shedded tears of a repented sinner.


I can live with a broken heart, but not with broken trust.


Call this a sentimental crap. Call it whatever you want.


But when you look into my eyes, I expect nothing but the fucking truth.


Tell me...


"Have you ever dance with the devil under the pale moonlight?"

Yes, that question is both metaphorical and rhetorical. Because I knew the answer all along.


Yes.. I'm a benign yet sadistic being in many ways you can't imagine.

Second life

I saw a public health poster reminding us to bring our mom to health service. Which reminds me that all the things in our life may not come true without her existence. That may include our very own presence in this world.

If one drives to Terendak Camp in Melaka, within the 4th Regiment compound you will come across a huge 15 feet in depth fish pond. I was 8 years old when on one fateful day I found myself at the bottom of that pond. The murky green water had filled part of my lungs making them harder to inflate with every passing second. What occurred for few minutes feels like forever when you are somewhere between life and death.

At that very moment I saw another person in that fish pond. A figure of a girl roughly 2 feet in front of me. She smiled and pointed up toward the surface gesturing me to swim upward. Retrospectively, perhaps my brain had become hypoxic of oxygen and started to play trick on me. Visual hallucination. Funny enough, I did not feel I was in any grave danger. Not a strike of fear or panic engulfed my mind. I feel protected as though someone was there all the while telling me that everything is gonna be all right.

Just before my vision became fuzzy I saw another figure came right from above me with arms wide open and pulled me out of the pond. An army sergeant came by to help and gave me pulmonary resuscitation for 5 minutes.

***

My mom... up until this very day never know how to swim. On that day she jumped into that pond without hesitation and saved me.

Happy birthday Mom.

Thank you for everything.

Different strokes

Great time with good friends having splendid food...

What could be a better way to fuel your weekend other than this..

It is time like this that I start to count the blessings in my life, what it has to offer.

All the beautiful things in life is always a subjective thing between people.

Even when it comes to the same person, the perspective on things might differ as well, most of it would be depended on the state of mind that shapes that particular mood at the given time.

Earlier in the evening as I walked out to my car, as the sun was setting fast, and the cloud was pouring its heart out, the image of this old lady who was paralysed due to a major stroke (cerebrovascular accident / angin ahmar) sitting on her wheelchair waiting for someone to pick her up just hit me right home.

I can't stop from thinking about her even as I reach my destination. Would there even be a meal waiting for her at home?

Kiss of life

The average age of Malaysian folks getting a heart attack these days is 57 years old, and 59 years old for a stroke. A much higher rate compared to western countries. Surprised?

Well I'm not surprised, since KFC has been part of our weekly diet these days.

Even our sponsored breakfast at drug talk this morning was well *smirk* is no other than your own uncle Ronald's delicious hamburger.

Do you know that major risk factors for myocardial infarction are:

1. smoking
2. hypertension
3. hyperlipidaemia
4. diabetes
5. obesity
6. male
7. age
   

The good news is most of these attacks would kill you instantenously, so it would be a quick agonising death. So it can be anywhere from your bathroom to the boardroom or while you're having sex (oh yes grandpa, yup yup). If you lucky enough you might make it to an ER. Once you are stabilised, you may get an angiogram basically we poke your artery and push a wire into the opening of your coronary vessels and inject a contrast to find blocked vessels.

Hurm but only IF you survive the first attack. So first you gotta teach your spouse, children, girl/boyfriend a CPR.. to you know increase your survival odd if let say you collapsed with a cardiac arrest.

Ah well enjoy the show.. penat lah tulis banyak2.

The last bus to Santa Fe

The truth is out.

What do you do when you found out that what you've been holding out all this while is nothing but some illusion in an October sky. A mirage in the burning Sahara.

Yes perhaps some people would stay in the dream pretending that nothing happen, while others would opt for the quickest exit route.

In the end it has been a very enlighting path for yours truly. It makes me realise that there are people out there each with their own unique character and personal agenda.

The real questions is what do you do?

In the word of Jack Ryan to the old man in the White house...

"Sorry Mr President, I don't dance".

Achtung!

I was told that I'm being too bloody sensitive and over-emotional when handling myself in public. I'm aware of my personality and will admit that I'm not the most macho guy ever walk the earth. One thing for sure I could only get vulnerable when it comes to the person I care. Well yeah I'm a person who evolve with time. Every single thing that I absorb along the way would be processed within my frontal zones and digested with care. If it's a total crap, then it will be flushed out of the system like every single wasted material there is. Some habit I could shake it off, and some might stay put.

Only time would tell whether the man I am today is the person I will be tomorrow. As for now, I got some feedback which I will keep a mental note on.

The bad news is one thing for sure there will be some collateral damage at the hospital next week, as my mind is still recovering from the side effects of those 2 types of pills I took. The good news is I know every single one of them by now. So yeah it won't effect my clinical judgement, but it may effect my internal mood. Yeah be careful of self medicating doctors. We can be very loose & unpredictable in our action.

So it seems that finally Dr Jeckle and Mr Hyde want to come out and play.

Be afraid. Be very afraid.

Stranger

It is a silent morning.

Too quiet that I could hear my own breathing
Counting down my own pulses and they are pulsating at 100 beats per minute.

The palpitation of my own heart is so strong now that I feel a bit giddy as I stand up looking for the light switch in the bathroom.

I catch my own reflection on the mirror and a stranger is standing there staring at me looking rather intense. For a while it is as if we're having a staring contest. He looks rather shaky to me and I bet I could take him down with a low hook swing across his right ribs.

However this morning I think I'm gonna leave him alone.
I'm not going to give him the fight he can't possibly win.

Your smile

There are many things inside the human body which I could explain,

and yet my heart has its reason of which my reason knows nothing of.

The red rose that refuse to die

This evening as I was sitting there looking at the balcony. I thought to myself that as this Ramadhan is coming to the end, few things have managed to linger in my mind.

1. The beautiful colourful neon lights that shimmer the corridor of my late night on call duty.

2. A patient who died on one fateful Friday evening while the whole unit was on our way to break our fast at Midvalley. We stayed and worked on him for 1 hour. He didn't make it though.

3. The busy clinic workload with over 100 patients to see from 9am to 4pm. That includes a patient whom I caught red-handed with a cigarette pack in his breast pocket (while I was auscultating his heart) while swore to me before then that he had quit for good. The two of us had a really good laugh on that one. Not forgetting to mention a 70 year old makcik whom after knowing that I'm not married wanted to match-make me with her daughter. And a nenek who really want me to come over to her house for raya.

4. The early morning long-distance wake-up call that woke me up for sahur. Boy I'm gonna miss that one.




5. The after office-hour chess games that we indulged in while waiting for traffic to ease down before we hit the road. Last score, that guy beat me 8 to 6.

6. But even with all those in mind, the one thing that really matters to me is the thought that one day I hope the owner of this red rose would come back for it. Even though it no longer has life within it. But to me it is very much alive ever since the night I brought it home with me on June 19.

Selamat Hari Raya ;)

Save Yvonne's Sight

I've been tagged by Andrea Whatever, to aid in campaigning for this unfortunate young lady.

Yvonne Foong, 22, has neurofibromatosis type II, which has severely affected her sight and hearing due to tumours in the brain and spine. She is scheduled for an operation between 1 and 4 December 2009.

She is hoping to raise the money by republishing her book I'm Not Sick; I'm Just a Bit Unwell in English and Chinese. The books are now available in Malaysian bookshops and from her web store. She is also selling T-shirts at bazaars and via her web store. You can read about her surgery and donate to her fund.

Good luck Yvonne!

Cranky but...

The Tuesday clinic was busy, we got around 60 patients to see and that all had to be done before 2pm before the cardiology fellows kick in and wanting to start their own clinic duty.

One patient that I saw, a 70 year old lady in a wheelchair whom had all sort of medical illness under the sun. From gout to heart disease; stroke, hypertension to diabetes. You name it, she could practically be a walking pathology textbook.

What strike me was her personality. Although she's living in an old folks home without any surviving relative, she was pretty much more alive than I was on that day. Chirpy in characters and love making jokes with our staffs. Gee! She could be wearing a purple wedding dress and a red hat, and she could still beat Britney Spears' arse any given sunday.

Then I thought, it could probably be that she was just happy for some particular reason on that day. Perhaps she got a new set of dentures or she got lucky the night before. Who knows? Romance could still blossom in the old folks home right. The notebook, anyone?

However, when I flipped through the notes looking back at her previous clinic visits, even one of my friend agreed with my impression of her that day.

Then it finally sank to me, she probably has lived a wonderful fulfilled life. It is as simple as that. And all of those years have make her a generally cheerful person.

That alone is enough to bring a smile to my face for the whole day.

Controlled Insanity

Some of the guys in my department are marching toward the final weeks of Part 2 exam in Masters of Internal Medicine. Juggling time between your waking hours in the wards, books, and interrupted sleep at home could get a bit tricky. It's nothing compared to your spoon-fed under grad days in medschool.

Now there are kids to take care of, disgruntled spouse who hasn't got laid for few days. Bills to pay, pets to be fed and anything in between. They could easily be spotted like a walking zombie with a facial expression of a patient with toxoplasmosis. On a personal note, I remember walking to the exam theatre for my Part 1 wearing my t-shirt inside out, but that is another story.

Whatever it is guys, don't forget to bring your 2B pencils, an eraser... and yeah zip-up your pants too will ya.

***

the song is a parody of Billy Joel's 'We didn't start the fire'

http://www.youtube.com/watch?v=RjKLNSOiIZU&feature=fvst

May I have this dance

Relationship is something that you can't develop with anyone you like. It is a gift that sometimes comes from the most unusual source. And when it happens you would have to nurture it, and it takes more than just a person. It takes two to make it works into something meaningful.

It is quite a bizarre experience to be able to connect to a stranger within a short space of time. The thing that bond this two people together can be in forms of shared joyful event or a painful episodes in their yesteryear.

This connection can also be developed into something more wonderful. However as life would has it, not all things are meant to be the way we sometime want them to be. Maybe if we found that person years earlier - it may have work fine and dandy But fate has it that person met someone else first, and we're just a little bit too late. Which somehow creates a sticky situation.

With that in mind I wanna share with you one of my favourite film scene.

Like Frank in this clip, given that he's not blind and he met Donna years earlier than Michael, perhaps they can be more than just a dance-partner (Sorry Charlie, you're still a baby). Because I can sense the chemistry in them. How they trust each other in creating their moves, the way their body react to each other. But circumstances has it that their magical moments last only in that short evening.

On the other hand, I would like to believe that we could extrapolate this metaphor beyond the dance floor, to dance to this life like how we tango.

"...If you made a mistake, you got all tangled up you just tangle on!"

Let's toast to life.

Life less ordinary with cream

One thing for sure, fasting month always has this rather odd effect on my internal body clock. I could never go back to bed after sahur, no matter how much alluring the bed looks like at 5.50am. I would rather have a hot shower so that by 6.40am I could be sitting in an empty seminar room at the hospital looking through journals for my thesis proposal.

At 5.01pm I would retreat back to the seminar room and continue with the reading & typing. Which usually will end up with me breaking the fast with the on-call boys.

By 11 at night, I would curl up on the bed again with the air-cond breezing at 25 degrees, and Cavatina playing softly in the background.

3am: Having fun at the carnival again. A little girl dressed up in a fairy costumes gave me her lollypop. Somehow I manage to punch a clown who won't reveal his dog-balloon trick to me.

5.15am: ZZZ *^$%& ... Huh what was that?! Crap (hit the snooze button).

Serenade

Good night.

Sayang

I was on call again last night, so I made a quick stop at the emergency department hoping to have a quick chat with my old buddy whom I haven't seen for a while. We came all the way from med-school days.

Having just returned from a long holiday, you could tell from his skin tone that he'd muck about too long with his scuba stunts.

"Sorry can't talk now bro, I'm busy" Joe looked preoccupied with his patient in the last cubicle. For a man who just came back from holiday he looked like shit.

I shifted my attention to his patient who seemed to be in laboured breathing. The man is in his late 40's. Muscular and tall, rather good looking I suppose. The non-invasive ventilator AKA CPAP covered the centre of his face. The mask snuggled quite nicely to his dark brown beard. The CPAP machine is used to force oxygen pressure into his lungs to help him breath better.

"Hurm asthma, looking pretty bad here, you may need to watch for respiratory fatigue, he may well need to be electively intubated" I told Joe what he already knew.

"Yea yea! We've done all we can for now, but what I really need right now is his family's phone number, coz this guy is too breathless and tired to tell us, and we've been trying to locate his next of kin via his handphone directory" Joe's losing his cool that night.

We looked through the usual method...under each possible alphabet:

W = for wife

I = isteri

A = abang/adik/ayah

etc.. etc .. nothing useful came out.

Moments passed, before it hit me "Joe, try under S"

"Huh for what, superman?"

"Just give it a shot, will ya buddy"

True enough the word SAYANG appeared on the screen. I smiled thinking to myself this patient before us could be the last romantic Malaysian man on earth.

Joe quickly made the call and spoke to a lady who is the wife of this unfortunate chap.

"Ma'am we need to inform you that your husband is ill, his asthma may got worsen and it would be better if you could come to our hospital now"

"Well I really can't come right now, there are lotta things I need to handle at home, with kids and everything, really I can't, doctor just do whatever you can to help him and I'll come by 1st thing tomorrow morning, I promise" she ended the conversation.

Joe looked at me "So much for sayang eh"

"Hurm well maybe she lost a little bit of those sayang through out their years together " I looked at the patient, hoping he didn't hear what his wife said to Joe.

I suppose the last thing the man with 'broken lungs' needed at that time is a broken heart.

Think warm thoughts

The first half of last night on-call was not that bad, the High Dependency Ward was as usual fully occupied. But all of them were pretty much stable, none on inotropic or ventilator support. Couple of cases in the general ward tend to be manageable in the usual manner.

The tone however changed by 12 midnight. The first call came in from Anita the House officer (HO) on call telling me that a patient with a severe stage chronic lung disease secondary from smoking had a poor oxygen saturation monitoring.

I hurried to the patient's room to find him not breathing with no pulse palpable.

"Call the code and push the resus trolley!"

I jumped on him and started CPR. The HO was rather junior and looked quite stunned with the whole commotion, she said she never saw a patient collapsed before.

"That's just great" I thought.

"Don't worry there's always a first time. Grab those gloves and use the ambubag to ventilate him, follow my lead" I tried my best giving her a reassuring smile.

We worked on him for 45 minutes, however unable to revive him. I called the time of death and broke the bad news to his family. They broke down in tears.

**

By 3am I managed to laid down in the on-call room and found myself in a colourful carnival, the sun was bright, it must had been a warm Sunday afternoon. There were lots of balloon and clowns.

At 6.30am got a long-distance phone call which in a way kept me awake till morning, which was absolutely all right since I did not want to go back to sleep anyway. By 8.15am as my shift had ended and I was on my way home, my pager beeped again. There's a patient with a crashing blood pressure. The in-charge doctor in that unit had left and the new shift oncall has yet to arrive.

I made another 200m dashed to the unit and found that the patient was already ventilated to a machine. The cardiac monitor showed a Ventricular Tachycardia, the blood pressure was dropping faster than my idle brain activity could cope with at that time. I ran fingers along his neck and found a pulse.

"Bugger me! There is something on line 15, paragraph 1, page 80 of that little black book that deals with this type of medical emergency" The morning after your on-call is never designed to deal with an emergency situation like this.

BING! BING! Suddenly I felt like someone just sent me an online medical article to my woozy mind, which I hope not from our friendly wikipedia. It became clear then.

"Okay charge the defibrillator machine with synchronisation" I told the nurse.

"Stand back. Clear."

I held the paddles to his chest, gave them a bit of pressure and hit the button.

The patient on the bed jolted as I zapped him with 300J of electical energy sending him back to sinus rhythm.

Less than 5 minutes he went back into VT, but thank God the second cardioversion managed to sustain the heart in sinus rhythm.

That was a close one.

I lost one patient and got back another. Another tiring post call day and all my body craved for this morning is a hot meal and hot shower...

.. and perhaps nice warm thoughts too.

Holding on

Tonight I find my self back in my empty condo. The invincible cats are no longer making noise. It's either they had run away or my neighbours have adopted them for good, feeding them with a make believe Friskies. Lolly, the overweight pooless pink panda has gone asleep. Hope she has a good dream.

The sound of the ceiling fan keep me company for a while. Just enough till the broken clock in my bedroom strikes 11pm.

I suppose nothing in this life is for certain, right? Make use of our existence in a good way. Do not cause harm to others. For all we know is that all despair needs is for good men to do nothing. And I have this sneaky feeling that there is only few good men left in this world.

Good night Lolly.

Different angle

The young man with leukaemia who slept opposite my bed is no longer there this morning, either he has passed on or they have transferred him out to an isolation room sometime late last night.

The old Chinese man in room 1 has definitely moves on to a better place. I made the visual confirmation as I walked passed his room earlier today. Ironically he was pretty much 'alive' and looked well at 12am last night. We exchanged glance and nodded off to each other like any regular Asian gentlemen. He did not exhibit any particular characteristics indicating that he is going to meet his maker (well mine too) anytime soon.

Anyhow, his stiff cold body is now tightly wrapped in a white cloth. You could easily tell which side is up. I am sure rigor mortis had set in for few hours now.

In hospital, your perspectives on life and death are different depending on whether you’re staying as a patient or working as a staff. Your mental and physical fitness offers a different tone to the way you perceive things.

Even though I have seen death so many times before, yet I feel vulnerable this time around. Yes there is a soft glaze of fear in my eyes.

Well, I got to stay in for another few days to complete my antibiotics. Okey I better continue with my work now, I have promised someone that I’ll get busy and get some of that done today.

The patient

The patient is a middle age Malay male who came to the Emergency Department shortly before 9pm. He complained of fever since 5am the same day. By noon his fever became high accompanied with chills and generalised muscle ache and joint pain. By dusk, his sore throat became more evident. He told me that he was otherwise healthy.

The Prof (our respiratory physician), a man in his mid 40's happened to be in the ED that night briefing the ER crew regarding the latest Press Statement made by Tan Sri Ismail Merican on the worsening crisis of H1N1. Prof took one look at the patient in front of me, and quickly said

"We need to admit you because you have Influenza-like illness, but since you have been exposed to a lot of H1N1 patients last week, we can't be too careful."

I arranged for his bloods investigations, chest X-ray the whole lot and sent him to the ward.

I checked back on him 2 hours later and by then he had already received his antibiotics, antiviral and on IV drip.

That's when he asked me, which I thought was strange "So how are you feeling, much better?"

"I dunno... I still have the fever, I guess it's too soon to tell" I replied.

I looked back at the figure who asked me that question, it was actually a lady nurse who came to checked my vital signs and changed my IV fluids. That man had disappeared, and I am the patient after all.

"Houston, we got problem"

Osmivir / Tamiflu - 75mg twice a day

As per yesterday..


1266 cases

47 new cases. All local transmissions.

4 deaths - the latest being a 20 year old woman. She died at her prime.

On the other hand, it's my turn to be in charge of the H1N1 cases in this hospital.

This morning, one of my colleague who's handling H1N1 with me was rushed to the emergency department for cough and shortness of breath.


The enemy is a lot closer than I think before.

Right now I'm staring at them everyday. If anything gonna happen it's gonna be a bloody murder in first degree. It's going to be a point blank shot.


Come to think of it, I can't shake off this headache and mild fever since this morning.


Shit.

Beautiful imperfection

"My wife's been dead two years, Will. And when I think about her, those are the things I think about most. Little idiosyncrasies that only I knew about. Those made her my wife. And she had the goods on me too. Little things I do out of habit. People call these things imperfections Will. But the truth is they are not, and that's the beauty of it" - Good Will Hunting.

"And we get to choose who we're going to let into our weird little worlds. You're not perfect. And let me save you the suspense, this girl you met isn't either. The question is, whether or not you're perfect for each other. You can know everything in the world, but the only way you're findin' that one out is by giving it a shot" - GWH

"Baby, now we are going to check whether you are snoring or you are not, this is the proof. Let's go, follow me" - The angel I met on Baker Street.

***

Yasmin. Thank you.

The story teller

(illustration showing blood clot within brain tissue)

Yasmin Ahmad is admitted for an intracerebral haemorrhage. A not so friendly term for the brain I'm afraid. The bleeding inside the brain could easily displaced the brain tissue creating an oedema (swelling) which could give rise to increasing pressure within the rigid skull. A surgery usually neeed to be done to release some of that pressure. I'm sure the attending doctors are doing cerebral protection aka 'resting her brain from further insult' by keeping her on the ventilator.

I do not know her personally however as far as her work in concern, she's a talented film maker. Some of her stuff are purely classic, educating and catchy in many ways, especially the short ads for TV. A Malaysian story-teller. This is my favourite, when after watching it made me wanna pick up that phone and called my parents.



Yasmin, you get well my friend.

Honour

I don't believe in perfection. But I do want to believe in happiness. At this point of time that happiness seems so distant. All my life I have tried to do the right thing. I've failed before, yes. And I have made several mistakes in my life. I hope that one day I could find that happiness in this life. To have someone that could really like me for what I am, my strengths and my flaws. A woman that could cherish and honour me the way I honour and cherish her presence in my life. That's all I need, a person that I could really trust.

As for now I think the only thing I could do on my part now is to become a better me.

A better man.

Bruised

It's me again, same man, bit older and wiser I hope. Just got back from the no-man's land, all bruised, black and blue. As I said there is no certainty in life, you gonna either end up alone or you could end up meeting someone, fall in love and if you're lucky that person will love you back the same way.

+++

In this regard, you sir! Yes you know who you are and you gave me some solid points back then. Which I just didn't want to listen. So padan muka saya!

I believe that a relationship needs to be nurtured so it could blossom into something meaningful, like everything good in life, it takes time to grow. Alas! Unfortunately it can be ruined by one single night (or two if you like).

You need to respect and trust that person. Fuck everything else, even love is allowed to come later. Those are the basis of a strong partnership. When those are cemented, nothing could shake it not even the the devil or the deep blue sea.

If you cannot trust the one you care, then forget everything else. And when you eventually do stop caring, then the relationship is in deep shit, and when shit hits the fan, even the McD Mozarella dippers gonna be in your top list rather than that person.

Am I preaching..? I hope not. Because I'm not qualified enough to give an intellectual insight on that matter of importance between the two gender. Perhaps I need 4 - 6 breakups before I could write a thesis on "Love and lies: Revisited".

But what I do know, early this morning I found this clip, which I could relate to. But that was before a phone call came through and make me think that after all that had happened, something good may still be possible. Only if you could nurture back the trust and respect.

Oh crap! When I feel much better. I'm gonna take down the clip. That is just my pain doing a puppy face impression.

Iron

I find it easy to engage in some major deep thinking when I'm ironing my shirts. I find the action itself has a calming effect on me despite the hot blazing surface on the other side of the metal in my hand. With every corner and crease of that cloth finely pressed while manouvering it to every crease and pleat my mind would assess every bits of information from every fold of the 34 year old temporal cortex.

This morning, I found myself ironing a lot longer that I had to.

Being that cool man

Once, I told her "I'm going to live in the moments, that I don't want to think too much about how this relationship going to end up in the future."

However, these last 4 weeks taught me that it is easier to utter those words than walking in it.

For the old saying that there is no certainty in life except for death and taxes. I've learned those words like hundred of years ago. But I somehow managed to appreciate the true meaning of it lately. The feeling can be unbearable sometime that I wish I could have a heart made of adamantium. Poor mortal soul like me would never learn his lesson until I got shot in the spleen with thousand of poisonous darts made by Mr Umpa Lumpa from the lost tribe of Inca civilisation.

As much as I wanted to 'turn on my self-defence mode' few days ago, and be that cool man with a half burnt ciggie in my right hand, and proudly announced to my internal organs that the name of the game has changed.

Or has it changed?

She had just left me a couple of hours ago, crossing thousand of miles back to her city. If it is true that the name of the game has changed, how come part of me is now longing for her scent and presence.

I think I can see her now sitting in my balcony looking away.

Dengue fever

She complained of slight fever, followed by muscle and joint ache.

I should have known better.

Those are the signs of the potentially fatal viral illness.

We went to hospital, true enough her platelet counts dropped to 25,000.

"Dear, you have dengue" I uttered the dreadful words.

The next 3 days were some of the 'toughest days' of my life, seeing the one you care about laying in the hospital bed.

4th of July 2009

We had dinner at KL tower. I was looking for a more romantic spot, perhaps a more quiet surrounding. Instead we got a nice asoh who kept coughing every 15 mins next to our table.

The menu was just all right. My taste bud was hungrier for more exotic delicacy, however in the end I realised that all of those were just not as important as her presence there with me. And the scenery, well it was still breathtaking as ever.

Finally, the red box was on the table. She looked surprised. She opened it and smiled.

"I love it. Thank you dear" She smiled.

That was one of the best night of my life.

Hope

6.7 billion world population.

28 million lives in Malaysia.

8 million resides in Klang valley.

What is the chance of meeting, falling for and 'go crazy' toward someone who feels the same way towards you? I'm not here to give the answer. Some questions are best left unanswered. Ignorance is sometime a bliss.

I've found the person I was searching for, if for any reason it doesn't work out. Then I'm out of this game. But by God, before the cupid is shot dead, before the last candle flamed out, before the love in her eyes fade away...

...I would do anything to make it work.

And where's that letter that supposed to arrive 3 weeks ago. I need it very badly.

Please

Please don't go.

The one that slipped away

The 48 year old man was ill.

He was admitted with fever, cough and productive sputum.

Within 24 hours of ward admission, his condition deteriorated. At 45 breath per minute and dropping in conscious level, we knew he's not gonna make it without a ventilator (breathing support).

We had to intubate him before he deteriorated even further. By Friday nightfall he's already on triple heart-supporting (inotropic) drugs. The chest infection looked rampant at that stage. His prognosis was rather gloomy. I was on call that night, and by 5am we began the 4th inotrope.

"Shit, things doesn't look good. Nurse Maria, could you please call his wife and children, I need to break them the bad news"

Two hours later, as I was telling them his grave condition and that his likelihood for survival is looking thin, I saw his heart beat went flatline on the cardiac monitor.

"Damn!" I cursed silently.

I quickly asked the family to wait outside. We called the code and worked on him for 40 mins. Sounds of adrenaline ampoules broke the silence.

"Come on, stay with us... stay with us" I heard someone whispered those words to my ears... only to find that person was me.

A nurse recited the Shahadah to his ears while the rest of us working on him.

We couldn't revived him. At that point of time I like to believe that God loves him best.

As I told the family afterward, the wife broke into silent tears.

***

Update:

Yesterday we got our country's first case of positive H1N1 transmission.

22 cases.

A global pandemic.

We are at war with another microorganism.

The important thing is to remain calm.

(and yes avoid overcrowded place and sneeze into your tissue)

Observation

Learning medicine is similar like learning other disciplines - it's a lifelong process. An old axiom says "Learn one, do one and teach one". Much alike the master-apprenticeship style of learning. Having said that, you don't have much time when it comes to formal training in post-grad world. Only four years, and then you're on your own most of the time.

If you are lucky you could end up in a big tertiary hospital where you could do curbside consult on the way to cafeteria by asking your say... buddy cardiologist about some puzzling 'heart' case that came in last night.

Interesting cases mostly come in through clinic, where patients come in for follow up. The rarer the case is the more doctors will gather to observe and learn.

The trick however is not to stare, coz it is rude

... a simple observation will do :)

Old warrior

Good bye old friends.

You've been there for me through thick and thin.

Through those busy- busy on call nights (or those lonely nights too).

Now the time has come for you to retire.

Rest well.

A chocolaty affair

I was 10 minutes late for clinic that day. Instead of seeing patients, I found myself queuing up at the hospital convenient store buying a chocolate bar. Ever since London, I developed craving for chocolate bars. God knows why. As I grabbed a 90g Cadbury's Roasted Almond at the counter a whole lines of other chocolate bars fell onto the ground.

"Oh mak kau!! chocolate is good!" A lady of early 50's behind me melatah, loudly.

I smiled to myself and told her that it's okay and she can jump my queue because it's gonna take me a while to pick up those bars.

"It's okay I'll wait. So doctors also eat chocolate eh?" I supposed she wanted to be friendly by asking innocent questions.

"Yes but not always. Sometimes, it's not good for health y'know" I was kneeling on the floor while looking up and smiling at her. I thought this is just perfect all I need now is an engagement ring.

"So how often is considered as okay?" Gee.. this lady is persistent with her questions.

"Like everyday." I laughed out a bit while paying the cashier.

Then I realised that neither she nor the row of people who apparently had been listening to our conversation behind her get my joke. They were all looking at me with a semi-puzzled look blended with seriousness.

Suddenly I felt like being put on a spotlight - the crowd were waiting for my professional answer on how much is considered as a safe level chocolate consumption.

At that moment the only thing I can come up with was...

..."Actually my friend's is pregnant and this is for her.. err she's craving for chocolate. Bye!"

(gulp)

Always

As I'm sitting in the dark living room. I ponder on what had happened in my life. She's everything in my life. My best friend, loved one. My pure source of joy in this world. And it causes me a great sense of agony to know that the last thing that I've made her to feel is pain. And the last feeling that she has for me is hatred. Help me God. Help me take this pain away.

There's not much I could do about the past. I can't help thinking about the future though. What kind of life would I have. Thirty years from now... would I be another old man with a bitter soul dreaming about the one that got away. The one that got away? Have I ever truly had her in the first place. I don't know. But what I do know is perhaps... if I have treated her as good as I should have things might have ended differently. For I know, one thing will forever stays true, that she will always be on my mind.

Maybe I didn't love you
Quite as often as I could have
Maybe I didn't treat you
Quite as good as I should have
If I made you feel second best
Girl I'm sorry I have blind

You were always on my mind
You were always on my mind

Maybe I didn't hold you
All those lonely, lonely times
I guess I never told you
I'm so happy that you're mine

Little things I should have said and done
I just never took the time

You were always on my mind
You were always on my mind

Tell me, tell me that your
Sweet love hasn't died
And give me
Give me one more chance
To keep you satisfied
I keep you satisfied

Little things I should have
Said and done
I just never took the time

You were always on my mind
You were always on my mind

.......

I never thought that someone could ever touched my heart the way she does.

I never thought that I could ever be so madly be in love with someone.

This morning the sun disappears.

No light, no joy in the skies.

And i found my self fall again, harder than before.

And as i typed these words down.....

....numbness engulfed me....as i broke into tears.. i guess i forgot how fast these boys can flow.

...

at 3o's sthing of my life, I found another way of disappointing others and myself.

can't even look at the mirror in front of me.

I'm sorry

Have I taken the beautiful things in my life for granted?

To begin with, beautiful things does not always happen to a punk like me. So my attitude has been in a constant sense of gratitude whenever something nice happen. I would treasure it.

But human do make mistakes. And I had done something really bad, a mistake that beyond any reasonable doubt could cost me the one I love.

I have hurt the one I treasure most. As the sun breaks the sky early this morning I felt as though as a little fairy sat on my shoulder and said "You gotta stop doing these things, and pull your acts together or you gonna end up losing her, do not make promises that you cannot deliver".

So on my way to the hospital later in the morning, I tried putting myself in her shoes. Trying to feel what it must have felt like to be on the receiving end. What I felt was something distant yet familiar. Something that I haven't felt for a long time since last year.

"Boy, Tinkerbell.. you are right after all, for I am nothing but an ungrateful fool".

An empty street in Jericho

"Dear, I don't think there is a canal up front, looks like a dead end" She looked both confident and mesmerising at the same time.

"Hmm yes hun, you could be right, maybe the bartender gave us the wrong direction..

...but I like it here, come to think of it this is much better than some canal...

... I would probably remember this better than any other places we had been to" I looked back at her. She was standing there underneath the Oxford sun with a late-spring breeze gently kissing her long hair.

I tried to take a mental picture of her in that moment. Worrying that I might forget the whole detail, I quickly grab my trusty camera and took a snap.


"What? This street?" She took a sip of her hot mochaccino. There's a big black stain on the top of her white dress.

"Yes dear... you, me and an empty street in Jericho." I grinned.

For a moment, I thought I could see her eyes gleaming beyond those dark sunnies.

***

Many weeks later I found out that such canal exist.


Still, I don't feel like I miss one single darn thing. Because all that matters to me is that she was there with me.


I sometime do ask myself one thing though "Does that street in Jericho still exist? or does it simply cease to exist because we are not there anymore?"

Comfort

The 50's year-old man has been sleeping along the corridor for many nights now. His wife has been ill for many weeks at home and by the time they seek medical advice the diagnosis which came back as lymphoma, has spread badly.

Upon sunset, the rest of his family member would return home. However not wanting to be apart from the person he loves all his life. I supposed it is logical for him to stay close to his wife. Preparing himself emotionally for the inevitability. The fact that he is not allowed to stay 'over the night' inside the female ward, does not deter his feeling. He finally found comfort on the floor.

What a similarity... Just like that floor, life could be both hard and cold sometimes.

Remote

Today I found myself behind the steering wheel. Unable to decide my destination. The sun was scorching hot burning the plants in the courtyard. That however did not seem to bother a couple of teenagers from playing basketball.

Once, she asked me how do we know whether we are in love with that particular person. I answered, it's how that person make us feel about our existence and place in this world. With that she gave me the most beautiful smile that I cannot possibly forget for the rest of my life.


Finally, I locked the car, went back into my apartment and drew down the curtains in my bedroom.


Not long afterward I found myself walking along a remote beach. Unable to feel the heartache deep inside my soul.