29 March 2009

Memory lane No 1

Back in winter 1999, somewhere in a remote area, an old huge hospital stood grandly on top of a green-hill next to a 6 acre park.

A pimple-ridden medical student was all eager in doing his first ever ward round with a group of housemen, registrars and consultant. The team stopped by a patient who was looking rather breathless on oxygen support ventimask 24%.

"So Malaysian lad! What do you know about Chronic obstructive airway disease" Professor James Conaglen a 68 year old medical consultant took off his reading glasses and gave his infamous cold icy stare toward the rather innocently-looking medstudent.

With his clean crisp white coat the 6' 5' giant easily towered everybody else in the team physically & emotionally so to speak.

"Well sir, the disease is characterised by (bla bla) in which (yada yada) and last but not least, the treatment would include ( badabim bada bush)." in one confident single breath.

"Boy, humor me for a while here will ya, did you find yourself constipated this morning?" Conaglen grew a nasty-looking smirk at the corner of his lips.

"Err not really, why would you asked that?" the young man smelled something was bloody rotten in the state of Denmark.

(drum roll...)

"Because son, I think you are full of shit." He laughed away, savouring his golden moments.

Funny, after all these years. That's the only thing that I could remember from his teaching round (except of course the case of a 50 year old bloated lady who farted every 5 minutes).


Btw folks, Earth Hour was here at 8.30pm last night. All the wards including the ICU have pledged its full support and were all excited in joining the mass effort in saving our world energy.

Or is that really what's going on? - any brave conspiracy theorist out there?

"Yippie kayeeeee mother-earth!!"

26 March 2009

Farewell to stranger

"Life is shorter than you could imagine. Better make full use of it. Don't just sit on your chair whining about how bad life is treating you" He uttered those words slowly yet in a steady strong manner.

I could tell that it was one of his good days, the time when the pain was not that bad and he could breathed normally, sipped his tea while throwing some random advice at me while I looked at his pain-relief chart. Nothing could take 'chatty personality' away from a man. Not even cancer.

The old man was diagnosed with pancreatic cancer few weeks before I met him. One of the most painful entity ever known to mankind. Though the dull intermittent pain could be ease down with regular doses of morphine. Still at time he would jolted and whimpered in agony due to what we call 'breakthrough pain'.

His wife died many years ago and his only child was living abroad but often came home to visit him. A stubborn man he was, he insisted to stay on in Malaysia, believing that one should die on the same land as one were born. Well fortunately he had a maid to help him manage those final months of his life.

He passed away almost 4 years ago, in his sleep. Just few weeks before his 70th birthday.

"I have regrets y'know. Few of them, but I've lived my life to the fullest. The only thing I wish for is to have my wife here with me - even for a few second..."

"... I just wanna look at her one last time before I pass on".

He smiled gracefully.

23 March 2009

A tale of two heroes

I've always thought that the man who stood in front of that tank on that fateful day was one brave soul who stood his ground in the name of democracy.

However I had forgotten that there was another man in the equation, the one who was inside the belly of the iron beast.

The tank driver could easily be court marshalled by the army for not driving his tank forward. I suppose a direct violation of his superior's order would spell death by firing squad (... okay maybe not but what the heck - i'm such a helpless romantic fool when it comes to tales of bravery & courage).

Instead the man inside the tank made his stand on that day too. A universal truth proclaimes that it is not easy to take another man's life.

(especially if that man was only armed with 2 TESCO grocery bags)

21 March 2009

Passive on call

6pm - Call from respiratory team, they just saw a patient with suspected TB meningitis. They've started the anti-TB meds. Somehow still wanna do CT brain with contrast, and if no hydrocephalus. They want me to proceed with lumbar puncture (LP) . Yeah right in middle of night. Like that gonna change any management for the night. Come on guys, I despise your sense of humour.

7pm: A 43y male with acute myeloid leaukaemia M4 on HIDAC regime developed rash and facial flush. No laryngospasm. Lungs clear. No anaphylactic shock. Discussed with hematologist. IV hydrocort 200mg IV with IV piriton 10mg. Stay cool.

8pm: 54 y male with Wallenberg syndrome a week ago now had his BP skyrocketed to 200/100 while on 3 anti-hypertensive meds. I started him on IV GTN 5 mcg/min. Let bring the baby down slowly.

1opm: The guy who need LP had multifocal infarct shown on the CT brain, looks like an innocent by-stander. Vital signs stable. Anyway, as much as I 'wanted' to do the LP. His relatives were not around to sign the 'informed consent' form. Damn it - looks like tomorrow's job then.

11pm: Got call from standard 6's classmates. They wanna have quick reunion. So had few drinks and dinner in front of the hospital.

12.30am: Zzzzzz

630am: Fresh saturday. Were I'm oncall last night?

17 March 2009

Tough love

"I guess there is no other option" I'm telling myself aloud, also with a faint hope that Kelvin my new gym buddy got a few brighter ideas between his ears.

The iron bar felt as cold as ice and would had yelped if it were alive as I held it tight within my grip.

"I know this is gonna hurt you more than you gonna hurt her" There's 70% tone of empathy in his voice, and I swore that the other 30% has a slight humorous hint in it. I'm gonna kick him in the arse afterward. But as for now, first thing first.

I raised the devil up in the air aiming at my car's right rear window. My baby is looking helplessly at me. Kelvin took a few step away, maybe he didn't want to end up chewing pieces of tinted glass tonight.

The chilly night wind blowing mercilessly. Time stood still.

"Well here goes nothing.. I'm sorry dear" the bar made a 'swoosh' sound as I swing it down and made a direct hit on the window.


"What the...??" Kelvin mumbled some R18 words.
We both look at each other, amazed at what had just happened.

12 March 2009

Checkmate (shah mate = the king is dead)

I bumped into my best buddy from UKM matriculation days. So we took a trip down the memory lane over a quick dinner. Which mainly revolved around good old days, old flames and other long lost friends. We were quite close and had entered 2- 3 chess tournaments back in our glory years.

That somehow rejuvenate my interest in chess. I haven't played it for a while, reason mostly I got no-one in my circle whom enjoy the game or let alone plays it. Most of them who own a set would hide it somewhere underneath the staircase.

Fate had it that last weekend I stumbled across a poster at a local KFC outlet saying "Chess (catur) games this sunday at 2pm, join us and have some fun". I said to myself "why not.. this is too perfect to be a coincident". Thus with that in mind I felt the spirits of legendary chess players such as Bobby Fisher, Boris Spasky, Kasparov and Emmanuel Lasker had re-entered by body once again. The time has come for me to return back from my premature retirement.

I was the first to arrive, followed by other players who came and sat at the other table. So I said to myself this is just perfect... small number of players, small event (too small in fact). Just a couple of rounds to get it off my system and I'll have a merry weekend.

And finally they brought the box and to my surprise (I had bit too much of those this week)...

"What the....(toot!)... a local 'monopoly-wannabe gameboard!!" I shouted silently to my good ear. Oh come on guys, are you saying that when the brilliant mind whom invented this new game, suddenly ran out of ideas on what to name it. So I smiled politely and left.

Back in my bat-dungeon, I decided not to be disheartened by that mild hiccup. If I can't find a decent game in my own neighbourhood. I might as well cross the Pacific. And that was how I met my 2 new friends, from Nashville and New Jersey. I got few good opening moves and brilliant middle games.. up till the chess.com online server got disconnected, twice.

Well.. whadayaknow, nothing is perfect.. not even a clear blue sunday sky.

08 March 2009


What should have been quite a quite on call yesterday had turned 180 degrees into 'the battle for internal jugular vein' by midnoon. Not since the Japs surprised the Yankee navy armada in a remote Pacific naval base called Pearl Harbour, has human history witnessed the kind of shock and awe I get when I found out that I had to perform an elective internal jugular vein catheterisation on a warm Saturday afternoon, for a what supposed to be a regular haemodialyis.

Despite a massive radar support via an ultrasound machine, the vein seem to shy away from my 16 gauge needle.

Thank God I didn't hear any 'popping sound', the last thing I want on my bloody hands today is an iatrogenic pneumothorax, bilaterally.

Have I renewed my medical practice insurance policy? Gulp!

06 March 2009


I was called up to see a late referral at 1am the other night. The surgical had messed up this one pretty good. What started as an upper abdominal pain was seen and dismissed because per rectal examination was omitted and it's only late at night when someone realised that the haemoglobin had dropped from 10 to 6 g/dl.

Intravascular volume depletion is the name of the game and they managed to do some damaged control by pumped in multiple bags of pack cell transfusion and colloid drip to stabilise the blood pressure and planned for an urgent scope.

I arrived at the scene and almost had a heart attack when I saw the patient in the most unimaginable state. I could almost here the sound of 'exorcist' music tune played in the background.

"Hey don't look at me, that uncle like it that way" Ganesh the surgical MO gave me the defensive look.

"Well just tell him that fashion is so 70's, plus be careful of what you wish, coz you might get it" I gave him a dry smirk.

After completed my assessment I fixed my eyes on Ganesh "Here's the scoop buddy, urine's is kinda slow here but that's because he's dry, don't worry he's non-acidotic and potassium in normal. You fix the tummy and pour in the blood, once the bleeder is caught, his hydration and kidney would behave like a good boy".

As I walked out of the ward, I heard Ganesh's spoke over the phone to the scope room "Okey guys we're going in!"

I smiled. That somewhat sounds familiar.