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.