Laughter the best medicine?

LEARNING ORTHOPAEDIC THE MALAYSIAN WAY

2011-07-24T05:25:00.000-07:00

Looks like the open fracture has been fixed with external fixation, but yet malunion still persists...

(Pic courtesy of Dr. LJ)

MALAYSIA BOOK OF RECORDS

2011-07-24T05:19:00.000-07:00

Apparently the oldest living person in the world is from Sarawak...

(Pic courtesy of Dr. LJ of SGH)

CRIME SCENE INVESTIGATION

2011-07-09T03:52:00.001-07:00

The oncologist was discussing with his trainee about a paediatric patient with a particular brain tumour who needed a certain radiotherapy treatment.

Oncologist: Have you seen CSI? (refering to craniospinal irradiation)

Trainee: Which episode?

Oncologist: ???

MISSING GLASS EYE

2011-07-09T03:47:00.000-07:00

This was posted on the notice board outside the medical school library. I wonder who is the poor student who lost his/ her glass eye.

MODERN RADIOTHERAPY USING DEAD CHICKEN

2011-07-09T03:09:00.000-07:00

The Urology & Oncology Departments of University Malaya Medical Centre have a combined clinic every Friday to discuss urology cancer cases such as prostate cancer, renal cell carcinoma & so on. During one particular combined clinic, the Urology Professor was telling his medical student about a patient with prostate cancer who was being referred to the oncologist for radiotherapy.

Urology Prof: This patient is going to have IMRT

Medical student: (shocked) Ayam mati????

Oncology doctors: (pengsan!)

*IMRT stands for intensity modulated radiation therapy, a modern radiotherapy technique where the intensity of radiation can be modified to deliver high dose radiation to tumour while sparing adjacent normal tissues.

YOU KNOW YOU'RE GETTING OLDER WHEN...

2010-11-26T18:23:00.000-08:00

Scenario One....at radiotherapy review session

Patient: (who is in his twenties) doctor, are you married?
Doctor: (this boy really got nerves, does he know how old I am?)
Patient: Doctor, if you're not married yet, maybe you can consider my uncle

Scenario Two....at clinic counter

Doctor: (receiving a parcel from a despatch boy) ok lepas sign kat sini, apa lagi kena tulis?
Despatch boy: Kalau doktor muda lagi, I akan mintak phone number...tapi tak payah lah

Scenario Three....at another ward to see a referral

Doctor: (searching for a middle aged malay lady in bed 23....but noticed that it is an elderly Chinese lady occupying the bed)
Doctor: (went to ward counter & asked the clerk) mana patient XYZ yang sepatutnya berada di katil 23?
Clerk: Mana ada, doktor? Memang patient ABC yang duduk katil 23. Ward ni takde patient nama XYZ...
Doctor: Is this Ward 7C?
Clerk: Ini Ward 6C la

Sleepless in UM

2010-11-04T20:43:00.000-07:00

A drug rep turned friend recently asked me about my blog over lunch. He said I haven't been active in here lately. Well, at least he didn't say that my blog is full of cobwebs. Anyhow, I decided to just drop a few lines. Weird things have been happening to me and around me lately that I thought maybe the ghost month hasn't ended yet.

Came to office on a weekend to do some paper work and noticed all my patients' files were missing from my room
Couldn't leave office after work is done because a bulldozer was blocking my car
Couldn't get an urgent MRI (magnetic resonance imaging) eventhough it was urgently needed and patient was willing to pay the extra charges
Heard noices outside the oncall room at night but nurses said there was no one around
Oncalls are becoming more and more "jonah" with unexpected things happening
A medical officer calling a support staff weirdo (I do not condone to this of course)
A support staff calling a registrar the most troublesome person she's (the support staff) ever met (WTH)

and the list goes on....

My friend will probably freak out reading this and will never ever ask me to update my blog again, haha...

6 weeks appointment

2010-09-10T19:17:00.000-07:00

Usually appointment is given 6/52 (6 weeks) after radiotherapy for doctor to review. I suppose this is a special case where patient is required to return after 6 weeks to review the doctor.

now hospital also got ah long

2010-09-05T02:58:00.000-07:00

(This notice was found in a hospital compound somewhere in East Malaysia)

practise what you preach

2010-09-05T02:49:00.000-07:00

My friend, a physician, was counselling a patient with chronic alcoholic liver disease to stop drinking alcohol during one of her weekend rounds. At the end of the counselling, while my friend was walking away from the patient's bed, she realised that she was wearing a t-shirt similar to that in the photo above...

Leftie for a day

2010-09-02T01:18:00.000-07:00

Since young, I've always like to look at people who are left-handed. They are unique & mysterious & tend to be very artistic. Secretly I wished that I was left-handed. My wish came true on Monday when I injured my right wrist while driving back from a friend's house after dinner the previous night.

It felt like something "snapped" suddenly, only that I didn't actually hear any "snapping" sound. There was sharp shooting pain at the wrist, radiating to the elbow & fingers. I manage to drive home that night & to work the next day, using mainly my left hand as any pressure to the right side brought back the sharp shooting pain.

At work, I had problem writing prescriptions & on patients' case notes. Therefore I had to resort to using my left hand, even when examining patients. It sure felt weird & awkward to examine patients using left hand, including a per rectal examination!

The pain subsided the next day without any pain killers or anti-inflammatories. But there is still a dull ache on & off....perhaps it is time for another role reversal. Let's see....which Orthopedic colleague should I bug?

a great achievement

2010-08-26T22:33:00.000-07:00

Got this on facebook (from Dr. LJ of SGH)

Had a patient with difficulty passing motion because of immobilisation due to back pain. So we started him on pain relief, lactulose and bisacodyl. Some days later, patient got better and it was obviously reflected in the House Officer's entry:

"Yay! Patient can finally BO."

*BO= bowel open

HOW TO SULK

2010-08-14T09:05:00.000-07:00

Sulking is emotional strike action. You still function as a human being but you work to rule. You must never agree to anything, you must only ever acquiesce to things. When someone asks if they should put the kettle on, the correct answer is, "If that's what you want do to." That's because the underlying message for all sulking is that deep hurt is being felt because the other person is utterly selfish.

The big dilemma with sulking is whether you should slope off to another room and do it. Remember that out of sight is out of mind, and they might forget that you're in a mountainous sulk. The best solution is to stay in the same room but pretend other people are not there.

Eye contact is a big no-no for sulkers for two reasons: firstly, no eye contact is the clearest possible sign that a major sulk is under way; secondly, if someone were to do anything funny or loving and you were to see it, you might inadvertently smile and the sulk would be irreparably damaged. It's a cast-iron rule that once you've unsulked you can't then resulk. It's like frozen food - once you've defrosted you can't then refrost.

Sulks can last anywhere between seven minutes and seven years. Teenagers are in an almost perpetual sulk because they are in a continual state of being misunderstood. When people are in a sulk they discover how much harder everyone else has to work to humour them. Some people enjoy this so much that they decide to become permanently grumpy.

The sulk, like the trifle, is a peculiarly British thing. That's because it's the form of emotional expression for people who don't know how to express themselves. The sulk says, "I can't express myself, so I'm not going to express anything and you'll just have to guess what I would have expressed had I been able to express what I wanted to express."

The sulkee then has to decide their response to the sulker. Ignoring the sulk is like ignoring the laundry basket - it'll keep building up until it gets very unpleasant indeed. What's generally required to end a sulk is a mixture of complete attention, physical reassurance, brief subjection to verbal sarcasm, and then major admission of guilt and selfishness.

As the air clears it's absolutely vital not to say, "That was a big sulk, wasn't it?" This is the quickest possible way of launching the world's largest, longest and deepest sulk.

(Adapted from The Guardian, Saturday 16 March 2002)

Doktor Adik

2010-08-13T19:18:00.000-07:00

While most Chinese aunties think I'm in my 20's, one particular patient (a 16 year old boy) at my old hospital actually thought I was younger than him! I grew up watching the series Doogie Howser MD but I didn't think my young patient is old enough to have watched that show.

I knew something was amiss when during ward rounds he kept addressing himself as "abang" and called me "adik", but because I was his doctor, I became "Doktor Adik".

He was finishing chemo when I left the hospital & I never got to tell him that doktor adik is actually doktor kakak. But I guess some truths are better left unknown :)

anywhere also can

2010-08-13T06:24:00.001-07:00

when there is no parking, anywhere also can...

Reversed role

2010-08-06T20:40:00.000-07:00

I was feeling awfully sick last weekend. Urrgh, I hate it when the role is reversed, ie when I become a patient. I don't know what I salah makan that caused this bad AGE (acute gastroenteritis). It was unlike the usual AGE that I get (abdominal pain, diarrhoea), this time there was also athralgia, myalgia & fever that made me totally debilitated. ECOG performance status was down to 3 (in bed > 50% of the day).

I had no appetite to eat at all, even the smell of food made me feel nauseated. Took MC on Monday but went back to work on Tuesday. Thank God I recovered pretty quickly with regular Paracetamol & plenty of fluids. Appetite is now back to normal, but not sure if that's a good thing or not :)

how old are you doctor: another deja vu

2010-07-30T23:36:00.000-07:00

Chinese aunties just love to ask this question. Years ago, I would have felt offended, but I think I'm getting used to it now. In fact, I enjoy seeing the surprised look on their face (eyes open wide & jaw drop) when I say that I'm in my mid-30's.

Most of them guess that I'm in my mid to late 20's. Not bad. I take that as compliment...and I would always flatter them back by saying that they too look more youthful than their actual age. It's part of doctor-patient bonding :)

I'M NOT OKAY: A DEJA VU

2010-07-30T23:02:00.000-07:00

Although I work at UOK (unit onkologi klinikal), I'm not okay. I dread going to work everyday. Don't get me wrong, I love my job, but I just can't stand the cold environment in my department.

Some ENT doctors describe allergic rhinitis as hell on earth. I know exactly what they mean, especially if I've forgotten to use my steroid spray in the morning.

Because of the cold, my fingers were also discoloured on a few occasions (raynaud's phenomenon) & not to mention the constant urge to eat something. In a way, I miss the "south pole" which is warm & hot...

Sperm Banking

2010-07-15T01:22:00.000-07:00

A colleague of mine was trying to arrange for sperm banking for a young man who was due to start on chemotherapy for testicular germ cell tumour. Since the service is not available at our centre, she called another hospital to find out.

Doctor: Hello, selamat pagi...

Operator: Hello, selamat pagi, Hospital XYZ, boleh saya bantu?

Doctor: Boleh sambung ke Sperm Banking?

Operator: Sorry, sini hospital, bukan bank...

SURVIVAL OF THE FITTEST - THE DANIEL'S THEORY

2010-07-02T19:53:00.000-07:00

The selection of candidates for next year's Masters in Clinical Oncology will be somewhat different.

Those who resemble Deborah Henry or Amber Chia will be exempted from interview.

Those who don't will have to undergo an endurance test in the jungle, on top of a very academic oriented interview. They will need to spend 24 hours in the jungle without food, water or extra clothing. By midnight, one senior will be assigned to release the tigers & another will be responsible to get the pythons. If majority still survives till morning, more tigers & pythons will be brought in. Those who can come out of the test in one piece will be accepted into the programme.

How am I supposed to come out

2010-07-02T19:49:00.000-07:00

4F's revisited

2010-07-02T19:15:00.000-07:00

It is almost like a deja vu, though it has been almost 3 years since I last worked here...

FAR

The parking woes seem to be a never ending story. It has gotten a lot worse in fact, with all the construction going on. I force myself to come early every morning, to get a good parking place nearer the department (because I am just too lazy to walk).

While I manage to avoid the daily morning walk, problem arises when it is time to go home (sigh....)

* see picture later

FREEZER
(This is the worse part of the 4F's)

I kinda miss the hot environment in HKL. I really dislike the cold. I don't know how I managed to survive in New Zealand, but I'm definitely not surviving well at the moment. Room 7 & 8 in the clinic are a nightmare. On the few occasions that I sat there, my fingertips actually turned red & swollen (raynaud's phenomenon) & I could not write properly on patient's case notes...so the other reason why I come early to work is to 'book' a clinic room that is less cold.

FLOODED
Haven't seen this one yet so far...

FADED

There is no change from 3 years ago, especially since the Law faculty is still next door (their building is always bright & colorful)...while the Medical faculty is grey & gloomy.

EAR WHAT ??

2010-07-02T07:34:00.000-07:00

Has anyone heard of or actually tried ear candling?

This topic (ear candling) was presented at our hospital's CME (continuing medical education) this week. Apparently it is a form of alternative medicine where a hollow candle is placed into the external auditory meatus (ear canal) with the other end lit up. It is said to have originated from the Hopi tribe in North America (if I heard correctly).

Practitioners of ear candling claim that it can cure many illnesses/ ailments, among those mentioned during the CME:

(1) Chronic sinusitis (for some reason, my colleagues looked at me when this was mentioned)
(2) Ear wax
(3) General well being
(4) Purify the mind (it was then my turn to look at them)
(5) etc
(6) etc

But please do not try this at home, as there isn't any scientific basis or evidence of benefit. In fact, it may be hazardous to one's health or even cause damage to the ear canal or tympanic membrane (ear drum).

SAWANG

2010-06-27T16:47:00.000-07:00

A friend sms-ed me last night, asking me when am I going to update my blog. She says that my blog "dah bersawang" (which means full of cobwebs wor...)

Well, the thing is I've just moved to a new centre, nothing fun or funny has happpened yet. So full stop for now.

To be continued later...

COMMUNICATION BREAKDOWN III

2010-06-01T18:41:00.001-07:00

A medical officer from another department was in our ward to see a patient.

Nurse: Can I help you, doctor?

Doctor: Plastic

(referring to his department & that he is there to see a referral)

Nurse: (disappeared into the treatment room & re-appeared a moment later with a yellow biohazard plastic bag)

Multipurpose Japanese Green Tea Bag

2010-06-01T18:18:00.001-07:00

I was taking a Japanese Green Tea Bag to the pantry. Got spotted by a nurse and she asked me, "Dr.Lee, what you doing with that condom?"

(Dr. Lee, SGH)

Hours before Datin's visit

2010-06-01T18:01:00.000-07:00

Minutes after Datin's visit

2010-06-01T08:19:00.000-07:00

A NEW IMAGING TECHNIQUE?

2010-06-01T08:04:00.000-07:00

WHERE ART THOU

2010-06-01T08:00:00.001-07:00

If the Radiologist Of The Day is not in the Radiology Complex, then where is he/ she?

When you're faced with a stressful situation everyday...

2010-06-01T07:53:00.000-07:00

(pail isn't for chemo induced vomiting, but to collect water dripping from aircond/ ceiling)

Nothing beats a cup of hot milo prepared by a caring nurse...

2010-06-01T07:40:00.001-07:00

I LOVE THIS DOCTOR

2010-05-30T19:48:00.000-07:00

Q: Doctor, I've heard that cardiovascular exercise can prolong life. is this true?

A: Your heart is only good for so many beats, and that's it... don't waste them on exercise. Everything wears out eventually. Speeding up your heart will not make you live longer; that's like saying you can extend the life of your car by driving it faster. Want to live longer? Take a nap.

Q: Should I cut down on meat and eat more fruits and vegetables?

A: You must grasp logistical efficiencies. What does a cow eat? Hay and corn. And what are these? Vegetables. So a steak is nothing more than an efficient mechanism of delivering vegetables to your system. Need grain? Eat chicken. Beef is also a good source of field grass (green leafy vegetable). And a pork chop can give you 100% of your recommended daily allowance of vegetable products.

Q: Should I reduce my alcohol intake?

A: No, not at all. Wine is made from fruit. Brandy is distilled wine, that means they take the water out of the fruity bit so you get even more of the goodness that way. Beer is also made out of grain. Bottoms up!

Q: How can I calculate my body/fat ratio?

A: Well, if you have a body and you have fat, your ratio is one to one. If you have two bodies, your ratio is two to one, etc.

Q: What are some of the advantages of participating in a regular exercise program?
A: Can't think of a single one, sorry. My philosophy is: No Pain...Good!

Q: Aren't fried foods bad for you?
A: YOU'RE NOT LISTENING!!! ..... Foods are fried these days in vegetable oil. In fact, they're permeated in it. How could getting more vegetables be bad for you?

Q: Will sit-ups help prevent me from getting a little soft around the middle?
A: Definitely not! When you exercise a muscle, it gets bigger. You should only be doing sit-ups if you want a bigger stomach.

Q: Is chocolate bad for me?

A: Are you crazy? HELLO? Cocoa beans! Another vegetable!!! It's the best feel-good food around!

Q: Is swimming good for your figure?
A: If swimming is good for your figure, explain whales to me.

Q: Is getting in-shape important for my lifestyle?
A: Hey! 'Round' is a shape!

Well, I hope this has cleared up any misconceptions you may have had about food and diets. And remember: 'Life should NOT be a journey to the grave with the intention of arriving safely in an attractive and well preserved body, but rather to skid in sideways - Chardonnay in one hand - chocolate in the other - body thoroughly used up, totally worn out and screaming 'WOO HOO, What a Ride' And For those of you who watch what you eat, here's the final word on nutrition and health. It's a relief to know the truth after all those conflicting nutritional studies.

1. The Japanese eat very little fat and suffer fewer heart attacks than Americans.

2. The Mexicans eat a lot of fat and suffer fewer heart attacks than Americans.

3. The Chinese drink very little red wine and suffer fewer heart attacks than Americans.

4. The Italians drink a lot of red wine and suffer fewer heart attacks than Americans.

5. The Germans drink a lot of beers and eat lots of sausages and fats and suffer fewer heart attacks than Americans.

CONCLUSION: Eat and drink what you like. Speaking English is apparently what kills you.

(Got this from my Aunt, on email)

NO MOUNTAIN TOO HIGH

2010-05-27T19:12:00.000-07:00

April & May 2010 had been the most horrendous months in my life. Working and preparing for my final exam at the same time had proved to be both physically & mentally demanding, especially when I was placed in a centre notoriously known for its heavy work load.

Just before the exam, I had already lost 3 kilos (over the period of 2 months). I was eating quite a bit during my on-off study break, so I was wondering where all the food went. My weight was down to below 40 kilos on 2 previous postings at this centre. So this time around I was trying my best not to lose too much. For someone who weighs around 43kg on average, to lose even a few kilos, I would look cachexic.

The first component of the exam was the COQ (case oriented questions). That was quite alright, although there were minor hiccups (as one of my consultants had put it) here & there. Question number 3 was a radiotherapy planning question on cancer of the maxillary antrum. Most of the candidates were seen touching & feeling their cheeks, with one candidate even measuring her cheek with a ruler. It would have been a nightmare for the invigilator if the question was related to some other body parts.

MCQ (multiple choice questions) was the tough one, partly if not wholly, because of the negative marking. One candidate took 2 Paracetamol before going in for the paper. I came out of the exam hall with a stiff neck & also had to pop in 2 Paracetamol. During the night, most candidates had difficulty sleeping. One watched Korean soap opera till wee hours in the morning & another drove out to the Mamak shop for a drink. We are now able to laugh at ourselves, but the stress that we felt at that time was just overwhelming.

The final 2 components (ie. Clinical & Viva) were held 2 weeks after the written. By 21st May, everything was all over. It felt like a huge mountain was being lifted from my shoulders. I went back to work the next day (Saturday) & did 3 calls (2 active calls & 1 passive) over a duration of 4 days. That was a pretty un-human thing to do, but thankfully I managed to survive. I have now lost another 2 kilos, so yes, I do look cachexic.

It is now time to repair the sublethal damage & reoxygenate…

COLLEAGUES FROM PARADISE

2010-05-27T19:04:00.000-07:00

Knocks frantically on the oncall room door at 7 o’clock in the morning when you are getting ready for work. The knocking becomes louder & louder, & when you finally open the door, your colleague says to you, “Oh, ingat you masih tidur lagi.” (Reason for knocking on the door: need to use the toilet)
Comes to your ward holding a piece of A4 size paper, when you are doing rounds/ procedure/ resuscitating patient. The colleague watches you as you are doing your work & then when you are finally done, he/ she passes you the piece of paper (borang cuti) for you to sign.
Leaves undergarment on the oncall room sofa. You cover the item with some old newspaper but can’t sleep very well in the night as you keep having the image in your mind.
Calls you at 10 o'clock at night using hospital phone (so that you would pick up) & asks you to cover him/ her the following day as he/ she needs to go to the bank. (Reason: kad ATM patah)

Sunatinib: the way to go

2009-12-08T05:02:00.000-08:00

A drug representative from a particular company was promoting her product to us recently (a targeted therapy for the treatment of renal cell carcinoma & gastrointestinal stromal tumour).

"Targeted therapy is the way to go from now," she said.

If Sunitinib is the targeted therapy for the above mentioned malignancies, perhaps Muslim children in the future can just take a similar kind of drug & avoid going through the anguish of circumcision?

New specialties

2009-12-07T21:27:00.000-08:00

Coverlogist: a doctor who covers people on a daily basis (ie. colleagues who are on frequent MC or EL)

Locumologist: an underpaid doctor who does locuming after working hours

Paktologist: a casanova doctor who is caught courting a nurse at the back stairway of the hospital building

GHKL: free promo

2009-12-07T21:17:00.000-08:00

Welcome to the Gym of HKL: no need to pay a single cent, in fact you get paid for all the workout, weight loss guaranteed.

Triceps, biceps, abs: CPR on patients
Power grip: winding patient's bed up & down
Step reebok: going up & down the staircase
Blood circulation: walking from ward to ward, clinic etc
Weight loss diet: oncall food

IS THAT A GREEN WORM IN THE SINK?

2009-10-26T01:34:00.000-07:00

IT'S CACING PITA

2009-10-26T01:07:00.000-07:00

HEAD & NECK CT

2009-10-02T22:39:00.000-07:00

A colleague of mine was preparing for a presentation on head & neck tumours. He was searching for CT scan images on the internet & came upon the image shown above. The anatomy seemed rather peculiar, very odd in fact (unlike normal adult anatomy). It wasn't too long before my friend realised that he was in a veterinary website & the image he was looking at actually belonged to a german shepherd.

BACK TO SOUTH POLE

2009-09-29T17:07:00.000-07:00

Will be returning to the "south pole" aka "mad house" aka "hell of KL" in 2 months time, but am already feeling the stress & tension.

The only good thing about going there is that we can lose weight easily without doing exercise, as work is so hectic that there is no time to sit down & have proper meals. On my previous 2 rotations there, my weight was down to 38kg. But I have since gained back the weight that I lost.

My colleagues & I were discussing yesterday & we concluded that we'd rather be "fatter" than to go back to the "mad house"...

DARK AGES

2009-09-27T22:51:00.000-07:00

When I arrived at work this morning, I saw my staff bringing 2 torchlights to my consultation room. Curious, I asked, "Why need 2? 1 is enough lah...I don't need 2 torchlights to look at patients' throat."

The reply I got?

"Doctor, these are not for looking at patients' throat. The light in your consultation room is out."

US of A?

2009-09-24T20:24:00.000-07:00

I normally have my morning drink at the clinic while waiting for our clinic assistants to sort out files for patients scheduled for the day. I can't help smiling to myself one particular morning when I overheard the following conversation between the 2 clinic assistants:

CA1 (much older but new to the department): akak rasa patient ni takkan datang klinik hari ni pasal dia dah pergi Amerika..

CA2 (younger but has been in the department much longer): macam mana akak tau patient ni pergi Amerika?

CA1: tu...ada orang tulis kat file patient "pergi US"

CA2: ohhh.....yang tu bukan lah....pergi US maksudnya....pergi UltraSound

ABOUT SEVENTH SENSE & FOUL WORDS

2009-09-21T22:57:00.000-07:00

6 September 2009: Day 7 of passive call

12am:

A&E MO called...there is a private wing patient who needs admission..

Advised the MO to call the private wing (as I'm oncall for non-private patients only)

12.20am:

Can't fall asleep

Got a feeling the A&E MO will call me back & tell me there is problem admitting the patient to the private wing

12.30am:

The A&E MO called back...

Private wing not accepting patients after hours

12.40am:

Drove to hospital

12.45am - 2am:

Attended to the very ill patient

Informed poor prognosis to family

Instructed night staff nurse what to do

2.30am:

Drove home

Got a very bad feeling patient won't last the night

5.20am:

Staff nurse called

Patient succumbed to illness

5.30am:

Drove back to hospital to certify the death

Parked at carpark nearest to my department

(designated to admin staff actually but usually empty after hours & on weekends as they don't come in for work)

7am:

Ward round at male & female wards

9.30am:

Did discharges (online computer system)

10am:

Computer crahsed on me

Discharges (including 1 with long standing history & prolonged admission) all gone

!!?$^&*#@

10.30am:

Staff nurse asked: macam mana doktor, nak buat lagi ke? tapi computer masih crash lagi

10.35am:

Decided to just go home

While walking to the carpark, got an extremely bad feeling that my car might be clamped

(coz it happened once before)

10.40am:

Noticed an odd looking yellow metal crap at one of my front tyres

!!?!@!#@

Called the security office immediately

11am:

Waiting for security to come & unclamp my car

Took photos of the other 2 unclamped cars nearby (with stickers similar to mine, indicating that they belong to doctors)

11.15am:

Security guard came (without key)

Was told I need to go to their office to settle some paperwork & bayar saman

?!!!!$%^&#

11.20am:

Refused to go

Refused to pay

11.30am:

Security guard went to get key

Second warning issued

!!?!?@!!#

12pm:

Arrived home

GCS (Glasgow coma scale) 3/15

Prayed hard no one calls me till 8am the next day

FEMALE BRAIN

2009-09-21T22:37:00.000-07:00

A friend recently commented that she's been studying for the last 25 years. Wah...that long meh? 2 & a half decades, that's crazy. Well, that was my initial response. But when I thought about it again, ohmigod...I have also been studying for the same amount of years.

I recently dreamt something pertaining to thyroid, after I read about thyroid cancer. In the dream, I was giving advice to a friend who came to my hospital for a thyroid problem. It didn't surprise me though, as I often dream about things that I encounter at work or things that I read. But it does appear that my brain still actively works even when I'm asleep. No wonder it is difficult to get up in the morning...

Today, I'm reading about brain tumours. I was searching the internet for some info & stumbled upon this....

A man went to the doctor's. The doctor came in and said, "Well, I've got some good news and some bad news."

The patient sighed, "Okay, give me the bad news first."
"The bad news is that you have an inoperable brain tumor."

The patient looked very grave, and asked, "And what are the good news, anything to help me with the brain tumor?"

"The good news is our hospital has just been certified to do brain transplants and there has been an accident right out front and a young couple was killed and you can have which ever brain you like. The man's brain is $100,000.00 and the woman's brain is $30,000.00."

"I'm glad to hear there's something you can do to help me," the man replied, "But, out of curiousity, why is there such a big difference in the price of male and female brain?"

The doctor replied, "The female brain is used."

CLINIC JOKES

2009-07-31T23:37:00.000-07:00

A cardiothoracic surgeon is married to a neurosurgeon for many years but childless. They sought help at the fertility clinic. The problem was soon identified: they are so busy that the only time they meet each other is at the fertility clinic.
A trauma surgeon had been so busy in the hospital all this while, trying to save lives even in wee hours of the morning, that he did not know what to do after retirement. He was heard saying this to an ex-colleague: it's only me & my wife at home, I really don't know what to do.

IT’S WRITTEN ON YOUR FOREHEAD

2009-07-31T23:31:00.000-07:00

It's my habit to browse through patients' files to get a rough idea of their background, illness and latest blood tests or imaging studies, before calling them in to the consultation room. This is my encounter with a patient whom I saw for the first time:

Patient: (entering the consultation room) Good morning, doctor...

Doctor: Good morning, teacher...(smile)

Patient: (shocked & turned pale) How do you know I'm a teacher?

Doctor: It's stated in your file..

Patient: (so relieved) Ohh...I thought I have the "teacher look"

Doctor: (LOL)

NINETY NINE

2009-06-11T16:59:00.000-07:00

Recently I went to another ward to see a patient who was referred to Oncology. When I arrived, the patient (an 80 over year old Chinese aunty who speaks only Cantonese) was being examined by a medical student, in the presence of 2 other medical students & their clinical tutor.

Medical student: (listening to patient's chest) Aunty, breath in & out...

Patient: (staring blankly at medical student, obviously not following the command)

Medical student: Aunty, say 99

Patient: (same as above)

Medical student: Aunty! Say 99

Patient: (still same as above)

Medical student: (shaking her head & turning to clinical tutor) Patient not co-operative

TOP 10 REASONS FOR EMERGENCY LEAVE

2009-05-28T01:33:00.000-07:00

Maid ran away
Train new maid
New maid ran away
Kad ATM patah, need to go to bank
Grandmother died (for the third time this year)
Ran over a cat, need to send car to carwash (to remove evidence)
Tap burst, house flooded
Kad ATM baru sudah ready, need to go to bank again
Car window jammed, can't wind up
Maid came back, pregnant

Some are genuine, some are not. Obviously some are made up by me.

No. 6 happened to me last year...I ran over a cat in front of the Emergency Department on my way to work on a Saturday (passive call). But I sent my car to the carwash only after I have finished my ward rounds. It took me a week to recover from the trauma of killing a cat in this manner.

No. 9 also happened to me on new year's eve of 2008. It was early in the morning when I had just arrived at the hospital gate. I did not take emergency leave but sent my car to the workshop for repair & then came back to work as usual. That was definitely a reminder that my "milo tin" (kancil) is getting old & need to be replaced in the near future...

ROLE REVERSAL - AHHHCHOOO

2009-05-28T00:53:00.000-07:00

I have had allergic rhinitis for as long as I can remember, usually triggered by

Dust

Pollen

Cold

Hot/ stuffy environment

Most of the time, the symptoms are short-lived. But it has recently gotten worse, partly due to stress at work & partly due to my neighbour who smokes like a chimney.

There are 4 areas at my workplace that I cannot stand:

Ward (too hot)

Clinic (dusty air-cond)

Radiotherapy planning room (too cold)

Oncall room (dusty air-cond again)

That will be like.....my entire department! Prevention is better than cure, but I can't be not going to work, right?

Went to see the ENT specialist & had scope done (ahhhchooo). I dread having any foreign body in my airways as it will always trigger a reaction. I still remember sneezing whole day after having nasal swabs taken from both my nostrils before my trainee internship (final year) in Waikato Hospital in New Zealand. I had no choice as it was compulsory for all final year students.

Anyway, I am now being diagnosed as having severe allergic rhinitis associated with severe bilateral turbinate hypertrophy (the ENT doc calls it "kissing turbinates"). The pic shows only 1 of the enlarged turbinates.

The symptoms are better with nasal steroid spray & anti-histamine, but the turbinates are still "kissing" each other. To put it crudely, it's like having 2 marbles stucked in the nose :p

I have been advised to have the "marbles" removed for long term relief.

MERDEKA FOR NOW

2009-05-28T00:28:00.000-07:00

I'm finally out of the "south pole" after 6 gruelling months. Will be putting up a few delayed posts.

SOUTH POLE

2008-11-27T19:09:00.002-08:00

I’m completing my attachment at the current hospital & will be going to Hospital Kuala Lumpur (aka HKL aka Hell of KL) for the next 6 months. Based on previous experience, I would probably, most likely, not see sunlight throughout that period of time (ie go to work before sunrise & come home after sunset). A friend asked where am I going, where there is no sunlight? South pole??

Well, I don’t have to go that far. The place is just in KL. I don’t actually mind not seeing sunlight, not that I love the sun very much. But to work 36 hours a day is no joke (there are actually many other “Iron Ladies” in the country besides Tan Sri Rafidah Aziz). Mr. Liow says we are allowed to go home after 24 hours? We’ll see if that’s possible & I’ll be the happiest person…

In the meantime, I’ll have to “hibernate” from internet again. Sayonora for now. Will be back once I get to see the sunlight again.

CREATIVE PATIENT II

2008-11-27T19:09:00.001-08:00

My colleague showed me this poem written by one of the patients whom we are treating:

Tiap-tiap penyakit ada ubat
Carilah seberapa cepat
Jangan lewat jangan lambat
Di Hospital UKM ada tempat

Malam tidur siang jaga
Makan atau minum ada selera
Staf-staf baik belaka
Ramai kawan sungguh gembira

Layanan staf-staf saya hargai
Banyak nasihat yang diberi
Tanpa bayar hanya pri
Betapa senang rasa di hati

ROLE REVERSAL III – BUYING MC

2008-11-27T19:04:00.000-08:00

I felt sick two Wednesdays ago. It was kind of like a sudden onset thing. I mean, I was totally okay the day before, except for feeling a bit tired & sleepy. I was with the rest of the team (specialists, medical officers, nurses) at grand ward round when I started feeling feverish & having joint pain. I tried to ignore the symptoms till the end of the ward round, but it just got worse after that. I developed chills & rigors with some rashes on my upper limbs.

My diagnosis was viral fever. Had my FBC (full blood count) checked. Haemoglobin & platelet count were within normal range, but TWC (total white cell) was slightly raised. I thought that was peculiar, as bacterial infection would cause TWC to go up, not viral. But at least the platelet count was normal. I don’t mean to be paranoid, but living in a condo where people come to do fogging every fortnightly, I have to think of dengue fever as a differential diagnosis.

I still went to work the next day. I thought I’d be okay with regular paracetamol & increased fluid intake. Afterall, viral illnesses are self-limiting. But before I even started work, I felt sick again, with uncontrollable chills & rigors. I was already on 3 layers of baju & got the staff nurse to get me extra blanket. My symptoms subsided later in the day, with paracetamol & I actually managed to work full day.

I could prescribe medicine & order investigation for myself but I couldn’t sign my own MC. Neither could my colleagues & I couldn’t go to the Staff Clinic because I’m not a hospital staff (I’m just doing attachment). So I’m left with no other choice but to “buy” MC from the nearest GP clinic the following day.

At the clinic, the doc found out that my throat was injected & I was still having fever at 38.1°C. It came as a surprise to me as I did not have any symptoms of sore throat or cough. But it made sense, as bacterial throat infection causes white cell count to up & fever with chills & rigors is possible. I was given a course of anitibiotic & MC for the day.

Upset that my initial diagnosis was wrong, I checked my throat upon reaching home. It was really swollen & looked almost obliterated (gasp). I took my medicine diligently & recovered in no time.

FORMER MP, NOW PRESIDENT

2008-11-27T18:59:00.000-08:00

Patient: Doctor, you’re very cute lah

Doctor: (smile)

Patient: You remind me of someone…

Doctor: Who?

Patient: You remind me of…Gloria Arroyo

Doctor: (Gasp. Not another Filipino)

*Refer to “8th Wonder of the world” (Sept 2008) & “Mistaken Identity” (April 2007)

PROTECTIVE GEAR

2008-11-17T00:08:00.000-08:00

Last month, I saw an old Chinese aunty (who was previously treated for breast cancer) in clinic, who came for her follow-up visit. She was clad in a very nice looking ‘samfu’ (Chinese traditional wear). Clinical breast examination is mandatory, so I instructed the patient to undress. I noticed that she was having great difficulty in doing so & decided to help. Only then I realised that at every level of the buttons, there were actually 2 types (besides the typical “hook & eye”, there was also the “push button” type). I was so curious that I just had to ask:

Me: Aunty, why do you wear this kind of baju when you know that you’re coming to see doctor?

Aunty: I purposely one…

Me: Huh? Why?

Aunty (sheepishly): Hehe…I thought if doctor see I got difficulty, doctor will say, aiyah nevermind lah, no need to examine lah...

Me: (pengsan)

ONCALL SYNDROME : SIGNS & SYMPTOMS

2008-11-09T17:17:00.000-08:00

Periorbital oedema (from lack of sleep)
Acne vulgaris (due to lack of sleep & emotional stress)
Low back pain (from doing CPR)
Abrasion wound (sustained while climbing onto patient’s bed to do CPR)
Athralgia, myalgia (from physical stress & hospital acquired organisms)
Altered sensorium & hallucinations (from lack of sleep/ rest)
Epigastric pain & heartburn (lack of food)
Xerostomia, angular stomatitis & dysphagia (lack of fluid)
PTSD (post-traumatic stress disorder) – from running over a cat & killing it instantly on the way to work, in front of the Emergency Department

EASY WHAT

2008-11-09T17:05:00.000-08:00

My colleague, Dr. L, saw a young man (let’s call him Mr. X) with a particular tumour who had to undergo chemotherapy. The patient was advised to go for sperm banking as treatment & the disease itself could result in infertility. After making the appropriate arrangments, my colleague updated our specialist about it:

Dr. L : I’ve already referred Mr. X to the Fertility Clinic for sperm banking, but I’m not sure how they’re gonna do it… (referring to the process of registration, counselling session & so on)

Specialist : Easy only what…they just need to give patient some magazines & a bottle

NOT ENOUGH

2008-11-07T00:39:00.000-08:00

Seems like micropore's not enough, need elastoplast...stronger...

MULTI PURPOSE

2008-10-28T01:28:00.000-07:00

I still remember how we used to carry micropore plaster & torniquet around as housemen (especially in O&G posting) for IV (intravenous) line setting. Recently I found out another use of the micropore...

STILL DOWN

2008-10-28T01:22:00.001-07:00

Everything seems to be down lately, not just the computer system...

THANK YOU FOR CALLING

2008-10-22T18:11:00.000-07:00

Hello and thank you for calling The State Mental Hospital.
Please select from the following options menu:
If you are obsessive-compulsive, press 1 repeatedly.
If you are co-dependent, please ask someone to press 2 for you.
If you have multiple personalities, press 3, 4, 5 and 6.
If you are paranoid, we know who you are and what you want, stay on the line so we can trace your call.
If you are delusional, press 7 and your call will be forwarded to the Mother Ship.
If you are schizophrenic, listen carefully and a little voice will tell You which number to press.
If you are manic-depressive, hang up. It doesn't matter which number you press, nothing will make you happy anyway.
If you are dyslexic, press 9-6-9-6.
If you are bipolar, please leave a message after the beep or before the beep or after the beep. But Please wait for the beep.
If you have short-term memory loss, press 9.
If you have short-term memory loss, press 9.
If you have short-term memory loss, press 9.
If you have low self-esteem, please hang up. Our operators are too busy to talk with you.
If you are menopausal, put the gun down, hang up, turn on the fan, lie down and cry. You won't be crazy forever.
If you are blonde, don't press any buttons. You'll just mess it up.

(Courtesy of Dr. LJ)

INTERESTING SIGNS

2008-10-22T18:05:00.000-07:00

Sign over a Gynecologist's Office:
'Dr. Jones, at your cervix.'
--------------------------------------------

In a Podiatrist's office:
'Time wounds all heels.'
--------------------------------------------

On a Maternity Room door:
'Push.. Push. Push.'
--------------------------------------------

At an Optometrist's Office:
'If you don't see what you're looking for,
you've come to the right place.'
--------------------------------------------

*Got this on the email (from Dr. LJ of SGH Kuching)

ALWAYS DOWN

2008-10-15T00:46:00.000-07:00

I saw patients in the dark (well, not totally in the dark lah, but 2 out of 4 fluorescent lights in my consultation room were out) for the last 2 days. Computer system is still down. Probably needs viagra. As for myself, I think I need patience & anger management course...

WHY LAH?

2008-10-12T17:02:00.001-07:00

We change duty every month as part of our training. So this month I’m no longer in the clinic, but covering the chemotherapy daycare. If you thought the lack of soap in the clinic was bad enough, the consultation room at the daycare doesn’t even have a sink & obviously no soap. Every time after I examine a patient, I have to pop over to the nearest toilet to wash my hands. There is minimal soap there & no tissue. Patience is indeed a virtue.

To add salt to wound, the computer system has been down for more than a week now. As a result, I have been unable to trace patients’ blood results or view images (x-rays, CT scans, MRI etc) & this really hinders my job. Patients are obviously unhappy.

Patient 1 : How is my blood test?
Doctor: I’m sorry, I can’t seem to get it on the computer

Patient 2: What does my CT scan show?
Doctor: Hmm…sorry, I can’t get the images on the computer

Patient 1: Why like this?
Patient 2: How come like that?
Doctor: I also don’t know lah, have to ask Mr. Liow

WHAT'S THAT?

2008-10-12T16:57:00.000-07:00

I was a refered a case from the Orthopaedic Ward during my recent oncall. The patient (we shall call her Mdm X) was an elderly lady with breast cancer & metastasis to the spine with cord compression. The symptom of lower limb weakness (as a result of spinal cord compression) had been present for about 2 months, but there is no total paralysis yet. So the neurological deficit may still be reversible (either with high dose steroid, radiotherapy or even surgery). After reviewing Mdm X, I wrote down my plan in the her folder:

1) Continue analgesia
2) Worthwhile to start Dexa
3) To discuss with Oncologist about radiotherapy
etc

Shortly after I left the ward, the Orthopaedic staff nurse (SN) called me on my handphone:

SN: Doctor tadi review Mdm X kan?

Me: Uh-huh…

SN: Dalam plan, nombor satu, continue analgesia, yang tu saya faham…tapi nombor dua, worthwhile to start Dexa…apa itu worthwhile?

* Analgesia means pain relief
* Dexa is short for Dexamethasone, which is a steroid

MEMOIRS OF AN ONCALL DOCTOR - TGIS

2008-10-12T16:56:00.000-07:00

People told me it was going to be very quiet in the ward during Hari Raya, as everybody “balik kampung” during the festive season. But it was not to be. I broke the tradition by filling up the ward with multiple admissions from the A&E (accident & emergency). I used to just get some “sprinkle” of my housemate’s “Jonah-ness”, but I think this time around, it’s the Jonah Hurricane.

Day: 6 out of 7

8.00am
Drive to work
Ward round at Male & Female Wards

10.30am
Finish ward round
Paper work
Phone rings

A&E MO: Eh, you’re oncall again?

Me: Yup

A&E MO: I thought you were oncall yesterday…& the day before yesterday…&…

Me: We’re oncall the whole week, Monday to Sunday

A&E MO: Wah…tak pengsan ke?

Me: (Memang nak pengsan lah ni)

A&E MO: By the way, I have another case to refer...

11.00am
Clerk in the new case
Can’t view blood results & x-ray images on computer – system down
Problems arise in the ward
Attend to problems

12.30pm
Feeling extremely hungry
Food court & canteen both close (for Hari Raya)
Drive out to nearest restaurant (which happens to be KFC)

12.45pm
Queue up at KFC
Many customers
Only 1 counter open

1.00pm
My turn to order
Phone rings
Staff nurse needs me in the ward
Take away festive combo (damn hungry)

1.20pm
Settle problem in the ward
Go to car (to drive home & eat)
Phone rings
Staff nurse needs me again in the ward

1.40pm
Drive home
Have lunch
Lie down for a while, exhausted

3.00pm
Phone rings

Help is needed in the ward

6.30pm
Settle problem in the ward
Go home for dinner

8.00pm
Phone rings
Staff nurse needs advice

10.00pm
Go to bed

10.30pm
Phone rings
Staff nurse needs advice

1.20am
Phone rings
A&E MO needs advice

3.00am
Phone rings
Staff nurse needs advice

5.00am
Phone rings
Staff nurse needs advice

6.30am
Alarm clock rings
Thank God it’s Sunday (ie. last day oncall)
Hand over pager 8am Monday

CREATIVE PATIENT

2008-09-29T20:14:00.000-07:00

My colleague got this as a hari raya gift from her 70 plus year old patient, who hand made the 2 peacocks herself (from used cans). So sweet...

HOSPITAL TERMINOLOGY II

2008-09-21T17:09:00.000-07:00

Jonah (refer to “Oncall Teruk- The Sequel”)
A doctor who is so very busy during his or her oncall duty. Things tend to happen (one after another) that one can’t even imagine. My housemate, L, is by far the most jonah person I know. Colleagues & other staff think that the “mandi bunga” cannot work anymore. What L needs to do now is to take the next available flight to Thailand to pray at all the Buddha statues there.

Celebrity
A famous doctor who has been to space, done modelling, ventured into restaurant business & so on & so forth. His name was suggested as the guest of honour for a breast cancer awareness campaign, since he had done wonders for cervical cancer. The ambassador for breast & cervical cancers is preferably an individual who poccess both organs, but it doesn’t really matter since the main objective is to attract women of all ages to participate.

8TH WONDER OF THE WORLD

2008-09-21T17:07:00.000-07:00

Being a doctor in the government sector has never been a bed of roses or a stroll in the park, but rather a bed of “duris” & a fall (with abrasions & laceration wounds) in the drain. The “sabun” episode may seem trivial, but it sure does add salt to wound. Sometimes I wonder how I managed to survive this 8 years. That’s why there is a need for laughter otherwise kepala will pecah. Funny questions/ comments from patients (usually old aunties & uncles) sometimes just brightens up the day.

Patient 1
Patient: Doctor, are you from here (refering to Malaysia)?

Doctor: Nope, I’m not from here (refering to KL)

Patient: Ohh…I thought so…are you Filipino?

Doctor: (Gasp) Do I look or sound like a Filipino?

Patient: Filipinos speak good English

Doctor: (……and Malaysians don’t?)

Patient 2
Doctor: Good morning, Aunty (in Mandarin)

Patient: Oh, good…you’re the first Chinese doctor I meet at this hospital. I can’t really understand Malay & I have many doubts about my illness

Doctor: (Explaining in great detail about breast cancer in Mandarin)

Patient: Wah…doctor, how did you learn all those medical terms in Mandarin?

Doctor: Oh, I learn from patients…and nurses

Patient: I thought you're from China

Doctor: (This is the first time someone has said that. My Mandarin must have improved tremendously over the years…an OCBC no more)

Patient 3
Patient: (who came with husband) Doctor, you look very young. How old are you if you don’t mind me asking?

Doctor: Why don’t you take a guess?

Husband: Must be 20 plus

Patient: Where got 20 plus, aiyah you ah. Doctor in specialty can’t be 20 plus only lah. Must be 30 plus already lah…

Doctor: (Wife smarter than husband)

Patient 4
Patient: Doctor, are you mixed?

Doctor: No, I’m pure Chinese

Patient: Really? But you look like mixed…like those actress in the TV

Doctor: (head reached the ceiling already)

* OCBC stands for “Orang Cina Bukan Cina”

SINCE WHEN HOSPITAL GOT CHICKEN?

2008-09-17T23:12:00.002-07:00

(Pic courtesy of Dr. LJ)

LUX & PALMOLIVE

2008-09-17T23:12:00.000-07:00

Date: 2 days before Malaysia's 51st Merdeka Day
Venue: Doctor's consultation room

I was frantically looking for soap (to wash my hands) after examining a patient's backside (with gloves on, of course) but to no avail. This is roughly the conversation between one of the clinic staff & me:

Me: Kenapa tak ada sabun?

Staff: Memang tak ada sabun. Bilik 2nd bos pun tak ada. Hanya bilik big bos (refering to our head of department) saja ada...

Me: Habis tu, macam mana nak cuci tangan?

Staff: Kena bawak sabun sendiri. Dr. N (who is a colleague of mine) pun bawak sabun dia sendiri

Me: (pengsan)

BANK ROBBERY

2008-09-10T20:41:00.000-07:00

This is just too funny not to share. Got it on my email.

Excerpted from an article which appeared in the Dublin Times about a bankrobbery. Once inside the bank shortly after midnight, their efforts at disabling the security system got underway immediately. The robbers, who expected to find one or two large safes filled with cash & valuables, were surprised to see hundreds of smaller safes throughout the bank. The robbers cracked the first safe's combination, and inside they found only a small bowl of vanilla pudding. As recorded on the bank's audio tape system, one robber said, "At least we'll have a bit to eat. "The robbers opened up a second safe, and it also contained nothing but vanilla pudding. The process continued until all safes were opened. They did not find one pound sterling, a diamond, or an ounce of gold. Instead, all the safes contained covered bowls of pudding. Disappointed, the robbers made a quiet exit, each leaving with nothing more than a queasy, uncomfortably full stomach.

Next day, the newspaper headline read:

IRELAND'S LARGEST SPERM BANK ROBBED

WARD ROUND/ CLINIC JOKES

2008-08-19T17:31:00.000-07:00

Our PM used to wear batik a lot, but now he prefers jeans.

We are expecting a change of government soon... from 3M (started from Tun M's time) to 1 'S'

One can go to space & come back as an orthopaedic surgeon, no need to take exam.

PAST MEDICAL HISTORY

2008-08-11T22:29:00.002-07:00

My recent “role reversal” reminded me of the times that I had been a patient, since my Day 1 of life:

I was born a tiny baby, with periorbital oedema (swollen eyes). Doctors thought I had congenital liver disease. So, as a neonate, I was already subjected to blood tests & investigations. So kesian hor. Results were all negative of course, as the periorbital oedema turns out to be a ‘trademark’ that stayed till this very day. It becomes obvious when I don’t have a good night sleep (best example: post-call)

I come from an atopic family. I had my first asthma attack at the age of 3. My respiratory tract is tremendously super-sensitive. I have had infections from the top to the bottom (ie. from upper respiratory tract infections to bronchitis to pneumonia). My greatest enemies are dust & pollens. I was a regular patient at the local hospital, that the nurses there actually gave me an “accolade” (ie. the girl who takes Piriton like taking rice). Piriton (or Chlorpheniramine) is an anti-histamine which can be used for runny nose, allergic rhinitis or any allergic reaction. When I was studying in New Zealand, I dreaded spring the most, as pollens would be flying everywhere. My record was sneezing non-stop 30 times. (Of course I didn’t count lah, a very empathetic friend of mine did.)

My second greatest enemies are dogs. I was bitten by my neighbour’s dog when I was in Primary 4. Received 4 stitches. The scars are now still visible on my right shin. I remember wailing on top of my lungs when the MA (medical assistant) at the Queen E Hospital did the T&S (toilet & suturing). While my classmates treated me like a ‘princess’ (they carried my bag, bought food for me & I didn’t have to do any duty during recess), my PE (physical education) teacher wasn’t so kind. I had a “D” on my report card, with the comment “cannot run, cannot do long jump”.

It is never fun doing PR (per rectal) examination on patients, but at least I can tell them exactly how they are going to feel during the procedure. I fell (from height) & landed on my bum at the Outward Bound School, when I was 14. Suffered an anal tear (ouch!) & presented to the paediatrician with fresh PR bleed (eek!). The rest is history.

FOLLOW UP APPOINTMENT

2008-08-11T22:27:00.000-07:00

I went for my follow up dental appointment on Saturday. I wished I didn’t have to go, but I didn’t want to be a non-compliant patient/ defaulter. Spent almost an hour & a half on what I call the “electric chair”. The dentist gave me LA before he started drilling & digging deep into the root canal of my affected tooth. Although there wasn’t any pain, I could feel the amount of pressure the dentist applied. It felt as if my oral cavity was the bonnet of a car & the dentist a mechanic trying to fix a defective component of the car engine.

I felt pain after the LA weaned off & had to take analgesics again.

It is no fun being a patient.

WHAT’S IN A NAME

2008-08-10T19:36:00.000-07:00

Pic didn't turn out so well. It's the microbiology report of a patient whose tracheal aspirate was sent to the lab for culture & sensitivity. Note that the name of the doctor who ordered the test is underlined in red (which reads Dr. Trachea). It could be a typing error, but it sure reminds me of a Dr. Vena whom I have referred a case to before. If I can remember correctly, it was a Nephrology referral. It would have been interesting if it were a vascular case.

(Pic courtesy of Dr. LJ of SGH, Kuching)

ONCALL HANGUS

2008-08-07T01:09:00.000-07:00

This is worse than oncall teruk...

(Pic courtesy of Dr. LJ of SGH, Kuching)

ROLE REVERSAL II – A PRETTY HORRIFIC EXPERIENCE

2008-08-04T00:10:00.000-07:00

It was almost like a deja vu, but not quite. I started having toothache last Tuesday. It was a dull nagging pain initially, which I tried to ignore (again). Not surprisingly, it got worse the next day & affected my sleep. My cheek on the affected side was a little swollen & I felt feverish. I decided to consult a dentist at my hospital.

I first called up the Dental Clinic. The staff who picked up my call advised me to go to the Staff Clinic, which has an ‘in-house’ dentist. Unfortunately, I was not allowed to register at the Staff Clinic because I’m not their staff (I’m only doing a 6 month attachment at the hospital). Okay fine. The next thing I did was to go back to the Dental Clinic. I was willing to pay as a private patient, but again I was not allowed to do so as I’m actually a staff. What the ****

I was losing my patience already & decided to contact one of the dentists personally. I told her my problem over the phone. She sounded quite alright. Since the toothache was troubling me quite a bit, she advised me to start taking antibiotic (Augmentin) & pain killers first before she attempts to do anything. It would be too sensitive for her to examine or do any procedure at that point in time. That seemed like quite a reasonable approach. I was also advised to do an x-ray of the troubled tooth & its adjacent counterparts.

As a very compliant patient, I did exactly as I was told. The dentist said she would look at the x-ray & let me know later via her dental assistant (DA). She said perhaps she could see me in 2 days time. Meanwhile, I should continue on my antibiotic & analgesics.

The dull nagging pain then became a more severe throbbing pain which not just affected my sleep, but my meals & my work too. Naturally, I tried to get back to the dentist. She was busy, so I spoke to the dental assistant. She said her boss’s appointment list is full for the next 2 weeks & I can only see her after 2 weeks. 2 weeks? The gods must be crazy.

(This is roughly the conversation between me & the dental assistant)

Me: Can you please tell the dentist that the pain is getting worse & it is affecting my work? (I was then put on hold for a while)

DA: Dentist say if you want MC, just come over to Dental Clinic & she will give you MC

Me: Then what about the x-ray? What did the dentist say about my x-ray?

DA: Dentist saw the x-ray. Didin’t say anything

Me: 2 weeks is too long, can’t you give me an earlier appointment? (put on hold again)

DA: Dentist will see you next week, Tuesday, earliest appointment

That night (Thursday), the throbbing pain got worse & I actually went in to the hospital for ‘a shot in the arm’ (intramuscular Tramadol). That was the only parenteral (injection) analgesic available in the ward. The jab was superb, my pain subsided very quickly & there was no more throbbing. But at the same time, I also became drowsy quite fast. This is a side effect of Tramadol, which is an opioid (as mentioned in my original “Role Reversal” post)

I slept on & off till the next morning. Took a cab (was still a bit woozy so decided not to drive) to a private dental clinic. The Dentist was fully booked from morning till evening (which was good & bad). Good because the number of patients usually indicates the doctor’s skill & bad because I might have to come back the next day or find another dentist. But something which I wrote (or declared rather) on the registration form made them offer to slot me in between their pre-booked patients (ie. Occupation: Doctor)

An x-ray was repeated & showed a small abscess at the apical region- not at the same tooth, but the one adjacent to it. I wasn’t surprised or in denial, unlike before. I had sort of expected this when I started having the pain. But of course, I can’t help asking why me?

Like I said in my old post, I’m an obsessive-compulsive teeth brusher, who does it so many times a day. Some people I know brush only once a day & nothing of this sort happen to them. Isn’t that so unfair? My mum said maybe it is because I brush so many times that I get this problem.

I spent the next 1 hour on the dentist’s chair (which sounds nearly as dreadful as the electric chair). LA (local anasthesia) was given to numb my jaw before the dentist did his job in drilling, digging & draining my diseased tooth. I was put on a pair of dark glasses throughout the session so that I didn’t have to see what the dentist & his assistant were doing to my oral cavity. I thought that was a brilliant idea, on the dentist’s part. I burnt a hole in my pocket for the procedure, x-ray & consultation fee, but I left the clinic a satisfied patient.

Back at home, I continued taking my antibiotic & pain killers (namely Paracetamol, Voltaren & Tramadol – but not all at the same time, milder one first & slowly go up the analgesic ladder).

While the dental problem is almost solved (follow-up appointment is in one week’s time), another problem arose. The day after my visit to the dentist, I developed generalised body rash with pruritus (itchiness) which was most likely a delayed allergic reaction. I think I fit snugly into the description of a ‘high risk patient’ (see “Hospital Terminology” post). Fortunately, the symptoms subsided slowly with anti-histamine from my housemate, who was already prepared to send me to the ED (emergency department) if I had started wheezing.

I do not know what caused the the allergic reaction. It couldn’t be Augmentin as I had been taking it for many days. In fact, I had the same antibiotic, on top of Metronidazole (Flagyl) during the first episode. It could be Tramadol but Voltaren is more likely the culprit.

The last time I had an allergic reaction was to a type of alcohol, about 2 years ago when I was still in Kuching. I had pruritic rashes & asthma attack, where I sought treatment at the ED of my old hospital. In New Zealand, where I drank alcohol only on social occasions, I only experienced rashes but no wheezing. After the episode in Kuching, I had stayed away from all types of alcohol. Maybe that’s a good thing.

Anyway, what puzzles me now is that I never had any allergies to medication in the past. I had taken Ponstan before for dysmenorrhoea (period pain) & Voltaren is from the same family. Oh well…I guess life isn’t interesting if there are no events once in a while…

HOSPITAL TERMINOLOGY

2008-08-04T00:02:00.000-07:00

VIP & VVIP
(Not those driving big cars like Mercedez or BMW or Perdana, these are very & very very irritating patients)

I don’t mind if patients like to ask a lot of questions (even if the questions are 2 pages long & written on A4 size paper), because as patients, they ought to know what exactly is happening to them & what treatment they are having, but it gets on my nerves when things like this happen:

Case 1
Patient: (with a rombongan of relatives coming to visit) I’ve been here for 3 days, no doctor come & see me, didn’t give me any medicine, I’m just waiting & waiting

Relative: (angry & looked like ready to challenge the small petite doctor) So what’s the status now??

Doctor: (very calm but a bit sarcastic) The status now is…..the same…. as what I’ve informed the patient & his wife….today, yesterday & the day before yesterday

Patient: No medicine for 3 days

Relative: Why no medicine?

Patient: You see this little canulla here (on patient’s arm)? Our nurses have been giving medicine in the form of injection 3 times a day for the last 3 days & patient is actually improving with the medication

Case 2
Patient: (loudly as if an emergency had occurred) Nurse! Nurse! Nurse!

Nurse: (rushing to patient) What happened?

Relative of patient at next bed: (also rushing to help) What happened?

Patient: (now in a soft voice) Nothing, I just want my walkman (which is placed at the cupboard next to the bed)

Case 3
Patient: I can’t go to toilet, I feel weak (which is actually fair enough)

Nurse: Okay, then I get you a bed pan. We will pull the curtain & you can ease yourself here

Patient: I don’t want bedpan

Nurse: How about pampers? Then you don’t have to worry till the next morning.

Patient: I don’t want pampers

Nurse: Then what do you want?

Patient: I want the doctor to put in a catheter

Nurse: Doctor is not here at night. Doctor will only come (from home) when there is an emergency

Patient: Then call the doctor to come now

UK
Stands for ‘ubat kampung’, very popular among Malay patients

Bomohs tend to promise something that doctors can’t (ie. CURE, for cancer & many other chronic diseases)

US
Stands for ‘ubat sinseh’

Ranges from powder to liquid or even tablet form (sinsehs are now getting more & more sophisticated, some even have name cards & distribute pamphlets to hospitals), usually made from plants, including grass & mushroom

TM
Not telekom malaysia but ‘troublemaker’, usually a relative or family member of a VIP or VVIP (Examples – as above)

High risk patient
Either a relative/ family member of a medical staff or is a medical staff, tends to ask a lot of questions & the more the questions, the more problems/ complications seem to arise

WRONG END

2008-07-17T21:42:00.002-07:00

I recently called the Neurology Ward accidentally when I actually wanted the Nephrology Ward. The staff who picked up the phone said, “Oh, sorry. Sini kepala, bukan kencing.”

IS THAT A NERVE?

2008-07-17T21:42:00.001-07:00

After a combined meeting with the Orthopaedic & Pathology Departments, our Consultant, Prof F, mentioned that one of the Orthopaedic Consultants should have been a Neurologist. One would have thought that the bone surgeon has the mind of a physician, but it turned out that his name is Prof Saraf.

SAY WHAT?

2008-07-17T21:41:00.000-07:00

A 70 plus year old Chinese uncle with throat cancer & depression was seen at the Psychiatric clinic not long after he was discharged from the Oncology Ward. He was noted to have frequent vomiting, poor oral intake & generalised body weakness. The Psychiatric doctor who saw the patient decided to admit him to the Oncology Ward.

At Grand Ward Round the next day, the staff nurse-in-charge presented the case to the Consultant & his team, comprising of specialists, medical officers & other medical personnel.

Everyone was awaken (especially those who were sleeping/ falling asleep) when the staff nurse said, “This patient has oropharyngeal carcinoma & he is admitted for sterilization.”

The Psychiatric doctor had written the plan as “to admit patient for stabilization” & the nurse had read it wrongly.

JUST IN CASE

2008-07-17T21:40:00.000-07:00

An ex-colleague of mine, who is now a physician in Miri Hospital, was referred a case from the Orthopaedic Ward. The patient, a very frail 80 year old lady, was admitted for a hip fracture. My friend was amused & irate at the same time as the reason for referral was “in case the patient dies of unknown medical cause”.

ONCALL TERUK – THE SEQUEL

2008-06-30T22:49:00.000-07:00

Recently I learnt of a term which has got nothing to do with the famous New Zealand’s All Blacks, Jonah Lomu. Apparently, “Jonah” means someone who is “hot” during oncall time, ie. has the affinity to attract patients like bees to honey & ants to sugar.

My housemate, L, who is also my colleague, is one of the most “Jonah” person I know. Our passive call at HUKM Oncology Department stretches over a week, ie. from Monday to Sunday. L had to return to hospital after hours on the first day itself. This went on a few times throughout the week with the grand finale on Saturday & Sunday, where L had to sleep in (at the ward).

My most dreaded fear came true. Being L’s housemate & the next person to oncall after her, I was afraid of getting some of her “Jonah”-ness. True enough, she did pass on some to me. My call was rather “hot” too, with multiple admissions from the Emergency & multiple mortalities….& I had to sleep in at the ward as well, sigh…

Anyway, my week is up, thank goodness for that. Now I just hope (& pray) that my next call will not be so “Jonah”.

Maybe I should go play some rugby…

OCCUPATIONAL HAZARD II

2008-06-25T22:18:00.001-07:00

Two anaesthetic medical officers met at a dinner function, together with their spouses. After the usual hello’s & how are you’s, one of doctors commented, “Your wife has a short neck, difficult intubation.”

ANTICIPATORY EMESIS

2008-06-25T22:17:00.000-07:00

A talkative Chinese uncle was having his second cycle chemotherapy at our Oncology Ward at HUKM when the whole team (specialists, medical officers & nurses) was doing rounds & came to his bed. He was telling the medical personnel his experience during the first chemotherapy. One of the medical officers, a Malay lady, asked the uncle (who can’t speak English), “Uncle, sekarang ada muntah kah?” And the patient’s reply?

“Sekarang, belum lagi muntah. Tapi, sekejap lagi akan muntah.”

THE PSYCHIATRIST AND THE PROCTOLOGIST

2008-06-04T20:48:00.000-07:00

Got this from my buddy Dr. LJ on the email:

Two doctors opened an office in a small town and put up a sign reading:

"Dr. Smith and Dr. Jones: Hysterias and Posteriors."

The town council was not happy with the sign.

So the doctors changed it to read,"Schizoids and Hemorrhoids. "

This was not acceptable either.

So in an effort to satisfy the council, they changed the sign to "Catatonics and High Colonics."

No go. Next, they tried "Manic Depressives and Anal Retentives."

Thumbs down again. Then came "Minds and Behinds."

Still no good. Another attempt resulted in "Lost Souls and Butt Holes."

Unacceptable again so they tried "Analysis and Anal Cysts." !

Not a chance. "Nuts and Butts?"

No way. "Freaks and Cheeks?"

Still no go. "Loons and Moons?"

Forget it. Almost at their wit's end, the doctors finally came up with:

"Dr. Smith and Dr. Jones, Odds and Ends."

Everyone loved it.

A DOC'S LIFE

2008-06-04T20:42:00.000-07:00

You know you’re an overworked government doctor when…

1) You don’t see the sunlight (you go to work before sunrise & come home after sunset)

2) You sleep at the hospital more than you do at home

3) Your neighbours probably think you work as GRO because you always come home late & sometimes don’t come home at all

4) After a night of oncall, you notice 3 big pimples on your forehead

5) On closer look, your eyes resemble those of a panda

6) At year end, you realise your annual leave is untouched

7) You go back to your hometown only once a year

8) You go to the hairdresser & she/ he asks you, “Wah…your hair so long already. You never cut ah?”

9) You go to your beauty therapist & she exclaims, “Wah…so many pimples, how long already you never do facial?”

10) You weigh under 40kg without having to go on a diet or do exercise

SAFE SEX

2008-01-24T22:33:00.001-08:00

I read this joke in the newspaper after former Health Minister Dr. Chua Soi Lek admitted that he was the man in the infamous 'sex video'--

"Latest advice from the Ministry of Health - for safe sex, wear a face mask, not a condom."

CHRISTMAS BLUNDER

2008-01-24T22:24:00.000-08:00

In the hospital, we often use the phrase "top up", for example, top up medication or top up haemoglobin (by means of blood transfusion). While having lunch with an old friend on X'mas Day (at a popular restaurant at Mid Valley Megamall), I asked the waitress if I could "top up" my drink. The bewildered waitress looked at me for a moment, then asked, "You mean refill?"

WORST SUBJECT

2007-11-21T00:22:00.001-08:00

Intensive Radiation Physics course & end of course test have just ended ...

QUOTABLE QUOTES

2007-10-31T21:10:00.000-07:00

The top 3 quotes for the month of October 2007:

A good surgeon knows when to cut, but a better surgeon knows when not to cut - Dr. M (UMMC)

Faslodex? Umm, it's a fast Lodex lor (as oppose to a slow Lodex, whatever that means) - Dr. I (UMMC)

Are we getting our year end bonus? Or has it been sent to space? - Dr. L (SGH)

* Faslodex is a hormonal treatment for breast cancer & its name has got nothing to do with how fast or how slow the drug acts in the human body :)

ARRGH

2007-10-30T17:15:00.000-07:00

Medical Statistics test is coming up....

SILICONE

2007-10-30T17:13:00.001-07:00

This picture of Pam Anderson graced the slide presentation by our Pathology lecturer, Dr. M, on the topic of breast carcinoma.

* Just for info, breast augmentation with silicone can mask or mimic breast cancer.

QUADRUPLE BLIND STUDY

2007-10-30T17:09:00.000-07:00

My specialist recently mentioned something about how important history taking is. 80% of diagnoses are made based on history while the remaining from physical examination & further investigations.

I’m sure you’ve heard the joke “double blind study” (ie. 2 orthopaedic surgeons looking at an ECG), but I bet you’ve not heard about the “quadruple blind study”. Well, here’s how the story goes:

I was the Surgical Medical Officer (MO) oncall at Sarawak General Hospital, when the ED (emergency department) MO paged me to see a patient with acute right sided lower limb swelling & pain, to rule out the possibility of deep vein thrombosis. The other differential diagnosis was cellulitis, so the Orthopaedic MO was also called in.

4 doctors (ie. the ED, Surgical & Orthopaedic MOs, as well as the ED specialist) stood at the end of the bed & looked real hard at the patient’s leg, but none could come up with a diagnosis. After much discussion about the possibilities, including neuromuscular conditions, our patient (who had been keeping quiet & listening to the doctors) spoke, “Doktor, saya rasa saya ada gout lah. Dari dulu lagi, saya selalu kena macam ini.”

If only one of the doctors had asked the patient if he had similar symptoms before…

WHAT’S YOUR DEFINITION OF SEX?

2007-09-23T17:01:00.000-07:00

I was surfing the internet recently from my clinic room in UMMC, with the intention to find info for my upcoming presentation on ovarian & Fallopian tube cancers. I searched through Google using the key words ovary, Fallopian tube & cancer. Guess what happened? I was instantly “blocked” by the UMMC’s Nadi IT with the following message:

“No entry. Related to Sex.”

This reminds me of a joke someone sent me quite a while ago, about Ah Beng trying to fill up a form at the Public Services Department in Singapore. Under “Sex,”, Ah Beng had written “twice per week.”

HIBERNATION

2007-09-11T16:59:00.000-07:00

I think I need to “hibernate” from blogging for a while, for academic reasons. But please don’t stop visiting my blog. I will still update if something really funny comes up. Or perhaps you can do a “retrosceptive study” on my blog? :)

DUMEX & SUSTAGEN

2007-08-26T16:57:00.000-07:00

In medical school, we learnt that “small talks” can be used to build rapport with patients before the actual consultation. In real life, “small talks” can be quite effective if used appropriately. I have been rather successful with my “small talks” all this while, until recently …when I noticed that some of them have turned out to be a little peculiar.

Conversation 1
It was a Friday morning & one of those days that I decided to dress differently just for the fun of it (I wore a baju kurung). A Chinese aunty came to the clinic for follow-up.

Me: Good morning, aunty. How have you been? (I spoke in Mandarin)

Patient: (Shocked) Wah, you can speak Chinese ah?

Me: Of course I can speak Chinese. I’m a Chinese.
(Didn’t dare to disclose the fact that I only picked up Mandarin over the last couple of years)

Patient: (Shocked again) You’re chinese?

Me: Yes, I’m Chinese.

Patient: (Looking very skeptical) If you’re Chinese, why are you wearing baju kurung?

Me: (Pengsan)

Conversation 2
I saw another Chinese aunty who came for follow-up not too long after the first incident. Chinese aunties are prone to forgetting English names, so I thought I’d better introduce myself by my Chinese surname.

Me: Good morning, aunty. I’m Dr. C. How are you today?

Patient: (Looking skeptical) Dr. C?

Me: (Caught her looking at my name tag) Mm-hmm

Patient: But your name tag says Dr. F leh?

Me: (Pengsan second time)

Conversation 3
A Chinese uncle visited our clinic for the first time after undergoing an operation to remove his colonic tumour. He was referred by the surgeons for further treatment to prevent the tumour from growing back.

Me: Good morning, uncle. I’m Dr. F (Learnt my lesson already)

Patient: (Smiling) Good morning

Me: (Looking at patient’s details on the registration form & pointing to the age) It says here, uncle, that you’re 74 years old. Well, you certaining don’t look 74.

Patient: (Smiling even more) Hehe…I do a lot of exercise. Maybe that’s why I look young. How old do you think I look?

Me: Mmm…about 60 plus? Definitely not more than 65.

Patient: (Laughing now) Wow, you’re so generous.

Me: (Got up from my seat to reach for something. Can’t remember what, probably the stethoscope)

Patient: Wah, doctor, you’re quite small-sized oh. How come ah? You didn’t drink enough milk when you were young?

Me: (Really pengsan)