1st & last, do no harm

electricity & water don't mix

2012-02-18T11:20:00.003+08:00

in the old days, which is as recent as last month, the Xrays, ultrasound & CT scans taken at the radiology dept have to be physically transported to the wards or clinics, so that the respective doctors can view them. but a lot of things can happen to these hard-copies on the way out from the xray dept. they could be lying around in the dept while waiting for the porter to pick them up, the porters themselves could take their sweet time with these films or they could be misplaced just about anywhere else.

all of which add to the delay in which a diagnosis could be made or treatment started. even if nothing life-threatening, a patient may still have to wait hours waiting for the doctors to review the films. how inconvenient!

well, guess what? the hospital finally invested in an online system where the xray films are immediately uploaded & these can be reviewed immediately at anywhere a viewing screen is installed.

i saw one of these in the wards but it was placed just next to the wash basin.

i thought it was unintentional but the same thing was done at another ward.

you'd think that with it's team of IT-savvy staff & electrical engineers, the hospital would be advised to keep the computer & wash basin apart.

perhaps somewhere along in our education system, while we're striving to train rocket scientists (or astronauts?) & genious mathematicians, someone forgot to teach the students to use common sense.

03-2266 2222

2012-02-13T13:07:00.000+08:00

this call came thru this morning & that's the official looking number displayed on my hp.

the voice on the other end was gruff & official sounding, & was apparently a high-ranking police officer from bukit aman who could identify my name. he went on to ask if i knew 2 names he mentioned. when i said i didn't know them, he proceeded to elaborate that they lived in my area & were involved in large borrowings from banks in hong kong. he 1st spoke in english, then mandarin.

i've received many scam emails before from persons in africa who wants to use my bank account to deposit cash due to me from generous but unknown politicians. i've also had youths with neck-ties coming to my home asking me to scratch their lucky draw cards.

but this is the 1st time i've had a phone call like this, so i cut him off in mid-sentence. i figured if he was genuine & serious, he'd call back & i'd apologise for the poor connection. but he didn't.

you read the papers & everyday there are stories of deception where people deposit cash to a stranger's account to gain more cash or to cement an ambiguous relationship. they are gullible maybe because of desperation or greed.

after all, desperate situations demand desperate measures.

& nothing ventured, nothing gained.

my neighbour just bought a whole bunch of watches from a friend in a business deal. now, she's asking the wife to help peddle them for a commission.

who was it who said there's one born every minute?

a twist in the tale

2012-02-06T20:57:00.000+08:00

you must have read this somewhere but i'm going to post anyway.

a tourist to spain made a point to watch a bull-fight in madrid. he was impressed that the matadors on that day seemed to effortless stick spears into the bulls & thus killing the animals. at the end of the spectacle, he opted to have dinner at a nearby restaurant. he was fascinated that the most popular dish looked like what he thought was meatballs. he asked the waiter what they were & was told that they were actually deep-fried bull testicles, from the animals that were killed at the bull-ring. he was initially aghast but curiosity got the better of him as the diners seemed to enjoy their meals. he made an order & he was indeed convinced it was the best meat-balls he's ever savoured.

so good was the dish that he returned the next day to the same restaurant & ordered the same. however, this time he was disappointed that the meat-balls were much smaller in size. he asked the waiter why that was so, to which the waiter replied:

sometimes, the bull wins.

i remembered this tale because of a patient who came for minor surgery today. he was involved in a road traffic accident where the car he was travelling in crashed into a tree. he was a back-seat passenger while the driver & front passenger died in the head-on collision.

and he wasn't even using the seat-belt.

he was extremely fortunate. in a collision like this, he only sustained a cut on his shoulder while his 2 friends perished.

yeah, somtimes the bull wins.

victoria

2012-01-31T00:11:00.000+08:00

a queen of england.

a state in australia.

a railway station in london.

wife of david beckham.

a reknown lingerie brand.

and the new australian open tennis women's champion & current world #1.

so, it was coincidental that my daughter would be enrolled into victoria junior college for A-levels. according to the students, the top 3 ranking JCs are raffles, hwa chong & national. they joked that those who fail to enter hwa chong end up in national, while those that couldn't enter raffles would settle for victoria.

she quipped that she'd be considered a raffles drop-out. i reassured her that she'd be less stressed in an environment where expectations aren't sky-high & just to enjoy herself in the last 2 years of formal schooling. i know i did.

i just hope the boys won't be too much of a distraction.

at the crossroads

2012-01-30T01:23:00.002+08:00

5th formers are spoilt for choice these days. there are so many paths they can take to pursue their career dreams.

those who can afford private education, go on to foundation courses or A-levels, either locally or overseas, based on their forecast results. foundation courses fast-track on to university within a year while A-levels exams may be taken in june of the following year, allowing entry into UK universities in september.

yet others wait for the SPM results & then apply for matriculation or 6th form. these are the government's equivalent of foundation courses & A-levels, respectively.

amidst all these, there's the annual saga of government & private scholarships & the long-drawn issue of the fair disbursement of these awards.

so many choices. how would you choose what's best for your kids? how would they choose?

This is what the LORD says: “Stop at the crossroads and look around. Ask for the old, godly way, and walk in it. Travel its path, and you will find rest for your souls.
Jer 6:16

killer breakfasts

2012-01-27T14:04:00.000+08:00

this is typically what N takes for breakfast. today, it's nasi lemak. tomorrow, it may be mee goreng & the next day, a burger. but it almost always goes with a 500-ml bottle of carbonated drink. coke today, maybe sprite tomorrow.

N is a 20-something male nurse who graduated a few years back. the health lectures he listened to during his training days must have been lost on him. or maybe, he wasn't paying attention. or worse, he couldn't care less.

he is already grossly overweight but he's ok for now because he's still young & (looks) healthy. give him another 20 years on this diet & he'll be another health statistic. you know, hypertention, diabetes, stroke & coronary artery disease. he must have overlooked the fact that we've had patients in their 40s coming in for heart bypass surgery.

we've already repeatedly drummed into him, warning him of his folly but the advice has fallen on deaf ears. maybe he's stubborn & couldn't care less.

but this isn't an ideal world & we all know it. because in an ideal world, doctors don't smoke, lawyers don't cheat, accountants don't embezzle & politicians speak the truth.

what do you think an ideal world is like?

“There is no ideal world for you to wait around for. The world is always just what it is now, and it's up to you how you respond to it.” ― Isaac Marion, Warm Bodies

ground zero

2012-01-26T12:20:00.003+08:00

i've not been to JB, where i was born & bred, for over 3 years since the old man passed on. so, it was a homecoming of sorts when i met up with my remaining relatives & friends this lunar new year.

catching up gave me a glimpse of my past again - rediscovering my roots & experiencing a sense of deja vu. it was all too familiar, this JB town - the dirty streets, the crowded food courts, the recognisable faces. & yet JB the city felt strangely foreign - flyovers appeared where there once was only roads congested with traffic, residential areas that were previously considered "ulu" are now townships in their own right.

this trip also provided the opportunity to speak my native teochew again - words, sentences & their intonation that were kept in the back-burner all these years jumped to the fore. but alas, they sounded foreign to my kids & for that, i take responsibility for not passing down the clan's legacy. i consoled myself that millions now speak mandarin instead of dialects.

i foresee that these trips to JB would be less frequent in the future. once the old guard fades away, there's no reason for their kids who now have their own families & who do not reside in JB, like me, to return to their place of birth.

JB would be like ground zero. a happy place once alive with people i know & loved, but soon to exist only in distant memories. i felt a sense of belonging & yet the detachment from the images that i know & remember so well is obvious.

i smiled knowingly, chuckled to myself at people & events past, & then move on.

**my profile picture was taken at my great-grandma's attap home in jalan ngee heng, right where danga city mall now stands**

like a lottery.

2012-01-22T00:11:00.000+08:00

a lottery, as we all know, is a game of chance. whether you choose a series of numbers or buy numbered tickets, you win by a lucky draw. there's no intelligent thinking or effort that determines the outcome, except only by chance.

like sending your car to the workshop. if you go to a manufacturer authorised workshop, you'd expect a certain standard of service. you'd think the mechanics are well-trained, the equipment up-to-date & the spare parts genuine. but is it possible, by chance, one day you are allocated a mechanic who has some personal problems that affects his work? imagine what could go wrong after he's done with your car.

like going to the emergency department. you find out that you require urgent surgery & the surgeon, by chance, needs to attend an important dinner that very day. so, he hurriedly tries to complete the surgery in time for his dinner date. imagine you are that patient & what could possibly go wrong.

things happen, often randomly, but by the grace of God, we are mostly spared the dire consequences.

a bird in hand.

2012-01-21T13:11:00.000+08:00

you know how the saying goes - that it's worth 2 in the bush?

i just found a new meaning today.

Y is a 77-yr-old man with severe heart disease complicated with renal failure. his wife has left him & his 4 children are not the least bothered about him.

that's because he has a 2nd wife. she's on her own because her own family doesn't know about this marriage, if one was ever held. she has not been seen since Y was admitted 2 days ago.

that leaves Y all alone floundering in the ICU. his heart is giving way & his kidneys are packing up. he's hooked up to a ventilator & there are tubes galore sticking out of him. he won't last the day.

what a way to end the year - dying alone.

yet, isn't it a paradox when they say 3's a crowd??

it's in the genes....... isn't it?

2012-01-16T15:31:00.000+08:00

we are all familiar with the tradition of assigning a child's physical appearance to either parent or even to a grandparent, sometimes even down to a particular feature of the face. remember kirk & michael douglas's trademark chin?

sometimes we dissect the child's character & habits as well. take my daughter for example. she takes after my looks, is introverted & often melancholic like me, & has inherited my (ahem!) brains.

but, alas, she drives like her mum.

she failed her driving test again. sigh, now i have to go home & lend her my shoulders.

oh yes, like her mum, she doesn't take failure too well.

but my son, conceived 8 years later, is altogether different. he doesn't look like either of us, has a dimple on his cheek like his grandma, has a gentle disposition like his uncle (my brother). he only takes after me in our common interest in watching & playing football & he enjoys helping out his mother in the kitchen & housework.

such is the mystery of the human character. only God knows why we are made the way we are.

You made all the delicate, inner parts of my body
and knit me together in my mother’s womb.
Thank you for making me so wonderfully complex!
Your workmanship is marvelous—how well I know it.
You watched me as I was being formed in utter seclusion, as I was woven together in the dark of the womb.
You saw me before I was born.
Every day of my life was recorded in your book.
Every moment was laid out before a single day had passed.
psalms 139:13-16 (NLT)

gold

2012-01-12T18:01:00.002+08:00

the media reported a gold rush of sorts in johor baru yesterday. with gold price at a high, it's understandable why people would pan for the precious commodity.

as it turned out, it's only granite imbedded with iron sulphide, which glitters under sunlight.

i got a call from a nurse very early this morning about a patient in the ward who was restless from a head injury. i had seen him earlier yesterday & prescribed the appropriate medication. however, the nurse didn't adhere closely to the prescription, which resulted in the patient getting restless, & which got me all riled up.

at 2am.

instinctively, i gave her a mouthful, which could have been worse but for the fact that i'm a natural late-sleeper. i've ranted about incompetent nurses before here, here & here.

but some nurses are really good, although sadly, they are few & far in-between. like male nurse D. he started as a clerk & the hospital sponsored his nursing diploma. after completion, he served his bond faithfully - willing to learn, accepts criticism, is hardworking & has a nice personality. one of my colleagues Dr K took him under his wings & trained him up to be his (Dr K's) assistant in OT. D is good at what he does.

now that his bond is near completion, D has found a better paying job elsewhere. we threw him a farewell lunch today. i told Dr K: you're going to lose your right-hand man soon.

Dr K replied, rather crudely : he's only my left hand little finger.

i thought that was uncalled for. it's so hard to find decent nurses these days & doctors should appreciate when they get good ones. for that matter, hospitals should similarly try to retain their staff, especially so those that bring up their good name.

after all, many things glitter, but only real gold has intrinsic value. all the best to your new job, nurse D!

**image from the star**

ordinary

2012-01-08T23:43:00.005+08:00

that's what the "O" stands for in O-level exams.
my daughter doesn't feel it's all that ordinary. in fact, it's giving her the jitters as the day of reckoning arrives.

those days, we all went to the school office & queued to get the result slips. no one else would know the details if we chose not to reveal.

in my daughter's school, they will assemble in the school hall. the top students (7As & above) will be called up by name & the number of As announced. then, they will go up on stage to collect their slips.

the other less successful students will just get their results individually & with much less fanfare.

no wonder, the girl has jitters!! but i guess she will just have to get used to the pressure-cooker pace, because that's the way it is & i don't envy her one bit.

on the day i got my results, a bunch of us walked from school through the botanical gardens towards town center to catch a bus home. on the way, we monkeyed around, ate ice-cream & joked. there wasn't much pressure. none of us did exceptionally well but we all did enough to get into 6th form & that mattered the most.

ah, life was ordinarily simple then.

still an "L"

2012-01-05T17:21:00.000+08:00

the girl went for her driving test this morning. i had hoped she would pass 1st time but she didn't.

did she knock into a pole during parking?

no.

did she slide down the slope?

no.

did she forget to put on the indicator light when changing lanes?

no.

so, how did she fail?

she ran a red light.

i'm still reeling from the shock - there's a potential speed demon in the family.

old school

2012-01-02T19:15:00.001+08:00

i know it's odd to talk about old when it's less than 2 days into the new year, but a member of the old school has passed on.

i read the obituary of prof sengupta, head of orthopaedics when i was his student. his department has this to say about the good professor:

there's no doubt the prof loved to teach. as students, we used to dread his teaching wards rounds, only because he could spend a whole session on just 1 patient, elaborating on clinical signs, diagnosis, treatment & how such a patient may present during the exams. his morning round would often stretch through lunch & the part we dreaded the most was that he could stand throughout the whole proceeding by the patient's bedside, so we had to stand as well. he would end at about 1.30pm & we would have to grab a quick bite before afternoon classes commenced again at 2pm.

such diligence & dedication is rare nowadays.

so, dear prof sengupta, on behalf of the class of 79/84, we all salute you, together with the late profs karim, raman, dhanaraj & bosco, as pillars of our medical education.

you've taken our hands, opened our minds & touched our hearts. you've made us into who we are today & we thank you.

may your soul rest in peace.

start well & finish strong.

2011-12-31T16:28:00.000+08:00

i like to start well. if it goes well, it sets the ground plan for better things to come.

just like a day at work.

or, a business venture.

or, a relationship.

there was a scraping noise that came on from the back tyre whenever i reverse the car. i sent the car to UMW for a check yesterday & within the hour, the service person called to say it was just a small pebble that was lodged in the brake disc. no damage was done & no parts needed to be replaced after the pebble was removed. total cost : 2-hour loss of use of car.

many years ago, on a trip from penang to KL, i accidentally drove off the road kerb & when i steered back onto the road, there was a noisy rattling sound that came from the back wheel. i drove into a gas station in ipoh & the foreman shook his head & said it could be a ball-bearing problem. since i know squat about car repairs, i had no choice but to let him take each wheel off, inspect them & watched him test the brakes. finally, he said it was the brake pump or something like that. he changed a part & then as he placed back each wheel, he casually removed a pebble from a rear wheel.

aha!

total cost : rm35 for parts & labour, & a bitter taste in the mouth.

he could have removed the wheels, dislodged the pebble & billed me the same for labour costs & i might have been happier to hand over the money. as it stood, this experience just propagated the widespread belief that most car mechanics are con-men. in a way, i was glad i wasn't driving a Merc or a BMW. who knows what else he could have ripped off - a broken axle?

so, the UMW experience had left me with a sense of fairplay, a warm fuzziness. we can be fair & still be profitable. or, we could be firm with our kids & still earn their love & respect. wouldn't be it nice if this sort of justice prevailed in all aspects of our lives, from the way we treat our family, friends & enemies & from the way the govt treats its citizens?

i can't remember how this year started off for me, but i'm sure glad it ended this way. all's well that ends well, they say.

may this year also end well for you & may you all have a blessed 2012!!

I have fought the good fight, I have finished the race, I have kept the faith. 2Tim 4:7

bali - the sequel

2011-12-30T23:47:00.000+08:00

i didn't read the novel eat, pray, love. neither did i watch the movie, so i was pleasantly surprised to be told that jimbaran bay that we passed by on the way to uluwatu was a location shooting site for the movie.

there was some religious ritual going on that day. the sand is fine, the water looked clear &, coupled with fine weather, it would be picture-perfect for the movie. no wonder the leading lady, played by julia roberts, fell in love here.

uluwatu temple is 1 of 9 directional temples (which are located at various corners of island that serve to protect from the evil spirits)

here, you have to watch out for the monkeys as they are brazen enough to snatch caps, sunglasses & other loose articles from you.

the famous (& touristy) kecak dance is held here daily at dusk, where the setting sun provides stunning backdrop.

the dance is based on the Ramayana which tells the story of Prince Rama who wants to rescue his kidnapped wife Sita from the hands of the evil Rawana, King of Lanka. the Prince asks the General of the Monkey Army, Hanoman, for help. it is a typical story between good and evil described by performers who wear colourful masks, are beautifully dressed and dance gracefully.

after the show, we were driven to jimbaran beach for a seafood dinner. it's obviously another touristy area as most of the customers looked "foreign."

the food was well-cooked & reasonably priced. we had cuttle-fish...

huge prawns.....

& crabs.........

but before everyone rushes to bali for what appears to be delectable fresh seafood, our guide told us that most of the seafood is imported from java. after we've had dinner only did he reveal that the 2nd bomb attack on the beach in 2005 occured only a short distance from the restaurant where we just had dinner.

an unexpected surprise was having a meal at a restaurant offering crispy chicken.

i have to admit the balinese have perfected "crispy" to an art. the chicken was good down to the bones.

people who enjoy shopping & sight-seeing will like bali. there are sea sports activities that will also appeal to enthusiasts. which doesn't leave much for kids to do. so we tried out whitewater rafting, which the guide reassured us that is safe for kids. rafting is mainly along the anjung river & there are many operators offering it.

safety helmets & life-vests are a must. after a short descent down the hill, it's onward ho!

very mild ride. not much adrenaline rush. very suitable for kids. (& those with weak hearts!!)

finally, the famed temple at tanah lot (literally, island on the sea) which can be accessed when the tide is low. it was built to worship the God of the Sea.

tourists usually congregate here to catch the sunset.

you could have told me this was taken in penang & i would have believed you.

that concludes our brief 5-day vacation to a really beautiful island. people are friendly, cost of living is very affordable & crime rate is very low. i would definitely visit again.

but not before i've read eat, pray, love..

blood is thicker than water

2011-12-29T14:00:00.000+08:00

my son would have been a marvellous elder brother.

he loves taking care of children younger than him - playing games, sharing toys or just simply being with them. but as it is, he will remain the younger of 2 siblings & that's unlikely to change.

the other day, i asked him that since he likes playing with joseph, a really cute 4-yr-old from church, would he mind if we exchanged his sister for joseph, so that he'll always have someone to play with. he thought for a while, then declined the offer. i asked him why, & he replied as-a-matter-of-factly that she is still his sister.

i was pleased with his decision, although i wouldn't have despaired had he accepted the offer, not that i could make it happen. despite his loneliness while the sister is away at school, i'm glad he realises that blood is still thicker than water.

was it worth the drive?

2011-12-28T14:13:00.001+08:00

penang is a good 5-to-6 hour drive. add another half to an hour for the holiday traffic on the expressway. but we usually spend the christmas weekend with the in-laws.

i don't envy the penangites for the constant traffic crawl & for the escalating cost of property but you can't beat penang for the variety of food on offer.

we had our 1st lunch at the newly opened coffee island at gurney drive. i like it for the ample free parking & the cheap lunch. the main course....

............came with soup, dessert (kuih & fruits) & drinks in a buffet spread....

my sambal fish with brianyi rice costs only rm10.90, & there's no service charge or govt tax!!

our 1st family dinner was at a restaurant in cititel hotel, a whole 8-course of it.

the next day, it's off to penang road for the cendol...

2 stalls....each claimed to be famous but 1 seemed to attract more customers. we showed no favouritism by having 1 bowl from each stall. what caught my eye was this man frying char kway teow...notice anything odd?

he's promoting his stall based on his handedness....

is he a marketing guru or what?

chowrasta market along penang road is where you get reasonably-priced tau sar pneah, nutmegs, rojak sauce & lots of other stuff....

i must also tell you about this new place that just opened recently along northam road called...

it sells hawker fare but i like it because there is ample free parking. i may sound overly concerned about parking but not having lived in penang or KL/PJ in recent years, i personally dread driving round & round searching for a place to park. so, a spacious & free parking lot is like heaven on earth for me.

what's more, it's right by the beach, as the name suggests. there are over 20 stalls serving all kinds of penang food.

we used to go to porntip's for thai food but that has since closed. the in-laws took us to the thai restaurant at heritage club on scotland road, near the penang sports club. nice ambience, food tasted authentic & yes, ample free parking again!

one more for the road - dim sum breakfast at bali hai along gurney drive. it was still packed when we arrive at 10.30am.

but, it was good - everything you'd expect from a popular dimsum restaurant.

we left for home soon after breakfast. i think the person most happiest with this trip is the mother-in-law. she hasn't seen my daughter for 2 years & we had dinner together every night we were there. she's getting on in age & there won't be many more dinners like these.

as for me, i quite dread driving the long distance but i'd do it for the old lady. the sumptuous spread is just an added bonus.

front passenger

2011-12-21T23:55:00.008+08:00

when i was a child, i enjoy sitting on the front passenger seat of a car because i get a good full view; sitting at the back only offered one view. if you have children, you'll know what i mean & why kids like taking the front passenger seats.

little did i know that, without a seat belt, the risk for injury in a frontal collision is high. nowadays, we have seat belts, air bags as well as car seats for kids that restrain & protect the front passenger.

but these devices are helpful only if they are used. if you have a child sitting on your lap, no matter how well you yourself are restrained & how tightly you hold on to your child, it's as good as not having protection in a collision.

this is what happend to a 4-yr-old child sitting with her mother on the front seat when a collision occured.

it's a broken thigh bone aka femur - not life-threatening but very painful. fortunately, it was the only injury suffered but it could easily have been worse considering that the car was a write-off.

the mother only had a gash on the forehead while the father who was driving the car sustained a similar fractured femur. both had undergone successful surgery.

who should be responsible for this injury to the innocent child?

may you have a safe journey if you're travelling this festive season.

master entrepreneur

2011-12-19T12:47:00.002+08:00

doctors are not generally known to be skillful businessmen because i think, to be successful in business, you need to be book-smart, street-smart & daring.

so, one out of three won't do.

but i feel one of my colleagues made a masterful move when he took in a junior partner to "share out" the work. so now, he comes in only in the morning or afternoon, or sometimes, not at all while the young fellow is doing most of the work.

the best part is my colleague can go on vacation as & when, according to his fancy. imagine sipping pina colada on a sun-drenched stretch of white sand with the palm trees swaying to a beach boys CD - not working but money rolling in all the time.

is that a master entrepreneur or what?

i could learn a couple of tricks from the old man himself.

the gift

2011-12-17T23:34:00.001+08:00

some years back, i won an 2GB iPod nano in a competition. not being one for mobile music, i passed it on to the girl who was in primary 6. she warmed up to it & eventually, it seemed like the ear plugs were perpetually attached to her ears.
2 years back, the battery started to fail & she implored me to get her battery replaced as she can't study without them. the new battery is about half the cost of a new set, so i got her a new 8GB one instead. i posted it here.

now, that has given way as well. it seems these china-made screens & batteries don't last long. although i had previously agreed to get her an iPhone after she's completed her O-levels, she now asked if she could get a new 64GB iPod touch instead of the iPhone.

it arrived this week......

....except that i got her a 32GB unit with this message......

was i being mean?

nah....i'm just a loving father with a cynical sense of humour.

monkey see, monkey do

2011-12-12T23:44:00.001+08:00

i usually don't imitate people blindly. most of us don't anyway. but yesterday, i bucked the trend.

we were at sunway pyramid & had just parked at the multistorey carpark. as i was trying to remember the section where we had parked, i saw someone else who had also just parked, take a photo of the marked pillar with a phone camera.

i immediately whipped out my phone & snapped at the pillar.

now, why didn't i think of that before?

best ribs?

2011-12-12T11:28:00.006+08:00

tony roma's are well-known for their ribs. yesterday, we were at the sunway pyramid outlet for lunch & i have to say their trademark beef ribs looked & tasted great - so succulent, you can just bite the meat off the bone.

and it goes with 4 different sauces, barbeque & honey amongst others, to enhance its flavour.....

the portions were quite large & even though we had the standard order, we were left satiated...

we were here because we were given some vouchers & normally, the ribs would cost, at least to me, an arm & a leg. but where else can you feast on what's often regarded as the best ribs in town?

ps. this is NOT a paid post

pay rise.

2011-12-09T23:50:00.003+08:00

so, the government has given the civil servants another pay rise.

they are all rejoicing now - praising the government for being sensitive to their needs during this difficult time. some even added it'll motivate them to be more productive.

you think?

and don't expect the private corporations or self-employed people not to do anything about it. expect your neighbourhood char kuay teow hawker to start raising his prices or reducing his portions. why should he sit still & watch while the millions on government payroll reap the benefits? then the public transport companies will raise their fares, car repairs will be more expensive, price of supermarket items will trend upwards & your salon will charge more for haircuts/perms/highlights.

it's a vicious cycle we are all caught in.

and yes, don't be surprised if your medical bills start to climb, too.

but then, this could all be just conjecture. after all, i have no training in economics.

breaking free

2011-12-05T12:09:00.000+08:00

the SPM exams just concluded last week & my daughter got to hang out with her ex-classmates over the weekend. amidst the girl talk, they shared amongst themselves what their study plans were, or rather, what their parents have planned for them. most will move to KL/PJ to pursue A-levels/matriculation. one will go straight to UK for A-levels, another to AIMST in sg petani for science matric leading to dentistry & yet another will stay back for STPM.

so many options & they are spolit for choice. i was relieved to hear none will quit school.

although most will miss home when they further their studies, there is one particular girl who expressedly relishes the separation. she just can't wait to get away from her family. & who can blame her when her overbearing parents control every aspect of her life, even which friends to make or hang out with.

given the environment that we live in, with threats from perpetrators of crime in both the physical & virtual world, some restraint is necessary so that the kids do not wander too far from safe ground. & for parents like us, the wisdom rests in knowing where the limit lies, blur at times as it may be. too much restraint may instill a feeling of imprisonment & the child can't wait to break free; too much freedom results in not knowing where the limits are.

parenting is never easy, is it?

Train up a child in the way he should go,
And when he is old he will not depart from it.
prov 22:6

stuff i didn't know about bali, but i'm ok with it anyway.

2011-12-03T23:54:00.003+08:00

i think we were generally "ill-prepared" for this trip, in that we didn't do much detailed background reading. even though it wasn't planned with military precision, it really turned out quite nicely maybe because we took things as it came. perhaps that's how vacations are meant to be enjoyed.

(1) i had this bizarre idea of renting a car & driving, GPS-guided of course, around the island at leisure. that way, we can slowly explore most of the tourists' attractions unhurriedly. until someone told me the roads are narrow &

motorists obey traffic rules even less than those in m'sia. we therefore followed the recommendation of others to hire a guide & driver/car instead, & that turned out to be a sound idea. with a land area almost 6 times larger than penang, there is much to explore. here, the guide, Mr Dana, explains the sights as we travel in comfort in a MPV. he gave an excellent account of bali & i would strongly recommend him. incidentally, missyC gave me his contact some time back..

(again, notice the narrow road)

2) balinese women are no pushovers. they work hard, not only looking after the family but help out their spouses at work as well. if left without transport, they move around carrying loads on their heads.

3) the cottage industries are located at specific districts, eg. in celuk, there are numerous silverware shops along one particular road.

somewhere along a road in ubud, there too are clusters of shops displaying & selling wood/carving products.

4) besides the ubiquitous nasi goreng & satay, 2 dishes tourists scramble to savour are babi guling (suckling pig) & crispy duck. the babi guling, though a must-try dish, is certainly no match for our siew yoke (roast pork) in appearance & taste.

the skin wasn't even crunchy. so that was a disappointment maybe because i expected more. the crispy duck is something else. it's deep-fired till you can actually chew on the bone.

oh yes, satay is served the traditional way, complete with a burning charcoal grill.

5) kintamani in north-east bali has been likened to cameron highlands in terms of altitude and climate. at 1200m above sea-level, it was a welcome reprieve from the heat of the lowlands. i even noticed some roadside stalls offering strawberries. it's here that the active volcano mt batur & it's adjacent lake is located. tourists actually trek up its peak to catch sunrise. the black-coloured earth by its sides are fertile lava spewed out during previous eruptions.

nearby is where the some of the rice terraces are located.

rice, being the staple food in the region, is grown also in the fields. here on the terraces, each farmer form part of a cooperative that shares the limited water supply & the complex irrigation system is jointly maintained so that a farmer does not block the water from flowing downward to rice terraces below his. communal living is a major issue in bali - families are closely-knit & wives are expected to look after the parents-in-law till they pass on.

6) also in kintamani, we visited a family-owned coffee plantation. the 2 varieties grown are the well-known arabica (more expensive because less caffeine content) and robusta beans. but what we really came for is the kopi luwak - coffee made from beans that had been ingested & passed out by the civet cat.

by some weird twist of fate, this product is now the most expensive coffee in the world.

dare i try some?

this shop assistant beckons with a cuppa & a smile......at Rp50k (about rm18) a pop. oh, what the heck, i've already had babi guling & crispy duck, one more won't hurt.

of course, to savour coffee, you have to take it as it is, unadulterated by sugar or milk. i confess that i'm no connoisseur, so to me, it didn't taste anything different from the brew from ipoh or muar. perhaps a tad sourish but it had the ooomph though. i was wide awake after that. should you be in a boutique cafe & the premium coffee you ordered tastes like s**t, you know, you could be right! anyway, i bought a box home..

so, if you're ever in the neighbourhood, give me a shout & i'd love to make you a cup of the most expensive coffee in the world. but do give me a few hours' headstart because i've got to 1st retrieve it from the safe deposit box.

**i thought i could squeeze bali in one post but looks like there'll be a sequel**

i'm a millionaire!

2011-11-29T23:51:00.004+08:00

actually it's no big deal la!

most malaysians visiting indonesia carry with them millions of rupiahs - after all a million rupiahs exchange for about rm360.

we were on our family vacation in bali over the weekend. flying by air asia, we tried to save as much as possible by paying only for the services we needed. so, we did self check-in, ordered in-flight meals online, paid for a 20kg luggage & didn't select our seats. we thought it was a challenge to pack 4 person's clothes into one bag with a 20kg limit but we amazed ourselves that we were able to, by bringing only the necessary personal effects. (sorry, boy, you can't bring your scrabble set.) we could achieve this feat because each of us could carry a hand luggage of up to 7kg apiece.

we elected to stay at sanur (about 30min's drive from the airport) instead of the more famous kuta area, made infamous by the bomb attacks some years back. it's obvious from day 1 that balinese are deeply religious. they place burning incense in front of their businesses as offerings to the gods....

....and some have little statues of the deities as well.....

because of the deep religious beliefs, it's not surprising that major crimes in bali are few & far in between, except when committed by foreigners, like the bomb blasts of 2002 & 2005.

one item of news which you probably didn't know...last week, during the summit of east asian countries, the airport at denpasar had to be closed to prepare for the arrival of barak obama. a passenger plane that was supposed to land at 6pm had to be diverted to bandung, 860km away in java, & finally landed in bali only at 2am that nite.

talk about making a grand presidential entrance!

**next : the tour proper begins....**

L

2011-11-23T16:54:00.000+08:00

the girl is happy as a Lark!

she just called to say she passed her undang-undang test. that sort of impressed me because she only had 2 days to read the book. so, she'll be getting her Learner's Licence soon.

she can expect to be derided as a Lembu when she holds up traffic on a single carriage way. but that's nothing new because we all went thru all that ourselves.

if she passes the driving test 1st time - now, that would reaLLy impress me. lets see if a bit of my driving skill rubs off on her.

doc's family annual vacation 2011

2011-11-23T02:00:00.001+08:00

the year-end school vacation has started.

the girl is back home.

the family are together once again.

many years ago, we agreed we'll travel together just once a year, so that it's something to really look forward to.

you could say, it's our pot at the end of the rainbow.

we're headed to bali tomorrow.

the pot at the end of the rainbow.

2011-11-20T23:55:00.005+08:00

the pot of gold - this was how i viewed the year-end vacation.

after a whole year's work, it's time to sit back & laze around a bit. that's how it was when i was in school.

but how time's they're a-changing.

now, there're various holiday enrichment courses to prepare students get a head start for the new year. language, sciences, maths, self-improvement, music, etc etc. so much tuition, so little time for being a child!

just last week, after the year-end exams, my son asked his schoolmate who lives in the same taman if he wants to play football on thursday. the classmate said, he can only play on sunday because his weekdays are packed with tuition, from afternoon to nite. BM group tuition, BM personal tuition, Chinese personal tuition under 2 different tutors, English personal tuition, Piano tuition under 2 different teachers. his mother is currently looking for maths & science tutors.

no wonder he seemed like a dull boy! but all that extra lessons must have had some effect as he moved up one class. the irony is that his father had, some years back, launched a tirade against all the kiasu mothers who enrolled their children in multiple tuition classes. he must have relented & decided that if you can't beat 'em, then join 'em.

in the mean time, i think that pot of gold remained elusive to the students today.

i lost it!

2011-11-17T23:44:00.003+08:00

my temper, that is.

anticipating a long day in the OT today, i arrived on the dot & expected to start right away. i was horrified that the IV drip has not yet been set up for the patient & hence the pre-medication has also not been given. the nurse at the reception bay was nowhere to be found. i asked the other nurse at the counter where the reception nurse was & she said nurse M was in the pantry.

i marched straight to the pantry & there she was - nurse M having breakfast at 9am with a few others. i didn't hesitate to give her a mouthful & then went straight into the Sister's office to let her know my disgust - how can your staff have breakfast during working hours when the work has not been done??

naturally, Sister gave nurse M another earful. so there you are, a lousy start to a long day that got at least 3 people upset & left everyone else uneasy. i was surprised when nurse M confronted me later & accused me of humiliating her in public. although i didn't respond, it bothered me for a while & after much thought, i realised that i should have pulled nurse M to one side before reprimanding for her tidak apa attitude towards work.

in the end, i decided that although i was upset at nurse M for not doing her job, i should have handled the matter more professionally (& gentlemanly?). i managed to catch her before she completed her shift to apologise.

at least, i know that i will sleep easy tonite & tomorrow will be a new day with a new start.

BM paper 1

2011-11-14T23:49:00.004+08:00

the SPM starts today with BM paper 1. the mention of that paper always sends chills down my spine. many years ago when i sat for that paper, i forgot to write my index number on a few answer sheets. which means, should they become detached from the front sheet, they could not be traced to me. i had nightmares of the examiner chucking them into the waste paper basket.

the fear of failure did play on my mind throughout the exams. i imagined repeating form 5, or forced to start work.

as it turned out, i got a P7 - a pass which allows passage to Form 6. those days, there weren't much choice for middle-income family like mine - studying at Taylor's (the only local private college those days) or overseas was beyond our means. and a credit in BM is required to enter Universiti Teknologi Malaysia, which would have fast-tracked to my dream career in engineering.

anyway, i sat for the supplementary BM paper in July the next year & got a C6. i jumped for joy & you'd think i score an A1!!

students nowadays are spoilt for choice for career paths after form 5. i wish them all the very best & hope they seize the day.

but i wouldn't want to be in their shoes!!

it's only a numbers game la!

2011-11-11T23:50:00.008+08:00

11.11.11

this date is over-hyped. my obstetric colleague has FIVE C-sections today to cater to some parental whims & fancies.

but one couple took it a little too far. the mother-to-be developed pregnancy-induced hypertension & had been treated for it. but as it neared 37-weeks, the blood pressure was getting out of control, hovering around 160/100, thus endangering the lives of both mother & child. my colleague recommended an early C-section on the 9th. but as you'd have guessed, both parents wanted the delivery on the 11th.

in order to satisfy the pandering & yet protect the pregnancy, the c-section was planned for 11.45pm on the 10th, so that by the time the baby is delivered, it would have been past midnite & well into the 11th.

it wasn't a moment too soon either. there was meconium staining in the amniotic fluid already, suggesting that the baby was in some degree of distress. fortunately, there wasn't any obvious damage.

however, when she (yes, it's a girl!) grows up, i wonder if she would appreciate that her parents played the numbers game & endangered her life, so she can be born on a supposed auspicious date & have a series of 1's on her myKad?

for whose benefit, i wonder?

chalk & cheese

2011-11-09T01:13:00.004+08:00

when we have 2 of something, we just can't help but compare them; none more so than comparing our children.

one could be a fast learner, the other not so.

one more talkative & expressive, the other introverted.

one a leader, the other a follower.

the list goes on.

we've read before in nursery rhymes what little boys & girls are made of.

boys are snips & snails & puppy dogs tails, while girls are sugar & spice & everything nice.

take the exams, for example. my son just takes things in his stride - he studies just enough to get us off his back, still wants to play & watch TV during exam week, & even if he drops to a lower class next year, life will still go on without a care. he doesn't know what stress is & if nothing else intervenes, he will definitely live to a ripe old age.

my daughter is the direct opposite. she has to complete her revision at all costs, sacrifice sleep to study, will eat when stressed, & will cry & wail if the exams don't go well.

as it is, the boy did just enough in the year-end exam to remain in the same class, while the girl is going thru a torrid time in the ongoing O-levels.

p/s. i actually wrote a similar post after the boy's midterm exams. read here.

there you are - 2 different peas from the same pod who will walk different life's paths. like chalk & cheese.

best coffee in the world

2011-11-05T23:46:00.003+08:00

you're probably thinking arabica, vietnamese, starbucks, or even kopi luwak.

actually i care not for the expensive or exotic stuff.

a full sachet of nescafe 3-in-1 in a mug of boiling water with a measure of milk. it's the best coffee in my world because my son made it for me for breakfast this morning.

what a way to start off the day!

ps. he also made the best ice cream in the world.

angels & demons

2011-11-01T12:41:00.016+08:00

overheard in a phone conversation:

Dr A : nurse, what time is my patient's operation scheduled for?

Nurse : 1pm

Dr A : ok, make sure i get to operate before Dr B. after all, i booked my case before him.

Nurse : ok

Dr A : make sure you don't call for Dr B's patient until i've finished with mine. he can operate after office hours if he wants to. **evil laugh**

this, by the way, is not a scene from a dan brown's novel. maybe it should be retitled halloween in hospital. **more evil laugh**

dangerous sports

2011-10-28T23:50:00.001+08:00

you'd think motorsports is dangerous. after all, 2 people were killed separately in Las Vegas & here in Sepang just last week.

you'd think competitive rugby & football are dangerous, these being contact sports.

you think bungee-jumping is dangerous, since it is invariably listed as an exclusion in accident/travel insurance policies.

what about high-jump in school?

you'd never expect this to happen but it did. this 10 year-old boy jumped & landed on his outstretched hands. being right-handed, the impact was felt on this hand & it broke 2 bones. just goes to show that you don't need to participate in dangerous sports to be injured.

i should know. my son broke the same 2 bones playing goalkeeper in a football game with his friends earlier this year.

it's time i took a break!

2011-10-23T23:54:00.000+08:00

i suddenly woke up at 8.25am this morning. almost immediately, i jumped out of bed & called the hospital to inform i'd be late for the 8.30 start. as i was dialling the phone, i then realised it's sunday. feeling relieved, i went back to sleep again.

i reckon when it's your job you think about the 1st thing of the morning, it's time for a break. or, reappraise the priorities

as if to reinforce that notion, i inadvertently pumped RON 97 petrol at the gas station, which i've never done before.

i can't wait for the girl to return home next month for family vacation.

so, you think you're safe at 33?

2011-10-20T22:51:00.000+08:00

you'd never expect someone who's 33 years old to have a stroke, right?

wrong.

this technician was at an office meeting when he suddenly keeled over & starting talking gibberish. he was brought to hospital & a CT scan of the brain revealed a blood clot in his brain.

while preparing for surgery, a repeat scan revealed that the clot has expanded.

the clot was successfully evacuated. he is recovering in ICU & he woke up this morning from the sedation. it was noted that his blood pressure was excessively high before surgery & this was most likely the reason for the stroke. apparently, hypertension runs in his family.

if he doesn't take care of himself, he can expect to have another stroke or even a heart attack before he reaches 40.

gives new meaning to the term life is short, doesn't it?

new breed of doctors?

2011-10-15T17:23:00.001+08:00

my friend who lives in klang valley told me a branch of a well-known medical centre has just started in his neighbourhood. it specialises in neurosurgery, spine & cardiac surgery. so, all doctors of these disciplines have moved over from the main centre to the new site, leaving behind specialists who are brainless, spineless & heartless.

you have been forewarned.

end of the road?

2011-10-14T13:10:00.001+08:00

this was taken from a FB page of The Alliance for an "Idiot-Free" America

i wonder if we, here in malaysia, will be in the same position when our oil wells run dry.

out of one's league

2011-10-13T12:43:00.000+08:00

i'm a bit part player in the stock market. that means, i occasionally dabble in it & only with blue chip stocks because i don't know or haven't learned the twists & turns of a wily stock investor.

that also means i won't get extremely rich from a bull run. more importantly, i won't be impoverished with the downturn.

i'm cautious mainly because i'm using my own hard-earned money.

unlike the GLCs who are spending money as if it grows on trees. take Proton for example. remember they bought the italian motorcycle company MV Augusta in 2005 for 70m euros, then sold it off a year later, without producing a single bike, for a token sum of 1 euro? yes, FIVE ringgit! the irony is that the company that bought it for 1 euro reportedly sold part of it to BMW for a reported 93m euros, & the remainder to Harley-Davidson for 109m euros.

& it was reported today that proton may sell part of the loss-making Lotus. seems like nothing Proton touches turns to gold. other than benefitting the manufacturers & the downliners, i don't think Proton did justice to the motoring public by mass-producing affordable cars. it's only affordable because the other cars were slapped with high import/excise/sales taxes.

perhaps car manufacturing is out of our league. or, we should only let competent people manage & turn the company around, like how they did for Air Asia & SP Setia.

most eligible bachelor

2011-10-10T22:53:00.002+08:00

bachelor may not be the appropriate description because my colleague is recently divorced. his was supposed to be the happy-ending genre - 2 doctors who married & went on to specialist training. he qualified & went into private practice while she qualified & was sent overseas for further training. they were supposed to start a family when she returned.

but she didn't.

she found life away from home to her liking, so much so that after the supposed 1-year training, she found herself another job & just continued working. it's been over 2 years since she left, so after many (failed) attempts at reconciliation, he gave up & filed for divorce. the papers just came through.

word spread fast, not so much the doomed marriage as a 40-something medical specialist with a flourishing private practice now available for suitors of the romantic kind. he has the temperament & character that would make any propective in-laws sit up & take notice.

already i can see 2 families making moves to catch his attention. he may want a break after the trauma of the divorce but he's just too nice a guy to remain single - he needs someone to share his affection &...er...wealth.

but here's the catch. he attends church & if he adheres to church beliefs, he can't marry without being branded as an adulterer, no less.

"I tell you that anyone who divorces his wife, except for sexual immorality, and marries another woman commits adultery.” matt 19:9

i don't know how this will pan out as we all watch with anticipation.

exam fever....& why you can't give up!

2011-10-05T18:05:00.002+08:00

yes, it's that dreadful time of the year again...for anxious students & their super-over-anxious parents.

i'd be lying if i say i'm not concerned for my daughter whose exams start in 2 weeks. having gone thru my fair share of tests & assessments from age 7 till 36 (!!), i think i may have figured out the twists & turns of exams.

1st, you're not competing against one another but rather against the system. as long as you achieve certain marks, you'll pass or score an A. yes, the examiners plot a curve & then decide on the cut-off points, but these points don't change much from year to year. if the exam is exceptionally difficult, as what my friend said about the PMR BM paper yesterday, most people will find it difficult, so the points will be lowered accordingly. i overheard my teacher friend said the standard of SPM Add Maths is so bad, the passing mark is 20%!!

so, it's actually in the students' interest that they have group studies/discussions & share with each other what topics they think are more important. that's called spotting questions & i believe this term still apply these days. my friends & i used to spot, in the sense that we've covered most exam topics & then we decide, based on previous years' questions, which are likely to be ask that particular year, so we can emphasise on those topics & hope to score should it be asked. but you have to have covered MOST topics, if not all. of course, when you haven't & are desparate, you'd also spot questions but i call this gambling with your future!

2nd, most students would have diligently prepared months before the exams & no one will ever admit they've completely covered the whole syllabus. even so, i'm quite obssessive about making sure the other preparations are in place, eg. full complement of pens, pencils, rulers & erasers, identity card, hankerchief (to wipe the sweat from forehead & palms) & watch/clock. after all, the revision is already in the head & there's not much more you can do about that, but you don't want to be rattled because of a oversight, eg. don't forget fresh calculator batteries!

3rd, don't forget to pray. doesn't matter which religion you embrace, you still need the confidence that a Supreme Being is on your side. especially when all else fail, when you're staring at a question & don't know how & where to begin, or when you're facing an essay question with no points in your blanked-out mind. when you're in dire straits & the sinking feeling is overwhelming, your last hope will be to call out, pray, exhort, chant or just mumble. you don't know Who's listening & Who's going to give you enlightenment. besides, you have nothing to lose.

fast-forward a few months, & when the results are announced, if you scored, then congratulations are in order. otherwise, don't fret that you didn't achieve your target. yeah, i know, your parents are disappointed & you're frustrated & the whole world seems to be against you. your friends have moved forward but you're sort of stuck in a rut.

who's to know what the divine plan is for you? is it for you to take a detour from your desired career path？or, should you start back at square #1 & start your journey all over again, hopefully be better equipped the next time?

after 30 years of sitting for exams, i've been thru it all - success, disappointment AND outright failure. the battle scars tell of the detour & square #1 tales. & more.

that's why i dare tell you - don't give up because it ain't over till the fat lady sings!

love transcends all

2011-09-30T01:06:00.000+08:00

now that the dreaded ghost month is over, expect a lot of happy occasions, like marriages, house-warming, etc to take place.

2 nurses are tying the knot soon. theirs & the grooms' families seemed happy.

a friend's daughter will also be getting hitched but the parents aren't too pleased because this one needs to transcend racial & religious boundaries. it's never happened in the family before so it came as a shock when we found out about it.

but the girl is a matured adult, trained in a top UK university & holding a decent corporate job, so presumably she's well aware of the implications of her decision.

circumstances like this often remind me of Samson who chose to marry a Philistine girl, even after his parents questioned his choice.

sometimes life just don't turn out the way we envisioned but that doesn't mean it's all bad. make lemonade, we're urged. make do with what we already have & build on that.

after all, we're also told, of faith, hope & love - the greatest is still love.

happy wedded bliss, everyone!

playing for God

2011-09-25T23:23:00.000+08:00

being able to play music is a gift.

from God, no less.

if kids can be encouraged to play for God, then i think they may just appreciate this gift. so everytime care group is held at my place, we get the kids to play when we worship.

we look forward to their playing for the church when they are older.

holding hands

2011-09-21T17:00:00.000+08:00

kids hold each other's hands in friendship。

kids hold their parents' hands for guidance。

couples hold each other's hands in love。

protesters hold each other's hands for solidarity.

so, can i say a patient would hold the doctor's hand for comfort?

bali

2011-09-20T16:40:00.000+08:00

t hat's where we'll be spending our annual family vacation this year end.

but we have absolutely no idea where to stay & what to visit, so any tips/pointers would be very much appreciated.

TQ.

safety on the highway

2011-09-19T23:55:00.000+08:00

Q: what do you do when you are involved in a minor accident on the highway?

A : once the car is "safely" parked on the hard shoulder, get everyone out & stay clear of the car!!

this guy had a minor accident on the NSE, & as he was trying to retrieve something from the boot of the car, a van hit him.

he's very fortunate to be still alive, except for a disfigured face & badly broken leg.

total duration of surgery = 5 hours

future procedure = at least one more surgery, on the foot

time before he can walk unaided = 3 months +

estimated hospital bill = currently RM20K+

good thing he has insurance cover!

PS. i personally don't think the hard shoulder is a safe place to park. if i had a puncture on the highway, my safest option is to get the PLUS guys to change tyres for me.

slip-shod puncture repair?

2011-09-16T23:30:00.000+08:00

it was a nail with a large flat head embedded in the tyre. what's odd was that the tyre wasn't flat even though i hadn't driven the car for almost 24 hours & it was by chance that i noticed it, because of the large prominent head.

the neighbourhood tyre shop was closed today, so i drove to the next one that was open. i was rather surprised that the guy didn't even removed the tyre from the rim. he just pulled out the nail, pushed in a black tarry plug & inflated the tyre to check for leaks.

this is the 1st time i've seen it done this way. previously, at the other shops, the guy would remove the tyre from the rim, pull the nail out, insert the tarry plug thru the puncture, then paint the inner surface of the tyre with some glue. even at the last puncture, the guy offered me either the "standard" repair like what i just described, or a "superior" repair. in the superior repair, the repair plug is shaped like an umbrella, in contrast to being just tubular...

the flat part being positioned flush against the inner tyre wall, thereby improving the seal. this costs RM12, in contrast to the RM5 standard repair. i read somewhere that if the guy doesn't inspect the inner wall of the tyre, he has not ascertain the true extent of damage to the tyre. in a way like a doctor who prescribes cough medicine without at least listening to the chest with a stethoscope.

based on what i saw today, like an unsatisfied patient, i'll be going back to my regular tyre shop for a 2nd opinion.

a new world order

2011-09-13T17:53:00.001+08:00

the miss universe pageants are more often than not won by fair maidens from the americas or europe. this year, miss angola (where?) won it.

the world no.1 in men's tennis has been traditionally an american, swede, german, spaniard or swiss. this year, it's a serbian. (where?)

the men's sprint king(s) are usually americans. this year, the jamaicans are the stars.

the F1 has been dominated previously by ferrari, mclaren or mercedes but not anymore. red bull is actually a drink.

the world, encompassing sports & politics, is evolving. people from lesser known countries are gaining prominence. is it in the genes, diet, upbringing, training methods, political systems or climate that determines winners?

the only malaysian sports personality that has consistently gain international attention (for the right reasons, mind you!) is nicole david, & to a certain extent, lee chong wei. after millions poured into sports by the govt plus mega-bucks private sponsors, what has our sportsmen/women achieved on the global arena?

doubles pair koo kien keat-tan boon heong says it all. after 5 years, they have chosen to part company with coach rexy manaiky. when you have an illustrious ex-world champion as coach, & you chose to train under an unknown to revive your flagging careers, you know you're done & toasted. (read here) better hang up your rackets and/or have your heads examined than embarass the country.

perhaps i wrote in haste. after all, who would have thought miss angola could be miss universe & a serb could be triple grand slam winner?

and, america never had a afro-american as president until recently. in the same vein, is it possible USA can win the rugby world cup currently playing in auckland? after all, how much different is american football?

well, let's see if koo-tan could be part of a new world order.

Awesome

2011-09-13T15:49:00.000+08:00

that seems to be the buzz word amongst teens these days. don't know how it came about but it's definitely here to stay. it's suppose to imply something commendable, like clever, helpful, hardworking, witty, resolute or even compassionate. so, perhaps instead of conveying the actual virtue, youths just use "awesome" to cover all bases.

my daughter's class is no different. when they had to design their class t-shirt this year, they came up with this....

i just rolled up my eyes & shook my head.

she is in Sec 4I, hence the play on "Four I." her schoolmates in Sec 4S, though also lacking in originality, at least are slightly more creative. their T-shirt reads: " May the Four(S) be with you." force, get it?

anyway, she's just gone back to school after a week's break. she has expressed some regret leaving home to study in s'pore, when her ex-classmates back here are having a relatively easier time. i guess she missed the camaraderie of old.

occasionally, i do emphatise with her - living with room-mates, each with their whims & fancies, taking bus to school, eating boarding school food & restricted by hostel rules & regulations, for someone who has, before this, only known the comfort of home.

but then, how else do we test our resolve & determination in facing life ahead?

These trials will show that your faith is genuine. It is being tested as fire tests and purifies gold—though your faith is far more precious than mere gold. So when your faith remains strong through many trials, it will bring you much praise and glory and honor on the day when Jesus Christ is revealed to the whole world. 1 Pet 1:7

& how else shall i describe her, having to go thru the trials & bearing up with them?

perhaps this is why the word "awesome" exists.

universal studios - how to cut costs

2011-09-03T02:26:00.000+08:00

we are malaysians. when we travel to a country like s'pore, we ~~behave like cheapskates~~ become cost-conscious & try to reduce expenditure because of the unfavourable exchange rate. this was what we did when we visited universal studios during the raya break：

1) save on accomodation : be thick-skinned & stay with a friend/relative. no point having friends & relatives if you can't impose! however, soften the burden for them by buying them at least a meal during the stay.

2) save on tickets : go on non-peak days where each ticket is SGD4 cheaper for both adults & children. better still book online, so you don't need to queue to buy tickets. these tickets are valid for 180 days from the date of intended visit. get 20% off if you use your mastercard to purchase.

3) save on food/drinks : although you are allowed to bring in only drinking water, don't fret. there are plenty of drinking fountains within the park where you can replenish. since the ticket allows you multiple entry on the same day, check out the two 7-11 stores just outside the entry/exit gates. you can get a good variety of sandwiches/ puffs & drinks. really, you're not thinking of having a full meal, right? unless you want to throw up during one of those rollercoaster rides.

4) save on souvenirs : they're all the same wherever you go, right? made in china but you pay for the franchise name. choose well, because they're most likely to be chucked one side when you get home.

5) there's a VIP express ticket you can buy for an additional SGD30 (on top of your regular ticket price). this allows you to go to the front of the queue for any ride. so, if you're planning to buy a 2-day ticket on account of the long queues, this is a cheaper option if you can only spend one day at the park.

so, despite the crowd, despite having to queue for up to an hour for certain rides....

the boy thoroughly enjoyed himself. me? i'm just glad to give him this opportunity to relate to his friends who have been here before.

he even had the chance to participate in the intro of the waterworld show...

these people who helmed the show are obviously pros & the dangerous stunts were well-choreographed.....

finally, one last stand before departure - holding up his sole souvenir, a unique drinking bottle shaped like an elongated hour-glass..

PS. we went on a s'pore school day, the tickets were purchased with mastercard, we had a light lunch at 7-11 & we stayed at my brother's in yishun. check out their website when planning your trip.

travel smart

2011-08-27T23:23:00.001+08:00

this 72-yr-old indonesian lady was on vacation when she tripped & fell, breaking her hip bone. surgery was carried out the same day she was admitted.

now, she needs to rest & rehabilitate. she can't bear weight on the affected leg for 6 weeks, which means she'll need either crutches or a wheel-chair. that probably means she can't fly home using low-cost terminals that don't utilise sky-bridges; getting into the plane on crutches or on a wheel-chair would not be possible.

and, before all that, there's still the hospital bill to contend with.

herein lies the problem. she doesn't have travel insurance. which means, she has to foot the hospital bill, buy a new (full fare) plane ticket & everything else in between, eg. hotel accomodation on discharge. as i explained the logistics of the transfer out of hospital after discharge, i could see the pained grimace on her face.

a lot of these hassles would have been taken care of had she bought travel insurance. for only a small fee (eg. rm50 for asia for up to 10 days coverage) the cost of any medical expenses, lost luggage, missed or cancelled flights would be compensated by the insurer. that's a small price to pay for peace of mind, considering if say, you've paid rm3k+ for a skiing vacation to korea.

this lady's additional expenses for the mishap would easily amount to rm10k.

so near, & yet.....

2011-08-22T19:58:00.001+08:00

we went down to visit the girl who just finished her Prelims (aka trial exams). we were in vivo city where the boy usually ask to ride on the sentosa express. we've not been on the express for some time, so he was thrilled when there was a stop for universal studios. we got off this stop just to check out the theme park.

of course, he couldn't help posing. & i think he was salivating, too...

i would too, if i were a kid!

PS. universal studios wasn't in our plans for this trip, but it could be in a future trip.

transferring out

2011-08-19T12:57:00.010+08:00

we do that quite often.

that is, transferring patients, invariably from the ICU, to a public hospital. sometimes, the patients are doing well except that the bill is getting to be a burden for the family. but more often than not, the patients aren't doing well; remaining in the ICU with no obvious light seen in the proverbial tunnel & with a big hole burning in the pocket, moving to a public hospital is the only way out.

also we have a situation here that is far from satisfactory. there are 4 neurosurgeons in the state & all of them are in private practice. so, if there are patients with serious head injury but who cannot afford the exorbitant private hospital bill, they get the initial immediate treatment at the local emergency department but will need to make the 100km+ journey to a neighbouring state for definitive neurosurgical management. all that delay will not improve functional or survival outcome for such patients.

so, it is with some sadness that we had to transfer out one such person yesterday. he had emergency brain surgery done & was not recovering well. staying in the ICU has been taxing on the family finances & after 10 days, they have no choice but to move to a public hospital in another state.

if only there were a neurosurgeon at the local hospital, the initial surgery & subsequent rehabilitation would have been done at an affordable cost. at least, the average man on the street would have been given a better chance at survival.

so, in this respect, it's easy for me to see why people harbour so much disdain for submarines, national service programs, overseas study trips & 100-storey towers. what good is all that when their right to proper medical care is eroded by the day.

fakes

2011-08-13T23:37:00.005+08:00

i heard this on the radio on the way to work, that imitation iPhone 5s are readily available in China now, even as Apple has yet to officially sell the phones. not at all surprising since even fake Apple & Ikea stores have been reported to operate there as well. read here & here.

before we shake our heads & go tsk-tsk at the Chinese, we have our own claim to infamy as well, like fake DVDs of movies that aren't even officially released yet. don't forget we have fake people as well, like bogus taxi & bus drivers who attack female passengers, bogus doctors who are actually medical assistants or med school dropouts, & bogus engineers who build leaking roofs & cracked support beams, just to name a few.

but i think the biggest fakes are the bogus politicians who do not look after the rakyat's interest. they make policies that don't benefit anyone except select groups - they roll out unity programs that disunite the various communities, build aesthetic but non-functional megastructures instead of schools & hospitals, & train undergraduates who are largely unemployable.

& in these difficult times, they prod us into austerity drive while they splurge.

this is the usual fate of seized fake dvds.....

if only those uniformed fellas show equal conviction with fake politicians.

Déjà vu

2011-08-10T23:19:00.001+08:00

i was in a "flash-back" situation today.

this young lady was due to have a caesarean section at a private maternity home yesterday in another state. unfortunately, the anaesthetic was unsucessfully administered & the surgery had to be cancelled. she was subsequently referred to this medical centre for further management.

as i spoke to her, the memories of those early days came flooding back - when, as a trainee specialist, i used to go around doing locums at various GP clinics & maternity homes. it was hard work but ~~the tax-free income~~ lucrative - one session done on a day-off would cover a whole month's room rental, & then some.

the obstetrician assistant at that maternity home must have been a junior trainee, like i was many years ago. the arrangement was a win-win situation - the obstetrician pays below-market rate for the assistant, who would be more than happy to supplement the income from the day job.

except when something unexpected like this happens.

anyway, for today, we are just glad to help in the safe delivery of a healthy bouncing boy!

panacea

2011-08-09T00:14:00.001+08:00

he's only 48 years old. yet, he's had diabetes & hypertension for over 10 years! last year, he had chest pain & an angiogram showed he has 4-vessel heart disease. he subsequently had angioplasty with stenting to the diseased vessels. now, he's on a total of 7 different tablets - 2 each for diabetes, hypertension & blood-thinning & 1 for cholesterol.

but i don't think he's duly worried because since the angioplasty last year, he's put on another 20kg!! after minor surgery today, he was panting & gasping for breath - symptoms pointing to poor cardiorespiratory health.

i dread to think what might happen after MAJOR surgery. but if he's not careful, he might not live long enough for another surgery. i suspect part of his indiscretion is that his employer is footing his medical bills & he probably has the misconception that as long as he faithfully takes his pills, all will be well irrespective of his undisciplined lifestyle. like a panacea.

in the brief period of time that i spoke with him, i explained that his diabetes, hypertension & obesity all add to the risks to his life & outcomes include a heart attack, stroke or even sudden death. how he deals with this information is entirely up to him.

if i meet him again, i'll post an update.

haematemesis

2011-08-08T00:04:00.004+08:00

that's the medical term for vomitting blood.

no, none of my patients is suffering from this, thank goodness! but that was how i felt today. the hokkiens call this feeling "thor huek."

if you've been warded in a hospital, you'd know when things don't go right. they dish out porridge when you ordered western, the medications are served hours late, or worse, omitted altogether, or they have to repeat a test because they didn't do it properly the 1st time. and, your doctor still doesn't know what's wrong with you.

these little glitches become magnified in critical areas like the ICU, operation theaters or emergency department, where a error of judgement, however slight, can make a difference between life & death.

i had the misfortune of being in that position today. the patient was seriously ill but the senior nurse attending to the patient with me was totally out of sync with the situation - not thinking, not pro-active & certainly not competent. i had to give explicit instruction every step of the way & this was a senior nurse who teaches other nurses the tricks of the trade.

i'm just glad i don't have to ~~throw up~~ do this too often.

oh no! another turnaround?

2011-08-07T00:22:00.004+08:00

we are really going nowhere!

after all the flip-flops, are we re-visiting the issue of the teaching of english again? DPM & minister for education just directed the DG to re-evaluate this issue, after discovering that students up to the level of tertiary education are not able to communicate comfortably in english.

no one's actually surprise - the rot started from 1970 & except for a brief reprieve from 2003 till 2009, english has been on a slippery slope.

or, could this be an election ploy? either way, a generation & a half of students have suffered the ignominy of inability to read, write & speak the international language of science & commerce.

nothing short of a strong political will can reverse this.

the 7 blunders

2011-08-05T23:50:00.002+08:00

The seven blunders of the world was a list Mahatma Gandhi reportedly gave to his grandson Arun Gandhi, written on a piece of paper, on their final day together, not too long before his assassination. In his final years, the elder Gandhi kept his grandson close at hand and set aside an hour everyday to be alone with the boy.

1 WEALTH WITHOUT WORK

2. PLEASURE WITHOUT CONSCIENCE

3. KNOWLEDGE WITHOUT CHARACTER

4. COMMERCE WITHOUT MORALITY

5. SCIENCE WITHOUT HUMANITY

6 WORSHIP WITHOUT SACRIFICE

7. POLITICS WITHOUT PRINCIPLE

makes a lot of sense, don't they? how many of the above do you think apply to our country?

10 pins

2011-07-31T12:14:00.012+08:00

people i know are dying like 10 pins.

the relatives of 2 colleagues of mine died just this week - one from cancer of the lung, the other, of the liver.

another colleague is now undergoing treatment for lymph node cancer.

who's next, i wonder? the waiting is akin to a game of russian roulette. we used to be in the dark concerning the cause of cancer, but now we know better. cigarette smoking, human papilloma, hepatitis B & Ebstein-Barr viruses，& Helicobacter bacterium are all known causes. but what about our lifestyle, the food & water we consume & the air we breathe?

the movies Erin Brockovich & A Civil Action are stark real-life reminders of the health hazard in our environment when we get careless or indifferent. remember Bhopal & Chernobyl? Germany is considering shutting its nuclear power plants in the wake of the Fukushima tragedy & so, you wonder, do we really need a rare earth plant in this country? no wonder the people in kuantan are up in arms at the decision.

in the meantime, the trigger-pulling continues.....

free health check

2011-07-30T00:13:00.001+08:00

a friend sent me an email with an idea you might want to explore further, given the current spiralling of health costs.

also read the satirical account here.

**thanks, Tun, for the email**

how to make birthday parties fun

2011-07-29T23:40:00.002+08:00

i've attended a few kiddy birthday parties that were actually fun, but this one's a bit different.

besides the usual food & drinks.....

or singing the birthday song around the cake .......

i think the kids love it more when they can interact...

like shooting each other with water pistols!!

kids with happy faces....isn't that what a birthday party is supposed to be?

philosophy of life

2011-07-23T13:25:00.000+08:00

A boat is docked in a tiny Mexican fishing village.

A tourist complimented the local fishermen on the quality of their fish and asked how long it took to catch them.

"Not very long." they answered in unison.

"Why didn't you stay out longer and catch more?"

The fishermen explained that their small catches were sufficient to meet their needs and those of their families.

"But what do you do with the rest of your time?"

"We sleep late, fish a little, play with our children, and take siestas with our wives. In the evenings, we go into the village to see our friends, have a few drinks, play the guitar, and sing a few songs.

We have a full life."

The tourist interrupted,

"I have an MBA from Harvard and I can help you! You should start by fishing longer every day. You can then sell the extra fish you catch. With the extra revenue, you can buy a bigger boat."

"And after that?"

"With the extra money the larger boat will bring, you can buy a second one and a third one and so on until you have an entire fleet of trawlers.

Instead of selling your fish to a middle man, you can then negotiate directly with the processing plants and maybe even open your own plant.

You can then leave this little village and move to Mexico City , Los Angeles , or even New York City ! From there you can direct your huge new enterprise."

"How long would that take?"

"Twenty, perhaps twenty-five years." replied the tourist.

"And after that?"

"Afterwards? Well my friend, that's when it gets really interesting," answered the tourist, laughing. "When your business gets really big, you can start buying and selling stocks and make millions!"

"Millions? Really? And after that?" asked the fishermen.

"After that you'll be able to retire, live in a tiny village near the coast, sleep late, play with your children, catch a few fish, take a siesta with your wife and spend your evenings drinking and enjoying your friends."

"With all due respect sir, but that's exactly what we are doing now. So what's the point wasting twenty-five years?" asked the Mexicans.

And the moral of this story is:

Know where you're going in life, you may already be there! Many times in life, money is not everything.

“Live your life before life becomes lifeless”

**thanks, CT, for the email**

i must be more careful with patients with large noses

2011-07-22T09:39:00.000+08:00

who'd thought that a large nose would be a point of contention?

this patient, Mr E, was to undergo a major back operation, which means he has to be positioned face downwards during the surgery.

as standard operating procedure, a soft gel support was placed below his face as cushion. the surgery was successfully completed in over 6 hours. however, 2 days later, Mr E mentioned that his nose was dark red & i explained to him that was because he had been lying face down for over 6 hours, so that was a result of pressure on his nose. it was then that i noticed he had an exceptionally large nose. still, i reassured him that it will get better with time. unfortunately, it became infected after a few more days & antibiotic injection & cream had to be administered. he had gone home since & i hope all will resolve when he comes back for review.

what Mr E has is a typical case of a pressure sore on his nose, the same type bedridden people get on their backs when they lie too long in one particular position. sometimes, even after we've taken the necessary precautions, unexpected events like this still occur.

which is a real damper, especially so since the major back surgery had gone on well.

51.7km

2011-07-18T15:27:00.002+08:00

it was with a little apprehension that i approached the same spot where the accident happened exactly 4 weeks ago. a bit like returning to the scene of the crime & it was fortunate that no one got killed.
this was the 51.7km mark, southbound on the NSE, just after the simpang renggam exit.

i slowed down a bit while taking in the whole scene. there weren't any brake marks on the road to betray what had happened. i also pointed out to the family the spot on the grass verge where i had parked while checking out the passengers in the other vehicles. everything looked normal.

in seconds, we had gone pass. as a reflex action, i looked into the rearview mirror, hoping to see something (or someone) out of the ordinary. there was none.

but i knew in my heart, an angel of mercy had watch over us at that very spot.

help!

2011-07-16T12:57:00.001+08:00

sometimes i dread it when i receive sms's like this from my daughter....

usually, she wants something done immediately.

sometimes i can't do it because i'm tied up at the hospital, in which case i just give some advice over the phone & leave it to her ingenuity or resourcefulness to sort the issue out. which is not a bad thing because she can't be depending on me forever for solutions or answers.

sometimes, i'm at home, so i help her out. but i must appreciate that she still realises that she can depend on me just when she needs me most, esp now that she has flown the nest.

we were there...

2011-07-14T23:02:00.008+08:00

no, not at the street protest......(hangs head in shame)

but with the kids at the stadium for the much anticipated friendly game between a malaysian selection & the visiting arsenal football club.

this was our (B8 & i) 1st time watching a game at the national stadium but it was the kids who were more excited. for us, it's an important bonding exercise because we all enjoy watching football on TV & this was certainly one game the kids will remember for a long time to come.

& it's obvious from the colours of the crowd, the majority were there to support the visiting team.

what's not so obvious was how our wives allowed the kids to go for the game. it started promptly at 8.45pm & by the time we got home, it was way past midnite - way past their bedtime & there was school the next day.

where your treasure is.....

2011-07-11T17:59:00.000+08:00

i was very attached to my previous car, one i held on for 10 years till it was more sensible (& financially viable!!!) to trade-in than to keep. it was serviced & maintained at the franchise dealer, using only original parts. i even washed & waxed the car myself.

don't blame the wife for calling it my 1st love.

but when i finally decided to trade-in, i elected for something i thought i would not be so attached to - a common japanese car that i could maintain ~~cheaply~~ affordably & service at any workshop, that i could park anywhere without fear of being vandalised & that i would fill in ron95 petrol without 2nd thoughts.

so, when i was involved in an accident recently, i thought i really had gotten over my car-attachment obssession because i really didn't feel any sort of heartache, considering it was just bought last year. seriously. i was just glad everyone in the car was safe & that i could still drive away after the collision.

but when i sent the car to the workshop today, i had a bit of reservation. well, ok, more than a bit. we have all heard of unscrupulous mechanics who pass off inferior parts as original & do slip-shod repairs. when i left the workshop, i've not felt this "loss" since my daughter left for boarding school. like a part of me is gone.

perhaps it's just my personality & not because of the car. i still keep my old handphones, cameras & clothes. i just couldn't let them go, so much so that the wife called me a hoarder. that's true because, frankly, there's just too much junk in the house!!

in biblical terms, my heart would be in the wrong place.

For where your treasure is, there your heart will be also. matt 6:21

life cut short

2011-07-07T22:15:00.015+08:00

let's face - we often take things for granted.

when we wake up, we expect the sun to be shining & breakfast already on the table. when we prepare to go to work, we expect the car to run, traffic to be bearable & the office a temporary sojourn for the next 8 hours or so. while at work, we expect to kids to be at school & when we get home, dinner to be ready.

most times, that happens.

sometimes, things go wrong a bit. we wake up with a flu, the car doesn't start, the traffic is chaotic & the boss at the office is in a foul mood.

sometimes, things go wrong a lot, like lives are cut short. we often think of the young adult who is struck with cancer, or the teenager in a road traffic accident, or a toddler drowned in a bath-tub.

all expectant mothers hope & pray they have a smooth pregnancy. or at worse, just a bad bout of morning sickness. but not this one - 7 months into an otherwise uneventful second pregnancy, she realises one day the baby doesn't kick. a check with the doctor confirms her worst fear - her unborn child has no heart beat.

it's painful. i can see it in her eyes & yet, i also detect a steely resolve. that life has to go on. that there is still time to conceive another child. that all is not lost.

i think this is an exteme version of life cut short - life snuffed out even before the child has the chance to see & breathe the world, not that it's a pretty sight now. i want to console the mother but i can't because as a doctor, i can't explain why this happened, & as a person, i can't comprehend the agony parents go thru when their child's passing predates theirs.

so, i just held her hand.

some parents don't love their children

2011-06-30T12:49:00.002+08:00

this rant is written out of anger, so don't take me seriously because these careless words may not describe the actual situation.

some parents DON'T love their children because they let the kids climb on parked motorcycles. so when the motorbike toppled over, it's fortunate that only the hand is badly hurt while we've actually seen worse injuries before.

some parents MAY love their children because when the kids are hurt, they sent them to private hospitals for immediate attention. maybe it's out of guilt, or maybe they have accident insurance.

some parents DON'T love their children because half an hour before the start of surgery, they give them a big glass of water because the kids complain of thirst. taking food or drink just before a general anaesthetic constitute a risk to the patient because the stomach contents can come back out into the mouth & then track into the lungs, causing a severe chemical reaction.

some parents DON'T love their children because, instead of accompanying the kids to the operating theatre for emergency surgery, they go out for a meal instead, leaving the kids with equally young siblings in hospital. seriously, how can the parents even swallow food at a time like this?

anyway, against the rule of Murphy's Law, everything turned out well. the surgery was a success & nothing went into the patient's lungs.

as an after-thought, perhaps this mother DOES love her 4-year-old daughter. it's just that i've imposed my own values on her. i should give myself a slap on the wrist.

like i said, this is just a rant. an angry one.

best ice cream in the world

2011-06-29T00:56:00.001+08:00

baskin-robbins 31 flavours?

haagen-dazs?

ben & jerry's?

for me, that's not even close. it's neither the brand name nor the flavours that count. it's the way it's prepared.

fresh out of the freezer, diligently scooped & delivered with a smile...

isn't it wonderful to come home after a hard day's work, then put the feet up & have an ice-cream cone served from a loving heart.

definitely the best ice cream in the world!

football, anyone?

2011-06-27T00:49:00.002+08:00

the English are coming!

well, not actually! even though they are English in name, Arsenal, Liverpool & Chelsea football clubs have more foreign players each compared to home-grown ones. even the respective managers & majority shareholders aren't English!

no matter. the fact that they will each play a malaysian selection here in KL should be enough to stir interest from both supporters & football neutrals. so B8 & i are bringing 3 of our boys for the arsenal game on july 13. it's on a weekday, so to me, it's a surprise the 2 wives agreed to let the boys go, considering the match will end past their bedtimes.

no matter. the boys are especially thrilled. now they can watch in real-life the stars they adore on-screen. i will be using the ticket as a bargaining chip - i'm certain the boy will do whatever he can in order not to forfeit the chance to watch the game live.

so, i can expect him to be extra hardworking, exceptionally helpful in the house & exhibit good behaviour. someone mentioned these carrot-and-stick disciplinary methods are outdated.

you think??

i need guidance

2011-06-25T15:32:00.001+08:00

sometimes you get an obese patient which makes certain procedures a nightmare to perform.

like with this 85kg girl. i needed an extra-long 4" needle to be inserted thru layers upon layers of fat to reach the target space. there're no firm landmarks to help guide the direction to which the needle is to be directed, akin to flying in the dark without radar guidance. but whenever i'm faced with such difficult circumstances, whenever i know i can't depend on knowledge, skill, experience,or intuition, i ask for divine instruction.

it worked & having another 2 patients this week, weighing 95kg & 100kg respectively, i know i can't rely on myself to get it right anymore. so i put it on record......

the psalmist said :
I will instruct you and teach you in the way you should go;
I will counsel you with my loving eye on you. (32:8)

for me, that's good enough.

McMedicine

2011-06-24T13:35:00.001+08:00

"Welcome to the emergency department. May I take your order?"
"I'll take the chest pain value work-up."
"An EKG with a side of blood work. Any toppings today?"
"Sure how about aspirin, nitroglycerin and dilaudid. Morphine makes
me itchy."
"Would you like a CXR with that?"
"No, I want to supersize that to a CT scan."
"That will be an extra $2,000; is that okay?"
"Sure, why not!"
"Okay that will be $50 with your co-pay; anything else?"
"Yes, make it snappy!"

if you've ever ordered fast food over the counter, you'll know that once you get to the front of the queue & you've made your order, the food comes pretty fast & furious. it's what we've come to expect, so you can imagine at some time in the future, we might just demand medical help ASAP.

we all can't bear waiting at A&Es, or at any hospital department, for that matter. everything seems to go at slow-motion & what's worse than waiting is waiting WITHOUT explanation.

patient satisfaction is one area that hospitals try hard to improve. even as a patient, i don't mind too much how high the quality of care is, as long as it's reasonable. & as long as the pain is relieved, the swelling reduced or the bleeding stopped, i'm quite happy. throw in doctors & nurses who are emphathetic & can communicate well, then forgive me for thinking i'm in 7th heaven!

the only thing out of control is waiting time. hospitals can work on this by setting expectations & providing explanations.

by setting expectations, the patients are informed of the timing of each step of their workup. here the business principle of "under-promise, over-deliver" is practised. by setting an estimated time that can be met 99% of the time, patients are more likely to be pleasantly surprised when less time than expected is spent on waiting.

however, in the 1% chance of time over-run, explanation should be given to the patients, & apologies extended if appropriate & an updated encounter timeline offered. patients understand difficult situations when these concerns are conveyed to them.

we're still a long way off from providing quick & efficient service in our healthcare system, unlike the way it's done at fast-food joints, but if we can achieve half that customer satisfaction, expect to see ~~patients~~ clients with smiles as wide as the golden arches.

**thanks, T1, for the email**

stigma

2011-06-22T00:06:00.001+08:00

while waiting for the police report to claim from the other party, i've been driving around with a badly dented back bumper.

what's your opinion of a driver who drives such a car? was he the unfortunate one who was rear-ended though no fault of his? or, was he careless when reversing? were the rear sensors not working or not loud enough?

however, i did notice one thing. at traffic stops, the car behind would stay a little further away from me. wouldn't you if the car in front had a bumper like this......?

happy-go-lucky

2011-06-21T13:05:00.001+08:00

when you have kids, you can't help but compare them, eg. who talked or walked 1st, who's the grumpy one & who's fussy with food.

my daughter is very much focussed in school, conscientious in her work & will strive hard to do well.

my son is just the opposite. though he enjoys school (because he can play with his friends, i suspect) he nevertheless slacks if there an opportunity for it, & is happy if he can skip tuition.

during the recent mid-term test, he ended up in 36th position out of 42. i told him his performance is not good & he will drop class if he doesn't buck up. all he said was：

it's not so bad, what? there are still 6 people below me!

well, this is one boy with a glass-half-full outlook in life and God willing, he will live contentedly to a ripe old age.

a fathers' day i won't forget

2011-06-20T17:07:00.001+08:00

not because i delivered the message in church.

but because, for the 1st time (& i pray, the last) i was involved in an accident on the highway. traffic was heavy & both lanes were laden with moving vehicles. i was on the outer lane when the car in front suddenly slowed down & braked. i did likewise & so did the car behind. although i stopped in time, the car behind didn't & he rear-ended me. not only that, the car behind his also knocked into him.

we all felt the sharp jolt & the kids sleeping at back had a rude awakening. thank goodness for rear seat-belts & the discipline instilled in using them at all times.

as it turned out, only the back bumper was severely dented & part of it had abutted against a rear tyre, making a sort of scraping noise. but the car behind, a waja, suffered heavily. besides the front & back portion damage, i could see water, probably from the radiator, leaking as well.

the 3rd car, a wira, had frontal damage. both the waja & wira had to be towed but fortunately, no one was seriously injured. a child from the waja had a mild knock on the head while the driver of the wira had neck pain. without identifying my background, i had a cursory look & reassured both that they will be ok.

but you have to hand it to the ~~vultures~~ tow-truck operators. 3 were at the scene before you could say "insurance." i could still drive, so after getting the relevant info from the driver of the car that hit me, i made my way to the police station myself, thanks to the GPS.

i thought i had all the essential info but having undergone a traumatic experience, i left out an important piece of info. the EXACT　LOCATION of the accident. it's ironic, esp when i had a GPS with me. so after making a few phone-calls, it was one of the tow-truck operators who provided the location.

when making a report at the police station, the young driver of the wira arrived later. his neck was still stiff but i reassured him that he'll be fine. we had a chit-chat & he surprised me when he wished me Happy Fathers' Day.

ha ha, like i said, this is one i won't forget!!

comedy of errors

2011-06-17T00:19:00.005+08:00

there are 5 of us in the same department. when pay day arrives, one of my colleagues will collect the cheques & distribute them to the others. but recently, i deposited the wrong cheque & didn't even realised it till much later.

this is how it happened.....

my colleague who collected the cheques passed to me someone else's envelope & then passed mine to the other person. the 3 of us didn't even notice the error because the names on the envelopes are similar.

the 2 of us who received the cheques wrote the our names & account numbers at the back of the wrong cheques without checking.

and, we both deposited the cheques at the banks' machines, again without checking.

having to retrieve the cheques from the bank after several days' lapse meant we'll both get our pay late.

let's hope we don't treat our patients the way we handle cheques!!

incidentally, this reminds me of several Air Crash Investigation episodes on tv. it's almost a ritual - the plane company cuts cost, the maintenance guy changes a wrong-fitting part, the supervisor overlooks, the plane is in the air when the pilot realises something is wrong & soon the plane disappears from the radar screen.

except that this comedy of errors is not so funny.

old-fashioned hair cut

2011-06-16T00:07:00.001+08:00

when i was young, my father took me to his regular barber shop in town for our hair-cuts. all the workers were indians & that's how i came to view barbers - that they all are indians. nothing racally-biased, just a profiling anomaly. it was when i was in my teens that i realised people other than indians can cut hair as well. they were called hairdressers or the more fashionable name hairstylists.

but i've always gone back to the traditional indian barbers. besides the resulting nice clean look, some of them provide a shoulder rub/massage as well.

but when i got older, i realised they were generally more expensive than some others, because they were members of a barbers' association where the prices were fixed. currently a simple cut costs rm9.

because of that, i've stopped patronising them as other non-members charge cheaper. no, i'm not too much into the classy cut-wash-and-blow type, operating in the malls with a fancy shop-name. no, i just want a clean cut.

and i'll shave myself, thank you!

my son goes to the same shop where the wife gets her hair done. his cut costs rm5. so when my regular guy told me he's hiked his price from rm6 to rm8, after all these years of loyal patronage, i decided to jump ship.

except now it doesn't matter who snips, as long as it's a clean cut & ~~cheap~~ reasonably priced.

just like how my father taught me; a legacy i'm passing on to the boy.

attention X-files buffs!

2011-06-13T13:55:00.002+08:00

we've not had a good conspiracy theory since the 9/11 WTC controlled demolition theory.(read here)

then, i stumbled upon 2 (yes, TWO!) yesterday.

the 1st involved the earthquake affecting fukushima & the damage to the nuclear reactors.(read here) didn't it occur to you that a 9.0 richter scale earthquake might have caused more destruction than a few buildings & a nuclear reactor?

the 2nd relates to the recent e.coli contamination of greens in europe. as the finger pointing goes around from country to country, read this interesting take on the tragedy. it's uncanny that a new bacteria strain possesses such extensive resistance to currently available antibiotics.

is there more evil emerging in this world beyond our wildest imagination? fox mulder would have been glad to come out of retirement to solve these!!

hopefully, this will help get you through your monday & new school-term blues.

a green idea

2011-06-12T11:18:00.019+08:00

this is too good an idea not to share.....
Seal Plastic Bags with Old Bottle Caps

WHO EVER THOUGHT OF THIS SHOULD GET A GREEN MEDAL
WHAT A GREAT IDEA.!! NO MORE TWIST TIES OR RUBBER BANDS. This method is WATER PROOF AND AIR TIGHT. The guy who first thought of the idea should be given an award for originality!!!

Cut up a disposible water bottle & keep the neck & top, as in the photo.

Insert the plastic bag thru the neck & screw the top to seal.

The bag is made to be air-tight, such that water will not
leak, the secret lies with the top & screw cap.This
is a great idea to share. Good for us and the
environment too. Zip-top bags are great, but sometimes
you buy something in bulk and you're stuck with an
unsealable bag. Home-centric blog Re-Nest shows us
an easy way to give these bags an airtight seal with an
old water bottle. All you need to do is cut off the top of
the bottle and take off the cap. Push the bag through
the bottle neck, fold it over the edges, and twist the cap
back on. Now, your bag has an air and water tight seal,
and you didn't have to waste the bag.

**thanks, KC, for the email**
PS. my opinion is that to prolong the lifespan of the plastic bag, you seal it closer to the open end at the beginning, & as the contents are used up, you reseal it further & further away from the open end.

5% solution

2011-06-08T15:27:00.000+08:00

we do a lot of calculations in medicine. maybe that's why maths is an entry requirement to med school.
for example, patients are prescribed dextrose 5% as an intravenous drip. what this contains is 5g of dextrose (aka sugar) in 100mls of solution. this equals 5000mg in 100mls, or 50mg per ml.

similarly, normal saline or 0.9% saline contains 0.9g of sodium chloride (aka salt) in 100mls of solution, which equals to 900mg sodium chloride in 100mls, or 9mg per ml.

so, 5% of any medication equals to 50mg of that medication in 1ml of solution.

yesterday, i prescribed a 0.5% of a local anaesthetic to a patient to be given in the ward. the solution is prepared & labelled as 5mg per ml from the manufacturer. so this nurse called up the pharmacy & asked if they could prepare a 0.5% solution for the ward. the pharmacy assistant said they couldn't do it & asked the nurse to do it herself. feeling lost, she reverted to me on my instruction, saying the local anaesthetic only came in 5mg per ml preparation & not 0.5%.

if you go by the previous example, 5% solution is the same as 50mg per ml, so 0.5% is the same as 5mg per ml. which means, the nurse should have just used the solution as prepared.

this is a basic calculation which everyone prescribing, preparing & dispensing medication should be familiar with. fortunately or unfortunately, the responsibility of giving the right dose to the patient falls squarely on the doctors' shoulder.

don't you think an A in maths should be a compulsory requirement for entry into med school & a strong credit for nursing & pharmacy school?

after all, you don't want to to be on the receiving end of a 10-time higher dose of medication, right?

how to score in matriculation (& enter med school)

2011-06-02T13:59:00.002+08:00

the wife's nephew visited us yesterday & related how life is as a medical student. he is both diligent & intelligent, scored a string of As in the SPM & got into a local matriculation course. he then shared with us how he managed to excel in matriculation & got into med sch.

he had a bumi room-mate who's not too smart & who's been given ~~a head-start~~ "extra" course assignment. not being able to cope, this room-mate sought the nephew's help in answering & completing the work. as it turned out, most of the questions in the assignment eventually came out in the final exams.

needless to say, the nephew aced it.

that's how he got into med school.

cool, eh?

i hate love

2011-06-01T00:03:00.003+08:00

got this link from Jemima's blog. the book sounds like an interesting read & there sure are things you don't learn in school. i like this one in particular:

"Have you ever been in love? Horrible isn't it? It makes you so vulnerable. It opens your chest and it opens up your heart and it means that someone can get inside you and mess you up. You build up all these defenses, you build up a whole suit of armor, so that nothing can hurt you, then one stupid person, no different from any other stupid person, wanders into your stupid life...You give them a piece of you. They didn't ask for it. They did something dumb one day, like kiss you or smile at you, and then your life isn't your own anymore. Love takes hostages. It gets inside you. It eats you out and leaves you crying in the darkness, so simple a phrase like 'maybe we should be just friends' turns into a glass splinter working its way into your heart. It hurts. Not just in the imagination. Not just in the mind. It's a soul-hurt, a real gets-inside-you-and-rips-you-apart pain. I hate love."
— Neil Gaiman (The Kindly Ones)

doesn't this just feel like it's talking about you?

a (dangerous?) precedent

2011-05-30T14:37:00.001+08:00

there's been a few odd incidences here & there but this is the one that got me all riled up....

it was already arranged months ago to have leaders' training session last friday & all CG leaders are ~~required~~ invited to attend. then, earlier in the week, the pastor emailed to all leaders involved to enquire if the session could be brought forward to thursday instead, because it clashed with a charity dinner (on fri) which the church contributed but isn't even directly involved with.

in reply to the email, i wrote : has there been a precedent when a church-sanctioned training was displaced by a charity event?

only J responded, emphasising on setting our priorities right with God.

Paul wrote to the Hebrews:

Have confidence in your leaders and submit to their authority, because they keep watch over you as those who must give an account. Do this so that their work will be a joy, not a burden, for that would be of no benefit to you. (13:17)

i've had several disagreements with the pastor before but just let him be because of Paul's admonishment to the church, but now, i'm not so sure. i just feel that one shouldn't rush in where angels fear to thread.

it's times like this that i think i may have Pharisaic ancestry.

Mr & Mrs K - part 2 (or is this the finale?)

2011-05-28T10:00:00.007+08:00

i had just spoken to Mr K's oncologist today & he said something that struck me numb. well, sort of.

he said one of the most tragic experiences in life anyone can face is to find out that you have stage 4 cancer, which is essentially incurable, and you never had any symptoms to even suggest that anything was wrong - no pain, no numbness, no discomfort, nothing.

you go for a routine medical check-up & BANG! the huge tumour is staring at you from the xray.

i had the question at the tip of my tongue - how long has Mr K got - but i refrained from asking. because it's all irrelevant now. it's too late but Mr K should make peace 1st with himself & with his God, & then with the world.

after the hair-drop, vomitting, weight loss & feeling like it's the end of the world from the effects of chemotherapy, at least reconciliation will preserve some degree of dignity on the final stretch.

be strong, Mr & Mrs K!

Mr & Mrs K

2011-05-26T23:48:00.000+08:00

this is about Mr & Mrs K from the previous post.

i was quite certain Mrs K was going to do Mr K in, but as it turned out, Mr K's brain surgery was a success & he recovered without much fuss. the biospy taken from his brain showed that it was a small-cell carcinioma & in this case, most likely to have spread from his lung. he has been referred to the cancer specialist & will receive chemotherapy next week.

i met up with the couple again today. he looked cheerful while she was lovingly feeding him dinner. i asked him about what the other doctors have said to him & noticed the wife putting her finger to her lips, implying that he doesn't know his real condition is & what's in store for him.

it's just reinforced what i had thought all along - she's the one making decisions for him.

so, can you forgive me for thinking that she'll do him in ??

a hurried decision

2011-05-21T14:51:00.000+08:00

Mr K, 45 years, a chronic smoker now presenting with a brain tumour. a CT scan of the chest revealed another tumour in the right lung, even bigger than the one in the brain, & it has even shown signs of spreading out already.
this new finding has taken us all aback. after presenting the pros & cons of brain surgery to the family, expecting them to think over carefully, they made the decision to operate within the hour. apparently Mr K is undecided but Mrs K has made the decision for him.

without any surgery, he may succumb to either tumour in 3 - 6 mths, even with chemo and/or radiotherapy.

with brain surgery, he may last slightly longer, probably up to a year. but that is only if it is vastly successful & recovery from it is uneventful.

but i'm not optimistic. i think they should deliberate over the weekend & come to a consensus. as it is, i can see some of his family members are keen on surgery, while others aren't. & this decision is made while tears still flow & the duress is obvious.

i feel this is a hurried decision. and, i sure don't have a good feeling about the outcome.

ugly head

2011-05-19T16:15:00.001+08:00

when we talk about a drug problem, what usually comes to mind are images of intravenous users in back alleys, air passengers stuffing contraband into hidden compartments & every known orifice, or patrons high on "ice" in a club.
we all know the problem permeates much wider & deeper than that.

i still remember vividly when i was on-call one evening while training at a teaching hospital. we were considered junior doctors then & were searching high & low for the lecturer-on-call to help us handle a particularly difficult case. despite repeated calls on the phone, pagers (there were no handphones then) & PA system, he was nowhere to be found.

then someone finally located him, on the toilet floor, groaning & frothing at the mouth. found nearby was a used syringe. empty.

to cut the story short, he had been injecting himself with painkillers & this time, he overdosed. he was immediately admitted to the ICU & subsequently recovered. my boss, to his credit, kept things under wraps - told the offender to take medical leave & on completion of his expatriate contract, to return home. the hospital was not informed the real story behind this episode.

later, after i had left the hospital, i was told one of my junior colleagues did the same thing. he was then asked to leave post-grad training.

at another hospital where i worked in UK, i found out 9 years later that one of my peers had been doing the same thing when we were in the same department. he had been depressed because he couldn't pass his post-grad exams. in the end, he also left training & ended up a GP.

so, i know a senior, a colleague & a junior who had abused drugs. well, surprise, surprise, the ugly head has reared again.

now, a male nurse i used to work with had been found to falsify entries in a drug record book, including creating fictitious patients to obtain the pain-killers. doesn't matter if it's for personal use or worse, for resale; he will be punished, subject to an internal inquiry. his HOD is obviously not as gracious as my ex-boss, which is why the misdeed is the talk of the local medical fraternity.

and unless he can pull cable or divine intervention intercedes, his career as a nurse is as good as over. which is a real pity because he has shown such good promise as a capable & competent paramedic.

teacher's day

2011-05-17T13:48:00.001+08:00

i have to confess i don't have any recollection of a teacher's day celebration, such that yesterday passed by without much ado for me. but that does not take away the impact teachers had on my life.

i am still in contact with Pn Rahmah (primary 1 teacher), Mrs Thumboo (primary 2 & 6, read here) & Mrs Chan (biology, 5th & 6th form). but the one who convinced me on a career path was Mr GV Pillai (physics, 5th & 6th form). he was such a masterful teacher, appropriately so as he was the only one with a M.Sc in school, he made physics so simple that a whole bunch of us in class decided we want to be engineers.

so what happened?

that's when i met the other Teacher:

As Jesus started on his way, a man ran up to him and fell on his knees before him. “Good teacher,” he asked, “what must I do to inherit eternal life?” Jesus looked at him and loved him. “One thing you lack,” he said. “Go, sell everything you have and give to the poor, and you will have treasure in heaven. Then come, follow me.” Mark 10: 17, 21

so, did i interpret this encounter correctly? did i sell off my engineering ambition to take an alternate path to public service? perhaps the circle will be complete only when i ~~backtrack~~ return to serve the poor.

friday, may 13

2011-05-15T23:53:00.001+08:00

because the boy's birthday falls on exam week, we decided to celebrate it on friday, after CG. his sunday school buddies were invited & to him, that's all that matters.

in fact, because he has only one much older sibling & few cousins, none of whom live nearby, his friends mean a lot to him. as parents, we try to provide him opportunities to fellowship & give him a sense of belonging outside of family ties.

and for one day a year, he is the centre of attention. who doesn't relish that?

& he gets the applause appropriate to the occasion....

for a child, all innocent & impressionable, what can bring more happiness to the birthday event than to have fun & share a meal with his peers.

i never knew the trauma of may 13, 1969. i only read about it. but we are all grateful that on this particular friday, we celebrate another year added to the boy's life & pray that we in malaysia continue to live in relative peace & harmony.

even as some irresponsible bloggers & press media try to fan the flames of racial & religious discontent.

month of May

2011-05-09T23:55:00.000+08:00

May is supposed to be a merry month, presumably as it heralds the coming of summer.

not so for my kids, both of whom were born in May. they can't truly celebrate their birthdays with a lavish meal on an outing because both are right smack in their mid-term exams.

perhaps that's just a small price to pay.

after all, this May could have been much worse off if you take the context of Osama or George Yeo. suddenly studying on your birthday doesn't seemed that difficult.

my elder girl agreed.

informer

2011-05-02T10:40:00.001+08:00

the income tax dept is very keen to reward informers who snitch on tax evaders (read here). i have my personal experience with an informer this morning.

except that she was "a nurse" who called me up at 6.30am to tell me about a new patient who was admitted at 12 midnite. despite his multiple medical problems, she could not provide more details, like the duration he's had the problems & the medication he's currently taking.

and no, she also hasn't traced the patient's old notes which held a wealth of information the health status. as such, i could not give any instructions over the phone.

so, as far as i'm concerned, she wasn't a nurse (hence, the open & close inverted commas in the initial description of her job), she was just an informer.

she just passed a message, a task a ward clerk would have performed admirably with less salary.

the wedding - an english lesson

2011-04-30T13:35:00.000+08:00

you couldn't have missed it - it was the wedding of the year, maybe of the decade or the century. it was televised on both free-to-air and satellite TV & the media screamed its headlines.

so here's our english lesson....

what's the difference between complete and finished?

when you marry the right one, you are COMPLETE.

when you marry the wrong one, you are FINISHED.

AND when the "right one" catches you with the "wrong one," you are COMPLETELY FINISHED!!

so, i wonder what the outcome will be when you refuse to vow obedience.....　

don't be

2011-04-29T00:38:00.000+08:00

don't be fat.

ok, if you can't help being tubby, at least don't smoke.

ok, ok, if you weigh 108kg & smoke 3 packets of ciggies a day, at least stay away from doctors.

unfortunately, if you're obese & you smoke like a chimney, you're most likely to develop diabetes, hypertension and/or high cholesterol, & then you CAN'T avoid doctors.

and, if you have to undergo difficult abdominal surgery, your recovery is very likely to follow a stormy course.

Mr G is such a person. he had to spend one day in ICU hooked up to a ventilaor after surgery, because he couldn't breathe, when most people would have just breezed through.

he's only 45. i dread to think what he'd be like in 10 years if he didn't change his life style!

migration to new zealand

2011-04-28T13:06:00.000+08:00

when we vacationed in NZ last year, the whole family thought aloud in the same wavelength - fresh air, fresh milk, fresh lamb & lots of space. if you disregard the occasional tremor, it is a very liveable place. truth be told, we did toy around with the idea of migration.

but looks like 10 malaysians beat us to it....(read here)

apparently, in NZ, when you are caught for a drug-related offence, you are not executed like in some unciviilsed countries (see, another reason to move to a country where you actually live longer!) but granted permanent residence with free food & a place to stay, albeit behind bars. hmmm....think of the lamb shanks, fresh strawberries & local wine you'd be served!

actually, these drug mules give other bona fide travellers a bad name. don't be surprised if the immigration & custom officers give you a dirty look when you next visit.

ditto heathrow airport.

in the mean time, our NZ dreams remain just that.

dreams.

playing God......with a twist.

2011-04-22T14:35:00.004+08:00

i posted earlier about how doctors are sometimes accused of playing God (read here). here's one with a twist......

72-year-old Mr O was admitted a few days ago with chronic obstructive airway disease & acute renal failure. after he had gone for a CT scan & then connected to a ventilator to assist breathing in the ICU, his daughter then dropped a bomb - she wanted to take her father home.

WHAT?? we were stumped!

if a patient is incapacitated, we often respect the wishes of the family as to how they want treatment to proceed, within reason, of course. so while Mr O will benefit from a few rounds of haemodialysis & a few days on ventilator to tide him over this difficult period, there is still no certainty that he will be back to normal after that. he could remain in critical condition, or even get worse. perhaps it's the lack of a guaranteed outcome that the family chose to defer further treatment. both my colleague & i don't know for sure why the family took this course of action.

however, having to make many difficult decisions each day, it does lighten our burden just a bit when the patient or the family make their own decision & boldly adhere to it.

it's out of our hands now.