Tuesday, November 27, 2012

why you must tell your doctor everything.

53-yr-old man due for minor hand surgery. smokes but denied any known medical problem. a manual worker in the plantatiuon.

a routine pre-operative ECG showed that he had a recent myocardial infarct, aka heart attack. when asked in detail if he had any chest pain recently, he thought for awhile & said he did have a gastric-like pain 2 weeks ago & was a bit breathless at that time. however, he felt better after that without seeing a doctor.

as we all know, a myocardial infarct sometimes presents with atypical symptoms (read here) which are often ignored. for doctors, these should trigger off the alarm bells.

a blood test confirmed the recent infarct. he was informed of his condition & advised that the surgery should be postponed till the cardiologist checked him up. he subsequently had an angiogram which showed that 3 arteries in his heart were significantly blocked. he is scheduled for cardiac bypass surgery in a few week's time.

if he had undergone the hand surgery, there's a 1-in-3 chance that he will have another heart attack, in which case, there is a 50% chance he will succumb to it. which means that, if we had proceeded with surgery, there's a 1-in-6 chance, ie. 16%, that he will die on the operating table.

grim statistics but a solemn reminder of our mortality.

so the next time your doctor asks you if you have any medical problems, think carefully before you answer.

it could well save your life!

Sunday, November 25, 2012


Blessed are the peacemakers, for they will be called children of God. matt 5:9

this may sound like the beginning of a sunday sermon but it's not. it's a confession actually.

today, i made peace with my mother.

happy birthday, mum!
"and i realised when you look at your mother, you are looking at the purest love you will ever know." mitch albom in For One More Day

is ignorance bliss?

life is like owning  a car.

when you send your car for servicing at the authorised dealer, you usually assure yourself that the mechanics would do a good job & the parts changed are original ones. as long as the car runs like clockwork, you usually don't care too much about the bill.

consider this hypothetical situation.

a man injures himself badly & seeks medical attention. he goes to the emergency department, expecting to be seen by an experienced doctor who will examine & manage him appropriately. he would then be sent to the ward for further treatment & recuperation, or to the OT to have his injuries operated upon.

does it boggle the mind that his injuries are so severe because he is given less adequate treatment & because his condition is not stabilised at the emergency department, when he is sent to the OT, he is more dead than alive??

like i said, life is like owning the car. when you refrain from patronising the road-side workshops & choose to pay top dollar for the service at the authorised dealer, you don't expect your car to breakdown a day after the service. as long as it runs, you're contented.

sometimes, it's better not to know what transpires within the confines of the workshop.

or the emergency department.

ignorance is bliss.

P/S. in the same vein, you really don't want to see what's going on in the kitchen of your favourite restaurant.

Thursday, November 22, 2012

coming out of the closet

no, it's definitely not what you think it is.

i meant, what if you've been writing/commenting/blogging anonymously all this time, and then you decide that, for some inexplicable reason, you're going to reveal yourself to someone?

and, oh yeah, there are pictures to go with the disclosure.

the response from the other party was an emphatic :

Omai! Omai! This is so spine-tingling!!

yeah, just like a spy thriller movie.....and the opening scene unfurled today.

PS. hmm....maybe it is really what you think it is. after all, when you come out of the closet, people see you for what you really are (warts & all usually come to the fore) & what your deviant unusual inclinations & queer orientations are. and, hopefully, in a civil society such as ours, you are still accepted for what you truly are.

Wednesday, November 21, 2012

the best brains

come march/may when the results of the SPM/STPM are released, the top scorers will proudly reveal to all & sundry the secrets of their success & then sheepishly hope that they'll get into medicine, dentistry, engineering, law, finance, & blah, blah blah.

nothing has changed over the years but apparently the govt will try to alter the mindset of our youngsters & get the top students into teaching. (read here) so, can you imagine straight-As students, instead of seeking employment in hospitals, clinics, law firms & banks, in the future would be heading for the schools?

neither can i.

at least, not when licences are freely given to start private medical schools, for whom a critical mass of students is necessary to make the business viable. yes, it's a business & a lucrative one at that. guess how many A's a student should have to meet the lowered requirements?

your guess is as good as mine!

Saturday, November 17, 2012

the waiting game

8.30am - scheduled time of surgery.

it's now 8.45am.

patient on the operating table.......anaesthetist ready to start......surgeon waiting in earnest.....

and, nurses just started preparing her instruments.

time of actual start of surgery - 8.55am.

it's days like this (& there are many of late) that makes me dread coming to work.

i suppose it could be worse - i could be dealing with a govt dept.

home alone

about twice a year i get to be home alone for the weekend when the wife brings the kids to the hometown.

i'm ok with it - not that i don't miss them (i do!) but i've got stuffs that keep me occupied.

for a start, i work.

i've also got a whole weekend of football on astro plus i've just started reading Life of Pi again. actually, i commenced reading last year but somehow after about 10 chapters, the unfolding of the growing years of the protagonist got a tad boring & i stopped. now that the movie version of this Man Booker prize winner is to be released next year, i thought i'd pick the book up again.

oh yes, i bought it last year at a book fair because the hard-cover sold at less than half price. much as i enjoy reading, i usually purchase when the books are really on sale.

like today. i dropped by the local bookstore & this just jumped at me from the discount counter. the yellow tag was a dead giveaway....

it's 2 years from its 1st release but where can you get a current hard-cover by a best-selling author for rm9.90 these days?

yeah, the wife & kids would be home before i know it!

Friday, November 16, 2012

football = sex?

you must have seen it on the sports channel, or at least, your football-mad colleagues would have been ranting over it at the office.

yes, i'm referring to zlatan ibrahimovic's outrageous overhead kick against england in a friendly in sweden this week.

as i was talking about it with some friends at work, this nurse, still single but in a relationship & who obviously had witnessed the wonder goal, injected : yeah, fantastic shot - as good as any orgasm i've had!

hmm, such vivid imagination!

not sure if she was exaggerating - but it was fabulous. it would be right up there with those scored by messi or ronaldo. a definite contender for goal of the year. decade even.

and yeah, i'll be thinking of the goal if i ever meet with the boyfriend.

Wednesday, November 14, 2012

time bomb in a bun

yesterday i learned of  the existence of a word that has been named "word of the year" by oxford dictionary, although it's the American Dialect Society that started this award in 1991. previous awards have gone to words like 9-11, subprime & tweet. anyway, this year the winner is.......


what?? (read here)

i doubt i'd be using it any time soon in my everyday conversation, unless i'm in deep discussion over some political or financial issues. however, it seems the americans, dissatisfied with the choice, thought selecting this year's U.K. Word of the Year was obviously total omnishambles.

never mind which word deserved the accolade, as inconsequential as it may be, but i did learn a phrase that would definitely make a difference in my life (& hopefully everyone else's too).....

a time bomb in a bun.

it's used to describe fastfood breakfast sandwiches (read here) & there's plenty to choose from, going by media adverts. currently, one promotion on TV guarantees nothing can go wrong in your day if you start off with their breakfast menu. ha ha, very effective but nothing could be further from the truth.

surprisingly, that's not the worst breakfast you can have. apparently, from the same report, NOT having breakfast is even worse for your health. i think that's probably true - my friends who fast during ramadhan swear they put on even more weight during that time than any other month of the year..

someone once advised me, long before i entered med school, regarding diet - have a king's breakfast, queen's lunch & a pauper's dinner. the rational is that you need a good proper meal to start the morning, & as the day winds down, the activities get less strenuous, you require less food.

i'll mull on that later but if you'll excuse me, i'll need to go for a late breakfast now....

Wednesday, November 07, 2012

an offer you can't refuse

reminiscent of a godfather movie, my colleagues say it's an offer you can't refuse.....

a brand new C180 at rm212,888. i assume they meant a mercs has never been cheaper more affordable. if that's true, car aficionados must be drooling all over at that offer.

for me, i didn't bat an eye-lid but i did wonder if this is one occasion where one buys something one doesn't really need, with money one do not have, to impress people that one don't even like??

Tuesday, November 06, 2012


this is the time of the year when parents of school-going children rejoice or grieve.

the year-end exams should have been announced. high-scoring students will win prizes for their achievements while those lagging far behind will get scoldings from their parents demoted to a lower class.

and tiger mums* would not exist if not for schools.

the reason we put the boy thru a mandarin-medium school is solely for him to learn his mother-tongue language; anything else useful that he picks up would be an added bonus. but because both the missus & i aren't native mandarin-speakers, we could not help him much in developing this language skill. even though he has tuition for this, we did not expect he would excel by way of exam results.

this year, he attained 26th position in a class of 39, a slight improvement over last year & he will remain in the same class for next year.

thru my (biased?) eyes, he has excelled.

he can speak & write mandarin far beyond our expectations, but what we find most encouraging is that he delights in going to school. as long as he enjoys school & doesn't run foul of the teachers, i think 26th or any other position, mucht like our age, is just a number.

*to be grammatically correct, shouldn't they be called tigress mums?

Monday, November 05, 2012

another reunion

besides the lunar new year reunion with the family, i have 2 other reunions which are both not held annually. one is with the 6th-formers which is held every 4 years on the same weekend as the football world cup final (read here); the other, with the varsity mates.

yesterday, we had varsity reunion 3.0 in KL.

35 turned up. most are from klang valley with 2 from penang & 1 from kota kinabalu.

we caught up on old times - shared jokes, traded barbs & revealed secrets long buried in the past. there were a few mates i've not met since graduation!

i learned 2 things :

(1) from personal accounts, UM med grads tend to tell it as it is, & non-alumni don't like that. most think we were over-meticulous & overbearing, sometimes bordering on arrogance. but that was the environment we were nurtured in, instilled by the icons of medical academia of old, to strive for perfection excellence. looking back, we were glad we went thru that because they pushed us to be the best we can be.

(2) one of my mates revealed he has found peace in, and with, himself. he's a paediatrician in private practice who's running an orphanage in addition to his clinic. this commitment runs from 9am till 12mn everyday - strenuous but it's something he enjoys doing, charging those who could afford & helping out & providing shelter to the disadvantaged.

in my opinion, that's a noble intention we all should aspire to. the wise man once said:
So I perceived that nothing is better than that a man should rejoice in his own works, for that is his heritage. (Eccles 3:22, NKJV)

Friday, November 02, 2012

the black cat

many years ago during an inter-school debate, i heard one student taunt his opponent : my esteemed friend over there is confused, like he's in a dark room, looking for a black cat (pause) which isn't there.

looking back, it was a cynical comment & it sounded authoritative yet lacked substance. it's one of those phrases you bandied about just to impress the judges. much like a pick-up line.

a semblance of that statement was taught in med school. searching for a cause of an intra-abdominal infection can be difficult, hence "pus somewhere, pus nowhere, pus under the diaphragm." it just means that if you suspect pus in the abdomen, but you can't seem to find it, try looking under the diaphragm.

and no, i didn't learn any pick-up lines in the lecture halls either, but i digress.

so today, a 30yr-old lady presented with a lump in the groin. a biopsy of the tissue had been done & the lab reported it as metastatic cancer, which means this swelling in the groin (aka secondary tumour) is a result of the spread of a primary tumour.

this lady had been subjected to a battery of investigations to locate the offending growth - tests like gastroscopy, colonoscopy, ultrasound, CT scan, MRI & even a PET scan. but zilch! it's nowhere to be found. i can emphatise with her - it's an unnerving feeling that you know something sinister is growing in you & yet it remained elusive.

like the black cat.

running out of places to scan, & as if to grasp at straws, we did a scraping of the uterus & cervix today. just in case, because already we're at wit's end.

let's hope it's truly darkest before the dawn.