Tuesday, August 22, 2017

Never been overseas

Thailand, 1984


Other than Singapore, I have never travelled overseas until med school is over. Four of us took on this ambitious 2week self-planned tour of Thailand, as a reward for passing out as medics.

We got a ride from Penang into Haadyai with a friend & stayed with him as he showed us around town as well as a day out to Songkla.

But the real trip began when we ventured ourselves into Bangkok by bus, asking for help & directions from what little Thai we learned from guide books. No mobile phones, internet, Google maps or Agoda...it doesn't get any more basic than that.

So, we made our way to Grand Palace & Floating Market & watched a Thai boxing-cum-cultural show, all this on a shoestring 50baht-a-nite guesthouses.

Took the overnite bus to Chiangmai, & went on a boat ride on the Mekong river by Burma's border to Chiangrai, the northernmost Thai town, just for the fun of it. Watched natives smoke opium, kids beg for money & girls dance on bartops. That was the closest to anything naughty we ever did...scouts' honour. Nope, not for us the tiger shows, no siree!

That was the 1st & last time we travelled together. 2 months later, we were posted to different parts of the country to begin our new lives as working adults.



Return to Innocence

Jason Bay, 1978.


It was the 1st church camp I ever attended.
Living off well water & kerosene lamps.
Fresh (sea) air & sunshine.
Played football by the beach &
Watched sunset at dusk.

The mosquitoes were relentless but the snakes stayed away.
The camaraderie was strong & the fellowship warm.
I was a new believer.
Love was in the air but I made a mess of it.

Ha ha, that's why I will never forget this.

Monday, August 21, 2017

Right time, right place.

It's often proclaimed that wherever we are, whatever we do, it's for a reason. Like if we had not gone there, then ...... or, If we hadn't done that, then...........

If you are religious, you'd feel it's even like a divine decree.

Last Wednesday, I was at such a place and time. My scheduled case didn't not take place & at 4pm, I was just walking pass the surgical ward, getting ready to change & go off.

I got an urgent call from that ward that one of the patients I had anaesthesied earlier that morning was having a convulsion & was not conscious.

I was by the bedside before you could say Code Blue. With the help of the nurses, we proceeded to do CPR. Although the heart momentarily stopped beating, we managed to restart it because  prompt action was instituted early, which is the essence of CPR anyway.

The stay in ICU was quite stormy, and we weren't sure if the patient has suffered brain damage because he remained unconscious for 2 days after that. But on the 3rd day, as we scheduled him for  CT scan of the brain, he suddenly opened his eyes & started to respond to instructions.

All I could say was Hallelujah. It felt like a religious decree that I was at that place at that time.

The patient was discharged very much alive from hospital today.

Wednesday, August 16, 2017

Falling below expectation

In a way, looking back, I felt I was indifferent at best & negligent at worst.

The nurse called me last night about a late admission. This patient was supposed to have surgery this afternoon & I would usually see & assess on the morning of the surgery. Not knowing any detail of this patient, I refrained from giving any medical advice over the phone, lest it was inappropriate. Besides, once I start getting involved, I know the nurses will call me for every discomfort the patient may complain of throughout the night.

Therein lies my predicament. I am a doctor and yet I want a good nite of uninterrupted sleep, because I am not on call.

At my age, I dislike, & try to avoid, on-call duties, because I am on my worst behaviour without sleep.

Tuesday, August 08, 2017

Grumpy old men

I've always held the belief that as we get older & approach the sunset of our lives, we tend to be less uptight & bothered about trivial matters. But 2 recent encounters with my colleagues didn't attest to that.

The 1st, already in his mid-60s, was upset when we met in the doctors' lounge. I casually said he's come early to the lounge for breakfast. It was about 10am then. Apparently he took offence to that remark, that i implied he has no patients in his clinic. Hey, buddy, lighten up lah - it's a downturn that is affecting everyone - why do YOU think I am also in the lounge having breakfast?

The 2nd encounter just happened today, also at the lounge. This mid-50s chap remarked that I was being cynical & sarcastic when I mentioned that he was on a rampage with the food. He was already on his 2nd helping then. Hey, buddy, lighten up lah - the food is for everyone & there's more than enough to go round, even for 2nds.

So apparently I have offended 2 colleagues in as many weeks. Maybe I should look at myself. Maybe I am the grumpy one.

Sunday, August 06, 2017

The elective posting

It's time for the daughter to pick the hospital elective posting for next year.

Her 1st choice is a popular district hospital 160km away because there are more hands-on & practical experiences there. She will have to find new accommodation in the district & may be on the road often.

The 2nd is the city hospital only 12km away & 25 mins by train. On top of that, she already lives near the train station. For logistic reasons, being a foreign student, I much preferred she remained in the city.

As it turned out, she was allotted the city hospital. I was glad. And I forgot to mention that had she been posted to the district, she planned on getting a car & driving the 320 km round trip every week.

Phew!

Thursday, August 03, 2017

1st Christmas in the UK

this would be remembered for the wrong reasons.

i was on-call & the 1st case for the day was a 70+ year old lady for a DHS insertion, a procedure to fix a broken hip. the standard anaesthetic technique in that hospital was to give a general anaesthetic supplemented with a local anaesthetic (epidural).

the general anaesthetic went smoothly but i had some difficulty with the lumbar epidural, resulting in the accidental puncture of the dura. instead of abandoning the epidural & just have the general anaesthetic, i proceeded against better judgement to attempt again at a different (higher) level. after administrating the full 20mls of the local anaesthetic, true to form, the blood pressure crashed & the patient heart stopped. resuscitation was unsuccessful.

i can't tell you how angry i was with myself for such a novice mistake. maybe i was indifferent, maybe i was over-confident but i will never, ever forget how a lapse in concentration resulted in this unnecessary death. one good thing that came out of this was the unwavering support the consultants gave me, even at the inquiry for peri-operative morbidity and mortality.

i want to believe this made me a better doctor today & that death was not in vain.

Tuesday, August 01, 2017

Last day.

Having worked at the hospital for 25 years, from a shoplot practice to a new independent medical centre, and then to be part of a major healthcare chain, you'd think she'd be missed when she finally retires.

Truth be told, I can't remember the last time I have worked with a nurse so obnoxious, I just dread if we had to assist surgery in the same theatre.

I won't miss her. Seriously. Honestly.

Monday, July 31, 2017

Mini culture shock

In my 1st job in the UK, I was waiting for the hospital transport to get me to another hospital. As the van stopped in front of the lobby, a middle-aged gentleman in a full suit, coat, tie & all, disembarked from the vehicle. Trying to be friendly, I approached him.....

Me: Hi, is this the van to the WH hospital?

Him : Yes, indeed it is.

Me : By the way, I am Dr T & I am the new SHO. And you are Dr........?

Him : I am Ray & I am the hospital porter.

Lesson #1 : in the UK, most men in the service industry, from top down, wear full suits.

Lesson #2 : Introduction is commonly by 1st names.

Therein, began my memorable 4-year sojourn in a foreign country.

Saturday, July 29, 2017

Looks are deceptive

My friend's daughter is having her wedding reception dinner tonite. I am going to be late. I am thinking about the peer pressures of the modern day matching of life long mates.

I sensed that my friend was a bit disappointed. You see, the bride is a dentist and it would be expected by some quarters that she would pick someone with a similar honorific, e.g. Dr. Whether she wouldn't or couldn't doesn't matter, at least to me. I played table tennis with the guy last week and from that brief encounter, I was impressed with his soft spoken manners & politeness.

Doesn't matter if he's just plain looking or just an architect. He's in for the long haul. A successful marriage goes beyond looks & vocations. They both love God & that counts for everything.

And love is all they need.

Congrats, Ivan & Yen.

Friday, July 28, 2017

Am I losing him ?

I've always thought that I have fostered a blood-is-thicker-than-water bond with both my kids.

It's our (the boy's & mine) ritual to have breakfast on Saturdays when we have no commitments - he, to the school and extra-curricular activities, & I, to the hospital. Usually we'd have either the chicken briyani or tosai/canai.  Yes, we're that set in our ways. So when I asked him today if we are OK for breakfast at 9.30am tomorrow, he said it depends if he could wake up on time.

His response rankled me a bit; if he really enjoy having breakfast with me, he'd make every attempt to get up by that time, as I would. Besides, 9.30am is not that early by any measure.

I know when kids grow up, they often have their own circle of friends which they would want to hang out & chill out with, at the expense of the family

But I'd rather hope he'd choose dad over sleep. We'll see.....

Sunday, July 23, 2017

glutton for punishment


The hospital requires all doctors to undergo basic training for resuscitation to maintain its quality control status. Actually, it's already part & parcel of what we were trained to do, except that most of us have lost touch with the actual practice & may not have kept up with recent advances.
What's required is the attendance at the one-day in-house training & testing, again to satisfy the quality control status. All will naturally pass the tests, although some may need a 2nd attempt to pass. Basic stuff really. Once every two years routine.

However, what I did to fulfil the title of this post, is to take the advance course run by the Health Ministry. Not necessary to do this but I did it anyway. One full day of training and another half for the testing.

The price to pay : hefty course fees, unpaid leave on a Sat, 2 sleepless nites, and (to my colleagues and I) unnecessary self-inflicted stress.

The reward : a refresher on the theory & practice of giving life a second chance.

The course wins hands down.

Friday, July 21, 2017

Reminder to self

Made this decision in 1979 & never looked back since.

Through thick & thin, sleepless nites in the four seasons, forgoing social activities & staying beyond appointed working hours (what's that?), in life & in death, the Lord sustained me.

I have found my calling.

Wednesday, July 19, 2017

Learning for others

Many years ago, in the 80s, when I rode on the MRT in Singapore, I was so impressed by the almost seemless connectivity between North-South and East-West lines, that when I rode on the LRT in KL, the contrast couldn't be more glaring as I had to exit one station, walked to another in the vicinity, buy another ticket to ride on another line.

Years later, our transport minister finally realised his & his predecessors' folly at the disconnect of the whole system.

Too many crooks....err.....I mean cooks, spoil the soup, I guess, but we all end up slurping the unpalatable stuff.

New world hotel

I was staying at this downtown hotel & had a look at the snack tray. And guess what's in it?

Aphrodisiac and prophylactic.

Are we a progressive society or what?

Tuesday, July 18, 2017

Cholangiocarcinoma

This is a malignant growth of the ducts that connect the liver and gallbladder to the small bowel. These ducts deliver bile to aid digestion of fatty food. Diagnosis is often late & the downward course is often rapid.

My colleague's brother had it & he just passed away today. This condition struck a resonant chord with me because the very 1st patient I had as a medical student in the surgical ward (circa 1982) was this cheerful and obese middle-aged gentleman who was admitted for jaundice.

Mah Hung was his name & how I can still remember that, I don't know  ...... maybe it was because he was my 1st surgical patient & I saw him every weekday till he finally passed away.

But I will never forget his kind words to me during one of our meetings. He advised me to work hard to be a good doctor and hoped that I will be a specialist one day.

Dear Uncle Mah, you are long gone but your kind wish did come true. I was touched then, just as I am today. Thanks for being my patient & my  teacher, for who you were, what you had & what you went through. May your soul rest in peace.

Thursday, July 13, 2017

Extended invitation

Yesterday, the drug rep invited the 6 of us out for dinner. 3 of us couldn't make it, so the senior colleague, on his own accord,  invited a few nurses to take the place of the absent doctors.

In the end, 5 nurses turned up & 1 even brought her grown-up daughter. Even though the dinner came under company expenses, I felt it was highly inappropriate for my colleague to invite the nurses for what was clearly an invitation for doctors only. And to bring your daughter for a department function spoke volumes of the lack of etiquette & common sense.

I felt sorry for the rep. I wonder how she is going to explain to her boss about the extra (non-medical) heads for dinner, at RM85 net per pax?

Tuesday, July 11, 2017

Mt Kinabalu

This is the Big Event of my year so far. Last August, my walking buddy told me of a vacancy in his group going up to Mt K in April this year. Having been mulling about doing the climb for some years, I jumped at the opportunity to realise this dream.

We started training by climbing the local hill (vertical ascent 140m) & despite carrying backpacks of 7kgs, it was far short of the 8km trail & 3200m vertical ascent of the real thing. But it was better than not hike training.

There were 6 of us in this group. They had originally planned for 2015 but the earthquake put paid to that. So, after a 2-hour bus ride from Kota Kinabalu, we finally arrived at the park HQ in Ranau, which is already 1800m above sea level. We will spend a nite here & the adventure starts the next day.....

Should I start blogging again?

It's been 2 years since my last entry. This morning I had a brief chat (read: 2 sentences each) with an ex-classmate from 6th Form & she persuaded me to reconsider blogging. So here I am.

I think I was more diligent previously because there were stuff I wanted to share.

And  rave.....

.....and vent.

But I stopped because I felt it was time consuming, to fire up the laptop, to draft & rewrite the narrative, so that it sounded credible, with punctuation in the right places & tenses correctly emphasised.

But mostly because the smartphone was a gadget from Mars & I hadn't subscribed to a data plan yet. That all changed now, & I can literally blog anywhere, anytime.

So here I am. Feel free to welcome me back.