safety on the highway

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?

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

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

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

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

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.....

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

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

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

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

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

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?

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

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

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

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

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

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

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

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!

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...

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.....

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

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

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

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?

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

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

"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

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

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

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

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

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!

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

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

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)

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

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?