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?

a (dangerous?) precedent

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?)

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

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

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

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.