Saved by the ECG

33yr old male doctor admitted for nose surgery. Overweight 100kg with high cholesterol 8.7 (normal upper limit 5.2). No known medical problem.

On the operating table, it is routine to attach wires to patients for monitoring the heart & respiratory functions. This patient's ECG showed a bizarre pattern, even after adjustments were made to rule out artifacts.

When I asked him what his previous ECGs were like, he said he never had one done, understandably since he is only 33. so, I decided to postpone surgery till the cardiologist has given him the full workout.

In what I do, the patients who enters the OT alive should similarly emerge likewise.

I want to keep it that way.

**contrast this**

Naughty post

Rojak without prawn paste;
Satay without peanut sauce;
English breakfast without bacon;
Nasi lemak without sambal;
Cendol without gula melaka;
ABC without red beans...

No lah, it's more like sex with a condom on....

Isotonic drink WITHOUT carbonation.

My father's son

I had a bit of a rollercoaster growing up.

My father used to work with the British army in Singapore. We were quite financially well off. Staying in the clan's home, we had 2 rooms & we were the 1st family with a TV. We eventually moved out to our own home.

When the Brits withdrew, he was laid off. We tightened our belts during this difficult period. He then worked for a while with a timber company in Temerloh (Pahang) & then Paka (Trengganu), which means he was away from home a lot. When the company closed down, he came back & became a driving instructor. I still mention with much pride that I was taught by him.

He's always been thrifty in his spending. In fact, when we go to the supermarket, he'll just wait outside because he said he has nothing to buy while we filled our trolley with groceries.

I still retained that DNA. Which is why I was ecstatic when I found this ......

After all, I AM my father's son. I think I'll wear this to church tomorrow.

ambition

my son says he wants to be a pilot. either that, or play for Manchester United.

my daughter says she wants to do internal medicine. either that, or cancer research.

i feel it's good to have an ambition. at least, there's something to look forward, and work towards, to. an objective to focus & channel one's energy & time.

but the wise man has this to say....

Many are the plans in a person’s heart, but it is the Lord’s purpose that prevails. (prov 19:21)

i should know. after all i wanted to be a bus conductor, and then an aviation engineer.

see how i turned out.

:P

1st time on a plane

I was a houseman in the medical ward when this middle-aged Sarawakian gentleman, visiting Pesta Pulau Pinang with his family, suffered a massive heart attack. Although he made good recovery, he was apprehensive about returning home, so his family requested for a doctor to accompany. Guess who was given the free trip responsibility to transfer the patient home? Unrecorded leave, some more, yayy!

The journey (Penang-KL-Kucing-Sibu-Kapit) was largely uneventful. Truth be told, if anything should happen, there's not much besides CPR that I can offer but I suppose my presence was all that is required.

Reached Kapit after a nite in Sibu & a boat ride on the Rejang. Found out that the guy owned a coffee shop. Looking back, they really took care of me throughout the whole trip. Funny thing, I can't remember his name or his shop, but the name of the hotel he checked me into remained in the backburner all these years. Mahligai Kapit.....and I was treated like a king.

Thanks for the memory, Towkay.

Kapit, Jan 1985

PS. I met an old flame on the flight from Kucing to Sibu, but that's a story for another day. :P

Houseman

 16th July 1984

1st day as a houseman, posted to the Paediatrics ward at Penang Hospital. I must confessed that I was disappointed that I didn't get my 1st choice posting to Johor Baru Hosp. Having lived away for 5 years in med school, I thought I 'd rather enjoy staying at home for a change.

As it turned out, Penang was a game changer for me. Chance for me to live fully independent in a place I am not totally unfamiliar with. I spent a week here in 1975 for a national level chess tournament and another 2 weeks in 1983 for a community health survey as part of the medical curriculum.

So, what happened in the 4 years in Penang?

Earned my 1st paycheck, found out I can date Penang girls on a motorbike, owned my 1st car, started post-grad training, spent a memorable 08-08-88 with a few close buddies and met the girl I was to marry.

(And others events I can't mentioned without getting indecent. Heh, heh!)

A game changer.

6th Form

English College, 1977

I love this class USSB. Upper Six Science B.

Marvelous Chemistry, Biology, and General Paper teachers, and special mention to the late Mr GV Pillai, Physics teacher. I did apply to be an engineer, you know, but I digress.

And my beloved classmates who were comrade-in-arms in work & play.

I'd like to think you've all impacted my life as much as I have yours. 

We should have organised our 20th year anniversary this year. 

I should have.

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.



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.

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.

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.

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!

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.

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.

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.

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.

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.....

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.

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.