There's an obese kid in the room...cant u see??

Oncall again. Another resuscitation. Despite all we did, another child dead.

 This is the one thing about my job that I hate the most. But most times, I am able to deal with it, and tell myself that we had tried our best. I know as well that my colleagues and I have to often remind ourselves and each other, that no matter how bad we want to, we cant save everyone. I usually am most aggrieved when the child that died had been a relatively "well" child, no known illness, pretty much a normal kid. But in this case, although the family claims their child had been "normal & healthy" prior to getting this bout of infection few days ago, I really have to disagree.

One look at the patient you can tell that he has a serious medical condition. It was so obvious. But probably the family never saw it as a medical problem. I'm sure most of the people who knew him and had seen him (or other children like him) didn’t think so either.

The patient was 5 years old. He weighed more than 40kg.

He was morbidly obese! So much so that we couldn’t see his neck, and when he collapsed, the doctors in the ward knew right away that they would have difficulty intubating him but fortunately they manage to get the anaesth in to help.

But all was not well. His heart stopped 3 more times after that, and we couldn’t revive him anymore after the 3rd round. He died less than 12 hours after he was admitted.

It was so sad to see the doctors huffing & puffing doing CPR on a 5-year old kid! They should have been able to do the chest compressions using only one hand! But because of his big size, they still had to climb on the bed and do the compressions with both hands. And because his weight was waaay off the chart for his weight, his meds were given based on the ideal weight for his height, which was not as accurate as compared to giving meds to a kid with proper normal weight.

He had an infection yes, but his heart was actually already hypertrophied, and that's most probably why he succumbed quite fast. His heart was already in trouble no thanks to his obesity, and all the infection did was tip it off the edge.

Like I said, I know that many people do not see obesity in children as a serious medical problem, just like it is in adult  (and even that is only recently recognized and accepted by the public), because when I do see an obese child and pass the comment to the parents, the reaction I usually get from the parents (who would have brought the child in for another complaint usually eg. Fever/cough/runny nose/etc) would range from -- "Eh tak baiklah doktor ni cakap anak saya gemuk" or "ha-ah la doktor, tapi dia ok, main semuanya ok, takde apa2".

So in this case, although I am still aggrieved that we couldn’t save him, I cant help but feel that the adults are still to be blamed for letting him get as fat as he is. People need to recognize that obesity is a SERIOUS problem in children as well as adults, and that chubby fat kids do not equal cuteness, and do not especially portray healthiness (observe that many people will say "wahhh…sihatnye anak awak ni" instead of "wahh..obes-nye anak awak ni"). I understand that we dont want to hurt their feelings, we wanna be sensitive, which is fine, dont say it to the parents' face in public, or dont say it in front of the kid, but dont mask or hide the problem by implying that it's ok to be fat, the kid is still really cute. (in my defence, when I do make the comment above, that a kid looks obese, it is honestly out of concern for the kid, not passing judgement to the parents..but ok, I get it, people are sensitive... I should be more sensitive too..).

And when I say people, I do mean EVERYONE of us, including doctors and medical staff, because I know for a fact that there are doctors who prescribe vitamin supplements, and other supplements like omega-3-fish oil and colostrum to kids with cough and cold, in addition to the usual meds. It's one thing if it's for a skinny kid or even a normal kid with perhaps poor appetite, but if it’s a real chubby obese kid sitting in front of you in the clinic, you should findout why he/she is so, and then try and get them to lose the weight instead of supplying them with more multivitamins, colostrum and fish oil! (if it's simple obesity of course.. Other diagnoses need to be ruled out as a cause for the obesity ie metabolic syndrome etc whereby you would then need to refer them to the experts, but reducing weight still plays a huge part in the treatment).

Anyway, I'm definitely not an expert, but I do believe that we need to be able to identify that there is a problem first before we can actually try and solve it.

Kids, eat healthy, play more!
Parents, get ur kids to eat healthy and play more!!

KONY 2012 - save the children

Whatthe hey-? A medley.

1st week back in Melaka. Conversation with one of the bosses:

JT: so, in case you don’t know this yet emie, our department here is very fertile..
Me: huh?
JT: yea, everyone seems to end up pregnant here.. so I better warn you.. ha-ha (nervous laugh)
Me: umh.. ha-ha (real nervous now..whatthe hey-)

2nd week in Melaka. A female security guard waved at me, she actually remembered my face.
Guard: Hey doktor, lama tak nampak.
Me: ye kak, saya pindah KL 2 tahun.
Guard: oo..sekarang dah balik sini balik?
Me: ye kak *smile*
Guard: oo..baguslaah… Gemuk dah doktor sekarang ye!
Me: ..haha..yelah kak .. *smile*

The next day. Same guard, smiled at me. I smiled back.
Guard: Doktor, dah memang kerja balik sini lah ye?
Me: ha, ye kak..
Guard: Doktor gemuk betul la sekarang ye..
Me: ..haaa.. y e .. k a k… *smile paksa*

Later that same day. Same guard, with another guard. I could feel it coming. Smiled at me and waved. I waved back. Prayed that the elevator doors would open immediately as I pressed the button. They were  just a few feet away from me.
Guard (telling the other guard): tu doktor tu kerja sini dulu, sekarang dah balik sini balik. Dah gemuk dah dia sekarang..dulu kurus.
Me: (whatthe hey-?) *acute depression*

2nd month in Melaka. Doing post-call rounds in adult ICU, 7am, in scrubs, haven’t showered yet. Approached by the ICU staff:
RN: doktor, you HO(houseman a.k.a graduated doctor in-training AND mostly very young) GA(general anaesthesia) ke HO surgery?
Me: *Stunned*
RN: Eh, doktor, doktor ni HO GA ke HO surgery?
Me: err..saya MO (a.k.a medical officer..and mostly older more mature doctor)  ..
RN: oh ye ke.. sorry, sorry, ingatkan houseman tadi.
Me: (what the hey-? You made my day!!!) *perasan smirk ON!*

Just yesterday.  Doing oncall morning rounds by myself. Approached by a houseman from my own department, who has worked with me for at least the past one week:
HO: you jaga jaundice cubicle jugak ke?
Me: huh?
HO: you jaga jaundice cubicle jugak ke?
Me: still huh?
HO: …realization hits as she slowly starts to recognize and remember who I was again ….oh, sorry doctor, I thought you were the houseman here…so sorry..
 and dengan penuh sheepish-nya she left me…
..and again I was stunned.
Ok, but that HO memang known for her dumb-blonde attitude lah... but, seriously?
Whatthe hey-?

ouch! crushes hurt too.

i had this huge crush on this guy for the past 2 years. but a crush is a crush.. nuthin serious, not to the point that i wanted to do anything about anyway. friends who knew about him did "layan" me for fun, teased me, asked me to kirim salam (sheeshh.. the more i write this the more high-school it sounds..so embarassing!!)
so anyway, like i said, it was fun while it lasted, it felt "light" and harmless..another eye-candy for me, or so i thought until i found out that he is now engaged and soon to be married (dont ask me how i know or found out, because it is sooooooo high school tween stalker stuff, it'll make me look even more pathetic). i was shocked, because i thought he was still single, like, dont-even-have-a-gf-single, and now he's soon to be married!! and boy was i crushed. i surprised myself even, cuz i didnt think i actually cared so much :(
sorry heart, i let u down.

me.uptodate.

o wow.
it is now 2012, and we're already a week into February.
my last entry was many many many moons ago.

where do i even start?

last year was a very trying and tiring year indeed. i remember how last year, 2011, started for me.
i was oncall on that last day of the year 2010, when the country won a football game against indonesia, and the people were given a public holiday for that.. but being the doctor oncall on that day, i still had to work anyway, but it's now made worse by the fact that i was oncall on a public holiday instead of just a weekday, which we doctors hate.. i also later realized that i was working through the new year's eve of which the numbers were turning into 1.1.11.
imagine, the number a lot of pregnant mothers had been eyeing to be their babies' birthdate.
it was one-hell-of-a-busy call.
i was flat, dead tired the next day, which was new year's day 2011, the day i had dreaded coming, as i was gonna turn 36 on that day, and for some reason i was really depressed about that. that was how last year started for me.

and then it was all blurry.

 all i could remember were the damn exams!! it was like  this huge gravitational thing, that no matter whatever else i was doing, whoever else i was supposed to be with or shud be concentrating on, it kept pulling my attention back to it. no matter what i did, and as much as i hated it, and hate to admit it, it became the center of my so-called universe, the one thing i hated most but could not ignore. yuck. i dont remember much about what went on last year except for the bloody exams, i even remember just staying at my aunt's place studying, even during Eid!
so thank God Almighty that it passed.  i passed. only with God's great mercy and grace of course.

during those hated days studying for the exams, just as it was looming round the corner, my family was hit by the news that my mom has breast cancer. she found a lump during a self-exam, and we had it checked, and it was cancer. no family history, nothing. my mom was always conscious about her heath ,and had been quite healthy. she underwent the surgery to remove the tumor just after my written exam,  and is currently still undergoing chemo. she has lost a lotta weight ,and hair..but we have God to thank again that she is otherwise quite well. except for the few days after she gets her chemo when she'll be a bit weak from all the nausea and vomiting, on regular days she is otherwise up and about as usual around the house.

then, relieved that the exam was finally over, so i can perhaps now concentrate on my family especially my mom.. i was told to leave KL and go back to work in Melaka. such mixed feelings i had when i got the news..
i hated working in (UM)KL, but staying at my parents' house was a real bessing.
to be back working in Melaka would not be bad at all, i think, as anywhere is better than where i was (UM), but it also means having to part ways with my mom again, at a time when i feel like i should be around her more. but i followed orders and back to melaka i went.

then all of a sudden, as friends and relatives started to find out about my mom's illness, we were struck with another sudden sad news, my uncle..my mom's only sibling, her older brother.. died in an MVA, after his motorbike was hit by another bike. i could only imagine what my mom must have been feeling that day. we needed to stay strong for her, for my uncle's family, my cousin, and our opah.

all the sad stories aside, we did have things to be happy and thankful about. my parents got another grandson, in the name of Azhan Nazrie, my sister's 3rd kid, born on 27th May 2011. along with the 2 older kids, Amirah and Aliff, they remain our greatest loves, bringing us joy every time they are back from bintulu for a visit.

i got an aparment of my own, altho i havent had the chance to properly stay there yet. i also finally departed from my 1st baby-kelis3037-who had witnessed many tears, blood n sweat shed by me at her steering wheel. and i'm not ashamed to admit i bawled like a baby the day i gave her away..but it was in exchange for my current beau-PaulthePolo, so i recovered rather quickly. (yes, i name my cars.heee)

i feel like there were more to 2011 than what i've typed so far, but my mind is drawing a blank right now. probably it was those damn exams again, obscuring parts of my memory in my brain, or maybe i'm out of practice, havent made an entry in here for almost a year now.

i'm happy to report that i welcomed the new year more readily this year, even though it still brought with it another bigger number for my age as expected. i spent each meal on that day with different people, completing it off with a durian feast courtesy of my beloved brother. so i had a good birthday. probably because i also made sure that this time, i was not oncall that new year's eve.  i think people just love getting a kid on new year's day, coz let's face it, it IS cool to have new year's day as your birthday.