help! my baby is laughing..

heard this from a friend of mine, who saw a patient, a 1+ yr old malay baby, brought to the hospital for a burn injury to the face.

history taken: parents were worried that their child may have been "possessed" by some spirits. reason?

the kid likes to laugh and babbles by himself, even when there was no one around (lemme remind you again, the kid is just past 1 year old, not even speaking very much yet at all, so if you ask me... he's perfectly normal!!).

so what do the parents do?

they brought the kid to a bomoh (of course!). and the bomoh did the usual..mutters a few words of mantera.. burn some kemenyan.. carry the burning kemenyan in its little claypot container thingy over the kid's head and "smokes" him (or the spirits out-God knows), and .. whoops! the container tilted..and whoops! all the burning kemenyan fell onto the poor kid's face!!

kid cries, of course (he obviously wont be laughing for quite awhile..at least not until he's in good spirits again). according to my friend, good thing the eyes were not affected, or he could've been blind!

sheesh..

oohh.. and there goes the head.

scenario:a teenage boy was playing with his 2 yr-old cousin, and by playing, he meant throwing her high up in the air ("oh look, ur flying!). catch. up in the air again. catch. the girl squeals. up in the air again..higher now..
and... tang!..slosh!.. there goes her head!
ok.. i'm exaggerating.. her head didnt fly off.. but she did sustain a deep laceration wound to her head, after being hit by the blades of a whirring ceiling fan that was just inches from her head!
so with blood covering half her face and she screaming in pain, she was rushed to the hospital by the whole family.
examination showed that she also had a depressed skull fracture, and was bleeding into the layers covering her brain.

obviously this isnt the 1st case of a child sustaining head injury from the blades of a ceiling fan. we see quite a number of this preventable injury at the emergency dept. and they get them through different ways too.. from jumping up and down on the bed, from jumping down from an upper bunk of a bunk bed, from being thrown in the air by an adult... and then .. tang!..slosh.. there goes the head.

interestingly the other day when i was seeing the 2 yr-old girl, there were different comments made from the staff as they hover around:
staff 1: uih.. that's why-lah, cannot throw the kids in the house, gotta do it outside the house, out in the open area. no ceiling fans there!
staff 2: what was the speed of the fan.. laju sangat kot?!
staff 3: must be the ceiling of their house is too low.. that's why can hit the fan!
staff 4: no-lah..not safe to use ceiling fans.. we should all just use air-cond only!


so i had to tell them: umm..no.. the one important lesson to be learnt here is.. NOT to throw a kid up in the air..like anywhere, eVer (Yup, i even strained on my V there!)
we live in hot malaysia..and not everyone can afford air-conditioning, and so it's totally okay to have a ceiling fan running at top speed i think, as long as you dont throw a kid up to its rotating blades!
even if you were doing it outside, or you dont have a ceiling fan, and your ceiling's real high.. what if you throw a kid up in the air, and u slip and/or couldnt catch the kid back?
maybe..there goes the head, and/or neck, and/or arms, and/or legs .. you get the picture.

is this my anak? lemme see...

this is also an overdue entry of mine, but it happens from time to time.

there i was doing rounds in the ward, i see a kid, i thought the kid might look a bit dry, with what looks like sunken eyes, so i ask the mom just to be sure..
me: puan, is this your anak here?
the mom: yes, this is my son..
me: are his eyes usually like this?
the mom: huh? what dya mean?
me: well to me they look a bit sunken, but what do you think? are his eyes normally like this?
the mom: hmm.. (looking at her kid).. i'm not sure-lah doctor..
me: okay, do you think your kid look different to you? or macam biasa je ?
the mom: um..entahla doctor, i'm not sure..
me: okay (losing some patience).. siapa jaga anak you ye? do you see your kid everyday?
the mom: not really la doc, i work see, so morning when i leave for work, he's not yet awake, evening when i comeback, he's either asleep or playing in his room..
me: (being kepoh-chi) oh.. dont you feed/play with him in the evenings?
the mom: no.. i have a maid..
me: (still being kepoh-chi) weekends?
the mom: oh yea-lah sometimes weekends, but he prefers to be with the maid, cuz he's used to having her around him everyday kan.. and myself, i only have the weekends to rest cuz i'm usually very busy with work the rest of the week.
me: o-kay (losing some more patience) .. maybe i should talk to your maid then huh?
the mom: oh yeah.. (obviously not getting it).. do you want me to get her then doc?

sheessh..
well obviously the majority of parents are the total opposites of the one i'm describing above. most are able to notice even a tiny red dot"..that was never there before" appearing somewhere on their kid's body and will demand to know what and why is the dot there.

i remember the years when my mom was working overseas, and we only see our parents like once a year or sometimes less frequent than that..and this one year that i went to visit them, i just had my ears pierced-for a 3rd time- and i thought my dad will never notice, cuz he never said anything the year before when i had them pierced the 2nd time, and cuz i thought he never notices these things anyway.. .. then that first night i arrived and we were having dinner, suddenly he said "so, last year 2, this year 3.. you plan to add one every year are you?" referring to the piercings. i was surprised that he actually noticed, but even more surprised that i actually loved the fact that he did!

on with the hospital scenario-cont'd (1-2 days later)..
me: okay.. your kid can be discharged today..
the mom: oh alright.. can i have an MC then doctor?
me: for your kid?
the mom: no-lah doc.. he's in kindergarten only, they dont care. for me-lah.
me: (straightfaced) but then you're not sick..

long story shortened, the mom wasnt sick of course.. so i explained to her that as a matter of fact we dont giveout MCs, not even to our paediatrics patients. they and the caregivers (in this case it was actually the maid that was taking care of the kid in the hospital half the time anyway!) get a memo/letter that states that the kid has been in the hospital.

moral of the story?
i need to stop being a kepoh-chi..

to whine, to shine..?

it has been a stressful month or so at work. the ward and nursery is forever full lately, with sick babies and kids... and the ever demanding parents! they're just getting on my nerves. i mean, it's one thing if you're being worried/concerned for your kid, but it's a whole different thang when it's pure paranoia thinking doctors are there to purposely hurt your kid for fun.
i've blogged about this before but arrrrggghhh.. everyday is becoming a struggle now for me, to get my bum off the bed every morning and drag myself to work to face these parents. parents who decide to bring their kid in at 2am because the kid's been havin' cough and cold past few days, and havent been able to sleep tonight, (thus keeping the parents up as well).. and then by the time the docs do the rounds at 8am, they're already asking to go home. so i tell them "well, u just came in 5 hours ago..why not stay another night so we can observe your kid a bit more?", and when they still insist, giving us 101 reasons as to why it's difficult for them to stay on, i had no choice but to let them go (usually at their own risk (AOR) if they insist), only to have them come back two days later, cuz the kid's still sick. well, d-uh!
some of them who had insisted the earlier discharge and signed the AOR, upon seeing another doctor on re-admission, even have the nerve to say "actually the day my kid was discharged, he/she was still not that well yet but the doctor still discharged him/her anyway" !!!
aiyoh..sabar jelah..

so why do i still drag my butt to work everyday? sounds corny..but for the innocent little patients of course. they dont get to choose their parents, and some are just unlucky to get stupid ones. so screw those parents, i'm there to help the kids.. but then i dont know how long i can hold on..


patients like cute lil JK here, who has apalstic anaemia, is forever playful when she's relatively well, and refuses to stay isolated in her room.. she likes to tease me, but decides to play shy when i aimed for a shot of her picture. she btw, has great support from her parents and extended family.. and they've always been cooperative with us as well. just to point out that there are exceptions of course.

in the news

Thursday July 10, 2008

Doctors' strike shuts hospitals throughout Nepal

KATMANDU, Nepal (AP) - Striking doctors in Nepal shut down all the hospitals and clinics in the Himalayan nation Thursday, demanding better government protection against attacks by angry relatives of patients who have died.

Doctors had shut down hospitals in the capital, Katmandu, on Wednesday and expanded the strike to the rest of the country on Thursday.

Emergency services remained open.

Doctors groups say there have been several incidents over the past year in which people attacked or threatened hospitals and doctors over allegations of negligence in their relatives' deaths.

Dr. Kedar Narsingh of the Nepal Medical Association said the strike would continue until the government responds to their demands.

"The government has not even bothered to call us for talks and has not taken us seriously,'' he said.

"We will continue our protest until the government responds positively.''

In the latest incident, the family of a patient who died after kidney surgery threatened doctors at a hospital in Katmandu over the weekend.

Narsingh said the government had promised better security at hospitals two years ago after a similar incident led to a doctors' strike, but little has been done.

...............................................................................................................

what is the world coming to?

pray that malaysians takkan la sampai macam tu sekali..
but everyday at work seems like we're heading towards that direction. parents claiming we're treating their ill kids as pincushion la, experiment la, .. asyik cucuk saja ambik darah..
hya..if there is any other way for us to take blood from your children, less invasively, like picit kuku and darah terus keluar dari hidung ke.. or press the nose and blood comes out of the bellybutton ke.. dont u think we would take blood that way?
do you think we would just go to the ward at 3am in the morning, and since there's nuthin else to do, we play "let's prick the children and drain their blood away" for fun?
contrary to some beliefs.. we dont drink children's blood.. nor do we find anything useful to do with their urine or feces either, that we would ask you for the samples, or on occasions we ourselves have to stick a tube up their urethra (a.k.a the pee-hole), other than to have them sent to the labs so we could try and figure out why the heck is your child so sick, and try our best to make them better, cuz umm... isnt it why you brought them to us in the 1st place?
this may not have any medical explainations to it.. but from the (still very)limited experience of working with sick kids and babies for >6 years now, i find that babies whose parents are so calm, understanding, supportive and most of all very cooperative with us while we're treating their child.. these kids turnout well, despite our so-called medical opinion that they were so ill that they may not make it through..these are the kids who not only survive..they survive well, and grow healthily & beautifully.. passing way beyond all of our previous grave expectations.
but those babies whose parents are so inconsiderate, rude, accusing, overly paranoid etc (basically plain bad lah).. their babies seem to just give up on life.. even if their illness are not that serious, in our so-called medical opinion "should be okay one"... these are the kids that decide to turn for the worse..
sigh...
we remind ourselves..at least i make sure i do... to treat the patients..not the parents.. it's not the babies' fault that he/she were born to rude, stoopid moronic parents.
contrary to popular beliefs, doctors are humans.. with feelings.. we too feel sad, depressed even sometimes, when we couldnt save a child. how can people accuse us of "saja2 biar budak mati" is just beyond me.
i dont normally cry in front of parents when i deliver them the bad news, however sad i was feeling at the time... but i remember on one occasion not that long ago, after telling a couple that their child had died (after staying with us for a longtime in the NICU), they both nodded sadly, there was a pause, i stayed with them all ready to console them, my hand on the mom's shoulders.. then both of them surprised me by saying "thank you doctor, we know you have tried your best, and we appreciate everything that you and your team-the doctors, nurses, have done for our baby. only God can pay you all in return"
and there was no stopping the tears that rolled down my cheeks..

roasted baby anyone?

true story:
18 day-old baby admitted with what looked like severe skin infection over his face and neck. it was all red and angry looking, with a few areas peeling off. his eyes were shut closed with gooey purulent discharge, and he's got crusts all around his mouth as well. the parents initially claimed they too have no idea how their baby got that bad. then later they offered us this little info: their lil one was crying non-stop, driving evryone crazy.. so they took him to a 'bomoh' hoping he can help them stop the baby's crying. the bomoh then gave them a mixture of coconut oil + onions + black pepper, and told them to smear the mixture onto the baby. and so the 4-time parents did. all over his face, esp around his eyes, and mouth (cuz u know-crying..mostly involves the eyes and mouth? the tears and the wailing? i dunno-this my theory) and never washed it off, in fact, kept on reapplying it daily onto the poor sucker's face (sucker-get it?cuz he still breastfeeds?harhar)-one coat of seasoned oil after another.
we're talking about a pair or parental unit here, who's had 4 children- basically 'marinating' their lil one cuz he cries a lot, and cuz the bomoh tells them too.
why cant people follow doctors' orders like that-no questions asked.
i mean these parents, after finally letting us know this important piece of information, actually asked us afterwards: u think this might be related to whatever is happening to our baby?
um..yee-ah!
why dont you try smearing the same ingredients all over your thirty-sth-yr-old skin and see what happens. i mean, the kid was just past a week old at the time.
sheesh..
course, i didnt say that to the parents. i'm just a doctor, not a bomoh. i cant just tell people what i want.
instead, we washed the poor baby's face off - start him on antibiotics, and he got better after a few days.

gunny baby

MALACCA: A newly-born baby girl was abandoned in a sundry shop lavatory for 10 hours on Wednesday by a widow who thought the infant had died at birth.It was only after Malacca Hospital authorities treating the widow for bleeding realised that she had just delivered, did the story emerge.Gynaecologists suspected something was amiss when the woman denied having given birth despite the obvious signs of delivery.They called in a cousin of the 35-year-old who got to the bottom of things after speaking privately to her.The cousin rushed to the shop, where the widow worked, and found the baby in a gunny sack about 10pm.The infant was rushed to the hospital and placed under observation in the children’s ward.It is understood that the 2.4kg infant will be handed over to a relative’s family as the widow had given permission to hospital authorities to do so.The episode began about noon when the widow gave birth.Thinking that the baby had died, the mother of two placed the infant in the sack and left her in the lavatory.She then sought treatment at a nearby clinic but was referred to the hospital where she coughed up the truth that she had abandoned the baby in the shop.State Human Resources, Health and Consumer Affairs Committee deputy chairman Datuk Abu Pit, who visited the baby yesterday, said she was healthy despite not having been fed for 10 hours.

this was in the news a few days ago. i'm usually skeptical when it comes to reading or watching news in the paper, tv, or worse..the internet.. but i can assure you that the above really happened.
the baby's amazing.. except for some minor abrasions on her little knees, she's doing quite well currently. a great fighter-survivor. other babies would throw a fit -literally- if not fed for just 2-3 hours after delivery, she survived for 10!
in the news, they made the mother sound slightly more humane that i think she is though. she initially refused to tell everyone where exactly she left the baby, adamantly saying that the baby's already dead anyway.