kenapa anak saya takut doktor? (based on real-life events)

Scenario 1:
I meet an old frend/relative with his/her cute kid. Kid starts coming to me arms outstretched to salam or mintak dukung. I stretch my arms too, ready to receive the incoming bundle of cuteness and affection.
Kid's mom/dad: "Adik, acik ni doktor tau. Adik takut doktor kan?"
Kid: *patah balik* tak jadi kawan
Me: Dengki la. Kau memang nak anak kau benci aku ke apa?
What really bugs me: *Dahle le kau panggil aku acik!*

Scenario 2 (this happens ALL the time, but I especially hate it when it happens when I am just about to examine a kid):
Kid's mom/dad: "Haa, cucuk dia doktor, cucuk dia ni. Dia nakal sangat!"
Kid: *looks at me with those big eyes, lips tremble, mouth opens and .. *CRYYYY (as loudly as a kid can cry)
There are multiple reactions to this one ..
Me: *Acute deafness*
or ..
Me: Olololo ..tak cucuk la.. *dan ayat2 pujuk seerti dengannya*
or ..
Me: Dengki la uols. Kan dah nangis. (mood still good, laugh with parents)
or ..
Me : Donkey la korang  #@**!!^&;^%$#! (mood out, temper in, what I really wanna say, but dont say la of course, dalam hati only)

tak menjawab soalan (based on real-life events) part 3

Q = Question asked by me.
A = Answer I get.. or rather did not get.

Sometimes it may be due to hearing (wrongly heard) and sometimes maybe because the questions are not specific enough.

Scenario 1
Q : Aku tak pernah jumpa lah si polan binti polan tu? Orangnya baik tak?
A : Oh, aku selalu jumpa dia. Orangnya ..badan besar-besar.
Q : ..erk.. so baik ke tak baik tu?

Scenario 2
Q : Anak you tengah demam ni, makan minum semua ok?
A : Ok doktor.
Q : Bagus. Jadi tak ada muntah2?
A: Muntah2 ada.
Q : Oh, ada muntah. Jadi minumnya cukup ke tak tu?
A : Minumnya kurang doktor. Makan pun sikit.
Q : Baiklah. Kencing berak semua ok?
A : Ok doktor.
Q : Tak ada cirit birit?
A : Cirit birit start pagi ni doktor.
Q : .... Anak you tak sihat ni dah ada bagi apa2 ubat?
A : Tak ada bagi ubat lagi doktor.
      Kecuali ubat demam.
Q : (doktor pun rasa cam nak demam mak oii)

discharge please

"Tak boleh discaj ke doktor? Doktor saja je kan nak tahan anak saya lama2 kat wad ni,"
"Cucuk sana cucuk sini. Doktor nak buat anak saya bahan ujikaji/eksperimen ke?"

These are comments that my colleagues and I are quite familiar with receiving.
My short and immediate response?

"Tak."

Honestly, as a paediatrician working in a busy government hospital, I definitely do NOT want my ward to be full with patients. I prefer to have zero admissions. If patients do need to be admitted, I will try my best to make sure that they don't have to stay more than they have to. In paediatrics, patients are babies, infants, toddlers, children. So lagi la orang kata "Kasihaaann. Budak kecik."
So yes, the less veins we need to prick, the less pain we need to inflict, the better.
Believe me, even though pricking patients for blood or IV cannulation will help junior doctors to master this skill, no house or medical officer ever groans at me when I tell them "no need to take blood" or "no need to insert IV line". Lagi diorang happy adala.
For us, the less work the better.

So why do we still admit patients to the ward? Why do we keep some of them longer in the ward compared to others? Why do we send multiple investigations, not just blood, but also, urine, stools, sputum and even the often "feared" spinal fluid sometimes?

Well, why are the children brought to the clinic/hospital in the first place?

Children don't bring themselves to the clinic/hospital.
I do not go to your house or look around town for ill children to take with me to hospital.
YOU bring them, you the parents and caregivers.
Because you are worried that something is not right with them. They may be sick. Ill. Unwell. Not their usual self. Have a toy stuck up their nose. Breathing funny. Whatever.
If they are okay, we reassure you and send you home. If they are unwell, but we think you can just treat them at home, we send you home. But if we think otherwise, we ask to admit the child.

Various reasons.
The child is too ill.
We don't know what's going on so we need to investigate.
We think we know a little bit but we need to make sure.
We do know what's going on, but the treatment needs to be given in the ward/hospital, not at home.

Why do we keep them long in the ward?
Various reasons as well.
The child is too ill.
The treatment needs to be given a long time.
The treatment is not working. We need to try another way/treatment.
We still do not know what's going on.

Definitely NOT because we like or saja-saja.
We may "try" different treatments, especially if one is not working, but we're definitely NOT doing "experiments" or treating your child as a lab rat. We may not have all the answers but we can't and won't just give up that easily.

In the end, we want the same things as you. For your child to get better, so we can discharge you.
Less patients in the ward/clinic, means less work for us.
We do like having less work.
Don't take it personally.
We assume when there is less work for us, there are also less sick children out there. And that's always good.

Ah. But there are people that say to me "But that's how you make money whaaat."

Again, I reiterate, I work in a government hospital.
Ada patient ka, tak ada patient ka, gaji aku sama whaaaaat.

it's okay to cry

In practicing medicine, doctors generally cringe at the term "breaking bad news". Bad news in medicine can either be finding out that you have an incurable disease, or that you can never have children of your own, or that you will never walk again, or that you or your loved one is dying, or finally, that your loved one is already dead.

Back when I just started in medicine, and was a jovial, enthusiastic young woman who was proud to be a doctor albeit totally naive of what was expected to come, I used to believe that it is not okay for a medical staff, especially a doctor, to cry in front of a family or a patient when you are breaking the bad news to them (or "informing DIL" as what is commonly used in Malaysian hospitals today).
I felt that it is okay to show a sad face, but not to the point of tearing up or crying. I felt that crying in front of them made me appear unprofessional, that instead of showing sympathy/empathy, I would be showing too much emotion, and probably a sign of weakness too. I was even proud to be able to do all of my "inform DIL" orders without shedding a tear all all through my housemanship and into the early years of being an MO. Until one day, and I remember this vividly, I was an MO in charge of NICU, and we had this one particular baby girl that died.
The baby had been critical for many days from a severe infection, and we already had to actively resuscitate and perform CPR on her multiple times.  I had repeatedly explained to the parents that their baby was really ill and that the next time we have to do a CPR again, we might not be able to revive her anymore, and that she might die at anytime; standard "informing DIL" stuff.
Every time I told them the news, the mother would sob and cry.
The father would repeatedly mutter "Yelah, baiklah doktor," hands on his wife's shoulders, his own eyes red.
The nurse sometimes too can be seen wiping off her tears as she stood behind the parents.
And I would stand there and look at them, pausing my explanation for a moment of respectful silence, solemn look on my face, eyes dry, and in my head thinking "ok don't you dare cry too emie. ok how long is this gonna take, I have other babies to see". For me, in order to dissociate myself from the atmosphere of engulfing sadness and tears, I turned the baby into another job task, just a checklist on my long list of work to-do list.
On the day that the baby finally died, the parents have not reached the hospital and by the time they arrived, we had pronounced the death and I was already writing up all the necessary paperwork. So I went to see the mother as she stood by her baby's body and was ready to explain to her what happened; how she had continued to deteriorate and how we tried to resuscitate her. Again, standard stuff, when the mother turned to me and actually smiled. I was a bit puzzled seeing her smile at that moment so all I ended up saying was "Takziah ye mak" (I'm sorry) and she nodded and actually said "Thank you doctor."
Before I could say anything else, she said "Saya nampak setiap hari, pagi petang siang malam, bagaimana doktor dan nurse menjaga anak saya dan anak2 orang lain dalam icu ni. Saya tahu doktor dan nurse2 semua bekerja keras untuk cuba pastikan anak saya dapat baik dan hidup lebih lama. . Tapi Tuhan lebih sayangkan dia. Saya harap doktor dan nurse2 semua jangan putus asa ye. Dan jangan sedih. Saya amat2 menghargai segala apa yang doktor dah cuba buat untuk anak saya ni. Saya redha dia pergi."
(I know how hard you and the nurses work all day and night to help by child and the other children in this icu. I know how all of you have tried to keep my child alive, but God loves her more. Please don't be discouraged and don' be sad. I am truly grateful for all that you have done for my baby. I accept her death.)
And for the first time ever in my medical career, I let my tears roll down my cheeks right there in front of the mother. I couldn't stop them even if I wanted to. And I didn't dare open my mouth to say anything for fear that all that would come out are loud ugly sobs.
It was like a huge slap on my face. I was not sad at the time but the mother thought I was. Because I could be sad, and perhaps should be too. Because of her unexpected gratitude and encouragement, in the wake of her baby's death, I was woken up instead. That in being a doctor, it wasn't JUST work that I'm doing, that it wasn't JUST a job. A patient is a human being. A patient is somebody's mother/father/daughter/son/sibling/spouse/friend. He/She is somebody's loved one. Even if you don't know the family or the friends or the loved ones. A patient who has been under your care, whom you have looked after, whom you have tried to treat, who was your responsibility, of course you can be sad too if they die. You don't need any permission.You don't have to suppress your sadness. You can definitely cry if you want to. You don't have to of course, but it's okay if you do. (Hopefully not to the point of the patient's family having to console you instead of you them, but you get what I mean.) There's no need to be ashamed.
Because doctors are humans too. And we all need to remember that.

kesah seorang boss

Alkesah, ada seorang boss.

Di suatu pagi di hujung minggu, di kala boss sedang bercuti, boss terima khabar ada timbul masalah di tempat kerja. Masalah itu bukan masalah baru, kadang2 memang boleh berlaku. Tetapi selain dari itu, boss diberitahu ada juga masalah kedua yang telah timbul, yang berpunca akibat dari kecuaian anak2 buah boss.
Boss naik angin lah.
Boss mulalah membebel. "Aku dah cakap kat diorang ni berkali2, jangan buat begitu, jangan buat begini. Budak2 ni degil juga. Tak mahu dengar cakap aku. Tak percaya cakap aku. Sekarang dah jadi macam ni. Aku jugak kena pergi selesaikan."
Suami boss yang mendengar di rumah itu mengangguk2 saja melihat boss bersiap2.
"Awak bersiap ni nak ke tempat kerjakah?"
"Yelah, saya nak basuh diorang cukup2!" dengus boss penuh marah.


Selesai bersiap, boss seperti biasa mencium tangan suaminya sebelum keluar. Kemudian dia singgah di bilik mak mertuanya yang kebetulan datang melawat dari kampung. Niat nak beritahu mak, dia terpaksa keluar bekerja pula.
Boss selalu mengingatkan suaminya, orang boleh kata suami itu "boss" kepada isteri, (atau isteri itu boss kepada suami - sukahatilah) tetapi mak tetap big boss kepada kedua2nya.

Tiba di bilik, dilihatnya mak sedang bersolat. Masa itu pukul 10 pagi.
Mula2 boss pelik, tapi terus teringat. Oh, mak solat dhuha.
Tiba2 boss insaf.
Baik boss ambil wudhu dan solat dhuha dulu. Sudahlah pada waktu hari2 bekerja boss memang jarang dapat solat dhuha.

Selepas solat, hati boss automatik tenang.
Boss tukar niat. Baik dia pergi kerja untuk cuba selesaikan masalah yang timbul itu dulu. Kemudian baru dia akan tegur dan tangani isu kecuaian anak buahnya itu. Boss tanam azam akan cuba tangani dengan berhemah dan profesional, tapi tetap tegas. Marah2 sahaja tak ada gunanya. Jiwa boss juga yang bertambah stress.

Boss bersyukur sebelum keluar bekerja dia sempat diingatkan bahawa walaupun dia seorang boss, ada yang lagi boss dari boss2 dan big boss.
Dialah the Almighty Boss, dan kepadaNya lah kita berharap, kepadaNya lah kita berserah.

tak menjawab soalan (based on real-life events part 2)

More ward round scenarios.

Scene 1
HO    : This baby is the one with the hypokalemia.
Pakar : What is the latest serum potassium level?
HO    : Err.. (flips the pages of the patient's file)..there is a half gram potassium in the drip, Doctor.
Pakar :  ?? (What'd I ask?)

Scene 2
Pakar  : (on the phone) Hello, can you tell me how many empty beds we have in the ward today?
HO      : Hello Doctor, yes lemme see..err..there are 26 patients right now in the ward, Doctor.
Pakar   : ?? (What'd I ask?)

Scene 3
Pakar   : How old is the baby today?
HO       : Err...He was born on 23rd Feb, Doctor.
Pakar    : ?? (What'd I ask?)

gosh i'm old..and fat..and old(based on real-life events part 1)

Okay, I've posted these scenarios before in facebook in a visual comic formal.
Just reposting them here mainly to keep this blog "alive", but also to practice translating them into writing.
HO = house officer/junior doctor
Pakar = specialist (in these scenarios all me)

Scene 1
HO                             : Mother is geriatric, this is her 10th baby..
Pakar                         :Geriatric?? How old is the mother?
HO (who is 25yo)     : 40yo, Doctor
Pakar (43yo, no kids): *cry*

Scene 2
HO    : Mother is obese..
Pakar: Obese? How big is the mother??
HO    : Well she's about your size, Doctor.
Pakar : *%^&**$#!*

Scene 3
HO   : We sent FBC, LFT, RFT, CRP, ABF, IEM, TORCHs, xray, urine..
Pakar: So many investigations!! Who ordered them?!
HO   : You did, Doctor.
Pakar: Oh, did I? *blush*

this is emie. she's a doctor.

there are different ways we get introduced to people.

it almost always start with your name, followed by maybe a little bit more information about you.

like, this is emie. she was my friend in college.

or she was my neighbour.

or she works in JB now.

or she's so and so's daughter/sister/cousin etc.

you get the picture.

a small polite conversation then usually follows this introduction.

but what happens after you get introduced to people and they mention your occupation instead?

like, this is emie, she's a doctor.

well, when you get introduced as a doctor, most times you get these raised, often questionable eyebrows first as a response.

at least i do. as if to say, really? she doesnt look like a doctor. 

or really? i thought she's a teacher (refer to another previous blog entry. this i take as flattery) .

or she sure isnt dressed like one. (this will make my aruah mama go i told you so. she told me so soooo many times).
or really? she's too cute to be a doctor. (okay, i made that one up).

then other questions usually follow. 

if you're a doctor, some people may ask you where you work, which hospital, is it a busy/nice place, even maybe which medical school you went to etc.

or some people will just straight up ask you a medical question, more often than not, pertaining to their own health or worries about a certain ailment that they have, rather than a general question like, how about that zika,huh?

itu okay lagi. you still try your best to answer their questions.

but it's a little awkward when this is at a funeral, or you're visiting someone ill at the hospital, and you get introduced to the person's relatives who are also visiting, like what happened to me recently. a friend's close one was critically ill and admitted to the icu, so i went to visit. the atmosphere was sombre, the person was on a ventilator, with tubes and wires running to and from his body, the machines were beeping. there was another relative there so i was introduced by my friend as emie, old friend. she's a doctor. the relative then proceeded to asking me what i initially thought was going to be with regards of the ill person that we were visiting. understandably. may be she's hoping i could help explain certain things further.

but no. she actually went on to tell me about how she was also hospitalized in the same hospital a few times already for multiple surgeries, the last one on her uterus, just last year. i just listened politely and nodded a few times, i see, i see.

she then went on to tell me she is still having some symptoms which she wasn’t sure if it was related to the surgery or the underlying condition that she had, or whether there is a new diagnosis or if it was all part of the aging process, and asked if i knew what they were.

errrrrrrkk…

so i said, well i'm not a gynae so maybe you can ask your gynae next time you see him/her. i looked over at my friend and saw that HE looked real apologetic.

seriously.

that's not the worst scenario though.

imagine a kenduri kawin. you are really hungry, and boy does that nasi minyak look yummy & inviting, let's quickly find a seat. a relative sees you and calls you to sit near him/her. you gladly walk over, that plate of warm nasi minyak + rendang daging + ayam masak merah also calling you to quickly grab a seat so you can quickly eat (hey that rhymes!)

another introduction of ini emie, anak so & so, dia doktor kanak-kanak by the relative to a pakcik you dont know and his family.

this pakcik you were introduced to then briefly looks at you, washes his hands (he was eating) and lifts up his shirt to show you that rash/mole/growth/something-that-looks-like-a-map-of-somewhere on his belly/chest/armpit (!), and asks you if you know what it was, he's had it for awhile now, so can it be cancer?

the nasi minyak suddenly turns cold and no longer look appetizing.

why i still haven't quit my job

i find work to be increasingly stressful and tiring recently. it isn't anything more than the ordinary of course, working as a doctor in a government hospital, it's all part of the job. but there are times when you feel really tired, both physically and mentally, to a point that, for me, i start to think about the possibility of quitting. this also isn't surprising or new, you can talk to any doctor, almost all if not everyone of us have thought of quitting more than once in our medical career. the worst for me was probably when i was doing my masters program. the pressure to perform well, pass your exams, finish your thesis, all while still providing service to the patients in the hospital and being oncall, at the same time trying to balance your personal needs and the needs of your family, was more than enough for you to think of quitting at a daily basis! it's definitely not as bad now, but from time to time, the feeling does creep up again.
so i decided to take a day off today just to unwind and "recharge" myself. i went to the bank, did a bit of groceries and some shopping and then went back home, cooked a bit and then started reading a new book-iban journey by golda mowe. by the way, i went to the bookstore just now only to buy a pen and a whatchamacallit the whiteout-liquid-paper-correction thingy, but of course i cant help from browsing the book section too, so i ended up paying about rm100 for 3 books, 3 pens and whatchamacallit the whiteout-liquid-paper-correction thingy,  . sigh. i really should have bought the pen at the grocery store.
anyway, suddenly there was a whatsapp message from the sister in my palliative care team, sharing with me a message she received from a patient of ours today. just yesterday, the patient came to the hospital for her cardiology clinic follow-up and went looking for me in the ward. she wanted to show me the tablet she got from the children's wish society (cws). she was referred to our team about one and a half year ago, because she has a congenital heart condition that is now worsening and is limiting her daily activities and eventually her lifespan too. she is a very shy and quiet girl and it took me quite an effort to get her to warm up to us, and some coaxing to get her to tell me if there was anything that she wished to have. in the end she wrote me a 2-lined letter stating that she would like a tablet.

so i referred her to the cws team who then got her the tablet she wished for just about a month ago. and so she came to the ward yesterday to show it to me, and then asked to take a photo together. and so we did, i chatted with her a bit and that was it.
who knew, after that she sent a message to the sister, sharing the photo that was taken, and inviting us to visit her at home for raya. but what blew me away was that she also said that she misses me and that she loves me like her own mother!

so what am i supposed to do, (other than cried like a baby) after reading that?

well i cant quit my job yet, that's for sure!

the death deal

all of us die. death is the only thing 100% guaranteed for us mortals.
i deal with death and tend to dying patients everyday as part of my job.
paediatric patients.
children. babies. newborns.
it isnt easy.
but as difficult as it is for me, it is more difficult for the parents and families of these children.

the expected "normal" life cycle for us start within our mothers' womb. we are born as somebody's son/daughter, and then we grow and become adults, as our parents grow older and see us becoming parents ourselves, and they get to be grandparents. and when the time comes, our parents die and leave us to continue the cycle.

but when the child dies before the parents, the life cycle gets disrupted. it creates a huge black hole in the parents' lives. there is not even a specific term designated for these parents whose children died before they do. unlike "orphans", "widows" or "widowers".
although life can and will continue on for most of these parents and families, for some of them the major event disrupts their life cycle so significantly that it just goes spiraling down from there.

i dont have children of my own.
i did have 3 pregnancies.
i had a ruptured ectopic last year that almost took my life, and i didnt even know i was pregnant at that time.the closest i had to almost feeling like an expectant mother was for the 2 weeks after finding out i was pregnant before the 2 miscarriages i had, most recently about 6 weeks ago.
even then i was quite emotionally affected, so i can only imagine how it is for the other mothers out there who carried their babies for 9 months, or have already held their babies in their arms, breastfeed them, watch them grow, worry for them, play with them, scold them, love them.. and then to watch their babies & children die.

i see and talk to these mothers and fathers before and after their child's death. and that's how i know how difficult it is. i try my best to help them get though it. there is nothing i can do to bring the children back, but i try and help the parents get back on track. not by making them forget. i actually help them to remember. many dont want to be reminded. it is normal to be sad. but you should hold on to the lovely memories of your child as a way to move on. you can never forget. those who think or say they can, have merely put aside the memories of their dead child in a tightly sealed vault inside their memory bank and sooner or later the vault will explode open, and that's when you get problems.

i'm not just talking about depression, anxiety, anger management issues, alcoholism or substance abuse. these things can happen to any of us who have lost our loved ones, not just parents who lost their children.
but when it comes to parents who have lost a child .. the explosion of the bottled up feelings (that vault i mentioned earlier) can happen when the mother gets pregnant with another child and may cause problems in that pregnancy. or soon after the new baby is born ie post-partum depression/anxiety. it's one thing not being able to stand hearing about other people getting a new baby or even the sights and sounds of other people's children laughing and playing.. but what about their own children. losing one child does not mean you are no longer a parent. many of these parents still have other living children.. neglect, if not actual physical abuse, may occur to their other children, often without the parents realizing it.

even though i have been dealing with death and dying children everyday as part of my job, it doesnt get any easier. it doesnt make me "immune" or "numb" as some people may think ("emie mesti dah tak heran tengok budak2 sakit ye..dah biasa tgk budak2 sakit ye.."). some of these parents initially say to me too " doktor tak paham, doktor apa tau.."
i would be a heartless superhuman if all that was true. or the opposite. a non-human.
in paediatric palliative care, even though we know that there is no more cure for their disease, that their lifespan is now made shorter, that they are dying, and we make sure that the parents understand this, our goal is to try and make these children live as much as they can for the time that they have with us. as my palliative team and i tend to these dying children and their families, we get to know them and become close to them too. and even if it's true, that when the children die, we may not be as badly affected as the parents themselves, there's no denying that we are still affected. for the brief time that we had with them, they became our children. at least that is how i feel. but i know most of the medical staff in my team feel the same. we have debriefing sessions for ourselves from time to time to help us deal with the sadness and emotional pressure. because we also need to remember. we also cant forget.

why i am a 25 year old doctor. or at least look like one. at least to the eyes of my darling patient.

this was a conversation on whatsapp between a patient of mine and a staff nurse on my palliative team. the patient's nickname is "baby" and she is 10 years old with  congenital heart disease. initially when she was referred to us, she was so shy and i had a real hard time getting her to talk to me. her condition was slowly deteriorating, and her mom revealed to me that baby was becoming very moody and was often angry towards her mom and her older sisters. in order to get her to talk to me and gain her trust, i asked baby to come up with any questions that she may have for me. they can be about anything. i promised that i will answer all her questions or will at least try and find the answers for her. when i saw her 2 days later, she had written 6 questions for me, 3 of which were actually about her mood swings and whether they were related to her heart disease. i was happy that i managed to get straight to what had concerned her mother and  me, and i addressed the questions and explained to her the best way i could. according to her mom when we followed up on her recently, baby's mood has been much better at home now, and i'd like to think that our little q&a session helped her with that, even if a bit. 
as for the other 3 questions, well surprisingly, they were all about me.
she asked what my full name is, whether i am married, and my age. when i told her my age, she didnt believe me, stating that i look younger, and i laughed (happily, of course! i know i know.. she's only 10, what does she know about how 40 year-olds are supposed to look like, but hey.. i'm taking it in. or rather-sucking it in. get it? haha). anyway, that was more than a month ago, and at the time it was only she, her mom and myself during that meeting because she was too shy to even let my nurse in. but the nurse continued to visit her everyday while she was in ward, and later even visited her at home after she was discharged, and they have been keeping touch via whatsapp. when i had to go on leave for 2 weeks after my recent miscarriage, we had to postpone her clinic appointment with me, and that's why she asked if i was well too during the whatsapp chat. it's so amazing that even though she herself is unwell (she doesnt even go to to school anymore because she tires easily) she still thinks about my health. here's to you, your health and your happiness, darling baby. God bless you, not just for being so naive and kind for saying i look 25 ;), but for being the sweet strong thoughtful you, as a reminder for the rest of us to love life and always be thankful. 

happy mother's day

i was in my bereavement clinic this week and was seeing a couple who had lost 2 babies in 2 years.
dad is coping fairly well, better than his wife because he feels that going to work and keeping busy helps.
mom (and dad) agrees that it is more difficult for her to cope because she mostly stays at home and when their other children (they have 3 older ones) are at school she will be alone. and because she is the mother. with the support of the husband, she is taking up sewing and knitting classes just to occupy time. i asked what else can she do at home and she told me "i dont know, not much. i try to watch tv but these few weeks have been especially hard because there are so many shows and ads about mother's day.....".
i immediately agreed with her on that.

tomorrow is mother's day.
today marks the 9th month of mama's passing.
life goes on,, the crying has lessened a bit, but i still dreaded her birthday, the coming ramadhan &  syawal, the date Aug 9th .. because i knew i will be missing her more on these occasions. for some reason i had sorta forgotten about mother's day until i first saw about it on tv a few weeks ago. so i guess you can say i was a bit taken aback, makes me miss her even more and made the tears appear again.
even when she was alive the mother's day shows and ads on tv can make me emotional, but back then i could just call her right away, tell her i miss her, love her.. or if i am in town, celebrate the day with her with our family, a special lunch or dinner.
this year onwards, we can no longer do that.

my sister called me the other day, crying as she heard a mother's day ad on the radio as she was driving (read:stuck in an awful jam) to work.
so it's not just me.. it's difficult for all of us.

the bereavement continues on.
we love you mama. alfatihah.

last year we celebrated mother's day and our dad's bday together. here they were with the 3 grandkids. i almost missed it because i was at a wedding. so glad hubby & me still tried our best and drove all the way to join the dinner. who knew it was the last time we were able to celebrate mother's day with our dearest mama. 

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!!

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-?

call paeds, the placenta is coming!

scene in the operating theater while a friend of mine was standing by with a nurse for a delivery.

RN: by the way doctor, just to let you know, we have another case after this.

MD: ok, what's the case?

RN: MRP

MD: ... ?? err... Manual Removal of Placenta??

RN: yes doctor.

MD: ...??? and you want me to standby?

RN: yes doctor.

MD: ..(turning blue from trying not to laugh)... err kak, saya doktor sambut baby, tak sambut placenta!!

RN: oh, ye ke doktor?

cakap biar terang, doc!

a friend at work shared with me this one:

- her brother, who i take it from her description, is a bit on the overweight side, asked her opinion regarding a symptom he is having. she advised him to do a few blood investigations, which include few that requires him to fast first...lipid, sugars, etc. so she told him "ingat, puasa tau pegi amik darah2 tu".

so the brother literally "puasa" la.. .. he even woke up at 4 am to drink a full mug of milo as "sahur", and went to take the bloods at 7 am.

obviously, she only has herself to blame, for not clarifying to the brother earlier on how it actually works ;)

this one happened quite awhile ago already, at the previous place where i worked. i probably blogged about it already too, cant remember, but i still think it's funny..hehe.

- a chinese colleague was asking in malay, a young girl's parent whether her kid ever had an ultrasound done to look at her kidneys, "puan, anak puan punye buah pinggang ada pernah tengok tv ka?"

haha!

"to cure sometimes, relieve often, comfort always"

yesterday i saw this early morning show on tv called "tanyalah ustaz".

the topic was "jin & alam ghaib".

interesting, and something i have not much knowledge about, so i sat down to watch while taking my breakfast before leaving for my oncall.

at one point the ustaz was telling the viewers to always consider alternative medicine, in this case, perubatan islam- whenever we fall sick , and especially when doctors/modern medicine are unable to find the cause or definite diagnosis for the medical problem.

but then he also went ahead and made a statement which totally shocked me, that i almost choked on my karipap sardin!

he actually went on to advise viewers "bila2 doktor tak dapat cari punca atau diagnosis untuk sesuatu penyakit itu, mereka mesti nak mintak satu- ambil sum-sum tulang. tuan2 dan puan2.. kalau boleh, cubalah elakkan dpd perkara ini.. ambil sum-sum tulang ini adalah amat bahaya.. boleh menyebabkan lumpuh. jika doktor mintak ambil, cubalah dulu cara lain. ingat ye!"

!!!!

manalah i tak almost had to heimlich manouver myself!

no wonder lah selalu susah nak dapat consent for bone marrow and lumbar puncture!

the public has already been misinformed enough about how doing a lumbar puncture and taking cerebrospinal fluid (CSF) or air tulang belakang can paralyse people, now he is saying ambil bone marrow or sumsum tulang will also cause the same. both are totally different things, located at different anatomic sites, and the procedures done to obtain them are also different.

sigh..i'm not here to talk about how we do lumbar punctures or bone marrow aspirates, we do it multiple times on a daily basis at the hospital, especially in the oncology wards, and since malaysia still require us to take consent for these procedures, "berbuih mulut" to have to inform patients and parents about them already.

the ustaz no doubt is probably well educated in his own field, but i dont think he should make such bold statements about medical procedures before getting the facts right.

whenever patients at the hospital express their wish to try other means, be it "islamic", bomoh, chinese, homeopathy, etc.. we never say "no", as long as they can still continue their treatments or follow-up with us, and the alternative medicine doesnt interfere with ours. and i know for a fact that whenever most of us do something, or about to carry out a procedure, we always pray that everything goes well... no matter what religion/belief we have, or who it is we were praying to, we know that we are merely humans, bound to make mistakes, and the last thing we wanna do is harm a patient, and so we pray to higher powers to help us.

o well, i'm probably digressing now a bit at least, i'm sure.. but i've mentioned this over and over again, reminding myself, my colleagues, the staff, and especially the really junior doctors out there (although i still consider myself junior as well) that we should always treat a patient just as how we would treat someone dear to us, or just as how we ourselves would like to be treated, should we become patients ourselves.

to quote a few points from the oath:

"I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help."

to quit or not to quit.

oh crap.
i'm having those feelings again.
nak quit nak quit nak quit.
warrrrrrrrrrrrrgh. benci.

ah.. you're single, so you must not have a life.

scene 1:
me joining the department one month ago, and reporting to the boss on the 1st day.
boss: do you have a family?
me: umm.. yes.
boss: how many kids?
me: oh no.. not married. no kids. i mean i do have a family..like my parents and sibs and such.
boss: ha.. good, then you have a lot of time in your hands, can study. nothing to distract you.
me: err..ok.
boss: you must be smart, you're in the masters now, cannot just study from the books. must read journals, go on the internet, attend conferences. haa, and you're single, night time you dont have anything to do, go attend drug talks, sometime they have these talks that they can sponsor you for. you just go-lah, get educated, also get free dinner.
me: err..(nod my head)

scene 2:
a new junior boss joins the department. senior boss overheard talking to her PA about him.
senior boss: is he married?
PA: yes, he's got 2 kids i think.
senior boss: aiyah. susah la.

now, the senior boss has no intention to ngorat the junior boss, trust me, although it's easy to misunderstand the conversation. she just prefers people with no kids so they can commit 110% to their work. for some reason, they think that if you're married, and especially if you have kids, you get "distracted" more.

i was talking to a couple of colleagues about this. seems like the generation gap is quite huge in the department. the senior bosses are the type who goes to the hospital any time of day, even on the weekends, even though they dont have to. the junior bosses are around to look after the rest of us and the patients of course. apparently few of the seniors, even when they are away on vacation, will have people text or call them to inform about the patients!
the commitment is admirable of course, but i think it is more about trust than anything. they just couldnt trust the junior people.
they also dont get it that these people take leave to see their kids off on their 1st day of school.
they dont get it that they must oversee the kids doing their homework at night (let the teachers worry about that).
they dont get it that we need at least a couple of weekends off a month to be with the family and friends.
they say things like "my daughter is 13 years old now. i never actually get to see her grow up as a kid .. i cant believe she's a teenager now".
these people breathe, think, talk, eat, drink, live and die of hospital and medicine. it's their life.
it's admirable.
but not really desirable.
not for me anyway.
i'm single yes, but i still have a family, friends, and a life i want to enjoy and spend time on, other than just my career.
hmph.
i dont think they will get that.

mother's instinct

these are some of the (scary) true stories i've heard from people about their maids. this in lieu of the recent news on maids being abused and so on. real names been changed for obvious reasons and just cause ;)

1) rozy was having a bad feeling about her maid. she couldnt specifically say what it is, but she told her husband that she's worried about how her maid fares at home when they're both at work. her husband reassured her that she shouldnt worry, from what he could see, she seemed to be okay with the kids. rozy wasnt convinced and couldnt get rid of her uneasy feelings. her girls were too young to tell her anything in details if she asked them. one was about 2 yrs and the other 8 months old. her husband then suggested that they get a webcam on their computer to "keep an eye" on the maid. so they did. and got the shock of their life.
scene: maid brought the younger girl (8-months) in front of the tv (which is where the computer and webcam were also placed) to change her diapers. she was watching the tv at the same time. baby girl, as usual, was struggling to get away from her, preferring to crawl away bottom-less and free. maid roughly struggled back with her to make her stay flat on her back. baby girl cried. maid then grabbed the baby's shoulders and shook her repeatedly, shouting at her to stop crying.
rozy, knowing all there is to know about shaken baby, brought the baby for a medical checkup after that (after sendinng off the maid of course). true enough, there were signs of shaken baby in her girl's brain already. apparently that wasnt the first and only time the maid had done that.

2) suzy was suspicious of her maid when she asked her for some money. it wasnt much, about rm50, and when she asked her what it was for, the maid said she had borrowed money from the maid working for suzy's parents, and needed to pay her back. so suzy gave the money to her maid, and later at her parents', asked their maid if her maid had paid the money back. their maid denied getting any and claimed she never loaned her any money in the 1st place. suzy then asked her maid again why she needed the money, and her maid confessed that she actually borrowed money from another friend, but she refused to tell who the friend was. suzy wondered who it was and when was it that her maid got to socialize. she suspected that it was when her older kids are at school, and only the youngest one at home. she told her husband this, and that perhaps they should install a cctv at the house to see what goes on during the day when they're at work. husband refuses since they cost a lot of money, and that she's probably worried too much about nothing. he suggested however on installing security alarms, due to the increasing number of break-ins they heard around the area, and they did.
one night they got the shock of their life when suddenly the newly installed alarms went off. they both ran down and saw that the front door was opened. the maid was in her room, shivering with fear, because apparently she was the one who had opened the door, not realizing about the new alarms. she was actually all ready and made-up for a night in town with her new boyfriend, and apparently that wasnt the 1st time she had sneaked out of the house at night after the family has gone to bed.

3) rudy and his wife have a business together. they have 4 kids, 3 in school, and the youngest, denny, is 2 yrs old. they have had different maids over a period of about 12 years now, no real problems, all the maids were sent back according to the scheduled contracts and whatnot. their latest maid has been staying with them for about a year now.
although they've never had any problems with their maids, rudy and his wife were always cautious, and they have had cctvs around the house for a number of years now. mostly for security, but it helped them keep an eye on the kids as well, where they can still see them from their office.
one fine friday, after the friday prayers, rudy got a call from his maid telling him that denny had bumped into a piece of furniture at home and now had a bruise on his nose. rudy went home and saw the bruise, a huge one across denny's nose, and also a small bleed in his conjunctiva (white eye). his wife was suspicious that the bruise was due to something else rather than bumping into the furniture, and so rudy reviewed the recording on the cctv for the day just to be sure.
scene: maid was feeding denny his lunch, and being the active boy that he is, denny refused to sit still while waiting to be fed. the maid got tired of shouting at him, and proceeded to slap him in the face (same site as the eye bleed) and didnt stop there when the boy started to cry. she then bashed him on the face and head with her fist, and when he fell, she then kicked him, and finally spit on him!!!
rudy was obviously so shocked when he saw this, told his wife, who was also too shocked and just too upset to see the tape. they brought denny to the hospital to be examined (he's okay, the lucky guy), then brought the tape and the maid to the police.

4) hady has 2 kids, a 2-year old boy, and 3 months old girl, and his wife has just gone back to work after the confinement period. they had a new maid to care for the kids, who they have trained in the past 3-4 months while the wife was still on maternity leave. one day, after about 2 weeks going back to work, the wife had to go outstation for a meeting and had such an uneasy feeling about the kids, she called hady and told him about it. she asked him to go home and check on them. usually, she was the one who would go home during lunch break because her workplace is real near their house. hady tried to reassure her that everything should be okay, and that she was probably anxious because this is the 1st time she's away from the kids, but she didnt believe him, at least until he promised her he would go home and check on them. so hady asked for a bit of time off from work that afternoon, and drove home. to his surprise when he got home, the front gate was locked as usual, but the front door was widely opened, and he could hear his son crying from inside the house, calling for mommy. he rushed in called the maid's name, and saw that his baby girl was in her cot dowstairs, sleeping, (and breathing, thank God), and then found his crying son upstairs in his bedroom. he called for the maid again but there was no answer. he asked his son where the maid was, but his son said he didnt know. apparently he woke up and when he couldnt find the "kakak" around the house, he opened the front door to see if she was outside but when he saw that she wasnt, he got scared and just went inside and cried instead. hady then informed his wife who immediately drove home, and they informed the police. they concluded that she left the house herself since she took all of her belongings with her. nothing was taken or stolen from the house neither.


i dont have a maid, and my family never had one (my dad "hired" his own sisters last time to help look after us when we were growing up), and i know for a fact that there are good reliable maids out there, but just to remind everyone to always be careful .. and to trust a mother's instinct.