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

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.

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.

"they will sumpah you in the kandang"

i had to give a statement in court the other day for an abuse case i handled years ago.
somebody gave me advice on what to expect when i'm in court, "they will bring you into the kandang, and then they will sumpah you.. after they sumpah you, then you sit, and they will start asking you questions.."
those are her exact words.
what she was trying to tell me is that they will bring me onto the witness chair and ask me to angkat sumpah ..
hehe.

anyway, so here's what happened. it was the first time i ever went to court for anything. i was kinda nervous. in the witness room, i saw the patient's mother, who gave me this advice, "doc, you better say your prayers.. these people sometimes play dirty, and they might voodoo you, you know. that's what happened to me last time, after the lawyer asked me the questions, i suddenly got stomach cramps, i had palpitations, and i just stuttered.. they had to postpone the trials last time! you be careful up there doc!"
umm.. right, the symptoms she described could easily be attributed to nerves, but i didnt tell her that and just nodded my head.

after a 2-hour wait, i was finally called in.
the "angkat sumpah" part went well.
then before i sat down, this lady sitting in front of the judge (the sign on her desk said she's the translator) asked me to say my name outloud.
so i did.
then they asked me to state my age outloud.
so i did.
and to my surprise, she actually repeated the number again, in a much louder voice.
umm..why is that? i had to prevent myself from smirking.
then, she asked me to state my current home address.
i was again, surprised, but did as told. the judge and lawyers copied evrything down in writing, and the judge even made me repeat the address.
umm.. ok.. i know the alleged perpetrator was in the courtroom, and although i was called in as an "expert witness", my statements would actually be working "against" him, and voodoo/black magic aside, isnt giving out my full residing address to the room "risky"? i wonder if they ask all witness in all cases to do this...
like i said..this is only my first experience in court. hopefully it's the last.

another interesting observation in there was that, there was no transcriber/stenographer available. therefore, whenever i said anything, the judge and lawyers all got busy jotting down my words.. there were no eye contacts at all at the time, and i was reminded to speak slowly cuz "we have to write down what you say". so i did, pausing once in awhile till one of them looked up to me to ask me to continue.
even the lawyer who was asking me the questions, would immediately look down again and feverishly wrote all my answers, while he/she was still standing!
it was so unlike on tv!
i felt like putting up my hand and ask "isnt there supposed to be a transcriber-person-with-the-tiny-typewriter that can help you take down everything?"

i felt soo "jakun" with everything that i was no longer nervous, and by the time we were halfway done, i was already, surprisingly, bored!
i caught myself looking at my watch and rolling my eyes once, and then realized "shoot..what if they have a cctv in here and saw me doing that?"

anyway, about 40 mins later i was released from the kandang.
hopefully that was the last time i ever have to enter such "kandangs" ;)
i dont know if my statements were actually of any help at all, or whether the case is finally closed or whether the victim (my patient) won. i also dont know for sure whether the alleged perpetrator in the case was really guilty, there is no way i can be 100% sure, unless i was actually at the scene of the crime when it happened. the only thing that was evident to me was that the girl was obviously emotionally affected, and at the time, there was medical evidence suggestive of a rape. i have no idea if the lawyers or police had any other evidence.
i can only pray for justice to be served.
and glad that i'm not a lawyer.

kidz

these are just a few of my collection of photos of kids in action. they're just adorable!
how can some people stand to hurt/abuse them, i can never understand.

always let a kid be a kid...(i guess easy for me to say, cuz none of them are my own.. once they poop or throw a tantrum.. i hand them back to their moms..heee..)

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.

sigh.breathe in.out.sigh.snort.blah.sigh again.

just finished all 6 seasons of sex and the city (again).

just discovered that i really luv 24! (only seen 1st 2 seasons so far-yeah,yeah, long way to go) but i'm stuck now.

and am so in luv with kiefer sutherland. he seems cool.

missed the SAG awards yesterday. lupa. was so engrossed with 24 season 2. saw the last 12 episodes back-to-back. slept at 3am.

work is as work sometimes, unfortunately, is.

another desperate mother left her newborn baby in a drain.

poor lil one a real fighter tho.

alive and kicking.

well not exactly kicking-was lethargic by time he got to us.

but still ok, considering.

he got bruises all over.

must be bruised emotionally too. left unwanted by own mom.

world oh world.

sigh.

bed beckons.

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.