Lotus - surviving life & remaining pure to urself

Just a thought

2011-05-09T14:09:00.000-07:00

I am just too lazy to blog these days; and given the confidential nature of my work, I have to be careful what I write here.

Today a patient asks me to be his HIV physicians during my rotation at my current hospital. Have to say, I kinda feel honoured being asked to do so, especially me being so early on in my specialty. I am still a baby HIV physician trainee. Oh well, I will start to have my own immunocompromised patient list by end of this month. So many new things to learn; the new anti-retrovirals drugs combo just keep growing and with a new horizon of treatment for Hepatitis C, I think I will struggle just to keep up!

And doing the infectious disease on-call is still pretty exciting for me. I start to get the hang of the usual malaria/TB stuffs/meningitis and encephalitis stuffs, fever of unknown origin but there are still rare ones like chikungunya (I was like chicken what?? not a very exciting disease actually) ~ I still go "Wow!". Wouldn't say I missed acute medicine on-call, but I do feel slightly less confident in managing general stuffs. I am still quite amazed to get call as far out as Bristol, Birmingham since I thought they will ring London School of Hygiene and Tropical Medicine.

Probably its just me who find all this stuffs very exciting. Its just soo different from my previous work.

Opinions

2011-02-07T14:25:00.000-08:00

Big society; NHS reform and GP consortium; failure of multicultural society; raising university fees; library closure...what's next? All these spells R.U.I.N.S to me. Bodoh.

I hope Egypt will find its footing soon. May Allah bless and provide his guidance.

I have been reading some vile comments from UMNO supporters who say only to save UMNO people in Egypt in this random website which should remains nameless. I personally think such comment can only come from the scum of the earth who (unfortunately) lack education and happen to be UMNO supporter. I don't trust any politicians, you see, nor support any political parties.

You are human, treat and respect other human please, regardless religion, sexuality, ethnicity or background. Allah Maha Besar, and who are we to judge other fellow human beings?

Moving on

2010-11-26T11:41:00.000-08:00

Wrap up MRCP journey, finally. Then the 3 diplomas I need to do as part of my exit exam, bring it on.....

I am moving on to a greener grass of doing non-acute non-resident 24 hour on-calls. Bloody yeay!! Lets hope it will match my expectations. And I will be learning a hole lot of new stuffs, exciting!! Probably fancy doing lab tests :)

I used to enjoy doing this acute on-calls, but I start to find some house officers incredibly annoying - no sense of trying to learn or working out what's wrong with the patients; doing tests for the sake of tests, patients suffered post-op complications as simple as urinary retention after surgical discharge cos nobody bothered to examine someone's tummy...I will go mad if I was the patient. Don't even start on people leaving can-do-in-the-morning-clinical procedures for night team. Gosh, set my temper flying already!

On behalf

2010-09-20T14:26:00.000-07:00

of my owners who are currently terlampau malas nak update blog, we all would like to wish selamat hari raya and maaf zahir batin. Anything accidental, ampun maaf yer..

Lots of love and kisses,
Kitty and her beloved guardians

Knowsley Safari Park

2010-08-12T16:43:00.001-07:00

Recent trip to this park - picture include lion crossing right in front of our car, a group of cute meerkat and the sealion show.

Egypt and vasculitis??

2010-08-08T14:08:00.001-07:00

It has been a rather odd week medically speaking.

I had a few young men who all ended up with diagnosis of vasculitis, and all of them have visited Egypt few weeks either during or prior evolvement of the disease. One of them is very sick indeed, having vasculitis affecting his kidney, his GI tract (bleeding PR), skin (developing pressure sore - which is odd in an active and prior to this perfectly healthy 20 sth man), probably infarcted his tonsillar artery..and it is just awful. The renal team is hitting him hard with cyclophosphamide (which cause azoospermia) and probably have to think of other immunosuppressive drugs if this doesn't control his disease.

The other one is looking more like limited Wegener's...and we are pulsing him with methylprednisolone...again coming back from Egypt.

And in clinic, I had someone who developed reactive arthritis post-diarrhoea in Egypt, and the clinical picture is looking more and more like ankylosing spondylitis.

Odd, indeed.

Kitty

2010-08-01T13:41:00.000-07:00

Al-fatihah

2010-07-19T10:47:00.000-07:00

I never met her, and yet her stories touched the depth of my heart. She passed away today.

http://onebreastbouncing.blogspot.com/

Reading this story, I do hope, I have provided the best care I can give to people I have treat, and I have lessened their pain and anger somehow along the way. Somehow my job is getting more and more into providing palliative care these days.

Kitty

2010-07-08T14:51:00.000-07:00

So damn cute!

She is going to be one spoilt kitten.

Sigh

2010-07-03T02:46:00.000-07:00

Lately I don't feel like I am saving life very much.

It starts to get rather depressing in the ward....so many metastatic and recurrent cancer that is beyond human capabilities to treat; and you know it starts to affect you when you really have to start to thinking about a good death, and having second thoughts.

Metastatic prostate cancers, metastatic stomach cancer,the supposed benign astrocytoma that failed to response to radiotherapy and even 3rd line chemotherapy,a ;young man with metastatic bowel cancer after cured 2 years earlier and needing nephrostomy tube, countless lung cancer (and i have a sinister feeling some of my treated pneumonia will reveal neoplasm and these people have performance status 3), bleeding brain tumour...and a number of neutropenic sepsis post-chemo....in the last 2 weeks alone. By the way, it is Acute Medicine Admission ward, not oncology ward.

The thing is if you find neoplastic in someone who is fit to undergo some kind of treatment, that is fine; but the really is, many of mine, are not. Have to say, a lot of respect to doctors who does Lung cancer clinic.

Kitty

2010-06-20T10:12:00.000-07:00

This gorgeous little kitten is what occupying us at the moment.9 weeks old.

NHS efficiency

2010-06-16T10:48:00.000-07:00

We have "Efficiency manager" shadowed our ward round few days ago. Our medical ward is not that big; we have physiotherapist with the zimmer, carer serving breakfasts and feeding patients, nurses going in and out giving patient medication and we the doctors seeing patients and writing notes, and going in and out looking at results on computer.

This efficiency manager followed us around, standing outside the curtain when we see patient....its like a space-occupying lesion squeezing in and out.

Now you tell me why our NHS trust is in the red.

And by the way,in the NHS trust near our hospital, why build a new hospital building with only 25 year old life span? The main hospital in the city built in the 70s already crumbling down.

GRAZE

2010-06-12T12:09:00.000-07:00

For your free box use code:8D5D61X

Sakit la hati pulak tengok England game ni...Aku lepuk jugak the goalkeeper Green ni.

This says it all

2010-06-01T14:14:00.000-07:00

Was watching tonight news, and the newscaster said something along this line:

Israeli action is condemned by the whole international community and the UN; will they be punished? No.

Even the British family effort to fight justice for their children who has been wrongly killed by Israeli army come to nothing.

http://www.guardian.co.uk/world/2003/oct/20/israel.foreignpolicy

Gloom

2010-05-24T11:39:00.000-07:00

I had a very sickening feeling when I heard a fellow Medical Registrar had a massive subarachnoid bleed during this morning handover.

It turned out I didn't know him before. He worked at my previous hospital.

He just finished his night shifts.

It is so very very sad.

It is so poignant; someone whose most life has been dedicated to others, will continue to serve others. There is already talk about organ donations once he is certified brain dead.

I pray for his family. I wonder if I knew his wife; with us being in a small deanery. May she have the strength and mental agility to go through such a painful time.

Life, such a fragile thing.

Summer is here

2010-05-23T03:55:00.000-07:00

........

2010-05-16T02:34:00.000-07:00

Has a 106 years old admitted when I was ontake last night.

This must be some sort of a record.

The oldest patient I had previously is a 102 year old with dementia. She went home after a month whilst we sorted out her social side; still walking.

GB, DC and NC

2010-05-11T14:21:00.000-07:00

Quite sad Gordon Brown is now gone, but I think its time for him go. I always think of him as a pretty decent and quite charismatic person, but he made plenty of bad decisions. Letting go a lot of British institutions; that is always bad on my book. Don't ever let go national identities and institutions.

I don't think I can really warm up to David Cameron. He come across as trying too hard, too fake and has the kind of face I cannot trust; but I do think he did his best in the last few days.

Nick Clegg has the right kind of persona; but Lib Dem conducts throughout this hung parliment fiasco only re-enforced my belief that politicians cannot really be trusted. Power, eh? Its intoxicating.

This is my two cents.

IT

2010-05-07T13:15:00.000-07:00

First and foremost, my current workplace IT isn't exactly the best thing in the world.

My ward is currently "pilot"ing electronic TTO.

The thing that anger me the most is the time it is taking to bloody complete one TTO. Yesterday, my house officer took 2 1/2 hours doing 4 TTOs, and I felt very very annoyed. I was the one who ended up to complete all the ward jobs, including talking to a number of families. (How slow can one be typing on computer?).

And this electronic TTO...for some reason, whenever I did them, I was felt with a sense of wanting to throw the computer to the ground and chucked the printer out of the window. I don't think this is a normal response. No, I don't find using the system is hard; I used to work as medical secretary and my typing skill is certainly much better than my ward clerk.

The problems are:

The printer keep jamming/not printing/ink problems...

The system hang.

You have to manually type the drugs, select the brand, select dosage, select frequency..

We still have to do discharge summary..

For control drug I still need to do the handwritten version....and some drugs not even listed in their computer system...pandai tak?

Instead of seeing patient, I was forced to spent so much time doing this bloody thing and I think the IT person they sent to ward to supposedly help us with this thing has slower typing skill than me;and half of the time she has no bloody idea what to do when the system doesn't do what it supposed to do.

Bloody waste of my time.

Hmmm...

2010-05-06T13:23:00.000-07:00

4 electronic TTOs in 2 1/2 hour time?

I am bloody impressed.Grrrr.....

Touched

2010-04-25T17:30:00.000-07:00

My brother waited for me to wish him happy birthday on Monday the 26th. I am slaving myself away for on-calls and didn't get home by 10 pm.

Due to time difference, I manage to wish him despite the delay.

Love you always, my youngest bro. Thank you for making me feel like I am the sunshine of our life.

Just a thought

2010-04-24T16:02:00.001-07:00

I think Motherhood is a privilege, not a human right.

It crossed my mind, that's all.

Life ain't a bed of roses

2010-04-21T14:22:00.000-07:00

As I looked around my ward today...

A 28 yr old woman who has a stillbirth 7 weeks ago.

A 56 yr old woman whose husband suddenly walked out of their marriage out of the blue. They have been together since she was eleven. Don't underestimate the power of a broken heart and its manifestation in physical illness. She helped to sooth and calm the depressed and deeply anxious elderly lady who is having unstable angina next to her bed.

In the next bay, a psychiatrically disturbed and recently became-a-mum Type I DM keep demanding painkiller. She has a morphine addiction and purposely induced hypoglycaemia by injecting excess insulin to her body. Her 6-7 weeks old baby may be taken into foster care soon.

And you just have to get on. Who says life is fair, eh?

Count your blessings.

Today

2010-04-15T11:11:00.000-07:00

My consultant said,"I practically lost the will to live now" by the time we saw the ump.......th patient.

I let him go to have his lunch.

Faith

2010-04-06T15:45:00.000-07:00

If you pray for patience, does God give you patience or opportunities to be patient?

Kick Ass

2010-04-04T16:59:00.001-07:00

I am pretty sure this movie is banned kat Malaysia.

Its pretty messed-up children/teenager superhero movie with soooo much profanities and violences matched only (or even more??) by Kill Bill. A 11/12 year old girl muttering the word C--T? B----- hell.

And yet it is so funny; and there is a little touch of humanity too...Have to say, I did have a good time at cinema.

And I think there will be a Kick Ass 2.

The price of obesity

2010-03-31T09:00:00.000-07:00

Is awful.

I had a morbidly obese patient admitted to us a few days ago. She ended up with acute kidney failure after nausea and vomitting 9 weeks after a gastric balloon operation. Severe metabolic alkalosis so she must have vomitted significant amount of stomach acid.

She is the same age as I am.

She is bed-bound and has pressure sores.

Its a bit of a nightmare to sort out all the x-rays and things. The X-ray bed couldn't support her massive weight you see.

She is now in ITU for intensive monitoring. Oliguric despite plenty of iv fluid in the ward and the last thing we all want is heart failure.

I feel truly sorry for her. She has the operation (or shall I say endoscopically) done privately, and I suppose not very much sedation use because she is high risk for any general anaesthetic and a true nightmare for anaesthetist if any thing went wrong.

She certainly not my first morbid-obesity patient. When I was a house officer, I remember this morbidly obese patient died as a consequence of heart failure and I can certainly recall how the chest x-ray can only capture one lung field because he is so big.

It sad really. What strikes me with this woman is how young she is, same age as me and she is blessed with 2 young children, who probably will end up as orphans in a few years if their mum couldn't sort herself out. I guess this gastric balloon must have been a last resort, which unfortunately without the complications.

I hope she makes it through this ordeal.

Friendship lasts

2010-03-13T08:37:00.000-08:00

Its been an absolute blast. Met up with few friends who I haven't met for a good 10 - 12 years. Such such a comforting thought that we all behave the same, despite some of us have become mothers. Nobody trying to be perfect friend or parent or individual. Friend who can literally shout off at the phone whilst she tried to park...or becoming a mad facebook woman when she tried a stint as a stay at home mum, how we all bloody lazy to iron our clothes and made the spouses to do them...hahaha, so funny.

I hope we can all stay imperfect for each other.

Realisation

2010-03-06T02:45:00.000-08:00

Sometimes I think I just need a reminder that mum loves me.

Her sms is always ever so sweet.

I will always be there for you, mum.

I wish you can just open up to me when your heart is broken. I am done with keeping an upper stiff lip.

Stress

2010-02-10T13:42:00.000-08:00

Alhamdulillah, I got the post in the specialty I want. Been waiting for this for one year at least. Will be taking over the post when current registrar completed her CCST this October. No more training post for this for at least a few years in my deanery.

Alhamdulillah.

I will be the Genitourinary and HIV registrar this October. Got the call 1 hour after the interview.

One down, and one more source of stress to go.

I am still grieving for my granddad. The voice that dictate at least half of my life. I missed him....but I guess I have let him go when his hearing went, and it became incredibly difficult to have a decent conversation. Upon hearing of his death, I became incredibly distress, called hubster and went home to sob my heart out.

Wish me luck.

Irritable.

2010-01-11T11:36:00.000-08:00

I feel rather irritable today...

Ok, things that annoyed me is when patients are not managed properly...like someone is in congestive cardiac failure with only antibiotics for 3 days. I am aware patient not giving appropriate history, but a good clinical examination should reveals that, especially someone who is grossly oedematous and has a massive heart on CXR! Paling menyampah is a house officer yang banyak alasan buat keja, or do the job for the sake of it. Annoyed, annoyed, annoyed.

My meningitis man is better! Woohoo!! It feels rewarded. I mean, seriously, if he comes a couple days later, he would have turned up dead, leaving 4 children and a widow. Its a good thing his GP send him to the hospital despite his letter saying viral illness. This case holds a rather special place to me, since I managed him from clearking in, get CT brain done and did his lumbar puncture and sort out the public health side of it. How often is it you see a proper pneumococcal meningitis?

Meningitis

2010-01-08T15:19:00.000-08:00

Let just I say, I truly not impressed with the public health registrar who has no medical training at all.

Had a definite case of bacterial meningitis today. Probably the longest time of lumbar puncture I ever done, had to swap mid-way whilst getting the cerebrospinal fluid sample cos my back is killing me. Ended up having to use the smallest gauge of needle cos all the black (can't remember the gauge) ones are gone; its either that or a big giant spinal needle. The cerebrospinal fluid is very turbid, very thick. 1 drop takes about a minute and a half to come out from the needle, no matter how much I adjust the spinal needle. 3 bottles collected. The result is typical textbook bacterial meningitis with at least 2.5 gram protein and 3100 white cells in it..

Yes, I knew the management is different between pneumococcal and meningicoccal. Yes, we can see gram positive, pictures looking more like pneumococcal but there is no way I can 100% rule out meningicoccal. Possible, probable, its all sound the same to me. Apparently possible and probable meant different things to public health, and it doesn't help this person has zero medical training.

Nothing is ever hundred percent in medicine. Doesn't make any easier for me whose job is to make some really important decision in many people life...sometimes the balance hang on what will kill the patient first. Awful, isn't it?

The worst winter in the last 28 years

2010-01-05T14:41:00.000-08:00

Enough said.

The view is absolutely gorgeous.

Functionally doesn't work in real life though. School and offices shut down. We are severely affected in the health services; operations, clinics and angiogram cancelled. Doctors and nurses struggled to go to work; everyone snowed under. Manchester ambulance service has to declare major incidents.

I am damned tired from the traffics.

Couldn't really imagine on-call this weekend. I better brought spare clothes and food, in case having to sleep over!

Here to HOPING!

Ichi rittoru no namida

2010-01-02T16:38:00.000-08:00

Berjurai-jurai air mata tengok citer ni.

Have to say, quite impressed with the way they potrayed the signs and symptoms of spinocerebellar degeneration.

The wide-based gait, the nystagmus, the past-pointing, dysdiadokinesia and gradual onset of bulbar signs.

Its a true story. She died at the age of 25. I couldn't even imagine being in her place, having the disease at the age of 15.

My consultant has Multiple Sclerosis. I can see his gait being affected to a degree. Truly amazing, and a kind person. He can still performed angiogram and inserting pacemaker. What a courageous person.

All these neurodegenerative and demyelinating diseases does make you questions certain things in life. 1 litre of tears...what an apt name for a personal diary.

On a more cheery notes, please don't bring me to Cheshire Oak (again). Udah2x la tu shopping time sales nak mampuih ni. Remember, you are skint. Exam.

2010

2009-12-31T17:14:00.000-08:00

2010 is here, finally.

I am going to enjoy the last year of my 20s.

2009 has not been an easy year for me. Wouldn't say I come out unscathed, but it did make me realise a bit more about what I want, and hopefully what I will be.

I am fortunate to enjoy what I do.

I am going to work hard to get this exam thing done. At the moment I am alternating between panic to chill and then panic again and then scared, then back to panic etc... Not quite sure what to expect with this new station in PACES.

Now back to panic...aaaaaaa!!! (Taknak la fail kalau boleh...haiyooo)

Azam baru?? Targets?

2009-12-25T13:00:00.000-08:00

Kejap jer dah 2010...

I do have certain targets that I am in dire need to achieve...and other wishes for next year.

Nak kena complete my MRCP. Already out of nearly 2 grands (pound sterling) for PACES preparation and exam fee.

I have this longing of doing a Master degree.

I want to see the world. Rasa macam ambik 6 months off work, beli world-wide hop-on hop-off flight ticket and just be a free spirit and travel to my heart contents. I am sure this rubs off from Sue, my SpR.

I want to be closer to my sister and brothers. To support my youngest brother music career.
http://www.myspace.com/lisasdiaryofficial

It will be great if God grant me with motherhood (but please, don't ever approach me with broodiness).

Rasa nak a new car....buy another house. (See, this is selfishness and pure self indulgence)

Nak be healthier and more exercise.

Nak build up savings and investments (dengan self-indulgence?? I am crazy.Nak kena buat locum ni, but malas giler. I love my job as they are now.)

Death

2009-12-19T16:45:00.001-08:00

My beloved paternal grandmother passed away today.

I couldn't go home..

She died in her daughter's arm (my aunt), surrounded by all family member. It was quick, painless and peaceful. I thought it might been a pulmonary embolism or a massive myocardial infarction. She has been unwell for quite some time, hence it doesn't exactly come as surprise. But it is sudden, and the whole of my family had to left the wedding on my maternal family side, travelling from Tanjung Karang to Batu Pahat.

It gives me some sort of peace to know my grandmother died in a relatively quick painless and comfortable death.

I am a bit morbid; to me personally, having seen many deaths in my career, a "comfortable" and dignified death is very important. Seeing some patients "decaying" in front of your eyes is not very nice.

I remember seeing this end-stage myeloma patient, diseases recurred despite bone marrow transplant, completely blood and platelet transfusion dependant, need constant almost daily treatment for hyperkalaemia and hypercalcaemia. This went on for almost a month. He slowly deteriorating in front of our eyes. We finally have to confront the family with the awful truth that he is going to die (either from bleeding to death or arrhythmias) and we literally buying time with all these transfusions (he need it every 2-3 days, the whole bone marrow are populated by myeloma cells). He is never going to leave hospital if we are going to continue to do this. (Even worse, the disease recurs whilst he is on chemotherapy.)...It was hard; this poor man already exhausted and you can clearly see he wanted rest, and the children were crying wanting him to continue whilst they search for treatment in America, eventhough deep down I have a feeling they knew his disease is not salvage-able.

Socializing

2009-12-18T17:24:00.001-08:00

I love my current workplace. Well, I think I do anyway.

I have been out with the Diabetes & Endocrine team (consultants, SpRs, specialist nurses and the secretary) at least for 2 outings (already) this year alone. Found out one of my bosses is a big fan of Shakira. And please, this is not drug-reps-sponsored thingy; this pay-it-yourself 30 quid dinner and make-an-effort-to-look-nice.

The Christmas do was so much fun..fun. My SpR and I were dancing with the Stroke Consultant.

And no, I don't drink any alcohol at all.

Ok peeps, need to get some shut-eye. Tomorrow going to be a busy day for a little get-together. Hubster and I are doing the cooking..

Random thoughts

2009-12-12T17:51:00.000-08:00

Remortgage - done. Within 20 mins by phone that is.

It feels like I am further and further away from Malaisie. Am I losing my roots? I couldn't imagine where I will be in 20 years time. The thing is I never even imagine I will ever go abroad or become a doctor in my teenage years. Always thought that is for someone else; and here I am.

Night shifts has become scarily busy. And there are plenty seriously sick people. So many heart attack, and the tertiary interventional hospital are running out of beds. My hospital have been running amber on our bed status for days (we have yet to close down our Accident & Emergency and divert admissions; lets hope that doesn't happen).

Ever wonder why the Westerners are fighting for democracy in Afghanistan? So many of these young soldiers die, and I feel truly sorry for the sadness to their family. A country so corrupt, so poor, so much fightings and yet a Muslim country? I often wonder why there is so little input from Islamic country (Muslim helping Muslim?). Perhaps we all never find the true answer.

I don't like paediatrics.

Sometimes I feel lost.

Study..study.

Smooth transition

2009-12-03T12:58:00.000-08:00

Back in cardiology now.

It feels easy and smooth, despite a rather chaotic arrangement. No proper SpR ward round and I am rather confuse with the consultant arrangements, nonetheless it still feels ok, I suppose. Its rather nice that I have to stepped up and lead the cardiology ward again.

Its still early days...we shall see.

Neglect

2009-11-27T11:05:00.000-08:00

Today I had someone who has maggotsssss in their groin. In A&E, she is profoundly in shock (as in medical term meaning - hypotensive and tachycardic), severely dehydrated and septic, coated in her own faeces and urine and she has maggots brewing in her groin which is drenched in candidiasis. (and this is not the therapeutic maggot; this is infestation)

And she lives with her child.

The nurse said to me," How could this person do that to her own mother?".

Its hard to say. I think I will wait until what the social service found in their investigation before drawing my verdict. From what I heard so far, I don't think she is a tolerant person and very aggressive and violent towards her social worker.

Very sad indeed it comes to this.

Dementia and Hospital Stay

2009-11-17T11:22:00.000-08:00

Marah la pulak aku dgr this survey from Alzheimer's Society.

Do they really think that we don't want to discharge our dementia patients ASAP? Lots of them have no carer, no one to bother to help caring after them, which is why they stay and occupy our hospital and intermediate care bed so we can help sort out the social, their care package and living circumstances and activates government funding. They already medically ok for discharges agessss ago.

You see, don't just read the headlines. A lot of good work go unnoticed.

PCC

2009-11-16T12:00:00.000-08:00

Today is the first I handled Prothrombin Complex Concentrate. Had this lady with INR > 10 and endometrial cancer, bleeding per vagina, bleeding per rectum, melaena, haematemesis and in congestive cardiac failure and pretty much our last shot. God bless her.

Once issued by consultant haematologist, I collect, mixed them, administer, complete all their paper works. This precious stuff is for doctors only, even the staff at transfusion will not help me calculate the flow rate for slow iv injection.

Expensive stuff. I can't remember how much it costs, I knew it is a least a few thousands pound per vial.

Should I medicalised this blog?

2009-11-09T14:42:00.000-08:00

Suddenly I feel I should write more medical stuffs in this blog; you know, things like the gold standard treatment for certain diseases etc...? Perhaps too boring, no? Probably because I feel too content to write anything else?

Let me just talk about my experiences in Diabetes, esp with this not-exactly new drug called exenatide.

I mean, pure biology exploitation and how you see it is interpreted in clinical practices. It comes from the poisonous lizard found in North America, which eat only about 4 times per year. A bit complicated to explain, this incretin-mimetic effects, but it has something to do with hibernation.

It doesn't always work for everyone, but when it works, it works wonders. I achieved weight loss and better diabetes control. I mean, some of them even come off insulin completely and we can give it to HGV driver. For those who don't know, in the UK, once you go on insulin, you are no longer allowed to driver heavy good vehicle, and license revoked, which means loss of employment, and obviously, this is a massive issue for one's life.

p/s; Comel sungguh ikan2x barbs saya. Lots to learn about aquarium rupanya. New hubster obsession, tido dekat dgn ikan lagi. Comel betul.

Equity

2009-10-31T06:50:00.000-07:00

Woohoo!

It looks like the equity of the house has increased? The developer is selling our house type GBP 6000 more than its value back in 1 1/2 year ago. In the current economic climate, I supposed that is good. Not that I am thinking of selling; I do love our little green energy saving house (well, I do try my bit with the recycling etc..).

This is nice

2009-10-23T13:35:00.000-07:00

It gives me a good glow of nice feeling when one of the cardiology SpRs told me her boss gives me a compliment about me and the cardiology team is looking forward to my coming to them. Its nice being remembered for being good.

(Her boss and I used to work together at the local cardiology interventional centre.)

(Yes, I am like Elliott Reid of Scrubs, full of my neuroses)

Medical Jokes

2009-10-18T14:52:00.000-07:00

Please ignore it if you don't think its funny.

In a conference, three doctors are talking about PCC and medical emergencies. One of them is a haematologist, one of them is an Obs and Gynae and one of the is Accident and Emergency Consultant. They are talking about the use of PCC.

Turn out they are not in synch with each other.

Haematologist : PCC ~ prothrombin complex concentrate
Obs & Gynae : PCC ~ post-coital contraception...hahahaha

Bleeding emergencies eh?

P/S: PCC (prothrombin complex concentrate) is a bloody fantastic stuff to stop major bleeding post warfarin. Intriguing stuff, apparently some minority Aussie emergency medic did use PCC to stop massive bleeding eg: in road traffic accident even for people not on warfarin. Well, kinda remind me of that factor VII people stock up during TT race (not usually use anyway).

.....

2009-10-09T13:29:00.000-07:00

Malas betul nak update blog these days.

Been on nights, and busy beraya'ing, up to Londres and upnorth.

I thought it is cute - hubster obsessing with aquarium and fishes, and almost drive me up the wall; but didn't we got a great bargain. Puas hati betul dapat this antique chest at bargain price which we used as fish tank stand.

Nights and on-call has been great albeit massively busy (end up to have to use theatre recovery area as temporary makeshift ward).Incidentally when I was on night take, we have all female surgical and medical night team..

I was wondering whether it is something in the air, have quiet a significant number of post-chemo neutropenic sepsis. I even have a lady with zero neutrophil count for at least 2-3 days. I also realise something how protective I was about them, counselling them about dealing with things that you have zero control. I guess it was all to do with my previous job. I so remember a 18 year old with bone cancer, and boy didn't they zap him with such a strong chemo regime to cure him completely and mind you he has to fly over to England and back to the island to have his chemo every 2 weeks, and obviously we had to deal with complications. He had neutropenic sepsis every-like single time post-chemo, bleeding from nose & platelet 3, numerous transfusion, end up getting C.difficile and how I had to call his district nurse to check him out as he almost get into real medical trouble when he refused come to us when he was sick. By the time he finishes his chemo, I think both of us are pretty exhausted by it. It kinda help me caring for me since I ended up knowing him so well, and kind of being able to predict how his bone marrow behaves post chemo.

Courage, my friend, is the word of the day.

Random thought

2009-09-14T12:45:00.000-07:00

I think I just have to throw away that bottle of rose syrup. Was craving for a nice rose syrup, and since that was the only rose syrup available in the asian shop, decided to bought them. It has some serious minyak rambut after-taste. Pening ok; I did drink it with a peg on my nose.

Just finished my night shifts; slept till 16:30 and now wide awake at the wee hours of morning. Ended up making my first attempt of home-made white bread. Ok gak la,patut put a bit more yeast and let it air a bit longer.

Night was slightly challenging, but ok. Imagine dealing with a 30 stone (about 200 kg is it?) confused unwell septic agitated man, pulling out all access and pushing all of us and managed to get out of bed? End up having 3 security guards to finally get him back on to the bed. I thought I had every thing under control after I got an access, did blood gases and he kept his oxygen. He as still tachypnoea and trying to get up.Was looking at his blood results, the nurses was doing his iv meds when suddenly he went into cardiac arrest. Eventful.

So so much happier at the new hospital.

Was watching depatches - middle class recession. I didn't realise how much architecture firm was hit by this recession.

I am hooked on Jay Sean new single with Lil' Wayne - Down. Dunno if it is going to be released in the UK. Currently riding high 2nd on US Billboard. Not bad for Barts and the London med school drop-out eh? He is breaking into the US music market. I wonder what happened to R, we were in the same year in med school and he did give me a ride to Macro, somewhere in East London. Last time I heard, I knew he is trying to get into Bollywood film industry, making contacts with film producers. He graduated and his back-up plan is if film industry not working out, he can work as a GP. Imagine GP-slashed-Bollywood film producer.

Quote of the day

2009-09-06T06:47:00.000-07:00

I just find this refreshing.

Get over your insecurities and just try to be the best you can.

(Trust me, I do have many).

Hector, Achilles, Helena and the Trojan War

2009-09-03T16:31:00.000-07:00

I am mourning the death of Prince of Troy, Hector.

Bloody hell, can't believe to get quite emotional watching Troy. Eric Bana as a Hector, what a fitting potrayal.

I am gonna find a good book to read about Hector.

Testing2x

2009-08-29T14:29:00.000-07:00

Saja testing upload gambar. Tgh nak springclean all my stuffs and thought abt selling some of them books.

That is the view from the house.

Just an opinion

2009-08-27T16:36:00.000-07:00

I don't actually get much distracted with the hype of current pandemic of swine flu. If anything, it kinda annoys me with all these hype. Well, anyway, someone is making money from facemasks. Its a good thing, isn't it?

I personally find facemask is pretty much useless and I don't think there is any evidence it reduces any sort of transmissions; unless it is made up to the industrial health care standard. Clean hygiene is the key, wash your hands, use tissues when sneezes etc... Its a pandemic, almost half of the population will end up being a carrier. Of course someone with co-morbidities and extreme spectrum of ages are more susceptible to it.

Anyway, a number of patients presented to me with query swine flu (bearing is mine I work in hospital setting so most have been assessed by primary gatekeepers ie GP & A&E), almost all turn up with different diagnosis like metastatic colon cancer, pulmonary embolism, lymphoma etc. I guess what I am really saying is never assume and always start from a fresh slate.

Public fear is not something that can be taken lightly.

Happy Ramadhan!

2009-08-21T12:04:00.000-07:00

Tomorrow is the beginning of Ramadhan; and here the toast to a blessed month.

Feel quite relief it started on Saturday. I have been working on a 12 day direct working days stint (including 3 x busy 12 hours shift),and started to feel really old doing these, but hey, we all survived these, don't we?

X Factor starts tomorrow, yeay! Haha, poor sofa will see more of me and hubby butt-prints. (There are reasons why we blow our money on these sofas.)

Need a haircut.

I am thinking about making dinner menu; nak start beribadat banyak2x sket and want to be a better muslim, baca Quran on daily basis.

Nak form a study group utk PACES. Gonna blow money for PACES courses.

I want to be a bit fitter.

P/S: I cannot tell you how much the word "teruja" bugs me; but then, what else can you translate excited to?

Spinal tap weekend

2009-08-16T15:03:00.000-07:00

Malas giler nak update blog now......

Anyhow, settle really well into the new hospital...A busy district hospital I may say; this year alone the A&E has attended 60,000 patients already and we only into August this year. We effectively cater for about 330,000++ population. Busy, isn't it? MAU alone has 50-60 daily admissions.

But I am happy. No longer embroiled in moral dissillusion..

The weekend on-call was busy; its a lumbar puncture weekend.I already did 3 this weekend alone. I find it really therapeutic to watch the manometry;funny eh? I dunno, as soon as I connect the manometry,watching the CSF fluid rises, I just shut down from all flurry/ the constant bleep. In my previous medical job, you go 8-9 month with hardly one lumbar puncture. (Am I trying to imply something? I dunno).

I am just so tired now....nanti la update when I feel like it. I am gonna go back to a lot of cooking and baking this year..yeehaaa!

Waiting....

2009-08-04T14:37:00.000-07:00

Is such a misery....

On a more pleasing (to me) note, on my last day of on-call, I managed to sent a subarachnoid haemorrhage from the island to the neurosurgery theatre at the specialist centre for hydrocephalus drainage in less than 10-12 hours time(from the time he was wheeled to A&E). I was kinda thinking with rapid deteriorating GCS 11/15 to GCS 3/15, Cushing reflex in all its glory,respiratory acidosis, apnoea breathing and we had to intubate him before wheeling him down to CT, we might not have much to offer. Lo and behold,they took him over and we managed to get air ambulance and anaesthetist to fly him over to the mainland. Very sad thing to happen to a fit non-smoker 40-ish year old guy without any significant past medical history, and no history of headache. I was initially thinking of hypertensive encephalopathy with his admission BP of 250/130.

I was imagining what his wife and family must be feeling - just in one day,or seconds even, their whole life has been turned upside-down. One minute you could be living your dream, the next minute everything turn to dust.

Just to get this off my chest

2009-07-21T02:30:00.000-07:00

Personality clash? or we just don't share the same sentiment of humour? I really struggle to share rapport with these 2 Sudanese guys; doesn't help that I couldn't really understand one of them and he constantly bickers with the consultant.

Cakap melayu lah.

Yang buat hal, yang sorang lagi la.Tak paham betul kenapa nak ambik hati sangat pasal comment aku - aku tak paham kenapa dia handover and nak document TLC lagi pasal pesakit tu dah DNR; it sounds like everything sorted by the team. Pas dia ni tak tau apa diagnosis pulak tu - mcm tak masuk akal la pulak kenapa nak suruh on-call team just to document TLC? handover apa mcm ni? Aku masuk ward, pesakit ni dah GCS 3/15, end stage heart failure i.e dah nazak berhari-hari.

Malas aku nak gaduh dgn mamat ni. But seriously, I am losing my respect to him anyway. Tak pernah aku jumpa orang suruh HO kasi atropine for complete heart block without cardiac monitor kat depan mata, cakap, don't worry ada telemetry kat ward lain. Gila apa? Ko nak kena ada cardiac monitor depan mata. Aku tegur la baik-baik, pas tu dia cakap dia tahu apa dia buat; sombong lak tu. Pas tu aku lagi sakit hati dia boleh tuka on-call shift tanpa aku punya agreement...

Malas nak layan la. Mungkin pasal takde pompuan level senior kot,senior trust grade/consultant people susah betul nak terima pendapat pompuan or STs. Aku paling tak suka time dia start cakap pasal islam and mcm orang lain ni lagi rendah moral.Kalau bersifat mulia tu takpe la, ini chauvinistic nak mampus.

There you go, off my chest.

PMS

2009-06-30T15:24:00.000-07:00

I know this come every months; my emotions are all over the place and my monthly bouts of migraine. I can go from hours of crying to laughing with my mates in a matter of minutes. Its crazy.

In the last 4 days, I have been through 3 sailings and 1 chartered flight. I am exhausted by these commuting. Tomorrow I am back to work - 2 more donkey days.

On a more cheerful note, I am just so happy with facebook & blogs! I can now keep in touch with my bros and sis at a more constant basis; something that I yearns for in the last few years. We are all at different places and stages of our life, either work-wise and uni-wise; we all grow up apart and how I wish we can be closer. I left home when I was 13 to go to a boarding school and hasn't really been properly back at home since then.

Another blergh day

2009-06-22T11:09:00.000-07:00

Today, as usual, I am as inspired as my foot. Dunno how long this feeling will last, oh, well, near the end anyway. I dunno if I can take the daily bitching with my Oncology nurse; I have to seriously salute her patience. I can only do my part by looking after Oncology/Haemato-Oncology patients as best and as well as I can. God bless R-CHOP regime.

Today also confirmed my role as a tool/hamba abdi to the team.

Do you know what cheer me up at work today (this is what I have been reduced to)? That same hilariously funny drug addict who continues his flirting shamelessly, asking to see my left hand in front of the whole of wards staffs and consultants, asking me to visit him in the psychiatry unit. Bloody hell, I do attract some stalkers.

My right thumb still sore from tapping this 80 ++ year old guy chest - the worst possible state; dementia, keep leaning to the side I am tapping, need to be hoisted to the bed and he keeps moving, jumped at least 3 times when I try to put the needle in. End up tapping 610ml straw coloured fluid from his left lung & no pneumothorax, phew!!I am not surprised to see how bent the needle is when I took it out.

Why is weekend so short? I missed my weekend with my dearest. This weekend menu, sushi!

Static

2009-06-19T10:33:00.001-07:00

Too many things happening right now..I am just not in any mood to be chatty about it. I guess these too shall pass.

Work, as usual, blergh..... I picked up a near-missed case of contained ruptured spleen at 3 am in the morning(double-whammy with being on warfarin and has prosthetic valve). And the spleen is out, people,IT IS OUT. I saw my first leptospirosis. I mean,yucks,I can't believe how many long-tails (rats is a bad word on Isle of Man) live on this island; ye la kan, takkan nak terjun Irish Sea kot. Apparently them living on someone's garden is common....

That drug addict with a memory of a fish is hitting on me again today; already forgot he did the same yesterday.He cheered me up...hahahahaha, and by the end of the conversation he divorced me and said I should go back to high school. It must be the boredom that he actually looked forward to be admitted to Drug and Alcohol Unit.Asking me on daily basis,"What this pretty doctor doing here, why do you want to be a doctor and end up with are you sure you are not in school?". He certainly cracked me up.

I should probably hang out with my ulcerative colitis patients. OMG, social life sucks.D is so cranky all day today.

Jo is leaving to Texas for good; I am sooo gonna missed her.

Beachy Head tragedy

2009-06-05T16:58:00.000-07:00

This is one of the saddest story I ever read. It makes you wonder, is life is ever fair?

http://www.dailymail.co.uk/news/article-1191129/The-smile-parents-live-The-heart-breaking-story-Beachy-Head-tragedy.html

Somehow it reminded me about a case I did encounter a couple of years back; it is not similar, but it makes me think what a broken heart can do to oneself. What do you do when the light goes out?

This young girl was brought the local casualty where I work. Found by police, still partially alive, hanging from a rope. She was comatose when she arrived. Heart still beats.My senior took over, and as I flipped through her medical notes, I remember feeling - "this is a girl who really determined to die no matter what we do, and whatever happened to her previous life, her heart is already shatterred to million pieces".

This is one of my many reasons why I cannot do mental health.

Wake up call

2009-05-31T04:16:00.000-07:00

I have been having sleepless night about this, and reality sinks in, it does hit you hard on your face.

I wonder if this is the wake up call I need.

Leave

2009-05-27T02:44:00.000-07:00

You have no idea how much stress I have to go through to get leave.

I don't even freaking do the Tuesday clinic, and you have full team on that day. You don't need me honestly and please let me go.

I need a break; otherwise I might be heading for a breakdown. I am already disillusioned and disheartened with my current job. The job title is a misnomer and I don't want to be trained by someone who is never ever have any training in this specialty. Amazed?

This is saying something.

Twitter

2009-05-20T15:52:00.000-07:00

Oh my God; I think I have gone mental.

I am busy like a mad woman,and yet here I am thinking about joining Twitter.

Why?

To follow this dude:

http://twitter.com/AnoopDoggDesai

Oh dear.

I just come out from another heavy duty on-calls and bed crisis.The last guy I saw 10 minutes before my shift finished have good going liver failure from paracetamol overdoses; taken unintentionally whilst he's gone binging 3 days ago.I can bet this will be the biggest regret he ever have in his life. Let's hope he doesn't get encephalopathy later; have a gut feeling he might be going into liver transplant assessment later.

It annoys the hell out of me when this GP couldn't understand that we are having a bed crisis; we even have to hold up some of our A&E admissions.

How do you chill?/Fav things

2009-05-19T16:02:00.000-07:00

1.Music.

2.My own alone time.

This is especially true after on-calls time.It does get me down after spending the whole day sorting other people problems all day long/all night long. Just leave me alone, I am done answering bleeps/calls.This is for me to keep my sanity.

Another reason why I love Paris street cafes. You can just grab a book, sit and read under the awning of the street cafe, people-watch, drink good coffee and eat great crepes.And it doesn't seems odd, cos there are plenty of people do that.I do feel odd if I did it in London and certainly never did it in KL.

3.Bitching session with colleagues (usually work-related stuffs. I don't bitch about friends,silly or personal stuffs.To me, people dictate their own life..)

4.A good book.

5.Navigating a foreign city.

6.Travelling by train in Switzerland. It feels so magical, and you can choose a quiet, zero noise coach to really enjoy the scenery.

Done

2009-05-17T15:02:00.000-07:00

Done the weekend; back to usual working hour tomorrow. Hoping wednesday on-call to be better.

Its not too bad.

Saw my first ever malignant hypertension yesterday. I was asked to review his blood pressure, and as soon as my foot step into the ward, my alarm bell went off left,right and centre,lo and behold, the CT showed he bleeds intracerebrally.30sth year old guy, and his BP is 230/130;bloody hell. And he is peeing grams of protein in his urine..

Today, I find out that we don't have amphotericin at all on this island; and I thought the pharmacist is joking.

Pissed

2009-05-15T14:52:00.000-07:00

I am seriously bad-tempered today. It annoyed me so much with these constant phone calls. At one point, I have an unwell patient (hypokalaemia with seriously remarkable ECG changes, and some really mad electrolytes changes), another A&E doc trying to refer an Acute Coronary Syndrome, I was on the phone talking to nurse practitioner from another hospital and the bleep continue to go off cos a GP need to speak with me. And not 5 minutes later, another GP. I had to leave to J, the consultant to continue the ward round with the house officer.

Talk about trying to juggle all these balls.

Could you please let me see the patients instead, please. I am tired
being on the phone.

Have to say, most of them are appropriate calls, but seriously not impressed when one of the referrer start saying things like Type 2 DM changing to Type 1. I was like, "what are you talking about, mate? This guy has just switch his anti-glycaemic to insulin; it doesn't mean Type 2 change to Type 1. Odd.".

I have a temper of Kratakoa, and I like things to be done properly. Don't start to get on my nerve saying X and X patient cannot go there b'cos these ward is for these and these. We are a small hospital and if I say X need to go there & HDU nursing, that is where they need to be. (And you can see why I want the way out of acute on-calls.).

A hellish week coming up

2009-05-14T13:53:00.000-07:00

Starting tomorrow, my hell on earth begins.I have 3 long day of successive on-calls.Then continue to work the next week and another day on-calls coming up. Since all these swine flu cases hasn't died down yet and the *&*%**&^& hospital policy, I have to triage all the calls from GP, and not just from A&E; which means not only I have to go one side of the hospital to another, I will also get constantly bleep and be on the phone. I am also the "babu" , holding down the role of house officer, SHO and registrar for my team cos my superior did not trust his so-called second man.

Pandai kan?

I cannot tell you how much all these get on my nerve.

Times like these, I really don't mind swine flu myself.

Which way?

2009-05-08T15:47:00.000-07:00

I kinda sad a colleague of mine is hanging his medic boots to do MBA. He is a good doc, but I guess if your heart not in it,you are not in it.

I have to do some hard thinking as well. Was on the phone with the Prof. late last night. There are no more training posts in the specialty I want to do in my deanery. Despite passing the interview, and appointable as ST3, its just no more post this year. And it just hit me that this is really I want to do, and I knew I am really excel at.

I knew how fortunate I am that my deanery is supportive as ever. Hang about until the post available in 2010 (pretty depend on the SpR getting their CCST)? Move to other deanery later?

I am tired of moving, for now.

Bank Holiday

2009-05-04T06:11:00.000-07:00

Happy Anoop day everyone! (most people probably will not understand my obsession with this really articulate-breaking-all-the-stereotype 22-yr-old guy Chapel Hill native. I guess blame it on the Nooper troopers who have been feeding me the "Anoop"icillin! Its especially embarrassing when your consultant cardiologist announced it to everyone after our heart failure meeting.)

I am chillin' now. Mani's farewell dinner was a blast, and we all had a fantastic time and driving up to the highest point of the island at midnight for some picture-taking and these smokers for chain-smoking session.

Need somemore sunshine!! If its not for me, please, let it be for the flowers I am
trying to grow in our backgarden.

Now,back to more studying to do.

Chill pill

2009-04-29T14:26:00.000-07:00

I need a "chill" pill, or just take time off, just away from this place.

I couldn't stand anymore appalling behaviour. Its called "handbagging one workload to another". I can go on and on, but I better stop, just in case. I thought we have service committment? or let just dump it to someone else?

Its disgusting.

Some people seemed to have this superiority (or is it chauvinistic?) complex thinking that I have to wait on them hands and foot,on top of babysitting the trust grade!

Annoyed, tired, angry. Throw me some of the chill pills, will you?

Poor J, D and A. They all have to listen to my rantings this morning. The nurses have been kind at least, throwing chocolates at all directions to me. I literally warned everyone of how cranky I was.

You know what annoys me? The way he kept going about how we "muslim" etc...and why does he have to make it sound isolated and like we better than anyone else. (no integration, no effort befriend other religion. I thought we live in the UK; we don't live in a muslim country. Is it so hard to respect other beliefs??). I mean some of them doesn't even show a behaviour that earned any respect eg: calling nurses stupid,incredibly rude to our "customers", and not to mention clinical negligences (some already ended up in the court of law).

Peace!
(at least I am going out tomorrow for a farewell dinner. Italians, yummm).

Teaching

2009-04-28T10:38:00.000-07:00

Oh, I am just very pleased today.

Had to give a lecture on Chronic Lymphocytic Leukaemia + Promyelocytic leukaemia during today medical meeting. I did get a little bit work-up since I never done a haematology job before; apart from occasional meeting or managed them during on-take or as ward patients. Much of the lectures material did come from British Society of Haematology plus books etc..

It went very well, and I am so pleased that most medical students,house officers and my colleagues, consultants gave a very good feedback and said I made it sound so simple, like understanding immunophenotyping and flow cytometry. J, my consultant cardiologist, as usual making jokes, saying wow, I didn't know you knew all these "dirty" names, referring to all the chemotherapy drugs name that rolls off my tongue eg: alemtuzumab, rituximab,chrombucil,fludarabine etc. Having said that, it wasn't too alien to me anyway,since I was a regular prescriber of rituximab when I did my rheumatology job.
(Really need to teach him how to make a proper joke.Its sad, I knew.)

Feel truly encouraged. I guess I should still pursue a combined teaching and clinical career.

Alpha female

2009-04-24T13:27:00.000-07:00

Yes, I am one. Not ashamed to admit it.

D, the grouchy male colleague just laugh out loud when I told him this.He has been stressing out, bless him.I am so done with stresses.

Anyway,feel sad that my Noopy is out. At least he no longer be the receiving end of the verbal and mental abuse thrown to him by the judges (who says different things in front of the camera and off-camera).What can I say, bloody rigging the show.Still continue to be his big fan and I have got my Nooper troopers! Clef hangers rocks!

Obsession

2009-04-19T02:08:00.000-07:00

I think its already unhealthy.

I required daily dosage of "Anoop"icillin in the form of Facebook Group,Noop-Dog.com, Anoopdog.com.

Please don't throw him under the bus again, the inconsistent + already-rigging-the-show judges!!I will stop watching AI if he is gone by next week.

Even my consultant knows.This is what happen when three of us went out for the supposed-to-do action plan for our audit but ended stuffing our face with Chinese food like there is no tomorrow.

Embarrassing.

And the action plan is still bloody outstanding.

Sigh...

2009-04-14T15:51:00.000-07:00

This morning standby call arrest didn't survive.Hyperkalaemic dialysis patient.

I broke the news to his wife,with the police.

I wish I could shift this cloudy mood.

The trip

2009-04-13T14:08:00.000-07:00

It was fun. I think I did underestimate Barcelona; but what a gorgeous city!!!An architectural heaven; I was seriously mesmerized by Gaudi creations. Breathtaking and to think he got this idea in late 1800/early 1900! I did find it rather hilarious he was killed by the tram.

The beach was gorgeous.We sipped our lovely "european coffee", facing the sea, listening to the waves, watching people wave-surfing,listening to the band playing spanish music..then it started to rain. Well, it was fantastic whilst it lasted.I can totally imagine spending summer in Barcelona.

Love the street performers along the La ramblas. Make me want to salsa-dance.

We also indulged in seafood, paella, gelatos, nougats,lobsters etc. If I missed Muara Klang, I will go to Barcelona just to feast on their food. We had this lunch at this so-called Japanese Kaiten (not pure japanese, you could tell it is mixed with Chinese) and we had like 6 udang galah, 2 plates of clams,3 plates of fried squids,at least 10 pieces sushis, 2 plates of salmon sashimis,mixed olives-oil laden fried seafood and cucumber masked as courgette (tertipu betul; dahlah teringin nak makan courgette).

So much to do at this city. Want to go to the aquarium,sekali tengok panjang nak mampuih dia punya queue. Terus cancel.Pas tu pegi Barcelona stadium - have to say it is a bit crappy. My reaction was like - "you mean, that's it?". Should have gone to Tibidabo.

Transport is excellent. If you have lived in big cities, navigating through metro/tram/train/bus will be a breeze.Honest, despite the language. I love this tram stop which is called "Maria Christina".

Got tons of pictures,but until I can be bothered to learn how to post photos in blogspot, this will be it.

Back to being "coerced-swapped" on-call tomorrow.

Sisterhood

2009-04-07T10:22:00.001-07:00

Interesting article in Daily Mail (urgghh, I can't still be reading the tabloids,can I?) about sisterhood.

I realise I do get on better with the boys in my job.

Mind you, having said that, I did have one of the best time of my career when I was at Liverpool Heart and Lung Hospital. All head-strong female SHOs (only one guy,hehe); such fun you guys! The cardiologists were quite baffled at the beginning when he saw all of us descended to the induction.

Sisterhood or no sisterhood, bitchiness does exists in the "guys" world too.

Just be careful about what you say,be subtle and try to be as diplomatic as you can.FYI, I don't like my current SG. He creeps the hell out of me, and I would rather dismiss him as he is well-known for his useless-ness. I mean you have to be really bad at your job to not knowing clinical indications for radiological tests.

Temper

2009-04-04T14:28:00.000-07:00

Yes, I am having a terible temper.

Ni kalau tuka forms lagi,memang mengamuk aku dibuatnya. Already waste 150 pages; and All-in-one printer is not as fast as a laser.

Well, Anoop better go through next week.That Matt Giraud started to annoy the hell out of men.JT wannabe - except he is less cute and less luck, and to his credit, probably as talented.

Temper, temper, goes away.

Work etc, and still obsessed

2009-04-03T02:56:00.000-07:00

Done - my 7 in a row nights. Nothing exciting, apart from learning the H.O is quite crappy and trying to learn to live with the persistant annoyance that come from nursing staff.

Baadddd girl, this H.O of mine.Giving beta-blocker to a bronchospasm lady. The reason - trying to slow down the physiological heart rate response to coughing fit and bronchospasm?? I mean, WTF?

I swear to God this bank nurse is purposely driving me up the wall.I mean every 2 minutes, she comes asking, doctor, doctor, this and that, then come again, doctor, doctor, do this, then come again etc.... I literally say to her,"Oh my GOD, what else do you WANT now?. SO getting me on my nerve.

I thought I want the only one been driven up the wall by some of the nursing staffs. Today, when no one else around, J confided to me, the nurse L is driving him nuts with her persistent nagging and meddling.

Enuff about work. Still loving the Dawg. His voice is awesome, smooth and so RnB. Even though the judges were incredibly harsh about his "Caught Up", the more I listen to it, the better it actually sound. I literally humming the song during our post-take morning ward round. I definitely got "caught up".

American Idol is annoying because the judges purposely pimping some of the contestants and the Ford advert is absolute garbage.

Obviously the obsession continues..

2009-03-26T19:16:00.000-07:00

Yeah,baby. Noop dog in the Top 9.

I can't believe that I stay tuned for the live blog of the show since, well, you know, I couldn't watch the show live.

Mental, I tell you. Again, as I say before, it provide much needed distraction and I am starting my 7-in-the-row night tommorow. Formula One is also on this weekend.I am pretty much occupied,ha!

These are the reason why I find this Anoop dork so "adorkable":

1.His prof.,family and friends spoke so adorably about him and it just show what kind of person he is. Could easily go to Law School/be an academician.

2.You got to love the swagger. The voice is just so soulful, so R n B; it melts me!

3.His inner confidence, and how much he is at ease with himself.

4.His respectful manner.

5.The fact he is not a typical rock star. He is doing a master degree + competing in a reality TV.

Still obsessed

2009-03-24T15:31:00.000-07:00

I know.

I watch that blooming Anoop video about 20 times.I am mad; well, at least it took my mind off this disheartening feeling I have at work.

J has been great to listen to all my ramblings/rants; A, despite his sometimes mental solutions to our patients problems has been entertaining my "you-have-no-idea-the-craps-I-have-to-deal-with".

Anyway Bel, I disagree with you, and no, no, no, not Urology, babe. Psychiatrist, yes. Anoop dawg is sooooo adorkable! So cute! Do you know Jay Sean was my senior at med school? He quit during his third year and launched himself as a singer.

At the end of my tethers

2009-03-22T16:45:00.000-07:00

Survived the on-calls.

There few things I cannot say here, as it frustrated me deeply and let just make peace with A&E by saying, suffice to say, no one come to direct harm and I managed to control the situations before patients get any worse.

I have never encounter such ignorance and such a rude attitude between doctors.

First time ever, I meet an F2 who never ever done or even try a femoral stab.Ended I am the one who has to clerk/get access/blood/sorting everything out for the patient because they are "too busy". What is the point of A&E existence then?

Craps you don't need to read

2009-03-20T16:36:00.000-07:00

Haiyo....geramnyer....

Such a looker, man. My eye candy. Such soulful voice. Who else? Anoop.

This is a mad crush.Blame it on the on-calls, and my hubby not around.

(Oh my God, I can just imagine everyone laughing and falling off their chairs reading about this.Me,such a serious doc!)

Anoop's post

2009-03-19T07:21:00.000-07:00

I am getting rather obsessional with this Anoop guy.

OMG.I even visited and almost join all these Anoop fans websites;watch his video at least 6 times already and if I didn't watch his American Idol videos, I went on to watch his ClefHanger videos (UNC Acapella Group). Why am I getting all these teenage angst?

Oh My God, he is so cute,macam shahrukh khan.

American Idol + my craps

2009-03-18T15:38:00.000-07:00

Yeah,baby!

Go, Anoop Dog! I thoroughly impressed not just by vocal, but by his personality.Totally unfazed by the whole fame thing and a great self-believer, without coming across as arrogant (which sometimes is hard to do).

Anyway, great bitching-get-it-out-of-your-system sessions today, guys! (It was 5 of us and yeah, I am the only gal.You should see S go when he kick off with his clinically-incompetent-massive-liar-lets-give 15L & diazepam-to-type II R.F junior).J has ever been so sporting; I never had a consultant who say if I need to let the steam out, I can just go and rants and rants to him. I actually think he enjoys it. I have a feeling I am funny when I go on my ranting mood.

Updates

2009-03-12T15:16:00.000-07:00

Nothing really.Everyone knows my life consisted mostly of works & socialising with med colleagues (who else will listen to my whims).

Chatting away with J, my previous consultant; well, both of us on-call today and keep encouraging me to go and visit the island eg: beautiful outdoors etc. I can pretty much say hubby & I kinda lost interest in visiting places in the UK. I mean whenever you go, most of the time, same kind of shops,same kind of scenery. You can only take so much of farms & meadows and greenlands, sheeps and cows, right?

I could do with a year break & get a postgrad degree in Paris.

Can't wait to go to our honeymoon in Barcelona!

And medical staffing is ever so great. Not just they didn't approve my leave which I ask for ages ago, and now they want me to cover another team and they approve my HO leave, which leave me on my own devices. My SG is absolutely useless.Never know that people can be employed out of pity.

On-call is ok today. J & I get a bit excited with a rather unusual junctional arrythmias (not WPW btw). I just wish J will stop with his banana story (keep asking me to be the witness) and it starts to make me feel embarassed.

Another Royal College exam coming. Well, I guess that's the price of being a doc in the UK. Endless assessments,e-portfolios, KBA and future GMC re-validation every 5 years.

Politics

2009-02-27T17:29:00.000-08:00

I purposely stopped reading anything regarding Malaysian politics. It fills me with dread.

People used to criticise Mahathir and nepotism etc, but at least I think he did maintain the political climate. I don't care what he did behind the closed door, but at least the politicians behaved.

Now? I accidentally watch the so-called debate or more politically correct to be put as a session to "celaka" and gaduh like budak-budak in dewan parlimen. It shocked me. Shame on all of you..I lost all my respects to them all, the damned politicians (pembangkang or pemerintah).

Don't critic if you cannot accept criticism from someone else.

p/s: I don't support anyone.I don't trust politicians.

Impatient patients

2009-02-23T12:34:00.001-08:00

Well, I guess we all have our own fair share of rude patients, however nice one can be.

Today has been a particularly busy day. Ward round in the morning, gastro clinic in the afternoon and I have to nip in in-between to supervise ETT,answering constant bleep from house officers and wards and doing tertiary referrals. I cut short my lunch break and had to review someone in CCU come done to clinic. The clinic was running late and with all the last minutes add-on patients we had. I think I did pretty well juggling all these while being unwell with tonsillitis at the same time.

I had to answer a call from a tertiary hospital in the middle of my consultation and this very impatient patient suddenly just flipped saying it was rude to answer a call and we all should dedicate our time to clinic...bla..bla.. Obviously as a doctor, I just eat the humble pie and apologise, saying I had to, as this is an important call (an intracerebral bleeder). Then she just left the room.

Obviously I don't take this personally, and professionally I booked her for another appointment.

Nonetheless, respect is a very important thing and if you are going to be rude and nasty to my staffs, please leave the room. I may look like "a softie", but you DON'T cross the line with me.

My current obsession

2009-02-22T14:17:00.000-08:00

Torvill and Dean. (and its not just because of Dancing on Ice is currently on).

My God. The more I read about it, watch the Bolero/Paso Doble and most of their dances in Olympics and International Competition, the more and more beautiful I saw their relationship is. The twinkles in their eyes, their spoken words, their chemistry is just fantastic. I kinda wish they marry each other.

Its like the bestest of friends and forever belong to each other. I do think Torvill is the love of Dean's life and vice versa, but its not the sort of relationship that end up in marriage.

And Christopher Dean is so cute! What a gentleman and he truly looked like an ice blonde prince!

The new low

2009-02-18T11:03:00.000-08:00

You have no idea how much I want to cry when I ask the house officer:

What do you think of pO2 of 6 kPa, normal pH, normal pCO2?

He said: I dunno, normal?

And he seriously has no idea of Type I & Type II respiratory failure. This, is beyond belief. I am VERY WORRIED.

James Morrison

2009-02-17T16:47:00.000-08:00

I just realised how beautiful the lyrics for most of James Morrison's songs.

Really awesome.

"Broken Strings" lyrics is definitely "something". (I just couldn't find a fitting word to it. Beautifully abstract and yet so concise?).

I also cannot get rid of The Saturdays' "Issues"; keeps playing its tune in my head.

Just awful

2009-02-16T16:04:00.000-08:00

Today is an awful day.

Start off my morning by one of patients dying from carcinomatosis (pretty much deteriorated rapidly over the weekend) and ended up the day with an intracerebral bleeder and a surprise result of metastatic malignant melanoma from his bone biopsy (while all the while everyone has been thinking about sarcoma/plasmacytoma line).

Everyone knew what stage 4 malignant melanoma prognosis is like.

Its just zapped all my zest today.

Staying back this weekend

2009-02-14T18:00:00.000-08:00

Decide to stay back this weekend to sort out life, paper works etc...

Literally spend hours trying to sort out study leaves (yup, more courses, hence more fulus terbang), future exam dates, annual leaves, which on-calls to swap..Not to mention forms filling, absence cover etc... Banyak betul. Everytime nak buat something, its planning, planning, planning. To book flights, ferry. Menyampah betul la. How I wish everything can be spontaneous!

Went out with 2 of my consultants and my previous F2 yesterday night for a drink. I think I manage to "socialise" our medical department a little bit. Its a bit sad that everyone sort of segregated in their "own community". I mean this place do have a potential to be a good place to work if everyone socialise a bit more, instead of segregated to Asian/Manx/outsiders?

As usual, our Valentine's Day is a delayed celebration. April? Barcelona? We shall see.

Doctor?

2009-02-12T14:24:00.000-08:00

It makes me feel a bit sick today that people are using their "doctor" title (i.e not a medical degree doctor, but doctorate/PhD) to dissilusion our nursing staffs. Ok, fine. I knew how hard you work for that PhD degree, but please don't do that to "scare" hospital staffs.

Please.

Even I don't use my title outside my work. I would rather people not know what I do for a living. Its not because I am ashamed of it, but I find people attitude is different when you introduce yourself as a doctor.

Presentation

2009-02-09T17:14:00.000-08:00

I am sure people are sick of me by now.

Another presentation for grand medical round tomorrow. Then ward work, then rush off to airport. Interview then flying back the next day.. Seriously, all these flights and boat rides is going to burn me/D/K out. During on-call handover tonight,D just couldn't stop slagging everyone off after he is forced to do the nights. Grumpy D!

I have done so many presentations and lately I just feel I want to step back a little.

Its kinda nice my current consultant complimented my presentation skills today. He said, "Very polished"; although I did went a bit uh..uh.. during Q & A sessions afterwards.

Well, teaching career? Get involved with uni? Hmmm, I probably should start to volunteer to tutoring the Liverpool medical school PBL group.

change of heart

2009-02-07T05:13:00.000-08:00

This last week and the next weeks has been and are going to be a real roller coaster of emotions for me.

I have been having a lot of thoughts, change of mind and heart of where my future career is heading.

I am a generalist, that I knew.

p/s: eh, ada pulak orang shooting drama depan rumah aku.

Reality TV (sorry Bel,stealing your title)

2009-01-30T16:06:00.000-08:00

Yeah, big fan of reality tv. I do have memorable contestants in some of them.

Strictly Come Dancing - Alesha Dixon (this ex-Mis Teeq girl really can dance. Its mesmerizing.Fall in love with her Waltz. Her Tango, Cha Cha, Show Dance - breathtaking!)

Dancing On Ice - Love and just love Ray Quinn. Come on Liverpool! I loved the city; loved its people. Really friendly people.Like during today flight, this Liverpudlian girl suddenly sneezed so loud, she was standing next to me,we looked at each other and just burst laughing, together with her mum.

X-Factor - Ruth really impressed me when she sang one of Take That song. The final performance of Hallelujah by Alexandra. Leona live singing Run on X Factor.

Stop watching BB 3 - 4 years ago.

Hubby and I loves American Idol.So best just sit in his lap and watch American Idol. Am in clingy mood now. On-call tomorrow. Sigh.

Grumpiness

2009-01-25T12:10:00.000-08:00

Funny that as soon as I touch down on the soil of this island, my grumpiness returns.

All the joy of holidays and honeymoons dissipates so quickly; I even wonder did I just went to Paris?

Be positive dear, be positive (really trying hard at it).

Paris is lovely by the way. Always is. Despite having been to the city for a few times, it still excites me. We took a walk in middle of the rain, just going along the trocadero and eiffel tower; and still feel happy. I just love the fact you can "people-watch" at the street cafe, eating nutella laden crepes and enjoy hot cup of coffee (we did just that near Moulin Rouge). We had a fantastic late lunch at this French/Italian restaurant along Champs Elysse. Even had a proper Japonais dinner at this little avenue near Concorde!

Am going to learn French.We even thought of moving to Paris! Ha! I could do with a year working there, couldn't I? Something to ponder upon. It will be fantastic to be able to work and live for a couple of years in Europe - learn the language, cultures etc...

It will be just lovely to do that.

Now, back to earth. Work dear, work.

Me likes!

2009-01-17T10:24:00.000-08:00

By Phil Chavanne:

As Woody Allen put it: “As long as you haven’t been kissed during any of those rainy Parisian afternoons, you haven’t been kissed at all.” Paris is where sleepy marriages are rekindled, the flames of passion ignited, vows renewed, and special someones met.

After thoughts...

2009-01-16T11:53:00.000-08:00

Alcoholic and IVDU are two of most distinct groups of patients who present huge challenges - clinically and socially. They are the people who need most helps, and yet are the most non-compliances, probably most aggressive and they have this love-hate relationships with the hospital staffs. I strongly suspect IVDU must have something in their genes - the addiction, the survival gene (you will be amazed how much they "come back" despite the thrombosis,the infection, the bleeding etc..) and probably most intelligent (medically speaking). Ever heard about the "skin poppers"? I mean the idea of creating an infection on the skin - stimulate blood vessels growth -hence new areas to inject when you run out of veins? That is genius, not to mention a healthy medium for all the bugs.

Yesterday, I had to console this upper middle class businessman. He misinterpreted what my seniors said and thought he can self-discharge. There is no way in hell I am discharging him - Child Pugh C with alcoholic hepatitis; and I will drag the psychiatrist/use the law or police if I have to. First hospital admission, and we just managed to get him out of his encephalopathy and sepsis. In his own word, "I am a condemned man". That is an absolute truth, and I don't think his liver will ever recover (still scoring C despite all we did). Only time will tell, and we are entering a 3rd week here. His pre-operative risk is in excess of at least 70%. I literally brought him back down to earth; and I hope he realise the enormousity of the damage to his liver. I feel sorry for the children.

On-call was fine yesterday; very busy and we accept plenty of interesting cases. I really had to sit down and think and work out the diagnosis for this jaundice patient. The jigsaw doesn't really sit together.Interesting to know what is the final verdict.

Apart from that, can't wait for Paris! Shhh, not really telling anyone at work, its so damned difficult to get leave from this crazy rota.When I come back, it will be hell anyway.