H1N1 inching closer, hitting the statistic...

A(H1N1): Malaysia records 4th death, more schools closed (Update 3)


PUTRAJAYA: A 20-year-old woman suffering from Influenza A(H1N1) died on Tuesday, the fourth person to die in Malaysia due to the virus, while more schools and campuses were closed when students exhibited flu-like symptoms.

The woman, who had contracted the virus through a local transmission, died at the Malacca Hospital from “severe community acquired pneumonia” at 9.40am.

Health Ministry director-general Tan Sri Dr Ismail Merican said the woman, who had suffered from obesity, had only sought treatment at the hospital on July 26, 11 days after contracting the disease.

She suffered clinical complications on July 27 and a throat swab was taken on Tuesday.

“The deaths reported affected victims between their 20s and 40s. They had early symptoms but sought treatment late and doctors did not suspect that they were infected by H1N1.

“This is discomforting to the Ministry,” he said after chairing the National Pandemic Preparedness Plan technical committee meeting here Wednesday.

Asked why the ministry was not alerted on the case on Tuesday, he said the doctor had only discovered she had H1N1 infection after her death.

Dr Ismail said he was informed of her death after the Institute of Medical Research got the results on Wednesday morning.

On whether the ministry would take action against hospitals for failure to detect H1N1 cases early, he said, “We don’t want to resort to the blame game. We advise patients to go to hospitals if they have symptoms.”

He said members of the public were still taking H1N1 lightly even after four deaths, adding that the latest victim had not heeded to her parents’ advice to go to the hospital for early treatment. He also said that doctors should be more alert.

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you can imagine what happened next...
today, an extremely different whether took over my ward...
all the sudden, everyone in my ward was wearing a face mask.....
the doctors who were previously exposed to this patient, are like super anxious...
the other staffs (me, included) who were previously exposed to these doctors,
are super anxious too...

you think they'll close down hospital melacca and quarantine everyone???
finally, a long break... haha...
~in your dreams~

i wonder, will the workload reduces when people gets paranoid... even my patients are asking for early discharges... haha, yeah, for the first time... an EMPTY bed in the ward... wow!

i know, i work in a high risk environment, sometimes, i do wonder, is it worth it?
risks of needle prick injury, TB contact, dengue contact, and now this???

p/s: guess what? even KTSN was closed down because of H1N1... sometimes, to think about it, when somebody gets infected, you close down the institution and send everyone home, those with (and without) fever... how smart.... i wonder....

deceptions

23.07.2009

I lived in a world of lies.
Deceptions.


And so, I wore a mask today.
Hoping that it would hide all emotions.
Secrets.
Hoping to numbed those feelings.
To shadow them away,
The slightest clue, the minute hint,
Perhaps, everything.

It had not been raining for quite a while.
Until today.

They said that one will grow stronger with time.
I doubt I’ll ever will.
The emotions, greater than what my heart is able to contain.
The burden, heavier that what I can shoulder.
No one told me it was going to me like this.
No one told me that I was to be less human.

I do not want to get used to seeing this,
To get used to being less emotional,
To be accustomed to seeing illnesss, disease, deaths and loss,
When hopes shattered, love is lost,
And we could not even say that we had done our very best,

I learnt 3 new words:
1. FATE
2. LIMITATION
3. PURE UNLUCKYNESS

there has been a death in the opposite house

picture by enchantress

Date: 23.07.2009
Time: Post-Call 36 hours
Weather: Raining heavily

Problem List/ Chief Complains:
1. Menstrual Day 1
2. + a terrible headache
3. + temperature spiking
4. + a really bad call...
5. + a really, really, discouraging, demotivating, spirit-breaking, on-call MO


i thought things could never get worse,
but it did...

Let me shared an old poem with you by Emily Dickinson.
Perhaps, it could best express the dark feelings in me...
together, let's say a silent prayer...



There's been a death in the opposite house
As lately as to-day.
I know it by the numb look
Such houses have alway.

The neighbors rustle in and out,
The doctor drives away.
A window opens like a pod,
Abrupt, mechanically;

Somebody flings a mattress out,--
The children hurry by;
They wonder if It died on that,--
I used to when a boy.

The minister goes stiffly in
As if the house were his,
And he owned all the mourners now,
And little boys besides;

And then the milliner, and the man
Of the appalling trade,
To take the measure of the house.
There'll be that dark parade

Of tassels and of coaches soon;
It's easy as a sign,--
The intuition of the news
In just a country town.

-by Emily Dickinson

*happy*

20.07.2009, 10:56am, General Hospital Malacca,

rounds with Dr Gary Lee,

Mah Jah blood pressured was well-controlled,
i must have been the wishes and prayers from the fellow readers,
fit for discharge...
TCA nephro follow-up

*shinyin happy* ^^


p/s: going to find BoonLee, or rather, BoonLee is here in Malacca... yippie!! *happy*

So this is love…

“But of the tree of knowledge of good and evil,

thou shalt not eat of it:

For in the day that though eatest thereof

thou shalt surely die”

MakCik XYZ, lets call her Makcik Jah, 52 year old lady with hypertension, diabetes mellitus and End Stage Renal Failure (ESRF) was admitted to the hospital for acute pulmonary oedema secondary to hypertensive emergency.

Okay, let’s turn this story into more fiction, less academical. This is not another PBL session.

You know, there is this saying that you can have any disease in the world, but never ESRF, end stage renal failure. (a condition where the kidney malfunction is so bad that you need either a renal transplant or long term dialysis to prolong life) ESRF... Not only is it financially burdening, time consuming, but also emotionally exhausting. Imagine, dialysis three times a week, each time about 4 hours. The transporting time, waiting time, not yet included. It cost an avarge of about RM200 weekly for dialysis, RM12,500 to make an AVF (fistula for dialysis). (related article: the man in the next cubical)

Makcik Jah had been in the hospital for the past 2 weeks, under my care. Although I prayed very much that she would be fit enough to discharge, her blood pressure is simply too high to allow it. She had been maximized on most hypertensive drugs.

And everyday, she would ask, ‘boleh balik doctor?’ and I had to look back in her eyes, ‘sorry Mak Jah, hari ini tak boleh la, tekanan darah masih tinggi’… I hate having to give disappointment to patients. ‘tak apa la makcik, cuti di sini sajalah, kan ramai kawan-kawan baru’ trying to pujuk her a little… then she would let out a giggle… showing some gaps in her row of teeth...

Every morning, at the bed of Mak Jah, is her husband, let’s call him Pak Jah. I really salute him. Seriously. Every morning, his daily routine would be going to the wards, bringing breakfast to Mak Jah, wait patiently until visiting hours starts, cheer Mak Jah up, teman her for dialysis, weight her after dialysis, carry her around... he would supervise her medication, pronounce those medication names as fluent as the pharmacist, stating the dosage and function of each... he would put up with her unusual temper swing, sometimes, her stubbornness... what patience he had...

I guess it is not easy to care for one who is on ESRF, with dialysis on every other day. Mak Jah also had a right below knee amputation secondary to diabetes. So, Pak Jah, had to carry her around, as she was already ADL (activity of daily living) dependant.

I mean, isn’t that a big commitment? i had never seen their kids visiting. Very often, it is just Pak Jah. everyday, every morning, every evening, every moment. It was as if he lived half his life in the hospital.

And I guess, the saddest thing is that, she had some degree of Alzheimer disease. She does not remember many things, and will not remember many things. correction: she could not. I wondered how it is like, taking care of someone who do not remember much of you, and will not remember much of the time you spent together.

Pak Jah would come up to me from time to time, asking me how is Mah Jah’s progress. He would ask for favours like to spend time to pujuk and advice Mah Jah to take her medications, and not to skip meals. Sometimes, despite our hectic schedules, i guess we tend to obligue.

As you see, Mah Jah tend to reject food when she is a little upset, and she would go into an episode of hypoglycemic attack. Each time Pak Jah would buy outside food for Mak Jah, a few options, and coax her into eating. And he could feed her, care for her, love her.

I think he could have abandoned her, at any point in time, but he didn’t.

He could have gave up on her, but he didn’t.

He, being a muslim, may indulge in the luxury of having a second wife (maybe third, or forth), but he didn’t.

Their life savings went into providing better care for Mak Jah, and dialysis is not cheap, mind you.

I think the hospital can be a very sad place.

But sometimes, if you look hard enough, just around the corner, you may just spot happiness.

Perhaps, so this is love...

*apple-ized*

p\s: had my first on-call, will find time to blog about it ^^

(related article: the man in the next cubical, a sad story)

WOW! : Confessions of a house officer #5 – Day 19 of life, the WOW theory~ and the WOW-ing me~

I guess my last post was rather traumatic… depressing,.. or more accurately, hateful, in a way… sorry about that. I did not meant to be demotivating. The last thing I need is to demotivate all those medical student / HO-to-be out there, or amplified the sadness is my fellow friends/colleagues.

You know, sometimes, when you are in your down-most condition… like when nothing can get worse,.. then suddenly, something happens, and things miraculously gets better.

I remembered once, a friend of mine, bingwui , he has this WOW theory. which was pretty interesting. So, allow me to share this theory with you today.

Quote: The reason I wanna do medicine is because medicine wows me. Medicine wows me more than other fields.

I think this is one of those things that keep us going.

When I performed my first delivery, the beauty of childbirth, bringing life to Earth, WOW! (correction, the mother brings life to earth, God creates life, we merely facilitates)

The first time I saw the fundus of the eyes, the pretty optic disc staring back, it was the most beautiful thing in the world, WOW!

The first time I auscultated a murmur, like the wind hushing,WOW!

The first time I heard a prosthetic heart click, like the clicking of the watch, WOW!

The first time I saw a craniotomy surgery, the pulsating brain, WOW!

My first forensic experience, although eerie, yet WOW!

The time my schizophenic patient shared his story, stories of attempts suicides, unbelievable...

The good old days spending time with the kids at the peadiatric wards, the time the kid gave me his transformer stickers, shared his toys, WOW!

The first time i saw blue eyes, correction: blue sclera, WOW!

The first time I performed CPR, and patient regained a pulse, *beep*, spontaneous breathing, WOW!


When I insert the needle into those veins, see the blood gushing out, WOW!

When I get a successful branula on a difficult patient, WOW!

When discovered a misdiagnosis, WOW!


When discovered an abdominal aorta aneurysm the other day, incidentally, WOW!


So yes, everyday is a WOW! day… there is always something new.

-------------------END OF WOW! STORY----------------------------------

I discharged 5 of my patients today. It was tiring, writing referral letters non-stop. I know, some might think I mengada wanna find work to do by referring here and there. But really, it makes a difference you know. Like when you incidentally found your patient to have a neglected cataract, the simple referral letter to opthal can actually give her the luxury of perfect vision again, something she might not think she’ll ever had. That referral to the health clinics can offer better compliance to medication and better diabetic/blood pressure control. That letter to Social Welfare and SOCSO may ease her financial burden. That request for physiotherapy may prevent contractures and improves quality of life. That letter for home nursing may ensure better supportive care for the patient. Like I had said earlier, the pen can be a very powerful object. And I ran 2 pens out of ink, within 3 days. My fingers and arms hurt. But, it is okay.


So, my hateful days at the wards did get better.


1. Guess what? I’ve got a new MO (medical officer), Dr Gary Lee and Specialist, Dr Ahmad in the ward, and they are SUPER NICE!! Serious!super SUPER NICE!! Sure, the workload did increase, with them being very thorough with patients, but it is nice that we learn a lot from them. And yes, they have a good sense of humour, they treat patients (and co-workers, and HOs) very nice and life just gets better.


2. My tagging days are over! Yippie!! I get to punch out earlier… recently as early as 830pm, I’m aiming for 7pm.


3. I am glad I am getting my daily dose of endorphins before sleep. ^^

Confessions of a House Officer #4 - Day 13 of life

I hate my job.

I hate my life.

I can’t decide which of them I hate more.

So, I started to hate my job on day 13.

WOW! That is quite early to start with.

I hate having no time to eat, no time to breathe.

I hate having to generalised breakfast, lunch and dinner into ONE meal.

I hate losing the luxury of sleeping.

I hate working hard, yet NOT appreciated.

I hate having sore legs and the wrong footwear.

I hate not having time to shop for new shoes (despite having sore feet for weeks). no time to send my laundry (what more doing it), etc.

I hate it when unnecessary procedures and test were put upon patients.

I hate it when I was asked to take a good detail history, and the next day was told that I had ‘too many information’ in the clerksheet. I thought they were relevant positives and negatives.

I hate it when my writing style was criticized.

I hate it when I had to waste my time tracing lab results.

I hate this very much.

I hate it when they didn’t have a computer system like HUKM. (oh, how I missed HUKM)

I hate it when I had to go through a whole stack of lab results and do 'office work' like finding forms, puncturing holes, filing them.

I hate forms in general.

I hate it when the ringing tone to the lab takes a long 4 minutes, and later, I was entertained by

‘please try again’.

I hate it when staff nurses refused to help doctors do ECG. What did you learn in nursing school anyway?

I hate it when the PPK disappeared at night. and when Trop T levels were needed ASAP, we had to do the PPK’s job to head to CCU to get a simple ‘special bottle’ for Trop T, go back to the ward to take blood, then send the results to the lab and get it back stat. and at the same time, we need to review the patient and get an ECG done. and later I find 7 PPK lepaking at the lab counter. At that point, I just wished to strangle either them or myself.

I hate it when the pneumonic tubes were just for display, non-functioning.

I hate it when thyroid function tests were ordered for every patient with borderline tachycardia, with no attempts to get history of hyperthyroid or hypothyroid symptoms. What difference would it make when they are euthyroid? Oh, come on, she’s having fever, of course she’s tachycardic!

I hate it when we were taught to be 'clinical' people who emphasizes on history and physical examinations, and when started working, we were taught to be 'lab' people who orders all investigations under the sun. 'Medicolegal reasons, or so, it seemed'...

I hate it when the beds in the hospital are not adjustable. How am i suppose to check for JVP or prop up breatheless patients?

I hate it when all the SPO2 machines in the wards are not in good condition, and when I bring it up to the KJ, I was told that ‘terpaksalah’....

I hate it when I want to elevate a patient’s upper limb, I can’t find a simple triangular bandage in the whole ward. And the reason the staff nurse gave was ‘sini bukan orthopeadic’… oh, come on, even a first aid kit has a triangular bandage!!

I hate it when I take 1.5minutes to take blood, and double the time to find the syringes, and triple the time to label them and fill up forms.

I hate it when I requested for a chest x-ray to look for cardiomegaly, clearly fill up that request form, and the radiographer did a AP view film.

I hate it when i weren’t allowed too many opinions.

I hate it when my attempts to be holistic to the patient was rejected.

I hate it when different specialists/MOs have different opinions. It can be very confusing.

I hate it when I was not allowed to offer pain relief to my patients.

I hate it when staff nurses report everything to me, and I find myself doing someone else’s job, while mine was not settled yet.

2 days later, I learnt that it was called 'taggers kena bullied'.

I hate it when my superiors are serious people who enjoy sarcasm, and lacked sense of humour.

I hate it when I learnt that we should never go against our superiors.

I hate it when my seniors advises us to just do our job and pretend to be dumb.

I hate it when life becomes a routine.

I hate it when life becomes demotivating.

I hate it when people around me are no longer inspiring.

I’m tired.

So very tired.

So tired, i think i forgotten how to smile again.

I think I have depleted positivity.