BABIES DO NOT GROW ON TREES. PLEASE LOVE YOUR CHILDREN.

I was on call in the operating theater (OT) last night.

It was quite an eventful night. Very taxing, both physically and emotionally.

Then, there was this case which was put up at about 4am in the morning.

There was this 4 year old boy, let’s call him XY, 13 kg, with total amputation of the left middle finger and amputation of the tip of the 4^th finger with open fracture of the middle phalanx. Are they going to resuture the finger? – I asked Khalidah. She was not sure either.

The child arrived at the OT. Small and fretful. I could not imagine how mischievous he might have been, to be involved in such accident. He held on to his mother.

Further history from the mother, XY was playing alone when his hand, in her very own words, ‘tersepit kat pintu’. How did it happened?? I blurred, she replied ‘tak tahu lah’. DENIAL. I quickly ran through some short medical and surgical history and examined the child, then pushed him to OR6. (Operating Room 6).

The child was put under general anesthesia and the orthopedic team planned for a refashioning on his fingers, which means, no they were not going to reattach his fingers. This was obvious right from the start – we did not have a hand surgeon in hospital Melaka.

I went through the case notes later, only to discover the hidden agenda. The child was the youngest out of 4 sibling. He was playing alone at home, at the door, when the accident happened. His parents brought him to the hospital only FOUR hours later. The ortho team initially planned to refer and transfer them to Hospital Serdang for reattachment, however, the parents refused for referral because of ‘domestic issues’.

WTF!

I mean it is difficult to salvage a finger which had been amputated for 4 hours, but if you were the mother, and you know that your kid still have a chance to reattached the amputated limb, wouldn’t you go all out??? And they say mother’s love is the greatest love of all… I cannot be too sure. His father wasn’t around for opinions either. Just because you think you can have as many babies as you like, it does not mean you get to neglect them.

BABIES DO NOT GROW ON TREES. 

PLEASE LOVE YOUR CHILDREN.           

It pains my heart so very much when seeing incidents like that. What if the child grew up and wanted to be a surgeon? What if he wanted to be a pianist? Of course, there is prosthesis and all, but why not give him a chance? It is such a sad story….

To add salt to the wound, rub it in, there was another unfortunate case last night, following that case. 10 year old girl, let’s call her XX, came with amputated right ring finger, case put up by orthopeadic team for refashioning of finger. From the history, it was an accident, the child was riding on a bicycle when her finger caught between the wheel and amputated. I feel sorry for the girl. She would never wear her wedding ring perfectly again. It is so sad.

I think I will not like my next houseman posting – orthopeadics. It is a ‘BRUTAL’ department, I think, with lots of amputations which I could not bear to see. Amputation of finger, or fingers, toes, limbs, BKA, AKA, etc…. I wonder how would I ever survive the OT then.

My GA MO, Soon, newly wed last month, apparently, he shared similar opinions, he said disappointedly, ‘I really cannot understand these parents, how could they leave their kids like this’.

I replied, ‘Soon, when you have kids, please take good care of them’

i think parent-ship can be one of the biggest challenges... 

sometimes, i wonder how my parents did it...

they must have been like SUPER MOM and SUPER DAD...

how i missed you...

will be home soon...

(p/s: names and demographic data had been modified to preserve confidentiality)

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....

Are housemans and doctors overworked and underpaid??

Okay, obviously, the answer to the above question is a big YES. Obviously, doctors are overworked and underpaid. SO overworked that it can become a occupational hazard

- working an extended shift of 24 hours more than doubles your risk of being in a car crash

Well, here's a good news for House Officers! Although after reading this piece of news, i was still skeptical whether is it really true that we will get the day off after a 24-hour duty? wow! i thought that it was only true for the anesthetist and psychiatrist.

Having optimal manageable working hours is good, not just for the doctors, but also the patients.

however, i thnk that the government should also address the issue of shortage of doctors.... when they reduced the working hours, the number of HOs for each shift would be dispersed, thus less HO, more workload.. is that even possible?? seriously, we need more doctors in the government sector (like we all don't already know that..)...

And you wonder why there are still so many students who want to take up medicine... but of course, you and i know, no matter how tough life is, this can be a very rewarding job ^^
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original article here

Thursday December 18, 2008

Day off after 24-hour duty for trainee doctors

KUALA TERENGGANU: Trainee doctors will now get a day off after carrying out their 24-hour on-call duty.
Health Minister Datuk Liow Tiong Lai said the directive will take effect immediately.
He said it applies only to housemen on active call and at the hospital the entire time.
“We will not let these trainee doctors be overworked. We will look into their welfare,” he told reporters yesterday after visiting the Sultanah Nur Zahirah Hospital.

Pleased to meet you: Liow shaking hand with hospital staff members during his visit to Sultanah Nur Zahirah Hospital in Kuala Terengganu yesterday.

Liow was asked to comment on grouses from trainee doctors that they sometimes had to work almost 24 hours and then report to their superiors the next day.
Some trainee doctors complained that they had to work seven days a week without a single rest day during their two-year stint in government hospitals as housemen.
Liow said trainee doctors should also be allowed to concentrate on getting the right exposure and medical proficiency by giving them off-days.
A trainee doctor at Sultanah Nur Zahirah Hospital, who only wanted to be known as Sally, said she was relieved to hear that the ministry would look into their welfare.
“Frankly, we are very exhausted as we have to focus on our training and also carry out clinical rounds frequently,” she said. “It is stressful.”
Sally said she and her colleagues were unable to pay attention during their stints due to fatigue and time constraints.
On another matter, Liow said about 4,000 Chikungunya cases were reported throughout the country this year.
He said the virus was first detected in Johor and spread to several states, the latest being Kedah.

Want to marry a doctor?

most trusted. admired. eligible =P

Are you a Medical person?

Or perhaps a Surgical person?

Anyway, i just got back from work, when my friend, Ric surprised me with a very interesting news from Reuters ^^ So, i shall not comment on it, but rather share the whole news clip with you...

The medical profession is the most trusted, most admired and most eligible marriage partners!!!

OMG!! Now, that's interesting~ haha! (my lecturers and consultants would love to read this!)

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Want to marry a doctor? Survey shows most do


Wed Dec 17, 10:37 pm ET

SINGAPORE (Reuters Life!) – It really does pay to be a doctor, with an international survey showing the medical profession is the most trusted, among the most admired and includes the most eligible marriage partners.

By contrast, actors and musicians, along with journalists and advertisers, were among professionals that people trusted the least, and were also least likely to choose a partner from, according to a survey by Synovate, the market research arm of Aegis Group plc.

"Much of who we are is tied up in what we do in the hours from nine to five, and often way beyond," a Synovate statement said.

"Asking someone what they do for a living is often the first question you ask them; right after 'what's your name?'."

The survey polled about 5,500 respondents in Brazil, Canada, China, France, Malaysia, South Africa and the United States.

It asked people what makes for an admirable job, which professions they trust or do not, who is overpaid, and which profession they would prefer to marry.

Sixteen percent nominated doctors, nurses and other healthcare professionals as their preferred marriage partners, higher than any other profession.

Other eligible -- and admired -- professions were education, at 14 percent, and science and technology, at 10 percent.

Educators and doctors were also voted the most trusted by an overwhelming 86 and 87 percent, followed by homemakers and those in science and technology.

Only one percent picked retail professionals as partner-material, and those in media and marketing, as well as entertainers, did little better at two and three percent.

These professions were also among the least trusted by respondents, who, across the seven markets, picked the media as the single least trusted group.

Entertainers, along with corporate executives and lawyers, were voted as being the most overpaid, while homemakers and educators were among those seen as being underpaid.

(Writing by Miral Fahmy, Editing by Gillian Murdoch and Bill Tarrant)

Click here for original article....

too many movies perhaps?

i think most guys would love this!

Doctors are human too, not God..

i was surprised to see this article on the Headlines of The Star, this morning..... seriously, i wonder where does Tan Sri gets his data... and base on what parameters do he want to screen the students? MMSE? personality test??

and i think, sometimes, they tend to forget that doctors are human too, not God.... under such circumstances; not just the work load and ridiculously long on-call hours, these doctors are not just physically but also emotionally, mentally and spiritually challenged... knowing that you have done your very best, yet you could not help the patient further... losing hope, seeing deaths,... tears and disappointments,.. under such circumstances, anyone with a heart may break... many people falls into depression with MDD(Major Depressive Disorder)... should we deny this group of people treatment and the chance to live their dreams?

more importantly is when people break, they should be allowed a moment to weap, learn, heal, recover and rise again.. i have known doctors, good doctors, who had psychiatry illnesses like MDD and general anxiety, yet, having symptoms under controlled, they make a great doctor...

and i believe that medical school is just a small part of life, if we cannot handle the stress in med school, the future would be very difficult for us... passing exams is not the hardest thing in medical school, but rather, learning and obtaining as much skills, knowledge and wisdom as possible within these 5 years, so that we can use them to help our patients, heal illnesses, save lives - that is perhaps an even tougher thing to do...

give your very best for each patient..

do your best, and let God do the rest...

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The Article from The Star:

Sunday November 30, 2008

At least five doctors to suffer from mental woes every month

By M. KRISHNAMOORTHY

KUALA LUMPUR: Every month, at least five doctors are found to be suffering from mental illnesses, director-general of health Tan Sri Dr Mohd Ismail Merican said.
He said these doctors were either psychotic or neurotic but still managed to get into medical schools because these schools were not screening students meticulously enough.
“When the doctors complete their two-year housemanship and their applications are submitted for registration with the Malaysian Medical Council (MMC), they fail to get registered.
“Their supervisors do not certify them as fit to be registered because of indiscipline and poor attitude arising from mental health problems.
“The mental cases range from psychotic to neurotic. Psychotic cases include delusions and hallucinations, and neurotic behaviour includes anxiety, fear and anger due to the competitive environment,” said Dr Ismail.
These medical graduates, totalling about 60 cases a year, are unable to cope with their housemanship as they may have been pressured by their parents to take up medicine.
Dr Ismail said it was disheartening to note this emerging trend due to an inefficient selection process, adding that the mental cases were referred to the Medical Review Panel (MRP).
Since many of these graduates have spent a lot of money on their medical education, the MRP may extend their housemanship and at the same time send them for psychiatric treatment.
“In the event they are assigned to work, they will be thoroughly supervised and counselled by experts and given light duties until their mental condition improves.
“I am not so sure whether we can identify those with attitude problems during an interview unless such problems are obvious,” Dr Ismail said at a forum on Training Future Doctors: Have we got it right?”
About 2,000 medical doctors are registered annually from 21 local medical schools and 400 recognised schools overseas.
Different medical schools around the world have different selection criteria for their students, Dr Ismail said.
However, he said that the ministry was also planning some form of examination to check their attitude, knowledge and experience after they complete their final examination.
Most of the mentally ill students, he said, could have undergone pressure and depression while studying and faced difficulty in coping in a hospital environment.
The other weakness was a lack of proficiency in the English language.
Higher Education director-general Prof Datuk Dr Radin Umar Radin Sohadi said the ministry was currently reviewing universities’ curricula to ensure high standards in medical education and training for doctors.
“Uppermost on our minds will be the safety and well-being of patients,” he said.

Buckle up, think of your love ones...

An article from The Star Newspaper:

Saturday November 1, 2008

60-day countdown to rear seat belt use starts today

By ROYCE CHEAH

(Use the rear seat belt now.) Otherwise the police will stop you, question you and give you a pep talk.... DATUK SURET SINGH

KUALA LUMPUR: The 60-day countdown to the compulsory use of rear seat belts has begun.

Starting today, authorities will conduct daily operations to ensure rear seat passengers buckle up before it becomes compulsory on Jan 1.

Road Safety Department director-general Datuk Suret Singh said motorists must ensure passengers wear their seat belts if they did not want to have an interrupted journey.

“Otherwise the police will stop you, question you and give you a pep talk,” he told reporters after carrying out a road safety advocacy campaign on the Sungai Besi highway here yesterday.

Suret Singh said a survey among 2,000 respondents found that 70% to 75% were aware of the importance of wearing rear seat belts.

“However, 60% said they would start using them only when it becomes compulsory while 80% are not even aware that it will come into effect on Jan 1,” he said.

He also cautioned parents against having children under five wear adult seat belts and advised them to use child safety seats instead.

“As for those between the ages of five and 10, they can use the adult seat belt but will need a booster for height,” he said.

Suret Singh said that Proton and Perodua would be announcing in early December the schedule for the free fitting of rear seat belts for cars that do not come with them.

He said motorists with such cars need not rush to fit the rear seat belts as the department had given the manufacturers three years to ensure all such cars were fitted with rear seat belts.

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Because 80% of Malaysians were not aware of the implementation of compulsory rear seat belts, which will come into effect on Jan 1 2009, i shall blog about this today.... In fact, if you drive a Proton/Perodua, there will be free fitting of rear seat belts this December for cars with no rear seat belts.

NEWTON FIRST LAW: MOMENTUM

"A body continues to maintain its state of rest or of uniform motion unless acted upon by an external unbalanced force."

Understanding this law, something of which we would have learned during physics lessons in high school, we should understand that when a car suddenly stops, (whether in a crash or emergency brake), the occupants will continue moving in the fast initial velocity and will either

1. be crashed into the vehicle structure

2. be thrown out of the vehicle and crash into a wall/road/another vehicle/ other static objects/etc

3. crashed into the other front occupants

The front seat belts only prevent the formal two, having both front and rear seat beats on would prevent all three.. The middle rear seat passanger can also be prevented from being thrown out with rear seat belts. In a collision (even at a mininum of 50kmph), any occupant in the vehicle will be thrown forward with a force of between 30 to 60 times their own bodyweight.

Let's say you weight an average weight of 50kg,

and 50 x 30 = 150kg,

F = ma , F=50 x 30 x 10 = 1500 N

or perhaps a more precise calculation:

and F=ma

a = (V-u) / t

{acceleration = currant velocity minus initial velocity, then divided by time}

So, if you are breaking from 100km/h to 0 km/h in say 2 seconds,

a=50 m/s2

F= 50 X 50 = 2500 N

that's the amount of force you put on the driver/passenger in front of you!

and of course, if you were speeding, like at 140km/h, the force would be: F = 3500 N !

Even if you were driving at 50kmph breaking in 1 second, your F = 2500 N

Now you see, the impact you could have towards your front driver or yourself..... To solve this problem, there is only few solutions:

1. Reduce the 'a' - Drive slow and safe, DO NOT SPEED!!

2. Reduce the 'm' - Loss weight? haha! another benefit of weight reduction, i suppose.....

3. Prolong the 't' - by using seat belts, etc..

Restrain systems, eg seat belts are designed to help keep people in the vehicle, away from the vehicle structure and other occupants, and to distribute the forces of a crash over the strongest parts of the human body, with minumum damage to the soft tissues..

In fact, countries like Hong Kong, had understood the benefits of wearing rear seat belts and had implemented this rule much earlier.

There is however a set back : The adult seat belt is designed for people 1.5m or mote in height. Therefore, for children/babies, an appropriate child restraint includes a baby carrier, child seat, harness or booster seat suitable for the child’s weight is necessary. I hope the government would take this into consideration.

Do make a point to make sure everyone in the car has their seata belt on before driving.

Final words from me : Buckle up, think of your love ones...

conserving energy, fuel, and $$$

In response to Primus's 6 things i hate about the bloody oil price... here's some tips on how to conserve fuel, save $$$

1.Don't signal – ever
Not that Malaysians use their indicators anyway but it is an even more compelling reason to not waste energy on that blinking light

2.Don't park in multi-storey car parks (eg: terminal 1, Seremban)
Going up and down ramps burns fuel. Better to just leave the car outside on a single yellow line. Besides, the spins give you a headache!

3.Don't brake for bumps
Braking burns fuel so just keep accelerating over speed bumps.

4.Commute off-peak
Avoid the rush hour traffic by going into work at 10am and coming home at 3pm.

5. Delay switching on headlights
Wait until it gets really dark or until someone flashes you before switching on headlights.

6. Sing
Radio music is lousy anyway. Sing to entertain yourself instead of letting your Blaupunkt burn more fuel.

7. Carpool
Cram as many people as possible into your Kancil. Besides, the added weight helps with braking. You’ll have someone to chat on the journey. No more flipping stations finding the right junk to listen to.

8. Use the emergency lane
Why sit idle in traffic when you can gain ground efficiently on the extra lane?

9. Coast downhill
Turn off the engine and free up the gear when going down a slope. Let gravity do the work, not petrol.

10. Invest in body kits
Making the car more aero-dynamic with sporty skirting and spoilers reduces drag and fuel consumption.

11.Use 18-inch rims
Big rims mean less tyre material, i.e. rubber. Therefore less rubber is burnt while driving and less resistance/ friction.

12. Drive on the line
Align the middle of the car on the line that divides two lanes on a dual carriageway. This reduces the need to make sharp turns as you are effectively using the racing line.

13. Go through red lights
If you are in front at a traffic light, go straight on. Braking hard for a yellow or red light burns fuel.

14. Use high gears
If using a manual car, try to go from first straight to fourth. Keep the revs to below 1,000rpm.

15.Take MCs
Utilise your entitlement to the max. Every day that you don't go to work is RM saved on fuel, toll, parking, etc.

16. Know your roads…
Decide the best route to take and make sure you know the roads... getting lost in KL makes you take a super long route, thus more fuel consumption.

17. Plan your journeys
If you have 7 things to do, plan it out, make a checklist and do it in one journey instead of 7.

18. Fill your tank early in the morning
Fill your tank early in the morning when the ground temperature is still cold. Remember that all service stations have their storage tanks buried below ground. The colder the ground, the denser the fuel.When it gets warmer petrol expands, so buying in the afternoon or in the evening.... your litre is not exactly a litre.

19. Fill in slow, save in more
WHEN YOU'RE FILLING UP, DO NOT SQUEEZE THE TRIGGER OF THE NOZZLE TO A FAST MODE. note that the pump had (3) stages: low, middle, and high. When you pump in low mode, the vapours that are created are minimized. All hoses at the pump have a vapour return. If you are pumping on the fast rate, some of the liquid that goes to your tank vapurized. Those vapours are being sucked up and back into the underground storage tank so you're getting less worth for your money.

20. Do not wait until your yellow petrol sign shows at your dashboard
ONE OF THE MOST IMPORTANT TIPS IS TO FILL UP WHEN YOUR TANK IS HALF FULL. The reason for this is, the more fuel you have in your tank, the less air occupying its empty space. Less space, thus less evaporation.

Ok, so I've got 20 points down already. When I have more, I'll put them up. If you've got an idea for me, it's time for a shout-out! ^^

p/s: calculate your extra expenditure on fuel here: http://boxstr.com/files/2299275_wqfom/?token=f01ca28e818007472c20a69f693bfc77