You probably have gone over the edge when....

You probably have gone over the edge when...

1. you start regressing into your childhood and play an improved version of 'let's play dress up' on FB...yup, i've recently started playing Cocogirl on FB...yes, i used to be quite tomboyish...but if there was one (girly) thing i loved when growing up (besides going for ballet lessons) was dressing up my barbie...

2. you don't give a damn about your exam anymore when it's less than 2 weeks to your exam...especially when you used to be someone who'd cry a river if you get anything less than an A...in fact, you now wish you'd fail your exam so you have a valid reason to call it quits...

3. you think that indulging in no. 1 would be a good career move than the living hell you have to go through daily...yes, at this very moment, i wish i could just walk away from this hell i'm in and move on with my life...

Sigh...it's been almost a month since i last type a post...or has it been more? i don't know...when in hell, one loses track of time...i don't revel in bitching...and i hate the idea that more often than not, when i'm typing a post, i'm bitching about my life...it's just not healthy...i wish that i could type happy/inspiring/touching/optimistic post...instead of lamenting about how i work like a dog on a daily basis, indefinitely...some would call me ungrateful...and maybe i am...but i really thank God everyday for His daily miracles for getting me through each day of living hell...without Him, it would have been much worse...but i'm only human...a self-centred, self-preserving, selfish creature...who wants a good life, who doesn't want to suffer so much, who longs for a family of her own...but my work life is such a black comedy that ppl laugh at my predicament and console themselves saying, "thank God my life isn't as bad as hers"...and the most common word used to console me and my colleagues is 'pity'....i'm sure they meant 'pathetic' but i guess most ppl still have manners...

I don't know how long more i have to live...but somehow wasting my next 3 years in this living nightmare doesn't seem worth it...Oh Lord, please, i know my suffering is nowhere close to what Jesus had to suffer (and i did bring this upon myself)...but i don't know how much longer i can go through this...if You're willing, please give me a way out...if it's Your will that i have to go through this living hell, then please make it more bearable...thank You, Lord...Amen...

Back home for Chinese New Year...

So i got through another week of free flap frenzy...2 free flaps in one week...which was quite bearable since we've had 4 free flaps in a week previously...got off work a bit earlier on Thursday evening coz my train back to KL was at 7pm...showered, last minute packing and then found out my phone got cut (cos apparently our account has reached its credit limit)...good thing Karen came on time to pick me up...but there was this stupid jam on the way to the train station...so i fretted...coz i ain't gonna miss the train...i was getting the hell out of KB that night no matter what...thank God we made it in time...and the train was delayed anyway...

Boarded the train about 720pm...ate my dinner....and slept at 8pm plus...only got up to answer nature's calls...although i kept getting awakened whenever the train stopped...but still, at least i could sleep...reached KL Sentral about 9am Friday morning...by then my phone was back on...called mom and bro came with her to pick me up...got home to get Pei and we went to Puchong for dim sum...yummy! first porky meal of the new year...char siew pau never tasted so good...and i was craving for lau sa pau just a few days back and i got to eat it...ahhh, God is good...

Went for grocery shopping with mom, bro and Pei in the afternoon...bought some baby stuffs for Colleen's Olivia (need the parent's name for contrast since Ernest's daughter will be named Olivia as well)...went out to yum cha with Cam and Wei Yew at Chatime (Cam's favourite) at Sri Petaling after dinner...it was good to catch up...we stayed till about 1030pm...then i sent Cam home and went home...

Was reading some journal articles for my case report while waiting for Ah Lok to get home and call me...and was listening to this song by Joshua Radin called "The Fear You Won't Fall"...nice and mellow...and melancholic...Ah Lok said that song describes our situation perfectly...anyway, we chatted till about 330am...and i got awakened by a call from the stupid hospital at 930am...urgh!!!! like i thought they should know how to call the on call MO and i'm obviously not on call...idiots!

Been spending the whole day doing my case report...got the introduction and discussion done...hope it's adequate...part of the case report is done as well...just need to add the operative details when i get back to KB...need the patient's folder for that...that shouldn't take too long...need to hand it in soon...before the supervisor comes chasing for it again...sigh, despite the holiday, i still need to prepare my case report, presentations and study...Lord, help me to be discipline and finish my work and study...

The 12 days of New Year...

So today is the 12th day of the New Year...which also meant i've already been working 2 weeks in 'hell' again...although the grass is no longer green...and life is no longer as good as the last 3 months, i really thank God that it hasn't been the 'hell' i've been expecting...but then again, the flap frenzy has not started yet...i might be singing a different tune when it does...

Still, after only 2 weeks, i'm already tired...and feeling a little low...must be the lack of sun exposure...but i really praise the Lord that my past few calls have been amazingly good...if not, i'd probably feel worse...yesterday was GA OT day...i thought i wouldn't be able to go to CF coz i expected a long day...but miraculously the last case got cancelled and i managed to go to CF...albeit a bit late...and despite the talk lasting almost 2 hours, i miraculously made it through the whole talk without falling asleep within the 1st half hour...God is so amazing...

I liked what the speaker quoted from CS Lewis...he said: Sin is man telling God, "go away! leave me alone!"...and hell is God's reply to man saying, "have your wish"...i couldn't help nodding in agreement...this concept is quite liberating for me when it comes to the question, why is there hell if God is a loving and compassionate God...He didn't create hell with the intention to torture His children...but we choose hell when we do not choose God's love...because really, without God's love, life is hell...you don't even have to wait till afterlife...and therefore i should not call the place/condition i am in now 'hell' since i know God's love is with me...

Saw a link which a friend put up on FB...it was Jason Mraz's new song called 'I won't give up'...i was intrigued...so i listened to it...and i loved it...i really liked the idea of the song...how this guy won't give up on his hope for 'us' with the girl....in this twisted hopeless romantic mind of mine, i felt like this song sang of the feeling of a certain guy for me...yup, i've got my head too far up in the clouds...getting quite delusional...anyway, here's the link:

Jason Mraz - I Won't Give Up

So the new year has started off quite bearable...i guess if you were expecting the worse, anything less than worse is really not bad at all...i just pray that when things do get worse, i would still be holding on to God and trust in Him to help me through tough times...so here's to 2012...have a great one...even if the world ends...

The Return to CF...and a dysmenorrhoea-induced vasovagal attack...

I went to the USM’s CF yesterday…after a long long long time…since I left USM and started working in Sabah, I’ve never visited KB again till I came back here for Masters…and I’ve been wanting to check out the CF for the last 5 months plus...of course the first 4 months were quite impossible coz I was in HUSM…then I started my rotation in HKB and I’ve been meaning to go but somehow everytime Wednesdays 730pm come I’ll forget that I was supposed to go to CF…so yesterday I reminded myself the whole day that I had a date with God that evening…

And horrible me actually didn’t feel like going when the time has almost arrived…but I went anyway…and I’m glad I did…the CF is held at the Murni hall now…and we just sat on the floor on mats…we had praise and worship session like old times…and most of the songs we used to sing back then…and being in the Murni hall…brought back so much nostalgia…I was so moved during the worship session that tears were free-flowing…after all these years, I’m back where it all started…the place where I really found God…and how our hide-and-seek relationship really started…one where I kept hiding and He kept seeking and have always found me and brought me back to Him…

It’s been 5 years since I graduated…and I’ve stray away from Him uncountable times…just like Israel…and yet He has always brought me back to Him…and I’m just so amazed at how far He has brought me through…just like the line from the song “Through It All” that goes: “You’ll never let me go, through it all”…then we had a speaker from FES who gave us guides for bible study…sitting on the floor for almost an hour gave me such a butt ache and back ache that I realized I’m no longer as young as I used to be…

So I woke up this morning feeling a lot better…I’ve been down with a flu since Monday…went to work ready for my 4 consecutive calls in a row…we had clinic in the morning…my boss admitted 2 patients…one for I & D, another for T & S…was planning to do them after lunch…and thank God the flap case was postponed…coz then it would have been a longer day for me…anyway, just about half an hour before clinic ended, I had a bad attack of menstrual cramps…today was my 4^th day of menses…it has been happening on and off lately but the pain usually is self-resolving after about 10-15 minutes…

But after clinic, the pain was still there and seemed to be worsening…I thought I’d take a quick drive to get lunch and come back to the hospital to continue my work…walking to the car park was a challenge…but I managed…then halfway driving to Chinatown, I felt a vasovagal attack coming…I guess the severe dysmenorrhoea must have induced the vasovagal attack…and I have had history of vasovagal attacks during recovery from flu…short of total blackout, I had all the symptoms of turning cold and clammy, lips as pale as sheet, nauseous, hands trembling with tingling sensation, upper and lower limbs turning into jelly…I was praying that I would make it to some roadside where I could park before I totally blackout and crash into something….

Thank God I managed to find somewhere to park by the roadside…I thought resting a while until the wave has passed would help…but the pain and all the symptoms only got worse…the pain was so bad that I felt like defecating…so I had to go to a budget hotel which was just opposite the road where I parked to use the toilet…I was in the toilet for a good while…of course with defecation the pain was still there…so in the end I had to ask for help from the hotel people to send me back to the hospital…I didn’t think I could drive back there on my own without risking an accident which would only made matters worse…

So the nice couple drove me to the hospital…dropped me at the casualty, went to park my car and returned my car keys…I wanted to offer them cab money since they drove my car but the guy said he’ll get his friends to pick them up…really thank God for kind strangers…so I went into the triage, telling the staff there that I was a doctor who works in the hospital and I’m sick…they didn’t even bother to take my blood pressure at the triage…they sent me to the yellow zone and left me there to die…ok, so I’m being dramatic…I’m sure no one ever dies of pain-induced vasovagal attack…but from previous history, whenever I had vasovagal attacks, my blood pressure drops to as low as 60/30mmHg…and I need IV drips to go in fast to bring my BP back to normal…

Of course since they left me lying there for so long, by the time I called a student nurse to check my BP, it was 100/62 mmHg…I supposed my body has compensated…but the pain was still unbearable…I think I can imagine 1/10^th of a contraction pain now…and I’m definitely going for epidural childbirth…my menstrual cramps lasted probably an hour plus and I really thought I would die…while in pain, I called Kean Khang to see if he was in the hospital…coz I didn’t know how long more till the casualty MO would come to help me…and I needed pain relief real bad…thank God he was PM shift and he was free…

By the time he came to casualty, the casualty MO had just attended to me…so I told her I need drips and pain killers…and I’ll be fine…so Kean Khang tried to set an IV line on my right hand but failed…thank God the nursing coordinator managed to set a line on my left hand…coz all my veins were constricted and collapsed…usually, my veins are very prominent…then Kean Khang smuggled a dose of dynastat from OT for me…after that, my pain was gone and so were the other symptoms…of course the 2 pints drip helped too…in the end, I had to ask my colleague to take my call today…I really felt drained after the ordeal…I think I need to rest today so I can continue to be on call the next 3 days…very kind of my colleague to agree to help…

I felt really alone in my pain earlier…I cried out to the Lord to take the pain away but the pain only became worse…at that time I really wished I had someone beside me to hold my hand and tell me that everything was going to be alright…but I don’t have that someone…and I couldn’t hear God telling me that…but I was very grateful for Kean Khang…his presence made me felt less alone…and I felt that I still have friends who will come to my rescue when I need help…God bless him…and the kind couple who helped send me to the hospital…

On call 3 days in a row...

I really shouldn't be complaining about my work life in HKB...coz i really have so much more time for myself compared to my work life few months back...and there have been days when my calls were 'call-less' last month...but since November started, my lucky streak has worn off...i'm only half way through my 10 calls and i'm able to claim most of my passive calls for 'more than 4 hours of work after office hours'...i think God knows i need more money lately, so He's giving me the opportunity to earn more during my calls...but i still want to have my beauty sleep, Lord...

Yesterday i started my 1st of 3 stretch of continuous calls...not a good start...they just kept referring cases...and the last one was this idiot who was riding a motorcycle without helmet (coz it's jalan kampung) and banged God-knows-what and fell over...again, i must wonder why are there so many ppl in the world who were born without protective reflexes...one would think that when a person is about to fall, his/her limbs would be outstretched to break the fall and thus be of worse condition than one's face...but since i became a plastic surgery MO, i've seen so many idiots with horrifying facial laceration (only) but their limbs were unscathed...some don't even have a bloody scratch on the upper limbs...as if God made the face to stop a fall...

Got the call at 2am...and was in casualty till 4am...bugger....was only able to suture part of his wound coz it was at the left lateral canthus and it was bloody deep and wide...to suture it anyway would leave him with a squinted eye...not that i care if he ended up having eye asymmetry...he was asking for it anyway...but i wouldn't want my boss to think that i do not value cosmetic and aesthetic results...not that putting a full-thickness skin graft on his wound would restore proper facial contour but at least his eyes will still be symmetry....

So i'm keeping my fingers crossed that tonight will be a quiet night...since tomorrow i'm still on call...Lord, i'm looking forward to Friday...i'm dipping into mild depression...so i'm having my dose of caramel hot chocolate to lift my mood and hopefully aid in my falling asleep....yes, despite being tired (and able to fall asleep anywhere at any circumstances during the day), i still have problem falling asleep at night in my bed...

Intensive course....

Our 1st week of intensive course just ended today...with a 20-question MCQ paper...the last 2 weeks i've been just trying to play catch up...with what? i can't pinpoint it...maybe it's just my own shadow...but i really feel like i've just been dashing from point A to B and C and D and so on...and without me realizing, 2 weeks have passed by...and i haven't studied much...

I've probably failed my MCQ paper today...despite the fact that almost all the questions were pass year questions which we managed to get our hands on...and which we tried finding answers to the questions...still, nothing in life is guaranteed yea? guess we'll see how next week goes...there'll be practical and viva sessions by the end of the week...i hate vivas...i've always failed them...

In times of haste and rushing through days without being able to stop and smell the roses, i'm reminded of Corrinne May's song "Slow down"...i really wish i can slow down...can't wait for next month...i'll be in HKB...and i'll be going to UK for a week...ah, release is finally here...alright, i'm post call today and i'm playing keyboard at church tomorrow...need to get enough rest....

A post call Raya...

So i've survived by 3rd eod call...there was referral last night from district...30 year-old lady involved in an MVA...she was the front seat passenger and she wasn't wearing her seatbelt...the driver tried to avoid an oncoming lorry and swerved to the left and crashed into a retaining wall...the patient hit the dashboard and smashed the windscreen...thus sustaining bilateral corneal laceration and a huge forehead laceration wound....since eye team was going in for EUA and T & S, so our side would do the forehead T & S under GA as well after they've fixed the eyes....

Got a call from OT just before 6am saying the eye team was almost done so i went into OT straightaway....then the eye ppl told me they had to suture the left cornea as well coz there were some lacerations...so i waited (while sleeping uncomfortably in OT) for them to finish...but by the time they finished it was 8am...my call was over...so i had to passover to my colleague who was on call today to come into ot to start suturing the patient's forehead...i felt bad for passing over to him but we're both doing eod calls...so i think i need my rest so that i can be on call again tomorrow....

Came back and zonked out till almost 2pm...if it weren't for my mobile messages, i probably would have slept till later...that's how tired i was....thought wanna go out for dinner with some friends...but most of them are working today...bad timing...when i'm working they are not, and vice versa...oh well, it's not like i'm not used to having dinner on my own...gonna study till dinner then need to go hunt for food...i think most eateries would be closed due to raya...

5 EOD calls in a row...Selamat Hari Raya indeed...

Yesterday i started my 1st of 5 EOD calls in a row over the Hari Raya Break...i'll be on call again on Saturday, Monday, Wednesday & Friday...praying really hard there won't be any onslaught of facial burn patients that the casualty ppl would intubate freely without ensuring if there was a place to ventilate the patient...coz then i would be the one who need to beg around for portable ventilators or a place to ventilate the patient if the burn unit is already ventilating 2 patients....i'll settle for minor limbs burn...even facial lacerations on idiots who still managed to get into accidents despite the massive jam that's going to happen over the Raya break....please Lord, have mercy on me...give me the strength and peace to go through the coming week...

Selamat Hari Raya anyway....

The longest 2 days in my life...and more to come...

So the bunch of us started working on Wednesday morning...went to the hospital at 730am...it was our elective OT day...so day 1 of life in the department we get thrown into the furnace...we had a free fibular flap...saw 2 cleft lip repairs...assisted one frontalis advancement...and then scrubbed in for the flap as well...the flap started at 1030am...we only finished at 330am Thursday morning...and had to send the patient to ICU...had to made sure the transfer was uneventful so that the flap won't be compromised...and no, that wasn't the end of it yet...

There was a wound debridement and escharotomy in the emergency OT so us taggers had to stay back to assist and observed...and it ended about 6am plus...by the time we got out of OT and got home it was past 630am...so i only had time to bathe and brush my teeth and it was off to work again...i managed to sleep for like an hour during the escharotomy...but i really had problem keeping my eyes open during the briefing by our head of department...and there was a free flap which was postpone from yesterday which initially was cancelled...but then after lunch we got a msg saying it was on again...groan!!!!

So we went into OT...the latissimus dorsi free flap for foot reconstruction started at about 3pm...and we managed to get out of OT by 1030pm...woohoo!!! that was a miracle...at least Cinderella managed to get home before 12 midnight...really thank God for that...wanted to go to church this morning (in Kelantan we go to church on Fridays instead of Sundays coz Fridays are off days and Sundays are working days)...but when i woke up it was 1030am...hehe, church was halfway through...Suet Lai said don't worry...God will forgive me...He understands that i'm too tired...i just hope this won't be a regular thing coz i really want to start going to church again every week coz i haven't been doing that back in KK...

Oh well, at least today i got to rest a bit...managed to study a bit too...though half of the stuffs i read i couldn't understand...hopefully i'll be able to study enough to pass my 1st year exam...so many things to read...so little time...although it's really tiring to be in OT for long hours, but i actually like the things i'm observing and learning...so i guess it's not too bad...hopefully i can pull through these 4 years...gonna need lots of prayers and miracles...and probably won't be updating my blog as often...then again, since it's my only outlet, i may have more input...hehe...

Registered....

I've been in Kelantan since last Friday...and have been house/room-hunting since...Suet Lai and Jacintha 'pseudo-kidnapped' me to Perhentian Island on Saturday...all the while i had the idea that we were just going to the beach for a day trip...but i was glad for the getaway...only thing was i didn't bring an extra change of clothes and toothbrush...hehe, excuse to buy t-shirt and shorts...we stayed at this place called Bubu at Long Beach, Perhentian Kecil...the room was quite pricey...rm350 per night for a double...but it was quite cozy...and the view of the beach was just too lovely that i was trigger-happy with my camera...well, this was probably my last holiday before my suffering begins...

Spent the afternoon enjoying a nice Swedish massage and foot reflexology...and then wile the time away lying on a beach chair under an umbrella, reading a book and enjoying the view and breeze...ahhhh, this is the life...didn't see any sunset though since we were in the east coast...went to this restaurant called Oh La La for dinner...which was ran by these bunch of ang mohs...so i tried their beef wellington...which was pretty decent to me...initially we wanted to stay up and go to the beach about early morning to watch the stars and hopefully catch a few shooting stars...but i guess age is really catching up and so we were sleeping by 1am plus...

Came back on Sunday morning...managed to find a room which was quite spacious...and the rent was quite cheap...i still need to get some furnitures for the room...but at least the place was flood-safe...and the hall is so spacious i can have a party every weekend if i wanted to...except that it probably won't happen since i'd hardly be at home...and the downside is that i still can't move in coz the previous tenants still have their stuffs in the room...so until today, i'm officially home/roomless and a refugee...thank God for Suet Lai who allowed me to bunk in with her...

So this morning was the registration for the master programme...met up with quite a few old friends...it's good to see back familiar faces...some from back in uni...some from work...the registration didn't take too long...Sharon and i were done by about lunch time...so Jacintha came to pick us up for lunch...had arabic food at this place called Arabesque...had nasi mandi kambing...

So tomorrow is orientation...and then my suffering would start...gosh, this actually feels a bit like marriage...once you've signed the papers....you're bounded...for life...ok, at least for the master programme it would only be for the next 4 years...oh well, looking from the way things are, i might never get anywhere close to signing marriage papers...

Almost died...

Ok, maybe i'm being a drama queen...maybe i'm exaggerating...but i almost died today...or at least almost suffered major injuries...thank God for His protection over me and my friends...we were going out to town for lunch after clinic...i was sitting in the front passenger seat in Yap's car...suddenly a car was charging into our lane, right into our car...the car was going damn fast....and the idiot driver (a man) wasn't even looking at his right before changing lane...and he didn't even signal...Yap had to blast the horn to alert him and swerved to the right up the divider...good thing no one was standing at the divider...and the idiot didn't even slow down...he just drove right on..

I actually screamed coz the car almost hit the left front and i really thought it was going to hit my side...if Yap wasn't quick enough to swerve the idiot driver would have banged into my side...got my heart racing for a while there...really really thank God that we didn't get into an accident...it was such a close call...i was like thinking, damn, i'm still young...haven't even got married...don't let me die or get disfigured yet...

Am back home now...watching a Chinese drama...called 巴黎童话 or 'Paris fairytale'...coz Peter Ho is in it...but i'm getting a tad irritated with the drama...coz Peter Ho's character is yet again the guy who's in love with a girl who's in love with another guy...urgh!!! and this drama is so complicated it has a 7-angled love connection....and none of the persons love the persons who love them...or should i paraphrase it as everyone loves someone who doesn't love them....it's really so sad...why is it even called Paris fairytale when it doesn't even look like there will be any happy ending?...

Ok, gonna continue watching my drama...hehe, still watching it despite all the complaints...like i've said before, i'd rather cry about other ppl's (fictional) lives than my own...

Surviving 7 successive EOD calls...and Butterfly Lovers...

Yesterday was Good Friday...and i finally finished my 7 successive EOD (every other day) calls this month...totally gave a new meaning to TGIF!...i guess i asked for it...was trying to finish up my leave since i'm leaving for masters soon...so i took 2 weeks off this month leaving me with only 2 working weeks...and each of us surgical MOs had to have 7 calls this month...hence my torturous 2 weeks...but yea, thank God that i survived without any mishap...

And i supposed watching 'Butterfly Lovers' aka 梁山伯与祝英台 helped me through these 2 weeks as well...been watching the 41 episode series which stars Peter Ho and Dong Jie (this is the newer version)...i've always loved this story...it's just too tragically romantic...and i love Peter Ho as 梁山伯... he's quite fitting in period stories like this...although his 欧辰 in 'Summer's Desire' is probably the best so far...i'm starting to watch another of his drama series called 'One Meter Sunshine'...old one...digging up all his older dramas...

Tomorrow's Easter...will be going to church...just have to make sure i don't wake up late...thinking of going to Tg Aru in the evening to watch the sunset...if it doesn't rain...

Bad call and drama...

Lately my calls have been "Jonah calls"....and yesterday wasn't an exception...not that any patient died...but i was awake till 530am trying to settle a urology patient...if i did believe in past life, i must have been a mean and horrible urologist...that's why i'm paying this life by suffering urology mess...and maybe i'm getting delusional...but i'm convinced that the urology HO on call last night was all set to ensure that i have a bad call...and maybe there are more HOs out there who are conspiring as well...hahahaha, i must be having post call delirium...that's why i'm not making sense...

Didn't go to church this morning...would have been sleeping throughout the sermon anyway if i went...came back home and bathed instead...and slept till lunch...then went for lunch at Becky's place...came home and started my drama marathon on youtube..currently i'm watching a China production called "Love of the Aegean Sea"...not too interested in the lead actors...watching it coz i had an inspiration about going to Greece...thanks to Sharan, my ex-roomie in uni...anyway, i'm finding this drama a bit draggy...and i can't stand the male lead coz he's such a wuss...and the female lead has a perpetual "my father just died" look regardless of whether she is or isn't with the male lead...quite annoying...

I love the 2nd male lead though...truth be told, i've always had the affinity towards the 2nd male leads in almost every drama i've watched...after all, i'm in the same boat too...so i can relate...that's why i root for 2nd male leads...i guess it's coz the guy's love for the female lead is so amazingly persevering...even though the female lead will never end up with him (except for Peach Girl), the guy never stops loving the girl...i don't cry for the male and female lead...but i cry for the 2nd male lead...but in reality, a guy like that doesn't exist...i was telling a guy friend about it and he totally affirmed it...if there was a guy who would fight for my love and persevere that long in his love for me, i'll definitely be touched and want to be with him...

Unfortunately, love like that is hard to come by (or non-existant)...i supposed that's why i'm still waiting...but i'm afraid i may be waiting in vain...still, perhaps one day i will meet the guy who is worthy of my love and whose love i'm worthy of...till then, i should focus on my Greece trip...i even have a title for it...Chapter 30: I dream of Greece...i guess i should sleep now and start dreaming about Greece...

Praecordial thump...

I'm spending my lazy Saturday afternoon watching "Love at the Aegean Sea" aka 情定爱琴海 ...i'm actually supposed to be on call today...but my colleague wanted to change his Sunday call with my Satuday call...after yesterday's tsunami alert, i was pretty glad we changed calls...if tsunami did hit our KK shores, there would have been quite some casualties today...

Anyway, yesterday afternoon our department had our usual HO teaching...somewhere along my unit's consultant mentioned about using praecordial thump to try to jump start the heart in a patient with leaking/ ruptured abdominal aorta aneurysm who is in asytole...coz CPR would completely exsanguinate the patient...weird that suddenly this term would come up...coz it has been haunting my mind the last few weeks...

We never really found out the cause of my Pa's death...we just put it down as myocardial infarction... most likely it was arrhythmia that caused his heart to stop....and i couldn't help wondering if i was there to give him a praecordial thump, would it have been able to jump start his heart?...boss said a praecordial thump can give up to about 100kJ of shock to the heart...that is as good as a DC shock...maybe then i could have been able to save Pa...but the fact remains that i was not there that morning beside Pa...because i've always been happier being away from home...because i've spent the last 10 years trying to leave my home behind...and now it's too late...even if i want to go home, Pa won't be there....

There're so many regrets and guilts...that i don't even dare to put them in words...coz even if i did, what good would it do? there's nothing in this world that i could do to make it up to him...everyday i wake up and think "another day has gone by"...i go to work and pretend as if everything is the same...i try to function normally and i find that i can...i don't burst into tears when my patients die during my calls even though i'm reminded of Pa's death...but it still doesn't make me wish any less that Pa is still around...Pa, let me know that you're really in a better place...so that i can let go and move on....

The return of the Angel of Death...

I was on call yesterday...was a relatively good weekend call i must say...although the 2 cases we did in the morning ended up pretty complicated and we only finished at about 3pm...after that, went for lunch with my senior MO and his wife and baby...his wife was shopping for a friend's farewell present... and he wanted to shop for his wife's birthday gift...so after lunch we were at Charles & Keith (coz they were having sale)....

After his wife left, we went back into the store to buy some shoes that she liked...i ended up buying a pair of black strappy heels with studs which was going for 70% discount...so i only paid about rm53 for the pair of heels...i actually preferred the brown or the cream-coloured one but they only have my size in black...oh well, black still looks good...

We went back to do on call rounds and everything was pretty quiet though i had to go back to the hospital once to see some new admissions...thought maybe i could rest at home that night coz i wasn't feeling too well...but i guess the Angel of Death wanted to make a comeback...got a call from my specialist on call about 10pm telling me that there was an UGIB patient coming from Queen casualty...massive bleeding...but as with Malaysian efficiency, the patient only reached the OT at 12am...

Patient was intubated when he arrived...and blood was practically pouring out from his mouth and nostrils...and his nasogastric tube free flow was about 1 litre of fresh blood...so we proceeded to perform an on table OGDS to try to look for the source of bleeding...but all we could see was gush of blood...so we proceeded to exploratory laparotomy immediately...when we opened up the stomach, we found massive amount of blood clots...but no bleeding source...so we moved on to the duodenum...nothing in D1 and D2 but blood...

We were racing against time coz the blood and blood products were taking rather long to reach the OT...i could see the patient's heart rate steadily dropping from 100 plus bpm to 90...then to 80...to 70...to 60...and we still hadn't find the source of bleeding...but my surgeon suspected the worst so he opened up D3 and D4 and we finally found the source of bleeding...it was an aorto-duodenal fistula...we couldn't proceed to repair as patient was too unstable...by then his heart rate was 30 plus...and his pulses were no longer palpable...and we couldn't proceed with CPR due to medical futility...

The poor uncle...may his soul rest in peace...it's a horrible feeling...watching a patient die...and you can't do anything to save him because it was too late...and the indignance you feel when you know the patient could have reached the OT way earlier if not for the gross mismanagement at the referral level...sometimes you wonder if this was all really written in the Book of Life and Death...did God really plan for the 12 hours delay to OT? did God really plan for this uncle to die because of the gross mismanagement of his condition? oh, sorry, activated the God-complex mode...

Sometimes you would think that medical personnels are cold and heartless...coz even in the face of death, we still joke and laugh...forgive us, we don't mean to be cold and heartless...for some of us, it's a defense mechanism to deal with deaths...and many of us have seen too many deaths that we'd all sink into the dark abyss of depression if we allowed them to affect us...and it doesn't help that some of us are the Angel of Death incarnates...

On call, Van Ness Wu and a mistaken identity

So i'm on call today...3rd call of the new year...somehow it doesn't feel like a new year has begun...same routine, same kind of calls...well, at least i'm back in general surgery...no new year's resolution whatsoever...got a msg earlier from an aussie no...thought it was another friend who's working overseas now...and then suddenly i thought that maybe it was from the nightmare of Adelaide...so i was kinda rude in replying....turned out it was Jess...hehe, she's back in Melbourne...but i could have sworn i had her Melbourse mobile no. stored in my phone...guess it's been that long since i heard from her and i just changed my phone about half a year ago...hehe, paiseh only...

Anyway, i just finished watching Autumn Concerto over the weekend...and the lead actor was Van Ness Wu (of F4 fame; no, i was never into F4)...so i kinda googled him and found out that he is a Christian...and that he only became a believer about 2 years plus ago...and from the youtube videos i've watched about his personal testimony and interview, he seems to be a fervent believer...involving in evangelistic outreach...signing the true love waits card... kinda inspiring...kinda gives me hope that all is not lost...

God did come for the lost after all...and i'm very touched to know that Van Ness is a brother in Christ and that he has found the Lord as his Lord and Saviour...i've been slipping away from God and at this moment i'm feeling rather lost...but i guess God is still waiting for this prodigal daughter to return to Him...if only i can find the strength to do so...i'm just tired of repeating the 'sin and repent' pattern...instead of growing, i just keep running in a hamster wheel...Lord, please give me the strength and courage to come back to You...

Excuse me, i'm not your one-stop CBD insertion referral centre...

I don't know since when a urology MO has become the only MO who can insert CBD for patients who can't pass urine/ has swollen penis but apparently for the last few days, it has come to that...it's quite irritating to get referrals like that when there are hundred over patients in the clinic waiting to be reviewed...and as if i'm not seeing enough penises and scrotums per day in the clinic, i have to see them in other wards as well...

On Monday an MO from a particular ward called me up to help one of her patient who had bladder tumour and had acute urinary retention...she told me she tried inserting a size 16 urinary catheter but it wouldn't go in...so i went to see the patient...i tried size 18 and 20 but he probably had some anterior urethral stricture coz those sizes wouldn't pass through...i thought of inserting a cystofix but i couldn't even see which was the bladder proper from the ultrasound...so in the end i tried a size 14 and it passed through...phew!!! and i found out from the nurse that the MO didn't actually try inserting a urinary catheter on the patient...

On Wednesday, i got a call from the same MO...about the same patient...apparently his urinary catheter dislodged while he was sleeping...pretty amazing considering there was a water-filled balloon that prevents the catheter from getting dislodge and one would need to yank really hard and traumatize the urethra to get it out without deflating the balloon...i asked the MO to re-insert another size 14...she asked her nurse to call me back after 15 mins telling me she failed...fine! so i went to re-insert a catheter for the patient...couldn't get a size 14 in this time, so i tried a size 16...it went in easily...no resistance whatsoever...@#$#$%%^

The same afternoon, a Queen Casualty HO called me for CBD insertion...i had just left Queen earlier and had just reached SMC...reason for CBD insertion: to monitor urine output...patient was ventilated for APO...reason for difficult insertion: patient's penis is very oedematous...i asked the HO...did you try inserting it yourself...he said yes but failed...i asked if his MO tried and failed too...his answer, i quote "i don't think my MOs can insert a CBD becoz they haven't done it for a long time".... what the #$%$%&^*^&!!!?!!!

And an ortho HO referred a patient with generalized scrotal and penile swelling to me...patient has been practically bed-bound for a week...has low albumin...and he wants me to rule out scrotal infection....why do i keep getting referrals like that? when i was doing general surgery calls, i used to get referrals for scrotal swelling...now i'm i uro, i still get referrals for scrotal swelling...just wait till i'm back in general surgery...i will never see a scrotal swelling, ever again...

So i went to Queen Casualty after my rounds in SMC...i looked at the patient's penis...yea well, it was swollen...but i could still see the urethral meatus...no reason why any doctor who is not blind shouldn't be able to insert a urinary cathether for the patient...so i tried a size 14....there was only some mild resistance at the prostatic urethra which after some adjustment, the catheter was in the bladder...for goodness sake...i'm not a one-stop CBD insertion referral centre...

What is happening to the doctors these days? what? only uro MOs can insert CBD is it? if this continues, there will come a day when things get so bad that "refer to surgical MO for nasogastric tube insertion" becomes a routine...as it is, i've gotten 2 referrals "refer to surgical MO for proctoscopy"....as if we were never thought how to do a proctoscopy in medical school...oh Lord, give me strength to stay sane...this is really stretching my limit....

Yes, i know the patient needs blood...but i can't produce blood magically...

So yea, selamat hari raya to everyone...while everyone was happily eating their lemang and rendang yesterday, i was on call...and it was one heck of a call...as if my pre-call bad day was a prelude to an even worse one during my call...Yap and i were in the OT the whole day clearing up the leftover cases from the day before...a laparotomy with bowel resection, an open cholecystectomy, an I & D, 2 perforated appendix...don't ask me why we took so long, but we just did...and halfway through had to go ICU coz one patient died..what did i tell you eh? at least one death per call...

And as if that wasn't enough, i had to settle the uro patients....and there was a liver abscess patient in sepsis who was unstable...and the nephro ppl totally set my nerves off...they sent 2 patients from their ward to our side for Tenchkoff catheter insertion the following day...and the HO on call informed me that one of the patient's femoral CVC was removed in the morning because there was pus discharge from the insertion site...which was fine...it should be removed...but the least the nephro ppl could do was to bloody reinsert one and bloody dialyse the patient before they sent the patient over...patient's potassium was 6.1 and he was supposed to be for operation the next day...really, what were they thinking? expecting the surgery MO on call to settle their crap? well, they chose a bloody wrong day and person to mess with...so i asked the HO to call the nephro MO to settle their own crap...seriously, i should write a complain letter to the Head of Nephrology Unit and Medical Department to tell them how irresponsible their bloody MOs are...since my big boss has been telling me that the medical MOs have been writing him a lot of 'love letters' regarding our surgical MOs...

We finally took a break at about 10pm plus for the first meal of the day...by then i was just so hungry and grumpy and ready to faint...thank God the OT call HO belanja us at Upper Star (coz i taught her how to do appendicectomy)...i had lamb chop...felt like the best lamb chop ever coz i was raving mad hungry...then we had to rush back to OT coz there was still another appendicectomy...which i asked Yap to teach the OT call HO coz i didn't think i was in the right state of mind to teach...and we were expecting a 25 year-old guy from Hospital Kota Marudu who had an MVA and his Hb dropped from 11.9 to 2...we thought it would be a miracle for him to survive the 2 hours plus journey to KK...

But arrived he did...the casualty MO in SMC called me about 2am to inform me that the patient has arrived...when i saw him, his BP was 84/47 mmHg with pulse rate of 130...pale as sheet...abdomen was distended and tense...they scanned him in Kota Marudu and saw free fluid in abdomen...so i called boss on call and informed him...he asked to post the patient immediately for exploratory laparotomy and proceed...the patient had 3 pints of packed cell from Kota Marudu, one of which was transfused on the way...2 of which we started transfusing while he was in the casualty enroute to OT...we crossmatched more blood but could only get 3 pints from SMC...but we couldn't wait longer...so we started surgery at 245am...the 3 pints blood we had were quickly consumed...

Big boss was called in...patient's right liver lobe, right kidney and adrenal were totally smashed and bleeding profusely...they removed the right lobe of his liver, his right kidney and adrenal...surgery took about 3 hours plus...i was scrubbed in initially but as the blood seem to be taking forever to materialize, so i had to unscrub...and produce blood magically...although it was post-fasting month and the blood banks are low on blood stock...so i had to ask the runner HO to go to Queen to get blood...they could only give us 6 more pints...and a DIVC cycle...they took about an hour to get the blood back to OT...and while then i was helping the GA side to put up the IV drips, give medications...and i was getting scolded from the GA specialist on call for not getting the blood fast enough...and i didn't like the way she was implying that the surgical team wasn't controlling the bleeding fast enough...

The thing was, i agree that the blood wasn't coming fast enough...and that we weren't fast enough in controlling the bleeding...but in case that specialist didn't notice, i'm not God...i can't just snap my fingers and 20 pints of blood would appear instantaneously....big boss is not God...he can't just lay his hands on the patient and heal the patient...considering that he did a right liver lobectomy, right nephrectomy and adrenalectomy in about 2 hours plus, that's quite amazing already...though i must commend that the GA specialist did well on her side to keep the patient alive...anyway, i guess it's God's will that this patient survived the operation...he had a total of 12-13 pints of packed cell transfusion, 1 DIVC cycle and another 6 units of fresh frozen plasma...

Patient was sent to ICU post-op...and until 8am this morning, no one called to inform me that the patient has died...so i assume he would live...big boss asked me in the OT during the operation if i still want to do surgery after this...i told him, if i were the GA MO, i would still be awake while the operation is being done...what i didn't say was the only difference is that as a surgical MO, i can be ordered around by the GA MO/specialist to produce blood magically, whereas as a GA MO, i can order the surgical MO/HO to do the impossible...sigh, i'm just so tired...and tomorrow i'm on call again...and ppl still watch Grey's Anatomy/House/ER and think being a doctor is so cool...hahahaha...

Today is the first time i ever felt like quitting...for real...

I got transferred to a new rotation after i got back from a great holiday...i've always hated that unit even as a HO...you know how when you come back from a real high to a real low? that's like a great height to fall from...and today is the first time i ever felt like quitting..for real..one of our patient, a 15 year-old girl with history of cancer was admitted for ascites...we drained out about 1.5L from her abdomen 2 days ago...she felt better....this afternoon, when i was about to do my pm round, the nurse informed my HO that the patient's blood pressure dropped drastically...so the HO told me and we went to check on the patient...

So i gave her fluids...and do the necessary investigations...she looked quite drowsy and ill...i told my colleague who in turn told my consultant (who happened to come for pm round)...i thought he'd come to see the patient...but he didn't...my colleague came to help but as she was on call, she had to go to OT for a case...so i was resuscitating the patient with the help of the nurses and 2 HOs...we put in a central venous line...put in a urinary catheter to monitor her urine...tapped her abdomen coz it was so grossly distended and tense...by the time we did all these, it was after 6pm...

I was about to go home and wanted to have a last look at the patient to make sure she was ok...that was when i noticed she suddenly became unresponsive and looked like she was having a tonic fit... had to intubate her immediately...but of course, since this was in the ward, immediately took like forever...and the on call HO in-charge of my patient was an ultra-imbecile...thank God the other 2 on call HOs who were helping me were capable...i think Murphy's law was at work today...whatever that could go wrong, did...

I was in the ward till 830pm plus...we did CPR 3 times for the patient...shocked her twice...overloaded her...she went into acute renal failure...i just couldn't save her...she couldn't even live to celebrate Hari Raya tomorrow...i didn't watch her die...i left the hospital after ICU called to transfer her...i thought she would make it...or at least i prayed she would...but one of the on call HO msged me after i got home that she passed away...

I'm just so angry at the whole thing...at myself, at the bloody imbecile HO, at my boss, at my colleague...i shouldn't have to stay to settle patients after office hour when there're on call MOs...and i shouldn't have to be angry at stupid HOs even though they are stupid...i shouldn't have to be angry at my boss for not caring for his own patients...and i shouldn't have to be angry at my colleague because she left me alone to resuscitate this patient...but i'm angry at myself for feeling all these... i shouldn't even care...patients die anyway...in 2 days, none of the ppl involved in the situation would remember the patient...but it will haunt me...for a while...

I need to get a new job...where i won't have to see patients die...cause patients' death...maybe i really should go to NZ and become a seasonal fruit-picker/packer...or maybe i should become a wedding planner...at least i'll make ppl happy...instead of killing ppl...

I'm leaving...on a jetplane...and still having bad call...

I'm on call today...in Queen...my last call before i leave for NZ tomorrow...and so far i've been picking up messes...while creating mess myself...i think my boss on call must be cursing me now...in the morning, medical referred an 80 year-old man to rule out intra-abdominal injury...so i asked why did they think he was having that...the MO told me he had a fall...i thought, hmmm..did he fall from like 10 feet or something? and if he did, why would he end up in medical ward in the first place?

They got an ultrasound abdomen for the uncle, and the radiology MO informed me that the uncle had free fluid in the abdomen most likely due to splenic laceration...so ok, i went to see and was quite appalled by the course of events that ended the uncle in medical ward...he was actually referred for anaemia for investigation...they missed the crucial information that he was actually hit with a plank on his abdomen...right...so called boss on call...she asked to transfer patient over to surgical...for splenectomy..so yea, 1st mess picked up...

Then medical referred another 20 year-old guy for acute abdomen...they think he was having typhoid...his abdomen was very distended...ultrasound showed free fluid with sediments..so possible perforated bowel...called boss again...she asked to tap to see what fluid comes out...but i couldn't see anything when i scanned the guy's abdomen with the kuno scan in the medical ward...so i just poked at the right iliac fossa...aspirated a lot of air...then got some small intestinal fluid came out...looked like liquid faeces...so i thought ok...so it's bowel contents...so sent patient to surgical for laparotomy...then i told boss and he said that i poked through the bowels...shit!!!! so 2nd mess picked up...and er..created as well...now i hope his wasn't a negative laparotomy...

Medical also referred another 77 year-old aunty for rectal mass...the specific referral was for surgery to do proctoscopy...excuse me, but since when only surgical MOs are capable of doing proctoscopy? and the medical gastro team is capable of doing a colonoscopy, taking biopsy and getting the HPE result all by themselves all this while...since when are they no longer able to do so... forcing them to turn to the surgical team for proctoscopy? my my...how things have changes...oh, but i didn't pick this patient up yet...waiting for the HPE after the gastro team performs the colonoscopy and obtains the biopsy...

Then i saw another patient in the casualty (i actually saw a lot more but this one is the most interesting by far)...49 year-old aunty who presented with 5 days history of progressive abdominal distension and absolute constipation...no history to suggest colorectal or gynae malignancy...the only signs of malignancy was that she was quite wasted and pale...per rectal revealed an anterior mass externally compressing the rectum...so we did a per speculum and vaginal examination... we found a cervical mass...so called boss on call again...and she asked to refer gynae to take over first and surgery team will review the patient in their ward...poor aunty...

Oh well...come tomorrow, i'll be leaving on a jetplane...for a break i so badly needed...NZ, here i come..."i'm leaving, on a jetplane, wish i don't have to be back again, oh babe, i love to go" (sang to the tune of 'leaving on a jetplane')....my life is in a mess and it's time for some time off for personal reflection and soul-searching...hahaha...i always think that a trip would do that for me... but after i come back from every trip, i still feel lost and "un-searched"...sigh...may this restless wanderer finds rest some day....