Kenangan

Sedar tak sedar hari ni sudah 18 Disember 2011. Rasa bagai baru semalam aku menuliskan 18 November. Hampir pula terlepas untuk membayar ansuran kereta.Sudah semakin ke penghujung tahun Masihi.Entah apa yang bakal menanti kelak.

Sudah setahun lebih juga aku menjejaki alam pekerjaan. Mana sangka, cita-cita di bangku sekolah kini telah menerjah kehidupan realiti, tinggal untuk memperelokkan lagi sahaja.

Bekerja di tanah air ini memang mencabar. Lain benar cabarannya dengan di Ireland dahulu. Di sana, walaupun tidak berkesempatan makan gaji dengan Kerajaan Irish, aku sempat juga memasuki Health System mereka yang ternyata lebih dekat di hati pesakit dan pekerja. Tak sabar menanti bila agaknya kerajaan Malaysia hendak memperkasakan Family Medicine dan menambahkan lagi bilangan government and semi-government hospitals.

Dahulu ketika di Medical School, saban tahun pasti aku akan dihantar ke periphery hospitals.Tahun kedua ada Family attachment di Douglas, sebanyak lima pertemuan diatur dengan Mr Browne yang menghidap Parkinson dan Bipolar Disorder itu.Perjalanan ke sana dengan menaiki bas nombor 6 atau 7 sungguh mendamaikan, menyusuri countryside yang lebih kampung daripada Cork itu sendiri.Sebelum pulang, acap kali aku singgah di Dunnes Store di bandar itu.

Tahun ketiga, aku dihantar ke Clonmel, sebuah lagi perkampungan Irish yang serba hijau.Perjalanan menaiki bas memakan masa sejam setengah. Kami ditempatkan di sebuah Bed and Breakfast yang sempurna dan selesa.Selalunya kami menumpang kereta kawan-kawan mahupun senior untuk ke hospital yang terletak agak jauh, di atas bukit pula tu.Sebulan di sana, aku attached dengan Geriatrics and Endocrine.Suka hospital di sana, tak begitu ramai seperti di Cork.

Masuk tahun keempat, aku ke Dungarvan untuk GP Attachment.Hanya aku dan Brian, seorang pelajar matang dari USA dihantar ke sana. Lokasi penginapan dan klinik sangat dekat, lebih-lebih lagi apabila melalui Dungarvan Shopping Centre sebagai short cut.Bertemu dengan GPs dan patients yang sangat baik.Kemudian untuk Surgery, aku dan Afzan dihantar ke Mallow, sebuah hospital kecil di atas bukit yang mendamaikan. Kami tidak begitu rajin ketika itu, jadi hari Jumaat adalah hari yang dinanti-nantikan untuk kembali ke Cork.

Final year...aku ke Clonmel sekali lagi untuk A&E attachment.Basically unit itu tidak begitu menggerunkan berbanding di sini, kadang-kala begitu sunyi tanpa kes. Bila berlaku kes besar macam gun shooting, kami pula tiada kerana pulang berhujung minggu.Kami berempat dihantar ke sana, aku, Peter (yang kemudiannya masuk wad selama 10 hari kerana subarachnoid haemorrhage), Aoife Turner (yang telah digoda oleh Registrar di situ sampai mencarinya di BnB) dan Jean (Miss Cork 2008 yang sebelum itu baru sembuh daripada seizures).Kemudian untuk GP attachment, aku ke Mallow sekali lagi, kali ni lebih berada di bandar yang kecil itu, hanya sekali aku berjalan selama hampir sejam ke hospital untuk sesi bersama physiotherapy.

Sengaja aku coretkan memori ketika peripheral attachment dahulu, agar tidak luput di ingatan.Honestly I enjoyed being in Ireland no matter how difficult my life was before.No matter how easy my life now, being in my own place, things are just not comparable...

Aku juga appreciate keindahan bumi Allah di tempat-tempat lain sekitar Ireland. Antaranya Dublin yang serba maju dan dihujani oleh ribuan manusia, Limerick yang terkenal dengan kes-kes jenayahnya namun masih bisa menggamit hati atas keindahannya, Waterford yang mungkin hanya  dua kali kujejaki tapi penuh bermakna, Wexford yang mempertautkan satu ikatan cukup bermakna, serta Galway yang juga kampung seperti Cork. Cuma Belfast yang tidak sempat kujejak...Teringat pula pada Cliff of Moher, tempat pilihan Westlife membuat video clip mereka, Ichydoney Beach..tempat kami bertiga berkelana, yang kemudiannya diperkenalkan kepada ayah, mak dan YB tatkala mereka berada di bumi Ireland dahulu, serta Clonakilty yang meninggalkan seribu satu kenangan...

Kini semua kenangan itu pasti tetap kukenang, dan aku akan teruskan langkahan kakiku untuk ,mengejar apa yang harus kukejar..

Jumaat lalu ketika di kedai buku, aku terpandang pada sebuah buku bertajuk,"Masih Bujang? Relakslah..." Menarik tajuknya tapi aku tidak terpanggil untuk membaca atau membelinya.Aku bersyukur atas nikmat bujang yang Allah berikan, ia umpama "waktu lapang sebelum sibuk".Masa yang ada ini dapat kugunakan sebaiknya untuk sesuatu yang mungkin tidak akan dapat dilakukan lagi setelah berumah tangga kelak. Namun, aku hormati dan gembira dengan rakan-rakan serta juniors yang telah pun berumah tangga pada usia muda.

Aku percaya bahawa Allah itu lebih tahu bila waktu yang sesuai untuk kita mengubah status diri. Jika aku mahu, Dia lebih tahu, jika Dia mahu, aku tidakkan tahu...

Bila aku bawa mak dan ayah ke kenduri, soalan yang sama orang tanya, " tak kerjakah hari ni?"...Wah...bosan sungguh mahu menjawabnya, balik-balik kerja juga yang dibicarakan, jika aku bekerja, tidak muncullah aku di kenduri itu.Sekarang ni ke mana-mana pun mereka melihat aku bersama mak dan ayah, kelibat abang-abang tiada lagi, benarkah satu hubungan menjadi renggang apabila satu hubungan lagi dijalinkan?

Bits and Pieces

I have been in this new department for more than a month. I started with the toughest ward, followed by the so-called chill ward, but not to our team apparently !
My main concern before I join the department was how do I deal with the frequency of patients needing resuscitation, especially during oncall times? Now, resuscitating patients are part of my routines!

Patient collapsed

When patient undergoing haemodialysis suddenly developed hypotension, and your MO was unreachable, all you do is to withold the dialysis and start inotropes, since the patient can't tolerate fluid resuscitation. Here in this department, you work more independently, when you can't contact your MO, you better do something, as long as patient survives!

When initiating resuscitation, remove your white coat and the hanging name tag, but make sure your stethescope is reachable.Emergency trolley must be pushed to the bed, pull the curtain, put on cardiac monitor, ask the nurses to prepare adrenaline/atropine and ask them to call MO.

On our first day in this ward, two patients collapsed and unable to revive :(

Today, a patient collapsed for the second time, at about the same time as yesterday. I joined in the team to help, and alhamdulillah, during my chest compression, patient's heart beat came back and he survived. What important is not the outcome, but the effort you have put into. I could have just walked away and let my oncall colleague handle it but what if the patient is your relative, would you stay and help all out or leave?

Misi oh Misi

Tired of being called Misi. I don't look down on Misi, never do I, or will I, but I just can't tolerate those who simply call us, the female HOs, "Misi" just because we are all female like the nurses. Yesterday, while me and Vadi were doing morning reviews, a man came asking about his father's diapers size. He spoke English (that means he is somehow educated), but he called us NURSE.My friend spontaneously answered him, "We are not nurses, we are doctors. The nurses are there, you can ask them". The man was like, "oh, uh..uh".Seeing him in "shock", I just gave him some advice about the diapers (since I am taking care of my grandma, I know some things about adult diapers).

Today, a son in law came to me asking about his father in law.He called me Misi.I said, " I am not Misi." He laughed..then continued asking the questions.Okay, fine, maybe he came from a village and not that educated. I could tolerate that. In the evening, he came again, calling me Misi.My oncall colleague corrected him, "Ini bukan Misi, ini doktor." He still laughed and continued asking.So, what do we call this?

When we were walking to the auditorium for a meeting, a woman stopped my colleague by calling her Misi.She wanted to ask something, My friend just smiled and responded to her query.Ehem, my friend is a tall, slim girl who really have the look as a doctor. But still...?

Consultant Who Needs A Moral Education Class

He is a consultant radiologist but he acts like a billionaire who doesn't mix with people. Every time when you went to see him for some imaging, he will just ignore you totally. Like you are begging for his money. Like he pays for all the imagings.My friend who went to see her earlier just showed the imaging form in front of his face after he ignored her once and just walked away.Me, being a bit more patience, I just waited and waited, standing there like nobody business, until another consultant radiologist came and asked me, and I finally got the approval from the other consultant who wasn't even in charge of CT that day!

In the evening, I was supposed togo and get another outpatient appointment for my patient but I specifically told my MO that I can only take the next day as I can't tolerate one more "mute moments" from the consultant. He understood (maybe he had experience it before) and allowed me to go the next day. Alhamdulillah, I got an early appointment by a better radiologist the next day.

Weddings

I sincerely apologize to all my friends who invited me to their weddings, but I couldn't make it.My classmates in MRSM got married last weekend but I was working all day. My colleague last minutely invited me to his wedding in Kedah but I couldn't go as well. My junior who got married few months ago and currently pregnant - I started tagging in my last department during her reception and I started oncall in that department on her husband's reception day. My Indian colleague's wedding on Wednesday last month - also I couldn't go as I was working PM shift till 10 pm (but I only went back at 11.30pm).I was also working till 5 pm on my secondary school friend, who invited me 2 days prior to her wedding via SMS.

Again, I apologize for all my absence. And to those who did not invite me (because they invite via Facebook but I don't own one), I don't feel left out, but instead, I am thankful that I did not receive the invitation, hence, I don't have the responsibility to go...

Hoping and giving up

Unsure how and when, but I really have high hopes to go to Kelantan, particularly a few places...The best time to go is before the general election...

And I am giving up on something that I think is not meant for me.Once its deleted from my life, it can never be retrieved back.I think this is the best.

Pengaruh Benadryl

Migraine pula malam-malam begini. Ditambah pula dengan perasaan yang bercampur-baur.

Esok bakal memulakan posting baru. Tadi baru siap assessment and logbook semua. Dah masuk fourth posting ni, terfikir pula, layakkah sebenarnya aku? Ni kira dah jadi SHO, genap setahun menghabiskan housemanship. Tapi knowledge and experience tak seberapa. Siap terkantoi dengan head of department bila dia tanya pasal pathophysiology tadi. Mujurlah dapat peluang kedua. Mujurlah Allah permudahkan jalanku. Masa susah ingat betul pada Allah, masa senang…kadang-kadang boleh lupa. Astaghfirullah.

Ahad yang lepas adalah oncall terakhir di department ini. Tercampak di MH pula. Sedih betul melihat keadaan labour room sementara sekarang – macam kem pelarian!! Kasihan pada ibu-ibu yang bersalin di situ. Suami pun tak boleh masuk dah sebab keadaan di situ dah tiada privacy antara patients. Mujurlah tiada flat baby malam tu. Dah la kami berdua relax saja bila dapat panggilan. Siap boleh delay lagi. Tiada lagi adegan berlari pecut turun tangga untuk resuscitation.

Dah batuk semula..hari tu dah ambil masa dua bulan untuk fully recover.Sekarang recur balik. Semalam lepas dinner, aku pun bengong-bengong sebab berada di bawah pengaruh Benadryl. Baring sambil tonton 30 minit bersama Ustaz Don, last-last Ustaz Don yang tengok aku. Sedar-sedar dah 12.30 pagi.

Sekarang headache…macam-macam jadi hari ni. Paginya ke hospital terpacak depan kaunter menunggu specialist in charge sign logbook. Mujurlah dia sign tanpa banyak cakap. Balik rumah makan breakfast, tok pula buat hal. Kena cuci-cuci sikit baru keluar dengan ayah untuk servis kereta. Balik rumah, Tok buat hal lagi.Memang menguji kesabaran bila menjaga orang tua. Aku rasa otaknya tengah atrophy, sebab tu dia jadi satu macam hari ni. Petang keluar lagi ke hospital, tunggu HOD dari dalam office sampai ke luar office.Alhamdulillah, dia sign juga logbook tu. Balik hujan lebat, terus ambil mak kat GMC, singgah kedai beli makanan dan balik.Headache…

Malam ni nak tengok lagi 30 Minit Bersama Ustaz Don tu. Tak ingat langsung isi ceramahnya, Benadryl lebih kuat nampaknya. Walaupun aku tak prepare apa-apa untuk esok, aku harap aku akan dapat melaluinya. Kali ni aku keseorangan. Semoga Allah beri kekuatan dan kemudahan buatku.

Kebanjiran Pakar

Siapa kata negara kita kekurangan pakar perubatan? Sebenarnya setiap hari kita dapat melihat kemunculan pakar-pakar perubatan baru, terutamanya dalam bidang kanak-kanak.


" Saya tengok dia okay saja, tak perlulah ambil darah"
" Dia nampak penat, tapi kat sini tak buat apa-apa pun, saya nak transfer ke private hospital lah"
" Kenapa, awak tak pandai ambil darah?"


Kenyataan di atas adalah antara komentar yang dilontarkan oleh pakar-pakar ini. Saban hari mereka cuba sedaya-upaya untuk mengetengahkan pendapat mereka yang sangat profesional itu. Mereka buat keputusan sendiri sama ada ingin membawa anak yang sakit ke hospital segera, ataupun tunggu sehingga lewat malam, ataupun tunggu sehingga dapat cuti, ataupun ketika anak sudah nazak. Kemudian mereka juga yang pilih sama ada mahu masukkan ke wad atau tidak. Kemudian mereka juga yang pilih sama ada mahu diambil darah atau dimasukkan branula atau tidak. Kemudian mereka juga yang membuat pemerhatian ke atas pesakit sama ada rawatan yang diberi mencukupi atau tidak.


Wah, bayangkan jika setiap lima puluh pesakit di wad itu mempunyai pakarnya sendiri, bukankah negara sudah mengalami kebanjiran pakar-pakar pediatrik?


Pada suatu pagi Sabtu yang tenang, sedang aku dan MO buat morning rounds, seorang nurse memanggilku untuk membantu oncall collegue ku di dalam bilik rawatan. Dia tidak dapat mengambil darah daripada seorang kanak-kanak perempuan yang dirawat sebagai dengue fever. Aku masuk ke dalam bilik rawatan, keadaan agak tenang, kanak-kanak itu baru habis menangis. Dengan izin Allah, hanya sekali cucuk, aku berjaya mendapatkan FBC itu.Bapa kepada kanak-kanak itu membuka pintu walaupun prosedur belum lagi habis. Dia masuk untuk mendapatkan anaknya walaupun sudah jelas tertulis di pintu bahawa ibubapa dilarang masuk.(kawanku kata sebelum itu dia asyik buka-tutup pintu saja, memang mengganggu konsentrasi)


" Ni cucuk berapa kali ni???"
" Saya cucuk di sini, kawan saya cucuk di sini." Rakanku menjawab, cuba mengawal keadaan.
" Kenapa, awak tak pandai ambil darah?"
" Kadang-kadang memang susah sikit, encik."


Lelaki itu membawa anaknya keluar. Mulutku terkunci tapi hatiku hitam terbakar. Walaupun kenyataan pedih itu ditujukan kepada rakanku, aku tetap terasa. Apa agaknya pekerjaannya? MA dekat OPD yang selalu dan pandai ambil darah kah? Kalau pandai, lain kali encik ambil sendirilah ye.Peristiwa itu sampai ke pengetahuan MO dan nurses. Rupa-rupanya dia memang kurang bertamadun. Panggil staff nurse sekadar bersiut-siut. Apakah mahal sangat suaranya? Atau dia terlalu keliru sehingga tidak tahu apakah yang patut dipanggil terhadap wanita beruniform putih , bertudung dengan lilitan biru di kepala?Esok paginya jangan haraplah kami nak "sentuh" anak dia lagi. Ada juga manusia begini, entah bagaimanalah anaknya bila besar nanti jika bapanya berperangai begitu.


Malam yang lain pula, juga malam yang tenang, oncall dengan MO dan specialist yang baik. Ada satu new case referred from LWEH. Datang ke wad pukul 8 malam.Bila specialist buat rounds, dia clearly introduced herself, dan kemudian bertanya, kenapa mereka datang after 5 pm? Bukankah seizure tu dah berlaku pukul 1 pm? Mereka tidak menjawab. Tapi yang aku tak puas hatinya, bila specialist dan MO dah habis rounds di ward, dan pergi ke CICU, tiba-tiba bapa budak tu datang kepadaku.


" Misi, saya nak minta bawa balik anak malam ni boleh tak? Saya takut dia tak selesa, tak boleh tidur di sini.Lagipun malam ni takda bagi ubat apa-apa kan? Esok baru Neuro team nak tengok dia kan? Lagipun dia cuma fits bila kena hot bath saja."


Erk!!! Tadi masa rounds tak nak tanya, sekarang dah takda specialist baru nak tanya. Dah la panggil aku misi. Malam tu aku dan partnerku dan MO pakai blue scrubs, nampak macam misi eh?Baiknya misi ikut rounds,lepas tu tulis-tulis pula dalam notes patient. Okay, boleh dimaafkan, mungkin mereka selalu dapatkan rawatan di private hospital, di sana kan doctors cuma rounds pagi, waktu lain semua cuma ada misi,so mungkin dia fikir begitu.Aku inform MO dan sudah tentulah dia tak izinkan. Aku explained sebaik mungkin dan mereka tak jadi balik. Mujurlah mereka pandai berbahasa.


Satu, mereka ada delay untuk datang ke sini, after office hours baru sampai, tatkala bilangan doctors sudah berkurangan, Neuro team pun dah balik. Kedua, mereka tentu kecewa kerana kena duduk di wad dengan pesakit lain, maklumlah, mana ada single room- double room macam di private hospital. Ketiga, mereka lebih pentingkan keselesaan anak daripada kesihatan anak, sebab tu mereka nak selesa di rumah, sedangkan mereka tak tahu, bila-bila masa saja budak tu boleh fit balik.


Kesimpulannya, banyaklah keputusan-keputusan bombastik telah dihasilkan di wad ini, hasil kerja keras pakar-pakar bertauliah ini. Banyak lagi, sampai tak tertulis  di sini.Pengajarannya, ibu bapa perlu berilmu dengan ilmu yang betul, dan gunakanlah ilmu itu untuk kesejahteraan anak-anak, bukan untuk mencari kesalahan dan kekurangan manusia lain, kerana anda juga adalah manusia.

Credit Card Syndicate

To those out there who owns a credit card, please be careful. Widely used tactics nowadays -- you will get a phone call from someone who sounded like a good person, either using a private number/ landline number/mobile number. The person will mention your name and explained that she/he would like to send you a VIP card to those using credit card, or she/he would want to confirm with you regarding delivery of credit card, or any other reasons involving a credit card. He/she would introduce him/herself as someone by mentioning a name, as to appear more real. Then she/he would start asking your credit card's expiry date.

Please, do not ever mention your card's expiry date as the real credit card officer will not ask you this information, she/he already have it! Only if you were the one who made the call first to change or ask something then only they will ask your credit card number [not expiry date] for confirmation.

Last week, an Indian guy called my brother, telling that he wanted to confirm a delivery of credit card. Immediately my brother suspected him a scam, as he collected the card himself from the bank, there was no delivery occurred. The guy requested for the expiry date and of course my brother refused to give, so the guy threatened to block my brother's credit card. My brother challenged him back, and after several more conversations, the guy cut off the line. My brother phoned his bank immediately and confirmed that the guy was not an authorised credit card officer from the bank! So the next day my brother called me to warn me about this...

Two days ago, a woman introduced herself as Shila, called me using mobile number 0162627544, saying that she is sending a VIP card for all Mastercard/Visa card holders. She asked my card expiry date...I was like, uhh..she is asking the question? So I asked her back, why do you want to know the date? She said, she wanted to confirmed the card,before delivering the VIP card.I paused for a few seconds. Then I asked her back again, why do you need the date? She gave the same answer, then I quickly said, bukan apa, sekarang kan banyak sindiket tipu kad kredit..Then she hung up.

I feel like cursing her with all my heart, I sent her text message, saying that I will make a police report, and the message was delivered. After that, the number was uncontactable till today.

I thank Allah for making my brother to warn me fast, or I would have trusted the evil "Shila" and uncover my card expiry number, then she would have enjoyed online baking to the maximum before I could realized that my bills has reached the maximum.

So for all card credit holders, be super extra careful...and to those who are evilly involve in the syndicate, please repent before it is too late. Anyway, the money you obtained is not halal, regardless you are a Muslim or not.

I hate people who just like to be evil opportunists and make other people's lives miserable.And things that I wonder now is, how do these evil people know that we are holding a credit card? They know our names and our contact numbers.Did they get it from the bank? Or they themselves work in the bank? Hurmmm...

Post call

:(

RESPIRATORY

Alhamdulillah, I completed 5 weeks of Respi last Wednesday, plus I got 2 days leave after that. What a beneficial experience, and great knowledge I had obtained. My specialist is my own supervisor, at least she knows me, knows my capability. I feel comfortable working with her, she is a young specialist, perhaps her pathway in her career was smooth. We were oncall together a few times, and we felt comfortable and easy working with each other. My consultant is a Kelantanese modern Malay woman. She is unique, can be nice and can be stunning as well. During oncall, all the MOs and HOs are afraid of her especially during rounds. That day she ignored the new MO (as she was unable to present the case and didn't know how to prescribe the right antibiotics) and asked me to present the case. I heard she is usually okay with house officers.I did learn something important from her : "remember your case well".


My MO...uh,hard to say about her.She had always been on leave, leaving me alone doing her job and my job. People said she is @#$%^ but with me she seems okay, she trusted me and told me her personal feelings. She warned me earlier if specialist was in bad mood. She needed my help in translating to Malay several times, I needed her help in inserting difficult branula several times.Yet, everyone was horrified by the way she poked the patients.The nurses said, even HOs are better aka more humanly...


I learnt about the metered dose inhaler...from salbutamol, to budesonide, seretide, flixotide etc. From simple MDI to easyhaler e.g. giona, buventhol etc...nebulisation - from 0.5:3.5 salbutamol to AVN to budesonide 1 mg BD. I listened to all kind of lungs - crepitations, ronchi, biphasic stridor (prolonged inspiratory sound), wheeze, prolonged expiratory phase etc. Learnt about anti reflux for GERD - omeprazole, ranitidine, domperidone...learnt about sleep study and pH study...learnt about BIPAP - the IPAP/EPAP, rate and oxygen..went to radiology department many times to get barium swallow appointment and HRCT appointment...counting respiratory rate every reviews..


All patient under respi follow up who presented to casualty will be admitted, they are chronic patients, so better be safe than sorry, admit them for at least one day, then discharge the next day if well.My specialist called me lucky as I discharged many chronic patients once I joined the team the week before Raya.But I was the one who suffered to finish the long and complicated discharge summaries...Also the stacked of census in clinic...unsure who will do it next month as there will be no more HO in respi...


My favourite respi patient, Adam currently just re-admitted for aspiration pneumonia...poor that cute little baby.So adorable, I feel like hugging him, of course I can't do that...My second favourite is of course Cingi, who was acutely unwell and pushed into PICU when I was oncall there for the first time. Now she is very well in the ward, so friendly, she likes to touch people's hands and always smiles..


My good friend took over respi for 2 days when I was on leave, and she had been complaining about the workload and environment to my other good friend. I thank her for her presence, but imagine, how I suffered for the past one month, being alone and stress?? Despite all the hardships, I considered lucky for not being sent to oncology or nephrology...because that is even more difficult.


Thank you Allah, tomorrow I'll start general medicine with most of my good friends in the same ward with me :) And tomorrow I am going to be oncall and off the next day. Now we have new rules, whoever oncall, tomorrow will get day off after pass over to the morning persons.So now we work for 24 hours, no longer 36 hours.They can't practice the shift system, so this is the best they can do...