Sunday, April 27, 2008

nothing is more dangerous than...

... a doctor who is not in control of his facts.

i write this as i am frustrated about a Medical MO in my hospital, whom i believe has grossly underestimated the severity of a patient's disease.

this 70 year old lady has psoriasis (i'm sorry, but you just have to google all these weird terms) for 30 years. for the last 2 weeks, she has had fever with chills and rigors, and now the psoriasis skin lesions have worsened and spread to her palms, soles and mouth. she is dehydrated and unwell, but thankfully not to the point of severe exhaustion.

i thought she had Stevens Johnson Syndrome, or erythrodermic psoriasis, because she appears fairly ill. SJS is dangerous, and needs careful management of her fluids and nutrition.

instead, the Medical MO writes down in his notes "...denies worsening of skin lesions" - a blatant and stupid lie, and decides to treat her for pharyngitis.

pharyngitis. that's a disease for children and young adults. how many 70 year olds do you know who has pharyngitis with fever for TWO weeks and NO marked sore throat, and has an existing skin condition worsen appreciably, and have all her relatives say the same thing?

he says her throat is injected but not inflamed. of course! that should cause the fever for 2 weeks! why didn't i think of that? and then he orders a blood culture. great. for pharyngitis. and then he keeps her in the ward for three days already.

if he's so sure that it's pharyngitis, why not just discharge her home? huh? huh?

he's not in control of his facts, unfortunately. and that makes him dangerous.

Sunday, April 20, 2008

sungguh menarik!

that's Malay for "very interesting", i'm told. i got this off the Internet, and i loved it, i think it's so bodoh (that's Malay for "dumb"), but in an endearing way:

Excerpts from a Dog's Diary

* 8:00 am - Dog food! My favorite thing!
* 9:30 am - A car ride! My favorite thing!
* 9:40 am - A walk in the park! My favorite thing!
* 10:30 am - Got rubbed and petted! My favorite thing!
* 12:00 pm - Lunch! My favorite thing!
* 1:00 pm - Played in the yard! My favorite thing!
* 3:00 pm - Wagged my tail! My favorite thing!
* 5:00 pm - Milk bones! My favorite thing!
* 7:00 pm - Got to play ball! My favorite thing!
* 8:00 pm - Wow! Watched TV with the people! My favorite thing!
* 11:00 pm - Sleeping on the bed! My favorite thing!

Excerpts from a Cat's Diary

Day 983 of my captivity.

My captors continue to taunt me with bizarre little dangling objects.

They dine lavishly on fresh meat, while the other inmates and I are fed hash or some sort of dry nuggets. Although I make my contempt for the rations perfectly clear, I nevertheless must eat something in order to keep up my strength. The only thing that keeps me going is my dream of escape.

In an attempt to disgust them, I once again vomit on the carpet.

Today I decapitated a mouse and dropped its headless body at their feet. I had hoped this would strike fear into their hearts, since it clearly demonstrates what I am capable of. However, they merely made condescending comments about what a "good little hunter" I am. Bastards!

There was some sort of assembly of their accomplices tonight. I was placed in solitary confinement for the duration of the event. However, I could hear the noises and smell the food. I overheard that my confinement was due to the power of "allergies." I must learn what this means, and how to use it to my advantage.

Today I was almost successful in an attempt to assassinate one of my tormentors by weaving around his feet as he was walking. I must try this again tomorrow --but at the top of the stairs.

I am convinced that the other prisoners here are flunkies and snitches.

The dog receives special privileges. He is regularly released - and seems to be more than willing to return. He is obviously retarded.

The bird has got to be an informant. I observe him communicate with the guards regularly. I am certain that he reports my every move. My captors have arranged protective custody for him in an elevated cell, so he is safe. For now . . .

***
for the record, i'm a dog person. i particularly love the daschund, the sausage dog!

Friday, April 18, 2008

The Desensitised Doctor

it was a busy shift today. i had to go for a talk, which ended around half past four. when i walked into Casualty, it was chaotic - there were simply too many Yellow codes lying around in various stages of dying. i counted at least 8 of them, not including one Red code and at least another 5 Greens (Trauma Centres worldwide code their patients - Red for imminent death, Yellow for very-nearly-there, Green for not-so-urgent and White for the non-emergencies).

i saw someone i know, whose husband is completely unresponsive but with stable BP and pulse, coded Yellow. my colleague was already attending to him, so i turned my attention to the other 4 Yellows which were not attended to yet. and promptly forgot about Mr K, with a hypotensive VT, APO, dense lacunar stroke and polytrauma to keep me occupied.

and then there were three 80 year olds and one 90 year old who were brought in, countless accidents, two bad lacerations, two dog bites and a hornet sting, and i had to dissuade a father from taking his son who badly fractured his forearm bones, to a traditional masseuse.

suddenly a Green awaiting transport to the ward for hyperkalemia began vomiting blood - all 2-3 litres of the stuff, some of which splattered all over me because i was the first to move. more resuscitation, more work.

and when i got back and got into the shower, i realised something: Mr K is the husband of Auntie Victoria, the cook at the Centre for the Intellectually Disabled in Taiping (Sekolah Semangat Maju), whom i love and adore. he is the father of Gunaseelan (my classmate) and Venoo (my junior in high school), whom i know and respect. he used to be a grasscutter, but with tremendous dignity. he cycled everywhere, and always had a smile on his face. he had salt-and-pepper hair, but no wrinkles.

yes, i hugged Auntie Victoria when i saw her just now, and it was a long hug, but really, was it worth anything? Mr K had a parietal brain tumour not amenable to surgery, and i immediately saw him as "less worth saving" than someone with a more correctable condition - the other Yellows beckoning to me with their fluorescent glory.

yes, i can persuade myself that i did the best i could - i allocated scarce resources appropriately, i saved those whom i could, my colleague had already attended to Mr K, there were other people that needed attention, Mr K was stable and not in imminent danger of death, it was a busy shift - yes, i can always tell myself that i am absolved, that God will understand, that Auntie Victoria will understand, that i DID give her a hug.

but in reality, i realise that i am small. that i am already desensitised to death. and that i may have lost my humanity in treating people like colour codes, and not humans.

oh please Lord God - save me.

Thursday, April 17, 2008

high school debating

when i was in UKM, i did a spot of debating, and i guess i was reasonably successful. high school debating was always something to drive me nuts - it was always prepared speeches and showy language, and not enough matter or substance. nothing prepares you for the real university-level debating.

so i'm always very happy that IIU Malaysia has organised a university-style debating tournament for high schools in Malaysia, for the last 7 years. they are one of the best debating universities in Malaysia, and has considerable support and goodwill both inside and outside their university as well as Malaysia.

four years ago, we started sending the first St George's and Convent Taiping teams to the tournament. the best achievement was one team making Quarters in the second year. this year, it's the fourth squad Taiping has sent into battle in Gombak.

and it's the best squad so far, in terms of debating success! St George's One made it to the Semis and lost very narrowly to the eventual champions, Sekolah Tunku Abdul Rahman. Convent One made it to the Quarters, and lost narrowly to the same team. we placed 2 speakers in the Top Ten, and both St George's Two and Convent Two (made up entirely of Form3 students) finished at 4-3 after 7 preliminary rounds - amazing achievements for young kids with zero experience and minimal training!

Convent Two even had the audacity to finish the first 5 rounds with 4 victories - if the prelims had ended there, they'd be in the top 5 teams in the country! Form 3, i tell you - no one suspected otherwise.

there were 90 teams in the tournament, and together with MRSM Taiping, 3 of 8 Quarterfinalists were from Taiping, and 2 of 4 Semifinalists too. i was looking forward to an all-Taiping Grand Finals - but it's something to look forward to in the next 2-3 years. haha!

Sunday, April 13, 2008

what do doctors blog about?

i'm not exactly sure, but sometimes they have an irresistible urge to talk about their cases, as follows:

CASE ONE: 15 year old schoolboy with a lisp, sees a 50cm-long-1cm-diameter black snake on the road in his school, decides to kill it. steps on the snake 5 times, and decides the snake was dead, and picks up snake in right hand "sebab nak buang" (because i wanted to throw it away). and gets bitten. twice. drops snake, and "pijak ular lagi 8 kali" (steps on snake another 8 times). hahahahaha!
VERDICT: admitted for a night for a swollen right thumb.
MORAL: Once Bitten, Twice Shy (or Thirteen Steps to a Dead Snake)

CASE TWO: 37 year old man with an abscess on the back of his head for 3 weeks, avoids doctors for that entire duration. convinced by a friend (or was it an enemy...?) that his cure is a leech. puts giant leech on abscess "sebab nak hisap nanah" (because i wanted it to suck the pus). the leech drops after 30minutes, and he bleeds non-stop for 6 hours. hahahahahaha!
VERDICT: discharge, but unable to promise never to repeat stunt.
MORAL: Once Bitten, Twice Shy (or A Leech is Not a Pus-sy)

***

Thursday, April 10, 2008

200. Boat Building

this marks the 200th post - not the proudest moment of my life, really. instead of re-examining my intentions for continuing a blog in a blogsphere where a new one comes out every 37 seconds, i think i'm just going plough on (hopefully not in an agricultural way, haha!) and try to entertain as much as i can.


when i was in Pangkor, i rented a bike and went out on the first day, before anything official had started. the island was small enough to go around it in 30minutes by bike, over very challenging steep hills, difficult even for a motorcycle.

eventually we cycled the damn island, but that's another story.

on my way back, i saw that there was a ship being built. from wood! so i stopped and had a chat and took pictures.

this was what i saw first from the roadside:





already this boat looked like it will never capsize, only 1.5 months into its life.







i've always liked boats that were built from scratch - the hard wood, the traditional approach, the stability of the step-by-step - our ancestors used to cut down a large trees and hollow them out and voila! a dug-out canoe. and used those canoes to go all around the world - even out onto the open ocean where they couldn't see the other piece of land and didn't know where they were going.

i spoke to the guy who was sitting by the roadside, watching other people scurry around the boat. he looked like a boss-man. like many working men, his answers were succinct. exclamation marks are my own - he answered in a monotone. here's the FAQ:

Q: how much does that boat cost?
A: RM400,000!
Q: how long will it take you to build it?
A: 6 months.

Q: where do you get the wood?

A: Pahang.
Q: how many feet is this one?
A: 65-footer.


Q: what wood is it? A: cengal batu for the sides, and cengal for the mainframe.
Q: how much is it? A: RM7000/tonne for cengal batu, RM4000/tonne for cengal, and prices are increasing.

the mainframe - how they start with the skeleton. it's the third contract, and they'll start on it after finishing the other one.






this is what the fish-eye view of the boat is - i had to scramble underneath the boat to get this shot, all the whole worrying that it'll all collapse on me. i tried punching the wood as well, just to test its hardness - harder than steel! the electric saws that they use to cut them into shape, has to have their blades changed (not sharpened, but replaced) every 2 months!!



Q: are you the boss?
A: no, i'm the engine man.

Q: wow! how much is an engine?

A: RM200,000.

Q: wow! how many BHP?

A: (i'm vague about the answer, i think it was around 600bhp)

Q: what are the propellers made of?

A: bronze. bronze!!

Q: how big are they?

A: 80 inches! (that's longer than i am tall!)

Q: how many boats get built a year?
A: last year, only 2 contracts. this year this is the 2nd contract. so far 3 contracts this year.

Q: how long will they last?

A: 30 years maybe.

the boat is taking shape, especially from the sides. note the amount of nails (1cm diameter) that are hammered in. on average, around 20% of nails get bent if hammered in wrongly, because the wood is so hard.


Q: if fibreglass fishing boats are so much cheaper (i know they are around RM100,000 for a 30-footer), why build a wooden boat? A: it's usually sturdier in the water, and their fathers used to fish in a wooden boat too.

taking a break - i wonder if his father used to build boats too. it's such an art, and there are no textbooks, and they serve apprenticeships for 5-7 years before they become a full-fledged boat-builder. i hope this never dies out.


Friday, April 04, 2008

obituaries, and why i love them

macabre huh? tonnes of people die every day, and some are very famous and have their own obituaries plastered across newspapers all over the world, most recently like Benazir Bhutto.

yet others aren't so famous in that way, but they were important people in Mathematics or Marine Biology perhaps, or they were a champion horse jockey, or a brilliant First Violinist in the Kiev Philharmonic Orchestra, or a notorious prankster, or a war photographer, or the screenwriter for Gone With The Wind, or a noted Egyptologist, or the creator of the modern jet turbine, or a world-famous restorer of medieval Japanese swords, or a million other people who deserve as much attention as the Hitlers and Monroes of our time.

the Greek god of Death is Thanatos, and not surprisingly there is a branch of human knowledge that studies death, and it is called Thanatology. students will read about how cultures deal with death, the social anthropology of death, religious and medical implications of death, and so on.

obituaries fascinate me because death brings a distinct clarity to our souls, and the achievements of the dead (while they were alive) stand out very clearly. obituaries show us exactly what these "obscure" people have accomplished, and best of all, we will listen and appreciate for a change, because ALL cultures honour the dead, and the least we can do to honour them, is by listening, and remembering, and appreciating.

death is so final, and such a reminder of how temporary things are, that obituaries share its finer qualities - an encapsulation of a person's life from womb to tomb in less than 1000 words and a picture. we are reminded in one brief article how short our lives really are, but how much beauty and achievement we can cram in a few short years - obituaries serve as a reminder of the gallantry of human effort, as well as the inevitability of our passing.

***

i read obits from The Economist and The New York Times, and i came across this brilliant set of questions to the NYT's Obit Chief, and his equally succinct replies:

1. How do you go about approaching famous people while they're still alive to request an interview for their future obituaries?
2. Do you seek interviews only with those in good health, or also those known (or rumored) to be sick or in decline?
3. Do your reporters in such interviews delve into touchy subjects or disputed events and facts of a subject's life?
4. Do famous people tend to try to whitewash or aggrandize their pasts?
5. Does anyone ever spill the beans about their role in unsavory events, or candidly confess to unflattering actions on their part?
6. Does The Times ever promise to embargo juicy, newsworthy details until the subject has died?
7. Has any famous person ever succeeded in pulling the wool over your (The Times's) eyes?
8. Does The Times ever gloss over, or omit entirely, the sordid details of a famous person's death?
9. Obituaries usually get the last word about a person. Does that place any special burden on you?

1. Directly but also delicately.
2. All of the above.
3. They had better.
4. I think you know the answer to that one
5. Not to my knowledge, but it's what we live, hope and pray for.
6. Yes, always. That's the deal, and sometimes the carrot.
7. I'm guessing: Yes.
8. We may not be needlessly graphic, but we don't ignore them.
9. I think so. And many people think of a Times obit as the last last word. So it's a double weight.


***

it's hard not to put a sombre tone on this post, but any levity will only destroy the sanctity of Death. obits make me stop and feel for a while, but sometimes they also make me laugh! :-)

***

just before i click post, i realise that today is the Chinese All-Soul's Day, when we pray to those who have left us, and it's 4/4/08 as well. i'm not exactly superstitious... but shudder!

Tuesday, April 01, 2008

two weeks of not blogging

when you come back from a holiday and you haven't blogged for some time, you have lots of stories to tell and you feel like telling them all, but it'll take time, and you prefer to do things verbally, because they're interesting stories, which can potentially go flat if they're read and not heard - and you love to see people's eyes light up when you tell them a story, something you cannot see when you're writing something down and won't ever know who reads them.

and the tremendous amount of blogs in the world these days is commensurate with the information explosion that is happening all over the world. everyone with a blog thinks their own opinions and stories are the most interesting thing in the world, when in actual fact, the readership is largely numbering in the double-digits. perhaps including this one, haha!

so with so many blogs coming up, who's going to read them? we have to read our friends' blogs (no matter how boring) because it's socially important. we catch up with a few we're interested in, and we follow a few religiously because we love reading them. this is in addition to updating our own blog - the sourcing of stories, the typing, the proofreading and the is-this-interesting-enough questions we ask ourselves... on top of our work commitments, or family, or sports, or reading, or pleasant conversations. how ever do we find the time??

***

i spent 2 weeks in pangkor with voonhoong, my best buddy for 5 years from UKM. we shared a room, and in general behaved at a constant low level of rebelliousness.

the second last day we were there, we decided to go kayaking to Pangkor Laut. we made it there and was swimming in Emerald Bay before we were chased away after 30minutes by the guard. on our way back, we decided to go in between two rocky outcrops, as it was the quickest way back.

nearing the two outcrops, we encountered turbulent water, and despite full strength rowing for 5 minutes, we remained absolutely at a standstill! so we put on our lifejackets (we had taken them off to get an even tan), and rowed full strength for another 5 minutes, and again got nowhere!

when the first doubts entered our heads, along comes a motorboat with a 19 year old at the helm. he asked if we were okay, and said that the water is a little turbulent. for a moment, we didn't want to ask for help (chauvinistic idiots), but after a second thought, agreed to let them pull us to safety. so we held on to their boat, and they pulled us out of the area of turbulence, and we kayaked the rest of the way back to shore.

phew! i'm alive! we are both agnostic/free-thinkers, but we were moved to spend a minute's silence in the hotel room afterward.