Talking about Human Rights...

I posted on Female Genital Mutilation in 2005 and would like to share it here again after reading some related articles online lately. Many knows and are familiar about male circumcision, but I believe not many have heard about female circumcision, which is also known as Female Genital Mutilation (FGM). Up to these days, FGM is still practiced in few countries like Africa & Middle East etc.

I had came across a case of Female Genital Mutilation(FGM) for elective Caesarean Section in 2005. That patient is an African lady, from North Africa and the "female circumcision" practised there or FGM is a social custom. Her's is FGM type 3, involving excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation), removal of clitoris (clitoridectomy), excision of the labia minora , & cutting of the labia majora which are then stitched together in order to form a cover over the vagina, with a small orifice left (which can only admit in two fingers). (Don't u think this is very inhumane to do such "surgery" on the girls? Sad to know that such event still occur in this modern world).

It was difficult for that African lady to undergo vaginal delivery as there is a high possibility of severe perineal tear. (Well, if she really insisted on going for vaginal delivery, then the attending doctor has to cut off the fused part of the labia for the baby to come out and to restitch it back again after the delivery). She underwent an uneventful Caesarean Section and the baby was delivered safely.

No picture here but if u wanna see how is it like, u can always google on it, and not forgetting many had lost their lives due to FGM complications especially those performed using the traditional unhygienic methods and non sterile instruments in the rural areas (and forget about local anaesthetic nor pain relief during the surgery).

Side note : Malaysiakini is giving free access from 4/3/08 till 10/3/08 without having to log in to read the news and articles. Don't miss this opportunity :)

Photo Hunters : Practical

Today's theme is Practical.

The Real Human Skull - One of my Year 1 Anatomy OSCE (Objective Structured Clinical Examination) or Practical Exam question. I can't remember what is the exam question that came out during my time as it was more than a decade ago. Is it something to do with the name of the facial bones or brain components or the blood vessel?

p/s : The human skull picture was taken somewhere else (not inside the exam hall).

Plastic Raffia String

Normally we use the plastic raffia string to tie up things especially plastic bags or boxes. However, I found out another usage for raffia string while seeing a patient in the clinic few weeks back. When I examined my patient, I noticed she used the plastic raffia string instead of belt to tighten her shorts. Yeah, she is one of those from the lower socioeconomic group. I guess she couldn't afford to buy a proper belt and I'm indeed amazed with her idea of using plastic raffia string in replacement of belt. I have seen several poor patients using pieces of clothes as belt but using plastic raffia string? This was the first time...

Can grow back?

Several days back, I saw a male patient in the clinic. The poor chap has carcinoma of the penis (or in layman term, cancer of penis) with partial amputation of the penis done several months back. The wound and the stump was healing well. After asking some relevant questions and examined the patient, he asked me one question towards the end.

Patient : Doctor, "that place" can still grow back or not?
Me : (Thinking inside my heart - wah.. cut liao how to grow back woh?)
Me : Nope, cannot lah..
Me : (Wanting to tell him if hand or leg kena amputate, will it grow back ah?)
(The actual conversation was in Malay language).

I believe deep inside his heart, he knows the truth and the answer to his question, but he still dowan to give up "hope" kua? Hopefully someone will give him a different answer or something that he loves to hear? The truth really hurts, huh? Aiyh.....

15th June 2007

Today is 15th June 2007. It is amazing how fast time flies. Without us realising, half of the year 2007 has gone (with the wind?). And not only that, 15th June 2007 is also a milestone to me, as it marks my 10th year in service. I can still remember clearly what happened 9 years ago (15th June 1998) when I just joined the service, reported duty to Ministry of Health and started my profession in Sarawak General Hospital in Kuching. Happy Working Anniversary? Nah...

Should I continue on with what I'm doing now? Or should I venture into a different field (for a change?). Should I embark on a new journey and start a new chapter? Mmmmm... Well, it's almost 1 am. Time to hit the sack & Zzzzzz.

p/s: And Yee Hon at one point thought I'm probably only a few years elder than him - like around 24-26 years old. Wah... Kkkkkkk...

Quote "Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own." NIV Matthew 6:34

Related entries :
*15th June 2006
*15th June 2005

Yucks..

Misti commented on the Durian post regarding "you cannot eat liulian during the day or before you go to work. or else burp habis!" , and this reminds me of this particular incidence again.. Hahhaha.. although the event took place 7 years back (in year 2000), I can still remember it clearly. Although I shared this 2 years back, it's worth sharing it back again, since Misti waited eagerly for the story (under the table summore!)

That night, i had a young Malay patient with suffered compound, comminuted fracture of the femur for surgery. He had MVA (motor vehicle accident) at 4:30 pm in the evening, and he took durian half an hour prior to accident. ( i normally will ask the patient when was their last meal and what they took, as stomach emptying under normal condition will take 6 hours. This is important to prevent aspiration of gastric contents into the lungs (hence aspiration pneumonitis) once patient was under general anaesthesia). I called the case around 10 pm at night (6 hours after his last meal). I intubated him with cuffed ETT with cricoid pressure applied, and he was put under general anaesthesia.

The surgery itself took approximately 4 hours and finished around 2 am in the early morning. I reversed the patient from all the anaesthetic drugs and inhalational agents. Upon awakening, the patient vomited out large amount of partially digested durian (almost one bowl), and stink the whole operation theatre. My assistant (GA nurse) couldn't stand the smell and vomited, hence leaving poor me handling the patient alone. The surgeon had left much earlier on (as usual). The circulating nurse was no where to be seen. The scrub nurse was busy cleaning the surgical instruments in the other room. The hospital attendant hadn't arrived yet despite being called earlier on. I had to clean up the "mess"- sucking the remaining durian debris from the mouth, wiping and cleaning his face etc. I really had to hold my breath while doing that. I had to make sure there was no more residual vomitus left inside the mouth and the patient was fully conscious prior to extubation. (Stomach emptying normally takes 4 to 6 hours but the process may be impaired by certain factors, such as major trauma/accidents which might cause gastric stasis. This was well proven in this case, as the food particles stay intact in the stomach even though 10 hours had passed since his last meal).

Luckily there were no other emergency cases following that and I can close the operating theatre. The partially digested durian really stunk, and the smell remained inside the fully air-conditioned operation theatre for several hours. I had encountered with several more disgusting episodes in the past, whereby patients vomited on my clothes, and to make the matter worse, I cannot leave and clean myself or change my clothes immediately coz I have to attend to the patient first, or else they might aspirate their own vomitus or fell down from the operating table. (Some will struggle in the merge of waking up), Some of the patients are aggressive and we have to be alert. Else, might kena pukul buta-buta anytime. Who says being a doctor is glamorous ???

Transvaginal Cholecystecytomy?

Recently, one of my colleagues sent me a link regarding Transvaginal Cholecystecytomy. My first response when I saw the word "Transvaginal Cholecystecytomy" is ... o.O & Huh, followed by My goodness !!!!!!!!

For those who doesn't understand what is it about,
Transvaginal Cholecystecytomy = removal of the gallbladder through the vagina. (Don't tell me u dunno what is gallbladder or vagina)

First of all, is the Conventional or Open Cholecystectomy,
Subsequently, the less invasive Laparascopic Cholecystectomy,
And now... the experimental Transvaginal (Laparascopic) Cholecystecytomy..

*Speechless* NES? FKK? Mmmmm..... ;)

"Incidental" Findings???

I came across the hilarious picture from MMR, regarding Kermit the Frog and his X-ray findings... Kermit the Frog is a very popular muppet character during my childhood days. Reminiscing The Muppet Show and the nostalgic Sesame Street... Don't cha love miss those characters?

Seeing the picture somehow reminds me of a case that I heard from my colleagues several years back - regarding a "blur" obese female patient who presented with symptoms of intestinal obstruction. After the usual history taking and physical examination, appropriate investigations were carried out - including an AXR (Abdominal X-ray). When the doctor in charge reviewed the abdominal X-Ray film, he got a shock out of his life. Much to his horror, the Abdominal X-Ray revealed a foetus (baby); which meant the gal was pregnant and the poor foetus was exposed to radiation! (Mmmmm.... radiation exposure to the foetus and the possibility of spontaneous abortion, risk of congenital malformation, mental retardation, increased risk of childhood cancer etc).. The gal didn't know she was pregnant at the first place. Who to blame? I can't remember the details of the case... whether she remembered her last menstrual period? Did she had irregular menstrual cycle? etc. I have no idea what happened to the baby either...

Why wanna lie?

I read from Eve's post regarding a patient with vaginal candidiasis who denies any sexual contact earlier on (citing her religion doesn’t approve of premarital sex). On and off, we will get patients who are reluctant to reveal or hide their sexual histories. What's the point if she comes to clinic or hospital hoping the appropriate treatment given while withholding the truth? We are not the kay poh or busybody medical practitioners who enjoy digging into patient's personal details for no apparent reasons nor judge their behaviour. We will only ask relevant questions according to the clinical presentations which will aid in the diagnosis. STD is never idiopathic, and so is pregnancy. (Idiopathic means occur spontaneously or without any known cause).

This reminds me of a case I saw in the past. A 18-year-old girl presented with history of painless vaginal bleeding and she denied any history of sexual intercourse. Ultrasound was performed and the finding was suspicious, although not the classical findings. Since we can't take the patient's word 100%, so urine pregnancy test was performed and the hCG hormone level was sky high !! Not only she was pregnant, not with normal pregnancy but with the dreadful Molar Pregnancy (or Hydatidiform Mole) !!

She was admitted to hospital and despite that, she still insist she is a virgin. My goodness... If she never had sex, how the heck she will become pregnant? At last she finally admitted, but that doesn't really matter anymore. (There is only one exception which occured 2000 years ago - whereby the Virgin Mary is conceived by the Holy Spirit). Suction & Curettage was performed subsequently without any complications. Luckily she didn't suffer from Invasive or Metastatic Moles or Choriocarcinoma.

Susuk

Life Focus section in The Star @ 10th February 2007 had an article on SUSUK. What the heck is Susuk? Susuk is not the abbreviation for Susu Busuk, okie? It is the ancient art of implanting foreign objects under the skin ---> to make that person more alluring woh. Betul keh? Berkesan keh?

Reading the news reminds me of some the cases that I encountered personally few years back. One of the cases was a Malay guy who allerged MVA (Motor Vehicle Accidents) with some minor facial abrasion wounds. X Ray revealed no facial bones fracture but numerous pieces of small metals or needles embedded in the orofacial region. The extend of "injuries" as per X Ray however didn't correlate with the "clinical findings" that we observed. If the foreign bodies were due to broken glass pieces or metals, then the patient definitely had to undergo surgery under General Anaesthesia to remove all the foreign particles. The patient was quite reluctant to tell the truth initially but after serials questioning, he finally admitted he had susuk in the past. (Save us the trouble to explore the wounds since those are embedded susuk and not broken glass pieces). At times it is difficult to differentiate these needle implants from small broken pieces of glasses or metals.

X Ray of someone with susuk (The Star Newspaper)

Besides inserting needles into their faces, I have seen cases of guys & girls with implantation of needles in their chests & thighs. Not only that, I have encountered few Malay young chaps with metal beads inserted underneath the shaft skin of the penis (not only one metal bead, but three). And these metal beads are mobile & can move around during sexual intercourse. They believe this has some special magic power to enhance their beauty and attractiveness, to enhance their sexual performances and sexual pleasure. Does these practices really cause physical transformation? Is it related to black magic or charm? *Ahem...

The Story of KK

The frequently appeared KK as in CKK, FKK, LKK, PKK, SKK, TKK, CKKK, TLKK, FFKKK recently reminds me of the famous KK story in the hospital which we encountered very frequently in the clinics or hospitals. On & off, when I asked the patients regarding their medication history, I will have patients (especially those middle-aged or elderly patients) telling me about the white KK pills, which they take for fever. What the heck is this KK pillss ? Haha, it is none other than Paracetamol (PCM) or Panadol tablets. How this name KK come about? Why KK?

Thanks to the huge KK imprinted behind the panadol tablets, giving the impression to some of the patients that KK is the "other" name for panadol. They never realised that KK = Kementerian Kesihatan (Ministry of Health) ! Many times, I was tempted to tell them the truth that KK is not equivalent to PCM but at the end, I didn't :P

See? Even ponstan (mefenemic acid) also has KK imprinted on the capsule :P

p/s: Hope nobody FKK (faint kaw kaw) after reading this post....

Armpit ?

Aitelyu, when seeing patients, one of the clinical examination that I dislike is examining the armpit or axilla (mainly palpation for axillary lymph nodes). I don't mind shoving inserting my index finger into the anus (for PR or per rectal examination) or my index and middle fingers into the vagina (for VE or vaginal examination) cos at least I'm wearing gloves for the latter two procedures.

Why examining the armpit or axilla is not favourable? Imaging touching, examine and palpating the wet and sweaty hairy armpit with bare hands and fingers? It is not just a superficial touch but few several deep touches,including pushing the fingers into the axilla region for thorough examination of the armpits, especially patients with cancer or lymphoma. Summore, there are 5 main groups of axillary lymph nodes. If the armpit is dry, it is still alright.

Of course the proper way is to examine patient with clothes off which I do when examining or palpating other body parts. But when I examine armpit, I prefer to examine with clothes on, provided they wear thin clothes, so that I can have a thorough feel & palpation without "direct" touch. Kkkkkk.... The reason is very obvious right? I don't think you all want to touch other people's armpits if possible. If the patient wears sleeveless clothes, Mmmmmm... I kena many times liao examine patients with wet armpits with my bare hands. But I still have to act cool & professional like nothing had happened, and carry on with the other necessarily clinical examination :(

Side note : Pleaseeeeeeeee don't wear sleeveless clothes when u go for follow-up, (psssss...cos doctors are humans too). :P

Spectacles

I know most people prefer to wear contact lens or have LASIK (Laser Assisted In Situ Keratomileusis) done. But... there are still some who still opt to wear glasses, like yours truly. Most of my short-sighted or myopic doctor colleagues (I will say >95%) still wear spectacles. Our great surgeon, Bernard also wears glasses.

Spectacles also act as the protective gear for our eyes against the blood or any other form of body fluid from patients, especially for surgeons or those who do procedures. It is not a pleasant experience to have blood or body fluid, secretions or discharge to accidentally splash or spurt onto the face, moreover into the eyes !! Wearing that pair of eye goggles is not practical and just too troublesome, unless the patient is known to be Hepatitis or HIV positive.

Remembering the days when my face was splashed with the gush of amniotic fluid aka liqor when the amniotic membrane was nicked during Caesarean Section for a patient with polyhydramnios (excessive liquor) and macrosomia (big baby) - free facial :( Luckily I had my spectacles on. And not forgetting the spurting of blood occasionally when the blood vessel or artery was nicked, and the worst one is vomitus (*&%$#@ yucks !!) I wore contact lens too in the past (during my undergraduate time) but I find it a bit troublesome. Meticulous and needs to be handled with care.

I know most of you here wear contact lens but I will still say YES to glasses.
Pssss... last but not least, don't you think those who wear glasses looks more intelligent? LOL

My First Time...

We have so many "First Time" in our lives.. There are "First Time" in everything... Below is a compilation of some of the interesting medical related events that I encountered for the first time in my life.. Surprisingly I can still remember some of the details although that was so many years back. I know I will enjoy reading this post again in the future :) The PRICELESS REAL LIFE experiences !! My Nostalgic Experiences. All these are now history.. HARI ITU DALAM SEJARAH.

1.First time dissecting a corpse/cadaver (real human leh!) : 19+ yr old
I did this on the 5th week of my First Year in Medical Faculty. First time dealing with & touching the real corpses & cadavers !! Don't play-play. Mmmmm...... Surprisingly no thrilled feelings... I was not scared at all. Is this considered as brave? or cold blood? or indifference? or don't care?

Remembering the hatred formalin used to conserve the cadavers to prevent the decaying process - The formalin cause tearing & giddiness to each & everyone of us (poor us) towards the end of the day. There are more juicy details regarding dissection on a earlier post that I wrote way back in 2005. Those who are interested can peep there (including the cadaver pictures).

2.First time conducting delivery : 22+ yr old
This was during my fourth year in Medical Faculty. We need to conduct minimum 10 normal deliveries. My first experience of watching a expecting mother giving birth to a baby is really unforgettable. All the pain, agony, suffering & sacrifices that a mum has to undergo & deal with from the first day of pregnancy till the day when the baby was born. The sacrifices that a mother has to made for her baby.

It was scary the first time I observed the amount of blood loss during delivery. And not forgetting cutting the perineum with the episiotomy scissor during crowning without any analgesia or pain relief. Ouch !! But apparently, the pain of childbirth is much greater then cutting the flesh.. And not forgetting the tearing of the perineum that might occur and the pain that the mother has to endure. There were no epidural for labour pain during those days.

The first delivery that I conducted was a G4P3 Malay lady, and her baby was a baby boy. Forget about the bloody part of conducting delivery.. Dowan u all to throw up :P After sucking and cleaning up the mucous and secretion from the nostrils and oesophagus and clamping of the umbilical cord, the baby was dried and cleaned up and shown to the mother for identification of the baby's sex. Then the baby was placed either inside the incubator (after placing the name tag) or given to the mother for bonding.

After delivery of the baby, that was not the end of the story yet. An IM injection of syntometrine was given to the mother to shorten the 3rd stage and to prevent excessive blood loss and favour the separation of the placenta. Needs to rub the abdomen and massage the uterus, and feel for the fundus of the uterus prior to applying control cord traction or CCT to deliver the placenta. Cord blood was taken for G6PD screening. After delivery of placenta, it was time to clean up the "mess", to evacuate all the blood clots, checking the extend of perineal tear and cleaning up prior to stitching. A great sense of achievement and accomplishment during that moment. Come to think of it, that little baby boy is now 11 years old. :)

3.First time doing Autopsy/Postmortem : 23 yr old
Can't remember what was the first case I performed the real life autopsy liao. This was totally different from dissecting a cadaver cos the body was still flesh, I mean the person had just passed away not long ago. We need to observe 10 autopsies inside the mortuary in GHKL earlier on before performing 3 on our own.

The first time I performed autopsy, I remembered cutting the scalp and opening up the skull...
Removing the rib cages with an electronic saw... Blood started oozing... The good thing was I didn't have to worry about blood loss when I cut the body cos he was dead. (unlike when doing surgery on alive person). Next, Dissecting out the liver, lung, intestine etc etc.... Weighing each organs separately & jot down the weight (just like how the liver was weighed in the wet market) Cutting & slicing the organ into slices to look for any pathology and taking samples for histopathology if indicated. And at the end, we dumped everything (including the brain) inside the abdominal cavity before sewing up the incision with a huge gigantic needle & thread..

4. First time performing surgery (refashioning of finger for crushed injury) : 24+ yr old
This happened during my housemanship time. That night was my second time doing on call duty as the HO on call in Orthopaedic Department. I was called to the casualty by the Casualty MO to perform refashioning of the middle finger for a guy with crushed injury. This was indeed a scary experience cause I never observed how a case of refashioning of crushed finger was done. That was my 5th day working as a doctor in Orthopaedic Department. The MO on call refused to come and just give order via the phone how to perform the surgery when I asked for help. You can imagine how stressful & tensed I was at that moment.. I was sweating when I performed the refashioning. Luckily I didn't tremble :P

Giving ring local anaesthesia to the crushed finger (half of the middle finger was gone). Using rubber band as tourniquet to prevent bleeding. Then clean & sterilize the finger with povidone iodine & isoprophyl alcohol as antiseptic. Nibbing and chipping off the broken bony fragments and smoothen it to the appropriate length.. Cutting off & trimming the excess flesh & skin so that the skin flap is able to cover the refashioned finger, before stitching back the finger stump. Although this was my first time, the end result still looked good.

I prescribed antiobiotics and pain killer for the patient and gave him a date for further follow-up. Other simple surgery that I have performed myself subsequently are such as: tendon repair, wound debridement, I&D, SSG, plating, K-wiring, Caesarean Section, ERPOC for abortion, Tubal ligation (BTL), Appendicectomy, Excision of ganglion, breast lump(fibroadenoma, breast cyst), lipoma, sebaceous cyst, dermoid cyst, Saucerization, Circumcision etc etc.. Those were the days :)

5. First time doing CPR (cardio pulmonary resuscitation) : 24+ yr old
That was during my housemanship time in medical ward. A ESRF patient on Peritoneal Dialysis suddenly collapsed while dialysis in progress. During those days when we were on call in medical wards, we did at least one CPR every night, and at times can be up to 3 CPR per night (the unlucky ones)... This was nothing glamour at all, unlike in tv drama series. There are no heart thumping crescendo music to heighten the tension situation in real life and death emergency situations. No background orchestra music. No back slapping congratulations when able to revive the patient. No one will help to wipe your sweating forehead. No rewards, no compliments and no glory. And such tensed situations arised every now and then. If CPR failed, the next duty was to break the bad news to the family members. Towards the end of the days... a tiring body, an exhausted mind, Sakit tangan, sakit badan....

This is another long winded cheong hei post of my real life experiences. This is not the end yet. I would like to make this into a TAG (itchy hand mah).. My very first own home made tag. I would like to tag these few people to come out with their memorable First Times.. (First time baking a cake? First time io ka chng? First time acting as angelic angel? First time playing guitar? First time killed an ant? First time doing this or first time doing that? Anything will do, as long as it was meaningful and memorable to you).

1. May - A Rather Undignified First
2. LB - The 1st Time Ever I Saw
3. Angel - Five First Time©
4. Pink Cotton - First Times...*wink wink*
5. Ben - 3-in-1 Tag Debts
6. SA - 5 Things Post (About Gaming)
7. Butt - First times
8. King's wife
9. Kenny - My First Time
10. Bernard - My First Time

Stethoscope Snap On Rim

This is what I get on my first day in KL, The Littmann Stethoscope Snap on Rim. There are few who asked me what the heck what issit? Mmm... basically it is just a piece of expensive rubber/plastic to hold the diaphragm in place (to the chestpiece of the stethoscope). I bought it at 8:30 am on Thursday morning. Fifteen minutes after I bought the rim, I got a phone call from ayam panggang Will reminding me to buy the stuff. The next day, I get another last minute reminder from Pink Cotton via sms "Don forget to buy.. erm.. buy the.. dono wat thingy, ok?" Hahaha, cute lah her :D

A piece of rubber like this costs me RM25... I have changed the rim twice since it is "fragile".

My good old Littmann Stethoscope (still as good as new), which has accompanied me faithfully since 1994 - with the new Snap on Rim but old Diaphragm, old Chestpiece, old Binaurals and old Ear tips.

Interesting Facts

I get to know some interesting facts from my pharmacist colleague few days back, regarding how drugs or medicine were dispensed in the early days (in the early 70's) when she just started her career as pharmacist in hospital. During those days, empty containers or bottles for cream/ointment or solutions/syrup/liquid prescription were not available or supplied by the pharmacy in hospital. Patients had to bring their own containers.

1. Cream and Ointment will be placed on banana leaves and wrapped up or folded prior to dispensed to patients.

2. For solutions/liquid/syrups (eg cough syrups), patients had to buy empty bottle containers from the nearby shop (eg. those empty coca cola or F&N bottles) and placed the empty bottles at the dispensary counter for the pharmacist to pour in the solution/liquid/syrup.

3. The most interesting one is regarding eye drops. I can't imagine and can't believe this actually happened in the past. The solution for eye drops was poured inside the empty bottles bought from the nearby shop (and sometimes those patients will buy big bottle for just few mls of eye drops as small bottles were not available). Flexible plastic dropper bottles are not available in the past. And here comes the most interesting part - regarding how the eye drops are instilled or applied to the eyes ...

What the patients used to instill or to apply the eye drops? (Forget about the eye drop droppers which were not available during those days).
Wanna make a wild guess ?

Straws !! Those drinking straws !!!!!
Patients used those drinking straws to draw the eye drops from the bottle and to instill the eye drop to their eyes !!
I really get a shock. Can u imagine that ? Forget about sterility and hygiene.... I wonder what was the rate of infection during those days..

These are some of the PRICELESS info I gathered from my colleague.
Consider ourselves blessed with the advancement in medical practice and health care. And never take things for granted :)

One after Another..

Lately I have seen one elderly patient (in her mid 70's) being diagnosed to have 3 different cancer/carcinoma at different stages of her life. Earlier on, she was diagnosed to have Cervical Carcinoma (cancer of cervix) and was treated with radiotherapy. Few years later she has another different cancer - Carcinoma of the right breast (breast cancer); Mastectomy with axillary clearance was performed followed by chemotherapy and radiotherapy. Then she gets another different cancer years later - Colorectal Carcinoma (cancer of the colon); Anterior Resection was performed. Now she comes back with suspected recurrence. What a mishap. This "poor" lady is so unlucky. Being diagnosed with one cancer is already depressing and heart breaking for many. More over she gets one cancer after another. I have seen many suffering from two different cancer but this is the first time I see one with 3 different cancer. Mmmm... Is she suffering from Familial Cancer Syndrome? However, this lady has positive thinking with very strong will. She still looks fit and energetic and looks much younger than her real age.

Chewing GUM?

While driving from Sabah back to Brunei, we drove pass the GUM Clinic in Limbang district. The first time I heard about and knew the existence of GUM Clinics was during my medical school days in the mid 90's. My first impression of GUM clinic at that time was... Is that a periodontal clinic? Hahaha..

I'm sure some of you don't know what is GUM clinics. Some might not even realise the existence of such clinic.. GUM clinic has nothing to do with periodontal nor gum related disease. It is not a dental clinic either. GUM Clinics are Genito-Urinary Medicine Clinics that specialize in sexual health including STD (STD is not "Sambungjauh Terus Dail" but Sexually Transmitted Diseases) and VD (Venereal Diseases). Bukan Klinik Gigi atau Klinik Gusi :P

Ambulance Ride

My deepest condolence to Dr Norbaizura Yahaya's family. Dr Norbaizura is a young Malaysian doctor who suffered severe injury and succumbed 2 weeks later in ICU after involved in an ambulance accident. She accompanied a patient in an ambulance from Seremban Hospital to Selayang Hospital and on the way, the ambulance she was travelling in burst a tyre and overturned. The news in the STAR paper today mentioned that her family is not eligible for compensation because she was not yet confirmed in her service. For a doctor to be confirmed in service, it takes at least 3 to 4 years or can be longer at times for those "unfortunate" ones.

Usually the most junior doctors (mostly the House Officers) in the medical hierarchy will be the one assigned to escort or accompany patients during transportation from one hospital to another. It is sad to know that prior to confirmation in service, these medical personnels are not eligible for compensation if any mishap occurs while on duty. This is totally unacceptable. Can a junior doctor decline to accompany the patient in the ambulance if he or she is not yet confirmed in service? We all know the answer; That is impossible :(

Escorting patients to another hospital inside an ambulance is definitely not a pleasant experience. In fact it is scary, and at times it is hazardous. I had escorted patients inside an ambulance few times in the past during my early years working as Houseman/Intern and Junior Medical Officer. I really have to pray hard for a safe journey each time prior to sitting inside the ambulance accompanying the patient to another hospital. Some of the ambulance drivers will drive and speed like Mat Rempit on the road. And not all the 4 wheels of the ambulance are touching the ground each time when we were on the road.

Imaging speeding at the speed of 120 to 160 km/hr inside an ambulance on the road. (Ambulances have no legal speed limit). At this speed, those who were sitting inside the ambulance (either the accompanying doctor, nurse , MA or attendant) will be swinging on the seat while the patient might be thrown here and there on the stretcher inside the ambulance. Luckily the ETT was secured properly. It was not easy to manual ambubag the patient in such condition. The long, nauseating, hair rising, nerve wrecking and lip smacking ambulance ride. Worst still in the rural areas in Sarawak.. with narrow, winding roads and pot holes everywhere. I really have to thank God I have survived all the previous ambulance rides safe and unhurt, except for giddiness, headache or nausea. My friends and colleagues who escort patients in ambulances in the past have similar stories too. And I guess most doctors have their own stories regarding their ambulance ride experiences...

p/s : The above mentioned is not applicable to ALL ambulance drivers. There are some nice ambulance drivers too...

Colourful Pills

While clearing my things a couple of weeks ago, I noticed few packets of expired pills.. Too sayang to throw away the pills just lidat without taking any nice shots of them. Pills in various sizes, shapes and colours are excellent still objects for photography session. I can add these photos into my photo collections which were categorized under objects with subcategory medicine :) Over the past few years, I categorize all the photos I took into different folders - with different categories and subcategories. Up to date, I have 900++ folders just for the photos I took :)

Do you recognise what are these pills? To treat which medical conditions?