so tired...

long time since i feel this tired during on call. think my passive call today was worse than my active call yesterday. it's nothing extraordinary yesterday, with admissions for accidents and head injury, appendix, abdomen pain and, of course, upper gastrointestinal bleeding. done 2 OGDS (stomach camera), 2 operation, see CT scan for head injury and managing pt in full blown sepsis (severe infection). hardly anytime to sit down n rest my legs. but somehow manage to pull through the nite, although didnt get much sleep.
but really, the ward turned into nightmare today. so many admissions in the morning into our female ward. we have 9 elective admissions for operation tomorrow. 3 of them manage to be shifted to second class ward in another ward, but still we have extension of 6 in ward 17( and it is still before 5 pm). pt have to be placed in the middle of hallway and corridor near the toilet. so uncomfortable to both pt and working staffs. then i began my second call by starting a laparotomy case (major case for abdominal injury) early in the morning (w/ my specialist of course) and later have to review pts in periphery wards till 1 pm, before breaking off for a quick lunch and came back to hospital for another 2 urgent OGDS for bleeding cases. my colleague who is active call today started his marathon of appendix in operation theatre since morning. one of the scope i repeated on the same pt i scoped last night coz she bled from the site we took biopsy for tissue study. though the biopsy was indicated, i felt half-regretted for doing the biopsy for her.
i was stucked in the hospital till 5 something before i had chance to go home n took nap of 2 hours, before coming back to hospital to review a referral from medical department. my active call colleague finally came out from operation theatre and hopefully he wont need me to go back to the hospital tonight. the ward was so bad that three of our surgeons took turn to drop by and making sure e/thing is fine.
tomorrow i'm going to be elective operation for the whole day. though i'm not a religious person, but, oh well, God bless me to have good night sleep tonight. :P

dec is marry month!!

attended 2 wedding within this single month! seems like the end of the year is good time to get married. haha. both are good friends of mine n had wonderful wedding ceremony done for their big day. feel happy for them and wish them happily ever after :D

but it also mean a bit loss from my pocket money bcoz of the ang pau.. haha

watched 2012

recently watched the movie in taiping cinema with my husband :) as whole, i think it's a great movie, with so much effort and time n money being put in to give us the ultimate impressive effect. storyline was quite straightforward i would say, as expected, issues of humans' differences bound to be brought up n the ulgy side of human when it comes to life n death situation. i love the part where the ground started to give way n how the whole town being split up and submerged into the sea. the only safe place is the sky! building the ark was impressive too. after watching the movie i actually was a bit worried whether anything would happen in 2012. :P

i'm legally married!

090909, on this day, i signed down my name in the marriage certificate in an ordinary looking association building in Ipoh. witnessed by both our parents, we exchange our rings in elated mood. but seriously, after that day n the mini honeymoon we spent in langkawi n now back to work, it seem there's nothing different at all. not that i'm disappointed or want to complain. i just realized it's a small step forward in our future. maybe the ceremony not done yet, tht's y i feel e/thing is the same as usual. work, eat, go home, sleep, n the cycle go round n round. n we still only can meet up in weekends n holiday.

hope by end of next year, we could really live like a normal couple :P haha.

6 weeks in ICU

we are having rotation posting to ICU in our hospital for 6 weeks. each MO (medical officer) from our department will go to ICU to work and learn critical care in anaesthesia by rotation. and this week it is my turn to go. already went for a week, n being there just confirmed one thing at least: i really dun like ICU :( so many ill patients, all with pipe down their throat and not responsive to our call. of course, they do respond when they get better and got transferred out to general ward. and managing them increases further the stress level. work load otherwise is much less compared when working in surgery, due to we have more colleagues to help out in lesser wards... but i do start missing my appendix already :P

had some emotional trauma happened related to work recently, but luckily i'm recovering now. and hope things will be better when time passes.

end of the month would go back KL to start planning my wedding schedule. busy scale escalating....

recent plans

things start to get busier with months go by. :) most likely my schedule for coming year will be like these:

Aug till mid sept: ICU posting for 6 weeks to learn about acute management in ICU and hopefully ventilation settings :) challenging as those are new things to me (again...)

sept 9: memorable day for me and my darling for registration of marriage. the event will take place in associate registrar of marriage in ipoh witness by both our family.

sept 22: it's my MRCS exam day in KL. currently revision is underway n hopefully i can finish reading the book. but i'm trying not to put so much stress on it. greater stress means poorer performance from me. :P

oct 3: i'm part of commitee for basic surgical workshop to be held in the hospital on this day. so meaning while preparing for my wedding n exam n learning new stuff in ICU posting, i also working as secreatary in this project

dec 5: my friend's wedding dinner in penang. already promised i will go :D

dec 26: family trip, including my dear, to langkawi for three days. good time to relax.

jun 2010: another friend's wedding dinner in ipoh. very good friend of mine. :)

july - aug 2010: hopefully my wedding dinner here. :p

oct 2010: may have chance to apply for master of surgery. UM programme offers training in hosp ipoh n in-campus in KL. a win-win situation

so, something like this. busy time ahead.

i'm having bad luck recently...

recently had bad luck with my car. she made funny noise 2 weeks back then suddenly cannot start my car one hot afternoon. luckily i was at home. but i had to take the half day off n ask for help. at the end, it was becoz the battery was dead. i changed a new one with $250. most likely can tahan till one year.

i had another jump today. i went to pick my colleague in her neighborhood which i had never been there before. just when i'm making an U turn, my car overran a divider beside the road and one of her front wheels hang half an inch above the ground, unable to proceed or reverse. i was so frustrated and worried whether she sustained any internal injury :P luckily a few uncles staying in the neighborhood helped jacked my car up and placed few bricks under the wheel and i was able to reverse my car back behind the divider. it took half an hour there. phew... luckily nothing is leaking from my car, but i sensed something might be wrong to her absorber... will have to bring her for checkup again next time i go back kl

but seriously, didnt expect the neighbors were so helpful. things would be much different in KL. for the first time, i'm glad i'm in this small peaceful taiping working. :)

brain tumor? brain abscess?

patient presented with gradual worsening GCS and generalized weakness. there was no history of trauma or fall, nor low grade fever or fit. she recently undergone some ovarian surgery. so unlucky for her to have this. she was referred to hospital Ipoh as well for further investigation.

pork leg in nibong tebal ~~~

another day we went to nibong tebal to try these. A staff nurse my boyfriend working with brought him there and he fell in love with it instantly, n i can tell why ;)

looking forward the weekend...

going back home in the weekend n looking forward for the food there. haha.. maybe can bring my boyfriend to try these :) looks delicious but at expensive prices.

my birthday in Taiping

ahah.. think it's late to post this, but the cake is really nice n feel like showing it to u all. celebrated my birthday in Taiping in April with friends n they bought me this! :) nice choco cake after a sumptuous meal.

classic pics for brain aneurysm

i was on call one day (or wasn't I? i cant remember. s/times it doesnt matter whether u r on call, if u r involved in a case, u settle it there n then) n came across a referral with CT brain like these. this is what we call 'star sign'. ruptured aneurysm in brain blood vessels must be considered until proven otherwise. the patient was then referred straight to hospital Ipoh Neurosurgical department. Aneurysm mean abnormal dilation of blood vessel and may end up ruptured if unchecked or not repaired. it can happen to any part of the body where there is vessel. brain vessel aneurysm is especially dangerous if ruptured and usually they wont show any sign unless they rupture.

hypertension

hypertension = high blood pressure, probably the most common cardiovascular disease in our society. it involves abnormal pressure documented within our vessel wall itself due to several factors. most often it is due to unhealthy diet, causing thickening of vessel wall and accumulation of fat along the wall. this lead to unhealthy vessel wall and the blood vessel became less elastic, making the heart to pump higher pressure to exert desired effect. these thickened vessels are quite fragile and easy to break when the pressure is too high, thus making the control of the blood pressure very important.

initially we need at least 2 blood pressure reading on 2 different circumstances higher than normal value to diagnose a patient to have high blood pressure. on first high reading, we advise patients to modify their diet and lifestyles, encouraging them to do more exercises and screen for high cholesterol status. when the blood pressure is persistently high despite all these are done, then the role of medication came into play. in government sector, at least 5 different groups of antihypertensive medicine (medicine for high blood pressure) are available to our population. which group to use or what combination to use would vary among patients' age group and health condition.

unlike some patients' belief, oral antihypertensive treatment is lifelong treatment once it is started. so, we do not cure hypertension, but we control it with medication. with medication, patients achieved optimal control of pressure, and therefore reduce the risk for cerebrovascular event (stroke), heart disease (heart attack) or impaired renal function (kidney function)

important aspect in controlling high blood pressure would patients' cooperation in taking medication as advised by doctors, healthy lifestyle (daily) and balanced diet. smoking is proven to worsen high blood pressure control and also lead to many other diseases. the steps mentioned are not difficult to be done, but often is the most difficult to be maintain by patients throughout life.

life is never meant to be easy

although i already realize the truth, but events happening around keep on reminding me that life is never easy. probably it was never meant to be. maybe it supposed to be challenging, most of the time we will feel defeated, depressed and always sit in one place with despair, but eventually the only right thing to do is to get back up and move forward to more difficulties in life. am i being pessimistic? maybe, but tht may as well be the truth. like my bro said, plan too much, u'll get nothing achieved. s/times we just have to do things step by step. speculate only some time n portion of near future. things happen and ppl change, so a long detailed plan may possibly cant be carried out as we expect it would.

not so long ago, we have the excitement of planning our future: together and aspiring each other's work and future career, with nice imagination of having small but sweet and warm family together. we thought we have good chance to work together again, just like last time during housemanship. but an offer letter assigned him to a new psy hospital in his hometown. this apparently is a better option for him, n without doubt, supported him to go there to work. it would be better for his postgraduate programme. but also at the same time, i have decided to pursue my part of career in my current hospital, most likely working towards postgraduate programme as well. with such twist of event, i can already foresee at least another few years we will be working in different district, striving hard for further success. but scene of having a home together seem so much dimmer now. i cant denied i have mixed feelings, which at some moments i dunno how to handle them except keeping quiet. it is the best choice we have, but probably marriage will be a bit difficutl up ahead. i'm not confident in distance r/ship even it is only 60 km away.
we will be only meeting up over weekends when not on call, probably one or two nice dinner together per week, n half our meetings will be together with his relatives. i'll have to handle my stress from work myself and alone most of the time, with maybe ventilation to him through only phone calls, not accompaniment. my video game and laptop will still be my loyal companions within the four walls of my room. friends, sure i have quite a number here. but the one i want to be with the most, he is not there half the time.
condition may as well worsen when we both become specialists. being in govt sector where medical staffs are always severely in shortage, we would most likely get assigned to different districts to serve the public better. children, another major factor to consider. how can i be confident to raise my own offspring without firm stable home for them? i'm not sure. currently i feel doubt, not about my work as a doctor, but my future as a person. helps and advices are always within calls and steps away, but there are things i think that i have to think through myself
despite all these troubling my mind at more n more frequent intervals, there are times i regretted to get into relationship. it is an emotion wanting to escape from reality, but eventually i realize i'm still glad that i came to know him.
problems will undoubtly be solved eventually. the point is i have to find the solution in time and try not to ruin what i hold dear.

influenza A

since SARS, nipah and bird flu, yet again we face treat for having possible pandemic disease throughout our world. it wasnt tht long tht malaysia got the first infected patient since the outbreak in mexico. as fas as i undrstand we have yet to develop any vaccine to this newly mutated virus. i do hope my family in KL are ok and hoping for the best for my brother working abroad in singapore. personal hygiene and frequent hand washing is important. if possible, kindly avoid crowded places to reduce chance of getting infected. mom, maybe cooking at home would be good option for u there in KL. :)
crossing my fingers, hope all these will be under control soon.
confirmed cases reported in hospital sg buloh, Penang GH, and treated patients in GHKL. not very good chance for hospital taiping, i think. :P

hydrocephalus

my bro implied maybe i should say s/thing about medical stuff a bit, n since my memory still fresh after attending the synapse course, i'll talk abit on hydrocephalus.

Hydrocephalus literally means (in Greek) 'water+head'. n sometimes u may heard ppl having babies with big head, with lots of water inside. in medical terms, it means active distension of ventricles in the brain with collection of CSF inside. ventricles are spaces inside the brain which are important for good flow and drainage of brain fluid. CSF stands cerebrospinal fluid, means brain fluid which is comminucated into down the spine via the ventricles and blood vessels. all normal ppl have normal size of these spaces. we have place inside the brain that produce this brain fluid and we have natural perfect drainage system to drain them outside the narrow place of our skull into our blood vessel eventually.

what can happen is a number of events can take place and cause this drainage system goes wrong. either the development of the brain during fetus is not normal, infection or tumor inside the brain cause obstruction to happen and therefore the brain fluid was kept producing but not drained adequately. with no else where to go, the spaces inside the brain (ventricles) will be dilated (swollen, distended, etc) so therefore the term ' water inside the head'. Neurosurgical experts will further grade the condition into truely obstructing or communicating hydrocephalus. but generally, babies with hydrocephalus need to be treated with, most if not all, surgical intervention. we will try to identify and remove the cause if possible. if the hydrocephalus is mild and the brain was not being compressed, we can monitor and see first. if the cause cannot be removed, then we aim to divert the brain fluid flow away to some other place where it can be drained properly. n hence u heard ppl doing 'shunts' or 'tube' or 'pipe' inside the head.

some of the important questions ppl concern: will my baby intelligent? function impaired? able to walk? etc etc. this really depend on the condition of the brain when we saw the film and examine the babies. IQ may be affected, movement may also be questionable if part of the brain being compressed is related to that function, life span of the babies affected vary depending on what events they undergo later (eg: surgery, disease, infection, long hospital stay, rehabilitation program etc etc...) but hey, nothing in medical is for sure and there's no 100% accurate answer. we have example of a child who had a shunt inserted for hydrocephalus going to normal school and score in academy. provided with background of our society, i think no parents would give up on their children who has hydrocephalus. what is important is we need close follow up with these patients and provide support as needed.

back to taiping...

i have spent good amount of time at home in KL, as long as 6 days. mwuahahaha.... n bought a couple of new game for my PS 2 but unfortunately one of them can be only played using newer version of PS 2 (which my sis has it...)

next i attended the Synapse II in Hospital Ipoh organized by neurosurgical department. would say that i learnt some good knowledge about brain pathology although only guidelines in management, furnished by high technology exposure from famous neurosurgeons from around the country. think medical field is doing better in producing more n more specialised consultants and surgeons. :D

once i'm back to taiping today, i have another half day extra. so i went to settle my application for MRCS exam. plan to attend the exam in september in KL... but my god, isnt the fee expensive... spent almost 1.5k on a bank draft, n becoz i dun feel secured mailing it to UK with just pos laju, i used a courier to send it, which also cost me a fortune... argh... i have to push myself hard to pass this exam. ;P

might take the eve abit more relax, then start working in books tomorrow. ;O

Interesting post

I've been working here for 2 years, but only recently i saw this. Guess there's specialty for everything. hahaha. :D

i'm going to start a new blog

i have not much experience in blogging, since i only blog once a while. hope i can update more often, n it's actually a good way to share with my friends especially i'm not always around to meet them n my family. found my old blog is a bit hectic to manage the profile n settings. think i want to try another type for better features. :)

anyway, think these 3 patung got a bit resemblance to me n my siblings. what do u think? hehe