Thursday, July 31, 2008

Burn, baby, burn

“The strong wind howled in fury as the heavy storm reigned in disdain. Thunder and lightning flashed across the dark skies as people sought cover under sturdy buildings. A group of little boys who were playing football in the field ran for any form of shelter but one of them was too slow and providence had it that he would be struck by lightning. Among the group of children, he was singled out by Fate. A few thousand watts of electricity flowed through his body. The initial agony was mercifully quick as the child collapsed from the sheer heat. As the path of electricity zapped through his body, all the cells along the way were literally ‘fried’ by the high temperature.”

Small towns, especially in states with paddy fields do see a lot of cases of lightning-related burn injuries. The surgical team (plastic or general surgery) manages these patients together with the anaesthesiologist, physicians and so on. These patients has dismally low rate of survival due to the massive injuries. Their faces will be charred beyond recognition and their skin in hard, unyielding pieces that might compromise even their breathing.

“In the casualty, the child was seen frothing from his mouth as we quickly intubated him so that he can continue breathing with the aid of a machine. All the important steps were taken to stabilize him in order to allow him a fighting chance of survival. A few long incisions were made on his chest wall so that the thick ‘casing’ of burnt flesh is opened. This is ‘escharotomy’ a life-saving procedure so that the child’s chest wall could expand. Multiple intravenous lines were set-up and a massive transfusion of fluids was initiated to replace the loss of tissue and fluids. Investigations were taken. There are tubes almost in every body orifices as the child was admitted to intensive care for the biggest fight of his life that is just to stay alive as in this case, it does consume a lot of energy.”

One of the most dramatic burn injuries are lightning-related injuries. The patients suffer from multiple organ damages and the protective skin cover is loss. The heart could stop just because of the massive electrical discharges. The kidneys will inevitably fail. Not to mention, the susceptibility to infections as the patient falls prey to multiple bugs within and without himself.

“His parents waited outside the cold corridor, huddled together in nervousness and anxiety. More relatives arrived to accompany them as each took turns to go into the intensive care to visit the little boy, who looked extremely small and fragile. Most of them gasped at the sight as the normally active, playful, cheeky child is now reduced to a mass of dark, charred flesh dependent on machines to be alive.”

Electrical and burn injuries are quite common in Malaysia. Lightning-strikes are rare and dramatic but household burn and scalds are daily occurrences. We see babies, children, adults and grannies with all kinds of accidents involving hot water, oil, petrol, etc. This is just a grim reminder of how badly a person can get burnt.
“1 week has passed by. The child grew almost emaciated over time. His fever has never settled. The armamentarium of expensive antibiotics couldn’t seem to halt the progression of the massive infection. One by one, his organs failed him. By the second week, the doctors faced the grim, unpleasant prospect of announcing the unevitable…that the child might be taken off life support due to the hopeless situation. The entire family came to the meeting with sober faces and downcast facies as a somber atmosphere descended upon the meeting room. Breaking bad news can be the most difficult, heart-wrenching communication in a doctor’s life. Before long, the whole family came to accept the situation and the child passed on in peace after a few short years on earth.”

Grief can be a healing process for many. When it comes to road-traffic accidents, assaults, severe burns and so forth, the sudden escalation of bad news may be unacceptable to many people. Somehow, we doctors face it so much that we run the risk of becoming numb to the emotional upheaval in order to protect ourselves, our mental health. Yet this opportunity and privilege to embrace life at its core, to deftly handle all the highly-charged emotional situations, is part of this art we call medicine.

By the way, a few friends have asked me about the relevance of the photographs that i put in my blog as it's usually not related to the topic i m speaking about. the only reason is that my topics are usually kinda grim and I need to insert some hopeful, happy pictures to balance up the article.

My love for the written word

Recently, I have acquired the taste of reading non-fiction articles and blogs. Being a bookworm all throughout my teenage years (& maybe until now), books are priceless treasures that will always gladden my heart. I have learnt early in life that no one can steal knowledge and wisdom away from you. Nonetheless, this newly-discovered interest in self-help and non-fiction books sprung out of nowhere and now I am reading 3 books simultaneously on various issues.

One of my all-time favourite is the ‘Purpose-Driven Live’ by Rick Warren. I have just completed ‘How to Win Friends and Influence People’ by Dale Carnegie. There is also the famous book on the 7 Habits to achieve an Effective Life by Stephen Covey opened on my desk. I don’t know how I could assimilate all these ideas at the same time but trust me, reading self-help books can be quite illuminating and challenging at times.

Why illuminating? It dawned upon me that I’ve been cultivating wrong habits all this while and perpetuating errors in the way I handle people. Why challenging? There are so many ideas and thoughts that I have yet to bring myself to accept although I do believe that these are very good, noble suggestions. Nevertheless, I’m a fan of this kind of books now.

Then I realized that all these books are written by Western men. It’s not that I have anything against the Western civilization or the male gender. It’s just kind of funny that a lot of fiction and literature materials are written by great female writers but when it comes to good non-fiction, I need to search a while before finding good female writers. Of course, an army of feminists will howl in protest and start hurling names like JK Rowlings, Jane Austen, Virgina Woolf, Agatha Christie, etc but then I start to scratch my head and rethink..

hey they all write fictional, entertaining stories mah. How about some nitty-gritty stuff on world peace, global economy or something like that? (chuckle, world peace is a tribute to all the beauty pageant contestants) Is there someone to accept the gauntlet, this challenge of writing something that can alter the lives of many?

Just the other day, I was wondering whether I could start writing a book on any given subject, especially a non-fiction book. What will it be? Is it possible for a young Malaysian girl to write about something that could transform many people and help motivate someone else?

The normal expectation is that I will write something about medical life and my career but together will my dry style of writing and lack of wit, the end product might be something that is run-of-the-mill, downright boring and uninspiring.

I am still thinking and pondering. Can my online friends suggest any ideas? In the meantime, let me continue to indulge in my twin passions of writing (blogs) and reading (any books whatsoever)

Saturday, July 26, 2008

It's not always about me..a community-minded message :-)

Human beings are very funny creatures. There is always a deeper instinct to fight for survival but given a choice, we do have noble and high motives in each of us. True altruism and activism lie within us depending on how much we give others some thoughts in life instead of thinking about ourselves all the time. Being too introspective reinforces our selfishness and self-preoccupation. So today I am going to talk about two topics which are not related to me.

Recently, there was an issue with land instability in a hostel near Gopeng, which is 45 minutes away from here. The students of a matriculation college were staying in a block near a slope. Due to the recent rain, the slope became unstable and the land started to give way. However, before disaster strikes, the students were moved out of their rooms before any landslide or building collapse were to occur.

Then the news died down and nothing much was mentioned about this tale. I found out that for the past few weeks, the students were camping out in different halls while revising for their exams. Others bunked in with their friends on other blocks. Hundreds of students were displaced from their rooms.

It’s weird that construction work and safety standards concerning public buildings seem to deteriorate with time. It was just recently that another state building in Perak collapse. Before long, this silver state will be known as the state with most collapsible buildings. We cannot have ‘house of cards’ being toppled over at the slightest storm or tremor. The quality of buildings should be guaranteed before it was declared fit for occupation.

Somebody from a pharmaceutical firm approached us recently concerning a vaccine which is in the market for some time but slow to gain popularity due to its controversial nature. Why? It’s to prevent infection from certain strains of human papillomavirus that can cause cervical cancer. We all know that HPV is transmitted via oral-genital or genital-genital routes, meaning it’s mostly through sexual intercourse.

Numerous debates raged on in a few developed countries between some moral-religious bodies and the health authorities. Some feel that the use of the vaccine in young ladies/girls (before the age of 26 year old) will promote promiscuity while the health workers heavily promote this vaccine as we cannot regulate human behaviour nor it’s a licence to do whatever we want with random people.

Most importantly, we feel that it’s a tool to prevent the second most-lethal cancer among women in many countries, including Malaysia. As of now, the only prohibitive factors among many would-be takers are the cost, accessibility and the lack of promotion as to many people, cervical cancer is considered ‘taboo’ and most prefer not to talk about it.

As a young doctor who is within the targeted age group, I welcome and highly-appreciate any form of enquiries or discussion about this cancer, the innovative and easily-available vaccine and any thoughts on prevention of cancers among women in Malaysia, especially breast and cervical cancer.

Oh, talking about breast cancer, of course for now, we cannot prevent the development of breast cancer but early detection is life-saving and breast self-examination is the among the simplest, routine action any woman can do monthly.

Friday, July 25, 2008

My Funny Friend & I

For the first time in my life, I think I have found a girl with the most humourous life and funny spirit. She is working in the same hospital as me and she really does the darnedest thing. I mean, the things that happen when she is around is downright hilarious and offbeat. Of course, this kind of things could be worrisome at times but hey, we always have a good laugh about it later.

For example, we all know that the price of steel and metal products is going up. As a result, metal thieves are having a field day stealing any form of metal things. Covers for potholes, steel pylons and even electrical cables are the most wanted things in Malaysia.

In TI, certain houses have potholes right in the middle of the front gates. In normal scenario, the covers will be intact and functioning well. However, my friend had her pothole cover stolen but we didn’t know about it. On fine night, exactly like Mr Bean, she didn’t see the gaping hole and fell into the open sewage hole. She literally disappeared into the face of the earth before our eyes!

Of course, she suffered from some injuries to her legs but you could imagine our initial shock and the later laughing sessions. It was really now you see her, now you don’t :-p

The next occasion was something that just happened recently. She was having some stomach pain and took a sedating painkiller. Mind you, it was just 1 tablet and she is a healthy young lady. Before long, she became very sleepy due the medication right in the hospital. In fact, she was so drowsy, she fell asleep in the casualty.

Being doctors, her colleagues were so worried that we ran a battery of tests for her and even set her up on an IV drip. However, all she wanted was a good sleep for a few hours and she achieved that…in the casualty department! This sleeping beauty was so knocked-out that when I went to collect her, I sent her home and she proceeded to even more sleep.

So this article is all about my cute friend who lightens up the lives of all her friends. Here's a big cheer to Emily C :-)

Saturday, July 19, 2008

Durian Fever

Malaysians love durians. Therefore this is a season of love as we begin to find this thorny fruits in abundant through-out this country. All durian-lovers welcome this period of fruitfulness with eagerness and exuberance. As for me, I haven’t eaten this fruit for nearly 2 years and so I was very eager when a few friends began to tempt me with this indulgence. We made a date to consume this ‘heaty’ fruit on a good Friday evening.

After work one fine Friday as I was walking back home from the hospital, I exited the casualty and lo and behold, there was this car filled with durians. Being a very curious person, I approached the makcik who parked her car quite near the red zone (resuscitation exit) to see what’s going on. To my pleasant surprise, she was selling durians!!

Yup, exactly on the day we wanted to have a durian party, the durians came to us right to our doorstep at the front of the casualty. I was thinking of a durian-related injury or something like that but seriously, only this kind of funny event can occur in a Malaysian hospital. Leave it to the spirit of entrepreneurship! In Malaysia, we not only could find pizzas for delivery but we could even get durians delivered to us!! Moreover, the makcik comes from Kg Gajah, which is a town very famous for good durians in Perak.

I couldn’t resist the temptation and called my friend from the labour room to come out and help me pick some of the fruits. We’ve gotten a handful of big durians at the price of RM10 and within minutes, a group of us were in my apartment eagerly consuming the sweet flesh right after work.

I guess we will never understand why foreigners detest this awesome fruit as we greedily feasted on the scrumptious fruit. Of course we already made a date for the next party! So is anybody keen to join us in D.C for the next gathering? The King (of fruit) is here!

P.S.: Serve me right for being such a glutton. I woke up this morning and lo and behold…pimples! Yup, had a minor breakout on my face due to the ‘heaty’ nature of this marvelous fruit. Should have taken some mangosteens to balance thing out. Hahaha…

A Bloody Tale

This is a true story of a lady in my hospital. The following tale is not for the faint-hearted.

Madam E is a 37 year-old Indonesian lady who has a child back in her homeland. She is unsure of the baby’s father. A few months ago, she entered Malaysia illegally while she was heavily pregnant. She is also unsure of this baby's father. She came to a small estate near T.I and stayed here with a few men. All she knew was that she was looking forward to delivering this child and resuming her usual work. What kind of work, I am not sure though.

A few days ago, she came to the hospital bleeding and holding a baby in her arms. An umbilical cord was dangling out from her. She looked pale and almost unconscious from the ongoing hemorrhage.

As we checked her and her baby, we realized that the child was no longer alive. Then we discovered a gruesome tale. Apparently, this lady was unbooked and uncared for throughout her pregnancy, She couldn’t remember how long was her pregnancy and she didn’t seek any medical help in this entire period. On that eventful day, her water broke and she delivered her baby all by herself in the run-down shack she was sharing with a few other men. Being left all alone, she didn’t know what to do. In fact, this is her first ‘natural’ delivery as her first child was delivered via Caesarean section in Indonesia.

We didn't know what crossed her mind at that point but in her panic, Madam E knew that she had to detach the umbilical cord. With a massive pull, she tore the umbilical cord in half but neglected to tie the baby’s end of the cord. As she held her baby, the baby bled to death. From its own umbilical cord. In the meantime, she was also bleeding away as her placenta was still in her body. The men returned home from work and discovered the gory spectacle. They rushed her to the hospital.

As she was in need of blood transfusion and urgent removal of the retained placenta, she was rushed to the theatre. However, it was a difficult operation and along the process, her womb was removed. The reason why the surgical team was called in was because her ureter and bladder (2 urinary organs near the womb) was injured. We repaired the damage and sent her off for further urological care in Klang Valley as soon as she was out of the theatre and stable for transportation. Currently, she is doing very well, minus a womb and a baby.

The mortality rate for mothers and newborn babies in this country has been kept low for many years. It is a testament of our country’s development and it is an indicator of the healthcare system in our country. In fact, Malaysia has been cited and praised by WHO and many global bodies for our efforts in improving the maternal and children healthcare.Yet, when this kind of incident happen in our land, we always ask ourselves whether we should be more vigilant in protecting our borders against illegal immigrants so that ‘aliens’ wouldn’t misuse and abuse the public facilities, etc.

On the other hand, the basic tenet of medical care has always stress on providing universal healthcare for all, especially refugees and those seeking asylum. So how about this lady? At the present moment, we are providing the best professional services for her but how does a Malaysia lay-person feel about this issue? The debate will never end.

P.S.: The pictures have nothing to do with the story. It’s just some fillers to add in some colour.

Sunday, July 13, 2008

The race is on (Mini Road Trip Part 2)

“The heart is pumping. The adrenaline level is elevating. The respiratory rate increases. The distribution of blood supply changes. The muscles contract and relax in perfect unison. Every senses and systems in the body ready themselves for the next challenge.”

Being in a race is what each human craves for. Our minds and physical selves are attuned to challenges in life. Whether it’s a rat-race on the ladder to success, or a marathon road-race or a race to the best results in exams, whether we hate it or love it, we are always in some sort of race.

However, for someone who can be quite sedentary like me, running 10 km is not a joke. Getting my lazy butt out of the labcoat, into the right attire and the proper warm-up are monumental chores by themselves, not to mention the daily runs in preparation for the actual event.

And yet, there I was, outside a stadium in Ipoh, at an unearthly hour (6 am on a Sunday morning, what the heck!!) in shorts and T-shirt, waiting to join a herd of humanity in a 10 km road race. Truthfully, this little cilipadi has never ran more than 5 km non-stop before so I don’t know what possessed my tiny brain to register and turn up for the event. God bless my friends with awesome persuasions and amazing motivational skills, I believe. Maybe I am too optimistic for my own good at times….

As I warmed up by the tracks and look at my fit companion, my heart thumped in trepidation, excitement and seriously, I was also a bit scared. Of course, being as egoistic as ever, I grinned on and commented on how green the grass was, how annoying the loudspeakers were and how fit some of the runners look, etc, etc. My companion must be wondering how weird I WAS…I know I can be a bit hyperactive when I am nervous…maybe I was in overdrive mode that morning.

The level of enthusiasm and excitement in the crowd was enough to buoy me over as I lined up at the starting line. I began to forget my hesitation and worries. I started running and before long, I was in my strides comfortably..settling into a steady (read: slow) pace. I know I will exhaust myself if I keep up with the forerunners so therefore I saw a relatively similar group (read: kinda unfit) and stayed with that pack.

By 3-4 km, I was beginning to wonder when is it gonna end. Some people were beginning to take short-cuts across fields (Malaysians will take short cuts even in a road race!!) while a large amount of people slowed down to walking. I was sorely tempted to slow down but I was warned that if I slow down, I may never continue to run again. I fought off the temptation.

By 5-6km, I took a sip of water and realized it wasn’t such a good move after all. My right side started to hurt (read: side stitch) as I remember that I have this bad habit of not breathing properly during a run and probably I couldn’t keep up the pace. I slowed down and before long, I was brisk-walking (read: slow-poke girl)

The sun was rising and I saw the 7 km sign. I wish I signed up for the 7 km run instead of 10 as I pushed myself on and ran intermittently. Oh dear Lord, when is the torture gonna end? Began to make mistakes and almost twisted my ankle by the roadside but thank God I didn’t. Droplets of sweat began to trickle down my neck. Rubbish thoughts flowed through my mind as I remembered that my Form 1 teacher used to teach us that animals sweat, men perspire but ladies glow. So, I ceased to sweat and began to ‘glow’ remarkably. With all those irrelevant thoughts flitting through my mind, I feel my sanity deserting me somehow.

By the 8-9km, I was unable to run much..most of it was walking. Yeah, maybe my hypoxic neurons began to delude myself that I was in a walkathon instead. I felt so pathetic as I prayed inwardly for some inner strength to come. Surprisingly, my weary brain and muscles recovered as I pushed up my speed and began running.

The last kilometer was a blur. I think I was running towards the stadium in the midst of a rapidly enlarging crowd. I know I wasn’t crawling for sure! As I drew near the finishing line, I saw a lot of people holding certificates. In my mind, I knew that getting a certificate will be a big bonus and most likely I was too late. True to my predictions, that was not my certificate for the little cilipadi turtle. Sigh…

So what’s my conclusion for the day? Running is fun, if you don’t walk..and I will damn sure make myself better prepared if I am going for the next run. At the rate I am tempted by my friends, I think most likely I will turn up for another round of battle. Hey, I have nothing to lose right? (except a few undesirable inches haha)

So that was the most apt finale to my road trip up North as I finished my first 10 km race in one piece, had a scrumptious lunch and drove myself back to D.C. Till my next adventure, this is the CPD signing off..adieu.

Friday, July 11, 2008

Wanderlust reactivated

My German is limited but I have one favourite word derived from the strong Teutonic language. 'Wanderlust' : A strong impulse to travel. An irresistible urge to see new places. I have been struck with this feeling over and over again in various stages in my life.

From my sojourns in England, Scotland, Ireland, Holland, Germany, Belgium, France, Switzerland, Italy to Singapore, Thailand, Vietnam and Indonesia, I've yet to see and experience enough of this wonderful planet.

Of course, my financial state has a big say on where I want to spread my wings. With the current global oil prices, I have resorted to domestic travels on many occassions and I would say that our beloved land is wonderful on her own accord too.

The furthest I could go was in the Land below the Winds and I would say that it was a blessed and amazing trip. There is so much more to explore in Sabah, especially since I am a diver. Everyone has heard of the amazing Sipadan, Layang-layang and Mataking islands and I have yet to explore these idyllic splendours.

There is also a recent obsession with physical activity. As I am not getting younger with each passing year, I figure that I need to be more active as I add more years to the calendar. My sudden interests in running, rollerblading and hiking surprised myself even. Being a normally sport-reticent girl, I could not believe my tiny frame could do all those things (sometimes all at once). So it proves that if I could do it, so can anyone else!!

My next competitive run will be at the Shape 2008 at end August and I really look forward to a better timing. I choose to believe that since Olympics 2008 will be held in China, as part of the Chinese diaspora, I would like to activate my life and reach some form of physical peak before I start to deteriorate and gain more cellulite!!

Recently, I appeared in the mainstream newspaper..all for a good reason of course. My blog was happily featured in the Malay Mail. Of course I was elated and so many people teased me about my sudden 'fame'. I have this serious delusion that I will be getting like 100 hits per day and will soon start to gain a giant cyberspace audience. However, I was brought sharply down to earth again when my hits plummeted to a dismally low figure the very next week. So it was the perfect proof of the saying 'pride goes before a fall'. Taught me a humble lesson not to have 'great expectations'.

With my Dickensian aspirations gone, I was also humbled by a few breaking down gadgets. For the past few weeks, found out that my computer has totally misbehaved. I couldn't check certain mails or upload any blogs at home. Today I manage to do this because I came back to KL and am using someone else's computer. I felt that it's because I began to use NOD32 as AVG is no longer free. Anyone experiencing the same prob with certain antiviruses?

Personal note...time to tell stories from my encounters with patients again. There was this old Malay auntie who is in her late sixties. Initially, she was admitted to the medical ward for sepsis..which is widespread infection involving the blood. Everyone felt very sorry for her as there was no relatives or friends with her. She is totally visually-impaired and very thin. She couldn't fully communicate with us as her speech is slurred from a stroke 2 years ago. She was like a toddler, fully dependent on her carers and yet obviously, her carers have deserted her.

The first time I saw her, she was groaning in pain as I moved her to see the gluteal abscess (large boil in her buttocks) which may need some operation. I suspected something was terribly wrong as her left thigh was deformed. There seem to be 2 segments to her thigh and it struck me that it could be a fracture of the femur that was neglected.

As her abscess grew larger but her medical condition improved slightly, my team decided to take over the management and transferred her to my ward. There we found that the reason she was crying so much was because of a non-union fracture of femur therefore her thigh was swinging about each time we moved her for dressing and so on. We have to create a stoma (diversion of faeces to the abdomen wall by putting the colon outside it) so that faecal material doesn't contaminate her buttock wound and many bedsores.

Her condition was further complicated with a lice infestation (while in ward) and severe anemia due to GI bleeding and low albumin due to poor nutrition. After intensive feeding via IV lines (parenteral nutrition), she improved and we discharged her back to nursing home last week.

Guess what? Today she came back as she vomited blood in the nursing home and her wound became all dirty. She was still unable to walk due to the non-healing fracture and she was in sepsis again. Why do I want to share this story? Sometimes I wonder with so much of technology and affluence in the society, what happened to filial piety and love? Where are her children and family members? Why are we neglecting our fellow citizens and fight other people's 'war'?

As I write this entry and ponder upon life, I guess sometimes I am also guilty of neglecting and ignoring people that need me, especially the older folks. So this is in tribute for all those old aunties and uncles in the nursing homes and geriatric wards and especially for geriatricians who care for them. You, the 'warga emas', are indeed admirable, lovely people and we from the younger generation should learn to appreciate and care for you. Old is indeed gold :-)

Tuesday, July 8, 2008

A Mini Road Trip up North

There is a town in the north of Malaysia which I seem to have a 'connection' to. Each time I drive towards this charming mining town, I come back with many stories to tell and more than a few happy events. Of course there are pictures to be taken too :-)

Drove alone after a relatively relaxing call to meet up my pals and enjoy good meals. Firstly, met up with the Hospital gang at Brewster, old city centre, Ipoh. This is a chill-out place with relatively good food. I wonder if the tequila in my fish has anything to do with my extremely

good mood that evening. Ah, good company and ravenous hunger are the best accompaniments to any meal! I swear...

Then, I hung around the old town area and snapped a few pictures as the sky was brilliantly lit by the setting sun. I spent quite some time contemplating the best way to capture the colours but I guess my photographs couldn't depict the majestic hues on display that evening. Everything was bathed in the warm afterglow of the setting sun amidst the limestone hills. It was so surreal that I am a silent bystander witnessing the beautiful creation of God. As the busy traffic buzzed past me, I am just so thankful that I was there at the right time.

My trip was interspersed with a simple and uncluttered wedding ceremony and a long rest before the main 'highlight' of the weekend, the Ipoh International Run 2008. Being unprepared, I was in much trepidation and excitement. To cut a long story short, I completed the 10 km race in one piece but I am not going to reveal my timing (shy lar...) My competitive streak in me was kind of disappointed but I vow to do better if I am going for another race in the future. So God please help me to have the discipline to train and improve, hehe.

Sometimes when I am not in a rush, I tend to take the trunk roads as these meandering roads are filled with characters and I love picking up interesting anecdotes about life as I zoomed past the zinc attaps of old kampung houses, brooding cows grazing by the roadside, abandoned tin mines and happy children playing by the roadside. That lazy Sunday was the perfect example of how relaxed I was. As I drove past the rustic countryside, I couldn't resist snapping a few snapshots of the unfolding scenes on my way home.

The most historical and yet decaying stretch is the sad old shophouses by the road between Gopeng and Ipoh. The crumbling facades hid uncountable tales and if these buildings could speak, their stories would fill many volumes of text. My imagination ran wild with possibilities as I imagine the lives of those past inhabitants. Who are these people who owned and lived in these houses? What were their concerns? What made the people leave this town in droves? What does the future holds for these monuments to time?

To be continued....

Tuesday, July 1, 2008

Saying farewell

Another close friend is leaving Teluk Intan for greener pastures up north. She is one of my makan buddy and a grand listener who listens to my many complaints, mumblings and grumblings. As of 1st july, I bid farewell to at least 7 friends who went off to work in bigger hospitals as they leave this town, one by one. One of my housemate is now in KL, busily treating sick children in the biggest hospital in our country while another is on her way out to Penang.

On the other hand, I am still here in Diamond Cove. Each day, I wonder when the transfer letter will come. As I do not intend to pull ‘strings’ or cables, I guess it will take some time. At least, I enjoyed (and still do!) my posting here (remember my long post about what I learnt here?). However, it’s also time for me to further my career. I know that once the letter arrives, we are not given much time to move. In fact, it is often backdated J. This is the normal fate of doctors in Malaysia. Most of us are not given much choice when it comes to posting. My boss has 3 little kids in KL but worked in Teluk Intan for more than 1 and a half year. He commutes almost weekly just to see his children. When his son fell sick, he could not even nurse his child.

For the sake of the community and the nation, we neglect our basic health and needs. Some family matters are put to the backburner for the sake of helping patients. It’s not that all patients are appreciative of what we do. In fact, some even question our judgment and repeatedly refuse interventions although we are doing our best for them.

We realize that some of us need to go to the smaller district to serve the people. What we are dissatisfied with is that those in contacts with ‘bosses’, those people with ‘cables’ to pull and those who have influential families seem to never leave the big towns. A few of my friends in the Klang Valley has never served in the small towns or kampongs. There need to be a revamp in how doctors are being posted around the country. Some of us feel that there should be a rotation system whereby everyone is required to serve in the districts for a reasonable period of them unless they have very concrete reasons to stay in the big towns. If not, why are we given the same pay regardless of where we serve? Why are we all called doctors?

Otherwise, a lot of less ‘well-connected’ doctors in the peripheries will feel marginalized and demotivated while the ‘upper crust’ or ‘higher society’ remain contented and pampered in the Klang Valley, etc. At least for now, this story has a happy ending as my boss successfully ‘win’ his appeal and he is now working nearer to his young family. How about many other silent doctors who remained in far-away hospitals, especially those in very rural areas in East Malaysia? When will they ever see justice being served?

On the other hand, in our practice, now all patients do accept our choice of treatment. No matter how much we trumpet evidence-based medicine and obtain the best advances in medical care, we still cannot change mindsets and attitudes. One of my patient was diagnosed with cancer of the colon, which is operable, but she refused surgery as her children and family members wanted to try alternative treatment. Another Orang Asli gentleman has operable pancreatic tumour but gave up because he feels that he is too old. He was 65 year-old.

How do we as doctors respond to this kind of scenario? When I was much junior in service, I will feel very disappointed that my patients do not want me to help them. At that point, I feel like I have failed them. As time goes by, I realized that I am also doing my best by offering kindly advices laced with empathy. By giving them informed choices, we give them control over their lives. Maybe that is the most important thing in their lives at the moment they discover that they are terminally ill. When someone is faced with a life-threatening illness, they often feel fearsome due to the lack of control and hopeless due to the looming disaster.

Therefore, giving them autonomy is not such a bad thing after all. As long as they are making valid decisions with a sound mind, the best that we could do is to respect their decision and wish them best of luck.

By the way, to my dear friends who are now chasing their dreams in bigger centres, to those of you following your heart’s desire, to my pals who is travelling on a different path in life from mine, this piece is dedicated to you. For you have proudly done your part for the poor and oft-neglected folks in the districts. May God be with you and take care...