Through it All: Decade of ups-and-downs in the world of cilipadidoctor-ing

Just like the eminent PM LHL, who has been at the helm of this little red dot for a decade...for me, it's been nearly a decade of 'repairing' the human body. Guess I'm showing my age by penning this post but I can't resist as it's been a very interesting day of reflection. Deep thoughts often open up the floodgates of penmanship in me, unlocking the writer's block in me and of course allowing me to revive my blog once in a long while.

Why the sudden impetus to write on this calm, windy Saturday afternoon here in the balmy tropical island of Singapore? Probably the recent conversations about life and death due to Ebola Hemorrhagic Virus with my Nigerian doctor-friend who is fighting in ground zero in combination with the joyful announcements of the successful Singaporean contingent in the just-concluded FRCS (GS) examinations in KTPH.

Spent nearly half the decade of 'doctoring' in Malaysia before settling in Singapore. Eternally-grateful for the teachers from both countries who have enlightened me along the way, gifted me knowledge in the human body and honed in me the skills necessary to be a good general surgeon. Sometimes I do miss practising in Malaysia, the hustle and bustle of a Malaysian general hospital where we truly see the meaning of 'general' in general surgery.

My happiest memories of being a clinician were those of patients grasped from the jaws of death, those turned around from the light at the end of the tunnel and their subsequent walk out of the hospital. It's been a wonderful, fulfilling journey and I pray to God that He will give me much wisdom, ability and opportunities to minister to the ill. 

Nostalgia aside, life is very different now. The focus is excellence in the highest level, fighting alongside the best minds in this tropical metropolis. Be it persevering in the war against cancer, suppressing my adrenaline rush to remain the calmest mind in the face of a surgical emergency, teaching the brightest young minds in YLLSoM or calculating p-values and confidence interval...I am grateful for being allowed to flourish in this institution. Truly I have now understood what is meritocracy and what opened doors mean....

My twin passion in professional life is in general surgery and public health and my quest is to leave a great legacy for many female surgeons and public health practitioner a few decades down the road. So before that could come to fruition, please pray for me as I prepare for the largest battle of my professional career in a few months' time. I may not know what God has in store for me as these are kairos moments but I know that He is always there for me through it all....

Haze Myth: PSI vs Visibility vs PM2.5

Rumours abound in times of trouble...and its' human nature to 'panic' and fear the unknown or unnatural. As a medical doctor and recent public health graduate, sometimes we see things differently through broader lenses. Rational, educated mind is a good defense against irrational feelings and emotions. Despite what our eyes tell us, let us focus on creating solutions and calming those around us, instead of creating more anger and fear. That's why I was quite impressed with what PM Lee said recently regarding this crisis - no megaphone diplomacy for this statesman.

Firstly, the PSI has been adopted in Singapore to give the public an up-to-date information on the air quality in this country, as opposed to the different indices used in US, Malaysia, etc. It's a composite of various substances in the air which may cause harm to the human body if we are exposed to it in significant concentration, depending on what is your health status. A normal healthy adult obviously could tolerate the pollutants a bit better than a sickly person, the young and the old. However, if you are exposed to it in significant amounts over a prolonged duration, there may be both short and long-term effects.

Secondly, I would say of all the pollutants being reported, the most insidious and hardest to clear from our body is the PM2.5 particulate which is lodged in our alveoli. These particulates are suspended in the air, but invisible to the naked eye and odourless. When its consistently high (as reported by various authorities), it can cause long-term lung damages, especially lung fibrosis in the future. Not now. What's happening now is the sequelae of direct irritants in the air, to our airway - sore throat, cough, asthma attacks, shortness of breath, conjunctivitis, headache etc. It's usually a brief episode unless the hazy condition persists.

Thirdly, staying indoors is a good advice, provided that you have air purifier or a good working air-conditioner with functional air filter. Indoor air quality can be worsened if u open the doors/windows intermittently and trap the haze within the closed compound. Especially for those susceptible to the effects of haze, please take precautions - wear a well-fitted N95 mask properly whenever u are exposed to hazy outdoor air but do not hoard. There are more than enough masks around - just be patient and resourceful. Visibility is not equivalent to high PSI. Check the official results regularly to be well-informed.

Lastly, public health problems require public health solutions...it has be long-term sustainable solutions, tackling the root causes and not just a one-off assistance. Short term measures like creating rain artificially or fighting the fire are temporary measures. We have to work together to tackle the root causes of why these fires are started at the first place. Eradicate poverty, improve on peat-fire surveillance, tighten legislations and change this burning practice. This is a man-made calamity, which means, we can work together to eradicate the cause and not point fingers. Empty vessels are of no help now. Human behaviour may be hard to change, but it's not impossible. The collaborative task-force should be sustained long-term and not hastily convened at the sight of trouble. Prevention is better than cure....

Meanwhile, continue to keep calm, drink lotsa water and pray on.

Caveat: This article is purely personal opinion and doesn't amount of professional medical advice. Please seek a doctor's consultation if you are suffering from the effects of haze. Thank u.

Garden or Hospital?

This is what I see daily as I savour the short walk into my new workplace. The grounds are exquisitely peaceful and uniquely different from any other places I have worked in. I'll give you a few glimpse of this grand old dame of a hospital in the following few pictures (I must say that my handphone camera doesn't do the beautiful grounds much justice).

In its' verdant gardens, there are also a lot of huge stately trees beautifully preserved. You can see the flora and fauna as you walk into the hospital, from the bus stop on Alexandra Road all the way to the 'grand' entrance.

Looking across from the main entrance, we could see a neo-classical fountain with a Grecian figurine and a myriad of flowers - lilies, bougainvilla, etc. Apparently, there are various birds spotted in this garden too..This is truly a place for people to recuperate, recover and get well in.

And as you approach the information counter in the foyer of the main entrance, there is this refreshing, wonderfully-scented Christmas tree that is made of a real pine tree. Quite a beautiful place to work in, I must say... The only downside is that the open grounds made it quite difficult to leave the hospital for food/home/shopping during this rainy season.

Next stop, I'll intend to take more photographs of the colonial building itself as this hospital used to be a British Military Hospital followed by a Japanese military headquarters during the World War 2 before being renovated to the well-equipped, clean and beautifully-designed AH. Hopefully, I will unearth a few of the colourful history (maybe even discovering some lurid/grisly tales from the past) in this hospital before they move to the west in a few years' time. Wondering what is the status of the building then. Cross my fingers and hope they will not alter it too much or destroy the heritage preserved within.

A Brother's Love - My first liver transplant

The first time I met Mr E in National University Hospital was on the day before he would take the biggest risk of his life. I was struck by this friendly and cheerful giant. At over 180m tall and more than 100 kg, he clearly towered over me, the unsuspecting tiny surgical registrar. I noticed how much he engaged himself in the conversation as my consultant surgeon explained to him again about the entire procedure, never mincing a single word on how things could go triumphantly right..or even tragically wrong.
 

            He is one of the healthiest person in the room and we have to be absolutely certain that it. After all, we have subjected him to almost every single laboratory tests and imaging modalities available in this medical centre on a young person who would never need it under normal circumstances. However, Mr E is not a normal person..in fact, he puts all of us to shame for doing something remarkable for his brother. He is giving up more than 70% of his liver although he absolutely doesn’t need to do so. All for the love of his youngest brother, Mr A who could die if he doesn’t get a liver soon.

            What drives a person to this kind of sacrifice? As I prepared myself mentally and physically for the exciting yet arduous task of a living donor liver transplantation on a beautiful quiet Saturday morning in NUH, I asked myself whether I could have done the same for my siblings or loved ones. Why are doctors willing to help be part of this big risk? Why are we not saving more lives this way? Why?

            No choice. There is simply no choice for people like E and his brother. I can only think of these 2 words. Between life and death, they decide to seek life. They travelled all the way from Middle East to Singapore in order to seek the best that liver surgeons, hepatologist, radiologist immunologist, etc could offer.

If only more people step up and say, “I am willing to be an organ donor shall I perish and I am suitable to be one” or “Please doctor, my loved one may be dying, but I want his death to be life for many others”. In dying, we can find life but why are people so unwilling to do so. As many of us search for answers and dwindle on longer and longer based on indecisiveness and fear, courageous people like Mr E and many others embark on this path less travelled – living donor liver transplantation (LDLT). A path fraught with legal red-tapes, financial constraints, personal sacrifices and even death for both donor and recipient. It's never a path taken lightly or without due consideration.

Organ transplantation is not new in this region. In fact, Human Organ Transplant Act (HOTA) has been around for at least 2 decades in Singapore but the numbers of transplantation has been dwindling abysmally over the years. The amount of liver transplants done in this country this year is woeful and augurs poorly for the future. We have less than 10 cadaveric transplantation cases countrywide this year, which was the bread and butter of transplantation surgery.

 As a result, most of the transplants had been the extremely high risk LDLT. This is in comparison to some other Asian centres, like Korea and Japan where it can be an average of 350 cases per hospital per year. This means that there is at least one transplant going on in the operating theatres each day, every single year in these hospitals.

 The saddest part for me is that many people hesitate to donate organs of their dying loved ones due to many reasons. My head spins when I hear of many creative, incredulous reasons why a person in intensive care cannot donate their organ. There are no logical, moral, religious and logistics reasons not to donate organs in this country. My summary of all the excuses so far are captured in 2 adjectives: unwillingness and ignorance.

Every case of transplantation is an exciting journey upon itself but not every transplantation stories have happy endings. They almost never receive the publicity or fanfare they deserve. During my first experience with a liver transplant surgery, my heart was beating in joy and humility for what I was about to experience – it’s literally sharing the gift of life from one person to another. In my little mind, it was one of the best, jaw-dropping, awe-inducing demonstration of surgical knowledge, dexterity & skills, inter-disciplinary teamwork, medical camaraderie and top-notched, dedicated support staff.

This act enables someone who was constantly ill and dying and transforms them into a real human again. They will no longer be dependent on machines and doctors for long term. Although each recipient may face an armamentarium of medicine in the beginning, they will soon be weaned down to one or two maintenance medications and minimal follow-ups with doctors.

 

What are the highest achievements of a civilization? What is the marker of a successful, egalitarian society? It’s when we stop looking inward and start to look at the common good. It’s when we see our struggling, suffering comrades and in love, extend a helping hand. We must continue to support the transplantation program in this country before it becomes a dying art, a fossil, a relic of past glory.

 

As of today, Mr A is still resting in intensive care while Mr E is carefully nursed in another high dependency unit. We pray that these 2 young people will recover soon and return heroically to their country within 1 or 2 months.

Transformed! Part 1

I'm home and already I miss the happy, friendly people, the delicious bryani of Hyderabad and the van-rides everyday:-P.....Seriously speaking, I have never been so grateful for everything in my life. How can I begin to describe the things I have witnessed in India, the heart-breaking testimonies of the orphans and the slums dwellers there? It ain't how Hollywood painted it to be, in case you begin to visualize Slumdog Millionaire (although it is a very good movie, nothing beat the real life experience). This is faith in motion, reaching out to the needy and giving what we can to those with open hearts.




There are no pictures, except for those in my mind, and no proper words to describe how I felt when I first saw the squalid dwelling tents that these people inhabit. No sanitation, no proper electricity, no walls, no doors, no beds, no kitchens...I couldn't believe it at first that families actually fight for survival on a daily basis in such a condition. After an initial few hours of denial, I accepted what I see before me. God removed the sense of hopelessness that filled my heart in the beginning,and gradually I see the fighting spirit and the hunger for self-actualization, love and medical care among these people.





As we played with the orphans and children in the slums, I could sense the love and light of Christ permeates through their lives. So many abandoned and lonely little children began to emerge from their former shells and blossomed into sweet, well-behaved and loving kids.





The cute munchkins have no Internet, television, Toys R Us...just donated clothes, simple food and each other. Yet, with their beaming smile and huge, intelligent eyes, they welcomed us as we sang songs of praise together, played games, learned various skills and acted Bible stories together. When we as temporary sojourners in their lives prayed for them, I could sense the covering of God's protection and grace upon their lives.




Some of the children told me that they want to be medical doctor, software engineer, artists as they gave me huge hugs. What I hope for is that the children could sense the love we have for them although we could only spend a few days with them. I hope that they will grow up strong and healthy, that they could achieve their dreams for I see so much potential and hope in each of them.




When we were at the medical camps, again there is this powerful atmosphere that swept across the village as we set up camp. The first camp was in this hot, dry village that seemed so remote. The 2 local doctors told us that this is the first time the organization has gone into this village. I was overwhelmed, not with the amount of patients...hehe, I felt like a mini-celebrity for the day :-) but with the reception and how much of honour and gratitude the villagers accorded to us. I saw all the women who needed medical attention while my colleagues saw the men. As the village is very far away from the nearest hospital, I am not sure whether they can go for further investigation but we gave our best and referred some to further care.





At the same time, the rest of my team-mates were busy doing a lot of things...playing with the children in the courtyard in front us on our verandah, under the bright sun and deep blue sky. Some of us were speaking to the villagers, praying and releasing blessing upon the villagers who came to us. When we left at sunset, although many of us were sunburnt and exhausted (all of us dozed off in the long, bumpy and warm journey back to Hyderabad) awashed with the afterglow of a precious and soul-enriching experience.





The next medical camp was an equally amazing experience as we saw patients in the city slums, under the shelter of a half-finished building (a.k.a. construction site). The spectrum of patients were different but the crowd came despite heavy rain and strong winds. We saw more babies and mothers this time as the adult men seemed to be out working. After the strong heat of the first camp, indeed the cool weather was a huge blessing to us as we see patients after patients non-stop.




To be continued.....

The Most Important Patient in my life

What happens when the doctor falls ill? I’ve never asked myself this question until I was in hospital for an illness in the past 1 week. Being so fit and healthy my entire life, it was a big surprise to me and everyone around me that I was having such a serious medical problem.




It was life-threatening and thoroughly unexpected. Being ill for a week, I initially thought I was having a mild infection until I listened to my own lungs and ordered my chest X-ray. I was immediately admitted by the physicians and a procedure was done for me.




Being in the hospital for 4 days had been an emotional roller-coaster. I kept on asking myself, asking God : Why me? Why this problem when I am so young? What is the reason? Why do I deserve this when I have always done my best in treating patients and saving lives and doing good? Is it worth working so hard my life but getting this ill?










I went through an entire spectrum of emotions: denial, anger, depression, bargaining and acceptance. Everything that Elizabeth Kubler-Ross described in her human psychology book on hearing bad news. In retrospect, it wasn’t totally bad news but to me, at that moment of weakness, I really crumbled. The strength in me went out and I burst into tears. In the deepest valley of my emotions, I drew joy and assurance from God. Good friends came and counseled me. Mostly, I prayed and worshipped the Lord, seeking answers and peace.




Finally I found the inner joy and peace. The Spirit of God enveloped me so thoroughly that within 1 day of feeling in the dumps, I was back to my usual self. Optimism, happiness and pure faith flowed in me. I started smiling at my friends. I was thankful and amazed by the huge amount of visitors…I was being visited almost non-stop daily. Doctors and nurses don’t adhere to visiting hours and they all came in, cheering me up and showing me how much they care. Friends from church dropped by and prayed, bringing with them beautiful flowers and tiny gifts that really touched my heart.




Most of the time, I wasn’t tired or breathless. In fact, after my procedure, my cough reduced drastically and my fever settled. Although my diagnosis is still elusive (mine a case of medical connundrum worthy of the attentions of Dr Gregory House), I was being treated in one of the best facilities in Asia.








The medical and nursing staff that attend to me have been professional and the best that I’ve encountered. My investigation results came out very early and conveyed to me almost immediately. I know my hospital bills will be substantial, but judging from the level of care, I know that I was in the right place.



As I now recover at home with a small, residual problem and a lot of antibiotics, I still do not have most of the answers. In fact, I am not even sure of my own diagnosis. The biggest lesson I learnt is to slow down and to de-stress. I need to re-evaluate the way I work, my extreme dedication and lack of rest played a role in reduced immunity, thus I fell ill.








Recognizing that God has ordained this rest and this entire episode. Everything that happened has a reason in God’s big picture, I no longer strive for answers or live in negative emotions. Instead, I choose to focus on His goodness, mercy and love, to look at the bright side of things and to be happy so that I could recover fast. I wish to contribute to society as soon as I can. So, in order to do so, I need to be fully healthy again.



For I know that I am the most important patient to myself.

Operation Share International 2010: Bringing the gift of healing to the nations Part 1

As I gazed into the merry, beautiful eyes of the little girl in front of me, I cannot help but feel elated. A deep sense of fulfillment descended upon me as I sensed the gratitude and happiness emanating from the girl’s mother and the impish 6 year-old patient. I’ve just operated on the girl’s hernia and she was about to hop onto her mother’s old, rundown motorbike (without any helmets).

“Sakit?” I enquired. “Olak, olak….” She smiled and they rode off in the sunset.


This is just one scene out of many in my days in Sogod, Cebu. People streamed in and out of the tiny district hospital, seeking help as the doctors and nurses worked non-stop in few makeshift theatres. Some were sitting down as we removed the lumps while others were sedated or put under anaesthesia in 2 little rooms shared by 4 operating teams.

I consider it pure joy and absolute blessing to be able to work with the wonderful, selfless surgeons and surgical residents from CBUH (Cebu Doctors University Hospital) and the group of volunteers from Singapore various hospitals (namely 8 surgeons, registrars and MOs from NUH and 2 doctors from SGH and AH respectively)

When we arrived in Cebu City in the early, pre-dawn hours of Tuesday morning, Dr A Yu and Dr H Chua from CBUH sacrificed their precious sleep in order to ‘deliver’ us safely to a pension house for some much-needed rest. When we woke up, we met a few other surgeons in Ayala Centre for an extremely sumptuous lunch at Laguna Beach Café.

A short sight-seeing tour around the heart of Cebu City marked the very good beginning to a wonderful trip. Each day, we were fed with delicious Cebuano delicacies and housed in the amazing Alegre Beach Resort, 5 minutes away from the Sogod Hospital.

This exceptional resort is the fine epitome of Filipino hospitality and grace..we don’t deserve of such a favour and yet we are here, housed in one of the most beautiful seaside resort in Cebu. Each classy room has soft beds, big couch and world-class bathroom.

Not only that, I was so fortunate to meet KLL, a beautiful young surgical trainee from Adelaide. This girl blessed with exquisite skin and a cheerful, humble disposition is a fellow KLite. The talented new roommate is also a photography enthusiast and loves God and His children. No wonder we clicked so well….

Anyway, the first day was quite eventful as I discovered that we could take out lumps with only 3 or 4 instruments…a blade (without blade holder), artery/clamp, needle holder and a pair of scissors (and when its not necessary sharp, we made do with the blade!). Giving the patients LA was actually breeze-free as the tough Cebuanos didn’t even bat their eyelids as we tackled large lumps with just 10 or 20cc of lignocaine. Amazing people! Working non-stop, we operated on 5-10 patients per session per surgeon in the minor OT.

At the same time, many other teams were working hard in removing big uterine or ovarian masses, thyroids and hernia in the major OT. I joined them when the minor OT became way too hot and unbearable in the late afternoon and discovered that the major OT was almost equally as hot.

Sweat trickled down my scrubs as we operated with table lamps and head lights. Light was inadequate, equipments were at times lacking but we know that we must work under whatever circumstance, pushing our endurance and skills to the limits. Yet I applaud the nurses, nursing assistants, anaesthetist and triage doctors. They are the unsung heroes for supporting and aiding us all the way. Without them, without the wonderful human spirit of love and giving, we couldn’t have done all these operations in extreme circumstances. Bravo and well done!

Furthermore, this experience of a lifetime, my baptism of fire in mission marked a few first times for me. I did a herniotomy without any diathermy, 2 thyroidectomies (with guidance from the consultants) with minimal equipments and a few lumps in children without GA (just LA). Of course people might baulk at the lack of sterility and warm temperature, but I seriously applaud the mission organizer for organizing this wonderful experience. Bringing surgery to the underprivileged in Sogod involves marvelous logistics, impeccable skills and people with humble, willing spirit.

Most importantly, I am sure that this exchange of skills, cultural experience and knowledge between the surgeons from Singapore and Philippines will culminate in better ties and regional co-operation in the future. As I observed the wonderful, skillful hands of the surgeons I’ve met here, I realized that I couldn’t be more thankful for the opportunities given to me in Malaysia, Singapore and Philippines.

In each country, I’ve found precious, priceless ‘gems’ in my journey in surgery. For example in Cebu, I am truly amazed by the beautiful parotid operations, the precise anatomical hernia repairs, the exquisite cleft lip repair under LA. It was indeed medical textbook came alive.

Although the whole trip ended so quickly, I know that I will see Cebu again. For the warm, friendly souls I’ve met and the grateful patients have truly touched my heart. Even as I walked down the warm ward on the last day, checking on all the patients that we operated on, I knew that this is the first of many more surgical missionary work that I will do in the future. For much is given to us, much shall be released to the nations….

Therefore, a big thanks to all the people I've met the past 1 week. I look forward to many more wonderful missionary work in the future as my promise to God when I first entered medical school came into fruition...

P.S. : I've uploaded a few more pictures that displayed here in my fb album and I'm sure that many more pictures will appear as more than 8 dslr cameras appeared in the tiny Sogod hospital. Seriously, I've never seen so many doctors interested in photography before. Astounding!

What happened @ Yam-yam?

It's not easy getting days off from clinic. What's even more difficult is getting the whole surgical gang out for dinner on a working Monday. Our regular workload and patient flow is pretty heavy but with the recent influx of medical officers in the department, life can be good when it comes to sampling Ipoh's gastronomical delights.












In conjunction with our colorectal workshop, we were fortunate enough to get 2 full days of seeing interesting cases courtesy of Prof Charles and Miss Chan. Although we see a lot of bowel-related cases in normal general surgery, there are also some high-level cases and procedures which are rare and technically-demanding. So, I was very glad that we all had a chance to be immersed in the 'gut' for a few days













After hours of playing with the gut, we need to fill up our guts too and what better place than somewhere extremely near to the hospital (so near, we could actually walk there but being Malaysian...who walk when we have cars!)












We decided on Yam-yam, a Nyonya-Chinese fusion restaurant at Old Greentown. It was surprisingly packed that Monday night and I've forgotten how food taste like in this place. I remembered it was previously unremarkable. I guess I could be prejudiced because the last time I came to this place, I was still a little houseman in 2006, living on my meagre salary.

There were 18 semi-hungry people (we were well-fed throughout the entire day) waiting for food amidst the crowd. It came sooner than expected as everyone was in a good mood (courtesy of some 'sponsors')

The omelette was alright although very small for 8 people (each table). On the other hand, the pandan chicken was tasty, very fragrant and well-marinated. I guess no one could go wrong with this dish.

The tofu was quite good while the tomyam was ok. At least, the entire dining experience was very pleasant as we catch up with each other.

So, what's CPD's verdict again?

IMHO, Yam-yam is not as unremarkable as I remembered it to be. The price is reasonable and the place has an authentic, old-world charm to it. Food is quite good, especially for a big party of 4 or more people. What's more importantly, the location is excellent for those of us in town.

Witnessing an accident first hand and musing on defensive medicine

Being a healthcare personnel has its shares of ups and downs, perks and quirks, joy and sorrow. We are often silent witnesses to some of the most tumultous events in a person's life. Trauma, birth, death, cancer, severe illness, recovery..these are all parts of the circle of life that we encounter daily.




For example, we were travelling for dinner while oncall during the Raya period. You can say that we are having a very good call if we are able to go out for makan at normal times. Anyway, we were following an old Roadways bus near an intersection in the Greentown area when a blue Viva shoot out of the intersection. BANG! I heard a loud sound and there was a collision right in front of us.




We immediately parked our car near Dave's Diner, jumped down the parking lot (I was glad I was wearing trousers and could run around anywhere!) and checked on the passengers of the small car. Apparently, a young girl was the 'unlucky' driver with her boyfriend sitting next to her. We checked on her briefly and although the car was totally wrecked (it looked bad), the direct impact was on the back seat behind the girl thus she was spared from any bodily harms. We let the paramedics do their work and continued on with our dinner.





Anyway, the incident made me wonder about emergency services. Although all 3 of us in the car was fully trained for emergency procedures as we are surgical registrars and medical officers, we would not be able to do anything if there were serious injuries outside the hospital. We do not have any medical supplies, oxygen tanks, splints or even bandages in the car. In fact, I don't even carry any resuscitation tools with me at all times.





On the other hand, I have recently heard of the Good Samaritan principles in the practice of medicine. Basically, if a doctor decide to help a person in need outside the hospital (let's say in a medical emergency on an airplane, in a boat, by the roadside, etc), we are equally liable to any untowards event in case of death, permanent disability, etc happening to the injured person. In short, we could be sued for malpractice despite the lack of diagnostic and treatment tools. Moreover, medical malpractice insurance may or may not cover the doctor, as the person in need did not deliberately seek our help in the first place; i.e. the person in need is technically not a patient as he/she did not solicit us.





Now this puts a lot of us in a dilemma isn't it? As a fellow human being, we would normally offer help and being medically-trained, everyone would expect that a doctor is the best person to assist a person in distress. However, there is this hand-tying, law-suit happy society nowadays that would not hesitate to persecute anyone that could be blamed in the event of an unhappy ending. I guess this will again reinforce on the practice of defensive medicine....





How about me? Would I help a person in need? I guess I need to be wise in offering help as the ultimate tenet is : FIRST, DO NO HARM. Whatever it is, we must remove ourselves and the person in need from danger and then, intelligently & calmly assess the situation. After all, we cannot be a 'hero' and try to perform some 'miracles' without back-up personnel and the proper tools and facilities!!

A Journey Well-taken

This journey was started way back in medical school. It was my dream to become a surgeon when I entered med school. The journey was eventful but I know that God's gracious hands was upon me. Taken a very expensive route to my intended 'destination' and travelled to Singapore on my own for this high-stake 'gamble'. And today, you can say that I 'won big' :-)





I'm so humbled by this blessing. I've tried my best and went through the mental and emotional stress. I thank God for I emerged one intact piece!! Thus, I've entered the world's oldest surgical association. Another progression towards my goal, a big step forward.




So, a big thank you to all of you who helped me along, borrowed me books, let me practised with you in hospital, motivated me, pushed me along, humoured me, eaten with me, tolerated my mood swings, laughed with me, scolded me for not revising enough!! I've now gotten my MRCS (Edinburgh) and part 1 of M.Med (Singapore). THANK YOU!!!!

Facts can be stranger than fiction

After years of working in the hospital, the human body is more amazing than ever. The amount of things that people put inside them, develop from within their cells and accidentally found inside themselves are just stupendous. My series of cases are just the tip of the iceberg and i've not found enough time to actually write about most of them.





















Anyway, we did a laparoscopic procedure not too long ago and found this structure near the appendix. Bear in mind that we started the procedure aiming to remove an inflammed appendix only to be puzzled by this structure.

These are still images from the laparoscopic tv as I was the camera-woman holding the telescope while my boss did the operation with long instruments (a.k.a laparoscopy) through small key-hole incisions in the abdomen.

As the end of the day, we removed this 'egg' from the patient's abdomen. It was lying freely near the appendix, not attached to any structures at all. What does it look like to you?

Then came along a girl involved with an accident and she was semi-conscious. These series of images from a CT scan film should have NEVER existed.

So what do you see?

Girl @ Work

This article marks the rare appearance of pictures of me from work and something featuring my little car...










What’s a good day for me on a working day?

1. Assisting at least one interesting case
2. Having my meals at regular hours (preferably a good meal too)
3. Successful operations done by yours truly
   

So, on any account, I would say that I had a very good week so far. Firstly, I settled a lot of errands as home including letting my car has its treatment and health check-up at a friendly neighbourhood ‘car-spa’. I knew the uncle since young and was very happy when I didn’t have to go to the ‘official’ Perodua showroom with inflated prices.

Secondly, I was involved in the colorectal workshop, which is an annual event at RPB whereby a senior consultant surgeon from NUS in the land down south, will do a series of cases and endoscopic ultrasound of the anus and rectum.

The most fun time for me was when I got to assist something I have never seen before, which is a rectovaginal fistula repair using a labia majora flap. Oops, let me rephrase that in English…we repaired an abnormal track between the rectum and vagina by tying off the track and inserting a flap (some other living tissue from nearby that area) so that it will not occur again.

Sounds easy, but looked complicated enough for me. Of course I was very happy at the end of the day! Ah, I love my job :-) Helping people pass motion is part of a good day huh?

Thirdly, I had my meals at regular hours so far. Yay! No more gastritis pain and hunger pangs. Now that the hospital has only 3 working lifts, my work involves a lot of climbing up and running down at least 6 floors a few times a day…so good food is mandatory for survival. Somehow, echoes of the Queen E Hospital in KK kept on running in my mind as I walk past the broken down lifts. Shudders….

Today I saw a patient with bowel cancer in whom we cannot do a curative operation because of a severe aorta problem that IJN also couldn’t operate on. As she has two time bombs in her body, I had a very difficult task of explaining to the old lady on how there are limits to medical science and I admitted that we couldn’t do the curative as any one of the operation will risk her life and cause immediate death on table.

I was very apologetic and sad as I counseled her on ‘palliative’ care. As I go on, I realize that a good surgeon knows when to cut but it takes a courageous, good surgeon to know when NOT to cut. The decision to spare the patient from the risk of almost immediate death if we attempt operation was made by my seniors but as I was counseling the patient, I felt that I was learning very important life skills too.

So at the end of the day, the silver lining is that the patient accepted my explanation graciously and agreed for our future efforts in easing her suffering as she reach the end of the road soon. It reminded me that life and death is in God’s hands indeed….

Things we doctors find inside the human body

The human body contains many orifices. Certain ‘adventurous’ people do go off-tangent and occasionally they decide to insert various objects into their body parts. As I deal with the gut a lot, obviously we have to extract things stuck in the lower throat, oesophagus, rectum and the anus. Anything other than those areas, we have to wait and see..nature will expel a lot of objects as long as it can pass into a few constrictions in the gut.








We were chatting about the number of times we were called to remove things stuck and so far, a lot of notable patients came to mind. Over the past 2 years here, let me recall the few interesting incidents.

Patient number 1 came in with pain in his ass and previous history of schizophrenia. We brought him to the theatre and lo and behold, we found oranges, lemons and apples in his rectum. Now we know how he likes his fruits huh? Up his rear end!

Patient number 2 is a lady who came with bleeding from her urethra (urinary tract). We scanned and investigated her but could’t find anything wrong. After putting a scope up her urethra, guess what? We found the plastic cover of an eyeliner. Apparently, the patient ‘sat’ on her eyeliner cover and conveniently ‘forgot’ about it. All’s well that ends well as she left the hospital with no inanimate objects in her bladder!

The most recent event involved an elderly gentleman (in his seventies) who came with pain and bleeding from his anus. An X-ray showed a remarkably long and tubular object (around 25cm long) lodged in his rectum. I tried my best to stop laughing when we realized that it was a ‘toy’ stuffed up his rectum..yup, uncle went to Thailand and bought a dildo. Next thing he knows, he lose hold of the ‘slippery’ object while enjoying himself and the thing went in deeply into his rectum. When we asked why he inserted the dil— into his rectum, he said it helped him to pass motion.

As usual, Ms-aspiring surgeon was on-call and I tried to remove it in the OT but it was almost impossible as the did— slipped even deeper into the bowels the more we try to maneuver the long object out. It took us another day of waiting so that the bowel peristalsis pushed down the object and in the end, we managed to extract it with a lot effort, team-work and coordination.

In conclusion, a piece of friendly advice from the doctor : If you cannot resist inserting any foreign object into your body, do tie a strong string around it! The gesture is much appreciated :-P

My perspective..exploring life among OA in Tapah

I’m one of those people who moonlight in local GP (General practitioner) clinics very rarely, like for example once a month. So far I’ve seen a variety of cases in different clinics just to experience the life of a GP in various towns in Perak.









Not long ago, I’ve visited a clinic in Tapah town and realized that I enjoyed seeing the orang asli (OA @ indigenous) children a lot. There are plenty of settlements scattered along the mountains bordering Tapah town and as a result, many of them seek medical treatment and earn their living in this town. When I sauntered into the night-market during my break, it was interesting to notice the rather unique items on sale. Instead of the normal ‘Made in China’ products we see in most night-markets, I see a lot of Made-in-Malaysia products…for example, wooden/rattan handicraft, beads, embroidered crafts and unusual herbs, spices and plants.




As I browse through the interesting items, I can’t help but observe the traders. A lot of them have very big smile but poor dental hygiene. I wonder how long it has been since they last went for a dental check-up. As I glanced at their skin, I was greeted with very darkly-pigmented, loose folds and brown, coarse hair. Some have very thin limbs but protuberant abdomen.

The same goes for children. The range of nutritional deficiency and childhood illnesses that we see is just the tip of the iceberg. The stark contrasts between urban children I see daily in KL, Ipoh or Teluk Intan and the little kids in Tapah OA settlement draws me to muse about my role in life and some of my forgotten dreams. The reason why I don’t want to be a paediatrician is because I cannot bear to see ill and dying children. I love to see them happy and running around healthy. Of course I can still be a paediatric surgeon but that is something to be considered for now.

Anyway, back to the OA children. As I see very few patients in my clinic, I actually had the luxury of taking detailed history from the parents so that I could go in depth into the children’s state of health. This is very different from the usual extra-hectic government hospitals and clinics and as a result, I could even find out about their diet, daily activities and practices.

I found out that most of them eat very simple food…cassava, legumes, wild plants, fish from the river and some poultry like chicken, duck, etc. The meat products are reserved for once a week or during festive occasion. Of course they consume clean water piped in from water collected high up in the mountain stream but some houses do not have electricity or a proper sewage system.

The older children attend school up to a certain age but life begins early and hard among these community. Some teenage girls marry early and have 3-4 children by the time they hit 21 year-old. Their husbands work very hard manual work until they are way past retirement age. The older children (>7 yr old) take care of their younger siblings while the parents work hard to bring food for their many children.

While life goes on in these communities as if it was 50 years ago, the rest of us chat via Wi-Fi at Starbucks, Coffee bean and etc, drive the latest Honda or Toyota cars and eat at the best restaurants in town. Yours truly have the luxury of blogging from a nice computer in an air-conditioned room while being well-fed daily. All this makes me feel very humble and grateful for all that I have as I ponder on how certain segments of the society live in abject poverty. As we celebrate another festive season, let us examine ourselves and begin to do something for others instead of being so inward-looking. Charity begins at home...

Snippets from the hospital hallways

“A few days ago, a young girl under the age of 18 year old lost massive amount of blood during an illicit rendezvous with a man in his twenties. She was brought into the hospital very pale and still bleeding. The gynaecology team was called in for repair works while police officers waited to take statements from the doctors and the persons involved.”

“A few weeks ago, a very young boy under the age of 15 year-old trembled as he described how he was sodomized by a man within some bushes, in the broad daylight. The perpetrator was not wearing any form of protection and his virus status was unknown.”

“A few months ago, a dead baby wrapped in a sarong was brought into the mortuary for post-mortem. There were strangle marks on its’ neck as a long umbilical cord was still attached to it.”

These are just some of the real-life crimes happening in a small town. Some down-to-earth, kisah benar that will never make it into mainstream papers as it occurred to normal people in a small town. Some people may feel nauseated by these descriptions while others hungrily read on for more gory tales. Most will feel quiet indignation and anger at the depths of wickedness and cruelty that can occur in a peace-loving, gentle society.

To health-care professionals, we have no right to judge when people come to seek our help. Our creed and professional code of conduct compels us to treat whoever that comes knocking for help. Although our hearts may cry out at the injustice and malignant wrongdoings, we can only administer whatever the best medicine could offer. We couldn’t take justice into our own hands or assume that someone is guilty until proven otherwise. We soothe the broken-hearted, cheer up the depressed, calm the anger and alleviate the pain. That’s all we could do in our workplace.

However, with the advent of technology, a lot of things can be changed. Prevention is more important than cure. We must always rise up the alarms whenever there are suspected criminals or dangers in our midst. Civic-consciousness is missing in our society sometimes. Children must be taught to beware of certain warning signs, especially in strangers as they are frequently the victims of these sensational crimes. So I penned these paragraphs as a reminder that security is always an important issue and knowledge is power. Ignorance is no longer bliss.