DoCPeriNeuM

Keep Left if not overtaking

2009-04-26T04:22:00.000-07:00

There was this one day when a group of us was using the emergency staircase to go out for lunch and I can't resist but to take a bird's eye view (so called) of this group of student community nurse. And I am quite surprise they adhered to the rule of keeping left if not overtaking. LOL.

neglected

2009-04-20T06:09:00.001-07:00

OK yes...i must admit that i have neglected the blog for some time now. Well to be honest i had a long break from the WWW as i was literally blocked from blogging as i HAVE no internet connection. Reasons? well i forgot to pay for my celcom broadband, and the connection is almost always poor where i am staying currently. I think those are just plain laziness. yes yes... lazy.

Work is from bad to worst. I think there's something in the waters of sarawak that seems to make every single women here very very fertile. Recent years have seen an annual increment of patients from 11k to 13k. If that coupled with lack of staffs (docs as well as nurses equally) then it would be an overworked environment. I also believed that because the hospital i worked in now has the up to date equipments plus a 42 inch flat screen LCD or plasma TV in every single delivery room, people are just swarming in to have a feel of the rm40k bed as well as to deliver. Take a look at the picture below and tell me how many hospital (private or public sector) has this sorta setup?

Ok ok....again i am just finding excuses to neglect blogging. But seriously recent times makes it so difficult to freely voice out opinions, comments or making statements. I feel not safe blogging. hmmmmmmm

Cicaks intimacy

2008-11-01T01:23:00.000-07:00

Having parked my car at my apartment and as I walked towards my front door, I happened to noticed this two little thing having some quiet time to themselves. But of course, I just had to take a few shots of it.

A little description, tail on the right hand side of the picture belongs to the left 'cicak' and vice versa.

When your Boss starts reading your wall on facebook..

2008-10-30T06:56:00.000-07:00

So it was one of the days when we (O&G) were having our routine pre-operative meeting and it was not until the end that my Boss started to be really kind (Not to say He is not kind...He is don"t get me wrong...shit hope he is not reading this).

Well, that's of course after Liverpool (his favourite EPL team) beat Chelsea the day before I think. Recent times in the department has been really busy. I don't know why but people in Kuching seems to be really fertile. Annually we have almost 13k deliveries and the work load is just tremendous. The pressure is so intense that some of my colleagues decided to vent out their frustration through words written on Facebook Wall. One wrote that she is going to jump down the 5Th floor of a building. I guessed this sort of gave him the impression of just how hard the Reg and MOs were working.

So he said this... "I know you all have been working very hard and I appreciate all this. But please do not be so stressed up till you want to jump down from buildings. I got to know this from your facebooks!"

At that moment, we all looked at each other and start whispering away... "......don't add him as a friend!"

Cobra is that YOU?

2008-10-11T20:45:00.000-07:00

Today morning as I was walking towards my car, I met this little fella just by the side of the road of my apartment. First look startled me as I would not be expecting such a long slithery creature in an enclosed area. Well technically it wasn't that long. Perhaps a mere 30 cm. But no doubt about what it was when the hood started to spread and a loud hissing voice emitted. Woohooo... it's a baby Cobra! It was with stripes of black and yellow, well I can't really tell what sort of Cobra it is. Anyways, I immediately took out my lousy phone ( oh how i wished i had a better camera phone!) and started taking videos of it. Then as i watched it slithered away into the drain, I realized I was late for my morning rounds.. hehhehe

Hungry Ghost Month

2008-08-29T21:59:00.000-07:00

It's been quite a eventful month I would say for my work. We had a few near misses and some are potentially medico legal 'incidence'. After all it is Obs & Gynae we are talking about and we all know the up and coming trend in 'suing' medical staffs for this.

I think it may have been due to the fact that lotsa lost souls wanted to have infants to accompany them in the afterworld. I am not superstitious but it's just my thoughts, my idea, my impression and my fear.

Things needed a change. We all need to upkeep and update ourselves to serve better. I am not perfect myself and hence I too am still going through and reading to improve myself. These I feel are essential in the field of medicine. However, now and then.... we do have people who are resistant to changes. I would think that there are many reasons for this;

1. They are just plain lazy...
2. They are afraid of more work...
3. They feel that they know everything as they are more senior...
4. They think they are just wasting time because others are not changing...
5. They feel that by changing...it would mean that they are wrong previously..
6. They are moving somewhere else...or retiring and not bothered...
7. They are Malaysians.... and it takes Malaysians a very VERY LONG time to make changes...2020 remember... so its 12 years to go..
8. They are old horses...and old horses are hard to retrain..

Whatever the reason may be...they are just lousy reasons. We change everyday.. even the way we shit, eat and drink. So what's so difficult about it? I change my underwear everyday for heavens sake!!! Imagine if one doesn't? It would be stained and f**king foul smelling eh? Exactly like in the field of medicine...we would be full of shit...shitty work and services. That's what the public thinks of us, those working in the public sector.

Sigh.... I just sometimes wonder how we are going to improve ourselves in order for the world to see us as a developed country. We lost their confidence in our seafood export, billions of dollar investment in the pearl of Orient and for me... the RCOG is not even recognising the part one MOG master's programme as equivalent to that of part 1 MRCOG.

Sad..but true...

I need another diving trip.... upset already... anyways...my phone is ringing and I need to supervise my colleague in a caesarean section..

Look what the secret recipe did to us.........F**K!

2008-08-12T06:35:00.001-07:00

Dinner at Secret Recipe 120808

2008-08-12T06:23:00.000-07:00

2008-08-09T06:21:00.000-07:00

Just got back from my 'yoga' diving session in perhentian island. This time around I brought two of my friends along. They took up the diving course while I had some leisure dive.

I had wanted to dive this place called Turf Club to capture some seahorses. Had one, but it was just not in the right pose... hence..I decided to leave it alone.

Highlight of the trip is mainly my friends and their new found sport.

I did took a few pictures of an octopus hidden deep within the sandy bottom. Each time my strobes fired, the poor little thing blinked in surprise. After about five to ten shots, I thought that the little thing would be blinded with all those lights.

The 'abused' octopus.

The sandy bottom.

Erm..don't really know what sort of corals these are.

Divers...above.

Divers...below.

Clown Fishes...

Feather stars....

And this small pipefish...

Ahh....I am just sitting here now and thinking whether I should just book the trip to Lembeh to join the rest of my other friends end of this year. But I guess I would need to look into my account book prior to that. HAhahahhaa...

RFMF

2008-07-29T05:39:00.000-07:00

So it was the time of the year again when I happily looking forward to attend the rainforest music festival in sarawak. This is an event that I do not miss. I have been going there for the last few years, well interrupted by my two years working in UK of course. This year round is pretty much the same apart from the EXPENSIVE Tickets, Lousy Shuttle services and the Smelly sand pitch in the middle of the concert.
I was there this time around with a new group of friends. Some from my department, and others from another department. Hmm...dunno what to write about this... so pics should be sufficient.

The view from afar...

Me and the two ladies...and yes...I do have purple hair...

The percussion workshop in progress...

Our malaysian kelabit girls wooing the crowd...

My nieces and their dreams?

2008-06-22T00:14:00.002-07:00

My two nieces went to watch and experience the Japan GT in KL just recently. I heard from their mom that they had a great time. I wish I could have been there as well, not to watch the cars racing by with loud engines...but to take pictures of the GT girls!!! Anyways, they were posing along the circuit and perhaps in the next 15 years they might turned out to be GT queens as well? Nobody knows.. hehhe

Now..........

10 Years Later....

12 Years Later.....

15 Years Later....

A colleague's Bday

2008-06-04T04:56:00.000-07:00

So...i am again up to my mischievous mood again and this time around, its my fellow friend who is due to celebrate his birthday. This friend of mine...well he is a trained feto maternal expert who has just recently found his way back to Malaysia from abroad. He came back from the UK probably about less than a year ago and is quite alright. Me and my friends decided to have a little tea party at his place (erm yes at his place...we forced him to). So it was supposed to be some pot luck thingy but ended up with him preparing erm one plate of salty chicken wings and another tasteless plate of chicken wings too. Dharminy brought pizza i think. And TanTL bought some cheese cake from secret recipe. Me? i bought him a bouquet of flowers made partially from some blown up condoms! yes condoms..

People in Kuching hardly see this type of bouquet i guess. I had to buy some coloured ones, make my way over the the florist and requested for them to blow them up and placed it like some sorta flower arrangements.. hehhehe... it turned out not too bad at all. Just that the florist burst 2 of them whilst trying to blow them. Erm.. yup they used their mouths and not the pump device cause Erm... dunno why... hhehehe perhaps based upon experience?

So here goes.. some nice pictures from the day it self...

Cheers!!!

Do you look at what you shit?

2008-05-31T21:13:00.000-07:00

(pic from vegancampus)

The thought came to me as I am sitting in Starbucks having my morning breakfast and cuppa. Well, am not trying to be disgusting but I was just wondering how many people actually look at what they pass out after what they have taken in the day before. To me looking at my shit is utmost important. Tells me lots. For instance, it tells me;

1) whether my food is digested or not. Things like corns don't get digested that well.. so you do see them the very next day.. hehhe...
2) consistency, yes the texture...hard, semisolid... fluid, and of course I want to also know if there is any blood in it (frank).
3) how long can a shit go without breaking up? To be honest the longest I had was about 20 cm in length (erm just guessing and not taking a true measure), 2 inches in width and depth. How did I ever manage to do this without breaking it... hmmm well i just had to slowly raise myself while the shit comes out and before the tip touches the base of the bowl in order not to break it. Gross? You Bet!!!!
4) making sure that there is no worms there...
5) Regular colour of the shit and correlate it with the food I took the day before..

so..think about it...and start looking at your shit...

I NEED internet Connection!!!

2008-05-22T06:15:00.000-07:00

Internet connection for me these few months has been disgusting. I now have to make my way to the nearest Starbucks to receive their WIFI broadband connection. How sad. I need to upgrade my Celcom Broadband!! ... sad...

I Am Back....

2008-05-15T23:27:00.000-07:00

I have been very busy since starting my new job in Kuching. Well, its my old job but in a pretty new environment now and therefore trying hard to settle in. The other main reason was that I am locked out from surfing the internet what not blogging as I do not have any internet connection apart from my Celcom Broadband....which is running by kbps...so not ideal for uploading anything at all.

There are so many things to blog about and too little time. Latest event? .. I accompanied a new found doctor friend to have her tattoo done. Pretty impressive tattoo artist. He manage to sketch the tatts in a few minutes and the next day, my friend had it permanently inked. Right at her butt. Hahahaha... here are some pics ..and if the connection is fast enough I will throw in the video clip as well.

Kuching

2008-01-10T01:56:00.000-08:00

Finally back in Kuching after so long. The minute the plane flew over the skies of the land of hornbills, I had noticed some changes. There are new housing areas now, more buildings, and roads are wider.

I reported back to work yesterday.

There is a new shopping complex called Boulevard, been there, and unfortunately still sucks. Depressing standard as compared to those in KL. Sigh, what is wrong with the developer and architect?? Anyways its the usual walk around town and completing the three other complexes within an hour prior to heading towards my favorite vegetarian shop. Was glad it is still there.

There are not many familiar faces in the hospital but yet I was recognized by my previous staffs immediately. Even the director's secretary remembered me. Almost everyone asked about my diamond earring. 'I have given it to my sister' I replied. 'Aiyo, sik macho gi lah cam tok' some had passed comments. Only one realises I was not wearing my usual frame less spectacles.

My big boss is not around. he went on leave. I will be seeing him tomorrow morning in his office. He had called a day earlier and spoke to another colleague of ours. 'He is back? So does he still have his diamond earring? Is his hair purple?' Boss asked. My colleague laughed. Another suggested I dyed my hair purple or perhaps wear a wig tomorrow, just for the fun of it. I would be schizophrenic or manic to go with that idea.

Looks like its going to be a tough road ahead from tomorrow onwards. Hope I do not collapse under pressure. Here goes...

Yat Yat Fatt!

2008-01-01T08:34:00.000-08:00

I just realized that 01/01/08 if pronounced in Cantonese means 'Everyday is Wealth'! i.e YAT YAT FATT. Wow.... what a discovery. I do hope it would be wealth for me everyday loh.

And with that I decided to indulge myself in a new watch. I like watches. I have in fact 3 'sorta luxury' watches bought in stages of my life. The first when I joined medical school. Followed by my very first year as a house officer. Now since I have got my postgraduate, I once again upgraded my watch. Ahhh... how I loved my new time piece.

Oh by the way, anyone of you heard about the latest news to hit Msian politics? Someone pretty much linked to KKM has admitted to starring in a special kind of DVD. Sigh, what a news to hit the health services (in a way). Oops OK OK..not to complaint.... jeez..

Good night YAT YAT FATT, and hello 2nd of January.

Welcome 2008!

2007-12-31T22:43:00.000-08:00

Its the new year once again and time to set my new year's resolution. Hang on...wait a minute.. I have never (and I mean it, NEVER) had any new year's resolution all these years. Why bother when most of the time I do not even fulfill my own self promises. So be it then, yet another year to spend without any resolutions. Really? Hmmm I think turning over a new leaf would be great this year...hence... I shall make not resolutions but plans...

Looking back at 2007, I think I may have achieved the most.
Cash? tick (Not my first million but lets just say enough for me to spend).
Career? tick (Finally, for a while I do not need to sit for any exams).
Friendships? tick (got to know a whole lot of new friends).
Travels? tick (added a few countries to my travel log).
Health? tick (touch wood, have not been sick the whole year).
Family? tick (its been ever closer and more time spent).

Hmmmm..so that leaves me with possibly the most popular question of all, Love? Well, I don't seem to be able to tick this as yet. Hahaha... perhaps this year would enticed me into having a proper relationship. As in a possible 'leading towards happily ever after fairy tale Shrek like' friendship. Hmmmm.... it does gives me the creeps though. Maybe I am just not ready.

Anyways, moving on to this year, there are a few things in mind that I would like to accomplish. Firstly my own attitude in work (Only the higher being would know what I intend to change in myself). It would be soon that I set foot again on the native land of Sarawak, returning to my old hospital. Not for long though, as I do miss KL and would LOVE to transfer back if and when my application reaches KL. Don't get me wrong, I don't intend to work in the 'all too famously politically run' HKL but instead to somewhere near KL. Malacca sounds good. Even Seremban would do.

I plan to dive more this year if time and my wallet permits to practice on my passion for photography underwater and above water.

I would love to be more patient and ready to give in more easily this coming year. Perhaps Letting Go would be a good idea too.
Not going to complaint about too much work and too little pay. Not going to complaint about the 'nuts' of the government and its policies. Not to complaint is the best.

I definitely will be seeing the new year in a whole new perspective as I have a new pair of eyes! Yes I do mean a new pair of eyes. Not new glasses or some expensive frames. I literally mean new eyes as I have just spend a fortune on correcting my vision with laser. YES!! No need to scramble and look for those cumbersome spectacles anymore when I am on-call! Vanity? Sorry mate, never that but convenience YES! Looks to me like a 2008 6/6 vision!

There are just way too many things to write about what I intend to do for the new year. I think I shall leave it for the next several post since I do have 365 days to go still.

Cheers!

My camera equipments (above water)

2007-12-11T21:00:00.000-08:00

(left to right: Nikon D200 with 60mm f2.8 macro lens, Sigma 15-30mm for my Canon EOS30 film, Quantaray lens, Nikkor 80-200mm f2.8, 18-70mm zoom kit lens, 105mm f2.8 VR macro, Canon 28-70mm kit lens, Canon EOS30, background Manfrotto tripod and picture taken with Nikon D70 with Tokina 10-17mm FE lens)

I loved my tokina fisheye zoom lens. In fact i used it so often i tend to neglect the rest of my lenses. Many would feel that the distorted angle makes the pictures weird but i find that it gives it a little more artistic look compared to the normal conventional straight angles.

Here, i took this picture when we (Ronnie, Pei See and Eric) were exploring Bali in a Suzuki Vitara. Notice how i was able to capture the whole interior of the car with my favourite lens?

Mom used to say that i looked like a 'wanna be' pro photographer and the truth still remains. I am still a 'wanna be' trying very hard to learn photography but like any other testosterone raging male, i love gadgets. From Macbooks, Ipods, IPhone, cameras, cars, watches,gadgets, gadgets, gadgets!

And the buying does not stop as i now need a proper dry cabinet to store my equipments.

(will also post my collection of underwater gears in the near future)

Diving with Mantas (Komodo) Part 6

2007-12-11T20:15:00.000-08:00

This school of jacks (fishes approximately about 0.5 meters in length) greeted us as we descended next to liberty wreck. I had wanted to take a snap from below the school of fishes to capture a 'tornado' effect but before i knew it, they moved further and made it quite difficult for me to approach. Erm, another reason perhaps was because i wasn't skilled enough. Hehehe

During surface interval, I played with my camera in the resort's pool. I thought this shot may have been quite interesting. Camera held underwater and shot upwards towards the flower with the villa as the background. Too bad it had not capture Mount Agung at the same time.

The following two pictures are of nudibranches. Some kind of sea slugs if you were to ask me. Maybe one can perceived it as snails without the shell and painted with multiple colours. These are invaluable as subjects of photography on a muck dive. When i had started taking pictures of these with my point and shoot, i almost always took pictures from the rear until i was corrected by another fellow photographer. The best view should be frontal potrait. I took these with my 60mm Nikkor Macro about inches away from the subject.

Diving with Mantas (Komodo) Part 5

2007-12-07T20:02:00.001-08:00

More pictures from my trip...

Ghost Pipefish. Elusive and uses its camouflage ability to evade any potential predators and photographers.

The entrance of a pub in Ubud.

A Moray Eel. Recent studies suggest that morays has an inner jaw used to further engulf their prey quite similar to those on ALIEN 'the movie'

'Bapak's' family on the day they prayed for the new year as well as their 'mobile' blessing. These are traditional Balinese attire.

Sunset view from live aboard 'Baruna'.

This little boy is at Kuta beach playing with a small little crab in his 'Tupperware' container but very willing to strike a smile and pose for my camera.

Diving with Mantas (Komodo) Part 4

2007-12-02T19:19:00.000-08:00

After returning from Komodo I decided to travel to Tulamben, east of Bali to dive there as well since I had already paid for the flight. My sister was kind enough to help me amend the ticket (and I have yet to pay her back). The trip was about 2-3 hours through stretches of roads with handicrafts shops all the way. We took a detour to enjoy some fish satay famous I would say for not only the tasty food but more of the numerous flies around us. Not that the flies deterred us from the meal.

The Villa owned by an Australian which cost about USD20-30 per night. With your own private pool (something not foreign in Bali) and the sea view.

Balinese are known to pray the whole year round. When I was staying there, they were celebrating the 'motor vehicle's' new year. Yes they pray for their 'MOBIL' as well.

Diving with Mantas (Komodo) Part 3

2007-11-29T23:33:00.000-08:00

Diving in Komodo, one cannot miss the chance of a lifetime to view the well known dragons right? We stopped over on one of the islands to visit these massive 'bacteria infested slimmy saliva' reptiles. Each adult measuring to about more than 7 feet long. There were rangers all around us 'sorta' protecting us from any possible attacks using a 'y' shaped branch or poles. Just days ago we were chatting with another tourist and had viewed a photo of his bathroom at the park's accomodation in which a Komodo dragon was taking a nap!!

The scene around Bali near Kuta.

View around the hotel's pool.

Diving with Mantas (Komodo) Part 2

2007-11-28T04:00:00.000-08:00

Words and pictures can be difficult to express how I felt but the following video will give you an idea of it. Courtesy of Eric, hehhehe.

Diving with Mantas (Komodo) Part 1

2007-11-28T01:42:00.000-08:00

I flew to Bali on the 14Th of November very much looking forward to my diving trip in Komodo. It was supposed to be a short trip of 5 days at the most but in the end it was 2 weeks plus. The highlight of the trip was definitely my dive at Manta Alley. There were about 11 (minimum I would think) Mantas of all sizes gliding gracefully amongst us. It was pure amazement for the entire 2 dives, each lasting about 50 minutes. 50 minutes because I used up my compressed air quicker than the rest of the season divers and being a 'not so fit' person.
This was my second dive trip using my new camera rig and I enjoyed every minute of it. I was testing out my wide angle lens on this dive and the Manta was the prefect subject. I do must admit that my photography skills is still very depressing.

(Me and the Manta... comparing my size with the smallest of them all)

The first night of my check out dive, yes...it was a 'dare devil' feat to dive at night in a whole new dive site, I was stung by Hydroids. The scar still remained until today as I blog. It was not because I touched them but I was pushed by another diver during a current surge and felt the stinging sensation immediately right after on my left wrist. We surfaced much earlier as it was just not 'environmentally' safe to continue the dive. My first encounter with night dive currents. Hehehe

For the next 3 dives I had decided not to bring my camera along with me as i wanted to get used to diving, the buoyancy control, breathing compressed air....the basics.

But who can resist not taking any pictures at all after the third dive!!! And of course...the first picture...self portrait using my Tokina 10-17mm.

*Will be posting a video (taken by a very experienced fellow friend) of the Mantas next entry...

Diving in Komodo, Bali (Tulamben), Strolling in Kuta and Ubud

2007-11-26T02:37:00.000-08:00

Am taking a long trip from working. Felt I should indulge myself into more quality of life than just working and making a living. Well...of course I need to work to get the money to go for all these trips.

Am still in Bali, Legian's Zanzibar blogging this. I started my journey here from the 14th of November. My initial intention was to dive in Komodo...then I was invited by two of my friends to join them in their trip to Tulamben for further dives there. I agreed. I changed my air ticket and then decided to stay for another week. Woohoo...it was definitely worth it.

Will be flying back tomorrow to Kuala Lumpur.

Will post pictures and videos as soon as I can.

Will post pictures of me with my underwater rig, my 'wifey', my campanion for the whole 10 days of diving. Heheh...

I have been 'PUNKED'

2007-11-04T02:51:00.000-08:00

It was my last day at work. Said all the goodbyes and gave all the hugs and kisses. Had my lunch and thanked my consultants for being exceptionally brilliant throughout my two years working in the UK. Then it all started.

I was walking back towards the secretary's office to hand in my bleep when my colleague had asked me to help her see a patient in the antenatal ward. Apparently she was heading towards the gynae ward to attend to another emergency. Oh well, just another case before leaving so i agreed.

I entered the ward and the first midwife i met looked afraid and shaky. I asked her what was the matter and she gave me a run down of the case. Here it goes;

A 40 year old (A-PAWLING ANNETTE was her name but i had paid no attention to the APAWLING part!) plus patient came self admitted with complaints of per vaginal bleeding and abdominal pain and claimed she can't be pregnant although she did had 6 months period of amenorrhoea (no periods basically) . She was acting really abusive and aggressive and had taken a swiped at the potter already (at this point the potter was mumbling over his walkie talkie ' its ok...everything is under control..the registrar is here' also showing me a plaster on his hand). She is now in the side room, locked in the bathroom and refused to come out.

I asked the midwife whether she looked pregnant but the midwife replied that the patient was high on the BMI side so it was difficult to know. Immediately i asked for a portable ultrasound scan to be brought over. I then motioned myself towards the room and as i approached, i could hear a woman screaming at the top of her lungs saying ' i am going to kill myself!!! how can i be pregnant!! i dont't wanna be in the hospital!!! '

My heart started pumping faster, shunting all my blood to my head to help me think. The first thing i had thought of was, 'oh my god...we have got a possible psychiatric patient in the ward and an agressive one...what would happened to the rest of the patients??? how am i going to ensure the safety?'

In the room, another midwife was trying really hard to convince and persuade the patient out from the toilet. I asked whether the consultant on-call had been informed. Well at this point i thought he should be informed. Then another scream "IF ITS A MALE DOCTOR I DON'T WANNA SEE HIM...ITS MEN WHO DID THIS TO ME!!!!! GET HIM OUT OF HERE!!!!"

I told the midwives there (which suddenly doubled in numbers perhaps tripled) to try and get a female doctor if the patient didn't want a bloke. But, at this moment, the patient gave in and came out...with a PLASTIC BAG covering her head!! SHIT!! Definitely PSYCHIATRIC CASE I told myself. I politely introduced myself to the patient who at this point remained aggressive and loud. The pillows, magazines and jugs of water were all over the floor. I looked at her tummy, but couldn't convinced myself she was pregnant at all. I proceeded to chat with her and suggested she sits on the chair to start off with. Then I requested for her to allow me to remove the bag over her head of which she agreed to.

THEN!! THEN!!! that i noticed it was a familiar face, one of which i recognised immediately..... it was one of the midwives!!! and there was i standing in the room with laughter and claps all around... They had me! I have been punked. My heart stopped palpitating and slowed down. I was flushed with embarrassment. I applauded to their acting skills. Absolutely incredible.

Being a Chinese is not by default a Mr LAU!!!!

2007-10-26T02:03:00.000-07:00

I would have had a splendid on-call last night had it not for a distracting phone call from this #@"$! lady via my Msian mobile number.

The story goes like this. It was like what I have written in my previous post, the delivery unit was clear and there wasn't any patient to be seen. I had not slept well during the day prior to my call last night so I decided to hit the sack much earlier at about 12 midnight (In preapartion for a busy night). I went into deep sleep but was disturbed by not my bleep which was rather unusual but it was my mobile (Msian number and on roaming).

Now I generally do not answer any unrecognised phone number as my phone is on roaming (hence I will have to pay for any phone calls received from anywhere in the world) and kept that way only for emergency calls from family (and sometimes friends). This individual however was quite adamant to get in touch with the person on the other line. After ignoring the persistent vibrating phone for countless time I finally gave in and answered. At this point, I was really thinking that someone had wanted to get in touch with 'ME' urgently.

(grumpily waking up ..hehhehehe)

me: Hello?

#@$%! lady: Hello, may I speak to Mr Lau? (NO PLEASE I HAD NOTICED)

me: Erm, Mr Lau? I am terribly sorry but I gather you have got the wrong number. (thinking at this point it will end my conversation quite abruptly....I can literally hear the bill going up at F1 speed rate..)

#@$%! lady: Not Mr Lau? But you are Chinese right??

me: Yes, I am Chinese but I am not Mr Lau.

#@$%! lady: But Mr Lau gave me this number....errr ...err...I want to speak to Mr Lau. You are Chinese right?

me: Look, I am NOT MR LAU AND YOU HAVE GOT THE WRONG NUMBER!!!!!

I hanged up.

Really, I am seriously annoyed with this lady. Not only did she not comprehend that I am not the Mr Lau or Mr whatsoever having told her so, the #@$%! lady thinks that as long as you are Chinese you are then by default a Mr Lau!!!

My dad or some of my friends I have noticed tend to have a long conversation with people calling up the wrong numbers...

Most of the conversation includes:
'Who do you want to speak to?? Who is this?? What number do you wanna call???'

'Are you sure you have got the right number? My number is this this this'

Frankly, I do not see a point in asking what number the other person on the other line wanted as it is ALL IN THE MOBILE's DISPLAY and I DON'T really want to know who they want to speak to, full stop. SO I religiously hang up once they start off with 'harlo, ah ngu ah??' or 'Ah Lim ah, your bla bla bla bla'

looking good..

2007-10-25T12:56:00.000-07:00

Nothing to do with physical appearances i am afraid. What i am trying to say is the delivery unit's board is CLEAR!! Yup, no patient at all when i took over at 830pm tonight. Great... now i can just sit back and watch the 40+inch plasma TV in the doctor's mess. At least till i received my next bleep though.

Its final night of work here and to be honest i do prefer working a long 24-36 hours of on-call rather than doing long 12 hour shifts for 7 days in a row. It is just too tiring and exhausting.

Its confirmed, my last day in UK will be on the 5Th of November. By 11 am that very day I will be on one of MAS airlines heading back to Kuala Lumpur. Probably about time too as i dislike the coming cold weather. Its currently about 10 degrees C and perhaps due to some strong winds will drop to below freezing this weekend. BrrRRRrrrRRRR....

Time to get back to work....erm i mean act like i am working hard... shhhh

2nd of my last 4 nights

2007-10-23T15:42:00.000-07:00

There is two patients on the delivery unit now. One in the pool with a history of IUGR( Intra Uterine Growth Restriction) and I just heard she is fully dilated and vertex is visible. Great. Why is she in the pool? Well..i think she initially had wanted a home delivery despite being advised not to as the baby was found to be ?IUGR and hence offered an induction. She declined but agreed to having the baby in the hospital. Further, she requested for a pool delivery (will post a picture of the pool, perhaps tomorrow after my call).

The other lady is only 7 cm dilated, only a cm change from her last review at 7pm. Well, sounds to me like a poor progress and she is just having about 1-2 contractions in every 5 minutes. Midwife is not sure of the position of the baby....hmmmmmm. I guess she might benefit from a few drops of syntocinon stimulation then. I do hope both patients are not going to be problems for me later.

Am drinking my cuppa now as i blog this entry.....

Me and my mate's conversation...

2007-10-21T14:25:00.000-07:00

It was not long ago I had a conversation with a mate of mine whilst we were walking around Portobello Market about the thought of having a tattoo. Yes, permanently having an inked design of desire on our skins. Why you may ask would I want such a thing on my body. There are many reasons why one would get a tattoo. Some to remind them of their loved ones, some as a symbol of spiritual beliefs, others just mainly to attract attentions.

I don't really know what my mate's reason was for his Celtic Cross and i didn't really asked him but will do so when we meet up again in the next few weeks. But a Celtic Cross is the characteristic symbol of Celtic Christianity, though the symbol has older, pre-Christian origins. Such crosses formed a major part of Celtic art. This design is also referred to as the Irish Cross, or as the Cross of Iona. Well, at least that's what i came across via Wikipedia. They are not easy to do. Interlacing knots, a chief feature of Celtic tattoo art and a symbol of the constancy life, is one of the reasons why these tattoos are so difficult to create. Their cyclical design and symbolic emphasis on knots that have no beginning and no end.

Well, we did walked into a tattoo parlour that day but walked out quite soon after as it seems quite a dodgy place. I think many people have in the past linked tattoos with sailors, criminals, heavily bearded bikers, the Yakuzas, triad members or even the punks. But these days, they are quite a common sight. When I was working in Sarawak I have encountered a number of patients with the famous 'tribal' tattoos.

Later that month or I received a message from him saying he had already made an appointment to have one done. The day after I was supposed to meet up for BBQ in London to view his design but because I was on-call that weekend I only managed to view this above picture.

So did I then got myself one? Yes I did, but not after a while. I had always wanted something special, something that reminds me of myself, something which is unique in its ways...and hence I decided on a pair of wings. I drew myself a pair of wings. Yes..my own design...well partly as I had to show it to my tattoo artist and have her change or make them a tattoo possible one.

Why wings? Well, to me my angel wings represents partially the rebellious side of my personality. My freedom. It symbolises enlightenment, guidance and protection "to be taken under the wing" and perhaps inspirational. It also represents my loved ones....my family.

Did it hurt? To be honest, one of the many reasons I wanted one was to be able to feel the pain. That feeling is difficult to describe. I would say it felt like a nagging cat's claw digging into your skin and pulling across. The outline is rather uncomfortable compared to the process of shading and filling in.

Will i have another? Yes...of course. The day I had it done, I was already thinking of having another. It can be very addictive.

Was i worried about possibility of infectious diseases? Well, if i were to have it done in Malaysia, yes i would. My artist's place is as clean as a dental clinic (if not cleaner) and all equipments are disposable. They are also registered with the local health authority. There is no nicotine smell, no dodgy drug pusher sitting in the corner or alcohol in sight. So, no i am not worried.

And here it is, my wings.......

50-50

2007-10-21T01:51:00.000-07:00

Only about 2 more weeks or so and I will be on my way home. Excited..yes you bet. However I do have mixed feelings about how I will be adapting to work in Msia. Various things came to my mind.

Firstly, I will have to start writing in patients notes and not have them typed out by the secretaries (from my dictation). It would be a disaster trying to figure out the long list of medical problems from patients because;

a)almost always they are not aware of their own personal health problems

b)they are only aware of a single miracle drug called 'the white pill of KK' (Kementerian Kesihatan's famous pill)
There are other reasons of course...

In terms of Obstetrics, some of them includes;

a)Back to the good old days of limited antenatal scans for dating in all patients. I will be expecting patients coming in fully pregnant and ready to labour away without any antenatal care at all. This including no routine 20 weeks anomaly scans, so a number of patients would turn up with fetuses with spinal tube defects, heart defects, etc.

b)Screening? In terms of detecting trisomy or chromosomal defects? Well, again...none, as i believe its illegal to perform termination of pregnancy so there is no point in doing it. Moreover..it is so expensive to perform amniocentesis that only the private sectors are able to offer such services.

c)What about patients choices?? As in caesarean sections? I can just imagine myself giving an hour of counselling on the benefits and risk of a vaginal birth after c-section as well as a planned elective c-section to be followed by a response of 'Tak tahu lah. Doctor rasa apa paling bagus saya ikut sajalah' or 'Suami saya cakap potong sajalah' and perhaps just a blank face?

d)No community midwife to lend a helping hand for the continuity of care for the obstetric patients. i.e we doctors see all patients in the clinics.. so hm mph...100 odd per clinic..busy busy busy. Hence..the 10 minute consultation for a patient who had travelled 3 hours from her home (1 hour walk, 1 hour boat ride and the remainder 1 hour of bus journey to the clinic) requesting to be seen first bypassing the 30-40 odd patients ahead of her because she need to make her way back.

Gynaecology,

a)Although we have the cervical screening programme, but we do not have (i feel) a good recall system where patients are automatically reminded to attend the health clinics for repeat smear test. And hence...I am sure I will be seeing many cervical cancer patients within a year (I have not encountered a single one here after two years).

b)Conservative management for ectopic pregnancies would be very difficult as patients need to pay for the test done (beta hcg) and hence would be way too costly for them as compared to surgical or medical treatment. Follow up would not be feasible and the risk of them collapsing in a kampung somewhere is a possibility.

c)Although NICE has issued a guidance on the management of menorrhagia using the MIRENA as the first line of treatment, I doubt many would be having this as again it comes down to cost. So it would still be the reliable tranexamic acid or norethisterones...

d)There isn't any proper primary care trust where patient health information are constantly shared with the hospital or made available partly because patient do a lot of 'GP shopping'. Perhaps the GPs may want to group together and form a trust?

These are just the tip of the iceberg of my concerns. Lastly, I have always wondered how one become a consultant in Msia. I do not recall we have a system to promote someone from the specialist status to consultant status and correct me if i am wrong but it appears that if you are in the service long enough and grow some white hair, then perhaps you can then be promoted in such a manner. Do enlightened me...

Just my thoughts. You may disagree or perhaps miraculously agree with me but I welcome all comments..

Hehehhe

Time to pack

2007-10-08T14:49:00.000-07:00

I have only about a month to go before heading back home. Lots of things to pack. Somehow i find it really amazing. I came with a single large baggage and i am going home with at least 6 boxes and two large baggage. Hmm looks like i have done quite a bit of shopping here in the UK.

Had my last three nights of on call and it has been surprisingly quiet. Last night itself i only needed to review a patient at about 3 am, and the rest of the night i stayed in bed. Now that's really good as i am practically the only doctor doing all the ObGYN stuffs at night from 830 pm till the next morning. Although i had a chance to warm up my on call bed, i must admit that i have not slept in recent times when i am on call. I believe that i am being paid not to be in my bed but to stay awake to work like the rest of my team. The midwives.

Arrggghhh so much to pack.... hmmm alright then...back to work...

Monster working long nights today

2007-10-05T04:22:00.000-07:00

I will be working long nights today. It would be my 1st of the last 7 nights i will be working prior to my departure from this hospital as well as this country. I hate working nights. No SHO to talk to. Nothing to do. The doctor's mess is too far from the delivery unit to hang out in. However i do like the fact that they have a huge 40+ inch flat screen TV there with SKY satellite network. Hmmm... oh well.... might as well get over it...

The Monster in Me...

2007-10-04T10:22:00.000-07:00

Am very tired today. Had a long session of antenatal clinic and felt could have been more productive in seeing more patients. It just so happened that there are two difficult or rather complicated patients to deal with and required plenty of counseling and discussion. Then later on the day, had to see a couple with a newly diagnosed cystic hygroma on the antenatal ultrasound scan. Both the patient and husband were indeed anxious and I cannot imagine how i would feel if I were to be in their shoes. Anyways, will be referring them for further scan in Cambridge under the feto maternal unit and hopefully its just an isolated soft marker.

In the afternoon, I showed some of my new colleagues around the hospital and dealt with some rota issues. To be honest, am not too keen in arranging the rota for the next few weeks. So, that completed, I went down to town to hand over to 'Karen' my 'wings' to be amended so that I can have it done (will blog about this another day). The receptionist said that the earliest booking would be in December! ahhh... now how am I going to have it done before that????? well..I would just have to wait and see really.

So, came home and had no mood to wash my clothes. Went back out again and rent 300 to watch tonight. Ordered Chinese take away because again...no mood to cook my dinner. Yes.I do cook my own dinner. And yes...I am not that bad a cook. Have Jamie Oliver to be my mentor (via BBC on the TV).

Will have to do my laundry tomorrow morning since I will be doing nights tomorrow.

Somehow..I fear that I am turning into a monster after all that had happened today (as you can see above, taken today evening). Argghhh!!!

WSH Registrar Leaving Do 02102007

2007-10-03T14:13:00.000-07:00

The Obs and Gynae department had arranged for a leaving do for all of us specialist registrar as it was time to move on to our next job (well..for me another month though). We had dinner at this place called Chez Gerard. Brilliant food. Excellent wines. Wonderful people. Almost all the consultants were there to dine with us. We had also the company of the ever wonderful midwives, the gynae clinic nurses, MCTA, and our SHOs as well. Tears were shed and plenty of hugs and kisses but the main important thing was we had fun. The clinical director gave a speech and gave us each a miss/mr book based upon our working attitude and what the rest felt about us. Inside each and every one are the signatures of all our consultants. ahhh...... i am missing this place already. Will make the most of it the next and last month of work here.

My drawing...

2007-10-01T15:01:00.000-07:00

I have finally completed the second of my drawings, or an attempt at canvas painting using acrylic paints. I took several pictures to show the progress I made each time as well as the final product. I named this piece..the awakening of docperineum.... hehhehe

London 290907

2007-09-29T18:04:00.000-07:00

I went to London today to do some shopping before i make my journey home in the next two months. Don't really want to rush everything at one time. I ended up buying clothings for my sister from dorothy perkins and H&M instead. Got a few pieces from GAP for my nieces as well. Then had japanese dinner with Chloe at Selfridges. We then head off to the London Eye to snap a few night shots. It was pretty windy and chilly tonite and i dread not bringing my Manfrotto tripod for this kind of shot. I did not really manage to get any great shots, but these are the few that are worth showing. It was about 10 pm before we head back to another high school friend's house where i will be staying over for the night.

Had a few glasses of wine and am ready to hit the sofa for the night.

My window...

2007-09-22T15:23:00.000-07:00

Ever wondered how one would look through your window and see what you see every morning, afternoon, evening and night? I looked out from my window today as usual and thought to myself ' Will I will miss this view in about two months time when i am home?'.

I called home and chatted with mom about almost every single new gossips or happenings. We talked about how my cousin sister and her husband had been robbed on the NKVE a few days back. He is recovering from the 'parang' slashes and she is taking more days of MC to allow her bruised limbs and cuts to heal. My cousin sister had jumped out from the car whilst it was going at about 40 to 50 miles per hour after it was hijacked. She had been brave. Had she not done that, i am not too sure whether i would be seeing her anymore. I would have imagined the worst possible outcomes if she was still in the car.

I am quite surprised how unsafe Malaysia had become. I fear for my two nieces after reading the news on Nurin. The little girl who had been brutally abused and murdered. I had jokingly suggested to have CCTV installed in the house. Mom laughed and for a minute I think she did give it a second thought. I then remembered it was not too long ago fibrate had wrote about her in-law's house.

The cost of living has escalated I was told. Mom was comparing prices of raw meat now and a year ago. An example that she often used. She continued saying that an outing nowadays can easily cost more than 50 ringgit. I believed her. 50 pounds can keep me going for two weeks here. And that includes my car petrol.

I ended the conversation early as I had planned to go to town. Again i looked through the window. 'Yes, i am definitely going to miss UK'.

And yes, the window had nothing to do with my conversation.

Time

2007-09-15T04:06:00.000-07:00

I have created this video using still photography of the blue skies just outside my window. I was thinking about all the good times i had in the past and whether i would be able to experience them again.

13/09/2007.... First LSCS of the day..Uterine Rupture..

2007-09-14T05:42:00.000-07:00

I was on call that very morning. Made my way to the delivery unit and met the consultant and my fellow colleague from the previous night. She looked exhausted. Probably a busy night I thought to myself. In room D, the room that we were all paying close attention to. A patient who had one previous cesarean section and a successful vaginal birth after was in labour.
'Progress has not been good' i heard one midwife commented. 'The CTG looks suspicious' my colleague said. 'I think she need a fetal blood sampling to assess further' she added. I waited no longer. It's all I needed to know prior to gathering the equipments for what is coming next. Fetal blood sampling. A very safe procedure done mainly to access the pH of fetal scalp blood obtained from a few superficial scratches.

The test revealed a pH of between 7.35 to 7.37 in three samples. That is absolutely normal for the baby. Nothing could be better. CTG at this time still remained suspicious. The plan was to see how she would progress in the next hour. I had examined her and she was still about 8 cm dilated. She had been 6 Cm dilated for the last 6 hours. I had requested for her to be catheterized to empty her bladder.

A minute later, it was chaos. The fetus was in obvious distress. The heart rate dropped to a mere 80 beats and remained there for the longest 5 minutes of my life. I decided it was not a good idea to carry on with the labour. I made several urgent phone calls, to the theatre staffs, the anaesthetist, and the consultant. I had wanted this baby out now.... right this moment.

The panic and confused patient was rushed to the theatre for a grade 1 LSCS. My heart rate almost invariably can be felt beating against my chest in cases as such. Patient was in theatre at 0918 and general anaesthesia commenced at around 0925. I had noticed the abnormal hump on the patient's abdomen. I have always called this the 'camel hump' as it looks like the baby's buttocks is raised high on the mother's anterior abdominal wall. Knife to skin at 0927. As I entered the abdomen, a sudden gush of fresh blood and I recognized the pale body of a fetus. 'The baby is out of the uterus! Call the consultant this instance! Start syntocinon 40 units please' I called out in sequence. Baby out in 2 minutes from skin incision.

As usual I had my trusty Paediatric colleagues to help with the resuscitation. I scanned the uterus for severity of the damage. Tears noted extended to the broad ligaments but fortunately no further than that. I had managed to achieve haemostasis. My consultant was there to give me a hand with the remainder of the surgery. We had avoided a possible uterine atony or hysterectomy. Blood loss was less than what I had expected. 500 mls. 'You do like excitement don't you? It only happens to you isn't it?' my consultant joked.

Half hour later, I was told the cord pH of the baby was 6.9. An acute drop. Too close for comfort. It could have been a perinatal mortality case in next month's meeting but thankfully not.

Patient remained stable post LSCS and baby is fine in SCBU.

I had another call few hours later from delivery unit. A patient who again with a previous scar now in the second stage of labour and had fresh bleed from the vagina. My thoughts 'If this is another scar rupture, i will be very very very surprise!'

Here we go again.

Feeling Macro Dirty....

2007-09-10T13:17:00.000-07:00

So...i decided to follow suit another blogger, Odysseys of George to show some macro stuffs which are considered as dirty. Yes the all mighty FLY! I had this little fella in my room one day and i literally followed it all around with my camera to get some pics. Well, i am not saying my room is dirty..err hellooooo.. but its just that this nosy little fly probably got into my room as its getting quite cold now approaching autumn. That's one of the reasons for other critters to be crawling into the house.

Its quite hard to get a good focus on this fly as it almost always senses that i am near or perhaps intruding its personal space. And i am sure its because of those super fine sensory hair all over the body. Cool eh? Bet you have not see a fly in this way or up this close before. Guess most of the time its either like 'ice kacang' after you had killed it or it had already escaped your deadly fly 'badminton racket killer'.

Here it is again... on my curtain. This is probably about 10cm away with a 105mm Nikkor Micro lens.

Koala Bear

2007-09-05T05:07:00.001-07:00

My cousin is doing her PhD in Singapore and well i got hold of this picture which is supposed to be B cell under microscopy.I was told it looked like a Koala. And i think it does!! ehehhe.. just like staring at the clouds and imagining animals out of it.

Look away if you are arachnophobia

2007-09-04T10:19:00.001-07:00

I came back after doing long nights (oncall) and was pretty tired when i saw this little critter roaming around my kitchen. Despite the fact i would lose an hour or two of my sleep, i grabbed my camera and took several shots of this spider. Initially up on the ceiling, it web-slinged itself to the nearby sink and sat there on my cleaning sponge.

Should doctors be oncall from home?

2007-09-02T04:06:00.000-07:00

What does it mean when a doctor is said to be oncall? Watch ER or Scrubs and the first thing that comes into mind is that the doctor is working overtime in the hospital...and perhaps also over the night. Right? Well perhaps but not entirely true.

The doctors seen mainly working over the nights in most public hospitals (in Malaysia) are newly graduated house officers and their counterparts the medical officers, or sometimes registrars. So, what about specialists then? From my experience (and please do not quote me), the higher your status the less work it seems when you are oncall. Meaning? Put it this way, in medical field, specialist works from home and can be consulted via their mobile phones. Medical officers can be contacted via pagers/bleeps but they are on site and if needed will come to review. And finally the front man, house officers see most patients admitting or presented to the hospital. I wouldn't even want to mention consultants...as i believe you would get the idea now.

Having said that, this is not entirely true for some fields though, for example surgical/orthopaedics where surgeons are almost always around for theatre times.

So what you may say? It basically mean that the most junior and inexperience person is treating majority of the patients. Surprised? You bet! It may have changed over time but seriously this is definitely very true. Getting the seniors involved therefor depends on the insight of house officers, whether to refer or not to refer. Many a times, fear of disturbing a "specialist's sleep" (so called, but remember they are still oncall and being paid) or even the medical officer delays such decision till the early hours of the morning rounds. Patient would then suffer as a consequence.

Would senior supervision throughout the night help? Definitely. Would night rounds with the seniors be helpful? Definitely. Should there be fear of referring to the seniors? Definitely not! Should seniors be vicious, mean, inconsiderate, nasty to the juniors when they are so called 'disturbed'? Never.

Perhaps we take it for granted that litigation is not as rampant compared to the western world and take the risk of allowing the current practice to carry on. Perhaps we are short of doctors, but we are sure having lots of colleges producing new doctors. Perhaps we have been in such situation (as house officers) and hence felt that the new doctors should go through such 'so called' experience of working but wouldn't it then be a vicious cycle?

This is merely how i feel, what i experienced and it may not be similar to where or what others practice, but hey this is my blog and i think i can voice out my thoughts... hehehe.

Well, what are your thoughts?

My underwater rig

2007-08-26T11:30:00.000-07:00

I bought this rig about a year ago. First used it when i went diving in Hin Daeng November 2006. And since then i have not had the chance to even get it into a pool. Well, that's also because it is safely stored in my room about 13 hours flight journey from where i am now. I have decided to use ultralights arms instead of the sea and sea arms shown in this picture. I am thinking about getting the dual sync cord rather than using just optical fibers to fire up my strobes. There is so much more i want to do with this system. Time ticking now... before i get my hands on them again.. hehehe... two and a half months to go... YES!!!

This is how my desktop looks like when i am surfing the internet

2007-08-26T11:23:00.000-07:00

I must admit i surf the internet a lot. I like reading underwater photography forums to learn as much as i can from the pros. I like to keep myself updated with news from the college. I like to listen in to my itunes at the same time. I love to browse through Apple products and always keeping an eye open for things to purchase (yes... i am an online shopping junkie as well)... I am so sian...

Rome (Part 2.... before the next part)

2007-08-23T12:33:00.001-07:00

People would not talk about Rome and not even mentioned the Vatican right? I had my most amazing experience with the Vatican not only from this trip but also from Angels and Demons, a book by the famous Dan Brown. From afar, the St Peter's Basilica and Square does not appear to look big at all but look closely and you would see that the structure (yet again) is massive! To get an idea of what i mean, it is estimated that the square is 314 meters long and 240 meters wide.

The Egyptian obelisk that stands in the middle is about 25 meters high.

I joined a small guided tour as i didn't want to wander around the Vatican Museums not knowing what to look for and what was the significance of things i see. It took a long journey from the entrance all the way to the Sistine Chapel, the highlight of the Vatican. All along the way, sculptures, statues, frescoes followed by more of them as i made my way through room after room.

The School Of Athens by Raphael. Try to spot the self potrait by Raphael in this picture..

Inside the Basilica. One can literally place the statue of liberty in here and still have room to spare.

Rome (Part 1..if there is a part 2)

2007-08-23T08:53:00.000-07:00

I had just woke up trying to recover from my five days in Rome. Some may think that five days is not enough to see this place, but its definitely more than i needed. I had enough of Italian food for now. I do not think my taste bud has yet gotten over Italian spices. I am malaysian chinese and i need Chinese food.. or at least something different. So, Rome.. first impression? Busy. One word says it all. I would think that Petaling Street or Kuala Lumpur can be Rome for a day if the Colosseum and Roman Forums had been placed there.

The Colosseum is a massive structure! I can imagine why it had retained its place as one of the seven wonders in the world. To walk around this site at night would have been really eery as an estimated one million life was taken here together with the hundreds of thousands of animals. Yet, people 'lepak' here till very late..and i also had dinner in one of the restorante next to it.

Fontana De Trevi . The fountain was built by the architect Salvi (17Th Century i think) in the time of Clement XII, and decorated by several artists of Bernini's school. It is the front of a large palace (Palazzo Poli) decorated with statues and bas-reliefs on heaps of rock. The fountain is not only celebrated for its excellent water but for the legend that whoever drinks it or throws a coin in the fountain, will assure his return to Rome. Your back to the fountain when the coin is thrown. Did I? I didn't. I had a feeling i won't be back in Rome and moreover having only a €2 coin is enough for a bottle of water in the hot summer weather than to waste it.hehe.

The Roman Forum was the central area around which ancient Rome developed. Temple of Vespasian on the left, Arch of Septimius Severus behind or rather in front of the remains of the Temple of Saturn in the foreground. On the right are the three columns of the Temple of Castor and Pollux and the Palatine Hill, and slightly to the left of these is the Chiesa di San Lorenzo in Miranda. In the distance, the Colosseum and the Arch of Titus are visible.

to be continued.... 8)

Summer Ball

2007-08-18T00:02:00.001-07:00

(Registrars posing!)

(My fellow Registrars)

Went to the hospital's summer ball last night. I didn't bother to rent a dinner jacket (tuxedo) as i didn't see how i can justify to myself spending about £60 for some clothing that i would only wear for a couple of hours. Food was good. Crowd was good. Wine was excellent.

(Midwifes dressing all up and looking dazzling)

After dinner, we were off our seats and started dancing.. erm..unfortunately to mainly old songs...things like dancing queen, saturday night fever etc. No linkin park, amy winehouse, heck not even Queen! But overall had a jolly good time and by 12 midnight it was time to go. Board the taxi and back to my room. Had quite a bit to drink so thats the reason for the taxi. Hehehe..

I have just got time to post some pictures before i leave for Rome in a couple of hours.

Fourth Card Trick (Spades to Hearts)

2007-08-12T18:12:00.000-07:00

Third Card Trick (Disappearing Ace)

2007-08-12T17:56:00.000-07:00

This trick is again for beginner like me. Expert eyes would be able to pick out the trick.

Driving around

2007-08-12T13:15:00.000-07:00

What do you do when you have an hour to spend whilst awaiting for your laundry to be done? Well, i drove around Bury St Edmunds. Its a small town so it's quite easy not to get lost. I passed a whole lot of open fields, houses, shopping mall, sugar factory and then back to collect my laundry. Had a great time getting some summer sunshine. No i am not bored. I just felt i haven't really had the time to see the nature surrounding my habitat.

Underwater Photography

2007-08-08T11:21:00.000-07:00

I got into diving when i started my medical officer-ship in Kuching many years ago. Had my first few lessons with my housemate then. I remembered going to this island called Satang Island for the first taste of compressed air and the underwater realm. It must have been the worst dive i have ever had. Visibility was a mere 50 cm i think. I can't even see my own outstretched hand. Fish? You would wish. All i see is rocks, sandy bottom and more sandy bottom. Nevertheless it did not deterred me from diving further. From then onwards i went on to do my advanced open water with HM who specifically came back to Malaysia from UK in Perhentian Island. That was the time i was introduced to my first ever true underwater photography. I never looked back since. Now having dive in Hin Daeng, Hin Muang, Sulawesi, Sipadan, Mabul, i am looking forward to my possible diving trip to Komodo Island Indonesia end of this year.

To make it even sweeter, i am now equipped with my Nikon D70, Nikon D200, Sea & Sea DX70 DSLR housing with two strobes, the YS 90 Auto and the new YS 110 TTL Sea & Sea , Ultralight Arms, Fisheye focus light, 10-17mm Tokina wide angle, 60 mm Nikkor macro lens and not forgetting my compact sony T1 underwater digital compact camera as well. Ahhhh...what a long list. Heeheheheh.. All i need now is a Pelican case to pack all this. Sigh... another pay check 'habis'.

Pictures? Well although it seems that my underwater rig is darn 'pro' but ahem...i have not had that many chance to dive the last two years. But..i am going to make up to it...when i am back in Malaysia.... year end. I promised myself.

2007-08-06T14:59:00.000-07:00

Happy patient..sometimes

2007-08-06T09:47:00.000-07:00

I was on call this morning from 830am till 1pm. Feeling dreadful i got myself to face the ever fateful "board of patients that never seem to stop filling up". There weren't many cases i need reviewing. I then had the most remarkable referral..well..almost a referral... NO..its not. Its a midwife telling me that i had a gift over the weekend from a patient whom i had seen earlier last month.

"Dr Tan, you have two bottles of wine from a patient" the midwife claimed.

"Really?" I couldn't believed my ears. "Are you sure its for me?" I reconfirmed.

"Yes. There you go, a card with it. Open it and see who it was." she said.

I steadily ripped the letter open and read it. I of course couldn't recall who the patient was or when i had seen her but felt happy that she was grateful for what i have done for her and her baby. Not sure if she is delighted that i have literally cut open her abdomen and delivered her baby, removing her chance at vaginal delivery plus ensuring she gets another 3 days of additional stay post operation. I completely took over her control of the whole labour process. Oh well, anyways i must have done it for a good reason to deserved the two bottles. Cheers!

Second Card Trick (The Flying Ace!)

2007-08-01T14:54:00.000-07:00

Since the last post on my first card trick, i have not been able to find time to practice any new tricks except for this one which was learned in an hour. I then spend about 2 hours making the video (and yet again using my Macbook webcam) and editing to finally able to upload it to 'youtube'. Here it is, what i call my first flying ace of spades. I am sure there are better versions of this by other better magicians and not by an extremely new beginner like me. Do enjoy... and i welcome all comments as well as critiques! Cheers!

Back to Art (Part 1)

2007-07-30T12:32:00.000-07:00

I bought a set of acrylic paints to start painting again. Just to get my mind off work. My masterpiece is on a piece of canvas and i am going to donate it to the midwife's coffee room. They may want to auction it to pay for a new microwave oven. Will show once it is completed.

Cord Prolapse

2007-07-28T01:09:00.001-07:00

Just had a cord prolapse about an hour ago. Received a call from patient who had informed us that she had just ruptured her membranes and noted 'something' in between her legs. We had 'blue lights' up to her and i had given specific instructions to the paramedics what to expect and what to do. Midwife was in her car, stepping on the accelerator trying in vain to reach the patient.

Got a confirmation from midwife...'Its definitely cord!' ..as she made her way in with the ambulance.

I have assembled the theatre staffs, anaesthetist, paeds as well as SCBU. Scrubbed up at 0745 waiting anxiously for the patient to be pushed through the two operating theatre doors. The consultant on call was making her way in. It might take a while before she arrives.

In the next 5 minutes, the two wooden doors opened and in came two paramedics in their green uniform..and the midwife on the trolley with the patient in the semi recumbent position, her hand in the vagina. I can feel all the adrenaline rushing through my blood vessels. My heart was beating up to a 120 beats per minute. I can literally hear my own palpitations. The staffs were frantically getting her onto the table. I rushed them.

'Were there two heart rates?' i called out. 'How's the pulsation on the cord?' i asked again. 'It seems to have stopped about 4-5 minutes ago' the midwife replied underneath the surgical drape i threw over her and the patient after i had cleaned the patient's abdomen. I didn't had the chance to say hello to the patient or even looked at her face. She was under general anaesthetic the next minute. My surgical blade just inches above the area where i would make the incision. I performed the fastest c-section i can the very moment the anaesthetic reg says 'go'.

Patient was in the theatre 0755.

She was anaesthetised before 0800.

First twin came out at 0800.

Second twin was at 0801.

Twin one had the cord prolapsed. Pale and lifeless at birth, it took a while before the paeds got the heart rate and continued with their resuscitation. Twin two was crying nearby within the resuscitaire trolley.

I saw my consultant through the small window of the doors. She gave a 'thumbs up' as though asking if everything was alright. I managed a nod whilst closing up the bleeding uterus. She acknowledged.

The theatre was bustling with activities. Nurses running in and out to SCBU. Consultant Paediatrician making orders and registrars setting up lines. I did not hear a single whimper from twin one. I heard somebody in the theatre said 'she's got a heart rate and looking pink now'. I gave out a sigh of relief. At least its not a still birth. We are still to know how extensive the damage was. It would take some time before i get that answer.

I walked out from the theatre after about half an hour. Wrote my surgical notes and handed over to the next registrar on call. Tired. I changed and made my way out from the hospital. 'Were you on last night?' C asked. 'Yes' i answered. 'Hm mm i supposed that's the reason for the mayhem in the theatre, eh?' she teased. I laughed and said 'Well, you know me. Whenever i am on call, things do certainly happened and its almost always busy.'

Its bright and sunny outside. I can feel the warm summer sunshine on my face. 'I hope its going to be quiet tonight' i whispered to myself.

Switchboard: I have a GP on the line for some advice please...

2007-07-26T02:52:00.000-07:00

My bleep went off around an hour ago. Dialled switchboard to reply.

Switch: Switchboard...

Me: Hi..bleep *** obs and gynae SpR please

Switch: I have a call from a GP for advice please...

Me: OK.. Hello G'monin...its the obs and gynae reg here...

GP: Hi..i am 'so and so' and have a lady here with abdominal pain mainly at the supra pubic region. She has had previous laparotomy for ovarian cyst in year 2001 (6 years ago!) and 3 months back had a scan which showed a haemorrhagic cyst but was discharged later with conservative treatment. No surgical intervention.. 'mumble mumble with patient in the background'...

Me: And the urine is clear of any infection?

GP: Yes i have tested it. And...i think she ought to be seen by gynae because she has this cyst..

Me: ???? Huh..but what makes you think its the cyst that is causing her this pain? It can be anything at all right? And moreover haemorrhagic cyst tends to settle. Do you think we should think about other diagnosis as well or perhaps have a surgical review?

GP: Well..it must be since she had previous cyst problem (clearly quite annoyed with me)

Me: 'thinking to myself...what a lot of rubbish!' But we cannot be sure of that. It still can be a surgical case.

GP: Well..i am sure its a gynae case because yada yada yada (giving me a rubbish percentage for repeat ovarian pathology).

Me: No i think she should come to A+E and to be reviewed by the doctor there and then we shall decide whether she need a gynae review...

GP: 'mumble mumble' fine! ..'click' (and he put the phone down)

Me: (%$&*!)

15 minutes later i get a call from A+E:

A+E: did you just received a call from a GP?

Me: Yes i did...

A+E: We do not do triaging here in A+E (WHAT?? then WHAT does the A+E Do???)

Me: Then, can't the doctor there see first before referring because abdominal pain can be of any pathology..

A+E: Well..we don't do that..its for you to see and decide...

Me: Whatever (flabbergasted!!!)

so...what does the A+E doctors do then? and does it mean that all women with abdominal pain is due to ovarian cyst until proven otherwise?? Even if she has previous cyst problem it does not automatically means she has gynae problems now.

??????????????????

Being depressed

2007-07-25T06:36:00.000-07:00

Its so funny that around 70% of the patients i see in the clinic had at one point suffer from depression whether treated or not (not randomised controlled study ya). And there was a point in time that the local newspaper published an article on this country being a HAPPY PILL POPPER nation. GPs here would prescribe 'happy pills' just like how vitamins are being offered.

And, to be honest lately i have been in this similar mood as well. Depressed? Dunno.... Bored? Dunno..... Need a break from work? Definitely! I guess working for the last month for every single day (on calls most of the weekend including this coming weekend) did take a toll on my mood. I felt like going somewhere to chill out. To relax. To get myself off medical stuffs or even work.

Have tried not to think about work by working on beginner's card magic tricks but hm mm its not working.

So, i indulged myself in doing online shopping. My favourite past time whenever i am feeling low. What do i buy? Well...mainly man's toys... but in particular underwater photography equipments. Got myself a new strobe... and a focus light. Am just waiting to use them. Maybe this year end when i am back in Msia.

First card trick (learned in one week)

2007-07-24T14:40:00.001-07:00

I am into learning magic card tricks now...erm having seen some latest David Blaine Street Magic. Well i am still very very very VERY new with this... and i am sure experts out there would laugh at this trick. But hey..i am pretty proud that i am able to pull it off in a week. Hard finger workout which is good for further surgical work. Do enjoy...and comments are always welcome. Cheers.

I wanna go layang layang and similan

2007-07-16T14:43:00.001-07:00

Nudibranch again
Originally uploaded by orcastyl

oh dear... i have got crave for diving again. aiyo just like how my friends here crave for chocolates after lunch, supper or dinner. i wanna go see some nudibranchs! ohhh...i crave for some compressed air.. hahhaha....

Besar Mak Ini (BMI)

2007-07-16T07:26:00.000-07:00

I had two caesarean section to be done today under the elective list. Both patient weighing over BMI 35. One was for twins (again??? this is the third one this week! where the %£$%! this people get so fertile?) and the other was for failed induction.

First one had a stunning BMI 49! What the..'besar mak ini'! Yes yes...here is this asian chap weighing less than 75 kg doing a c-section on a lady twice the weight of him. Can you imagine? Obesity is definitely becoming a problem this century. Worst of all she is also diabetic on insulin for the last 20 years. Hmm not a great combination. i am sure if i were to ask, it would be not a surprise if she also smokes. To add to that...had two previous scars (c-sections) as well.

C-section was like hell... had to tape her abdomen up using elastoplast making sorta like X mark on her abdomen. And even then had to have two of my courageous assistants to assist me.

Next lady, another staggering BMI 47! Besar mak ini! Another X mark on her abdomen.

After this two c-section...my hand was really aching. I am sure i saw my arm muscles twitching in agony.

Sigh... no rest however... as i am writing this...another patient is being wheeled into the operating theatre for c-section. Wish me luck.

Sunday at Ickworth House

2007-07-15T10:34:00.000-07:00

Ickworth House...the present house begun in 1795 by the Hervey family. There are about 70 acres of gardens, including woodland walks to the front of the house and the Italianate Garden to the rear.

About 1800 acres of woodland and parkland offering a variety of wildlife. Alas..the sky was gloomy and i wasn't prepared to get wet today hence just strolled around the house. The house itself play host to numerous fabulous paintings, furniture, silver and porcelain. No photography inside so i can't really show you anything.

She is doing alright..

2007-07-13T16:24:00.000-07:00

Came to hospital tonight to do my last on call (for this week), the 8Th one in a row and the patient i was looking forward to review first was the one whom had the post partum bleeding.

She was already out from HDU and has been extubated since 1300. Had four units of bloods transfused and she was no longer bleeding. Brilliant! Observation had been stable throughout the day whilst i was sleeping and recuperating from last night.

She was with her husband, twins in her arms...baby girl left and baby boy right.

One happy family.

One lucky patient who had survived the traumatic ordeal less than 24 hours ago.

We went through the events that took placed and even had the time to laugh about the whole experience. That scary 4 hours when she was still in the operating room, with her husband in the delivery suite holding on to the twins not knowing exactly what was happening is just too much for anyone to handle.

me: alright then...i have gotta go see other patients..now you take care..and i may pop in once a while during the night to check on you...

patient: thank you doctor

I left the room knowing she will do fine.

Unlucky Thursday Night going into Friday the 13th

2007-07-13T03:30:00.000-07:00

Did a c-section for twins yesterday and maybe its my 'mulut celupar'....as i have told the patient and partner that i fear she may have uterine atony (womb lembik like dough!). That's because she has been in labour for hours and although relatively pain free with the epidural in situ, and on maximum doses of syntocinon...she wasn't really progressing or dilating her cervix. 8 hours into her labour...i had a look at the partogram ( graph showing labour progress) and decided i would throw in the 'white towel' and call it quits with any chance for vaginal delivery.

Had a chat with patient...and i strongly advise against her wishes to carry on another two hours. Everything she did was perfect...its just one of those cases where her uterus just wouldn't contract efficiently. So..brought her to theatre about 3 am. C-section was straight forward... no complications until...the uterus starts to relax. I generally ordered prophylactic doses of syntocinon (erm..hormonal drip to enhance womb contraction) but in this particular case...the uterus just refused to budge. Doses after doses of carboprost as well as per rectal misoprostol did not make any difference.

So, she bleed and bleed and although given other medications to stop the bleeding...she continued to bleed. Had to call the consultant in and .....after hours of massaging her uterus (another means of trying to contract the uterus), we ended up opening her abdomen and performed a B-lynch suture (will show illustration below). Well that kinda stop her bleeding after losing nearly 2/3 of her body's volume.

(BJOG)

She was later send to the HDU for further monitoring. Sigh..what a night .... oh did i mention that half way through the re-laparotomy i had to rush to delivery suite to perform one ventouse delivery and assess a lady for manual removal of placenta, as well as another patient with thick meconium stained liquor (pooh in the fluid surrounding the baby in the womb) with pathological CTG.

That was how busy it can be on my calls. It has been busy calls for me ever since October 2006. It doesn't help when its Friday the 13Th.

one more night of on call to go....

3 more to go

2007-07-10T20:43:00.000-07:00

Its about 0435 am now and i have 3 more days of 12 hours back to back on calls to go. I do hope i can survive till then. Am really looking forward to the weekend.

Does it only happen to me?

2007-07-10T20:19:00.000-07:00

It sometimes puzzle me as to why some doctors are just plain ignorant. During my last few days of on call i have had a couple of referrals of which i thought could be easily handled by even the most junior doctor but... no...they had to be referred for a second opinion.

First case, a three year old girl who had sustained a perineal injury while playing on the slide. No child protection issue are of concern. Paeds registrar had wanted me to give an opinion of any possible laceration of the ? vagina. Firstly I wasn't impressed with the timing of referral as the child was admitted seven hours prior to this. Secondly, she had not even attempted to examine externally the child's perineum. How lazy can one get? We refer to the paeds when there are issues about ambiguous genitalia but they can't even tell whether there is any laceration on the labia??

Second case, a woman had just recently had a termination of pregnancy (which is entirely legal here in the UK under the Abortion Act) but subsequently passed out a piece of tissue which was said to be a fetus by the GP. Women was obviously distraught and came to the A&E for reassurance. Doctors in the A&E examined the product and inform me that it was definitely a fetus. So, i send the patient up to the ward for a review. The so called fetus? Well...it turned out that it was a piece of placenta tissue. i don't think it is at all hard to recognise a fetus. It should look like a very very small baby..with a head, upper and lower limbs! Poor lady was so convinced that she burst into tears and had to be persuaded to calm down and reassured..

I am not saying i am perfect but at least i try harder than these doctors...sigh...

070707...

2007-07-07T07:13:00.000-07:00

Hmm..its the seventh of the seventh month in the year zero seven..and i have seven more days of oncall to go. And..to top that..i had also work on the sixth of the sixth month of the year, zero six last year.

i wonder who was born this morning at seven o'clock? As i was walking along the corridor this morning having done my rounds, a patient whom i saw earlier had really wanted her baby to be born today. She was admitted for induction for post dates and due to have an artificial rupture of membrane in the delivery unit. And she did said that as i am a 'chinese' i would be able to understand the reason she wanted the baby delivered on this auspicious day?????? how bizarre... i didnt know number 7 is good for chinese?? is it??

beep beep beep....alright alright... gotta answer my bleep now...

Status 'tigris' epilepticus

2007-07-01T13:05:00.001-07:00

I was kinda bored this weekend and decided to visit Linton Zoo which is only about 10 miles off Cambridge. Climbed out of bed, made breakfast, called home, and after a quick bath....grabbed my Lowepro bag with my 'ka chang' and drove to my destination. It was cloudy initially but the sun came out and it was just brilliant. Linton Zoo is not big...just small enough to house some big cats, zebras, lotsa owls, tamarins, birds and a handful of reptiles. Enough for me as i dont really wanna spend too long there anyways.

Paid £7 at the entrance and made my way around. Saw the birds...turtles....toucan...some owls... and then...the BIG CATS. As i was walking near the enclosure, some tourist told me to watch out as the 'Lion' was apparently spraying around. I then noticed that it was in 'heat' and erm..manage to get a glimpse of a courting and mating ritual. Guess nothing to do, so eat, sleep, shit, and sex loh..

Then i heard a roar...almost a roar...more like intermittent grunts. The sound was definitely from a big animal. I moved on...and the sound was coming from the 'tiger' neighbours. There were 4 tigers there. The next thing i know, i was witnessing an event that i have only seen in humans... status epilepticus. Status 'tigris' epilepticus..

I manage to capture that very moment with my camera. I was disheartened to watch that cat fitting away and nothing can be done. Hands tied. Some of us watching managed to get the keepers to help but i guess there isn't anything that can be done. The other tigers just refused to leave as though sensing something was wrong with their sibling. Its just amazing. It went on and on for at least 10-15 minutes. Tonic-clonic (shaking violently) all the time... with heavy breathing in between... then...finally it stopped. The tiger was very drowsy and struggling to be on its paws. It made a few steps and fell back to the ground. As though knowing what actually happened, another tiger seems to be encouraging it. Half an hour past before the tiger regained its composure...moving around the enclosure...being watch by new oblivious tourist.

i wish that tiger would be examined by the vet soon...

What do you mean NO theatre?

2007-06-30T13:47:00.000-07:00

I previously worked in a hospital in east malaysia where there isn't any dedicated obstetric theatre (am talking about a tertiary hospital). When there is a need for an emergency c-section, we simply call up the theatre, booked the case and several minutes later send the patient for the operation. There are times when we couldn't get a theatre because the two theatres are both occupied with other emergencies. And many times we manage to open the 3rd theatre just in the neck of time to prevent potentially fatal outcome. You can just imagine the adrenaline rush when situation as such arises.

Having worked in the UK for the last two years (well, almost), i came to realised the importance of not only having a theatre specifically tailored for obstetric patients but also an anaesthetist working full time for the delivery unit.

Why? Firstly, when any patient is to have an emergency section this can be done without any delay. If a trial of instrumental delivery (i.e. potentially ending up with a c-section) is needed, this can be carried out in the theatre. This won't be possible where i was working before. I remembered that whenever i had to carry out a ventouse delivery, i had to inform the GA MO that i may come to the theatre for a 'crash section' if i fail to deliver the baby. At this point, there will be two midwifes with a trolley bed all gear up for transfer and another with a shaver in hand. Sounds scary? You bet.

Epidural services in labour? Utmost important to help labouring women to control the pain. Would you be able to get this there? Never... unless you are a specialist labouring away perhaps. Or an anaesthetist. Reason? No one is able to monitor the patient if she is to have an epidural (or rather no one WANTS to monitor). No anaesthetist is in charge of the delivery unit to perform the procedure. Sad right? I had once felt so disgusted with myself as an obstetrician telling the patient that she can't have the Entonox as it ran out and she can't have another dose of pethidine as it was too soon after a preceeding dose an hour ago. Its practically asking the woman to bite on to her 'baju' and carry on with the labour pain.

I was hoping things would be better in the years to come. Alas...how wrong was i. JL in the last week had emailed me and told me that he was put on the 'center stage' and had some 'grilling' as there was a delay in a c-section for 3 hours. This was a case where a women had meconium (unborn baby's pooh) stained liquor and not in labour requiring immediate delivery. Reason for delay? you guessed it... theatre busy with other cases... This would not have happen had there been an obstetric theatre right? I strongly believe its the system at fault. Unless there is commitment of the anaesthetic team to provide the service of epidurals, an obstetric theatre and delivery unit oncall anaesthetist, there would not be an improvement in provision of care.

(me talking to my gwai lo anaesthetic colleague)

me: know what... the last hospital i worked in do not have a theatre like here... and erm..(malu look) no epidural as well...

gwai lo: What do you mean NO theatre? This is so @£$%! ridiculous.

Pictures with my new Nikkor 80-200mm f2.8

2007-06-25T15:26:00.000-07:00

cat at abbey gardens

young duckling

canary i think...

duck again

a friend taking a snack while i snap

a robin....
i am in love with this new lens.........ahhhhhh

2007-06-25T05:47:00.000-07:00

Awwwww....how cute

2007-06-25T04:36:00.001-07:00

I get paid to see this awesome view! First class seat all with attire and limited viewers only. Special VIP seat. Aint that nice?

Waiting in agony

2007-06-24T23:42:00.000-07:00

Its about 0746 now on a monday morning of 25062007. Just finished a Caesarean section about an hour ago. Reason? well, fetal heart rate went down to about 80-70 bpm lasting probably about 10 to 15 minutes. Rushed to theater for a grade 1 section. Baby is fine. Thank goodness... (another life saved)

Am just waiting to hand over in the next half hour or so.

Am waiting also for the arrival of my new gadget...toy....boy's game.... whatever you call it. I call it...my 'bazooka'! Its my new telephoto lens...a nikkor 80-200mm f2.8D ED.

And ....to add to this....my Crumpler Mcbain Laptop bag, to house my pearl white Macbook.

ahhhhhh.... i do hope they arrive before the planned protest and strike by Royal Mail.

Now its FIVE!!

2007-06-23T14:22:00.000-07:00

When i said earlier that ectopics comes in three..boy am i so so wrong. Another two patient with ectopics was admitted over a 24 hour period. First patient was seen by myself and the other by my colleague earlier today.

I was oncall last night and about 330 hrs plus, had a call from the A+E sister saying that they are really working their butt off...and requested for me to see this patient who hasnt been seen since she came in around 2300hrs.

Me: Hello, its the gynae reg here..... (waiting for an answer)

Sister: oh...hi there... a+e is really busy and i was wondering whether you would be kind enough to help us see this one patient who has a positive urine pregnancy test and in quite a lot of abdominal pain. And she has been here since like 3 hours ago and none of the doctors here are able to attend to her... would you mind?

Me: Sure.. will be there in a second

Sister: you are a star....thanks....

Knowing that A+E is where you hardly get any help, i rushed (well, literally walk) over to the delivery unit...grabbed a few speculums (my plastic companion during my oncalls), swabs, gels and glove and went downstairs.

After a quick history taking and examination...i concluded that she had a ruptured ectopic. I admitted the lady and performed an ultrasound scan on her which true enough showed collection of fluid (very likely blood) posterior to her empty womb...and also all over her liver.

She underwent a diagnostic laparoscopy (keyhole surgery) and subsequently a laparotomy to remove an ovarian ectopic.

I saw her again just now...and she appears to be alright. YEAH!!! another life saved!!

Its Dad's birthday...

2007-06-22T04:49:00.000-07:00

Its dad's big day today. I woke up late after an exhausting day yesterday. Stayed in bed till i can feel the warmth of the sun rays (am working nights tonight). I had intended to send a message to wish him yesterday but it was too early for him..and it might have just woke him up from his sleep. Anyways...send the message this morning. I know that sis would be bringing him out for dinner with the rest of the family anyways. Hmmm...it has been a long long time since i last celebrated with him. I guess its time for me to change that..and next year...i will be around (i promise)
Happy Birthday Dad...

(picture has nothing to do with title)

Can you read this?

2007-06-21T10:56:00.001-07:00

am trying out the hindi fonts... so here goes

ई लिके हिंदी मोविएस

इफ यू कैन रीड थिस थें इट्स मोस्ट लिके ठाट मय हिंदी इस रेअल्ल्य गूढ़।

ई हवे अब्सोलुतेल्य नो आईडिया वहत थे हिंदी वोर्द्स स्तान्ड्स फ़ॉर!!

बुत, इट्स सो कूल तो बे अबले तो विरते सोम लंगुअगेस यू कांत सिम्प्ल्य उन्देर्स्तंद!!! हाह्हाहाहा

थैंक्स फ़ॉर रीडिंग अन्य्वाय...

Erm..can you understand them?? hehhe...neither can i... hahha..i do hope its not some bad words...

This is how my name is suppose to be in Hindi तन यिअप लूंग
8)

Ectopic pregnancies comes in three

2007-06-21T10:48:00.000-07:00

I have always have these things with ectopic pregnancies and whenever i am oncall, it appears that almost always three cases would turn up in the entire week. I do not know why..but i guess its just superstitious. But heck, last friday there was one..and today there is TWO!! Yes two...both listed up for laparoscopic surgery. But alas... i am off work now..and the consultant will be doing it. Shucks.. wish i could have a go at them...

But its alright.. i had my share of surgery this week. Did er..lets see... one total abdominal hysterectomy, one vag hys and posterior repair, and saw one manchester repair. Not too bad i would say.

By the way...you should see the manchester repair that my consultant did. the cervix was so long that it protruded out from the vagina..and its so bizarre. Both me and the consultant stared at it and looked clueless.. hehhee...

busy busy busy

2007-06-18T14:55:00.000-07:00

Oh my god..first day at work after my long leave and so so *@£$! busy. Firstly did my rounds in antenatal ward. Not too bad...had only a few patients that i need to see. Then off to gynae outpatient clinic. Saw patients from about 10 am till 1 pm..then accompanied my consultant to do pre-op rounds for cases in the afternoon.

Manage to grab chicken and prawn jambalaya for lunch...then went to theater at 130 pm and performed two elective cases. First case, diagnostic laparoscopy followed by a small resection of a possible endometriotic mass over the broad ligament. Next, did a hysterectomy for a lady with menorrhagia secondary to uterine fibroid. All the time looking at the clock so that i do not overshoot the 5pm mark as i am oncall..... then whilst i was writing up the operative notes...cun cun 5 pm...colleague hand over an emergency LSCS (caesarean section) for poor progress... alamak....

ok..ok...so introduce myself...and then JUST BEFORE starting...got a bleep!! Midwife from ward says got late decelerations on CTG!! aiyo.... howlah i can see the patient... hmmm then i arranged for the lead midwife to go see what the hell is happening. Appears that it was a pathological CTG post induction of labour...ok ok...so decision for back to back LSCS... (hungry somemore that time).

After second LSCS,,hurried to grab dinner...then aiyo...still got 4 patients to review in antenatal ward and one patient to have an ARM done... hurry hurry hurry...

by the time i knew it was 830pm and handover period, my bleep went off again. Its my colleague bleeping me and coming on for the long lonely night... sigh...what a relief...

i am oncall again tomorrow...

Nothing better to do...so much time!

2007-06-16T09:13:00.000-07:00

mom and dad went back to malaysia today. I drove back to La Klo Yee after Heathrow and although initially had intended to go out to meet paul and vinna....but it was raining quite heavily (was in the car driving... @%!£% took a wrong turn as tomtom no GPS signal!)...so i decided to be 'lazy'...i stayed indoors instead..and started on my little project (and i promise you that more will come).

I have always wanted to make my own animation using still pictures captured on my camera (dunno why, at the same time...got a Mac magazine and they were writing an article on how to!! yippee!). So...i was like thinking hard on what object or subject to use. Then... blink!... i remembered CH had bought some...erm...erm...dunno what those dolls are called lah. From Prague...

So, all ready... camera out (my D70 Nikon), tripod...and then snap! snap! snap! .... but aiyo... battery run out. Forget to bring charger! Shit...

CH: erm erm... (cooking her porridge) use mine loh... i dont know whether can use or not lah...
Me: Can ah?
CH: Can..
Me: thanks (inside.....jumping up and down...boing boing boing like small boy excited)

Camera ready... Powershot S3..snap snap... I think i took about 274 pics to make this short film. Uploaded onto my Macbook's IMovie and then did some editing. So here it is...the end product. Cute leh... I call it...erm "THUN YUP LUNG" -meaning in cantonese..(direct translation bounce into hole!
MUAHAHHAHAHAHHAHAH

oncall on monday 18062007....

2007-06-14T15:46:00.004-07:00

(will be back to this working environment.......)

my two weeks leave will be over this sunday. two weeks as a tour guide for my parents. hehhe...hmmm quite tiring. more like oncall 24 hours day after day. tomorrow i will be heading down to london again and over the weekend to meet up with my mates. i think we have plan for something but i cant quite think of (more like cannot remember) where we are going or what we will be doing. whatever it is...i am sure i will enjoy it. Joshua had wanted us to have our tattoos done over the weekend... but yet again i am not sure whether it would work out this time. I had suggested that we crashed La Klo Yee one last time before it is closed for good. Making sure we have got lotsa lager and wine (dont care whether red or white, just heck it and drink till vomit out all our gut juices) to last us multiple rounds of 'chor tai tee'.

I want to go diving!!!

2007-06-14T15:26:00.001-07:00

Oh..how i wish i can go diving now... hmm its been so long now since i last dive. I have gotta get into those tight wetsuit of mine and breath some compressed air and to basically listen to my breathing and the sound of bubbles rushing through my ears....and frantically trying to capture underwater images with my nikon d70. ahhh.... how long more do i need to wait???? erm..HM, if you are reading this...lets plan to dive end of the year mate. And this time...can capture more of my picture ah? i was just going through my collection of underwater pics and i think i have hardly a handful of my picture.... sigh....

Venice (Italian: Venezia, Venetian: Venezsia, Latin: Venetia) Part 2

2007-06-12T12:04:00.000-07:00

2007-06-12T10:16:00.000-07:00

I just stocked up my fridge with lots of lager.. its so warm here in Suffolk during summer that i need some cold beers to cool myself down. especially during the night. Not as warm as in malaysia but still warm for me.. hehhe...Oh how i wish i am diving in some remote island south of thailand... ah....ah.... nice.....

Being Casanova....

2007-06-11T14:09:00.000-07:00

We all know who Giacomo Casanova is. He was famous for being a womanizer but alas many didnt know that he was also a famous Venetian adventurer and a writer. He uses his charms to conquer women during the 18th century and the story is he had sex with at least 120+ women!!

I saw this shop and within it, a Casanova mask!! I bought the mask eventually...hmm perhaps in the near future place it in my apartment as a form of deco. But just prior to that i just had to take a picture of myself in it. hehhe... and mind you... there were lots of other mask to accompany me...

Venice (Italian: Venezia, Venetian: Venezsia, Latin: Venetia) Part 1

2007-06-11T13:59:00.000-07:00

Night views at the Grand Canal.

A typical view encountered in almost every single corner.

Venice (Italian: Venezia, Venetian: Venezsia, Latin: Venetia)

2007-06-11T13:44:00.000-07:00

Venice. A place where couples were very keen to explore and to experience the romantic scene, beauty, ambient, the carnavale. How untrue.. the venice today (from how i see it) is full with tourists...including myself. Left, right and centre...all over you will see people. There is not a corner, especially at the San Marco square that you wont find a homo sapien. But yet it still offers plenty of photography opportunity. For the next few post..i will be showing some of my best shots around Venetia. I took a very short trip to this part of italy...and love it!!!

Eggs

2007-06-06T13:40:00.000-07:00

My mates got me a pair of eggs. Rubber eggs. They bounce when thrown onto the floor. They smelled like rubber. They feel like rubber. They weight as close as 'free range organic' eggs do. They looked damn real. But i cant cook them when i am hungry!

On-call

2007-06-05T16:04:00.000-07:00

What do i do when i am oncall at night?

10 things i do....

1. I work for 12 hours straight shifts.
2. I work alone if i am working night shifts. Meaning.. i carry both the SHO as well as the Reg's Bleep (or pager and yes.. i work alone at night. No SHO).
3. I cover the antenatal ward, gynae, central delivery suite as well as any referrals internal or external (GP referrals).
4. I have to write up all fluids and medications.
5. I insert almost all needed IV access.
6. I do all the emergency caesarean sections, manual removal of placentas, extended perineal tears and attend all emergencies (well...i do call for help from the on-call consultant when there is the need!).
7. I see all patients coming into central delivery unit who are categorized as high risk.
8. I reviewed all non-reactive CTGs.
9. I get to sleep when i have the time. But, ever since October 2006, i decided not to...as i will still not be rested.
10. I make men cry by delivering their newborns.

the very first thing i knew about Zambia

2007-06-04T17:36:00.000-07:00

Just prior to my two weeks annual leave to be a personal tour guide to my parents here in the UK, i was on-call. And during that hot saturday afternoon, I had a patient who is into her term plus 13 days of pregnancy. Erm... thats what we think she is..because we have absolutely no antenatal records whatsoever from her country of origin, Zambia. She left Zambia to be in this country when she was about 35-37 weeks pregnant and i have no idea how it was possible for her to escape the flight restriction.

Anyways, she was induced for post term and planned for an artificial rupture of membranes (i.e. erm...breaking the membrane at the neck of the womb/cervix to release some yucky 'pandan smell' of fluid to release some chemical substance which would then start the contraction... yada yada yada).

Problem!! We (midwife and myself) noted that she didnt had any antenatal booking blood results of HIV/RUBELLA/HEpatitis B or C!!!

That sort of makes things more complicated as Zambia, since the mid 1980s has been compounded by one of the world's most devastating HIV and AIDS epidemics. The statistics alone are shocking:

one in every six adults is living with HIV
98,000 people died of AIDS in 2005
life expectancy at birth has fallen below 40 years
710,000 children are AIDS orphans

The prevalence of HIV infection in women giving birth in London was 0.38%,compared with
0.06% in both the rest of England and in Scotland (RCOG).

and, and..... fetal heart rate is not the best as well.... BUT,

I dont want to cross infect her baby iatrogenically.
I dont want to risk myself or my staffs to possible infection by not knowing her status.
Heck, i dont even want her not knowing her status and then not getting any possible treatment...

We then manage to get an URGENT HIV testing (courtesy of the oncall consultant microbiologist) and got the results within 3 hours (how efficient!). IT WAS NEGATIVE. Phew.... what a relief. I did what needed to be done... i ruptured the membranes........yucks...

*Any women diagnosed HIV positive during pregnancy should be informed that interventions (such as anti-
retroviral therapy, caesarean section and avoidance of breastfeeding) can reduce the risk of mother-to-
child HIV transmission from 25–30% to less than 2% (RCOG).

Dad & Mom in Europe...

2007-06-03T15:55:00.001-07:00

My parents are here in London!! Picked them up at Heathrow this morning. They have been around europe for the last one week and i will be their tour guide for the next two weeks here in the UK. Have planned for them to do some shopping tomorrow at Oxford Street, Harrods and possibly Selfridges. Then it would be journey up to Bury St Edmunds before a short trip to Venice. Hmmm planning to take some pictures of them on the gondola since erm...they make me so 'pei' by being SO 'LOMANTIC'!!

NiCoLe

2007-06-01T14:49:00.000-07:00

Wanna know how cute my niece is? She danced to my fast and furious soundtrack...thats how cute she is.. hehhe

Oh and by the way, if you are wondering how old she is.... its 1 year plus. Yup... 1 year plus and the video taken in my car...

Pregnant?

2007-06-01T10:48:00.000-07:00

"For 14 years I had my stomach stapled before they realised I wasn't fat, I was pregnant"
www.dailymail.co.uk

In my limited years of working as an obs and gynae registrar, i have encountered patients quite like the cartoon above.

Today, i met another who didn't know she was pregnant. She is already about 30 weeks into her pregnancy. Really...how hard is it to tell whether you are pregnant?? If you are to have sex and use absolutely no contraception at all, you stand a chance every single month to be fertilised (well, provided you ovulate every month). And as long as one is still menstruating, there is a possibility even if 50 years of age.

"Miss a period, check the urine pregnancy test!" is what i can hear my lecturers screaming when i was still in med school.

making men cry...

2007-06-01T04:06:00.000-07:00

I made two men cried in the last 24 hours. One was yesterday when i delivered a baby via ventouse (or vacuum) delivery. Baby cried straight after birth and then the next whimper came from the dad!!! Surprisingly at that same moment, baby stopped crying...hmm perhaps trying to listen in to the father...

Next was at cesarean section today. Another dad cried... He was in the midst of taking pictures of his baby boy halfway out of mom's abdomen. Hehehhe... i manage to put up a peace sign when they were about to take a family picture...but ah..the consultant anaesthetist says 'looks like the doctor wanna join in but because of hospital policy...erm... NO!' sigh... never mind...

3131

2007-05-31T14:22:00.000-07:00

Went back home after work today at about 9pm plus. Exhausted. On my tray in the doctor's office..something cheered me up. My friends at work left me something. It was a couple of cards and two bottles of wine to celebrate my 3131. I checked my phone....dad left a message as well. And so did many other friends. Hooray!!! Its a great feeling....

What a waste of spinal anaesthesia...

2007-05-31T10:12:00.000-07:00

Am oncall today (yes..on my birthday!!).Took over the bleep at lunch time after munching down my roast lamb and cabbage. Was told that a patient is going to the theater for an EUA (examination under anaesthesia) because she has a LARGE (maybe 8 cm by 8 cm )haematoma (blood clots) on her right vaginal wall, seen earlier by another SpR.

Went to theater, anaesthetist registrar took about 45 minutes trying to insert the spinal. Failed. Consultant came in... took another about 15 minutes and finally manage to put the patient to ease. Then up goes the legs onto the stirups... and to my surprise, the LARGE haematoma decribed to me by the midwife was merely 3cm by 3 cm in diameter and probably would not need any evacuation at all. Anyways, since already in theater, i completed the suturing and repair in less than 5 minutes.

What a waste.....

Up and coming audition for Grudge 3

2007-05-30T14:24:00.000-07:00

A friend of mine played with Photobooth on my Macbook whilst i was visiting. This is one of the many pictures that she took. I have then decided to do some editing and the end product looks pretty much like the 'lady ghost' in Ju-On (Grudge).

Another year older...

2007-05-30T13:26:00.000-07:00

When the clock strikes twelve midnight tonite... it would mean that i have been in existence for the last 30 (yeng said 31....erm but i prefer to be 30 loh if can:01/06/07) completed years on this planet. Much have change since then..

Its weird to know that i have evolved from a combination of a single sperm (out of the millions) and a single egg, to what i am now.....