A holistic approach

While dealing with specialist, one would usually learn more from the experienced ones.

While there are things that we often miss while dealing with patients, there are also things that is obvious but deliberately missed by us, the healthcare 'professionals'.

In the emergency department, we often tend to give treatment to patients, without explaining much to them, or to their next of kin.

The lesson I have learnt from Dr Chan Pei Fong was a valuable one.

Most of the patients need to pass urine, pass motion and some will feel hungry after more than 6 hours in the ED.

However, we often ignore them while dealing with more vital stuff, forgetting that those are the basic human needs as well.

'Patient will remember you if you take care of those 3 things, and not by how much medication you have administered to them', said Dr Chan.

This is undeniably crucial.

Those are basic human needs.

Also family members are worried too, it is our responsibility to explain to the family members and reassure them!

So yesterday I did the exact same thing, I guided a 80 years old patient to the loo, step by step, slowly.

I looked out for patients without blanket, and asked if they would like to have one, and nicely covered it on their shivering body.

I guess after 2 years of working, there is a need to revive the compassion in me.

There is no excuse to just focus on the 'important' stuff, while ignoring the 'basic' stuff.

It's time to improve!

How is my night?

Last night I was dealing with 2 deaths in red zone ED itself.

As contrary to what others believe that doctors are acclimatized to death, what I can say is, I have seen death in the past 2 years more than most people in their lives, but the scene of family members weeping in front of the cold body lying lifelessly is still not a good sight to me.

There is an old aunty who was involved in a road traffic accident, and sustained multiple extensive intracranial hemorrhage.

Her conscious level started to drop after few hours, and by evening she is already not responding to call.

'Ma, I am back to see you', uttered her son who rushed back from JB to see her one last time.

There was no response from his mother, not even a single sound, except for the constant beating sound of the cardiac monitor.

The woman died 3 hours after being sent to the ward for comfort care.

I wondered how many of us would be saying the exact same words when we are back to see our parents?

Saying it for a thousand times when they are gone does not make up the time loss when they are still around.

Another one was an Indian gentleman who has a wife and 2 children, suffered from heart attack.

We were starting chest compression from the moment he entered the ED door upto the zone itself, as he were already lost his consciousness before arrival.

He did not make it.

Heart rate and pulse oximetry not recordable.
Breath sound and heart sound could not be heard.
cardiac monitoring showed asystole (flat line)
blood pressure unrecordable.
pupils 5mm/5mm fixed and dilated.

As I penned down this routine words which is not something new to me, family members rushed in.

I did not talk to them. As I believe no words can replace a living man.

I was observing from afar, saddened by the harsh fact that we cannot save all lives, and eventually everyone will have to return to their creator.

I do not believe there is any doctors who are good in dealing with death, maybe not from my experience.

Life is temporary. Death is inevitable. 

'I am busy'

'I am busy'

Perhaps the most overused words for me, with such under rated meaning behind it.

When 'I am busy', I am spending 30 minutes taking blood from a difficult patient, with constantly cursing and screaming directly at my face.

When 'I am busy', I am tracing an important CT brain for a patient, as I am worried bout the outcome of the fall from 2 storey height that he had.

When 'I am busy', I am attending an unstable patient, whose blood pressure is constantly low despite giving high noradrenaline support.

Yet there are people who will say words like 'There is no such thing as too busy to reply a message, it just depends on your priority'

While some seem to be offended, it is actually quite true. Priority always comes first. And when you are dealing with humans who have excruciating pain, your priority is to win the deal between you and the grim reaper who wants to suck the life out from your patient.

Thus, the word 'busy' seems to not able to compensate the daily warfare happening in the hospital.

It should be replaced by:

- I was having a back-breaking call last night attending to the non-stop admissions to yellow zone

- I skipped my lunch as my 30 minutes early referral to ICU is more crucial than my rumbling stomach 

- I was late to home 2 hours as the patient decided to vomit blood and life out, right before I stepped out from the hallway

If you have been through what I have been, you will appreciate life and understanding more about suffering.

But fortunately, if you have also not been through what I have been, look around you, you should be grateful =) 

Who is your best friend?

Who is your best friend?

A question that is asked way too frequent.

The older you are, the wiser you become, and so they said, which is partially true.

As I continue to grow in the society, I realized that this question, which I can easily answered if you were to ask me 10 years or 15 years ago, is not an easy question afterall.

I have friend AAA, the friend who is aggresive in learning, believing in focusing on self, who constantly improves oneself. Whenever opportunity strikes, I am humbled to learn together alongside him. This makes him my best friend when I am learning while working.

I also have friend BBB, the friend who believes in work-life balance, the one who will not give extra effort once past her working time, which is not wrong afterall. This makes her my best friend, as she is the one who constantly reminded me of the life after work, that we do not dedicate our lives to just work, and life's too short not to enjoy with your love ones.

Not to mention friend CCC, my best friend when it comes to dealing with my hard times. He may not be physically with me all the time, but he assured me that he will be there whenever I needed advice or help. The one whom I will forget when I'm in my comfort zone, but will only remember when I'm down, and he doesn't mind!

Also friend DDD, the one who is way older than me, who constantly enjoy food all the time. I may not be a food lover, but I can't deny that sometimes a good meal with good companion is all I need after a long day work.

How bout friend EEE, the one whom I seldom meet, although we stayed not far from each other, the one who constantly shared the same beliefs and ideology, who believes in inspiring young people, our juniors, as life is not just about living with ourselves, but to interact with others.

And not forgetting friend FFF, GGG, HHH and so many more, who will only appear at certain times, a certain moment in my life, a certain place which is unpredictable, and at a certain stage of my life..

But one thing is always certain, we not only grow physically older, but our minds grow mentally wiser day by day.

Who is my best friend? This is a question way too easy but too complicated to answer.

FFXIII

Wishes can come true, but not if you just wait for miracles. Miracles are things we make for ourselves, here, and now.

It's easy to lose sight of things in a world as wide as this one, but if you keep going, you're sure to find what you're looking for sooner or later.

When prayers turn to promises, not even fate can stand in our way. We held the light of hope in our hearts, and achieve the impossible.

Now we live on, to greet a new dawn. 

Distribution of Oranges & Love

18 January 2017 - Tzu Chi Melaka have their usual weekly Wednesday visit to Hospital Melaka but this time it was special because we distributed mandarin oranges to patients in the Medical, Palliative and Oncology wards in view of Chinese New Year next week.

We visited with only 1 aim, that is to brighten someone's life up by giving hope and lending ears to those who need it. It is a skill that I need to acquire and practise in order to initiate conversation with patients, especially the non-formal conversation, asking concerns, and try not to go overboard.

In this visit, I have particularly noticed a few things that I have learnt:

1. Patients with chronic illnesses (stroke, cancer) are in despair and sorrow, we can offer them hope by reminding them of the things that the currently have. For example, a stroke patient can still speak fluently (left sided stroke will have impaired speech), or a cancer patient is just tired but free of pain and have good family support. They, just like us, need to be constantly reminded of the things that we have, rather than the things we do not have.

2. Not all patients will listen to me, it depends on the 'channel', if the topic is good, then we can talk for long, but if its not, then its better to move on. No matter how good or how well can I speak, some patients just refuse to listen, this always remind me to be down to earth, we cannot save the whole world.

3. Family members need support too! The best that we can do is to listen actively to their pleas and hardship. I knew it is not easy to take care of an adult especially if they are sick for a long time. Most of the time I can only give suggestions to them, and give them some positive inputs as to remind them of how tough and how filial they are.

To be frank, hospital visit appears to be easy but it actually requires great mental strength and motivation from the volunteers like us. The first person we must motivate is ourselves, once we are in the phase of mindfulness, the road ahead will all be laid out smoothly~ =)

Video and Photos source: Tzu Chi Malaysia youtube https://www.youtube.com/user/tzuchimy

Tzu Chi Clinic with Dr Yap

15 January 2017 - How many of you have seen a person who are well to do in the society, highly respected, and at the same time, treats everyone equally and same? Well, I have the opportunity to knew this man, Dr Yap.

Dr Yap comes to Tzu Chi free clinic on the 3rd Sunday every month with his wife to give free medical consultation services to the poor and needy in Melaka. I am particularly inspired by his attitude in life and his approach to each of his patient, listening attentively, giving respect and building rapport with his patients.

In my lifetime, I have only encountered a few person who treats everyone equally. If you are thinking whether you are the one? Try to think of the people you have seen on the street, the cleaners, the security guards, lecturers, professors, doctors, nurses, bangladeshi workers, the auntie who sells lottery, the uncle who sells tissue and the young Indian boy who sells kacang putih, do you treat them all equally? Yes, I do, and Dr Yap is also one of the people who does it.

Today I have learnt the technique of ultrasound to visualise a uterine fibroid with his guidance. He told medical students like us that it is always a need to treat the patient as a whole, to detect their underlying problem and not just the presenting complaints.

His humble personality and his openness to approach to medical students like us made me feel that there is still hope in the doctor's world. Doctors who are highly educated are not all arrogant and egoistic, he is one of the exception.

I am always grateful that I am exposed to Tzu Chi in Melaka early. The experiences I have gotten so far, made me a stronger person in life.

Visit to Nazarath Home

11 January 2017 - Starting the year of 2017 (Year of the Rooster) with this new post! How time flies~ I started this blog 10 years ago in year 2007 to describe my experience during one of my St. John duties in Stadium Perak. Link below:

http://ivantan5.blogspot.my/2007/08/thr-raaga-concert-duty.html

How much I have grown, physically and mentally 10 years ago compared to now. One thing is for sure, I am becoming better and better day by day. I wonder how will I be 10 years from now? Will I still be able to maintain my current personality to adapt to the challenges in the near future? Only time will tell~ =)

I joined my college student council family to spend my Wednesday evening in Nazarath Home, an old folks home cater to the poor and needy in Klebang Besar, Melaka. I always love participating in events like this, events which keeps me in touch with the people of the neglected society.

There are 43 students, mostly from BDS (Dentistry students) in which some I have knew them earlier (Melissa, Abok), and fortunately, both my groupmates, Izzul and Wei Hoong were there with me too, if not it must be awkward to be with so many people whom I have not known. Oh, Ian was there, a good buddy of mine who carried his guitar and played the carol songs for the people there.

Some people joined because they wanted to bring joy to others, but for me, it works both way. I realised that my communication skills in approaching strangers is improved this time, I am able to initiate a smooth conversation with the people, thanks to my professor, Dr Ng Sin Hui who always demonstrated to me the art of communication in the hospital wards. Thank you Sin Hui (if you're reading).

Visit to homes always makes me grateful, not only for what I have physically, but also constantly reminds me of my peaceful state of mind, undisturbed, unaffected. The people there have different stories and different experiences in life, some speaks for us to listen, while others actually speaks for themselves with us as listeners. I feel that the only way to get in touch with the people is to actually go to them and understand their story, not to comment nor suggest anything. It is through experience that we keep ourselves on our toes all the time~ =)

小明拔牙记

24 November 2016 - It was a usual Thursday afternoon when my class ended early at 3.30 pm. In view of my free time, I went to the dental clinic in my college for a check up on my supernumerary tooth (an extra tooth which grows out of proportion in the oral cavity) for the first time.

Upon arriving, I had a normal check up by the dentist on the ground floor of the clinic, Dr Raeshma. She noticed that one of my molar tooth (wisdom tooth) is slanted and decayed. I was shocked and surprised at the same time, how could my wisdom tooth decayed without any symptoms, I was talked to myself. After that, she referred me to 3rd floor for 'further evaluation', which I thought is great.

However, when I arrived, there are so many dentistry students there, some of them were the ones I knew like Yi Wei, Chopper, Kit Yee, etc. The feeling is strange because I am meeting them as a patient rather than as a friend. Each of them wanted to have a look at my tooth condition, which I happily agreed, because I understand, yes, I understand the feeling of an eager students who wants to learn.

Since my case is just a normal tooth extraction, the dentist there advised me to do it on the same day itself, I agreed. The guy who gave local anesthetic to me is a first timer, with his seniors teaching him how and where to inject the 2% lignocaine. I personally have no problem with it, I don't mind being a subject for learning, as I recalled the situations where I gave my first injections, first cannula, first glucometer, etc, but I can't deny that I was nervous, not because of pain, but simple just nervous, because this is the first time I am actually seeing a dentist for my oral hygiene.

Andy, a year 4 dentistry student started the procedure, with his juniors surrounding me. They were speaking in their dentistry language (bucker tooth, tooth 1-8) and as usual asked me not to be nervous, I finally knew the real feeling of being a patient and surrounded by so many enthusiastic students at once. However, Andy could not extract the tooth out, and had to called for help from Chopper, a final year student. After much effort and swapping of instruments, changing of maneuveres, he could not remove it too.

I was checking my pulse rate at the same time and I had tachycardia because of the long procedures. I thought mine was an easy case, but when they finally asked the doctor for help, I knew something must be wrong with my tooth. After an hour, the lignocaine effect starts to wear off and I can feel mild discomfort, and with much effort, the doctor removed it and it was found that the root of my tooth is bend to 90 degrees, that explains the difficult procedure. The entire procedure took more than an hour, but I knew it was not their fault, as my wisdom is not like the rest, wisdom tooth I meant.

I personally wanted to thank all the dentistry students and dentists in the dental clinic for their hardwork and because of me, they have to work beyond 5 pm. I decided to blog this because the experience in the dental clinic is so new to me, and I am able to really feel what it feels like to be a patient myself. At the same time, I would also like to advise those who are reading this to have a regular dental check up because who knows, you may detect a big problem early! :)

Segamat

23 September 2016 - Going to Segamat, Johor for my 1 week labour posting is definitely an enriching and memorable one~ =)

MMMC (Segamat Campus), actually it's just shop lots~

Days before going to Segamat, I was worried, mainly because of the current comfort zone in Melaka I have been enjoying all these while. I need time to adapt to a new environment (I guess everyone does), and going there for 5 long days means no aircon, no good food, no friends and no comfy bed.

Main entrance to Segamat Hospital

I was driven here not only by car, but also by the positive feedbacks I got from my friends and seniors from the experiences they had in Segamat Hospital. On the first day itself, I examined a placenta with the guidance of Staff Nurse Tay. I can feel the soft and bouncy consistency of the placenta along with its umbilical cord.

Examining the placenta (more like washing vege)

Fortunately, there are 2 other friends from Batch 32 who came for labour posting as well, and they are Wei Ling and Fatin Shahira, so it means we have female chaperons to facilitate in procedures and also for permission to observe some obstetrical procedures, YAY! As males, Yong Jin and I faced many rejections in the O&G postings (in Melaka Hospital!) even to see some basic abdominal ultrasound scans~ =(

The 4 of us sticking together all the time~

First day of posting is on a Sunday, since the official working day for Johor starts on that day. Nevertheless, we stayed until 9 pm to watch the last emergency LSCS (lower segment caesarean section) to sum up our day! Felt so occupied and tired for the day but we have definitely learnt a lot compared to Melaka.

The rest of the days in Segamat were well spent, with the exception of me going back to Melaka for portfolio defense on Tuesday and coming back on the same day ~_~

The dorm view from my bed

For our stay in Segamat, we are granted a dormitory which is actually modified shop lots few minutes away from Segamat Hospital. There are various students from other postings who were staying with us too. The ground floor is the male dormitory whereas the 1st floor is for females. There are also washing machines, clean toilets with functioning heaters for bathing purposes and a study room with aircon for us.

Guess what is my bed number ;)

Frankly speaking, the dormitories are quite stuffed up and it gets warm at night. This condition also favours some blood-sucking visitors to drop by and feed on us, they are none other than the cute cute bloody mosquitoes x_x This reminded me of my time when I was staying in an old hostel room in Tagore hostel, Manipal. I told myself that I have survived that hostel for a year, and now these temporary uncomfortable-ness are just tiny challenges in life~ =)

Dinner at Kampung Cafe

Food in Segamat is good. There are many hawkers centers around and also some nice cafes nearby. The cost of living there is lower as seen by the price of the food. A plate of chicken rice costs RM 4 while in Melaka, it easily costs more than RM 5. For the first 2 days, Yong Jin and I were just roaming around during meal times to explore the unexplored areas LOL. On the 3rd day itself, we had dinner with Wei Ling and her friend, Kah Suen who is in Anaesthesia posting.

Aircon study room, time to take a nap!

Some new friends I have met in Segamat:
1) Wei Ling: With the surname of Lee, she is one of the person from Batch 32 whom I know she exists but I don't know her personally before this. Quiet and shy at first but friendly, approachable, and straight-forward when we get to know her. Laughs a lot. Laugh threshold moderate.

2) Kah Suen: Knew her since first year because of Chin Leong. Can laugh suddenly walao, without any triggering factor or stimulus. Laugh threshold lowest among humanity. But as future doctors, we don't discriminate our patients friends~ jk

3) Fatin: She is a proactive person and a learner. Even with 3 of us as Chinese friends, she doesn't isolate from us much. She even remembered that the first time we met was in Kochi, but as usual, I couldn't recall my first encounter with people that I'm not close with LOL

4) Leon: He is a final year medical student from Monash, based in JB. Serious looking at first but is approachable and helpful at times.

5) Dr Cheong & Dr Woo: Both of them are housemen graduated from MMMC Batch 25. They totally understood the pain of having a portfolio that need to be filled by doctors (if you get what I mean). Dr Cheong is good in his CME presentation, with adequate medical knowledge, he knows what he is presenting and is able to answer questions directed to him. Definitely one of the person I am going to look up to!

6) Hasif: The one who slept beside me (not on the same bed). Super-friendly and is willing to share his experiences and advice to me all the time. He is from the same batch as me but different class.

Oh and did I mention the super cool UD52 O&G specialist I encountered on the first day, Dr Arivendran. With a stylish classical maggi hairstyle, hawaiian shirt, bluetooth headphones on his neck and a croc slipper, he just go for ward rounds as usual with his soothing English accent~

Definitely one of the place I will miss~ 

Experiences in Segamat is one that I have learnt the most in my O&G posting. I managed to get hands on to conduct the 3rd stage of labour (placental delivery), perform a PV examination to look for cervical dilatation and effacement, and many of the practical things I am only able to get from textbooks if I were in Melaka.

Went through ups and downs, thick and thins, thank you guys~ =')

Thank you to all who have guided me this far. I am currently in my room in Melaka, enjoying the chilling aircon and back to my comfort zone~ =)