Joseph at the pianoforte. He’s getting lessons from ee poh.

Can become a pro or not?

Update: I’ve uploaded the same video on you tube too… I wonder which is better.

A 40-year-old man first saw me a couple of months ago. He wasn’t the patient but he brought his son for a hernia repair. He said he had a lump at the side of his neck. I felt it and said that we should investigate. He said “ok, but later”.

Recently he came back because he remembered the lump. I felt it … it had increased in size and number. It was alarming to find them growing so quickly. And not only in the neck, there were lumps in the armpit as well. So I took a few out and sent them for pathological examination (microscopic examination). After the results came back, I ordered a CT scan from the neck to the pelvis. This is a view of the CT image:

Can you spot the difference between the right and left sides of the neck?

Here is the CT at the level of the chest… there are some lumps in the armpit as well.

The pathological diagnosis was mixed-cellularity Hodgkin’s lymphoma. Hodgkin’s lymphoma is a malignant growth of lymph node cells. I referred him to the oncologist in nearby Kepala Batas Hospital for oncological treatment. These are treated mainly with chemotherapy and sometimes accompanied by radiotherapy.

Do you take responsibility for the delay? I wish I had insisted that he got the lymph nodes sorted out right after the child’s hernia was repaired.

George passed me the baton for the 11th edition of the Malaysian medical blog rounds. I’d been to most of the medical blogs before, particularly if they were highlighted on the blogrounds but this task had me running around today looking through the blogs for the highlights of the week (or so). And what a hectic week it has been in medical blogosphere. Let’s take a look at the “classical” week of a “typical” doctor and the doctor-to-be….

Mondays - urgent patient matters

Don’t we all love swinging into action the moment the week starts, as George did. He started with a rectal cancer and it gets even more adrenaline pumping as he finds a patient with an abdomen as high as a mountain due to a ruptured AAA.

George shows the distended abdomen

It wasn’t all rough and tough as greenpasture talks about more delicate surgery, involving glands and nerves. The physicians had something to think about as well, as Dr Ng talks about the use of drug-eluting stents.

Smoking can be hazardous to your health; and not your own only… as pilocarpine’s patient had her caesarean section delayed because of a smoker. So don’t blame a doctor for asking whether the patient smokes or not, as Saw Ling exposes the smoking patient.

Sometimes, the doctor is at the receiving end of the heathcare, as eskay finds her tooth in trouble.

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Tuesday - patient care matters still prevail

Dobbs highlighted the Health Minister’s remarks about the quality of housemen and medical training which sparked a discussion on private medical schools. Fang tells us about the elective students coming to his department. “I seems start to understand why generally house officer every year getting more and more lousy(excluding some of the good one),” he laments. Doc managed to put in a word about the quality of nursing graduates from nursing schools. “So, as for medical courses, in our hurry to fill in the missing numbers, have we compromised on the quality of students?”, he asks.

Florence Nightingale, picture “borrowed” from Doc’s blog

Fibrate’s hospital has started something new to bring some cheer to the patients. BTW, happy birthday! Patients surely need comforting but perhaps laugh therapy of Patch Adams fame might actually be helpful too? In the meantime, SweeKheng tells of Kak Faridah who stayed in hospital for weeks attending to her sick mother. I suppose the patient’s own family needs to chip in to provide the necessary care.

But some patients get on your nerve don’t they? As cytusm narrates the story of kiasu Penangite patients.

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Wednesday - wider issues in Malaysian medicine.

Palmdoc highlighted the issues raised in the local blogosphere surrounding funding for heathcare. Dr. Cheah calls for continued freedom to blog in the Malaysian blogosphere:

For now, bloggers, like me, will have to stand behind fellow bloggers who all firmly believe in the freedom of speech and independence of the press. So bloggers, unite and stay united. It may affect us more than we think it will.

Yenjai witnesses the apathetic attitude of Malaysians in public. But kudos to the boy whose shoe-laces was caught at the end of an escalator in a shopping complex.

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Thursday - time for the techie toys

Jimbo recently got offered to freelance as a medical writer; and to aid him in his task, he has acquired a new toy, a “generic” mp3 player which doubles as a recording device. Hope to see your write-ups soon, Jimbo. Doc Chan also has some ideas… he is thinking of a wireless stethescopes, using bluetooth technology, perhaps something prometheus might be able to help with? Doc Chan also highlights the use of e-prescribing which might replace the infamous doctors’ handwriting on paper. Palmdoc brings us up-to-date on what new medical stuff’s available for palm.

Prometheus‘ toys

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Friday - medical students’ field day.

Our medical students had some lessons to share with us:

izahAhmad relates what Banting posting is all about: “You will treat cough and cold, avulse in-grown toe nail, drain the abcesses and nurse the sick. In short you will participate in care of patient.”

Kenster had the experience of the first time being on call… ever. She had the “pleasure” of having a “pseudo-homey” call room.

Plus I should mention that the call room is located in the abandoned part of the hospital…just empty hallways and even emptier rooms. Major spook factor lor…

She had an interesting array of patients that she saw with the resident.

Chia Huan reports about the valuable experience with the flood relief team from Hospital Permai. She reports… “I felt so lost and helpless when i saw the whole primary school filled with 360+ families and 1700+ victims in total.” In the end, she learns something from the people she intended to help… “When we give to others, we actually gain something from them without knowing”.

… and last but not least, Chang Yang shares with us the intricacies of restroom etiquette:

..unless the urine in my bladder has reached the critical mass, I wouldn’t think about breaking the tension in the toilet. It’s too dangerous. Why is it dangerous? Haha, I just learnt that urinals can be a potential trigger of a toilet war…

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Saturday!! - relaxlah!

Chen has a blog full of “jalan-jalan” and “makan-makan” stories. This time she tells us where to go in Klang, Ipoh and Kampar. Shah goes to Kuala Selangor for some great shots of nature in Taman Alam. Sbanboy goes even further and takes us to Bangkok for a visit to the Floating Market of Damnoen Saduak.

Vagus tells us he is coming home for a couple of weeks and will be sharing on postgrad medical training in the US. So watch his space for the date and time.

It looks like the medical students travel even more:

• Smilyn goes to the Zoo
• Ying Ci in Rome
• Sam Leong in Scotland
• GRChew in Finland
• Sarah in Moscow
• Ken in Odessa
• Sheena in Prague

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Sunday - new in the family

We want to welcome Cayden, Eve’s baby boy. She had to undergo a Caesearean section but she’s back in action already. *respect* Dr Yap also has a recent addition, Ethan, after a wise man, an Ezrahite, in Solomon’s time. He talks about naming a child:

Something deep within tells us that the child has such intrinsic traits and in some way the name spells out his destiny. It also defines our aspirations, and the way we hope to bring him up - with a sense of grit and readiness to face life head on; knowing the God who calls him, and what he is called to.

Soon they’ll be talking, and the source of clever remarks as BuffaFly has the pleasure of finding out.

Finally, senaiboy has got baby photos to show too. Hop over and take a look!

… any volunteer to do the rollcall of honour for next week? Let me know by Saturday… otherwise I shall wield the finger…an tag someone. Muahaha. I have a good idea who to tag already.

Update (31-1-2007): Bloground 12 by Jimbo.

Chen tagged me this time with another new meme, which she created herself. So, first things first as in any exam: read the task properly. Haha. Sorry for the delay. I had written it earlier but the PC hung (or should it be hanged?) and I was a bit busy to restart until now. It’s a holiday in Kedah today: the Sultan’s birthday.

“I would like to tag these few people to come out with their memorable First Times…
…. Anything will do, as long as it was meaningful and memorable to you.”

So here are some “First times”:

1. Taking the cue from Chen, I shall tell the story of my first time at anatomy dissection class in the first year of medical school. We had recenly started classes after orientation and after lectures in the morning, we trooped off to the dissection hall. We were introduced to our cadavers. My group had a male cadaver named “Sam”, or rather we named him Sam. He was a stiff as he can be. The first thing that Sam greeted us with was the pungent smell of formalin in which he had been soaking in the basement since he arrived in KL. Sam was imported from somewhere… but I shan’t say from whence he came. After the initial formalities, and a sign of respect, we proceeded with gusto.

The funny part of this experience came after the class. I was the last one to wash up in the washing area. This was hidden from view of anyone standing at the door. After washing, I came out and found the hall deserted. I ran to the door and found it locked. Ok, relax… there must be another door I can open from inside. I mean, why would anyone make sure ALL doors of the ANATOMY DISSECTION HALL cannot be opened from inside, right?

Tried the doors in the middle and the back of the hall.. all locked. I went downstairs to the lower level. Ewww…. the formalin in the air was even stronger. There was a pool of formalin and half-dissected cadavers soaking in it. Allllrrrrrright… I hastily went back upstairs and found the department phone extension. Ring… ring… no answer. Everybody had left. Called the security desk… the pak guard didn’t have the key for THIS door and he would call Prof to come by and let me out… Arggghhh!

Fortunately for me, I found a swing window whose latch could be opened from the inside. They don’t make dissection hall windows at eye level, so I had to climb up to it and hoist myself out on to the outside ledge. Phewww…

…. Prof N arrived later and laughed his head off. So did I. Come to think of it, I don’t think I ever went back to check whether the window was ever re-latched. Hmmm…

2. One topic also so “cheong hei” liao…. ok gotta K.I.S.S. this time.

The first time I flew was to Darwin, Australia to attend a Red Crescent Cross Society youth camp in Alice Springs. I was 16 and I met up with a fellow member, Benny from Kuching, in Darwin ‘cos he flew from Kuching directly. I remember taking the train from BM to KL and then the bus to Subang to catch the Malaysia Airlines flight to Changi. Taking off for the first time was exhilarating…and landing was even more “kan cheong”. In Changi, I got on to a Qantas flight to Darwin. I arrived that night to great Australian Red Cross hospitality.

Little did I realise that my work later would involve flying….

3. Right after housemanship, I was posted to Sarawak for my Medical Officer job. No appeals, no delays. Within a week of receiving the letter, I was on my way to Kuching. Upon arrival at the airport, the immigration department stamped a “work permit” on my passport. Imagine that, “West Malaysians” need a passport to enter Sarawak and a work permit to be employed there. After checking in to Borneo Hotel, I went to the Health Department to see the “Dragon-lady”.

I thought that, being fresh from housemanship, she would keep me in Kuching fo awhile. No such luck. “Bintulu” she said, ” you’ll like it there.” What? Where’s Bintulu? She showed me where it was on the map and gave me a ticket to fly the next day. Wah… no time to even “cuci mata” in Kuching.

The next day, I had the first experience of a Fokker 50. As the name suggests, it’s a propeller aircraft that seats 50 passengers. OK.. they tell me it’s got the best reputation for safety if it crashes in the sea. Right… how comforting. Anyway that’s beside the point… Landing in Bintulu was the scary part, for the first-timer to Bintulu. It airport was right in town. As I stepped out, the first thing i noticed was the fragrant aroma of the sea…. just like Butterworth. It was something I had missed in KL.

Working in Bintulu was great. The colleages were great, the staff were good, the people were friendly and the work was challenging…

… what had my work got to do with flying? Well, it’s because of where I worked: in Bintulu that made me have to fly whenever I wanted to go to Kuching or KL or Penang… plus from Bintulu, sometimes we had to transport patients by flight to Kuching….

… plus…

4. It was the first time I got on a helicopter. It was a Bell 206 5 seater. Captain Mat D was the pilot. I was excited about it… here’s a chance to do something different (for us “sua koo” West Malaysians). After clearing with the tower, we took off. Capt was gentle on the Bell. He had already some time flying commercial aircraft after retiring from TUDM. Still… it was quite a first experience for me. After that, I was to fly quite frequently and had the oppurtunity to experience various “pilot styles”.

The view was great from heli’s. Probably the most memorable sight was a flock of great hornbills in flight over the tree-tops. Majestic indeed.

Bells were the workhorses of the health department in Sarawak whenever we needed an airlift. They fly at about 1000 feet at an airspeed of about 130 km/hour. It gets us to Sibu or Miri in an hour and for only RMxK. Hmm… is this classified information?

Anyway, we had 4 days a month for flying service to outlying “rumah panjai” in the less accessible areas of Bintulu division. Besides the flying service, we used the Bell for transfer of very ill patients to Sibu or Miri (that is if the one and only long-distance ambulance is already utilised to send another patient).

5. Finally, I performed my first appendicectomy in Bintulu. I was on first call (that means take care of all the patients in this 130-bed hospital). The second call MO (every single MO was senior to me at that time) had gone to accompany an ill patient out of town, so I was alone. I did orthopaedics for my surgical posting and not general surgery during housemanship, and medical students always go to theatre to watch the “canggih” cases, not the humble appendicectomy. So I’d never even seen one done before. Of course I had done other operations before, including Caesarean sections in housemanship.

But this one had to be done. So I went to the hospital library and found “WHO’s Manual of Surgery for District Hospitals”. It was a really good book for me during those years in Bintulu. I read the chapter on appendicectomy and went to OT. SN Sim and JM Rigen (scrub nurses and OT assistant) were a great help that night. They gave me the right instrument and suture every time.

I sent the patient home 3 days after the operation. He was so bored in the ward. Nowadays, we keep patients for a day only but, at that time, I wasn’t taking any chances.

The surgical experience in Bintulu changed my career path. I was interested in every discipline in medicine until my housemanship. After my housemanship I wanted to do orthopaedics. Working in Bintulu made me choose surgery.

So, there you have it. I guess you can’t talk about “first times” without being a bit “cheong hei”.

Who shall I tag? Let’s get the Negeri gang to start talking…. let’s put owns hands together for Jimbo, Ah Pek and Jonzz….