Hidup mulia

Dalam urusan harian, saya melihat pelbagai telatah manusia apabila berdepan dengan penyakit, baik dari pihak pesakit mahu pun ahli keluarga yang menjaga. Pada penulisan saya yg terakhir, saya ada bercerita sedikit soal kematian. Isu utama yang ingin saya utarakan sebenarnya adalah kematian di usia muda. Rentetan daripada isu ini, saya panjangkan kepada isu memaklumkan pesakit nazak atau terma perubatannya ” Death in line (DIL)”.

Apabila berdepan dengan pesakit terminal yang hampir menemui ajal, pada kebiasaannya kami dapat menjangka masa depan (prognosis) pesakit… Oleh yang demikian berita buruk ini perlu disampaikan kepada waris untuk mempersiapkan diri mereka andai pesakit menemui ajal.. Teringat saya pada seorang pesakit yang berumur lingkungan 25-30 tahun.. Beliau adalah bekas penagih dan menghidap HIV positive, masuk wad kerana lemah jantung akibat jangkitan kuman di jantung (infective endicarditis) .. Apabila jantungnya berhenti berdenyut, kami berusaha keras melakukan CPR dalam kubikal yang tertutup … Saya berdiri dihujung kepalanya mengepam ambo bag bagi bekalan oksigen manakala rakan lain memainkan peranan masing2… Sedang kami hampir mengesahkan waktu kematian kerana harapannya untuk “kembali” sudah tiada, bapanya muncul dan berdiri dihujung katil bertentangan dengan saya.. Beliau nampak terperanjat dan terus melaung2 macam disampuk hantu, naik kekatil dan cuba untuk memeluk pesakit sambil cuba dihalang oleh seorg lelaki lain. Beliau cuba melawan sambil terpekik2 meminta dilepaskan … Pada fikiran saya dia mungkin ingin melafazkan syahadah ke telinga pesakit lalu saya meminta dia di lepaskan dan rakan saya memberi laluan kepada si bapa untuk datang ke kepala pesakit .. Beliau kembali tenang, mencium anaknya 3 kali sambil membaca beberapa kerat ayat Quran … 

Pesakit ini bukan di bawah jagaan saya, barangkali kematiannya tidak disangka menyebabkan waris terkejut … Saya faham, apa yang dilakukan oleh si bapa, anaknya barangkali sudah kembali ke pangkal jalan namun apa kan daya baru hendak bertaubat, dia sudah di panggil untuk menghadap yang ESA. Hancur harapan si bapa tidak terhingga ..

Sesudah waktu kematian disahkan, beliau dan isteri masih lagi menagis teresak2 di satu sudut … Bersabar pakcik, ajal maut ditangan Allah ..

In medical ward death and dying is part and parcel of my daily work.. I was in orthopedics for 4 months previously and during that time, i never experience patient collapse and died in front of my eye … Of course patient admitted to orthopedics are different compared to those admitted in medical .. most of them are younger and have mild underlying illness such as hypertension or diabetes which are in the early stage ..Few weeks ago I was oncall with 2 other colleages. At arround 12 noon I received a call, a 27 years old lady was admitted. Through the phone the staff told me patient was unstable and has been having difficulty in breathing. I put down the phone and attend to the patient … As I approach her, I saw a young lady gasping for air, swollen all over her body … Its like michelen ghost we see in the ghost buster cartoon … A high flow oxygen mask was put on her and she can still communicate with me .. Her husband was standing besides her with sun glass hangging on his nose .. I was a bit irritated actually .. According to her husband she has been having difficulty in breathing for past 1 week and finally decided to bring her here that day as it become worsen … 5 months ago she was diagnosed with end stage renal failure with nephrotic syndrome and hypertension… Prior to that she had an abortion … Both of her kidney was not functioning and was advised to undergo AV fistula so that hemodialysis can be done.. I’m not sure whose to blame but she refused the AV fistula and op for homiopathy therapy…. Her blood pressure was high and blood investigation showed she had uremia caused by accumulation of urea in her blood, her lungs and abdomen was fill and fluid  … She need peritoneal dialysis urgently  however her coagulation profile was prolonged .. It means if we dialyse her, the procedure may caused and uncontrolled bleeding and she may died of severe bleeding. We plan to transfuse 2 pints of fresh frozen plasma in attemp to fixed her blood defect however during 1st pint of transfusion, she deteriorated, her pupil was sluggish despited of presence of spontaneous breathing and slightly high blood pressure … Soon after that she vomited blood, she started gasping and blood pressure started to drop and death in line was in formed ..   She past away around evening in the presence of husband and family members…

This is one of few death I confronted during my oncall .. Just for the record the management of this patient was done in the presence of my medical officer …

Using or choosing an alternative care is not wrong but defaulting hospital medicine and refusing life saving procedure is a huge sin .. Personally I was angry and disappointed with the husband … But I do realized that people have their own belief and paradigm .. In this group of patient, time talking and lots of patients need to be invested during the first time they came to us 5 months ago … We have miss the boat and people end up dead in front of us .. So many “if” comes to my mind but what different does it make for her … Another patient came and while attending to them, I gaze my eye on her empty bed thinking what if ?

Alhamdulillah after a month of ramadhan we finally come to the eve of syawal … Congrats to all … personally to my new brother in law David Barnett who experience ramadhan for the first time this year … It would be nice if he could be here and celeberate aid mubarak with us ..

With coming to the end of ramadhan means my wedding day is just around the corner .. Yesterday I called my fiance … She was feeling a bit low coz had to work oncall when there’s lots of preparation need to be done at home .. Can’t help you with that dear … I pitty her a lot actually coz she had to do so much … on friday last week she spent the entire day buying dry food  … Food are prepared by her family members and neighbours so she need to buy the ingredient herself with the help of her father and mother …. On saturday she fetch her sister from air hitam and then spent the entire day buying door gift and other decoration items .. On sunday the same thing, however in the afternoon when I called her, she told me she left her key inside her locked car in the middle of batu pahat town … hihihi gosh she was so cranky when I gigle …. I can imagine how hectic she must be … I tried to help by calling the proton edar 24 hours service but I don’t have the detail bout her car so I send her the phone number … only after that she started to sound more sweeter and calmer … hi sayang2 … I wish I’m there assisting and facilitating everything … and finally yesterday .. she had to come for work for another 32 hours …

Me on the other hand are enjoying my life while waiting for the big day .. everything were well catered .. like the vanue we only rent the dewan serbaguna and they prepared all the decoration … for food we pay cathering of coz and they solve everything … my room my sister is taking care of that .. hihi ..

I’m thankful … :o)

Few weeks ago I was in batu pahat spending few days with my fiance …. We meet the wedding planner to look for wedding dress and make up artist … Looking for the right dress was tough … There were too many option to choose from and we just don’t have any idea or theme to start with …  So we look around, look at the megazine … Finally we agreed one main dress and another 2 side dress for photo session ..

I used to wonder, why people spend so much effort on their wedding … To me the important thing was akad and the rest are just additional matters … Now when it comes to my own .. I come to realize the feeling of having a nice wedding day …

On the  day when couple become husband and wife, a lot of close friends and relatives will be there to celebrate and share the happiness and joy … That day, every eye will be focusing on the wedding couple … HAvin a good reception means a happy guest … So how do we make our guest happy ???? Yeah thats right … Good food and beautiful decoration … There’s no need to spend so much .. A simple and nice presentation will do … As long as the food taste good and the event flow nicely .. thats more then enough …

A lovely time spend with the wedding couple will bring a good memory for a life time … And that is every wedding couple wish for  …

It was a beautiful day today … I had half of the day on the bed sleeping .. woke up at 4 pm .. pray , read the quran and pray asar … the HBO showed apocalypto …. then went out for a short jogging …. its fasting month, so can really ran that far .. tired la … my wedding is in 27 day … so far all preparation has set … emm tomorrow my fiance will go to the kadi office to submit our wedding application …

wow after 28 years of  single life i finally am getting married …

My fiance is a 27 years old obstetric and gynecology medical officer in a district hospital .. we meet not long before i proposed to her .. She was a bit skeptical at first as our relationship was still young … but then she except, and so after I pass my final exam … we got engage ..

The first time I saw her I told myself what a beautiful lady .. She looks professional and sofisticated doing her ward round assisted by her houseman … in my mind, i felt that i will never get a girl like that ..  i’m not in her league .. girl like that will never go out with guy like me …. hehehe … for a few week i can’t stop thinking bout her  … luckily I had a friend who’s working with her .. we meet accidently and i ask him bout her … it turns out she’s ireland student and just cam back after 1 years working abroad .. man things just got a bit worst from “might not” to “never in my life” will i ever going to have a date with her …

I just try out my luck… she was single so there’s no harm asking right .. I called her and we went out for a dinner …. from one dinner to another .. then we started went out for movies … the rest was history …

After 5 years of hard work .. I finally got what i call the first achievement of my goal … As "cleshae"  as it may sound but yeah it seem only yesterday I step into IMU in Bukit JAlil.. I took oath as IMU MBBS graduate on the 8th of august 2008 hehe 08/08/08 … what a number huh … Yeah it was the best moment in my life … 4 years of biochemistry in UM and another 5 years of MBBS in IMU … In united state .. Its common for medical student to have a basic degree .. So it’s not such a biggy to have 2 first degree ..
There are lots of limelight of mylife happens while I was in IMU … The prominant ones of course … exam ! exam !and exam ! … Every exam is a heart pounding experience … starting with the first semester exam .. back in my time we had our exam after one sementer in IMU .. Those who failed this exam can re-sit the exam in a month time… if still failed student will be sacked from the program … Can you imagine, all my classmate are straight A’s students …Its tough  thinking  that  I’m  not as smart  as others  … so work my ass of like crazy … Memorize every word of my notes … Then comes the 3rd semester, 5th, 7th, 9th and lastly the semester 10th exam …
During my clinical years in Seremban Hospital and Batu Pahat, I learn that to be a doctor you need to be a bit above average then general population in term of IQ .. but having a strong mind is not enough .. coz its tiring being medical student .. you have to attend ward round, spending long hours in the ward taking patient history and examining them … not just 1 patient yeah .. more then 3-4 patient every day … then go back read up .. prepare report, presentation, end of posting exam which will be accumulated in final exam … So you need to be not just smart but also active .. thats why student of the future need to involve in school activities if they want to be a doctor to train themselves from the begining … they need to be tough like a rock …
Of course the opportunity to meet and learn from the best people in medicine in malaysia is the main limelight of my life… I feel I’m bless to be in Seremban and BAtu pahat, coz IMU has such a wonderful lecturer teaching us … We have people like Dato’ Kew , Prof Cheong, Dato’ Zaky Murad and Prof Richard in Medical Department, DAto’s KAndasamy and Prof Ramesh in Surgery, DAto’ Siva, Dr. Zain and Dr. Sulaiha in O&G, Prof Boo, Prof Moti and DAto’ Jay in peadiatrics, Prof HArwant in orthopedics, Dr. Loh in family medicine and many2 more …
All these people give a huge impact in my medical profession .. they have molded me and tough me how to approach and think in dealing with patient… tough me to be scientific and evidence based, to look for clinical finding instead of gut feeling, to be professional at all time, to put patient as priority, to continue learning on every patient that I meet and lots more ..
In the end, I finally understood, medicine is about inheriting the responsibility to care for the sick people …  Its about doing things the right way … There are lots of malpractice going around as people are doing things their own way .. so in making sure we did the right way, we need something like a blueprint or a DNA to mapped excellence so that newly graduate doctors maintain high standards of health care …  for that  ..  I see the importances of the 8 IMU outcomes proposed to us from day one of our life as a medical student .. By achieving these outcomes, InsyaAllah, the good quality of care will be preserve  .. 
Truth to say, I only realise the important of these outcome on my final semester …Well, better late then never right ..

Earlier this morning I spend few hours holding a patent’s hand while she was having uterine contraction in the delivery suit. When I started my oncall arround 8.30 pm, she was already there and was in labor for 4 hours before i arrived. I plan to put my things and prey Isyak first but since there are lots of patient in the delivery suit I had to postpond. I just knew tonigh I’m going to prey Isyak around 2 o’clock in the morning … It was my last week in ObGyn posting and I had 2 more delivery to conduct and 2 more cesarean section to assist to complete my portfolio…. And so she’s the 4th or 5th delivery then hehe … She was admitted for her 3rd pregnancy and so far her cervical opening is only 6 cm after 4 hours of labor.. Based on my little experience its going to be another 4 hours atleast before she reach 10 cm… While I was counting her contraction, another patient came in for delivery. This is her 10th pregnancy and she is only 34 weeks of gestation.. She was earlier admitted for leaking liquor and was discharge, then she went to market to buy grocery and had little argument with mother in law and suddenly feel like she about to deliver … My other college were busy with their cases so I took the case also ..  Again based on my little experience the more you deliver the easier it gets so I would aspect she’s going to deliver in 1-2 hours time … Now I have 2 mothers to take care simultaneously … Hero huh … hehehe … 10 minutes counting her contraction then go to the next patient … so i was like a very busy husband taking care of two of my wife hahahahaahahah …. both are in pain but the second patient was a bit more comfortable … As I aspected she delivered not long after that and i had my 4th delivery … She delivered a healthy baby boy and it was an easy delivery … Alhamdulillah ..There were no injury hence no suturing needed … After I send her to the ward, I rush back to my first patient … As the labor progress the contaction become stronger and of coz the pain become more unbarable … Initially while i was counting her contraction she suddenly grab my arm, then I took her hand and hold them everytime she had a contaction ..  I guess in this moment of terror, the rightful person to be there would be the husband … however since the condition of the delivery suit is not condusive enough to allow this.. so husband were called in to assist when its time to push the baby out which is during the second stage of delivery … She reach full dilatation at 12.30 in the morning and a healthy baby girl were delivered at 12.45  …. She had a few tears on the vaginal wall and suturing is needed … While I was assisting the midwife suturing the vagina, we were told that there was a patient need for emergency cesarean section due to fetal distress and she (the midwife) is needed in the operating theater …. I needed the case, so I ask a college of mine to take over and rush to the operating theater .. There I look at the case note and inform my lecturer i’m assisting the surgery … Then I meet the surgeon incharge and thanfully he allowed me to scrub in … It was a complicated surgery as there was adhesion between the uterus and the abdominal wall .. The surgery lasted for 1 and half hour and I finally went out of surgery at 2.30 am in the morning … It was my last delivery of the day … I went back to the delivery suit and it was less hactic then before so I took the opportunity to prey Isyak … As I expected earlier .. In the end I needed another cesarean section to complete my portfolio and hopefully got it before end of this week …

I got a huge shock last week … while i was enjoying my early dinner, my dad suddenly came and told me he had choose my future wife… of course I was shock and a bit disappointed … i didn’t say anything and continue finishing my dinner … suddenly the curry i ate taste sour …. after washing my hand in the kitchen i just walk slowly to my room and lie down on my bed thinking what the hell has got into my dad … knowing my dad, i knew he didn’t really meant what he say coz everytime he got this new ideas, he got excited and start talking about it ….
On the next day, me, mom and dad had lunch together again… in the middle of our lunch, he open THE issue again but this time he was calmer then yesterday … he told me that my sister and her boyfriend plan to get married around september this year … so since i’ll be finishing my study around that time so he plan to combine my wedding with hers … the problem is i don’t have a partner yet and so he told me he have 2 girls for me to choose … gosh what is this … 1960’s is it !!!! hahahahahahaah
Luckily dad understand me well .. so he didn’t force me to except .. he gave me the phone number of one of the girl … I decline his offer politely … the idea of getting marry is just not in my mind at the moment or atleast not anytime soon …

I talk to several close fren of mine about this … most of my guy fren laugh their troat out and as for my female fren.. some say i should go ahead and some say better don’t …

Do we marry a stranger … and then we learn to get to know our bride and hopefully we fall in love with her … Who among us are willing to take the risk ? Do we simply choose a women and get married ? I do realize that in Islam, we believe that love comes after marrige … What I’m trying to convey here is my preferrance, if I were to marry someone, I would prefer to marry someone I knew … Marrige is a life commitment … it involve two hearts and on a bigger picture, 2 family … Going back to the early phase of a relationship, where two people meet and fall in love … they fall in love because they have found someone meaningful to their life .. I belive when we fall for a girl and confess our love… we confess to a special person that we plan to marry … Hehehe .. perhaps as corny as it may sound … I actually belive in what I say … Finding the right person may take sometime … But I would rather live a single life waiting … PAtient is a virtue …

During our discussion today, Dr. Ling who is our lecturer started of with chit chat before we move into our main topic which was on Diarrhea .. He came with a question of the 5 language of LOVE. I was puzzle actually, I taught he meant was the love word in 5 different languages…  daaaa …. Then he point out that people have five different way that make them feel loved. Those language are TALK, TOUCH, TIME, GIFT and ACTION …

According to him, for example his father is the action type so, to show that he love his father he’ll do things for him and if he give him something, he just return it back to him ..  So he say you need to show your affection and love according to the language of love of your partner…

After that he ask us one by one on the type of a lover we are …

The excercise he demonstrate was actually simple but meaningful. For a moment there, during the discussion my mind was not focusing into in the discussion… I was thinking of all the happy moment I had … Initially when he ask me, I told him i was the TIME kind of lover … I would feel love if my partner spend her time listening and enjoying what I enjoy most …. It’s about having compatibility … But then after giving my answer, I kept thinking about it and recall what actually make me feel being loved… I then realize, the moment i really felt that I was really loved is when i spend my time with my friends … There are a few people in my life that I treasure the most …. Of course I love my parents but I feel closer to these people …  some of them are male and some are female … I find that everytime i spend time with them, I can talk about anything and I feel safe … I’m willing to travel far or spend lot’s of money just to have few hours talking or watching movies or go out jogging  with them …. They don’t judge me for things I’ve done … There are time when I was at my worst behavior, and even though they don’t agree and acknowledge that i was wrong still they are there supporting me, making me feel that i’m still a better person and there is always opportunity to turn things around…..

I didn’t spend time with these people in one go, most of the time it’s one on one situation. Either we went out watching movies, or had breakfast together after jogging or just a simple call for advice or sharing … It’s like DAnny Crane and ALan in Boston legal i guess … It’s male bonding not gay .. hehehe

If that is so, then I ask myself , what about all the time i spend with my ex-girlfriends … If any of them read this, surely they feel upset .. dont get me wrong .. It’s totally a different feeling …

Perhaps i’m afraid of commitment … or perhaps i haven’t found the right person … Honestly I don’t have the answer … 

There are time where i felt that it doesn’t matter who ever i married as long as she can be a good wife … I fell that every woman is the same and i can adapt or be happy with anyone of them .. but as time past along with several people i involved with, I soon to realize each person are different …  and it matter who i plan to spend my life with  …. I realize that personality and chemistry is important …. Beautiful face doesn’t mean and absolut happiness but a good laugh and understanding pay a bigger role … 

I see a bigger challange in  front of me … I have few more months in campus before i go of working in the big world … There are someone out there …. Perhaps she’s in africa or Japan or england or perhaps she was someone i already knew …. who ever and what ever it is, I hope i make a wise decision every step of the way …

For every expected mother, there is nothing more they desire then having a healthy new born child. Those who were in the position of deciding whether to sacrefice their life or the life of their baby (mother who had breast cancer diagnosed during pregnancy for example), would choose the life of their baby and end up dead as a result of delayed treatment causing a child without a mother. This is the undying love of a mother.

At the moment I was posted in the neonatal ward for a week which is part of 4 weeks posting in pediatrics. The case I mention previously was a case i’ve heard during a seminar done by the Obstetric and Gynecology Department.

In relation to that, I have a patient of mine who is 13 days old. She was a chinese baby girl and part of her story was taken from her mother who was sitting beside her child bed in the neonatal ward.

Just a brief introduction, neonatal is a baby less then 28 days, infant is less then 1 year, toddler is 1-4 years and more then 4 years old is child … Back to my patients mother..

When I 1st meet her mother she was lying on her bed talking on his cell phone. Seeing thats she was preoccupied with her "business" I look around looking for her child and the bed tiket where all the information was placed. I couldn’t find either one.. So I taugh perhaps the child was somewhere else together with the bed tiket so i decided to go back with Irni and plan to come back again later..

On my way out, I saw the mother with a baby out side her room. She was there for close monitoring. Her story started when her mother was admitted for delivery. During her admission, her fetal heart was unsatisfactory and vaginal examination was done only to found that the umbilical cord has prolapse. She was rushed to the operating theater and an emergency cesarean section was done to save her child. When umbilical cord prolapse, the fetal body part will press the umbilical cord againts mother’s vagina causing obstruction of blood supply from mother to fetal which contain oxygen and nutrition. Having an obstructed cord is like someone is closing your nose and mouth causing you to suffocate. So this is the scenario we are looking at here .. When the child was delivered she was not breathing. CPR was done and she come back however her breathing require and assistant from a ventilator machine. Post operatively she was place in the neonatal intensive care unit. Her mother visited her in the NICU on the second day.

During a week stay in the NICU she had multiple seizure and her primitive reflex which normal newborn child had was very mild and incomplete. She had what we call as hypoxic ischamic encephalopathy (HIE) stage 2. To me this is the worse thing that can ever happen to a new born child…  She had a brain damage ..

When I examine her, she didn’t open her eye, her body was floppy, her primitive reflex was very poor … If only her mother have seen the outcome of baby similar to her child in 5 or 10 years time, she would understand my worries … As I wrote the case on my note from the other site of the bed, I can see her mother nursing her with love and tender. Perhaps she aware, or perhaps she doesn’t, her child is going to be mentally and physically retarded .. I guess what ever it was, things has happen and she would love her no matter what …