sharksdinner

First post 2012

2012-02-12T01:00:00.000-08:00

My time at Western Health really flew. I have never known time to fly so fast. There is also talk about my a ten year reunion amongs my medical school friends. A whole decade!
Little Dahathri went for a tumor resection in his tongue. We are still waiting with fingers on the results. But I somehow feel everything will be fine. I obviously didn't do anything very clever, or design them in such a way, but all my kids are extremely durable. Thatshoyldpull them through most things in life.
I am sad to leave so many friends behind at Western, but it was immensely gratifying to work with such a great bunch. They are not the type to shower praise easily and I was extremely pleased with their opinion of me. They also did a lot for my little one!
The Austin is a larger setup then Western with more complex cases, and already the specialist seem to have a certain degree of confidense in me.
Back to hitting the books for now.

2011-12-15T01:32:00.000-08:00

just moved into my new house. its nice and comfortable and the kids and wife really love it. mafeitz is having a wonderfull time here.

sometimes, i wonder if i bit off more than I can chew.....different country, new workplace, new home, formal project, exams.....

but then again, i have been struggling for such a long time, that if i get things my way i probably wont know what to do!

2011-09-06T06:03:00.001-07:00

mafeitz landed in Australia yesterday. He's in Perth, technically, he much closer to KL than he is to Melbourne. getting somewhere with organizing stuff in my life. I think..my new ipad might help a bit.
Happy I got a five star rated review from my bosses during assessment time.
checking out for now.

2011-08-06T23:02:00.000-07:00

the season is starting to change. the days are getting slightly longer and warmer, quite an interesting. studies are slow and i am not exactly in one of my most productive and progressive times. there are several important things to get done and i intend to get them organized soon. or maybe i just need a break....

new updates

2011-07-16T16:58:00.001-07:00

for the first time in my life, I chickened out of an exam.....

went on a motor home tour with the family. we toured the great ocean road with the family, went to the grampians, halls gap, ballarat and back. took a whole week. wife and I were exhausted but it was a good experience and the kids loved it.

just came back from the mount baw-baw. it was snowing and we went toboganing. Shastri and Ardithya look like they had been born into the snow. Wife felt a little cold and retired to the heated for most of the trip....

BACK AT LAST

2011-06-01T07:15:00.000-07:00

At last I managed to get my blog back! I had some major issues accessing it and never set down to resolve them.

Melbourne and my work has been treating me well. My consultants and supervisors and mentor had been very kind and accommodating. They were also happy that I seemed to settle down well.

I initially had a confidence issue. I am now out of my playground, in a developed country and clearly out of my comfort zone. I slowly learned that working in busy Malaysian hospitals has prepared well for working here. I am also more on my toes.

Workouts are fairly regular and I am nearly as strong as I was in early twenties!

The baby is a giant! Wife and I think he is even bigger than the oversize Shastri. He's only six months but is well the 15kg range, and he's not a chubby kid. Just a big, long guy. He's learning to cruise and can really scream! He screams and screams in anger whenever he doesn't get what he wants.

Shastri is still the tallest in his class, and sounding more and more like an Aussie everyday. Ardithya is his quiet self, he really smart and independent and really doesn't kick up a fuss or trouble anyone.

Wife is busy, but coping well and even started gym sessions.

All of us are into wildlife and we have visited the Melbourne Zoo, and two open range zoo's.

There was unexpected bad news, Dr.Maslina died suddenly. Shocker!

Some memories. Shukor's one year passing came and went....

Friends (except for good old Sam) made in through the finals. Sam will make it the next time. Happy for them. Well thats's not entirely true. One or two raise great concerns as future anaesthetist. I am kind of worried as most of my family is based in KL and should any need surgery, I really wouldn't want these odd characters floating around. Anyone reading this blog will have no trouble in listing them down....Well there are plenty of good up and coming anaesthetist amongs my friends and the odds of my family being anesthetized by these odd ones are as rare being struck by lightning, I think!

working in western

2011-02-13T01:41:00.000-08:00

My first week is over, and if the work routine is a sign of things to come, guess I am gonna be okay.

I was basically doing all the non-ot work an anaesthetist does, reviewing pre-op patients, doing post op rounds on patients who had a spinal/epidural (yup, they are all followed up here), setting difficult iv lines, attending code blues, doing acute pain and chronic pain rounds and I did venture in OT to see how things are done.

The patients are are treated very well, given adequate explanation about whats to be done and followed up. This is by no means saying the patients back home are treated badly! Its just different. For example, we don't write 'language barrier' when communicating with a non- English speaking patient. The hospital provides interpreters on demand. Its simply not acceptable to shove things into a patient without them understanding completely and totally whats to done. Which is the way it should be.

Another thing is that patients are never referred to by their race/religion/colour/sexual preference.....their names are used each and every time.

The nurses are indeed territorial about their patients. And any patient they touch is their patient. Their attitude is commendable, but for a newcomer like me, things can get sticky....I need to build up a good reputation and prove myself before I am to be trusted fully. I am out of my comfort and have to work hard, which is one of the reasons I came here in the first place. I probably want to prove to myself more than anything that I am capable.

Speaking of hard work, what are the hours like? Well, the week for a non-OT schedule is a solid 8am to 6pm day, from Monday to Thursday, with a half day of work on Friday and academic sessions for the other half. Work is hard, and you have as quick. Imagine, answering a code then doing and epidural before going to the clinic to see a pre-op patient! Snapping at any of nurses is bad idea! We don't have too anyway, they went out of their way to help me on several occasions. At six sharp, we can hand over to the afternoon person, (who works till 10 pm), then go home. The consultants present cases and discuss mortalities on Friday.

Its obvious, that while we work hard, great emphasis is placed on rest, recovery and education, so that we can be even more productive at work. Its something that doctors in Malaysia should strive for instead of taking pride in how many hours they work without falling asleep!

Next week, its a different schedule...

In Melbourne

2011-02-06T02:43:00.000-08:00

Life has been very, very hectic!

Psychiatrists' listed house moving as the second most significant stressor in a persons life. Try moving to another country and starting a new job at the same time!

There were numerous hurdles to overcome. Packing goods was backbreaking, tedious and painfull. Total damage; more than 800kg of goods sent...then there was financing to organize, visa's to chase....the list never seemed to stop

Upon landing, there was more fun and games to follow. Good thing, dad organized an apartment in the heart to Melbourne while waiting for our house in the suburbs to be settles.

Everything would have gone well if not for DHL's mess in delaying our goods! We managed to organize furniture(another nightmare! brand new self assemble furniture is not advisable when you a million things to settle-good second ones will do), a car. phones. internet.

Melbourne is indeed a very environmental conscious city, and all recycled garbage need to be recycled. Something we Malaysians should also take up seriously. Well, I don't have a recycle bin and had to take a car load of card board boxes to the recycling plant myself!

Mafeiftz had a baby during this time, congrats my friend!

We have been here for about two weeks now and things are falling in place. Tomorrow, I start work!

Small accomplishments, big accomplishments

2010-10-17T08:20:00.000-07:00

Wife gave birth to little Dahathri safely! It wasn't an easy LSCS but Dr. Premitha did a good job and now there are 3 little guys in my house. Hmm, maybe 2, Shastri doesn't show signs of quitting his exponential growth. He permanently outgrew his toddler, preschool mentality....he's all but a man now.

I passed my ANZCA in a hard fought battle fraught with exam stress and personal issues, but I managed to come out tops.....

Got called for a job offer in Melbourne and wife is all for it...now to prepare for that.

2010-08-27T07:52:00.000-07:00

managed to get called up for the viva in australia

establishing my aquarium, got the tank planted, did my own diy co2 setup, and building a cannister filter. for a diy naive guy like me, that takes some effort. my brother contributed a great deal by letting use his factory and drill bits.

wife getting more pregnant-if thats possible

workouts-still not optimum

kids got chicken-pox!

2010-08-14T05:28:00.000-07:00

Its been such a long time since I bloged consistently. Its a real test of discipline and I guess I suck!
I keep reminding myself the real reason I blog is so that I can review some things that happenin my life and my kids can see what I have been up to during my younger days. I am good 32 years old and guess I lived through a lot of stuff for someone my age. I do hope the best is yet to come. Some day, I plan to make an interesting list of things that have been happening in my life.

Things of interest of late:

1. Redoing my discus aquarium. Its occupying my heart and soul! Dr.Ling, my good friend is also a discus/planted tank enthusiast and is extremely helpfull. Wife is also a discus fan.

2. Wife is due with our third child in October.

3. Attempting to repair my botched Anzca attempt. Will I make it?

We enlisted in a nearby country club and I started some form of regular workouts...

My good friend Mafeitz is now a fully qualified anaesthesiologist. Some strange twist of fate have always seen to it that our paths cross event though we drift in different directions and I hope I will join his ranks someday.

Kids? Ardithya stomach issues is somehow getting better and Shastri is huge!

Thats all for now.

nothing much to blog about

2010-07-06T06:41:00.000-07:00

life been pretty routine. preparing again after i botched my physio paper. been through the operation rooms, ICU and now back in obs...

kids growing fast and my third is on the way.

haven't been working out as much as i like too, plan to remedy that.

SELF PITY

2010-03-25T10:08:00.000-07:00

Sometimes, the temptation to feel sorry for yourself is very great. Unfortunately, its leads to vicious cycle of self pity and doesn't do any good for anyone. When you have several mouths to feed, its also a luxury you can ill afford.

Many people have the strength to plow through obstacles others place before them. They all make inspirational stories. But I still believe the greatest battles take place when we overcome our own self pity and the desire to stop feeling sorry for ourselves..sadly such stories dont make good reading material and will never be told.

2010-02-14T07:22:00.000-08:00

My kids are growing before my very eyes! Shastri is so large and outgoing for his age, so outgoing that he can be handfull sometimes. He's adjusted well to his new kindi. Its a Mandarin based school and he is own his way to mastering a third language. Right now, he is torn between deciding to a cop or a cardiac surgeon..he doesn't seem to be the anaesthetist type.

Aditya is a darling in his own way. He has some health issue and as a result doesn't tower over other kids like his brother. His penchant for violence, destruction and disorder and chaos is also absent, unlike the older one. He is agile, quick and has an acute intelligence. He fiddles around with tv remote batteries when the channel don't change. He also like building things and seems to know where all the light switches are. He clearly has a mechanical mind. Wife is a bit concerned about his medical issues but i think he will grow up to be fine young man.

My wife and I seem to be spending more time with each other of late. We go jungle trekking and hiking on weekends. We also talk a lot more.

She made the most delicious lunch for my birthday. I have eaten in many fine restaurants but my wife's cooking beats them all. Her lamb stew was simply amazing today.

Soon it will be exams again, but with so many more important things going on, I don't seem to be studying much! Oh well.....cant have everything all the time.

2009-12-18T04:02:00.000-08:00

I went through most of my blog and I realise that most of my blog/life is work related. I guess that's how most adults spend their life. However, its certainly not about living life to its fullest. Its easy to lament that vacations and holidays are hard to come by but, if I try hard enough I can put together a couple of hours a day for my wife,kids, gym , dog and doing other routine stuff.

I shall certainly make the effort.

When I see several of my ICU patients and the state they are in, I do worry about myself. Rest, relaxation and hobbies are something that need to be enjoyed on a daily basis and not something that's been put of until after retirement....some of us may become seriously ill just at time and that throws a spanner in the works.

I recently met up with one of my old friends M, he is a legal moneylender now but has been through quite a bit. Days of working the club doors at nights, collecting money for loan sharks, going to jail for firearm offences and finally a fallout with his old cronies. You would think he would look old and haggard after all this. He doesn't, truth be told, I have aged more that him! And he has left me miles behind in the bench press department. His age, 44!

I believe its because of his priorities. If any job takes him away from his wife, kids and gym for extended periods of time, he leaves and goes back to a meagre existence of 'cukup-makan'.

I am sincerely trying to be the best at what I do. Many people are better than me in my job and I really try to improve and emulate them. The question is, why? And and what cost?

2009-12-03T08:23:00.000-08:00

time certainly flew very,very fast and before i knew it, it was time for exams. Those were very stressfull days indeed but I am glad I and my study partner. adeline made it. There wasn't much in the way of celebrations, just a good sleep and back to work. but the feeling of accomplishment was really good...

life goes on and now I am back to ICU again, working with my good friend of many years mafeitz.

guess its going to be fun

In every bad there is some good

2009-08-30T07:14:00.000-07:00

Exams are coming and like many typical students, I am beginning to put in the hours. Its in times like this I wish I had been more productive earlier. Oh well.....

Last Friday, to protest the relocation of temple to section 23, 50 foolish assholes with nothing better to do paraded with a cows' head and cried for blood at the Selangor state secretariat. If I had been hanging around there, I think my head will be dangling next to the cow's. Scary stuff. ( bear in mind that I am not the type that get's scared easily)

The internet, mainstream and side stream media was flooded with comments of people and politicians on both sides the camp.

The Hindus and non Muslim were understandably upset.

Its interesting to see what the Malays said.

Some Malay Muslims did not mind a temple, some did. Some said Barisan was to blame for this mess, some said PR was to blame. Some said there were ample amount of temples around. Others said to let them be, most of these temples were there when the British came....

But an overwhelming majority of these same people with all the different opinions, political background and walks of life uniformly felt that the demonstrations were stupid, uncalled for and not in the spirit of Ramadan.

I originally wrote a different post on Friday itself tittled 'What's wrong with my country?' There is a saying in Tamil that translates; in every bad thing there is a good thing. After reading all these comments from facebook and many web sites, I do know that we have grown as a nation and there is still plenty of unity among the people despite our differences.

Salam Merdeka and happy Ramadan guys.

A typical on call

2009-07-17T08:32:00.000-07:00

Most of our life revolves around an 'on call'. Its a run -the-mill bread and butter of our lives. Life changing incidents take place during an on call, we are learning new things all the time and it conditions us for all kinds of emergencies and scenarios. Your innermost behaviour will surface during a busy on call; the hardworking solid guy n girl, the dumb ass, the talk-a-lot, the slow inefficient klutz, the uncaring bastard......they all come awake in us.

This was my typical call yesterday:

On arrival-big Nigerian guy with a gigantic slash wound on his back, lying on his stomach. There blood everywhere and he insist he just needs a couple of stitches and he will be on his way. Breath smells of alcohol, not the medical kind. Oh well, GA time! Slap in a a-line, turn him on his stomach and the surgeon gets to work. 4 pints of blood and two hours later, all is well.

Next case, stable patient coming from ICU for washout of his infected laparotomy wound. Simple washout and we are done. Its nearly noon.

SMO Hady and I converge in the team leaders desk to catch our breath and see whats next. In comes in a pregnant woman in labour who ruptured her uterus. Adeline shouts for help. Its a mad scramble to crash in on an operating theatre and we induce in less than 5 mins. Baby's out, surgeons do a good job and tragedy is averted.

Time to do a quick tracheostomy for a patient who is ventilator dependant. I help start the case, the ENT surgeons scrub in and its all left in my partners hands. She too has been having some difficult cases so far but still looks bright and cheer full.

We really need to get some rest but in comes a poor hungry child who has been fasted for some time. She has rhadomysarcoma and needs a CVL for chemo, bone marrow biopsies and lumbar punctures. Not a dying emergency but it needs to be done to expedite treatment, and the child can then break her pre-op fast.

Another couple of hours and the child can eat. I am hungry!

Hady kept himself busy doing a couple of nerve blocks of this nice gentleman who needs his leg to be amputated. He has such a sick heart, its barely beating. Hady and Wong did a good job, blocking the femoral and sciatic nerves. I throw my 50 cents worth by blocking the saphenous nerve!

While waiting for the block to work, we begin an ENT case on a patient with stridor, he had hypopharyngeal cancer and his trachea is stenosed. He can barely breath well and has a bad heart, needing bypass surgery at some point of time. An A-line, intravenous anaesthesia, jet ventilation and we are good to go. The surgeon dilates his trachea and we wake him up well.

I go to get food while Hady and Wong begin a laparotomy, a genltleman had a perforated duodenum after a difficult endoscopic procedure. 4 hours later and all is not well with him, operation done but I had been a bit liberal with fluid and now he's overloaded. Hady settles the problem with some Lasix and he pees buckets!

Next we start 100 kg lady who had ruptured an ovarion cycst. She looks ill and severely septic and my partner and I get get to work. Induction is smooth, the surgeons open up and there is about 200 mls of smelly pus in the abdomen. She is much better post op. And its also early in the morning.

I get a spinal anaesthesia going for a young forklift driver who wrecked his ankle. Nothing to it, pretty straight forward.

The neurosurgery team tells us to get a theatre ready, the have a little baby with head injury coming from Seremban and he needs an operation. I get my little drug book, check the doses, prepare the drugs, organise the theatre, machine, warmers and fluid, have a quick shower, a strong coffee and wait. And wait. And wait. Neuro surgery calls and says they will do him later.........

We just get in bed when the surgeon shouts for help. He's doing a gastroscope, the patient bleed half his total blood volume and needs resusitation. We get our half sleepy asses in the the theatre and begin work. An hour later, the surgeon found the bleeder and injected adrenaline. Patient stable for now. Anaesthetist are in good spirits, its morning and our call is over!

the big one is nearing

2009-06-20T02:45:00.000-07:00

exams are coming soon and its really spoiling my happiness. the workload is horrendous and tiring, and now things are a bit more complicated with family and all.

anyways, just sort of servicing the blog. will write more next time aroung

Shukor Adnan

2009-05-26T05:36:00.000-07:00

Our family driver who has been with us for sixteen good years died suddenly today. He arrived through an uncle's recommendation sixteen years ago for rural Kelantan and become proficient in his job.
He was loyal, hardworking and extremely dedicated to his job. He hardly seemed to tire despite my dad's hectic schedule and played a large role in our family. Work certainly wasn't easy but he stuck through it thick and thin.
He displayed the characteristic honesty and sincerity Malays are known for. He saw me through most of my secondary education, marriage and became friends with my two boys. He was with my family before my youngest brother was born and watched him grow.
His large family migrated to Kuala Lumpur and he did a good job as a family provider. He also recently became a grandfather.
He saw my dad through 4 general elections and was no doubt a big help to him.
As expected, there was sadness and tears all around.
May he rest in peace.
26-5-2009

Back again

2009-05-08T06:38:00.000-07:00

The whole month passed in a blur, we we nearly as busy as I used to be i HKL. The department was chronically short wit many candidates going for exams, there was the pressure of doing a short charged rooster and tempers did fly more than once. 8 calls, plus occasionaly coming back on your off day saw the month through fast.

Hopefully this month is a bit easy.

I am also starting to feel exam stress and wondering if I can make it through the big one in november. Time will tell.

I do seem to be spending more time with my elder son shastri. He is growing bigger and stronger by the day and more and more defiant when he gets upset. From time to time, he does need a firm hand which only a dad can possess. I am also learning that as a dad, you need to earn respect and lead by example. The baby Arditya is starting to grow. He is much healthier now and really loves me. I just wish I had more time for him.

The end of obs

2009-04-01T06:35:00.000-07:00

I just finished my two months of being an amature obstetrics anaesthetist. Other than the sad maternal death, it was fun and gratifying.

I inserted more than 30 labour epidural. Being a person who always seeks instant gratification, a working epidural is highly rewarding, both for me and the patient. I may have inserted for more epidurals in my old place(close to 70 in the same duration), but I actually learned more here. I could hang around each patient longer, troubleshoot and actually ensure better patient satisfaction. I visited my patients through their labour and made adjustments in my epidural drugs. Talking to them through the process and telling them what i am doing seemed to helped.

I had my share of screw-ups which contributed to the learning curve!

Of course there was more to the posting than epidurals but to write about everything will fill many-many pages. I guess there are always two attitudes we can have when we are doing the same stuff; been there, done that or lets see what i can learn/re-learn.

The most efficent army

2009-03-22T07:12:00.000-07:00

During a hiking trip(another story) I was talking to my friend, a Burmese, about the conditions back home. I am always interested in the lives of people in other countries and I like to ask basic and silly questions like "do you guys have traffic lights" or "what do you eat for breakfast".

During the course of our conversation, I discovered that the whole country is run by the military. They have their own cabinet, their own departments and their own state run companies. The burmese army is multi-talented.

They can control agriculture, telecommunications, the banking system, the health and education system and about everything else in the country.

They can also deal with naughty people well. Trials don't run for ages-ages like they do in many countries. Almost all trials are short and sweet, almost like formalities.

The army is running the country on its own and it must be an uphill task,since they are facing economic sanctions. Their health care system is not bad, basic but providing pretty much all the medical needs of the population. There are many well trained burmese doctors working in our country and they can attest to that.

They had one major problem in 1990, when they lost the elections. They dealt with the problem in a novel and original way, they didn't hand over power and the head of the coalition that won is still under house arrest.

I just wonder whether all in the ruling party are of one mind, or do they have their own internal power struggles and strife's? Who inherits the position of the head of state and how is the selection process?

We are an open democratic country. But do we have our pride intact? We and pretty much
every other small nation have to face human rights accusations from the mighty and oh-so morally superior US. They got very angry when one of our politicians was subjected to a police investigations.

We so very spoilt and dependant on their buying power to keep us comfortable. I am not saying and over authoritative government is good, but sometimes I think our government lacks a strong backbone.

Soft parents breed rude spoilt children.

BAD CALL

2009-02-27T09:42:00.000-08:00

I cant believe a pregnant mother died in front of me. When I look back, there were a few more things I could have done in a better way. I knew things were going to turn bad for her before anyone had a clue. I couldn't word it, I couldn't point anything abnormal out and she was so fine. She looked okay in every one's eyes but mine. This doesn't make me feel gifted or clever in anyway. On the contrary, I am kicking myself. I choose to ignore my instinct and rather than watch over her like a hawk. I told myself its just some silly paranoia. If I had listened to my instinct, will things have turned out differently? I will never know. Was she medically salvageable? No one will ever find out.
The worse part is that I am no amateur in sensing danger. I have repeatedly done it. I can literally smell trouble. Sounds even more silly when I ignored my intuition ,doesn't it?
Our brain is capable of many weird and wonderful things we are only beginning to understand. Everybody has some degree of intuition. Even cows and goats can sense when they are going to be slaughtered. Practically every woman who was a victim of a sexual crime will tell you that she felt hunted the whole day. Good cops can sense when their quarry is near. Likewise for the crooks!
What happens when we repeatedly ignore our intuition, instinct, sixth sense or whatever we call it? The same things that happens when don't use a muscle. It will inevitably atrophy.

On another note, I learned how much I am capable of. Despite my inner turmoil, I somehow managed to work as usual after the tragedy. When I am a specialist, if such an incident happens to one of my medical officers, I will make sure he/she gets off duty straight away. Its common sense. In any other place, that is standard protocol. As I mentioned before, I am working in a special place with lots of fun, excitement and challenges. The other thing that sort of kept my spirits up was the thought of my friends who sprung up from all over the hospital to help. Thanks guys.

shastri's hike-pics

2009-02-17T06:06:00.000-08:00

SHASTRI'S HIKE

2009-02-16T05:33:00.000-08:00

Its been some time since I actually wrote something. Life has been busy and exciting. Early in the month, I took shastri for a hike and my younger brother got most of the trip on his new SLR. Its up a hill called bukit tabur near my house. Its nice to live close to a quartz hill but as you can see from a picture, there is rampant environment destruction.

Shastri is one tough three year old and amazed some of the climbers we saw on our way up.

Most of the hill is formed by the pretty but wotrthless quartz and the view is good. Its overlooking the Klang Gates dam.
Shastri may have been up it but the bukit tabur is not for beginners and climbers have fallen to their death before. Always go prepared and take sensible precautions.

IRRATIONAL BULLSHIT

2009-01-28T04:13:00.000-08:00

One of the advantages of a blog spot is that you have the right to rant whatever you want on it. Here I go.

A patient is not supposed to receive HIV tainted blood. A military aircraft is not supposed to have technical problem and crash in some one's house and kill civilians during a drill. Knee replacement patients are not supposed to develop post op joint infection. It sucks. It really is unfair. But these bloody things happen all the time in the real world. Time and time again. We should not tolerate such things, we should investigate, learn and rectify.

Kugan's death in custody is exactly the same thing.
His parents have every right to grieve, file a wrong full death suit and sue the government. An OKT should not die in custody. It just must not happen!

But look at the crap the acclaimed malaysiakini is dishing. Check out the their free column, 'will kugan get the justice he deserves'. I don't doubt most of those comments are what the public is feeling at the moment. But we all know how irrationality spreads and about herd mentality. A news portal is supposed to correct misconceptions and not give rise to bullshit like malaysikini does.

Comments by a malaysian: Has the force (police) done anything to be proud of? It seems to him that they are more interested in catching pirated disc peddlers. One good cop is a paraplegic after an ambush went wrong three years ago in Grand Seasons Hotel. Two crooks nearly died and an entire gang of robbers went down during that ops. The notorious Nine Sea Dragons are all behind bars after they got their asses kicked in Klang. A group of students who kidnapped and torched their friend for ransom are now facing the death sentence. Another group who hacked a doctor in Bangsar to death is also in jail. Does 'a malaysian' know what happened to Mat Commando, the Evo 5 gang, and the mamak gang? Does it occur to him that a lot all the lives are risked during intelligence gathering to make a successful drug bust? No. Instead, to him, the people charged with protecting him have become his biggest enemy. Has he lost his mind?

Peter Ooi spoke some sense. But, in contrast to A Malaysian, anyone's comments will make sense.

Xroy, came out with a conspiracy theory, concerning a criminal police force. There are many, many things he doesn't know. The truth Xroy is much, much more that you could stomach. By the way, have you ever entertained the thought about a 'criminal US government' and their repeated attempts to topple our government. Something to ponder....

MP raised some points about Obama's action to ban torture and thinks we should follow their example. He has valid points, and the innocence of a 5 year old.

Megat Z made a good point, stating that the initial 'water the lungs' is probably just a medical finding. The follow up investigation is important.

Sritharan and Milton Yap both have good comments on Syed Hamid going after the two deputy ministers who appeared at the mortuary in good faith.Unfortunately, Milton Yap has little or no knowledge regarding medical reports(Buy an ICD 10) and suggested the doctor who wrote the report should have his license revoked and be charged with perversion of justice. Looks like we all have a sadist in us.

Vijay is angry with Palanivel for suggesting the matter be investigated by a comittee, instead stating that is a time for justice and retribution. That statement sounds so much more catchy. Watching too many zorro movies vijay?
'In any other country, those in high places would have resinged by now.' Every other country has a decent and honourable government but us. Did malaysiakini get little kids to comment on the issue? Which other countries? Heard about the stuff that goes in the NYPD, the shooting and subsequent death of a teenage commuter in the UK and the 'soft' interrogation techniques approved by the us marines.Not to mention what goes on behind the doors of a superpower like China or an ultarian government like singapore. Shall we talk about India?Looks like our Malaysiakini reader needs to get up and smell the shit stained roses of life in today's world. Or better yet vijay, look up to the great pakatan government to form a truly honourable government. They the saviours of malaysia in the twenty first century. Ask the Kapar MP, he will tell you. Vijay should just stick to his zorro movies. The real world sucks big time.

GONE IN A FLASH

2009-01-27T04:45:00.000-08:00

We had this gentleman who was recovering from a bad case of pancreatitis in ICU. It was a stormy recovery, but the patient was never critically ill at any one point of time. He and his family did interact with us often enough and they were all sharp and keen to know about his progress.

He was certainly getting better and on the morning of his planned discharge, was actually sitting on a chair. I was post call and handing over to my friend.

By afternoon, he intubated, ventilated and on high, high inotropes. Dying, in front of all of us. Something went badly wrong.

He died early next morning.

Damn.

DEATH IN CUSTODY

2009-01-24T04:27:00.000-08:00

Its all over the papers, malaysiakini, on makkal.org, on nearly every anti-establishment website you can think of. The death of young Kugan in custody.

He was arrested, interrogated and apparently led the cops to the recovery of stolen cars. He also lost his life in the process. He died after five days. It takes a lot to snuff the life out of a fit healthy person.

An unhappy group( I wont refer to them as a mob) barged into a mortuary and took photos of his battered body. My heartfelt condolences to his parents. No parent should see their children in such condition.

I am writing my opinions in this blog so I don't care what others think.

We can learn a few things from this tragedy.

1.Being intricately familiar with both 'our' world, the 'underworld' and the criminal justice system, my comments should count for something. Sorry, but cant elaborate more.

2. Being an Indian, I get distressed when I see another Indian treated badly. A Malay, a Chinese, Japanese and anyone would feel the same. We all are not Kugan's parents. They have the right to feel whatever they are feeling. Many of us do not know and cannot even imagine their feelings. Don't all of us get over emotional, and start blaming all the cops, accusing UMNO of bigotry and nazi behaviour, blaming najib and pak lah and looking towards the great Pakatan as a saviour. Nobody has the right to politicise any one's death.

3. It is not acceptable when someone dies in custody. A death in police custody destroys the credibility of the police. Reduced credibility of the cops is demoralising to the whole police force and country, retards our criminal justice system and allows more crooks to walk free at the end of the day. We, the unarmed public would be the ultimate losers in such a scenario.
As such, the case should be thoroughly investigated.

4. Is Kugan a criminal? The case is under police investigation and none of us should comment.

5. He got detained by the cops and died. NEVER GET INVOLVED IN CRIMINAL ACTIVITIES. That's the surest way to never die in custody. Not a full proof way but the best way I can think of. There is a small group of Indian criminal gangs that operate within the Klang valley. But they are not the Italian Mafia. Poorly educated, financially weak and ill equipped to deal with the law when in catches up with them, many are subjected to all the injustices in the criminal justice system. They cant hire good lawyers, they can't post bail, they cant communicate well with the judge and are often denied bail. Many are abandoned by their 'gangs' and their poor parents languish outside the lock-up. To all Indians, the law isn't kind to us, please shun from all forms of criminal activity before many more die in custody. CRIME JUST DOESN'T PAY.

6. Many of us Indians are Hindus. As such, we believe in the law of karma. Don't do things that make people curse at you. Don't harm the population. don't extort, don't terrorise people, don't brandish weapons at every opportunity. Bad things happen when people curse you. Once again, its not a full proof way to stay out of trouble but it helps.

7. The police are not evil corrupted bigots who hate us. They are normal people. Trust me, I know many of them. I am not defending those accused in Kugan's murder. I am telling you what I know. They receive reports from victims all day long. They have seen a grown man cry when his car got jacked with his wife and daughters in it. They have seen parang cuts in those who did not surrender their vehicles. They are not trained like medical doctors to view all life as equal. They have an inbred hatred of all crooks. That's how things are. If you get caught by them being naughty( I am not talking about speeding) you are in for a hard time. DON'T GET CAUGHT. CRIME DOESN'T PAY.

8. Think about this. Why should the police beat and physically abuse Indian detainees? Anything personal? They can protect themselves. They have nothing to fear from criminal gangs. Bad guys are not a threat to them. Each blow they deliver lands them closer to the possibility of going to jail. A jailed cop is in a bad way. Why would any law enforcer take such a risk? A common hatred for all Indian people? Be objective and logical before we hurl all sorts of accusations at anyone, whoever they may be.

9.We don't have a CSI but our Special Branch is one of the best in the world. These are the same guys who won a twelve year war against the communist. They spend hours and days away from their family, have no 'additional' income due to the undercover nature of their job and risk their lives. They know who the crooks are. Think about it, do they gain anything from labelling you,me and every other muthu as bad guys? Don't ever be the bad guy in their books. Once anyone gets labelled as a troublemaker, the local CID is going to come down hard on them.

I am not be role model of Indian youth. I am sending a very different message from what Hindraf sends. As such, I don't expect my comments on the issue to make me a community hero. But I am telling every Indian youth the way things are in this country. They really should stay away from crime. There shouldn't be any of our young ones behind bars.

THE LIBRARY

2009-01-18T04:10:00.000-08:00

Like any dad, I am proud of my boys. Other guys have may have their ATV's or super bikes but I am proud of my eldest boy. He is full of the hormone that makes life worth living-testosterone. He is big, tough, naughty, likes guns, enjoys wrestling and punching me, loves jungle and river trekking and is brave.

He is probably a dying species in today's politically correct world of metro sexual males.

He also has another side to him, he loves reading. He cant have enough of books. He likes all of them; storybooks, gun books, animal picture books. Children's books today can cost a bit nowadays.

We enrolled him as a member of the national library and have been frequenting for two Sunday's in a row. Its easy, you can walk in and read or become a member instantly if you want to borrow books.

The kids section is impressive, there are tons of books to choose from and plenty of sofa's to sit and read them. Yup, sofas like those in your hall. Wife and I just take turns reading to him and leave after and hour or two with a few of his favourite books.

It beats spending a Sunday morning in the mall or at home watching t.v. I hope he remembers such trips when he grows up.

Kudos to the staff and the government for maintaining such a place that's free for all Malaysians.

WAR, WAR AND MORE WAR

2009-01-11T04:59:00.000-08:00

I think that Israel measures are beyond self defense. Their suffocating blockade of Gaza and now their inhumane military measures is going to gain Hamas more and more sympathisers and increase future militant strikes.

As Mahatma Gandhi said, this eye for an eye policy will make the whole world blind.

Are all the papers lying about the magnitude of civilian casualties? I really don't think so.
Too many kids are dying. At what number of civilian casualties does a military defensive move become pure terrorism?

Many leaders believe that the US can bring about a halt in Israel's offensive. Too me, thats debatable.

I find myself asking what is their stand in the wake of the Gaza crisis? How vocal have they been with regards to all those pictures of dead Palestenians spread across the headlines.

They were far more vocal, angry and much, much more responsive when Anwar Ibrahim was detained following sodomy allegations. They summoned our ambassador, publicly requested a transparent investigation and Madam Rice asked for a 'fair trial'.

Rejecting their goods and products? Difficult but I will do my part. Rejecting their endorsed 'leaders' of my country- definately.

Chronic unhealing maligant ulcer

2009-01-08T05:53:00.000-08:00

Happy new year to those who celebrate it. I personally think its a highly commercialised alcohol drinking festival. I really don't ape westerners and I cant seem to understand its popularity here. Anyway for the record, Hindus have celebrated more than 5000 plus new years. It loses its thrill after a while.

Anyway, bigger things are happening. Gaza is getting pounded really badly. The amount of non-combatants Palestinians dead is staggering. And sad. The Muslim world is especially vocal. I just wonder why the non-Muslim world isn't. Those are innocent people.

If you google the word Palestine or Israel, you will learn a lot about the settlement of Jews there 3400 ago, their earlier fight for a state and subsequent defeats by the Romans, (132 BC). They did not rule the land for a long time after that. Later, after the Romans the the byzantine emperor conducted a the first of many genocides against Jews. During the crusades, Christians waged wars against Jews in the region. The Jews, original inhabitants of the area, were expelled many times and even driven close to extinction.

Muslims first conquered the are in the seventh century and ruled in until the 20th century.(the ottoman empire-area referred to as Palestine). Correct me if I am wrong but they were the first to allow the return of Jews to that area, known as Palestine. Once again, Jews became a sizable majority in Jerusalem.I did not come across articles any massacres of Jews by the Muslims or the ottoman empire. Once again correct me if I am wrong.

The British got into a fight with Germany during world war 1 and the Turkish took Germany's side. In return for financial support, Britain promised the Jewish people a home-state of Palestine when they defeated the ottomans for control of Palestine. They kept their word. See British mandate of Palestine and the Balfour declaration. The need for an actual formal country for the Jews became urgent after they were nearly exterminated(for the hundredth time in history). The Arabs firmly opposed giving any of their land to the Jews and the Arab Israel wars broke out in 1948. We all know who won.

The Palestinian Muslims became refugees and have since then been venting their anger at the Jews.

My question is this- did Hamas think Israel would compromise on the safety of their precious state after everything that has happened to them? They can actually defend themselves now. They enough massacres.

The Palestinians' anger is understandable. Many of their loved ones died during the Arab-Israel wars. They all now live in squalid refugee camps that are periodically demolished by Israel. They are surviving in horrible living conditions, lining up for hours to go to work in what was once their homeland.

Hamas fighters are prepared to sacrifice their lives for a proper home. But to they have the right to involve non combatants, knowing full well the extent of Israel's response? Why did they engage the Israel army with weak and ineffective rocket fire from settlement areas?

Israel will never defeat them. Hama's membership will hit the roof next month, by more people who lost their homes and children.

This vicious cycle will never end during our lifetime.
Whose side am I on? I think everybody should just STOP IT!!!

Good days

2008-12-29T05:35:00.000-08:00

Can't seem to believe my luck. I am not deeply religious but I really believe someone's listening. I had three whole days off! Just for myself and family. Kids, wife and I went trekking up a waterfall, hiking up a hill, to a park in Taman Tun and to a movie. I also managed to catch up with old friends who I had not seen for 18 years! The world is really a smaller place thanks to facebook.

I did not forget about my patients though and called ICU often to find out how their doing! Unhealthy obsession? Perhaps. But there is something to learned. They ( the patients) did well without me fussing about them 24/7. Hmmm.....

Of course life wont be like this all time, but its a welcome break. I suppose we all need to take things in our stride. Books and studies during these happy times? Well, we cant everything all the time.....

The ICU and family

2008-12-20T03:41:00.000-08:00

At times, work in the ICU does take its toll. I can't seem to leave my patients and my screw ups at the workplace. More than once, after my 24 hour call, I call my friend who is on call the next day to find out about my patients.
At home, especially after a bad call when some of them turned bad or unexpectedly died, I tend to brood. My wife takes it the wrong way at times.
Our calls can be bad, I don't have the energy I used to possess. I sleep most of the day and bury myself in my books at night.
Six on calls. Six post calls when my family doesn't see much of me. That's close to half a month. Some days, I get stuck in a traffic jam an arrive home in the late evening.
I also try to hit the books whenever possible.
As a result my contribution at home is nothing to shout about. My son misses playing with me. My wife has to care for a problematic baby on her own most of the time. Her understanding and patience only go so far.
Being a gym rat and an outdoor freak doesn't help. I yearn for a trek in the jungle but I have to deny myself. It doesn't seem good to be spending what little free time I have away from the family. That leaves me a little frustrated.
I had a whole day free day today and it was a good day. Good family time.
Rare days like these make me think and count my blessings.
I had my fun in the past. I did many exciting and thrilling things. Many people will never get to do the things I did, many who try wont even survive! Those were good times.
I suppose there is a time and place for everything. Now I need to grit my teeth and go through these tough times. Once I am done with the major exam, there will be good times again, just like a close friend of my is enjoying now!
Tough times don't last, tough people do.

Honestly speaking.......

2008-12-11T09:45:00.000-08:00

Its about 2am now and I am sitting opposite a 58 year old who was ill, well on the way to get better, then unfortunately on my call, he took a turn for the worse. His blood pressure dropped, needing powerful vasopressors and his kidneys shut down for a second time.

I just told his family he was on the road to recovery prior to that.To say I was embarrassed is putting it mildly.

There is this so called rule in ICU. You are never supposed to give patients relative any glimmer of hope that their loved ones will ever get better. In case they dont, then to relatives wont jump on you. We and our silly precious asses we are so bent on protecting.

Like many things in my life, I do this differently. I tell them that their relative/loved is ill but whenever I think so, I tell them he has every hope and chance of getting better. The truth and nothing but the truth. If he is a no hoper, I tell them so. If there is a small chance he will get better, I tell them so.

Many times, many times I have been wrong. 'Your dad is dangerously ill, but with our interventions he has a fair chance of getting better' or 'Your dad has certainly improved and I think he is going to be OK'.

I dont know much yet, but I need to commit. And using what little knowledge I have I will commit when pressed for information.

Like today, I have often been met with 'Didnt you just say....." or 'what went wrong.." sometimes meaning 'what did you do wrong...'

I dont really care. I said it and I meant it now they are upset and I dont blame them. Sometimes things happen.

I just hope and I become I will have a bit more right than wrong most of the time. But I hope I wont change

Sakit hati 2

2008-12-07T04:29:00.000-08:00

He did appear to be improving. Slowly, gingerly, with him wide awake, I extubated him, liberating him from the ventilator and free to breath entirely on his own. The first 24 hours, everything looks OK. Hope it will stay that way.....

2008-12-07T04:15:00.000-08:00

The whole country is once again shaken by a similar tragedy in a similar are with similar reactions from politicians. My deepest condolances to the victims and families affected. My close friend is one of them. Is extremely difficult for a family of five to be evacuated without many belongings.

Instead of playing the blame game, lets all as Malaysians not buy houses on hillslopes, built in water catchment areas or in previous forest reserves. Developers will get the message. There is enough flat land in the country to cater for all our needs. Land to cater for our greed? I don't think there's enough in the world.

I have become cynical with age. With regards to the words of politicians promising to stop indiscriminate development, we all know it has happened before with similar effects.

Medical Racism

2008-12-03T05:51:00.000-08:00

We doctors are a bunch of racial stereotyping, racist, group of individuals who can put politicians to shame.
"This Indian man had been ill for......"
"This Chinese man need an urgent operation........"
"This Malay lady needs dialysis....."
We always mention the patients race when we present the case, or when we make referrals. And we have for always been doing it. We do it very important and specific reasons. Its just that I don't know what they are.
Everybody else is free to do what they want, I am going to try to stop with this silly practice.

sakit hati

2008-12-03T05:21:00.000-08:00

A 60 year old gentleman was unfortunate enough to fall very ill from a bad foot infection, had a heart attack in hospital and nearly died. he needed close to 15 minutes of CPR, cardiopulmonary resuscitation and by all the books, he should have died.
He defied the odds and now he alive. He's wide awake and hooked on to a ventilator. he's blood pressure is just holding with a ton of inotropes.( drugs that are infused to support heart rate and blood pressure in ill patients are called inotropes. Stop infusing them in people who still need them and they can die
His kidneys have failed to function and he needs dialysis.
The problem is he has a very sick heart. his ejection fraction is only 10%. a mere 10% of blood that enters his heart is being pumped out-ejected. that's barely compatible with life....most patients with similar heart function wouldn't be alive. but he is.
and he is awake and aware.
He cant breath very well on his own but that's not really the problem, our ventilator is connected to his lungs via an endotracheal tube and it does a good job helping him breath.
An ejection fraction of 10% isn't enough for the heart to pump blood at adequate pressure to reach all his organ.no matter, our inotropes are helping. Like super turbocharged amphetamines, grade A rocket fuel for his heart, they are being infused into his blood stream 24/7.
Now his kidneys have failed him and he cant produce urine to remove excess fluid and waste water. No matter, we have a super gentle and efficient dialysis machine that sucks and filters blood and returns it clean.
through it all he remains awake and aware.
the problem is how long do we continue? his family has been told but did i do a good enough job in explaining to them the gravity of the situation? did i paint the full picture clearly? its really not easy to tell people looking for any bit of hope that there's only a small chance of him getting well.
Small but possible. He is alive so far. I really hope he gets well.......

Intensive Care Unit

2008-12-02T03:34:00.000-08:00

This is my second day in the ICU. For me, its a really cool place. Very few doctors have a ward all to themselves where they can actually snatch patients from the brink of death, take over most of their vital signs and wait for them to get better.

An ICU doctor is given the an impressive array of tools and human resources that is seldom available to regular doctors to help their patients. We can order the most expensive antibiotics at the stroke of a pen, ventilate our patients with machines worth as much a a brand new car, and get at least three well trained health care professionals to take care of our patients in day.

There's tons to learn. Each and every patient is different and a template management seldom fits everyone, if anyone at all.

Hope I have an educational posting

Death Squats

2008-11-30T05:01:00.000-08:00

This afternoon, I went for my rare workout. Playing with heavy weights is something I have been doing for more than a decade. Many things have come and gone but the weights in my life have always been there. Squats, bench presses, pull ups, I have been doing them for ages and ages. Workouts are rare due to other commitments but its still something I need.

For some strange reason, I like the pain. Its my barometer of what I can take.

Its very easy to reduce a pound or two, just rack the weights and call it a day. Being a solo activity,no one will know you did less than usual. Except you. Thats the most important person.

But I persist, through torn tendons, strained ligaments and a nauseating build up of lactic acid. Its nice knowing that i beat myself...

Today, it was death squats. 300 pounds of full squats, 20 times. I normally do ten good reps. today did 20, just for the heck of it.

Things you can learn from the weight room

1. Those who whine and cry when they dont get acknowledgement from other people are just cry babies.

2. Your own expectations of yourself are sometimes the hardest to live up to.

3.Do more than you think you can, sometimes you will just surprise yourself.

Going to be interesting to see what monday will bring.......

my story

2008-11-29T04:53:00.000-08:00

In todays web world, i really dont feel secure blogging about major life events. We don't have any more privacy nowadays, with the creation of emails and facebook and now, after the virus age, major spyware. Its really difficult to know who's having access to what and what their information will be used for.

Certain events in our life can have legal implications and may even affect the safety of our loved ones. You really never know.

Not that I have anything naughty, like I said u never know.

However, I would like to leave some part of behind in writing for my children to read and laugh about some day.

I cant really blog about the 'fun' thigs in my life and neither can I blog about my past....

I suppose I would like to start fresh, with whats going on here and now.

There plenty to write about