WORST SUBJECT

Intensive Radiation Physics course & end of course test have just ended ...

QUOTABLE QUOTES

The top 3 quotes for the month of October 2007:

• A good surgeon knows when to cut, but a better surgeon knows when not to cut - Dr. M (UMMC)

• Faslodex? Umm, it's a fast Lodex lor (as oppose to a slow Lodex, whatever that means) - Dr. I (UMMC)

• Are we getting our year end bonus? Or has it been sent to space? - Dr. L (SGH)

* Faslodex is a hormonal treatment for breast cancer & its name has got nothing to do with how fast or how slow the drug acts in the human body :)

ARRGH

Medical Statistics test is coming up....

SILICONE

This picture of Pam Anderson graced the slide presentation by our Pathology lecturer, Dr. M, on the topic of breast carcinoma.

* Just for info, breast augmentation with silicone can mask or mimic breast cancer.

QUADRUPLE BLIND STUDY

My specialist recently mentioned something about how important history taking is. 80% of diagnoses are made based on history while the remaining from physical examination & further investigations.

I’m sure you’ve heard the joke “double blind study” (ie. 2 orthopaedic surgeons looking at an ECG), but I bet you’ve not heard about the “quadruple blind study”. Well, here’s how the story goes:

I was the Surgical Medical Officer (MO) oncall at Sarawak General Hospital, when the ED (emergency department) MO paged me to see a patient with acute right sided lower limb swelling & pain, to rule out the possibility of deep vein thrombosis. The other differential diagnosis was cellulitis, so the Orthopaedic MO was also called in.

4 doctors (ie. the ED, Surgical & Orthopaedic MOs, as well as the ED specialist) stood at the end of the bed & looked real hard at the patient’s leg, but none could come up with a diagnosis. After much discussion about the possibilities, including neuromuscular conditions, our patient (who had been keeping quiet & listening to the doctors) spoke, “Doktor, saya rasa saya ada gout lah. Dari dulu lagi, saya selalu kena macam ini.”

If only one of the doctors had asked the patient if he had similar symptoms before…

WHAT’S YOUR DEFINITION OF SEX?

I was surfing the internet recently from my clinic room in UMMC, with the intention to find info for my upcoming presentation on ovarian & Fallopian tube cancers. I searched through Google using the key words ovary, Fallopian tube & cancer. Guess what happened? I was instantly “blocked” by the UMMC’s Nadi IT with the following message:

“No entry. Related to Sex.”


This reminds me of a joke someone sent me quite a while ago, about Ah Beng trying to fill up a form at the Public Services Department in Singapore. Under “Sex,”, Ah Beng had written “twice per week.”

HIBERNATION

I think I need to “hibernate” from blogging for a while, for academic reasons. But please don’t stop visiting my blog. I will still update if something really funny comes up. Or perhaps you can do a “retrosceptive study” on my blog? :)

DUMEX & SUSTAGEN

In medical school, we learnt that “small talks” can be used to build rapport with patients before the actual consultation. In real life, “small talks” can be quite effective if used appropriately. I have been rather successful with my “small talks” all this while, until recently …when I noticed that some of them have turned out to be a little peculiar.


Conversation 1
It was a Friday morning & one of those days that I decided to dress differently just for the fun of it (I wore a baju kurung). A Chinese aunty came to the clinic for follow-up.

Me: Good morning, aunty. How have you been? (I spoke in Mandarin)

Patient: (Shocked) Wah, you can speak Chinese ah?

Me: Of course I can speak Chinese. I’m a Chinese.
(Didn’t dare to disclose the fact that I only picked up Mandarin over the last couple of years)

Patient: (Shocked again) You’re chinese?

Me: Yes, I’m Chinese.

Patient: (Looking very skeptical) If you’re Chinese, why are you wearing baju kurung?

Me: (Pengsan)

Conversation 2
I saw another Chinese aunty who came for follow-up not too long after the first incident. Chinese aunties are prone to forgetting English names, so I thought I’d better introduce myself by my Chinese surname.

Me: Good morning, aunty. I’m Dr. C. How are you today?

Patient: (Looking skeptical) Dr. C?

Me: (Caught her looking at my name tag) Mm-hmm

Patient: But your name tag says Dr. F leh?

Me: (Pengsan second time)

Conversation 3
A Chinese uncle visited our clinic for the first time after undergoing an operation to remove his colonic tumour. He was referred by the surgeons for further treatment to prevent the tumour from growing back.

Me: Good morning, uncle. I’m Dr. F (Learnt my lesson already)

Patient: (Smiling) Good morning

Me: (Looking at patient’s details on the registration form & pointing to the age) It says here, uncle, that you’re 74 years old. Well, you certaining don’t look 74.

Patient: (Smiling even more) Hehe…I do a lot of exercise. Maybe that’s why I look young. How old do you think I look?

Me: Mmm…about 60 plus? Definitely not more than 65.

Patient: (Laughing now) Wow, you’re so generous.

Me: (Got up from my seat to reach for something. Can’t remember what, probably the stethoscope)

Patient: Wah, doctor, you’re quite small-sized oh. How come ah? You didn’t drink enough milk when you were young?

Me: (Really pengsan)

PROMO FOR McD

A former colleague in Sarawak General Hospital, Dr. LWC, was doing rounds with his house officers in the Medical Ward recently, when they came to a HIV-positive patient who was admitted for a certain infection. The doctor who admitted the patient had written down "MAC" on the case notes.

Dr. LWC asked the house officers what MAC means. There was a period of silence, followed by a small tiny voice from the back, saying, "Big MAC? As in MAC Donalds?"

(MAC actually means Mycobacterium Avian Complex, which is the patient's diagnosis)

ALL IN ONE

During our first lecture on Radiobiology with Dr. L, she showed us this picture on her final slide & said, "Now you all can go home.....and study."

OCCUPATIONAL HAZARD

Risks of needle prick injuries & exposure to radiation aside, I think I might actually have a serious occupation related problem when ……

1) I started looking at people’s veins while waiting to board the plane (I went back to my hometown recently) & thinking whether intravenous cannulation is going to be easy or not if they collapse & need resuscitation.

2) I’m stucked in the jam (it’s KL lor), I look at car registration plates & associate the alphabets with medical conditions, for example MBC (for metastatic breast cancer), ADH (for anti-diuretic hormone) etc.

3) I think of an old friend (whom I met at our secondary school reunion recently) as a “multipara” rather than a “mother of 3 kids”.

WHO ARE YOU III

My 3 colleagues & I (they are only 4 of us in this year’s Masters in Oncology) join the much bigger Public Health group for lectures on Medical Statistics. A few from Psychiatry also attend the same classes. Because we are the minority groups, we are identified by our units rather than individually. And the handle given to us?

“The Oncos & the Psychos”

F FOR FISHING

That’s exactly what 2 of my course mates have been doing in lectures, especially boring ones like Medical Statistics (some people may enjoy it but I dislike the subject). Sometimes I love watching them when the lectures get too boring. I believe if they continue doing that throughout the academic year, they might actually catch a shark or even a mermaid :)

Towards the end of one particular Statistics class, our lecturer, Dr. MA, showed a slide of a koala bear clinging on to a tree branch & said to us, “Do you all know that koala bears sleep 22 hours a day? It’s such a waste because they miss out on all the fun.” I don’t know about my 2 colleagues but I’m pretty sure the slide was shown for a reason :)

MORE F's

As time passes, I’m discovering more & more F’s at UMMC. Just last week (on a Friday evening) after our tutorial on Oncological Emergencies ended (at 6pm), my eagerness to go home vanished when I saw what had become of my car (which was parked far far away from the hospital building).

With the original silver colour in the background, there were rough brown spots all over (like a polka-dot cartoon car). From a few metres away, I could already guess what the dots were, but I just had to go nearer for confirmation (I was in denial). My car was full of bird shit!!

F*** I wanted to curse, especially after I inspected the other cars parked near to mine & found not a single speck of dirt. So unfair.

It is increasingly difficult nowadays to find parking, especially after the new batch of undergraduates joined the Medical Faculty. It came as a surprise to me as most of my friends & I used public transportation when we were Medical students. Time has changed I suppose. And this is the reason why I am forced to park far far away & risk having my car polluted by the anencephalic species.

If I were Princess Fiona, I would create my own parking space or have an invisible car which doesn’t require a parking space, but unfortunately I’m just a poor government servant, who is waiting impatiently for the promised pay hike ;p

NOMENCLATURE

In pathological examination involving malignant tumours (or cancers), the terms well, moderately & poorly differentiated are commonly used to describe the tumour cells. Differentiation means the degree of resemblance of the tumour cells to normal cells.

Our Professor in Pathology, Prof LM, has a unique & interesting way of explaining differentiation to the class:


Well differentiated baby → a baby who looks exactly like one of its parents

Moderately differentiated baby → a baby who looks a little bit like the mother & a little bit like the father

Poorly differentiated baby → a baby who doesn’t look like either parent, but still can make out its race (ie. Malay, Chinese or Indian)

Undifferentiated or anaplastic baby → can’t make out anything, probably from outer space

KKM

My housemate & colleague, who used to work in Penang General Hospital, told me about a Matron at her former hospital, who had to attend meetings after meetings as part of her job as a nursing administrator.

Upon returning to the office (after the many meetings), the Matron was asked by one of her staff about how they went. The Matron jokingly replied, “Well, you know lah. KKM kan Kementerian Kuat Meeting & Kementerian Kuat Makan (referring to the many tea breaks during the meetings).”


* KKM is short for Kementerian Kesihatan Malaysia, for those of you who are not aware of its real meaning :p

COMMUNICATION BREAKDOWN II

I received an sms from my former colleague in Kuching, R, telling about her experience with an elderly patient in the clinic. It reminded me of my own experience with an orang asli patient in Seremban General Hospital many years ago (Tales out of medical school & From memory bank). This is more or less the conversation between R & her patient.


Dr. R: Pak cik makan ubat apa?

Patient: Tak ada makan ubat, doktor

Dr. R: Bila sakit, pak cik tak makan ubat?

Patient: Tak, doktor

Dr. R: Jadi pak cik tahan je lah bila sakit?

Patient: Auk, doktor (Yes, doctor in Sarawakian slang)

Dr. R: Kenapa tak makan ubat?

Patient: Tak ada ubat, doktor

Dr. R: Kalau pak cik tak makan ubat, habis pak cik makan apa?

Patient: (must have thought in his mind why is the doctor asking him a funny question, before coming up with the best logical answer) Makan nasi lah

FAQ

Frequently asked questions (besides the one earlier) by patients & nurses include:

“What’s your weight?”

“Are you below 40 kilo? I think so lah.”

“Are you married?”

“Are you Kadazan?” (for those who know where I come from)

“Are you Iban or Bidayuh?” (for those who think I’m Sarawakian)

“Are you on diet?”

Well, the determination of one’s body physique is an interplay between genetic & environmental factors & I think mine has got to do with the genes. So no, I’m not on a diet. I’m just small-sized & petite by nature. I used to weigh below 40 kilos some years back, but not anymore :)

I'M NOT OKAY

I'm shivering inside the "freezer". Have not been feeling very well over the past few days & it sure doesn't help much to be working in this uncondusive environment. Doctors are also human beings, we are not exempted from falling sick. I have not been doing much today, except for seeing a few patients in the ward. I feel so tired that my eyes just want to close (lethargy induced ptosis). Perhaps I should get toothpicks to keep my eyelids apart. I have come across people who request (or demand to be more precise) for MC for the slightest fever & the slighest aches. But when a doctor falls sick, he or she would still have to continue working & doing oncall duty until he or she is totally debilitated & bed-bound.

HOW OLD ARE YOU DOCTOR?

I have been asked the question “How old are you, doctor?” numerous times, by my patients (most of them Chinese aunties). And every time, I would ask them back, “How old do you think I am?”. It really doesn’t help to be a doctor who looks 10 years younger than her actual age. After Form 5, I did 1 year of A-level before attending medical school for 5 & ½ years. Now it has been 6 years plus since I graduated & started working. So how old does that make me?

Here are some of the responses I got from my patients:

Not very smart Chinese aunty → “You look very young lah, doctor. Must be very smart, graduate so early. I guess…..you are only 21 years old.”

Another not so smart Chinese aunty → “You cannot be more than 24 years old. Wah…..so young become doctor, must be very smart.”

Pretty smart Chinese aunty → “I think you must be around 35, considering the time you spent in medical school & the years of practice. But your face doesn’t look like 35 because you have baby face.”

Also quite smart Chinese aunty → “You look like you are in your early 20’s but I think you are older than that because you spend so many years in university.”

Overtly generous aunty → “Your face look like 18, but I think you are around 20 plus.”


None of them has guessed correctly, but I give credit to the aunty who guessed my age to be 35. I think she has been the closest so far.

PROF WHO?

When I was young (primary school age), I used to read Borneo Post, a Sarawak based paper as my mum (she’s a journalist) was one of its regular contributors then. I often read about the state’s politicians, such as Datuk Amar Sulaiman Daud, Datuk Amar James Wong, Datuk Amar Alfred Jabu & etc. I used to wonder why all these VIPs seem to have similar first names.

I guess that’s excusable (or forgivable) considering I was only 9 or 10. Recently, a friend of mine, L, was at the Radiology Department to look for a certain Professor (in Radiology), who reported the CT scan of her patient. The report stated that the CT films were read by Professor Madya so & so.

L asked a Radiology staff where she could find Professor Madya. Obviously the staff replied, “Which Professor Madya?” since there are so many Professor Madyas in the Department. It took L a while to realise that Madya is not the Professor’s first name, but part of the academic title. Can L be excused (or forgiven), you think?

YOU OKAY?

I frequently hear my nurses (here at UMMC’s Oncology Unit) say “UOK” when they are calling people at other deparments, for example, to trace scan report from Radiology or to get blood investigation result from the lab. And every time, I would be wondering to myself what they mean. Are they being polite & asking how their counterparts at the other departments are doing or UOK actually has some other meaning?

It took me 3 weeks & a half to figure out that UOK stands for “Unit Onkologi Klinikal” – my own department! How shameful, I must admit. By fellow blogger Fibrate’s (It’s a doc’s life – geddit?) definition, I would be considered a “complete lulu”. In fact, I did feel “lulu-fied” when I realised how silly I was. I guess this is probably an example of the Malay saying, “malu bertanya sesat jalan” (though I didn’t actually “sesat jalan” lah) or perhaps, as a “neonate” at UMMC, I have yet to learn all the “jargons” to “gain full entry into the club”.

* Fibrate, sorry for the little violation of your copyright. I’m going to link you soon.

JARGON

I was reading my Manual of Clinical Oncology & came across a little footnote (on one of the pages on cancer terminology) which read, “Jargon is the use of pseudo-words plucked from a “word salad” to make the simple appear arcane, to disguise one’s ignorance of a subject, or to have secret codes that can be used to gain entry into a club.”

The medical profession is often mistaken as a “prestigious club” by many, including medical professionals themselves. Of course, medical professionals are able to speak a “different language”, one which is taught only at medical institutions. It seems reputable to be able to speak this language, but is it so in real life?

Here are 3 examples of conversation (between doctors & patients at my old hospital in Kuching) which illustrate the above meaning of “jargon”. I’m exaggerating a little bit, just so that you get a clearer picture:


Case 1
Patient: (who has breast cancer & not that highly educated) What do I have, doctor?

Doctor: You have Infiltrating Ductal Carcinoma of the breast, where the surgeons have performed total mastectomy & axillary dissection.

Patient: Infiltrating what?

Doctor: Infiltrating ductal carcinoma, which is a cancer, so what you need now is chemotherapy, radiotherapy & possibly hormonal manipulation.

Patient: (confused) …chemo….and…?

Doctor: Yes, chemo. Do you agree for chemo?

Patient: Must I have chemo? What if I don’t want chemo?

Doctor: If you don’t have chemo, you are going to die. Do you want chemo or do you want to die?



Case 2
Patient: (who has breast cancer & highly educated) I have a friend who went for FISH test …

Doctor: (who didn’t really know what the test is all about) So?

Patient: I was just wondering if I should do that same…

Doctor: You’re here today for your chemo, but your total white cell count & neutrophils are low, so we have to delay chemo for a week …

Patient: (got distracted by doctor) Oh? I can’t have chemo today?

Doctor: Yup.

Patient: Why is is so?

Doctor: Well, chemo causes myelosuppression, that’s why your total white cell is low. You can’t do anything about it. Just go home & wait. Come back next week.


Case 3
Doctor: Kenapa bunuh diri?

Patient: (who attempted suicide an hour before, by consuming excessive Paracetamol tablets -- keeping her head down & remaining silent)

Doctor: (lifting patient’s chin in a rough manner) Saya tanya kamu, kenapa bunuh diri?

Patient: (still keeping quiet)

Doctor: (turning to junior doctor & nurse) Do a gastric lavage & take PCM level. If exceed, just give N-acetylcysteine. Follow the “black book”.


* Sorry, this is not exactly something that fits “Laughter the best medicine” though I did laugh when my former nurses told me about them. Maybe it was the way they told me, with the gesture & the imitation of various doctors, but what had transpired is actually a sad thing & certainly a disgrace to the medical profession.

MISCALLEANOUS IV

• “If a patient with diabetes is called a diabetic & someone with an amputated limb is an amputee, what do you call a person who has a stoma?” our Consultant Surgeon (in Sarawak General Hospital, Kuching) Mr. WCM, quizzed us during ward round. I actually didn’t know the answer, but one of the House Officers replied confidently, “Stomee”. It sounded funny that even the patients laughed. The correct term is “ostomate”.

• During an MRCP (Member of the Royal College of Phycisians) teaching session, one of the candidates, HT, was asked a question about a physiological condition which can aggravate a certain medical problem. HT was also given the clue that the particular physiological condition occurs only in women & not in men. He thought for a while & gave the answer, “Menstruation”. The other candidates thought HT’s answer was outrageous. Perhaps he had forgotten that pregnancy is also a physiological condition that occurs only in women.

HUMAN HAIROMA VIRUS

I attended a CME (Continuing Medical Education) on HPV (Human Papilloma Virus) vaccination recently at UMMC. It somehow reminded me of the Human Hairoma Virus.

Human what virus? Never heard of it? But of course, the virus does not exist. Human Hairoma Virus, or HHV for short, was “fictionally invented” by yours truly back at IMC (International Medical College), together with a senior whom I was pretty close with. We wrote about HHV in the college’s newsletter, “Med About U”. We even drew cartoon pictures of the virus.

HHV was supposed to cause hairoma (tumour consisting of hair) of the male & female genito-urinary tracts. I think we also included cartoons of what hairomas of the uterus & cervix looked like.

Those were the crazy & care free days…

COMMUNICATION BREAKDOWN

• Effective communication is actually very important between medical personnel (doctors, nurses etc) & patients. I’m sure many of you have heard about the “heart murmur” & “hot mamma” joke.
  
  Well, this is a real life conversation between my former nurse (at the Radiotherapy Unit in Sarawak General Hospital) & the husband of a cervical cancer patient undergoing radiotherapy. The husband was upset after being told by the radiographer that they would not be able to have sexual intercourse during the treatment period. He wanted to confirm with another medical staff. Both husband & wife are Indonesians.
  
  
  Husband: Nanti bila balik rumah, bisa ranjang?
  
  Nurse: (Heard ‘ranjang’ as ‘telanjang’) Bolehhhhh………
  
  Husband: (Surprised) Bisa??
  
  Nurse: Bisaaa….
  
  Husband: (Confused) Ngapa tadi orang bilang ng’gak bisa?
  
  Nurse: Bisa. Kenapa tidak bisa? Di rumah, tidak ada orang tengok. Bisa buat apa saja.
  
  
  * Ranjang, in Indonesian language, means “bed” or “bed-related activities”.

• Communication between medical personnel is equally, or in fact even more important. Before radiotherapy treatment begins, there is a pre-treatment session called “simulation”. A simulator is a machine which can produce conditions similar to radiation therapy & the process of simulation is important for an Oncologist to plan the area to be treated.
  
  Once, a House Officer (HO) from the Surgical Ward called up the Oncology Unit (at UMMC) to get an appointment date for a patient for simulation. WZ, the Senior Oncology MO, had informed the HO to indicate on the referral form, “patient for simulation under Dr. A”. (Dr. A is one of the Oncology Specialists & the head of department).
  
  When the patient turned up at Oncology, the staff had a good laugh as the referral form read, “for stimulation under Dr. A”.
  
  

4 F's

This is not the 4 F’s (risk factors) for developing gallstones (ie. Fat, Female, Forty/Fifty, Fertile) but my new discovery of the 4 F’s of University Malaya Medical Centre (UMMC), KL.

Far

I live in Old Klang Road & it takes me about 20 to 25 minutes to get to UMMC. My colleagues who are from KL think it is “super fast” (since under an hour is considered “fast”). In Kuching, my rented place was only 5 minutes away from the hospital (Sarawak General).

My housemate & I car pool to work everyday (we work in the same department & there is no oncall, for now). We normally park at the Medical Faculty of University Malaya (most doctors do that) & walk across to the Medical Centre. The daily morning walk should help me to stay slim, hopefully :)

The Oncology Department is situated at the newer wing called Menara Timur & it is miles away from the Menara Utama (main building). Oncology patients are admitted to different wards (namely Medical, Surgical, ENT & Orthopedic) because we don’t have our own ward. Most of the in-patients are situated at the main building so I’m getting daily late morning & afternoon walks as well.


Flooded

Recently we hear about burst pipes in various Government deparments. Well, UMMC doesn’t have that problem (I hope) but along the walk way from Menara Utama to Menara Timur, you can find pools of water here & there. This is indeed an eye sore, especially for an established medical institution like UMMC.


Freezer

The Oncology Unit in UMMC is by far the coldest place I’ve ever been in my lifetime. Okay, I’m exaggerating. I’ve survived below zero degrees at winter time during my final year (medical school) in Hamilton, New Zealand, but that was okay because I was equipped with winter clothing & a heater.

The clinic area is quite alright (I mean the cold is still bearable) but the radiotherapy treatment area is just horrendous. The temperature is such because of the radiotherapy machines.

My fingers were cramped on at least 2 occasions that I could not write (on patient’s notes) properly. Thank God they did not turn blue. I swear I would turn up for work in full winter wear (including gloves) if this happens again.


Faded

On the way to work, we have to drive pass the Law Faculty before reaching the Medical Faculty. My housemate never fails to comment on how nice the Law building is. The Medical Faculty, on the other hand, is very ancient looking & gives us the creepy & eerie feeling everytime we walk pass there to go to the medical centre. None the less, it has produced many prominent doctors in the country, namely the current Director General of Health & the Minister of Health.

As medical students at the International Medical College (IMC), we made occasional visits to the Anatomy Department of University Malaya for Anatomy sessions as we did not have our own wet lab. Someone told us that Botak Chin’s (the notorious criminal) head was being kept there. Now, when I walk pass the Anatomy Department, I can’t help but think of the specimen, which could still be there, floating on preservative fluid, inside a huge glass container……I guess that explains the creepy feeling.

WHO ARE YOU II

I would definitely remember Sarawak General Hospital & its "community" (after all Sarawak is a place like no other) but I think with this post, I would remember them even better. It's funny how certain nick names actually come about.

• Kayu: Stiff as a piece of wood, often engages in monotonous & monosyllabal conversation & has a "masked-like face"

• Cousin-in-law: From surname 'Law'

• X-man: From first letter of name

• King Kong Bundy: Physical appearance & gait

• Bawang besar & bawang kecil: A staff nurse & a JM (Jururawat Masyarakat) who are best friends but different in body physique

• Twins: 2 male Surgical Registrars who are always seen together (someone commented that they seem to be closer to each other than to their wives)

• Olive (Poepye's wife): Because of physical appearance

• Major babe: Hot, sexy & still unattached

• Midget: This one's a bit mean, but thank god it's not me :p

• Gikun: Short for gigi kuning (this one's kinda mean too)

• Baby (as in "baby sihat"): 2 male doctors share the same nick name

DOOR TO DINNER TIME

The Cardiac Department of Sarawak General Hospital holds an annual Cardiac Dinner with the wife of the Sarawak's Chief Minister as the guest of honour. According to those who attended the dinner, her speeches seem to get longer & longer each year. A colleague of mine has planned to bring her story book to read at the next dinner!

NAME LONGITIS

If you have visited the website kennysia.com, you would have come across a post with the title "Datuknameistoolongitis". He is talking about the roundabouts in Kuching, Sarawak. Not only are they huge, their names are really long too, especially those in Petra Jaya area. In fact, names of roads are no different. Sarawak General Hospital, where I worked, for example, is situated along Jalan Tun Ahmad Zaidi Adruce, named after the former Tuan Yang Terutama (Governer) of Sarawak. Parallel to Jalan Tun Ahmad Zaidi Adruce is Jalan Tun Haji Abang Openg. Common sense would tell you that Haji should come after Tun & Abang comes after Haji, but sometimes one may get confused (like yours truly) & the Tun, Haji & Abang come out in a different order than what they should be (with due respect to the late ex-Governer of Sarawak).

IS THAT A NERVE OR A BLOOD VESSEL

This is the conversation between a surgeon & his assisting House Officer (HO) during a total thyroidectomy (removal of the whole thyroid gland) in the OT (operating theatre):

Surgeon: Retract properly

HO: Ok

Surgeon: Are you falling asleep?

HO: No

Surgeon: Then retract properly

HO: (Suddenly, after a period of silence) Eh, eh, eh, eh, eh…

Surgeon: (Startled) What??

HO: Nothing

Surgeon: @#$%!

HO: (Again, after a period of silence) Eh, eh, eh, eh, eh…

Surgeon: (Startled for the second time) What??!

HO: Is that a nerve or a blood vessel? I think it’s a nerve.

Surgeon: Can you please shut up, I didn’t ask you. You’ re banned from coming to my OT.

(This may actually serve as a tip for those who are "non-surgical minded" & not keen to assist in operations, especially long ones. Perhaps you could try getting yourself banned from going to the OT. Just kidding.)

WHAT DO YOU CALL

These are some of the jokes my colleagues & I heard as medical students:


Q: What do you call the muscle that turns the head?
A: Gluteus maximus


Q: What do you call a medical student inside the operating theatre?
A: A space occupying lesion


Q: What do you call two Orthopedic surgeons trying to read an ECG?
A: A double-blind study


Q: What do the ENT surgeon call a chronic sinusitis?
A: Hell on earth


(Gluteus maximus is the main muscle of the buttock)

MEDICAL RECIPE

The franchise restaurant Secret Recipe had just set up its first branch in Kuching. Some of my doctor friends joked about opening a restaurant in the future should they quit doing Medicine for whatever reason. Instead of Secret Recipe, it would be known as "Medical Recipe":

• Menu would comprise of health food only
  


• Drinks would be served on cups & glasses in the shape of syringes
  


• Instead of using aprons, waiters & waitresses would be wearing white coats (We must comply to the Ministry of Health’s policy)
  


• Dim sum would be served on Emergency Trolleys
  


• Seats would come in the form of bed pans
  


• Tables could be leveled up & down like the hospital beds, according to customers’ preference
  
  

KIA ORA

Kia Ora from the hot & blazing Kuala Lumpur. Kia Ora is hello or greetings in New Zealand's Maori Language. In another foreign language, I was told, Kia Ora actually means "What's the time?" Anyway, the heat in KL is almost unbearable & not to mention the never ending bumper to bumper jams. I wonder how I would survive here for the next 4 years. I guess laughter is the best medicine. Here are some posts which were written back in Kuching.

SAYONARA

I received my offer letter to study Oncology at the University of Malaya two days ago. It was also the dateline to reply to the Ministry of Health whether I accept the offer or not. After filling up the necessary forms & faxing them to the given number, I was told by the Ministry staff that their fax machine "sudah lama rosak". I was then given a new fax number. Obviously I wanted to know if the second fax went through. The same staff slammed the phone on me. She was annoyed that I kept calling her. It seems that the Malaysian Public System has not changed after 6 years! Anyway, I have to start packing. So, sayonara for now. Will update again from the national capital.

KUCHING HOPELESS - ONCALL TERUK

If you have read the post “Mad mad dogs working in a mad mad world”, you would get some idea about how bad it is for a doctor to be oncall in a Government hospital. It is not uncommon for us to work 36 hours a day without sleep. Before each oncall, we have to prepare ourselves mentally & physically. On top of being doctors, we also have to be iron ladies, bionic women & superheroes. Some of us are “hot” & some are “cool”. “Hot” here doesn’t mean “sexy” or “a major babe”, but the ability of a doctor (when he or she is oncall) to attract patients to the hospital or ward, like ants to sugar & bees to honey. I can be considered rather “hot”. My record as a House Officer had been 36 hours without sleep or shower (felt like a zombie, a salted fish & even a dead man walking). I had taken my lunch at 6 in the evening & my latest dinner was at 10 o’clock the next day. My good friend, LJ, is another “hot” one at the hospital, since housemanship till now. The ward is always full when she is on duty. During our last call as House Officers in the Surgical Department, she was stucked in the Operating Theatre (OT) the whole night till the next morning, assisting our Paediatric Surgeon with a complicated case (a premature baby with Tetralogy of Fallot defect if not mistaken). At the end of the surgery, LJ actually fell asleep inside the OT. If your being too “hot”, the nurses would tell you to “mandi bunga” first before coming to work (like Ramona Rahman in the movie ‘Fenomena’)- with the more types of flowers the better, to get rid of “sial”. You should also comply to certain “pantang” during oncall, like not wearing bright red or black. Red would cause you to be “hotter” & black, as we all know, is a sign of mourning. “Cooler” colours like light blue or green are recommended.

DO NOT, DO TOO

This is a conversation between a surgeon & a patient who had undergone a laparoscopic cholecystectomy (removal of gallbladder) during the surgeon’s night round…


Surgeon: (Clapping his hands) Out, out, out, all relatives out, doktor nak buat round.


Patient: (With a wet towel on his forehead) Demam la doktor.


Surgeon: (Looking doubtfully at the patient) Demam ke?


Patient: (Annoyed) Demam le. Tak nampak ke?


Surgeon: (Looking at patient’s observation chart) Missy tulis tak demam pun.


Patient: Missy salah tulis.


Surgeon: Missy! Mari sini…patient cakap awak salah tulis temperature chart dia


Missy: Patient ni memang tak demam la.


Patient: Demam la.


Surgeon: (Looking sharply at the nurse) Lebih baik awak check temperature dia ni lagi sebelum aku laser korang semua.

(Again, this is just for laugh. The surgeon is actually someone I personally feel comfortable & confident working with. Though he’s known as a “mulut laser”, he is actually quite kind hearted & works for the best interest of his patients.)

MISCALLEANOUS III

• I was giving chemotherapy to a female patient at the Radiotherapy Unit when she read what was written on my name tag (ie. Dr. Flora). “How to pronounce your name?” she asked, “Drf…Drf…Drflora, wah so difficult to pronounce one, are you Iban or Bidayuh?”

• When a patient comes in with a heart attack, there must be prompt diagnosis & prompt intervention for the best outcome. The Cardiologists always preach about “Door to balloon time” (ie. from patient’s arrival to the hospital to the time of angioplasty) which should be less than 60 minutes. Balloon refers to angioplasty. Another phrase commonly used by these heart doctors is “Time is myocardium & myocardium is time”. (Myocardium is the medical term for heart muscles) My friend WL, who is an MRCP (Member of the Royal College of Physician) candidate, complained about a particular Cardiologist, Dr. L, who is always late for teaching sessions: “Door to teaching time is more than 60 minutes!”.

• A former colleague of mine at the Accident & Emergency (A&E) Department, CSW, had a unique way of telling me she was pregnant. During our afternoon shift together, she said to me (in a serious tone), “I’ve just been to the Antenatal Clinic. There’s something growing inside me.”

• A transexual male visited our A&E once when I was on night duty. He complained of chest discomfort & shortness of breath. I asked my nurses to do an ECG (electrocardiogram) on him as he had a previous history of heart problem. While doing the test, I heard my nurses say behind the curtains, “His boobs are bigger than ours.”

• A 21 year old male was brought in to the A&E one Sunday morning after he fitted during an alcohol binging session with his friends. He was clad only in his underwear & there was a spoon in his mouth. His friends thought removing his clothing might help & the spoon was to prevent tongue-biting during seizure. We ran a number of investigations, including blood tests & an urgent CT scan of the brain, but all the results came out negative. Most likely the patient had fitted as a result of alcohol intoxication. One of the A&E Medical Assistants (MA), TBT, read my report on the patient with much enthusiasm & interest. However, at the end of it, he seemed to be interested only in one thing (ie. the underwear). “What do you mean he was clad only in underwear? You mean he was only wearing underwear ah?” he asked.

• A senior Staff Nurse at the RTU (Radiotherapy Unit) Ward told us about a funny incident that happened when she was working at the Labour Ward many years ago. A cleaner had found a pair of glasses on the floor next to a lady who had just delivered a baby. Assuming it was the patient’s, the cleaner just put it on her without asking. The doctors & nurses got panicky when the patient complained of sudden blurring of vision after giving birth. They thought it was pre-eclampsia (a high blood pressure symdrome which occurs during the perinatal period) as blurry vision is one of the symptoms. They only found out what happened after much questioning. The patient (who is from the kampung & uneducated), actually thought that every woman would be given glasses after she has delivered a baby.
  

WHERE'S YOUR WHITE COAT

The news that came out today (1 May 2007) on the front page of The Star (Malaysian Medical Association to Ministry of Health: No Neckties, please) reminds me of the many spot checks done by our Pengarah Hospital, to “catch” doctors who are “not properly dressed”. In a warm & humid country like ours, wearing white coats & neckties (especially in non-air conditioned Government hospitals) can be a nuisance. Furthermore, it is unlikely that doctors have the luxury of washing these items on a daily basis. Thus, they serve as habitats for bugs & germs, which may subsequently be transmitted to patients or family members at home. However, the Ministry of Health maintains its policy for all doctors to wear white coats & neckties, stating that there is no body of evidence to prove they actually cause infection to spread. “It is a long established policy that we have since Merdeka. Doctors must maintain their dignity & dress properly,” the DG (Director General) had said. I’ve been listed in the Pengarah Hospital’s little notebook (the 555 type) for not using a white coat during one of his spot checks at the Medical Ward. I think the notebook should be full by now, considering the number of doctors in the hospital who do not wear white coats. Here are some of the reasons given by doctors whose names are in the little notebook. (Well, except for one. You’ll find out why.)

• “My white coat is in the laundry. Haven’t got time to collect it yet.”

• “I have to perform bone marrow aspiration & prepare chemotherapy. How do you expect me to wear a white coat?”

• “I’m going to go to the OT (operating theatre) now.”

• “The DG is not here.”

• “I’m not a doctor. I’m just visiting my relative who is admitted to the ward.”

• “My white coat & necktie are still hanging on my ceiling fan at home. I tried to commit suicide last night because I’m so stressed out at work.” (said in a very sarcastic tone after the Pengarah had left)
  

JUST FOR LAUGH

10 things that you don’t want to hear your surgeon say (before, during or after surgery):

• I forgot to take my tremor pills this morning.

• I left my glasses at home, can I borrow yours? Since you’re going in for surgery & won’t be using it.

• This is my first operation on a human patient. I used to be a butcher.

• Our lab mice ate your skin graft.

• Is this a blood vessel or a nerve? Opps, it’s the ureter.

• Are we supposed to remove the right or the left kidney? Nurse, take your pick.

• Liver is on the right & spleen is on the left…or it is the other way around?

• Uh-oh

• Shall we break for 10 minutes? I need to run over to the library to get the anatomy textbook.

• We left a pair of scissors in your abdomen, I’m afraid we have to open you up again tomorrow.

(I read something similar in the Readers’ Digest before & got the idea from there. Hope there is no hard feelings from my surgical friends.)

WHO ARE YOU

I received a call from a Burmese ENT (Ear, Nose & Throat) Surgeon recently, who wanted to refer a patient with nasopharyngeal cancer for further treatment at our Radiotherapy Unit. “I’m Dr. A, the ENT Specialist from Sibu Hospital. Who are you?” he said over the phone.

Well, my name, according to the Oxford English Dictionary, means the Roman Goddess of flowers or flowers & plants found in a particular area. My Chinese name, on the other hand, is beauty & compassion. I don’t own a florist nor do I have a beauty parlour (see “A Needle Pulling Thread”) but I guess “flower, beauty & compassion” illustriates my life as a medical doctor & my enthusiasm in caring for cancer patients.

Okay, enough of babbling & blowing my own trumpet. This post is actually about funny, unique & distinctive names or monikers which I have come across since medical school.

• In IMC (International Medical College), we had a former coursemate with the initials SSG. She was teased because SSG also stands for Secondary Sex Glands & Surgical Skin Graft.

• Another classmate, SL, used to drive a car with the plate number starting with STD (registered in Tawau, Sabah) & because of that, she was known as the “STD Girl” (Sexually Transmitted Diseases). My mum actually wanted to name me Phyllis, but she decided against it because it sounds like Syphillis, which is one of the sexually transmitted diseases. I guess I really have to thank her for that. I don’t mind being called “floor” or “flour”, but I definitely don’t want to be known as Syphillis or “STD Girl No.2”.

• As House Officers, my colleagues & I have met patients who are known as “don’t know how to pour”, “a sitting statue”, “rocket the son of banana” & “Japanese sandals”. (Real names are not revealed out of respect for the patients)

• One of my ex-colleagues at the A&E (Accident & Emergency) has the initials TSS. The nurses & other colleagues gave her the nick name “Teh Susu”. “Tea or coffee? With or without milk?” was often heard at the department whenever TSS was on duty.

• A former colleague of mine at the A&E, CSW, is married to another doctor, who is a Paediatrician. One day she lamented to me that people had been calling her names (Tau Sar Pau, Char Siew Pau & even Pau Jing Tien or Justice Pau, the Chinese serials) because of her husband's surname. "Well, at least it's spelt P-A-O & not P-A-U. So it's not that bad," I tried to console her. After a long pause, she said to me sadly, "It's P-A-U."

• A 3 year old boy was brought in to the A&E by his parents one night when I was on duty. He had a common cold & was running a fever, but what caught my attention was his name, printed at the top right hand corner of the A&E Triage Form. It says “Kenu Reef”.

• Besides the “Hollywood actor of Matrix fame”, I’ve also met “football galacticos” like Figo, Beckham, Ronaldo & Ronaldinho, at the A&E.
  

LABOUR ROOM DRAMA

• When I was a House Officer at the Labour Room, my colleague AKH was using the toilet for a long time one morning. Concerned that he might be unwell or having a stomach upset, I asked him what happened. His reply? “I had a rectal delivery.”

• I was excited to hear about a twin delivery at the Labour Room. “The second twin has just come out,” one of the midwifery nurses announced. As I entered the delievery suite (hoping to see 2 newborn babies), I was horrified to find out that the second twin was not a baby but something else altogether. When a woman is in labour, she uses pelvic muscles to push the baby out. Coincidentally (or ironically), these muscles are the same as those used for passing motion, especially constipated stool. I think you can guess what the second twin was.

• The term grandmultip is used for women who have given birth 6 or more times. During my time at the Labour Room, I came across a lady who was about to deliver her 17th child. She was not merely a simple grandmultip but a super-duper-grandmultip. Our O&G (Obstetric & Gynaecology) Registrar was concerned about the patient’s health & offered her a tubal ligation after the delivery. We were all so surprised when she actually refused the procudure, saying that her husband would not be happy with the idea. Instead of persuading her further, our Registrar (who was a little annoyed) said to us, “I think we should castrate the husband.”
  

ROLE REVERSAL

Have you come ever across a dentist who talks to you & asks you questions when he or she is doing something to your oral cavity? Obviously there is no way you can answer. The best you can do is probably just a murmur or a funny sound from your voice box which you can’t even control.

I had toothache for 2 days before I saw the dentist at my hospital. It was a dull nagging pain which I tried to ignore initially but it was affecting my eating so I thought I should consult a dental doctor. Furthermore my cheek was also slightly swollen on the affected side. It wasn’t that obvious but my landlady noticed it.

After a brief history taking, the dentist, Dr. S, did some percussion on my troubled tooth as well as other teeth adjacent to it. Each tap sent a shiver down my spine. I was then sent for a few shots (x-rays) before Dr. S informed me the diagnosis.

I was having a pulp abscess (gasp) & had to undergo a pulpectomy. I thought it was only a minor problem which could be solved by just filling the tooth. I surely did not expect to hear pulpectomy. It was an unfamiliar term to me, unlike appendicectomy, cholecystectomy or mastectomy.

I have been rather obsessive-compulsive when it comes to brushing teeth. I think I do it more often than anyone I know, so how on earth did I get a pulp abscess. It was simply unjust, I was in denial.

Dr. S said she would try to do it without LA (local anaesthesia) first & if I couldn’t stand the pain, she would give me a jab. It wasn’t too long before we both realised that I required LA. My whole body tensed up when I saw the LA needle being brought near to my mouth. I held on to the arm of the treatment chair so tightly as if I was seeing a ghost in front of me. I think every muscle in my body contracted when Dr. S pierced the needle through my gum. Ouch!

For the next 1 hour, my jaw was numb & Dr. S did what she had to do. While drilling, digging & draining, she asked me about my work at the Radiotherapy Unit :)

I asked for a sick leave after the procedure ended, but Dr. S felt that I could still work since I had been given LA & there should be no pain. I was prescribed with a course of Metronidazole & Paracetamol for pain relief. Since my pain threshold is low, I changed Paracetamol to Tramadol (which contains codeine, a mild opioid).

With my jaw & cheeks still numb, I saw patients at my clinic at the Radiotherapy Unit. It was kind of weird & I actually talked funny. After a while, the LA started to wean off & I felt pain again. Tramadol made me woozy & I had to take the rest of the day off.

Back at home, I went straight to bed & slept till the next day. I think I even hallucinated due to the side effect of the drug. While the opioid got me “high”, Metronidazole caused gastric discomfort. Being a patient was definitely not a stroll in the park.

I went back to the see Dr. S a few more times after that (for follow-up treatment) before I was declared dentally fit & each time I actually felt like defaulting my appointment. Just the thought of the LA needle scares me like mad.

I still have a final check-up, which I think is already due. Dr. S didn’t give me an appointment date. She said I could just walk in to her clinic anytime, since I work at the same hospital. I think I should go. I have to practice what I preach, I really shouldn’t become a non-compliant patient.


(There is exaggeration here & there, but I hope you enjoyed this post. Dr. S is actually a highly skilled dentist & also a friend.)

A NEEDLE PULLING THREAD

• I have read on Reader’s Digest about a guy with the surname Baker who owns a bakery. There were also other examples of individuals around the world with surnames related to their careers. In my very own hospital, there is a senior surgeon with the family name “Jahit”.

• When a doctor becomes a surgeon, he or she is no longer called “Doctor” but “Mister” or “Miss”. The fiance of my colleague WL (who is in the Surgical Masters Programme at one of the local universities), would be completing his surgical training soon. “When is your fiance becoming a Mister?” I asked WL & her reply was “He has always been a Mister all his life & was never a Miss.”

• One of the Oncology Medical Officers, MM, wanted to perform a Per Rectal (PR) Examination on a patient with symptoms of prostatism, to feel for the size & consistency of the prostate gland. After positioning the patient, she realised that the patient doesn’t have an anus. He had actually undergone an operation (abdominal-perineal resection) for rectal cancer, where the rectum & anal canal were removed. This reminds me of the advice given to us in medical college by one of our clinical professors (from “Tales Out of Medical School”). “There are only two instances where you can’t perform a PR. Number one, you don’t have an index finger, and number two, the patient has no asshole.” I guess MM had a hands on experience on lesson number two.
  

CLINIC TALK – MACAM2 ADA

• One of our RTU (Radiotherapy Unit) patients was supposed to have a blood test done at the Klinik Pakar (Specialist Clinic) which is situated at a different block. She asked my Staff Nurse for direction & also the spelling of Klinik Pakar. “Is it Klinik B-A-K-A-R?” she said. I was so tickled that after the patient left, I told my nurse, “Since when is our Specialist Clinic on fire?”

• At the RTU Clinic, a female patient suddenly came into the room when I was still seeing another patient. It was rude for her to do so especially when her name was not being called yet & I was still having another patient in the room. I was about to give her a piece of my mind when she told me, “My husband asked me to jump queue because he’s very hungry.”

• All the four MO (Medical Officer) Rooms at RTU clinic are inter-connected. Once, when my colleague next door was talking to a patient, we heard her say, “Awak ok ke? Kencing bagus? Ada sakit perut?” It was quite a busy day with patients coming in to the clinic almost non-stop. Before the patient replied to the questions, my assisting Staff Nurse said, “Saya yang tak ok. Dari pagi belum kencing lagi. Perut sudah sakit.”
  

MISCALLEANOUS II

• One of the Staff Nurses from the Radiotherapy Unit was hired as a helper to take care of a patient warded at Female Medical. The patient was intubated & connected to the life support machine, thus required continuous & intensive care, including regular suction of the intra-tracheal tube. While doing suction, the Staff Nurse was spotted by a doctor at the ward, who was surprised to see a helper doing that. Though she took up the job outside working hours, she did not want her identity as a hospital staff to be known. When questioned by the doctor about her ability to perform nursing care, the Staff Nurse replied, in an Indonesian accent, “Saya Sista dari Indon, doc. Kalau suction macam ni bisa saya buat, doc.”

• A Chinese lady with psychiatric illness was seen by my former colleague at the A&E, YY, for a particular complaint. After the meeting, the patient seemed to have fallen head over heels on YY. She started sending love letters to the A&E using scented envelopes with cute stickers stuck on them. To our surprise, she actually has a good command of English & very neat handwriting. Each letter was at least 2 to 3 pages long. Once she came to A&E to look for YY when I was on duty. YY was on leave if I’m not mistaken & I had just cut my hair really short at that time. The patient approached me & I told her that YY was not around. In her next letter to YY, she wrote, “I came to A&E to look for you the other day but the trainee boy told me you were not working.”

• There have been many medical dramas on television, such as Scrubs, House, Grey’s Anatomy, Medicine Ball, Medical Investigations, ER & Chicago Hope. While Scrubs is hilarious, Grey’s Anatomy can be in a way classified as a super-soft porn. As a medical student, I used to love watching ER & Chicago Hope. But I think the best medical drama is the one we watch “live” everyday at the Sarawak General Hospital. My colleague, LJ, calls it “Kuching Hopeless - Oncall Teruk.”

• The public hospital in Brunei Darussalam is called Rumah Sakit Isteri Perempuan Anak Saleha or RIPAS for short. It is named after Sultan Hassanal Bolkiah’s Consort. A friend once told me a joke about Bruneians being afraid to go to the hospital as RIPAS also stands for “Rest In Peace After Surgery.”

• Dr. B, the Oncology Head of Department, has been working in Sarawak General Hospital for the last one & a half decade. Originally from India, she had worked in Singapore for a couple of years before coming to Malaysia. Not being familiar with the ethnic groups in Sarawak when she first arrived in the state, she was surprised to see a Kenyah (Orang Ulu) lady who was referred from a district hospital. “This patient came all the way to Kuching? Why is she so fair?” Dr. B had asked the nurses. She mistook Kenyah as Kenya, the African country.

• Once I received a call from the staff of a courier company, who wanted to send a parcel to me at my working place. I gave him directions to my clinic at the Radiotherapy Unit (RTU), which is a separate building from the main hospital block. He said he had never been to that part of the hospital, so I described to him the exact location of the RTU, in relation to the main block & other nearby structures, including the mortuary & the student nurses’ hostel. When my parcel arrived, I couldn’t stop myself from laughing. Written in large bold letters beside my name & address was “Belakang Rumah Mayat, Unit Rediotopi”.

• It is a well known fact that Government documents in Malaysia take at least 6 months to get processed. I remember the time when I first came back from New Zealand & wanted to apply for a post. I had called up the One Stop Centre (set up by the Ministry of Health to help foreign graduates with their applications) & greeted the operator good morning. Instead of returning my greeting, she barked at me with “Apa kau mau? Tak pandai cakap Melayu kah?” Well, this is Malaysian Public Service. I got my job after 6 months. A colleague of mine, LWC, has been working for the past 6 years but have yet to be confirmed in service. His documents have not been processed by the respective departements within the Ministry of Health. He had made countless telephone calls to the Ministry but was pushed from one person to another. Frustrated & almost blowing his top, he was finally directed to the “correct” person, only to find out that the officer was out attending a function ie. “Majlis Pekerja Cemerlang”.
  

MISDIAGNOSIS

• I saw a homeless man with Cardiomyopathy & heart failure when I worked at the A&E. He had symptoms of breathlessness & generalised body swelling. A good samaritan had brought him to the hospital. On questioning, I found out that he had actually just been discharged a few days back from the Male Medical Ward. The patient then showed me his discharge document from the ward. The diagnosis was written as “Vagabond”.

• Dr. PN, a local Sarawakian doctor who used to work at the A&E, is well-known for his good looks. It was not surprising that some young female patients actually flirted with him (& vice versa?). One particular day, he had seen a young lady for a certain complaint. At the end of a relatively long consultation, he had written down “Manja-litis” as the diagnosis.

• I was on shift duty at the A&E on a particular Sunday afternoon when a young lady was brought in to the Yellow Zone by her boyfriend for breathing difficulties. The boyfriend told us it was asthma. As a doctor, I could tell it wasn’t asthma by just looking at the patient. She was hyperventilating! Just before they came to the hospital, the boyfriend had scolded her for something & she got upset, thus triggering the hyperventilation. A plastic bag was given to her for re-breathing by my Staff Nurse, who then asked me what else should be done with the patient. At that moment, the boyfriend was seated on the patient’s bed & was holding her hand & carressing her face to comfort her. Annoyed that I had to attend to such a case on a Sunday afternoon & influenced by DR. PN’s previous “diagnosis”, I told my Staff Nurse, “The patient has manja-loma & she needs an urgent manja-lectomy.”
  

OPPS, IT'S A BABY!

• A lady was brought in by her relatives to the A&E’s (Accident & Emergency) Yellow (or semi-critical) Zone & was seen first by the MA (Medical Assistant). She complained of sudden onset of severe abdominal pain associated with abdominal swelling. The MA had described the patient’s abdomen as grossly distended. Upon examination by the MO (Medical Officer), the patient was found to be in labour. A quick bedside ultrasound was done & confirmed a full term-sized baby. The patient, who denied being sexually active, asked “How did it get there?”
  

• On another occasion, a thirty something year old unmarried woman was brought in to the A&E by her mother for abdominal pain & per vaginal bleeding. Like the previous patient, she too had strongly denied any sexual activity. Investigations, however, revealed an ectopic pregnancy. If not operated on immediately, an ectopic pregnancy could rupture & would then be life-threatening. The patient consented for surgery, but told the attending MO, “Can you tell my mother that I have a growth somewhere in my womb or ovary & it has to be removed immediately?”

FROM MEMORY BANK

• Back in fifth year Medical School, I was attached to Dr. MB, a Consultant Physician at the Middlemore Hospital in South Auckland. Half way through our ward round one day, Dr MB suddenly told the team that he wanted to see Mr. Brown first before continuing with the rest of the patients. I was surprised as we did not have any patient by the name of Mr. Brown. I was even more curious when Dr. MB started walking towards the cafeteria. It turned out that Mr. Brown was not a patient but coffee!

• A native lady with chronic renal impairment was admitted to the Female Medical Ward for haemodialysis work-up during my houseman time. During ward round, our Nephrologist, Dr. C, spoke to the patient, who was then sitting on the bed. Dr. C wanted to know where the patient lived, so that dialysis could be arranged at a centre nearest to her home. “Mak cik duduk mana?” Dr. C asked, and the patient’s reply? “Atas katil lah.”

• The Orang Asli patient I saw at Seremban Hospital as a second year Medical student also had similar antics. She was admitted to the ward for symptoms of heart failure. The reply to my question “Bila mak cik batuk?” was “Bila saya batuk lah.” (From “Tales Out of School”) I remember asking her also about her appetite. “Makan macam mana, mak cik?” I said to the patient, and she replied, “Macam ni lahhhhh”, gesturing to me how she eats with her hand.
  

MIND YOUR LANGUAGE

• Being English & Malay educated, I had utmost difficulty in communicating with Chinese patients, especially when I first started working in Kuching, Sarawak, where most Chinese speak Hokkien or Mandarin. My dialect is Hakka, which I don’t speak fluently. I had been called an OCBC (Orang Cina Bukan Cina) & some say I’m a “banana” just because I don’t speak Chinese well. Fortunately over the years, I’ve gradually picked up Mandarin from my colleagues, nurses & patients at the hospital. After 6 years, I can now do consultation with Chinese patients in semi-perfect but understandable Mandarin. While learning ‘more difficult’ words like “ruan chow” (ovaries), “tze kung jing” (cervix), “tan pai tze” (protein) & “suek siau pan” (platelets), I had forgotten to brush up on my pronunciation of ‘simpler’ words like “yen jing” (eyes). “Yen jing” if pronounced differently, means glasses or spectacles. My hanyi pinyin is hopeless. I guess I just don’t have the “Mandarin tongue”. So on one occasion while examining a patient at the RTU (Radiotherapy Unit) Clinic, instead of telling him to remove his glasses so that I could examine his eyes, I had told the poor man, “Please remove your eyes, I would like to have a look at your spectacles.”

• Chinese dislike the number 4 (“se”) because it sounds similar to death or dying. A former non-Chinese speaking specialist at the RTU, Dr. K (no relations whatsoever with Datuk K or Siti Nurhaliza), was seeing a breast cancer patient & her family for the first time. Both patient & family spoke only Mandarin. The patient had undergone curative surgery & was at the RTU clinic to discuss regarding further management of her cancer, including radiotherapy & chemotherapy. She inquired about the total number of chemotherapy cycles. Dr. K was trying in vain to converse in Mandarin. In an attempt to inform the patient that there would be 4 cycles of chemo, he had said, “You are going to die.” The patient was in shock & was about to leave the clinic when a Mandarin speaking Bidayuh nurse came to save the situation.
  

MISTAKEN IDENTITY

• As the Medical MO oncall, I saw a 60 something year old Chinese Aunty at the Emergency Department for recurrent fainting episodes. After a thorough examination, she was found to have no acute problem & was discharged with a follow-up appointment at the Medical Specialist Clinic. On her follow-up day, I happened to see her again. To test her memory, I asked her if she remembers me. “Ahh….yes,” she said, with a big smile on her face, “You are the Member of Parliament for Kuching.” Apparently, I do resemble the young lady politician from DAP who won in the last General Election, according to my colleagues & the nurses in the clinic.

• In the Medical Department, we have to see patients at the Male & Female Medical Ward, the Medical Daycare (situated at the 7th floor of the main building) & the Specialist Clinic. A particular patient, who received treatment at the Medical Daycare, was subsequently followed up at the Specialist Clinic. I happened to see her on both occasions. At the clinic, she told me, “You look like the doctor in 7th floor. Her name is Dr. Flora, but she is Chinese.” Somehow, I had looked like a native Iban to her on her second visit.
  

MISCALLENEOUS

• In medical school, we learnt about sexually transmitted diseases (STDs) like gonorrhoea & syphilis. During his lecture on the topic, our cheeky professor told us, “Remember, you don’t get STD from sitting on the public toilet bowl, but you might get STD if you sit on the toilet bowl with someone else.”

• During my housemanship at the Female Medical Ward, an elderly Chinese lady in her eighties was admitted for lung infection. When our senior Consultant Physician, Dr. CPH, came for rounds, he noticed there was actually a pair of crutches beside the patient’s bed. Apparently the patient used crutches at home but none of the attending doctors know about it. Dr. CPH was very upset that we did not bother to find out more about the patient’s pre-morbid condition at home prior to admission. Dr. CPH stressed to us about the importance of treating the patient holistically & not just the disease. At the end of the rounds, he said to us in a serious but sarcastic tone, “As punishment, I want all of you to talk to the patient & find out more about her. Why is she on crutches? Does she like Britney Spears? Which of Britney Spears’ songs does she like most?”

• My ex-colleague, SS, was the House Officer oncall in the Male Surgical Ward, when 2 family members (a guy & a lady) of a particular patient approached her. She was seated at the nurses’ station & was in her scrubs. “Missy, air sudah habis,” the guy told her. “Saya bukan missy….” she tried to explain. But before she could tell them who she was, the guy spoke to his female relative, “Oh…dia ni bukan missy, dia attendan saja.”

• Another former colleague, AC, whom I used to work with at the Gynae Ward as a House Officer, had similar experience. She got a lot of the “Missy, air sudah habis” (referring to the intravenous fluids) & was getting rather fed up. She lamented to me one day, “People always think small & cute girls like us are nurses…small & cute girls can also be doctors what.”

• The Medical & Surgical Departments have a combined monthly CME (Continuing Medical Education) at my hospital. It has been a well known fact that Surgeons don’t get along very well with their Medical counterparts. Once, when it was the surgeon’s turn to present, the topic GIST (Gastro-intestinal stromal tumour) was chosen. Before he began his power point presentation, the surgeon told the audience that GIST also stands for “Gut Is The Surgeon’s Territory”.

KRAZEE MEDICAL POSTING

• I was calling the Kota Bahru Hospital in Kelantan to trace some results (our bone marrows are being sent there routinely) & was connected to the Haematology Lab. The lady staff who answered the phone greeted me with a “Selamat pagi, haemoglobin lab”. Then she started laughing & told her colleagues that she had accidentally said ‘haemoglobin’ instead of ‘haematology’ before attending to me again.

• One of the HOMOs (House Officer/ Medical Officer) at the Female Medical Ward was calling Hospital Kuala Lumpur one morning to refer a case to an Endocrinologist there. She asked the operator to connect her to the Endocrine Clinic. The operator replied, “Endocrine? Nama doktor ke tu?”

• The Medical Department has a weekly Grand Ward Round with our senior Consultant Physician, Prof CPH. Once we were discussing about a young man with SLE (Systemic Lupus Erythematosis) who presented with haematological manifestation (anemia & low platelet counts). Because of the low platelet, he was instructed to have CRIB (Complete Rest In Bed) to avoid any traumatic bleeding. However, he developed spontaneous bruising/ haematoma on his right thigh in the ward. Prof CPH, with a sense of humor, inquired if the patient’s girlfriend had visited him the night before. Instead of Complete Rest In Bed, they might have had another form of CRIB ie. “Couple Rolling In Bed”.

• I was post-call & doing my morning round when a middle-aged Chinese man approached me. It was a weekend so I was in t-shirt & jeans. The man was looking for a friend who was admitted to the ward. I told him to check at the nurses’ station, which is not very far from where we were. Surprisingly, he did not move but instead spoke to me sternly, “You are a nurse, aren’t you? Why are you not wearing your uniform?”

• I was using one of the Specialists’ room to see patients at the Medical Out-patient Clinic, as the specialist himself was away. When a particular patient was called, he walked into the room with this very disbelief look on his face. He said, “The sign on the door says ‘Dr. Kalwinder Singh Khaira’. I really didn’t expect to see a small Chinese lady doctor.”

• In our Medical Out-patient Clinic, elderly patients, in particular those who are confined to wheelchairs, are given priority to be seen first. We had one such patient (an old Chinese lady) one afternoon. When her name was called, her Indonesian maid wheeled her in to the consultation room & she was also holding a walking stick. When I was just about to get up to help her, she “miraculously” stood up, put her walking stick aside & walked gustily towards the consultation table. I was too stunned to say anything, but the assisting nurse was obviously annoyed. “Wah…hebat betul aunty ini. Main tipu lah dia,” she said sarcastically. Our patient, however, did not get the message as she can’t understand Malay.

• On another occasion, the Medical Out-patient Clinic received a call from a certain Datuk, who said that he was coming for review that particular day. The staff nurses became anxious about this VIP’s visit to the clinic & started making arrangements for him to be seen ahead of other patients. Dr. Tay CL, one of our Specialists, was “chosen” to see the patient. She was not very keen about the idea, being a strong believer in treatment equality, regardless of socio-economic status. “Datuk, Datuk, what Datuk? I only know 2 Datuks….my paternal & maternal grandfathers,” she said angrily.

• During one of my oncall duties as a Medical MO, I was referred a case from the Female Surgical Ward, where I used to work before. I greeted one of the nurses there, whom I have not seen for a while. “How are you?” I said & her reply? “Still the biggest & the fattest.”

• Our hospital’s blood bank has been running dry for the past one month. As the Haematology MO, where most of my patients require blood or blood product transfusion, I try my best to promote blood donation, especially among medical staff. When Dr AF, a Cardiologist, came to our ward to see referral cases, I took the opportunity to ask him to donate blood. “I’m sorry I can’t…because I don’t have enough myself,” he replied. “Someone caused me to have haematemesis (medical term for vomiting blood) yesterday…”

VARICELLA ATTACK

This has been my longest holiday at home. Thanks (but no thanks) to Varicella zoster.

Varicella zoster. Nice name isn’t it? But unfortunately it is the bug that causes chicken pox & shingles (or “kayap” in Malay). The Chinese (Hakka) call it “Sang Sa”. In direct translation, that would be “grow snake”.

I remember having measles when I was young, but not chicken pox. About 6 or 7 years back, I stayed with 3 cousins (in Sandakan) who were having chicken pox. I was there for a month doing my Electives at the Duchess of Kent Hospital. When I got back to KK after the Electives, I developed vesicles on my face & body, which had lasted only a few days. There was no fever or other symptoms. I thought that was weird, but still possible in the case of “subclinical infection” for someone with partial immunity.

I can’t imagine I’m having a full blown disease now. I don’t remember being in contact with anyone with chicken pox recently. Even when I did before this, I did not develop any infection.

The only source that I can think of is a patient in the Male Surgical Ward. He was admitted for enterocutaneous fistula (an abnormal connection between the intestine & the abdominal wall) & stayed quite long in the hospital till he had surgery to correct the defect. He was on TPN (total parenteral nutrition) the whole time, which required him to have a central venous line (CVL).

The CVL had to be changed every 1 to 2 weeks to prevent infection. I was not the doctor taking care of him (as I was attached to the Female Ward) but I inserted the CVL for him once when all the other doctors in the Male Ward were busy. So after this one time, he would always request for me to do it instead of others. And each time, I would oblige if I wasn’t busy. One day, he developed shingles & was moved from the general ward to an isolation room. It was also time for the CVL to be changed!

I inserted the new line for him in the isolation room about a month ago. The incubation period (i.e. time of exposure to start of illness) for chicken pox is only 1 to 2 weeks, so perhaps he isn’t the source of infection after all. But having said that, my colleague Adibah, who is taking care of the Male Ward, developed the same infection just a few days after I did.

People say I’m too old to catch chicken pox at 30. Well, I know of a lady who got it at the age of 48! And my friend Adibah is just a year younger than me.

I took acyclovir (anti-viral therapy) within 2 hours of developing vesicles. I guess I was both paranoid & kiasu. For acyclovir to work, you have to start taking the medicine within 24 to 48 hours of symptoms.

2 days prior to that, I had headache, joint pains & felt feverish. I had just gotten back from Kuching then. I knew it was some kind of viral infection. A few different diagnoses came to my mind. One of them was viral meningitis. Thought maybe I had contracted it from my flight back to KK. So when the spots appeared, I was kind of relieved actually.

I received a lot of advice from friends & relatives about the do’s & don’ts when having chicken pox. These are some of the useful (?!) tips:

1) Cannot mandi
(Hah…are u sure ah cannot mandi? Die lah if like that. Some more the lesions are so damn itchy!)

2) Don’t take soy sauce as it will cause more scars. It will also darken the scars
(Errm…ya meh?)

3) Drink lots of coconut water (Apparently for “cooling effect”)
(My mum actually bought 3 coconuts on my 3rd day of infection)

4) Don’t go under the fan
(Wah so hot…where can tahan oh)

5) Drink plenty of fluids
(This one seems to be the most popular…)

6) Don’t scratch. It will cause ugly scars
(Of course I wouldn’t want that, would I?)

7) Put calamine lotion on your body
(That’s for the itch)

8) Buy lots of DVDs so you won’t be bored at home
(Haha…this is the best!)

9) Don’t eat seafood & eggs
(Why ah?)

10) Don’t take peanuts (To avoid having more lesions)
(Seriously?)

For the first week, I took shower with a certain bean plant (dried form). Like coconut water, it has the “cooling effect” & helps with the itch.

I guess the horrible thing about having chicken pox is the itch part. You just feel like scratching & scratching & scratching…. But I think I’ve done well though, with the help of anti-histamines of course. I hope this “battle” with Varicella is going to end soon & I’ll emerge the winner!

(Written in May 2006. I was house-bound for 3 long weeks.)

MEDICAL BIZZARO

• My former colleague at the A&E (Accident & Emergency), AA, was on night duty when a worried looking man came in holding something in his arms. It looked as if he was cuddling a baby. AA thought the baby might be unwell & quickly went to attend to them. AA had a shock of her life when she realised that “the baby” was actually a monkey! The man’s pet was sick but he did not know where to go in the wee hours of the morning & tried his luck at the A&E.

• On another occasion, AA was on duty when a psychiatric patient was seen at the A&E for abnormal behaviour. AA was walking past this patient, who was lying down on one of the examinations beds, when she suddenly felt something land on her blouse. AA had another shock of her life when she realised it was faeces! The psychiatric patient had passed motion on the bed, grabbed his own stool & aimed it directly at my poor friend. From that day onwards, AA always brought extra clothing to work.

• Both stories about AA actually came out in the local Chinese newspaper. Few strangers had come to the A&E to look for her to get the last 4 digits of her IC. They thought both incidents were interesting & out of the ordinary & wanted to buy 4D lottery!

• I was the Surgical Medical Officer (MO) on-call when a 50-plus year old native woman came through the Emergency Department (ED) for symptoms of intestinal obstruction & PR (per rectal) bleeding. The ED MO had examined her first & found a hard mass on PR examination. She called me to see the patient as she thought it might be a rectal tumour. The “tumour” turned out to be 20-odd rambutan seeds clumped together at the rectum & causing obstruction. The patient had taken the rambutans 2 days before. According to her, people in her kampung normally eat rambutans together with the seeds. I had the “honour” of manually removing the seeds from the pateint’s back side.