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.
  

MAD MAD DOGS WORKING IN A MAD MAD WORLD

• I was oncall at the Male Medical Ward during my first year as a House Officer & was having a really busy night. The staff nurse woke me up at 5.30 in morning to review a patient who had just been admitted. I had just gone to bed for less than half an hour & felt really groggy. I must have looked horrible because the first question the patient asked me was, “Are you okay?” & he was having a heart attack at that time!

• SSH, a colleague & a good friend of mine, was seeing patients at the Gynae Clinic when she was post-call one morning. She was so tired that she actually fell asleep while talking to a patient. She woke up only when her forehead fell onto the table.

• On another occasion, SSH had written her own name on the “Patient’s name” column of the discharge summary meant for a lady who had just delivered a baby.

• On at least 2 occasions, I’ve written my own name as the “Procedure to be performed” on the Operation Consent Form.

• I was on-call with a new Medical Officer, CY, when a patient in the Male Surgical Ward suddenly collapsed in the middle of the night. We resuscitated him for an hour & managed to revive him. Unfortunately, about 2 hours later, he succumbed to his illness. That was around 4 o’clock in the morning. We were all very tired. CY was writing the Death Certificate when he suddenly jumped up and startled everyone…...He had written his own name as “The Deceased”.
  

MORE MEDICAL JOKES - KISAH BENAR

• During my attachment at the Oncology Unit as a Medical Officer, I saw a lady in clinic who came for her yearly follow-up. She told me that during her last visit she was seen by another doctor who looks like me. As I examined her, she gave a description of that doctor. I was smiling all the while, as I was the one who saw her the year before.

• Another patient, at the end of my consultation with her, said that she wanted to ask just one more question before leaving. Preparing myself mentally for her high-tech and scientific question (or so I thought), I was really surprised to hear what she had to ask: “Can you call my son? This is his phone number. He is still single,” she said, as she handed me a piece of paper.

• It was also at the Oncology Clinic where I saw an Indonesian lady who came all the way from Pontianak, Indonesia for her follow-up. She had previously completed treatment for cervical cancer and was in remission. It took her eight hours of bus ride to get to our General Hospital from Pontianak. When I instructed her to remove her underpants so that I could do a vaginal and speculum examination, I noticed that she had removed one panty after another. I was so curious that I had to ask her why. The nurse assisting me at the time was also very keen to hear her explanation. We managed not to laugh until the patient had left. We thought her reason did not make sense: “It is a long journey from Pontianak and there is no toilet in the bus, so I have to prepare myself just in case I need to pass urine.”

• It is a routine for patients in the Male Cancer Ward, where I worked, (situated on the second floor of the unit) to be called over the intercom to go for radiotherapy treatment in the ground floor. Everyone was amused, however, when three particular patients were called one afternoon: “Jus, Mangga, Redy, sila turun ke bawah.”

• As medical staff, we often use certain terms to describe colours, like jaundice for yellow, anaemic for anything which looks pale and cyanosis for blue. If someone says that a pen is anaemic, it means that the ink is faint. The nurses at the Male Cancer Ward found it rather amusing when one of the doctors who worked there before, wanted to borrow a red pen one day. She had asked, “Anyone has a blood pen?”

• A patient in the Male Cancer Ward was required to go for a chest x-ray one day and was informed by the staff nurse about it. “Pak cik kena pergi tangkap gambar,” said the nurse. Upon hearing that, the patient asked to be given a few minutes- so that he could go comb his hair first!

• During one of my night duties, everyone became “awake” at 3 o’clock in the morning when a young and sexy Indonesian pub singer, clad in an “ultra-mini” skirt, with leather jacket and knee-length leather boots, walked in to the A&E (Accident and Emergency) complaining of abdominal pain. As she took a seat opposite a 70-year-old uncle who was having nebuliser for his asthma, one of the nurses said, “We better keep an eye on the uncle, just in case he develops a heart attack."

• A psychiatric patient was brought in to the A&E one day when my colleague Khaira (a non-turban wearing Punjabi) was on duty. Her family members complained that she was being verbally and physically aggressive at home. Before Khaira could interview the patient, she took one look at him and asked, “Awak Shah Rukh Khan atau Rahul?” Khaira tried to ignore her question, but then she asked again (this time in a much louder voice), “Awak Shah Rukh Khan atau Rahul? Cakap!” When my colleague said he was Shah Rukh Khan, the patient promptly got up from the examination bed and started singing a Hindi song.
  

BUNGY BABY

The Labour Ward is where most of the action and excitement takes place. It is a busy place where everyone- doctors, nurses, midwives, and medical students included, is kept on their feet most of the time. It is not exactly a place I would like to be at, but I had no choice when I was on-call during my second posting as a houseman.

I was on-call on Merdeka Day, 31st August 2001. It was an extremely busy day. Pregnant ladies kept pouring in to the Labour Ward, one after another. I had lost count of the total deliveries that day. All the babies seemed to be so eager to come out of their mothers’ wombs and be tagged as “Merdeka Babies”. Even premature ones could not wait another day.

My most interesting, or should I say worst, experience at the Labour Ward happened when I first started at the department. My colleagues call it the “Bungy Baby” story. A native lady in her second pregnancy was brought in by some relatives one night when I was on duty. She did not speak Malay well and I had difficulty communicating with her. The relatives left early. I knew that was not a good idea.

She looked very comfortable so I decided to clerk her first before doing a vaginal examination. She was not a very good historian, but I managed to gather that she was not having regular and strong contraction pain. Her face was somewhat “masked-like” and expressionless, so that made it difficult to tell whether she was in pain. But I then proceeded to do a vaginal examination quickly as I noticed changes on the cardiotocogram. The baby’s heart beat was occasionally falling from the baseline.

I was horrified to find that her cervical os was almost fully dilated. I told her not to push before I dashed off to grab a wheelchair, to get her to a delivery bed as soon as possible. As I wheeled her into the room, I reminded her repeatedly not to push yet. She had kept a straight face from the moment she walked into the Labour Ward with her relatives, and had not uttered much.

The worst happened as we reached the delivery bed. The pregnant lady was still on the wheelchair, remaining silent. Two midwives were around. I heard one of them said aloud, “Oh, shit.” Something had dropped. I was stunned for a moment, before saying “Oh, shit” myself. I froze for a second or two, before I could act accordingly. The baby had come out, and almost dropped on the floor, if not for the umbilical cord, which was of just the perfect length. Our patient remained calm.

I felt very bad after that, but I had refused to take the blame entirely. I was haunted by paranoia for the next few days. The very sight of a pregnant lady sent shivers down my spine. I did vaginal examination on all patients who came in with the slightest sign of labour. There was not going to be another “bungy baby”!

MEDICAL BLUNDERS

• My friend’s colleague was doing his Orthopedic rotation as a house officer when he was asked by his specialist to take consent from a patient for a below knee amputation. The Orthopedic surgeon later had a surprise when he saw (on the consent form) “Balloni amputation” as the procedure to be performed.

• A similar incident also happened to one of my colleagues when he was a houseman in the Orthopedic Department. He was jotting down the management plan for a patient during an early morning ward round. The patient was supposed to have surgery later that day and intra-operative imaging (I.I.) was to be performed. The rest of the team had a good laugh when they realized what was written on the patient’s case note: “Patient for eye-eye.”

• My ex-roommate and colleague once told me about a houseman in the Orthopedic Ward, who is either colour blind or was seeing colours when he was on-call one night. He was clerking in a patient who was involved in a road traffic accident (RTA). In the patient’s case note, he had documented down how the incident took place: “RTA happened when patient could not stop in time when the traffic light turned blue.”

• After assisting in a bowel surgery as a house officer, my friend LJ was responsible for filling in the forms and taking the specimens (which included part of the small bowel and a piece of the large bowel) to the lab for urgent examination and reporting by the pathologist. When the report came back, it was stated that the small bowel specimen had gone missing. Only the large bowel was examined. LJ went searching high and low for the lost item, but to no avail. Furious, LJ had written this down on the patient’s case note: “COULD NOT FIND SMALL BOWEL. NOT IN OPERATING THEATRE. NOT IN LAB. MAYBE SOMEONE STOLE IT TO MAKE KUEH CHAP.”

• When LJ was a house officer in the Gynae Ward, a patient with infected Bartholin’s cyst was admitted for treatment in the form of marsupialisation. In the patient’s discharge summary, LJ had drawn a diagram to show where the cyst was situated. Our ward Sister was horrified to see the completed summary. In an attempt to make the diagram look ‘more real’, LJ had added on some pubic hair!

• A thirty something year old lady was admitted to the Gynae Ward for a diagnostic laparoscopy when I was a house officer there. She was married for 5 years but had no children. During rounds, my specialist Dr. NSE had informed the patient that the laparoscopy and earlier investigations did not show any abnormality on her part. Dr. NSE inquired if the husband could come to hospital to have his seminal fluid tested. She asked in Malay, “Suami kamu boleh datang untuk check air manis?” At that point, I heard my colleagues and some of the nurses giggling at the back. One of them whispered, “How does she know it’s sweet?”

• When we first joined the Labour Ward as house officers, we were warned by our seniors and the midwives not to stand too near to a woman in labour to avoid “mandi liquor”. One of our colleagues JS, a Punjabi, had a ‘hands-on experience’ of “mandi liquor” when he stood at the wrong place at the wrong time. He had to go back to change as he was drenched from his turban down to his feet!

• My colleague CGS is one of the most blunt person I know. Once when I was working with him in the Female Surgical Ward as House Officers, a patient was admitted for acute appendicitis. She was a fairly plump woman in her late twenties. CGS had assisted our Medical Officer in the appendicectomy. The next day during ward round, he had told the patient, “Wah, kamu banyak gemuk lah. Susah oh operation. Kami kena pakai cangkul untuk cari kamu punya appendix.”

• CGS also has the most unique way of asking questions. When another patient was admitted to the Female Surgical Ward for suspected acute appendicitis, he was responsible to clerk the patient in. In female patients presenting with acute abdomen, it is harder to make a diagnosis (as compared to men) as the problem could be arising from the reproductive organs. Gynaecological causes such as ectopic pregnancy or twisted ovarian cyst need to be ruled out. CGS was trying to find out whether the patient was sexually active or not. A staff nurse who was nearby could not believe her ears when she heard him ask the patient, “Ada ular pernah masuk tak?”

• A 14 year old boy was admitted to the Male Surgical Ward for perforated appendicitis when we were House Officers there. He underwent emergency appendicectomy. Post-operatively, he was kept NPO (nil per oral) & given Normal Saline & Dextrose drip. The following day, he requested for his drip to be changed to “Soya Bean” like the patient at the next bed. We had a good laugh when we realised what he meant was actually parenteral nutrition.
  

TALES OUT OF MEDICAL SCHOOL

• During our first year of Medical studies at International Medical College (IMC), we were taught by our professor, Dr. PJT, that one of the investigations needed for the diagnosis of a particular disease was a “namby pamby CT Scan” (which I think, in plain English, means “the same old CT Scan”). When the question came out in our semester exam, a number of us in the class (myself included), being ignorant at that time, actually wrote down the answer exactly as what we were told, i.e. “namby pamby CT Scan”.

• As a second year medical student, I was asked to take history from an “Orang Asli” patient during one of our weekly visits to our teaching hospital in Seremban. She complained that her body had swollen up and she was having occasional cough. “There, like her,” she said, as she pointed to a fairly plump nurse who happened to walk past us. “When do you cough?” I asked, hoping to identify aggravating factors which brought on the cough or made it worse. I was amused to hear her answer, “I cough when I cough lah.” She sounded annoyed.

• During one of our weekly visits to our teaching hospital as third year medical students, my classmate KT was assigned to take history from a Malay lady who could not speak or understand English. The patient was admitted for abdominal pain and distension. The conversation was going on quite smoothly in Malay until a point where KT wanted to find out if the patient has passed wind or belched. She couldn’t think of how to ask the question in Malay so she said, “Ada ‘urgh-urgh’ dan ‘put-put’?”

• On another occasion, KT was instructed by our clinical tutor, Prof JW, to listen to a patient’s heart sounds. With enthusiasm and confidence KT took out her stethoscope and listened carefully to the patient’s chest. With a worried look on her face, she informed our tutor that the patient did not have any heart sounds. Everyone had a good laugh when we realised that KT had the stethoscope earpiece the other way around!

• KT also had a tendency to doze off in class. She had tried to chew bubble gum to keep herself awake, but it did not work. One day during Clinical Psychology class, our lecturer, Dr. Caroline Logan, suddenly stopped lecturing, walked up the steps in our lecture hall to where KT was seated and whispered something into her ears before continuing lecture again. The whole class was curious, but we managed to ask KT about it only after the lecture had ended. Dr. Logan had told her, “Next time, please drink a cup of coffee before you come to my class.”

• Dr. Paul Jambunathan was also another lecturer who taught us Clinical Psychology in medical college. He was a funny guy with a great sense of humor and was always “young at heart”. (I think he probably still is) During one of our first few classes with him, a classmate interrupted the lecture to ask a question. “Excuse me, Sir…” our friend said, raising his hand so as to be noticed. But before he could ask his question, Paul interjected and said, “Don’t call me Sir. You can call me Paul or you can even call me Jambu, but pleeeeeease don’t call me Sir.”

• One of the lecturers who taught us Anatomy was Dr. NBR, an expatriate from India. With a heavy Indian accent, he would teach us about the “spinal kard” (spinal cord) and the various “argans” (organs) in the body. During one of his classes, we were interrupted by a staff from the administration office, who came to inform Dr. NBR that his wife was on the phone. We were both surprised and amused when he replied, “Which one?”

• Dr. DP was a visiting lecturer who came all the way from Scotland for our Genetics module. On the first day, he proudly announced that he had just learnt his first Malay word and greeted all of us with a “Selamat Paji”. Every morning, without fail, he would say “Selamat Paji” to us before starting lecture. This went on for about a month before we decided to tell him the correct pronunciation.

• Dr. KK was another visiting lecturer from Scotland, who came to teach us Respiratory Medicine. He was tall, fair and quite handsome. Some of the girls wondered if he was married. During one of his lectures on Power Point, he showed us a picture of a small Caucasian girl in between his slides and proudly announced that it was his daughter, who was celebrating her birthday that particular day. A majority of the class responded with “Oooh”, “Ahhh” and “How sweet”, and then there was a huge “Sigh” coming from the back row (a female voice obviously).

• I had written an article about Princess Diana shortly after she and her companion Dodi Al-Fayed died in a tragic car accident back in 1997. It was published in the tabloid “The Sun” with the heading “In Mourning of Princess Diana”, along with my passport size photograph just next to the heading. One of our clinical tutors at medical college, Dr. Jag, had pasted the newspaper cutting on the students’ notice board. A senior approached me a few days after that. She said, “I was so shocked to see your photo next to the words ‘In Mourning of’. I thought you died. Thank God you’re okay.”

• One of the mnemonics which I can recall from our medical college days is “Caroline Logan has a Great Sexy Body” (for the different dermal layers in the skin i.e. Stratum Corneum, Stratum Lucidum, Stratum Germinativum, Stratum Stellate and Stratum Basale). Dr. Caroline Logan (as mentioned earlier) was one of the lecturers who taught us Clinical Psychology.

• Our college newsletter, “Med About U”, was produced once every two months by the Students’ Editorial Board, with Dr. Caroline Logan as the advisor. Different lecturers were being interviewed for each edition. One of the routine questions was “Why do men have nipples?” I particularly liked the answer given by our Deputy Dean at the time, Dr. Ong Kok Hai: “I suppose it’s the same as why women have nipples. But it is what is behind the nipples that is important.”

• In medical school, we learnt that a complete abdominal examination includes checking the genitalia and doing a PR (per rectal) examination. PR (or DRE for Digital Rectal Examination) involves putting the right index finger into the patient’s backside, mainly to feel for any mass and to examine the stool. “It is a sin to not do a PR on patients with gastrointestinal symptoms,” one of our professors in IMC once told us. “There are only two instances where you can’t perform a PR,” he continued, “Number one, you don’t have an index finger, and number two, the patient has no asshole.”

• I have always received comments about being ‘under-sized’ for my age. While I was studying in New Zealand, where everyone is much bigger in size than me, I was always mistaken for being younger than my actual age. On the first day of my Surgical attachment as a fifth year medical student, I was called to the operating theatre to assist in an operation. There, I met my supervisor for the first time. He was already at the table half way through the procedure. After gearing up for the surgery, I approached the table and greeted him. He looked at me and said, “Oh my God! That is the smallest pair of hands I’ve ever seen.” During an End of Year Formal Dinner at the end of my final year, as a 24-year-old, I won myself a “Paediatric Award” – for being mistaken as a child of a Chinese patient at the hospital!

• As a final year medical student in New Zealand, my classmate WY who was also my housemate at the time, assisted her O&G (Obstetric and Gynaecology) Registrar in a hysterectomy. Before the procedure began, WY was given the opportunity to practise inserting a urinary catheter for the patient. At the end of the operation, one of the operating theatre nurses noticed that the urinary bag was filled with blood instead of urine. WY had accidentally inserted the urinary catheter into the wrong orifice!