Sunatinib: the way to go

A drug representative from a particular company was promoting her product to us recently (a targeted therapy for the treatment of renal cell carcinoma & gastrointestinal stromal tumour).

"Targeted therapy is the way to go from now," she said.

If Sunitinib is the targeted therapy for the above mentioned malignancies, perhaps Muslim children in the future can just take a similar kind of drug & avoid going through the anguish of circumcision?

New specialties

Coverlogist: a doctor who covers people on a daily basis (ie. colleagues who are on frequent MC or EL)


Locumologist: an underpaid doctor who does locuming after working hours


Paktologist: a casanova doctor who is caught courting a nurse at the back stairway of the hospital building

GHKL: free promo

Welcome to the Gym of HKL: no need to pay a single cent, in fact you get paid for all the workout, weight loss guaranteed.


Triceps, biceps, abs: CPR on patients
Power grip: winding patient's bed up & down
Step reebok: going up & down the staircase
Blood circulation: walking from ward to ward, clinic etc
Weight loss diet: oncall food

IS THAT A GREEN WORM IN THE SINK?

IT'S CACING PITA

HEAD & NECK CT

A colleague of mine was preparing for a presentation on head & neck tumours. He was searching for CT scan images on the internet & came upon the image shown above. The anatomy seemed rather peculiar, very odd in fact (unlike normal adult anatomy). It wasn't too long before my friend realised that he was in a veterinary website & the image he was looking at actually belonged to a german shepherd.

BACK TO SOUTH POLE

Will be returning to the "south pole" aka "mad house" aka "hell of KL" in 2 months time, but am already feeling the stress & tension.

The only good thing about going there is that we can lose weight easily without doing exercise, as work is so hectic that there is no time to sit down & have proper meals. On my previous 2 rotations there, my weight was down to 38kg. But I have since gained back the weight that I lost.

My colleagues & I were discussing yesterday & we concluded that we'd rather be "fatter" than to go back to the "mad house"...

DARK AGES

When I arrived at work this morning, I saw my staff bringing 2 torchlights to my consultation room. Curious, I asked, "Why need 2? 1 is enough lah...I don't need 2 torchlights to look at patients' throat."

The reply I got?

"Doctor, these are not for looking at patients' throat. The light in your consultation room is out."

US of A?

I normally have my morning drink at the clinic while waiting for our clinic assistants to sort out files for patients scheduled for the day. I can't help smiling to myself one particular morning when I overheard the following conversation between the 2 clinic assistants:

CA1 (much older but new to the department): akak rasa patient ni takkan datang klinik hari ni pasal dia dah pergi Amerika..

CA2 (younger but has been in the department much longer): macam mana akak tau patient ni pergi Amerika?

CA1: tu...ada orang tulis kat file patient "pergi US"

CA2: ohhh.....yang tu bukan lah....pergi US maksudnya....pergi UltraSound

ABOUT SEVENTH SENSE & FOUL WORDS

6 September 2009: Day 7 of passive call

12am:

A&E MO called...there is a private wing patient who needs admission..

Advised the MO to call the private wing (as I'm oncall for non-private patients only)

12.20am:

Can't fall asleep

Got a feeling the A&E MO will call me back & tell me there is problem admitting the patient to the private wing

12.30am:

The A&E MO called back...

Private wing not accepting patients after hours

12.40am:

Drove to hospital

12.45am - 2am:

Attended to the very ill patient

Informed poor prognosis to family

Instructed night staff nurse what to do

2.30am:

Drove home

Got a very bad feeling patient won't last the night

5.20am:

Staff nurse called

Patient succumbed to illness

5.30am:

Drove back to hospital to certify the death

Parked at carpark nearest to my department

(designated to admin staff actually but usually empty after hours & on weekends as they don't come in for work)

7am:

Ward round at male & female wards

9.30am:

Did discharges (online computer system)

10am:

Computer crahsed on me

Discharges (including 1 with long standing history & prolonged admission) all gone

!!?$^&*#@

10.30am:

Staff nurse asked: macam mana doktor, nak buat lagi ke? tapi computer masih crash lagi

10.35am:

Decided to just go home

While walking to the carpark, got an extremely bad feeling that my car might be clamped

(coz it happened once before)

10.40am:

Noticed an odd looking yellow metal crap at one of my front tyres

!!?!@!#@

Called the security office immediately

11am:

Waiting for security to come & unclamp my car

Took photos of the other 2 unclamped cars nearby (with stickers similar to mine, indicating that they belong to doctors)

11.15am:

Security guard came (without key)

Was told I need to go to their office to settle some paperwork & bayar saman

?!!!!$%^&#

11.20am:

Refused to go

Refused to pay

11.30am:

Security guard went to get key

Second warning issued

!!?!?@!!#

12pm:

Arrived home

GCS (Glasgow coma scale) 3/15

Prayed hard no one calls me till 8am the next day

FEMALE BRAIN

A friend recently commented that she's been studying for the last 25 years. Wah...that long meh? 2 & a half decades, that's crazy. Well, that was my initial response. But when I thought about it again, ohmigod...I have also been studying for the same amount of years.

I recently dreamt something pertaining to thyroid, after I read about thyroid cancer. In the dream, I was giving advice to a friend who came to my hospital for a thyroid problem. It didn't surprise me though, as I often dream about things that I encounter at work or things that I read. But it does appear that my brain still actively works even when I'm asleep. No wonder it is difficult to get up in the morning...

Today, I'm reading about brain tumours. I was searching the internet for some info & stumbled upon this....

A man went to the doctor's. The doctor came in and said, "Well, I've got some good news and some bad news."

The patient sighed, "Okay, give me the bad news first."
"The bad news is that you have an inoperable brain tumor."

The patient looked very grave, and asked, "And what are the good news, anything to help me with the brain tumor?"

"The good news is our hospital has just been certified to do brain transplants and there has been an accident right out front and a young couple was killed and you can have which ever brain you like. The man's brain is $100,000.00 and the woman's brain is $30,000.00."

"I'm glad to hear there's something you can do to help me," the man replied, "But, out of curiousity, why is there such a big difference in the price of male and female brain?"

The doctor replied, "The female brain is used."

CLINIC JOKES

• A cardiothoracic surgeon is married to a neurosurgeon for many years but childless. They sought help at the fertility clinic. The problem was soon identified: they are so busy that the only time they meet each other is at the fertility clinic.
• A trauma surgeon had been so busy in the hospital all this while, trying to save lives even in wee hours of the morning, that he did not know what to do after retirement. He was heard saying this to an ex-colleague: it's only me & my wife at home, I really don't know what to do.

IT’S WRITTEN ON YOUR FOREHEAD

It's my habit to browse through patients' files to get a rough idea of their background, illness and latest blood tests or imaging studies, before calling them in to the consultation room. This is my encounter with a patient whom I saw for the first time:

Patient: (entering the consultation room) Good morning, doctor...

Doctor: Good morning, teacher...(smile)

Patient: (shocked & turned pale) How do you know I'm a teacher?

Doctor: It's stated in your file..

Patient: (so relieved) Ohh...I thought I have the "teacher look"

Doctor: (LOL)

NINETY NINE

Recently I went to another ward to see a patient who was referred to Oncology. When I arrived, the patient (an 80 over year old Chinese aunty who speaks only Cantonese) was being examined by a medical student, in the presence of 2 other medical students & their clinical tutor.

Medical student: (listening to patient's chest) Aunty, breath in & out...

Patient: (staring blankly at medical student, obviously not following the command)

Medical student: Aunty, say 99

Patient: (same as above)

Medical student: Aunty! Say 99

Patient: (still same as above)

Medical student: (shaking her head & turning to clinical tutor) Patient not co-operative

TOP 10 REASONS FOR EMERGENCY LEAVE

1. Maid ran away
2. Train new maid
3. New maid ran away
4. Kad ATM patah, need to go to bank
5. Grandmother died (for the third time this year)
6. Ran over a cat, need to send car to carwash (to remove evidence)
7. Tap burst, house flooded
8. Kad ATM baru sudah ready, need to go to bank again
9. Car window jammed, can't wind up
10. Maid came back, pregnant

Some are genuine, some are not. Obviously some are made up by me.

No. 6 happened to me last year...I ran over a cat in front of the Emergency Department on my way to work on a Saturday (passive call). But I sent my car to the carwash only after I have finished my ward rounds. It took me a week to recover from the trauma of killing a cat in this manner.

No. 9 also happened to me on new year's eve of 2008. It was early in the morning when I had just arrived at the hospital gate. I did not take emergency leave but sent my car to the workshop for repair & then came back to work as usual. That was definitely a reminder that my "milo tin" (kancil) is getting old & need to be replaced in the near future...

ROLE REVERSAL - AHHHCHOOO

I have had allergic rhinitis for as long as I can remember, usually triggered by

• Dust


• Pollen


• Cold


• Hot/ stuffy environment

Most of the time, the symptoms are short-lived. But it has recently gotten worse, partly due to stress at work & partly due to my neighbour who smokes like a chimney.

There are 4 areas at my workplace that I cannot stand:

• Ward (too hot)


• Clinic (dusty air-cond)


• Radiotherapy planning room (too cold)


• Oncall room (dusty air-cond again)

That will be like.....my entire department! Prevention is better than cure, but I can't be not going to work, right?

Went to see the ENT specialist & had scope done (ahhhchooo). I dread having any foreign body in my airways as it will always trigger a reaction. I still remember sneezing whole day after having nasal swabs taken from both my nostrils before my trainee internship (final year) in Waikato Hospital in New Zealand. I had no choice as it was compulsory for all final year students.

Anyway, I am now being diagnosed as having severe allergic rhinitis associated with severe bilateral turbinate hypertrophy (the ENT doc calls it "kissing turbinates"). The pic shows only 1 of the enlarged turbinates.

The symptoms are better with nasal steroid spray & anti-histamine, but the turbinates are still "kissing" each other. To put it crudely, it's like having 2 marbles stucked in the nose :p

I have been advised to have the "marbles" removed for long term relief.

MERDEKA FOR NOW

I'm finally out of the "south pole" after 6 gruelling months. Will be putting up a few delayed posts.