YOU KNOW YOU'RE GETTING OLDER WHEN...

Scenario One....at radiotherapy review session

Patient: (who is in his twenties) doctor, are you married?
Doctor: (this boy really got nerves, does he know how old I am?)
Patient: Doctor, if you're not married yet, maybe you can consider my uncle



Scenario Two....at clinic counter

Doctor: (receiving a parcel from a despatch boy) ok lepas sign kat sini, apa lagi kena tulis?
Despatch boy: Kalau doktor muda lagi, I akan mintak phone number...tapi tak payah lah



Scenario Three....at another ward to see a referral

Doctor: (searching for a middle aged malay lady in bed 23....but noticed that it is an elderly Chinese lady occupying the bed)
Doctor: (went to ward counter & asked the clerk) mana patient XYZ yang sepatutnya berada di katil 23?
Clerk: Mana ada, doktor? Memang patient ABC yang duduk katil 23. Ward ni takde patient nama XYZ...
Doctor: Is this Ward 7C?
Clerk: Ini Ward 6C la

Sleepless in UM

A drug rep turned friend recently asked me about my blog over lunch. He said I haven't been active in here lately. Well, at least he didn't say that my blog is full of cobwebs. Anyhow, I decided to just drop a few lines. Weird things have been happening to me and around me lately that I thought maybe the ghost month hasn't ended yet.

• Came to office on a weekend to do some paper work and noticed all my patients' files were missing from my room
• Couldn't leave office after work is done because a bulldozer was blocking my car
• Couldn't get an urgent MRI (magnetic resonance imaging) eventhough it was urgently needed and patient was willing to pay the extra charges
• Heard noices outside the oncall room at night but nurses said there was no one around
• Oncalls are becoming more and more "jonah" with unexpected things happening
• A medical officer calling a support staff weirdo (I do not condone to this of course)
• A support staff calling a registrar the most troublesome person she's (the support staff) ever met (WTH)

and the list goes on....

My friend will probably freak out reading this and will never ever ask me to update my blog again, haha...

6 weeks appointment

Usually appointment is given 6/52 (6 weeks) after radiotherapy for doctor to review. I suppose this is a special case where patient is required to return after 6 weeks to review the doctor.

now hospital also got ah long

(This notice was found in a hospital compound somewhere in East Malaysia)

practise what you preach

My friend, a physician, was counselling a patient with chronic alcoholic liver disease to stop drinking alcohol during one of her weekend rounds. At the end of the counselling, while my friend was walking away from the patient's bed, she realised that she was wearing a t-shirt similar to that in the photo above...

Leftie for a day

Since young, I've always like to look at people who are left-handed. They are unique & mysterious & tend to be very artistic. Secretly I wished that I was left-handed. My wish came true on Monday when I injured my right wrist while driving back from a friend's house after dinner the previous night.

It felt like something "snapped" suddenly, only that I didn't actually hear any "snapping" sound. There was sharp shooting pain at the wrist, radiating to the elbow & fingers. I manage to drive home that night & to work the next day, using mainly my left hand as any pressure to the right side brought back the sharp shooting pain.

At work, I had problem writing prescriptions & on patients' case notes. Therefore I had to resort to using my left hand, even when examining patients. It sure felt weird & awkward to examine patients using left hand, including a per rectal examination!





The pain subsided the next day without any pain killers or anti-inflammatories. But there is still a dull ache on & off....perhaps it is time for another role reversal. Let's see....which Orthopedic colleague should I bug?

a great achievement

Got this on facebook (from Dr. LJ of SGH)

Had a patient with difficulty passing motion because of immobilisation due to back pain. So we started him on pain relief, lactulose and bisacodyl. Some days later, patient got better and it was obviously reflected in the House Officer's entry:

"Yay! Patient can finally BO."



*BO= bowel open

HOW TO SULK

Sulking is emotional strike action. You still function as a human being but you work to rule. You must never agree to anything, you must only ever acquiesce to things. When someone asks if they should put the kettle on, the correct answer is, "If that's what you want do to." That's because the underlying message for all sulking is that deep hurt is being felt because the other person is utterly selfish.

The big dilemma with sulking is whether you should slope off to another room and do it. Remember that out of sight is out of mind, and they might forget that you're in a mountainous sulk. The best solution is to stay in the same room but pretend other people are not there.

Eye contact is a big no-no for sulkers for two reasons: firstly, no eye contact is the clearest possible sign that a major sulk is under way; secondly, if someone were to do anything funny or loving and you were to see it, you might inadvertently smile and the sulk would be irreparably damaged. It's a cast-iron rule that once you've unsulked you can't then resulk. It's like frozen food - once you've defrosted you can't then refrost.

Sulks can last anywhere between seven minutes and seven years. Teenagers are in an almost perpetual sulk because they are in a continual state of being misunderstood. When people are in a sulk they discover how much harder everyone else has to work to humour them. Some people enjoy this so much that they decide to become permanently grumpy.

The sulk, like the trifle, is a peculiarly British thing. That's because it's the form of emotional expression for people who don't know how to express themselves. The sulk says, "I can't express myself, so I'm not going to express anything and you'll just have to guess what I would have expressed had I been able to express what I wanted to express."

The sulkee then has to decide their response to the sulker. Ignoring the sulk is like ignoring the laundry basket - it'll keep building up until it gets very unpleasant indeed. What's generally required to end a sulk is a mixture of complete attention, physical reassurance, brief subjection to verbal sarcasm, and then major admission of guilt and selfishness.

As the air clears it's absolutely vital not to say, "That was a big sulk, wasn't it?" This is the quickest possible way of launching the world's largest, longest and deepest sulk.

(Adapted from The Guardian, Saturday 16 March 2002)

Doktor Adik

While most Chinese aunties think I'm in my 20's, one particular patient (a 16 year old boy) at my old hospital actually thought I was younger than him! I grew up watching the series Doogie Howser MD but I didn't think my young patient is old enough to have watched that show.

I knew something was amiss when during ward rounds he kept addressing himself as "abang" and called me "adik", but because I was his doctor, I became "Doktor Adik".

He was finishing chemo when I left the hospital & I never got to tell him that doktor adik is actually doktor kakak. But I guess some truths are better left unknown :)

anywhere also can

when there is no parking, anywhere also can...

Reversed role

I was feeling awfully sick last weekend. Urrgh, I hate it when the role is reversed, ie when I become a patient. I don't know what I salah makan that caused this bad AGE (acute gastroenteritis). It was unlike the usual AGE that I get (abdominal pain, diarrhoea), this time there was also athralgia, myalgia & fever that made me totally debilitated. ECOG performance status was down to 3 (in bed > 50% of the day).


I had no appetite to eat at all, even the smell of food made me feel nauseated. Took MC on Monday but went back to work on Tuesday. Thank God I recovered pretty quickly with regular Paracetamol & plenty of fluids. Appetite is now back to normal, but not sure if that's a good thing or not :)

how old are you doctor: another deja vu

Chinese aunties just love to ask this question. Years ago, I would have felt offended, but I think I'm getting used to it now. In fact, I enjoy seeing the surprised look on their face (eyes open wide & jaw drop) when I say that I'm in my mid-30's.

Most of them guess that I'm in my mid to late 20's. Not bad. I take that as compliment...and I would always flatter them back by saying that they too look more youthful than their actual age. It's part of doctor-patient bonding :)

I'M NOT OKAY: A DEJA VU

Although I work at UOK (unit onkologi klinikal), I'm not okay. I dread going to work everyday. Don't get me wrong, I love my job, but I just can't stand the cold environment in my department.

Some ENT doctors describe allergic rhinitis as hell on earth. I know exactly what they mean, especially if I've forgotten to use my steroid spray in the morning.

Because of the cold, my fingers were also discoloured on a few occasions (raynaud's phenomenon) & not to mention the constant urge to eat something. In a way, I miss the "south pole" which is warm & hot...

Sperm Banking

A colleague of mine was trying to arrange for sperm banking for a young man who was due to start on chemotherapy for testicular germ cell tumour. Since the service is not available at our centre, she called another hospital to find out.

Doctor: Hello, selamat pagi...

Operator: Hello, selamat pagi, Hospital XYZ, boleh saya bantu?

Doctor: Boleh sambung ke Sperm Banking?

Operator: Sorry, sini hospital, bukan bank...

SURVIVAL OF THE FITTEST - THE DANIEL'S THEORY

The selection of candidates for next year's Masters in Clinical Oncology will be somewhat different.

Those who resemble Deborah Henry or Amber Chia will be exempted from interview.

Those who don't will have to undergo an endurance test in the jungle, on top of a very academic oriented interview. They will need to spend 24 hours in the jungle without food, water or extra clothing. By midnight, one senior will be assigned to release the tigers & another will be responsible to get the pythons. If majority still survives till morning, more tigers & pythons will be brought in. Those who can come out of the test in one piece will be accepted into the programme.

How am I supposed to come out

4F's revisited

It is almost like a deja vu, though it has been almost 3 years since I last worked here...


FAR

The parking woes seem to be a never ending story. It has gotten a lot worse in fact, with all the construction going on. I force myself to come early every morning, to get a good parking place nearer the department (because I am just too lazy to walk).

While I manage to avoid the daily morning walk, problem arises when it is time to go home (sigh....)

* see picture later


FREEZER
(This is the worse part of the 4F's)

I kinda miss the hot environment in HKL. I really dislike the cold. I don't know how I managed to survive in New Zealand, but I'm definitely not surviving well at the moment. Room 7 & 8 in the clinic are a nightmare. On the few occasions that I sat there, my fingertips actually turned red & swollen (raynaud's phenomenon) & I could not write properly on patient's case notes...so the other reason why I come early to work is to 'book' a clinic room that is less cold.



FLOODED
Haven't seen this one yet so far...

FADED

There is no change from 3 years ago, especially since the Law faculty is still next door (their building is always bright & colorful)...while the Medical faculty is grey & gloomy.

EAR WHAT ??

Has anyone heard of or actually tried ear candling?

This topic (ear candling) was presented at our hospital's CME (continuing medical education) this week. Apparently it is a form of alternative medicine where a hollow candle is placed into the external auditory meatus (ear canal) with the other end lit up. It is said to have originated from the Hopi tribe in North America (if I heard correctly).


Practitioners of ear candling claim that it can cure many illnesses/ ailments, among those mentioned during the CME:

(1) Chronic sinusitis (for some reason, my colleagues looked at me when this was mentioned)
(2) Ear wax
(3) General well being
(4) Purify the mind (it was then my turn to look at them)
(5) etc
(6) etc


But please do not try this at home, as there isn't any scientific basis or evidence of benefit. In fact, it may be hazardous to one's health or even cause damage to the ear canal or tympanic membrane (ear drum).

SAWANG

A friend sms-ed me last night, asking me when am I going to update my blog. She says that my blog "dah bersawang" (which means full of cobwebs wor...)

Well, the thing is I've just moved to a new centre, nothing fun or funny has happpened yet. So full stop for now.

To be continued later...

COMMUNICATION BREAKDOWN III

A medical officer from another department was in our ward to see a patient.

Nurse: Can I help you, doctor?

Doctor: Plastic

(referring to his department & that he is there to see a referral)

Nurse: (disappeared into the treatment room & re-appeared a moment later with a yellow biohazard plastic bag)

Multipurpose Japanese Green Tea Bag

I was taking a Japanese Green Tea Bag to the pantry. Got spotted by a nurse and she asked me, "Dr.Lee, what you doing with that condom?"

(Dr. Lee, SGH)

Hours before Datin's visit

Minutes after Datin's visit

A NEW IMAGING TECHNIQUE?

WHERE ART THOU

If the Radiologist Of The Day is not in the Radiology Complex, then where is he/ she?

When you're faced with a stressful situation everyday...

(pail isn't for chemo induced vomiting, but to collect water dripping from aircond/ ceiling)

Nothing beats a cup of hot milo prepared by a caring nurse...

I LOVE THIS DOCTOR

Q: Doctor, I've heard that cardiovascular exercise can prolong life. is this true?

A: Your heart is only good for so many beats, and that's it... don't waste them on exercise. Everything wears out eventually. Speeding up your heart will not make you live longer; that's like saying you can extend the life of your car by driving it faster. Want to live longer? Take a nap.

Q: Should I cut down on meat and eat more fruits and vegetables?

A: You must grasp logistical efficiencies. What does a cow eat? Hay and corn. And what are these? Vegetables. So a steak is nothing more than an efficient mechanism of delivering vegetables to your system. Need grain? Eat chicken. Beef is also a good source of field grass (green leafy vegetable). And a pork chop can give you 100% of your recommended daily allowance of vegetable products.

Q: Should I reduce my alcohol intake?

A: No, not at all. Wine is made from fruit. Brandy is distilled wine, that means they take the water out of the fruity bit so you get even more of the goodness that way. Beer is also made out of grain. Bottoms up!

Q: How can I calculate my body/fat ratio?

A: Well, if you have a body and you have fat, your ratio is one to one. If you have two bodies, your ratio is two to one, etc.

Q: What are some of the advantages of participating in a regular exercise program?
A: Can't think of a single one, sorry. My philosophy is: No Pain...Good!


Q: Aren't fried foods bad for you?
A: YOU'RE NOT LISTENING!!! ..... Foods are fried these days in vegetable oil. In fact, they're permeated in it. How could getting more vegetables be bad for you?


Q: Will sit-ups help prevent me from getting a little soft around the middle?
A: Definitely not! When you exercise a muscle, it gets bigger. You should only be doing sit-ups if you want a bigger stomach.

Q: Is chocolate bad for me?

A: Are you crazy? HELLO? Cocoa beans! Another vegetable!!! It's the best feel-good food around!

Q: Is swimming good for your figure?
A: If swimming is good for your figure, explain whales to me.


Q: Is getting in-shape important for my lifestyle?
A: Hey! 'Round' is a shape!

Well, I hope this has cleared up any misconceptions you may have had about food and diets. And remember: 'Life should NOT be a journey to the grave with the intention of arriving safely in an attractive and well preserved body, but rather to skid in sideways - Chardonnay in one hand - chocolate in the other - body thoroughly used up, totally worn out and screaming 'WOO HOO, What a Ride' And For those of you who watch what you eat, here's the final word on nutrition and health. It's a relief to know the truth after all those conflicting nutritional studies.

1. The Japanese eat very little fat and suffer fewer heart attacks than Americans.

2. The Mexicans eat a lot of fat and suffer fewer heart attacks than Americans.

3. The Chinese drink very little red wine and suffer fewer heart attacks than Americans.

4. The Italians drink a lot of red wine and suffer fewer heart attacks than Americans.

5. The Germans drink a lot of beers and eat lots of sausages and fats and suffer fewer heart attacks than Americans.

CONCLUSION: Eat and drink what you like. Speaking English is apparently what kills you.

(Got this from my Aunt, on email)

NO MOUNTAIN TOO HIGH

April & May 2010 had been the most horrendous months in my life. Working and preparing for my final exam at the same time had proved to be both physically & mentally demanding, especially when I was placed in a centre notoriously known for its heavy work load.

Just before the exam, I had already lost 3 kilos (over the period of 2 months). I was eating quite a bit during my on-off study break, so I was wondering where all the food went. My weight was down to below 40 kilos on 2 previous postings at this centre. So this time around I was trying my best not to lose too much. For someone who weighs around 43kg on average, to lose even a few kilos, I would look cachexic.

The first component of the exam was the COQ (case oriented questions). That was quite alright, although there were minor hiccups (as one of my consultants had put it) here & there. Question number 3 was a radiotherapy planning question on cancer of the maxillary antrum. Most of the candidates were seen touching & feeling their cheeks, with one candidate even measuring her cheek with a ruler. It would have been a nightmare for the invigilator if the question was related to some other body parts.

MCQ (multiple choice questions) was the tough one, partly if not wholly, because of the negative marking. One candidate took 2 Paracetamol before going in for the paper. I came out of the exam hall with a stiff neck & also had to pop in 2 Paracetamol. During the night, most candidates had difficulty sleeping. One watched Korean soap opera till wee hours in the morning & another drove out to the Mamak shop for a drink. We are now able to laugh at ourselves, but the stress that we felt at that time was just overwhelming.

The final 2 components (ie. Clinical & Viva) were held 2 weeks after the written. By 21st May, everything was all over. It felt like a huge mountain was being lifted from my shoulders. I went back to work the next day (Saturday) & did 3 calls (2 active calls & 1 passive) over a duration of 4 days. That was a pretty un-human thing to do, but thankfully I managed to survive. I have now lost another 2 kilos, so yes, I do look cachexic.

It is now time to repair the sublethal damage & reoxygenate…

COLLEAGUES FROM PARADISE

• Knocks frantically on the oncall room door at 7 o’clock in the morning when you are getting ready for work. The knocking becomes louder & louder, & when you finally open the door, your colleague says to you, “Oh, ingat you masih tidur lagi.” (Reason for knocking on the door: need to use the toilet)
• Comes to your ward holding a piece of A4 size paper, when you are doing rounds/ procedure/ resuscitating patient. The colleague watches you as you are doing your work & then when you are finally done, he/ she passes you the piece of paper (borang cuti) for you to sign.
• Leaves undergarment on the oncall room sofa. You cover the item with some old newspaper but can’t sleep very well in the night as you keep having the image in your mind.
• Calls you at 10 o'clock at night using hospital phone (so that you would pick up) & asks you to cover him/ her the following day as he/ she needs to go to the bank. (Reason: kad ATM patah)