Welcome 2008!

Its the new year once again and time to set my new year's resolution. Hang on...wait a minute.. I have never (and I mean it, NEVER) had any new year's resolution all these years. Why bother when most of the time I do not even fulfill my own self promises. So be it then, yet another year to spend without any resolutions. Really? Hmmm I think turning over a new leaf would be great this year...hence... I shall make not resolutions but plans...

Looking back at 2007, I think I may have achieved the most.
Cash? tick (Not my first million but lets just say enough for me to spend).
Career? tick (Finally, for a while I do not need to sit for any exams).
Friendships? tick (got to know a whole lot of new friends).
Travels? tick (added a few countries to my travel log).
Health? tick (touch wood, have not been sick the whole year).
Family? tick (its been ever closer and more time spent).

Hmmmm..so that leaves me with possibly the most popular question of all, Love? Well, I don't seem to be able to tick this as yet. Hahaha... perhaps this year would enticed me into having a proper relationship. As in a possible 'leading towards happily ever after fairy tale Shrek like' friendship. Hmmmm.... it does gives me the creeps though. Maybe I am just not ready.

Anyways, moving on to this year, there are a few things in mind that I would like to accomplish. Firstly my own attitude in work (Only the higher being would know what I intend to change in myself). It would be soon that I set foot again on the native land of Sarawak, returning to my old hospital. Not for long though, as I do miss KL and would LOVE to transfer back if and when my application reaches KL. Don't get me wrong, I don't intend to work in the 'all too famously politically run' HKL but instead to somewhere near KL. Malacca sounds good. Even Seremban would do.

I plan to dive more this year if time and my wallet permits to practice on my passion for photography underwater and above water.

I would love to be more patient and ready to give in more easily this coming year. Perhaps Letting Go would be a good idea too.
Not going to complaint about too much work and too little pay. Not going to complaint about the 'nuts' of the government and its policies. Not to complaint is the best.

I definitely will be seeing the new year in a whole new perspective as I have a new pair of eyes! Yes I do mean a new pair of eyes. Not new glasses or some expensive frames. I literally mean new eyes as I have just spend a fortune on correcting my vision with laser. YES!! No need to scramble and look for those cumbersome spectacles anymore when I am on-call! Vanity? Sorry mate, never that but convenience YES! Looks to me like a 2008 6/6 vision!

There are just way too many things to write about what I intend to do for the new year. I think I shall leave it for the next several post since I do have 365 days to go still.

Cheers!

My camera equipments (above water)

(left to right: Nikon D200 with 60mm f2.8 macro lens, Sigma 15-30mm for my Canon EOS30 film, Quantaray lens, Nikkor 80-200mm f2.8, 18-70mm zoom kit lens, 105mm f2.8 VR macro, Canon 28-70mm kit lens, Canon EOS30, background Manfrotto tripod and picture taken with Nikon D70 with Tokina 10-17mm FE lens)

I loved my tokina fisheye zoom lens. In fact i used it so often i tend to neglect the rest of my lenses. Many would feel that the distorted angle makes the pictures weird but i find that it gives it a little more artistic look compared to the normal conventional straight angles.

Here, i took this picture when we (Ronnie, Pei See and Eric) were exploring Bali in a Suzuki Vitara. Notice how i was able to capture the whole interior of the car with my favourite lens?



Mom used to say that i looked like a 'wanna be' pro photographer and the truth still remains. I am still a 'wanna be' trying very hard to learn photography but like any other testosterone raging male, i love gadgets. From Macbooks, Ipods, IPhone, cameras, cars, watches,gadgets, gadgets, gadgets!

And the buying does not stop as i now need a proper dry cabinet to store my equipments.

(will also post my collection of underwater gears in the near future)

Diving with Mantas (Komodo) Part 6

This school of jacks (fishes approximately about 0.5 meters in length) greeted us as we descended next to liberty wreck. I had wanted to take a snap from below the school of fishes to capture a 'tornado' effect but before i knew it, they moved further and made it quite difficult for me to approach. Erm, another reason perhaps was because i wasn't skilled enough. Hehehe



During surface interval, I played with my camera in the resort's pool. I thought this shot may have been quite interesting. Camera held underwater and shot upwards towards the flower with the villa as the background. Too bad it had not capture Mount Agung at the same time.



The following two pictures are of nudibranches. Some kind of sea slugs if you were to ask me. Maybe one can perceived it as snails without the shell and painted with multiple colours. These are invaluable as subjects of photography on a muck dive. When i had started taking pictures of these with my point and shoot, i almost always took pictures from the rear until i was corrected by another fellow photographer. The best view should be frontal potrait. I took these with my 60mm Nikkor Macro about inches away from the subject.

Diving with Mantas (Komodo) Part 5

More pictures from my trip...


Ghost Pipefish. Elusive and uses its camouflage ability to evade any potential predators and photographers.


The entrance of a pub in Ubud.


A Moray Eel. Recent studies suggest that morays has an inner jaw used to further engulf their prey quite similar to those on ALIEN 'the movie'



'Bapak's' family on the day they prayed for the new year as well as their 'mobile' blessing. These are traditional Balinese attire.


Sunset view from live aboard 'Baruna'.


This little boy is at Kuta beach playing with a small little crab in his 'Tupperware' container but very willing to strike a smile and pose for my camera.

Diving with Mantas (Komodo) Part 4

After returning from Komodo I decided to travel to Tulamben, east of Bali to dive there as well since I had already paid for the flight. My sister was kind enough to help me amend the ticket (and I have yet to pay her back). The trip was about 2-3 hours through stretches of roads with handicrafts shops all the way. We took a detour to enjoy some fish satay famous I would say for not only the tasty food but more of the numerous flies around us. Not that the flies deterred us from the meal.


The Villa owned by an Australian which cost about USD20-30 per night. With your own private pool (something not foreign in Bali) and the sea view.



Balinese are known to pray the whole year round. When I was staying there, they were celebrating the 'motor vehicle's' new year. Yes they pray for their 'MOBIL' as well.

Diving with Mantas (Komodo) Part 3

Diving in Komodo, one cannot miss the chance of a lifetime to view the well known dragons right? We stopped over on one of the islands to visit these massive 'bacteria infested slimmy saliva' reptiles. Each adult measuring to about more than 7 feet long. There were rangers all around us 'sorta' protecting us from any possible attacks using a 'y' shaped branch or poles. Just days ago we were chatting with another tourist and had viewed a photo of his bathroom at the park's accomodation in which a Komodo dragon was taking a nap!!


The scene around Bali near Kuta.



View around the hotel's pool.

Diving with Mantas (Komodo) Part 2

Words and pictures can be difficult to express how I felt but the following video will give you an idea of it. Courtesy of Eric, hehhehe.

Diving with Mantas (Komodo) Part 1

I flew to Bali on the 14Th of November very much looking forward to my diving trip in Komodo. It was supposed to be a short trip of 5 days at the most but in the end it was 2 weeks plus. The highlight of the trip was definitely my dive at Manta Alley. There were about 11 (minimum I would think) Mantas of all sizes gliding gracefully amongst us. It was pure amazement for the entire 2 dives, each lasting about 50 minutes. 50 minutes because I used up my compressed air quicker than the rest of the season divers and being a 'not so fit' person.
This was my second dive trip using my new camera rig and I enjoyed every minute of it. I was testing out my wide angle lens on this dive and the Manta was the prefect subject. I do must admit that my photography skills is still very depressing.

(Me and the Manta... comparing my size with the smallest of them all)

The first night of my check out dive, yes...it was a 'dare devil' feat to dive at night in a whole new dive site, I was stung by Hydroids. The scar still remained until today as I blog. It was not because I touched them but I was pushed by another diver during a current surge and felt the stinging sensation immediately right after on my left wrist. We surfaced much earlier as it was just not 'environmentally' safe to continue the dive. My first encounter with night dive currents. Hehehe

For the next 3 dives I had decided not to bring my camera along with me as i wanted to get used to diving, the buoyancy control, breathing compressed air....the basics.

But who can resist not taking any pictures at all after the third dive!!! And of course...the first picture...self portrait using my Tokina 10-17mm.



*Will be posting a video (taken by a very experienced fellow friend) of the Mantas next entry...

Diving in Komodo, Bali (Tulamben), Strolling in Kuta and Ubud

Am taking a long trip from working. Felt I should indulge myself into more quality of life than just working and making a living. Well...of course I need to work to get the money to go for all these trips.

Am still in Bali, Legian's Zanzibar blogging this. I started my journey here from the 14th of November. My initial intention was to dive in Komodo...then I was invited by two of my friends to join them in their trip to Tulamben for further dives there. I agreed. I changed my air ticket and then decided to stay for another week. Woohoo...it was definitely worth it.

Will be flying back tomorrow to Kuala Lumpur.

Will post pictures and videos as soon as I can.

Will post pictures of me with my underwater rig, my 'wifey', my campanion for the whole 10 days of diving. Heheh...

I have been 'PUNKED'

It was my last day at work. Said all the goodbyes and gave all the hugs and kisses. Had my lunch and thanked my consultants for being exceptionally brilliant throughout my two years working in the UK. Then it all started.

I was walking back towards the secretary's office to hand in my bleep when my colleague had asked me to help her see a patient in the antenatal ward. Apparently she was heading towards the gynae ward to attend to another emergency. Oh well, just another case before leaving so i agreed.

I entered the ward and the first midwife i met looked afraid and shaky. I asked her what was the matter and she gave me a run down of the case. Here it goes;

A 40 year old (A-PAWLING ANNETTE was her name but i had paid no attention to the APAWLING part!) plus patient came self admitted with complaints of per vaginal bleeding and abdominal pain and claimed she can't be pregnant although she did had 6 months period of amenorrhoea (no periods basically) . She was acting really abusive and aggressive and had taken a swiped at the potter already (at this point the potter was mumbling over his walkie talkie ' its ok...everything is under control..the registrar is here' also showing me a plaster on his hand). She is now in the side room, locked in the bathroom and refused to come out.

I asked the midwife whether she looked pregnant but the midwife replied that the patient was high on the BMI side so it was difficult to know. Immediately i asked for a portable ultrasound scan to be brought over. I then motioned myself towards the room and as i approached, i could hear a woman screaming at the top of her lungs saying ' i am going to kill myself!!! how can i be pregnant!! i dont't wanna be in the hospital!!! '

My heart started pumping faster, shunting all my blood to my head to help me think. The first thing i had thought of was, 'oh my god...we have got a possible psychiatric patient in the ward and an agressive one...what would happened to the rest of the patients??? how am i going to ensure the safety?'

In the room, another midwife was trying really hard to convince and persuade the patient out from the toilet. I asked whether the consultant on-call had been informed. Well at this point i thought he should be informed. Then another scream "IF ITS A MALE DOCTOR I DON'T WANNA SEE HIM...ITS MEN WHO DID THIS TO ME!!!!! GET HIM OUT OF HERE!!!!"

I told the midwives there (which suddenly doubled in numbers perhaps tripled) to try and get a female doctor if the patient didn't want a bloke. But, at this moment, the patient gave in and came out...with a PLASTIC BAG covering her head!! SHIT!! Definitely PSYCHIATRIC CASE I told myself. I politely introduced myself to the patient who at this point remained aggressive and loud. The pillows, magazines and jugs of water were all over the floor. I looked at her tummy, but couldn't convinced myself she was pregnant at all. I proceeded to chat with her and suggested she sits on the chair to start off with. Then I requested for her to allow me to remove the bag over her head of which she agreed to.

THEN!! THEN!!! that i noticed it was a familiar face, one of which i recognised immediately..... it was one of the midwives!!! and there was i standing in the room with laughter and claps all around... They had me! I have been punked. My heart stopped palpitating and slowed down. I was flushed with embarrassment. I applauded to their acting skills. Absolutely incredible.

Being a Chinese is not by default a Mr LAU!!!!

I would have had a splendid on-call last night had it not for a distracting phone call from this #@"$! lady via my Msian mobile number.

The story goes like this. It was like what I have written in my previous post, the delivery unit was clear and there wasn't any patient to be seen. I had not slept well during the day prior to my call last night so I decided to hit the sack much earlier at about 12 midnight (In preapartion for a busy night). I went into deep sleep but was disturbed by not my bleep which was rather unusual but it was my mobile (Msian number and on roaming).

Now I generally do not answer any unrecognised phone number as my phone is on roaming (hence I will have to pay for any phone calls received from anywhere in the world) and kept that way only for emergency calls from family (and sometimes friends). This individual however was quite adamant to get in touch with the person on the other line. After ignoring the persistent vibrating phone for countless time I finally gave in and answered. At this point, I was really thinking that someone had wanted to get in touch with 'ME' urgently.




(grumpily waking up ..hehhehehe)

me: Hello?

#@$%! lady: Hello, may I speak to Mr Lau? (NO PLEASE I HAD NOTICED)

me: Erm, Mr Lau? I am terribly sorry but I gather you have got the wrong number. (thinking at this point it will end my conversation quite abruptly....I can literally hear the bill going up at F1 speed rate..)

#@$%! lady: Not Mr Lau? But you are Chinese right??

me: Yes, I am Chinese but I am not Mr Lau.

#@$%! lady: But Mr Lau gave me this number....errr ...err...I want to speak to Mr Lau. You are Chinese right?

me: Look, I am NOT MR LAU AND YOU HAVE GOT THE WRONG NUMBER!!!!!

I hanged up.

Really, I am seriously annoyed with this lady. Not only did she not comprehend that I am not the Mr Lau or Mr whatsoever having told her so, the #@$%! lady thinks that as long as you are Chinese you are then by default a Mr Lau!!!

My dad or some of my friends I have noticed tend to have a long conversation with people calling up the wrong numbers...

Most of the conversation includes:
'Who do you want to speak to?? Who is this?? What number do you wanna call???'

'Are you sure you have got the right number? My number is this this this'

Frankly, I do not see a point in asking what number the other person on the other line wanted as it is ALL IN THE MOBILE's DISPLAY and I DON'T really want to know who they want to speak to, full stop. SO I religiously hang up once they start off with 'harlo, ah ngu ah??' or 'Ah Lim ah, your bla bla bla bla'

looking good..

Nothing to do with physical appearances i am afraid. What i am trying to say is the delivery unit's board is CLEAR!! Yup, no patient at all when i took over at 830pm tonight. Great... now i can just sit back and watch the 40+inch plasma TV in the doctor's mess. At least till i received my next bleep though.

Its final night of work here and to be honest i do prefer working a long 24-36 hours of on-call rather than doing long 12 hour shifts for 7 days in a row. It is just too tiring and exhausting.

Its confirmed, my last day in UK will be on the 5Th of November. By 11 am that very day I will be on one of MAS airlines heading back to Kuala Lumpur. Probably about time too as i dislike the coming cold weather. Its currently about 10 degrees C and perhaps due to some strong winds will drop to below freezing this weekend. BrrRRRrrrRRRR....

Time to get back to work....erm i mean act like i am working hard... shhhh

2nd of my last 4 nights

There is two patients on the delivery unit now. One in the pool with a history of IUGR( Intra Uterine Growth Restriction) and I just heard she is fully dilated and vertex is visible. Great. Why is she in the pool? Well..i think she initially had wanted a home delivery despite being advised not to as the baby was found to be ?IUGR and hence offered an induction. She declined but agreed to having the baby in the hospital. Further, she requested for a pool delivery (will post a picture of the pool, perhaps tomorrow after my call).

The other lady is only 7 cm dilated, only a cm change from her last review at 7pm. Well, sounds to me like a poor progress and she is just having about 1-2 contractions in every 5 minutes. Midwife is not sure of the position of the baby....hmmmmmm. I guess she might benefit from a few drops of syntocinon stimulation then. I do hope both patients are not going to be problems for me later.

Am drinking my cuppa now as i blog this entry.....

Me and my mate's conversation...

It was not long ago I had a conversation with a mate of mine whilst we were walking around Portobello Market about the thought of having a tattoo. Yes, permanently having an inked design of desire on our skins. Why you may ask would I want such a thing on my body. There are many reasons why one would get a tattoo. Some to remind them of their loved ones, some as a symbol of spiritual beliefs, others just mainly to attract attentions.

I don't really know what my mate's reason was for his Celtic Cross and i didn't really asked him but will do so when we meet up again in the next few weeks. But a Celtic Cross is the characteristic symbol of Celtic Christianity, though the symbol has older, pre-Christian origins. Such crosses formed a major part of Celtic art. This design is also referred to as the Irish Cross, or as the Cross of Iona. Well, at least that's what i came across via Wikipedia. They are not easy to do. Interlacing knots, a chief feature of Celtic tattoo art and a symbol of the constancy life, is one of the reasons why these tattoos are so difficult to create. Their cyclical design and symbolic emphasis on knots that have no beginning and no end.

Well, we did walked into a tattoo parlour that day but walked out quite soon after as it seems quite a dodgy place. I think many people have in the past linked tattoos with sailors, criminals, heavily bearded bikers, the Yakuzas, triad members or even the punks. But these days, they are quite a common sight. When I was working in Sarawak I have encountered a number of patients with the famous 'tribal' tattoos.



Later that month or I received a message from him saying he had already made an appointment to have one done. The day after I was supposed to meet up for BBQ in London to view his design but because I was on-call that weekend I only managed to view this above picture.

So did I then got myself one? Yes I did, but not after a while. I had always wanted something special, something that reminds me of myself, something which is unique in its ways...and hence I decided on a pair of wings. I drew myself a pair of wings. Yes..my own design...well partly as I had to show it to my tattoo artist and have her change or make them a tattoo possible one.

Why wings? Well, to me my angel wings represents partially the rebellious side of my personality. My freedom. It symbolises enlightenment, guidance and protection "to be taken under the wing" and perhaps inspirational. It also represents my loved ones....my family.

Did it hurt? To be honest, one of the many reasons I wanted one was to be able to feel the pain. That feeling is difficult to describe. I would say it felt like a nagging cat's claw digging into your skin and pulling across. The outline is rather uncomfortable compared to the process of shading and filling in.

Will i have another? Yes...of course. The day I had it done, I was already thinking of having another. It can be very addictive.

Was i worried about possibility of infectious diseases? Well, if i were to have it done in Malaysia, yes i would. My artist's place is as clean as a dental clinic (if not cleaner) and all equipments are disposable. They are also registered with the local health authority. There is no nicotine smell, no dodgy drug pusher sitting in the corner or alcohol in sight. So, no i am not worried.

And here it is, my wings.......

50-50

Only about 2 more weeks or so and I will be on my way home. Excited..yes you bet. However I do have mixed feelings about how I will be adapting to work in Msia. Various things came to my mind.

Firstly, I will have to start writing in patients notes and not have them typed out by the secretaries (from my dictation). It would be a disaster trying to figure out the long list of medical problems from patients because;

a)almost always they are not aware of their own personal health problems

b)they are only aware of a single miracle drug called 'the white pill of KK' (Kementerian Kesihatan's famous pill)
There are other reasons of course...

In terms of Obstetrics, some of them includes;

a)Back to the good old days of limited antenatal scans for dating in all patients. I will be expecting patients coming in fully pregnant and ready to labour away without any antenatal care at all. This including no routine 20 weeks anomaly scans, so a number of patients would turn up with fetuses with spinal tube defects, heart defects, etc.

b)Screening? In terms of detecting trisomy or chromosomal defects? Well, again...none, as i believe its illegal to perform termination of pregnancy so there is no point in doing it. Moreover..it is so expensive to perform amniocentesis that only the private sectors are able to offer such services.

c)What about patients choices?? As in caesarean sections? I can just imagine myself giving an hour of counselling on the benefits and risk of a vaginal birth after c-section as well as a planned elective c-section to be followed by a response of 'Tak tahu lah. Doctor rasa apa paling bagus saya ikut sajalah' or 'Suami saya cakap potong sajalah' and perhaps just a blank face?

d)No community midwife to lend a helping hand for the continuity of care for the obstetric patients. i.e we doctors see all patients in the clinics.. so hm mph...100 odd per clinic..busy busy busy. Hence..the 10 minute consultation for a patient who had travelled 3 hours from her home (1 hour walk, 1 hour boat ride and the remainder 1 hour of bus journey to the clinic) requesting to be seen first bypassing the 30-40 odd patients ahead of her because she need to make her way back.

Gynaecology,

a)Although we have the cervical screening programme, but we do not have (i feel) a good recall system where patients are automatically reminded to attend the health clinics for repeat smear test. And hence...I am sure I will be seeing many cervical cancer patients within a year (I have not encountered a single one here after two years).

b)Conservative management for ectopic pregnancies would be very difficult as patients need to pay for the test done (beta hcg) and hence would be way too costly for them as compared to surgical or medical treatment. Follow up would not be feasible and the risk of them collapsing in a kampung somewhere is a possibility.

c)Although NICE has issued a guidance on the management of menorrhagia using the MIRENA as the first line of treatment, I doubt many would be having this as again it comes down to cost. So it would still be the reliable tranexamic acid or norethisterones...

d)There isn't any proper primary care trust where patient health information are constantly shared with the hospital or made available partly because patient do a lot of 'GP shopping'. Perhaps the GPs may want to group together and form a trust?

These are just the tip of the iceberg of my concerns. Lastly, I have always wondered how one become a consultant in Msia. I do not recall we have a system to promote someone from the specialist status to consultant status and correct me if i am wrong but it appears that if you are in the service long enough and grow some white hair, then perhaps you can then be promoted in such a manner. Do enlightened me...

Just my thoughts. You may disagree or perhaps miraculously agree with me but I welcome all comments..

Hehehhe

Time to pack

I have only about a month to go before heading back home. Lots of things to pack. Somehow i find it really amazing. I came with a single large baggage and i am going home with at least 6 boxes and two large baggage. Hmm looks like i have done quite a bit of shopping here in the UK.

Had my last three nights of on call and it has been surprisingly quiet. Last night itself i only needed to review a patient at about 3 am, and the rest of the night i stayed in bed. Now that's really good as i am practically the only doctor doing all the ObGYN stuffs at night from 830 pm till the next morning. Although i had a chance to warm up my on call bed, i must admit that i have not slept in recent times when i am on call. I believe that i am being paid not to be in my bed but to stay awake to work like the rest of my team. The midwives.

Arrggghhh so much to pack.... hmmm alright then...back to work...

Monster working long nights today

I will be working long nights today. It would be my 1st of the last 7 nights i will be working prior to my departure from this hospital as well as this country. I hate working nights. No SHO to talk to. Nothing to do. The doctor's mess is too far from the delivery unit to hang out in. However i do like the fact that they have a huge 40+ inch flat screen TV there with SKY satellite network. Hmmm... oh well.... might as well get over it...

The Monster in Me...

Am very tired today. Had a long session of antenatal clinic and felt could have been more productive in seeing more patients. It just so happened that there are two difficult or rather complicated patients to deal with and required plenty of counseling and discussion. Then later on the day, had to see a couple with a newly diagnosed cystic hygroma on the antenatal ultrasound scan. Both the patient and husband were indeed anxious and I cannot imagine how i would feel if I were to be in their shoes. Anyways, will be referring them for further scan in Cambridge under the feto maternal unit and hopefully its just an isolated soft marker.

In the afternoon, I showed some of my new colleagues around the hospital and dealt with some rota issues. To be honest, am not too keen in arranging the rota for the next few weeks. So, that completed, I went down to town to hand over to 'Karen' my 'wings' to be amended so that I can have it done (will blog about this another day). The receptionist said that the earliest booking would be in December! ahhh... now how am I going to have it done before that????? well..I would just have to wait and see really.

So, came home and had no mood to wash my clothes. Went back out again and rent 300 to watch tonight. Ordered Chinese take away because again...no mood to cook my dinner. Yes.I do cook my own dinner. And yes...I am not that bad a cook. Have Jamie Oliver to be my mentor (via BBC on the TV).

Will have to do my laundry tomorrow morning since I will be doing nights tomorrow.

Somehow..I fear that I am turning into a monster after all that had happened today (as you can see above, taken today evening). Argghhh!!!

WSH Registrar Leaving Do 02102007

The Obs and Gynae department had arranged for a leaving do for all of us specialist registrar as it was time to move on to our next job (well..for me another month though). We had dinner at this place called Chez Gerard. Brilliant food. Excellent wines. Wonderful people. Almost all the consultants were there to dine with us. We had also the company of the ever wonderful midwives, the gynae clinic nurses, MCTA, and our SHOs as well. Tears were shed and plenty of hugs and kisses but the main important thing was we had fun. The clinical director gave a speech and gave us each a miss/mr book based upon our working attitude and what the rest felt about us. Inside each and every one are the signatures of all our consultants. ahhh...... i am missing this place already. Will make the most of it the next and last month of work here.

My drawing...

I have finally completed the second of my drawings, or an attempt at canvas painting using acrylic paints. I took several pictures to show the progress I made each time as well as the final product. I named this piece..the awakening of docperineum.... hehhehe

London 290907

I went to London today to do some shopping before i make my journey home in the next two months. Don't really want to rush everything at one time. I ended up buying clothings for my sister from dorothy perkins and H&M instead. Got a few pieces from GAP for my nieces as well. Then had japanese dinner with Chloe at Selfridges. We then head off to the London Eye to snap a few night shots. It was pretty windy and chilly tonite and i dread not bringing my Manfrotto tripod for this kind of shot. I did not really manage to get any great shots, but these are the few that are worth showing. It was about 10 pm before we head back to another high school friend's house where i will be staying over for the night.

Had a few glasses of wine and am ready to hit the sofa for the night.

My window...

Ever wondered how one would look through your window and see what you see every morning, afternoon, evening and night? I looked out from my window today as usual and thought to myself ' Will I will miss this view in about two months time when i am home?'.

I called home and chatted with mom about almost every single new gossips or happenings. We talked about how my cousin sister and her husband had been robbed on the NKVE a few days back. He is recovering from the 'parang' slashes and she is taking more days of MC to allow her bruised limbs and cuts to heal. My cousin sister had jumped out from the car whilst it was going at about 40 to 50 miles per hour after it was hijacked. She had been brave. Had she not done that, i am not too sure whether i would be seeing her anymore. I would have imagined the worst possible outcomes if she was still in the car.

I am quite surprised how unsafe Malaysia had become. I fear for my two nieces after reading the news on Nurin. The little girl who had been brutally abused and murdered. I had jokingly suggested to have CCTV installed in the house. Mom laughed and for a minute I think she did give it a second thought. I then remembered it was not too long ago fibrate had wrote about her in-law's house.

The cost of living has escalated I was told. Mom was comparing prices of raw meat now and a year ago. An example that she often used. She continued saying that an outing nowadays can easily cost more than 50 ringgit. I believed her. 50 pounds can keep me going for two weeks here. And that includes my car petrol.

I ended the conversation early as I had planned to go to town. Again i looked through the window. 'Yes, i am definitely going to miss UK'.

And yes, the window had nothing to do with my conversation.

Time

I have created this video using still photography of the blue skies just outside my window. I was thinking about all the good times i had in the past and whether i would be able to experience them again.

13/09/2007.... First LSCS of the day..Uterine Rupture..

I was on call that very morning. Made my way to the delivery unit and met the consultant and my fellow colleague from the previous night. She looked exhausted. Probably a busy night I thought to myself. In room D, the room that we were all paying close attention to. A patient who had one previous cesarean section and a successful vaginal birth after was in labour.
'Progress has not been good' i heard one midwife commented. 'The CTG looks suspicious' my colleague said. 'I think she need a fetal blood sampling to assess further' she added. I waited no longer. It's all I needed to know prior to gathering the equipments for what is coming next. Fetal blood sampling. A very safe procedure done mainly to access the pH of fetal scalp blood obtained from a few superficial scratches.

The test revealed a pH of between 7.35 to 7.37 in three samples. That is absolutely normal for the baby. Nothing could be better. CTG at this time still remained suspicious. The plan was to see how she would progress in the next hour. I had examined her and she was still about 8 cm dilated. She had been 6 Cm dilated for the last 6 hours. I had requested for her to be catheterized to empty her bladder.

A minute later, it was chaos. The fetus was in obvious distress. The heart rate dropped to a mere 80 beats and remained there for the longest 5 minutes of my life. I decided it was not a good idea to carry on with the labour. I made several urgent phone calls, to the theatre staffs, the anaesthetist, and the consultant. I had wanted this baby out now.... right this moment.

The panic and confused patient was rushed to the theatre for a grade 1 LSCS. My heart rate almost invariably can be felt beating against my chest in cases as such. Patient was in theatre at 0918 and general anaesthesia commenced at around 0925. I had noticed the abnormal hump on the patient's abdomen. I have always called this the 'camel hump' as it looks like the baby's buttocks is raised high on the mother's anterior abdominal wall. Knife to skin at 0927. As I entered the abdomen, a sudden gush of fresh blood and I recognized the pale body of a fetus. 'The baby is out of the uterus! Call the consultant this instance! Start syntocinon 40 units please' I called out in sequence. Baby out in 2 minutes from skin incision.

As usual I had my trusty Paediatric colleagues to help with the resuscitation. I scanned the uterus for severity of the damage. Tears noted extended to the broad ligaments but fortunately no further than that. I had managed to achieve haemostasis. My consultant was there to give me a hand with the remainder of the surgery. We had avoided a possible uterine atony or hysterectomy. Blood loss was less than what I had expected. 500 mls. 'You do like excitement don't you? It only happens to you isn't it?' my consultant joked.

Half hour later, I was told the cord pH of the baby was 6.9. An acute drop. Too close for comfort. It could have been a perinatal mortality case in next month's meeting but thankfully not.

Patient remained stable post LSCS and baby is fine in SCBU.

I had another call few hours later from delivery unit. A patient who again with a previous scar now in the second stage of labour and had fresh bleed from the vagina. My thoughts 'If this is another scar rupture, i will be very very very surprise!'

Here we go again.

Feeling Macro Dirty....

So...i decided to follow suit another blogger, Odysseys of George to show some macro stuffs which are considered as dirty. Yes the all mighty FLY! I had this little fella in my room one day and i literally followed it all around with my camera to get some pics. Well, i am not saying my room is dirty..err hellooooo.. but its just that this nosy little fly probably got into my room as its getting quite cold now approaching autumn. That's one of the reasons for other critters to be crawling into the house.


Its quite hard to get a good focus on this fly as it almost always senses that i am near or perhaps intruding its personal space. And i am sure its because of those super fine sensory hair all over the body. Cool eh? Bet you have not see a fly in this way or up this close before. Guess most of the time its either like 'ice kacang' after you had killed it or it had already escaped your deadly fly 'badminton racket killer'.



Here it is again... on my curtain. This is probably about 10cm away with a 105mm Nikkor Micro lens.

Koala Bear

My cousin is doing her PhD in Singapore and well i got hold of this picture which is supposed to be B cell under microscopy.I was told it looked like a Koala. And i think it does!! ehehhe.. just like staring at the clouds and imagining animals out of it.

Look away if you are arachnophobia

I came back after doing long nights (oncall) and was pretty tired when i saw this little critter roaming around my kitchen. Despite the fact i would lose an hour or two of my sleep, i grabbed my camera and took several shots of this spider. Initially up on the ceiling, it web-slinged itself to the nearby sink and sat there on my cleaning sponge.

Should doctors be oncall from home?

What does it mean when a doctor is said to be oncall? Watch ER or Scrubs and the first thing that comes into mind is that the doctor is working overtime in the hospital...and perhaps also over the night. Right? Well perhaps but not entirely true.

The doctors seen mainly working over the nights in most public hospitals (in Malaysia) are newly graduated house officers and their counterparts the medical officers, or sometimes registrars. So, what about specialists then? From my experience (and please do not quote me), the higher your status the less work it seems when you are oncall. Meaning? Put it this way, in medical field, specialist works from home and can be consulted via their mobile phones. Medical officers can be contacted via pagers/bleeps but they are on site and if needed will come to review. And finally the front man, house officers see most patients admitting or presented to the hospital. I wouldn't even want to mention consultants...as i believe you would get the idea now.

Having said that, this is not entirely true for some fields though, for example surgical/orthopaedics where surgeons are almost always around for theatre times.

So what you may say? It basically mean that the most junior and inexperience person is treating majority of the patients. Surprised? You bet! It may have changed over time but seriously this is definitely very true. Getting the seniors involved therefor depends on the insight of house officers, whether to refer or not to refer. Many a times, fear of disturbing a "specialist's sleep" (so called, but remember they are still oncall and being paid) or even the medical officer delays such decision till the early hours of the morning rounds. Patient would then suffer as a consequence.

Would senior supervision throughout the night help? Definitely. Would night rounds with the seniors be helpful? Definitely. Should there be fear of referring to the seniors? Definitely not! Should seniors be vicious, mean, inconsiderate, nasty to the juniors when they are so called 'disturbed'? Never.

Perhaps we take it for granted that litigation is not as rampant compared to the western world and take the risk of allowing the current practice to carry on. Perhaps we are short of doctors, but we are sure having lots of colleges producing new doctors. Perhaps we have been in such situation (as house officers) and hence felt that the new doctors should go through such 'so called' experience of working but wouldn't it then be a vicious cycle?

This is merely how i feel, what i experienced and it may not be similar to where or what others practice, but hey this is my blog and i think i can voice out my thoughts... hehehe.

Well, what are your thoughts?