me: oii mat
mamat: acam china pek
me: kucing you acam??
mamat: baik baik
me: boleh pinjam kejap??
mamat: kenapa pulak??
me: oh tak de la, anjing gua bosan.
mamat: bapak(stressss giler).....
Tuesday, June 27, 2006
Sunday, June 25, 2006
World Cup fever
patient walks into the doctor's chamber limping with a broken lower leg...
Dr: aisay, asal kaki boleh patah?
patient: pasal macam ini. semalam masa tidur gua mimpi gua sedang main bola kat world cup. kat mimpi saya tendang bola tapi mana tau sebenarnya tendang isteri pulak.
Dr: ohh, pasal itu kaki patah la.
patient: oh bukan la. isteri bangun dan kasi patahkan kaki....
Dr: aisay, asal kaki boleh patah?
patient: pasal macam ini. semalam masa tidur gua mimpi gua sedang main bola kat world cup. kat mimpi saya tendang bola tapi mana tau sebenarnya tendang isteri pulak.
Dr: ohh, pasal itu kaki patah la.
patient: oh bukan la. isteri bangun dan kasi patahkan kaki....
Friday, June 23, 2006
Wednesday, June 21, 2006
Cranky Old Fart
two days ago, i was assigned to take the history and examine this 81 year old chinese(hokkien) man. buggar is the crankiest patient i've ever came across. he was admitted for shortness of breath and productive cough for the past 2 weeks. at the same time i noticed he had echymotic and purpura lesions all over his upper limb, lower limb and chest. so i enquired bout it and this was the conversation went
(conversation was in hokkien)
me: ah pek ah, how long you been have this lesion??
COF: lu see tenang ah?? (are you chinese??)
me: ah see see. wah see tenang lang(yes yes im chinese.)
COF: lu gong balak eh tenang la!!! lu men chai chee geh semua eh lau tenang lang pun tiok eh!!! haiyahhh. see beh gong eh loh kun lar lu!! (you stupid chinese la!!! dont you know that all old chinese men will have this skin lesion!! what kind of stupid doctor are you.)
according to his file he is also a known case of congestive cardiac failure, hypertension and chronic obstructive airway disease.
me: ah pek ah?? lu ooh see mee see mee pee boh?? (ahpek, do you have any other illness)
COF: boh la boh la!!! lu mai chah see chah lang la(no la no la!! dont bug me)
me: lu ooh chak yok boh??(are you on medication)
COF: ooh(got)
me: eh yok chak choh see mee leh?? (what are the medication for)
COF: AIYAH!!! men chai lar. (aiyah, i dont know lar)
me: lu boh mui loh kun ah??(didnt you ask the doctor)
COF: MUI LAI KAM LAN AH!!?? ee kong see mek wah pun boh bim pek. loh kun kioh wah chiak, wah mai chiak lor.Hai yah!!!(ask for what, to suck cock isit!!?? what he said also i dont understand. doctor asked me to eat, i eat lor. hai yah!!)
on his social history
me: ah pek, lu see kah siang kiah? (ah pek, who are you living with)
COF: kah wah eh boh kiah la!! na wei!! wah mui lo, lu see kar lu eh lau boo kiah see boh?? wah lau weh, lu ah. meng ang kan eh gong mee kia (im staying with my wife la. na wei!! i ask you, you are living with your mother right?? wah lau weh, you ah. asking stupid questions)
following day, when i was following up on him he just got up from his sleep and was drinking a cup of milo.
me: ah pek, kia nid oo kar ho boh?? (ah pek, are you feeling better today)
COF: wah lau weh!!! koh see lu lagi ah!! ho sim lu la. wah see puek chap it hueh liao la. lu eh sai hor wah see huah hee tampuk boh. mai lai cha wah la.( wah lau weh!!! its you again ah!! for goodness sake, im 81 years old now. can you pls let me die in peace ah and dont come and disturb me la)
(conversation was in hokkien)
me: ah pek ah, how long you been have this lesion??
COF: lu see tenang ah?? (are you chinese??)
me: ah see see. wah see tenang lang(yes yes im chinese.)
COF: lu gong balak eh tenang la!!! lu men chai chee geh semua eh lau tenang lang pun tiok eh!!! haiyahhh. see beh gong eh loh kun lar lu!! (you stupid chinese la!!! dont you know that all old chinese men will have this skin lesion!! what kind of stupid doctor are you.)
according to his file he is also a known case of congestive cardiac failure, hypertension and chronic obstructive airway disease.
me: ah pek ah?? lu ooh see mee see mee pee boh?? (ahpek, do you have any other illness)
COF: boh la boh la!!! lu mai chah see chah lang la(no la no la!! dont bug me)
me: lu ooh chak yok boh??(are you on medication)
COF: ooh(got)
me: eh yok chak choh see mee leh?? (what are the medication for)
COF: AIYAH!!! men chai lar. (aiyah, i dont know lar)
me: lu boh mui loh kun ah??(didnt you ask the doctor)
COF: MUI LAI KAM LAN AH!!?? ee kong see mek wah pun boh bim pek. loh kun kioh wah chiak, wah mai chiak lor.Hai yah!!!(ask for what, to suck cock isit!!?? what he said also i dont understand. doctor asked me to eat, i eat lor. hai yah!!)
on his social history
me: ah pek, lu see kah siang kiah? (ah pek, who are you living with)
COF: kah wah eh boh kiah la!! na wei!! wah mui lo, lu see kar lu eh lau boo kiah see boh?? wah lau weh, lu ah. meng ang kan eh gong mee kia (im staying with my wife la. na wei!! i ask you, you are living with your mother right?? wah lau weh, you ah. asking stupid questions)
following day, when i was following up on him he just got up from his sleep and was drinking a cup of milo.
me: ah pek, kia nid oo kar ho boh?? (ah pek, are you feeling better today)
COF: wah lau weh!!! koh see lu lagi ah!! ho sim lu la. wah see puek chap it hueh liao la. lu eh sai hor wah see huah hee tampuk boh. mai lai cha wah la.( wah lau weh!!! its you again ah!! for goodness sake, im 81 years old now. can you pls let me die in peace ah and dont come and disturb me la)
Saturday, June 10, 2006
death in the ward
two weeks ago, i had a patient who died on me. this was not the first time that a patient i knew died. what made this different was that i actually saw it happening in front of my own eyes.
i was about to leave the ward with the rest after a massive round of ass jacking from our orthopedic lecturer when we noticed the emergency. so some of us thought of staying back and skipped lunch to see and gain experience on managing an emergency case.
the poor guy was involved in a road traffic accident. according to friends in the A&E, he was vomitting out blood there. the doctor thought they had stabilized him so they shifted him off to the ward. that decision probably caused him his life.
once in the ward he was coughing out massive amount of blood. when the doctors inserted a tube into his lungs, blood came gushing out. within a minute or two, there was more than a liter of blood in the container. they had to clamped the tube to control the blood lost while they arranged for a blood transfussion. in the mean time, the patient became restless and started to struggle. so they had to restrained his arms while me and a few others held on to his legs. blood was just pouring out from everywhere. his lungs, his ears, his iv line and his pants were soiled with urine. he probably was bleeding into his abdomen as well cause from visual inspection, it was grossly distended. CT scan revealed a skull fracture.
in other words he was a goner no matter what.
as the doctors tried valiantly to resuscitate him, he suddenly just stopped moving and went blank. his eyes were opened and was starring blankly into space. then his heart stopped and his PO2 stats started dropping. one of the doctors started doing cpr while the rest continued to resuscitate him. the blood lost was so massive and quick that the doctors had to manually transfused the blood by injecting it straight into the veins instead of letting it dripped by itself from the beg.
in situations like this and in everyday life, i feel very useless if i just stand there doing nothing. since cpr can be tiring after a while, i asked if i could help them with it. and they allowed me to do it. i've done cpr many times on a mannequin but having a real dying person under your hands is totally totally totally different. i have no problem recalling on my earlier training but the difference between a dummy and a real life person is that you can break a man's rib if you do it to hard.
and thats what exactly happened to me.
i heard a bone cracking sound under my hands and immediately felt my hands tensed and turned cold. did i just break the man's rib??? the question kept on repeating itself over and over again in my head but my hand kept on with the compression albeit with lesser force. then this female doctor whooped my ass from behind and said, "eh kenapa lemah sangat?? you tak makan ke??"
"takut patah tulang dia nanti," i replied
"tak pe. kuat lagi."
so i went backed with the original force of compression but within a few minutes i heard the same cracking sound. and the whole mental torture raged on in my mind. i told myself it couldnt be a fracture cause the chest contour and resistance was still the same. i did it just so that i can continue with the job at hand and not be paralyzed with guilt and self-doubt.
after 30-40mins of cpr and other forms medical resuscitation, the guy's heart still failed to beat on his own and he was declared dead. his family members who were near the bed were informed of his death. we just moved away in silence.
at that point i was not sad or anything. i didnt even know the guy in the first place. i was just worried that i did more harm than good. and somehow or rather by my inexperince, i helped pushed him to the other side. these issues bugged me for two whole days. it kept on creeping into my mind and every attempt to shrug it off was futile. friends told me it probably the sound of the the bone moving in the joint space, just like when you crack your knuckles. and if it was a complete fracture, the chest resistance and contour would be different.
the issues was finally put to rest a few minutes back when i spoke to a dear friend who is practicing medicine in the UK. she said the A&E doctors there told her if you dont break at least a rib during cpr, you are doing it wrongly. it indicates that you are not compressing hard enough hence blood flow to the rest of the organs is insufficient. and judging by the severity of the patient's hemoptysis(coughing out blood) he probably had a couple of rib fracture from the accident itself.
whatever it is, it was a good learning experince. i just wish it wasnt such a traumatizing one.
i was about to leave the ward with the rest after a massive round of ass jacking from our orthopedic lecturer when we noticed the emergency. so some of us thought of staying back and skipped lunch to see and gain experience on managing an emergency case.
the poor guy was involved in a road traffic accident. according to friends in the A&E, he was vomitting out blood there. the doctor thought they had stabilized him so they shifted him off to the ward. that decision probably caused him his life.
once in the ward he was coughing out massive amount of blood. when the doctors inserted a tube into his lungs, blood came gushing out. within a minute or two, there was more than a liter of blood in the container. they had to clamped the tube to control the blood lost while they arranged for a blood transfussion. in the mean time, the patient became restless and started to struggle. so they had to restrained his arms while me and a few others held on to his legs. blood was just pouring out from everywhere. his lungs, his ears, his iv line and his pants were soiled with urine. he probably was bleeding into his abdomen as well cause from visual inspection, it was grossly distended. CT scan revealed a skull fracture.
in other words he was a goner no matter what.
as the doctors tried valiantly to resuscitate him, he suddenly just stopped moving and went blank. his eyes were opened and was starring blankly into space. then his heart stopped and his PO2 stats started dropping. one of the doctors started doing cpr while the rest continued to resuscitate him. the blood lost was so massive and quick that the doctors had to manually transfused the blood by injecting it straight into the veins instead of letting it dripped by itself from the beg.
in situations like this and in everyday life, i feel very useless if i just stand there doing nothing. since cpr can be tiring after a while, i asked if i could help them with it. and they allowed me to do it. i've done cpr many times on a mannequin but having a real dying person under your hands is totally totally totally different. i have no problem recalling on my earlier training but the difference between a dummy and a real life person is that you can break a man's rib if you do it to hard.
and thats what exactly happened to me.
i heard a bone cracking sound under my hands and immediately felt my hands tensed and turned cold. did i just break the man's rib??? the question kept on repeating itself over and over again in my head but my hand kept on with the compression albeit with lesser force. then this female doctor whooped my ass from behind and said, "eh kenapa lemah sangat?? you tak makan ke??"
"takut patah tulang dia nanti," i replied
"tak pe. kuat lagi."
so i went backed with the original force of compression but within a few minutes i heard the same cracking sound. and the whole mental torture raged on in my mind. i told myself it couldnt be a fracture cause the chest contour and resistance was still the same. i did it just so that i can continue with the job at hand and not be paralyzed with guilt and self-doubt.
after 30-40mins of cpr and other forms medical resuscitation, the guy's heart still failed to beat on his own and he was declared dead. his family members who were near the bed were informed of his death. we just moved away in silence.
at that point i was not sad or anything. i didnt even know the guy in the first place. i was just worried that i did more harm than good. and somehow or rather by my inexperince, i helped pushed him to the other side. these issues bugged me for two whole days. it kept on creeping into my mind and every attempt to shrug it off was futile. friends told me it probably the sound of the the bone moving in the joint space, just like when you crack your knuckles. and if it was a complete fracture, the chest resistance and contour would be different.
the issues was finally put to rest a few minutes back when i spoke to a dear friend who is practicing medicine in the UK. she said the A&E doctors there told her if you dont break at least a rib during cpr, you are doing it wrongly. it indicates that you are not compressing hard enough hence blood flow to the rest of the organs is insufficient. and judging by the severity of the patient's hemoptysis(coughing out blood) he probably had a couple of rib fracture from the accident itself.
whatever it is, it was a good learning experince. i just wish it wasnt such a traumatizing one.
Sunday, June 04, 2006
breakin a bone
after spending 3 weeks in the orthopedic ward, i've come to two conclusions:
- i will never be an orthopedics doctor
- i never want to break a bone
breaking a bone is not something nice. getting the bone back into place is even worst. 100 times worst!!! especially if you have a low pain threshold level like me.
i have no problems looking at disfigured and deformed limbs. but the treatment, lord god....
if they say surgeons are butchers, then orthopedic surgeons must be the king of them all.
there was this guy(who looks like a bangla but has a Jamaican name) who broke a bone in his leg. so they had to do something called below knee skeletal traction where they connect a weight(around 5kg) to a metal rod in his leg. in order to that, they had to manually drill a 10cm steel rod through the guy' leg just below the knee.
they gave the guys some anesthesia over the area and they proceed to drill the steel rod into the skin through the bone and exiting on the other side. drilling through a bone is no easy job. on a scale of 0 to 10, i will say its around 12. one doctor will be pushing the guys' leg and another doctor will drill the rod from the opposite side. if ever these doctors loose their license to pratice, i bet they wont have problem getting a job Petronas CariGali.
it took 3 doctors to complete the job. there was a female doctor who tried drilling the rod through but i seriously doubt she contributed anything to the cause except to cause more pain and misery to the poor guy. below was the conversation that took place during the procedure:
D1: kasi kuat lagi!!! kuat lagi. ah, tangan jangan bengkok. nanti rod senget boss marah.
D2: ERGHHHRHHH....sial la!! tak boleh masuk!
D1: kakaka...kau ini lemah la. suruh pigi gym tak mau. ah X(akaD3) baik kau warm. nanti you punya turn.
*D3 really starts doing stretches while D2 continues to drill the rod. at the background, you have the pseudo-jamaican patient muffled groans.
D2: ARRGGHH....huh!huh!huh! wei penat la. hahaha. betul betul tak boleh la.
D3: ah biar saya buat sekarang.
D3 starts drilling with a vengence.
pseudo-jamaican: argh.....
D1: ah lagi lagi!!!! kakaka....fulamak. ini X kurus la tapi kuat macam badak.
pseudo-jamaican: argghhh....
D1: lagi lagi!!! jangan stop!!!
pseudo-jamaican: WARRRGGHHHHHHHHH.....
D1: apa pasal you jerit???
pseudo-jamaican: wah, banyak sakit man.....
D1 looks at the patient's leg.
D1: oh, rod dah hampir keluar. kasi dia bius....
skeletal traction....its the same thing that the bangla got.
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