My time in Song....maybe its time to move on

At KK Tekalit with a Hypertensive patient

Just got back from another week long medical trip up Katibas river. This was my third and most likely last trip up there. I’ve already applied to be transferred back to Sibu hospital. Heard that it will go through somewhere in july or august. But knowing how bureaucratic JKNS (Jabatan Kesihatan Negeri Sarawak) can be, i won’t be surprise if im transferred later.

I’ve been here for 10 months now. I know I volunteered to come to Song in the first place but a big part of me tells me that my time here is up. My long term goal is to be a surgeon. I realised I’m not the type of doctor who can sit in a clinic the whole day. It bores me.

Another reason is that I feel I’ve done all i can do to improve the health care here. This place probably needs a new MO with new ideas and direction to make health care here better.  Remaining here would just mean I’m holding up in my comfort zone and I wouldn’t be able to progress anymore.

         Got caught in a tropical thunderstom on the way from Tekalit to Bangkit. No choice to continue in the rain. My yellow arse was freezing out there.                                                

When i was first transferred here, the clinic didn’t have much despite it being such a beautiful clinic. We have patients up river in the ulu areas that have not seen a doctor in their entire life. There was no X-ray or organism culture facility. No infusion pump, no CTG, no ARM stick. The MAs didn’t have a proper guideline on how to follow up on hypertensive and diabetic patients. There was a gross lacking of emergency drug. We had a 10 year old speedboat with an equally old engine which breaks down after a single emergency trip.

All these are vital for a clinic such as KK Song since we have no road access to any hospital.  If there was an emergency and we can’t transfer the patient due to engine boat failure or bad weather, all these instruments are necessary to make a diagnosis and keep the patient alive and stable until transfer to a hospital.

I remember a case where a patient collapsed in my clinic in the middle of the night. We had to start her on inotropic support to increase her blood pressure but we didn’t have any dopamine or dobutamine. All we had was adrenaline but we had no infusion pump to administer the drug. So we had to inject 5 ampules of adrenaline into a pint of normal saline and titrate it that way. It was a rather crude and unorthodox way to do things but what choice have i got. I just wanted to save her in any way possible.  Her BP and heart rate went up and down depending on the position of her hand and IV line. We wasted a lot of time as well looking for another speedboat because the clinic’s speedboat broke down again after transferring a patient few hours before that. We finally managed to get a speedboat from a logging company. Unfortunately, we didn’t manage to save her. She passed away at the wharf while we were about to transport her. 

Had a time of my life at the waterfall in Sungai Engkaroh, near Bangkit.

Now, we have most (I stress on the word MOST) of the instruments that we need, we are able to provide better health care to the people here. We have a new speedboat (albeit a very small one) with a new 80hp engine. The old boat has been send for a very much needed servicing in Sibu. We have yet to receive our Xray machine but my boss has confirmed with me that Song will be receiving it in the new future. Guess the new MO and people of Song will benefit from it.

We have also started on a 3 monthly mobile medical to Ulu Katibas specifically targeting poorly controlled hypertensive and diabetic patients who are financially poor and can’t come down to Song for follow up. We use the 4 Klinik Kesihatan (Tekalit, Bangkit, Engkuah and Chemanong) as a focal point for these patients to gather and see me. Patients with good BP and glucose control will be seen by the MAs.

In the first visit, i saw a total of 210 patients with 90% of them for poorly controlled blood pressure and diabetes. In my most recent visit, i saw only 135 patients with roughly around 85% for poorly controlled blood pressure and diabetes. The number of MO cases has reduced but MA cases still remain the same. That means just after 2 medical camps, we were able to reduce the number of poorly controlled hypertension and diabetes patients by 60%.

The beauty of mother nature. I've fallen in love with Sarawak and cant get enough of her natural beauty

We also started taking blood specimen on the 2^nd visit onwards to check for their renal function. We managed to detect 8 cases of renal impairment and those patients were informed of their condition and are under close follow up in Song. Those who need specialise care were referred to Sibu for further management.

During these visits we also have informal CMEs (continuous medical education) for the MAs in the clinic so that they can better pick up red flag symptoms and signs and refer the cases to me early so as to prevent the patient from deteriorating further.

We also invited the dental team along with us. It’s always more fun to have the dental team around. The bigger the group the merrier it is. There was once case where a patient had been suffering from a toothache for 4 years but he couldn’t afford the RM20 fare to go down to Song to have his tooth extracted. When it was finally removed he was so dam happy and he was later cursing the tooth for the pain all these years. What a sight....

I guess another reason i want to go back is because i want to be a surgeon eventually. Seeing diabetic and hypertensive patients who refuse to take their meds days in and day out irritates me. I feel claustrophobic stucked in the clinic all day long. And looking at how my friend from the same batch as me and my juniors getting better and better in surgery makes me feel kind of left behind. The desire to go back and make up for lost time is strong. 

This is the life man. Just lying there and fishing without a care in the world with the sunset as your companion,  the breeze caressing your face and the melody of a running river in your ears. 

But at the same time there is a small part of me who still wants to stay for just a little while longer. I just found out i failed my MRCS exam. Will be re-sitting the exam in September. I’ll definitely have more time to study here than when i go back to sibu.

Another reason is that ive came out with a new idea. There are many other smaller tributaries along the rejang river  which stretch for kilometres with few longhouses deep in it. To travel to those longhouses one would need to travel by longboat and if the water level is low, you are required to push the boat for an hour or two. 

Im planning a medical trip to Sungai Lajan next month. The furthest longhouse(Rh. Jipon, what a name)  is 4 hours from Song. Need to take a 2 hour boat ride followed by 2 hours of hiking in the jungle to reach that longhouse. This is a pilot project. If i feel there is a need to conduct such a clinic, then will do so once every month for each river under Song KK. but can only carry out the project if im still in Song.

All up to God how long he wants to keep me here. 

Running....

i first started jogging when i was 14. it was in preparation for my school's annual cross country run. ever since then, i've always had this magnetism of sort for running. i jogged frequently during my teens. i remembered my best 10km was 48minutes when i was 17 years old. when i entered high school, my running became less. when i was in medical school it was even lesser. i ran only sporadically and my weight ballooned. 

after med school i had 6 a months break and i started running again. from a physical fitness stand point of view, i felt great. my resting heart rate was 62/min. 

but once i started work, i fell again to the routine of making excuses for not running. my running became sporadic again. i would be running hard for a month and once im able to run 8km (my psychological barrier) non stop, i ease off the peddle and stopped running for months only to struggle through everything again. 

when i started my district posting i was round and i weighed in at 87kg. i was told i dont look good cause im over weight but i dont really care for such vanity. but when i see ppl in their 20s getting hypertension and soldiers in their 30s getting a heart attack, it spooked me out. my own father had a heart attack in his early 50s and went for a triple by-pass surgery. i told myself im not going to die of a heart attack until my children graduate from college. 

so thats when i started running again. and dammit, it feels good....

there is something special about running. when you run there is this feeling of freedom that grows inside of you. to me running is more of a mental challenge than a physical one. when i run, it just ME against MYSELF.

when you can hear your own heart pounding and laboured breath and every inch of your body shouts out to you to stop, thats when mental strength kicks in. you force every aching muscle and joint in your body to push on and when you finally do reach your target distance, you feel a sense of liberation. of freedom..... 

you feel liberated cause you know you have what it takes to go beyond your own worst enemy....yourself. and that you are not a slave to your own earthly mortal body. it kind of gives you a weird sense of euphoria. i dont know if this is what they call a "runner's high."


running is also a good stress reliever. whenever im bothered or angered by something or when i loose a patient, i go for a long run. its a good outlet to release all those negative energy deep inside you. rather then let rip those pent up negative energy at some innocent loved one, i just run it off.  i found it has helped me cope with my short fuse better.

i read somewhere last year that only 1% of the world's population has completed a full marathon. that was when i decided running a full marathon is one of the few things i want to do before i die. Emil Zatopek (1952 Olympic marathon gold medallist) said, "If you want to win something, run 100 meters. If you want to experience something, run a marathon." 42.2km of non stop running is going to be one hell of a mental challenge and i intend to achieve it by 2012.

the Sibu mini marathon was the first open competitive 10km run in my life and i was happy i did it in 1 hour (despite weighing 82kg). next stop is the KL Standard Chartered 10km run on 26th june. hopefully can dip below 50 minutes. 

if everything goes to plan and i stay injury free, planning to finish the half marathon (21.1km) at the Standard Chartered  Singapore Marathon 2011 on 4th December 2011.

"You have to make the mind run the body. Never let the body tell the mind what to do. The body will always give up. It is always tired in the morning, noon, and night. But the body is never tired if the mind is not tired." 

George S. Patton, U.S. Army General, 1912 Olympian.

10km run on my bday

i never really was a birthday type of person. never did like big dinners or surprise party where im the center of attraction. makes me feel awkward. as long as my closest of friends and loved ones remember it and and im able to have a small simple dinner with them, im pretty happy. to me the perfect birthday is to sleep in till noon and then have a heavy hearty breakfast in bed and then go right back to sleep without any interruption.

i know....i sound like an old uncle.

so this year for my 29th birthday, i dont know what the hell i was thinking when i signed up for a 10km run when i have not ran the 10k since i was 17. i've started running again lately but the most i ran was 8km. i dont know why i did it. maybe it was due to the urging from a close friend. maybe i've gone nuts from the boredom in Song. maybe i wanted to see if i could still do it.

whatever it was, i was regretting it the night before the run. my friends had a birthday cake cutting for me the night before the run. before i blew out the candles, i did not wish for a million dollars or a threesome with sexy screaming Japanese twins or a PS3 + HDTV. i just wished to god that there will be a thunder storm in sibu the next morning so that i can sleep in.

when the alarm rang at 530am, there was no thunder or spliter splater sound of falling rain accompanying it. just the cockadoodledoo of a very irritatingly punctual and hard working rooster from my friend's neighbour's house. i was cursing myself for watching Thor at 11 pm and only sleeping at 230am.

managed to dragged myself out of bed and went through my toilet routine which consist of face washing, teeth brushing, butt scratching and chocolate making. put on my shorts and singlet with my bib number A224 and i was off to the run with 2 other friends.

we were told to be there by 645am for the registration. we reached there at 630am only to find out that "YOU DON'T NEED TO REGISTER" and the run only starts at 845am. so was banging balls for 2 hours.

finally at 840am, the organiser called for the 10km run participants to gather at the starting line. the next thing i know, everybody suddenly started running. there was no "on your marks, get set, go" or blaring of a horn gun. they just started running....must be Singaporeans running also.

since this was my first 10km run in years, i started off slowly. wanted to pace myself. so i was pretty much last in the initial stages of the run.

the running route was through a plantation road. once you reached 5km, you turn back and head back towards the starting line.when i was at the 3-4km mark, the leading pack (some army dudes) was already at the 6km mark. wat caught my eyes was a 60+ year old apek was among them. about 20 mins before this race, he ran and won the 7km category in 30 mins.

my ego when "pfffeeeeetttt..."

anyhow, i trudge along anyway at my own pace. slowly but surely, i was catching up with the rest of the crowd in front of me. the last 3km was difficult. it was more of a mental rather than physical challenge. gotta admit, that apek kind of inspired me to finished the race.

i eventually did finished the race at 31st (out of 60-70 ppl) placing with a time of just under 1 hour. i was surprised with the time. i thought i would finish at around 1hour 10mins. so in the end i was pretty happy with the race.

but next year, im still going back to sleeping and breakfast in bed....hopefully with sexy screaming Japanese twins.

Reflections

well....im 29 now.

i can still remember the time when i was still sucking on Dumex from a milk bottle like it was yesterday. or how my dad used to chase me around the house with a rotan when i was still wearing my kiki-lala shorts and t-shirt. how time has fly.

so much has happened in my life since then. some good. some not so good. a few highs and a few lows. but all happened for a reason.

i've fallen in love. i've fallen out of love. had my heart broken. broken the heart's of others as well. had known the beauty of waking up next to a loved one. and also experience the loneliness and sorrow of rejection and betrayal.

reflecting back on the past 29 years, there were many turning points in my life. each turning point in my life was preceded by an event of intense pain, hardship and sorrow only to be followed by a life changing realisation of what it all meant.

i think the greatest turning point was when my dad fell ill and passed away when i was 15years old. that one single event had the largest impact on my life. it was that one event that shaped my entire life and made me who i am today. i would not be who i am today if it was not for my dad's death. that day, December 15th 1997, was the day i took my first step to becoming a man.

my dad's passing left me feeling sad and fearful of what the future may hold. but above it all, regret was the feeling i felt the most. i regretted not being closer with him. i took for granted that he will always be there. at 15years old, i had yet to experience death of a loved one. the greatest regret in my life is not being there with my father on the day he fell ill and never regaining consciousness cause i rather hang out with my friends. i carry that regret till this day with me. that experience taught me that the lives of our loved ones are on borrowed time and that we have too treasure them while they are still around.

do you know how it feels to come home from school and see your mom crying in front of a stack of bills and not knowing what to do....my dad's death left a big void that needed to be filled. i had to step into that role for the sake of my younger siblings. i took my first job when i was 15. i started making important family decision at age 15. it was then that i learned that every action has a consequence. because of that, i think a lot before i make any decision. and i dont make any decision when im emotional cause experience taught me that its the worst possible time to make any important decision. i guess maybe its cause of this that i think too much. thats what my closest of friends tell me.

my dad was admitted to a private hospital for his illness. he was in the ICU for 10days before he passed away. my family was financially above average but we were by no means rich. he had no insurance. and we had trouble finding money to pay for his medical bills. and he just had a heart surgery which cost almost rm100k. mom kept dad in a private hospital cause the mentality was that private hospital was better than a public hospital. and she felt a debt of gratitude to my dad, so she had to give him the best there is. the hospital will call everyday stalking for money. each day in the ICU cost more than RM4k. i can still remember how my mom had to borrow money from friends and how she had to hound the bank. or how she cried when she couldnt find enough money when the hospital called and told her that the hospital cant keep my dad if she cant pay. i felt anger and outrage. but most of all, i was overwhelmed with hopelessness. powerless to do anything for my father.

that event made me the doctor i am today. that was when i knew how it felt to be poor and not being able to access medical care. i understood what hopelessness meant.that was the day when i knew what kind of a doctor i wanted to become. i told myself i would be a doctor for the poor and needy and give hope to those who have none. lack of money should never be an excuse for not having access to the best medical treatment available. everyone deserves a chance at living. rich or poor.

there were many more life changing events in my life. and along the way, ive made many mistakes. i've hurt many dear ones with my words or actions. but whatever mistakes i made, i learnt from them and it made me a better man.

sometimes, mistakes just cant be avoided no matter how hard you try. till this day (and more often this past few months), i frequently ask myself whether i will regret the decisions that i make today.

then i realised, the truth is"NO ONE KNOWS!!!"

you cannot see into the future to guide your decisions. you can only make them with a sincere heart and the best of intentions and hope for the best. if it turns out to be a mistake, then learn from it and move on. no point holding on to a regret. its better to have lived a fulfilling meaningful life full of mistakes rather than living in the shadow of fear and not experiencing life to the fullest.

after all, mistakes are part of life. its mistakes that make us human after all.

what is a regret,

nothing but a distant memory,

hoping to be a reality

(justine tan, dec 30 1997)