Monday, May 30, 2011

How I end up in India


Recently i received a request from a parent about choosing an offer. Back in 2007 i received the same offer letter from Public Service Department and were asked to go for A-level preparation in Kolej Teknologi Timur. I did not receive any other scholar or offer to other local universities at that time. Even though i received an offer to Sains Asasi in Kolej Matrikulasi Johor, i declined the offer and go for the Public Service Department scholarship.


Dear eve_lasting She told me you were at first were supposed to go to Poland but you end up in India.my question: 1. why did you not go to poland but went to india instead. Thanks, I will appreciate a prompt respond. Auntie N,

Dear Auntie,

Like i mentioned before , I am a JPA/PSD scholar. After the interview with PSD nationwide, we got a letter of offer to do medic in Poland. I personally never knew that the offer does not guarantee that we will be sent to Poland despite of having enough cut off points. 

In one year preparation of Poland bound, we have to seat for AS(advanced level) and A2 level.Poland and Czech bound students took 3 subjects ; Biology,Chemistry and Physics. Whereas, India and Indonesia took 4 subjects ; Biology,Physics,Chemistry and an additional Mathematic subject.

In AS unfortunately, only a few students scored all A's. The subject was tough especially Physics and we had only 3 month  to seat for the exam as compared to the real India bound students who had a comfortable time of 6 - 8 month to study for the subject.

When we have to seat for A2 ( 6 month study), i also have to seat repeat papers in AS paper. With lecturers advice, he told me to take only 2 repeat paper which is Chemistry and Physics because the burden to study AS and A2 at the same time is too much. I prayed and pinned my hopes very high on scoring a greater results in A2 to cover up my points in AS. Alhamdullillah, i managed to score 12/15 points which enables me to secure the scholarship.

These are the cut off points for different bounds:

Poland,Czech ( 1 year bound,3 subject)- 12/15
India ( 2 year bound ,4 subject )- 12/20
Indonesia (2 year bound,4 subject)-13/20

A- 5 point, B- 4 points, C-3 points and so on.

*Note: Not entirely a fact.Based purely from  my understanding.


Some students  in my batch who did not pass cut off points especially the ones who get 11/15 points, still managed to secure the scholar and were sent to Indonesia.However, the scholar money are even less than we get.


(Nowdays, PSD has been really strict about the cut off points. those who do not pass, PSD will not grant the scholar any further and they soon have to search for other opportunities and compete with the recent SPM leavers.1 year bounds are luckier than the 2 year bounds as if, unfortunately they didn't make the cut off point, they have to compete with juniors two years younger their age.

For Czech bound students, they have to undergo 3 obstacles;
-AS,A2 level,IELTS
-Entrance exam
-Interview

For Poland bound student, no interviews or entrance exam were conducted. We were told to fill a registration form to be given to an Agent  ( an official agent to handle student entries to unis by PSD) handling this matter.

Knowing that we do not have any entrance exam or interview and depending fully on A-level and IELTs results, we waited for the results anxiously. As soon i pass the cut off points, we were told by PSD to wait for the phone call from PSD. In no time, PSD announced the results for students who could fly to Poland. Those who can go to Poland were relieved, and for us who can't go to Poland were deeply devastated.. The placement is very much in  doubt for us but we just keep quiet because we don't want people saying we are being ungrateful. 

Our main dissatisfactions are ;

-even a high scorer in AS and A2 are not qualified to fly to Poland
-even a low scorer  but pass the final pointers could fly to Poland.


Our assumption was, either 
-the placement was sent in random or
- there is not enough seat for International quota in Poland.

In one case, she asked the agent about why she did not qualify to fly. But,there is no satisfying answer for her. She managed to call the university in Warsaw and were told that the university did not receive her 'form'. We do not know what kind of form was it actually.


Our doubt was:
-Does the result since AS is considered for Poland qualification ? If so, why there are some student who scored less in AS managed to fly too?
-How the Agency determine which student qualified to go to Poland? By total AS and A2 pointer or the total marks secured?


Nevertheless,PSD tried to place us in India as per agreement stated in the huge blue card. Bare in mind, the offer letter content to where ever it is, is merely an offer, not an official agreement. 

While waiting, we got a call from JPA calling us to attend a meeting in JPA building in Putrajaya for a pre departure briefing. In that call, we were given three choices;

- Study  MBBS in India for 5 and half year 
- MBBS twinning program of Malacca Manipal Medical College (MMMC)
or decline the scholar and study in Malaysia.

After three days or so, we chose what we think best for ourselves.Alhamdulillah,none of my friends who can't go to Poland decline the scholar. Althounh, i did hear rumours about a student who wants to stay in IMU and apply for PIDN instead of PILN.

As for me, i chose to do FULL TIME INDIA purely because of India's best clinical exposure,hands on examination on patients and HIGHER scholar money. (i am being really honest here...and plus i thought we would live in city , sort of mini-Sepang with Giant.. twinning program is in a remote area,very much like MARA-style area...took 1 hour by bus to reach town )

So, in such a RUSH we prepared our health check ups,vaccinations,documents(certificate translations),signature from parents employer ,visa and passport within one week and off we go to India. 

During my studies in India for 3 three years so far, there is no apparent issues on our Universitys' accreditation. Frequent visit by the Malaysia Medical Association(MMA)  to our college ensures our MBBS certificate is recognised by LAN and Malaysian Health Society.


I hope my story will answer your query. I often used "WE" rather than "I" to show you MANY of us couldn't go to Poland/Czech.The above information and dissatisfactions came by collective discussions with my friends not long time ago. These are the insights of what happened to us and does not represent our disloyalty towards the Goverment or PSD management. 




**********************************************************************************





thanks sweetheart. another question... my son also has an offer to do medicine in UIA. if you are in his position now, which you would choose?






 Dear Auntie,



Emm, if it was me..considering my parents economic status i certainly will choose any offer that comes with a scholarship.

Not to mention JPA will pay for universities fees, monthly allowance, accomodation allowance,book allowance etc..

If both programmes offer scholarship, i will definitely choose Poland.

During my interview with JPA, i always set my mind if the officer ask me the same question either to study in Malaysia or oversea, i will say this,

"sir..i personally think that knowledge can be acquired anywhere in the world provided we as the students are willing to put enough effort. I think that the medical education in Malaysia is at the same par with the other countries.Hence, me choosing this oversea scholarship is clearly about the rare experience that will someday be a great journey to myself mentally,emotionally and spiritually. "

I have friends who at beginning were bounded to India scholar, but later didn't manage to get it and later got a placement in UIA. Most of them if given another chance to do well in Pre-u level, they wanted to secure the scholar and go to India instead.


Note : Names and identity are not mentioned in detail to protect the integrity of the beholder.
You are free to share the entry with anyone interested in it.

 ************************************************************************





These are the answers i gave to the lady. This letter does not portrays my disappointment to anyone. It is just a sincere experience-telling-story to anyone wanting to know the risks ,pros and cons of taking scholarship within or outside Malaysia. I will soon post some more story about the reality of Indian Health Education. Whether the legend of India being GREAT at clinical exposure or not. Do wait for me. I hope my decision to study in India based on legendary clinical exposure is the best. 







Injections A Must-Know





Injections are designated according to the anatomic site involved.


Intravenous Injections



Intravenous line






Subcutaneous Injection



Intramuscular injections




Viva must know

  • What is the size of needle and syringe?
  • What blood vessels are susceptible for damage?
  • Application of types of injections in vaccine/saline/anaesthesia administration. (e.g MMR,DPT...)


Injections A Must-Know


Intravenous Injections



Intravenous line








Subcutaneous Injection



Intramuscular injections










Sunday, May 29, 2011

Ovarian cystectomy











Must know viva question

~ What is Groove sign
~ Clinical presentation of ovarian cyst
~Examination of abdominal distention

Saturday, May 21, 2011

Buruj: Bintang-bintang dalam Astronomy





Setelah di amati bintang-bintang di langit itu, terdetik pula dalam hati kecilku ini untuk mencoret sedikit sebanyak perihal permata angkasa, si bintang-bintang... Owh,Twinkle-twinkle little star..Mungkin tak ramai yang tahu apa nama buruj yang kita sering lihat di langit malam...Ada yang macam pangkah, ada yang macam busur, macam petani la, macam mangkuk la...macam-macam ada..ahahha.. Bintang yang ada kat Malaysia pun saya nampak kat sini..

Tapi macam ada yang kurang..Orang kata, Bintang pun ada musimnya..macam musim buah durian,mangga dan lain-lain..Kat India, yang saya kenal hanyalah Buruj Pari, empat gugus bintang yang tersusun indah dan kelihatan jelas di langit malam..Tak kisah lah kalau anda melihat bintang ini dari bawah pokok belakang rumah,atau dalam kenderaan yang bergerak seperti Inova ayah ketika balik kampung melalui Lebuhraya Utara Selatan ..Wahhh..rindu nak balik kampung...on way balik Pontian atau Kuala Lumpur,saya selalunya tak bley nak tidur sangat..excited punyer pasal. So, kami adek-beradek baringkan kerusi tengok bintang dan bulan ramai-ramai,bukak tingkap dan peerghhh..sejuk..segar..tambah lagi langit cerah, nampak  banyak gler bintang...Memang tak tergambar perasaan masa tue...Malam raya..sambil dengar lagu raya...Wahh...rindu-rindu !! 


p/s: RINDU jalan kat Malaysia,RINDU nak balik kampung,rindu nak dengar lagu raya,rindu ibu ayah,rindu Malik,Aja,Ajim,Maryam,Maryana dan kucing-kucing yang banyak itu especially BoB and Bobby, tak lupe juga mak dia, si PUasa( ibu panggil Puasa sebab datang kat rumah masa puasa) dan segalanya tentang Malaysia...

RINDU!!    RINDU!!!     RINDU!!! 

Ni setelah saya Google dan lihat isi kandungan web-web,ini antara fakta-fakta menarik yang ingin saya kongsi bersama..Semoga ilmu ini bermanfaat untuk anda..


Menggunakan Kedudukan Istimewa Bintang dan Buruj

Sejak zaman dahulu lagi manusia telah menggunakan bintang sebagai petunjuk arah. Perkara tersebut ada dijelaskan dalam al-Qur'an dengan maksud: 

"Dan Dia menciptakan tanda-tanda petunjuk jalan, dan dengan bintang-bintang inilah mereka mendapat petunjuk...."
(Surah al-Nahl: 16)

Bintang yang sesuai digunakan untuk tujuan penentuan arah utara ialah Bintang Kutub (Polaris) yang terletak bertepatan dengan paksi putaran bumi. Keadaan ini menyebabkan bintang-bintang lain secara ketara kelihatan beredar mengelilinginya.Bagi pemerhati di Malaysia, Bintang Kutub berada rendah di ufuk sebelah utara. Di negeri-negeri pantai timur seperti, Kelantan dan Terengganu, Bintang Kutub boleh dilihat berada lebih 5° di atas ufuk. Bintang Kutub berada dalam buruj Ursa Minor, tetapi lebih mudah dikenali melalui Buruj Bajalt. Buruj Bajak dikenali juga di kalangan masyarakat Melayu di utara Semenanjung Malaysia sebagai Buruj Timba dan ada pula yang menamakannya sebagai Bintang Senduk. Masyarakat Melayu, mempunyai pemahaman tersendiri tentang perkaitan di antara kedudukan Buruj Bajak dengan perubahan musim. Pada masa tertentu, apabila bahagian empat persegi Buruj Bajak yang disifatkan sebagai senduk menghadap ke atas, akan disifatkan sebagai 'musim yang sukar' iaitu musim kemarau. Ketika bentuk senduk menghadap ke bawah pula dikatakan menandakan 'murah rezeki' iaitu musim menuai.


Untuk mengetahui kedudukan Bintang Kutub, terlebih dahulu hendaklah kenal dan camkan bentuk Buruj Bajak.


Pada waktu malam di antara bulan Disember sehingga Mei setiap tahun, terdapat satu buruj lain yang menarik di tengah-tengah langit, iaitu Buruj Orion (Al-Babadur/Belantik). Buruj ini mudah dikenali kerana ia mempunyai tiga bintang berderetan di tengah-tengahnya. Ketika Buruj Orion berada di tengah-tengah langit dalam pergerakan hariannya (dikenali sebagai fenomena istiwa buruj) unjuran garisan yang menghubungkan Bintang Rigel dan Bellatrix menunjukkan arah utara. Bintang tiga berderetan dalam Buruj Orion pula digunakan oleh nelayan di Pantai Timur Malaysia sebagai panduan untuk kembali semula ke daratan dan menentukan arah kiblat.




Di langit selatan pula terdapat buruj yang boleh dijadikan panduan untuk mengetahui arah selatan dan sesuatu tempat. Buruj ini ialah Buruj Salib Selatan (Crux), yang dikenali di kalangan nelayan tempatan sebagai Buruj Pari. Buruj ini akan berada di tengah meridian langit selatan pada waktu maghrib di antara bulan Mei dan Jun. Arah yang ditunjukkan oleh garisan yang menyambungkan bintang A dan B ketika tersebut adalah arah selatan. Unjuran garisan tersebut kearah yang berlawanan untuk
mengetahui arah utara dari sesuatu tempat.
Buruj Pari & penentuan arah selatan







Buruj bintang yang boleh dijadikan panduan untuk menentukan arah kiblat ialah buruj Orion (Al-Babadur). Tiga bintang berderetan dalam buruj ini iaitu Mintaka (δ Orionis), al-Nilam (ε Orionis) dan al-Nitak (ξ Orionis) boleh digunakan sebagai panduan arah kiblat. Buruj Orionakan berada di langit Malaysia ketika waktu Subuh pada bulan Julai dan kelihatan tinggi di langit pada waktu tengah malam pada bulan Disember. Pada bulan Mac dan mana yang berhampiran dengannya, buruj Orion akan berada di tengah-tengah langit ketika waktu maghrib. Arah kiblat boleh diketahui dengan mengunjurkan arah bintang tiga berderet berkenaan ke arah barat, lihat Rajah 6.1.

Selain daripada buruj Orion (Belantik), arah kiblat juga boleh ditentukan dari arah utara dan selatan yang ditunjukkan oleh beberapa buruj bintang. Setelah diketahui kedudukan utara, maka arah kiblat boleh ditentukan berdasarkan bezaan sudut di antara arah utara dengan arah kiblat. Untuk mengetahui arah kiblat dari mana-mana tempat di Malaysia, bukalah sudut sebesar 68° ke kiri, iaitu arah kiblat yang dikehendaki. Selain dari bintang kutub, anda juga boleh menggunakan arah selatan yang ditunjukkan oleh buruj Pari atau Salib Selatan (Crux).




Colour of the Stars......
The Pleiades, the brightest star is Alkyone.

A star resides on the main sequence when it fusions hydrogen to helium in its core. This is the case for the most part of its life. It is relatively stable then.

From its color (= surface temperature) it can then be directly concluded to its mass, size and luminosity. Red stars are small and cool, blue stars big and hot. In between are orange, yellow (like our Sun) and white stars. In a diagram (Hertzsprung-Russell diagram) those stars are all in a row, the main sequence.




 Names of the constellations of stars...n the celestial equator aren't marked.



Andromeda n
Antlia s
Apus s
Aquarius *
Aquila
Ara s
Aries * n
Auriga n
Boötes n
Caelum s
Camelopardalis n
Cancer * n
Canes Venatici n
Canis Major s
Canis Minor n
Carina s
Capricornus * s
Cassiopeia n
Centaurus s
Cepheus n
Cetus
Chamaeleon s
Circinus s
Columba s
Coma Berenices n
Corona Australis s
Corona Borealis n
Corvus s
Crux (Southern Cross) s
Crater s
Cygnus n
Delphinus n
Dorado s
Draco n
Equuleus n
Eridanus s
Fornax s
Gemini * n
Grus s
Hercules n
Horologium s
Hydra
Hydrus s
Indus s
Lacerta n
Lepus s
Leo *
Leo Minor n
Libra * s
Lupus s
Lynx n
Lyra n
Mensa s
Microscopium s
Monoceros
Musca s
Norma s
Octans s
Ophiuchus
Orion
Pavo s
Pegasus n
Perseus n
Pictor s
Pisces *
Piscis Austrinus s
Phoenix s
Puppis s
Pyxis s
Reticulum s
Sagitta n
Sagittarius * s
Scorpius * s
Sculptor s
Scutum s
Serpens
Sextans
Taurus * n
Telescopium s
Triangulum n
Triangulum Australe s
Tucana s
Ursa Major n
Ursa Minor n
Vela s
Virgo *
Volans s
Vulpecula n



 Web menarik..



Sampai di sini sahaja...nati sambung ag ea... :D ngeee~~~


Friday, May 20, 2011

John Hopkins Medical Programme in Malaysia

Klik linknya di sini

Dengar cerita dari Bernama,

Akan ada new medical program di Serdang , Malaysia. Universiti terbaru itu bakal menarik minat para pelajar seluruh dunia terutama Asia Tenggara dan Timur Tengah.

Intake pertama dijangka bermula pada September tahun ini dengan jangkaan seramai seratus orang pelajar.
75 orang djangkakan untuk pelajar Malaysia.Diantaranya 50 pelajar Malaysia di bawah tajaan Jabatan Perkhidmatan Awam.

Dr Mohan yang juga merupakan Chancellor pertama University tersebut mengatakan project university dijangka menjangkau sebanyak 2.4 billion ringgit.

Pembinaan teaching hospital university ini juga merupakan salah satu agenda yang di bentangkan oleh yang Amat Berhormat perdana Menteri,Datuk Seri Najib Tun Razak dalam belanjawan aset negara 2011.

*
*
*

Kata dah bekukan program medic di Malaysia. 
Kata dah ramai sangat doktor.




Habis tu, apalah jadi dengan kami-kami yang baru habis nanti ?


Jangan yang di kejar tak dapat.
 Yang dikendong berciciran pula...

Wednesday, May 18, 2011

Test preparation for Opthalmology.

Tuesday, May 17, 2011

"Foxtrot Sierra... do you copy?"



28 November 2006




Phew! The A1 GP racing came and gone. I got lucky to be called again for the second time to join its medical cover team. Th experience can be summed up with 3 words - fun, hectic & wet. 
The medical cover was organised by our own military medics, with the inclusion of some civilian docs. 

It's always interesting to watch the way those army folks run the show. We got morning parades and briefing ala-ala "an officer & a gentleman" minus R.Gere of coz. I guess the take home message is teamwork begets success

We were devided into several key-teams, comprised of docs, paramedics/nurses. Each team had different role and were given unique call signs: e.g. zulu leader (team leader), papa lima (pit lane doctor), foxtrot sierra (flight surgeon) etc... this whole code-thing reminds me of J.A.G yeyeh!

The main role of each team will then be determined by the doc's (who lead them)specialities e.g. emergency physician, surgeon, anaesthetist, orthopods etc.

The Sepang medical center itself was turned (in just an overnight) into a 'mini-mi' hospital, we got everything from X-ray machine, observation ward to even an operating room! - Malaysia boleh kan! Even the mat-sallehs who co-supervise the whole action complemented our local effort as being among the best medical teams in the global GP arena. No play-play ah!

We had 3 days headstart purposely for only 1 thing = TRAINING. This includes from reporting accidents to evacuating drivers from their damaged cockpit. Most of the guys had been trained before in the previous race or tournaments i.e F1, Japan GT, so it was just a matter of getting back into shape & rhythm.

We also gotta learn and memorise the track well, esp. the dangerous turns & curves and the fastest & nearest route to the crash location and back to the medical center.

And oh boy! In Sepang circuit, when it rains it pours huhuh!



"Charlie 2 to Zulu leader, we've got a code red at turn 12, requesting Bravo unit assistance, do you copy? over".
PS: Did I hear somebody says F1 :)






19 November 2006

The morning after

Anaesthetist are bunch of docs who guard the ICU and OT (two places in hospital where tension can be quite nerve-wrecking). ICU patients are mostly unstable and usually connected to breathing machine. Which means they are not so verbal... and when they do complaint, it will be in form of 'dropping their blood pressure or heart rate'.
Perhaps that is why there is some form of global regulation that anaes usually gets a day off after being on-call for 24 hours. Whether that 'law' really exist or not, it is something that we do get and need after those semi-sleepless nights.


Question:

"Would you want an anaes who didn't get any sleep the night before, doing your surgical case; by choosing & calculating the correct drug types & doses to put you asleep on the operating table?"

Having said that, I pity our other colleagues from the other departments i.e paeds, surgical, orthopaedics etc. who don't get the post-oncall day off. This means they're working from 8am that day until 5pm the next day --> 33 hours straight.


So.. my most recent post-oncall day: I slept for good 6 hours.. pampered myself with 007 and a nice dinner at Piccolo Mondo! Now dat's my 'morning after' ;) Oh BTW, that blond chap... he is a perfect Bond (after Connery of course HAH).






09 November 2006

Box of chocolate


The on-call morning is likened to receiving your raya's angpow. The feeling of "You never know what u gonna get". You may end up with only one patient to look after or the whole 'full 10 beds' situation.

The passing over session is always d fun & crucial bit. Where the doc who was on-call the night b4 will go through all the cases in ICU with the one who is taking over that day.

i.e: "Mr James Bond is a 40y old Malay man who's admitted 8 hours ago for a gun-shot wound to the left upper chest causing left tension haemopneumothorax. GCS on arrival was 6/15. Intubated in ED with ETT 7.5mm @ 20cm under midazolam 3mg and suxa 100mg IV. Chest tube was inserted uneventfully in ED. The bullet was surgically removed 1 hour ago in OR. Blood loss 300cc. Haemodyamics stable bla bla.."

When reviewing patients, usually we break down the problems into systems i.e ventilation, haemodynamics, infection.. etc etc. That helps us to focus on specific problems or anticipate any future complications. Then we would go through the OT list -- cases need to be operated on.

Hmm.. I should start asking myself in Dirty Harry's style, every on-call morning...
"Ask yourself this. Do u feel lucky today ? Well do u punk??"



27 October 2006

The Master (program) and 'civil' servants


Come October every year, a substantial number of Malaysian doctors would compete to get into the Masters program which enable them to become a specialist. Another 4 years of their life will be devoted to exams, lectures, on top of daily clinical works @ hospitals (hey that's ok!)

However, the fustrating bit is the shenanigans we all have to face in order to apply for it.

Imagine all these paperworks and what not:
* u have to get sah lantikan, then sah jawatan (for whatever those mean actually)
* at least 3 years of service
* decide on the kwsp/pension options
* pass the 3-week 'induction' course
* security clearance (some have to filled this twice, since the first one gone missing) - a conspiracy that N.korea agents might infiltrate as under cover docs?
* etc etc

And if you wanna have those papers processed within 1 - 2 month instead of 1 year, one gotta climb the putrajaya stairs around 5-6x, 50x phone calls which may sounds like "Maaf encik, belum siap" or my favourite "..nanti saya passkan awak ke pegawai lain".

I seriously pity those docs who lives outside selangor or worse still @ sabah/sarawak.

Huhu don't forget that this special October - we only have 3 weeks due to the double festive season.. yeayy!

The clock in the OT is ticking my friend!
Shoits - i'm on call again this weekend






21 October 2006

"Dr atas panggilan"


Some hospitals still have "dr atas panggilan' stamped in front of on-call rooms. Yes-sirree your classic BI -> BM translation.

Yaiks! I never like being on call on weekends, it only means 1 thing: you're the only medical officer from your dept whom they will call should there be any emergency arise. The OT (operating theatre) of course is only open for emergency cases i.e appendicitis etc

Today i got 4 cases waiting in OT. That should keep me on my toes for d next 6 - 7 hours. Hopefully the ICU patients would be kind enough not to drop their blood pressure. Well another 24 hours to go before my shift/call is over. Then I'll hit the highway with my 'road-trip CDs'.

My kampung is waiting.. i hope the ocean is as blue as i remember it.
Selamat Hari Raya everyone!






20 October 2006

Breaking bad news

He had just turned 42. I could imagine him woke up that morning as usual. Maybe had sahur with his kids or kissed his wife on his way to work. It should have been another routine day.


Who would have guess that by 7pm he would be lying unconscious in a resus room with a group of strangers pressing on his chest.

The chest pain started around 6pm with no provoking factors. Crushing in nature and "it feeels like an impending doom". The ECG showed that the heart had been deprived of its birth right --> oxygen & blood supply and that caused the excruciating pain.
Without further warning his heart rhythm went berserk: supraventricular tachy (SVT), and caused the blood pressure crashed to 70/40. We need to stabilise his heart fast. I was called by Chan, the medical MO 'on call' to assist him in doing just that.

He's a moderate size guy, not the morbidly obese type, but a smoker. He's obviously anxious while his breathing was rapid and shallow. He's definity lost lots of CO2 and his ABG might shows an alkalotic picture.

I held his wrist feeling for pulse.

"Darn it, this guy is pale and sweaty, and the BP is way too low" I told Chan.

Maybe he knew that already. He didn't looked up, eyes still looking at the ECG in his hands obviously muttering about s'thing.

I told the patient what we're going to do, and 5 mins later I put him to sleep by using intravenous drugs while Chan connected 2 paddles to his chest.

"CHARGE to 100. Everybody clear!"

ZAPP!!

The machine delivers 100J of energy into the man's heart. The patient jolted while we held our breath.


We manage to arrest the SVT, but his heart suddenly went into 'heart block'. A nightmare. Within 1 minute the rate slowed down to 30 beats/min and changed to pulseless VTach. He went into cardiac arrest. Another type of battle had begun. Cycles of defibs, CPR and drugs were given plus intubation, but there was no respond at all.

One hour later his pupils were fixed & dilated. His hands were as cold as ice. No spontaneous breathing. Nothing.

"Time of death 20:05"

As i walked away to the counter i saw Chan talking to the wife. She bursted into tears in the arms of a relative. I saw his kids. Three of them ranging from 4 - 9 years old standing in a corner. The eldest seem to understand something bad had just happen to their dad. While the youngest looked unfazed by the whole commotion. I feel sorry for them, especially with Raya coming. They have now become anak yatim.

I wish there is a proper teaching in medschools on how to break bad news. Most of us learn it along the way by watching seniors. Then you sorta develop your own way of doing it. You definitely come across lot of styles, some bad examples too.

A useful method is to emphatize with the relative, to be aware that there is a lot of sadness and confusion going on. One has to be precise/clear and avoid using vague terms. I'd seen families who were still unaware of the death even after being told that the patient had passed away.

"Take a deep breath, choose your words carefully and don't rush it" my senior once told me.

Easier said than done.


 
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