The cassette

 

The other day my wife and I were reminiscing about the songs that we both enjoyed listening to during our youth in the car when Ryan (my 10-year-old son) leaned forward and asked:

“What’s a cassette?”

Sigh…

“It’s the small square thingy with that long string coiled inside”, his sister offered an explanation. “I loved to pull it out!”, she added as an afterthought. (We still had a few cassettes lying around the house when my daughter was a tiny tot so she knew what they were; by the time Ryan came along, they had been thrown away).

“It wasn’t a string!”, I said.

Double sigh….

The cassette reminds me of an era gone by. My youth was centred around the cassette, the only source of ‘cool’ music then (the radio sucked – as it still do today). I remember buying my first cassette when I was twelve. It cost me a fortune – RM 3 for a ‘generic’ cassette (that’s a fortune in those days when my daily pocket-money was only 20 sen). An original cassette would cost between RM 12 – 15. My first cassette contained a compilation of Abba’s greatest hits.

I fell in love with Abba then, and Air Supply, and the Bee Gees and John Denver (ya, ya, I know…quite cringe-worthy).

A typical cassette held about 60 – 90 minutes of music, typically around 10-12 songs. Those days I would compile a list of songs that I liked and then pedal out on my old trusty bicycle to ‘June Music’, a music store near my house where I’d surrender the list to the lady at the counter, pay her some money (typically RM 10 or so) and she would then source for the songs I liked and record them onto a brand new cassette. I would return a few days later to collect the precious new acquisition.

To listen to music, a cassette player was needed. My dad wouldn’t buy us one and so, during the school holidays, I made some extra pocket-money working in shopping malls or factories. My first ‘boom’box’ was a black Toshiba Mini-compo bought with my own hard-earned money when I was 15. It allowed me to not only expand my own collection of music on cassettes, it also allowed me to annoy the blinking daylights out of my family and everyone within a 500 meter radius from my home with loud music blasting from my boom-box.

Listening to music on the cassette was tricky. Since the tape only moved forward, if I wanted to listen to a particular song again, I’d have to rewind the cassette – hence in most cassette players those days, there was a counter built into the console – I had to remember at which number a song began so that I could rewind the cassette to that particular spot if I wanted to hear it again.

Rewinding a cassette using the mini-compo was a long tedious process – especially if the tape is extra long and the desired song was at the beginning of the tape! In order to speed things up, sometimes it was faster to just remove the cassette from the player, stick a pen or pencil into one of the holes in the cassette and do a rapid twirl – rotating the cassette on the pencil rapidly! (People from my generation would understand what I mean).

Over time, iron oxide from the cassette tape would accumulate on the player’s ‘head’ which would muffle the music – so I had to clean the ‘head’ frequently using a cotton-bud soaked in ethanol. It’s not an ideal solution because eventually the ‘head’ would be caked in so much dirt that it was impossible to remove all of them and so I had to contend with listening to inferior music.

Then came the Sony Walkman which allowed me to take my music anywhere I went. I got myself a Walkman when I went to med school. It was my pride and joy (it cost a bomb – my mum bought it for me). Of course, I didn’t realize I was lugging something the size of a brick by today’s standard – back then it was cool. It wasn’t cool when my senior borrowed my Walkman and broke it – which left me miserable and music-less for a while! Thankfully a junior gave me his mini-compo because he got a better one – to be stuck in India for years without a cassette player would be tragic.

And of course cassettes didn’t last very long. After a while, the music recorded on it would fade, or the tape would get ‘rusty’ with accumulation of iron oxide or fungus would grow on the tape (during the Indian monsoon, fungus grew on practically everything I owned!) or perhaps by mishap, the tape would get stuck in the player and the whole rim of tape would become undone when I yanked the damn thing out!

I think my interest in music waned with the advent of CDs and the eventual demise of the cassette. CDs were priced far beyond my budget (typically priced at RM 35-40 – strangely the price hasn’t changed much all these years).

Now, my son has an MP3 player smaller than the size of an Oreo biscuit which can store up to a thousand songs and capable of playing high-definition music over and over and over again till the cows come home (or at least until the battery dies) without any loss of quality. Even this will become obsolete as cloud computing is being embraced by more and more people.

Perhaps someday, my grandson would lean over and ask his dad this question:

“Dad, what’s an MP3 player?”

 

Exam Blooper #75

On the next day, I was again one of the examiners for the Sem 5 OSCE exam. This time round, the scenario was of a patient who has a massive right sided pleural effusion and presented with shortness of breath. The students’ task was to perform a respiratory system examination from the front and then report the expected findings in a patient with such a condition.

Here were some bloopers:

Introduction, explanation of procedure and obtaining consent:

1. Sir, I will be touching and feeling your chest.
2. Sir, I will be checking your respirator.
3. Mr Chee is a male. (No surprise there!)
4. Mr Chee is a SOB for 10 years.
5. I’m here to inspect your chest region (The chest inspector)
6. I will need you to remove your upper government in order for me to examine you. (The student activist)
7. I heard you have a brainy problem. (She meant ‘breathing problem’)

Inspection of the chest:

1. There is no sternal deviation.
2. The tracheal is of equal size.
3. There is no scar seen. (Actually the patient had a tracheostomy scar)
4. There is a scar but it’s of no relevance to today’s exam.
5. There is a scar, most likely the patient had a thyroid surgery.

Palpation:

1. The apex is palpitable.

Percussion:

1. Sir, I will be knocking on you.
2. It is slightly dull on the right side.
3. The percussion note is expected to be dull. (In pleural effusion, it is ‘stony dull’)
4. The percussion note is expected to be hyper-resonant. (For some reasons, quite a few students believed that the note is hyper-resonant in massive pleural effusion – weird).

Auscultation:

1. The is no bronchial heart sound. (I have never heard of one either)
2. There is no crepitation or crackles. (They are the same thing).

Again, passing this station is a no-brainer as it was too easy. Many students were evidently just going through the motions – some did not even bother to listen for the completion of inspiration and expiration before shifting the stethoscope to another location on the chest. A few students still use the elbow to percuss. A number of students asked the patient to use his (the patient’s) finger to demarcate the apex while the intercostal spaces were being counted – a terrible way to do things which also inconvenience the already ‘troubled’ patient.

Most students just regurgitated the mantra of ‘Mr So-and-so is alert, conscious, cooperative, lying comfortably in 45 degrees, not in obvious pain or respiratory distress, and there are no gadgets attached’ without so much as glancing once at the patient or showing any empathy. Others were obsessed with regurgitating the sentence ‘there is no chest deformity such as pectus excavatum or pectus carinatum’ and struggled desperately with the tongue-twisting description, firmly believing that these 2 deformities MUST be mentioned in the same breath as ‘chest deformity’ without actually seeing a real surgical scar present on the patient’s chest.

In my opinion, the station was too easy, too boring and lacked discriminative power.

Exam Bloopers #74

I was one of the examiners in the recently concluded Sem 5 OSCE. The OSCE format has changed somewhat these days – nowadays the students are evaluated fully for the clinical skills in the exam in contrast to the previous format where there will be one or two relevant questions asked by the examiner at the end after the student has completed his/her physical examination on the (simulated patient).

The effects from this change are:

1. It became super-boring for the examiner because the examiner does not participate actively in the examination but has been relegated to an ‘observer’ hovering in the background.

2. The entire OSCE station becomes too easy – because all the student has to do is to go through the motion of examining a particular system.

3. There isn’t a way to discriminate between the better students over the average students.

Anyway, on the first day, the station I was placed was a cardiovascular station. The scenario was of a man who had a ‘massive myocardial infarction’ several hours earlier who presented with shortness of breath. The task of the student was to perform a general physical examination and the CVS examination and report on ‘expected’ findings.

Here were some bloopers:

Introduction, explanation of procedure and obtaining consent:

1. Mr Chee is a 45-year-old young man
2. I need you to expose your upper chest so that I can have a good look and move it about.
3. I want to touch around your chest.
4. The patient looks slight disorientated (by this time, the patient was fast asleep from boredom)
5. The patient looks kinda sad

General physical examination:

1. The pale does not look nail.
2. On examination, the patient looks quite sad.
3. On his face, there is no discoloration. His lips are pink and moist.
4. The pulse is regularly regular.
5. There is no jaundice. (Almost all the students were obsessed with jaundice although the more relevant signs were pallor and cyanosis).
6. The capillary refill is reduced (The appropriate word is ‘delayed’. A reduced capillary refill means faster refill)
7. I didn’t want to check the pulse because it was not specifically asked for in the question (A very petulant and defensive student’s response when I hinted she should check the pulse).

Inspection and Palpation of precordium:

1. I will now look for the chest. (Huh? The chest is lost?).
2. Am I warm enough for you? (A student getting cosy with the patient).
3. I think my hands are warm enough for you. (A very decisive and dominant student).
4. Are my hands cold enough? (A student from Narnia?)
5. The apex is located in the…. (student starts counting) 1st intercourse, 2nd intercourse, 3rd intercourse, 4th intercourse, 5th intercourse…the apex is in the 5th intercourse-tal space.(A highly sexed student).

Auscultation:

1. The patient has a hairy chest, so I will use the bell to listen to the heart sounds.
2. On auscultation, there is loss of heart sounds.
3. On auscultation, there is no diminished heart sounds.
4. I will auscultate the mitral area using my bell.

Reporting expected findings:

1. The heart is displaced by fluid in MI.
2. In cardiogenic shock, the pulse is reduced in strength.
3. In the case of myocardial infection…..(many students could not pronounce ‘infarction’).

Most students performed well in the station which wasn’t unexpected as it was easy and all the student had to do was to go through the motion in a robotic fashion. Most students continued to talk and talk and talk while auscultating which made me wonder if they actually heard anything at all.

A few students were rude or abrupt with the patient. One student did not even bother to acknowledge a ‘Good Morning’ from the examiner.

All in all, I feel the station was too easy and boring.

Bad with dates

I’m lousy with dates.

I don’t mean the smochy-moochy-hold-hands-look-deep-into-the-eyes-on-a-moonlit-night type of dates nor do I mean an Arabic fruit.

I meant I am hopeless when it comes to the numerics on a calendar.

Take yesterday for instance. I was dead tired after work. It was pouring cats and dogs (even the heavens are crying over the farce of an election that we, Malaysians, had to endure. The jam to my parents’ home was horrendous. A journey that usually takes less than 20 minutes took 45 minutes to complete. But no, this had to be done. It was my mum’s 76th birthday. The wife and kids were already waiting at the restaurant for our arrival, the dishes had been carefully chosen beforehand – dishes that my mum would like; vegetables cooked into a consistency my dad, with his ill-fitting dentures, would bring himself to eat (my dad isn’t a big fan of fibres) and a dish or two to satisfy the kids.

It took me another 30 minutes to reach the restaurant. We settled down, the food came and just before we started eating, I turned to my mum and said, “Mum, we are having this dinner to celebrate your birthday!”.

She looked at me as if I just spoke Sanskrit! There was this uncomprehending blank look on her face. In retrospect, she was probably wondering if her son has finally come loose and lost the last marble in his overeducated brain. And then the look changed into amusement and there was even a hint of pity.

She looked at me and said, “Son, my birthday is 6 of JUNE!”

At the moment, I must have looked as if I had been struck by lightning, had a heart attack and bloody diarrhoea all rolled into one. And then it painfully dawned on me.

Gaaargh!!!! I got the dates wrong! (again). My wife gave me this “How could you have gotten it wrong (again!), you adorable idiot!”

That’s how I am wired!

I’m probably dyscalendarlexic if there is such a term.

I recall the few times I booked flights for the wrong dates or time. There were several times where I hurried to a meeting only to discover I got the dates wrong.

Like this morning, for instance. Yesterday evening, I received an email from my boss – the message was short – get a presentation ready for a meeting on the 10th of May. I looked at the date on my watch and I swear I saw 9th clearly shown on the watch’s interface! And so this morning, I decided to skip the ward round (something I loathe to do unless I absolutely had to – I feel I have done the patients a great disservice) and spent 3 hours preparing the power point. I finished the project 10 minutes before the meeting was due, gathered all my stuff, saved the power point into my pen drive, sipped some water, took a deep breath and said to myself, “YOU CAN DO THIS!” and headed off to the venue – only to discover it was empty.

I rechecked the email and lo and behold, I discovered the meeting is to be held this Friday and today’s date is 7 May 2013!

Gaargh!

And this, this one has to take the cake:

Once I flew off to Kuching to attend a neurology conference over the weekend and discovered upon landing that I had arrived one week too early! Thankfully, my wife was with me and we were left with 2 options – fly home on the next flight or take an unplanned honeymoon! We chose the latter and had 3 glorious days in Kuching.

The following week, I returned to Kuching for the conference and many of my fellow colleagues were amazed at how much I know about the city and getting from one place to another! LOL!

I didn’t tell them about my impediment with dates.

The new old pool

After what seemed like an eternity (actually it had been only slightly more than 3 weeks), the public swimming pool in Seremban 2 finally reopened to the public on 10 April 2013 (and about time too as my tan-lines were fading fast!) – *kidding.

What’s new about the pool:

1. The faulty pump and filter have been replaced. The water is now crystal clear again in contrast to the almost sewage-like quality of the water at the Paroi pool. 

2. The old management is gone (although not entirely as one of the previous staff has been rehired to continue his old habit of sitting around and doing nothing) and a new management has taken over.

3. The broken tiles at the bottom of the pool have been replaced. There is now no risk of accidentally swallowing diluted hemoglobin bled from the injured foot of idiotic pool users who cannot resist walking over broken tiles.

4. The locker fee has been increased from RM 1 to RM 2.

5. The pool is now closed on Monday (previously it used to open for the evening session – in the morning the pool is cleaned). However it is now open for all sessions on Thursday (previously it used to close for the morning session for cleaning). This raises a concern because it would mean the pool would be cleaned only once a week – not good at all, considering so many people jump into the pool without showering or even wearing proper swimming attire. 

What’s still the same with the pool:

1. The lockers are still the same – old, rusted and barely secure.

2. The entrance fee remains the same – RM 3.50 per entry which is actually far more expensive than public pools elsewhere (Putrajaya Precinct 16 pool charges RM 2 per entry while the Kelana Jaya pool in Kuala Lumpur charges RM 3 per entry and they have far better facilities). The good news is they plan to re-introduce the 10-entry-for RM 30 pass card in May – something the previous management conveniently abolished in their greedy bid for more income which angered many pool users (read: yours truly).

3. The deplorable toilet condition, sadly, remains unfixed. In the one week I’ve been there, I noticed the thrash (in the bin and the floor) has not been cleared at all. Broken taps were not replaced – in fact, nothing has changed. 

4. There is no lifeguard – so swim and drown at your own risk.

Happy swimming! With the current hot weather, the newly reopened old pool is a welcome sight indeed.

 

 

Contraceptive marriage

Received this referral letter some time ago. >_<

The Thin Red Line

Not too long ago, some one decided to adopt a rather ridiculous, in my opinion, infection control measure in the ward. Whenever a patient is detected to harbour a multidrug resistant (MDR) micro-organism, a thin red line will appear on the floor around the patient’s bed!

No doubt the intention is noble – it is to warn others, especially health care workers that there exist, in the ward, a patient with MDR bugs and (hopefully) take precautions when handling a person.

But no one really bothers. Hardly anyone notice the existence of the red line. Certainly the red line does nothing in infection control. The MDR bugs are color-blind and are certainly not threatened by the ominous red line.

This is what happens in an institute with little enforcement of infection control practices, where the isolation rooms are severely limited and always occupied, and where even alcohol-based hand wash is not freely available.

The thin red line makes a mockery of the whole idea of infection control.