Unfriended

“Sir, I can’t believe you don’t want to treat that patient! Nobody wants her you know! She is on her own, all alone! She cried just now when I talked to her! I told her I will get you to help her! I can’t believe you can do this! I DON’T WANT TO FRIEND YOU ALREADY!”

And thus was the rapid fire outburst from a student the other day as I was walking towards the male ward, fully intent to take a class for Clinical Presentation!

My immediate retort was:

“Last I checked, you weren’t on my FB friend list, so technically, you can’t un-friend me!”

I said it in jest of course.

What prompted the unusual outburst was a particular patient in the ward whom this particular student saw earlier.

Unbeknown to the student, a medical officer had already called me on the phone an hour earlier that morning to asked me how to manage the patient and I had instructed the medical officer on what to do.

I confess that what the medical student claimed was true, to a certain extent.

I did make the decision not to treat her.

Now, before I have to endure similar outburst from 700+ readers (that’s the average hits/per day for this blog), allow me to explain myself.

I took the entire group of students aside and spent some time explaining one of the fundamental aspect of being a doctor; which is: Some times we have to make hard decisions.

I found out that morning from the medical officer who called me, that this patient, who has HIV infection and was started on HAART (anti-HIV medications) 3 years ago, decided to stop her medications for the last 2 years on her own accord. She continued to come for her follow up in the clinic and each time when she was seen by a doctor, she would say she is well and that she is taking her medications correctly and on time.

The truth was, as soon as she got home with her bag of precious medications, she would throw them away!

Now, even though the medications were provided FOC for her, because the government absorbed the cost, her action was unacceptable!

Consider this: Each month’s supply of her medications cost the government (or tax payers) about RM 300. In 2 years, she has thrown away RM 7200 worth of medications!

When I first heard the news, my blood boiled!

I could have used the medications to treat so many other patients!

Wait! Before I am accused of being vengeful, I would like to state that I made the decision not to treat her for a few reasons:

1. By now she would developed resistance to the FOC medications she was on.

2. At the same time, she would have developed resistance to other medications in the same class as the ones which were prescribed for her, thus making alternative options difficult.

3. I need to reassess her attitude and willingness to change and weigh whether I should use more expensive second line medications for her.

4. Her chronic diarrhoea has to be investigated first (though I suspect it’s probably due to advance AIDS that she is in)

I remember back in those days before HAART was given FOC in this country (December 2006), I had to repeatedly make very difficult decisions to deprive patients of medications simply because they could not afford them. These decisions weigh heavily on my psyche and I know I will have to answer for them one day when I meet my Maker; but some one has to make the decision.

Personally, apart of breaking bad news about the demise of a patient to the relatives, this is one of the hardest part of being a doctor.

So, if making such unpopular decisions loses me friends, I guess it’s acceptable collateral damage.

Thurs, 300910 @ 0700

Sent by Jesus

Of all the strange encounters with patients that I had over the years, this one has to be one of the weirdest.

It wasn’t too long ago that I was doing the usual morning rounds in the ward. We (a few house officers, medical students, a medical officer and I) were going from bed to bed. The HOs were trying their best to present a coherent history of each patient to me when suddenly I heard a voice calling from some where to my left.

“Doctor! Doctor!”, he cried out

Thinking that he may be in distressed, I quickly walked over to his side and asked him what was the matter. Naturally my entourage of junior colleagues followed suit.

“Doctor”, he said, as he told hold of my hand; “Jesus sent you to me!”

For a moment I was stunned!

But before I could respond, he went on to say:

“I know that Jesus sent you to me. He said you will take care of me. I go to church and read my Bible.”

I turned searchingly to the medical officer, half expecting her to tell me that the patient has some sort of psychiatric problems and was wrongly admitted to the medical ward instead of the psychiatry ward.

Instead, she told me that the man recently found out that he was infected with HIV and now presents with 2-3 months of fever, weight loss, poor appetite and an abdomen which is ever increasing in size.

When I examined him, he had all the signs of late stages of AIDS and his body was probably being pummeled by all kinds of opportunistic infections or even cancer.

We immediately set in motion the series of tests and procedures to try and get to the root of his problem. Over the next few days, he took a turn for the worst as the medications we administered caused his liver and kidneys to fail. Meanwhile his abdomen got bigger and bigger.

I met his wife and found out that, to her, he was a good man who took care of his family. They have 3 children together. They all, including the wife, were tested negative for HIV and they were much relieved. The patient, I was told by the wife, recently found faith in Christianity and found the peace that he never had before.

We had to stop some of his medications to allow the liver and kidney to heal.

It was around this time that I went off for a 5 day trip to Sabah to climb Mount Kinabalu. My thoughts were constantly on him, even when I was huffing and puffing up on the mountain trying to reach the peak. I shared my thoughts with a fellow climber and he was amazed at the story. He said to me: “Just pray for him”.

In the end, that’s what I did.

The patient’s words burned into my mind.

“Jesus sent you to me”.

I felt like such a total failure, even when I was standing elated on Low’s Peak. I got to thinking, I wasn’t doing what Jesus did. He healed lots of people during his time of ministry and I couldn’t even get one guy back on his feet.

I found out that he passed away on the morning that I conquered Mount Kinabalu.

When I went back to work, his bed was already occupied by another patient.

The matter bothered me a lot, until one day, while driving home from work, I suddenly realized that maybe it wasn’t the healing that I was sent to do (assuming that I was sent by Jesus ….!) but rather to do what Jesus did to many others as well: to comfort, to listen, to care or maybe just to make his journey home a lot less painful.

Or maybe it was simply that I could pray for him.

Or that I could counsel and comfort the family members.

Or more likely, in my opinion,  so that I could be ministered to by the patient.

Tues, 280910 @ 0830

Global Warming on High Mountain

Okay, I am gonna write one more post on my  Mount Kinabalu experience and then call it quits (at least until the next climb…heh heh…)

One phenomenon, experienced by many but spoken of by few while climbing a high mountain is this:

We pass out a lot of gas…via the rear end. The higher we go, the more we expel!

There I was, huffing and puffing as I took one laborious step after another when I overheard a fellow climber from a short distance away telling another climber this:

“Hey, are you farting a lot? I am passing a lot of gas! So weird!”

There and then, it dawned upon me in a flash that I wasn’t just huffing and puffing from my mouth, I was also periodically puffing from the other end! LOL!

There’s a perfectly scientific explanation for this, of course. As one ascends higher, the air pressure becomes less on the outside. The body, attempting to equalize the pressure between inside the body and outside, would expel gas through the other end! Unfortunately, the gas propulsion does nothing to make one’s climb any faster.

Which is also why, the cabin of an aircraft needs to be pressurized because if it wasn’t, expulsion of bowel gas from all the passengers would inevitably turn the cabin into a deadly gas chamber!

So, a word of advice to future high mountain climbers: avoid ingesting anything that would add to more bowel gas production like onions and beans! Producing disgustingly noisy rear end gas expulsion is one thing but surely we do not want to add more to global warming or worst, gas a fellow climber behind you to death!

Spoiled Sink

I am at an age where most of my friends are already married and so naturally I would expect to get less of that ‘summon’ – i.e. an invitation to a wedding (which would mean a small financial hemorrhage).

In fact, nowadays I scan the obituary, in case any of my contemporaries decided to quickly demise to the blue yonder…heh, heh, kidding…

Anyway, as it turned out, an ex-classmate of mine decided to take the plunge and got married last weekend and invited me for the wedding lunch which was held in a seafood restaurant in Petaling Jaya.

I am glad I went because that was where I bumped into a fellow chronic blogger (whose blog I admire for its simplicity of thought and awesome pictures!). It was good to place a face to the comments I received from him on my blog.

Midway through the lunch, my fellow doctor and blogger excused himself to go to the gents and a while later, he came back and casually mentioned this”

“I think there’s something interesting for you to blog about in the toilet”

My immediate thought on hearing the cryptic message was: “Ah…obscene graffiti!!!” (it just goes to show what filth I have in some corner of my otherwise sanitized mind).

As it turned out, what he actually meant was this:

THE SINK WAS SPOILED

One would be inclined to think that once upon a time, this particular sink was a brat (because it was spoiled) and is now probably a reformed-sink as it is no longer spoiled. LOL!

Anyway, the statement in English does not convey the intended meaning which is: “This sink is not working”

Sat, 250910 @ 1745

Mali Blajar Engrish!

Spotted this sign at the intersection outside my home.

I think people who want to advertise in Malay (and Chinese) about learning English, should first brush up on their Malay first.

The word ‘Kesan’ would mean to ‘detect’ or ‘effect’ while the intended meaning, which is ‘effective’ should be rendered ‘berkesan’ in Malay.

Thurs, 230910 @ 0700

The Timpohon Trail

I decided to take the Timpohon Trail when I climbed Mount Kinabalu a few weeks ago, as opposed to the Mesilau Trail which I took in 2008 on my 1st attempt. The latter is a far more scenic trail but it is also 2 km longer than the Timpohon Trail. My aim was to summit the mountain and so any short cut to achieving that aim was most welcomed!

Of course, with the compromise, I had to settle for less of a visual feast. The Timpohon Trail, to put it very frankly, is boring. On the plus side, it is a fairly easy trail to ascend as steps are cut into the earth to facilitate the climb and frankly, anyone with a pair of sturdy legs should not have a problem climbing the 6 km trail from the Timpohon gate to Laban Rata.

Here are some photos I want to share:

The Timpohon Gate.

At the level of the Timpohon Gate, it was already quite high up in the mountain and the air was cool (cold if if there’s a breeze!).

That day, the sky was clear and we could see the peak of Mount Kinabalu from a distance.

A rough map of the two trails. The Mesilau trail joins the Timpohon Trail near the Layang-Layang hut. There are a number of huts along the Timpohon Trail, each conveniently located about 1 km apart. The huts are well kept with toilet facilities but water supply was not guaranteed.

Two of our guides. Believe it or not, the guy on the right is called ‘Arse’!! During the pre-climb briefing, he coolly raised his hand and said, “I am Arse, your guide”!! A few of us had to bite our tongues to stop from guffawing aloud! Not so nice thoughts were running through our minds, surely.

Are you lost? Follow that Arse! LOL!!!

While waiting for other climbers to be ready, some of us went up the wooden platform built on top of the Timpohon gate. On a clear day, one could see Mount Kinabalu clearly from this vantage point but by then the clouds have moved in. There was a squirrel there and it displayed no fear at all. In fact, throughout the Timpohon Trail, one could see many squirrels, particularly at the huts. These squirrels were obese mainly because they were well fed by climbers!

This is what happens when you snap a photo using Macro Lens!

Less than 0.5 km along the trail, you will see this small but beautiful waterfall called Carson’s Fall. Thereafter, unlike the Mesilau Trail, there would be no more streams or waterfall along the trail.

In contrast to the Mesilau Trail, the Timpohon Trail has more sign boards, maybe because it is the more common route taken by tourist. Of course, the information on the signs may not necessary be correct. Like this one for instance, it says apparently Moses grows well here! Personally, I did not encounter the prophet during the climb!

It’s quite impossible to get lost as there was always a green sign board that points to the summit.

In many parts of the trail, even handrails were provided.

Fungus and flowers were spotted occasionally.

At the 4 km junction, the Timpohon Trail intersects with the 6th km of the Mesilau Trail. By the time I got there, I found out that some of my team mates who took the Mesilau Trail had already zoomed past this point!

Another sign board pointing the way to Laban Rata.

Beyond that point, the air became noticeably colder and thinner. Ascending the trail became slower as we had to stop constantly to catch our breath. The flora also undergoes a noticeable change.

And then lo and behold, one comes to an area where all the trees are like giant Bonsai trees!

But even these trees soon gave way to stubbier and shorter plants as we went higher.

It was about 3 pm when I reached Laban Rata, after climbing for 6 hours over a 6 km distance. It was a decent ascent rate. By 3.30 pm, the rain started to pour but by then I was already inside the hostel, sipping a hot cup of coffee.

All in all, it was a very satisfying climb.

From Low’s Peak

The view, at the peak of Mount Kinabalu (Low’s Peak) at 4095.2 meters above sea level, was spectacular. It’s an awesome feeling standing there in the bitter cold and realize at the point in time with outstretched arms, I am the tallest person in Malaysia!

Let me share what I saw from the peak with you:

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And here are 2 more interesting pictures:

I was told that this is the first time a group photo of the team has been taken at Low’s Peak. though members of the climbing teams change from climb to climb, there is always a core group of leaders and organizers who are present in almost every climb. This time we were lucky we got such a big group together at the same time at the peak!

And this final picture is taken for the benefit of those who yearn to be on Low’s Peak but cannot due to any reasons. All you have to do is cut and paste your photo onto this picture and viola! You have your very own personal picture on top of Mount Kinabalu! Heh heh!

I’m just being cheeky. Sorry… :p

Tues, 210910 @ 0700

Up There

I knew I would not make it to Low’s Peak in time to witness the sunrise. By the time I noticed the first light of dawn peering over the edge of the mountain, I was on a rocky plain, with probably another 200 meters from the peak of Mount Kinabalu. To climb 200 meters at that altitude would take a long long time.

And so, I decided to stop and witness the sunrise there. It was really cold (a guide told me it’s zero degrees Celcius) and the strong wind was hitting my really hard, on the right side, abrasively numbing my right cheek, the only part of my body not covered by thick layers of insulating clothing.

Apart from the sound of the wind and the occasional cough or grunt from a fellow climber far away, the place was quiet. To stand there, alone, at that kind of altitude and cold and witness the birth of another new day was awesome.

Let me share it with you:

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Sugar Coating on High Mountain

Have you ever heard stuff that deep within you, you know it is too good to be true? You know, stuff like ‘Slimming Programs’, diet fads and the vague but saccharine sweet 1Malaysia concept?

There’s an old saying, “No matter how much makeup you apply to a monkey, it’s still a monkey” – meaning no amount of sugar coating can hide the ugly truth.

Okay, what would be your reaction if I told you that prior to climbing Mount Kinabalu, I stayed at a place called the Golden Resort Kundasang?

If you’re normal like me, you would probably visualize a Shangrila like place nested in the foothill of the majestic Mount Kinabalu. The vicinity would be surrounded by water fountains, chirping birds and other exotic flora and fauna. Within, the guest rooms would be heated, the beds made with clean sheets of white linen faintly smelling of lavender. And nearby, there would be a cafe serving piping hot Tenom Valley Coffee or Sabah Tea.

OR NOT!!!

Instead, I recall a harrowing ride to the place, located about 30 minutes away from the Kinabalu Park. It was dark (around 7.30 pm) and the road leading to the place was in a bad shape with certain sections totally obliterated by road works and landslides. Once or twice our van’s traction on the road almost gave way, giving all 11 of us in the van a near heart attack. The fact that it was raining didn’t help matter at all!

The so called golden resort did not even have a proper entrance. It wasn’t until the driver suddenly made a sharp right turn into a gravel road (and hitting the underside of the van onto the road shoulder) that we realized we have reached our destination.

It was too dark to see anything clearly and it took us a long time to locate the dormitories allocated to the various groups. We discovered that the dorms were not heated (it was so cold then!) and the toilets did not have heated showers! What we had was a tiny little kettle which we used to boil water over and over again in order to fill up a plastic tumbler in the bathroom so that we could take turns to wash up (there were 5 of us). There was a double queen size bed and a double-decker in the room but there were 5 of us. In the end one of us had to sleep on a mattress on the floor without a blanket (as it was not provided) and since the upper deck of the double-decker was in danger of collapsing, another had to sleep on the floor as well. In the night, cold moisture would seep in through the gaps in the floor board and wet the mattresses thoroughly!

Here are some pictures of the dorm we stayed in:

Five guys (including me) in a room meant for four.

The small kitchen. Note the tiny kettle on the stove.

The toilet.

But things did look less bleak the next morning.

Out through the window, we caught sight of the majestic mountain that we hoped to conquer in the next 24 hours! It was a sight to behold!

And the resort was indeed surrounded by farms and exotic plants, things which we could not see the night before.

And from the outside, the place really didn’t look all that bad!

So, was the Golden Resort Kundasang golden? Hardly.
Would I recommend the place? No!
Would I go back there again? Not if I could help it.

When I looked at the details of expenses (which was sent to me a few days ago by the organizers of the climb), I noted that it cost less than RM 40 per person for that one night stay at the ‘golden’ resort. For 5 fellas in a room, that would mean our dorm costs about RM 200 per night! That’s rather exorbitant for a pretty run down place, don’ you think?

Sat, 180910 @ 1219

Superhumans

This post is a tribute to 2 category of people at Mount Kinabalu. The first are the contestants of the annual Mount Kinabalu Climbathon (incidentally, the next one will take place end of next month).

They are not kidding when they call it the ‘World’s Toughest Mountain Race’. Contestants have to race to the top of the mountain and back in the shortest time possible. That’s a distance of 21 km with the highest point at 4095.2 meters above seal level!

When I was there, I saw 2 of the contestants training for the race. One was a hairy skinny Caucasian and the other was a rather slim but fit looking Chinese chap. Both of them were wearing only running attire (singlet and short pants) with a water pack strapped to their backs. Both of them have thigh and leg muscles the size of elephant’s! They took off before we started the climb up the Timpohon Trail and even before we reached a third of the way, they were already descending the mountain at great speed!

Truly amazing!

Here below are the records of last year’s heroes:

Imagine, up and down the mountain in less than 3 hours! It took me 6 hours just to climb the 6 km trail to Laban Rata!

The other group of superhuman I want to highlight are the porters. These are the people who day after day lug heavy stuff on the back up to Laban Rata. I have seen a woman carry 2 LPG gas tanks on her back, strapped to her head in my last climb. I swear, when she passed me and saw me panting and grunting away, she smirked!

I was told that each porter can carry up to 80 kg on their back! Most of the stuff that they carry are the bags of climbers. Occasionally, they also carry essential items up to Laban Rata, which is the last (and only) hostel up there before the summit.

One thing I noticed when I passed these porters is all of them smell of 2 things: cigarette smoke and alcohol. I guess they need this to psyche themselves up the trail day in and day out.

Above is a picture of a woman (apparently injured) being carried down the Timpohon trail by a porter!

So, to those of you who aren’t so fit but wish to climb Mount Kinabalu, you have the option of being carried. I am told that the charges vary according to the size and weight of the climber. I was told by a guide that the charge for carrying an adult down from Low’s Peak to Laban Rata is RM 350/km and from Laban Rata to the Timpohon gate is RM 250/km!!!

Fri, 170910 @ 0800