Monthly Archives: April 2012

Differential diagnoses of a dirty toilet seat


Dear People-contemplating-to-visit-Malaysia,

To my eternal shame, a common sight, regardless of where you go, which will greet you in my country (if you happen to stop over in the land between Singapore and Thailand) is this:

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My differential diagnoses for the drops of urine on the toilet seat are:

A. Hypospadias
B. Benign Prostatic Hypertrophy
C. Vertical Diplopia (seeing double vision making it hard to aim straight)
D. Micturition-induced-seizure
E. Urinary incontinence

But the underlying sinister pathology for this malady is really this:

DEEP APATHY AND SELFISHNESS!

People who can’t clean up their own mess should just pee at a tree outside or use a rubber band.

Condoms online


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If some one was to, say lean over, and look at the computer monitor in my cubicle, he may immediately jump to the conclusion that I am up to no good!

Why else would people send me emails regarding supply of condoms?!

I confess that I have solicited for condoms via email – in fact, I asked for about 1500 of them!

And no, I do not have such a healthy libido as to consume that many prophylactics (I wish!).

Rest assured that the request, directed to the Malaysian AIDS Council, was for a good cause. These condoms are to be distributed (discreetly and upon request only) to some of the eligible patients in the Infectious Diseases Clinic. We have been doing this for years and the last consignment from the MAC is almost used up (it took us close to 1.5 years to distribute about 1000 condoms).

So, the next time you see me lugging a huge bag of condoms in the hospital, don’t stare and don’t ask. :)

Confronting Mortality


Today was supposed to be just like any other day.

I wake up at 6.00 am, and complete my ritual of brush teeth-wash face-shave-wash face again-sit on the ‘throne’- shower-get dressed-greet the dog and give it a good rub down-eat my 2 slices of bread coated with generous amount of low-fat butter and kaya and drink a cup of malt enriched with oats-fuss about the kids-wash any leftover dishes in the sink-say bye-bye to the kids and wife- and drive to work while listening to the DJs on FlyFM poke fun at each other.

That’s what I do from Monday to Friday every work day, every week of the month, every month of the year for the last 10 years or more.

Today was supposed to be just another day of the week.

But it wasn’t.

A friend messaged me on Facebook, right after I completed another ritual of mine in the office (reading the Bible and pray), and informed me that a friend of ours suffered a massive stroke 2 days ago and is hospitalized in one of the specialist centres in KL.

I remember this chap – we weren’t really in touch all these years because we weren’t all that chummy – but I remember he was one of those ‘active’ ones in school – a school (or state?) swimmer, tall, tanned, good-looking, in short, he was everything that I wasn’t back in school (believe it or not, I wasn’t that tall back in secondary school before testosterone finally kicked in when I was 16 and I always came in last in swimming, if at all).

And now, an unexpected ill fortune has hit him, and hard.

It also reminded me of another guy I know, my best chum back in Uni days who became a surgeon only to be hit by a stroke a couple of years back which derailed his career. Ironically, he, like the other guy was a real energetic and active chap, excelling in all things physical. The news hit me hard back then and today’s news hit me equally hard as well.

I spent a little time praying for my friend. I consider my prayers down-to-earth. I didn’t pray anything earth shaterring. I didn’t pray that the stroke in his brain would spontaneously resolve and that all the damaged or dead neurons would suddenly be repaired and my friend would suddenly yank himself off the ventilator and jump out of bed screaming “Hallelujah!” at the top of his now-free-from-secretions lungs. Perhaps in my line of work, I have seen far too many deaths and not enough miracles. So I prayed that if it’s God’s will for him to recover, then let him recover as much of his functionality as possible; and if not, I pray that he would be quickly and painlessly transported to the bosom of his loving Father and that those left behind would be comforted.

Some people would be offended with my prayers.

Oh well, you pray it your way and I pray it mine.

In the ward this morning, my team and I had to handle a man in his 5th decade who is literally fighting for his life because he is slowly being suffocated by the accumulation of fluid in his lungs due to what is most likely a lung cancer. His wife said he never smoked in his life. She said it isn’t fair. They have 3 kids and the youngest is only 12.

I agree with her.

It isn’t fair.

Life isn’t fair. Karma fails us sometimes – bad people do well and good people suffer and die.

I build a wall around me so that I can give myself a false sense of security. I try to tell myself that the mortality that confronts those around me isn’t going to touch me. I know the wall has no foundation and every once in a while a crack appears on the wall. Like today.

Sometimes when I am alone and it’s all quiet, I open up the wall a little and think of my own mortality. I think I’ve lived a pretty awesome life but I want more! I want to see, feel, touch and experience more! I want to see my kids grow up, settle down, maybe pamper my grandchildren. I want to see iPad 10 released! I want to see the day they declare they have a cure for AIDS (and effectively put me out of a job!). I want to see Malaysia become a level playing field. The list is unending.

The expiry date is out there, I just don’t know the exact date. My Christian faith tells me that the expiry date is actually the ‘manufactured date’ for another altogether more awesome experience. I’d like to think it’s true.

Until then, I think I can safely say I’m immortal, at least on this side of heaven!

I didn’t stay morose for long today. I received a beautiful picture from Dorothy, my 85-year-old (that makes her my oldest Aussie pal! Way to go gal!!) camera-toting grandma has gone shooting again and see what she stumbled upon by the side of the road at Erskine Fall in Lorne, Victoria, Australia!

How can anyone look at that and not love life? :)

Oral Bacterium


 

I was a little miffed this morning to discover the house officer working in my cubicle (yes, the same one who made me lose my cool a while ago), wrote this in the prescription for a HIV-infected patient, for prophylaxis against Pneumocystis jiroveci pneumonia:

T. Bacterium 11/11 OD

For non-medical people, to prevent infection with Pneumocystis jiroveci, we often prescribe HIV-infected patients two tablets of oral BACTRIUM daily.

What miffed me most was the apathy of this guy – who either did not know there is no such medication called Tablet Bacterium or he really couldn’t be bothered to ask.

I’m feeling all angry again.

Showcasing Malaysian Stupidity


It has been a long while since I last read an article that got me laughing till my tears flowed freely. Today was one such opportune day. This article got me tickled so much, I’d like to share it in its entirety here.

Apparently, some people up there thinks that Malaysians are so sexually deprived and depraved that the sight of a ballerina in tutu would instantly turn us into lusty beasts that would start humping like rabbits gone mad. (Frankly, even in my wildest and most perverse fantasy the tutu would never be a feature. I suspect I’m not the only man who feels this way).

Take a read:

To tutu or not to tutu (breaking news) — Art Harun
April 05, 2012
APRIL 5 — Fearing a riotous backlash from Malaysia’s hyper-sensitive, albeit slightly blur, rakyat, the Malaysian Bureau of Riotous Eccentricities & Delusions (BORED) yesterday decided to ban tutus or any performances involving tutus anywhere in Malaysia.

Tutus, apparently, from now on, are deemed riotously indecent as it may cause a proclivity to immense sexual desires which in turn may result in an increase of illegal shagging, which, ultimately, will end in baby dumping, change of faith (especially among the Muslims) and an inexplicable — and highly undesirable — liking for Barry Manilow’s songs.

It remains hazy — as it always is in Malaysia around April every year — whether short skirts, tight hot pants, bikinis, swim suits, G-strings, kebaya Nyonya and tight kain batik as well as Aznil Nawawi are going to be deemed indecent anytime soon.

Speaking on the condition of absolute anonymity, a spokesperson for the Organisation of Malfunctioning Governmental Shit-Heads (OMGosh) — a new NGO established to defend riotous edicts by various governmental agencies — said yesterday that tutus are Christian Zionists’ propaganda tool which is insidiously aimed at the sub-conscious zone of every person, especially males of between 13 and 84 years of age. Tutus are thus malevolent agents of the Christian Jews who are hell-bent on destroying the rakyat through sex, sex and sex.

Says the spokesperson (quoted verbatim):

“We iz very the worried at diz tootoo coz dey iz work below the otak and the rakyatz not realise wen dey see tootoo dey all become like zombie like dat, dey no realise dey being converted by diz jahat evil Kristian Zionis. We at OMGosh tink diz tootoo is same with der tattoo which last month dat Erika Badu wanted to use to brainwash the rakyats.”

OMGosh, according to the spokesperson, has a 42-minute video (in HD) to prove its allegation that the poor and very weak Malaysian rakyat are being cock-and-bull-washed by tutus. It is estimated that to date, 17,000 rakyat have been totally “turn-around upside down” by the tutus.

Meanwhile, another NGO, Centre for Complete Kookooness (COCK), today released the result of a recent survey involving about 300 males who watched the uncensored version of “Black Swan” in controlled environments, including their bedroom and toilets. The survey reveals a shocking five of them having a complete hard on during the full duration of the movie, even during the scene where Nina-the-ballerina-in-a-tutu was lying bleeding.

That proves that tutus are indecent, says the chairman of COCK.

The chairman further says that although he is definitely not racist or anti-Semitic, the fact that Natalie Portman, who plays the leading ballerina in that movie, is Jewish did not escape his attention. According to him:

“Dat ah, pruf ferder dat der tutu and der Juice are axiz of evil.”

As of the time of writing, it remains unclear — as is usual here — whether Datuk Nicol David will be allowed to play squash in Malaysia wearing a short skirt as she usually does in every other tournament around the globe. It also remains completely a mystery whether in the next SEA Games, Malaysian bodybuilders are going to have to perform in kain pelikat and oversized baju batik.

Meanwhile, in an unrelated, but most probably connected, news, the organisers of a public forum on “Christian Aqidah — are we threatened by Dong Zong?” today announce that they are seeking a clarification whether the tutu ban will affect Bishop Desmond Tutu’s visit to Malaysia next week. He is supposed to deliver a keynote address at the forum.

Ternama News Agency: 5th April 2012 (four days after April Fool’s Day). — art-harun.blogspot.com

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Lost my cool


I lost my temper in the ward this morning during the rounds. Coming from a person who takes pride in keeping his cool, I’m terribly embarrassed by my outburst.

The outburst was the outcome of accumulated minor and not-so-minor irritants as the rounds got going:

1. I got irritated by Medical Officers missing obvious and not-so-obvious signs in patients and simply assigning a convenient diagnosis to patients and treating them with medications they do not need.

2. I got irritated by dental doctors who refused to entertain a request by a patient for a new set of dentures (which the hospital lost at the Emergency Department when he first presented with acute breathlessness) simply because “the patient is on anti-TB drugs” (I mean, WT*!)

3. I got irritated by a nurse who refused to cooperate with me, preferring to do her own thing when her job is to follow the specialists’ rounds. I had to tell her 4-5 times to bring a  bed pan for a patient who has been holding his urine since the night before and another 3-4 times to put another breathless patient on oxygen.

4. I got especially annoyed that the vital charts of the patients were not in their proper place. Some one took them away (presumably to mass-enter fictitious vital signs measurements at the counter).

5. I was also annoyed that the drug charts for the patients were removed by another nurse so that she can dispense the medications (which should have been done earlier).

6. I was irritated by multiple phone calls (from boss, from fellow colleagues, from patients and ex-patients – it felt like a “Call Jimbo and bug him NOW day”.

7. And most of all, I was extremely annoyed by the house officer who blatantly LIED to me in front of the patient by claiming he had examined the patient earlier when he did not (I asked the patient and he said he was not examined that morning).

And so I threw a tantrum – in front of the zero-integrity house officer, the medical officer, the many medical students around, the pseudo-deaf-nurse, the ward sisters and several other nurses and of course, in front of patients and relatives.

I’m ashamed of it. :(

But it got their attention. From then till the end of the ward rounds, I had the full cooperation from everyone. Every chart and folder was in place. Every X-ray film appeared instantly. Some one carried the alcohol handwash for me while I go from bed to bed; and so on and so forth.

My anger subsided somewhat after the rounds only to be reignited again when I went to see one of two referrals. The house officer in that ward did the unthinkable – He LIED! He told me that a patient is taking his own anti-HIV medicine and that’s why his medications are not documented in the drug chart when in reality, the patient left all his medications at home and have not taken any medications for 2 days!

After the whole fiasco, I had very little time to spend with my students but there was enough time to drum a few lessons into their shell-shocked heads, namely:

1. In order for effective management of patients, each member of the team must do their part. Team work is essential.

2. Whether they are stupid or dumb, if they have integrity, then all is not lost. If they are clever and has no integrity, then all is lost.

3. When a health care worker lies, the patient suffers.

So, guys, if you read this, please, for heaven’s sake, work with me and we can do wonders. Neglect your part and things will fall apart – including my cool.