Breaking point

sinking-boat-by-paul-collinsThere are days in the clinic that I felt like throwing in the towel, pick up my stuff and walk out of the place, never to return again. Last Friday was one such day.

“What happened?”, some one asked me on Facebook.

So many things happened that morning, with each episode sapping some of my energy, that by noon, I was a wreck of a human being, feeling exhausted, defeated and on the brink of giving up.

A sobbing student started off my day.

A healthcare worker who sustained a needle stick injury the day before was referred to the clinic – the only problem was the doctor who attended to her the previous day did not bother to draw blood from the source of the incident, preferring to rely on laboratory results that were 5 months old. The doctor’s decision negated proper management of the healthcare worker. It took us sometime too to trace the doctor and get the story. Precious time wasted that could have been used to see other waiting patients in the clinic.

Another needle stick injury referral, but this time from the Emergency Department (ED) where the too-clever-for-his-own-good doctor took it upon himself to manage the case WITHOUT referring to the medical doctor on call. The case was mismanaged, unsurprisingly. Again, time wasted trying to sort things out.

An unscheduled visit by a patient who fell and sustained a swollen leg and ankle. She even slapped me on the thigh when I suggested that the injury was probably mild (and it turned out to be mild). First time I was ever hit by a patient. (She apologized later). Her unscheduled visit delayed the clinic’s smooth running.

A patient turned up bearing a referral letter that was written in 2011! He didn’t want to turn up earlier because he was ‘scared’. He turned up now because he felt ‘weak’. His CD4 was only 16. It’s gonna be a long road ahead to help him regain his health.

My own resident counselor was sick. He told me he was sick. He had been sick for more than two weeks. Coughing incessantly and running a temperature. He hovered around me like a kitten waiting to be fed. I said I would attend to him as soon as I have time.

A patient who chose to default on his therapy years and years ago, preferring to take his meds as and when he felt like it. Now he is slowly dying. None of the meds would work anymore except two – and I didn’t have one of them. Buying them would be beyond the ability of any average Malaysian. I told him to wait for a few months while I try and find a solution. I’m not sure if he could wait that long.

Another similar patient, who decided to do the same as the guy above. At least this guy have some support. He has a loving spouse. And they were willing to buy one of the meds. It would cost them about RM 1300 per month. I would provide the other one. It’s what we call a ‘salvage therapy’ in HIV Medicine. It might work, but again, it might not. But now he is battling a fungal infection that has ravaged his entire body – it would take at least year of antifungal medications to eradicate the fungus. It’s worth a try. There’s no other alternative.

An elderly woman came, sobbing away. She stopped her medications – because they made her drowsy. She needed to be alert to work – to earn a living. She has no one else in this world. Her eye sight was so poor she had repeatedly cut her fingers while doing house chores. Her fingers are bandaged in plasters. We referred her to the welfare department months ago. We never heard from them – as usual. Most of my cases referred to the department were never attended to. Last week we had a patient who was referred TWO YEARS ago, and we are still waiting for a response. My blood boils inside. I wish the welfare personnel-n-charge some personal tragic events – so that he would suffer and it would help him see that desperate people referred to him all need help and he cannot play god. I told the woman we will try and find some help for her. I don’t think she believed me. Heck, I don’t even believe myself.

There’s the other patient who obviously needed treatment, and decided not to be on therapy but would rather try some traditional remedy. I let him. No point arguing.

An old patient with rash on his trunk. The doctors didn’t know what it was. A quick look after exposing the back confirmed it’s shingles. But he wasn’t even registered as a patient in the clinic! They just wanted me to have a look. It’s interesting. It’s nice. But it took up time. Again.

The nurse peeped in and said a few patients had passed away…

The computer logged me in and logged me out.

The printer refused to cooperate. I strongly believe it is possessed and hates me.

The junior specialist assigned to the clinic didn’t turn up.

Most of the doctors assigned to the clinic were inexperienced.

My research students didn’t turn up at the clinic.

The clinic was packed. It’s always packed these days. One consultation room meant for one patient, a carer and one doctor now sits at least nine – three doctors, three patients, three carers and an occasional 2-3 medical students. Privacy is a luxury. P & C is a myth.

My phone rang several times. Referrals from the wards. I don’t have time to see them. The 3G signal was so bad in the clinic I can’t download images sent by referring doctors.

The emails kept coming in – all urgent. All needing attention stat. I had a lunch meeting to attend to. I had a meeting in KL to attend after that. It’s Friday. I knew I had to crawl through weekend traffic to get home from KL.

Miraculously clinic finished before 1 pm that day. Sometime between 8 am and 1 pm that day, I had that thought. That ‘throw in the towel’ thought. It’s a viable option you know. I didn’t have to do this. My work in the hospital doesn’t add a sen to my income. I could sit in my office and do ‘admin’ work and still earn the same thing.

But I want to do it. But there are days that I am not so sure anymore.

I wish I have a magic wand to just wave over the patients and make everything alright. I didn’t. Instead, last Friday, I felt like a desperate man in a sinking boat frantically bailing out water with a small leaking bucket – with water pouring in faster than I could get them out.

As I walked out of the clinic that day, I didn’t feel relieved. I felt tired, exhausted and defeated. I also realized I did not attend to the counselor who was sick. I didn’t even know when he left the clinic. I hope he would forgive me.

I’m not looking forward to next Friday.

Healthcare workers with HIV


One of the most common question I get asked in the clinic or when teaching medical student is this one:

“What happens if a ……….. (insert doctor/nurse/medical student/lab tech) gets HIV? Will he lose his ….. (insert job/undergraduate studies/MARA scholarship)?”

I have, in the course of working, encountered quite a number of such people who were infected with blood-borne viruses (HIV, hepatitis B or C) due to their occupation or through behavioral indiscretions. And every single one of them have the same concern:

“What would happen to me?! Will I lose my job?”

I would like to invite you to find out for yourself, what is the position of the Medical Council of Malaysia on this issue, by downloading their guideline here: MMC position on HCW with BBV

Basically, this is what happens:

1. If you are a medical student and have HIV, you will be asked to stop medical studies.

2. If you are a medical student IN FINAL YEAR and have HIV, you continue studying, pass the MBBS, graduate and WORK as HO (terms and conditions apply), and even go on to do your Masters (T&Cs apply).

3. If you are a house officer with HIV, you can continue working (again T&Cs apply).

4. If you are a medical officer or specialist with HIV, you can continue working (and yes, again T&Cs apply).

The finger


The other day I was exiting the ward after the morning rounds when a Medical Officer (MO) came up to me and we had this conversation:

MO: “Prof, I hope you don’t mind, I have a stupid question to ask.”

Me: “Sure!”

MO: “The other day, I was resuscitating this patient who has HIV-infection and I came in contact with some of his body fluid.”

Me: “Oh…where?”

MO: “Um…my index finger..”

Me: “Were you wearing gloves at the time?”

MO: “No…”

Me: “Did you have any visible wound on that finger?”

MO: “No, I don’t think so.”

Me: “What are you worried about?”

MO: “Ummm….err… arrr…will I be infected?”

Me: “Nah…don’t worry about it!”, I said, as I left the ward with a smile and a twinkle in my eye…. “and oh, just don’t do anything naughty with that finger!!”. ;)

The one about attire

too-short-mini-skirtsOnce upon a time, in an institution of higher learning, complaints arose about the inappropriateness of the attire of some of its students, particularly that of the female gender. And so a meeting was hastily convened and distinguished people attended the meeting with the sole objective to regulating the attire of offending females.

A: We have received a lot of complaints about how indecent our students dresses.

B: True! Even the security guard at the entrance had complaint!

C: I agree! But it’s only limited to the women actually. Guys generally are ok.

D: Well, that’s coz guys have not much variety to wear anyway.

B: Some of the girls wear dresses that are way above the knees!

E: But I think it’s alright la, I mean just a little bit above is ok. Girls nowadays don’t like to wear knees below the knees. Maybe one inch above is fine.

C: Are we going to go around measuring the length of dresses now?

E: I also think that wearing round neck T-shirts is ok, as long as it is plain and has no words on it.

B: I disagree. Since the government institutions are going around handing out towels and sarongs to females with indecent attire, I feel we should follow the same.

F: I think we need to come out with a poster! A picture! Of a girl! Wearing a coat, and then next picture, show what the girl is wearing under the coat! And the stuff under the coat should be what is approved attire.

C: Good good! Just because there is a coat doesn’t mean they can wear anything they like underneath!

G: I honestly think any clothes are ok, unless they are transparent….


J: I think we need to ask the students what they think are appropriate or decent.


And that is the sad reflection of the shitty situation that has engulfed the long and large tract of land between Singapore and Thailand.

*This story is purely fictitious, any resemblance to any living or dying or dead organisms or objects are probably coincidental and tragically unfortunate.