My first CVL

Assalammualaikum!

It is already very late now - 11.19pm
I have a flight to catch tomorrow morning yeay! I'm going Sarawak for Fatin's wedding :D
Fatin married a BBC - British Born Chinese weewitt

But because today is one of those special days in my career, I decided I need to pen them down (or type, in my case)

So today, I was put on ICU duty, instead of GOT due to the lack of manpower in ICU.
And today also was my first time inserting a Central Venous Line (CVL)!
To non medical people, a CVL is a catheter (maybe "tube" sounds more familiar) that we insert into the body so that the tip of the catheter will lie in a patient's heart.
Yes, heart. The right atrium to be exact.
And we have to be careful to put into the vein, instead of the artery.

So today I inserted a CVL through a patient's internal jugular vein (that is the vein in our neck) - via US technique. 😆 😆

I know the older generations in medical would have laughed that I am so proud with this one CVL - they have inserted numerous during their HO years. I got my first only after I become an MO.

But, so what?
At least I have inserted one.
And this will certainly help me in future :)

So thanks Farid, for guiding me thru the insertion of CVL.
And Danny for being there, as an amateur as well hence I kept telling myself all the mistakes I did, are for me and him to learn 😀 😀

And I dont mind mentioning their names here - they don't even know the existence of this blog.

This is the check xray of the patient. We need this to ensure that the tip of our catheter is
nicely placed in the right atrium, not too low neither too high.

Til then!
Oh and I'll try to blog about my 48hrs Kuching trip :)


-Because life is a test-


 -AkMaR-
 http://nur-akmar.blogspot.com

Book Review: Have A Little Faith

Assalammualaikum.

I've always loved Mitch Albom's work.
I feel that they are always very inspiring, funny and resonates well with our real lives.
And they are usually expensive - relatively, compared to other thicker books.

In every bookfair, I will always look for Albom's books.
I'll buy them if they aren't too expensive.
And during the last Big Bad Wolf book fair in Mines, I managed to get hold of one; titled Have A Little Faith - which cost me RM12.
Not too bad.

This book is well written, and it teaches a lot of life values.
However, it is so very Jewish and Judaism-ish.

Albom's previous works are stories about his dying professor Morrie and his last words and life lessons. This book talks about his Rabbi - affectionately known as "the Reb" whom he knew from when he was a little boy but only recently reconnected with, when the Reb asked Albom to write his eulogy.
Let me give you a little bit of spoiler - it spans for more than 8 years, this book.
He describes how he grew closer and fonder of the Rabbi, the very being he was so afraid of and always avoided when he was young.

He described how well mannered, patient, peaceful, determined and kind hearted his Rabbi was.
The Man of God - that's how he always describe this man.
And I really really admired this Rabbi character - and I silently wish we have more Islamic preachers with these characteristics.
He keeps track of people in his congregation, made phone calls to the respective families when he heard of any weddings / child birth / deaths within, if he cannot attend the function.
He does house visits until he was too old to do so.
And he was well educated as well.

I like it that he MAKES phone calls, a rather dying trend of our society nowadays.
We WhatsApp, message, emails - which are actually not real conversations.
We can misunderstood and hid emotions with written conversations. We can always add "Haha" at the end of any sentence, to make it sound better, even if the sentence before might break our or the receiver's heart.
But when you call, you can hear the person's laughter, sorrow or even silence when the person at the end of the line tried to swallow her tears.

And anyone who have read my blog long enough will have noticed - I hate Zionism.
I hate them for oppressing and occupying the Palestinian lands illegally - and they hide behind the name "Israel" - which also equals to Jewish.
But not all Jews are Zionists though.
And the main character of this book is the Reb - someone of a different religion with me.
Someone of the religion that the Zionists hide behind.
Anyway, this sentence of mine can be politically challenged - lets put that aside for now.

The writer also talked about Pastor Henry Covington.
A determined, dedicated Christian pastor who was involved with lots of crime during his younger days - including drugs and was also jailed for some time.
And he formed and became the pastor of the My Brothers Keeper's Church - and has turned a new leaf. He described the man very well, and I believe Pastor Covington IS a miracle and a living proof  of what determination and faith can bring into a person's life.

Albom managed to make me fall in love with the characters, but of course, not the religions.
Most of the teachings are the same anyway, the Abrahamic religions.
Hence there was no reason for me to fall in love with the religions.

I hesitated though during the process of reading the book.
It took me more than one week, not because of the hesitations but rather due to the limited time I had.
And I thought of stopping myself from reading this book as it was too Jewish.
Will it benefit me more if read a more Islamic book instead?
Will this put me in the danger of Shirk?
I kept my mind open though - I am reading this book for the sake of reading it, and I already buy it anyway.
I will not let the book shakes my faith in whatever way.
And of course, it didn't.

I was very much absorbed into the story half way thru the book.
In fact, it taught me a lot about life and perseverance and having and keeping that strong faith.
And I am glad I did not stop reading it - just because I am scared it might make me turn my back towards Islam or, what will other people say if they know I read these kinds of books?
I was quite disappointed - oh why is Albom, the writer I admired is a Jew? I can accept him being a Christian or Hindu or Taoist. But Jewish?

But, come to think of it again, that was silly ain't it?
To think that my faith can be shattered from reading a non-fiction, non-biased book?
How thin was my faith?
If anything, after reading this book I felt my faith towards Islam just grew stronger.
I now have a better and more imaginable character to adopt into my life.
And I look forward to Albom's other works.

Let me end with a quote from the Reb

“Mitch, that's what faith is. If they spit in your face, you say it must be raining. But you still come back tomorrow.” 

-Because life is a test-

 -AkMaR-
 http://nur-akmar.blogspot.com

Anaesthesia MO

Assalammualaikum.

Today I was scolded, or rather cynically told off by an anaesthetist.
She came in while I was looking at my phone during the surgery.
Perhaps she wasn't pleased with it - but to be fair I wasn't looking at my phone the whole time.
She came during that time I was looking at my phone, answering texts.
My luck.

It was an expected long operation - at least 5 hours.
Hence the anaesthesia practitioner MUST be present and continually monitor the patient.
I WAS monitoring the patient.
But I am still very junior in this field, there are still many things I don't know although I admit I should have studied more these past few weeks.

She then started quizzing me.
How do we calculate the fluids requirement for this patient?
Do I know the difference btw fluid maintenance, fluid deficits and fluid loss?
How do we calculate?
Fortunately, very fortunately, I still have my HO-time notebook in my pocket.
And I could produce a very good well-calculated fluid regimen for her.
She complimented me for it, thank God.
But she wasn't happy that I did not calculate it before she comes in.
Hmm, some of my seniors will always skip this part hence I don't routinely calculate them - perhaps now I have to start practicing the good practice, and not just the routinely done ones.

The next question was on perioperative monitoring.
What do we monitor in long operations?
I could answer but I could not really tell the indications behind it - eg temperature monitoring.
Why is it so pertinent for us to monitor the temperature in a long-standing op?
I know we have to avoid hypothermia, but why?
I know hypothermia reduces metabolic rate and sort of slow down our body, but I can't provide a proper answer for that question.

Well later on I found out that there is this thing called the Lethal Triad: coagulopathy / hypothermia / metabolic acidosis.
Hypothermia leads to coagulopathy and met.acidosis which will in turn aggravate the met.acidosis and coagulopathy.

She then said something about Anaesth is a difficult field, people always think we sit idly during operations, but actually, it is very difficult. She said I should read more, and not just sit down looking at my phone - right to my face.
And she walked off.

I felt so bad.
I felt so guilty
I felt like a disappointment.
My mood was so low the whole day. I did not dare to look her in the eye after that.
She was so nice to every other MOs - perhaps I have not gained her trust.
And from what happened today, it will be harder for me to prove myself.
I do not hate her. I brought this upon myself.

To make things worse, I woke up late this morning and was rushing to work.
Hence I accidentally wore sandals to work - instead of a proper pair of shoes.
And I have to go out to the wards and do pre-operative assessment for patients having their op tomorrow.
That made me feel even less professional - going around the hospital with sandals.
And I left my stethoscope in the car - which really, added salt onto the wound.

So now, I am sitting down and reading about anaesthesia concern on the types of operations I'll be doing tomorrow - the ENT list.

I hope I'll do better tomorrow.
And will regain the confidence I lost this morning.

-Because life is a test-

 -AkMaR-
 http://nur-akmar.blogspot.com

The not-so-wise tooth

Assalammualaikum.

People call the human third molar as the wisdom tooth.
It really is, a misnomer - as it is no wiser than my other teeth.
In fact, I think it is even more brainless than the others.
Why bother come out when you don't have space to - and make my life miserable past 5 yrs and now worse past one week.

Too Expensive to Bother

So I had this wisdom tooth that started to appear some time before I continued my degree in the UK.
In UK, I think it was infected TWICE - within 3 years time.
I THINK it was infected, because I did not go to see any dentist there.
You see, somehow dental health is not included in the NHS free service (at least that's what people tell me)
Hence each visit to the dentist will cost about £20 - 30 - and thats more than RM100 - for a simple check-up, excluding the procedures or medication.
Thus I kept the pain to myself, gobbled down Paracetamol and it went away.
The first summer break in Malaysia, I skipped going to the dentist.
When the infection happened the 2nd time in the UK, I swore to myself that I will make it a point to visit the dentist in Malaysia when I get home.
And I did.
I just can't remember what the dentist did. I think she gave me an appointment date that I was not able to keep.

And then it wasn't so painful anymore.
Only some time it started throbbing and will usually go away after I brush my teeth so hard that my gum bled.

Too Busy to Bother

Then during my houseman year, it got infected again.
Not having time nor the luxury to go to the dentist, I kept the pain to myself again.
Earlier this year, it got infected again.
It was so painful and I was blessed to meet this one nice senior dentist in the hospital, that I asked for her help. She asked me to come to the clinic any time I can make it.

The first time I went, she said my wisdom tooth was impacted and inflamed.
But not infected - hence she prescribed me only Chlorhexidine mouthwash - no antibiotics.
She also kindly asked her junior to do scaling for me. My God, it was soo "ngilu".
And then she asked me to come when it is not painful anymore.
I felt like crying - how can the pain go away if you are giving me only mouthwash?
I felt the pain was different from the pain I had before.

But it did go away.
One week later, I showed up again at her clinic.
She had another quick look and asked me to set an appointment with the dental assistant, at a time convenient for me.
She will have to extract the tooth, if it is a simple procedure, I will get a 1 day MC.
If it's a complicated one, I'll need 3 days MC, as it will my face bengkak.

So I had to postpone the procedure until I completed my housemanship.
I won't be able to get a 3 day MC during my housemanship - it is just difficult.

Finally Free-er

So, I had the extraction done last Monday 27.2.17
She had a look and was saying things like "opening flaps", "making incisions", "gutters" and stuff - and she looked at me like I understood what she was saying. Oh come on, I'm a medical doctor, not a dentist.
I know what those words mean but I can't imagine the procedure.
But anyway, I simply nodded.
I felt so much in debt with her - and she's so nice that I do not wish to trouble her.

Oh, The Pain

The extraction itself was horrific.
It wasn't painful but the sounds of the machine all scared me.
She was being very considerate and kept asking if I was in pain.
She injected a very generous amount of local anaesthesia that I didn't feel any pain at all - just some pressure.
But it turns out that my not-so-wise tooth was very big and angled in such a way that she can't simply pull it out even after cutting the gum open, making a flap and gutter and whatnot that I heard her saying to her junior while exploring in my oral cavity while I quietly trembled in fear.

She had to call the Oral Surgeon to come and help but the surgeon was preoccupied at that time.
When you're in this line long enough, you know that when people started seeking help, things are not going as smooth as you hoped. Well, not to scare you lot but it's the truth.
Be reminded though, informing the superior and asking for help from the superior are two different things.

In the end, she had to break my tooth before pulling it out.
Sounds gory eh?
Imagine hearing the grinding machine, working it's way in your mouth.
And my jaw was so tired of keeping my mouth open, I wished someone can just help hold my jaws open. The bigger the better - clearer field for the dentist.

So after pulling the little demon out, she had to suture the flaps back.
And I got a 3 day MC.
My appointment was at 9.30am - post breakfast.
I finished everything - including taking the meds from the pharmacy at about 1pm.
And I went straight home and sleep.
It got so painful as the local anaesthesia effect is slowly fading.
And the oral painkiller needed time to take effect.
I skipped lunch and by the time Akmal comes home that night, I was famished.

The Recovery

The next day, I had porridge for all my 3 meals and I was so much on top of the pain.
I took painkillers on time and ate only soft food.
I was so pain-free and was certain can do the procedure again, if needed.
On my last day of MC, I started eating macaroni, and all was well.

Only on Thursday, the first day I started working - that the pain kicked in like crazy.
I was so much in pain I felt like crying all the time.
The throbbing pain comes and goes.
When it comes, I felt like punching my face hard, right on the spot near my jaw where the tooth was so that it gets numb.
I practically lived off Paracetamol, Ponstan and Ibuprofen on Thursday, Friday, Saturday and Sunday.
I asked Akmal to have a look at it a few times, and I made him explore around using a cotton bud which I really regretted after that as it worsen the pain and I had to push my cheek on my palm so hard against my pillow to sleep that night.
Last night it was unbearably painful that I had to skip dinner (but I had Manhattan Fish Market for lunch haaaaaa haaaa 😂😂 ).

And today was my appointment day to remove the sutures.
The day I've been waiting for since Thursday.
I did not want to go earlier since I did not want to be a burden.
I have used my privilege as a doctor enough, going straight to the clinic without having a proper referral letters and being able to call the clinic and change appointment dates to suit my schedule, and even had all the staff in the clinic calling me "Doctor" as I pass by - "Doktor, kumur mulut sini" / "Doktor, sakit lagi tak?" etc etc
I didn't want to be a crybaby hence I waited for this day.

The Shame of the Broccoli

And it turns out, the gutter or the socket where my tooth sat was very deep.
And I had food particles stuck there.
And bacteria were happily feasting on them - hence the pain.
The dentist flushed the socket using syringe and taught me how to do it myself.
And they found some small pieces of broccoli in there (I was so embarrassed at that time - I had it during lunch ytd) 😳 😳 😳 😳
"Doktor makan broccoli yeeee" - said the dental assistant.
Hilang ayu oi.
But I did really gargle as hard, if I can describe it that way, as I can after every meal.

Anyway, now the pain is improving although it is still there.
If anyone were to slap my face now, I'll throw that person out of the window for the pain of the slap will cause more than skin damage to me.

Okay, that's enough for now.
I hope when I re-read this post in a year time, I will remember how painful it was.

And see, I wrote a 1000 words essay on "Removing My Teeth"
I hope this didn't bore you!

p/s: I know the wisdom tooth and the wise tooth ARE different.

-Because life is a test-

There. The size comparison of my teeth vs left index finger

-AkMaR-
http://nur-akmar.blogspot.com

Korean Dramas and Their InfluenceS

Assalammualaikum.

I'm not proud of it but I have to admit that I am a fan of Korean dramas.
I must say, it has taken my free time away. I used to use them to read books.
This Halyu wave first came to Malaysia in 2004 I think.
I was form 3 at that time. The first few K-dramas were Full House, Stairways to Heaven and Winter Sonata.
I remembered SIGNING a contract with Mama - I get 3 hours of TV time per day but if I don't do well in my PMR trial, I will be left with only 1 hour.

Those 3 hours were for:
2 -3 pm Korean Drama at 8TV. Jewel in The Palace was aired at this time.
6 - 7pm Cantonese Drama on TV3
7 - 8pm Cantonese Drama on either TV2 or TV3; whichever more interesting. Later on, 8TV started airing Korean drama during this slot.

I did manage to keep my 3 hour TV time that year ✌

Korean dramas have their own attractions - those good looking actors and actresses are definitely their biggest magnet but they also have good scripts and storyline.
The plot - although sometimes predictable, is good and always some form of lessons in it.

The Theme

Each drama has its own theme and the story is made up revolving around this theme.
Descendants of The Sun - soldiers
Goblin -  supernatural world within our world
Jewel in The Palace - herbs, medicine and the kitchen of the palace

And each theme has substance.
Although they sometimes don't make sense eg the drama Emergency Couple where they made intern doctors working in the ED as the theme (I can assure you we don't have time to brawl over petty things in the hospital cafe if we're in our ED shift) but they are not vague either.
They showed the hours spent in the kitchen / military training / lectures and stuff.

The Script and Acting

Efforts are also put in to make the scripts real
The dialogues were carefully strung together.
And the actors actresses were convincing when they said it (of course, not ALL of them).

The Cons?

But let's face it.
The story itself is unreal.
How can they have so much time, to always hang out in a cafe (each drama will have its own cafe sponsor hence ALL the cafe scenes will be in that cafe, dal.komm cafe for instance - it appears million times in Goblin / DOTS )

The actresses don't do dieting - they eat everything from fried chicken delivery in the middle of the night to soju and BBQ chicken in the middle of the day - yet they are all so slim and thin and some were even muscular.

They are always doing exciting things. They are not even glued to the screen, watching K-dramas.
I always think, is this how life is in Korea?
They have time to go grab coffee en route to work?
They ride buses and tubes to work - only the rich has cars.
They walk around the beautiful parks.
They cry at the Han River banks at night when they are sad?

But how come I don't get to do that?
How come I am just so lazy to go out of the house to have a nice and peaceful tea time at the nearest cafe?
I rather stay at home - and watch Korean dramas, and watch them do all the things I wish I can do. The irony 😒

Anyway, I think I have to reduce my TV time now.
I have more than 3 hours per day of TV time nowadays, on my off days - which is really not good.

But then, with the increasing price of everything won't it be cheaper to just stay at home?
I pay a certain amount for my internet bills, no matter how many hours I stream every day.

Oh well
Til then,

-Because life is a test-

 -AkMaR- http://nur-akmar.blogspot.com

Apple Support

Assalammualaikum.
So yesterday I talked about my silly blunder - deleting 80GB of my files
Saying "silly" makes it sounds cute.
It isn't really.
I really feel stupid and angry and disappointed at myself for losing 7 years worth of files.

So yesterday I set up an appointment time for Apple to call me back for technical help.
I made it at 7pm and completely forgotten about it.
Today, on the dot at 7pm - I received a call from a Singaporean number.
Then only I remembered it must be from Apple.
Once I picked it up, a computer generated voice greeted me - Press 1 if I would like to speak to their technician or Press 2 if I would like to reschedule the call.
Convenient eh?

So I chose 1.
And the call was directed to another operator that says something like I am in a queue and will be entertained shortly.
I have been wondering since yesterday - who will I be talking to?
American? Or Asian? Or better, Malaysian?
Will I be charged for this call?
When I first saw the Singaporean number, I was relieved and disappointed at the same time.
Relieved because it will be an Asian person talking to me but disappointed - why isn't their call centre in Malaysia??

Anyway to my surprise - the person on the other end of the line was an American man (from the accent)
And throughout the phone call, he was being really nice and understanding.
It's been a long time since I speak purely English - I've been mixing Malay and English + Chinese a lot in Malaysia (and proud of it).
This man's choice of words were very pleasing and professional.
He kept saying "Aaah yes, I understand", or "It must be hard on you" "Oh yes I did that once as well and felt really bad myself" bla bla bla.
I can only think that he must have undergone a really good customer service training.
He might not mean what he said (Yes, they are mostly very superficial) but it is very comforting to hear.

I kept comparing him to the many many Malaysian telephonists I've spoken to.
Although Malaysian telephonists are helpful, they are not generally friendly and understanding.
They are almost robotic, and sometimes even challenging or laughed at us.

At the end of the conversation, he was trying to tell me that he can't help recover my files - he very aptly put in a sentence - "Well this is a very good lesson and experience for you. Next time you will know exactly what to do and have the power to decide how you want it to be done"
So customer-servicey kan?

OK lah, that's all for now.
I have to come to terms that I will not be able to recover my 80GB worth of files.
To be honest, I do not know what I lost yet.
I think I must have lost all my travelling pictures.
As for documents, I will feel the pinch when I need them later.


-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

That blunder

Assalammualaikum.

Just a quick update.
Recently (about a month ago), I had a major problem with the internal HD storage space in my Macbook.
I was left with only about 2GB space.
Naturally, I fiddled around and rediscover iCloud.
I've always had this uneasy feeling with online storage - I feel as if I risk exposing everything to the public if I were to store my files online. Hence I've never really explored iCloud.

But this time I was desperate.
I need the storage and my external HD wasn't working well.
So when I activated iCloud in my Macbook, it automatically transferred all my files into iCloud.
Then I found out that I only get 5GB of storage in iCloud for free. It won't be enough anyway. If I want more storage, I'll have to buy them.

Naturally, I did not want to pay.
Little did I know, it actually did not "copy" my files from Macbook to iCloud, it "moves" them.
For those of you who are used to these terms, you'll know what I meant.
It means I only have one copy of the files.
And I - like a fool - deleted those folders from iCloud (I thought there were two copies! One in iCloud and the other in the local drive!)
And suddenly I have 80GB of free storage left.
80 GB!

It took me a while to really understand what was going on.
I deleted 80GB worth of files and folders.
It was everything in my medical school years.
My eBooks, my lecture notes, my pictures, my working documents, every single thing.
I am now left with only songs and some pictures going 2014 backward (I kept them in a different folder).

I downloaded various types of file recovery apps, but they couldn't help.
Until about 3 days ago, I re-re-discover iCloud.
And realised to my horror that, I did not delete my files from my computer.
I deleted them from iCloud! I should have used iCloud to recover them.
And iCloud allows recovery of deleted files up to 30days from the day we deleted them.
But I could only recover ONE eBook - my Lippincotts Pharmacology eBook :(

And now, I have been spamming the iCloud support page to ask them if they can help me recover files deleted past the 30 day grace period.
Wish me luck!


-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com