Wednesday, October 30, 2019

Tweaked My Layout (Again)


Amalie Blog Template

Barely two weeks, and I have changed my blog layout again.
I dislike Carolina because it doesnt display all my posts in a page. It displays only the most recent post, and the rest are in grids.

Grids like these

I am also dissatisfied with the [Read More] fuction.
I don't like that function, it requires effort for readers to read my blog.
I'd rather read a blog which displays the whole post and I can read by scrolling down, and then able to read the next post.

For this Amalie template, I am still finding out how to remove this post footer.
It looked weird, the image in the background must have expired - hence it shows the triangle warning instead.

Getting rid of this footer soon

Still looking for ways to remove them and hope I will be satisfied with the outcome!

-Because life is a test-

Monday, October 28, 2019




This is Oyen.
She is not mine. I don't know whose is she.
I gave her that name this morning. She is currently pregnant - I don't know how far is she in her pregnancy.

I have never been a fan of cats. I don't like cats. I am almost scared of them.
I think I can't stand holding a moving living creature. It grosses me out. Maybe that is why I cringe waktu menyiang ikan - and I rarely do.
Aisyah, my sister is worse. She can literally cry when a cat comes near her, even when the cat is 6metres away.

Oyen started coming to my house around a month ago - or perhaps I started realising her these past few weeks.
Cats have been sleeping on my porch intermittently for now. But Oyen caught my eyes because she is pregnant hence she stands out from the other cats.
I started looking out for her lately. Maybe the maternal instinct kicked in, since she is pregnant.
Akmal started it first. He considered buying catfoods during our routine grocery shopping - the price was the only thing that stopped him. Why are cat foods so expensive?!
He then gave our leftover Texas Chicken to Oyen.
Since then I started giving some of our leftovers.
Then Akmal bought a pack of cheap catfood!

Her favourite spot - in front of my sliding door

This morning I saw her again.
She was lying in front of my door. I almost stepped on her as I was going out of the house to hang my laundry.
I was actually looking for her on my porch, not realising she was really beneath my feet.

Whosever she is, I think the owner is not taking care of her much.
She looks like she yearns human touch - if that makes sense. She keeps gesek-ing herself to my shoe rack, and my grille.
She gives the single mother vibe. Like she is now on her own, pregnant, surviving for her baby and must look for a place to give birth.
My colleagues said she is testing to see if I am trustworthy - if she can actually give birth here.
OhGod. That sounds like a commitment.

Cats used to sleep on my dustpan. I think it's because the plastic dustpan is warmer than my tiled porch.
But Akmal removed the dustpan, he put it upside down now. So cats don't really have a place to sleep on now.
And I feel bad for pregnant Oyen.
So I made her this.

Box bed - for Oyen

I put some cat food in it, she ate the cat food but did not sleep in the box.
She continued sleeping in front of my glass sliding door. Perhaps she needs more time to trust that box bed.
I hope no other cat will sleep there.
And I am prepared for Oyen to give birth to little kittens there, as long as they don't shit anywhere on my porch.

'til then.

-Because life is a test-

Sunday, October 27, 2019

Sanggup ke Jaga Tracheostomy?


I am an Anaest MO. That means I work in both the operating theatre (OT) as well as the Intensive Care Unit (ICU).
Undeniably, the patients in ICU are very critically ill patients - they require intensive care and resuscitation and monitoring to keep them alive, of course dengan izinNya.

Some of these patients sadly, after surviving the most critical part of their illnesses, they don't recover to their previous state.
They might suffer a stroke along the way, or the prolonged acidosis in them have affected a good portion of their brain function permanently, or just in general, became very weak and thus will take a long time to recover. These are the state ICU doctors call "Poor/Slow GCS recovery".
It just mean that their mental state and muscle power takes very long to recover.
And most, if not all of these patients are intubated.

Intubation is a way of delivering oxygen and ventilation to someone through a tube down his/her throat and straight into the lungs. And we can't keep the tube in the throat for long. There are a lot of problems tagging along with a prolonged endotracheal intubation.

An intubated patient. [Source]

So we will usually counsel the family for tracheostomy. Tracheostomy is basically an operation in which the surgeon makes a hole in the front part of the throat/trachea, below the vocal cord and passes a tracheostomy tube through it. The tube is the same size as the endotracheal tube, but it is shorter.
It bypasses the whole chunk of throat muscles - the muscles which a patient needs to control in order to breathe properly, the muscles which a very weak patient might not be able to control.

Tracheostomy Illustration . 

Tracheostomy. [Source]

Living with a tracheostomy is not exactly easy.
It affects not just the patient, but also the family members. More so if the reason the tracheostomy was performed was "Poor GCS recovery"
That means the patient will be almost vegetative, relying on the family members to care for him/her.

Normal people produce phlegm all the time - we then either spit them out or swallow them subconsciously.
But tracheostomi-ed patients can't do that. Coupled with the lack of ability to filter inspired air, patients will produce a lot of sputum especially in the earlier months. Thus family members MUST MUST MUST be able to perform suction of the airway - imagine putting in a smaller tube into the tracheostomy tube and suck all the mucus out. And it definitely is not for the faint-hearted. The patient will cough and gag and the secretions are not going to be clean and white. They are basically phlegm, spit, whatever you want to call it. They are not nice. They are gross.

So frequent suctions need to be done. And the suction is not just once early in the morning, and then once more in the evening when everyone's back from work. The patient's airway will be blocked by then. There need to be a dedicated carer to care for a trachy patient - to perform suction every few hours, more if the secretions are copious. See the commitment we need from family members? See why doctors don't perform a tracheostomy on just anyone?

I have had a few cases where the tracheostomy patient dies at home, some was even almost deliberately killed by their family members. One mother allegedly covers the vegetative son's face with a pillow to end his life. But hey, he wasn't breathing through his mouth nor nose! The son's lifeline was that tracheostomy tube, mom! Please don't ask me what happens to the son and the mother, I don't know. But I know things like these happen. Imagine what kind of frustration must the mother must have felt to try and end her son's life. Perhaps she thinks her son is not even living anymore, just laying there vegetative. Perhaps she thinks it might be better and easier for the son that way.

Tracheostomy is also not an easily reversible decision. There is no turning back.
In intubated patients, when the family and doctors agree, we can withdraw our treatments when we see there is no more that we can do. We can remove the tubes and let nature takes its course.
It is harder to do that once a tracheostomy tube is there. It is hard to withdraw treatment from tracheostomy, as we dont really remove the trachy tube from the body to withdraw treatment.

It always breaks my heart when I need to counsel family members for tracheostomy. Most of these patients are elderly, and the family I counsel are the children.
I need to really knock into them the reality of tracheostomy. Knock knock knock - these are what you signing yourselves for if u agree for tracheostomy. You mother or father will still be lying there, weak and very dependant on you. Tracheostomy is not going to fix it. Tracheostomy is ONLY to deliver the air into them so that they can breathe easier.
It doesn't fix their brains, it doesn't make their hearts stronger, nor will it cure the infection your mother / father might still be having.
And you now have to discuss with your family members - who CAN and who WILL take care of this parent?

Brutal question huh?
If they can't agree on a carer between them, then doctors can't perform the tracheostomy.
Then they might feel they are not trying the best for their parents - they will feel the guilt of not going all out for their parents.
But is tracheostomy really the best though in these patients?
If they DO agree for tracheostomy, but then later are unable to care for their parents, that will be an even greater sin.
The sin of menzalimi mak ayah sendiri. The sin when they let their mother father die drowning in their secretions, because there are no one to care for the parents. The sin of hoping and thinking "Baik lagi mak ayah mati".

But if they can't agree for tracheostomy - it might make them feel like they are giving up on their parents.
Tough, tough question.

Maybe this is the reason why many medical practitioners in the west are tyring to advocate an advanced directive - although it will be very hard to implement and has many loopholes in it.

A quesiotn for you:
Would you want tracheostomy done onto you in the future?

-Because life is a test-

[p/s: The terms in this post is simplified to suit the non-medical readers]

Friday, October 18, 2019

New Layout Again

I think I get bored easily.
I spent so much time browsing through free templates and tweaking them and then decided against them.

I hope this "Carolina" template will last me long.
But I hate the slider. How can I remove the slider on top?
I've Googled and tried almost all methods, non worked.

Ok, let's sleep.
I am in ICU now, oncall.
Pray hard not to get any referral tonight!

-Because life is a test-


Saturday, October 12, 2019

An Apple A Day Keeps The Doctor Away

This cracks me.

I posted it to my family WhatsApp group with the caption "My Future"

And my brothers replied:

Chye: Oh no, *throws Apple away
Wasil: #boycottapple and #boycottappleproduct

Just a short one today.

Gotta study and then, prepare dinner!
And I hate the "Shift" button on this keyboard. It's so user-unfriendly.

-Because life is a test-

Friday, October 4, 2019


So I talked about how my 2-year-old Macbook Air failed me and how much it will cost to repair it.

And I really needed a laptop to help me with my study, and so with mama's help - I bought a new laptop!
Yes, I really wish I could by the new Macbook Air 2019, but it will cost close to RM7,500 including the extended warranty.
After careful and almost, but apparently not extensive readings on the internet, there are many ultrabooks that trumped Macbook Air which included Dell XPS 13, Huawei Matebook 13 and ASUS ZenBook 13.
Huawei Mate 13 cost a bomb, and somehow Surface Laptop 2 did not appear during my research.

Hence I narrowed my readings down to Dell XPS 13 vs ASUS ZenBook 13 (Surface excluded, as I didn't know abt it 😑 ).
I went to Low Yat to see the price, and ASUS ZenBook is the cheaper one.
So I bought my very own ASUS ZenBook 13 for almost RM4k. Thank you Ma and Hubs!

Let's do a bit of review abt this laptop, after abt 2-3 weeks using it.

Let's start with the good things first.

The Advantages
1. The Long-lasting Battery
Last week I left the charger in Mama's hse in KL during my visit there.
With the battery at only 53%, I was afraid it will die after using - so I barely use it. Only used it about 2 hours every day and I set the battery usage to minimal. I switch it off every time after using it instead of just letting it sleep.

It managed to last me 5 days when the charger Aisyah posted to me finally arrived via PosLaju.

2. The small and compact body but 13" screen
Like the new Macbook Air, this ASUS ZenBook didn't have the extra space bordering the screen, it is almost full-screen, like mobile phones nowadays. So the screen is still 13" like my old MacBook Air but the body became smaller, since it doesn't need extra space.
And it is very light, barely 1.5kg.

I have not brought it to work but I am pretty sure it will not weigh my bag down like my previous MacBook Air.

3. The USB ports!
Not just one, but there are TWO USB ports on this machine.
One USB 2.0 and another is USB 3.0.
Hence I can easily connect my mouse AND printer at the same time, without worrying about charging the laptop.

The major disadvantage of MacBook Air 2019 in my opinion is the lack of USB ports. It has 2 Thunderbolt ports - one of which is also the charging port.

The Disadvantages
I am sad, there are still more of these compared to the advantages but perhaps I just need to adjust myself to Windows.

1, 2, 3. iCloud
This might be the biggest trouble I am facing now.
I use iCloud heavily ever since my switch to Apple 9 years ago.
I even paid for the monthly cloud storage. So when I had to switch back to Windows, I had trouble syncing all my iCloud documents into this ZenBook. Although there is an iCloud Drive software for Windows, it isn't as automatic as it is in MacBooks.
The document parts are all solved now, I managed to sync it to my C: drive.

However it can't sync my photos from iPhone as efficient as my MacBook can - simply because they are using different platforms.

I used to be able to take a photo on my iPhone and with internet connection, the picture will be on my MacBook within seconds.
If I do not have Internet connection, I can just AirDrop the picture from my iPhone to the MacBook - which takes seconds as well.
Now, I MUST have an Internet connection to be able to have the picture on my ZenBook, since iPhone can't Bluetooth files to computers and there is no AirDrop in between these two devices. The iCloud Photos are not syncing really well, I am not sure why so I had to go to, and manually download the picture into my laptop.

With this change of platform, it also mean I can't use Notes anymore.

No, this is not my Notes. This is from the net 😂

I take notes on the Notes app on my iPhone, and then I can edit it on my MacBook - because they sync.
Now I can't view them easily anymore because there is no Note software for Windows.

Maybe I need to start using Evernote now.
Alternatively, I can do this.

4. Compact Keyboard
The keyboard is really compact, I always mistype words.
The "Shift" button is especially challenging because it is as small as all the other letters buttons.
"Shift" buttons on keyboards are usually as big as the "Enter" buttons on laptops - if u know what I mean.
So now, everytime I need to type a capital letter, I have to stop and see the "Shift" button to correctly press it.

It's the right side of the keyboard that I found difficult adjusting to.

5. Speaker Pecah-Pecah
I am not sure what to call it in English but at certain volume, the sound starts to disperse haphazardly.
Imagine sound waves coming out at certain speed from the speakers and colliding with each other and the music produced is scattered - if that makes sense.
When I read the reviews, there was no mention about this. In fact, most of the reviews stated that the speakers are really good.
I wonder if MacBook speaker is exceptional, hence I got so used to it that I feel this quality is sub par.

I WILL adjust to this Windows ZenBook.
I aim to use it for years from now.

But as of now, I still have the intention to go back to MacBook. Perhaps after I complete my Masters training and become a Specialist and earn more

Some of the reviews I read: (in most of them, Dell wins. But ASUS is cheaper, but still more expensive than non-Ultrabooks)
1. ASUS ZenBook 13 vs Dell XPS 13
2. ASUS ZenBook 13 vs MacBook Air 2019
3. Dell XPS 13 vs MacBook Air 2019

-Because life is a test-