Police + Horses

Went to section 17 this morning. Suddenly saw 2 policemen riding horses and patrol in that housing area. felt so suprise and snapped this photo. Geik Kuan said don't know whether they can chase motorbike or motorbike chase them. Bear in mind that those policemen are not that well trained for riding a horse oh.. haha!

In Malaysia, we hardly see horses except when we go to Zoo. But now, heard that the government might want policemen to use it for patrolling. Can it works? If really going to start, those policemen with BMI more than 30.. can they ride those horses? poor little horses....

Police Academy..

Was spending my weekend on these movies.. POLICE ACADEMY.. not sure whether you guys still remember or watch these movies before. But seriously, I like these movies a lot when i was young. However, when i watch these movies again, felt so funny but kind of lost the feelings as when i was young that time. Anyway, it is still a nice movies which you might have forgotten after such a long time away from our childhood..

Just a thought of what is relationship..

I think Psychiatric posting did help me in understanding the act of an human. This posting do allow me to understand myself. What personality am I and what is the problem with my own personality. Same to the people around me. I started to understand that sometimes people do act "wierd" and it is actually due to their personality. Nothing can be blamed. There were a lot of doctors who said.. the way you act actually implicating how you were brought up by your parents. If your parents are drug addicts, then you might be ended up with the same problem as well.

Something make me felt sad yesterday. There is a psychiatry patient who told me that their family members ask him to move away from the family. I am not sure whether he is telling the truth or not, but i am sure that this is a sad story that I can never imagine. He was a breadwinner of a family. Now, he is mentally sick and the family member ask him to move away. I ask him.. Why? How could you give up like that? He just answer me that He also afraid he will be out of control and hurt them. It is better for both parties if stay separately for few hundreds KM away. Just curious whether who will do this to the family members?

What does a family mean? For me, it is a safe place where we can live as our own self without worries. Unfortunately, different people have different perceptions towards FAMILY. I received an email before and it is quite interesting as it said that FAMILY is stand for Father And Mother, I Love You. Of course, I do understand the situation of his family members and I am not blaming anyone because of that. But I do think that the world can be better with a bit more cares and loves...

Caning..

Caning. Do you agree with the act of caning? I think most of the people from our age group will still agreed with caning. Even I myself also agreed with it as I think this is a good way to discipline a child. Agree? People like me will give explaination that we were raised like that and you see.. we are still alive and stay in a very good condition and some of us may even achieve a succeful life.

The condition had been changed from time to time. Parents in the 80's and 90's will still can their child in order to discipline their children. But, as the development of human's right and child's right.. people start stigmatising caning as some of them may see it as a matter of violence.

I was having a tutorial sessions with a Child Psychiatrist this morning and she asked how many of us actually agreed with caning. Immediately, I raised my hand as high as possible as I think that caning with reasonable reason is good in discipline a child. What do you think? agreed? But what the Doctor said was true. When we can, we do leave some impact towards the child. Indirectly tell them that we are allowed to can other people. Your children will react like you as they learn mostly from parents.

There is always a better way to discipline a child. Can always use the award method. For example, star system. whenever they behave good for a day, give them a star. when they get enough star, award them with something beneficial. Do not awards with something material as they will become greedy in future. For eg: Can take them for a picnic, making cake together (strengthen the bond between parents and child). If they behave badly, take off a star which they earn with efforts.

I do think that the above method mentioned is quite useful. Probably caning is no longer a useful way of discipline a child. We are moving in 21st century d.. Probably things does change and we also need to change.. what was taught might not be always correct. With realization of problem existed, then only we can progress into a better condition..

Psychiatry

Just posted in the psychiatric posting for 1week. It is a scary but interesting posting. We call psychiatry as a mental illness which means the patient is sick mentally. However, normal people would like to label them as crazy...

Before i enter this posting, I was having the exactly same thought as psychiatric patient are crazy, loss of connection with normal people and some of them may become violent as well. It was quite a shock when i notice that most of them are actually really smart. They know very well with their own problem and sometimes they can even challenge you with their thoughts.. of course, don't ever challenge them back as you might provoke them..

From there, I was told that psychiatric patient wouldn't hurt other people except someone they know.. friends, family members.. That's why I built up my confidence and go to interview thems. Sometimes, will find that what they said were pretty true.. luckily I was warned by a senior buddy not to think too much regarding what they said.. if not i will ended up like them also.. haha!!!

There was once in the ward when i was attacked by 4 of them together.. huh.. so scary..!! once of them caught me and ask about Pethidine (pain killer - opiods type). The other came forward and listen and interrupt by asking me to do researches.. then, the 3rd one came over and introduce herself to me and keep on talking non-stop regarding her conditions and her hobbies. There come the 4th person, asking me about Patients' Rights.. huh..

Schizophrenia patient have hallucination. Imagine how scary it is if they tell you that they see someone behind you.. hohoho.. Scary, right??? hehe.. but overall, i do feel pity on their conditions. This is not what they want. They also wish to be a normal person but there is some problem with their brain which make them into a "CRAZY" person.

Mental illness become more and more common nowadays which can be due to the stressful life events nowadays. We shouldn't stigmatized those people. If we are to diagnosed ourselves, I think most of us (esp medical students) have some mental problems which might progress to Psychiatry illness anytime..

The old days in Tang Soo Do

Tang Soo Do, is a kind of martial art which is quite similar with other martials such as Taek Kwan Do. This martial art originated from Korea and it is slightly different from Taek Kwan Do in terms of techniques.
I joined Tang Soo Do since 1997. Slowly, I obtained my black belt 1st dan in the year 2000. It is quite an interesting sport for me as i feel great with all the movements, techniques coached by my master. Of cause, I aim to be fast and smooth with all the techniques. Tried to kick the opponents with each and every attacks. Trainings gave us a lot of chances to get to know each others. When it come to the training for national tournaments. it's really really tiring but challenging. I would say that the national championship training can kills us within half an hour if we are not well prepare mentally or physically. Even skipping a meal before the training or a improper rest/sleep the night before the training will make you suffer for half a day. Still remember that I get nauseated and have to lie flat for 15 minutes after half an hour of training. Aiming to kicks the kicking pad for 30 times within 1 minute is not as simple as jumping 30 times for 1 minute. Every kicks require combination of speed and power.
Tournaments are the best time to ensure your own ability. I started to participate in tournaments since yellow belt and I was lucky enough to be able to go to national championship in year 2001. Of cause, the presence of a few companions who were always tried to improve and beat down each other make the training and tournaments more challenging. We can actually see a big difference between state championship and national championship. In national, some people can fight by just standing on a single leg. don't be suprise that he can actually chasing you and beat you down by just hoping with a leg. Every kicks and punchs can make you fall down and slipped through the floor..
Still remember that there was once in a tournament, my opponent using "Spinning back side kick" and hit on my chest. Immediately i flew and slipped through the floor. Such a painful kick which stays in my mind until now..
We were asked to chop the breaks during upgrading exam to black belt. 2 breaks at a time is not an easy job. We also have to use the speed of our punch to create a blow that can blow off the candle's light (The white big candle lo.. not the tanglung/birthday small candle).
As a black belt holder, we used to help master during upgrading exams. A candidates who are taking a black belt upgrading exam requires to fight with 2 black belt 1st dan holder at the same time. For the candidate, it sounds like being in there just to get bullied. Of cause, black belt holders will take care of the juniors provided they know the way to get rid of attacks.. But i do notice that female candidates like to attack the private part of male seniors.. haha!
Tang Soo Do remained as the sport that i love the most. However, I had not been training for 6 years due to some injuries. Those are the old days with joys. It remains as fresh memory. Even though when i see the juniors' sparring nowadays, I still hope that i can stand on the stage again and participate in the tournament. But now, i need to convert those spirits into my studies! Need to be prepared for my final MBBS exam! Fight and fight to pass the exam and graduated as a doctor...

Ethic??

Ethic is a set of moral principles and we do believe that ethic is an important components in the practice of medical professions. What ever we did must be good for patient without getting or wish to obtain advantages in return. There is no 100% rights or wrongs when we talk about ethic but we do hope that we can do good with the guide of ethic.

When i was in first year of medical school. I was given an topic regarding EUTHANASIA(painless killing of a patient suffering from an incurable disease or in an irrecersible coma). Most of the country doesn't accept or pass the law for euthanasia as we think that we shouldn't have terminates someone's life. I also agrees with it as I think we as human should try to save lifes instead of terminating lifes. But, sometimes you will feel sad when you see someone suffering from a incurable disease and this is even more when the patient is someone you cares and loves. We do hope for the best for the patients and thanks to the law that doesn't pass the euthanaisa law as I believe a lot of doctors will ended up emotionally unstable if they were asked to terminate someone's life.

Sometimes, I feel sad when I see someone suffering and yet i can do nothing. Remember when I just started clinical year where we were exposed to patients instead of basic sciences, we were taught with a lot of physical examination teachniques. At that point of time, I become afraid of patient. Patients having abdominal pain but we still have to press on the painful abdomen. Isn't it seems to be a bit cruel? Then i started to avoid examining properly until when i realize that what I did is even more cruel if I missed the diagnosis.

A lot of my friends or relatives said: " Wah.. how come you guys are so darring and never scared of massive bloods, opening up peoples abdomen, seeing dead bodies..." Some people even said: "don't you have feelings?" I think most of us do have feelings and these profession does require us to fight together with patient who are standing in the border between life and death. And this even make us cannot be emotional and must always remain rational. That's why we are not encourage to treat our own relatives.

A Professor told me that sometimes we do wonders whether what we did is really good and beneficial for patient. For me, who are the ones that suppose to judge us regarding ethics at the end of the day? Who is the one that will determine whether we are doing the right things or not? But I do belive that we need to always remind ourselves that we hope that we are doing the best for the patients...

Memorable scenes..

Busy life in Kuala Lumpur. Finally can take a short break and come back to my hometown. On my way back to Teluk Intan, i saw quite a beautiful scene before the sun set. It was so beautiful. Since young, I like to be near with naturals. Like to enjoy the beautiful and natural scene. Here, I am going to share some of the pictures with you.. All these pictures leave a sweet memories for me during my growthing process and i felt so relax when i look at it.. When you are free, can always visit these places and get some good snap on it.

Over the left was a photo recently taken in Bukit Panorama, Sungai lembing in Pahang. It was situated 45 minutes drive away from Kuantan. But make sure that you arrive the village below the mountain around 5am. You need at least 45 minutes to 1 hour track before you are able to get up to the mountain and have this view. Nice??

This is another picture taken by Hsen in FRIM (Forest Research Institute of Malaysia). You can actually have a jungle trek and see some rain forest canopy within the jungle. There is a waterfall situated nearby and we did had a great picnic lunch and a birthday celebration with Ciang Sang over there. The waterfall wasn't take nice as compared with what i had in Bentong, Pahang.

Below is a picture taken in the look out point in Kuala Lumpur during DEC 2007 when we went out to celebrate a few birthday gals and guy birthday. The place was really nice and recommended by a lot of people. Of cause, it is a restaurant with a great view...

There are some few nice location as well.. but all those photos all gone together with my hard disk last year.. wasted.

My journey in Vietnam and Cambodia also have lots of nice view. Below this is the new 7 wonders of world - Angkor Wat. So so so incredible.. The scene is so beautiful especially during sunset. You must go back to Angkor Wat during sun set as the lighting will make the Angkor Wat looks gold in colour. By the way, my suggestion is to go Angkor when you are young. Cause you really need to walk a lot. We decided to take bicycle and we ended up having pain over the gluteal region because of prolonged cycling..

These is a super super nice photo taken by Mr. Ranjeev from our way to see sunrise in Hanoi City, Vietnam. The water was so clear and the scene is so beautiful. I really miss this a lot. Really miss the journey in Vietnam. Once i see these photos, i always can stop from thinking to go for vacation. What to do? No holidays in medicine. Have to work hard lo. Hope that can pass my exam and there go my another journey looking for nice views....

My CPR experiences

Another 4 months before my final exam. As usual, we were trained and taught with the Basic Life Support. 2 years in clinical years and I had just did 5 CPR (Cardiopulmonary Resuscitation). Out of my limited experience, 2 manage to survive meanwhile another 3 cannot be safe. Those cannot be save were happened within the recent week. One of them was an Indian during Deepavali.

This man was brought into Emergency Department at the evening of Deepavali. At that time, I was happened to be in Emergency Department during my surgery on call. We started Cardiopulmonary Resuscitation but the patient was unable to go through it. What make me feel sad was the moment when the doctor in-charged breaking bad news to the family members. The Emergency Department was crowded with 20 to 30 friends and relatives of this Indian Man. The moment when the doctor inform the family and relatives, I felt that it was really quiet with that slow running time at that moment. Break of the silence started with tears which floaded the Emergency Department.

It was an Deepavali for Indians. No body will ever wish their family members to leave them behind especially in a big celebration like this. For them, a happy celebration ended up with tears.

Another limited experience of mine was a Chinese Man brought in with Acute Myocardial Infarction (Heart Attack). Patient was cyanosed when he arrived in Emergency Department. We started with CPR and the patient was survive with the CPR. This make me feel great as I was able to help the patient.

CPR is something can be performed by any individual provided they know what they are doing. Taking a course and having a proper training will make you understand the CPR better and perform better.

Before we conduct a CPR, remember DR. ABC!!!
D = Danger. Make sure that the place and condition is safe for you to conduct the CPR.
R = Response. Tap or shake his or her shoulder and ask loudly, "Are you OK?" Proceed if the patient is not responding.
. = Stopped! Call for help. Ask someone nearby to call 999 (In Malaysia)
A = Airway. Make sure the airway is patent. AIRWAY: Clear the airway
Put the person on his or her back on a firm surface.
Kneel next to the person's neck and shoulders.
Open the person's airway using the head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway. If there is foreign body, evacuated it out.
B = Breathing. Use 5 seconds to check for normal breathing. Look for chest motion, listen for breath sounds, and feel for the person's breath on your cheek and ear. If the person isn't breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. Pinch the nose for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal. Then give 2 rescue breath. Make sure the chest rises during each breath.
If you believe the person is unconscious from a heart attack and you haven't been trained in emergency procedures, skip mouth-to-mouth rescue breathing and proceed directly to chest compressions to restore circulation.
C = Circulation. Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands. Use your upper body weight (not just your arms) as you push straight down on (compress) the chest 2 inches (approximately 5 centimeters). Do it fast and hard. After 30 compression, repeat with "B" statement with 2 breaths. Then repeat "C" and "B". You may check the pulse again in every 5 cycles of "B" and "C". Do it until there is sign of movement or Ambulance arrive.

Please always refer to the standard guide of CPR and go through a proper training course. It is a life saving procedure. By the way, the method mention above is only applicable to adult. Children would need another method. I had come across with the website of The Heart Foundation of Malaysaia (Yayasan Jantung Malaysia) and I believe they can provide a training to you. If free, please have a look on what they do in there.
* Any mistake, please inform me.
* Always refer to the proper guide and update yourself with the newest CPR method.

Be brave.. Face it..

Was having a student ward round few days ago and there, i met a patient with breast cancer which is ulcerating. After some history taking and I realise that the patient has been hiding from the family for quite a long time. None of the family members are aware of it. It is really sad to say that these does occur quite often in our community. A lot of patient are afraid of disease and they choose to avoid it. Probably they wish to try traditional medication or they just don't bother about it and hopefully it will get better by itself.

According to my lecturer, most of these cases can be seen among those who stay in rural area. When they came to us, the cancer had become an advanced disease. I think that education does play an important role. It is so important that every one know that early detected breast cancer can be treated well. To all my friends out there, please do not hesitate to see a doctor if you feel that something is wrong. Don't hide. Be brave enough to face it so that we can help you. Another lecturer of mine always tell us that: "there is always something we can do about it. Even with an end stage disease, we still can offer palliation to reduce the suffers."

Screening test for breast cancer is available. For those with strong family history of breast cancer, please screen yourself from time to time so that early treatment can be done if you have it. If you are busy with works and always say that you have no time to go to clinic/hospital, please do a self breast examination. Learn the proper technique for self breast examination and if you find a breast lump, go to the nearby clinic immediately. Most of the breast cancer presented with painless lump. This make self breast examination become more important as it can be asymptomatic in the early stage.

Last but not least, it is your own decision whether you want to seek any medical treatment or not. But I seriously hope that every one will take it seriously. Just like what the advertisement always say : "Ingatlah orang yang tersayang." Remember their loves to you and be brave...

Great effect of each words..

Since the first day i stepped into medical school, i was told that medical profession is always in the professional group in any of the community hierarchy. That's why a lot of people always ask for opinions from doctors as they always respect doctors. Of cause, the medical advice from doctors always have a great value and great impact towards a patient's life.
At first, I don't really understand how powerful a word can be. But slowly, I realize that words from a doctor can be very influencial. Let say if you SUSPECT a patient to have a cancer and you are just about to tell her that i am suspecting a cancer. Do you know how much this will affect the patient?
Once ago, a patient's relative told me how much he is disappointed with a doctor because of what the doctor had said. Even i myself also feel sad when i heard about those words used by the doctor. Doctors were given a trust, a respect by patient that they will act the best on behalf of patient. With this, doctors are given the power to break bad news which can be very cruel to the patient or patient's relative. Imagine that you need to tell patient that "Sir, I am sorry to tell you that you are having cancer", or "Sirs and Madams, I am sorry that we had tried our best and the patient cannot make it". Seriously, I feel that I am not ready for that stage yet. Not ready to break this type of news to patient or patient's relative.
I was impressed by a surgeon when i was posted in Klang hospital last year. There was a patient with Upper Gastrointestinal bleeding. Lying on the bed and not really responsive. He was taken care by a 15 years old son who is having a national PMR exam in 2 months time. This boy skipped his classes just to take care of his father in the hospital and this was realized by this surgeon. And she make such a comment to his medical officers and house officers: "We must do something and help them. We cannot let the situation like this and we must save them". I was really happy and amaze with this comment just like i felt a wave of bright light shinning out from her.
In hospital, simple word like how are you does means a lot to the patient. Same thing to a medical students like me. A simple word from us like how are you can guarantee a smiling face from patients and relatives.
Getting closer and closer to my final exam. Really wish that i can be a good and caring doctor and be aware of every words that i use as it really affects a patient's life a lot.