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Invictus

….by William Ernest Henley

Out of the night that covers me,
Black as the Pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.

In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeonings of chance
My head is bloody, but unbowed.

Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds, and shall find, me unafraid.

It matters not how strait the gate,
How charged with punishments the scroll.
I am the master of my fate:
I am the captain of my soul.

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Public Health

One more month has past through my internship. Didn’t really enjoy most part of Public Health…but once in a while there were memorable events i guess I’ll never forget. I’m at lost for words, so here’s some photos of it….

 

 

  

 

 This guy is about 5 foot 6 (i think), do you see the fine line on the wall?? that’s how high the water went during flood season.

 The local community’s superstitious believe.. the chili, onion and other stuff…to ward off i don’t know what.

 This was our field trip… chlorinating some of the well in the flood prone area. This area has no sewerage system and their waste are usually drained to the near by river..and when it rains and the river level rises…”the sewer” floods the area and contaminate the well…apparently diarrhea cases sky rocketed thereafter.  

 

 

 

Bunda Rani chlorinating

 

 Here’s another example of how high the water rose  (see the fine yellow line?)

 Here’s a picture of a lady drying her Quran after the great flood.

 

 Puskesmas (Pusat Kesehatan Masyarakat) Baleendah

 

 Daily breakfast… Bubur Aceh

 

P-E again

short note…before i forget about it.

G1P0A0 term gestation, inpartu (latent phase) with high BP (190/110). Proteinuria trace. 2 hours later….she convulsed.

Valium and MgSO4 was given..

Patient was somnolent…. Rx/ Emergency C-section

Frustrated!!

While others were enjoying their long wesak weekend going camping and falling into the stream n wat not…there i was literally stuck in karawang with no friends except my trusty lenovo n mobile T waiting for the fateful 24 hour oncall day.

Alhamdulillah everything went smoothly…no unexpected seizure, apnea or death, but plenty of patients to learn from.

1. That bloody ShOW??

Simply speaking, the 3 major signs of labour is bloody show (blood + mucous), gush of amniotic fluid and frequent contractions. 

Here comes a lady 9 months pregnant with chief complaint of profuse bleeding. Her vital signs were within normal limits (no signs of hemorrhagic shock). The 1st thing you would think about is antepartum bleeding (i.e. plasenta previa, solusio plasenta, uterine abruption). We didn’t do the vaginal touche fearing that if it was plasenta previa (low lying placenta), the bleeding would worsen.

Here comes dr doddy very early in the morning firing up his USG and discovered that the plasenta was infact in the fundus area (way up high!). He did inspeculum examination just to be sure…and he showed us the blood filled mucous …. that BLOODY SHOW!! haha

Rx/ Observe  labour progression

This is not the 1st time i encountered the so called “antepartum bleeding”. The very 1st time, i consulted dr rhabby about it over the phone and without even looking at the patient is said “Itu mahhh…SHOW ..tenang aja!” (it’s just show…relax).

In the 5 years of med school i’ve always thought that bloody show would be dabs of blood, like your last days of menstrual period…in reality it might even be as ‘gushing’ as the amniotic fluid. So if u ever encounter a term pregnancy with bleeding make sure to ask 1) is there mucous/lendir? 2) is this the very 1st time?…if the answer is yes to both then insyAllah it’s just SHOW. (plasenta previa usually bleeds earlier in pregnancy… around > 32 weeks).

2. A one year old molar??

Here’s another mind boggling tale for you. This girl (19 yo), married for one month came in with chief complaint of frequent, excessive, painfull mentrual period for almost over a year i.e. menometrorrhagia. (don’t ask me y she waited so long to come to the doctor)

Dr doddy did USG on her and discovered something that looked like “molar pregnancy”.

In molar pregnancy, beta HcG (the hormone pregnancy test pack detacts for) is veryy veryyy veryy high, due to hyperplasentosis. So clever enough we did a pregnancy test on her. Wo n behold..it was NEGATIVE..twice!

On vaginal touche…the uterus was like a 12-13 weeks gravid uterus, which is also another sign of molar pregnancy.

Let me sum up…

1. Menometrohagia for one year (before marriage)

2. VT: uterus 12-13 weeks

3. USG: suspect molar

4. Pregnancy test: negative

Any ideas??? I’m putting my money on endometriosis (based on the history). Will update on patient progress..n will read more on endometriosis. hehe

3. Missed Twin pregnancy

At 4 in the morning, this lady came refered by a midwife with High BD (160/100)…. ok, it’s not about pre-eclampsia this time! haha

I did her obstetrical exam n found out that her cervical dilatation with 8-9 cm…about an hour away from delivery. As i was trying to find the fetal heart rate via doppler i felt as though there was 2 hard long fetal parts on both sides of the uterus…thinking that the mother was having her contractions i dismissed reasoning and counted ONE fetal heart rate. Later, haris asked the mother weather she had done USG before…she said yes..and there was only ONE fetus found on USG.

One hour later she was fully dilated and ready to go. Here comes ONE baby girl….wait a minute….there’s another one!! breeched!! Thank god for the ever ready midwife, she delivered the breeched twin via Mauriceau–Smellie–Veit manoeuvre and BOTH babies finally managed to see each other face to face after many months being upside down. haha

Moral of the story is…never dismiss your instinct!!! even if there’s USG.

And oh yea….thank you to all the midwives in the world..even though some of u r very nasty people!!

Today in history

After 2 weeks in karawang district hospital in obgyn department it’s safe to say that i have learned alot. Wish i was brave to learn more. I’m constantly in fear of what mistake i’ll make day by day n think that the consultant will start screaming “Lu begok!” (u’re stupid!) in my ear.

Everyone is subjected to mistake once in awhile right? but when u think about other ppl’s health n life at stake u can’t help but be afraid  terrified of the mistake u will make…may make.

But anyways…the main objective of this entry today is to write down the cases i’ve encounted so that i won’t forget it.

1. Asherman Syndrome

It’s what happens when the uterus becomes scarred and stick together (intrauterine adhesion) post op. This lady came in with chief complain of amenorrhea (no menstrual bleeding), she previously had a large uterine myoma removed. The consultant (dr. Rhabby) did sound via her portio and felt that the sound could even past through the endocervix.

The result of this syndrome is the lady will become infertile. The consultant recommended a procedure to release the adhesion via stent. It uses a balloon catheter which is inflated intrauterine.  

i suppose it can also be use for uterine tamponade for uterine bleeding. Cool huh?

2. Incomplete spontanous abortion

Ni semalam punye cite. This lady came with chief complain of vaginal bleeding. She’s 8 weeks pregnant and the consultant (dr.doddy) did USG and found that there was no longer any gestational sac but there where still some product of conception left in the uterine.

I did vaginal touche and found that the cervix was 2cm dilated n i felt the retained products intrauterine.

The doctor suggested curettage to be done the next day. And he also suggested the mother to take a Toxoplasmosis test…apparently it is one of the major causes of spontaneous abortion here.

3.  Pre-eclampsia (AGAIN!)

Right now i’m following a patient with severe pre-eclampsia. She came in on the 16th of may with high BP (220/130). She was 21-22 weeks pregnant then. She was put on ceremax (nimodipine) for her high BP and placed under intensive care. Today her bp was 120/80..alhamdulillah. Sadly when we did USG on her baby…the baby was only 500kg (it’s supposed to be an average of 600-1000kg) by now. And since the only treatment of pre-eclampsia (in order to safe the mother’s life) is termination of pregnancy the dr (dr rhabby) decided to end the pregnancy…now it’s up to the patient. Hope to go see her again this saturday during oncall.

4. Molar pregnancy

“Hamil anggur” as it’s called here. Nothing sweet about it. A pregnant lady came in thinking that she’s pregnant and when we did USG on her there was no gestational sac only proliferating chorionic villi. She did go to a district clinic but the doctor there didn’t suggest curettage (to prevent molar from becoming cancerous is to do curettage)…wat a dumbass doctor!! 

 

Post curettage the lady is not supposed the get pregnant in one year and is only allowed condom for contraceptives (no pills, no japs nodda).

What is curettage u ask? It’s a procedure to remove unwanted remnants (of conception or endometrium) from the uterus using a curette. It’s sometimes used for intentional abortion.

I did it once but nothing came out. I’m supposed to be more forceful…hehe

 

Muir’s Web

Someone once asked “Do you value friendship by the quality or the quantity of time spent together?”

That got me thinking.. and my answer is.. NEITHER!

We tend to over analyze things sometimes. It’s not the amount of time or the quality of time you spend with your friends that make them good – heck, GREAT friends, it’s how much they leave a mark on you that matters. You may lepak with them all throughout your adolescent or you may have just been friends for a split second, but it’s what they make you remember them for, that last a life time.

I am blessed to have met great people and made even greater friends throughout my life. Some of which I’ve lost contact (but still very much in my mind) and some which I will see tweeting happily on tweeter evvverrryyy sinnnggleee daaay…

So, it’s an HONOR for me to write about them and leave you at awe at how huge my circle of friends have become over the years. If I could map them down, I bet it will look something like this MUIR WEB (habitat relationship web)

 

Let me start with my very very 1st friend.

My parents use to stay in Holland where my dad worked in shell. They were friends with a young couple who just gave birth to their eldest boy named Aji. The very first thing I remember about being friends with aji is that both of us were “shell brads” or more accurately called “oil n gas brads” because if ever any of the parents left shell, there were 99% chance that they will get a new job in an OnG company again! And… surprise surprise.. there’s also a 70% chance that the children will end up working in an oil n gas company like their parents. I guess it’s hereditary.

Me and Bukhari

(pasukan pelapis renang – courtesy of kak basyira)

Aji, due, sutra, nor, ika, fira, bukhari (the list goes on) were all fortunate brads of the ONG industry. We all stayed in PD and grew up there. We use to have weekly meets held by the OnG mothers where we managed to make a weekly mess of each others houses. I remember having birthday picnics at the beach right in front of our houses and car pooled to mengaji in Aji’s pajero.

Back when I was in college, aji, I and the rest went out for dinner and he picked me up on his pajero. “I can’t believe I use to ride at the back while your mom sent us for mengaji.. and now u’re driving it?” Hail to the old pajero…

Aji now leaves 5 minutes away from me. 🙂 But I never see him…

In the midst of my childhood, we moved to Tmn Tun (Atinahapan) and befriended a soon to be famous artist name Diana. The one thing I remember about this cheeky lad was that she “forced” me into playing bunga api in her house. The next thing I know I was running back home across the road with a burn on my pinky… nasib tak terbakar bungalow die.  

She now stays a block away from me 🙂 And yes, I never see her…(except on TV)

I stayed in Miri for awhile, and I don’t really remember them but I’d imagine we had a blast in the kampong primary school that gets flooded in the class rooms when it rains. Maryati and Frida. God bless them.

Everything starts when I moved back to KL and started primary. I met such wonderful people there. Sue was one of them. I remember meeting her for the 1st time, and since then, I think we were inseparable. We sat together at the back of the class; make jokes about the teacher teaching in front of the class – bla bla long story – we went to driving school together and happyly skidded through KL at 12 midnight.

Others included din, fai, hani, hana (eh, belum), puchi, which later will end up (in addition to the SK ONES) being called “The usuals” — plus many more others too many to mention here. And to imagine we were only 10 years old then.

 

Not to forget the beautiful Miss lyana that was my swimming buddy way back when. Although we were each caught up with our own cycle of friends, I was lucky to reconnect with this cheeky foodie recently.

As I struggled through high school, many more intrinsic yet fantastic faces showed up to fill the web.

One girl that fascinated me the most was this 20 something yr old girl (Arni) who was working as a reporter in NST. We chatted online like all other “normal” young adults then and met up one day to discover that we had everything except our age in common.

On the road to UK (which I’m still on, more like strayed away from), I entered A’levels at HELP institute, when it still had the yellow pyramid library. There, everyday, I eagerly waited for lunch break to meet up with the spunky group of girls from econs – ainun, shameem, ellisha and azzah.

Having strayed away from UK, I found myself in this strange land called Bandung. And despite the many break downs and “I need a cigarette!” moments (never attempted, promise), the beautiful hanim, yati, melia and ly stuck together like glue, we even had our graduation photo blown up but forgot we didn’t have anywhere to hang it up. (Maybe open a “private practice”?)

And then there’s “the usuals”… I don’t see anything usual about them. They r crazy extraordinary people that tweets for a leaving.

 

Last time I went home there was a hefty menu…

Dinner at home consisted of roast lamb, Yorkshire pudding and gypsy potato…and triffle for dessert

And, usrah menu consisted of bread, chicken tagine (morocco) and moussaka (Greek).

Lamb merry-nating!

Gypsy Potato

Roasted Lamb!

Baked Gypsy Potato

Dinner is served

My loaded Plate

Triffle (Email me to order)

Cup cake chic’s … i prefer Wilton’s cupcake at KD

Preparing moussaka

Home Made bread

Home made bread in the NEW double decker oven.

Whoopss…i forgot to take pictures of the moussaka and tagine…!!