Friday
11th September 2009
No matter how hard I tried, my eyes did not seem to be sleepy enough to fall asleep. Despite a hectic day and a chaotic last minute preparation of packing up stuffs for my one-week Orthopaedics posting in HoSHAS Temerloh, these eyes of mine are still fresh. I could not get my mind off the patient I saw earlier today.
She, was the same patient assigned to me 7 months back. She, was the only patient I got involved with, emotionally. I was contacted by her daughter during Ramadhan and was surprised to learn that Makcik had been readmitted to surgical ward, 4C. She was fasting at home and needed to go to the toilet when she accidentally fell down and hit her head against the wall. She sustained a laceration wound on the scalp with quite profuse bleeding. I visited her around day 3 of admission.
And to my surprise, she was skinnier (read: much much more cachexic) than she was before – although last time she was already very very skinny after losing more than 20kg of weight to malignancy. Her abdomen was grossly distended by ascites, and the fact that she was very thin, made the abdominal distension even more prominent – it seemed like she was trying her best to endure an unbearable agony. She was only managed palliatively, but even so, painkillers were no longer helping. Her suffering showed, in her deeply jaundiced eyes. She was on diapers, and could not even change her position herself. Her lower limb was already oedematous. Even to catch a breath of air, she needed to struggle. Perhaps pleural effusion had also set in by then. She recognized me, but was unable to say or do anything. How painful it was to watch her suffer. Indeed, it must have been even more painful for her.
Friday
18th September 2009
On this day I just came back from Temerloh posting the night before, accompanied by an unfinished case-write up which needed to be submitted on Friday, the 18th of September, 2 days before Raya, which is – today. A tinge of exhaustion which almost always escorts write-up-submission day was ignored due to the fact that our supervisor threatened to check our logbooks after being severely disappointed by our performance in Temerloh. So Friday evening was spent exploring the whole hospital for the normal Dracula-hunting procedures: blood taking and branula insertion. Plus certain additionals pertaining to Orthopaedics posting...
I had the urge to visit Makcik in 4C. How I strongly felt that this might be my last chance to meet her… at least before Raya, because she had been admitted for over a week and by Raya usually patients request to be discharged.. And I would love to wish her “Selamat Hari Raya Makcik, semoga Makcik Allah sembuhkan… Maaf kalau selama makcik kenal hana, hana ada buat salah silap pada makcik”
But the procedure-seeking was just soo compelling and although I already went to 4C, I don’t know why I didn’t visit her. Perhaps it was due to her curtain screen which was almost always closed, especially because they needed to change her diapers, and she normally performed solat with the screen closed. Or perhaps because I felt quite uncomfortable since her sons were there too. Or was it just because… I fear that I could not contain myself, seeing her suffer.
So in the end, I went home for Raya without visiting her for a second time.
But along the way, her daughter whom I grew close with, kept in touch by messaging me.
to be continued... one more to go...InsyaAllah...

Kenaikan harga gula sebanyak 20 sen baru-baru ini digambarkan oleh pelbagai pihak sebagai usaha kerajaan untuk mencegah penyakit berkaitan gula seperti kencing manis namun tidak kurang juga pihak yang mendakwa ianya sebagai satu alasan untuk menyejukkan hati rakyat.
Bagi merealisasikan gagasan kencing manis ini,adalah dijangkakan paket gula keluaran masa depan akan dilengkapi gambar-gambar penyakit berkaitan gula sepertimana yang dilakukan pada kotak rokok pada masa ini....
Selaras dengan itu, gula juga berkemungkinan menghadapi nasib yang sama dengan rokok,iaitu tidak akan dijual dalam skala kecil sepertimana juga rokok yang hanya akan dijual minima 20 batang sekotak.Penggemar gula mungkin akan disyaratkan membeli minima 20 kg pada masa depan. Manakala bagi pesakit diabetis pulak mungkin disyaratkan membeli gula dalam pek yang lebih besar iaitu sekitar 50 kg minima.Ini bagi mengelakkan mereka dari membeli gula sekaligus dapat membantu mengawal kandungan gula dalam darah mereka...
11 February 2009
11.11pm
“InsyaAllah, mck doakan hana mcm mck doakan anak2 mck jugak..”
“Hana pun dah anggap mck mcm mak hana sendiri…”
11.27pm
11 February 2009
Upon further reading, my assumption right now is that she might have gastric carcinoma with secondary metastasis to the liver and neck LN. (these are just my mere postulations since the results are yet to be known.
As I continue my reading, my heartbeat was drumming faster and faster. I find myself reluctant to know more, since the reality is too painful to swallow.
"Gastic carcinoma is a HIGHLY MALIGNANT adenocarcinoma” was the 1st sentence of the subtopic Gastric Carcinoma. I braved myself to read more.
"This aggressive cancer metastasizes early by way of lymph nodes, blood stream, and peritoneal spread".
As I scrolled more down the topic, I learned that treatment of this cancer involves radical surgical resection, either partial or total gastrectomy with resection of adjacent lymph nodes as well. It provides the only hope of cure and is also the best way to palliate the patient’s symptoms.
Unfortunately, the few last sentences were really heart-wrenching to me: “A palpable tumor in the left upper quadrant or an enlarged liver is an ominous finding, usually indicating advanced, inoperable disease. Radical gastric resection is contraindicated if liver metastases are present. These patients cannot be cured.” And in another book, “The detection of liver metastases often alters the surgical management of patients with cancer. Since most of these patients will have incurable disease, the primary goal of surgical intervention is to palliate distressing symptoms rather than undertake radical surgical resection. Overall, less than 10% of patients will survive more than 1 year after diagnosis."
Ya Allah… Beratnya rasa dada ni… Innalillahi wa inna ilaihi raaji’un...
"Setiap bencana yang menimpa di bumi dan menimpa dirimu sendiri, semuanya telah tertulis dalam Kitab (Luh Mahfudz) sebelum Kami mewujudkannya. Sungguh, yang demikian itu mudah bagi Allah. Agar kamu tidak bersedih hati terhadap apa yang luput dari kamu, dan tidak pula terlalu gembira terhadap apa yang diberikanNYA kpdmu. Dan Allah tidak menyukai setiap orang yg sombong dan membanggakan diri…” (Al-hadid: 22-23)
I be
This patient is religious too, she is the only patient in the female ward whom I saw praying when she was sick. Sometimes when I visit her during my oncalls, she would ask, “Ni semua ni kerja tak tentu masa ya?” I replied, we have oncalls every week. Then she adviced me so softly, “Nanti dah kerja esok, sebelum keluar rumah tu niatlah dua perkara, nak cari rezeki dan redha Allah. Barulah dapat kedua2 perkara ni. Kalau nak cari rezeki je, dapat satu je.."
Ant
Atau, setiap kali kita jumpa patients tu, hanya utk kepentingan studies kita semata-mata? Nak cari case best2, nak cover patients utk case presentations, nak cari case write-up, nak present case kat OT… macam selfish je bunyinya kan?
8.40pm
10th February 2009
7.45pm
As a medical student, I try very hard not to get involved emotionally with the patients I see everyday in the ward, especially those patients assigned for me to clerk, examine and follow-up. However, despite preventive measures, these attempts – of not getting emotionally affected – usually fail.
I was recently assigned a female patient who is 52y/o, nearly the age of my mother. Because this pt is sooo motherly and kind and caring, I grew sooo attached to her and began to love her more and more everytime I see her.
She presented with massive hepatomegaly (enlargement of the liver), so massive that the liver capsule is already stretched and thus causing her pain. Lower border of her liver could be palpated 18cm below the subcostal margin (imagine how big the liver span would be), and even the left lobe was enlarged, huge enough to be felt in the left upper quadrant, up till 10cm below her left costal margin.
Back to her case, suspicion of hepatocellular carcinoma was rendered unlikely by blood investigations of liver function test which was relatively mildly impaired and alpha fetoprotein which was normal. Hepatitis screening was also negative.
To cut the story short, the primary tumor turned out to be a gastric tumor. Biopsy showed atypical cells but the histopathologists were unclear of the exact diagnosis. Therefore gastroscopy was adviced to be repeated for a second tissue biopsy. However, currently the patient refused due to unbearable pain and discomfort during the process.
This evening I tried persuading the patient to redo the endoscopy and she asked a lot of questions regarding whether or not the agonizing process would affect her Mx later on. I promised her I would read more and explain to her again tomorrow, including the treatment options that the patient was so interested in.
To be continued...

URL: http://www.heraldmalaysia.com/hambaallah.html
At the time of posting, the URL http://www.heraldmalaysia.com/hambaallah.html returns HTTP error 404 (file not found). The screenshot's time was 8:25 pm, January 4th.
The message in the screenshot is clear, and is translated as follows:
we will not keep quiet as long as you still use ALLAH name.
save the sanctity of ISLAM
If you are wondering what this is all about, search/Google for "herald allah". The Malaysian Insider has a scoop on the defacement here.
Anyways, here's a summary:
- Herald Malaysia has been using the word Allah to refer to the Christian God in the Malay language version of the newspaper
- Some time in 2009, the Home Ministry banned The Herald to use the word Allah. It's main reason was that it might confuse Muslims, as Allah has been used to refer to the Islam God.
- On 31st December 2009, the High Court ruled that the order is illegal.
- And now we have this mess.
Jumaat (8/1/10) ni ade IRK class ngan Prof Tahir, bertajuk Human Research & Researh Practice pada pukul 11am- 12pm di LH1, IMC...ive informed setiap posting leader utk jmp HOD masing2 for excuse of any classes/teachings...
sekian harap maklum...