Pirated Shyang

你他＊的白毛

2013-03-30T23:51:00.001+08:00

电话闹钟响了起来
早上六点。
他＊的，好烂的一个oncall。
就好好给我睡一下可以吗？

来电显示014xxx，没有看过的号码
很不客气的“哈咯！”
对方带着微微颤抖的声音
"is this Dr Kho?"
电话是从离Kapit最远的一个Clinic打来的
KK Nanga Tunoh Scheme。
我看过Kapit的地图
这个地方根本像是在火星那样远。

Nanga Tunoh Scheme, Kapit

如果有人从那么远call来
知道一定是不大对劲了
跳了起来，温和的应了一声
“yes, boleh saya bantu?"

JM Evelyn.
一名community nurse，
白帽，紫色条纹
她简略的响我报上一个孕妇的病例

Kami Sedia Membantu, very true indeed.

二十岁，第四胎
二十七周怀孕（六到七个月）
凌晨一点开始下体出血
因为家住太远，晚上根本没有船可以到clinic去
所以一大早就到了clinic
就是早上六点。我的那通电话。

血压90/50mmHg, 心跳140
子宫颈开到了九公分
baby的心跳大概140－150
先救妈妈，我下令两条大line
立刻进了1.5liter的盐水
心跳稳定了些些，血压也上了一点点

情况听起来像 placenta abruptio.
不懂华语叫什么
如果要从Nanga Tunoh来到Kapit医院
她们需要搭上4x4上伐树用的路
一个小时才会到最近的河流，
做半个小时的船到另一个clinic，Nanga Gaat
从那里，坐一个小时半的快艇
才会到Kapit Hospital

什么塞！两个小时！
9cm，没有可能！
唯有在原地急救和做一切能做的事情

母女暂时还算稳定
现在早上8am，我还有两个内科病房和一个ICU要看

原地急救，要怎样把她们带出来呢？
MEDEVAC。直升机。
费了一大班功夫，从Kapit院长到Kapit省议会院长
到砂州卫生部的老板，call到乱
终于直升机安排到了！
从古晋起飞，预计下午十二点到Tunoh
半路会来Kapit载一名医生，到原地急救
然后直接飞往Sibu医院。
现在才8am。

我于JM Evelyn至少半小时通一次电话
感谢至少celcom没有把砂劳越给忘了
其实我也真的不能做什么
但是我知道我不可以慌
你在医院慌，人家在那里要怎样噢！

Thank you celcom.

10am
再次大出血，血压再一次crash
开了10cm，小宝贝也跟着出来了
胎盘也出来了
什么都出来了
下令syntometrine ＋ pit40
妈妈至少稳定一下了，至少是现在。

婴孩七个月大
不足一公斤
手脚无力，cyanosed。
JM Evelyn ambubag了一段时间
还是没什么起色
她告诉我“dada ada naik turun, tapi tidak gerak!"
一步步的我教她把拇指于食指夹再婴孩的脐带
然后在十五秒里，算一下心跳
“satu...dua...tiga...empat...lima........enam..."

婴孩心跳120bpm。
那安静的十五秒
我的心都快要停了下来。

好
至少妈妈现在还算稳定
孩子我不懂，心跳还好，但是不会呼吸！
什么都没有！要做什么！
把她放在强灯下，那塑料带包起来
至少不要让她冷到。继续ambubag。

11am
小宝贝离开了。
JM Evelyn 的声音几近崩溃。
无言。
好像眼泪有掉下来了。
我只记得把房门锁了起来。

JM Evelyn with Dr NCW. Hero of the day.

直升机终于到了。
同事兼老友ncw对妈妈做了应做的急救
把婴孩的遗体让家人领回
妈妈现在应该在Sibu了。
愿安好。

你以为在大炮吗？
你以为在看戏吗？
JM 是 Jururawat Masyarakat 的意思
也就是说她们的工作性质是不需要那么的临床（clinical）的
JM Evelyn 今天所做的一切
远远超乎了她所能驾驭的
自能说，行苦你了。

Aftermath.

你他＊的白毛。
生命因为你而变成一文不值的东西。

Medical Evacuation

诗翔。
28／3／13
人生会有几个这样的经历。

幼稚和天真的完美主义分子

2010-04-11T19:14:00.001+08:00

幼稚和天真的完美主义分子
每天操着不要朝九晚五的生活
向往无忧无虑的刺激生活
高风险的态度和行为有时是好的
但是如果个人的基础是幼稚和天真的话
我只能祝你不要跌到太凶

你可以不负责任的责备你不属于的地方
但是一味的指责和给于幼稚的意见
只会另人厌倦
讲那么多却没有一件事情是做的轰动的
就请你不要再继续了吧

My Grandpa

2010-03-26T00:59:00.001+08:00

before this exam,
i really talked to my grandpa up there somewhere (somehow la!),
tell him please dun let his physician be my examiner,
i agree he is a wonderful guy, but please dun let me get him,
i will thrilled and confirm die!

finally, i still got him.
and i suppose my grandpa did know what is the best for me.

又冷又怕

2010-03-11T21:04:00.000+08:00

今天被将会是后星期做我考官的专科医生吓
吓到我话都不会讲
吓到我非常后悔做么要进医科来受苦
吓到有一种想法
就是如果现在忽然不幸就不知道怎么样死掉的话
可能会是一种解脱的那种感觉

又冷又怕
不要在剩几天就要去考试的时候
才来吓我们啦！

Boring Day

2009-09-23T17:47:00.004+08:00

too bored today
is there any place u can get an escape package?
like they will come n pick u up at home n throw u somewhere
anyone?
grr..

不切实际的鼓励和赞赏

2009-09-01T21:17:00.004+08:00

如果说这个社会是一个学校的话
今天我上了一堂课

今天你表现了你的才华
很好真的很有潜力
大家给你很好的鼓励
很好的赞赏
我也觉得你真的很棒！
希望你继续努力！

抛砖引玉，
大家纷纷模范了你
很好！

被你抛砖引玉引出来的
如果是一块很好的料
当然也会得到全堂喝彩
只是表现平平
大家却虚伪的给于鼓励和赞赏
给我看来
这些虚伪只会给你带来更大的伤害
称的上是你的老友的却在最不适当的时候
给了你最虚伪的赞赏
请你不要在被蒙在鼓里而暗暗自爽
因为我是一个旁人
看了都为你心寒

称的上老友的
请你给他一个正面的建议吧
宁可虚伪的为他喝彩

适当和正确的鼓励和赞赏对每个人的帮助是很大的
过分和不切实际的鼓励和赞赏对人的伤害很大

与大家共勉之

OK! WHATEVER! AS YOU LIKE!

2009-08-25T14:30:00.003+08:00

today is my obs/gyn long case assessment day
posted to obs/gyn wards for 9 weeks, and i m happy that i got gyn for long case
dun really like (or hate!) obs!

very happy, when its my turn, Prof saw me n he actually brought me away to another case, which he think is better...so i like phewh~ good..i going to present to Prof, the senior obs/gyn consultant in SGH...someone who really appreciate ur knowledge n really good! so with all the good n high hope..i introduce myself to the patient nicely n start my 1 hour clerking.

my patient is a vr nice lady, 27 yrs old malaysian iban. G3P2, current in 23 weeks gestation.
was referred from KK Gita (Matang) cuz no fetal heart detected on daptone.
at SGH...scan was done n was told to have 'kandungan anggur' - a molar pregnancy.
ok good, time to shine! since i nvr expect to get this kind of case..but still good!

i think i clerk well with this case (associations, risk factors, past obs, etc) and had come out a vr good management plan for her..and yes...i even do a dipstix bedside..n protein was traced (?PE) so with all these in mind..i m ready to present this case to prof!!!!

SUDDENLY!!!!! I WAS BROUGHT TO THE OTHER LECTURER...THE WAT-THE-CRAP-SMKB!!!

and that time i really see SNOWSTORM!!!!!

i presented at least till management n follow up..but along the way i got irritated by so many atypical questions, which i would like to share with all of u!!! tamade!!!!

A is me; B is SMKB

1.
A: patient's blood group is AB, which is a risk factor for Molar preg
B: what!? then what is the paternal blood group? isnt that important!??
A: ...ok, sorry i didnt ask.....(so far i only come across the importance of maternal blood group, but also not proven yet!!)

2.
A: patient did not complaint of any abd mass or any acute pain, which i m worried of any theca-lutein cyst which tort and ruptured easily
B: ok..wadever, so do u noe how many % of patient will have theca-lutein cyst
A: in molar is around 10-30% (most literature quoted around 20%)
B: ur range is too wide, ok wadever u like
A: what!!???...

3.
A: uterus on palpation correspond to 20 weeks, not larger than date
B: so?? u should tell me the consistency!!!
A: (so so so so wad la! molar is a cause of uterus larger than date wad!!!) ok..it does not feel doughy!
B: ok, not dough, wadever u like

4.
A: so management is suction n curretage with oxytocin after procedure
B: what is the name of the thing they use to do SnC
A: er...its a curette with suction power..2 holes at the tips to prevent blockage
B: the name!
A: er......(thinking what special name tat thing have!!?)
B: SUCTION CURETTE!!!
A: mai high..that's not a name!!!

5.
B: ok, tell me advantage of suction compared to normal currettage
A: ok..to prevent embolisation during procedure, as the tissue is sucked out..not further curretted into the uterus
B: ok wadever u like
A: ....

6.
A: so after SnC, i will send the sample for HPE to confirm molar n to see any presence of invasion
B: tell me the characteristic HPE findings
A: ok, can see generalised/focal chorionic villi swelling + diffuse trophoblastic hyperplasia and +/- of fetal tissue
B: no, not specific enough!
A: ......
B: faster, i m waiting
A: ....sorry i duno
B: faster! i m waiting
A:......i really duno
B: hydroscopic degeneration of the cells.
A: ok. (wadever u back!)

A: during follow up i would advise for effective contraception, better to be barrier method, avoid IUCD and hormonal
B: why?
A: effective contraception, so when patient bleeds..pregnancy would not be an option; and since IUCD n hormonal can have breakthru bleeding..the presentation will affect my judgement on the progression of ds
B: ok, whatever u like!
A: ........

7.
B: lets say u following up patient and u c a vaginal mets
A: ok..so rare le..vaginal mets
B: tell me the exact site of mets in the vagina
A: er..........fornix?
B: NO
A: ....anterior n posterior vaginal wall??
B: ok which one!!!?
A: anterior?
B: NO!
A: posterior.
B: ok. then what should u treat?
A: since jus now i had started her on single chemo (methothrexate with folinic acid), now i would like to go for the EMACO regime
B: ok...good, EMACO, tell me the s/e of etopoxide
A: mana tahu la!!!!!

WADEVER U!
WADEVER U SMKB!
WASTED ALL MY EFFORTS FOR GYN/OBS!
U BETTER DUN FAIL ME!
F U!

No More Rainforest!

2009-07-09T17:48:00.004+08:00

Form 4: Pengawas Camp; cannot go
Form 5: Pre-SPM Exam; cannot go
Form 6: Pre-STPM Exam; cannot go
Year 1: Orientation; cannot go
Year 2: Orientation Committee; cannot go
Year 3: Sibu Posting; cannot go
Year 4: Bintangor Posting; cannot go
Year 5: FINALLY CAN GO!!!! ooops...H1N1; cannot go

great!
great!
great!

不要为你自己的错误找一个借口

2009-06-22T21:24:00.000+08:00

其实很多时候我都在思考一个问题
一般人都觉得读医的应该都是很聪明很勤劳的那种人
还记得第一年进医科
我看到了很多聪明的朋友
我也看到很多很努力的朋友
我因为先天资力不足，所以只能靠后天的努力
终于在过去的四年里成绩还算不错

刚记得大家刚认识时
每个人都很有冲劲
很自动自发，连走路的速度都很快
很多事情也不会去介意做得太多

四年过去了
我所了解的情况也不再看得到了

很高兴的，
有一些朋友还是带着一样的态度
自动自发，很努力的在学习
但是，这群人毕竟少之又少
所以当表现的勤劳一点的时候
反而会遭来闲话

"XXX还会在哪里？一定是在ward啦! hahahaah!"

其实我觉得自己懒就算了
人家勤劳就请你把嘴闭上
不要为你自己的错误找一个借口

为什么我写这些东西？
因为我不希望在不知不觉中被同化

与大家共勉之

诗翔
22/6/09

O Hantu O Hantu!

2009-06-18T21:49:00.002+08:00

鬼啊！鬼啊！

所怕的
所不想见的
所讨厌的
所不能接受的
称于鬼

鬼们
混在一起
商讨大事

损己利人，不做
损人利己，做
但是还要给自己理由

说是为了大家

鬼啊
鬼啊

iPhone?

2009-06-08T23:45:00.003+08:00

AirStrip Technologies out of San Antonio, Texas has just received FDA approval of the company's real time waveform monitoring software for the iPhone and Blackberry smart phones. The AirStrip OB application displays a live intrapartum fetal heart tracing and uterine tonometry data for obstetricians to watch over even while breaking for lunch in the cafeteria.

maihigh,
next item on the top of my wishlist -->iPhone!
kinda broke after my japan trip,
so yeah, might need some times...hahaha
not really necessary for a final yr medical student s well...
so for the time being...jus wait....
eagerly...

Yokoso Japan

2009-04-21T16:25:00.002+08:00

japan gives me a vr good impression
everything here is so different from my country
not only their thing, their ppl, their culture, everything,
is something i really impressed and enjoy living with it
i will tell u some vr impressive things,
more to come tho...

their dogs are adorable..and they can jus keep their dog in their pocket
all their dogs look so tame and really vr dog
and somemore u seldom hear them bark
they make sure they are clean, and u can c dogs whenever u go
not the dirty dogs...clean n high class dogs

their food is delicious!
my plan to lose weight here will fail!
definitely fail!
their food is so so delicious! and big portion! jus like hong kong!

their kids are so cute as well!
got one kid in the train keep reading the sign whenever the train stop
"suita, kinishibe, la la la la la la la" their voice somemore so cute

the cycle a lot..before i come japan, i already know they are a vr green country
and yes, this prove it..somemore their car all new new no smoke come out one
vr vr green

n the most important thing...japanese is vr vr vr polite!
i nod my head everyday for around 50-60times!
ahahahaha!

50mm f/1.8

2009-03-20T23:15:00.002+08:00

50mm f/1.8; finally got it!!!

so small, so light, so sharp

my father haha, on my new lens f1.8

不要再每天出theory了

2009-01-22T16:22:00.000+08:00

现实是肮脏的

这个世界如果简单来说的话
可以分成两种人

第一种是那种很喜欢团体生活
每天搞活动，搞联谊，有说有笑
人本来就是团体动物
很好

第二种是很我行我束，
你不反我的井水，我也不犯你的河水
人都有不同的看法，人格不合
你不犯我，我不犯你
很好

但是很多时候
大家都偏离了
搞活动的，鼓励成立小group
大家开始讨论别人
鸡蛋挑骨头，每天出theory
我们讲的对，你们讲的错！
很不好

朋友们，
把你的社交圈子放大
不要极限每天都只面对一般读医的朋友
每天在这个圈子钻钻钻
好事都变坏事

我非好人
我的宗旨就是
不能忍受自己看不顺眼的东西，
就像我不可能逼你去吃大便，所以你也不要那你的冷屁股来贴我的脸

至少我看得到我的错
虽然很难一下改掉
至少我看的到

不要怕，敢敢冲

2009-01-10T22:14:00.002+08:00

这几天都在下雨刮大风
家里这盆仙人掌也有好几年了
因为很有耐力，越长越高，
所谓树大招风，终于在几个月前历尽不起
到了下来
也许不可以说他经历不起大风
应该说那个花盆已经承受不了他的大了

所以老爸老妈就把他换到一个更大的盆
给他能够越长越大
不过在昨天，他终于又倒下了

老爸回来后
我告诉他，不如把他剪短吧
那样他就不会那么锋芒毕露了
老爸立刻告诉我
“剪掉！！？”
倒了不要紧！我们买更大的盆给他
再不够大，我们就把他种到地上！

老爸这种宁可死也不怕冲的精神让我很敬佩
很多时候，宁可死的精精采采
也不可以委屈求全
我是在这样的家庭里面被教育出来的

第四年的大学，
受了很多挫折
有想过不然就算了，
和大家一起做一个是一天过一天的医学生
把自己所坚持的理想放弃掉
仙人掌倒了
努力的爬起来吧！
不要让这个世界小看了你
有梦想的人就美丽

我会坚持我的信念
踩过我的人你小心一点吧
有一天我会拿一坨屎丢在你脸上

我的老爸。

2008-12-21T21:13:00.003+08:00

Canappeco, from japan.
with their latest album "Misora Sketch"
love the tunes,
listen la, although i duno wad they singing
but the melody goes really well:)

Iryu

2008-12-14T10:03:00.004+08:00

jus finish watched this japanese drama
iz called Iryu, like other medical drama
portray doctors in a un-realistic way
which may influence more ppl to into medic
but real life is not like drama, at all.

one nice thing about japanese drama is that
they put in a lot of life values and is more knowledge-orientated
if compared to western one
where they will stress on which doc sleep with wic doc
who love who, who got affair with who
which is actually vr irritating sometimes

iz a very interesting surgery-based drama
for medicine, the best will still be House!
jus that the cases in this drama is quite dramatic,
the scenario of the final surgery is:

9 month old, boys, known case of dilatation of left ventricle, is to undergone
Batista operation (removal of un-contractile portion of the ventricular wall).
Besides, iz a known case of situs inversus and there is only one coronary artery,
where the right coronary artery branched out directly from left coronary artery
rather than from the aortic sinus. Moreover, intra-op, they found a coronary
artery aneurysm on the left decending artery, which is undetectable during angiography
as it arise extraluminal, and the lumen remain intact. The aneurysm most likely
arised from previous Kawasaki Disease (common in kids).

the head surgeon immediately perform a by pass surgery with left gastro-omental artery
because the internal thoracic artery is still not well formed in kids. and followed
by the batista procedure.

situs inversus,
what is the chance!?

and yeah
really hope can go OSAKA next yr
and i will be observing the skill of japanese surgeons
world class :)

都跟你讲了咯

2008-12-01T20:35:00.004+08:00

都跟你讲了咯
我们这班人都很怪的
其实我觉得那些感去找医生诊断的医学生
是没有什么大问题的，至少他们能够接受自己有这种需要
我觉得一个人最重要的就是"Insight“
是你能够看到你自己的问题，然后接受它，然后改变它
很多人（特别强调的是我每天接触的医学生）
常常是我们讲的 ego-syntonic, 她们从不觉得自己有错
因为自己不懂，所以就不会去改，这种才是恐怖的一群

自从过了精神科，很想去找心理治疗师谈谈
我相信或多或少大家都有这种需要

医学生精神问题严重
我不赞同，因为我觉得应该是
医学生精神问题非常严重

Lousy Admin

2008-11-18T17:23:00.002+08:00

i should be in serian now for the busy n hectic district hospital posting,
i reached serian this sunday, after unpacking,
found out that the hostel hav no electricity
after asking the sec guard and unimas staff there,
they said they have "bill tercicir" and will try to settle the next day (morning)
ok fair enough, since iz a shop house, and iz vr vr dark and damn hot
so no choice, have to drive back to kch again after unpacking

monday,
i drove back to serian again, early morning,
since we have briefing by posting coordinator and orientation to the hospital
after tat, found out that the electricity still didnt come back yet
so i cannot tahan alrdy, so i called to faculty administration office

they tell me they hav to tell dean
dean tell have to tell main campus at kota samarahan
kota said have to ask finance department to settle bill
after tat hav to wait sesco to go to the hostel

and yes,
iz tuesday alrdy, and the hostel is still black out
and i still hav to travel up n down everyday
and i cant study anything
and i cant do anything other than feeling extremely annoyed
with those slow n lousy malaysia-style admin ppl

stupid UNIMAS
cant u just settle the pathetic sesco bill earlier?
karnasai, pls compensate me petrol money!

Wish List

2008-11-07T17:23:00.002+08:00

Nikon 50mm F1.8

after reading a lot of reviews from D4o users
and after seeing a lot of photos from this lens
i confirm i wan to buy once i get my money next yr
s a birthday present or wad la, wadever

拼吧！

2008-10-22T23:38:00.004+08:00

其实只剩一个礼拜就考试了，
但是现在外面下着雨，所以想写一点东西
先把读不完的书放一边

最近跟很多老同学谈起各自的状况
真的有很多朋友在医学系，都是从中学开始的朋友，
一些在英国，一些在澳洲，一些在莫斯哥，一些在乌可兰,
一些不知道在哪里，还有一些就留在古晋慢慢蹲

在不同的地方读医，有各自的利与弊
所以也开始看开留在本地留医也不一定是一个坏事
因为学医他不象其他科系，它注重的是人与人的交流，
和如何融入你服务的社群里
不管在哪里，大家好好拼吧，
你们都是很优秀的

一直都觉得其实还好
直到今年被分配到一个自己本身很不喜欢的小组
心情每天都收到影响而很难专心
其实我也了解不是每个人都和的来
就算和的来的好朋友，也有一天会因为意见不合
人嘛。

其实我真的是很显这组一部分的人
我觉得医学生都是怪人
我不排除我也是其中之一

K550i

2008-10-18T17:48:00.004+08:00

New gadget! New down-graded gadget!
k750i officially dead, after 2 weeks suffering with the
primitive Nokia 8310, finally decided to get this SE K550i
not better than K750, but my intention is to buy a mid-range phone
then abuse it in 2 years time! and only consider the need of pda while working
i dun tink i need one now, i may need a Harisson's medical book than
a samsung omnia haha!

another white stuff after white ikea desl,
macbook, sonic gear, apple remote,and apple mighty mouse

ok ok la...a sony ericsson 2 MP cybershot phone,
but the camera really not so good, compared to k750i
had taken more than 10k of photos with my k750i,
some of the photos some more published in newspaper, really good.

my phone history, started with Nokia 8310, then K750,
now K550

cheers!
exam coming!

Keep Swimming, Swimming, Swimming...

2008-10-12T15:43:00.003+08:00

had gone back to swimming, although i m still fat n slow
and the stupid stampark entrance fee increase again,
this make this sport damn expensive,
but i tink this is the few sport wic i enjoy doing it,
not like the stupid jogging wic i hate to do it,
n since no one here to play futsal,
yeah, go swim like a fish (or frog) lo haha

swimming oso one of the best cardio-pulmonary workout
build up ur lung function and heart s well,
iz important for a guy like me who suffering allergic rhinitis
and with a strong family history of cardiovascular ds

even bought this goggles, quite expensive but worth
TABAKA View racing goggles, orange color
anyone wan to join me swimming?
pls tell me haha

A Week Break

2008-10-02T12:40:00.003+08:00

raya break for one week
nice weather today
its nice to be at home n relax

Ouch!

2008-09-13T21:04:00.003+08:00

shyang: "don't pull me!!!"
hen: "grr..dun naughty!!!!"

then i become datuk lee chong wei..
ok lame. good nite