Count down

Count down.

Today was the most hectic day for me. Many people were on leave and there were people who took MC at the last minute, leaving two of us to run the clinic. I am so fed up, but just couldn't express out.

Worked till KMN.

There is no major new year eve celebration here and tomorrow is a working day, but there will be some count down moment at the clock tower.

Happy New Year 2008 to all my friends and bloggers who faithfully keep visiting me here.

Chinatown

For those who happen to be in Chinatown, don't forget to pay this magnificent temple a visit.

Dark history in P'tan

21 June 1953 - 27 December 2007

Boxing day

I took a day off to venture further into the neighbourhood. I am truely impressed to see a place that is so orderly and organized. The are so many shopping centres one would 'walk till you drop'.

Moving around is so much easier with the train system. I noticed that, the train was super fast, even the escalator moved faster.

It is just nice to window shop, cause everything seems expensive after currency conversion. But then, if one works there, things are considered cheap comparatively.

May be I should give it a thought of crossing over to work in future.

Merry Christmas

My plan to go back home has been crashed, cause a heavily-pregnant colleague could not do her calls. So, I have to be on-call for the next two weeks.

I am here alone tonight to 'celebrate' Xmas.


I miss all friends and family back home and I would like to wish them a Merry Merry Wonderful Christmas.

Food and food

How nice life could be if only I don't need to think what I am going to have for dinner every night. I may have taken things for granted, for all these while, food was ready prepared when I came home. Sometimes I did grumble that the food was not nice or there was too little food for dinner.

Anyway, now I have to hunt for food every night. I wandered off every night to different corners of the town looking for the right kind of food. It was quite tiring and sometimes I felt so lazy to even think and I would just skip dinner.

BTW, here are some good food:

Ginger and Onion Chicken Rice, RM5.00.

There are so many chicken rice shops over here, but this one stands out, cause it has the most customers, RM 7.00 (including soup).

Finally discovered one big hawker centre here.

Kum Heung Chicken Rice, RM5.00.
BTW, here is a good guide to food in JB.

District

As I am still new with the computer system, my boss asked me to visit the district instead, since I am very slow in seeing the patients in the clinic. Without hesitation, I happily agreed to the deal since I hate doing routines.

The journey itself took near two hours as my driver did not want to speed. There are a lot of speed traps around. This was just nice as I loved sight-seeing.

Here, I was in the busiest street in town. There are many hotels but I did see many food stores around.

'Wan-Than-Mee-Without-Wan-Than' noodles I had, RM3.50 (Small).

Ipoh trip

I travelled to Ipoh yesterday for a one day course on a long and tiring trip. I managed to book a nearby hotel for a night. Costing RM99, the room beats many hotels that claimed to be 4 or 5 stars in term of comfortability.

What more interesting was, the stay came with a complementary free entry to the spa.

Curry Mee ka liu RM 5.60

After some deprivation of northern food, here was a nice curry mee I had.

Rainy season

Despite having the influenza vaccine recently, I am still not immuned to it. These two days I have been having a bad URTI with sorethroat. The weather over here is partly to blame. It has been raining everyday since the second day I was here. This is kind of depress as I can't go out to explore the city.

Food over here sucs too. So far, I have still not found a store that sell chap fan or economic rice. I haven't also found a hawker centre that sell variety of food. Most of the shops that I went to, sell only one or the most two types of food. Guess, shops over here favor specialty food.

Here are some of the food I had recently:

Wan Than Mee, RM4.20 (Medium), opposite Century Plaza.

Wan Than Mee over here taste a bit funny. There is no soya sauce which makes it look pale.

Seafood Koay Teow Th'ng, RM5.00 (Small).

Still, the price is above average as compared to Pg.

Connected

I still have not got an internet connection but luckily I can access the net anytime during work as each of us are provided with a computer with broadband connection. This is because all our consultations are done online and all the data are kept in the computer system, i.e. our daily consultation are 'paperless', minus the lab investigations as we're still required to fill up many forms (carbon copy some more).

My work station.

As I am new to this 'hi-tech' thing, I am still not get used to the system. Can you imagine, I took 15 minutes to finish seeing one patient (plus all the data entry) for a case that usually take me 5 minutes? I am quite dislike been a 'robot' as all our clinical notes are entered with many clicks. One step missed, we would not be able to proceed. That slows down everything if one is not familiar with it.

Curry mee.

Things and food over here are very expensive. For the last few days, I have been eating in the canteen. Somehow, it is not as convenient as what I used to have in Pg, where hawker centres are just across the street. The eateries are all far from the hospital and we don't have much choices over here. That's why I said, Pg is still the best.

Anyway, I discovered some nice Curry Mee over Taman Nong Chik, but the price was damned cut throat, at RM 6.00 (big bowl) !

First week

Day 1.

Finally got myself registered on Day 1 after a long journey.

An*asa.

Spent a night in this 4 star hotel that cost me RM 225, rather expensive but this was the only decent one within the vicinity.

Night scene in the city.

Quarter.

Journey continued and I finally reached my destination after much long and tiring drive. Luckily I got myself a room to stay in this rather run down HO quarter. By the way, I am only allowed to stay for one month. I got to look for a permanent place.

Goodbye PG

Ready to go.

Goodbye PG.

Last night

All packed.

This is the last night I am blogging. Tomorrow, I am going to embark on a very long journey down south. I have been packing for the last few days. Living on a nomadic life. So tiring of shifting house again. I still haven't looked for a place to stay. Guess, just reach there and see.

PC Fair

Computer fair is back again, this time with great discount. I was looking for some pendrives. Just for 3 months since the last fair, the price for a 1Gb Pendrive dropped tremendously, from RM 38 to RM 26. Just wonder how low it could go down further in the next fair.

Crowd puller.

This one stood out, they were the cheapest. Customers were lining up to pay.

Kingston 1 GB RM 26, Sony MS Pro Duo (Ciplak) RM 55.

Damed cheap. Luckily It worked well.

Cool.

This little interesting cooling pad with 4 USB hubs cost RM15. However, connection through these hubs are very slow.

Vaccine

Just got the new influenza vaccination for 2007 jab today. This was a different brand from last year's. This one supposed to cause less pain during injection and less febrile reaction.

Ascaris

Ascaris Lumbricoides

Close up view.

20 cm in length!

After reading what Jimbo blogged about Ascaris, here I would like to share a funny incident happened to me while I was a surgical HO in Seremban Hospital.

A young lady was admitted to the surgical ward with severe epigastric pain. Half way through the clerking, the patient vomited out a worm in front of me. It was so shocking, yet interesting, and I decided to keep it in the formalin.

I also remembered during my diploma years, I helped a lecturer in Parasitology in a project where I was assigned to counting the eggs in the faecal samples collected randomly from a population in Kampung Cherang Laut. Believe it or not, the result showed more than 90% of the population were infested with the Ascaris worm.

Interesting facts about Ascaris lumbricoides:
1. It is the largest intestinal nematode.
2. A gravid female produces 200,000 to 250,000 eggs daily.
3. The eggs are resistant to various disinfectants and can survive in the soil for many years.

The adult worm stays in the small intestine. It was believed that when the female population exceeds the male population, the female worms would migrate to other sites to find mates, causing various complications, though, worm migration may be stimulated by anesthetic agents or subtherapeutic anti-helmintic treatment or by use of certain anti-helmintic (e.g. pyrantel pamoate).

How to prevent infection?
1. Eat cooked food and avoid taking green vegetables or salads, especially in places where human faeces are used as fertilizer and where sanitary conditions are poor.
2. Deworm every 6 months with anti-helmintic.

My memories

Ah, the good old bed I used to sleep.

Feel like an old duck retiring. 3 and a half years have passed, this was the longest period I served in a place. There were many fond memories to cherish. It was usually the on-call time that interesting events happened. I'd never stayed still, I used to move, find and do; time would passed by soon, before I knew, it was usually past 2 midnight before I could peacefully retired to rest.

Time to give space and move.

Ta Siu Yan.

Work meant work to me, I was a serious obsessive-compulsive worker. There were many ups and downs. In my darkest moment, after so much hard work, I was rewarded with a pair of slippers. I was so angry that I wanted to use it to 'ta siu yan', to get rid of all the bad luck. Eventually, I stepped and stepped on it numerous times.

The heat has turned cold now, fire is put off. I am leaving the slippers there for other emotionally tortured souls to step use, when they are cooling themselves in the bathroom.

Sales Rep

Missing Georgetown.

Being a physician, especially if one is new, has certain advantages, because medical sales rep love us a lot. Being new and enthusiastic, many reps want to meet us to promote their products. New and young physicians are seen as targets because they are the ones who are adventurous and would try anything new and trendy. The market is so competitive especially so if there are many drug choices to choose from. The drug companies also invest heavily on good looking and pretty reps to sweet talk us. We'd be invited for product launch, sponsored for courses, showered with gifts (and pens) as well as treated for a lunch. It was like an overnight fame.

They are now gone, as I ceased to become 'physician'.

Well, congratulation to all our new physicians who had passed the MRCP in KL recently.

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Medical sale reps do have special role in the health care. They are around to constantly update us on their products as well new evidence found from clinical trials or studies. However, we need to be discreet when come to prescribing drugs. We should consider various factors, like cost effectiveness, clinical risks, compliance and side effect profile, before we prescribe to patients. We should use our professional judgment and not subjecting ourself to personal gain.

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I was particularly pissed off with one sale rep who sells anti-obesity drug. I was asked to sign a form to have 2 sample boxes for patients. It has been 9 months and I still don't received my sample despite two earlier reminders. When I called her up yesterday, she had the gut to tell me that she didn't get to see me in the clinic, when the fact that she visited the clinic less often after that. I had asked her to cancel the form and I am contemplating to lodge a complaint with her manager.

Word of cautions: Never put down your signature unless you receive those sample.

Coal Tar

Tar-coals?

Being always a Cinapek, I don't really fancy Western food, but today I invited Ms Teh for lunch. Being an 'americanized' person she is, all she could only think of, was American food. So, she recommended me Chicken Tar-coals, what a name?

Actually, it was CHICKEN CLUB TACOS: Three flour tortillas (one already in the mouth) filled with mesquite chicken, chopped applewood smoked bacon, chipotle-ranch dressing, diced tomatoes, mixed cheeses and lettuce. Served with rice and black beans; RM 29.95.

I'm real sua pa (jungle) kau (monkey).

TEN

Generalized, dusky, erythematous rashes with extensive bullae and skin detachment.

This patient presented with acute onset of fever associated with oral mucosa and genital erosions. She developed the above rashes after two days. She was on nifedipine, enalapril, gliclazide, metformin and lovastation for more than a year. Two weeks prior to the onset, she was started on allopurinol for hyperuricaemia.

Many doctors are still so ignorant about the fact that, there is no indication to start allopurinol for asymptomatic hyperuricaemia. Allopurinol is one of the most notorious drugs that can cause Steven Johnson Syndrome and Toxic Epidermal Necrolysis.

In the first place, there should not be a routine to do blood uric acid level, unless clinically indicated. It is sad that many GPs as well as private laboratories performing routine blood tests fail to understand such principle.

Last

Last day and last call.

Every beginning has an ending. Life's like migratory bird, never get rooted in a place. Guess, by change, only we can progress. Yet, it's another flight, where new beginning awaits discovery.

I am now trying to figure out, how to finish my 38-day leaves this year.

Charity

I am still counting, 5 more days to go.

What a shocking news! Our 690 million new hospital is being built to cater for 30% foreigners and most of them don't pay their bills.

Sooner, we should rename all our hospitals with a prefix 'charitable' hospitals.

Even right now, we are having some foreigners in our ward. One is a Myanmarese with dengue shock syndrome. He was intubated in the ICU for few days. Though he recovered from the initial episode, right now he is still fighting for nosocomial pneumonia.

Another one is a Bangladeshi admitted for typhoid fever and liver abscess. This Bangla, who doesn't understand a single word of BM, is so uncooperative today. He refused branula for IV antibiotics and even refused to have his blood taken.

Come to think of it, he should be damned lucky. Currently, he is being nursed in a single room, equipped with ceiling fan, air-conditioned and attached bathroom while our poor locals are being cramped into "refugees camp" outside.

He should be damned grateful, because, at the end of the day, his stay and treatment here are FOC, taking advantage of our weakness. According to our MOH's policy for communicable diseases, all patients with notifiable diseases are to be given treatment FOC irregardless of their nationalities.

Otherwise, these foreigner will never get enough to pay for the medical bills, even if they work ten years and eating grass.

I think our government has only two choices, perhaps consider collecting back the unpaid money from their countries' representatives, or start promoting our 'Health Tourism with Free Medical Treatment" world wide.

Santa's coming

Here are some of the pictures I snapped recently showing early Xmas mood.

Hundred Santas over Hot Market.

Found this little Santa on the roof of the cupboard in one of the Paediatric ward.