"C" is for Cookie that's good enough for me,
"C" is for cookie that's good enough for me,
"C" is for cookie that's good enough for me,
Oh! cookie, cookie, cookie starts with "C"!

YES, I'M A COOKIE CONNOISSEUR!
Posted by nuni on February 4, 2010

Hanging out and hanging on

Life in medical, especially when I am based in ED is driving me nuts. It is as if my life is hanging on a flimsy thin thread. I needed to go out with my friends but at the same time, I really need my sleep too. It is no longer what people call ‘beauty sleep’. To me, lately, it has become more like ’sanity sleep’.

Tonight, I finally went out with my friends for dinner at BubbaGump Shrimp Co. at The Curve. Had a great time with Apam, Ah Hong, Tada and Juju. In return, I have to cut down my hours of sleep tonight to <5 hours… And I am on call tomorrow (which means no more sleep for another 36 hours). Damn, work IS stressful.

Just as I reached home, I heard someone mentioning the name ‘Forrest Gump’. Turned out Ba’ah and Kona was watching Forrest Gump on Astro. What a coincidence. :lol:

Ok, need sleep now. Nite, people! :D

N.B.: Really wonders if I can last over the weekend…

Posted by nuni on February 1, 2010

Half dead

Had a terrible call yesterday.

Actually it wouldn’t have been too bad if we finished our ward round much earlier than we did. Can you imagine finishing morning ward round at 1.30pm???

So I had to settle the discharges as soon as possible all by myself because I was left alone in the ward (my colleagues had to start their call in other wards). By the time I got to the blood works, new admissions started pouring in.

BG, who happened to have an appointment near the hospital that evening, dropped by to send me dinner… which I only managed to eat at 3am (that was only possible because I refused to do anything else unless I get to eat first).

When I finally thought I had settled everything, my specialist came to do round at 4am!!! Yes, at four o’clock in the MORNING!!! And it wasn’t a quick one… she was actually doing a teaching round.

At 5.30am, I couldn’t stand it anymore and simply doze off in front of the computer while ordering the morning blood works. Luckily managed to wake up by 6am to take all the bloods.

All the while, I was having a terrible headache and at one point of time, I was seeing doubles. Needless to say, I had to poke the patient twice to get the blood… and on my second attempt, he jerked his hand while I was withdrawing the blood, causing blood to spurt all over the place. I lost my temper there and then.

Luckily the day was not too bad and I didn’t drive to work the other day. BG went to pick me up at the hospital. Since he was stuck in the traffic jam, I took the time to sleep in the on call room… And continued sleeping in the car. Now I need more sleep. I can hardly open my eyes.

Good night everyone. :)

Posted by nuni on January 28, 2010

Panda me!

I have not been able to access the internet for the past few days because

1. Sunday -  The modem broke down

2. Monday - Still no modem replacement

3. Tuesday - I was on call

4. Wednesday - Being post call (as usual, I did not manage to get any sleep in the hospital), I collapsed on the bed as soon as I reached home, wasting the dinner Mama brought home for me (she did try to wake me up but to no avail :lol: )

On Tuesday, my MO, Dr P, who is also a good friend of mine had diarrhoea in the morning and insisted I start a drip for him. :lol: It was unnerving, having to set an intravenous line for a friend who is well known for his procedural capabilities and in a few months would become a specialist. I managed to set the line on the first attempt anyway (yay! :D ) and it was so funny to see him pushing the drip stand all around the ward during the morning round. :lol:

By the way, people have been calling me panda eyes (to which I usually would either say “Aren’t pandas cute?” or “No, I have raccoon eyes”) because I’ve had dark circles since I was in school. I guess it is genetic because even Kona has had dark circles since she was in kindergarten.

Ba’ah and Mama just returned from Chengdu, China the night I was on call (for the drama on their flight back to Malaysia - they had to do an emergency landing in Bangkok - read HERE). While in Chengdu, they managed to give the pandas a visit.

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Ba’ah thoughtfully bought a panda cap for me! :D

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It is actually meant as snow cap for kids. :lol:

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Aren’t pandas cute and adorable? :D

For Mama’s entry on her visit to the panda base near Chengdu, read HERE.

Posted by nuni on January 23, 2010

Deaths

First of all, I would like to convey my condolences especially to my aunt, Cik Maz (and also to her family) who lost her father, Dr Anuar Nor Arai on 20/1/2010 (read HERE). I attended the prayer rites on the evening of his death… And it was my first time ever attending such a function. I was not able to attend the funeral as I was on call on that day.

I had not lost anyone dear to me yet. The only time it came close to that was in 1995 when Mok, my great grandmother passed away on the day before the day I was to be announced as the best student in my school. I was too upset on that day to feel much sadness with the loss. Mama was away studying in the UK and Ba’ah had to go back to Kelantan for the funeral. Only my uncle (Cik Maz’s husband) could make it to the function and take pictures of me collecting the awards (as well as Boka and Yi who also won several prizes themselves). However, reality sank in after all the celebration in school and I did finally cry that night. I did love Mok and she was gone.

It was a sad occasion that day at Cik Maz’s parents’ house. It felt really weird as I’ve only been there on happy occasions - e.g. wedding receptions, birthday parties, raya open houses, etc. I managed to not cry but a few drops of tears did escape the moment I saw his face. He didn’t look any different from when he was alive.

I was well aware that he was a well known person in the entertainment field (after all, I did see a number of celebrities at Cik Maz’s wedding reception) but I never knew what he did exactly. Some time last year, Cik Maz invited me to watch her father’s latest theatre, Ronggeng Rokiah with her and her students but I was unable to join them due to work commitments. I also didn’t know Tok Selampit was written by him but that title is very familiar to me (though I can’t recall if I’ve actually read it).

Nevertheless, I would always remember him as the joyful uncle who loved to tease Kona when she was small.

May he rest in peace. Al-fatihah…

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Basically, this past week had been a week with many deaths for me. There was a case of a 19 year old boy who went asystole (i.e. dead) as soon as he reached the ward. We did CPR like crazy and managed to save him… for only another 4 hours. The problem was… He already had a heart valve replacement done a few years back but he defaulted his warfarin therapy. When he came in to our hospital, there was a huge blood clot sitting in his heart, causing its failure.

It was also the week when I survived 36 hours of non stop work and 4 CPRs with only 10 minutes of sleep (managed to take a short nap during lunch hour). I wonder how I survived that day… But I did. Needless to say, I was caught sleeping while standing up twice. :lol:

That day my ward had 4 patients on ventilators (the ICU proper has 16 beds; hence the joke - by our ward members and ICU staff - that our ward had turned into a mini ICU). When we intubated the 4th patient, ICU people warned us, “That is our last ventilator (apart from those being used in the ICU). Please don’t ask for another one.” :lol:

2 cases caught us by surprise.

Case 1

A Malay gentleman in his mid 40s who only seeked medical attention after having multiple neck swellings for 1-2 months. Biopsy was done and sent urgently to 2 sources - a private lab and the usual government lab (our lab doesn’t read biopsy samples and would send the samples to another government hospital lab). You will get the result faster with a private lab but it is not always very reliable. The government lab is more reliable but it might take some time before you get your result.

Anyway, the private lab result came back as lymphoma and the patient was urgently admitted to my ward. He was very well on the day of admission (he had no complaints whatsoever). But within the next 48 hours he deteriorated rapidly we could not catch up with the disease progression. His kidneys failed and he was bleeding profusely due to his deranged blood components which failed to normalise despite continuous transfusions with blood products.

2 hours after his death, we received report that he actually had myeloid sarcoma.

He has 3 children, the youngest being 4 years old.

Case 2

A Chinese gentleman in his mid 60s who was only discharged from our ward last week for congestive heart failure. We drained about 21 litres of fluid from him during previous admission and he actually came back within 5 days because of shortness of breath. On the third day of admission, he was still comfortably talking to us (no more shortness of breath) but during lunch hour (about 3 hours later), one of the nurses noticed that he was sitting quietly on his chair, not breathing. She immediately put him on cardiac monitor and what came out was a straight line. We commenced CPR immediately and managed to bring him back. However, he was not doing well as we had to support his blood pressure and ventilate him. He passed away the following evening.

It made me wonder about our CPR. If he had been at home at that time, he would probably had died in peace. I didn’t think we saved him. I think we simply delayed his death by 24 hours and hence prolonging his suffering. On the other hamd, it was probably good that we managed to delay it (even if it was only for 24 hours) because at least his family would be (psychologically) more prepared for his departure.

He only has one daughter who is now 12 years old.

That reminds me of another patient I recently saw in the ward. He was admitted for symptomatic anemia (his only complaint was lethargy and we discovered that his haemoglobin level was 1/3 of a normal person). He had no other illnesses. After we transfused him blood products, he was very well in the ward. Being an educated retired policeman, he was a very polished gentleman who does everything in a very prim and proper way; hence the reason why I remember him so well. He was planned for colonoscope and OGDS the week following his discharge. To make things more interesting, he forgot to take the laxative home with him so I called the family a few days prior to the scope appointment day.  That was how I discovered that he had passed away just the night before.

Enough with deaths. Ba’ah and Mama are now in China for their first holiday in 2010. This picture is so cute I could not resist publishing it here. :lol:

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Posted by nuni on January 15, 2010

Human vampire

Yesterday, I bumped into my favourite psychiatric patient, who my MO usually referred to as Uncle Bon Jovi (because he is a musician and he looks like a rocker guitarist; though he doesn’t play guitar) at the hospital lobby.

He looked really ruggedly smart with his long hair and sunglasses, wearing a pair of grey suit and accompanied by his driver… So much different from the sick old man wandering around in the ward wearing gloves and sunglasses in my ward.

He greeted me… And we had a short conversation.

Me: What are you doing here, uncle?

Him: Oh, I came to say goodbye and thank everyone for taking care of me when I was ill. You’ve been a very good doctor to me.

Me: Oh, thanks…

Him: I hope you stay human forever. You will, won’t you? You have a good heart.

Me: … (really speechless. Did he remember that he called me a vampire? :lol: )

Him: Ok, doctor. I have to go now. Hope to see you again. Goodbye.

Me: Bye…

He gave some imported chocolates and biscuits to us. Yummy! :D

He is definitely one of the patients that I will NEVER forget. :D

By the way, yesterday I was post call… Didn’t even manage to get a few minutes of sleep during the call. Managed to drive back home after work… reached home at 7pm.

I called up Mama while driving back to cook me some rice congee because I was starving (had so many things to do I only managed to get some Milo for breakfast and lunch). However, as soon as I reached home, I simply went comatose on the living room couch. :lol:

According to Boka (who came home from Penang last night), I did sit up and greet him when he arrived and went back to sleep. He also said that Mama and him tried to wake me up but to no avail. :lol:

I woke up at 6.30am (the time I am supposed to leave home for work) and was late for work today. :lol:

Had an incident with the pathology lab. It was a small issue (which was not my fault to start with), exaggerated by the people from the lab to the extent that their head of department actually called me up to give me a lecture about politeness and teamwork. I could not recall in any way I have been rude to anyone from the pathology department no matter how rude they were or how upset I was with them. Ever since I started work, I’ve only been rude and lost my temper only ONCE… to a VERY RUDE staff nurse.

I just hope the issue ended with that phone call to me. I hope it would not involve my superiors.

Posted by nuni on January 12, 2010

After 20 years…

Ba’ah was looking through some pictures from his camera and came across this one taken Christmas eve 2009 when I invited friends over for dinner.

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He said, “Hey, I think there’s a picture of Nuni with the same expression when she was small.”

Mama agreed, “I think it’s one of the pictures of her in the blue dress.”

Little did I know that Ba’ah really went through the old pictures and found this… :lol:

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Mama blogged about it and since it’s already published in her blog, I think I should put it up in mine too. :lol:

For Mama’s entry, read HERE.

Posted by nuni on January 11, 2010

Princess’ new boyfriend

Princess may be hitam legam but she sure is ‘hot stuff’. :lol: You can only imagine how noisy our house in Shah Alam was with all the male cats wanting to mate with her.

Unfortunately, she has no interest in sexual activities and would become agressive towards those who were too insisting. Hey, if she can fight snakes (read HERE and HERE) and hunt for birds, what chances do these sissy domesticated males have? :lol:

We neutered her long ago together will her all-black siblings and mother (and grandmother too?). However, she was friendly to a few cats who frequently visit our house for free food as if it was the best hang out place in the neighbourhood and she befriended the squirrel who lives on our mango tree too! :D

Anyway, she now has a new boyfriend at our new place in Setia Alam.

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Yes, that black shapeless thing inside the small ‘tent’ is actually my beloved cat, Princess (she’s actually Boka’s cat; 3rd generation :lol: ).

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By the way, it seems that Princess really loves her new ‘home’. :D

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Posted by nuni on January 9, 2010

No plastic bag day at Tesco Setia Alam

Today Tesco Setia Alam started their campaign to encourage shoppers to bring their own bags. From today onwards, they are going to do it every Saturday.

I am all for the campaign as I myself would always do my best to reduce the use of plastic bags. People at the hospital (the cafeteria, kopitiam and mini shop) know me well enough not to offer me any plastic bags whenever I buy something from them unless I buy really a lot of things (e.g. 4 packets of buns and 2 packets of Milo for my lunch and dinner, which I still refused the bag).

I remember seeing one person buying ONE packet of sweets and she actually ASKED for a plastic bag when the cashier didn’t give her one. I mean… ONE PACKET OF SWEETS and you need a plastic bag???

And I still remember there was one time I went to a 7-11 near my house. At the counter was a big sign that read something along the line of “We will not give out plastic bags unless you request for one.” I obviously didn’t ask for one (hey, I just bought 1 bottle of Coke and a bar of chocolate! I can handle 5 packets of sweets, 2 bars of chocolate and 2 packets of drinks without a bag, I can handle those too!) but the cashier insisted to pack them in a bag even though I kept telling him NO.

Anyway, back to the campaign by Tesco Setia Alam…

Why only Saturdays? Why not EVERYDAY?

And why do they still give out free plastic bags (it did appear as if they gave out the plastic bags for free but I don’t know for sure because I didn’t need them)  to those who did not bring their own bags? If this goes on, the campaign will never succeed.

In a way, I miss the shopping experience in Europe when I had to walk for 30 minutes carrying 2L of fresh milk (usually lasted for only maximum of 3 days :lol: ), 3L of orange juice (this one can last slightly longer, perhaps 5 days), 2 boxes of cereals, packets of frozen food, yoghurt and not to forget, tons of Walker’s crisps, at least once a week. Life was good back then. :D

Posted by nuni on January 6, 2010

Emergency leave

Today, I had to take emergency leave for the first time ever.

I was well in the morning while getting ready to go to work but the moment I unlocked the door, I felt nauseous. Before I could make it to the front gate, I vomited once.

Thinking that the episode would be over soon, I drove to work. Initially, I thought it WAS over but I had to make an emergency stop at the R&R and dashed to the toilet.

Stayed there for about 10 minutes, just in case I get nauseous again. I did not. Hence I continued my journey to work.

However, as soon as I reached the hospital, the whole thing started again. Knowing I wouldn’t be able to function as usual, I made the necessary calls to apply for an emergency leave.

Me: Jen, I’m taking EL today. I’m having hyperem (short for hyperemesis which means excessive vomiting)

Jen: You’re not pregnant, are you?

Me: Of course not! Just hyperem without the gravidarum. :lol:

* Hyperemesis gravidarum is the medical term for morning sickness in pregnant ladies.

Then I returned home and slept the entire morning. :lol:

On my way home, saw a terrible accident between a car and a motorcycle on the highway. Since earlier on, I passed by that area at 6.50am and the road was still clear and by the time I saw the scene at 7.30am, there were no victims to be seen (and I didn’t see any ambulance even though I parked near the A&E while at the hospital), I can just assume that the accident happened between 6.50am and 7.10am.

Even if the driver and rider survived the crash, they would have suffered massive injury. Both vehicles were totally smashed against the divider.

By the way, my nausea/ vomiting problem somewhat resolved after the long ‘nap’ that I took this morning. Perhaps the tramadol that I took yesterday morning had not been completely cleared from my system? Funny I didn’t have the symptoms right after taking that medication (like others do).

Posted by nuni on January 5, 2010

Drowsy at work

2 days ago, I started to develop left ear pain and subsequently diagnosed with external ear furunculosis (boil). Since the ear canal does not have any subcutaneous tissue, any inflammation there will cause great pain.

I was advised to start on a course of antibiotic and to take some pain relief medication. Since I have quite a high tolerance to pain, and I always try my best not to take any antibiotic unless it is really truly necessary for healing (e.g. if I am already in sepsis), I decided not to take any medication at all.

However, this morning, I woke up at 3.30am with SEVERE pain in my left ear which actually radiated to my right ear and causing me to have a terrible headache. It was so bad I couldn’t even move my head, much less touch my ear.

Going through our medication box, I could not find any paracetamol but instead found some mefenamic acid (a.k.a ponstan) and tramadol. Figuring that ponstan would not be enough to relieve the pain, I opted for the latter, forgetting its common side effect… drowsiness.

I felt like shit at work this morning. Our ward pharmacist was very quick to comment, “You look really exhausted. Are you post call?”

Half laughing, I told her, “No. I took tramadol at 4am this morning.”

She laughed.

Around noon, I was still extremely sleepy so I asked the pharmacist again, “How long does the effect of tramadol last?”

She gave me an apologetic smile and said, “Quite long.”

Hahahahahahahaha. The effect did not wear off until about 4pm. I totally had no idea that the effect could last that long. :lol:

Even my specialist noticed that and said, “Nuraini, you look very sleepy today…”

I quickly replied, “Sorry boss, I stupidly took tramadol this morning.”

He laughed too. :lol:

I would NEVER ever again take tramadol in the morning no matter how desperate I may be. Lesson learned.