Tapping the vein, looking for a juicy one, my head spinning from the turmoil of the previous night, I still smile as my phone beeps. I've got you to go home to, see. Then I think back on the previous night.  Blood taking is very mechanical, small talk required, but it gives room for the tired mind to wander.

The patient was desaturating, 'Tukar high flow mask' I say after listening for ronchi or prolonged expiration. The nurses are well versed, they've already set up the crash cart and he's on the cardiac monitor. 'Boss, I'd like to inform you...' I say over the phone not knwing the patient's going into asystole. I rush back and climb onto the bed to do the chest compressions which many people argue is life saving, but in most cases I've seen it's more of a life prolongation. GCS dropping,intubation required, the MO has arrived. Fluid already being run, patient maxed out on triple ionotropes we get a bradycardic pulse. Arms heavy from fatigue we scramble off the bed and squint at the monitor. Is that a rhythm? Do we need atropine? Then heart rate becomes zero again and we do chest compressions again, patient's heart is stubbornly in asystole. 30 minutes, 40 minutes, the surrounding patients are hushed, suffering qualms of fear at the impending death of a fellow ward-mate.

I don't want my loved ones to spend their last few minutes like that. I've seen enough in the last few months. I feel the helplessness of family and slight glint of (?misplaced) hope as we ask them to stay outside while we resuscitate. Up to today I still tear each time it happens.

As the rib cage becomes more yielding under our persistent compressions, and the pupils become fixed dilated from a previous sluggish response over 2 days, we know our chnaces are slim for the patient to wake up and smile at his family. We know. We tell the family. DIL issued we say. Dia sudah tak ader  we say. Tindakbalas terhadap rawatan sangat kurang, jangkitan kumannya kuat sangat. Each time I say it something twists inside of me. Could we have done more? It's a life. It's a person someone else loves.

I don't want my loved ones to go with an NAR, nor do I want them to have tubes stuck down their throats or central lines flushed with drugs that give us a false impression of haemodynamic stability. I dont want their last active thought to be that of a tired medical worker shining a torch into their pupils or palpating their carotids. I dont want people to stick grey branulas into their groin area as they try for femoral lines when the BP is already spiralling downwards. I dont want them to suffer. But I will be damned if I signed an NAR and didnt try for that slight possibility that I might spend another 2 minutes with someone I care for.

Essentially to me, that's what CPR is. a temporary prolongation of live, and thne if God willing and the patient has what it takes, he/she survives and we medical workers have one less heartache. Don't be fooled. We feel for each person we care for,  whether he's an innocent or crimina, whether he's rich or old, or whether we like him/her or not.

So yes, I am against NAR, unless the prognosis is really horrendously bad. Until then, keep resuscitating. I prefer my people alive.

Peanut Butter vs. Marmite – A Matter of Choice

http://www.notjustbeans.com/images/peanut-butter-spoon.jpg

You’re like peanut butter.

The smooth richness of your talk, the heavenly aroma of something nice and the crunchy bite of your wit and humour, all made complete by the outer packaging that’s just too alluring to the eyes.

Just one bite assures a craving for more.

But when you are there, the throat swells up, words won’t come out right, the heart starts pounding and chest starts heaving as I gasp to breathe. Once you’re in the system, my BP starts going nuts, I break out in cold sweat and my heart palpitates, rhythm gone awry and I truly believe that I’m about to die.

You’re like peanut butter.

You set off an anaphylactic reaction in me.

You’re like peanut butter, the ultimate temptation, the one who gives me a glimpse of heaven and hell all at once.

You’re like peanut butter, perfection on the supermarket shelf. You’re the one I walked right past by because you’re no good for me.

Now marmite is all I need to get me through the day. An acquired taste, I know, a humble one too. Without your pomp and marketing, but see, peanut butter’s the unattainable ideal and marmite’s the real flavour of life.

And I choose marmite.

Bigger than HIV?

I noticed it when I was 2 customers away from the check out counter. There was a dark discolouration at the corner of the cashier's mouth and the lady in front of me was rattling on and on about 'Gerpes' and her male companion made a crude remark that I unfortunately understood. Idiot.


When I got to the cashier, I smiled and told her that I'd be needing 2 plastic bags, please and I realised that in all probability the girl had an exacerbation of HSV. I considered the alternative of a malignised mole (meaning melanoma) but it was more of an ulcer, the location was typical for the HSV infection and given the unpredictable weather and dark rings under her eyes, the girl was probably immunosuppressed - the main reason that HSV flares up again from the latent form. Too medical-ish? :)


My point is, the couple before me should have known better than to throw words like that around, because like all other STDs, it attracts social stigma. If I with my broken Russian could have understood what they had meant, I'm sure the young girl did as well. Will someone say 'idiot' for me? Please?


The crappy thing about herpes is this: once you get it, there's no guarantee that it won't flare up again even with proper medication. It's a ghost that'll follow you around all life long. I'm qouting a lecturer here - sort of!


Herpes is more than an STD. Did you know that the chicken pox virus is a member of the Herpes family too? Yep. Chicken pox and shingles are related to HSVs too. 


EBV infections which look like the common flu/sore throat is also a Herpes virus, causing infectious mononucleosis and nasal carcinoma in susceptible populations.


Kaposi's sarcoma which look a lot like tumours of blood vessels is usually associated with AIDS, but in fact occurs in systemic dysbiosis and  other immunosuppressed states as well.


There is CMV which also looks like the common flu, the highest intrauterine infection to date and ones of the TORCH-ES infections the Ob-Gyns keep harping about.


Then there are the Herpes virus 6 and 7 which are still being studied. Type 6 is sort of connected with diaper rash. Really.


All in all, the 8 Herpes viruses are nothing to snigger about. I read in passing some time ago that in a decade plus Herpes viruses will become a bigger threat than AIDS so it's time people realised that going around cracking 'Gerpes' jokes at the expense of another person's self esteem doesn't make you chaste, it makes you an airhead. 


Sorry bout the vent, think of it as a part of the information parcel ;)

Not My Typical Monday

“There’s a daily withdrawal limit, so that means we get to pay only on Friday,” he told his

girlfriend.

My mouth stuffed full of fries, I could just nod. We had just booked our flights home.

So, wads of notes crammed into my jeans, we had pizza together. That was at 1400 hours.

Got home, soaked my laundry, defrosted the shrimp, looked up the recipe for seafood pasta,

opened numerous webpages and began my earth-shaking (not! ) task of leaving comments on blogger and replying a thread on FB that keeps us together still.

            Then my phone rang. It was my ex-roomie, E. “Loshi, do you have antacids?” Her voice was strained.

            Me being me, I yelled down the phone , “E! When’d you get back?!”  It took me three whole minutes to realise that something was wrong. I’m like that at times.

            Grabbing my antacids and other meds I keep around for gastritis I ran up the 2 floors to her room.

            The first thing I saw was her red round butt. Not E’s butt. P’s butt. She looked like she was doing some weird yoga pose, but in fact she was doubled over in pain in the middle of the floor.

            It took 30 minutes, a cold compress to her abdomen  and another two rounds of retching and puking, plus some exchanged worried glances between E, Y (the third roommate..) and I before I ran down to the djurni mama’s post to ask her to get an ambulance, leaving the other two in charge of the Emotional Department. That was 1656. I know that because I got a call right then from my ex which I not unhappily cancelled.

            “Padajdite ni monoshka,” the mamachka told me and I went to sit down at the sofa in the lobby.        

            I waited. And waited. And waited some more. Each passing minute had me convinced that the gastritis had led to a peptic ulcer, which in turn had perforated, caused freaking sepsis and formed a bloody abcess in her brain, on a background of pain shock, of course. The paramedics here are called ‘skora pamoch’ which literally translates as ‘quick help’. The freakin’ irony.

            It was worse because I had to smile at people I knew who walked past and tell them that I was waiting for a friend. A little white lie to prevent mass hysteria. Sort of.

            It took them 40 minutes and I had exhausted the limits of my colourful vocabulary in my mind. The paramedics came in then, bloody laughing and I stood up and to my utmost surprise, I smiled!

            Yeah well, she got poked in the stomach, asked a couple of routine questions and after a hushed conversation between those two tall men, got administered platyphylline.

            The three of us hovered in the background, squishing the occasional baby roach or two.

            Using what little Russian linguistic capabilities we had harnessed over these years, we communicated with those two giants and they whisked P and Y away in the ambulance to the hospital, leaving E and I with puke-pail, used ampoules and the task of getting all of P’s documents and personal items for an overnight stay at the hospital.

            Oh, and I put the shrimp back into the freezer… :)

            Approximately 1800 hours: E and I are sardined in the marshutka (sort of a shuttle van?) to the hospital, stuck between beautiful blonde with fake eyelashes and smelly old drunk.

            1835: We arrive at the old building and after even more waiting, bloodtaking and a zillion stupid jokes that we seem to spout at moments like these, P got the greenlight for the slumber party at the hospital ward. Woo-hooo!

            Then we get up to the ward and the medsistra informs us that P would be needing her own plate and mug if she planned on getting fed while hospitalized. Now how the hell had E and I overlooked a plate  and mug while packing for an emergency hospitalisation? I mean, seriously, man, what the heck were we thinking??

            After hugging P, we three musketeers walked down to the groundfloor and went to a store nearby to get the mug and plate and some food for the poor woman since it was now past nine p.m., which meant dinner at the hospital was over (thankfully? Haha..)

We also grabbed some M&M’s for sustenance ;)

            The walk back was a shocker. The stars were out, so many and so bright that my earlier peevishness dissolved like the M&M’s in my mouth. It was fabulous.

Then the wind started blowing. Talk about the calm before a storm.

            The wind was just chilly initially, teasing, then it got stronger and by the time we exited the pharmacist (we have to buy our own meds here… which I kinda like. Funny, aint it?) we had a minityphoon roaring around us.

            Pushing against it and giggling uncontrollably we walked down that last dark lane, expecting a  mental gold-toothed man, frothing at the mouth and wielding a huge chainsaw behind every tree, we got back to P finally.

            We passed her everything under the hawk gaze of the nurse and took ourselves home.

            2200 hours or something like that: We completely spooked ourselves out when we were walking out to the marshutka stop because the cats were yowling and dogs werenbarking at the raging wind. Three idiots, the Malaysian version :P

            2245: I turned the key to my unit to find that I had laundry to wash. My nightmare. I walk into my room and look myself in the mirror. My hair was a mess. My mum’s worst nightmare (my hair’s lack of regard for conformity is notorious at home).

            2358: Happy with my hot shower, I began typing this

            0031 hours: With a steaming mug of Milo at hand and my hair half dried, the minityphoon

is a scale 1 typhoon now. I hope the trees don’t get uprooted and that the stray animals and homeless have found safe shelter somewhere. I realise that the medical service in this country is slow because they lack the manpower and funds - the image of the overworked resident at the priomnaye adjeleniye (reception) is in my mind’s eye right now. I hope I wake up in time for lectures tomorrow, but I can’t sleep yet. I need my hair to dry first. One of the woes of the fairer sex :)… and I hope P’s ok.

*it is not 6 am plus... that's Malaysian time :). I must be growing old coz it isn't even 1 am and my eyes are so heavy already. Terrible. Maybe I should consider investing in a hairdryer?

Helping the Heart-Attackee

It’s February, and that means it’s heart awareness month. The leading cause of death worldwide is heart disease and related conditions, but you probably already knew that, yeah? ;)

I thought I’d share some info on heart attack, the most notably famous heart disease and also due to an e-mail I received (will come to that later…)

I’ve faithfully copied excerpts from About.com and familydoctor.org and pasted them here because they limit the medical jargon. Read it, ok?

I'm having a heart attack? (familydoctor.org)

The pain of a heart attack can feel like bad heartburn. You may also be having a heart attack if you:

• Feel a pressure or crushing pain in your chest, sometimes with sweating, dizziness, nausea or vomiting
• Feel pain that extends from your chest into the jaw, left arm or left shoulder
• Feel tightness in your chest
• Have shortness of breath for more than a couple of seconds
• Feel weak, lightheaded or faint
• Have sudden overwhelming fatigue

Don't ignore the pain or discomfort. If you think you are having heart problems or a heart attack, get help immediately. The sooner you get treatment, the greater the chance that the doctors can prevent further damage to the heart muscle.

What should I do if I think I am having a heart attack?

Right away, call for an ambulance to take you to the hospital. Don’t try to drive yourself. While you wait for the ambulance to come, chew one regular tablet of aspirin. Don't take the aspirin if you're allergic to aspirin.

If you can, go to a hospital with advanced care facilities for people with heart attacks. In these medical centers, the latest heart attack technology is available 24 hours a day. How well you survive a heart attack depends on how quickly you get treatment, how much damage there is to the heart, and where that damage is

What should I do if my family member/ friend is having a heart attack?(About.com – just slightly edited :D It was on how to help your spouse…)

1.       Have him stop all physical activity and sit and rest if he suddenly starts experiencing severe pain in their chest.

2.       Call 911 or call out for help if you are not near a telephone.

* In Malaysia, it’s 991 and not 911. Please try to remember, folks! It varies from country to country, I think.

3.       Push fast on his chest.

4.       If you can, give two rescue breaths after every 30 chest compressions.

5.       You don't have to stop to check for improvement.

6.       Don't stop until help arrives. This is because blood circulation increases with each chest compression. It is important to keep the blood flowing.

Tips:

1.       Don't advise him to start coughing. That advice that has been circulating around the Internet can not be verified by medical literature. The American Heart Association does not endorse cough CPR.

2.       Aspirin is known to prevent blood platelets from sticking together and can prevent a clot from getting bigger. The next time you have an appointment with your doctor, ask about the pros and cons of either of you chewing and swallowing one 325 mg. aspirin in an emergency situation.

* The cough-can-save- your- life-during-a-heart-attack legend is not true. Stop circulating that e-mail, please. (Yep, that’s the e-mail I mentioned earlier) Coughing may help regulate the heart rhythm (hence used in arrhythmias, but by PROFESSIONALS only) but most heart attacks are caused by thromboembolisms and vessel spasms. The coughing may further propagate the emboli.  

Summary? Stick to pressing the heart area – way safer.

* Learning CPR is not a bad idea, you know. Even if you are fortunate enough not to use it, a little extra knowledge couldn’t hurt, could it? ;)

* Heart diseases are preventable. Go google it or my post will be waaaaayyyy too long :P And please, bug your parents/uncles/aunties into going for regular health checkups. It really does make a difference between life and death.

* If a person’s having a heart attack, he has approximately 10 seconds before he loses consciousness. React fast. If the guy does pass out, DO NOT panic. Keep doing the chest compressions and rescue breaths till help arrives, all right? It keeps his heart pumping and that is vital.

Hope the articles I celok-ed help somewhat! Have a nice day, people.

Oh, I used ‘him’ coz typing ‘him/her’ took too much time, plus I’m notoriously lazy ‘bout things like this and

‘celok-ed’ is the local term for ‘filched’, in case you were wondering. It’s in Manglish ;)

p/s : Click here - for individual risk assessment . That makes me sound like a hypochondriac, doesn't it? Oh, well! :P 

The Wonders of The Brain

Well, i've finally closed my friendster account! Blogs that have a special place in my heart/mind/whatever la... have been faithfully copied n pasted here, but i'm deviating. I wanted to spout nonsense 'bout the power of the mind.

It was weird. My friend has a cloth hairband she loves and one morning, she was hunting for it high and low. We went over what she had done the previous day and frankly we were amazed at how much we were able to recall. Our memory worked backwards from her putting her keys on the study table after entering the room, a white baby T she had been wearing as she sat at the computer (FB-ing no doubt), the three mugs of coffee I had forgotten to make even after setting the water to boil. She mentioned the smell of the coffee that i eventually made and we also both remembered the Arabic ringtone of somebody passing outside the door. We could even recall the conversation we had had almost word for word!

Even with all that blinding brain power, we still could not place the elusive cloth head band =P

Before you smack your head with your palm or hoot with derisive laughter, allow me to explain. You see, our fabulous neurons could not locate that blasted piece of decorative headwear because it was a third person who had moved it - and she had thrown it away!

What transpired after that involved 3 girls, a blue bag and lots of soap, but that's a tale for another day.

The moral of my inane ramblings is this : It's funny what the mind recalls, we just never realise what we are taking in.

Academicians have suggested a 'recalling therapy' where after a long exhausting day, the person is supposed to write down what he or she did/saw/heard/smelt all through out the day. It supposed to help ease tension, calm your nerves and increase memory power - things that we really need to survive in today's fast paced world. Just thought that i should share it with you guys =)