A costly PD

30/11/2011 - An ill patient with traumatic PD (peritoneal dialysis) was quickly wheeled on a stretcher to the operating theatre for an emergency laparotomy, when we realised amidst the confusion, he has not removed his dentures. So I made him do so, quickly snatched it from his hand, placed it in a plastic bag and chucked it to the nurse. Off the patient went to the OT, and subsequently the ICU, where all was forgotten..

Until 5/12/2011 - was sitting at the front desk doing my work when suddenly this patient appeared out of nowhere in front of me. "Doctor..." he muttered in an unhappy tone. "Remember me?" I asked him what did he want? He pointed to his jaw and said, "My dentures. You took them. I want them back." I suggested that he should ask the nurses of the ward upstairs (where he is currently) to call ICU or OT to look for them.. The nurses didn't. So I took the initiative to help hm do so. Still he came down bugged me for a few days.

It was my day off yesterday. He couldn't bug me, so he bugged my colleague, who told him, "Uncle, it's only dentures. Get a new one! How much could it have cost?" His reply? "MINE HAD GOLD PLATINGS ON THEM."

Oops...

What a busy weekend passive call looks like

Finished morning ward work at 12pm. And wow, phone never stopped ringing ever since :P
12.30pm - 4 new admissions, active HO in charge of clerking patients not yet arrive, busy with work upstairs. Me and colleague settle 3 of the new cases.
1.00pm - Critically ill newly admitted patient needs urgent CT brain. Called radiology department. Both CT scan machines are not working (under maintenance), any emergency cases need to be sent elsewhere for CT scan - in this case a nearby private hospital. Told that houseman need to accompany patient while they arrange for ambulance.
1.15pm - Colleague from upstairs ward passes over list of blood results which need to be traced and informed.
1.30pm - Above-mentioned patient's blood results came back. Severe metabolic acidosis. Hypokalemia 1.47, hypocalcemia 1.88. Loaded with NaHCO3 x5 and fast correction K x2.
1.45pm - Patient intubated due to poor GCS. Developed ventricular fibrillation during intubation. After defibrillation patient asystole, revived by CPR.
2.00pm - Upstairs ward called. Patient with acute coronary syndrome and history of gastritis complained of epigastric pain. Called biochem lab to do serum amylase.
2.20pm - Critically ill patient fitted. Valium given.
2.30pm - Haematology ward called. Patient needs branula for chemotherapy and transfuse platelets.
3.40pm - After long walk to and back from haematology ward, noted above-mentioned critical patient's cardiac monitor shows ventricular tachycardia (VT, nobody even noticed). Ordered for ECG.
3.55pm - Just about to sit down to document about the VT, when suddenly a scream was followed by loud crashing sound. Psychiatric patient was placed beside the window despite strict suicidal caution. So what he decided to do? He heard voices asking him to go die, so he jumped out from his bed towards the window. Restrained by staff nurse but broke several window panes in the process.. IM haloperidol stat for sedation. Psychiatric MO was left shaking her head at us..
4.30pm - Upstairs ward called. Patient's serum amylase came back as >600 (pancreatitis). Need to refer surgical.
5.00pm - Another long walk to haematology ward - 3 patients had fever >38 degrees. Protocol for neutropenic sepsis says triple blood C+S (aerobic, anaerobic, fungal) on both arms before starting antibiotics. So altogether took 14 bottles of blood C+S (used up 28 lab forms, 4 dressing packs, 8 pairs of gloves and 6-8 syringes).
7.30pm - After all the blood C+S, 4 patients need platelet transfusion. Managed to annoy the blood bank MO at a time they are short of blood and platelets, so instead of 4 units, each patient only gets 2.
9.00pm - Another patient rolling about in bed due to excruciating pain. Chest X-ray shows ? suspected air under diaphragm - need to refer surgical to rule out peptic ulcer disease. Attendant has gone out to send blood investigations to the lab, so HO wheeled the patient to X-ray department for repeat CXR.
9.40pm - BUSE/Creat for critically ill patient not repeated since fast correction in the afternoon. Done. K+ still 1.74.
9.50pm - Upstairs ward patient needs accompanying to be transferred to ICU. Asked another colleague to help out.
10.05pm - Patient complained of acute urinary retention due to BPH. Urinary catheter reinserted.
11.30pm - Patient with hepatic encephalopathy fitted. Noted that despite being ordered at 7pm, patient not loaded with antiepileptic coz medication not endorsed on drug chart. Since already ran out of hospital drug charts, resorted to using drug charts imported from Hospital Segamat.
12.00am - End of shift. Critically ill patient died at 12.45am.

Thematic LG Week 1: What are the 3P's of true peace?

Currently listening: Brian Littrell - In Christ Alone

Philippians 4:6-9 Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. 7 And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus. 8 Finally, brothers, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable -- if anything is excellent or praiseworthy -- think about such things. 9 Whatever you have learned or received or heard from me, or seen in me -- put it into practice. And the God of peace will be with you." (NIV).

What is the difference between true and temporary peace? Temporary peace comes from within a person, when success is assured and circumstances are under control by oneself. True peace arises from putting one's trust in God, regardless of surrounding circumstances. Because the Holy Spirit is in you, you are able to live by faith, and not worry... no matter what happens. The Spirit empowers you to be faithful, to trust, to yield to the Lord's will.

Matthew 6:25-34 25 “Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes? 26 Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? 27 Can any one of you by worrying add a single hour to your life? 28 “And why do you worry about clothes? See how the flowers of the field grow. They do not labor or spin. 29 Yet I tell you that not even Solomon in all his splendor was dressed like one of these. 30 If that is how God clothes the grass of the field, which is here today and tomorrow is thrown into the fire, will he not much more clothe you—you of little faith?31 So do not worry, saying, `What shall we eat?' or `What shall we drink?' or `What shall we wear?' 32 For the pagans run after all these things, and your heavenly Father knows that you need them. 33 But seek first his kingdom and his righteousness, and all these things will be given to you as well. 34 Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.

1. God wants you to have true peace by praying - about everything
a) In prayer you are transformed
b) After praying, do your best and leave it to God. Don't start complaining to other people / acting restlessly as if no prayer has been uttered at all.
c) By praying you will started to think about holy things. That is why... (next point)

2. God wants you to have true peace by meditating on what is good/positive (act of thinking)
8 Finally, brothers, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable -- if anything is excellent or praiseworthy -- think about such things.
Romans 8:6 The mind of sinful man is death, but the mind controlled by the Spirit is life and peace.

3. God wants you to have true peace by putting into practice what you have learned. (act of doing)
9 Whatever you have learned or received or heard from me, or seen in me -- put it into practice. And the God of peace will be with you."

Come to think of it, yesterday's LG has many things to give thanks for.on my part.
Give thanks for the opportunity to once again come before God to worship Him and experience peace and joy.
Give thanks for the fact that I received healing after 1 whole day of severe URTI and headache (felt much better after praise and worship).
Give thanks for the lives of 2 people in my LG (you know who you are) - 1 took up the challenge to lead games for the 1st time, the other responded to pastor's sharing and made the decision to sign up for Malaysia National Convention despite the risk of supplementary exams and challenge of parental objections.
Give thanks for a fellow faithful Monash admin staff who faithfully join and intercede for us from time to time.
Last of all, really give thanks for the lives of members of U3, a group of people crazy for God (as Jing Jing puts it :p). Travelling up and down weekly, having to prepare to run 2 Lifegroups (1 in UTM, 1 in Monash) and 1 Saturday morning prayer per week, not an easy task.
Let's treasure the opportunity to serve while we still have the chance, believing that breakthrough is just around the corner :)

Fellowship of the mount

Currently listening: Hillsong - Eagle's Wings


1st day of the fasting month was a public holiday in Johor, so our Lifegroup went on a trip to Gunung Lambak. It was not part of our original plan, as initially we planned to visit a farm, but the entrance fee was rather costly, so we settled for a trek up the mountain. Things did not go smoothly at 1st, as we got lost in Kluang, and arrived rather late at 11am, just before noon.

Gunung Lambak, at 510 metres above sea level is the 2nd tallest peak in Johor. We were divided different groups, and each group went up at a different pace. At the end of the day, despite the pain and aches, it was a day to remember, as most of us shared during Lifegroup.

Going up the mountain proved to be a challenge, seeing as this is my 3rd trek up a mountain / hill. It used to be an easy climb up Bukit Pelindung back in my hometown (250 metres), and I thought 1000 steps in Melbourne was already considered tough. However, nothing could prepare me for what lies ahead.

The path initially looks easy, with steps and a proper pavement, but it came to a point where one had to literally climb up uneven slopes, loose rocks, logs and ledges. Kind of precarious if one is not careful, might slip and fall - reminds you that life is not that smooth sailing.

Jing Jing shared how the climb reminded her of the importance of preparation (whether it's climbing a mountain, or for other events), both physically and spiritually, as well as whether if she is by herself in challenging situations, will she continue to trust that God is with her through it all. David mentioned of through the muscle aches on the day after the climb how at times, painful situations are required by God to build people's spiritual muscles, just like James 1 urging us to persevere and consider it pure joy when we face trials of many kinds.

I think most of us would be proud of Su Peng, who made it all the way to the top. Despite her multiple complaints of wanting to go back down, Christie, Ethan and I pushed her to press on. I think at one point, I myself doubted whether she could actually make it physically, what more I have never climbed such a challenging mountain myself - the fear actually exists, especially when you look at the mountain's landscape. Nevertheless, the power of encouragement helped, good to see how we actually spurred each other on as a unit and family.

Christie mentioned how despite her athletic abilities, she learnt to put aside her preference to reach the top 1st, and instead learnt to go the extra mile for the people beside her. Imagine having to go ahead and survey which is the safest path to proceed, whether the slope is slippery or rocks are falling off etc. But eventually, as she put it, we go through the bitter moment together, we savour the sweet victory of reaching the mountaintop together.

Setting goals is indeed important, as Ethan summed it up. Today when we want to climb a mountain, you need to know details about it (location, height, condition, estimated time and preparation needed etc), otherwise we will just give up easily without a clear direction. Same applies in our walk with God, what we intend to achieve and where we are headed as a church and LG. Setting short goals helped spurred Su Peng and a few of us on to various subsequent checkpoints. All in all, we reached the top in 2 hours. We might not be the fastest, but we reached the goal in one piece.

As for me? I once again experienced how God's grace was sufficient for us to make it safely up to the peak. I shared midway through the journey that when you reach the top and look back at how far you have come, you will see it as a reference point in your life - God will take you to another level as you continue to breakthrough and overcome your challenges, coz in Him we are more than a conqueror.

I believe that everybody experienced personal breakthroughs on that day to spur them on in the coming weeks ahead. I knew I did, I was on call on the next day :p

Belated June reflections

Currently listening: True Worshippers - Tiada Ternilai

SRCC - A Mission Driven Church

Where there is no vision, people perish.

Almost a century before Christopher Columbus discovered America, or Vasco Da Gama set foot in India, there was an Admiral by the name of Zheng He, whom described how the emperor of the Ming Dynasty had ordered him to sail to "the countries beyond the horizon," all the way to the end of the earth." His mission was to display the might of Chinese power and collect tribute from the "barbarians from beyond the seas."
The Yong Le emperor had ambitious plans. A vigorous man, he rebuilt the Great Wall to the condition in which it exists today. He also built his new capital at Beijing, next to the remains of the former Yuan capital. The emperor decided to go ahead with the sea voyages that had long been planned. He appointed Zheng He to lead them and gave him the title "Admiral of the Western Seas."

At each country Zheng He visited, he was to present gifts from the emperor and to exact tribute for the glory of the Ming. The Chinese had a unique view of foreign relations. Because China developed its culture in isolation from other great civilization, it says itself as the center of the world. The Chinese called their country "the Middle Kingdom."

In 1405 Zheng He set out on his first voyage. No nation on earth had ever sent such a fleet onto the ocean. It included sixty-two large ships, some 600 feet long, larger than any other on the seas, much larger that that of European countries. Hundreds of smaller vessels accompanied them. A Chinese historian described them; "The ships which sail the Southern Sea are like houses. When their sails are spread they are like great clouds in the sky."

When Zheng He came back from his seventh voyage in 1433, he was sixty-two years old. It was not easy for him, as he had accomplished much for China, sailing through stormy seas and unfamiliar lands, having to cope with illness and disgruntled crew members whom failed to see the immediate fruits of their labour. When the emperor ordered him to return, he bravely refused, vowing to soldier on with the mission until he reaches Africa, risking his life for what he believed was greater cause. Though he died soon afterward, his exploits had won him fame, spreading the glory of the Middle Kingdom to many countries that now sent tribute and ambassadors to the court. Plays and novels were written about his voyages. In such places as Malacca and Java, towns, caves, and temples were named after him.

However, a new Ming emperor had come to the throne. His scholar-officials criticized Zheng He's achievements, complaining about their great expenses which nearly bankrupted the nation whose people have more pressing everyday needs. China was now fighting another barbarian enemy on its western borders and needed to devote its resources to that struggle as well. When a court favorite wanted to continue Zheng He's voyages, he was turned down. To make sure, the court officials burnt the travel logs that Zheng He had kept about his journeys to various countries. What remains as documentation of his voyages now only come from the pillar and some accounts that his crew members wrote.

Thus, China abandoned its overseas voyages and turned its back on the world. It was a fateful decision, for just at that time, Portugal was beginning to send its ships down the west coast of Africa. In the centuries that followed, European explorers would sail to all parts of the world. They would establish colonies in Africa, America, and finally in the nations of East Asia. China would suffer because it had turned its back on exploration. Zheng He had started the process that might have led the Middle Kingdom to greater glory. Unfortunately the rulers of the Ming Dynasty refused to follow his lead.

What's the difference between these 2 parties? Both have valid points for arguments, but only one had a vision to see the bigger picture, the other was more concerned and focused with problems at hand.

In the same context as we look at God's people today, are we more concerned with material things / personal gain which will one day pass away? Or the things of eternal value?

June has been one heck of a ride, from a new posting in O&G to the Southern Region church camp, something which I have been looking forward to. Initially, I was a bit concerned about not being able to make it for the camp, having been told that my current department is short of staff (the current people are doing alternate day on calls), what more the harsh working environment, making it difficult to obtain leave. Many people have said that taking emergency leave would leave a black mark on one's service record, what more in my current department but nevertheless I decided to put God 1st whatever the consequences, so I planned my leave a week earlier, feeling apprehensive on whether my specialist would even approve, as the department was seriously short of staff. Miraculously, she did, and I was on my way to Port Dickson for 4 days.

It was a camp which served up a lot of reminders. Initially I was quite disappointed and a thought actually slipped by that this is a waste of time and effort for me, since for the 4th year in a row (since I was a medical student), I was the only representative from my uni. However, having found out the reasons why my fellow colleagues were unable to make it, led me to remind myself that there is much that needs to be done in terms of supporting each other in prayer throughout challenges and helping each other grow and see the value of such events.

1st thing I got reminded of during the camp was to be thankful, knowing that as we choose to honour God, He will honour us and open a way. A fellow MO from Batu Pahat told me that I should count myself lucky, since not all departments will approve your emergency leave without consequences. I learnt to treasure opportunities to spend time with God, as well as brothers and sisters from other centres and countries (Hope India and Indonesia). Was really touched by the desire shown by them, 1 brother waited 1 year for his passport, while because of their culture, 2 sisters had to go through great lengths just to come to Malaysia - they had to travel and seek permission from all their relatives (uncles, grandparents etc), scattered throughout the many different districts in India. Even if 1 family member objects to their trip, they are not allowed to proceed. Despite several objections, eventually they managed to make it here. It really encouraged me a lot, especially when we tend to take many things for granted.

As a heart preparation, I told God that as much as I was going through a stressful time, I did not intend for this camp to just be a momentary stress reliever away from work, I wanted something more for the long term. For some reason the word that kept coming back was to trust in Him. Trust, that was the word for the season. Trust that despite the lifegroup is not seeing any results / growth at the moment, trust that although I have many weaknesses and may not be sure how He will use me, as long as I humbly say, "Here am I, use me," He will work in the background. Pastor once again shared his testimony of his humble beginnings when he was growing up, and how he 1st started the church in JB.

God has been at work without me realising. At times I do struggle from a lack of security according to my shepherd, ie I mind what people say or think of me, and find it difficult to accept what I perceive to be my own incompetencies - even recently some of my nightmares during my sleep reminded me of this challenge. It's difficult to learn to trust God when you are walking through a minefield, that is O&G. But why I mentioned that God is at work is because during my preliminary assessment with one of the consultants, try as I may, I received a quite a bad scolding.. initially I thought I had failed, but later my colleague came and told me that I was given a pass. Another reason came when during the weekend, I was still able to attend Sunday service on some days, although we work everyday without an off day, something which I am grateful for, although I do feel sleepy during the sermon due to fatigue. Some days I was even able to join lifegroup.

I was complaining to God why has he put me in a busy period and stressful department, when now is the holiday time in UTM for the brothers and sisters there to help pioneer something in Monash, or even why everytime when I am on-call, things tend to get busy / go horribly wrong. I guess He is trying to remind me to be humble and depend on Him, since His strength is made perfect in my weakness. Also at the end of the day, it is not by might nor by power but by His Spirit - God is the one who makes the seed grow.

Was grateful that in busy times, when you don't really have time to do much, God is still a God who listens to prayer. He knows what we will ask even before we actually do. My nametag has been missing for 2 days in the hospital, and despite turning my room upside down and searching all over the place which I could remember, I could not find it. I do not have the time to get a photo and make a new one at the office, so all I could do muster was a simple prayer and belief that my nametag would come back to me (before Friday's CME attendance). True enough, on Thursday, one of my MOs found my nametag in the ward. Really thank God for this little testimony.

Despite the lack of sleep and fatigue, through the many weeks of LG and Saturday prayer group in Monash, was encouraged to see how a fellow colleague had the desire and burden to commit more, as he sees the spiritual hunger in this place. Another was discouraged with the repeated rejections she face. Sad as it might be, it was an opportunity to encourage and remind them (and me) how it is not necessarily the end result that matters, but at times how such things can aid our faith. Whatever the outcome, give our best to God and leave the outcome to Him, coz it is not how much we do/say, it's the life transformation in our daily experiences that we desire people to notice and give glory to God.

Compelled by God's love, you would be surprised how walking across a darkened stretch of road, braving poor lighting and high speed traffic just to meet the needs of somebody could go a long way in bringing that person to LG (even if it was only once). Another example was a fellow Aussie housemate, how she kept turning down my invitation for LG, but as I kept inviting and sharing, to a point she asked me why I kept inviting her, she felt flattered. I shared what I see in the LG and church, and she joined us in the weeks to come, even during exams. During one of the uni holidays, leaders invited her to join Mandarin lifegroup (she does speak Mandarin for a Westerner). Usually foreigners get around in Malaysia by taxi. What encouraged me was how she took the effort to find out how to take bus for half an hour all the way to lifegroup. These little things really make you feel worthwhile in investing your life in others.

2 Chronicles 7:14 - if my people, who are called by my name, will humble themselves and pray and seek my face and turn from their wicked ways, then I will hear from heaven, and I will forgive their sin and will heal their land.

Not by might

Currently listening: Paradise - How could I live without You

"Let's not pray for problems to disappear, for there will always be problems, but we pray for the strength and perseverance to go through it."

That was what Ethan and I agreed, whatever posting I get after Surgery - and it turned out to be O&G.

Sister Christine's testimony during Sunday service served as a big encouragement, of how the BM church started within a church consisting of mainly Chinese-speaking congregation members, when somebody captured God's heartbeat, and was willing to take that step forward to respond by moving to JB to see such a group of people coming to know God's vision. No doubt it was tough despite the early enthusiasm, and there came a point of wanting to give up, but the reminder was always to hold on to God's calling and promises, why He had brought you here for in the 1st place.

Past 2 weekends have been busy, on call for surgery and tagging O&G. Nevertheless, managed to squeeze out some lunchbreak time for Monash prayer. During today's praise and worship, the above-mentioned song really spoke to my heart deeply, coz I was asking God, "If I'm going to work everyday from early morning to late at night, what can I do? Don't even have enough time to sleep, what more do ministry or see something happen?" And the verse which came to mind was 2 Chronicles 7:14 - If my people would humble themselves, seek my face and turn from their wicked ways, I WILL hear from heaven, forgive their sins and heal their land. I can intercede, and the past 2 weeks I was gifted the opportunity and some time to do so over lunch. His word says, "Ask of me, and I will give you the nations as your inheritance (Psalms 2:8)" Today, it is not by might nor by power, it is not so much about how much I can do, coz apart from Him we can do nothing. Continue to proclaim, continue to plant and water the seed, whatever happens, leave it unto His hands.

You are for me - Part 2

Currently listening: Kari Jobe - You are for me
(http://youtu.be/UbSMfL5LuSo)

Sunday 8 May was supposed to be a day of celebration (Mother's day), but instead it turned out into a nightmare when I wrote about how 3 patients collapsed and 2 died, and everybody ended up going home super exhausted at 3pm, with morning rounds not done.

Next day Monday during neurosurgical on call, one patient required active resuscitation, early in the morning. Patient died.

Tuesday - worked until 7pm, after 2 months of not putting in central venous catheter, needed some help from my MO to eventually get it in (enduring some criticism from a few colleagues along the way).

Wednesday and Thursday - got scolded a lot while assisting in OT. At times did feel extremely dumb and down..

The Monday after in the ward, was busy resuscitating a haemodynamically unstable patient with peritonitis, when patient beside her stopped breathing. Did CPR halfway only to be informed she is not for active resuscitation. However, in the busyness and confusion, mistakenly broke bad news to the patient's daughter over the phone that her mum has passed away. The result? She cried hysterically, screamed at me over the phone and hung up. Me? Left with the thought of her possibly filing a lawsuit against the hospital, and unfinished work to do (despite it already being lunchtime). Anyway, she came the next day to look for me (the HOs ran away, and the nurses lied to her that I was not around). Anyway when she saw me, I got nothing to hide, I explained my predicament and apologised. From her questions, I think she just wanted some closure over the matter. Hopefully the lady with her wasn't a lawyer, coz it's their word against mine alone.

1 Kings 19 talks about how Elijah experienced great discouragement after a death threat was issued for him by Jezebel. In his many complaints, God provided for his needs (physically in the form of food, and emotional support), and reminded him that there are still people around to do His work (Elijah was in despair because he thought there was nobody left). Was glad how He reminded me during LG of learning to see beyond the problems and issues, coz I have been complaining about the workload and the fact that one part of my insecure mindset couldn't stand feeling stupid. All this while without me realising, God has been working in a subtle way. Yes, it might be a lot of chaos, but on the other hand, I was able to complete a significant portion of my logbook in terms of clinical procedures. He is in control, His strength is made perfect in my weakness, and I came to a new understanding as to what it meant by 'Your grace is sufficient for me'.

I was quite concerned about how to get my forms signed off when my supervisor is not around and I was super busy when he decides to show up, but I did manage to get it done on the last day itself. I passed my assessment and bid farewell to surgery (for now).

You are for me - Part 1

Currently listening: City Harvest - Out of my hands

"I'm happy with your basic knowledge, but not with your initiative in terms of your logbook."

What my supervisor said after my assessment, left me wondering where am I going to get certain procedures done, especially since we don't see much of certain cases. Was also feeling rather tired and discouraged with the way things are going.

We had our church family day on the day after Labour Day. I was post-neurosurgical on call and came straight after work, so I did not expect to play a major part in the activities apart from being on 1st aid duty, but somehow leaders asked me to join in, which I did.

There were 4 teams, and I was in Green team, same as 2 years ago. It was an exciting time from the word go, with plenty of action and drama from the 1st game. Nevertheless, despite taking the lead, we finished last. By the time we reached the final game, we were in 2nd last place, and I was left telling myself,"Same old story as the last time around, nothing to cheer about, even our members seem the more quiet type, not possessing the fiery war cry of Red team, or the fighting spirit of Yellow team." So it came as no surprise that when I was asked to participate in the final game - tug of war, I was not enthusiastic at all (the last time I played, I had a bad experience of vomiting as a result of overexertion). Surprisingly, we won and managed to enter the finals.

When we were up against Blue team, I took a look and I was like, "What the..?" Their team possessed 2 'tanks / bulldozers' (whatever you call them), pastor, as well as experienced vegetables farmers from family group who are used to working the soil. I turned around to have a look.. whom do we have? Anyway, our team captain challenged us to pull in unison at a certain angle and face upwards. When the time came, I told myself that regardless of what happens, I just do not want to let go of the rope, I do not want to give up. I didn't know how everybody was doing, but I knew I was pulling like a madman. After no movement towards either side for some time, eventually somehow breakthrough came to our side. We won the 1st round, and for the 2nd round everybody gave their all, even though some of us felt that we had nothing left.

When the dust settled, I collapsed to the ground. We have won 1st place. As much several people came up to me with compliments about how well we did, how much of a difference it would make if I could transform that passionate display of strength into soul-winning etc, I was left with tears welling up in my eyes. Just felt like God was trying to encourage me on that day never to give up, keep pushing, but at the same time also to lay down. At the end of the day, no matter what happens, do what is humanly possible, leave the results to Him. He is the one who will carry you through, like the single pair of footprints in the sand.

SRCC - Sneak peak 2

12th Southern Region Church Camp - Sneak Peak 1

More to come :)

Thank you for the cross

Currently listening: Great is the Lord

1. It's been pretty busy and hectic lately. Got assessment next week (when I really did not expect it to come this soon). Quite unprepared. But in the midst of it all, really give thanks for how God opened up a way in certain things. This week I am supposed to be on call for Easter Sunday, and due to some incidents at work, was a bit concerned that the changes in on-call days might not be approved (so I was asking God, "How ar?"). Nevertheless, was glad that He made a way, when I was asked to replace a fellow colleague on Saturday instead. Praise God for this little miracle.

2. Easter Evangelistic Movie Lifegroup

It was a time to once again reflect on how God demonstrated His love for us - while we were still sinners, Christ died for us (Romans 5:8). As God saw the value in each life out of love, and Ben saw the potential in Jake, both were willing to invest and pay the ultimate price with their lives, hence let us truly live our lives well as a testimony to the work that was finished on the cross.

Currently listening: Laura Story - Blessings

Verse 1
We pray for blessings
We pray for peace
Comfort for family, protection while we sleep
We pray for healing, for prosperity
We pray for Your mighty hand to ease our suffering
All the while, You hear each spoken need
Yet love us way too much to give us lesser things

Chorus
‘Cause what if your blessings come through raindrops
What if Your healing comes through tears
What if a thousand sleepless nights
Are what it takes to know You’re near
What if trials of this life are Your mercies in disguise

Verse 2
We pray for wisdom
Your voice to hear
And we cry in anger when we cannot feel You near
We doubt Your goodness, we doubt Your love
As if every promise from Your Word is not enough
All the while, You hear each desperate plea
And long that we'd have faith to believe

Chorus

Bridge
When friends betray us
When darkness seems to win
We know the pain reminds this heart
That this is not, this is not our home,
It's not our home

‘Cause what if your blessings come through raindrops
What if Your healing comes through tears
And what if a thousand sleepless nights
Are what it takes to know You’re near
What if my greatest disappointments
Or the aching of this life
Is the revealing of the greatest thirst this world can’t satisfy
And what if trials of this life
The rain, the storms, the hardest nights
Are your mercies in disguise

More of You, less of me

Currently listening: Keith Slaten - Lord I thirst for You

"The layer of human turmoil - looting and scuffles for food or services - that often comes in the wake of disaster seems noticeably absent in Japan.

“Looting simply does not take place in Japan. I’m not even sure if there’s a word for it that is as clear in its implications as when we hear ‘looting,’" said Gregory Pflugfelder, director of the Donald Keene Center of Japanese Culture at Columbia University.

Japanese have “a sense of being first and foremost responsible to the community,” he said.

The communitarian spirit at the foundation of Japanese culture seems to function even more efficiently under the stress of disaster, he said.

The natural American inclination is to operate independently.

“So you do everything you can to protect your own interests with the understanding that, in a rather free-market way, everybody else is going to do the same. And that order will come out of this sort of invisible hand.

“And Japanese don’t function that way. Order is seen as coming from the group and from the community as a sort of evening out of various individual needs.”

Will this social attitude help Japan recover from this disaster? "In a word, yes."

Ref: http://news.blogs.cnn.com/2011/03/12/orderly-disaster-reaction-in-line-with-deep-cultural-roots/

1. Laying down ourselves. Something which I believe most of us find very hard to do in the midst of today's society which emphasises on grabbing what is best for ourselves whenever we can. Yet, in an island nation riddled by disaster, there are lessons to be learnt. Where young people make way for the elderly during food distribution, where there was order and respect for the law rather than complete and utter and chaos in places like Europe (during riots) and maybe even our own country. It's a good reminder to be sensitive to the needs of others.

2. This week has been a good learning experience. Challenged myself to lay down what I perceive to be lack of confidence to coordinate lunch sharing after Sunday service, and it does encouraged me to hear testimonies from people whom I have never heard from before. Also it taught me a lesson how I should learn to listen / respond / encourage when people share their troubles / dilemmas..

3. Received my 2 months of salary, and gave tithes for the 1st time (as a working person). There is that sense of joy giving back what God has provided.

4. Movie ECG, morning prayer at UTM's lakeside on one of the days, and CG evaluation reminded me of 2 things: 1) do my best and leave the results to Him (whether good or bad), rather than being obsessive about how things should work out 2. today it is not so much about how much we do, but that our being is also more important than our doing (our actions mean nothing if it is not supported by our life testimony, and our mindset determines the things that we do). It's hard to lay down certain bad habits, but would like to believe that this quarter will be a quarter of spiritual breakthrough and great harvest.

5. Shepherding this week was short, but Ethan's sharing reminded me of 2 things; 1. to learn to be flexible, when people or things are unable to fit our expectations - not to be demanding. 2. not to take things for granted, but to really treasure the time and opportunities I have where God has put me, coz we will not be in student group forever.

6. This week has been quite draining, as I worked from 6.45am-6.45pm everyday. In fact, when parents came on Tuesday, by the time I got home from accompanying them at 10pm, really totally knocked myself out in bed until the next morning. In addition, since I did not get much sleep from preparing for a case presentation on Thursday night after LG, even the decision to go for prayer meeting on Friday after work is really tough - when your brain is shutting down, your legs are giving in on you, and the traffic jam was horrendous. But I was glad I went - it was a night of intense prayer, spent seeking God wholeheartedly, and one which (coupled with this week's experience) spoke to me that if you really know who your Maker is, what He wants to do, and live a life surrendered to His will, certain things no longer matter / bother you (eg what people say, who offended you, what you didn't receive etc) which seem so petty in comparison to His plans and purposes. Coz today it's no longer about us.

8. You just never know where unexpected blessings will come from when you choose to honour and do God's work, as I just found out when my dad called me and offered to exchange a new laptop with my Dell PC. So I now have a new laptop! I prayed for a new bicycle to be more effective in my daily life and ministry, duno where it's going to come from, but we'll see :)

ECG

You'll never know that God is all you need,..

...until God is all you have.

Currently listening: New Life Worship (Ross Parsley and the Desperation Band) - Counting on God

After yesterday's Sunday service, I had a privilege to be in the car with W,one of the student LG leaders who sent me home. We were exchanging experiences on our job experiences, hers as an architect, mine as a doctor, and found not many differences - although I did share mine that for a hospital, it's a harsh working environment, no love, where you deal with staff and colleagues who are stressed up, and tend to be selfish - some even with attitude problems. Of course I do get scolded many times for various mistakes. And being call twice a week leaves you tired and no mood to do things at times. If you are not careful, instead of being agent of change within the working environment, it might end up the other way around.

But I did mention that it was in such times that you see God work wonders. Sometimes, as you go through certain things and you look back at how God pulled you through, and you share it with others, they will give you a weird look and wonder, "Is that even possible?"

W shared how she noticed many similarities of what I described with her days in UTM's architecture faculty - during that time, they are well-known as a bunch of students who are frequently very busy. If doctors on-call work 36 hours straight, they on the other hand could go up to 48 hours (with lights still on in their campus labs) during seasons for submitting assignments and projects. An outside person might wonder how God could work in such an environment, but W mentioned that she always reminded her sheep that they are the blessed ones - because it is in such times (when you feel like you are dying rushing your work, when you have nothing left to go on etc) that you experience God.

"People who have a comfortable life, stable job might make remarks on how God has blessed them, how His grace is sufficient for them etc., but many times all these end up as empty cliches which we used so frequently, that it has lost its meaning. When you are hard-pressed for a miracle and all the chips are against you, you won't just pray a simple prayer of a few lines asking God to bless you - you will cry out desperately, knowing that without Him, some outcomes just would not have been possible. Then you will realise that it is really His grace that is sufficient for you, what you say carries more weight and meaning."

She also shared practical experiences, how compared to those who are already working, owning a car as a public university student can be a challenge, when (not wanting to be a burden to your parents) you are paying for it with your scholarship and part-time job earnings. Sometimes, with only RM50 left in your bank account, you will be wondering whether to pump petrol or use the money to buy food. However, it is in such times when you see the need of owning the car as a student, to be a blessing in fetching people, you also experience His provision in ways you could never expect from the people using your car.

However, I guess the 1 thing which encouraged me the most was her testimony on her academics, how she made it her decision to God to lay down her studies, despite her results not being very good as compared to other students - and her decision not to compromise on various church commitments (despite whatever came her way - deadlines, fatigue etc). God blessed her with an award for being one of the best students in the faculty, but above all else, it left a mark within the student group - when you start to do this, other people start to look at their own lives and say "If an architecture student who is extremely busy can do such a thing, then there is no excuse for us from other faculties not being able to serve God wholeheartedly." She was the pioneer student from her faculty, and encouraged me to see that at the pioneering stage it is tough, but God has a wonderful plan and wants to pour out His blessing on such people. See it as a privilege, as the 1st doctor in Hope JB, as she was the 1st architecture student back then. Although it took her 2 years before she started bringing people to church /LG when she was already finishing her final year, today several of the leaders in student group come from this faculty.

"I have attended a seminar where there was this doctor from East Malaysia who shared her experiences. Due to the shortage of staff and heavy workload, she was greeted with many negativity when she started work. People were telling her that she would have to give up religion because she could not go to Sunday service anymore. But she refused to let all these bother her, in fact she woke up at 4am to go to the hospital so that she could finish her work by 6.30am or so before squeezing out time to go to church. The great lengths people are willing to go to serve God passionately. Today she is leading a group of Christian doctors in the hospital. See it in spite of your hardship and challenges that God is moulding and preparing you for greater things to come."

Thankful for that ride home..

In spite of overwhelming odds

Currently listening: Laura Story - Grace

Last week at Hope JB, we had a bible conference on A Priesthood Church, with pastor's passionate sharing on how each and every one of us are called to be a royal priesthood. As I was on call over the weekend, even when I turned up for the Sunday session, ended up sleeping on the couch due to over-exhaustion.

Then it was decided that I was to be the chairperson for that week's lifegroup (LG), which is slightly related to the theme. For someone who missed 80% of it, not sure of how I was even going to carry it out. On the day before the LG, it was a long day at work, followed by some unexpected circumstances which resulted in me returning home late after a meal with a fellow visitor. I got locked out of the hospital backgate as it was already after 10pm, so I took the long road which was poorly lit, and things did not turn out very well. Just before I left for home, I cut my toe when I knocked it against the leg of the mamak's table. Then, I tripped and stepped into a puddle of mud. I got home at midnight exhausted, whole body aching, and realising that I haven't really finished preparing for LG chairing tomorrow. What more, on the next day, I have an exam which I have not studied for.

In such a time, I emailed my shepherd. I mentioned that it's a funny feeling. On one hand you feel overwhelmed by many things, but on the other, there was that slight feeling of peace, as if God was trying to remind me that His grace is sufficient for me in spite of all the work and fatigue. His reply?

"As we continue to grow in Him and have more responsibility on our shoulder, we will naturally feel tired and overwhelmed. I believe this is the time where God wants to expand our capacity so that we will be able to do more for him in the future. In this process, there are many important lessons that we can learn to equip us to be an effective servant for Him. Keep it up bro, it's a time of moulding and transformation from God ! Breakthrough is just around the corner. As always, would like to encourage you with this verse (which also encourages me a lot :)

Phillipians 4:6-7 Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your request to God, and the peace of God which transcend all understanding, will guard your heart and mind in Christ Jesus.

Jia you bro. God grace is always sufficient. Let's do it together."

At the same time, I realised that I was feeling stressed coz it was my 2nd time chairing LG, and I was nervously holding on to some expectations on how I wanted things to work out. I had to let go and surrender the outcome to Him after doing my best, as it's not about me. As I did so, the LG turned out much better than expected. Surprisingly, what I had prepared hastily flowed well in line with the praise and worship that night, and many people's lives were touched as God moved powerfully that night. As I shared during the testimony session, God's grace is sufficient for us.

Give praise

Currently listening: Hillsong - Hallelujah

Though the fig tree does not bud and there are no grapes on the vines,
though the olive crop fails and the fields produce no food,
though there are no sheep in the pen and no cattle in the stalls,
yet I will rejoice in the LORD, I will be joyful in God my Savior.

The Sovereign LORD is my strength;
he makes my feet like the feet of a deer,
he enables me to tread on the heights.

Habakkuk 3:17-19

So to continue on from my previous post, 2 take home messages: joy and acceptance. Ethan reminded me during shepherding that it is very important that in all things we do, to do it out of joy and give praise to God whatever the outcome, otherwise a sense of discontent and bitterness will arise when we don't safeguard our heart.

Many times the expectation is there - I would admit that many times I do get upset when people don't respond the way I intended / produce certain outcome or result, something to improve as I got reminded by my shepherd, "You are dealing with humans, not robots, who naturally have a tendency to look at their limitations and self-interests 1st, rather than expressing their willingness. Take ministry for example - what if you get a sheep in the future which doesn't see the value of committing to certain things? Or lacks accountability and frequently lands you in trouble? If they still refuse to change after having done your best, then it's between them and God. But until then, how would you then continue to impart and encourage, sometimes challenge?"

Nevertheless, the things I want to praise Him for this week, despite the bad times:
-A department which teaches a lot.
-My leave for convocation approved after much waiting.
-Performing procedures which I had waited for so long.
-The strength to survive another busy on call.

Jonah Neurosurgical call Part 3

*Jonah = busy night, with many things going on and wrong*
Currently listening: Hillsong - Desert song

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For some reason, I don't know why they like to put me on call in neurosurgery, in the past 5 weeks already had 3 of them, and I don't really understand much what is going on in the patients since most of them are critically ill.

Yesterday just after 5pm, when we have not even finished the work at paeds surgical, they already phoned me to accompany patient to the operating theatre for tracheostomy. Even a colleague took pity on me, as to her surprise, "It's only 5pm, so fast already so Jonah ar?" Imagine having to rush to NeuroHDU, follow the patient to the OT as you bag the patient along the way. After the surgery, you have to go accompany the patient back to the HDU the same way you went to the OT, bagging along the way. Imagine doing the same thing for 3 consecutive patients (5 in total that night)..

Even the nurses were telling me that last night they had all sorts of things to name it; tracheostomies, new admission for hypertensive emergency, transfers from other hospitals, moving patients between ICUs, patient stopped breathing and requiring resuscitation, spillage of urine from patient's urinary bag, patients trying to pull out their endotracheal tube, schizophrenic patient struggling up and down in bed. So busy until did not even have time to go upstairs to do night rounds in the male and female wards.

Nevertheless, 1 thing which I gave thanks for, was the opportunity to carry out something which I have not been able to perform under my surgical MOs (which I have been praying for opportunities), 2 central venous line (CVL) insertions - and both were successful at 1st attempts :), despite the 1st one being done a bit fumblingly. Initially I was hesitant, coz both were IVDU patients (drug addicts, high risk of infectious disease) and 1 of them was the schizo patient screaming and struggling vigorously, but eventually as I took that step, the neurosurgical MO was willing to allow me to do it.

Overall it was a tiring night, didn't sleep until next day noon after paeds morning rounds, but again God was in control :)

Testimony sharing during Sunday service

Currently listening: Don Harris - For You alone (sung at CHC)

Good morning brothers and sisters. My name is Gary, and I graduated from Monash University, currently working as a doctor in Hospital Sultanah Aminah, Johor Bahru. I am currently joining the U3A student lifegroup. Today I would like to share with you my testimony on how I experienced God in my decision making process, and the precious lessons He taught me along the way.

First let me introduce a little bit of background of how I first came to know Hope JB. I came to know God while I was in my 1st year of my studies in Hope Melbourne, Australia, and have been joining Hope family of churches ever since. When I 1st came to Hope JB, it turned out to be a challenge for me. Why? The travelling distance was quite far from where I live, and I would end up taking public transport when nobody was coming along with me. In addition, I struggled a lot because I hardly knew how to converse in Mandarin.

Nevertheless, I overcame those struggles, and in my 3rd year God taught me a valuable principle, which has become the mainstay of what I do – Choose to honour God, and He will honour you. That is why I never compromised, be it in taking shortcuts in my academics or missing church activities, no matter how busy or tired I was. I saw how God blessed me in many areas as I made the decision to do so.

When I entered my final year, I was challenged to take that principle to another level. On one hand, I desire to see a lifegroup of strong and biblical medical students and doctors rise up and commit their lives to make a difference on campus and within the hospital. However, deep inside my heart, I also have my own dream, to become a successful specialist. When I went to Melbourne in my 1st year, I literally fell in love with the place, the working environment and pay in Australia was definitely better. It was very tempting, what more since I managed to get 2 provisional offers from Australia thanks to references from 2 prominent professors in my final year. But as I spent some time praying to seek God, and after consultation with leaders, I came to the conclusion that apart from my own personal reasons and preferences, I have no concrete reason to work there in terms of God’s plan.

At the same time, I faced challenges from my family, who were understandably upset and objected strongly to my decision to turn down my Australian offer as well as the option of working in their hometown. It was a very difficult situation for me, as I did not know what to do, apart from spending time praying. I was bothered with many doubts and questioned myself whether am I doing the right thing, since 3 years of putting in effort and I have yet to see much fruits from my ongoing labour. At one point I told God, if I am just wasting time down here, why bother? I might as well pack my bags and go pursue my own interests. I also have people telling me all sort of things out of good intention. One would say, “Don’t stay to see the seed grow, because sometimes you are one sowing it, only God can make it grow.”, whereas another would comment, “Don’t you have other churches in Australia / Malaysia to serve in? Why must it be Hope JB?” Nevertheless, this church is committed to fulfilling the great commission, and I told Him, “I may not fully understand your vision yet, but I want to stay back to learn, to be equipped and experience you more, as I have seen how lives can be changed as we offer ourselves to your plans and purposes.”

One day, I received an unexpected phone call from my dad, requesting for my personal particulars. I asked why. He wanted to pass it to his contact to see whether anything can be done about my hospital placement. Although I disagreed with the method, I appreciated it. From a situation where he was determined to prevent me from getting JB at all costs, God turned the situation around, where he was now going all out to help ensure I would get JB. I was moved to tears, and literally did not know how to respond. So did my shepherd, Ethan, when I shared this with him, he also did not know what to say apart from “God actually loves you very much”. In this process, I experienced how my parents still loved me and were willing to respect my decision, despite various disagreements.

My top 3 hospitals were all in Johor, 2 in JB, 1 in Batu Pahat. To some, this may be seen as risky gamble, putting all your choices in a single state, rather than varying it to stand a better chance of success. Furthermore, I did not know what to put as my reason for those 3 hospitals. Eventually I decided to do something crazy, by mentioning, “Commitment to my local church” as the reason.

God is good. I was offered Hospital Sultan Ismail as my placement (my 2nd choice). I was quite happy, it was a fully air-conditioned and computerized hospital, workload is more manageable and you get to do more stuff, but there is 1 problem: I don’t know any doctors / students there who have yet to come in – what am I about to do in terms of ministry?

At this time, my shepherd challenged me again, since it will not affect your initial outcome, why not you submit an appeal and ask for HSA? I was a bit reluctant to relinquish my offer, because I felt that I would be giving up something good for a worse working environment. However, I chose to believe that as we put God’s interests 1st, He will definitely look after our interests. Since I have limited time to appeal, I was at a loss again how to justify my reasons. Having ran out of ideas, I decided to submit another crazy yet not-so-concrete reason: Housing and transport convenience, and once again, church commitment. I was not holding any high hopes, since if you get your top 3 options, they are unlikely to entertain you. However, on the last day, God miraculously opened up a way, as they announced that my appeal was successful.

At the same time,I received encouraging news on my sheep who is currently in Hope Melbourne on final year exchange, where his humility to serve and help out in the student ministry, despite not having any title attached to him touched the hearts of several people. Having gotten a half-day off hospital work, he chose to take initiative and use the time to help out in campus ministry duties. It is indeed good news to hear how he is currently becoming a blessing to others, as he responded during altar call to have more passion in serving God despite his present struggles.

In conclusion, it has not been an easy process along the way, but I believe that I have been continuously reminded that as we make the best decision for God, He will for surely honour that decision. I might be very busy and stuck with various challenges at the moment, but I want to believe and be excited that where God has put me, He has His wonderful plan and purpose. All glory and honour to Him.

Psalm 126:5-6 - Those who sow with tears will reap with songs of joy. Those who go out weeping, carrying seed to sow, will return with songs of joy, carrying sheaves with them.

*Note: some parts have been modified for completeness

Minor posting

The nice things about paediatric surgery:
You get to be funny and play with the kids (the not so sick ones, that is).
MO's are willing to teach (in fact, you have a weekly case presentation session).
You get to assist in OT unlike the minor postings of neurosurgery and urology.
You get to run the clinic too, unlike the other 2 minor postings.

The not so nice things about paediatric surgery:
Blood taking in kids can be a nightmare (especially if they scream into your eardrums, and you already noticed at least 10 puncture marks on both hands and feet).
There are only 3 housemen in the department, so 1 person have to take turn to cover both weekends.
As in med school, paeds = medicine / surgery for little people, condensed into a short time frame, so the reading list (as expected) is super long.. 2 pages, for a month long posting.

Jonah Neurosurgery call Part 2

Neurology has been 1 of my sore spots in medicine, but my 3-month neurosurgical rotation in Australia has been fun. Somehow, 2 calls in neurosurgery has completely ruined my impression of it :p lolz
After finishing work at 6.50pm during a long surgical day, was just about to grab some dinner and have a rest, when neurosurgical male ward called at 7pm. They needed somebody to call Kluang hospital's MO to accept a patient due to be transferred. It's funny how the person who wrote the referral letter earlier did not call them up as well.

Going through the case files, before I could figure out what to do or say, rushed to the Neuro HDU - 1 patient has asystole. Upon arrival and jumping onto the bed to commence CPR, the heart monitor reveals the rhythm to be ventricular fibrillation (this would be a very good time to try and remember what was practised during SIM centre).. The MO allowed me to play with the defibrillator (different from the one we used in Monash / Australia), so I delivered 3 shocks to the patient. Adrenaline and atropine given. No response. The MO told me to go do rounds since nothing much could be done.

Going back up, managed to call up Kluang hospital and push through the referral, only to be told that the Kluang ambulance people could not wait and had already left. So the patient is staying with us, whether we like it or not. Returning to the HDU, had the unenviable task of filling up the death certification and documentation, as well as informing the friends who arrived and family over the phone. So unprepared.. I think I did fine, but if 1 thing bothers me, CPR attempt was documented as 30 minutes in duration, when in actual fact I don't remember anybody bothering to go on even more than 10 minutes..

Was in the process of taking ABGs when the OT called to run for blood at the blood bank. An 8-year old boy whom we saw earlier when he came to HDU was undergoing craniotomy, but upon arrival at the blood bank with the patient's info, they denied receiving any forms for blood request. It turned out that of all the bloods taken, the nurse forgot the GXM cross-match, and knowing how difficult it is to take blood from kids in the middle of surgery, the anaesthetist literally blew up in the OT..

It's already midnight, and I have been running up and down, and up again to the paediatric surgery ward. New case for admission, as the poor little girl fell forward off her bicycle and hit her head on the handle bar. You know what was the best part of clerking her? Dozing off in front of her mum.. and to add another moment of laughter, when I drew the diagram of the haematoma, I was actually extremely tired and sleepy, so for some unknown reason I labeled the wound 'For bowel prep'. By the time I was done, started TDS rounds at some weird time in the morning - 2am at male ward, and 3.30am at female ward.

At the female ward, I was greeted to the sight of a patient who appeared tachypnoeic, which was being ignored by the staff nurse to my annoyance. Suddenly, she began hyperventilating / gasping, and you could hear wheezes from her tracheostomy. ABG: respiratory alkalosis. Gave her some nebuliser and trachymask oxygen. Sent down to neuroHDU.

My colleague, who came into NeuroHDU as I left, was greeted to a sight of 10 patients, and turned towards me and griped, "Why in the world did you fill up my ward??!"

Call ended around 6.45am. No time to shower / eat / sleep also.. start surgical rounds.

30

The following 30-hour marathon takes place between 5.30am (14 February) and 12.30pm (15 February).

6.00am - Leave for work.
6.30am - Start clerking patients.
7.15am - Patient came in for epigastric pain TRO acute cholecystitis. Amylase 2478. Acute pancreatitis! Quickly scramble with MO to work out our management plan.
7.45am - Another surgeon replacing my consultant comes to review patients. Changed the Ranson criteria to modified Glasgow criteria. When everybody (even the MO) did not know what is the Glasgow criteria and its significance, he called all of us @$$h****, and asked how in the world did I pass med school.
9.15am - For some reason, today there are only 3 of the usual 5 people in our team. So with 1 patient who needs to rush to the scope room accompanied by a houseman, 3 patients who need to be discharged, nurses bugging you for bunged IV drips and bloods to be taken, the pancreatitis patient who needed an ultrasound etc, the surgeon asks 2 of the 3 to go down to clinic immediately coz it's overfilling with patients and the 5 housemen rostered for clinic are missing,(obviously not possible, ward work needs to be done 1st).
10.10am - The usual routine of being yelled at by the radiologist.
10.25am - Cancer patient A needs to postpone chemotherapy due to electrolyte imbalance. Palliative care unit not picking up the phone.
10.26am - Cancer patient B needs an oncology opinion regarding her chemotherapy due to neutropenic sepsis. HSI not picking up the phone.
12.15pm - A patient previously discharged after a Hartmann's procedure got readmitted for wound breakdown. The ward is filling up.
12.55pm - Just when you thought you have finished the work and are about to grab a quick lunch, the paediatric ward upstairs called. As the neurosurgical HO on call, need to review a young kid who suffered a temporo-parietal haematoma after a fall from 1 metre supine onto the concrete pavement while at the playground.
1.45pm - Rush back to the ward to review patients for afternoon rounds.
2.35pm - Afternoon rounds start.
3.15pm - Our consultant surgeon came. Learnt a lot from him, though got grilled a lot also. Asked me to be more confident.
4.15pm - Apologised to head of department who happened to be in the ward, for failing to trace his patient's histopathological report. Simply did not have the time.
4.40pm - Just realised that the next day's on call roster has not been drawn up.
4.45pm - Patient suspected anastomotic leak post-reversal of Hartmann's, planned for CT gastrograffin. Rushed to take consent and fill up forms.
5.15pm - Patient who came in earlier for wound breakdown had seropurulent discharge when sutures removed. Surgeon was initially worried about faeculent material resulting from fistula.
5.45pm - Family of a patient who has recovered from an upper GI bleed due to a gastric ulcer demands that you allow her to be discharged as she has been feeling anxious and uneasy with her hospital stay, though you wonder how to break the news to them that you were actually awaiting medical opinion regarding beta blockers for her sinus tachycardia, and psychiatry review for her apparent symptoms of low mood, poor eye contact, symptoms of persecutory delusions (bed has electric shock) and hearing voices of children playing nearby. Eventually no psychiatry condition elicited, allowed AOR discharge.
6.30pm - After the tests were planned, confirmed, and everybody has gone home, patient who was planned for CT gastrograffin mentioned that she had the abdominal pain because the nurse clamped her CBD. She felt better after its release. Endured a scolding from a pissed off MO to just do what the boss ordered when asked opinion to cancel the CT.
7.00pm - Ward work done. No time for dinner. Grabbed a bun and start Neurosurgical HDU night rounds.
8.15pm - Wondering what are all the PEEP/SIMV/CPAP measurements which the consultants and lecturers all dismissed as not important for our level during medical school..
8.30pm - 8 ABGs to be taken, 4 turned out to be VBGs.. *swt* have to re-do..
10.30pm - Night rounds at male and female ward upstairs..
3.30am - Finished night rounds. Felt like sleeping in one of the ward beds. Blurring of vision sets in (hungry and running on 2 cans of coffee) :p
4.30am - Patient from Segamat suspected intracranial bleed. Inserted CBD. Patient decided to urinate before CBD could be secured with balloon. CBD was shot right back out of his urethra, followed by a fountain spray of urine. What a mess..
5.55am - Half an hour more before my presumed end of neurosurgical call (and freedom) when the HDU phone rang. Please come upstairs to neurosurgical ward female, a patient chose this moment to go into asystole. CPR for over half an hour and had to accompany patient back to HDU..
7.30am - Start morning rounds (despite it being public holiday)
12.30pm - Finally able to go home.

Week 2 in General Surgery - Things that keep you going

Currently listening: Hillsong - Love like fire

Surgeon: So Gary, do you like surgery enough to become a surgeon?"
Me: Err.. actually not that keen on things which require quite a fair bit of hand dexterity.
Surgeon: I see, so what do you prefer? Something which requires more of foot dexterity?
Me: *swt*

2 weeks already. Finished tagging and already went through 1 episode of Operating theatre on-call. Imagine the sight of laparotomies and colostomies at 2am in the morning. 2 hours of sleep before starting next day of work, making it 36 hours straight on the job. Nevertheless, I think I can say things have been good so far.

Fell sick while working during Chinese New Year, but no choice lar, since I am saving my leave for convocation in Sunway. Being a 1st poster in the ward, among mostly more senior and experienced housemen can be intimidating, but should be fine as time passes. My philosophy has always been 'I may not be the smartest, but I try to compensate for it through hard work'. Yes, did get scolded by surgeons for things which are not really your fault, MOs who are hard on you coz I was quite blur having forgotten a lot of things since leaving med school, nurses with attitude problems, and colleagues who disappear and dump their work on you.. Also have been thrown into the deep end by being called down to review patients in the clinic, despite being only 2 weeks on the job (due to staff shortage).

However, amidst all these, able to see the positive results of going the extra mile for your patients, some of whom actually walked up all the way to your ward workstation to shake your hand in gratitude, while 1 Chinese patient gave me an angpau and orange.

There was also a difficult moment with an elderly Malay patient. She was a known case of anaemia, had cholelithiasis and was due for a cholecystectomy. Initially she was allowed to eat, then fasted, and the cycle repeated for 3 days in a row as her surgery kept getting postponed. Her young daughter, whom had taken weeks of leave from her workplace in Simpang Renggam, broke down in front of me, at the sight of her mother having to endure such a fate. Duno what to do or say, could only offer reassurance and a packet of tissue. When the surgery was over, the T-tube dislodged, and they had to go back in to adjust it and correct the peritonitis. By the time they were done, she had severe metabolic acidosis and altered mental status. Despite her daughter's frantic cries at the bedside, she could neither recognise her, nor me. Honestly, I was trying very hard not to shed a tear.. but we did all we could.

To cut the long story short, she did come out of ICU a few days later, anxious to go home after bouts of physiotherapy. Today although I was not the one to write her discharge summary (as I'm not rostered for work), she doesn't need me now - her family is currently by her side, and the last sight as I walked out of the ward was that of her daughter's face brimming with a smile. Priceless :)

A GPS Christmas