Lets grow wings and just float, shall we?

"when hair falls off and eyes blur And
thighs forget(when clocks whisper
and night shouts)When minds
shrivel and hearts grow brittler every
Instant(when of a morning Memory stands,
with clumsily wilted fingers
emptying youth colour and what was
into a dirtied glass)Pills for Ills
(a recipe against Laughing Virginity Death)

then dearest the
way trees are made leaves
open Clouds take sun mountains
stand And oceans do Not sleep matters
nothing;then(then the only hands so to speak are
they always which creep budgingly over some
numbered face capable of a largest nonglance the
least unsmile
or whatever weeds feel and fish think of)"
-ee cummings-

Let's Whip something up

I vowed to myself that amidst my surgical posting i shall put up numerous educational posts. But alas, time has eluded me and so here i am, up and awake at 1 am supposed to be studying for the much-anticipated rounds tomorrow with a very fierce attending, Dr. R...Digestive Surgeon..and as i was reading, i thought; why not?

i'll teach you a thing or two about surgery :p
so here goes. Tonight we shall learn about the 'Whipple Procedure' which is what MY patient will be having tomorrow morning at 7 am sharp.

this diagram is of an abnormal pancreas. Where a tumor has develop BEFORE a whipple procedure is performed.

In the beginning of the procedure, the surgeon will decide whether the tumor can be removed. The pancreas is examined by an open incision or by laparoscopic instruments. If the cancer has not spread to surrounding tissues, your surgeon will continue to perform the Whipple procedure.

The overall goal of the Whipple procedure is to remove the head of the pancreas and the attached section of the small intestine.  First, the end of the stomach is divided off and detached. This part the stomach leads to the small intestine, where the pancreas and bile duct both attach. In the next step, the cancerous head of the pancreas is cut, leaving it attached to the small intestine. Farther down from the pancreas attachment site, the small intestine is divided to free the section of the intestine that is connected to the pancreatic head. The bile duct is the last connection to be cut. This leaves the gallbladder and common bile duct attached to the removed section.

The next steps reconnect the intestinal tract. The stomach is connected to the small intestine, and the bile duct and remaining portion of the pancreas are reattached.

              Several tubes may be implanted for postoperative care. To prevent tissue fluid from accumulating in the operated site, a temporary drain leading out of the body will be implanted. Also, a G-tube leading out of the stomach will be inserted to help prevent nausea and vomiting, and a J-tube inserted into the small intestine will serve as a channel for supplementary feeding.  - taken from www..debakeydepartmentofsurgery.org-

okay, sekian terima kasih :)

2010

- Ace all my 2nd year clinical exams. No repetitions!

- Graduate by December 2010!

- Recite the Quran everyday and finish at least once this year! Amennn

- Buy meself a Blackberry!  (yippe!)

- Clear out my closet and re-organize!

- Travel Travel Travel (Bali is a MUST)

- Learn to swim & Dive ;)

- Attend besties weddings!

- Save at least RM 5k for my travel fund :)

- Read more books (leisure & medical)

- Consume healthier meals & NO MORE FAST FOOD!

- R-E-L-A-X 

i don't know. i'll add more when anything comes to mind :)

Yuletide and Snowmans

A very Merry Christmas to those that celebrate the red and green themed occasion. :)

Ho Ho Ho. Wish i got to go to a friends Christmas Party way over in Msia. sighs,. all the cookies, and puddings and good people i shall not see.

...feel like packing up and flying home. hehe.

i have to toughen up.

Cheers all.

Scrubs or no scrubs

You know your being upgraded when you get "called" to scrub in when others are not.
And no, its not just to hold a clamp in place or suction the oozing blood.
But suturing the tendon or actually to hold the saw on an amputation.

Score!

It pays to be hard-working after all.

You can call me stupid if i mess up. Never lazy. Ever.

                                                    Elephantisis scrotalis - operation 21/12/2009 (face left oout for privacy purposes) and no, he's not sitting on a pillow..that is exactly what it says. scrotalis.

necrotic burn wound. amputation in 2 hours. yeah. i am assisting ;)

mild contracture

auricular keloid

in other words. aesthetics scar removing operation tomorrow.

Knives and Forks

   A surgeon is like an artist, instead of using a paintbrush to create art, they use knives, a ten-blade (as you keep hearing them call out for in grey's anatomy, or ER) to help mold the human anatomy and restore function or aesthetics to their 'Art'.

   I think in every reference of surgeons in general, you can say they are the 'jock's ' of the medical field. If not i, they themselves consider surgeons the 'jocks' of the medical social scene. They walk tall, full of confidence, no fear, and just reeks of an aura i can only describe with words.

   I used to think that it would be cliche'; but being in my 3rd week of surgical rotation. I just have to say it. Surgeons are uber-cool. :P

  Of course, there are moments when i can hate them in an instant, but still marvel at their meticulous skill. Some are neurotic perfectionist which can be hard to bear, maybe even IMPOSSIBLE to bear but still.
Being in the ER for 2 weeks, i got to see first-hand, how the doctors deal with the most gruesome of situations. Imagine watching Grey's Anatomy, where they wait by the door in gloves and aprons for the ambulance that would bring i n anticipated patients? well, over here it's quite different.
We wait inside the hospital, with only our gloves as the protective barrier for us to handle the mess.

    Left right and center are patients with obstructive ileus, stab wounds, head trauma, multiple fractures, open, closed, you name it. But the worse is not the big bloody mess of a patient. But the seemingly normal one, walking in in a sarong covering a 2 year old tumor that is bigger than the patients head, oozing pus and necrotic tissue (dead skin). Oh wow, the smell will push you out of this world. And sticks on you- for days (maybe thats just my paranoia).

   And my job as the junior doctor? There are no nurses in the ER. we check the patient in, assess his/her A,B,C (Airway, Breathing etc), plug in the infusion needle, urine catheter and NGT if required.Any wounds, we get the liberty to be the ones cleaning it and suturing.

     It is tiring; but once you're in the heat of saving that patients life...it just feels worth it.
I was posted in Akademis Hospital last week on my own to assist 2 Surgical residents there. I was in charge of all operation prep procedures, clerking patients in the ER as well as rounds every day at 5   am and 4 pm in the wards.

    The best part of each day was the operations i get to see. If i was lucky, and the Attending is somewhat excited to teach, i get to scrub in and assist. (Photo of an OREF i saw, i assisted an ORIF repair on a fractured femur. but no photos. :( )

I never knew i could feel so excited about holding a clamp. Maybe its the air in the operation theatre. Maybe its the fact that sometimes you get to close up the patient. Maybe its because all is well so far.

8 weeks to go. This photo is a photo of a trepanase procedure, where Burr holes are made in the skull to release trapped air that caused an increased intracranial blood pressure.

Can't wait.

There's something wrong with Lord of The Rings

I read thi from a friends' page; Jason Leong. i thought it was funny and worth a mention. read it. :)

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When the dust has settled, and peace restored to Middle-Earth, once the mighty Sauron has collapsed, one applauds at a beautiful trilogy masterfully made by a genius equal to Tolkien himself, Peter Jackson. But now that I have time to reflect and swirl my thoughts about the plot, I realize that something is terrible wrong with the story of how Middle Earth was saved.

Here's what's wrong : I think Sauron should have won.

I mean, ya gotta give the guy credit. He was BRILLIANT! I mean, he created the One Ring, which controlled many other rings, which controlled the dwarves, the elves, etc. It gave the wearers a false sense of security, as if they were in control, but in actuality, they were not! The same concept can be seen today in pyramid schemes! Sauron was way ahead of his time man.

Okay, then he controlled Saruman, who looked extremely dodgy in the first movie, like the classic I-act-like-a-good-guy-but-

actually-am-the-bad-guy-just-wait-for-the-plot-twist kinda character. I dont trust Christopher Lee's eyebrows. Saruman then built this massive Isengard, which then had massive factories which built cruel war machines. Now we see Sauron embracing technology to achieve his goal.

First politics, now technology. Sauron can do it all.

Then, mastering genetic modification and biology, he created the Uruk-Hai ( which sounds like a bad Chinese word),a cross breed between Orcs and Men. Not only did he bred them, he assembled them into an army, giving them weapons and armor, and organizing them into an effective fighting unit.

One by one, cities in Middle Earth felt, in a meticulous decimation by Sauron's forces. Sauron was a tactical genius.

Then came Helm's Deep, and we all know what happened there. It is at Helm's Deep, where the first injustice occurs for Sauron.

Sauron had what, 10,000 soldies, outnumbering the Men. Not only that, they managed to break the fortress, something never done before. Then, in a matter of 10 minutes, his armies are defeated by Orlando Bloom skateboarding down a flight of stairs and....SUNLIGHT!!!!! The Black Evil , the Uruk-Hai, The Lidless Eye's army, the black shadow spreading across Middle Earth...were BLINDED by SUNLIGHT and then defeated? How is this realistic?

But Sauron was not one to give up. No sirree, he had perseverance,determination and the unwillingness to give up.He regrouped, and sent more armies, this time to thrash Minas Tirith. Sauron, ever the strategist, also sent warships BEHIND minas tirith to ambush them while they were preoccupied with the war at the front.

The Men were outnumbered. Many of their kind had died. THeir spirits were broken, and Legolas's hair was slightly out of place. They were about to be defeated, and rightfully so, for the master strategist had already beaten them.While the men were fragmented, Sauron's army was relatively united.

Then suddenly, Aragorn talks to a bunch of GHOSTS in a random CAVE and decimates the ENTIRE SAURON ARMY!???!!??!!?

Apa ni???

Who doesnt pity Sauron just a teensy weensy bit? I mean, cmon!