happy birthday - my beloved country...

it is the great day again...

I had been telling Ving that one of the 831 I would like to stand at the merdaka square joinning the crowd for the glorious moment - Ving just told me to stop dreaming...indeed, it become more difficult for me to fulfill my dream...there were always something disturbed my merdeka square journey...now, with Yun going to primary school it had become impossible - in fact this is day 2 of her primary school....I was thinking to enjoy a day off but Ving told me that better go working and earn some cash (46" LCD here I come...)

The end of my 1st months as a physician - a completely different life as a ED physician. More responsibility - now no more hit and throw patient to other people service...Patients are placed under my name, I got a table in the attending physician office(in fact I still spent most of time at the old call room : 175). 175 was the ext no of the ED call room, I had been this room since 11 years ago. There is a TV and now, I got a internet line here...So I felt more comfortable here than the office..Did I enjoy the life ? I am adjusting myself actually, but the 2.5 days weekend off cheer my life up. Spent every weekend with the family is something enjoying.

Today, while I was doing the ICU round, my cardiologist walked in and I greeted him "morning". Surprisingly, he spoke the word" merdeka". I grinned at him and raised my right arm and answered" merdeka" - well, at least it cure my home sick...half of the doctors in this hospital are Malaysian - all of us love the country....happy birthday Malaysia...

A patient who helped me with my viva...

This is middle-aged male who presented to ED with palpitation...average Taiwan aborigine.

 

 

 

I first saw him during my 1 years of practice, I was in charged of the emergency department then. Below is his EKG...

 

 

 

 

 

My spot diagnosis was PSVT then- usual antiarrythymia drug was given and he was discharged later. He had multiple episode of attack and most of the doctors in our hospital saw him. Sometimes - procainame works, sometimes verapamil work, however his symptom was settled most of the times in the ED. Until one day, he was seen and managed by our cardiologist and he was diagnosed as WPW syndrome. I smacked my head when I saw the cardiologist's note written at the front page of his case note - I missed it...A little embarass for a graduate from my college - during the our school days, there was this topic special on this WPW syndrom, an old professor who was very specialised in it. Well, so the verapamil was off from the antiarrythymic arsenal for him. I recalled there was 1 time when I had tried every drug I had ( minus adenosine - it was still a rare drug then). So I took my risk of giving him a dose of verapamil and successfully reverted him to sinus. But some of the doctors still refuse to do so and few times he was referred to a bigger hospital and got admitted.

 

For the past 10 years, he had seen in our hospital for 200+ times. The cardiologist had suggested him to go for EPS and ablation but he refuse. To make things worst - he had bad veins. There was a few times when I need to insert a int jugular line for him.

 

 

 

Today he came again...now he had developed atrial fibrillation - he had presented with the same old symptom - palpitation. However the EKG shows atrial fibrillation with short run VT...I load him with 300mg of amiodarone parenterally and his rhythm was reverted to sinus after 20min...he was discharged again.

 

 

 

This patient had saved me during my viva of the internal medicine examination. The examiner displayed an ECG through the projector and I did spot diagnosis - WPW.