Flash back

 It is a good time to flash back what had happened this year. I had continued to advance as required; gaining some new skill on programming, sharpened my skill on pocus and build up some muscle. I had completed the long term care course and acquired the registration qualification.

Yun had gotten into what she wanted and doing well. Xian had decided what he wished in the future and preparing for the path.

We had lost one of our pets; Titi had succumbed to malignancy around spring. Dragoncat is still holding on and hopefully we could keep her longer.

I had upgraded our projector to 4k after Xian won a buying option for PS5 on a lucky draw. For optimal performance, I had replaced our receiver and added 2 speakers onto the roof for Atmos. Well, stunning experience with UHD, but cost me a hand and a leg, good news was I am not looking forward to go to any cinema for movie in the near future.

I had been to the cinema three times in the midst of this pandemic, twice for TENET and once for the movies with the prohibited 3 letter words.

It was a rewarding and memorable year for me…however I reminded myself, not to be over joy as many had lost their life and more had suffered due to the pandemic….

The last day of the year

 Last day of the year and it is freaking cold as the island is stormed by the most severe cool front in 15 years; 12degree C when I climbed out from my warm bed...

I had to sit in front of the desk until 10pm and head back for the count down; it is an easy shift until now; travelling will only start tomorrow as today are still a working day.

The identification of 2 Covid19 cases related to the B117 British strain had shut down the country. Although no massive of local transmission was noted, the local authorities had halted most of the countdown event. Only 2 events are active; a concert going on at the east coast and the countdown around 101 building at T city.

I had several occasion taking swab test with full gear for suspected cases but however none of them came back positive. Although most of the places on the earth had shortened the quarantine period to 10 days, the island had still follow the 14+7 standard(14 days of quarantine with 7 days of strictly mask wearing when you are not alone). Play on the safe side is still the key....

The peace of mind however did not pacify my disturbing soul; I still missed homeland, everything of it, relatives, food….

Homeland had eventually given up on zero cases. We are seeing daily cases of four figure; 100+ ICU cases and 60+ respirator dependent cases. The strategy had apparently shifted to as long as the medical capacity is not overburden by the active cases, we can live with it. Indeed, you will not die if you got infected, but if no job, you are going to die every soon without income…

I had no idea how bad was the condition but some of my relatives were affected, they are still hanging on but would not hold on longer if the condition continues.

How long? It would be at least 8 months to execute a massive immunization and another 6 months to see the effect. So I don’t see any possibility I could step on the blood spilling land for another year...

Few more hours before going off and I had prayed deeply that everything would be the same when I laid my foot on the land again…  

three for a night

 It was a calm night shift until I expanded my portable army bed preparing for a good night retreat at midnight. Just after the setting up of my bed, I was called to see a patient came in for chest pain. The initial EKG12L had ruled out myocardial infarction and he was treated accordingly. The first round of pain killer combo however  did not resolve the pain and I had ordered an aortagram to rule out aortic dissection.

As I was stepping back into the call room, a police had brought in a patient complaining chest pain. The police claimed that he had run amok around the village and finally calm down after a chase. They had stressed that they did not used force to apprehend the patient. A friend that came in with them had however said that the police had forced him down from the roof. He had added that the patient was his construction co-worker who came from the east side. A relative had introduced the patient to him and had withheld that he had psychiatric disease.

The patient was tachycardic and normotensive. A immediate EKG12L was done and no sign of ischemic change. I had used to accept all the history input even if they were contradicted each other; I presumed that he had sustained trauma and most probably had an injury to his chest as his abdomen was flat and no tenderness was noted.

While preparing him for a CT with enhancement (he was 2^nd place in order awaiting the completion of the aortagram), another patient had presented to our ED. The patient was diagnosed as acute myocardial infarction and referred to a hospital up north for intervention as requested by the patient. On enroute, the patient had desaturated and the nursing personnel had decided to stop over at our hospital for further management.

Patient was irritable due to hypoxia and the initial bed-side sonography had revealed poor cardiac contractility and pulmonary edema. I had to intubate him prior to emergency percutaneous coronary intervention. His BP had crushed after the intubation as expected and I had to insert a central line and infuse dopamine to hold him long enough to the cath room.

It was 1+ hour later when I came back to see the trauma patient. He had looked paler and his abdomen had bloated. Apparently he had internal bleeding I had started another round of resuscitation in ED for this trauma patient. As the first patient, he was intubated and central line was inserted plus a load of blood product.

During the resuscitation for the 2 patients, their BP had reached a low of 30mmHg and with aggressive intervention, both of them had made it to the cath room and OR. The traumatic patient had proven to have a splenic rupture later by cat scan.

The other patient was a dud...after concluding three of them, I had managed to sunk into my bed at 5:45am...It was 20 minutes later when the swamp of morning patient rushed in....

It was a exciting night; with only 2 nurses and a aide, I was able to get the appropriate job done despite of the manpower issue. I just don't know how long can I keep myself in this shape to tackle similar scenario...

At my age, I am at the verge of going downhill, learning had become harder for me due to aging; however I thank the great one for his kindness to allow me to go through all this thrill and excitement...

The license path...

 I remembered one of the most important events for high school student back in my days was getting a bike license or driving license. Unfortunately due to financial constrain, I had left for my study abroad without getting any of them.

I got my bike license few months after I entered med school. The local authority had come to our school setting a exam track and tried to pass every student who took the exam.

However I got my driving license after I returned to the homeland just prior to my service with the MOH. I still remembered my solo drive from my house to buy chicken rice at noon after a big sweep in the house before CNY.

Compare to homeland, the local traffic condition is more friendly to bikers and a bike is a more convenient way of transport than car. I had urged Yun to get her bike license when she attained the required age however there was always something going on and she never gotten the chance to go for it.

As we don’t own a bike in the house, we had no way of letting her to practice her skill and prepare for the exam.

I had bought an electric bike for her to learn and however without proper coaching she failed her first test. After a few inquires, I had located a driving school nearby our house and she had signed up for a car and bike course.

The whole journey was eventful; she had  failed undang(over confident without proper studying) and also road test(just couldn’t explained why)….

The best and worst part was an motorbike accident on her first solo ride…a skidded attempt at cornering ended up with multiple wound (BAD!!!!)and good lesson for her to be very cautious later when she go on the road.(GOOOD!!!)

Yun had gotten the bike of her choice later and the electric bike was left to me. The bike was more convenient when we went around the town as parking lot had been less and less nowadays

Gadget for university

As Chinese proverb said, “One need to have a good tools to facilitate his works”. I had tried my best to provide them with good gadget on their path of study.

Yun was hanging with my Asus Zenbook with a i7 CPU obtained 5 years ago. I passed on the notebook to her when I bought a Surface Pro. The Surface Pro was great with the touch screen but otherwise, suboptimal for daily use. The old Zenbook although came with a i7 but yet it was marked as U and on par to a desktop I5. But Yun had a great time with it.

When Yun admitted to the university nearby, she had built herself her own desktop machine under my instruction. An I7 with 32gb RAM, equipped with a GTX1070 ripped from Xian computer.(Xian of coz, upgraded his to RTX2080)…

She had completed her port folio for university entry interview with both the gadgets.

When she accepted the offer at FJ, I had decided to get her a new laptop; although she insisted that she can still go on with the old Zenbook, I told her she need something solid as she will be carrying it to class very intensively in the future.

She wanted a Zenbook and I told her, it is not rock solid as Asus claimed and we need to get something military grade. That limited our choice to Dell, HP and Thinkpad. I got my Thinkpad many years ago and like any other Thinkpad user; it scorched a deep impression in most of the user.

We had communicated a few times and Yun had done the sourcing herself. She communicated with the sales on line and got a good bargain, truly amazed me, if I was the one who do the sourcing, I would just tick online and enters my credit card detail.

It was expensive sending kids to tertiary education….I had a relative who could barely support himself, baldly gotten married and currently expecting their first child. I just couldn’t imagine how the child could be raise, but yet someone will always said, in the past there was some parents who raised 8 children with income of  RM800/month.

     

     

The road I never travel.....

 

The road to collage had been rough for Yun. She had been very independent and things did not go the way that I had wished. Yun had special dreams during her final few years in high school. I had been giving support but sometimes what she asked had been way out of my expectation.

Those extraordinary thought like taking up a tuition course in Mainland while aiming for top design school in US, or studying in a night school for undergraduate Japanese language course at the northern tip of the island while preparing for university entry examination were presented to Ving and Me during the last few months of her high school days.

We did not approve her idea and finally I successfully persuaded her to take up the course she was offered – a multimedia design course at an university near our area.

The university was 20km and it was quite late when Yun decided to take the course. We had a short duration to prepare her for the course. She was not eligible for the hostel (home residence too close to the school) and luckily there was this private dorm with single occupancy nearby the school. Price was acceptable and it was 300m from the university. The room came with a small balcony but unfortunately located on 4^th floor and did not come with a lift. Well, nothing much to shout as Yun was till aiming for another course and I had told her that she might need a suitable environment to prepare herself. She had adapted well as she was good at this multimedia topic; she had performed well and won top prize in the school design competition. However she wanted something else.

During the last few months of her high school days, she had taken an active part in the organization of the graduation prom for the whole county. Their working group had presented a ticketing app and light shinning app which could coordinate mobile phone torch light in the prom.

Both app was developed with app inventor; very basic tools but it was a success. The ticketing app was initially tendered to a vendor and after the company failed to deliver, Yun had thrown out a usable app and presented to the county administration and the tender was awarded to her.

She had gotten report over newspaper and letter of thanks from the county administration for her contribution.

Unfortunately these stuffs came after the application phase of university.

She had prepared her port folio with this result and started application at the end of 1st semester through the talent selection program. Talent selection program was initiated few years ago by the ministry of education for talented students who do not have outstanding academic result to apply for undergraduate course in university. Seat was very limited and only less than a handful of seat was available each year.

Some of them needed interview. My brother had a chat with Yun when we met during CNY this year and told me that if interview is needed, Yun would definitely be selected as she had great presentation skill.

Indeed, my brother was right; Yun made it to list and there was the only university who asked for interview.

I still remembered that day she went for the interview. We took the high speed rail as  2 interviews (different faculty) was scheduled on the same day. The university was located beside the famous FJ night market in central part of the island.

We headed to the high speed rail station early that morning. Yun was prepared and she had put on a former suit with black blouse and white shirt that she seldom worn. She was nervous as I could tell from her eyes. We arrived at the station on time and took a cab to the school. I wished her good luck before the interview building and gone to the park nearby for a rest. I did not want to be one of those parents who nervously sent their kids to the doorstep of the interview room. It was her fight and not mine and I would need to show her that I backed her up all the way and not fight the war for her instead.

After waiting in the cold wind around the park nearby for 2 hours, Yun finally came out and she told me everything went smooth and the interviewers were satisfied with her, however they told her if she did not make the list she would be definitely chosen should she apply via the normal examination pathway.

It seemed that we had one ticket in hand and Yun was more confident during our chat during lunch. We found a good Korean restaurant nearby the school and I reassured her that she would make it. The afternoon session started at two and I had waited around the resting hall this time instead of open air. The waiting was a torment...

The interview lasted for 1+ hour and Yun told me that the professors were more interested on how she got the tender rather than her skill..

Anyway both interview gone smoothly and Yun made it to the list for both faculties. She had however opted for computer engineering after deep consideration…The hunt for hostel room,laptop, and driving license had just begun…..

still pending...

 

Months had passed since the disease crawled along the earth; I was lucky, the region I worked in had been freed from the terror. During the past few months, I had suited up for a few times to take throat swab for suspected cases but however none of them was positive. The tension had regressed to sub-normal and although I still follow strict protocol at work and wear mask while wandering around. Some of the public had started to neglect the necessity of taking precaution.

Life was nevertheless better than in the past but pending the international situation, we are still sitting on a bomb…

Reverting to normal life will be a dream for the next 2 years as no country will open up their border easily. Any foreign travel will be started with quarantine and ended with quarantine which lasted 2 weeks each; I do not have the luxury to spare the time….returning to Homeland will be a dream for everyone of us…

MCO and beyond

The successful implementation of 3 stages of MCO had flattened the curve and moving toward the lifting of such measures. The government had not revealed any detail and apparently is at the drafting stage.

The South Korea had demonstrated a similar situation as in Malaysia during this Covid 19 rampage. A cool period which both countries shown a good control and later an outbreak due to a specific religious cluster leading to a massive uproar of figure. The advance in technology of South Korea had however enable them to produce rapid test kit, GPS + mobile phone tracking system which enable the authorities to track down the victims, suspects and contacts. Their daily cases had decreased steadily since earlier this month and approaching single digit recent 1 week.

Malaysia lacking of those tools had however maintained a good control and paving itself toward a similar path.

The price was a total lock down jeopardizing its economy and daily routine of its peoples. The problem Malaysia facing at the moment is producing a good exit strategic for MCO.

The key to the success of South Korea controlling the Covid19 was not the tools they have but the self awareness of its peoples.

As quoted by Eun A Jo in an article posted in THE DIPLOMAT:

“While important, these governmental measures would not have been effective without the large-scale cooperation of the public, the imperative for which was painfully learned.”   

The painfully lesson of MERS in the 2015 causing many fatalities was due to withholding of information by the authority. The amendment of its infection control act had empowered the minister of health to collect essential data for contact tracing and also allow the public to assess crucial information regarding the spread of the disease.

It is a trust of both parties where violation of human right was definitely noted during the stage of pandemic.

The Malaysia had however lack of similar condition where people was not terrified by any plague like disease in the past 20 years. I remembered during my days as a house officer, the central part of Malaysia was haunted by the Nipah encephalitis. Initially it was considered as a JE outbreak but later it was proven otherwise. When I left Malaysia, SARS was terrorizing the Fareast; I remembered the KK I worked in had only 2 N95; which were the only PPE we had.

For all those years, my homeland has not been disturbed like what we had experiencing at the moment.

Well, it had been a good fight with the cooperation of the rakyat as the figure had been showing progression as time passed. However the challenge had only started as the exit strategy had to be implemented in a near duration.

The self awareness of rakyat is the most crucial part for the maintenance of the post MCO phase as China had shown the resurging of figure as they lifted the lock down. With more than 500+ arrest a day, our fellow rakyat will have to do better to ensure we had a smoother transition from the lock down.

The DG had however stressed on travel ban and it is a good news as our neighbor countries are not doing as well as we had so far.  

lock down....

It had been one of the worst periods since my practice. I had been through the SARS and it was kacang puteh compare to our current condition. At that period, we knew who to be aware of, but now we don’t.

Wearing PPE is currently not practice in my setting at the moment, but yet it might just hit us any moment.

Home land had deteriorated since early March after the big castle gathering leading to a massive cluster. Lock down implemented and it had gradually evolved to curfew-like condition in some area.

I had made calls on regular basis checking my parents living down south. Good news was my brother had returned from China and currently staying in the house, levering the burden of my sister-in-law. With my brother at home, everything is cooled and I really thank him for handling matters around my house at the moment.

Only less than 20 countries that were spared from this disastrous plague, most the heavily bashed country had started the lock down measure which proven by China to be effective in controlling the spread.

Medical staff elsewhere around the world had been battling the disease with their best effort and yet I am currently still comfortably sitting at my desk…I felt sorry that I couldn’t help my fellow Malaysian counterpart to ease their burden. I could just only pray for them hoping that they could hold on to the fight and win the battle eventually.

about the Indian dress

It is one of the darkest periods since I started my practice…When I returned for my training, SARS was haunting our society. We had massive community transmission, in-hospital transmission and the disease itself was so terrifying, patient suffered from severe respiratory distress and face either death or serious sequels in the future. However it was a period where we knew who to watch out for; only those febrile would transmit the disease. Febrile patient was seen outside the ED, rapid test was done to confirm if they were safe.

SARS- COV-2 is not same as its predecessor; those infected might not have fever, just only cough or ASYMPTOMATIC….We had facing the enemy we cannot see… blind folded…

The local authority had however made the hospitals believed that by screening fever at the gate could stop the disease. Slow down – yes, but STOP might not be practical…. Eventually all measures would fail as the only way to stop the disease is do what KJU did, which could not be attained by any democratic country. We are apparently losing the war, slowly.

The local authority had however had a good start by controlling the face mask distribution and production during the early stage of the disease. The safety supplement for all the hospital had been raised from week to almost 30 days at the moment. Nowadays, you do not need to queue a long duration to buy face mask (limited to 2 per week[ 3 starting at the end of the week]),  but some area are still facing shortages, however there are a few apps that could show you the storage of every pharmacy in the country.

Even now the local authority is still trying to tell the local peoples that there is a limited spread of the disease in only a few families instead of community transmission; but for us, the defense line had retreated from the immigration gate to the city street…

The declaration of community transmission would cause massive panic causing a further dampened the supply of face mask. If the truth is revealed, people would panic and wish to put on their mask all the time outside their residence. Imaging that you would need to supply one face mask to 23 million peoples every day (the current production is 8 million per day)…A lot of people had started to buy cloth to make their own washable cloth face mask (which could be reinforced by adding a middle pouch to insert a non woven fabric to strengthen its protection ability); Ving said that the textile shop was filled with peoples trying to buy cloth, it would take a few hours waiting time to be served.

There is still no local transmission case noted at the southern part of the country. I sincerely pray that it would stay the same for as long as it could.