Ishaemia-Reperfusion Syndrome

Aku baru start study surgery balik. Mase study bab shock, aku terbace bab ischemia-reperfusion syndrome dalam buku bailey & love's. Aku rase ramai budak2 medic esply Alex tahun 4 (skang tahun 5) yang tatau pasal ni sbb aku tak jumpe dalam slide lecture. Bagi aku benda ni sangat penting!

Sape2 yg ade buku surgery bailey & love's bolehla bukak m/s 13 part bawah sekali. Or boleh click link ni -> hamba wiki

Secara ringkasnye patient tu systemic hypoperfused, so cellular & organ damage progresses sbb direct effect of tissue hypoxia & activation of inflammation. Patient ni maybe ade hypovolaemic shock contohnya. So kita mesti nak correct volume & hypoxia tu. Kita pun bagila saline & oxygen. Tengok2 condition jd worse & patient tu maybe mati sbb cardiac arrest.

Sebenarnye ape yg berlaku tu la ischaemia-reperfusion syndrome or wikipedia kate reperfusion injury.

So management utk kes camni dalam buku ni sebut by reducing the extent & duration of tissue hypoperfusion je. Dalam wiki - aortic cross-clamping, therapeutic hypothermia & yang aku berminat nak tau dgn mendalam, hyrogen sulfide, H2S.

Ok, tu je utk hari ni. Good luck 10 malam terakhir ramadhan ni, sama-sama rebut pahala insyaAllah dan good luck kpd sape2 yg ade exam.

Mohd Peng

Where Did I Go Wrong?

Awak pernah dengar tak, orang laki pun ada maruah?




Saw the world turning in my sheets and once again I cannot sleep.
Walk out the door and up the street; look at the stars beneath my feet.
Remember rights that I did wrong, so here I go.
Hello, hello. There is no place I cannot go.
My mind is muddy but my heart is heavy. Does it show?
I lose the track that loses me, so here I go.
And so I sent some men to fight, and one came back at dead of night.
Said he'd seen my enemy. Said he looked just like me,
So I set out to cut myself and here I go.
I'm not calling for a second chance,
I'm screaming at the top of my voice.
Give me reason but don't give me choice.
'Cause I'll just make the same mistake again.
And maybe someday we will meet, and maybe talk and not just speak.
Don't buy the promises 'cause, there are no promises I keep.
And my reflection troubles me, so here I go.
I'm not calling for a second chance,
I'm screaming at the top of my voice.
Give me reason but don't give me choice.
'Cause I'll just make the same mistake,
I'm not calling for a second chance,
I'm screaming at the top of my voice.
Give me reason but don't give me choice.
'Cause I'll just make the same mistake again.
Saw the world turning in my sheets and once again I cannot sleep.
Walk out the door and up the street; look at the stars.
Look at the stars fall down.
And wonder where did I go wrong.

* Good luck test awak. Terima kasih buat saya macam ni. Abes test nanti, silalah bagitau saya yang awak tanak saya lagi dah. At least saya tak tergantung macam ni. Jangan seksa saya sangat, saya pun manusia.

A Rule of Middle Finger

Kadang-kadang hati kena keras. Kita buat baik orang pijak kita. Kita boleh buat pape, boleh terus baik, tapi aku nak macam ni.

Kamu pulak nak yang mana?

Yang ini?

Atau yang ini?

Kasar eh? Yang ni lembu sikit, ok?

Yang lembut pun tanak. Yang ni camane?

Dahla, buat je la pape yang kamu nak, fuck off!

Mohd Peng

ER 4

Malam ni pegi ER dgn we. Anip yb dtg lambat skit.

• Hari ni aku sedih skit sbb operation room kt ER traumatic tu tade surgery. Awal2 sampai ade la 1, tp tak ramai org plak. So aku tak tgk surgery ari ni.
  
• Hari ni ade kes antihistamine chlorpheniramine overdose, nitroglycerin overdose, atrial fibrillation, gunshot wound kt right lung, kes2 trauma org kene pukul sampai lebam 2 biji mata, eksiden & lain2. Kitorg dpt gak la belajar resuscitation skit2.
  
• Hari ni aku jumpe member arab 4 org, student nk masuk 5th year 2 org('ala' & sape ntah sorg lg) & nak masuk 4th year 2 org (ahmad & mahmud)... Dalam ICU kt ER outpatient mahmud ajak aku buat resuscitation utk sorg mamat arab, eksiden. Aku tanye doc kt situ, bape lame kene buat resuscitation tu, doc kate sampai dapat mech. ventilator. Kitorg buat insufflation je sbnanye, pakai ambu bag tu sampaila doc transfer patient tu ke ICU traumatic unit.
  
• Mahmud tu cam beserla, aku ingatkan die resident, tp time die nak buat iv cannula tu tetibe nurse ajar, so die student. Aku pun mintak nak buat gak iv cannula, die pun gtau nurse kt situ. Tapi syg skali sbb time tu dah dekat pukul 1, tak byk patient plak. Aku ingatkan kene tunggu doc suruh baru boleh buat IV cannula or pape basic procedure tu, rupenye ckp kt nurse je. Nurse tu semangat gak la nak ajar aku, haha.. sampai mcm nak paksa patient plak. Tape, esok luse aku dtg target nak buat iv cannula. Mahmud buat iv cannula ok, tp bile die nak amek blood sample utk patient lain, kantoi plak. Patient tua, bape kali cucuk ntah, tak dpt2 blood. Last2 nurse td dtg tak sampai 30 saat je buat, haha. Tp ni mmg beser la awal2 kan.. Pastu anak laki patient tu cam tanye2 apsal Mahmud buat tak jadi, nurse & mahmud tu cover baik je la.. hehe, standard.
  
• Ok first case antihistamine chlorpheniramine overdose, pompuan. Doc buat ECG & ECG die normal, doc auscultate, pun ok. So patient ni just kasik gastric lavage & maybe IV saline.
• 2nd case nitroglycerin overdose, pompuan muda, nangis2. Die ade deep shallow breathing, lebih dari 20 bpm. Doc buat ABG, resp. alkalosis. ECG die aku rase normal jgk. Tp tak follow up plak ape treatment die.
  
• 3rd case sorg nenek ade atrial fibrillation, just tgk doc buat ECG. Aku tgk kejap je, awe tgk lame, sbb ade patient emergency, die eksiden & ngadu abdominal pain. Besernye mmg org tekan2 kt sternum or in between eyebrow tu.. Aku nampak doc tu buat camtu. Tapi doc tu picit kuat2 nipple mak cik tu sambil sebut2 name die... hehe, skill baru ni. Then doc transfer patient tu ke ER traumatic sbb dorg suspect ade intra abdominal injury kot.
  
• 4th case - budak laki dalam belasan tahun, gunshot kt right lung, perforated wound. Tataula budak kecik tu buat ape sampai kene tembak, tp nasib baik la tak kene kt jantung or kepala, panjang lg umur die. Die kene tembak dekat depan skit dari mid-axillary line, dalam 4/5th intercostal/costal area, lubang dalam 2 x 3 cm. Doc2 resident berkerumun kt budak tu, sbb jarang kot kes2 cani. Dorg kasik 4/5 pack IV saline, kt tangan, central (neck) & kt malleolus. Sementara tunggu senior doc, dorg just cover perforated wound tu & stop bleeding mcm dressing beser. Pastu ade doc yg pegi amek ultrasound punye machine tu bawak masuk ward tu, pasang2 je blackout plak ward tu, haha.. ok2 tak baek gelak. Then dorg bawak patient tu pegi kt imaging room, senang citer. Pastu aku, awe & anip yb tak follow, kitorg pegi kt ER outpatient plak, lepak2 ngan student arab 4 org tu buat insufflation & etc.
  
• Tapi aku wonder la, ape ek treatment utk gunshot wound camtu? erm.. Concern kita selain drp bleeding, maybe ade pneumothorax. Pastu ribs yg patah & peluru tu kt dalam paru2 tu camane plak nak handle. Ntahla, aku pun tatau & tak ingat dah belajar ke belum bab ni. Korg ade jawapan? dialu2kan. Camanela kalo aku dpt patient camtu nanti.
  
• Minggu depan maybe aku tak dpt pegi ER, sambung lepas raya plak, sbb nak prepare utk show raya kt Cairo. Doakan show berjaya, insyaAllah, amen. Tq.
  
• Ok, tu je utk hari ni. Selamat berpuasa, ramadhan kareem.

Mohd Peng.

ER 3

Lambat skit tulis psl ER kali ni sbb aku tak bape sehat skit. Perut buat hal, aku dah telan byk ORS.. Yela, kalau boleh tanakla skip puasa. Malam tadi pegi dgn Pit Daz dari kul 9 pm lebih - pukul 1am tepat, hehe. 

Prof yg ajak aku pegi ER awal2 dulu ade dtg, Prof Islam name die.. Resident unit surgery aku dulu (hepatobiliary) pun ade dtg, Dr Islam dgn ape ntah lg sorg tu.   

• ER outpatient cam tak best plak semalam. So dtg tunjuk muke jap then terus pegi ER traumatic. 
• Semalam ade 4 surgery yg kitorg tgk. Utk yg tak amek medic, sebenarnye kes banyak sgt tau, tapi dorg kene beratur kt ward  menunggu. Kt ward menunggu tu ade doc2 yg uruskan pape yg boleh kt situ. Kalo dah emergency sgt baru masuk spontan punye surgery.. ni la specialty medic yg aku paling suke, emergency surgery.. Kalau nak sambung pakar pun aku sambung dalam bidang ni. Aku tak suke tgk org mati tak aman ni & specialty ni mencabar, tu pasal aku minat. Pape pun tu kuasa Allah kan.
• Ok, ade kes acute appendicitis, flexor carpi ulnaris rupture, extensor pollicis rupture & multiple fracture of mandible.
• Prof aku buat surgery utk acute appendicitis. Aku paling suke Prof ni sbb bile tgk die aku teringat kt M. Shadow, vocalist Avenged Sevenfold, haha. Prof buat incision kt lower right quadrant tu, then dorg keluarkan appendix & caecum. Mase tu aku tk caecum tu pelik, tak smooth, cam ulcer plak. Doc gtau tu early phase of appendicular mass, so boleh remove appendix. Kalo dah jd bulk @ appendicular mass, taleh remove terus, kene tunggu dulu bape hari sampai mass tu loose balik. Ade minor bleeding kt caecum tu, inflammation kan. So prof buat haemostasis suture, macam ligation gak, tp die suture terus mane2 vessels yg bleed. Pit Daz mmg mantap, aku pelik gak, apsal die prof duk suture je caecum tu, pit daz kate sbb nak stop bleeding, hehe. Then bile dah settle bleeding dorg proceed utk excise appendix. Dorg ligate kt neck appendix tu & clamp distal portion. Dorg tak buat double ligation. Then dorg potong area in between tu, so terputus la appendix & then kitorg blah. 
• Second case flexor carpi ulnaris rupture. Doc kate kes ni cosmetic jgk sbnanye. Surgeon yg buat operation tu aku rase plastic surgeon. Die sambung balik flexor carpi ulnaris tu je la. Tapi care anak murid die suture balik incision tu mmg nice & cantik. Maybe ni la specialty plastic surgeon. Nurse sorg tu nk jgk buat pandai, sbb die nampak ade 2 org org Malaysia kt OR tu kot, hehe. Tp suture die cam beser je la, byk sgt bleeding. 
• Pastu ade kes sorg budak kecik, die main pisau ke ape aku tatau la. Tapi extensor of the thumb die putus & tulang kt situ fracture. Mase x-ray dorg tak gtau ade fracture, so doc tu igt nak kene sambung extensor tu je la. So dorg masukkan jarum kt fracture tu, macam masukkan K-Wire jgk. Then dorg sambung balik muscle tu & then dorg remove balik jarum tu. Aku rase budak2 kecik kte taleh bagi internal fixation senang2, dorg kan tgh membesar, nanti terbantut plak ibu jari budak tu. 
• Then last case kitorg usyar semalam kes multiple fracture of mandible. Surgeon yg buat surgery tu baru tahun dua kuliah dentistry, hehe. Jgn pelik. Die ade degree medic, die maxillofacial surgeon. Tp maybe die nak subspecialist dalam orthodentistry jgk kot. Kitorg sembang dgn assistant surgeon, die orthodentist asal dari kuliah dentistry. Die kate die penah apply nak buat specialist kt HUKM Malaysia. Tp Malaysia banyak songeh mintak pengalaman 3 tahun keje. 3 tahun keje as MO, bukan internship. So die sambung je kt sini lg senang. Aku rase tersentuh bile die macam expect gaji kt Malaysia tinggi dari Egypt. Mmg la betol. Tp doc Malaysia tak pernah puas dgn gaji kt Gomen, so dorg blah gi private or migrate ke negara lain yg lg mahal cam Singapore. Kite tak pernah bersyukur kan. Bagi aku medic ni bukan pasal duit sgt, die passion ko nak rawat org lain. Benda ni yg aku kagum dgn doc2 & prof2 kt Mesir, dorg bleh je migrate kt negara lain yg lagi mahal salary, tapi dorg stay sbb sayangkan ilmu & negara snirik. Tapi aku senirik nak sambung specialist kt US/UK + keje kt sane jap kalo ade rezeki nanti, hehe.. Bukan sbb duit, tp sbb nak bawak diri & merantau lagi.
• Ok balik pd kes tadi. Patient tu request tanak pakai skru utk internal fixation of her mandible sbb die nak maintain function mandible. So surgeon tu sume pakai wire ape ntah. Sablom start surgery tu, dorg gulung wire tu jd cam bentuk sotong dua kaki, dorg buat banyak2 sotong tu. Aku tatau ape name fixation jenis camtu. 
• Time tu aku tgk la anaesthetist tu inject diprivan dalam 2.5 syringe 10 ml. Aku rase maybe 25 ml diluted. Then die buat jaw thrust. Asalnye aku rase dorg nak buat endotracheal intubation kot.. tp since surgery tu involve mandible, susahla kot. So dorg buat nasopharryngeal intubation, masuk kt hidung. Lepas dah sedate, surgeon pun start buat keje. Dorg masukkan amende ntah kt mulut patient tu, cam hold mulut patient tu then terus start masukkan wire sotong td tu, dorg cucuk tembus gusi patient tu terus then ikat. Gusi kt area yg fracture tu la. Aku & Pit tak tgk abes, aku penat da time tu, tak bape sehat kan. Then kitorg balik. 
• Hari ni aku terbace artikel Dr Asri psl doa untuk bukan muslim. Tersentuh aku. Kita selama ni duk benci sgt kt Cina.. Kadang2 kita kene fikir jgk, dorg pun manusia, walaupun bukan islam.
• "Dalam sebuah negara yang berbilang agama, adakah kesejahteraan dan keamanan akan tercapai jika salah satu masyarakatnya porak peranda? Jika masyarakat bukan Islam hidup dalam keadaan tidak aman dan bergolak sesama mereka, apakah negara akan aman?" - Dr Asri. 
• Tapi bila org politikkan agama, tu mmg sial la. PAS pun tak bolehla 24/7 politik duniawi, tambah dorg perjuangkan islam, dorg kene stick & tegas dgn Quran & Hadis, tak bolehla 24/7 tahalluf siasi. Sbb tu Ali bin Abi Talib penah cakap, "Perkataan yang benar, tetapi bertujuan batil" (Al-Khatib al-Baghdadi, Tarikh Baghdad, 304/10, Beirut: Dar al-Kutub al-'Ilmiyyah) 
• Walaupun aku sekarang ni cenderung kpd optimist dgn perubahan Kerajaan Barisan Nasional @ sokong Kerajaan BN berubah, tapi Islam is always my top concern. Kita tak boleh kekal defensive macam fahaman kaum tua. Islam ni utk disebarkan, kita kene sebar kt non-muslim. Kalau cina kafir takut kt Islam, kita tak boleh amal escapism, kita kene face it, itu realiti. Adakah dgn kekal dgn fahaman & budaya defensive, maka islam akan tersebar? Kita nak org hormat islam tapi kita tak hormat dorg? Kita tak tunaikan tuntutan islam sendiri kt kita dalam adab kita dgn org kafir? Macam tu nak sebar islam?
• Jadi ni antara dilema paling besar umat islam kt Malaysia sekarang ni. Nak doa kesejahteraan bukan islam pun jadi isu. Amende la org bukan islam duk fikir pasal islam agaknye kalo kite kekal terus camtu.. Dahla kita tak ikut betul2 adab muslim dgn bukan muslim macam dalam quran, pastu kita blame plak dorg. Tak kesah la yg jd isu tu Lim Guan Eng ke, Soi Lek ke, tapi prinsip tetap prinsip. Allah dah ajar kita camane nak beradab dgn dorg (al-Mumtahanah ayat 7-8), kita kene ikut. Tak boleh terus kekal escapism. 
• Tapi tu la, kalau nak proaktif skit bab2 ni kene cop wahabi. Skit2 wahabi. Apa la nasib... Semoga Allah mudahkan dakwah islam kt Malaysia, insyaAllah. Allahu'alam.

Mohd Peng

Dulu awak pernah citer kt saya, ade sorg senior awak ni pelik. Die minat kt awak tapi awak tak terima dia. Awak cakap kt saya, kalau sampai tahap dia nak bunuh diri, terpaksa la awk terima dia & tinggalkan saya. Tapi saya bagi awak nasihat, sbb saya sayang awak. Saya nasihatkan awak takyah terima dia & biar saya je la yang jumpe dia. Tapi awak bagitau, kalo awak tak terima dia, tetibe die bunuh diri, tak ke sampai mati awak akan rase bersalah. Ya, mmg akan rasa bersalah. Saya pun nasihat awak supaya avoid or reject die pelan2.. Doakan semoga hati dia terbuka lg utk yg lain. Lame2 senior tu pun hilang... kot la.. 

Tapi sekarang ni awk plak tanak cakap pape dgn saya. Tapela, saya tunggu. Selagi awak tak cakap ape yg awak patut cakap, sy tak kan blah, sy akan tunggu. 

ER 2

Hari ni lepak ER dari kul 9pm - 1am lebih. Mmg penat, tataula kalo dah keje, on call nanti camane, sigh.. Lepak kt ER outpatient & ER traumatic. Best!

• Kt ER outpatient hari ni tak ramai patient.
  
• Ade sorg laki mati, drug addict, addict tramadol, doc da bg adrenalin, diazepam & ape lg ntah.. tp last2 ECG die flat jgk.. sampai ajal, ape bleh buat. Amek pengajaran, kalau mati tak sempat taubat camtu camanela nanti kt akhirat, semoga Allah ampunkan dia, amen.
• Ade sorg pak cik tua, die ade IHD. Doc suh aku, din bujang & yasir buat ECG, tp kitorg tak igt da cane nak buat, so amek blood pressure je la. Last2 yg buat ECG tu aku igtkan doc jgk mule2, rupe2nye student arab tahun 5 kot, haha. Aku pun pelik, die awal2 dah salah masuk electrode sume tu... Pastu dah buat tu, ade doc lain bace pelik je ECG tu. Rupenye mmg die salah buat, T point tade, haha. Ok, tak baik gelak. Pasni kalo doc suh buat ECG aku nak buatla, sbb bleh belajar dgn nurse.
• Pastu ade laki muda trauma kt tangan, ade pak cik trauma kt kepala & kaki, ade laki muda hematemesis tapi nasogastric lavage cam tak jalan je, aku tatau nape. Ade sorg laki muda psychic trauma, mak die baru meninggal 2 jam sablom tu, ayah die meninggal 2 bulan lepas. Din bujang gtau care nak detect consciousness, tekan2 kt sternum or between eyebrow die. Doc yg buat tu tampar2 je die, die still je. Rase cam nak buat, tp takutla tetibe pape jd kt patient tu, lg pun just psychic trauma je pon.
  
• Ade sorg budak laki, doc nak amek arterial blood gas die.. tp lameee sgt. tatau ape problem. Erm.. ni je la kes yg aku igt kt ER outpatient.
• Then aku & yasir pegi ER traumatic, din bujang blah awal.
  
• Kt traumatic kitorg masuk operating room.
  
• Ade 5 surgery yg sempat tgk; metatarsal fracture, amputation kaki, maxillary trauma, temporal-zygomatic fracture & yg best skali hari ni kes sorg budak pompuan, kecik lagi.. ade subarachnoid hemorrhage kot...
  
• Yg metatarsal fracture tu, doc masuk K-Wire 2 batang, then sambung tendon ape ntah, flexor digitorum longus kot.. Yg kitorg belajar kt ortho nampak cam senang je bile dah lepas bedah. Tp time bedah tu mmg pening, kalo bagi aku buat td, mmg aku blank la, haha. Doc tak kasik general anaesthesia, kasik local je kot, patient tu siap garu2 kepala lg. Yasir mmg power, doc2 tu tgh sembang same2 dorg, teka2 nerve itu ini, skali ade 1 soalan tu, senior doc tanye, yasir jawab pelan2 & die betol, doc2 lain salah, haha, TABIK SPRING LA!
  
• Maxillary trauma tu cosmetic surgery, yela, sbb kt muka kan trauma tu.. Tp mmg pening jgk.. Nak jd surgeon mmg kene master anatomy.
• Yg lower limb amputation kt knee level, tu mmg sedih. Kesian patient tu, bangun2 dah takde kaki.. tp nak buat camane kan..
  
• Temporal-zygomatic fracture tu, kitorg sampai2 dah siap, doc tgh stitching. Time tgk tu aku teringat ade vessels kt situ, yg bentuk H, ape name ntah. Tp situ mmg common site utk fracture & bleeding. Tp tataula patient tu camane.
  
• Pastu kes budak pompuan tadi. Mase aku & yasir baru masuk ER traumatic tu, bdak pompuan tu baru masuk, kepala die bengkak, mmg pelik r bengkak die, mcm hydrocephalus plak. Time kitorg nak blah budak tu baru masuk kt OR. So layan jap la. Anaesthecian 2 org tu buat IV cannula kt malleolus budak tu utk blood & saline transfusion + drug skit, aku tak sure ape.
• Pastu surgeon tu mcm scratch kt kepala budak tu, kepala dah botak separuh, die mcm buat draft utk incision la. Then die masukkan IV saline + lidocaine/xylocaine . aku rase die buat Field block (subcutaneous injection of a local anesthetic in an area bordering on the field to be anesthetized).. sbb time die inject tu kepala budak tu cam kembang skit then kecut balik.
  
• Then lepas dah scrub pe sume, die pun start buat incision mcm bentuk U kt kepala budak tu, surround anterior fontanel. Then die pun drill anterior fontanelle tu, sambil tu nurse tlg sedut fluid2 yg ade kt situ. Lepas dah tebuk, die pun masukkan jarum ape ntah, jarum tu cam jarum beser tp belakang die, output die besar. Die masukkan jarum tu sampai kt subarachnoid layer kot. Mule2 kuar darah skit, then kuar darah + CSF, mmg byk.
• Pastu aku ngan yasir pun blah, nak solat tarawih + sahur plak..
  
• Hari ni kt NEJM aku dpt case infertility, mmg complicated giler, aku tak abes lg dgn case ni.. Couple tu dari Nepal then migrate kt US & bykla history die. Pas subuh jap lg sambung abeskan case tu.
  
• Ok la, penat, nak sahur & sambung tarawih. Tata~
  

Sabar je la...
Aku rindu kt Nana...
Rase mcm nak balik Malaysia plak jumpe Nana & kawan dia tu.
Payah nak settle online camni..
Dia pun tak kenal aku...

Tp buat masa skarang, sabar je la yg aku boleh buat.
Terima kasih sbb tak kutuk aku hipokrit =)
Aku akan terus mencuba =)

......
Ni aku jd judgmental. Bukan nak gaduh ye, positifla sket.. anggap ni reflection =)
Penat aku cari buku psychology.
Ok, kalau kau bace ni, aku bagi analisis free psl kau =)

Drp pemerhatian aku, kau byk buat "Reaction Formation" (Level 3 Defense Mech)
Reaction Formation ni bermaksud reaksi yang berlawanan drp ape yg kau rasa, ko deny ape yg kau rase, instead ko buat yg berlawanan dgn yg ko rase. Contohnya kalo ade org tu die takut hantu, tapi die pilih utk tak takut hantu.. Ni la reaction formation.

Aku tak kenal kau betol2 camane. Tp dr gaya kau menulis org dah boleh judge. Ko directkan blame tu kt aku. Ko play the victim, kononnya aku sajela yg duduk blame ko dan ko innocent & profesional. Aku tak kutuk pape ni. Tp ade line yg nipis utk membezakan samaada kau ni betol2 innocent & profesional or kau dalam separa sedar tgh buat Reaction Formation Defense Mechanism..

2nd ko ade buat projection (Level 2 defense mech).. Projection ni la yg aku ckp paranoia tu. Ko projectkan benda yg tak wujud kt org lain. Ko ade buat camtu.

Aku takkan bgtau ape perbuatan ko yg buat aku ckp ko pakai teknik2 tu dalam separuh sedar, ko cari sendirila, diri kau, ko mesti kenal, mesti ko byk bercakap sorg2.

Pape pun itu part of your character i guess. Ade yg boleh diubah & ade yg tak boleh. So aku boleh je terima kalau kau mmg camtu. Kene tulis betul2 ni, aku tade niat ek nak gado2 ni, ckupla. Ni penilian as a professional. Kau kisah or tak kisah judgment aku ni tu kau punye pasal. Tp aku sarankan kau renung2la skit. At least kalo ko tak ok dgn aku pun aku harap ko bolehla ok dgn org lain. Peace! =)

Sepatutnya aku tak patut tulis dah pasal kau.

"pesanan aku ko xpyh da post or tulis blog pasal hal ni...ble ko tlis hal
ni ko wat nana lg serbt n benci kt ko...bler ko tls hal ni seolah2 ko tagih
simpati dr org,..ko just ikt angin n mase je...mase akn tentukan
segalanye...ko hbskan blaja n stdy 2 hard...ko ada masa dpn yg sgt
cerah..hal ni terlalu remeh nk compare ngan harapan negara kt bahu ko"

Ehsan nasihat aku camtu.

Aku tgh cube elak drp kritik kau, drp tulis ape yg aku rase pasal kau. Aku tak cakap ko bipolar. Aah, mmg aku bipolar, aku still under treatment, tp aku dah give up makan ubat, aku nak cuba cara conservative.

Aku cakap ko paranoid. Paranoid ni maksudnye ko fikir apa yg tak wujud, ko buat andaian. Nana salu nasihat aku jgn buat andaian. Aku mmg tahu penyakit aku yg suka buat andaian. Tapi manela aku nak tahu bile aku betul & bila aku buat andaian. So bile aku undur balik, tgk ape yg aku dah buat, oh, aku sedar yg aku buat adalah andaian. Samala macam kau, bile kau tuduh aku nak pecah-belahkan kau & Nana, kau buat andaian. 2 3 hari ni aku dan kau macam tanak mengalah. Start Ehsan nasihat tu, aku rasa aku patut mengalah dgn kau. Biarlah kau nak cakap ape pun. Aku akan cuba jgk buktikan aku memang tanak bermusuh dgn kau, even aku nak berkawan dgn kau, aku nak sgt kau terima, redha & happy kalau Nana end up dgn aku.

Alhamdulillah, Allah bagi peluang aku belajar psl psychology. Aku share sikit pasal psychology, aku nak share part yang kau boleh apply dalam hidup kau, untuk kebaikan kau jugak ni. Ade 1 topik tu pasal "Defense Mechanism."

Kita akan guna defense mechanism ni bile2 kite berdepan dgn ape2 masalah, contohnya kalau org jatuhkan kita. Bila org jatuhkan kita, kita akan react subconsciously or separuh sedar. Tapi reaction ni bergantung kepada org tu la. Ade org die deny (denial) - tak terima kenyataan. Ade org die delusion - dia tak terima kenyataan dan dia create kenyataan yg lain drp realiti. Ade org mungkin lahir2 dia dah bijak or dia belajar drp pengalaman, tanpa sedar cara die react adalah cara org matang react. Dia ubah tuduhan org lain kt dia tu kpd benda yg positif, amek benda tu jd cabaran contohnya.

Generally we have 4 levels of defense mechanism:-

• Level I - pathological(sakit) defences (i.e. psychotic denial, delusional projection)
• Level II - immature defences (i.e. fantasy, projection, passive aggression, acting out)
• Level III - neurotic defences (i.e. intellectualization, reaction formation, dissociation, displacement, repression)
• Level IV - mature defences (i.e. humour, sublimation, suppression, altruism, anticipation)

Kalau ko berminat ko boleh la google psl ni dgn detail. Serius! Amat berguna! =) Tapi jgn terlampau nak ikut buku sgt, biar kita hidup smooth. Ada masa kita boleh ikut hati kita & ada masa kita kene duduk kejap, fikir dulu dalam-dalam.

So aku analyse tindakan2 aku dalam kes ni. Memang aku mengaku aku bertindak dgn tak matang. Mule2 skali aku start paranoid. Aku claim camni camtu sume. Then kau react, kau start accuse aku psycho & raih simpati. Ape yg kau buat tu sebenarnye character assassination, kau attack sume respon aku, sampai ape aje yg aku respon tade pun yg positive bg ko. Character assassination ni mmg useful weapon.

Aku plak terikut rentak kau.. Yela, sape tak emo bile masuk bab orang yg kita sayang, aku pun manusia jgk. So aku lawan kau. Tu pun aku cube jgk ckp yg aku mmg tanak bermusuh dgn kau. Sebenarnya aku boleh jgk buat character assassination kt kau. Tapi aku tak buat. Sbb aku tak sampai hati dan aku mmg tanak bermusuh dgn kau, percayalah, demi Allah aku tanak bermusuh dgn kau!

Cukupla sampai sini. Aku rase eloklah aku ikut nasihat Ehsan. Aku nak try defense mech. level 4 - sublimation, suppression, altruism, anticipation. Tp aku tahu, aku takkan mampu buat sume sebijik mcm theory. Ko pun tau kan theory dan practical ni beza. So the least yg aku boleh dan kene buat, aku diam je la pasal hal ni. Aku dah mengalah, aku dah mintak maaf. Aku harap hati kau terbuka la satu hari nanti, aku harap ko sedarla satu hari nanti yang aku ikhlas mengalah dan mintak maaf.

Ya, memang aku ade message Nana tadi & dia tak balas.. Aku tak mampu nak tinggalkan dia.. Sbb aku pernah janji dgn dia, aku takkan tinggalkan dia.. dan kalau aku bawak diri pun, tu selepas dia dah ade laki lain. Nana pun pernah janji dgn aku dia takkan tinggalkan aku as friend, die mintak aku bagitau dia kalau aku dah tak nak tegur dia lagi. Aku tak pernah lagi bgtau Nana aku tanak tegur die dah. Aku rase eloklah aku bagi space kt Nana, kt kau..

Yg aku ckp kt kau, aku akan tinggalkan dia, kalau tu yg boleh buat kau happy, aku nak bagitahu kau, kalau aku kawan dgn kau, maksudnya aku kawan dgn kau, aku ikhlas, bukan sbb aku nak kt Nana semata-mata... Plus mase tu aku tgh down sgt. Tapela, aku telan ludah aku.

Aku tak pernah rasa benci pun kau baik dgn Nana. Even Nana pun pesan, kalau nak kt dia, aku kene accept kawan baik dia. Tapelah, aku bahagia kalau kau & Nana bahagia.

Aku harap lepas ni kau tak tuduh aku berlakon, raih simpati lagi la. Aku pun macam kau jugak, aku pun ada hati & perasaan. Kalau ada ape2 yg aku boleh buat utk settlekan masalah ni, bgtaula, aku akan cuba buat ape yg aku mampu.

Last skali aku serahkan kt Allah semua ni. Aku harap kau tak tuduh aku hipokrit. Aku nak bersangka baik dgn kau. Aku harap kau pun boleh bersangka baik dgn aku. Terima kasih sudi baca.

Mohd Peng

ER 1

Lepas bukak pose & maghrib tadi terus pegi ER. Plan asalnye nak lepak kt ER surgery. Tp aku tak jumpe2 plak prof yg janji ngan aku tu. So aku pegi lepak kt ER outpatient, cam ER utk kes2 yg kecemasan yg tak teruk sgt la. 

Aku terpaksa la buat benda ni, kalau tak duk frust nonggeng je la aku kt umah. Ni pun tgh sedih lagi. Tapela.. doakan yang terbaik utk sume org. Lagi pun ni budaya sehat utk student2 medic.. perlu diperkembangkan. Positif! Ok balik pd citer ER:-

• Doc situ sume aku tak kenal, byk doc2 HO je.. ER ni tayah kenal2 sgtla bg aku.. lame2 lepak nanti kenal la tu. Tak sempat mase la.
• Awal2 sampai tu tak ramai sgt patient. Tak ramai tu means ade dalam 3 - 4 katil kosong. Masuk pukul dekat kul 10 tu mmg ramai, terlebih2.. katil mmg tak cukupla, haha. survivor tau belajar kt mesir ni. 
• First case aku dapat haematemesis (muntah darah). Patient tu bg history muntah darah. So sorg doc HO tu offer gurau2 kt aku utk buat nasogastric lavage, haha. Giler ape, aku tengok pon tak penah. Doc tu pun tau aku tak nak. 
• Dorg tak buat jaw thrust utk masukkan nasogastric tube tu beza dgn endotracheal tube. Patient tu duduk then kepala die flex skit. Lepas sapu gel terus je masuk. Nasogastric tube tu sambung dengan syringe besar, doc tu ckp tom syringe ke ape ntah name die, aku tak sure sgt. Pastu die inject saline skit then sedut balik sampai ade flow kt tube tu. Pastu kuarla coffee ground colour then tak lame pastu kuar fresh blood. Sbb ade fresh blood, doc kate patient tu kene transfer ke internal medicine dep. 
• Aku rase fresh blood tu may indicate duodenal or variceal bleeding.. aku rase duodenal. Tp kene buat further diagnosis la utk kompem. Yg dorg buat tu just procedure awal je, at least as a procedure utk transfer patient tu ke dep lain. Ok, abes psl patient ni, semoga yang terbaik utk dia, amen.
• Tetibe ade nenek tua nampak lemah giler, muntah2 die. Tp tade org nak tlg angkat, paramedic sorg je. So aku tlg.. tetibe sorg mak cik tu, anak die kot ckp "time kasih doktor..".. haha. aku start rase inferior skit da. Mak Cik ni kene food poisoning, so ade diarrhea & dehydrated. So doc kasik IV saline je dulu. 
• Keadaan kt situ mmg over crowded abes.. aku usyar kes2 yg aku sempat je. 
• Then ade sorg lg budak pompuan, complaint die same jgk, hematemesis. Tp lepas doc dah nak buat nasogastric lavage tu die nangis takut pulak. Sablom tu bukan main sakit tak tahan kt abdomen.. aiyoo.. mak pak die dah pujuk pun tanak, payahla nak masuk. Last doc suh die blah je la. hehe, macho doc ni. 
• Pastu ade sorg doc suh aku amek blood pressure sorg pak cik tu.. ok, aku amek & bp die normal.
• Then ade sorg mak cik tu ingat aku ni doktor, haha. Die mintak tlg aku check die. Aku cakapla aku student je, aku taleh buat pape pun sbenanye. Tp mase ke hulu ke hilir tgk patient2 laen, aku tgk mak cik tu sorg je. So aku pegila tgk die. Die bagi lab report..  tgk CBC die. Hb turun, Hematocrit turun, yg lain normal, tp platelet die naik. Amende plak dah mak cik ni kene, haha. Tp aku tau la die mesti ade bleeding tu. Tanye2 stool die ade darah.. pastu sambungla amek history skit. Then aku panggil sorg doc gtau psl mak cik tu & doc tu take over. Doc tu pun terkejar-kejar. Sume doc terkejar-kejar time tu. Nway bukan mak cik tu sorg ingat aku ni doktor, almost sume, skit2 tanye. Cuak jgk aku.. 
• Pastu doc lain suh amek blood pressure lagi.. erm.. aku pegila amek bp patient sorg tu. Actly aku rase doc tu cam nak suruh amek bp patient laen lg tu.. tp aku cam ngelak2 la, haha. Aku dah dpt bayang, keje HO nanti mesti kene buli camni... benda2 tak best suruh HO buat. Adus.
• Kes2 lain ade sorg budak tu ade trauma kt inguinal region, abes basah berdarah seluar die, doc wat dressing & bagi saline. Ade sorg polis tu, dtg 1 group.. tp aku tak paham polis tu sakit ape... dtg cam sakit2.. Tau2 nak blah dah, sehat plak aku nengok polis tu. haha.
• Ade sorg mak cik tu plak mcm dah nak convulsion, die ade dyspnea, deep shallow breathing, muke die pun toxic.. Sablom tu aku tgk die ok je.. Ade doc ckp kt aku tu psychic je. Tp anak die sampai marah2 doc tak pegi kt mak die dulu. So doc tu bg high pressure oxygen.. tp tak ok jgk.. so dorg bawak masuk ICU, cucuk ape ntah aku tak nampak then terus ok.. 
• Ade byk lagi la kes. Minor trauma tu ade lagi la. Tp tak larat nak tulis da.. So lain kali blehla join skali ye. Aku lepak ER tu baru 2 jam.. tp dah byk kes. kuat betol sakit org mesir ni, haha. Pastu aku pun penat.. so aku blah bodo2 je la. Sambung lagi lenkali, insyaAllah. Tata~

Mohd Peng

The Best Mental Therapy

How to cope when your life is falling apart?

Well people always say, "a bend in the road is not the end of the road... unless you fail to make the turn." Yes indeed it's true. I want to share with u'ols about myself.

 

1. I have 3 elder brothers. When i was suspended during my secondary study in Sekolah Alam Shah, my brothers used to tell me thing by thing, to teach me about the basic things again, to back to the basic, what i have to do, what i shouldnt do @ reformatting me.  
2. I didnt know when i was right & when i was wrong because i've lost my rational thought when i was accused to do this & that. I'd defended myself to at least not being expelled from the school in the school's court.
3. But one thing that changed me at that time, when i was about to be expelled from the school was when this very kind man named Abg Mahizan, he did change me. I was staying with my eldest brother in UTP, he's a lecturer there. Abg Mahizan was his housemate. Every morning, after Fajar prayer, Abg Mahizan will recite the al-Quran & this was the thing that's made my heart began to realize that i was too far from Allah, i'd never thought to honestly repent & seek for Allah's forgiveness. He started it slowly, invited me to perform & say the fardhu prayers first, then to perform them on time, to do good to people, to not being rude to people & to focus on my study. 
4. It's not that my brothers didnt do a thing, but Abg Mahizan's approach has made me to realize & to admit that what i did were wrong. I wish i can meet him again someday & may God bless him, amen. Because of him i changed & got the good result in my spm exam & able to study medicine now. Alhamdulillah.
5. But we cant expect life to treat us well all the time. Entering the tertiary study, specifically medicine has caused me to meet the new kind of problems & some of them are worse, caused me to up & down, flip & flop. 
6. So as the other teenagers, i've met a few girls & have fallen in love with them & u know the rest of the stories rite? 
7. All these up & down, flip & flop have caused me to develop the more severe mental illnesses. I began to enter the stage of manic depressive, became delusional & paranoid, some hallucination & consequently bipolar disorder. 
8. One of my senior here had suspected me to have this mental illnesses & he'd brought me to a psychiatrist. I took my treatment, then i felt better. But after a few months, i'll repeat this episode again & again until some of my friends had once thought that i have the seasonal mental disorder & misbehavior, hehe. 
9. My main problem is paranoia. It's the worst symptom. In some cases like politics, paranoia is very good, i've predicted a lot of political events & they are mostly correct.  But when it comes to relationship thingy, it's very bad, it's suffered me a lot. 
10. So as im writing this now, i'd just thought that it's been a long time since i last seek for the God's help. I always say dont do bid'ah, dont do khurafat, dont do this & that, let's practice the pure sunnah from the prophet Muhammad PBUH regardless of who we are, our political views & etc
11. Plus i had some dilemma with secularism, conservative & liberal thoughts regarding the islam, what is the real fundamental value of islam in this & that cases. 
12. But i think i just need to say these to myself, it's the time for the miracles & my arrival.
13. Islam is the best cure. I need to believe in Jodoh, destiny, believe in whatever God gives me is the best. This is the best mental therapy. It's not denial.
14. Let's pray that ill be doing fine through this Ramadhan & will change to a better person. I hope this is not going to be the same old "REPENKT", i hope this is the "Repent" what i believed some us had been waiting for & i thank you for being optimistic on me.
15. FYI, i was the youngest Imam in my kampung with some tajwid&makhroj error, hehe & it's a real surprise to compare me former & later.
16. Well, enough talking. Let's walk these talks.
17. Oh Allah, please guide me, amen.

Mohd Peng

The Very First Short Post

hehe... 

1 "Lim Guan Eng" is not enough. Why cant the 60.4% of Malaysian solve the islamophobic phenomenon in Malaysia? I hope the muslims in Malaysia will stop being defensive & neo-conservative. Spreading islam is one thing. Solving the income disparity is another thing. And reconstructing the income disparity by giving more to Malay is not that racist, it's equalizing, so that Malay can be more competent. Think guys,think!

Then talk...

And walk the talk!

Mohd Peng, BBC