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