Friday, August 29, 2008


Despite the continous flow of patients coming to AE today, nothing particularly interesting until the end of my shift when a young girl, accompanied by her mother and grandmother, came in with the hook of the handle of an umbrella stuck in her mouth. It was one of those cases that I would never see again in many years to come. Of course at the beginning nobody knew what exactly had happened. Obviously she was not able to give the details as the thing fully occupied her mouth. She could only cry. Apparently, her cry was heard in another room in her house, and the next thing the mother found her in that state. My consultant tried initially to remove the umbrella but it stuck firmly on her lower soft palate and there was a bit of bleeding. Worried that by removing it would cause more damage, my consultant contacted a paediatrician from another hospital. After much explanation they agreed for a transfer. An anaesthetist was also present and he was also worried about her airway. Later, a junior anaesthetist bravely attempted to remove the umbrella just before she was transferred to the children hospital. To everyone surprise he did it succesfully and there was no serious damage. I would never forget the relief that her grandmother showed.

Oh! Yes! I said yesteday I had a confession to make....well, not today....some other time

Thursday, August 28, 2008

Another day off

This week I work morning shift, the first time for the past 6 weeks. It has not been bad at all. I haven't got time today to write down some of the interesting cases I saw like : bilateral broken arms, pancreatitis, anaphylactic reaction, CVA, pregnant woman with thrombosis and a heart attack. I will talk about them tomorrow.
I also have a confession to make but I will wait till tomorrow..see what happens.
Going to bed soon.

Saturday, August 23, 2008

My week off.....

It was supposed to be a week off work, doing nothing, just relaxing.....well, that has not been the case. Usually, it would take 3 days to recover from a week night duty to get back to a day routine. Unfortunately, this time I didn't get a chance to recover that quickly as on Wednesday I had to attend basic paediatric life support course, which was a day course, being held at Children University Hospital, Temple Street about half an hour by Luas and a short distance of walking from the nearest Luas station.

It was an intensive course starting from 8am, finished at 6pm. There were about 20 of us from different specialities, whose job involving children, including nurses and doctors from emergency medicine, paediatric medicine, intensive care unit, orthopaedic and anaesthetic. We all were taught how to do a proper basic life support to a child in an emergency situation. Later that day after lunch each one of us had to perform in front of a small group of people, of what we had been taught. Although I deal with this nearly everyday with adult, it was quite nerve wrecking to lead the team when I was being judged and criticised. Overall, I enjoyed it, and I passed the practical test which was done at the end of the course. It was a simple test but I am proud with myself for being able to do it calmly and systematically. One of my principles in life is to enjoy every success, and to learn from each mistake, no matter how small it is. Having passed the test, I am in a better prospect to get a job in Jan 2009.

After the course, I went straight to the gym for nearly 2 hrs and by the time I got back, I was so exhausted that i went to bed early. The next day, thank god, I had the all day for myself, so I went to city centre and had my hair cut.

Friday, yesterday, I had to be at work starting at 8am. I was not supposed to but Samuel asked me to do his shift for a day as he had to go for a driving test. So there I was, got up early in the morning and drove for 1 hr to get there on time. The morning started with 2 hours teaching Session which occurs on friday morning only. Dr. Kelly, one of the AE consultant was there. Irene (a south african doctor), Esosa (a nigerian doctor) were also there. We were taught how to detect fractures or broken bones from xray. For adult, it can be quite easy, but in children, it can be quite tricky, because their bones are still developing, and certain fracture can be easly missed particularly on the hands, wrist or ankles/feet. At the end of the session we were shown by two representatives from a company which produces fibre layered backslab.

There are two common types of material used in AE to stabilise broken limbs before further review by the orthopaedic team. One is plaster of paris which application is quite messy and the other is fiber material which is much easier to apply. During the session we were taught how to apply the material properly.

It was fairly quiet afternoon in AE yesterday. Nothing interesting. One patient, he cut his upper lip after falling. The thing with a cut on the lips, I have to be careful in stitching it, otherwise it will leave a scar that could affect their social lives later. The wound needs to be closed precisely, and the patient needs to be warned about the comestic complications including the scar. With this young man I was quite happy with the result.

The other patient, came in with severe vertigo, which is a sensation that the room spinning around. It was so bad that she could not stand up or walk properly. Poor sod!. In vertigo, first of all we need to determine if there is a peripheral cause which is not that serious, or central cause, which means from the brain, which can be serious and needs urgent attention. With this lady, with previous similar episode and elevated lymphocytes, it seemed she had viral labyrinthitis, inflammation of the inner ear caused by a virus, which is self limiting. Considering the age and the severity i decided that she needed medical admission. Off she went under a medical team.

The last patient I saw yesterday was an elderly guy with non insulin dependent diabetes mellitus (NIDDM) or Diabetes type 2, came in referred by the hospital chiropodist, who is a person who is looking after toes and nails particularly in diabetic patients or in patients with peripheral neuropathy. The patient, apparently had developed peripheral neuropathy or loss of sensation, on his feet. It is quite common for a diabetic patient to have peripheral neuropathy as a late complication. The other complication is foot ulcer because of poor blood circulation. The combination of the two (peripheral neuropathy and foot ulcer) is disastrous. Because of he had loss sensation of the foot, he became less aware of the ulcer on the foot and he kept the pressure on the ulcer which made the ulcer worse. On examination the foot was swollen and red - signs of infection - and there was a small ulcer on the sole just near the big toe. It was oozing with pus, producing foul smelling. According to him, it had been there for 6 month. Just imagine how bad it was! It appeared that he had chronic ulcer with peripheral neuropathy and cellulitis which is infection of skin. I was worried about the bone which also might have been infected (osteomyelitis) and if so it is a serious condition. Regardless, he needed admission...

After work, I was rushing home with a plan to go to the gym and later to have a dinner with a group of friend to say goodbye to Liam who is moving to Australia. When I got back, I was too tired to go to the gym, but I managed to bring myself to the dinner. It was in Tante Zoe's restaurant, an american food restaurant in Temple Bar. It was ok. Nothing spectacular about the meal. Funny enough, Liam who is leaving, who organised the dinner had to leave the table even before the food was serve after he fell ill. We toasted, saying goodbye to Liam without his presence.

Tuesday, August 19, 2008


Eventually, the 12 hrs night shift for 7 days in a row ended yesterday. Another 4 weeks before i have another one. Now, I have a week off work...well not really, I have to go back for 1 morning shift on Friday after swopping with Samuel, the other AE sho.

The whole week last week was an interesting week. Few interesting cases I had to deal with, each one with different level of difficulties. One of them was a case involving an elderly man with multiple medical problems, came in by an ambulance with acute onset severe abdominal pain. The pain was initially located centrally, and it was very severe that I had to give him a small dose of morphine, which relieved the pain partially. He was sweating profusely, looked clammy with drowsiness. Vital signs were stable at arrival. Immediately I moved him to the resus unit, a special room to deal with a very sick patient. At first I thought he had bowel obstruction because the abdomen was distended and he had colostomy bag for rectal removal few years ago. During further assessment, he complained that the pain now was more severe on his back. The blood pressure dropped below normal value. At this stage I knew that he had an abdominal aortic aneurism (also known as AAA, triple A) which may had been leaking. I expressed my concern immediately to my senior colleague, who organised an urgent CT scan of abdomen, which later showed as expected, a leaking AAA. Subsequently, he was tranferred to another hospital, 1 hour away for emergency surgery. Everyone congratulated me for the quick action.

Working in emergency medicine can be daunting sometimes. It is a stressfull job with so many things to do at the same time. Time is the essence, and as a medical officer in AE you are working against it. Anyhow, with a case like the one mentioned above, it is all worth it. I know I make a difference, and it is, of course, fulfilling.

Most of the cases I dealt with in Drogheda during last week were traumatic injuries, particularly after midnight. I don't know how many I saw with a head injury and most of them were drunk. I just don't understand this drinking behaviour in Ireland. It is their culture alright, but why on earth they go out drinking until they can't stand up on their feet. Some of them become very abusive and aggressive when they are drunk. I had several cases like that last week. One of them was assaulted with a hammer. He was so drunk that he couldn't remember what exactly had happened. He sustained mutilple lacerations on his bald head, and on one of his ears. He was quite abusive against us while we were trying to clean the wound. After calming him down, we continued to clean the wound. Unfortunately we found he was bleeding profusely from the injured ear, and we could not locate the site of bleeding source. Ct brain was arranged, and luckily it was normal. We planned to admit him for neuroobservation and for ENT review because the ear was still bleeding. Frustratingly, once he was more sober, he walked out from the department with a bleeding ear. In a case like this, we only could watch him walked away as he was an adult......stupid adult! This only one example of the many....and we have just to put up with it.

Another case was an anorexic lady, fell in her house, complaining of very severe back pain. She was given high dose morphine, later difene per rectal but the pain persisted. The initial xray show no broken vertebrae nor pelvis. I was puzzled initially. I suspected it was psychogenic pain as the pain was inconsitent to the injury. She looked so thin, like a ghost. She came in with full make-up on her face and this was 4 am. I couldn't take proper history from her because she was shouting, roaring and crying. She kept calling, like a child, for her mother, who was beside her. She was in her 40's but looked much older than her own mother who was also dressed immaculately. I decided to keep her in AE for further review by my senior colleague. The next day, I was told she created a drama in AE after MRI scan showed normal results. The orthopaedic team didn't want to do anything with her because there was no broken bone. Eventually my consultant organised physiotherapy for her. Initially she was resistance to the intervention. After much persuasion she was discharged home the next day.

The saddest case or most tragic case was a case involving an elderly lady who fell from stairs in her home. She was found by her husband. On arrival, she was already on intubation, still breathing on her own but both eyes widely opened with non-reactive, dilated pupils. At this stage I knew she had a brain injury- more specifically brain death. On arrival the trauma team had already been contacted. During the assessment she stopped breathing and resuscitation was initiated and she was brought back to breathing on her own again. Eventually my consultant decided, with consent from her understandably distraught family to end her misery by stopping the life support.....she died in the department surrounded by her large family. I cried a little later during my break, thinking about my mother who also died tragically 10 years ago.

Life is so short and yet it is so precious. Appreciate what you have in life no matter how little it is because you never know when you are going to lose it. Appreciate the love you have from your family, your friends and of course your partner. Live to the fullest, and that is what I am going to do.....

(ps: for confidentiality purposes, I deliberately omitted the name of patients, their exact age, and the exact nature of injury including the exact site)

Friday, August 15, 2008

Feel like a long time ago since the last time I wrote in this blog. I started my 12hrs shift a day for 7 nights straight on monday 11/8. It was not as bad as I thought before I started. The problem is it is totally an anti-social shift to do. I can not do anything else like going to gym, meeting friends, cooking, and of course writing something on the blog.

It takes me about 3 hrs driving back and forth, so in total it is 15 hrs off, 9 hrs left which are used for basic things like sleep, eat, clean. In fact, I just got up about an hour ago and now ready to go to work again....Am I complaining? Not really. Just finding an excuse on why I haven't up-dated this blog as frequent as it should be.

Ok.....have to go to work now. Tomorrow I will talk about AAA.

Monday, August 11, 2008

A great weekend...

I did 12 hours shift working from friday night till saturday morning. It was raining heavily the whole night. Unfortunately it didn't deter people to come to AE. It was a chaos. As I was the only AE doctor there, and it was my first time working at night shift, so it was crazy. Anyhow i manage to survive.

I got home around 10 am and forced myself to sleep because I had to wake up early to cook dinner for a group of friends. I woke up at 2pm and ready to cook. I cooked Indian mee goreng and sweet spiced chicken wings. The kitchen was a mess afterward but hey, I have andrew to clean it up......sorry andrew, not my intention! The dinner was planned by Haiyu and I to say goodbye to Cindy and Paul who are going to emigrate to New Zealand at the end of the month.

Syed collected us at around 7 to bring the food to Haiyu's apartment which was located at Aungier Street, city centre. We were already late. Haiyu had cooked beef rendang which was nice. Manu, Haiyu's french husband, and his french friend was also there. Others were Cindy, Iban sarawakian girl, Paul, Cindy's Irish fiancee, Syed, my dear malaysian friend, Nico, syed's jewish argentian-spanish friend, Andrew, and Mitch, my other malaysian friend.

I had a great time. Everyone seemed to enjoy our food. Great company, great food.

Later that night, I went to Jeff's apartment for a small party. I was so tired so I spent lying on the couch listening them talking shit until 8 am sunday morning.

Friday, August 8, 2008

Something is missing....

I feel completely worn out today. Don't know why, can't figure out what. I am tired. No motivation. Feel like I have to push myself hard to do anything. Can't sleep. Signs of depression? Don't know. Missing my family? Hate my job? Need a major change in my life in every way? Don't know. I also have a premonition that something bad is going to happen, and I am scared of the unknown. Feel like everything right that is happening right now is not right. I have a great job, good money comes with it, have my own place, have someone that I love dearly to share my life with, but I feel that all that is too good to be true. I feel that something bad is going to happen to screw everything up so that my entire life would make completely different turn to start a new journey...........

I feel like lately I am consumed with work again. It is in my head 24/7. I hate doing things half way but lately that is exactly what I have been doing. I want to be the best, and I have been quite competitive but I have lost the drive lately. Although I think I am good at work, considering the responds I got from my colleagues, but I still think I am not good enough because I have failed to carry out the goals that I have set up myself to achieve.

Emmmm....such a relief to be able to release the tension in my head by writing them here. I already feel a bit better now. I should do this more often. I don't care if people read this blog or not. I do this for me....

It was a very busy night at work last night. The department is too small for big population it has to provide. It is crazy, considering Ireland is a first world country but the hospital's condition is like a hospital in 3rd world countries. I was shocked when I first got there. Too much politic in Irish health system but too litlle being done.

Last night I saw a guy whose anal muscle was weak that he couldn't shit properly for 2 weeks. Sent to the surgical team and the SHO was complaining about the referral. What am I supposed to do? The patient had problem shitting!

Then there was another patient, young enough, complaining of chest discomfort consistently for 2 weeks. all investigations revealed nothing and she was informed about the results. Not surprisingly, because I got this type of patients every so often, she was not happy. It sounded like she wanted something bad to happen to her.

Then, I saw a middle aged woman with a lung disease who came in with shortness of breath. She was nasty and snappy. She was like 'who the hell are you asking me all these questions, just fix the problem'. I was boiling up inside but keeping it calm on the surface. Smiling and be nice. It appeared she still smoked and didn't take her medications as regular as it should be. She wanted me to fix the problem that she created........but hey, I am just a doctor.....I only can give advices...

Before I left and that was nearly midnight, I saw a patient, a foreign national, who took overdose of benzodiazepine after finding out her foetus didn't have a heart beat on the same day she found she was pregnant..basically she had a miscarriage. That was sad......

On getting ready to leave the hospital, I bumped into my consultant, and he reminded me to be here by 8am tomorrow to attend the tutorial. No word on how are you, how are things. Fun and exciting work huh? I dont think so. Ok, I should be there tomorrow because I have missed the tutorials a lot due to the shift hrs. I got home at 1am , went to bed by 2am, set the alarm at 630am to go to the tutorial but I had difficulties to sleep. The alarm went off and I was so exhausted. I couldn't even lift a muscle. As a result I missed the tutorial again.......That what pissed me off....

Thursday, August 7, 2008

Anwar Ibrahim was charged yesterday. Olympic Game will start tomorrow

Wednesday, August 6, 2008

News from home...

I got a message from my baby brother, Amy, today at work looking for some financial help to get a new printer for his new laptop which I bought for him few months ago. I was busy at work to reply the text message, so the first thing I did when I got home at 1am was to call my baby sister , Midah, using Sykpe. She was already at the school where she was teaching, SM Teknik, Klang.

Apparently, Amy is in IKIM college in Kuantan at the moment, having registered last weekend to start his 3 years diploma course in accountancy under UTM. I am happy for him. He had a difficult childhood and teenhood having lost a mother who was very close to him at a tender age of 10. He was a lost soul for few years but he managed to pick himself up. I am proud of him for his strength and his fighting spirit. After SPM which he didnt do well enough to earn entrance to university, I sent him to politeknik to do Hospitality course which he seemed to enjoy. After obtaining his certificate, he decided to be independent and took a year off from his studies. With a help of my 2nd cousin, he got a job a sale assisstant which he extremely enjoyed that he decided to continue his studies in bussiness related course, hence, he is where he is now.

Another good news I received from Midah was, my other younger brother, Aboy, had just been accepted to start his training to be an inspector police. He will commence his training on September in Pulapol, KL. He had to undergo a long process of interview before being accepted. He has been recently engaged to a girl from the same village. I can't think a better job for him. Physically he is just perfect for the job. He is the most kind and honest member of the family. I wish him good luck with the 9 months training.

My granny, from my dad side is not well. She has dementia and physically she is getting weaker and weaker. We all don't know how old she actually is. In her ID card she has the same birthday as her first two children, and my Uncle is nealy 80 so she must be near 100. I can only pray for her wellness.....
This is what I sent to one of the NST editor last year. It was not published, and in a way I was glad because firstly, although the article had good points to ponder on, it was badly written in term of construction and grammar. I was in such a state at the time I was writing it, and I have no intention to reveal in what way. Secondly, some of the points were considered sensitive to many, and I am sure I would have trouble if it was published. Anyhow, the editor kindly replied the email.

"Hi yap,

I read your article (What's the point?: What maketh a Malaysian, anybody?) today with so many questions about myself, my race and my country and how frustrated I am with the current political views regarding racial interaction (relationship?) among Malaysians. It feels like we have moved backwards as a nation in terms of racial integration, and we as Malaysians have failed to progress mentally (and socially) in unity and in harmony.

I might be crucified to say what I am going to say next but I need to tell you personally how I am glad to have u around and challenge the mindset of the few (the many rather) in public (I assume they are from my race, the malays).

Let me tell you my story. I was from a small village. A malay village (very malay) somewhere very remote in negeri Sembilan. My family lived in proverty as rubber tappers. I was lucky (very indeed) that I was sponsored by yayasan sarawak to further my secondary education in Miri, Sarawak under student interchanges programme that my family didn't have to pay a dime for my education from that point. My mother let me go (out of our proverty) although it meant I could only see my family for one month a year. I have to tell you that I had one of the best years in my life. There I had the opportunity to know people from different races and religions but unfortunately it lasted only for 3 years before i was sponsored to study in a college which students were exclusively malay (namely MRSM) and had a chance to further my studies abroad under a government scholarship.

Having had a chance to visit many countries and learnt many different cultures in the world after my graduation, I have had difficulties to accept my position professionally in the name of fairness and justice. I had discussion with Malaysians (malay , Chinese, Indian) and my western friends about my background and how I end up to where and what i am now and it makes me wonder what if I were not malay. Would I be in the position where I am now if I am not a malay malaysian? Many would say you should be grateful, because you are malay and a malaysian, you have been given the 'special treatment'. Of course I am grateful but do I deserve it when probably (a fact likely) many Malaysians who are not malay and poor (but have the same potentials) continue to be at a low level of ladder of social hierarchy.

Live is about survival and only the fittest will survive but the situation (politically and socially) in Malaysia seems like its programmed based on who you know and what your race is. This is a social injustice and understandably (considering where I came from) I am propelled into dilemmas in trying to understand the whole situation. Am I proud to be Malaysian or should I be proud to be a malay? But what is a Malaysian when it is divided socially, economically, politically
(emm..sounds like in every sense) based on races? What is the meaning of being a malay? A muslim who is born in Malaysia and has chance better than the others to gain everything from the government? What do I know about a Malaysian? Malay, muslim and born in Malaysia? Doesn't sound right, does it, when you can physically see the varieties that exist in Malaysia? Why should the meaning of being Malaysian be divided by races and religions? Should not it be on how much you have contributed and want to contribute to your own country?

Young politicians today apparently haven't learned a lesson from history - May 1969 in Malaysia. I read with shame the recent news on the malay supremacy and why they think (the malay mainly- forget the other bumiputras!) are better than the others to deserve the 'special treatment'. They might incite the same racial confrontation but in a different context. The politicians are mainly to blame for all the fiasco. But again they are the product of an ideology that was established to purportedly correct the social injustice that existed just after the independence but is it (the ideology) relevant now? Should the definition of a Malaysian be changed now? But what is to change if we can't understand or accept what it is truly meant in the first place? Many more things I want to say but I will save them for the next time.
Terima kasih"

This is Mr Yap's reply:


Thank you very much for sharing your story with me. I wish more people were as open. I too, have many Malay friends who ask me and themselves very similar questions. It truly is a shame that people have trouble accepting themselves and others for what they are - people like everyone else.

Thank you so much for taking the time to write and I'm glad that the piece touched you in such a manner. I was very nervous about the kind of response the piece was going to get because experience has taught me that not everyone likes addressing this issue.

Take care of yourself and sorry for the late reply."

Well, something to think today.........

Friday, August 1, 2008

Another day at work....

It was a hectic day for me yesterday....which was my last day off work for this week. Got up early...well, not that early, about 10am, and without breakfast went straight to city centre to my bank to get a bank draft. I need to send the cheque to Liverpool children hospital for Paediatric Emergency Course which is going to be held in October. When I sent an email to them last week, they replied telling me there were only few places I had to send the application with the cheque ASAP. It costs me £279.....In addition to that I had to pay £250 for basic paediatric life support course which is going to be held at Temple Street Children hospital, Dublin on 21/8/08. I managed to post the letter to Liverpool but for the one in Dublin, I had to cancel the delivery because at the very last minute, I realised I forgot to enclose the application letter....damn! So I rush to get home before the post office closed. And you know what I did.....on the way back, I bought a new bicycle.....hahahahaha....typical me, so impulsive!
I need a bike anyway to make a trip to the city centre from my apartment. That bloody bike costs me £350 including the side bags, locks and a helmet. Once I got back to the apartment, it was just too late to post the second letter. To fill up my day, I decided to go to the gym with my new bike. Apparently, I quite enjoyed riding my bike. It is obviously faster than walking, and it's good for my health.....emmm.....I am gonna have good legs in a month time if I continue to use the bike.
My hectic day finally took a toll on me. By 9pm I was so exhausted,....and what did I do? Go to sleep....