Updated at 2pm: RPK is Released!

Malaysia's first blogger to be charged with sedition (Source: Mob's Crib)

Finally i breathed a sigh of relief. 

After bail was posted yesterday, and after 2 candle light vigils, RPK was released at 9.30am. 

This guy is really principled, and is good at making his statements heard. He refused to eat prison food (which led to the prison guards claiming that he was on a hunger strike), citing that the food was paid for by the Rakyat (citizens in malay), and he did not agree that the money was well spent this way. Absolutely, wasting the nation's coffer to stifle the voices of the people is a real waste of taxpayer's money. 

Interestingly he was remanded in the same prison where the 2 suspects who allegedly bombed Altantuya were jailed as well. RPK claimed to be shouted and threatened by these 2 accused, and only agreed to post bail after the prison authority told him that they could not guarantee his safety in the prison...

Seriously, the prison authority sounds really lame. 

---

Raja Petra out, explains U-turn on bail

Syed Jaymal Zahiid | May 9, 08 10:13am

The only reason Raja Petra Kamarudin decided to post bail today was because he had received information that his safety might be in jeopardy. After the news portalMalaysia Today editor was released on bail at 9.30am at the Petaling Jaya Sessions Court today, reporters were informed of to why he had suddenly changed his mind. "The prison authority told me that they cannot guarantee my safety because they had received some reports of threat and that Sirul (Azhar Umar) and Azilah (Hadri) had shouted and said that something will happen to me," he told reporters. Sirul and Azilah are the two primary murder suspects in the ongoing hearing of the killing of Altantuya Shaariibuu, a young Mongolian woman. Both are currently being remanded at the Sungai Buloh prison where Raja Petra prior to today, had been detained as well. Raja Petra also said that despite police attempt to guarantee that no harm will come to him by stationing Special Forces Unit (UTK) personnel to guard him, nothing was certain. "They told me that there are some 6,000 people in the prison and that there was no guarantee that any of them can't be bought including the guards so they advised me to meet my wife and post bail," he added. The popular blogger also dismissed suggestions by the media that it was most probably the prison condition that had forced him to change his mind. "I have been detained under the Internal Security Act before. They put me in solitary confinement which is worst than what I had experienced in Sungai Buloh," replied the blooger who looked tired but nevertheless in good spirit. Not on a hunger strike Raja Petra's decision to post bail was surprising as he had previously bewildered many including lawyers and family members by refusing to have any contact with them, including his wife Marina Lee Abdullah, two days ago. And this was just a day after he had refused to post bail after being charged. Marina had gone to the Sungai Buloh prison to meet her husband on Tuesday morning to ask him if he would want to post bail after having raised RM35,000 from well-wishers. However, she was told by the prison warden that Raja Petra did not want to see anybody, including her, and had also refused to eat. Marina was finally able to meet her husband yesterday and was told he had agreed to post bail. When asked why he had done so, Raja Petra said that he had no reason to meet them as he did not want anyone to convince him to post bail. "I had intended to stay until my hearing which is in October (but) changed my mind following the advise of the prison authorities," he said. He also said that he did not go on hunger strike as reported earlier but had refused to eat food provided by the prison. "The food is paid by rakyat. I don't think the rakyat money is being well spent so I refused to eat prison food," he said. A handcuffed Raja Petra was brought to the court from the prison at about 9.25am. He was wearing the same yellow long sleeved shirt and jeans that he wore on the day he was charged. He later changed first into a black 'RPK C4ME' T-shirt and then a yellow T-shirt. There were some 50 supporters waiting for his arrival at the court, who clapped their hands upon seeing him. He raised his hands to them. The supporters wore yellow T-shirt with Raja Petra's face and the words ‘Justice for all...tantuya' imprinted on it. Raja Petra, who has been charged for sedition, had opted to go to prison instead of paying the RM5,000 bail three days ago, which he said he could not afford. Hearing has been fixed from Oct 6 to 10 and Raja Petra would have to remain in custody until the hearing date in five months' time should he decide not to post bail. Charged with sedition Raja Petra was charged on Tuesday over his article that allegedly implied that Deputy Prime Minister Najib Abdul Razak and his wife of being involved in the killing of Altantuya. Raja Petra claimed trial to the charge. He was charged under Section 4(1)(c) of the Sedition Act for publishing the seditious article on April 25 on Malaysia Today. The charge sheet highlighted nine paragraphs of the article which was titled 'Let's send the Altantuya murderers to hell' as seditious. He is the first blogger to be charged for sedition in Malaysia. Meanwhile three men were detained by police last night for participating in a candlelight vigil held as a show of support for Raja Petra at Dataran Merdeka. Dang Wangi police chief ACP Mohamad Zulkarnain Abdul Rahman said they were among a crowd of about 100 who had gathered at Dataran Merdeka since 8pm. "The protestors dispersed peacefully about and hour later but the three of them were detained for questioning and were subsequently released," he was quoted as saying in Bernama. He added the gathering did not have a permit from the police.  Najib denies accusations Najib, who is expected to take over from Prime Minister Abdullah Ahmad Badawi as the country's next premier, has denied the charge against Raja Petra was politically motivated, the News Straits Timesreported yesterday. "The government has always taken a very liberal stand with bloggers and the Internet. But there are laws in this country related to sedition and defamation. "Just because you operate from cyberspace, it does not absolve you from having those laws applied to you," he said, according to the newspaper. Analyst Abdul Razak Baginda, who has links with Najib and top government leaders, has been charged with abetting the killing of 28-year-old Altantuya, whose body was blown up with explosives. Sirul and Azilah - two police officers from an elite force, whose duties included guarding the prime minister and Najib - were charged with the killing.

(adapted from Malaysiakini)

Hold Your Stick Steady Ya!

I almost said the word yummy

What do you see in this picture? What comes to your mind first? 

I saw veins, plenty of them. I almost said the word yummy. (What did you think? Tsk tsk)

Yesterday night one of my juniors in my resident hall (King Edward VII Hall) barged into my room, demanding that i teach him how to set an IV plug (intravenous catheter). He then related to me of an incident that he witnessed in the wards earlier that day. 

Having just finished his preclinical years (studying basic medical sciences such as anatomy, physiology, pathology, pharmacology etc) and all revved-up to set foot in the wards, he was eager to learn all the basics of being a clinical year medical student. One convenient way was to tag along the houseman in ward and observe what they do. R, a houseman who i know, was going to insert an IV plug when these students came to observe. 

*Clinical year denotes that medical education ceases to be all-lectures. Students will have to attend wards and take on an apprentice role, rotating across departments of different specialties 

Different gauges of IV catheters/cannulae/plugs, just like bullets

Having successfully inserted the plug, R was retracting the needle to check for backflow (blood flowing into the transparent catheter as a sign of successful insertion) when the patient's blood started gushing out in spurts. 

I could see the slight disgust that my junior felt towards R's perceived incompetence as he was describing what happened. I totally did not agree. There were many forces at play, and to blame the poor houseman while negating other possibilities would be plain simple-minded, not to mention unjust.

I really felt disappointed, or even angered at my junior's ignorance. I could understand if that demeaning account came from a layperson. We get misunderstood all the time by the laypeople. But from a medical student? Come on! 

Too often i have seen doctors being wrongly blamed* for untoward incidences that happen to the patients. We do not need more medical students joining the horde to help perpetuate the simple-mindedness. There are many forces at play. There are always physician factor, procedural factor, and patient's factor. But of course the physician is always the most convenient target. 

*Of course i acknowledge that there are instances where doctors clearly were at fault and had to be held accountable. I do not by any means discourage anyone from inquiring into events, but look at it with an open mind, and without emotions. 

Hospital is one scary place, no? 

Almost everyone who has been admitted to a hospital would have experienced that agony of having an IV plug inserted. Every patient hates it. 

Well, it's justifiable that patient harbours ill feeling towards the catheter, and in the same vein, the doctor who inserts it. 

However, believe it or not, we do not like it any better than you do. We feel the pain as well. 

----

I can still easily summon the memory, and the accompanying grief. I was trying in vain to insert an IV plug on a terminally ill patient. She desperately needed one for IV drugs that will lessen her suffering, however she had almost no accessible veins left on her body. 

Little by little, each time she was admitted for treatment, her veins would collapse from repeated insertions of IV plug. Little by little, the veins gave in to repeated trauma and thrombosed, or succumbed to inflammation (thrombophlebitis) which led to thrombosis as well. 

The back of her hands resembled those that came out from a battleground, perhaps surviving shrapnels from an IED. They were so blemished that there wasn't a square inch that was free from scars, or scabs from recent trauma. Her forearms were lined with tramtrack lines, formed by numerous previous IV cannulations, not dissimilar to the stigmata that IV drug abusers inflict upon themselves. 

Each time we got an IV plug successfully inserted, the team of student intern, houseman, and nurses would cheer triumphantly. The patient would thank us profusely, her gratitude overspilling from her jaundiced eyes. 

But the joy would never last long, as we knew that the next battle was impending. 

We were treading a fine line, between replacing the plug too oftenly, and leaving the plug for too long that infection would creep in, while always in full awareness that there might not be another vein the next time we look for it. 

The day finally came. We needed a new IV plug. The old one had been there for too long, and the surrounding area had started showing signs of inflammation. 

I was the student intern to insert a new IV plug. I only had an hour before she would receive her next course of medications.

I was naturally optimistic, being blessed with nimble fingers that were usually able to find a vein and put in a plug when it eluded others. But not this time. Meticulously i spent 5 minutes to coerce a vein to surface, gently tapping on it. It appeared, to my rapture, only to disappear once the bevel of the catheter made its first contact. Unfazed, i was scanning her entire arm for a viable vein. Ah found another one. Baby stay baby, it's gonna take only one second. Then baby went away. 

I stole a glance at my patient, she nodded to me approvingly, and conveyed enormous understanding. I however was reluctant to cause any more pain. After all i was just a student intern. I called my houseman.

She too failed after trying two attempts. There was no one else in the wards that we could ask help from. Only the two of us, and there were truckloads of patients who needed our attention too. I was left to my own device again while she attended to other patients, as the circumstances called for.

I explained to the patient, but before i needed to complete my sentence, she told me not to worry, that it had always been the case. The good veins were getting scarcer, i was told. Take my time, she advised. 

It was already time for her medication, yet we still did not have an access to infuse the medicine. 

While she showed great understanding, each time the bevel penetrated the skin there would be an inevitable, involuntary audible gasp of air, from the pain of punctured skin. I almost wept, guilt hammering at my conscience. 

Backflow*! I advanced the rest of the catheter in. But the blood stagnated in the translucent cannula. Sighs. The vein was too narrow for the catheter to tunnel in, only releasing specks of blood that gave me false hope.

*Newer generations of IV cannulae are made of translucent plastic capable of showing backflow. Backflow refers to blood that enters the cannula and can be seen flowing in just distal to the port, signalling that the tip of the cannula is now inside the vessel

I was nearing emotional breakdown when i finally got it. I inserted the needle between 2 old scars that were spaced less than 2mm apart. I just felt there was a vein, but i could never be certain. It was a leap of faith. Anyway i taped the catheter in place and flushed it with heparinised saline to prevent premature clotting of the plug. Wearily i clapped my nurse's hand which was held in high five. Till another day. She proceeded to administer the elixir of lesser suffering.

That other day never came, as i had finished my one month of student internship. I never found out what happened to my patient, whether she had any more invasive procedure to secure an intravenous access. I didn't have the heart to. 

----

I agree that not every houseman is as good at setting plugs. It's just like sports, some people will be more talented than the others. However, just like any sports, everyone improves with practice. And i can safely assure you that all NUS graduates are well trained in the drills of setting an IV plug, way before they started housemanship.

But it's not only the talent or skill that determines how well the procedure goes. There are many variables which are outside of the doctor's control. 

Entire body twitches in agony

Very often the patient twitches as the needle punctures the skin, and i realise that patients often are not aware of it. As a result of the jerky movement, the doctor loses the vein that was previously secured with finger pressure, thus the vein escapes from the trajectory of the needle. Some even tenses the muscle when the needle goes in!

That, i personally feel, is the biggest cause of repeated IV cannulation. 

At least we weren't born wrinkled right? 

As we age, our skin wrinkles, eye bag sags and breast grows pendulous. That's because our connective tissues all become lax. Similarly the vein becomes less fixed to the surrounding tissue, resulting in excessive mobility. On top of that, ageing changes the consistency of the venous wall, making it less compliant, and less easy to puncture. Therefore, in elderly patients we commonly encounter the phenomenon where veins evades the advancing needle. The doctor has to put in great effort just to outmanoeuvre the slippery vein, usually only succeeding after several attempts. Count yourself lucky if the doctor succeeds within 2 attempts. 

I had a bizarre experience when i was setting a plug on a muscular young man who had nice big succulent veins all over his hands. It seemed really easy and i thought even a novice could have inserted a plug at the first go, but somehow his vein collapsed everytime the catheter went in. No one could explain what happened, much to the patient's dismay. I tried, the houseman tried, the houseman from another team tried, the nurse tried. Eventually one of us succeeded, but i suspected that was more luck than skill. 

(There was no use calling anyone more senior than the houseman, as plug-setting is a fine motor skill which becomes lousy after disuse, and usually no one sets a plug after their housemanship except if you are an anaesthetist. The greatest disservice you can ever bring upon yourself is to insist you get the most senior consultant to insert the plug.) 

So what can we do if we suffer the misfortune of needing an IV plug? 

Calmness and serenity

Stay calm, relax and co-operate with the doctor. If the doctor has to try once more, too bad. Ask the doctor if you had moved unconsciously. Make sure you don't twitch your muscles in pain. Relax and stay calm. Be courteous to the overworked yet underpaid doctor (at least in Singapore). It will make it a pleasant experience for both of you.

If the houseman has tried more than 3 times, it's reasonable for you to ask for a few minutes break and resume later. You can even ask for the houseman to apply some local anaesthetic to numb the area. 

However if you start raising a ruckus, and stresses the poor houseman out, i can assure you he will falter. And it's a bad bad idea as there's almost always no one else in the entire ward to bail you out. 

So, next time if a doctor has to poke you more than once, smile at him, and say hold your stick steady ya! 

To Walk with RPK

(adapted from Malaysiakini)

I agree with Lilian, that it's more a symbolic gesture than anything. It's about how all of us are solidly behind RPK, to voice our solidarity with him.

 

It just pains me that another blogger of great calibre and integrity has been persecuted again, and for logics that, as usual, alludes us all. 

For the uninitiated, RPK is short for Raja Petra Kamaruddin, grandson of Raja Tun Uda (Penang's first Governor). RPK is the webmaster of popular news portal Malaysia Today, and is a influential orator who contributed immensely to the rise of the Opposition in the March Election. 

I have already banked in 1 USD to his paypal account. You can do so too. Details can be found at Malaysia Today.

More details at Rocky's Bru. 

The Greatest Pet of All!

Was reading about Genevieve's cute dog when i recalled this particular joke about a pet

It was a sweltering afternoon in a non air-conditioned ward. 

We were all hovering over the patient's bed, listening intently. 

Our tutor was there for the supervised history taking. It was an exercise to prepare us for our medicine track long case in Finals. 

Pam, if i am not mistaken, was the one taking history from the affable Eurasian gentleman. He was rather pre-occupied with his papers initially.

'Sir, when did you first have this shortness of breath?' Pam asked earnestly, while scribbling down the presenting complaint on her notepad, which was improvised from a small ring folder that Dean's Office gave us. 

Something caught his attention. 

He put down the broadsheets that was The Straits Times. Straightening himself on the white bed, he nudged his bifocals gently up his high nosebridge. He proceeded to assess each of us behind the thick lenses. 

'Wow.' He exhaled. We looked at him puzzled. 

Surprisingly similar facial expression. The boy i mean

'These days the lady doctors are getting really pretty!' He exclaimed in joy.

He gawked unabashedly at my female colleagues. The ladies shifted their feets slightly, feeling queasy.

Waving at Naga, he beckoned, 'Hey, lady doctor, don't be shy, come closer here, I can't see you well from here.'

Naga was rather at loss of what to do next, then sheepishly she obliged and went standing next to the head of the bed. 

'Wah all the lady doctors are so pretty. It's really great to be a patient these days...' 

He looked completely mesmerized by the presence of young pretty student doctors, probably felt the same way i would in the company of Greek Goddesses. 

I know i know, she's not a Greek Goddess.

I swear Naga blushed. At the periphery of my vision, i could see the tutor's eyes rolling upwards, and shook his head unapprovingly. He was amused though. 

Time was ticking away.

We only had 15 minutes for this history taking exercise, after which we would proceed on to discuss on the physical examination, investigations and management principles. Plenty more to do. 

'Sir why don't we discuss more about your shortness of breath? When did it first started?' 

Pam was starting to worry about the lack of time. Usually we would have covered a lot more grounds by then.

Satisfied from having checked out the 3 ladies, he rewarded us with an unhindered account of how the symptoms developed and so on. We were most grateful for that. 

'Sir, do you keep any pets at home?' Pam was rounding up the portion about respiratory system.

'Yeah of course. I've kept her for the past many many years. Really good company she is.' 

He must have really adored his pet, for hints of affection were clearly evident.

It mellowed everyone in presence. 

'That's great. Is it a dog? How often do you bathe her? Does she sleep in your bedroom?' Pam blasted a flurry of questions, now that time was running short. She needed to take a comprehensive history to get a favourable assessment. 

'No no, i rarely bathe her, but we do share a bed,' he let slip a mischievous smile. 

Something was amiss. 

'She's my wife.' 

The small curl at the edge of his lips then graduated to a wide grin. 

Movies that We should Avoid Watching

We should all just avoid watching movie that dabbles in our area of expertise. 

A spy should never watch James Bond.

Likewise, anyone from the triads or mafias should just stay away from all those gangster movies.

 

And any self respecting ogre should never set foot in a cinema that screens the Shrek....

Awake is actually a captivating movie with a good twist of the plot, and enough of suspense to keep us going towards the end. The casts manage to pull off their roles convincingly too. 

Not to forget there are eye candies that cater for audience of both genders, such as Jessica Alba for the girls and Hayden Christensen for the guys.  

Okok i admit i am bullshitting. Jessica Alba was just drop dead gorgeous. 

Nesa did not agree though (He is not gay, if you wonder). He just thought that Jessica Alba's body only got it right at the proportions, but not the absolute 'quantum' of each attribute. Well well... 

Anyway back to my point about why we should never watch movie that concerns our profession, so to speak. Let's see what's wrong with these screenshots from the movie.  

 

The anaesthetist is injecting an induction agent (to induce a state of anaesthesia) into a port of a intravenous line. 

The actor was doing it without first occluding one side of the line! 

That way whatever he injects in will flow in BOTH directions, instead of going straight into the patient's bloodstream. A substantial amount of the drug will go upstream!

And the induction agent we use here in Singapore is milky white... 

ETT in-situ

We don't just leave the endotracheal tube (ETT) in such a precarious position. Usually we secure it with an adhesive tape around the tube and secure each end of the tape on each side of the upper lips. 

Heart transplant surgery. What you are seeing is the complete set of staff on duty for that operation. 

This Varick University Hospital is seriously understaffed, or the staffs are all superhumans. Heart transplant is a major operation, and therefore the need for support staffs is huge. It can easily be twice of what you see here. Not forgetting those medical students who are eager to observe... 

No surgeons would squat and lie back against the wall when in full sterile gown. He even rests the sterile sleeves against the not sterile pants. Tsk tsk. 

You know, we don't wear surgical gloves for fun. We wear them to protect the patient from risk of infection. Which is why you don't adjust your surgical magnifiers with your gloved-on hand. That totally defeats the purpose of wearing sterile gloves, isn't it?

You ask the student nurse or medical student to do it for you. Haha.

Jessica Alba putting on a sterile gown. 

What's wrong is that the nurse assisting her is not wearing a glove on her left hand (therefore is unsterile). The gown has to remain sterile.

I know Jessica Alba is way prettier with her hair down, but no one steps into the operating theatre without wearing a surgical cap. She is not wearing sterile gloves too. What's the point of wearing a sterile gown then? 

The conclusion that Nesa and I reached for the patient in the movie was, if he had not died from any foulplay during the operation, he would have died anyway from the pathetic level of infection/contamination control practiced in this operating theatre. Really sad guy huh. 

Quite embarassing for a Hollywood production that ran on a multimillion dollar budget. 

If only they have hired me. But then again lowly medical students like me are a dime a dozen in the States. 

Seriously, what's wrong with the Government!

Adapted from The Star

I was really outraged when i first read about this latest stunt from the Malaysian Government, from 5xmom's blog.  

And I thought the Government had learnt some lessons after experiencing the close shave in the disastrous March election. Sighs. 

As usual, it's just another knee-jerk reaction. The neural pathway of knee jerk reaction, like all deep tendon reflexes, does not pass through the brain. 

Yes we can do it on dogs too

But what truly amazes me is the sheer number of brains that must have been bypassed, in all ranks of the Ministry of Foreign Affair. Tax-payers money gone up in smoke!

A solution like this is understandable if it comes from some mamak stall conversation, but from some high level government officials? 

Seriously, Malaysia can do better than this!

Just for Laughs #3 (not too tasteful ya)

Came across this funny survey that tells you how much you are worth on bed, in my case, as a gigolo. 

Takes around 3 minutes to complete. 



Now how much does $1132/hr measure up to everyone else? 

Not that bad huh. Any taker?