Selamat Hari Lahir ke-4 Mujahid

"Tepat jam 10.40 pm nanti, genaplah usiamu 4 tahun. Selamat Hari Lahir buat anakku sayang, Ahmad Mujahid. semoga menjadi anak soleh, hidupmu sentiasa di bawah lindungan Ilahi, diberkatiNya, dimurahkan rezeki. Wahai anakku, jadikanlah Allah matlamatmu, Ar-Rasul ikutanmu, al-Quran panduanmu, al-jihad jalanmu, syahid impianmu..inilah doa IBU buat mu, wahai Ahmad Mujahid. Ameen. (asalnya Ibu dan Abah nak bagi nama Amer Mujahid tp remang pulak bulu roma kami sbb nama yg cukup besar maksudnya)"

 4 tahun yg lepas, saya selamat melahirkan zuriat kami yg pertama. Penantian selama 9 bulan itu terasa cepat sahaja walaupun pada peringkat awalnya terasa berzaman. 

Antenatal

suami ketika itu baru bertukar kerja dr UTP ke TNBR...jadi perlu pergi Team Building di OBM, Lumut. saya ditinggalkan selama 2 minggu. Seperti biasa, saya due untuk datang bulan tp bulannya tak dtg2. Saya pelik, stress agaknya. tapi saya perasan suatu kelainan pd diri saya. beberapa selepas itu, saya seringkali sakit perut di waktu malam, mencucuk2 di bahagian bawah perut, awal pagi pula asyik cirit.Nak kata salah makan, tak juga. Selepas lewat seminggu, saya pon melakukan ujian kehamilan sendiri di rumah dan mendapati POSITIF. saya meloncat2 kegembiraan seorang diri. Tak sabar menanti kepulangan suami utk memberitahu khabar gembira tersebut.  Masa bagitau suami, suami tersengih lebar mcm kerang busuk.

seminggu selepas itu, mulalah morning sickness saya yg amat teruk. apa saje yg makan pasti keluar kembali. almaklumlah nih pregnant yg pertama, manja lah skit. tp memang pedih perut dan tekak sbb asyik muntah je. byk pula pantang larangnya. sepatutnya saya bermula bekerja sbg HO di awal Jun, namun selepas bekerja selama 3 minggu, saya tidak dpt bertahan disbbkan morning sickness saya. Saya HO baru, maka selalu dibuli dan oleh kerana tidak sihat, saya selalu MC dan tidak dpt fokus utk belajar dan menjadi HO yg rajin. Maka ramai senior2 HO menganggap saya pemalas. Saya berbincang dengan HOD saya dan dia bersetuju agar saya menangguhkan HO saya terlebih dahulu. Saya senang hati sbb tak perlu menyusahkan org lain.  

selepas tu, arwah mak dtg utk melawat saya, dan ketika itu, arwah jatuh sakit dan didapati menghidap kanser paru-paru. Saya yg tidak bekerja menjaga arwah mak saya di HUKM selama 2 bulan dan seterusnya sehingga saya bersalin.... full time. Ketika mengandungkan Mujahid, saya mengalami byk mood swing disbbkan hormon dan sering dilanda kesedihan melihat keadaan mak saya yg tidak sihat. Dalam sarat, saya seret diri saya utk menemani mak utk sesi kemoterapi. setiap hari melihat mak sakit dan lemah disbbkan rawat kemo tersebut. Bila sedih, saya mula jadi marah2 utk sembunyikan kesedihan saya. 

rawatan antenatal saya dibuat di Klinik Famili, Bangi kerana klinik tu kurang orang. Di penghujungnya, kami dirujuk ke Hospital Pakar Az-Zahrah, Bangi. 

seminggu sebelum saya due utk bersalin, mak pindah dan duduk bersama kakak. saya pula disuruh menyerahkan diri pada hari rabu 26 Dis 2007 utk di"induce" disbbkan Mujahid IUGR/ SGA. (EDD 27/12/2007). 3 hari sebelum bersalin, saya mengamalkan air selusuh, tp bukan air akar kayu apa2 pun, air bacaan doa dan Quran sahaja yg dibuat ileh ibu rakan suami yg merupakan anak murid Harun Din.

Labour pain

saya tiba jam 11 pagi. doktor datang dalam jam 2 pm dan hasil pemeriksaan VE (vaginal examination), pangkal rahim tertutup rapat, belum ada tanda2 bersalin, maka prostin pertama dimasukkan. Jam 4 pm, sakit mula semakin kerap. Saya gagahkan diri utk solat. suami membantu saya dengan membaca Al-Quran sambil menggosok2 belakang saya.Jam 6 pm, VE menunjukkan progress, bukaan rahim (Os) sudah 2 cm.  Khabarnya lepas isya', akan dibawa ke bilik bersalin. Maghrib pun tiba. Tiba2 lendir darah turun (show)..sakit tidak terperi. Saya mohon utk jama'kan solat maghrib dgn isya' namun suami kata saya sempat utk bersolat isya'. Menonggeng2 saya disbbkan sakit. Sudah beberapa kali jururawat datang dan menawarkan kpd saya utk mengambil epidural, namun saya menolak kerana ingin merasa kesakitan bersalin itu sepertimana ibu2 lain. Jam 830pm, saya di VE kan sekali lagi, baru 4 cm. Kontraksi semakin kerap dan saya semakin lembik. Solat isya' sudah masuk dan saya tertangguh kerana dek kesakitan. Jam 930pm, saya mengangkat bendera putih, saya mahu epidural. Namun jururawat hanya dtg jam 1015pm lalu menolak saya ke bilik bersalin utk diberikan suntikan epidural. VE menunjukkan antara 5-6 cm. tapi sakitnyer terlampau kerap, dah overstimulated...agak2nya disbbkan air selusuh. Bidan pun pelik sbb kerap sangat, maybe 5 in 10. sementara menunggu pakar bius dtg, dalam lingkungan 10-15 minit, saya rasa macam nak terberanak, menjerit2 panggil bidan. Bidan pula mcm tak percaya yg saya nak beranak sbb baru sekejap td dia VE saya. Tapi dia mula menyedari yg saya teramat sakit, lalu dtg VE sekali lagi.. alamak, dah fully...cepatnya... ketika itu, pakar bius baru tiba. Mereka tak sempat memasang branula, tiada IV drip, tiada CTG terpasang.. betapa tidak bersedianya mereka utk saya bersalin ketika itu. Precipitate labour lah kata kan. Tergesa2 mereka memanggil pakar saya. dalam menunggu tuh, air kutuban saya pecah, rasa mcm belon air pecah...brushhhhhh....sampai jer pakar, terus bagi laluan utk bersalin. Pakar suruh suami tengok kepala baby tapi suami saya tengok kejap je, tak sanggup tengok lebih2...dia kata ngeri. Dua kali teran, lahirlah Ahmad Mujahid....alhamdulillah.

2 weeks full of challenges part 2

Another week gone by and a fresh new week has arrived. I prayed really hard that this week would be better than last week. I was extremely tired with all the brain-consuming cases. Everyday i prayed that i work just for HIM. Work is also part of ibadah.....as long as our niat (all our intentions) is for Allah....LILLAHI TA'ALA. So this week, Allah still wants me to learn therefore he gave me more of exciting, interesting cases...2 weeks of intensive chronic illness course...

MONDAY 19/12/11

1) This patient was a one week affair patient. He was also my early bird patient for that particular day, came in complaining of genital ulcers for 6 months and wanting to screen for HIV. He said he confidently think that he has HIV. So after asking him a few questions, he said that he once had sexual intercourse with a prostitute who subsequently died of HIV, that was back in 2006. I checked his genital ulcers and it look like either gonorrhea or syphilis. His skin looks like as if he was about to have Kaposi sarcoma. But i wasnt so sure so i showed the genital lesion to my colleague and my FMS. My FMS was shocked, she did not say he has HIV but asking me his AIDS status...looking at his condition, my FMS sure he was already in the AIDS stage. So I sent him for the rapid test, HIV Elisa, hepatitis B/C screening, renal profile, liver function test, CD3, CD4. In KK setting with too many patients, I had very little time to counsel him about HIV. It wasnt fair to do one test without a proper counseling. His case did not end that day. After the rapid test, he went back home forgetting to come back to see me with his result. I called the blood-taking procedure room for his status...YES, his rapid test was positive. So we called him, and he came back the next day (on Tuesday) for a short briefing abt his condition. I completely prepare all the necessary to refer him to our HIV clinic. But he really look pale on that day. The next day (on Wednesday), I received a call from the IK (inspector kesihatan) regarding my notification of this pt's HIV status..he said this pt was already been notified in 2006. But when pt came in to see me on Wednesday for his CD3/CD4 blood investigation, he denied and claimed was not told about his status, so the IK asked me to inform and re-notify his AIDS once proven with lab investigations. Thursday, he came to see me, confused about the HIV clinic which was supposed to be on Friday. Then on Friday, he came in the morning and i told him his appointment is due at 3pm....planning to refer him back to PD.

2) Pt with underlying diabetes and hypertension came in for uncontrolled sugar and plus lumps and bumps at her underlying subcutaneous tissue. Maybe neurofibroma...??? pt was meant to TCA in 1 weeks time to review her sugar but apparently did not show up to me (maybe she went and see other doctor?

moral of the day - as doctors, we are exposing ourselves to high risk disease like HIV, hepatitis, tuberculosis...sigh...

TUESDAY 20/12/11

One patient referred from ED for repeat Potassium (kalium). She went to ED the day before complaining giddiness and noted to have hyperkalaemia (K+ 6.2) with no ECG changes. They wrote there "K+ 6.2 (lysed)", so patient was treated for "Giddiness secondary to electrolyte imbalance". No statement mentioning whether any correction was done nor any repeated blood potassium was done to confirm her potassium level.(to confirm the lysed sample). Pt was discharge and to come back at KK the next day to repeat her potassium level. Somebody at ED seem to be very confident about discharging someone with potassium of 6.2 without repeating it. If the repeated blood was a safe level of potassium, then it's ok to discharge and to repeat the next day, however, i assume they did not repeat it as it was not mentioned. patient can go into cardiac arrest if the potassium is too high. it must have been HO and that HO never discuss the case with her MO...sigh....so she came to me the next day with repeated potassium of 6.7. ECG no U-wave. Thank Allah as pt has no chest pain of sort. I called ED to refer the case as it was meant to be a red zone case. (need to call ED if it is red zone case or yellow zone cases that need special attention)..so I highlighted the fact that pt was "dangerously" discharged yesterday with potassium of 6.2....GERAM.....

moral of the day
1) dont trust your house officer....no no.. i was once a HO too... but we need to make sure  their training is adequate. Lately  we are hearing news about the increase numbers of HO but reducing quality of care from them as more numbers of HO would reduce their working hours and experiences hence reducing their responsibilities and so cultivating a negative, care less environment for HO to work. 
2) if you are not sure, please ask.... it's OK to say "i dont know" and there is no "stupid questions" when it comes to saving life. (Lebih baik kena marah sbb bertanya dari kena marah sbb tak tanya....kesannya lebih besar kalau tak tanya --> this is what i practice during my HO time)
2) MO must supervise more, so meaning MO have extra responsibilities.

WEDNESDAY 21/12/11

oww i sprained my neck 3 times (as per say in prev entry) yet i still come to work and yes, i saw interesting cases that day.

1) this pt came in the evening complaining of bilateral leg swelling for 2 weeks. She came a week ago, investigated by my colleague. ECG, renal profile and Urine FEME were done, at at glance, results were normal. So i planned to send her for a chest xray to see any heart enlargement. (3 importantg caused to rule out in a patient of bilateral leg swelling are HEART failure, RENAL failure, LIVER failure). Somehow, Allah wanted to show me something, so i took a second look at the investigation done the week before. I saw Potassium of 1.6...that was super LOW !!! (i had overlooked at it for the first time, in which i thought it was the creatinine that was 1.6 (creatinine of 1.6 is normal but potassium of 1.6 is super low - normal is 3.3 -5.1)....OH NO.....so instead of just a plain chest Xray, i sent her for repeat renal profile and another instinct told me to do one FBC (full blood count).....she was very cachexic, I asked her whether she had any significant weight loss and she said yes. so i wanted to do thyroid function test too. Anyway, she came back with a normal chest Xray but repeated renal profile showed potassium of 1.7 and FBC of pancytopenia (all blood parameters on the lower side - HB 6.0/ Hct 16/ TWC 2.1/ PLT 123. Vitals stable, afebrile, lungs were clear but her abdomen has ascites with some vague fullness over the lower abdomen query mass. So again, I called ED to refer the case for potassium fast correction and TRO malignancy (query gynaecological malignancy)....sigh... she really remind me of my late aunt who passed away from ovarian CA.

2) A neonate, day 5 of life came for neonatal jaundice. I saw the child has left preauricle skin tag. i wasnt sure with seremban's practice whether a child would be screened for any renal anomalies if they have skin tag/ pits over their ears. As i was unable to call the Paeds MO and my FMS was not too sure abt it also, so i had to discharge pt to come in the next day to repeat her TSB (total serum bilirubin). So that evening, I tried calling the MO again, and consult with her. MUST DO ULTRASOUND KUB, MUST REFER PAEDS.

moral of the day

1) must be very careful of what we are looking at

2) as doctors, we tend to LOOK at things WE KNOW. so can miss a lot of other things that we dont know
3) doctors still come to work when they are not well..sigh

THURSDAY 22/12/11

MC today, sprained my neck badly that I was unable to move it at all....however, because i was meant to refer the neonate today, i had to call my colleague to "catch" this patient. i did not write the plan about the paeds referral and ultrasound because i wasnt sure at that time and i had to discharge the patient first. So any enquries, i asked them to call me. But nobody did.....hmmmmmmmmm.....

FRIDAY 23/12/11

ALLAH'S PLANS ARE THE GREATEST. As i was worrying about whether my colleagues able to "catch" that particular neonate, apparently the neonate came back to me today..... i was happy.... so the truth was that the patient did not even turn up yesterday!!! Haha... ALLAH is GREAT.... so I safely referred the child to paeds and arrange an ultrasound for her. ALHAMDULILLAH

moral of the day - ALLAH IS GREAT. GREATEST PLANS ARE HIS

THE WEEK ENDS WITH EXTREME TIREDNESS BUT A HAPPY ENDING

2 weeks full of challenges part 1

Over the past 2 weeks, i have been awfully tired because of chronic cases that i saw in the OPD (outpatient department). I guess these are the challenges in the OPD. We are seeing different and variety of cases and have to make up the diagnosis, in which 50% who came actually plainly wants MC and majority of them has no proper diagnosis (because patients would come with "weird", made up presenting complaints). But among all challenges, the biggest would be TIME factor as we have very little time for each consultation. This is why many patients complaint that government doctors are not thorough enough. TIME CONSTRAIN has been the issue all this while especially when it comes to chronic and complex cases.

Most of the time, cases that I saw was a mixture of simple and chronic cases. Simple cases include upper respiratory tract infections, acute gastroenteritis and fever. Chronic cases include diabetic and hypertensive patients. But over the past 2 weeks, I have been getting chronic complex cases which require lots of time to think and squeezing my brain out in a very limited time frame. At that moment, I felt my brain was boiling and almost burst. The time limitation made things difficult as i need to focus on the condition and make a proper plan for the follow up. Despite all the difficulties, I felt satisfied because i was able to learn from those interesting cases i saw. Better than seeing same 'ol cases again and again.

MONDAY 12/12/11

I was doing my lunch call this week which means i had to work during lunch time from 1-2pm and my break will be at 2-3pm. As usual, the OPD card would arrive late...most of the time, the card will be arriving at us about 1hr to 1 1/2 hour late. Today, during lunch call, they "threw" me 7 cards at about 1.40 pm. Imagine seeing 7 patients in 20 minutes, meaning each patient will only has 2.8 minutes per consultation. Out of these 7 patients, 3 were complex cases. Dont expect me to see 2.8 minutes for complex cases. Really ridiculous.

1) Nepal patient came in without a translator complaining whole body ache. Denies fever. Other history were unable to obtain. This is really common sense. If you cannot speaks Malay/ English, pls bring somebody who does. The problem with this patient is that he brought in a friend but he too cant speaks any languages except his own language. That would not make any different, isnt it? This problem does not only occur in foreigners but also occur among our Malaysian citizen. So..what is it in 1Malaysia when even our own citizen unable to converse in our national language. Bangla lagi pandai cakap Melayu.  The problem with that is patients always believe that doctors have psychic power who can read their mind. "Cik datang sbb apa ye?/ Pakcik makan ubat apa?". The answers always sounded like these "Doktor lah bagitau saya sakit apa/ Doktor lah cakap saya makan ubat apa, saya mana tahu psal ubat2 ni".....  @#4#%^47 so ignorance

2) 2nd patient was deaf/ mute. i dont blame him for the language barrier. But it's definitely taking more than 2.8 minutes to see this patient.


3) the 3rd case was Philipino, just discharge from a private hospital with the complaint of palpitations for the past 1 month.(whom i guess was just recently diagnosed with a heart condition). She had been fully investigated at the private hospital and has her TCA with the private doctor but because of financial constrain, she want to continue her care here. But the problem was, i dont know the diagnosis, she came in without any referral letter from the Private Hospital. Not that i want to shooh her back to the private, I totally understand the financial problem..but at least informed your treating doctor first and get a discharge summary of your condition before transferring your care. This is really commen sence. Again, the thought that a doctor has a psychic power in play. When asked, she dont even know what was her main medical issues/ diagnosis, which further complicated and annoyed me. All she brought in was an envelope containing blood investigations and a few ECGs. If was like playing a jigsaw puzzle,muddling and sorting out little piece of information. Again, 2.8 minutes would not be enough for that, wouldn't it???I noted some blood investigations were taken from the emergency and few were from ICU..so there's a hint...so this must be something serious if she had been admitted to ICU. Basically, i nagged and nagged her for her ignorance. So to safe time, i asked her to do one ECG and to come back and see me after my lunch break. After consulting with my FMS, I referred her to MOPD. It would be easier if the private specialist refer straight to the government specialist. One problem of getting a good referral from private practice is that some private doctors were uncooperative in writing referrals.Some patients come to us to continue their medications as they could no longer afford expensive treatment but what medications, patients were  unsure, so i asked them to go back to their respective clinic to get the list of medications, so these private doctors would scribbles with illegible hand-writing, like as if they just not in the mood to write any letter. (baik toksah tulis gituh)

so for that day, i finished my lunch call a bit late. sigh... annoyed with the registration staff who sent those OPD card so late, annoyed for those complex cases of ignorance.

moral of the day

1) get discharge summary from treating clinic/ hospitals

2) bring translator if you have difficulties conveying your problem

3) time is always the limitation for a good health care in a government setting clinic
4/ doctors are not psychic

TUESDAY 13/12/11

Pt was just discharged from the ward, withholding her Atenolol and Gliclazide due to bradycardia and hypoglycaemia. On the day she met me, her sugar profile was quite high. Her previous OHA (oral hypoglycaemic agent) was only Gliclazide. I had very little information on why she was never been started on Metformin, But it need to re-start her on something for the sugar control. As in normal cases, pt would not be started on Metformin due to renal impairement. Maybe she has renal problem but i need to know her baseline creatinine and to confirm about it, I have to trace her NCD card (at her NCD clinic). At the same time, i asked her to do renal profile so i can see her current renal status. Apparently her creatinine was 149 ( in which increasing in trend), so she definitely cannot be on Metformin nor sulphonylureas (gliclazide/ glibenclamide) as she would go into hypoglycaemia, so i had to start her on bolus insulin. All these take a lot of my time....

WEDNESDAY 14/12/11

This patient was one of my early bird patient, came in with left sided facial weakness. A-ha, it was easy...it was Bell's Palsy, I was sure about it. Yeah but to confirm, i did a few examinations. The strange thing about it was the weakness was not all unilateral. Apparently, his upper part of his face was showing that he has left sided weakness (unable to shut his eyes, unable to wrinkles his left side forehead) but upon blowing up his cheeks, he was unable to blow his RIGHT side...if it was Bell's, he would be unable to blow his left side too.Something fishy about that finding. i was suspicious thinking that it could be CVA (stroke). So i called 2 of my colleagues to confirm, both of them said it was Bells. but i have this strong feeling that it was not as simple as Bells so i called another different 2 colleague and they think it was CVA....now that was confusing. Luckily i checked his BP and noted that it was super high so without any further delays, i referred him to A&E (Left facial weakness TRO CVA with possible Bell's palsy). Because I'm also practicing DEFENSIVE MEDICINE, every referral I made has its own reason. (before the ED MO chased me around for sending Bell's palsy to ED...ED MO loves to chase us here for sending crappy cases...tehehe), I elaborated, reasoned and justify  that the clinical examinations was not tally with Bells as Bells comes in with unilateral weakness (but not in the pt's case).  Thought pt has no comorbid prior to this, his arrival BP was high. And i did not serve him Nifedipine though he has high BP because if it was a stroke, that it would be dangerous to drastically bring down his BP especially in a clinic where we have no observation facilities. He would be better off in ED, if so they decided to give him the Nifedipine, he was able to be well observed in ED. Thank Allah that i did not receive any rejecting calls from ED that day. I wonder what happen to that pt......(if pt has normal BP, i probably treated him for Bells)

MOral of the day - do practice Defensive Medicine to save your own butt

THURSDAY 15/12/11

1) Bee sting case.. apparently i saw lots of bee sting cases where the bee stinged patients while they were riding motorcycle and the favorite target were the lips.Same goes as this particular patient who walked into my consultation room. This patient was special in the sense that his lips was super swollen, the biggest i have seen so far. Most of the patients, i send them back home. But for him, i sent him to ED. His lips were super swollen and that he also complained of breathlessness (though his lungs were clear). The fact that he said it wasnt a bee, that took my attention. The description suits more of a wasp than a bee. (it was bigger that a bee, it was black, not yellow n black striped). A single bee sting would be fine but a single wasp sting, very dangerous, pt need some observation. As my clinic did not have any SPO2 machine, so i reasoned with ED for my referral ( for observation and spo2 monitoring). Again, i was safe from receiving unwanted call from ED.

2) COPD patient, just discharge from ward a month ago, came in for his MDI. So I gatal2 and asked him regarding compliancy of his MDI. Apparently he was using Combivent BD dosing...(usually TDS) and so I was rather suspicious, so i asked him for his discharge summary to confirm his medication dose, so he took off his yellow MOPD booklet, noted that he was supposed to be on Combivent TDS with Budesonide BD dosing. In the notes, I saw that ward doctors have arrange him for an echo and TCA next month, date was not written in the booklet. So i asked for the TCA booklet and discharge summary to see when is the echo scheduled and at the same time, educating him for his compliancy. Relative agreed to bring in the summary for me. Pt wanted his meds so I said to him, "bring me the summary, only then i give you your meds" ( if i gave him his meds, he would have not come back). So pt was pissed off, left the room and made a statement full of sarcasm "kalau mcm ni, lebih baik jumpa doktor berbayar. Ambil ubat pon susah. Tak yah makan ubat  lah" I was trying to help him and this was what I get. Thank God that his relative was understanding and mentioned " ala, nak bayar duit wad pon tak mampu, nak bayar doktor pulak" So after 30 min, pt's relative came back with discharge summary and a torn MOPD booklet. So this pt was really angry with me that he torn off his booklet and threw into the trash can. His relative had to collect it inside the trash. Yes, as i would have guess, he defaulted the Echo TCA and MOPD too. So my assistant helped them back to get a new TCA...this time around, i really hope that he would not default.

moral of the day - some pt never appreciate your work to help them, they think you interfere with their life.asking too many questions, too thorough... yada yada. "tak tolong salah, tolong pon salah jugak".. so whatever you do, you are always on the wrong side.

FRIDAY 16/12/11

1) My first patient of the day. He came with severe bilateral leg swelling up to his groin (mind me,  his scrotum swollen up too)....YES i remember him, I saw him one month ago during my lunch call on a Friday evening, he came for URTI but because he has underlying DM and HPT, and was told by his relative that he defaulted his medications, I checked his sugar profile and BP, noted to have very high parameters. so I sent him off for renal profile for his renal status and urine to see ketones. Renal profile showed that he has some renal impairment. His relative informed me that he defaulted MOPD TCA years ago....so i asked him to come back in a week time to further follow up with his pressure and sugar - defaulted too!!! So that day, he came in with severe swelling for 2 weeks with shortness of breath. He even has ascites (fluid in the abdomen cavity). but his lungs were clear. His BP was high, sugar was high too.I nagged him for defaulting all his TCA....so i shooh him off to ED (CCF with fluid overload)

2) dengue case from Sungai Pelek. Pt was already seen at KK Sg Pelek on the same day, came back to us just to get a referral letter to go to ED as pt already being rejected by ED triage. For ED, why do you have to reject his case as he was very ill and if you check his dengue chart card, you will see that his haematocrit was increasing in trend. He was dehydrated. Worse, Sg Pelek, how cant you discharge pt with HCT of 50, i mean, his HCT was increasing in trend, at least this pt need some hydration.

3) old indian lady just discharge from ward, came in with a discharge summary but nothing written about the changes in her meds. Pt saying that the doctor in the ward changes her medications and to continue care in KK. The thing is that pt was not fully informed regarding her medications that she actually took Gliclazide, Glibenclamide and Metformin all three (N.B. Gliclazide and Glibenclamide are in the same class of drugs so they cannot be given together). She came in complaining of giddiness. Thank God she did not turn hypoglyacaemia. Maybe the HO in the ward did not explained properly to pt. Maybe because pt already old, she may have difficulties in understanding her meds.maybe maybe maybe (sebenarnya rasa nak marah tapi tak tau nak marah sape...sape punyer kerja nih...nasib baik pt tak collapse kat rumah....haiyaa), so it took me sometime to arrange back her meds.

4) end of the day, a newly married Indian couple came to see me, the wife having URTI.... well i have good ending seeing somebody dressed up in a wedding attire coming into my consultation room.very pretty.

moral of the day - 

1)some pt will only come to you when they are in trouble, when we give them proper TCA they refuse to follow up their care, only turns up when it was already too late. then by that time, they will come to you with issues that will EAT YOUR BRAIN

2) we're cleaning up other people's messy work like in case 2 and 3.

to be continued.....

sakit leher paling teruk

hari ni saya cuti...MC sebenarnya...boring pula duduk rumah...selalunya tak lah sebosan nih sbb mcm2 kerja yg saya boleh buat di rumah, namun sbbkan masalah "ni" saya langsung tidak dpt berfungsi dengan baik. cuaca di luar pun mendung aje menambahkan suasana kemuraman saya.

saya tak pernah terseliuh leher seteruk begini. semalam ketika bangun pagi, dah mula sakit..org kata salah bantal..tp saya masih boleh mandi dan buat kerja lain. cuma masa nak menyarungkan baju, saya tergeliat sekali lagi menambahkan kesakitan yg sedia ada. tapi saya cuba lagi....terus bersiap2 utk ke tmpt kerja. dalam kereta, tengah nak mengundurkan kereta keluar dr anjung rumah, saya cuba membetulkan lubang "air-cond" kereta saya yg paling kiri sekali, maka saya pon terseliuh buat kali ketiga dan ketika itu sakit tuh terus menangkap lengan kiri saya. terhenti seketika di dalam kereta. rasa mcm nak nangis. namun saya sangkakan takde apa2 cari sy terus proceed ke tmpt kerja.

saya mengalami kesukaran utk menggerakkan leher jd hal ini melambatkan proses sy merawat pesakit. di pengujung hari, leher saya menjadi2 sakitnya. bawa kereta pon tak boleh nak teleng langsung sehinggakan saya tidak dpt menoleh side mirror saya. di rumah pon sy tak dpt nak buat apa2. malam tuh nak tido serba tak kena sbbkan sakit...tak tahu nak baring mcm mana. asyik2 terjaga...sakit nyer tidak terperi....badan sudah lenguh tp nak gerak sangat, terlmpau sakit.

pagi tadi, leher saya langsung tak leh nak bergerak. nak bangun pun kena mintak tolong cik abang tarikkan. nak mandi susah, nak pakai baju susah...last2 pergi klinik amek ubat thn sakit dan muscle relaxant....dan amek MC...mcm mana nak memandu dlm keadaan sebegini. setelah makan voltaren dan orphenadol, saya pon dilanda rasa mengantuk akibat dek ubat dan juga kerana tidak dpt tidur semalaman. tak dpt nak buat apa2 kerja di rumah. sehingga kini, leher saya masih sakit terkehel...dah kurang sikit namun kena jaga elok2 sbb silap pergerakan, boleh menyebabkan kesakitan dan boleh terkehel lagi....

hmm....

Human's right is not to do human's wrong....

tajuk nih diambil sempena petikan kata2 seorang rakan saya....

baru2 ini kita semua digemparkan dgn berita tentang kehilangan seorang pelajar lelaki jurusan perubatan tajaan petronas yg dikatakan menghilangkan diri dan tidak dpt dihubungi selama 3 tahun. apabila membaca berita tersebut, kita pasti akan terkejut kerana pelajar tersebut langsung tidak menghubungi keluarganya dan mereka pula terpaksa menanggung beban hutang membayar penajanya sejumlah RM800k+. sehari kemudian, berita tentang status pelajar tersebut tersebar lagi, dikatakan duta kita di sana mengesahkan pelajar terbabit berada dalam keadaan selamat dan status perjalanannya di sana adalah sah.namun maklumat lanjut tentang kedudukan dan cara menghubungi pelajar tersebut tidak akan didedahkan kerana menghormati hak asasi manusia yg dipegang oleh kerajaan di sana. kerajaan kita berharap dpt menghubungi pelajar tersebut agar dia dpt berhubung terus dengan keluarganya. di hari ketiga, berita lain pula tersebar...benar atau tidak, saya sendiri tidak pasti. ia berkisar tentang pelajar yg sama yg berkahwin dengan lelaki warga sana...a.k.a. gay wedding. 

di sini bukan utk saya bergosip tentang kehidupannya...bahkan saya sendiri tidak tahu kebenaran kisah itu, mungkin ianya satu tabloid dan fitnah semata2. namun, persoalan yg ingin dibincangkan bukan tentang betul atau tidak kisah itu, namun yg lebih besar iaitu MENYELAMATKAN AQIDAH seseorang itu. andai kata khabar itu adalah benar...adakah kerajaan kita, duta kita di sana, pegawai hal ehwal pelajar di sana TAHU tentang kisah pelajar kita? adakah mereka cuba menutupi hal ini? oklah...hal2 sebegini yg begitu mengaibkan harus ditutupi dan tidak perlu dibincang di khalayak ramai kerana ia amat memalukan bg pihak pelajar tersebut mahupun keluarganya. namun, saya agak tidak setuju sekiranya mereka akan terus berdiam diri dan tidak cuba mencari pelajar tersebut atau mendapatkan nombor kontek beliau utk diberikan kepd ahli keluarga....terutamanya atas alasan menjaga hak2 asasi manusia..(human's right)....

seharusnya mereka mendedahkan sahaja kedudukan beliau dan cara utk dihubungi kpd keluarga agar dpt memujuknya kembali ke pangkal jalan. sebagai saudara seIslam, kita tidak patut membiarkan dia terus hanyut dalam dunianya yg penuh maksiat, dosa dan noda itu. kasihanilah dia....dia masih ada ruang utk kembali membetulkan syahadahnya.

saya tidak mahu membicangkan hal pelajar tersebut dgn lebih lanjut. dalam negara kita sahaja, terdapat byk kes2 yg serupa tp tak sama. beberapa tahun yg lalu, seorang melayu Muslim yg memeluk agama Kristian (tak silap saya namanya Lina Joy) yg mana dia dinafikan haknya utk bertukar agama di dalam kad pengenalan oleh majlis agama kita. sedihnya, msih ada segelintir org kita yg tidak faham lalu memberontak akan tindakan majlis agama tersebut yg menghalangnya  dr menukarkan agama di dalam kad pengenalan..ok...tukar agama di kad pengenalan tuh tak lah penting sgt berbanding dgn realiti yg mana si dia sudahpun murtad. itu bukan isu yg perlu digaduh2...apa sahaja agama yg tertera di kad pengenalan itu bukanlah penentu segala2nya, yg penting apa yg tertakhluk dalam hati masing2. tp dalam perbahasan tersebut, saya ada menulis satu artikel perbincangan di ruangan Yahoo!Groups. nampaknya masih ada yg tidak bersetuju dengan pandangan saya tentang perlunya kita sama2 berusaha menyelamatkan aqidah seseorang itu.

dari situ, bermulalah satu dialog antara saya dan penulis misteri ini..saya tidak pasti dia ini beragama Islam atau lain. namun, pintasnya, dia cuba menegakkan hak2 asasi si murtad tadi utk menentukan agama yg ingin dianutinya. ya, saya faham tentang hak2 seseorang itu...tapi bagaimana pula hak2 kita terhadap dia (Lina Joy) sebagai saudara islam? haruskan kita membenarkan dia berpaling tadah kpd Tuhan pencipta sekalian alam?? apakah tanggungjawab kita dalam usaha ini? tidakkan kita akan dipersoalkan kelak kerana tidak menunaikan tanggunjawab kita terhadap saudara seIslam kita ini? memang kita ada hak utk memilih jalan kita sendiri, nak baik, nak jahat, namun mensyirikkan Allah sesudah kita mengucapkan syahadah..itu kita tidak diberikan pilihan. kita harus/ perlu setia. sudah tentu, selepas berusaha bersungguh2 sekalipun, sekiranya dia ingin kekal dengan agama lain itu, itu hak dia...tp sekurang2nya kita sudah berusaha. tugas kita berdakwah...namun hidayah tetap dr ALlah.

contoh lain, kes seksualiti merdeka....bukan ini perjuangan mereka, namun di sebaliknya, mereka cuba memperjuangkan hak2 mereka utk hidup "normal" seperti org lain tanpa di pandang serong oleh masyarakat. ya..sekali lagi, kita berbicara tentang HAK ASASI...TAPI SIAPA YG LEBIH TAHU TENTANG HAK ASASI MANUSIA KALAU BUKAN PENCIPTA MANUSIA ITU SENDIRI YAKNI ALLAH SWT. 

kalau kereta rosak, pergi ke mekanik, kalau paip rosak, cari tukang paip....kalau hati rosak....Allah lah tempat yg harus kita tujui....sebagai analogi, seorang pencipta kereta PERODUA merekacipta sebuah kereta baru yg diberi nama VaVaVooM. disbbkan dia yg mencipta VaVaVooM, maka hanya dia seorang sahaja yg tahu cara mengoperasikan kereta itu, hanya dia sahaja yg boleh ajar org lain utk membantunya operasikan kereta tersebut, kalau kereta itu rosak, kpd dia lah tmpt pertama yg perlu dituju. kalau tanya org lain, pencipta peti ais Toshiba, sudah tentu dia tidak tahu cara membaiki kereta tersebut. jd konsepnya sama...

siapa KITA? MANUSIA bukan? siapa yg mencipta kita? ALlah...kalau kita mengalami masalah, siapa kita rujuk? ALLAh..pandai....so buku manualnya sudah tentu Al-Quran.... kenapa perlu kita mengambil sistem lain selain dr sistem Islam sedangkan di dalam Quran, sudah terbentang luas garis panduan yg ada utk kita selamat dunia akhirat. apabila kita mengambil sistem selain dr Allah yg mana ianya tidak sempurna, maka wujudlah lubang2 dan jurang2 kekosongan yg tidak dpt diisi yg disbbkan ketidaksempurnaan itu. oleh yg demikian, sistem2 lain pula akan wujud utk menutupi lubang2 tersebut....

sistem barat yg diperkenalkan kpd kita byk lubang2nya sehinggakan suatu ketika, antara lubang yg dikenalpasti adalah penindasan wanita. wanita2 barat semakin gempar dengan penindasan yg berlaku terhadap mereka lalu di situlah mulanya wujud konsep "feminisme" yg dibangkitkan dengan tujuan utk membela nasib kaum wanita yg ditindas, didera etc. kewujudan Sisters In Islam juga diperakui diadakan utk menutupi lubang2 yg ada dalam sistem yg diamalkan di negara kita. oleh kerana kita tidak mengamalkan Islam sepenuhnya, masih ramai di luar sana yg tidak memahami sepenuhnya tentang hebatnya wanita ini di sisi Islam...sehingga ingin mewujudakn satu organisasi berbeza pula utk membela nasib.  wanita solehah..tangannya yg menggoncangkan dunia.. dengan kesolehannya itu wujud pejuang2 Islam yg lain...bagaimana tingginya pahala yg Allah kurniakan kpd mereka yg sedang mengandung, berperang utk sersalin etc.... di samping itu, Islam juga membela wanita2nya dengan mempertahankan maruah melalui penutupan aurat, membela mereka sekiranya didera oleh suami dengan wujud hukum fasakh/ khulu' dan mcm2 lagi....semuanya bertempat. mungkin ada yg rasa tak setuju contohnya hukum faraid yg mementingkan lelaki, namun semuanya bersebab...tak payah nak terang panjang lebar di sini, itu kena bincang lain pula. namun kita masih buta, masih ingin mengagungkan sistem yg selain dr Islam...sehingga kini, saya tidak nampak perjuangan SIS releven kerana perjuangan mereka itu lapuk, Islam sudah lama memperjuangkannya 1500 tahun yg terdahulu. perjuangan mereka hanya mengikut nafsu utk memenuhi kepentingan sendiri.


Yg penting......hal ini tidak berlaku di dalam Islam kerana Islam itu SYUMUL, merangkumi semua aspek kehidupan.. KONSEP PENTINGNYA IALAH ISLAM ITU SYUMUL DAN CARA HIDUP YG SEBENAR.

apabila kita cuba mempertahankan hak2 asasi ini...kita perlu ingatkan kembali...apa sebenarnya hak2 asasi kita yg sebetulnya? YA..MENGABDIKAN DIRI KPD ALLAH. memanglah semua orang nakkan hak2 mereka, privasi, tak mau diganggu, pilihan sendiri, nak pilih rumah mana, warna apa, siapa nak jadi kawan dia, nak duduk mana, nak kahwin dengan siapa etc...tapi selagi itu tidak melanggari syarak, ia tidak salah. namun yg menjadi KESALAHAN  ini adalah memperjuangkan sesuatu yg dikatakan  "hak asasi" namun ia jauh terpesong dr landasanNYA. itu sudah bukan kira hak asasi lagi....

HAK ASASI ADALAH HAK2 ASAS MANUSIA DALAM LINGKUNGAN SYARIAHNYA...BUKAN HAK2 JURUSAN NAFSU DAN GODAAN SYAITAN.

wallahu'alam

genting trip

sabtu minggu lepas (10/12/11), kami sekeluarga pergi ke genting. nak kata bercuti, tak juga, cuma "short trip" sahaja. suami saya ada "friendly match" kat sana. saya mengambil kesempatan tu utk mengikut sbb saya tak pernah lagi smpai ke Genting seumur hidup saya.

kalau tanya genting...dalam kepala saya casino, tmpt perjudian terbesar....sebut lagi genting, terbayang pula taman tema yg besar di atas puncak gunung....jd tak ada sebab sebenarnya saya nak ke genting sbb saya tak berjudi...haram!!! dan saya tak main benda2 yg ada kat taman tema tuh sbb saya penakut....cumanya kalau nak pon harapkan pemandangan yg cantik. tapi kat situ tak byk "scenary walk"..semua org pergi ke genting antara dua sebab tuh saje. dan sbb tuh juga saya tak pernah jejak kaki ke sana mahupun teringin nak mengajak keluarga ke sana. tapi disbbkan suami ada aktiviti di sana, saya pon nak ikut, teringin nak tengok sendiri apa yg ada di genting tuh.

perjalanannya tak jauh dr rumah kami, agak2 kalau tak sesak di jalanraya, mungkin satu jam sahaja utk smpai ke pos pengawal genting highland tu. sebelum ke sana, saya dan suami sempat "survey" dalam internet tentang aktiviti2 yg boleh dibuat di sana. rata2 aktiviti main2. pastu naik kereta kabel. survey harga barangan di sana juga. byk komen dalam blog mengatakan harga makanan 2-3 kali ganda. paling bajet adalah makanan "fast food" tp itupun harganya tetap 2 kali ganda dr harga asal. bila dah tahu mcm tu, kami buat keputusan utk bawa bekalan sendiri....beli KFC siap2 dr sini....bawak nasi lemak lebih dr sarapan pagi.

setibanya di sana, kami pon naik kereta kabel Genting Skyway....pada mulanya, naik gayat juga saya dibuatnya....meremang bulu roma. tp lama2 naik seronok. setibanya di puncak, kabus tebal melitupi kawasan....smpai2 pon dah jam 130pm (sbb bertolak pon lambat dr rumah, ada kot jam 11am lebih cmpur kesesakan jalan di tgh2 KL tu)...sebaik tiba di puncak, kami terus menunaikan solat Zuhur. dr surau tu, ada tingkap2 besar dan boleh nmpak pemandangan yg sangat cantik....rasa segar dan tenang je melihat pemandangan tersebut.

dan lepas tu, kami pergi makan kat KFC, tumpang duduk je tp kami bwk KFC gak, cuma dibawa khas dr cheras. saya pon gatal pi jenguk harga..mak ai...memang btul....snack plate harganya RM 17.95 dan dinner plate RM 25.95..sedangkan harga di sini hanyalah masing2 RM 8.90 dan RM 11.40....untung bawak bekal sendiri. pastu kami jalan2 sekitar kawasan. tak masuk pon taman tema tu, tengok dr luar je. dengan anak2 kecil nih, tak terasa kerugian pon. cuma bila lihat taman tema dalaman (indoor)..cam best jugak...sbb anak2 kecil leh join. tp disbbkan kekangan masa, game suami dah nak start, terpaksalah kami turun kembali ke skyway utk turun bukit dan ke awana resort, tmpt suami akan bermain.solat asar di sana.

masa suami main, saya pon main sekejap dengan Mujahid...ala main badminton pukul2 angin je. insyirah pula sibuk minum susu. lama2 saya kepenatan, suruh mujahid main sorang2 dia. selepas perlawanan, kami solat maghrib dan terus kembali ke cheras....bertolak dlm pukul 8 dan tiba di rumah jam 9pm...

alhamdulillah.....dpt jugak jejak kaki di genting. kalau org tanya, boleh lah kata dah pernah smpai walaupun hanya buat seketika.tp kalau tanya saya, saya lebih suka cameron sbb saya suka tengok pemandangan. nak jalan2 sbb nak tenangkan diri, bukan nak peningkan diri dgn aktiviti2 lasak mcm kat taman tema tu....lagipun perasaan tak lah berapa tenang sangat di genting tu sbb terasa dekat dgn maksiat...casino bersebelahan je...

wallahu'alam.

a letter to our minister

To whom it may concern

i just saw in the news on tv a few days back and i was rather annoyed with the statement made by the minister of housing regarding the fact that they (the ministry) unable to produce a special act/ policy/ circular regarding the erratic rises of the price of houses these days. they claimed that they (the government) cannot control the prices because of the high demand of the houses and properties as well as the rising cost of raw materials. it is such a crap thing, i think...i mean, you are the GOVERNMENT. you make policies, rules and regulations, acts and circular yadda yadda...what do you mean when you dont have the power to do so...after all, all the laws and legal acts were made by the previous  government. things can change. if you can make our students confused with all sorts of policies and education programs, one day PPSMI, another day, no more PPSMI, so why cant you take control over the housing price like how you control all the controlled items like flour, sugar..like you can subsidised petrol...why cant help us in getting a decent inexpensive house??

one and half year ago, i booked a house in Alam Sari which is the only freehold land under PKNS in Bangi, the rest were least hold. the starting price of the house was RM 390 k plus...to me that was already expensive though i know that other colleagues of mine spend more than RM 500k for a dream house. i finally gave up that house due to other financial commitment. now, it has been more that one and a half year, guess what is the price of the SAME house? it reaches up to RM500k....imagine how much is the increment? when you say prices increases because of demand, highly cost materials and value of the land...how do you actually determine the value of the land? it's just a speculations, isn't it?  just a number with an unknown formulatory giving you the so-called value of the  house. so if there is an increment of more than RM100k per year, what is the price of the house in the next 3 years? 5 years? 10 years? what's gonna happen to my children...who will be an independent adult in the next 20 years? i'm sure by that time, houses will cost millions. even now, i've seen double storey  terrace house with land about 20x70' selling at the price of RM500k...that is in Kajang2...where are my children going to live? loans with banks now are also a hassle as for RM500k house will cost about a million or so when you complete your bank loan..if you're still alive to make the ful payment. thanks to the high interest rates.

our value of money is getting smaller, sooner or later, our currency will be similar to Indonesia which has very little value. imagine i small pack of nasi lemak in the future will cost you RM 25.....and with the little increment of salary for government servant, how are we going to survive in the coming future? how will our children live in that so-called modern urbanisation? my husband kept on asking me...by the time our children grown up, how are they going to buy houses if is is going to be more and more expensive? even now, i can only afford for necessity, not luxurious life....the poor will get poorer and yes... the rich will get more rich... true?

oh i forgot.. i probably asked the wrong question to the wrong person....you probably has not think about it yet...and yes if you do think about it, it's more for you own family and crony, isn't it? oh...cronyism....you probably has not think about it, about the future of your citizens because you are plainly thinking about yourself and survival of your own generations. and yes.. you will say "it's nature...those well will survive, others will extinct"..you dont feel our difficulties because by now, i bet you have lots and lots of investment and properties and houses...the number of houses/ properties you have are basically enough to sustain few lines of your generations... but not for us the citizens.

yearly, the prices of basic necessities are increasing but the increment of our salary is not up to the increment of these prices. cost of living shooting up but our salary is like snailing up the wall. my husband had a good KPI this year comparing to previous years but because they have this stupid bell shape graft to normalised and equalised the KPI score, my husband KPI has to be downgrade? what such nonsense is that? if you perform..you perform lah.. why do you have to downgrade? so what's the point of doing KPI if motivated staff who work really hard for a good KPI but in the end, being downsized?? in the end, that is what happened in government service...little increment,  little incentive but work like a cooly.. so everyone ended up doing their work "lenggang lenggang kangkung" or "melepaskan batuk di tangga" or "cant be bothered anymore" only.

so if you are the government, why are you not seeing this? not doing anything about it? you making lots of excuses and fuss like as if in the next General Election, you're predicting that you're going to lose, becoming the opponents, that is why by now, you're making statement that you are unable to do anything now.

you're so clever, you are chasing for glamorous, modern urbanisation and civilisation is looked as having a modern city with high sky rise building, chic fashion, modern dancing students like the permata....but yes, you forgotten few things...too much investment on those but little on other important element of being "modern" in term of health and "modal insan" and "sahsiah"... well just look at our teenagers now a days... so spoilt..the rates of premarital sexual and baby dumping increasing each year...we are moving back to jahilliyah world... aren't you concern about it? or you're too concern about your own survival.. oh yes... i forgot....you do want to survive.. on your own...what about health? you "catu-catu" all the medications, from originals to generic which is yes, less expensive therefore poorer control of diseases because they (medicine) are cheap, so they are less effective too.

you blinded everyone with all your colourful policies and incentives but in the end, brings nothing but more disasters to us...thank you....what can i say... 1Malaysia lah...

p/s - and yes, i'm also struggling finding enough money to get my son to a good kindergarten because now a days, they are quite expensive.. what to do, my salary is not enough for that. but one thing for sure, i'm not sending him to KEMAS nor Permata, he's only going to learn dancing and singing there.. sorry no thank you.

fasa baru..kerisauan saya

kehidupan kita penuh dengan fasa2 yg berbeza.. dari alam roh ke alam rahim ke alam dunia ke alam barkzah dan kemudian ke alam akhirat. dalam meniti fasa kehidupan di alam dunia ini, kita terpecah pula ke fasa2 lain, dr bayi ke kanak2, kpd remaja, dewasa, alam perkahwinan, berzuriat etc.

selepas melalui alam menjadi ibu bapa, kini saya melangkah pula menjadi ibu kepada anak bersekolah. tahun hadapan, anak sulung saya, Mujahid akan memulakan sesi persekolahannya di tadika. kalau ikutkan tahun, Mujahid masuk 5 tahun tahun hadapan, tp disbbkan Mujahid lahir di hujung tahun, maka dia masih 4 tahun 1 minggu apabila memulakan sesi persekolahannya.

rupa2nya pening juga nak memikirkan hal2 sekolah nih. pertama, nak fikir nak hantar ke tadika mana? sudah tentu nak cari yg terbaik tapi manakah yg terbaik? di smping itu, banyak tadika2 sudah tentu akan mempromosikan mengatakan programnya yg terbaik....dalam proses itu juga, yg menjadi permasalahan kedua adalah bajet/ kewangan. sama ada mampu atau tidak utk ke tadika itu. susahnya nak buat keputusan....nak 'syllabus' yg bagus tapi bayaran yg murah..ada ke??? gaji kami berdua duk takat tuh je... ntah lah bila kerajaan nak naikkan gaji nih. selain drpd tu, masalah ketiga ialah pengangkutan...untuk membawa Mujahid ulang alik dari tadika ke taska....mencabar rupanya ye menjadi ibu bapa ni.... yer betul... memang bukan senang jadi ibu bapa...banyak tanggungjawab.

dalam byk2 persoalan yg bermain di kepala seperti yg disebutkan di atas tadi, yg paling saya 'nervous' ialah memikirkan mcm mana nanti gelagat anak teruna saya nih dalam proses pembelajarannya...bukanlah nak berfikiran pesimistik tentang hal tu, cumanya sbb tak pernah lagi tengok dia belajar. di rumah pun, ajar sikit2 aje...almaklumlah kekangan masa buat saya yg terkejar2 menguruskan rumah termasuk masak, 'laundry' dll. di rumah, apabila berpeluang utk mengajarnya, Mujahid seakan2 tidak berminat dan tidak fokus. tapi apabila bertanya tentang progress anak saya di taska, cikgu2nya kata dia ok... sekarang nih pon Mujahid dah belajar Iqra' di taska....ikut makluman cikgu, Mujahid cepat tangkap..... terang hati..... berbunga2 hati saya mendengarnya... alhamdulillah.... dalam byk main, nak juga anak saya nih belajar....saya mengagak mungkin anak teruna saya ini perlukan suasana pembelajaran yg kondusif, sokongan rakan2 sebaya dan cikgu2 yg ada. di rumah, banyak selingan dan gangguan seperti mainan dan tv. pastu biasanya susah sikit nak dengar kata ibu bapa berbanding dgn cikgu2.

'nervous' menjadi2 bila kita lihat anak orang lain lebih laju dan 'super'. Ya, saya tahu...setiap anak adalah merupakan individu yg berbeza, jangan sesekali membanding2kan mereka kerana ini akan punahkan sifat kendiri mereka (self esteem)... bukan niat nak membanding2kan, cuma melihat perkembangannya (developmental milestone) terutamanya yg dibandingkan itu adalah sepupu2nya yg sebaya. Yg membezakannya ialah Mujahid lahir hujung tahun, maka perbezaannya hampir2 setahun, mungkinkan 'milestone' nya memang sesuai aja dengan umurnya yg lewat itu. kanak2 lain juga fasih namun Mujahid pelat...walaupun saya seorang doktor, kadang2 tak semua saya tahu... tak semua ada dalam buku..ramai sangkakan saya tahu namun saya hanyalah seorang ibu biasa yg turut mempunyai perasaan risau akan anak2nya. saya tertanya2...anak2 lain yg masuk tadika, semuanya sama aje ke..maksud saya, tak pandai tulis, baca etc.. 

semalam baru je pergi Hari Terbuka Little Caliph Duta Iman di Taman Dutamas...cawangan baru di BTHO ni..mcm menarik....tapi masa di sana, salah seorang cikgu di sana sempat melayan Mujahid. tiba2 dia tegur saya mengatakan anak saya nih "istimewa" sedikit. saya tak tahu nak respon mcm mana.... dia kata begitu mengikut pemerhatian dia cara Mujahid bermain dan mewarna topeng singa. dia kata anak saya takkan belajar mcm kanak2 lain yg seusia dengannya..mungkin dia akan nampak lewat/ kurang faham berbanding yg lain.dia nampak aktif dan kurang fokus/ kurang memberi perhatian. dia kata dia ingin memberitahu saya supaya saya sedar dan tidak menyalahkan anak saya sekiranya dia tidak 'perform' seperti yg diinginkan lalu memarahinya dan berputus asa...dia kata saya kena bersabar dan usaha lebih dr ibu bapa lain, saya kena byk luangkan masa mengajar dia. namun dia nmpak potensi Mujahid, dia kata lagi, Mujahid sebenarnya bijak dan kreatif dalam menyelesaikan masalah/ mencari penyelesaian masalah. saya terpinga2. apa yg harus saya lakukan? apa yg dia maksudkan? inilah yg menambah2kan kerisauan saya. saya pon sedia maklum yg anak saya ni kuat main, kadang2 buat mcm tak dengar... (telinga tersumbat ke?) tapi tak jangka hingga sebegini. sedangkan Iqra' di taska dia mengaji laju kata cikgunya....saya berdoa agar Allah mudahkannya utk saya dan Mujahid, kami sekeluarga..mudah utk Mujahid belajar, terangkan hati dia, dan terangkan hati saya utk mengajarnya juga...kita tunggu dan lihat perkembanganya nanti smbil doa dan usaha, Insya Allah...ameen.

cukup di situ...berbalik kepada 'nursery hunting' saya.........

pencarian pertama saya terhenti di PASTI. ingatkan nak hantar di situ kerana tertarik melihat kecilikan kanak2 usia muda begitu mampu memberi khutbah jumaat yg hebat (lihat youtube)....berdebat, berceramah, bersajak..subhanallah, bijak2 anak2 ini...aktif sukan dalam bola sepak, yg perempuan pula dalam bola jaring...pandai baca doa, hafal quran, hafal hadis... harap2 anak saya juga menjadi hebat sebegitu.... di samping itu, bayaran sesi pengajarannya adalah berpatutan dan mampu utk saya. berniat agar duit yg kita beri itu dapat juga sedikit sebnyk membantu pembangunan pendidikan kanak2 PASTI yg mana organisasi tersebut berjalan atas organisasi yg 'non-profitable'.

kemudian, tertanya2 pula psal Tadika Taman Kasih yg mana dimaklumkan bahawa cikgu2 berkaliber dan berdedikasi dalam mengajar terutamanya bab membawa. teringat anak saudara saya yg pd awalnya tidak tahu membaca,,dan dalam beberapa bulan sahaja.... wallaaaa...boleh membaca!!! saya nak anak saya pandai membaca. bab yuran pula, mahal skit dr PASTI.

di taman yg saya duduki, terdapat byk lagi tadika lain terutamanya tadikan yg berasaskan pendidikan Islam seperti Genius Aulad, Little Caliph dan CIC. bila melihatkan 'syllabus'nya, memang sungguh bagus dan ianya menggunakan bahasa Inggeris sebagai medium bahasa utama pembelajaran. namun, yurannya agak mahal. hmm. jauh mahal sebenarnya.


jadi yg mana satu? akhirnya saya dan suami terpaksa duduk membuat belanjawan keluarga 2012.. walaupun sebelum ini sudah berkali2 dibuat, tapi perlu di'revise' kan kembali... Ya Allah, tunjukkan lah kepada kami apa yg terbaik utk kami dan anak2 kami...saya dan suami sebenarnya buntu, tak dapat nak buat keputusan. yg berminat, Little Caliph, tapi dr aspek kemampuan, mungkin lebih berat kepada PASTI/ Taman Kasih (tp lebih berat kpd PASTI sbb pembelajarannya berunsurkan Islam)....Little Caliph tuh pon bukan sbb apa, sbb kakak ipar saya pon hantar anak2nya ke tadika sama tp cawangan kajang lah...kakak saya juga dan daftarkan anaknya yg sebaja dengan mujahid di sana... kami dalam dilemma... saya cakap dengan suami, apa kata tanya mak.... bila mak yg kata/ buat keputusan/ bagi cadangan, rasa 'secure' skit.. sbb mak tahu segala2nya....akhirnya

Little Caliph...here we come....

saya dan suami kena bajet ketat skit lah nampaknya.... harap2nya Allah permudahkan utk kami dalam urusan ini.... moga juga dimurahkan rezeki kami anak beranak.... (mcm naik gaji ke...hehe, tambah elaun ke hehehe).. saya berdoa moga ALlah kurniakan rezeki kepada kami dr jalan yg tidak disangka2..seperti dalam ayat seribu dinar..kena slalu praktikkan dalam doa harian setiap kali lps solat...moga juga Allah kurniakan kami anak2 yg soleh/solehah lagi bijak dan cilik. Ameen.

"Apa yg kita fikirkan itulah yg merupakan doa kita" jadi saya kena berfikiran positif.!!! caiyuk...

fixing your life

http://www.huffingtonpost.com/daliah-merzaban/how-to-pray-five-times-a-day_b_1103662.html

Daliah Merzaban

Middle East journalist and analyst

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How To Pray Five Times A Day With A Busy Work Schedule 

Before I genuinely began to cultivate and nurture my relationship with God, I regarded the five daily prayers that Islam enjoins on believers as laborious. It seemed impractical to expect that I would be able to stop what I was doing during my busy work schedule to take time out and pray.
Working as a news wire journalist, I was often spending upwards of 10 hours a day in the office or at conferences, interviews and meetings, barely able to make time for a lunch break. If I wasn't working, my time was divided between house chores, errands, family and friends, and exercise. I was punctual with everything in my life, except that I was late five times a day.
In my mind, it was not viable to expect that I could wake up before the crack of dawn to pray the early-morning prayer, fajr, otherwise I would be too tired to work effectively later that morning. It also seemed inefficient to interrupt my work meetings to pray duhr, the mid-day prayer, and asr, the afternoon prayer.
Making the sunset prayer maghrib was often a challenge because the window to pray is typically quite short and coincides with the time between finishing work, having dinner and returning home. So, in effect, the only prayer that was feasible for me to pray on time was isha, the evening prayer. For most of my life, thus, I would at best pray all five prayers in the evening, or skip prayers here and there to accommodate my immediate commitments.


Women pray at Prophet's Mosque in Medina, Saudi Arabia, Mandy Merzaban photo Without realising it, my inconsistency and approach to praying trivialised the principle behind performing prayers throughout the day. I believed in God and loved Him, but on my own terms, not on the terms very clearly set out in the Quran and Prophetic teachings. Yet praying the five daily prayers, at their prescribed times, is the backbone of being a Muslim; we cannot stand upright in our faith without them. It is one of the essential practices that God has called on those who endeavour to live in Islam, a state of existence whereby a human strives to live in submission to God.
When I came to truly understand the importance of prayer, the realisation was both overwhelming and quick. It dawned on me that if I was not fulfilling this precondition, then I really could not claim to be Muslim. Even if I desired to have a solid connection with the Almighty I was not taking the necessary steps to do so. I promptly reoriented my life and it has now been a year and a half that I have not intentionally missed a prayer time, whether I am in the office, mall, grocery store, out with friends or travelling.
Looking back, I see how wrong I was about the impracticality of Islamic prayers, which are succinct and straightforward notwithstanding their resonance. When I moved from trying to fit prayers into my life to fitting my life around my prayer schedule, I instantly removed a great deal of clutter from my daily routine. Since regular prayer promotes emotional consistency and tranquillity, I began to eliminate excess negativity and cut down on unnecessary chitchat, helping me be more focused, productive and patient.
Over a short period of time, what amazed me was how easy and fluid the prayers became. Performing the early-morning prayer actually gave me a burst of energy during the day and, gradually, the prayers that I had initially perceived as cumbersome became an essential facet of my routine. With God's help, I would find ways to make a prayer regardless of the hurdles. While in Canada for the summer, I would often catch duhr prayer in a department store fitting room, with the help of a handy Islamic prayer compass application on my Iphone.


"'Verily the soul becomes accustomed to what you accustom it to.' That is to say: what you at first burden the soul with becomes nature to it in the end."
This is a line drawn from a magnificent book I am in the process of reading by great Islamic thinker Al-Ghazali, entitled "Invocations and Supplications: Book IX of the Revival of Religious Sciences." Al-Ghazali describes a series of formulas, drawn from the Qur'an and Hadith, which we can repeat to help us attain greater proximity to the divine and purify our hearts.


Women gather for prayer outside the Prophet's Mosque in Medina, Mandy Merzaban photo At each turn in my quest to enrich my faith, I have found that what at first appears difficult becomes easy when performed with sincerity. Soon after I reoriented my life to revolve around prayer, the five prayers felt insufficient in expressing my devotion. I examined Hadith, or the traditions of Prophet Muhammad, peace and blessings be upon him, and discovered there were optional prayers I could add to my routine. Since then, I have not let a day pass without praying them.
To supplement my prayers, I have integrated various zikr, or remembrance and mentioning of God, into my days. Zikr, including repeating such phrases as "la illa ha il Allah" (There is no God but God), habitually draws our attention back to God.
Among the many rich invocations mentioned in Ghazali's book is this one which I have started to incorporate. As we leave our houses each day, if we say "In the name of God" (Bismillah), God will guide us; when we add "I trust in God" (Tawakalt al Allah), God will protect us; and if we conclude with "There is no might or power save with God" (La hawla wa la quwwata illa billah), God will guard us.

I suppose to an outsider, these acts of devotion can appear a bit obsessive, and I have had a couple of people say this to me. Yet it is an obsession with the greatest possible consequences that can improve rather than disintegrate one's disposition. The more time I devote to God, the greater the peace of mind I find filling my life and the more focused I become on what is important -- such as treating my family and friends honourably, working hard in my job, giving charity with compassion and generosity, and maintaining integrity.
Remembering God throughout the day, through prayer and invocation, truly does polish the heart as Hadith teaches; you erase obstructions that would impede faith in its purest form.


"Truly when a man loves a thing, he repeatedly mentions it, and when he repeatedly mentions a thing, even if that may be burdensome, he loves it," writes Ghazali.

Follow Daliah Merzaban on Twitter: www.twitter.com/Desert_Dals

Hepi 1 year old MYVi

lama juga tak coret sesuatu dalam blog nih, makin lama makin malas pulak. bila nak tulis, terbantut sbb sentiasa diganggu oleh anak2 tersayang...maklumlah nak attention dr ibunya.

pada bulan lepas, kita semua menyambut sambutan raya haji aidiladha, dan tidak seperti tahun2 sebelumnya, raya tahun ini agak berbeza buat saya sekeluarga. pada tahun lepas, disbbkan saya tidak mempunyai cuti yg banyak, maka raya haji disambut di kampung saya di Lenggeng. pada pagi raya pertama, kami membuat keputusan utk membawa anak2 melihat sendiri proses qorban yg dilakukan di jalan utama taman kami. dilihatnya lembu2 itu tenang dan pasrah sementara menunggu giliran utk disembelih. setelah leher mereka dikelar, mereka berbunyi mengeluh namun akhirnya tumbang kr bumi utk menjadi sumber makanan kita. anak lelaki saya sibuk seronok melihat lembu2 itu, saya pula termenung sejenak memikirkan betapa indahnya peraturan Ilahi kerana dijadikan binatang2 ternak ini jinak agar mudah utk dijadikan sumber makanan. di mata lembu tersebut, dilihat satu perasaan redha dan pasrah dengan ketentuan Penciptanya..

tahun ini, kami sekeluarga menyambut malam raya di lenggeng. tiada qorban dibuat tahun ini, kami sekeluarga membuat keputusan utk membuat tahlil selepas solat sunat raya dan kemudian brunch di rumah salah seorang makcik saya yg terletak berdekatan dengan surau/ madrasah datuk saya. tahun ini berbeza kerana kami kehilangan 2 orang penting dalam keluarga kami iaitu nenek dan makcik saya ( yg merupakan seorang pakar kanak2)...saya juga tidak cuti lama utk kembali ke terengganu kerana tak merancang cuti dengan baik jd dpt cuti sekejap je.

seperti tajuk di atas....bulan lepas juga, sudah genap setahun MYVi saya bersama2 saya. walaupun usia MYVI saya tuh bukan setahun, bahkan lebih dua tahun usianya, dia baru bersama2 saya dalam setahun sahaja.

setahun yg lalu , jenuh juga saya nak mencari kereta.. pd awalnya nak cari ketika saya di posting Kecemasan kerana saya kerja syif, jadi agak sukar utk suami menghantar mengikut masa syif... namun, lama kelamaan, kami sudah biasa dengan rutin itu lalu proses mencari kereta itu tertangguh. tapi di akhir posting tersebut, kami membuat keputusan utk mencari juga kerana takut2 bila saya dah MO nanti, saya kena dihantar tmpt kerja yg lagi jauh dan menyukarkan utk saya carpool dengan suami. suami saya kata saya kena praktis bawa kereta, nanti kalau lambat2, (last minute), kelam kabut pula. lepas survey2, akhirnya saya berkenan dengan MYVi yg saya pakai sekarang ni. sebabnya, tuan dia dulu menjaga dia dengan baik, keadaan kereta sangat memuaskan, dan bila memandu juga rasa selesa dan sedap, servis pula mengikut masa. keadaan luaran dan dalaman kereta bersih dan berkilat, tuannya dulu sentiasa membasuhnya. jadi ketika saya di posting paediatrics (posting akhir saya), saya pon banyak2 berlatih membawa kereta. nasib baik praktis, tengok sekarang kena "campak" ke seremban. masa pertama kali membawa kereta ke seremban, takut tak ingat punyer, ketar2 kaki saya sampai nak kejang kerana lama sangat tekan pedal minyak, walaupun bawa kereta automatik sahaja. almaklumlah, tak pernah bawa kereta utk jarak jauh dan jangkamasa lama. bulan pertama saya agak stress sehinggakan sentiasa diserang sakit leher dan bahu dan saya hampir2 putus asa kerana dek kepenatan. rasa mcm nak pindah balik. nak nangis. namun suami suruh saya bersabar, dia kata nanti lama2, saya akan biasa lah. tapi memang betul, lama kelamaan, saya menjadi biasa kerana ia sudah menjadi sebahagian dari rutin kerja saya setiap hari. sekarang nih dah 8 bulan di seremban. cuma......kadang2, saya kesian kat kereta saya sbb saya tak sempat nak basuh dia...sbbkan dia warna putih, jadi nampak comot.

sehingga sekarang, saya sangat terikat (attached) dengan kereta MYVi saya kerana dia telah banyak berjasa kepada saya dalam tahun pertama ini. saya sentiasa berharap yg kereta saya ni akan terus berjasa kepada saya. SAYANG MYVI!!!

ni gambo contoh je...kete aku comot sket haha

memori mak cidah

ini adalah sajak nukilan arwah makcik saya sendiri buat anak kembarnya di hari jadi mereka yg ke 18.

Nukilan untuk Ana dan Iya dari Ibu

23 november 91 mengimbau kembali

Rentetan sejarah tercatit kini

Gelaran ibu anugerah ilahi

Puteri nan kembar bak bidadari

Lahirmu penuh tanda tanya

Kehadiran dua mu tidak diduga

sayup suara tangisan pertama

Bahagia ibu yang gundah gulana

Hadirmu berdua membawa cahaya

Mengisi kesunyian jiwa yang lara

Syukurnya ibu tiada tolaknya

Hendak ku tangis tiada suara

Syukurnya nenda mu bukan kepalang

Keraguan di hati segera hilang

Sangkakan satu dua yang datang

Pemecah tradisi si anak minang

Putih kulitmu bak telur dikupas

Keayuan wajahmu pandang tak puas

Bisikan azan di telinga dilafaz

Moga awalan mu tak tercemar balas

Kaulah permata buah hati ibu

Dirimu dibelai umpama ratu

Kasihnya ibu tiada sekutu

Mendidik dirimu tak kenal jemu

Amanah tuhan semesta alam

Keatas ibu siang dan malam

Kasihku baja sayang ku siram

Moga jiwamu tak di intai kelam

Anakanda berdua belaian jiwa

Nasihat ibu bukan bersahaja

Datang dari cebisan rasa

Berlandaskan fakta serta agama

Pastikan dulu arah tujumu

Tanamkan azam tekad di kalbu

Kekuatan dan keyakinan sudah bersatu

Gelombang yang datang gentar teraju

Dengarlah sayang ibu berkata

Di atas tinta curahan rasa

Hati keruan berdebar dada

Risau nasib mu di hari muka

18 tahun cabaran usia

Pancaroba datang tak kira ketika

Jangan kamu lalai dan juga alpa

Moga remaja mu mekar berwarna

Dewasa kamu gelisah menanti

Bimbang bencana menerjah diri

Doa ku pohon tiada henti

Jangan maruah dipandang sepi

Wahai puteri ku cahaya mata

Selami keluhan hati ibunda

Nasihat ibu pantang didusta

Kelak dirimu akan kecewa

Sekian kali mendengar bicara

Kepercayaan ibu jangan di noda

Jauhi sikap tipu dan dusta

Sejahtera hidupmu dimaya pada

Berdiam diri bukannya sudi

Gerak langkahmu ku kawal rapi

Dosa dan noda jangan dicari

Binasa hidupmu membakar diri

Andai kau tewas tanpa diduga

Hancur hati ku penawar tiada

Kemaafan ibu usah dipinta

Umpama tenggelam timbul tiada

Pabila ibu anakanda khianati

Kesan nya dasyat tidak terperi

Akan ku tutup hati nurani

Derita ku bawa sampai ke mati

Berperi ibu bukannya benci

Menyiksa dirimu jauh sekali

Harapan hati menggunung tinggi

Matang berfikir jangan bermimpi

Sayang pada mu tidak terperi

Sanggup ku gadai nyawa dan diri

Sabarnya ibu terbatas tepi

Berputih mata rela kau pergi

Ana dan Iya buah hati ku

Pada mu berdua ibu berseru

Cekerawala batasan ilmu

Terokai ia jangan kau jemu

Taburlah bakti sepenuh jiwa

Untuk agama, bangsa dan negara

Jangan balasan diharap pinta

Syurgawi pasti buatmu di sana

Noktah kehidupan sudahlah pasti

Ayah dan ibu mu tidak terkecuali

Saat dan ketika mengundur diri

Airmata dibuang jangan sekali

Perjuangan mu anak ku belum berakhir

Pemergian ibu memang di takdir

Panjatkan selalu doa dan zikir

Mudah urusanku penangan bibir

Tinta keturunan pantang digadai

Bak pantai indah dilanda badai

Bergegar bumi ikatan terlerai

Salasiah nendamu pastikan bersemai

Indah namamu manja bak puitis

Mewarnai maya umpama perintis

Harapan Ibunda kaulah waris

Penyambung warisan minda yang arif

Lanjut usia mu doa di pinta

Bahagia hidup mu lindungan Esa

Anakanda berdua belaian jiwa

Berjuanglah kamu bagai satria

Duhai puteri ku tambatan sukma

Pesanan ibu jadikan pusaka

Kemenangan dijulang sedetik masa

Namamu dikenang selama lama

Berakhir sudah gurindam rasa

Cetusan hati ayah dan bonda

Buat pedoman anakanda berdua

Untuk menempuh alam dewasa

recall dua bulan

salam kembali... sudah lebih 2 bulan saya meninggalkan persada blog saya. banyak yg ingin dicoretkan namun hanya tinggal di dalam kepala sahaja, nak menaip tu terasa berat sedikit. lama2 idea2 yg ingin diceritakan tu sudah musnah dan hilang begitu sahaja. dan semuanya kembali kpd alasan yg sama iaitu SIBUK dan MALAS. sejak tamatnya Ramadhan tahun ini, saya seringkali dilanda kemalasan dan kepenatan. tak tau mcm mana time bulan puasa harituh saya kuat bertenaga utk terus memasak etc tp lepas2 tuh, semuanya terasa MALAS. memang benarlah bulan puasa ni mendidik disiplin, saya rasa disbbkan disiplin, saya mampu dan tegar utk terus memasak, menjahit di waktu malam walaupun sebenarnya kepenatan.

Raya tahun nih bercampur baur...pd awalnya saya merasakan ianya meriah kerana pd tahun ni, kami bercadang utk sedondon, saya dah jahit beberapa baju dan kami beli baju supaya boleh matching...dalam byk2 tahun, inilah tahun pertama kami sedondon utk raya. namun perasaan gembira itu tetap disulam dengan perasaan hiba kerana tahun ini, saya sudah kehilangan tiga org penting dalam hidup saya iaitu nenek saya, ayah mertua dan akhir sekali, makcik saya. pemergian makcik saya merupakan kemuncak peristiwa bagi tahun ini (walaupun sebenarnya byk lagi kemuncak cerita utk tahun ini dgn kisah2 gempa bumi, bencana alam etc di seluruh dunia).... tahun ini juga saya beraya selama seminggu di terengganu....sebelum2 nih, susah nak dpt cuti raya disbbkan oncall etc.sehingga kini, saya masih terkenang2kan arwah makcik saya...dan tidak lupa juga wajah arwah mak saya.

setiap hari saya memandu pergi balik kerja, saya merasakan alangkan seronoknya sekiranya arwah mak saya masih ada utk melihat apa yg saya ada saat ini. keluarga sendiri, anak2 saya membesar dengan sihat, saya dah jadi MO dan boleh bawak kereta merata2. ianya merupakan impian arwah mak saya. saya terbayangkan seronoknya sekiranya saya boleh membawa mak saya berjalan2 dengan kereta saya. walaupun pd asalnya saya takut membawa kereta dan pd ketika itu juga, arwah mak tidak menggalakkan saya membawa kereta sehinggalah saya dah HO, baru arwah mak bising suruh saya berjinak2 kembali membawa kereta. setiap kali kembali dr kerja, ketika saya melalui bandar seremban, saya juga  teringat akan arwah makcik saya. apabila saya encounter dengan kes2 asma (asthma) yg sukar dikawal di klinik asma (buat masa ni, saya yg menerajui klinik asma di KK saya), terasa teringin bertanyakan kpd makcik saya...disitulah terasanya kehilangan makcik saya  yg merupakan seorang paediatric respiratory physician.

sekarang, saya rasa sangat stress dengan kerja2 harian, terasa nak pergi holiday, nak lari dr semua hiruk pikuk kehidupan yg rutin ini. tak sabar2 nak menunggu masa tu tp bila ya????

sekarang juga, suami saya baru mendaftar utk master di Uniten, jadi byk masanya diluangkan utk ke kelas dan assigment. kadang2 boring juga saya dibuatnya..hmm...mmg taklah boring sgt bila ada anak2 di sini, tp tak lengkap kalau tak ada cik abang. rasa mcm nak buat sesuatu juga utk diri sendiri, saya ada dua benda dalam kepala, nak gardening...dan nak exercise. bab gardening tu saya teringin nak tanam pokok bunga tp tak tau nak tanam pokok bunga apa dan nak cari nursery kat mana. bab exercise tuh pon satu, teringin nak pergi gym, join kelas2 aerobik ke...tp bila nak buat nya? masanya???

oklah, dah habis berceloteh dan membuat ringkasan utk dua bulan lepas. nanti saya letak lah gambar baju yg saya jahit....menunjukkan bakat yg tak seberapa tu.....

her last say

in her blog.....http://shidmikegambit.blogspot.com/

How to supervise HO or junior doctors - my perspective

We have heard about story about competency of doctors nowadays especially HO. As HOD, I can see a lot of differences between HOs today and HOs many years back. I think there are various factors involved that make that differences. I can list down a few factors that I think are relevant for the differences.

a. Many years ago, there were only a few established local universities were recognised to train medical students with enough lectures and facilities. Selected students will be sent overseas to study medicine in recognised universities. But now, anyone can go to any universities for political reasons even to the unrecognised universities. We are now looking more towards numbers rather than qualities. We can't really blame the students for not performing sometimes. When you asked them, they said that they didn't have any exposure in certain disciplines. Lectures used to be cancelled many times due to many reasons. Sometimes they have to learn on their own without guidance. They learned from videos rather than real patients. Well, technology does play an important role in learning but to become a doctor I feel that we have to learn from a real patients.

b. I agree that we need changes in life or education system if the need is there. But don't make those changes for the sake of making changes or based on political pressure. When we politicised education, it will bring the whole system down. If the education system is almost perfect to produce good doctors why we have to change to a terrible one. If the changes needed, it should be done slowly and not abruptly. The education system keep on changing before you can see the outcome from the previous changes. When the minister change, the system change regardless how good the system is. I felt that the new medical education system is making the medical students more a follower and memorizer rather than having a critical and analytical thinking process. Their way of thinking is very compartmentalised rather than generalised. Intergrated system doesn't seem to help them in connecting their knowledge toward disease and patient as a whole.

c. Student factors. There are two extreme conditions. Those who got 4 flat during exam, all of them wanted to become a doctor even though they have no interest. Sometimes they are being forced by their parents. The parents dictate what their children need. Those who didn't get 4 flat but wanted to be a doctor badly have to go to the other universities in overseas where the training was terrible. There were another group of students who are second grader, badly wanted to be a doctor, went to the cheapest and affordable universities abroad under their parents scholarship and manage to go through the medical school with difficulty. Another group of students from the private universities whom their parents are well to do and not on any scholarship, don't really bother what's going on. Social background also play an important factor in determining the product of the good doctors. Mental, physical and innerself strength are important for the medical students to have because as a doctor, stress is part of our life. From my observation, our junior doctors are very weak and fragile on top of having lack of knowledge and attitude problems.

HOs many years ago easily can be trained, most of them. There were faster learner. They can stand alone after one month of initial training. They were more proactive and ever willing to learn. No questions asked. There will be no parents or politician interference. Rarely you hear that consultants or specialists being threatened by parents for teaching their children to become a good doctors. Now it become fairly routine. Yesteryears HOs were more polite and respect their seniors and superiors. Again I must say most of them. Therefore, one year HO training is adequate for them to be a safe doctors. They managed to handle many patients at one time. At the end of their housemanship, you will be able to see their maturation and competency. Now, the HO training is extended to 2 years duration. They have to go through all the disciplines in medicine before they can go out and practice on their own. Some of them need more than 2 years. There are so many of them, out numbers the patients. They come from various universities that you never heard before. 2 patients under their care, they can't even remember.

I attended a few motivational talk given by well known motivators talking about how to train the HOs. Look who is talking. I just smile to myself. Most of these motivators, they have left the government service long time ago and they don't really have the experience of training the new breed of HOs the way I and my friends do. It is very tough. The things that they do, the mistake that they have done are beyond our imagination. "Bodoh sombong pun ada". Sometimes you really have to go into the basic of medicine as if you are teaching the third year medical students. Attitude problems another one to handle. The worse thing is, went they make mistake they have no regrets. No guilty feeling. Caring is not in their vocab. Politeness is too far to practice. Some of them have no insight. For me, if the young doctors are incompetent and willing to learn, I will go all out to teach them and make them competent. It is my responsibility to ensure they are safe and the patients are safe as well. I am willing to take that challenge and I will do it my own way. You have to be firm and consistent. As a teacher or supervisor to these junior doctors, our aim is to make sure that the quality of medical services are up to the standard. If your are fast learner, you will leave my department on schedule but if you are slow learner, you will be with us till you learned. I don't really care what people say.