Wednesday, August 19, 2015


It has to be one of the most mundane birthday I have ever had. Started my day in Community Rehab Clinic seeing primary students with learning disabilities. As much as I love helping the students with learning problems, it drains the energy out of me. So many factors, so many ways to help. It can also be frustrating looking at how our rotting education policies are not helping out children in the rural places at all. Life is unfair.

Saw 8 patients through the morning, had lunch with boss and ward rounds which ended at 4.30pm with some discussion on coming courses and paediatrics related activities. Working with my current boss give makes us pushing ourselves to the limit. Her unlimited energy shows us what human is capable of doing. Planning after planning, project after project. Trying my very best to achieve a quarter of what she does.

Brought my camera out when I went for my routine jog hoping to shoot some dramatic sky but was gloomy. Went home after 8 laps, cook myself a nice filling dinner and studied.

As mundane as it could be, still took the time to reflect and count my blessing. Grew up with a super mom who brought me to this world 28 years ago, married the love of my life and now a father of a boy. Despite the future uncertainties with our current state of economy and politics in our country (heard that Mr Prime Minister? Citizens are suffering), I believe God will pull us through and bless us more than we can contain.

Recently inspired by the lyrics of this song by Hillsongs. Word of the season indeed.

If my heart has grown coldThere Your love will unfold
As You open my eyes to the work of Your hand
When I'm blind to my way
There Your Spirit will pray
As You open my eyes to the work of Your hand
As You open my eyes to the work of Your hand

Oceans will part nations comeAt the whisper of Your call
Hope will rise glory shown
In my life Your will be done

Present suffering may pass
Lord Your mercy will last
As You open my eyes to the work of Your hand
And my heart will find praise
I'll delight in Your way
As You open my eyes to the work of Your hand
As You open my eyes to the work of Your hand

Tuesday, August 11, 2015

Wedding and Mini Family Getaway

After a long and stressful weekend, I couldn't wait to leave Kapit albeit with a heavy heart because of the unstable patients I left behind.

Took Ethan on his 9th express boat ride out of Kapit, 9th AirAsia flight from Sibu to KL and his first ERL ride back home. He was an angel throughout the flight. He slept without making a big huha, eats his own food and played with us before he fell asleep again. Well, happy mood during day time comes with bad mood at night. He cried to sleep and woke up a few times throughout the first night back in KL.

One of the things I secretly anticipating for was durian. I know well enough that my father in law will definitely get durian to eat with us when we are back. True enough, we had so much durian that we had to forgo our dinner. Like father like son, Ethan devoured the durian we offered him and he really liked it a lot. So much that when we removed the durian from his mouth, he started crying. A true Malaysian is born!

The main reason we were back in KL was for Wai Kit and Carine's wedding.

Solemnisation and Exchange of Vows, IN CHINESE. Well done Carine!
No love story has touched me as much as Wai Kit and Carine's. I teared a lil when Wai Kit told his part of the story how Carine took care of him when he was in the ICU and how Carine was asking people to pray for Wai Kit when he was badly injured from a motorcycle accident. A walking miracle and faith. Had a great time catching up with Inn Shan and Yee Ling together with the ex-Kapit people during the wedding dinner.

Attended DUMC live at home on Sunday as Ps Daniel preached on Acts 2. The rest of the day was just resting at home and did some windows shopping in MV before having dinner with mom.

The most painful part of this trip is to leave behind Angel and Ethan in KL as I travelled back to Kapit alone. I alway enjoy travelling alone. But this time I miss Ethan moving about in my arms during the flight. I miss him putting his slimy finger all around my face before wiping his face full of saliva on my shirt. I miss hugging him.

As I will be back in Kapit alone preparing for my exams in September, I can rest assure that Angel will take really good care of Ethan. Cannot ask for a more capable wife like Angel.

Counting my blessings.

Sunday, August 9, 2015

Cases come in THREE

There is always a myth in our medical fraternity that when you see a complicated or interesting case, 2 similar cases will come knocking on your ER/clinic door soon after. I do not buy it. But I saw 3 cardiac cases of different severity just last week. Good cases come in three - Myth or truth?

It all started off with a school going girl coming in for some dyspnoea and chest pain. My ER colleague thought she looked pale and suggested to order an ECG to look for anaemia-induced strained pattern of the ECG like adults. Coincidentally I was reading the ECG chapter for my exams. So why not.

Though not commonly diagnosed with ECG, but I had the gut feeling that the ECG shows pericardial effusion with variable voltages. They called it electrical alternans where the R waves shows different heights within the same leads recording. True enough CXR showed a huge globular heart and pericardial effusion was confirmed with our ECHO.

Symptomatic pericardial effusion, there is not much choice in Kapit. Send out of Kapit or tap in Kapit. With permission from our paediatrics cardiologist, patient was wheeled into OT on the same day for a diagnostic pericardiocentesis under GA.

Being a first timer for this procedure, I held my breath from the insertion of the needle to the placement of the catheter with Saldinger method . It was a success. Patient was so much better the day after. But we still do not know what causes the pericardial effusion. Glad to have such opportunity to tap a heart before I leave Kapit.

While seeing the girl with pericardial effusion, out second case came the same afternoon from Poly Clinic, with an incidental finding of a likely heart block for paediatrics input. A school going girl planned for dental extraction noted to have irregular pulses but otherwise stable. Fortunately our cardiologist was due coming for visiting cardiac clinic 3 days later, so we gave an appointment to see again during cardiac clinic.

With all the rights of freedom of speech, my paediatrician declared, "So there will be a third case coming soon, probably during my absence when Nickson is alone"

This is another myth that we believe - DO NOT jinx yourself by inviting completed cases because they will actually come. I don't buy that either. But the 3rd cardio-pulmonary case came 2 days after my paediatrician left for a meeting.  T_T

It was the most complicated case that I have ever managed. It was a newborn with birth asphyxia complicated with persistent pulmonary hypertension of newborn. Unfortunately we lost the baby at day 3-4 of life. Wasn't a good experience but I learned a lot throughout the whole process. Thank God for Angel who understood and supported me all along. Told her I had never felt that stressful in my life before which was true.

Thank God everything is over. Had a nice weekend spending time with Angel and Ethan in KL. Nothing comforts me more than home after a long and stressful week.

So cases come in three?

Thursday, July 30, 2015


Rude sung by Magic was stuck in my brain for quite some time now. But today I am not talking about how a father rejecting a guy from marrying his daughter.

Rude is when you do not silent your phone in a meeting. Worse is when you yourself are hosting a meeting and suddenly your phone blast into life, you pick it up as and speak loudly, ignoring the people around you

The phone call you picked up in situation like this better be something about finding the missing 42 billion ringgit or re-reshuffling back the cabinet. Else I would expect one to respect what is actually happening around you. 

I find it very annoying when people do not silent their phone during a formal discussion or teaching. Well unless you are expecting a call or it is an emergency, phone calls can wait. It is common sense and manners. But i guess people do not care about manners nowadays. 

WikiHow shall teach us some Cell Phone Etiquette here.

The First Principle: It is not other people's responsibility to cope with your mobile phone use; it is your responsibility to use your mobile phone inoffensively. Please note that "inoffensively" is not defined by what you expect others to tolerate, but by what others do in fact find offensive. Ignore this principle, and you are sure to be rude.

See the word RUDE there?!

Following directly from the First Principle: You should assume that someone who asks you to turn your cell phone (or audio player) down or off is in good faith, and you should comply in good faith. They have a reason for asking, and it's probably not that they're trying to dominate you or hassle you or restrict your God-given right to free expression. (For example, people with temporal lobe epilepsy may find that certain sounds trigger seizures, and some people have neurosensory issues that cause extraneous noise to be a severe difficulty rather than a mild annoyance.)

No, no, no. Some people just think that they are more important and there is no need to listen to others. RUDE

Stay away from others while talking on the phone. If possible, keep a 10-foot (3 meter) distance between you and anyone else whenever you talk on your phone. Most people do not want to hear what you're talking about.

Try not to talk on the phone in any enclosed spaces, even if you're more than 10 feet away from anyone. They can still hear you (because it's an enclosed space) and usually, they're forced to just sit there and listen (and maybe be annoyed to some extent).

Don't talk too loudly. Generally you don't have to shout in the microphone to be heard on the other end. In fact, doing so often makes it harder for you to be understood. In addition, shouting on the phone disrupts people around you.

Don't put your phone on speaker. Just as many people do not want to hear your end of the conversation, they don't want to hear the other person's either.

But to some, they hope others will learn that they are so busy and hence important, so the whole world should witness the conversation over the phone. Again, RUDE

Do not talk about personal details in public. Personal is just that: personal. If callers want to talk about personal details, tell them that you will call them back later, move someplace where you can have a little privacy, or switch to text messaging.

Don't multi-task. Avoid making calls while driving, shopping, banking, waiting in line, or doing almost anything that involves interacting with other human beings. In some situations it puts your life and the lives of others in danger, and in other situations it can bother some people.

Know where not to use your phone. Some places are inappropriate for cell phone usage, so avoid talking on your cell phone or having it ring while in the following places:
  • Bathrooms
  • Elevators
  • Hospitals
  • Waiting rooms
  • Restaurants
  • Auditoriums
  • Taxicabs
  • Buses
  • Trains
  • Meetings
  • Libraries
  • Museums
  • Places of worship
  • School
  • Lectures
  • Live performances
  • Funerals
  • Weddings
  • Movie theaters
  • While visiting relatives
  • Turn your phone off at any time that you are asked to when on a plane.
    • Or, in fact, anywhere else where people are likely to be disturbed, unless it is important and you can't go anywhere.
Don't use your phone when having a meal with someone. Ideally, you should turn it off entirely. If you're anticipating an important call, let the person you're with know beforehand that you're expecting a call that you'll need to take. No matter what, don't hold a conversation at the table; step away, follow step 1, and don't stay away any longer than you would for a bathroom break. Never text at the table, even if the face-to-face conversation dies down. It will be seen as disrespectful.

Turn off your phone at the movie theater. Even if your phone is on vibrate, people can hear it during quiet parts of the movie. The light from your phone's screen is also very distracting. Don't check the time, don't check your text messages; just turn it off until the movie is over. If you get an important call that you must answer, exit the theatre before taking it.

Learn to text. When you're in an enclosed space, or you can't put yourself 10 feet out of everyone's way, it's inappropriate to talk but it's potentially acceptable to receive and send text messages. In such cases, keep the following rules of texting etiquette in mind:
  • Use the vibrate feature instead of an audible text alert.
  • Only text when you're standing still or sitting and out of anyone's way. Don't text while you walk or drive.
  • Don't text while doing anything that requires you to be attentive, such as waiting at an intersection for the pedestrian signal.
  • Don't text while at a meeting or conference. You should give the speaker your undivided attention.
  • Limit phone use during gatherings with your friends. Some friends (with or without cell phones) will find it annoying and inconsiderate.
  • Avoid sending others text messages containing anything that you would not say in real life. It is very hard to convey tones and sarcasm in texting and email, so realize that some things may come across as sounding unusual or offensive. Never send a message with sexual overtones, or one that could be construed as a threat.
I hope people learn manners. Enough of ranting.

Wednesday, July 29, 2015

It is a gloomy day for Kapit and Malaysia.

It was raining the whole morning in Kapit, made waking up from bed very difficult but life goes on. Did the routine - review, clerking and discharges followed by afternoon clinic. At least there is some good change in the climate after weeks of draught here. Ran 10 laps today and that made studying impossible tonight. Literally gloomy.

In contrast to the decision made by our Prime Minister today which brings the matter from bad to worse. Really sad to see a dictatorship in my own country. God bless Malaysia. Let us stay strong and pull through this atrocities for the country we love.

Monday, July 27, 2015


Took 4 days off including weekends to stay at home, settle some house chores, help taking care of Ethan and study.

What have I achieved?

Done quite a bit of questions in Pastest and did revision on topics that I used to know but now I don't or vaguely remember. The thing about medicine is, we have to practise to remember. That is why taking study break to sit at home and read doesn't really make me a good doctor. It only helps to consolidate my knowledge.

Spent time with Ethan and realised he is quite attached with his mommy now. Took the opportunity to spoil him by letting him sleep on my for the afternoon. At least he smiles more to me now. Parenting is something nobody can teach us unless we experience it ourselves. It was indeed challenging and fun at the same time. Being a doctor does not mean we are good parents. In fact we could be the worst parents. It all starts from zero on the day our child was born. Still learning, still struggling but seeing them grow gives us unspeakable joy.

Do the regular things in Kapit like eating out, grocery shopping. Things that I usually cannot do when I work. It is really good to just sit back and enjoy the town in the morning.

Lesser Pacer step count - average of 5000 per day. Way below my target of 10K steps a day. Makes me realised working is still the best way to get myself moving.

Did a photo shoot for Ethan. Totally love it. and thought about taking pictures as my side-income (again) which never became a reality.

Packed up some of the unused items in preparation for our great migration back to Kuching. People asked why leave? Well, it is time to move on.

Tried empurau for dinner. It is really time for me to leave Kapit. Been there, done it.

Watched DUMC live today. Totally in awed listening to Ps Kee talking about how Joseph died and how he instructed to people to keep his bone in Egypt and only to bring it back to Isreal when God delivered them from Egypt. Talking about faith that sees what is 400 years ahead. Time to think about what kind of legacy I want to leave behind when I die.

It was a fruitful break I would say. Time to get back to work.

A doctor (and a father) who works 7 days a week,

Sunday, July 26, 2015

A Glimpse of Next Generation

Was doing my routine jog at the stadium and overheard a conversation between 2 youngsters that goes somewhat like this:
"This place is mostly for (a certain race), if you want to see (another race) you would need to go to another stadium."

I hate racism, and conversations like this makes me angry. That is exactly what is being taught to the young children nowadays for them to give out such comments. I will not expect any changes or improvement until people stop their racial prejudice. We cannot change our parent's generation, but it is high time for us to change and remove such mindset for the coming generation. Race is for us to respect, not segregate and despise.

Into my fifth lap, I jogged passed a teacher who was puffing away on his cigarette ON THE TRACK after his football match in front of all the children and actual health conscious people who are doing exercise there. Then we wonder why are kids as young as primary school age starting to smoke in public. Well if my teacher does it in public, why can't I right?

What an irony that YOU AS A TEACHER to smoke IN THE STADIUM, ON THE RUNNING TRACK where people like ME who is trying to stay healthy together with all children around trying to AVOID YOUR UNAVOIDABLE SECOND HAND SMOKE?!

That's a glimpse of what our coming generation going to be.

Here is a photo of my next generation, taken on the same track on a day without smokers and racist.

Father of a next generation child,